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Biomedical subjects

Michael J Burke

Publications and source records attributed to Michael J Burke.

11 recordsLinked to original sources
PubMed2008

Rituximab for treatment of opsoclonus-myoclonus syndrome in neuroblastoma.

Opsoclonus-myoclonus syndrome (OMS) is a rare paraneoplastic syndrome that occurs in 2%-3% of patients with neuroblastoma. The cause of this syndrome is believed to be immune mediated, but the exact mechanism still remains unclear. There is an urgent need to improve our current strategies for treating patients with OMS, as many patients have significant long-term neurologic deficits and behavior disorders with current treatment approaches. Therapies that have shown to improve symptoms in these patients have ranged from ACTH and corticosteroids, to intravenous gammaglobulin and plasmapheresis. We report our experience with Rituximab in a patient with neuroblastoma and OMS.

Adrenal Cortex Hormones↗
PubMed2006

Concomitant use of vagus nerve stimulation and electroconvulsive therapy for treatment-resistant depression.

OBJECTIVE: This study explored the use of electroconvulsive therapy (ECT) in the pivotal study of vagus nerve stimulation (VNS) for treatment-resistant depression. METHODS: The clinical characteristics and outcomes of study participants who received ECT during the first 12 months of VNS were compared with those who did not receive ECT. Physicians were instructed to turn off VNS during administration of ECT. RESULTS: Of 205 (evaluable sample) patients who received VNS, 14 also received ECT. Participants who received ECT had a statistically significant greater number of hospital admissions (P = 0.037, Wilcoxon) and number of suicide attempts during their lifetimes (P= 0.022, Fisher exact test). Of 55 responders (> or =50% reduction in Hamilton Rating Scale for Depression-24 questions [HRSD-24] scores) after 12 months of VNS, 3 had received ECT. Of 32 remitters (HRSD-24 score, < or =9), 2 had received ECT. Administration of ECT did not affect the implanted VNS device, and the presence of the implanted VNS device did not affect the administration of ECT. CONCLUSIONS: Electroconvulsive therapy and VNS are not mutually exclusive. They can be used safely and effectively either sequentially or concurrently. Each can be prescribed as the depressive condition warrants-ECT for emergently worsening depressive symptoms and maintenance therapy and VNS for chronic, long-term therapy.

Adult↗
PubMed2005

Relative effectiveness of worker safety and health training methods.

OBJECTIVES: We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries). METHODS: Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training). RESULTS: As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements. CONCLUSIONS: Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Humans↗
PubMed2005

Leveling response factors in the electrospray ionization process using a heated capillary interface.

Several investigators have observed a discrepancy in electrospray response of complementary strands from denatured DNA, which has been attributed to the difference in hydrophobicity between the two strands; the more hydrophobic species tend to have higher ion abundances. The implementation of a heated electrospray source has allowed us to "level" the electrospray response for two equimolar complementary strands with different hydrophobicities. As the temperature was increased, the ratio of ion abundances of the less hydrophobic noncoding strand to the more hydrophobic coding strand approached unity. Furthermore, the heated electrospray source was used to denature amplicons containing 7-deaza purines, which can be used to facilitate sequencing by mass spectrometry.

Capillary Action↗
PubMed2003

Dual electrospray ionization source for confident generation of accurate mass tags using liquid chromatography Fourier transform ion cyclotron resonance mass spectrometry.

Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) has rapidly established a prominent role in proteomics because of its unparalleled resolving power, sensitivity and ability to achieve high mass measurement accuracy (MMA) simultaneously. However, space-charge effects must be quantitatively, routinely, and confidently corrected because they are known to profoundly influence MMA. We argue that the most effective way to account for space-charge effects is to introduce an internal mass calibrant (IMC) using a dual electrospray ionization (ESI) source where the IMC is added from a separate ESI emitter. The major disadvantage of our initial dual ESI source to achieve high MMA, and arguably the only one, was the time required to switch between the analyte emitter and IMC emitter (i.e., >300 ms). While this "switching time" was acceptable for direct infusion experiments, it did not lend itself to high-throughput applications or when conducting on-line liquid separations. In this report, we completely redesigned the dual ESI source and demonstrate several key attributes. First, the new design allows for facile alignment of ESI emitters, undetectable vibration, and the ability to extend to multiple emitters. Second, the switching time was reduced to <50 ms, which allowed the analyte and IMC to be accumulated "simultaneously" in the external ion reservoir and injected as a single ion packet into the ion cyclotron resonance cell, eliminating the need for a separate accumulation and ion injection event for the IMC. Third, by using a high concentration of the IMC, the residence time on this emitter could be reduced to approximately 80 ms, allowing for more time spent accumulating analyte ions of significantly lower concentration. Fourth, multiplexed on-line separations can be carried out providing increased throughput. Specifically, the new dual ESI source has demonstrated its ability to produce a stable ion current over a 45-min time period at 7 T resulting in mass accuracies of 1.08 ppm +/- 0.11 ppm (mean +/- confidence interval of the mean at 95% confidence; N = 160). In addition, the analysis of a tryptic digest of apomyoglobin by nanoLC-dual ESI-FT-ICR afforded an average MMA of -1.09 versus -74.5 ppm for externally calibrated data. Furthermore, we demonstrate that the amplitude of a peptide being electrosprayed at 25 nM can be linearly increased, ultimately allowing for dynamic analyte/IMC abundance modulation. Finally, we demonstrate that this source can reliably be used for multiplexing measurements from two (eventually more) flow streams.

Amino Acid Sequence↗
PubMed2003

Accurate tests of statistical significance for r(WG) and average deviation interrater agreement indexes.

The authors demonstrated that the most common statistical significance test used with r(WG)-type interrater agreement indexes in applied psychology, based on the chi-square distribution, is flawed and inaccurate. The chi-square test is shown to be extremely conservative even for modest, standard significance levels (e.g., .05). The authors present an alternative statistical significance test, based on Monte Carlo procedures, that produces the equivalent of an approximate randomization test for the null hypothesis that the actual distribution of responding is rectangular and demonstrate its superiority to the chi-square test. Finally, the authors provide tables of critical values and offer downloadable software to implement the approximate randomization test for r(WG)-type and for average deviation (AD)-type interrater agreement indexes. The implications of these results for studying a broad range of interrater agreement problems in applied psychology are discussed.

Humans↗
PubMed2003

Cohesion and performance in groups: a meta-analytic clarification of construct relations.

Previous meta-analytic examinations of group cohesion and performance have focused primarily on contextual factors. This study examined issues relevant to applied researchers by providing a more detailed analysis of the criterion domain. In addition, the authors reinvestigated the role of components of cohesion using more modern meta-analytic methods and in light of different types of performance criteria. The results of the authors' meta-analyses revealed stronger correlations between cohesion and performance when performance was defined as behavior (as opposed to outcome), when it was assessed with efficiency measures (as opposed to effectiveness measures), and as patterns of team workflow became more intensive. In addition, and in contrast to B. Mullen and C. Copper's (1994) meta-analysis, the 3 main components of cohesion were independently related to the various performance domains. Implications for organizations and future research on cohesion and performance are discussed.

Attitude↗
PubMed2002

Implementing a systematic course/clerkship peer review process.

