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Biomedical subjects

Elizabeth Wright

Publications and source records attributed to Elizabeth Wright.

18 recordsLinked to original sources
PubMed2007

Effect of glutathione S-transferase polymorphisms and proximity to hazardous waste sites on time to systemic lupus erythematosus diagnosis: results from the Roxbury lupus project.

OBJECTIVE: The high prevalence of systemic lupus erythematosus (SLE) among African American women may be due to environmental exposures, genetic factors, or a combination of factors. Our goal was to assess association of residential proximity to hazardous waste sites and genetic variation in 3 glutathione Stransferase (GST) genes (GSTM1, GSTT1, and GSTP1) with age at diagnosis of SLE. METHODS: Residential histories were obtained by interviewing 93 SLE patients from 3 predominantly African American neighborhoods in Boston. Residential addresses and locations of 416 hazardous waste sites in the study area were geocoded using ArcView software. Time-varying Cox models were used to study the effect of residential proximity to hazardous sites, GST genotype, and interaction between genotype and exposure in determining age at diagnosis. RESULTS: The prevalence of SLE among African American women in these neighborhoods was 3.56 SLE cases per 1,000. Homozygosity for GSTM1-null and GSTP1 Ile105Val in combination was associated with earlier SLE diagnosis (P = 0.03), but there was no association with proximity to 416 hazardous sites. Available data on specific site contaminants suggested that, at a subset of 67 sites, there was higher potential risk for exposure to volatile organic compounds (P < 0.05 with Bonferroni correction). GST genotypes had a significant interaction with proximity (P = 0.03) in analyses limited to these sites. CONCLUSION: There was no independent association between residential proximity to hazardous waste sites and the risk of earlier SLE diagnosis in this urban population. However, analysis of a limited number of sites indicated that the risk of earlier SLE associated with proximity to hazardous sites might be modulated by GST polymorphisms.

Adolescent↗
PubMed2006

Long-term effects of cognitive training on everyday functional outcomes in older adults.

CONTEXT: Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. OBJECTIVE: To determine the effects of cognitive training on daily function and durability of training on cognitive abilities. DESIGN, SETTING, AND PARTICIPANTS: Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. INTERVENTIONS: Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. MAIN OUTCOME MEASURES: Self-reported and performance-based measures of daily function and cognitive abilities. RESULTS: The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09). CONCLUSIONS: Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00298558.

Activities of Daily Living↗
PubMed2006

Childhood vasculitis and plasma exchange.

INTRODUCTION: A retrospective review of therapeutic plasma exchange (TPE) for vasculitis of any form during the period 1993-2003 was carried out in our unit. SUBJECTS AND METHODS: The case histories of 32 children undergoing TPE were analysed to determine short-term outcome. The vasculitides consisted of polyarteritis nodosa (PAN), ANCA-associated vasculitis (AAV) [encompassing Wegener's granulomatosis (WG) and microscopic polyangiitis (MPA)/idiopathic crescentic nephritis (ICN)], Henoch-Schönlein purpura (HSP) and non-classified vasculitis (NCV). RESULTS: All children with PAN (n=5) had a good response to treatment except for one with gastro-intestinal symptoms. One child was treated for crescentic nephritis, with 42% crescents seen on biopsy. The estimated glomerular filtration rate (eGFR) (Schwartz formula) for this child improved from 81 to 130 ml/min/1.73 m(2) post-treatment. Inflammatory markers decreased immediately following TPE and were maintained at the lower level for all the children. Ten children (n=12) with AAV received treatment for renal manifestations. Median creatinine clearances improved from 29 ml/min/1.73 m(2) (p<0.01) pre-treatment to 62 ml/min/1.73 m(2) (p<0.01) immediately following TPE and 69 ml/min/1.73 m(2) at 2 months post-TPE (p<0.01). Four children required dialysis; one child remained dialysis-dependent and one child progressed to chronic renal failure. Inflammatory markers decreased following TPE. All of the children with HSP (n=5) were treated for crescentic nephritis. Two regained normal renal function, and one became dialysis-dependent later. Most of the children with NCV (n=10) presented with CNS or general vasculitic features, with the greatest benefit for CNS symptoms. CONCLUSIONS: In our experience TPE appears to be of benefit during the acute phase of illness, especially in children with organ-specific disease.

