Evaluation of new surgical procedures.
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Australia↗
Biomedical subjects
G Simpson
Publications and source records attributed to G Simpson.
The generation of superoxide anions in glycation reactions with sugars, osones, and 3-deoxyosones.
Glycoxidation is a process whereby glycated proteins chemically generate oxygen free radicals. Superoxide anion formation was measured by the superoxide dismutase-dependent reduction of ferricytochrome C in glycation reactions at pH 7.0 in the absence of transition metal ions. Assays were linear over 1 h, and most activity was seen after a 2 d incubation of 5 mM L-threose and 10 mM alpha-N-acetyl-lysine (N-Ac-Lys) or 10 mg/mL RNase A. Trioses, tetroses and their corresponding osones and 3-deoxyosones had the highest activity (12-16 nmoles O.-2/hr/ml) with N-Ac-Lys. Osones and 3-deoxyosones alone generated considerable O.-2, whereas aldose sugars largely did not. Xylosone and 3-deoxyxylosone produced 6 and 10 nmoles O.-2/hr/ml respectively with N-Ac-Lys, however, xylose was inactive, as were glucose and fructose. Glycation assays with 3-deoxyglucosone and glyoxal showed no activity, however, methyl glyoxal generated 1.7 and 2.0 nmoles O.-2/hr/ml with N-Ac-Lys and N-Ac-Arg, respectively. Therefore, Amadori compounds composed of lysine and short chain sugars can rapidly generate superoxide anion in the absence of metal ions.
Arginine↗
Thrombolytics and pleural empyema.
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Empyema, Pleural↗
Access to health care. Part 3: Older adults.
OBJECTIVES: This report examines access to health care for older adults, 65 years of age and over. In the United States for 1993. Access indicators include having a regular source of care, place of care, main reason for no regular source of care, unmet health care needs, and use of clinical and preventive services. Sociodemographic characteristics include sex, age, race, income, health status, and health insurance coverage. METHODS: Data are from the 1993 Access to Care, Health insurance, and Year 2000 Surveys of the National Health interview Survey (NHIS), a continuing household survey of the civilian noninstitutionalized population of the United States. The sample for the Access to Care and Health insurance surveys contained 61,287 persons in 24,071 households. The sample for the Year 2000 survey was 21,028 persons. RESULTS: Persons with Medicare and private or Medicare and public coverage were more likely to have a regular source of medical care than elderly persons with Medicare only. Over 3.3 million elderly persons had at least one unmet need in 1993. Older adults on Medicare and public or Medicare only coverage were twice as likely to have unmet medical needs than those with Medicare and private coverage. Persons with Medicare and private coverage were more likely to receive immunizations than elderly persons with Medicare and public coverage or Medicare only. CONCLUSIONS: Although the majority of older adults have Medicare, this only provides a basic level of access to the health care system. Older adults who do not supplement Medicare with private coverage are at the greatest risk of having unmet health care needs.
Black or African American↗
Access to health care. Part 1: Children.
OBJECTIVES: This report presents national estimates of access to medical care and unmet health care needs for children through 17 years of age by selected sociodemographic variables including sex, age, race and/or ethnicity, family income, family structure, place of residence, and health status. In addition, the impact of children's health insurance status on access to care is described. METHODS: Data from the 1993 Access to Care and Health Insurance questionnaires of the National Health Interview Survey (NHIS) are analyzed to examine access indicators. The NHIS is a continuing household survey of the civilian noninstitutionalized population of the United States. The sample included 16,907 children from infants through 17 years of age from 24,071 households. RESULTS: In 1993, over 7.3 million U.S. children had at least one unmet health care need or had medical care delayed because of worry about the cost of care. These health care needs included medical care, dental care, prescription medicine, glasses, and mental health care. In addition, almost 4.2 million children lacked a regular source of health care. Factors related to access indicators included health insurance, family income, race and/or ethnicity, family structure, and place of residence. The lack of health insurance or inability to afford care was the main reason given by respondents for children lacking a regular source of medical care. CONCLUSIONS: In the United States, millions of children do not receive needed health care services. Uninsured children and those in families with low income are at the greatest risk of having unmet health needs.
Adolescent↗
Access to health care. Part 2: Working-age adults.