OBJECTIVE: A systematic course/clerkship peer-review process was developed to meet several objectives: improvement of quality of course/clerkship, enhancement of understanding of individual course and overall curricular content, improvement of communication and collaboration between basic science and clinical disciplines across campuses, provision of forum to address curricular concerns of students and faculty, facilitation of data collection for LCME reviews and the AAMC CurrMIT project; and monitoring curricular equivalency at multiple clinical sites. DESCRIPTION: Previously each course had carried out an internal review process. These reviews varied considerably in terms of the data collected and how those data were used for quality improvement. Data and outcomes of the internal reviews were seldom shared with colleagues, students, or administrators. This limited communication discouraged collaboration and led to disparity in curricular content between campuses. A collaborative effort between the medical school's Office of Medical Education (OME) and the Education Council, the faculty governance committee composed of faculty from each basic science and clinical department on each campus, has led to the development and implementation of a systematic course/clerkship peer-review process. Two standing committees of the Education Council oversee the systematic review process. One committee is charged with oversight of the first two years of the curriculum and a second committee with oversight of the third and fourth years. A two-tiered course/clerkship review process was designed with all courses undergoing a limited annual review. A comprehensive, "nuts and bolts" review for required courses was to occur every three years. The limited annual review was based on course evaluations completed by students, collected and summarized by the OME, and presented to the Education Council. The comprehensive review of a required course/clerkship occurred over a six-to-eight-month period. Course directors on each campus completed a questionnaire and submitted materials. To facilitate cross-discipline communication and synergy, a subcommittee composed of both basic science and clinical faculty, principally course directors, and at least one medical student who had completed the course at each campus reviewed submitted materials and had a series of meetings with the course directors, support personnel, and department chairs. Final review reports presented to the Education Council identify issues, concerns, and recommendations for action. To date 11 required courses have completed the comprehensive review process. Simple oversights, significant curricular disparity between campuses, and opportunities for multidisciplinary collaboration have been identified and addressed. Student-rated satisfaction has improved for those courses that have been reviewed. DISCUSSION: The systematic course/clerkship peer-review process has been a success, although there was initial resistance to "outside review." We have not yet completed one cycle of comprehensive course reviews but already faculty and administration have a better understanding of individual course and overall curriculum content. Faculty have developed working relationships and are sharing educational strategies across disciplines and campuses, and identifying innovative collaborations. The annual review process is now perceived to lack depth and is under reconsideration.

Clinical Clerkship↗
PubMed2002

Overreport on the MCMI-III: concurrent validation with the MMPI-2 using a psychiatric inpatient sample.

The MCMI-III (Millon, Davis, & Millon, 1997) is a widely used measure of personality often used in inpatient psychiatric settings. Although patients in such settings often overreport or exaggerate their symptoms, relatively little is known about how such a response set presents on the validity indexes of the MCMI-II. In this study, we used a sample of 191 psychiatric inpatients and compared MCMI-III modifier indices (Disclosure, Desirability, and Debasement) with the validity measures (L, F, Fb, F(p), K, and F - K) of the MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989). In addition, the MCMI-III Disclosure Index (Scale X, which imposes a set cutoff score for invalidity due to overreport) was compared to several cutoff scores on the validity scales of the MMPI-2. Although the MCMI-III indexes generally performed as expected, the MCMI-III had a very high tolerance for overreport. When contrasted with MMPI-2 F scale, the MCMI-II Disclosure Index (which gauges overreport) remained valid until scores on MMPI-2 F scale approached a T score of 120. In addition, the Disclosure Index was at the upper end or slightly exceeded the highest recommended cutoff scores on all other MMPI-2 validity scales except F - K. Clinicians using the MCMI-III alone are cautioned to consider the high tolerance the MCMI-III has for overreport.

Adult↗
PubMedDate not supplied

Trends in undergraduate medical education: clinical clerkship learning objectives.

OBJECTIVE: To assist and inform the process of revising learning objectives for the psychiatry clerkship, a comprehensive review of the current state of learning objectives endorsed by national specialty organizations for core clinical clerkships was undertaken. METHODS: National specialty organizations that have developed and endorsed clerkship learning objectives were identified and learning objectives and support materials were reviewed. RESULTS: All core clinical clerkships have learning objectives developed and endorsed by national specialty organizations. The format for organizing these learning objectives varies widely among specialties from lists of topics of interest to exhaustive curriculum resource guides. Most specialty clerkship learning objectives have undergone extensive revision since 2000 or are currently in the revision process. Comparisons and trends in specialty clerkship learning objectives and curriculum resources are discussed. CONCLUSIONS: Revision of psychiatry clerkship learning objectives will benefit from adoption of features utilized by other specialties, including: prioritizing objectives; emphasizing contextual learning and skills mastery; linking learning objectives to support resources such as clinical cases, recommendations for instructional methodology, assessment strategies, and performance expectations; and shifting the focus of undergraduate psychiatry education beyond the clerkship to the entire four-year curriculum.

Clinical Clerkship↗