Adolescent↗
PubMed2006

The effects of the ACTIVE cognitive training trial on clinically relevant declines in health-related quality of life.

OBJECTIVES: The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study used three cognitive interventions (memory, reasoning, or speed of processing) in order to improve cognitive abilities. In this article, we evaluate ACTIVE's ability to avoid extensive decline in health-related quality of life (HRQoL). METHODS: ACTIVE enrolled 2,802 adults aged 65 or older and randomized them into one of three cognitive interventions or a no-contact control group. Researchers obtained data on 2,147 participants at the 24-month follow-up. We measured HRQoL by using the eight Short Form-36 scales, and we defined clinically relevant decline on each as a drop of 0.5 standard deviations from baseline. We defined extensive HRQoL decline as clinically relevant drops on four or more Short Form-36 scales, and we assessed this by using multiple logistic regression methods that adjusted for sociodemographic, cognitive, and health status covariates, and incorporated propensity score derived weights in order to adjust for potential attrition bias. RESULTS: We found that 25.0% of ACTIVE participants had extensive HRQoL decline. Participants in the speed-of-processing intervention arm were less likely to have extensive HRQoL decline (adjusted odds ratio = 0.643; p =.004) compared with controls, and participants in the memory and reasoning arms were equivalent to controls (adjusted odds ratios = 1.149 and 1.014, respectively; ps =.322 and.919, respectively). DISCUSSION: Although all three intervention arms improved cognitive ability, only the speed-of-processing arm protected against extensive clinically relevant decline in HRQoL.

Aged↗
PubMed2005

Impact of mode of dialysis on intra-abdominal infection after simultaneous pancreas-kidney transplantation.

BACKGROUND: Whether peritoneal dialysis is a risk factor for the development of intra-abdominal infection (IAI) after simultaneous pancreas kidney (SPK) transplantation is controversial. METHODS: We investigated the incidence of IAI, and patient and pancreas graft survival rates of 120 patients that received SPK between November 1995 and August 2003. All patients were dialysis-dependent prior to transplantation; mean duration of peritoneal dialysis (PD; n=52) and hemodialysis (HD; n=68) was 20+/-15 months and 23+/-16 months, respectively. RESULTS: IAI developed in five PD and six HD patients (P=0.88). The time of diagnosis of IAI and the spectrum of organisms cultured were similar in the two groups of patients. Age, duration of dialysis, and method of exocrine drainage did not have a significantly impact on infection rate. Patient and pancreas graft survival rates were 92.3% and 88.4% in the PD group and 95.5% and 92% HD group (p=ns) after a mean follow-up of 42+/-27 months and 39+/-27 months, respectively. Overall patient and pancreas graft survival was not significantly affected by IAI. CONCLUSIONS: PD does not adversely affect IAI rate and is a safe mode of dialysis for patients awaiting SPK transplantation.

Adult↗
PubMed2005

Hepatic DNA adduct dosimetry in rats fed tamoxifen: a comparison of methods.

Liver homogenates from rats fed tamoxifen (TAM) in the diet were shared among four different laboratories. TAM-DNA adducts were assayed by high pressure liquid chromatography-electrospray tandem mass spectrometry (HPLC-ES-MS/MS), TAM-DNA chemiluminescence immunoassay (TAM-DNA CIA), and (32)P-postlabeling with either thin layer ((32)P-P-TLC) or liquid chromatography ((32)P-P-HPLC) separation. In the first study, rats were fed a diet containing 500 p.p.m. TAM for 2 months, and the values for measurements of the (E)-alpha-(deoxyguanosin-N(2)-yl)-tamoxifen (dG-N(2)-TAM) adduct in replicate rat livers varied by 3.5-fold when quantified using 'in house' TAM-DNA standards, or other approaches where appropriate. In the second study, rats were fed 0, 50, 250 or 500 p.p.m. TAM for 2 months, and TAM-DNA values were quantified using both 'in house' approaches as well as a newly synthesized [N-methyl-(3)H]TAM-DNA standard that was shared among all the participating groups. In the second study, the total TAM-DNA adduct values varied by 2-fold, while values for the dG-N(2)-TAM varied by 2.5-fold. Ratios of dG-N(2)-TAM:(E)-alpha-(deoxyguanosin-N(2)-yl)-N-desmethyltamoxifen (dG-N(2)-N-desmethyl-TAM) in the second study were approximately 1:1 over the range of doses examined. The study demonstrated a remarkably good agreement for TAM-DNA adduct measurements among the diverse methods employed.

