[Military psychiatry. You must be mentally ill, man].
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Adaptation, Psychological↗
Biomedical subjects
L Peterson
Publications and source records attributed to L Peterson.
Complacency, misdirection, and effective prevention of children's injuries.
Injuries are the leading killer of children in the United States, yet most parents, communities, and legislatures remain uncommitted to effective injury prevention. Possible reasons for this complacency are described, and effective methods, likely targets, and useful tactics for prevention are reviewed. The greatest challenges to injury preventionists are to persuade those who remain uninformed concerning the importance of injury prevention, to redirect those efforts currently devoted to ineffective interventions, to continue to evaluate and implement effective preventive interventions, and to search for improved prevention strategies.
Attitude to Health↗
Analogs of cyclosporin A modified at the D-Ala8 position.
The conversion of [2-deutero-3-fluoro-D-Ala8]cyclosporin A (1) to a dehydroalanine analog [delta-Ala8]cyclosporin A (2) was achieved with lithium diisopropylamide in THF at low temperature. This dehydro compound is a useful intermediate for the preparation of position 8 analogs of cyclosporin A formed from it by the conjugate addition of thiol compounds. NMR conformational studies have provided evidence for the restoration of D-stereochemistry in the modified Ala8 residues. The preparation of several of these cyclosporin analogs and their bioactivities are described.
Animals↗
Health consequences of behaviors: injury as a model.
Injury is the third leading cause of death in the United States and the leading cause for children, adolescents, and young adults. Injury results from multiple factors and so may its prevention. The first and simplest approach toward preventing injuries has been to innovatively and aggressively apply a traditional public health model. Strategically, the goal has been to remove harmful agents of injury and to make the environment safer. Tactics such as public information, product regulation, legislative action, and the like have been credited with reductions in mortality and morbidity. To expand our understanding and our prevention strategies across multiple injuries, other scientific knowledge bases and intervention models from fields such as psychology and child development are being used to study childhood injury. These approaches show that in addition to environmental determinants, psychosocial factors involving both the care giver and the child are related to injury. The research programs described here illustrate the advantage of investigating psychosocial factors at both molar and molecular levels. General characteristics of mothers and children related to injury help define families at risk, as well as suggesting vehicles for intervention. Behavioral factors influencing risk perception highlight the etiology of increased risk in adolescence. Injury episodes, even slight, as well as "near injuries" and dangerous and risky behavior can be quantified and analyzed by retrospective ("postmortem") approaches yielding data on commonly occurring consequences (and the lack thereof) for minor injury. Finally, approaches that simulate dangerous situations can identify interaction patterns that result in childhood injury. Based on such research, we are coming to view injuries as the result of patterns of behaviors that develop and persist over time, and as such these patterns can be detected and, one hopes, altered before a serious medical event occurs. The role of the pediatrician after injury occurs is clear. With regard to prevention of injuries, pediatricians' roles are being defined by those individuals who have begun to investigate causes, educate families, and advocate for regulation and prevention. However, like the causes and methods for prevention, the disciplines involved in the study and prevention of injury are multiple. Such a multidisciplinary approach that considers multiple factors, theories, models, and interventions to prevent injury may be the approach that is as simple as possible.
Adolescent↗
Elephants dancing in my head: a developmental approach to children's concepts of specific pains.
The present study produced an empirically derived, developmental continuum of children's understanding of specific pains. Subjects of 5 age groups: preschool (ages 3-4), first grade (ages 6-7), third grade (ages 8-10), sixth grade (ages 11-12) and college freshmen (ages 18-23) were interviewed with open-ended questions. The subjects were questioned extensively about 3 specific types of pain: an injury (skinned knee), a medical intervention (injection), and an illness (headache). Subjects were asked to describe each pain, tell why the pain hurt, and state the value of the pain. Their answers were then categorized and the categories ordered developmentally by experts in pediatric pain who were unaware of the children's ages. Then children's specific answers were given developmental scores. Multivariate analyses revealed that older children had more complex and precise understandings of pain, and this pattern differed by type of pain and by aspect of pain being considered. The subjects were also asked to report the frequency of their own pains and their parents' pain; parental and self-reported pains were closely related.
