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Biomedical subjects

J McCord

Publications and source records attributed to J McCord.

At least 19 recordsLinked to original sources
PubMed2001

Ninety-minute exclusion of acute myocardial infarction by use of quantitative point-of-care testing of myoglobin and troponin I.

BACKGROUND: Diagnostic strategies with ECG and serum cardiac markers have been used to rule out acute myocardial infarction in 6 to 12 hours. The present study evaluated whether a multimarker strategy that used point-of-care measurement of myoglobin, creatine kinase (CK)-MB, and troponin I could exclude acute myocardial infarction in </=3 hours. METHODS AND RESULTS: We prospectively enrolled consecutive patients (n=817) in the emergency department who were evaluated for possible acute myocardial infarction. In patients with nondiagnostic ECGs, we measured CK-MB, troponin I, and myoglobin with a point-of-care device at presentation and at 90 minutes, 3 hours, and 9 hours. Standard central laboratory testing of CK-MB was done at the same time intervals, and triage decisions were made by emergency physicians who were unaware of point-of-care results. Sensitivity and negative predictive value were compared for both the multimarker, point-of-care approach and the central laboratory strategy. Sensitivity and negative predictive value for point-of-care combination of myoglobin and troponin I by 90 minutes was 96.9% and 99.6%, respectively. CK-MB measurements and blood sampling at 3 hours did not improve sensitivity or negative predictive value. Median time from sampling to reporting of results was 71.0 minutes for the central laboratory versus 24.0 minutes for the point-of-care device (P<0.001). CONCLUSIONS: Acute myocardial infarction can be excluded rapidly in the emergency department by use of point-of-care measurements of myoglobin and troponin I during the first 90 minutes after presentation.

Acute Disease↗
PubMed1999

When interventions harm. Peer groups and problem behavior.

This article explored developmental and intervention evidence relevant to iatrogenic effects in peer-group interventions. Longitudinal research revealed that "deviancy training" within adolescent friendships predicts increases in delinquency, substance use, violence, and adult maladjustment. Moreover, findings from 2 experimentally controlled intervention studies suggested that peer-group interventions increase adolescent problem behavior and negative life outcomes in adulthood, compared with control youth. The data from both experimental studies suggested that high-risk youth are particularly vulnerable to peer aggregations, compared with low-risk youth. We proposed that peer aggregation during early adolescence, under some circumstances, inadvertently reinforces problem behavior. Two developmental processes are discussed that might account for the powerful iatrogenic effects.

Adolescent↗
PubMed1998

Multifocal atrial tachycardia.

Multifocal atrial tachycardia is typically seen in elderly patients with severe illnesses, most commonly COPD. The mechanism of the arrhythmia may be delayed afterdepolarizations leading to triggered activity, but this has not been firmly established. The initial treatment of multifocal atrial tachycardia should include supportive measures and aggressive reversal of precipitating causes. Since multifocal atrial tachycardia is commonly a secondary phenomenon, the role for antiarrhythmic therapy is unclear. Metoprolol, magnesium, and verapamil have been evaluated in a few treatment studies, and may have a role in the treatment of multifocal atrial tachycardia.

Aged↗
PubMed1998

The association of educational achievement and school dropout with risk of alcoholism: a twenty-five-year prospective study of inner-city children.

OBJECTIVE: This prospective study is focused on the characteristics leading to alcohol use disorders in early adulthood among a cohort of black children. The principal aim of this work is to examine the impact of educational attainment, school dropout and early school adaptation on the development of alcohol abuse and dependence in adulthood. METHOD: From a population that consisted of 1,242 first graders in 1966-67, a total of 953 were interviewed at age 32-33 about their current alcohol and drug use, educational attainment, employment and family situation. RESULTS: Diagnoses of alcohol abuse and dependence were defined according to DSM-III-R criteria resulting in identification of 13.5% as having a lifetime alcohol use disorder. Early predictions of an alcohol use disorder in adulthood included early reports of underachievement in first grade by the child's teacher, dropping out of high school, whether the family set definite rules about school during adolescence, and how often the adolescent worked on homework with his/her family. CONCLUSIONS: The results suggest that educational achievement and some early adaptive behaviors in school are associated with risk for alcohol use disorders. The public health importance of the findings are discussed.