Animals↗
PubMed2005

Viscoelastic and mechanical behavior of recombinant protein elastomers.

Recombinant DNA synthesis was employed to produce elastin-mimetic protein triblock copolymers containing chemically distinct midblocks. These materials displayed a broad range of mechanical and viscoelastic responses ranging from plastic to elastic when examined as hydrated gels and films. These properties could be related in a predictable fashion to polymer block size and structure. While these materials could be easily processed into films and gels, electrospinning proved a feasible strategy for creating protein fibers. All told, the range of properties exhibited by this new class of protein triblock copolymer in combination with their easy processability suggests potential utility in a variety of soft prosthetic and tissue engineering applications.

Biocompatible Materials↗
PubMed2004

Cardiac risk factor awareness and management in patients with systemic lupus erythematosus.

OBJECTIVE: To assess awareness and management of traditional cardiac risk factors (CRFs) in patients with systemic lupus erythematosus (SLE) and physicians. METHODS: SLE patients (n=110) completed a questionnaire concerning CRFs. Medical records were reviewed blinded to questionnaire results for the presence and management of 6 CRFs: hypertension, hypercholesterolemia, smoking, obesity, diabetes mellitus, and physical inactivity. RESULTS: Subjects were predominantly female (97%), mean (+/-SD) age was 43.4 years (+/-11.8), mean SLE duration was 15.3 years (+/-7.2), and 51% had > or =2 CRFs by self report. Twenty-three percent had never had their cholesterol levels checked. Hypercholesterolemia was more frequently documented in the medical records than reported by the patient (33% versus 24%). Physical inactivity was more frequently self reported than documented (59% versus 23%). Rheumatologists and patients had low interrater reliability for the presence of hypercholesterolemia (kappa=0.26) and physical inactivity (kappa=-0.02). More than half (58%) of CRFs were treated, and 21% of subjects with elevated cholesterol received a medication. CONCLUSION: Recognition, recording, and management of CRFs falls short given the significance of the problem.

Adult↗
PubMed2003

Chronic hemodialysis in infants and children under 2 years of age.

Over the past 16 years, 18 children under 2 years of age received chronic hemodialysis (HD) at our center. Five children were anuric at the start of HD and 6 had significant co-morbidity. The most common underlying diagnosis was posterior urethral valves. The median age at the start of HD was 12.2 months. A total of 39 episodes (defined as a discrete time period during which HD was the principle form of renal replacement therapy) of HD were performed, with a median duration of 7 months and 91.3 dialysis sessions per episode. Problems with vascular access were very common, with a revision ratio of 40%. Twenty-two line revisions were required for 36 episodes of line infection, with a median rate of line infection of 2.7 infections/patient years. The most commonly encountered organism was coagulase-negative Staphylococcus (69%). Twenty-three lines needed revision due to poor line function, despite the routine use of heparin. The effectiveness of HD was assessed in 11 patients who received HD for a continuous period of 3 or more months. The median urea reduction rate was 72%, while the parathyroid hormone levels improved to within twice the upper limit of the reference range in 69%. While there was no significant change in the median weight and height standard deviation score (SDS), the median SDS for head circumference showed significant improvement ( P=0.04). Both growth and developmental outcomes were strongly influenced by existing co-morbidity. Sixteen (89%) children were transplanted. Four (22%) children died, 3 after successful transplants. None of the deaths occurred on HD or resulted from its complications. In conclusion, HD in infants and small children is an effective and safe form of renal replacement therapy, but problems with vascular access limit its long-term use.