Adolescent↗
Inversion of chromosome 16 and dysplastic eosinophils in accelerated phase of chronic myeloid leukemia.
Abnormalities of chromosome 16, including inv(16)(p13q22), del(16)(q22), and t(16;16)(p13;q22), have been reported almost exclusively in association with acute myelomonocytic leukemia and are characteristically accompanied by abnormal eosinophils with dysplastic granules in the bone marrow. We observed an inv(16)(p13q22) in two patients with typical Philadelphia chromosome positive chronic myeloid leukemia (CML). The appearance of the abnormality of chromosome 16 was associated with acceleration of disease or onset of blast crisis and with the appearance in the bone marrow of abnormal eosinophils. In both cases the marrow karyotypes were 46,XY,t(9;22)(q34;q11)/46,XY,inv(16)(p13q22),t(9;22)(q34;q11). In these two patients the temporal association of the acquisition of the inversion 16 and the appearance of monocytoid cells and dysplastic eosinophils in the bone marrow further supports the relationship of this karyotypic abnormality with leukemic monocytoid and eosinophilic evolution. This secondary cytogenetic change appears to be an infrequent manifestation of specific phenotypic disease progression in CML.
Adult↗
Is cyclophilin involved in the immunosuppressive and nephrotoxic mechanism of action of cyclosporin A?
In this report we have approached two questions relating to the mechanism of action of cyclosporin A (CsA). First, we address whether the major cytosolic protein for CsA, cyclophilin, is directly involved in mediating the immunosuppressive activity of this drug, and, in particular, whether inhibition of this protein's peptidyl-prolyl cis-trans isomerase (PPIase) activity results in inhibition of murine T cell activation. Second, we ask whether the nephrotoxicity observed with CsA is related to inhibition of PPIase-dependent pathways in cells other than lymphocytes. Using a series of 61 cyclosporin analogues, we generally found a good correlation between cyclophilin binding and immunosuppressive activity for the majority of analogues analyzed. However, a number of compounds of distinct structural classes were found that could interact with cyclophilin but were much less immunosuppressive than expected. The inability of these analogues to inhibit lymphocyte activation could not be explained by their failure to enter the cell and bind to cyclophilin under the conditions used in the cellular assays. Surprisingly, a nonimmunosuppressive analogue, MeAla-6, which bound well to cyclophilin and was active as a PPIase inhibitor, did not induce renal pathology in vivo. Furthermore, another analogue, MeBm2t, which was immunosuppressive in vitro, possessed little or no activity as a PPIase inhibitor. These findings pose serious questions concerning a direct role of cyclosporin in mediating CsA's immunosuppressive and nephrotoxic activities. In addition, they raise doubts about whether PPIase has a direct function in lymphocyte signal transduction.
Amino Acid Isomerases↗
Ultrasonography in the detection of partial patellar ligament ruptures (jumper's knee).
The diagnostic performance of ultrasonography (US) in the detection of partial ruptures in the proximal part of the patellar ligament (jumper's knee) was studied. A total of 81 athletes with chronic localized pain suggestive of jumper's knee underwent US examination, and 25 of these received surgical treatment. Of 25 proven partial tendon ruptures at surgery, US correctly indicated the diagnosis in all cases. A cone-shaped, poorly echogenic area exceeding 0.5 cm in length in the center of the patellar tendon in combination with its localized thickening proved to be a reliable indicator of jumper's knee. One case was a true-negative. No false-negative or false-positive case was observed. Soft-tissue radiography in 14 cases showed a localized swelling but did not detect intratendinous soft-tissue abnormalities. US is the method of choice for the evaluation of jumper's knee, as it is cheap, non-invasive, repeatable, and accurate.
Adult↗
Disc degeneration and associated abnormalities of the spine in elite gymnasts. A magnetic resonance imaging study.
