Cost and quality information and health care market reform.
Explore the source record for details and available documents.
Coronary Artery Bypass↗
Biomedical subjects
D Shea
Publications and source records attributed to D Shea.
Who are we? We are only young once, make the best of it or get out of the way, here come the young'uns.
Explore the source record for details and available documents.
Adult↗
Educational attainment, occupational history, and stratification: determinants of later-life economic outcomes.
Determinants of economic well-being among men 25-44, 45-64, and 65+ were examined using data from the 1984 panel of the Survey of Income and Program Participation. A path analysis explored race, education, and occupational history effects on income adjusted for annuitized assets, household composition, and underreporting of unearned income. Direct and total education effects were undiminished among elderly persons, whose income derived mainly from benefits and assets, as compared with the nonelderly subjects whose income was dominated by earnings; education explained more of the variance in adjusted income for the elderly group than for the nonelderly. While Social Security income exerts an equalizing effect across educational attainment groups, private pensions and other important retirement income sources were highly education-dependent, producing a high overall degree of stratification on early-established socioeconomic characteristics.
Adult↗
How are pediatric training programs preparing residents for practice?
The majority of pediatric residents continue to choose a career in practice on completion of their training. Despite knowing residents' career preferences, many training programs have focused on inpatient tertiary care at the expense of primary care. Perhaps this reflects service needs and the significant technology and extensive information resulting in the growth of pediatric subspecialties. To determine the spectrum of didactic and clinical experiences pediatric training programs offer residents to prepare them for managing a practice, we conducted a survey of pediatric training program directors in 1988. Although the majority of residency programs have a practice management curriculum, the number of hours devoted to this area is minimal. In addition, a significant number of residents are not experiencing a community office rotation. This survey indicates the need to develop a practice management curriculum if trainees are to be prepared for choosing the right career and for being competitive in practice.
Analysis of Variance↗
Testicular infarction in the newborn: ultrasound findings.
Three patients with neonatal testicular torsion and infarction (two bilateral, one unilateral) are presented with a distinctive sonographic appearance. All five testes appeared inhomogeneously hypoechoic and each was surrounded by a brightly echogenic rim. Whereas surgical exploration was required in the past to establish the diagnosis of testicular infarction in the neonate, sonographic demonstration of the abnormality in the appearance of the testicular parenchyma permits nonoperative diagnosis. Because surgical salvage of the testis in the setting of neonatal extravaginal torsion is thought to be quite rare, the necessity of removing the testis is less clear when the diagnosis is established preoperatively.
Humans↗
Cumulative advantage, cumulative disadvantage, and inequality among elderly people.
It is often asserted that economic inequality narrows after age 65 when benefit programs replace labor markets as principal income sources. However, analysis of recent Census data suggests inequality is greatest among elderly people. The worst off one-fifth of the elderly (disproportionately unmarried women, minorities, and the physically impaired) receives 5.5% of the elderly's total resources, whereas the best off one-fifth receives 46%. Equalizing effects of Social Security are more than outweighed by private pensions, asset income, and other sources. Findings suggest a process of cumulative economic advantage and disadvantage throughout the life course.
Aged↗
Traffic safety effects of sobriety checkpoints and other local DWI programs in New Jersey.
We examined the efficacy of three Driving While Intoxicated (DWI) programs in New Jersey from 1980 through 1985, using covariance analysis of county data. Road blocks, the major component of the Strike Force program, were associated with a drop of 10-15 per cent in the single vehicle nighttime crash rate and showed a relatively stable effect over time. DWI Task Force, an education program, was associated with a 6-10 per cent total decline in the crash rate and declining impact over time. SOBER, another education program, was associated with a small effect in the first year and little or no effect thereafter.
Accidents, Traffic↗
Primary and secondary tumors of the facial nerve. A temporal bone study.
Of 1400 temporal bones in the collection at the University of Minnesota, Minneapolis, 17 temporal bones from 15 patients were found to have tumors involving the facial nerve. The findings were as follows: one case of facial nerve schwannoma; two cases of invasion of the facial nerve by contiguous tumor; and 14 cases of metastatic tumors involving the facial nerve. Facial nerve paralysis was present in half of the cases (nine of 17). Facial nerve paralysis was present in the case of facial nerve schwannoma, in both cases of invasion of the facial nerve by contiguous tumor, and in six of 14 cases of metastatic tumors involving the facial nerve. The presence of the facial nerve paralysis correlated well with the degree of tumor infiltration into the nerve fibers and the segment of the tumor involvement in the facial nerve. In the patients with metastatic tumors, facial nerve paralysis was a sign of extensive intracranial tumor involvement and was usually accompanied by other cranial nerve palsies, most commonly involving the fifth nerve.