Age Factors↗
PubMed2003

Alpha Thalassemia is associated with decreased risk of abnormal transcranial Doppler ultrasonography in children with sickle cell anemia.

PURPOSE: Cerebrovascular complications of sickle cell disease (SCD) are common, but the risk factors remain unclear. The multicenter Stroke Prevention Trial in Sickle Cell Anemia (STOP) provided an opportunity to examine alpha thalassemia-2 as a modifying risk factor, using abnormal transcranial Doppler ultrasonography (TCD) as a surrogate marker for cerebrovascular disease. The authors hypothesized that children with abnormal TCD are less likely to have alpha thalassemia-2, and an increased hemoglobin level accounts for this protective effect. METHODS: A retrospective study was conducted of children with SCD who had both alpha gene and TCD data from STOP: 128 with TCD of at least 200 cm/s (abnormal TCD) and 172 with TCD less than 170 cm/s (normal TCD). RESULTS: Alpha thalassemia-2 was more frequent in the normal TCD group compared with the abnormal TCD group. The odds ratio for normal TCD and alpha thalassemia-2 was 4.1. Adjusting for either hemoglobin level or red cell size (mean corpuscular volume) reduced the odds ratio only slightly. Age, normal TCD, and alpha thalassemia-2 had significant statistical interaction, so that alpha thalassemia-2 was not related to TCD for age 10 years or older. CONCLUSIONS: The frequency of alpha thalassemia-2 was significantly higher in children with normal TCD. Speculation on mechanisms of effect includes improved erythrocyte deformability, reduced red cell adhesion, and reduced nitric oxide scavenging in alpha thalassemia-2. The association of alpha thalassemia-2 and normal TCD adds to the evidence on the protective effects of alpha thalassemia-2 in SCD and highlights the contribution of epistatic factors.

Anemia, Sickle Cell↗
PubMed2002

Apolipoprotein E isoform mediated regulation of nitric oxide release.

Progressive dysfunction and death of neurons in Alzheimer's dementia is enhanced in patients carrying one or more APOE4 alleles who also display increased presence of oxidative stress markers. Modulation of oxidative stress is a nontraditional and physiologically relevant immunomodulatory function of apolipoprotein E (apoE). Stimulated peritoneal macrophages from APOE-transgenic replacement (APOE-TR) mice expressing only human apoE3 or human apoE4 protein isoforms were utilized as mouse models to investigate the role of apoE protein isoforms and gender in the regulation of oxidative stress. Macrophages from male APOE4/4-TR mice produced significantly higher levels of nitric oxide than from male APOE3/3-TR mice, while macrophages from female APOE3/3-TR and female APOE4/4-TR mice produced the similar levels of nitric oxide. Primary cultures of microglial cells of APOE4 transgenic mice also produced significantly more nitric oxide than microglia from APOE3 transgenic mice. These data suggest a potentially novel mechanism for gender-dependent and apoE isoform-dependent immune responses that parallel the genetic susceptibility of APOE4 carriers for the development of Alzheimer's disease.

Alzheimer Disease↗
PubMed2002

Relationship of adherence to pediatric asthma morbidity among inner-city children.

OBJECTIVES: Morbidity from asthma among children is one of the most important US health concerns. This study examines the relationship of baseline nonadherence to subsequent asthma morbidity among inner-city children. METHODS: A multisite, prospective, longitudinal panel study was conducted of 1199 children who were aged 4 to 9 years and had asthma and their caregivers, most of whom were parents, in emergency departments and clinics at 8 research centers in 7 US metropolitan inner-city areas. Nine morbidity indicators were collected at 3, 6, and 9 months after baseline, including hospitalizations, unscheduled visits, days of wheeze/cough, and days of reduced activities. RESULTS: Children whose caregivers scored high on a new measure, Admitted Nonadherence, experienced significantly worse morbidity on 8 of the 9 measures. Children who scored high on a new Risk for Nonadherence measure experienced significantly worse morbidity on all 9 morbidity measures. Multiple and logistic regressions found that the adherence measures had independent significant effects on morbidity. Combining the measures improved estimates of morbidity: children whose caregivers were poor on either adherence measure had worse morbidity than those with good adherence on both, eg, rate of hospitalization was twice as high, they missed more than twice as much school, had poorer overall functioning, and experienced more days of wheezing and more restricted days of activity. CONCLUSIONS: Risk for Nonadherence and Admitted Nonadherence independently and jointly predicted subsequent asthma morbidity. Targeting risks for nonadherence may be an effective intervention strategy. Most risks can be controlled by physicians through reducing the complexity of asthma regimens, communicating effectively with caregivers about medication use, and correcting family misconceptions about asthma medication side effects.

