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Biomedical subjects

L D Kennedy

Publications and source records attributed to L D Kennedy.

At least 19 recordsLinked to original sources
PubMed2001

Practice guidelines for lipid-based amphotericin B in stem cell transplant recipients.

OBJECTIVE: To provide clinicians who practice in the stem cell transplantation (SCT) setting with practical guidelines for the use of lipid-based amphotericin B (AmB) formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections. DATA SOURCES: Recommendations are based on the results of a two-day consensus meeting that convened clinicians versed in the management of infectious complications in patients undergoing SCT. This meeting, which was held October 21-23, 1998, in Orlando, Florida, was sponsored by an educational grant from The Liposome Company. In addition, primary articles were identified by MEDLINE search (1980-December 1999) and through secondary sources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from the data sources were evaluated, and all information deemed relevant was included in this review. DATA SYNTHESIS: Immunocompromised patients, particularly patients undergoing high-dose chemotherapy with SCT, experience a high degree of morbidity and mortality from invasive fungal infections. Historically, treatment for such infections with conventional AmB had been limited primarily by its associated nephrotoxicity. Lipid-based formulations of AmB have helped to advance the management of invasive fungal infections in the SCT population by offering a treatment alternative that allows for administration of adequate amounts of active drug to produce clinical and mycologic responses, compared with conventional AmB, in a delivery system that is less nephrotoxic. Unfortunately, these agents are relatively expensive. Therefore, patients who are candidates for lipid-based products must be selected carefully. CONCLUSIONS: Practical guidelines are provided for the use of lipid-based AmB formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections.

Humans↗
PubMed2000

Earnings histories of SSI beneficiaries working in December 1997.

Disabling conditions previously considered to be permanent and total are no longer viewed as automatic barriers to work. Medical advances, improved accommodations in the workplace, and changes in the nature of work for the working disabled have allowed many disabled people to rejoin the workforce. The Social Security Administration (SSA) has followed those developments with a view toward encouraging people receiving disability benefits to consider returning to work. To effectively target SSA's efforts and evaluate their success, information about previous work histories of the Supplemental Security Income (SSI) beneficiary population is used to provide baseline data. This article examines the earnings histories of 300,000 disabled SSI beneficiaries--one of the populations targeted by the expanded work-incentive measure under Public Law 106-70--who were working in December 1997. The article also investigates whether beneficiaries who are working have significant lifetime earnings and whether earnings patterns exist that might assist with SSA's work-support activities. SSI program records were matched to data in the Master Earnings File to explore the characteristics and earnings patterns before and after a person applies for benefits. The article addresses several questions: What are the general characteristics of disabled SSI beneficiaries? What are their earnings histories? Did they have an earnings record when they applied for SSI? Of the SSI beneficiaries working in December 1997, most tended to be younger than other disabled beneficiaries, to have some sort of mental disability, and to have earnings well below levels that would suggest their eventual, complete independence from the SSI cash benefits program. A look at past covered earnings revealed that the vast majority of SSI workers had a history of earnings before they applied for SSI benefits. Despite their severe impairments and age at the time of first eligibility, nearly 40 percent had earnings in 11 years or more. The amounts of those earnings were quite low, however, and were usually not high enough to preclude SSI eligibility. Examining the years immediately before and after the point of application indicated whether recent pre-application earnings were consistent with post-application return to work. Results were a bit surprising. They revealed that one-third of the 1997 SSI workers had no earnings, and another 28 percent returned to work despite having no earnings in the 4-year period before application. Persons receiving SSI because of mental retardation seemed to have poorer earnings histories than other workers but were more likely to return to work after application. That may be explained by their younger ages or may reflect the outside assistance they received in responding to SSA work incentives.

Adolescent↗
PubMed1999

SSI at its 25th year.

Beginning in January 1974, the three previously existing State adult assistance programs were amalgamated into the Supplemental Security Income (SSI) program, to be administered by the Social Security Administration. This change was made to provide a nationwide floor of income for needs-based assistance, and to make such payments more efficiently by working through SSA's existing network of field offices. This article traces the 25-year patterns of growth and changes in the number of persons applying for assistance, the number and proportion of those applicants who were awarded payments, and the overall number of persons who received SSI. Three major age groups are considered separately: those aged 65 or older, disabled adults aged 18-64, and children age 18 and younger. The last group was newly eligible under SSI for payments based on their own blindness or disability and not, as was the case previously, because they were a member of a needy family.

Adolescent↗
PubMed1998

Noncitizens and the Supplemental Security Income program.

The Supplemental Security Income (SSI) program, established by the Social Security Amendments of 1972 (Public Law 92-603), was designed to provide cash assistance to needy aged, blind, and disabled citizens, and noncitizens lawfully admitted for permanent residence or permanently residing under color of law. Since then, this means-tested program has undergone many legislative changes that affect the eligibility status of noncitizens. This article, presented in three parts, discusses the legislative history of noncitizen eligibility, and details relevant laws enacted since the program's inception; provides current data on the trends and changes of the noncitizen population; and describes the larger population of foreign-born SSI recipients, of which the noncitizens are a part. Data on the number of SSI recipients born abroad but who had become citizens before applying for SSI payments were not previously available. Analytical data are from the Supplemental Security Record (SSR) matched to the Social Security Number Identification (Numident) file.

Adolescent↗
PubMed1997

Hydroxyurea in the treatment of sickle-cell anemia.

