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Jessica Stern

Publications and source records attributed to Jessica Stern.

6 recordsLinked to original sources
PubMed2006

Confidence interval calculation methods are infrequently reported in emergency-medicine literature.

BACKGROUND: There are many different confidence interval calculation methods, each providing different as well as in some cases inadequate interval estimates. Readers who know which method is used are better able to understand potentially significant limitations in study reports. OBJECTIVES: To quantify how often confidence interval calculation methods are disclosed by authors in four peer-reviewed North American emergency-medicine journals. METHODS: The authors independently performed searches of four journals for all studies in which comparisons were made between means, medians, proportions, odds ratios, or relative risks. Case reports, editorials, subject reviews, and letters were excluded. Using a standardized abstraction form developed on a spreadsheet, the authors evaluated each article for the reporting of confidence intervals and evaluated the description of methodology used to calculate the confidence intervals. RESULTS: A total of 212 articles met the inclusion criteria. Confidence intervals were reported in 123 articles (58%; 95% CI = 51% to 64%); of these, a description of methodology was reported in 12 (9.8%; 95% CI = 5.7% to 16%). CONCLUSIONS: Confidence interval methods of calculation are disclosed infrequently in emergency medicine literature.

Confidence Intervals↗
PubMed2005

Functional correlates of mutation of the Asp32 and Gly34 residues of beta-catenin.

Beta-catenin is a multifunctional protein involved in both cadherin-mediated adhesion and the wnt signaling cascade. Mutations in exon 3 of beta-catenin have been identified in many cancers. In addition to disruption of key serine and threonine residues, mutations are frequently reported in other residues in exon 3 that are not kinase substrates. The most frequently mutated nonserine/threonine residues are D32 and G34. Since D32 and G34 are part of the ubiquitination destruction motif, DSGPhiXS, we hypothesize that this motif may contribute to disruption of beta-catenin homeostasis and lead to cellular transformation. We demonstrate that the mutants D32A and G34A exhibit no change in phosphorylation by GSK3beta, but display reduced ubiquitination compared to wild-type and S33A mutant beta-catenin. To assess the functional implications of these mutations, we created stable MDCK cell lines expressing these constructs. We found that stable cell lines harboring D32A-mutated beta-catenin were highly transformed, while S33A and G34 demonstrated only weak transforming properties in our assays. Despite altered ubiquitination status and increased transformation, the D32A mutant cell line does not display transcriptional activation of standard target genes. Therefore, D32A mutation may mediate transformation by an alternative beta-catenin-mediated signaling pathway.

Aspartic Acid↗
PubMed2005

A follow-up analysis of factors associated with head-injury mortality after paramedic rapid sequence intubation.

BACKGROUND: The San Diego Paramedic Rapid Sequence Intubation (RSI) Trial documented an increase in mortality after paramedic RSI, with hyperventilation identified as a contributing factor in a small subgroup analysis. Here we explore factors affecting outcome in the entire cohort of patients undergoing paramedic RSI to confirm previous findings. This also represents a synthesis of findings from previous analyses METHODS: Adult trauma patients with severe head injury (Glasgow Coma Scale score, 3-8) who could not be intubated without RSI were prospectively enrolled in the trial. This analysis excluded patients without traumatic brain injury (head/neck abbreviated injury score <2 or failure to meet Major Trauma Outcome Study criteria) or death in the field or within 30 minutes of arrival. Each remaining trial patient was matched to two nonintubated historical controls from the county trauma registry based on: age, sex, mechanism, abbreviated injury scores for each body system, and Injury Severity Score. Logistic regression, cohort analysis, mean least squares regression, and discordant group analysis were used to explore the impact of various factors on outcome. RESULTS: Of the 426 trial patients, 352 met inclusion criteria for this analysis and were hand-matched to 704 controls. Trial patients and controls were identical with regard to all matching variables. Mortality was increased in RSI patients versus matched controls (31.8 versus 23.7%; odds ration, 1.5; 95% confidence interval, 1.1-2.0; p < 0.01). Hyperventilation was associated with an increase in mortality, whereas transport by aeromedical crews after paramedic RSI was associated with improved outcomes. The reported incidence of aspiration pneumonia was higher for the RSI patients. CONCLUSION: Paramedic RSI was associated with an increase in mortality compared with matched historical controls. The association between hyperventilation and mortality was confirmed. In addition, patients transported by helicopter after paramedic RSI had improved outcomes. Paramedic RSI did not seem to prevent aspiration pneumonia.

Abbreviated Injury Scale↗
PubMed2003

Functional correlates of mutations in beta-catenin exon 3 phosphorylation sites.

beta-Catenin-mediated signaling can be constitutively activated by truncation or mutation of serine and threonine residues in exon 3. Mutations in this region are observed in many human tumors. Examination of the locations of these mutations reveals interesting patterns; specifically, Ser45 and Thr41 appear more frequently in malignant tumors, and Ser37 and Ser33 are more common in benign entities. To test whether these patterns represent functional differences in beta-catenin signaling mechanisms, we generated mutations of each of these residues. Stable transformation of Madin-Darby canine kidney cells showed a transformed phenotype with each of the four mutations, as assessed by growth in soft agar and collagen. Functional assays including proliferation assays, cell shedding assays, and wounding assays demonstrated two groups. Ser45 and Thr41 represent a more transformed phenotype, whereas Ser37 and Ser33 behaved similarly to the vector in these assays. Assessment of downstream genes demonstrated increased activation of the beta-catenin target gene cyclin D1 by Ser45. Finally, we examined the kinase activity of I kappa B kinase-alpha and found that this kinase, unlike glycogen synthase kinase-3 beta, appears to preferentially phosphorylate Ser45 and Thr41, independent of priming by casein kinase-1. We conclude that these sites may represent an alternative (non-wnt) signaling pathway, which may be inappropriately activated in tumors with mutations of these residues.

Animals↗
PubMedDate not supplied

Air medical transport of severely head-injured patients undergoing paramedic rapid sequence intubation.

INTRODUCTION: The San Diego Paramedic Rapid Sequence Intubation (RSI) Trial documented an increase in mortality with paramedic RSI of patients with severe traumatic brain injury. This analysis explores the impact of air medical transport of trial patients on outcome. METHODS: Adult trauma victims with severe traumatic brain injury (Glasgow Coma Scale score of 3 to 8) were prospectively enrolled. Paramedics performed RSI using midazolam and succinylcholine; air medical crews could be called at the discretion of ground paramedics, generally for anticipated prolonged transports. Patients were matched to historical controls using the following parameters: age, gender, mechanism, injury of severity score, and abbreviated injury scale scores for each body system. Patients transported by air and ground were compared with regard to demographics, clinical parameters, vital signs, arterial blood gas data, and outcome. RESULTS: A total of 336 patients were included (79 air medical and 257 ground transports). No significant differences arose between the groups with regard to demographic, clinical, vital sign, and arterial blood gas data. Air medical patients had decreased mortality (28% vs 31%, OR 0.9), and ground patients had increased mortality versus matched controls (33% vs 22%, OR 1.8). Discordant groups analysis revealed a statistically significant effect of transport personnel on outcome (P=.009). Neither advanced procedures nor the use of mannitol accounted for the improved outcomes; air medical crews used capnometry to guide ventilation on all study patients. CONCLUSION: Air medical transport of severely head-injured patients undergoing paramedic RSI was associated with improved outcomes. Improved ventilation by capnometry may account for part of these improvements.

Adult↗