Biomedical subjects

Michael Ross

Publications and source records attributed to Michael Ross.

At least 19 recordsLinked to original sources

PubMed2007

The compulsive sexual behavior inventory: psychometric properties.

Compulsive sexual behavior (CSB) is a putative clinical syndrome characterized by the experience of sexual urges, sexually arousing fantasies, and sexual behaviors that are recurrent, intense, and a distressful interference in one's daily life. Although the putative phenomenology of CSB has been described in the literature, the lack of a reliable, valid assessment tool has made investigation of prevalence, co-factors, and etiologic factors difficult. This study examined the further development of the Compulsive Sexual Behavior Inventory (CSBI) using a sample of 1,026 Latino men who have sex with men recruited and assessed using web-based technology. The scale showed a two factor structure (control and violence). Further, the CSBI and its subscales showed indications of validity in that those engaging in CSB-type sexual behavior (being drunk or high, feeling lonely or depressed, and feeling driven) had scores indicative of greater CSB. Those with scores above the median had more sexual partners and engaged in more unprotected anal intercourse than those with CSBI scores below the median. Additionally, the instrument showed equivalence when administered in English and Spanish.

Adult↗

PubMed2006

Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention.

Little research has examined predictors of condom intention within concurrent partnerships. This study examined predictors of intention among 259 male African-American crack smokers with multiple partners. Each participant reported personal condom intention at next sex, condom use self-efficacy, responsibility and outcome expectances for himself and his perceptions for his last two sex partners. Stepwise logistic regressions showed that for both partners one and two, condom use at last sex and personal responsibility for condom use were predictors of intention to use condoms at next sex. Perceived partner responsibility was an additional positive predictor with Partner 2. Hierarchical generalized linear model analyses showed that positive intention was associated negatively with perceived partner responsibility and intimacy, while positively related to situational self-efficacy. Personal responsibility interacted with intimacy such that only men who indicated the highest levels of intimacy were more likely to intend to use condoms. Overall, the findings in this study support the need for examining additional social cognitive constructs that capture the interpersonal aspects of sexual relationships such as personal and perceived responsibility, intimacy and how beliefs may change between multiple partners and across time. Finally, the differences in the valence of perceived partner responsibility across analyses and the interaction of personal responsibility with intimacy suggest the need for studies that include measure of power within the relationship.

Adult↗

PubMed2006

Undergraduate allergy teaching in a UK medical school: mapping and assessment of an undergraduate curriculum.

BACKGROUND: Concerns have been expressed by patient and professional bodies, and the UK Parliamentary Health Select Committee, about the poor standard of allergy teaching in UK medical schools. It is argued that this deficiency is an important contributing factor to the generally poor quality of care experienced by patients with allergic disorders. Allergy services are currently being reviewed by the Scottish Executive and Department of Health for England. OBJECTIVE: To describe and map the teaching of allergy-related topics in the formal undergraduate curriculum of a UK medical school. METHODS: We undertook a systematic analysis of learning objectives and other electronic documentation of modules taught during the five years of undergraduate medical training at the University of Edinburgh. RESULTS: Allergy and allergy-related topics are mentioned within the learning objectives of 11 (26%) of the 43 modules in the five-year MBChB curriculum. Our overall assessment reveals significant gaps in the described curriculum regarding allergy-related topics. CONCLUSION: Although formal teaching on allergic disorders has been identified in a number of modules throughout the five years, it is not comprehensively described in the course documentation and significant gaps exist. We accept that the delivered curriculum may not be captured by the level of detail present in the learning objectives and recommend that further mapping and triangulation is undertaken through student focus groups and information gathering from teaching staff. We also recommend that in the absence of informal and clinical attachment opportunities in allergic disorders, the stated learning objectives be developed into a coherent vertical element throughout the medical curriculum. This, together with an advocate and suitable assessment, would increase the impact of allergy training on students and emphasise the knowledge and skills required to deliver high quality allergy care.

Clinical Competence↗

PubMed2006

Detection of stool DNA mutations before and after treatment of colorectal neoplasia.