OBJECTIVES: This report presents data on access to health care for U.S. working-age adults, 18-64 years old. Access indicators are examined by selected sociodemographic characteristics including sex, age, race and/or ethnicity, place of residence, employment status, income, health status, and health insurance status. METHODS: Data are from the 1993 Access to Care and 1993 Health Insurance Surveys of the National Health Interview Survey (NHIS), a continuing household survey of the civilian noninstitutionalized population of the United States. The sample contained 61,287 persons in 24,071 households. RESULTS: In 1993, approximately 3 out of 4 working-age adults had a regular source of medical care. Nine out of 10 adults with health insurance had a regular source of care compared with 6 out of 10 adults without health insurance. For adults with a regular source of care, 86 percent received care in a private doctor's office, 9 percent in a clinic, and 2 percent in a hospital emergency room. The two main reasons given for not having a regular source of care were "do not need a doctor" (49 percent), and "no insurance can't afford it" (22 percent). Persons in the highest income group were more likely to report no need for a doctor (59 percent) than persons in the lowest income group (35 percent). About 40 percent of uninsured persons and 16 percent of insured persons reported an unmet medical need. CONCLUSIONS: Health insurance plays a key role in the access to medical care services. Persons who are uninsured or have low incomes are at the greatest risk of having unmet medical needs.
Adolescent↗
Treatment of pleural empyema.
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Drainage↗
Oral ganciclovir for the prevention of cytomegalovirus disease in persons with AIDS. Roche Cooperative Oral Ganciclovir Study Group.
BACKGROUND: In the advanced stages of the acquired immunodeficiency syndrome (AIDS), cytomegalovirus (CMV) disease, particularly vision-damaging retinitis due to CMV is common. We evaluated prophylactic treatment with orally administered ganciclovir as a way to prevent CMV disease. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled study of CMV infected persons with AIDS with either CD4+ lymphocyte counts of < or = 50 per cubic millimeter or counts of < or = 100 per cubic millimeter in those with a history of an AIDS defining opportunistic infection. Patients were randomly assigned, in a 2:1 ratio, to receive either oral ganciclovir (1000 mg three times daily) or placebo. RESULTS: The study was stopped after a median 367 days of follow-up. In an intention-to-treat analysis, the twelve month cumulative rates of confirmed CMV disease were 26 percent in the placebo group (n = 239) and 14 percent in the ganciclovir group (n = 486), representing an overall reduction in risk of 49 percent in the ganciclovir group (P < 0.001). The incidence of CMV retinitis after 12 months was 24 percent in the placebo group and 12 percent in the ganciclovir group (P < 0.0001). The prevalence of CMV-positive urine cultures at base line was 42 percent; after two months it was 43 percent in the placebo group and 10 percent in the ganciclovir group (P < 0.0001). The one year mortality rate was 26 percent in the placebo group and 21 percent in the ganciclovir group (P = 0.14). Therapy with granulocyte colony stimulating factor was more frequent in the ganciclovir group (24 percent) than in the placebo group (9 percent). CONCLUSIONS: In persons with advanced AIDS, phophylactic oral ganciclovir significantly reduces the risk of CMV disease.
AIDS-Related Opportunistic Infections↗
Comparison of three regimens for treatment of mild to moderate Pneumocystis carinii pneumonia in patients with AIDS. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine. ACTG 108 Study Group.
OBJECTIVE: To compare the tolerability and efficacy of three oral regimens for the treatment of patients with the acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia. DESIGN: A randomized, double-blind study. SETTING: 24 U.S. academic medical centers. PATIENTS: 181 patients with morphologically confirmed P. carinii pneumonia and alveolar-arterial oxygen differences (PAO2-PaO2) of 45 mm Hg or less. INTERVENTION: Patients were randomly assigned to receive trimethoprim-sulfamethoxazole, dapsone-trimethoprim, or clindamycin-primaquine for 21 days. Patients with a PAO2-PaO2 of 35 to 45 mm Hg at study entry also received prednisone. MEASUREMENTS: Serial clinical and laboratory evaluations for therapeutic response and toxicity. Therapeutic failure at day 21 was defined by any of the following: increase in PAO2-PaO2 of greater than 20 mm Hg; no remission of baseline signs and symptoms; and change in antipneumocystis therapy for reasons other than toxicity, intubation, or death. Dose-limiting toxicity was defined as discontinuation of therapy by the primary physician because of one or more adverse reactions. RESULTS: No statistically significant differences were seen among treatment groups in the proportions of patients who had dose-limiting toxicity (P=0.2), therapeutic failure (P>0.2), or a complete course of therapy (P>0.2). Survival during therapy or for 2 months thereafter did not differ among the three groups (P>.02). However, elevation of serum aminotransferase levels to more than five times the baseline levels was more frequent in the trimethoprim-sulfamethoxazole group (P=0.003), and one or more serious hematologic toxicities (neutropenia, anemia, thrombocytopenia, or methemoglobinemia) occurred more frequently in the clindamycin-primaquine group (P=0.01). CONCLUSIONS: The rates of dose-limiting toxicity, therapeutic failure, and survival did not differ among patients with AIDS who were receiving oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, or clindamycin-primaquine for mild to moderate P. carinii pneumonia. However, the limited sample size prevents the unequivocal demonstration of the equality of these three regimens. Differences in expected categories of toxicities associated with each regimen should guide the clinician in choosing first-line therapy, particularly for patients with baseline hepatic insufficiency or myelosuppression.
