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Biomedical subjects

J C Beck

Publications and source records attributed to J C Beck.

230 records · Page 13Linked to original sources
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Chronic (60-week) toxicity study of DUROS leuprolide implants in dogs.

The toxicity and pharmacodynamics of leuprolide acetate delivered from subcutaneously implanted DUROS leuprolide implants were examined in sexually mature male beagle dogs. The DUROS leuprolide implant is a sterile, nonpyrogenic, nonerodible, single-use, implantable, osmotically driven, drug delivery system for the palliative treatment of advanced prostate cancer. It contains 65 mg of leuprolide and is designed to deliver leuprolide continuously at a nominal rate of 120 microg per day for at least 12 months. Serum drug and testosterone concentrations were compared to values from dogs receiving monthly intramuscular injections of Lupron Depot 3.75 mg or no treatment (sham-operated). The local tissue response induced by subcutaneously implanted DUROS leuprolide implants was also evaluated. Beagles were implanted with a DUROS leuprolide implant for 52 weeks followed by removal and implantation of a new DUROS leuprolide implant for an additional 8 weeks. No mortality or morbidity occurred in this study. No treatment-related changes occurred in mean body weights, blood chemistry, or hematology during the study. Treatment-related atrophy of the testes, epididymides, and prostate gland, consistent with the known pharmacological effects of the drug, was observed in all dogs receiving the DUROS leuprolide implant or the Lupron Depot. Histological examination of these organs showed no distinguishable difference between dogs treated with the DUROS leuprolide implant or Lupron Depot. Weekly serum samples from dogs with DUROS leuprolide implants indicated continuous leuprolide delivery over 60 weeks, while some samples from the Lupron Depot group fell below measurable concentrations. Analysis of serum samples collected every 28 days just before Lupron Depot injection showed that 80% of these samples had leuprolide concentrations below the limit of quantitation (0.1 ng/ml). Serum testosterone concentrations were below castrate levels (<50 ng/dl) by 4 weeks after implantation of DUROS leuprolide implant and remained so for the duration of the study. Lupron Depot 3.75 mg also effectively lowered serum testosterone concentrations, but required reinjection every 28 days. All local tissue reactions to the DUROS leuprolide implant at implant sites were classified as mild following macroscopic examination. Microscopic site scores were mild to moderate. The DUROS leuprolide implant was shown to be safe, to provide continuous leuprolide delivery, and to effectively lower serum testosterone concentrations below castrate levels.

Animals↗
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Epidemiology of mental disorder and violence: beliefs and research findings.

Recent epidemiological studies illustrate that the link between violence and mental disorder is stronger than most psychiatrists previously believed. The connections between psychosis--particularly schizophrenia--and violence and between alcohol-related disorders and violence are especially clear. However, only a small minority of all people who commit violent acts are psychotic, and they are responsible for relatively little violent crime. This article reviews recent epidemiological and case register studies of mental disorder and violence. Lay and professional beliefs about the relationship between violence and mental disorder are reviewed and related to research findings. The implications of these findings for the psychiatric assessment of potential violence are discussed.

Age Factors↗
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Development of a health risk appraisal for the elderly (HRA-E).

The purpose of this project is to develop a health risk appraisal for the elderly (HRA-E) and test its application in both medical and nonmedical settings. The HRA-E system consists of a questionnaire and software for computer-generation of personalized reports to participants, 55 years and older, and their physicians. Items in the questionnaire cover a comprehensive range of content domains relevant to health promotion in the elderly. The goal of the HRA-E system is to prevent functional decline. Samples of eligible subjects from the American Association of Retired Persons (AARP), a group practice, and a senior center were extended invitations to participate. Those responding affirmatively to the invitation were given a questionnaire and evaluation form. Each person who returned the questionnaire received his or her personal report and a second evaluation form. Four months after receiving their reports, respondents were questioned about behavior changes during the interim. Preliminary findings, based on 1895 respondents, indicate that nearly all participants found the questionnaire easy to complete and were pleased with its overall length. In addition, most participants read their reports, and many planned to take action, based on report recommendations. In the next phase of this project, the intent is to refine the questionnaire, extend the intervention protocols for longitudinal application, and evaluate its impact on health-related behaviors, medical care utilization, and functional decline.