BACKGROUND: Whether stool DNA abnormalities arise solely from colorectal neoplastic lesions or are due to more pervasive field effects is not known. In the current study, the authors conducted a prospective multicenter study to evaluate the performance of stool-based DNA testing in a large cohort and to examine whether the findings before treatment persist after surgical resection and/or adjuvant therapy. METHODS: Patients with newly diagnosed colorectal carcinoma or advanced adenomas (AA) provided stool samples before therapy, 1-3 months after surgical resection, and 6-9 months postresection. Stool samples were analyzed using the multi-target DNA assay panel (MTAP) consisting of 23 markers: 21 mutations in the p53, K-ras, and APC genes, a microsatellite instability marker (BAT-26), and the DNA integrity assay (DIA), a marker of loss of apoptosis. RESULTS: Overall, 49 of 91 individuals (54%) tested positive with the MTAP test. The sensitivity of the MTAP test was 63% for invasive tumors compared with 26% for AA. Individuals whose lesions had a more advanced TNM stage or were located distal to the splenic flexure were significantly more likely to have a positive MTAP test. Of the 79 samples collected at 1-3 months after surgical resection of the neoplasm, 14 (18%) had a positive MTAP result, 12 of which were positive for DIA only. Of those collected at 6-9 months of follow-up, 5 of 72 (7%) tested positive on the MTAP panel. CONCLUSIONS: Although many samples collected 1-3 months after surgical resection of the colorectal neoplasm tested positive on the MTAP, most were negative by 6-9 months, indicating that stool DNA abnormalities disappear after treatment of the neoplastic lesions. Surgery and chemoradiation appear to induce transient DIA abnormalities that may be independent of the presence of neoplasia.

Adult↗

PubMed2006

Ten- and 20-year survivors of pediatric orthotopic heart transplantation.

BACKGROUND: Pediatric heart transplantation is entering its third decade, allowing for the first time an analysis of a large group of true long-term survivors, specifically children who have survived > or =10 years post-transplantation. METHODS: Fifty-two patients < or =18 years, who had undergone heart transplantation at Stanford between August 1974 and June 1993 and survived > or =10 years, were retrospectively reviewed. RESULTS: Forty (77%) patients are currently alive. Thirteen survived >15 years and 5 >20 years (the longest being 26 years). Actuarial survival was 79.4% at 14 years and 53.1% at 20 years. Cardiomyopathy was the reason for transplantation in 71% and congenital heart disease (CHD) in 29%. At last evaluation, 71% were on a cyclosporine-based regimen and 23% a tacrolimus-based regimen; 33% were steroid-free. Twenty-seven percent were totally free from treatable rejection, 44% developed serious infections, 69% were receiving anti-hypertensives, and 8% required renal transplantation. Neoplasms occurred in 23%, graft coronary artery disease (CAD) in 31%, and 15% required re-transplantation. Of the 12 deaths, CAD was the most common cause (n = 4), followed by non-specific late graft failure (n = 3), infection (n = 2), rejection (n = 1), non-lymphoid cancer (n = 1) and lymphoid cancer (n = 1). Physical rehabilitation and return to normal lifestyle has been nearly 100%. CONCLUSIONS: Heart transplantation in pediatric patients is compatible with true long-term survival with a growing cohort of children approaching their second and third decades. The gradual constant-phase decrease in survival noted in earlier studies appears to be continuing. Rejection and infection are low but persistent risks after the first years. Graft CAD and non-specific late graft dysfunction are the leading causes of death after 10 years. Rehabilitation is excellent.

Actuarial Analysis↗

PubMed2006

United States multicenter clinical usage study of the STAN 21 electronic fetal monitoring system.

OBJECTIVE: The fetal electrocardiogram system for electronic fetal monitoring (EFM) (STAN S21, Neoventa Medical, Moelndal, Sweden) has led to improved perinatal outcomes in other countries. We aimed to assess the ability of United States (US) obstetricians to use this system appropriately for intrapartum care. STUDY DESIGN: A prospective nonrandomized trial was conducted in 6 sites. Enrollment required a singleton vertex fetus, >36 weeks' gestation, with indications for direct fetal monitoring during first stage of labor. Appropriate use was measured by negative predictive value (NPV) of nonintervention for fetuses with nonreassuring fetal heart rate (FHR) patterns, normal STAN readings, and normal neonatal outcomes with umbilical cord arterial pH >7.12; and percent agreement (PA) for intervention decisions with 3 STAN experts who conducted retrospective case reviews blinded to outcome. RESULTS: Five hundred and thirty patients were enrolled. An NPV of 95.2% was achieved while PA between investigators and STAN experts was 84%, and 90%, for intervention and nonintervention, respectively. No fetus with metabolic acidosis requiring intervention was missed by US clinicians. CONCLUSION: US clinicians used the STAN system appropriately in a manner similar to that of experienced STAN users.