Adult↗
PubMed1999

Psychosocial impact of renal donation.

PURPOSE: To determine the psychosocial effects of donor nephrectomy on a sample of Canadian donors. MATERIALS AND METHODS: Patients donating one of their kidneys for transplantation at the Toronto Hospital between 1991-1996 were asked to complete a 170-item questionnaire designed to assess their psychosocial well-being and the impact of renal donation on various aspects of their lives. Of the 153 donors contacted, 104 (68.0%) have responded to date. RESULTS: Less than 5% of donors complained of renal donation severely affecting any aspect of their life. Most donors (84%) were able to perform their normal daily activities within 12 weeks of nephrectomy, and 75% had recovered their pre-donation level of work function by this time. Almost one third of donors lost wages because of their donation, and half incurred significant transportation costs. Very few donors (< 10%) complained of other costs. Almost 90% of donors felt that donating a kidney had positively impacted their relationship with the recipient, and donors felt that their relationships with the recipient were significantly more positive at follow-up (p<.003). CONCLUSIONS: Donating a kidney results in a moderate psychosocial impact on the donor and appears to strengthen the bond between donor and recipient. Recovery times to daily activities and work may be longer than anticipated in a large proportion of donors.

Journal Article↗
PubMed1999

Living donor nephrectomy: follow-up renal function, blood pressure, and urine protein excretion.

PURPOSE: To assess the effect of donor nephrectomy on blood pressure, 24-hour urine protein excretion, and renal function. MATERIALS AND METHODS: Of the 198 individuals who donated a kidney between 1991-1996, 101 had their blood pressure, 24-hour urine protein excretion, and serum creatinine concentration levels measured. The mean duration of follow-up was 3.2 +/- 1.6 years (range: 8.5 months to 6.5 years). RESULTS: Serum creatinine concentration was significantly higher (p<.001) at follow-up (107 +/- 20 umol/L) compared to before donation (86 +/- 18 umol/L). When follow-up serum creatinine concentrations were expressed as percentages of their pre-operative values, a gradual decline was observed with time (R= -.380). Diastolic blood pressures (p<.05) and 24-hour urine protein levels (p<.001) were significantly higher at follow-up, however, neither increased with time. The prevalence of hypertension and proteinuria in our donors was no different from that of the general population. CONCLUSIONS: Donor nephrectomy does not impair renal function or result in a progressive rise in blood pressure or urine protein excretion up to 6.5 years after nephrectomy.

Journal Article↗
PubMedDate not supplied

Labor pains: unraveling the complexity of OB decision making.

While a discussion of technology and childbirth seems paradoxical, the use of statistical modeling can extend the capacity of the human mind to quantify risk, to communicate clearly, and to recognize when action is necessary in an obstetrical setting. These models provide clinicians envelopes that define safe and reasonable clinical paths. They obviate the myriad of environmental, experiential, and individual factors that inevitably affect the process of identifying and responding to unsafe situations. As the number of variables increases, the ability of the human mind to analyze multiple, interrelated factors diminishes and is not consistent across place and time. The top obstetrical problems leading to birth-related injury and litigation are discussed: shoulder dystocia, hypoxic ischemic encephalopathy, and prolonged or difficult labor. Two case histories are presented to demonstrate the factors promoting medical error and the application of these new technologies.

Birth Injuries↗