Activities of Daily Living↗
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Getting the attention you need.

Employees have an enormous amount of business information at their fingertips--more specifically, at their desktops. The floodgates are open; profitable possibilities abound. But having to handle all that information has pushed downsized staffs to the brink of an acute attention deficit disorder. To achieve corporate goals, business leaders need their employees' full attention--and that attention is in short supply. Authors Thomas Davenport and John Beck have studied how companies manage the attention of their employees and their site visitors. In this article, they analyze the components of attention management through three lenses--economic, psychobiological, and technological--and offer guidelines for keeping employees focused on crucial corporate tasks. Their lessons are drawn from the best practices employed by today's stickiest Web sites and by traditional attention industries such as advertising, film, and television. The authors say executives must manage attention knowing that it's a zero-sum game (there's only so much to go around). Managers should also consider capitalizing on the basic survival and competitive instincts we all have that help determine how much attention we pay to certain things. For instance, the threat of corporate demise--and the consequent loss of jobs and livelihoods--undoubtedly focuses workers' attention on the need to change. Likewise, internal competition among business units may give employees added incentive to pay attention to a profit or sales goal. Leaders today need to pay more attention to attention because it's widely misunderstood and widely mismanaged, the authors conclude.

Attention↗
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Feasibility of using an alcohol-screening and health education system with older primary care patients.

BACKGROUND: This study evaluated the feasibility of a combined alcohol-screening and health education system for elderly patients METHODS: The Computerized Alcohol-Related Problems Survey (CARPS) was evaluated in primary care practices among 106 current drinkers, 60 years and older. The CARPS contains (1) a self-administered screening survey; (2) software to scan or hand-enter survey responses; (3) software to process data and electronically generate reports of patients' drinking risks; (4) health education; and (5) a database useful for clinical and quality improvement purposes. RESULTS: Nearly all study participants were able to complete the CARPS while waiting for a prescheduled appointment with their physician. There were 44% of patients who were hazardous and 9% who were harmful drinkers. About 20% of men and 26% of women were binge drinkers. Most (85%) patients agreed that alcohol is an important topic, 67% reported learning new information, 78% had never discussed drinking with a physician, and 31% intended to do so. After reviewing CARPS data, physicians concluded that alcohol use in the elderly is an important quality improvement topic. CONCLUSIONS: Combined screening and health education systems appear feasible for use in practice if they deal with pertinent health problems such as alcohol use. Their data can encourage discussions between physicians and patients and might be used for quality improvement activities.

Aged↗
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First cuneiform closing abductory osteotomy for reduction of metatarsus primus adductus.

The closing subtraction osteotomy of the first cuneiform effectively reduces pronounced obliquity of the first metatarsal cuneiform joint and predictably reduces the intermetatarsal angle in patients with metatarsus primus adductus. This osteotomy is combined with other procedures in surgical realignment of the first ray. Cases best suited for this procedure must be selected carefully. The procedure involves resecting the existing bone block from the opposing surfaces of the first and second metatarsal bases and from the distal one half of the opposing surfaces of the first and second cuneiforms. A triangular-shaped wedge of bone is then resected from the midbody of the first cuneiform while retaining a medial hinge. Closure of the first cuneiform osteotomy should require only minimal pressure. Two threaded Steinman pins transfix the osteotomy site. The vascular cancellous bone of the first cuneiform assures adequate healing of the osteotomy site.

Adolescent↗
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Dynamic assessment of cognitive and cardiovascular performance in the elderly.