Acidosis↗

PubMed2006

Do placental sections accurately reflect umbilical cord nucleated red blood cell and white blood cell differential counts?

OBJECTIVE: Elevated levels of umbilical cord nucleated red blood cells (nRBCs) have been used to assess in utero hypoxia. Although the umbilical nRBC value has been the 'gold standard', umbilical blood may not be obtained at delivery. We determined if the levels of nRBCs and white blood cell (WBC) counts in fixed placental sections might serve as a proxy for cord blood values. STUDY DESIGN: Umbilical blood and placenta were collected from 25 deliveries at Harbor-UCLA Medical Center. Umbilical blood and placental sections were analyzed for nRBCs (per 100 WBC) and WBC differential, and compared with the t-test or the Mann-Whitney rank sum test. RESULTS: nRBC counts were equivalent in umbilical cord and placental sections (5 vs. 4/100 WBC). Umbilical lymphocyte and polymorphonuclear leukocyte (PMN) counts were normally distributed, averaging 35 +/- 9 and 56 +/- 2/100 WBC, respectively. Placental lymphocyte (33 +/- 2/100 WBC) and PMN (60 +/- 2/100 WBC) counts were equivalent to cord blood values. CONCLUSION: WBC differentials and nRBC counts are equivalent in umbilical cord blood and processed placental pathology sections. For infants in whom cord blood cell counts are desired though umbilical cord samples are unavailable, fixed placental sections may serve as a proxy.

Adult↗

PubMed2005

Supportive social relationships and adolescent health risk behavior among secondary school students in El Salvador.

An increasing number of studies suggest that supportive social relationships in the family and school may exert a protective effect against a number of youth health risk behaviors. This study examines the association between perceived parental social support and perceived social cohesion at school with selected youth risk behavior outcomes (physical fighting, victimization, suicidal ideation, substance use, and sexual intercourse) among 930 female and male public secondary school students studying in the central region of El Salvador. The study questionnaire comprised closed-ended items of parent/school relationships and risk behaviors based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. In regression analyses, female students who perceived low parental social support were significantly more likely to report engaging in all risk behaviors examined, and female students with perceptions of low school social cohesion were more likely to report suicidal ideation, binge drinking, and drug use. Perceptions of parental social support and school social cohesion held fewer but still significant associations across risk behaviors for male students. Male students who reported low parental social support were significantly more likely to report suicidal ideation, drug use and physical fighting, while male students with low perceived school social cohesion were more likely to report physical fighting but less likely to report binge drinking. This study lends support to the importance of supportive social relationships for understanding youth risk behavior and suggests that supportive families and schools may operate differently for female and male students living in El Salvador.

Adolescent↗

PubMed2005

Snatching defeat from the jaws of victory: self-esteem differences in the experience and anticipation of success.

Successes--defined broadly as meeting important standards or receiving positive evaluations--are widely assumed to be enjoyed equally by people with high self-esteem (HSEs) and low self-esteem (LSEs). Three studies examined the contradictory hypothesis that HSEs react more favorably to success than do LSEs and that success brings about certain unfavorable consequences for LSEs. Undergraduate participants reacted to a laboratory-manipulated success (Studies 1 and 2) or imagined highly positive events in the future (Study 3). Self-esteem differences emerged in anxiety, thoughts about the self, and (in Study 3) thoughts about non-self-related aspects of the event. LSEs were more anxious than HSEs after succeeding, success improved HSEs' self-relevant thoughts but not LSEs', and LSEs focused more on success's negative aspects.

Achievement↗

PubMed2005

What we remember and what we tell: the effects of culture and self-priming on memory representations and narratives.