Achievement↗
PubMed1997

The inner city and drug use: initial findings from an epidemiological study.

Although scientific and policy statements regarding drugs often suggest that there are grave problems of drug use within America's inner cities, the evidence that supports these statements is often based on anecdotal or incomplete data. This study of African-American adults from the Woodlawn study followed longitudinally partially fills that gap, at least for learning more about those who spend some or all of their childhood within an inner city neighborhood. We found few differences between the lifetime prevalence of drug use and a national representative sample of adults of the same age range. Furthermore, a national household survey of African-Americans of similar age living in six central cities also reported low lifetime rates of illicit drug use. Nevertheless, those from the Woodlawn cohort had higher rates of use of illicit drugs in the past year than the national sample, especially those still living in areas with high rates of poverty. Additionally, reports of heavy drug trafficking were much greater in the inner city areas than in the suburbs.

Adult↗
PubMed1996

Considerations regarding biosocial foundations of personality and aggression.

I have suggested that research into biosocial processes has been impeded because of two mistaken opinions. The first pertains to a belief that biological processes are determinative. I have tried to show that they are potentiating. The second pertains to a belief that if biology contributes to aggression, biological interventions are necessary. I have demonstrated that social processes can alter biological conditions. I have also suggested that biosocial research can make important contributions through animal models and longitudinal studies.

Aggression↗
PubMed1996

Hemorrhage activates NF-kappa B in murine lung mononuclear cells in vivo.

Hemorrhage rapidly increases the expression of proinflammatory and immunoregulatory cytokines in the lungs. Binding elements for the nuclear transcriptional regulatory factors (NF)-kappa B and NF-IL6 (C/EBP beta) are present in the promoter regions of multiple cytokine genes, including those whose expression is increased after blood loss. In the present experiments, we found increased activation in vivo of NF-kappa B in lung mononuclear cells, but not in splenocytes, taken from mice 1 h after hemorrhage. In contrast, hemorrhage did not activate NF-IL6 in lung cells or splenocytes. Inhibition of xanthine oxidase by prior feeding of a tungsten-enriched diet prevented hemorrhage-induced activation in lung cells of NF-kappa B. Incubating splenocytes in vitro with xanthine oxidase activated NF-kappa B but not NF-IL6. Xanthine oxidase-induced activation of NF-kappa B was inhibited by manganese superoxide dismutase, but not by catalase. These results suggest that xanthine oxidase-mediated superoxide anion-dependent activation of NF-kappa B occurs in vivo and in vitro. This mechanism may contribute to increased lung cytokine responses after hemorrhage.

Animals↗
PubMed1995

"Best-of-breed" vs. monolithic solutions. Roundtable discussion.

The debate is hotter now than it was when we alluded to it in our June issue's "round table." CIOs and IS directors still wonder about the strategic advantages of single-vendor solutions vs. the best-of-breed approach. In June we noted that this dynamic has driven system acquisitions for several years. Since then we have witnessed what amounts to a feeding frenzy. We asked a few experts to discuss their perceptions of the controversy. Their comments follow.

Cost-Benefit Analysis↗
PubMed1994

Magnesium for myocardial infarction?

There are several theoretical mechanisms by which magnesium might be beneficial against ischemic heart disease. Yet numerous studies of its use in acute MI show inconsistent results.

Animals↗
PubMed1992

Using HIS data for health care research.

The importance of measuring healthcare performance and outcome rapidly grows around the world. As hospital information systems (HIS) become more commonplace, their use as clinical research tools can be easily developed. This is demonstrated in the article by two examples of clinical outcomes research undertaken on the world's largest HIS database. The research studies described in the article were on: (1) The effect of hospital 'experience' on inpatient mortality rates for patients with HIV-related pneumocystis carinii pneumonia, and (2) The effect of streptokinase and tPA on post-acute myocardial infarction survival rates.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Can disruptive boys be helped to become competent?