Cranial Nerve Neoplasms↗
New poly(A)+RNAs appear coordinately during the differentiation of Naegleria gruberi amebae into flagellates.
We have examined the nature of the requirement for RNA synthesis during the differentiation of Naegleria gruberi amebae into flagellates (Fulton, C., and C. Walsh, 1980, J. Cell Biol., 85:346-360) by looking for poly(A)+RNAs that are specific to differentiating cells. A cDNA library prepared from poly(A)+RNA extracted from cells 40 min after initiation of the differentiation (40-min RNA), the time when formation of flagella becomes insensitive to inhibitors of RNA synthesis, was cloned into pBR322. Recombinant clones were screened for sequences that were complementary to 40-min RNA but not to RNA from amebae (0-min RNA). Ten of these differentiation-specific (DS) plasmids were identified. The DS plasmids were found to represent at least four different poly(A)+RNAs based on cross-hybridization, restriction mapping, and Northern blot analysis. Dot blot analysis was used to quantify changes in DS RNA concentration. The four DS RNAs appeared coordinately during the differentiation. They were first detectable at 10-15 min after initiation, reached a peak at 70 min as flagella formed, and then declined to low levels by 120 min when flagella reached full length. The concentration of the DS RNAs was found to be at least 20-fold higher in cells at 70 min than in amebae. The changes in DS RNA concentration closely parallel changes in tubulin mRNA as measured by in vitro translation (Lai, E.Y., C. Walsh, D. Wardell, and C. Fulton, 1979, Cell, 17:867-878).
Amoeba↗
Sensorineural hearing loss in experimental purulent otitis media due to Streptococcus pneumoniae.
Sensorineural hearing loss (SNHL) has been described clinically following chronic otitis media with effusion, but to the best of our knowledge, no studies have demonstrated SNHL in an animal model of otitis media. Using the chinchilla model of pneumococcal otitis media, significant SNHL was demonstrated after purulent otitis media, especially at higher frequencies. Animals with otitis media received penicillin G procaine treatment for five days after otitis media with effusion (OME) was first documented; resolution of middle ear infection was confirmed by middle ear effusion culture in all animals. Both the inoculated and uninoculated ears were examined by tone burst-elicited compound action potential at threshold. The inoculated ear showed a marked hearing loss of 13 to 36 dB three to four days after OME was first documented; a hearing loss up to 24 dB persisted two to five weeks after inoculation. The change in the compound action potential was highly significant at all frequencies studied. Conductive losses were largely ruled out because there was no middle ear effusion at death and the tympanogram was normal. Purulent labyrinthitis was ruled out by histopathological study. These results indicate that purulent pneumococcal otitis media in the chinchilla model causes significant SNHL and suggest that the pathogenesis of SNHL associated with chronic OME in humans may be studied in this model.
Animals↗
Passage of albumin from the middle ear to the inner ear in otitis media in the chinchilla.
A study of the permeability of the middle ear-inner ear interface for macromolecules was carried out in chinchillas with open and obstructed eustachian tubes utilizing tritiated human serum albumin and immunoelectrophoresis. Tritiated albumin was placed in the round window niche area or normal animals and animals in which the eustachian tubes had been obstructed for 24 hours or 14 days. The tritiated albumin was allowed to remain in the middle ear cavity for 24 hours, Samples of middle ear effusion, perilymph, blood and cerebrospinal fluid were collected and measured for radioactivity. Radioactivity was demonstrated in the perilymph. Samples of middle ear effusions and perilymph were also studied by immunoelectrophoresis with goat antihuman albumin. Albumin placed in the round window niche of an experimental animal could be recovered unchanged in the perilymph. The results suggest a pathophysiologic explanation for the association of otitis media and sensorineural hearing loss or endolymphatic hydrops.
Animals↗
Changes in cognitive task performance across the menstrual cycle.