AIDS-Related Opportunistic Infections↗
Preventing childhood unintentional injuries--what works? A literature review.
AIM: The aim of this paper is to report on a systematic review of the world literature to provide information about the most effective forms of health promotion interventions to reduce childhood (0-14 years) unintentional injuries. The findings are of relevance to policy makers at a local or national level, to practitioners and researchers. METHODS: The relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with key informants. RESULTS: Examples of interventions that have been effective in reducing injury include: bicycle helmet legislation, area wide traffic calming measures, child safety restraint legislation, child resistant containers to prevent poisoning, and window bars to prevent falls. Interventions effective in changing behaviour include bicycle helmet education and legislation, child restraint legislation, child restraint loan schemes, child restraint educational campaigns, pedestrian education aimed at the child/parent, provision of smoke detectors, and parent education on home hazard reduction. For the community based campaigns, the key to success has been the sustained use of surveillance systems, the commitment of interagency cooperation and the time needed to develop networks and implement a range of interventions. Education, environmental modification and legislation all have a part to play and their effect in combination is important. CONCLUSION: The design of evaluations in injury prevention needs to be improved so that more reliable evidence can be obtained. Better information is needed on process, so that successful strategies can be replicated elsewhere. There is also a need for literature reviews on effectiveness to be updated regularly and for their findings to be widely disseminated to policy makers, researchers, and practitioners.
Accident Prevention↗
Statistical analysis of blood- to breath-alcohol ratio data in the logarithm-transformed and non-transformed modes.
The statistical analysis of non-transformed and logarithm-transformed blood- to breath-alcohol ratios ("blood/breath ratios") is detailed. The data analyzed were derived from 137 simultaneous blood-alcohol and breath-alcohol concentration measurements made between 15 and 179 min after the end of drinking, with 136 of the measurements obtained during the 15- to 124-min time frame. Although the distribution of the non-transformed ratios is positively skewed, and that of the logarithm-transformed data more closely approximates the normal distribution upon visual inspection, both analyses generated results that do not differ significantly from each other when considered in the context of "mean ratios + or - 2SD". This is in accord with the results of the Kolmogorov-Smirnov goodness-of-fit test, which does not reject either dataset and demonstrates that both are approximately normal. Since the logarithm-transformed data generate more conservative statistical blood/breath ratio ranges than the non-transformed data, they were selected as the basis for the principal conclusion of this work. That conclusion is a refutation of the argument that, breath-alcohol analyzers relying on a 2100:1 blood/breath ratio tend to underestimate the blood-alcohol concentrations of driving-while-intoxicated arrestees because the commonly accepted mean postabsorptive ratio is 2300:1. In fact, whenever the absorption status of a driving-while-intoxicated arrestee at the time of a breath test cannot be definitively established, the results of this work support the application of a relative error range of -40% to +28% for 95% of the population, based on a statistical blood/breath ratio range of 1259:1 to 2679:1, and -46% to +42% for 99% of the population, based on a statistical range of 1128:1 to 2989:1.
Absorption↗
Effects of serum separation tubes on serum benzodiazepine and phenobarbital concentrations in clinically normal and epileptic dogs.
OBJECTIVE: To characterize the effects of serum separation tubes (SST) on serum drug concentrations. SAMPLE POPULATION: Clinically normal dogs (clorazepate, n = 7) or dogs with epilepsy (phenobarbital, n = 7) were studied in experiment 1, and samples submitted for therapeutic drug monitoring (n = 87) were studied in experiment 2. PROCEDURE: In experiment 1, blood containing either drug was placed in 2 types of 4-ml SST (SST-A and SST-B) and in nonserum separation tubes (non-SST [control]). Samples were processed, then stored at 20 to 22 C (both drugs) or 10 C (phenobarbital only). Aliquots were collected for 96 hours. The rate constant of disappearance and the percentage decrease of each drug over time were determined for each tube. For experiment 2, paired samples were collected in non-SST and SST and submitted by mail for therapeutic drug monitoring. The SST samples were either decanted from SST prior to shipment (group 1; n = 30) or mailed in SST with serum in contact with the silica gel (group 2; n = 57). Drug concentrations and drug elimination half-life were compared between groups. For both experiments, drugs were detected in samples, using polarized immunofluorescence. RESULTS: For experiment 1, the rate constant of drug disappearance for both drugs was greater in the 4-ml SST-A (P < 0.0001). This SST also caused the greatest percentage decrease (20% for phenobarbital and 35% for benzodiazepines) at 96 hours. Refrigeration reduced the mean decrease in phenobarbital at 96 hours to 11%. For experiment 2, phenobarbital concentration was lower for both SST, compared with non-SST (P < 0.0005). Phenobabital had decreased a mean 6.4 +/- 0.5% in group-1 and a mean 30.5 +/- 11.1% in group-2 (P < 0.0005) samples. CONCLUSION: The SST should be avoided when collecting serum for monitoring of either phenobarbital or benzodiazepines. CLINICAL RELEVANCE: The SST can falsely decrease serum drug concentrations and should be avoided when collecting blood for therapeutic drug monitoring.