The Montréal Longitudinal Study of Disruptive Boys, an experimental study, was designed to understand boys who were considered disruptive in kindergarten. One part of the study involved assessing effects of a preventive treatment program carried out during the boys' early years in primary school. This paper reports on the outcome of the randomized treatment experiment 3 years after treatments ended. Disruptive boys were randomly allocated to a treated group and two nontreated groups. Treatment consisted of parent training and training of boys for social skills, fantasy play and television viewing. Results suggest that the treatment program had some positive effects. Some of the improvements were not evident immediately after treatment ended.

Achievement↗
PubMed1991

Competence in long-term perspective.

The concept of competence seems to be duovocal. In one sense, competence has been viewed as abilities or attitudes leading to academic and occupational achievement. In the other, competence represents the converse of antisocial, disruptive behavior-what might be viewed as a dimension of social adjustment. The purpose of the present study is to shed light on the development of competence defined both as achievement and as adjustment.

Achievement↗
PubMed1991

Superoxide dismutase therapy for myocardial ischemia.

Oxygen derived free radicals have been shown to be generated during reperfusion of ischemic myocardium by a variety of approaches including spin trap probes. Three levels of injury have been described for the reperfused heart. Periods of ischemia of only several minutes can trigger lethal arrhythmias on reperfusion. Anti-oxidants including SOD and or catalase, as well as iron chelators reduce the incidence of these arrhythmias in both dog and rat. Xanthine oxidase inhibitors are equipotent with SOD in this model suggesting that xanthine oxidase is the source of the radicals. Periods of occlusion lasting 10-15 minutes produce a recoverable defect in contractility termed "stunning". SOD plus catalase has been shown to reduce the incidence of stunning in a variety of models including the xanthine oxidase deficient rabbit. Neither agent on its own seemed to be effective against stunning in either the rabbit or the dog. Stunning is more difficult to demonstrate in the rabbit heart, presumably due to its lack of xanthine oxidase. Periods of ischemia in excess of 20 minutes will result in some irreversible cell death (infarction) with reperfusion. While studies using histochemical methods suggesting that SOD plus catalase given at the time of reperfusion could limit necrosis in the dog model, histological studies reveal that infarct size was not modified but rather, SOD appears to interfere with the ability of tetrazolium to histochemically discriminate between living and dead cells. While PEG SOD with its extended plasma half life was reported to reduce infarct size in the dog, it was unable to protect the reperfused rabbit heart. To date, none of the scavengers have been proven to limit infarction suggesting that free radicals contribute to arrhythmias and stunning, but do not kill cells in the reperfused heart.

Animals↗
PubMed1988

Parental behavior in the cycle of aggression.

In the study described here, a longitudinal, prospective approach was used to compare men who had been raised by aggressive, by punitive, and by neither aggressive nor punitive parents. The purpose of these comparisons was to attempt to identify processes that might account for intergenerational transmission of antisocial behavior. Men who had been reared in aggressive families tended to be expressive as well as to commit crimes. Men reared by punitive parents showed a tendency to be egocentric. I therefore suggest that parental aggressiveness may be transmitted through two messages. The first is the message that expressive behavior, including injurious actions, is normal and often justified. The second is the message that egocentrism is both normal and virtuous.

Adolescent↗
PubMed1988

Alcoholism: toward understanding genetic and social factors.

This study uses prospective data to assess the interaction of environmental and genetic contributions to alcoholism. Families of men whose genetic loading included fathers who were alcoholics were compared with men whose fathers were not alcoholics. Alcoholism among the former appeared to be promoted by mothers who held the alcoholic fathers in high esteem. The analyses suggested that genetic loading together with covert acceptance of alcoholism increases risk, as does absence of maternal control.

Alcoholism↗