Menstrual-cycle-related changes in estrogen were expected to differentially affect various cognitive tests. Specifically, the estrogen peak occurring at midcycle in ovulatory women was expected to facilitate performance of highly practiced "automatized" tasks and to impair performance of "perceptual-restructuring" tasks, compared with performance of these tasks in the postovulatory phase of the cycle when progesterone is thought to counteract the action of estrogen. Perceptual-restructuring tasks are defined as tasks in which the initial percepts to obvious stimulus attributes are wrong and must be set aside in favor of percepts to less obvious stimulus attributes. Eight-seven regularly menstruating undergraduate women were studied. Odd-numbered subjects were tested first on or about Day 10 of their cycle and then again on Day 20; even-numbered subjects, in the reverse sequence. Daily basal body temperature records were obtained. These temperature records suggested that 21, or 24%, of the subjects did not ovulate in the cycle(s) studied. No main effect of Day 10 versus Day 20 occurred for any task in the 66 women who did appear to ovulate. However, the magnitude of predicted shifts in performance was significantly correlated with proximity of the "Day 10" testing day to the thermal nadir of the basal body temperature record, the presumed preovulatory estrogen peak; and to the "Day 20" proximity to the basal body temperature thermal peak, the presumed progesterone peak. Subjects tested 3 or fewer days before the thermal nadir and on or after the thermal peak had the predicted significant changes on three of the four administered tasks. No other temporally defined group produced significant changes. The results of the study support the experimental hypotheses and also indicate that precise timing is essential to demonstrate the phenomena.
Adult↗
Silent otitis media.
There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed with emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.
Child, Preschool↗
Endolymphatic hydrops and otitis media.
Clinical observation of patients with fluctuant sensorineural hearing loss following or occurring with chronic otitis media led to the hypothesis that endolymphatic hydrops can result from chronic otitis media. Illustrative case reports are described. This hypothesis resulted in a temporal bone study of 560 cases in which 109 temporal bones demonstrated the presence of hydrops and 194 evidenced otitis media. Seventy-five cases demonstrated both otitis media and hydrops, of which 20 cases were selected for more detailed histopathological study. An interesting finding was the presence of apical hydrops in every case of the latter group. Statistical interpretation of this data helped rule out a coincidental or chance occurrence. A discussion of this clinical relationship included the significance of subclinical (silent) otitis media as a possible cause of endolymphatic hydrops.
Adult↗
Mycotic infections of the inner ear.
Explore the source record for details and available documents.
Adolescent↗
Dimensions of the subjective marijuana experience.
A Drug History Questionnaire and a Marihuana Effects Questionnaire were completed by 91 male volunteers who were experienced marijuana smokers. A factor analysis was performed on the frequency of occurrence data for the Marihuana Effects Questionnaire. The resultant factors were similar to those reported previously in the literature supporting the existence of a stable, verbally definable marijuana experience. In comparison to the drug history variables of marijuana smokers in the late 1960s, our population showed increased multiple drug use, an earlier age of introduction to cannabis, and heavier use of cannabis. An analysis of the interaction of drug history variables with experienced marijuana effects suggested that the more frequently one uses cannabis, the less pronounced the experienced effects tend to be.
Adolescent↗
The effect of marihuana intoxication on blood pressure.
Forty-eight experienced marihuana smokers were assigned to one of four groups: coltsfoot, placebo, low dose marihuana and high dose marihuana. While both marihuana groups showed significant increases in subjective ratings of intoxication and pulse rate, blood pressure readings were unaffected or showed a modest decrease. This latter finding is discrepant with previous studies and is explained in terms of a drug X person interaction present in those studies.
Adolescent↗
Odor and marijuana intoxication.
Assigned 48 volunteer adult males to four groups: a marijuana high dose, a marijuana low dose, a placebo, and a coltsfoot group. Each S participated in two 80-minute sessions; one involved listening to music, socializing, and smoking the drug, and the second was identical to the first with the addition of two extra placebo cigarettes which contained finely cut amounts of human hair. The odor of burning hair was rated previously as quite aversive by non-intoxicated Ss. Contrary to expectation, Ss in the odor condition indicated on self-ratings that they became significantly more intoxicated after the smoking of the hair cigarette. The opposite effect was found with a pulse rate measure. An additional 24 Ss were divided into high and low dose marijuana groups and run in an odor session, in which they were informed prior to smoking of the hair content. Heart rate for these Ss decreased significantly more than for the comparable uninformed Ss, although self-ratings continued to reflect increased intoxication.
Adult↗