The thoracolumbar spine was examined by magnetic resonance imaging (MRI) and the history of back pain was analyzed in 24 male elite gymnasts (age range, 19-29 years) and in 16 male nonathletes (age range, 23-36 years). Disc degeneration, defined as reduced disc signal intensity, was significantly more common in athletes (75%) than in nonathletes (31%). The gymnasts also had a higher incidence of other abnormalities of the thoracolumbar spine, and there was a significant correlation between reduced disc signal intensity and the other abnormalities among the gymnasts. There were also significant correlations between back pain and reduced disc signal intensity and abnormal vertebral configuration when the gymnasts run a high risk of developing severe abnormalities of the thoracolumbar spine, and they often have a history of back pain.
Adult↗
Four different mutations in codon 28 of alpha spectrin are associated with structurally and functionally abnormal spectrin alpha I/74 in hereditary elliptocytosis.
Hereditary elliptocytosis (HE) Sp alpha I/74 is a disorder associated with defective spectrin (Sp) heterodimer self-association and an abnormal tryptic cleavage of the 80-kD alpha I domain of Sp resulting in increased amounts of a 74-kD peptide. The molecular basis of this disorder is heterogeneous and mutations in codons 28, 46, 48, and 49 (codons 22, 40, 42, and 43 in the previous nomenclature which did not include the six NH2-terminal amino acids) have been reported. In this study we present data on seven unrelated HE Sp alpha I/74 kindred from diverse racial backgrounds in whom we identified four different mutations all occurring in exon 2 of alpha Sp at codon 28. Utilizing the polymerase chain reaction we established a CGT----CTT; Arg----Leu 28 mutation in one kindred of Arab/Druze origin. In two unrelated white kindred of English/European origin the substitution is CGT----AGT; Arg----Ser 28 and in two apparently unrelated white kindred from New Zealand, the mutation is CGT----TGT; Arg----Cys 28. Finally, in one American black kindred and in a black kindred from Ghana the mutation involves CGT----CAT; Arg----His 28. Allele specific oligonucleotide hybridization confirmed that the probands are heterozygous for the respective mutant alleles. All four point mutations abolished an Aha II restriction enzyme site which allowed verification of linkage of the mutation with HE Sp alpha I/74. Our results imply that codon 28 of alpha Sp is a "hot spot" for mutations and also indicate that Arg 28 is critical for the conformational stability and functional self association of Sp heterodimers.
Base Sequence↗
Ankle ligament injuries and operative treatment principles.
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Ankle Injuries↗
[Charges against nursing personnel].
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Denmark↗
Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals.
STUDY OBJECTIVES: To estimate the efficacy of a medical record review for identifying adverse events and negligent case suffered by hospitalized patients. DESIGN: Cross-sectional study comparing an objective medical record review with information available from hospital quality assurance records as well as risk management and litigation records. SETTING: Two metropolitan teaching hospitals in the northeastern United States. MEASUREMENTS AND MAIN RESULTS: Using the litigation and risk management records as a criterion standard, we found that the medical record review had a sensitivity of 80% (93 of 116; 95% CI, 73% to 88%) for discovering adverse events and a sensitivity of 76% (51 of 67; 95% CI, 66% to 86%) for discovering negligent care. We estimated that record review of a random sample of hospitalizations across a geographic region would have even higher sensitivity (adverse-event sensitivity, 84%; negligence sensitivity, 80%). Moreover, we found that the adverse events we failed to discover led to less costly malpractice claims. A significant number of adverse events (20 of 172) among hospitalizations never gave rise to litigation or risk management investigation. Six of the twenty were due to negligent care. Quality assurance efforts at the level of the clinical departments in one hospital led to review of only 12 out of 82 risk management records. CONCLUSIONS: The overwhelming majority of adverse events and episodes of negligent care are discoverable with the methods we used to evaluate medical records. Quality assurance efforts using similar record review methods should be further evaluated.
Cross-Sectional Studies↗
Parental injury prevention endeavors: a function of health beliefs?