Animals↗
Medicolegal alcohol determination: variability of the blood- to breath-alcohol ratio and its effect on reported breath-alcohol concentrations.
There is substantial agreement among scientists that the variability of a person's blood- to breath-alcohol ratio contributes significantly to the experimental error in results from breath-alcohol analysis. Some have argued that the need to correct for this source of error can be eliminated by reporting breath test results in units of breath-alcohol concentration rather than blood-alcohol concentration. A simple mathematical proof is presented to demonstrate that this is not the case. Moreover, the scientific and legal flaws of this argument are discussed, and recommendations are offered for dealing with the problems that have developed from adoption of this view.
Alcoholism↗
Alcohol abuse screening instruments: normative test data collected from a first DWI offender screening program.
OBJECTIVE: A variety of instruments are used by Driving While Impaired (DWI) screening programs nationwide to assess offenders for alcohol- or drug-related problems. This study presents normative data from five standardized instruments administered by a DWI screening program: the MAC scale of the MMPI, the Alcohol Use Inventory (AUI), the Michigan Alcoholism Screening Test (MAST), the Drug Abuse Screening Test (DAST) and the Skinner's Trauma Scale (STS). METHOD: The population under study were 2,317 first DWI offenders who completed screening evaluations in 1989-91. The sample included 24% women; the racial distribution was 46% Hispanic, 43% non-Hispanic white, 8% Native American and 3% other races. A statistical model was developed to determine associations among scores on the various instruments and age, gender, ethnicity, education, blood alcohol concentration (BAC) and validity measures on the MMPI-2 (L and K scale scores) RESULTS: There were significant differences in test scores among the ethnic- and gender-specific client groups. Test scores were significantly higher among men than women for the MAST, the D1 and D2 scales of the AUI, the MAC, and the STS. Correlations among the instruments were generally low, and the percentage of persons who scored above instrument cut-points varied significantly. The MAST identified the highest percentage of persons as alcoholic. MMPI profile validity was the most significant independent variable associated with test scores. Persons with scores in the valid range had higher mean scores on each of the instruments. CONCLUSIONS: The choice of instruments used in the DWI assessment can greatly influence the percentage of offenders assessed as having alcohol-related problems.
Accidents, Traffic↗
Avoiding pitfalls in medical practice valuation.
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Financial Audit↗
Isolation of a new foamy retrovirus from orangutans.
We have isolated a new foamy virus from blood samples taken from two apparently healthy orangutans (Pongo pygmaeus). The older orangutan has since died with encephalopathy after a brief acute illness, while the younger one, his grandson, remains well. These animals and 12 other orangutans had specific antibodies to foamy virus as measured by immunofluorescence. The new foamy virus and the antisera showed strong and specific neutralization, with only weak cross-reaction with other simian foamy virus strains. Southern blotting with gag and env probes of human foamy virus and PCR amplification showed that the new foamy virus, designated SFV-11, is related to, yet distinct from, previously characterized strains from humans, chimpanzees, and monkeys.
Animals↗
Prevention of epoxy resin dermatitis: failure of manufacturers to use available research information.
Research information is often recommended as a solution for occupational disease and injury. This study asks whether publicly available research information on prevention of a well-documented occupational hazard is acted on by an important sector in industry. The hazard, allergic contact dermatitis (ACD) caused by epoxy resins in paints, is particularly significant for painters, who may have to leave their jobs as a consequence of the condition. No evidence is found, according to a priori criteria, that paint manufacturers/suppliers acted on known prevention measures for epoxy resin ACD that are within their control to implement. The findings suggest that availability of research information alone fails to solve health and safety problems. Recommendations for avenues of direct and indirect enforcement where voluntary implementation is absent in the painting industry are suggested.
Australia↗
Age-related changes in scalp topography to novel and target stimuli.
Event-related brain potentials (ERPs) were recorded from young, middle-aged, and older adults to infrequent target and novel stimuli during a version of the oddball paradigm. Analyses of scalp distribution suggested that the shift to a more frontally oriented topography with increasing age was confined to the P3 component (as compared to N1 and P2) elicited by both target and novel stimuli. This first demonstration of an age-related shift in the scalp distribution of the novelty P3 elicited by auditory stimuli was associated with an age-related increase in the false-alarm rate to novel stimuli. These age-associated differences in scalp distribution and false-alarm rate are consistent with a change in frontal lobe activity with increasing age.
Acoustic Stimulation↗