Two experiments were conducted to explore culture and self-priming effects on memories of Caucasian and Asian American adults (N=526). In the experimental conditions, either the collective or private self was primed prior to retrieval. Participants then described their earliest childhood memories (Study 1) or recalled a fictional story (Study 2). Systematic cultural differences in memory content were obtained across both memory tasks, independent of priming conditions. Caucasians tended to recall specific, one-moment-in-time events that focused on the individual as the central character. Asians tended to provide memories of general, routine events centering on collective activities and social interactions. Priming effects also emerged: memory content reflected the particular aspect of the self being primed. Findings are discussed in light of the interactive relation between memory representations and memory narratives and the role culture plays in remembering.

Adult↗

PubMed2005

Placental compared with umbilical cord blood to assess fetal blood gas and acid-base status.

OBJECTIVE: To estimate the extent to which placental cord blood sampled from the umbilical cord at its insertion into the placenta and after delivery of the placenta, is in agreement with umbilical cord blood sampled from a clamped segment of the umbilical cord after delivery of the infant, for the assessment of fetal blood gas, acid-base status, and hemoglobin levels at birth. METHODS: Forty-eight patients were studied with arterial and venous blood sampling from the umbilical cord and from the placental cord insertion, with subsequent measurement of blood gases, pH, base excess, O2 saturation, and hemoglobin. The relationships of corresponding measurements from the placental and umbilical vein and from the placental and umbilical artery were analyzed using regression analysis, paired analysis of grouped means, and by estimating limits of agreement. RESULTS: The relationships between placental and umbilical cord blood measurements were described using a linear mathematical model, and although respective measurements were all significantly related (P < .01), this was strongest for both venous and arterial base excess and hemoglobin measurements (r values 0.91 to 0.99) and variably weaker for venous and arterial Po2 (and thereby O2 saturation measurements [r values 0.36 to 0.89]) and arterial Pco2 (and thereby pH measurements [r values 0.66 to 0.73]). Whereas base excess and hemoglobin measurements for both the venous and arterial placental and umbilical cord bloods were close in value over the range of values studied, Po2 and thereby O2 saturation values were variably lower in the placental vein compared with the umbilical vein, while Pco2 values were variably lower and thereby pH values conversely higher in the placental artery compared with the umbilical artery. Limits of agreement as a measure of the difference between paired placental and umbilical cord blood measurements were such that only those for base excess and hemoglobin were likely narrow enough to be acceptable for clinical purposes. CONCLUSION: Placental cord blood provides for a close estimate of fetal base excess and hemoglobin status at birth, but with more error for Po2 and thereby O2 saturation and Pco2 and thereby pH due to continued blood gas exchange within and across the placenta after cord clamping.

Acid-Base Equilibrium↗

PubMed2005

Cross-cultural discrepancies in self-appraisals.

Two studies examined self-appraisals in Japanese and Canadian samples. Study 1 included open-ended self-descriptions; Study 2 incorporated indirect measures of self-enhancing tendencies. In Study 1, the content analysis assessed spontaneous evaluations of self and others, private and relational self-statements, reflected appraisals, temporal and social comparisons, and evaluations of objects and events. Canadian participants typically provided self-enhancing self-descriptions. Japanese participants were generally evenhanded rather than self-critical or self-enhancing, although they were more favorable about relational than private aspects of self. In Study 2, Canadian participants reported that proud events felt closer in time and were easier to recall than similarly distant embarrassing events. Japanese participants reported that embarrassing and proud events felt equally far away and were equally memorable. The two studies provide evidence that Canadians possess stronger self-enhancing motivations than do Japanese and enable a cross-cultural analysis of several social psychological theories of self-appraisal.

Analysis of Variance↗

PubMed2005

Cultural differences in affective forecasting: the role of focalism.

The impact bias in affective forecasting-a tendency to overestimate the emotional consequences of future events-may not be a universal phenomenon. This prediction bias stems from a cognitive process known as focalism, whereby predictors focus attention narrowly on the upcoming target event. Three studies supported the hypothesis that East Asians, who tend to think more holistically than Westerners, would be less susceptible to focalism and, consequently, to the impact bias. In Studies 1 and 2, Euro-Canadians exhibited the impact bias for positive future events, whereas East Asians did not. A thought focus measure indicated that the cultural difference in prediction was mediated by the extent to which participants focused on the target event (i.e., focalism). In Study 3, a thought focus manipulation revealed that defocused Euro-Canadians and East Asians made equally moderate affective forecasts.