Sickle-cell anemia is a congenital hemolytic anemia characterized by sickle-shaped RBCs. The deformed RBCs become distorted and rigid and may occlude small arterioles and capillaries leading to tissue ischemia and infarction. Sickled RBCs are too fragile to withstand the trauma of circulation, and hemolysis occurs after they enter the circulation. RBCs with a high level of Hb F are resistant to sickling. Hydroxyurea has been shown to stimulate Hb F synthesis, leading to a reduction in the incidence of hemolytic and vaso-occlusive manifestations; however, hydroxyurea has no role in the treatment of crises already in progress. The National Heart, Lung, and Blood Institute announced in January 1995 that treatment with hydroxyurea leads to an increase in Hb F production within RBCs and a reduction in the frequency of painful crises in patients with sickle-cell anemia. Although the mechanism by which hydroxyurea increases Hb F is not known, one possible explanation is that hydroxyurea is cytotoxic to the more rapidly dividing late erythroid precursors, leading to the recruitment of early erythroid precursors that have demonstrated increased capacities to produce Hb F. Clinical trials have demonstrated that hydroxyurea results in an increase in Hb F concentrations; however, this increase may not dramatically affect the progressive vascular changes associated with sickle-cell anemia; thus, patients may still experience complications related to sickle-cell anemia. At North Carolina Baptist Hospital in Winston-Salem, NC, compliant patients with sickle-cell anemia are started on hydroxyurea. There are no specific criteria for patient selection or monitoring. The dosage is started at 10-15 mg/kg/d. Platelet count, complete blood count, and Hb F are monitored and hydroxyurea dosages are adjusted accordingly. Although hydroxyurea has been effective in the treatment of sickle-cell anemia, large double-blind, placebo-controlled clinical trials are needed to determine whether the risks of long-term administration outweight the risk of vaso-occlusive disease in untreated patients.

Anemia, Sickle Cell↗
PubMed1997

Women aged 65 or older receiving SSI payments, December 1996.

Older women who, even if they do receive Social Security benefits, are still eligible for Supplemental Security Income payments are certainly among the most vulnerable segments of our society. At the end of 1996, there were more than 1.5 million such women aged 65 or older who were receiving SSI payments. It is likely that these women have been poor for much of their lives, as they appear to become eligible for SSI before or close to their 65th birthday. These women represent 23 percent of the SSI caseload, and 8 percent of all women aged 65 or older in the country; almost one-third are aged 80 or older. In addition to the health limitations that accompany increasing age, about a third of these women appear to have been blind or severely disabled for many years, and had been receiving SSI even before they reached age 65. Their SSI payments averaged $237 per month ($137 if they also received Social Security, $394 if they did not). Sixty-three percent of the SSI population who were women aged 65 or older were also getting a Social Security benefit averaging $356 per month, but other than Social Security, they had almost no cash income. A few of these women were institutionalized, and almost 1 out of five reported owning their own home. Approximately half lived alone, and another 20 percent lived with only one other person. Of women aged 65 or older receiving SSI payments, 1 in 5 was not a U.S. citizen, and this group was even less likely to have Social Security benefits, or any other cash income. As a result, their SSI payments were higher. Data are not yet available to judge the impact of the complex series of changes made to SSI eligibility for noncitizens by legislation enacted in 1996 and 1997.

Aged↗
PubMed1996

Nicotine therapy for ulcerative colitis.

Smoking has been associated with a decreased frequency of UC. Currently, the role of nicotine for the treatment of UC is not established. Several studies have evaluated nicotine gum and transdermal patches as supplemental therapy for stable UC, but nicotine has not been compared with other treatment modalities. Nicotine dosages in the studies have varied from 5 to 30 mg/d without apparent dose-related therapeutic effects, and many patients have found relief from placebo treatment. Patients often do not tolerate nicotine therapy's adverse effects, which can include nausea, light-headedness, and headache. Due to the cyclic disease course of UC and the potential addictiveness of nicotine, further large studies are warranted to assess the benefits of nicotine therapy for UC. These studies should be conducted using a randomized, double-blind design with an extensive follow-up period. Until further trials are conducted, nicotine should generally not be recommended for UC treatment.

Colitis, Ulcerative↗
PubMed1983

Unearned income of Supplemental Security Income recipients, May 1982.

About 3 out of 5 Supplemental Security Income recipients have some type of unearned income. The major source of this income is Social Security benefits. Other sources are veterans' pensions, pensions from employment, asset income, and support and maintenance in-kind. This article presents for the first time detailed estimates of the distributions of these income sources, based on a 1-percent sample of May 1982 recipients. In two-thirds of the cases, the Social Security benefits were between $100 and $260 a month. Unearned income from sources other than Social Security was usually smaller. Only 5 percent of the SSI population received less tha $100 in Social Security benefits. Differences in distributions for retired-worker and disabled-worker benefits, and for widow's and children's benefits are noted.

Child↗
PubMed1978

Nitrogenase activity of Rhizobium sp. strains in pure culture in relation to extracellular polysaccharide composition and antigenic affinity.

Five strains of slow-growing Rhizobium sp. (strains CB756, 32HI, CB562, CB627 and QA549) out of seventy examined developed appreciable nitrogenase activity in pure culture. CB756 and 32HI were serologically indistinguishable and each produced 6-deoxy-L-talose as a major component of its extracellular polysaccharide. They did not share these properties with CB562, CB627 or QA549.

Antigens, Bacterial↗
PubMed1978

Ineligible spouses of SSI beneficiaries, December 1976.

A study based on program records showd that about 200,000 persons receiving supplemental security income (SSI) payments in December 1976 were living with a spouse who was not eligible for payments. In most cases, the beneficiaries were disabled and the spouses were too young to be eligible. Some spouses were receiving help indirectly from the program through the essential-person increment, State supplementary payments, or the deeming-of-income provision. Fewer than half the spouses had income of their own, however, and even when the income of both partners was combined, 55,000 households had no income other than the SSI payment. A sizable number of families included dependent children and thus may have been eligible for aid to families with dependent children.

Aged↗