To err is human: an interview with the Institute of Medicine's Linda Kohn.
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Biomedical subjects
Publications and source records attributed to L Kohn.
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Environmental lead is a toxic substance that is affecting the growth and development of 3 to 4 million U.S. preschool children today, with effects ranging from learning disabilities to death. This review of environmental lead sources and effects on children provides a background for comprehensive prevention of childhood lead exposure. Prevention strategies at the child, family, and community levels allow for widespread protection of child health and development. Prevention begins with an understanding of the person-environment-occupation framework for the factors that contribute to children at risk for lead exposure. An open system model is presented with specific interventions at the child, family, and community levels, providing innovative, integrated contributions by occupational therapy practitioners for lead exposure prevention and health promotion of children who have been exposed to environmental lead.
A qualitative study was carried out to explore the adolescents' representations of cannabis and related behaviors. Twenty-two young people aged 13 to 18 years and living in Brussels were interviewed using a half structured interview guideline. The analyse showed that there are three types of behaviors related to cannabis use: the non-users, the experimenters and the users. Parents, the school and peers seem to be specific determinants of cannabis use as well as the main information channels about this product. These preliminary results already lead ways to prevention: training of parents and teachers and school improvement.
90K is a widely expressed, secreted 90 kDa human serum protein found both in normal individuals and at elevated levels in the serum of cancer patients. Functional characterization revealed stimulatory effects of 90K on immune defense systems, such as natural killer and lymphokine-activated killer cell activity. Recently, experiments have shown that 90K expression in several tumor cell lines inversely correlates with tumor formation in athymic mice. The mechanism of this tumor suppressive effect is unknown. In the present study, we evaluated the ability of 90K to affect the expression of MHC class I molecules in the human breast cancer cell line EVSA-T. Treatment with 90K (1-50 micrograms/ml) caused the levels of MHC class I expression to increase approximately sixfold above control levels, as measured by flow cytometry. IFN-gamma was used as a positive control and yielded increased expression of MHC class I molecules approximately 8 times over control levels. These data demonstrate that 90K can directly affect the expression of molecules that are engaged in protective antitumor response.
A variety of clinical specimens from throat, nose, ear, eye, wounds, urine, and vagina were collected, cultured, and screened for beta-hemolytic streptococci. The Patho Dx Latex Strep Grouping Kit (Diagnostic Product Corp., Los Angeles, Calif.) technique was applied to colonies taken right from the primary cultures. Isolated strains were sent to the reference laboratory where they were grouped by standard techniques. The kappa coefficient of agreement between the Patho Dx Kit and the standard method was 0.958. We believe that, although better agreement was achieved by others with isolated colonies, a very good agreement is also achieved with primary cultures. The fact that the laboratory is able to report an accurate answer after only 24 h seems most advantageous.
When solubilized, radiolabelled membrane preparations from FRTL-5 rat thyroid cells are applied to TSH affinity columns, two separate peaks of protein can be eluted by high salts/high pH and low pH buffers, respectively. Immunoprecipitation with monoclonal antibodies to the TSH receptor shows that both peaks contain proteins related to the TSH receptor. If extracts were from cells grown without TSH, one peak has a approximately 300 K and the other a approximately 70 K protein the 70 K protein can be derived from the purified 300 K protein in vitro. A 50 and 20 K protein can be derived from the 70 K protein. If extracts are from cells grown with TSH, the peaks contain a multiplicity of additional immuno-precipitable bands of approximately 200, 175, 130, 90, 50, 20 K etc. These bands are shown to result from the ability of TSH to increase the synthesis (3-4-fold) and degradation (2-3-fold) of the 300 and 70 K proteins. The 300/70 K protein fractions are reactive with monoclonal autoimmune thyroid stimulating antibodies and contain a specific disialo ganglioside. The ganglioside migrates near GM2, i.e., like a lower order ganglioside, and contains fucose. In translation experiments, the monoclonal antibodies to the TSH receptor identify a single mRNA component which produces a protein of approximately 220 K. This protein is not present in thyroid cells which have no functional TSH receptor and which cannot be surface labelled with monoclonal antibodies to the TSH receptor.(ABSTRACT TRUNCATED AT 250 WORDS)
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Serum prolactin levels were determined in 123 patients who presented with menstrual irregularities and/or infertility of more than 1 year's duration. Sixty-three patients had hyperprolactinemia with serum prolactin levels of 26 to 843 ng/ml (normal 5 to 22 ng/ml); 44.4% of this group of patients received oral contraceptive for a period of 2 months to 7 years. Sixty patients were normoprolactinemic, with serum prolactin levels of 3 to 22 ng/ml; 33.4% of this group received oral contraceptives for a period of 6 months to 7 years. The age of presentation, onset of symptoms, age at which they started on oral contraceptives, and duration of use were tabulated. The data were analyzed using chi 2 test corrected for continuity. There was no significant difference in age at the time of evaluation between oral contraceptive users and nonusers with hyperprolactinemia. The relative odds developing hyperprolactinemia were 2.64 times greater among women who has used oral contraceptives for more than 1 year and 6.25 times greater if this use started before the age of 25.
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Chlorozotocin is a new anticancer agent with the chloroethylnitrosourea cytotoxic moiety attached to the carbon-2 position of glucose. Like other chloroethylnitrosoureas, this agent produces delayed myelotoxicity which is dose-limiting. A phase I trial of chlorozotocin with administration of glucose was done in an attempt to modify the myelotoxicity. The patients received the first course of chlorozotocin (200 mg/m2) in the fasting state and then the second course of chlorozotocin with boluses of a 50% glucose solution. With the second course of chlorozotocin administration, the glucose concentration remained threefold greater than after the first course for at least 1 hour. The plasma half-life and apparent volume of distribution of chlorozotocin were similar following either course. The wbc, neutrophil, and platelet count nadirs after the first course of this agent were not significantly different than the nadirs after the second course. We were unable to modify the myelotoxicity of chlorozotocin with boluses of a 50% glucose solution.