Affect↗

PubMed2005

HIV-associated nephropathy: a brief review.

HIV-associated nephropathy (HIVAN) is an important cause of renal failure in HIV-1 seropositive patients. The disease is characterized by collapsing focal segmental glomerulosclerosis with marked podocyte proliferation, microcystic dilatation of the tubules and interstitial nephritis. Patients generally present with advanced HIV-1 infection, renal insufficiency and marked proteinuria. No serologic markers exist to diagnose HIVAN, and given the broad differential diagnosis for renal failure in these patients, renal biopsy should be performed. Viral infection of renal cells plays a central role in the pathogenesis of HIVAN. There is now compelling evidence that highly active antiretroviral therapy (HAART) is effective in preventing end-stage renal disease in patients affected with HIVAN. The efficacy of angiotensin-converting enzyme (ACE) inhibitors and prednisone has also been evaluated, but larger prospective studies are needed.

AIDS-Associated Nephropathy↗

PubMed2003

A national survey of observation units in the United States.

The objective of this study was to survey the use of observation units (OUs) in the United States. A written survey was mailed to every third hospital (sequential by zip code) in the United States. There was a 32.9% response to the survey (522 of 1588 hospitals). A total of 18.8% of hospitals had an OU with another 11.6% planning to open an OU. Those hospitals that had OUs had a higher overall ED census, higher rate of diversion of ambulances, and were more likely to be in metropolitan areas (P <.05), but there was no relationship to payor mix or to ED hospital admission rate. The OUs were characterized by a mean 4.8 years in existence, 57.3% ED administratively responsible, 59.4% ED clinically responsible, a mean of 1330 patients per year, an average length of stay of 15.3 hours, a 4.2 nurse-to-patient ratio, and 22.3% hospital admission rate.

Emergency Service, Hospital↗

PubMed2003

The identity function of autobiographical memory: time is on our side.

Autobiographical memory plays an important role in the construction of personal identity. We review evidence of the bi-directional link between memory and identity. Individuals' current self-views, beliefs, and goals influence their recollections and appraisals of former selves. In turn, people's current self-views are influenced by what they remember about their personal past, as well as how they recall earlier selves and episodes. People's reconstructed evaluations of memories, their perceived distance from past experiences, and the point of view of their recollections have implications for how the past affects the present. We focus on how people's constructions of themselves through time serve the function of creating a coherent--and largely favourable--view of their present selves and circumstances.

Education↗

PubMed2003

Conceiving the past and future.

The authors compared people's views of their histories and futures by asking them to recall and anticipate personally significant episodes. It was hypothesized and found in Study 1 that individuals spontaneously recall an affectively mixed past, containing both "highs" and "lows," whereas they anticipate homogeneously ideal futures. It was further hypothesized that people devote little thought to negative futures, and this was tested directly in Studies 2 and 3 by assessing how quickly past and likely future events came to mind. Asked to report positive and negative episodes from the past and future, participants took longer to generate future negative than positive events. Speed of recall was unaffected by the valence of past episodes. In Study 4, the response latency difference was again replicated for future events and it was demonstrated that people are slower in both generating negative future events and judging those events as likely.

Adult↗

PubMed2002

Use of the tissue stress model as a paradigm for developing an examination and management plan for a patient with plantar fasciitis.

This case report demonstrates the use of the tissue stress model to develop an examination, evaluation, and management plan for a patient with an 8-week history of plantar fasciitis. The patient history focused on determining which tissues were being excessively stressed, and the physical examination was used to apply controlled stresses to these tissues and to determine factors contributing to the patient's condition. After it was confirmed that the patient's plantar fascia was under excessive mechanical stress, treatment first focused on reducing pain, inflammation, and stress on the plantar fascia and then on returning the patient to her running program while maintaining symptoms at a diminished level. The patient reported being free of pain 7 weeks after the initial physical therapy examination and at the 11-week telephone follow-up. Although no experimental evidence is given, this report suggests that this patient responded positively to treatment based on the tissue stress model.

Adult↗