Dynamic measures of cardiovascular and cognitive performance have been used as a preliminary step toward developing predictors of decline in functional performance in older persons. Both batteries use multiple measures to examine the cooperativity of various aspects of performance, and both examine the subject's response to naturally occurring stresses. In these two senses, the measures are dynamic. For the cardiovascular measure we conducted ambulatory monitoring of blood pressure and pulse at 7.5-min intervals over a 24-h period. These parameters were analyzed simultaneously to examine changes in one relative to the others, using spectroscopy. After appropriate filtering, several dominant ultradian rhythms were noted, with periods of 47 min, 180 min and 6 to 8 h, the latter rhythm being present only in subjects aged greater than or equal to 60. A battery of computer-administered cognitive tests was developed to assess reaction time, visual recognition memory and word recognition memory. This testing allows for both a time and performance level grading. The results of the computer battery correspond well with those for standard neuropsychological tests. In general, performance declined with age, and reaction time increased. The computerized tests are faster, more consistently administered, and do not rely on a skilled professional for administration or analysis. They also provide a wide variety of measures that can be used in isolating components of performance. Once the acceptability and tolerance of older subjects toward such testing was established, attention shifted to questions of measurement stability and discriminant validity. Since the project's primary purpose is to predict subtle measures of decline in function, the battery's ultimate test is in its ability to correctly identify those about to change functional status. However, many different measures of status change are possible, and the predictive accuracy will depend on the outcome chosen. Subsequent work will focus on the predictors to refine measures and compare data collected at one point in time with the predictive power of change scores that reflect the individual subject's "signature." By-products of this work include a wealth of longitudinal physiologic and neuropsychologic data on older persons and tools that may be useful to the practicing physician.

Aged↗
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Na+-electrochemical potential-mediated transport of D-glucose in renal brush border membrane vesicles.

The uphill transport of D-glucose in renal brush border membrane vesicles was correlated with the Na+ electrochemical gradient. Each component of the electrochemical potential, the membrane potential or the Na+ chemical gradient, when assayed independently supported the concentrative uptake of the sugar. When the two components were combined the rates of D-glucose uptake were additive. Accumulation of D-glucose as a function of various Na+ gradients, in the absence of a membrane potential, suggests a 1:1 stoichiometry between sugar and Na+ uptake. These findings are consistent with the role of ionic gradients in energizing uphill solute transport and, thus, provide experimental evidence that extends the chemiosmotic theory to the Na+ electrochemical potential-mediated transport of D-glucose in mammalian tissues.

Animals↗
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[Sex differences in drug use by over 75-year-old persons at home: an epidemiologic study in Bern].

The purpose of this study was to explore gender differences of medication use in a random sample of community-dwelling elderly subjects (N = 791). The average number of different medications in women (N = 578) was higher than in men (N = 213) (4.0 vs. 3.5, age corrected ratio 1.2, 95% confidence interval, 1.0-1.3). However, despite this relatively small difference in number of medications there was a major gender difference in the pattern of medications used. Compared to men, women had a higher use of benzodiazepines (risk ratio 1.7, 95% confidence interval, 1.3-2.3), diuretics (1.5, 1.1-2.0), nonsteroidal antiinflammatory agents (1.7, 1.2-2.3), and anti-depressants (2.5, 1.1-5.5), but a lower use of pulmonary (0.5, 0.3-0.9) and gout medications (0.2, 0.1-0.6). These gender differences in medication use can be explained by the fact that compared to men, women have a higher prevalence of non-lethal chronic conditions such as degenerative joint disease and hypertension. However, additional factors such as gender-specific differences in patient or physician behavior are likely to contribute to the observed differences in medication use as well. Overall, 36% of all women and 21% of all men were using benzodiazepines, with 42% of these subjects using long-acting compounds. Furthermore, 24% of all women and 15% of all men reported use of nonsteroidal antiinflammatory agents for which safer medication and non-medication alternatives would be available in many cases. Thus, women had a higher risk of inappropriate medication use than men. On the other hand, the finding that antidepressant use was 3% in men and 7% in women indicates that compared to women, men might be at increased risk for undertreatment of depression. Further causal evaluation of gender differences in both medication use and patient-physician interaction might contribute to detection and reduction of inappropriate drug use in older persons.

Aged↗