Investigating parents' beliefs about injury prevention may yield important information for planning preventive interventions. A comprehensive description of parents' beliefs about injury prevention is presented in this study, and effects of child age and sex are described. In addition, a health belief model was successfully used to predict parent-reported teaching of safety skills and preventive environmental interventions. The model successfully cross-validated the prediction in two independent samples. Parents reported low feelings of susceptibility or worry about injury. The variables most associated with parental preventive endeavors were the belief that intervention can avoid injury, a realistically high appraisal of the amount of time involved, and feelings of high knowledge and competence to teach safety skills. Implications of these data for designing more effective behavioral interventions are described.
Accident Prevention↗
Intermittent antimicrobial prophylaxis for recurrent acute otitis media.
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Acute Disease↗
Anthropometric characteristics, passive hip flexion, and spinal mobility in relation to back pain in athletes.
Anthropometric characteristics, passive hip flexion, and spinal mobility were examined and back pain was registered in 116 top Swedish male athletes representing four different sports (wrestling, gymnastics, soccer, tennis). Differences in stature, body weight, passive hip flexion, mobility of the spine in forward flexion, and asymmetry of the back were found when each group of athletes was compared with the rest of the athletes. These differences could be explained by a natural selection of individuals with the physical constitution required for the sport concerned, but they may also be a long-term effect of training. A small sacral inclination, defined as the sacrohorizontal angle, correlated significantly with back pain.
Adolescent↗
The role of CD4+ helper T cells in the destruction of microencapsulated islet xenografts in nod mice.
Islet transplants for large numbers of patients with diabetes will require xenografts. Microencapsulation is an appealing method for islet xenografting. However, graft function has been limited by a cellular reaction, particularly intense in spontaneously diabetic, NOD mice. The purpose of this study was to elucidate the mechanism of this reaction. Poly-1-lysine-alginate microcapsules containing 4000-12,000 dog or 1800-2000 rat islets were xenografted intraperitoneally into streptozotocin (SZN)-diabetic C57BL/6J and NOD mice, with or without recipient treatment with GK 1.5 (anti-CD4 monoclonal antibody) (20-30 microliters i.p. every 5 days, begun on day -7. Grafts were considered technically successful if random blood glucose (BG) was normalized (less than 150 mg/dl) within 36 hr. Graft failure was defined as BG greater than 250 mg/dl. Dog and rat islets in microcapsules normalized BG in both SZN and NOD mice within 24 hr routinely. Empty microcapsules and GK 1.5 treatments alone did not affect BG. NODs destroyed both microencapsulated dog and rat islets more rapidly than did SZN-diabetic mice (P less than .01). Graft biopsies showed an intense cellular reaction, composed of lymphocytes, macrophages and giant cells, and no viable islets. GK 1.5 treatment significantly prolonged both dog-to-NOD and rat-to-NOD grafts (P less than 0.01). Biopsies of long-term functioning grafts (on days 65-85) demonstrated viable islets and no cellular reaction around microcapsules; 1/4 rat and 1/8 dog islet xenografts continued to function indefinitely in NOD recipients, even after cessation of GK 1.5 therapy. Prediabetic NODs receiving encapsulated dog or rat islets mounted a moderate cellular reaction to grafts. Empty microcapsules excited no cellular reaction in diabetic or prediabetic NODs. We conclude that the NOD reaction to microencapsulated xenogeneic islets is helper T cell-dependent, and that the target of this reaction is not the microcapsule itself, but the donor cells within.
Animals↗
Anterior cruciate ligament repair with and without augmentation. A prospective 7-year study of 51 patients.
A prospective comparison was made of the 7-year results of repair of the acutely ruptured anterior cruciate ligament with and without augmentation using the longitudinal patellar retinaculum. The knee stability was evaluated by clinical tests and by a specially constructed testing device. In the repair group, 6/22 had unchanged activity and intensity levels compared with 24/29 in the augmentation group. Lysholm's functional score was higher in the augmentation group. All the clinical tests and all the objective measurements except Lachman's test showed better stability in the augmentation group.
Adolescent↗