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Biomedical subjects

R Clyman

Publications and source records attributed to R Clyman.

9 recordsLinked to original sources
PubMed2000

Parental attitudes regarding interviews about injuries to their children.

BACKGROUND: Questions about the circumstances of injuries, especially to infants and young children, might be perceived by parents as threatening or intrusive. Some institutional research review committees express concerns that interviews about childhood injuries may be offensive to parents. The perceived value and potential risk of questions about a young child's injury could affect the quality of responses. OBJECTIVES: To assess parents' perceptions of threat and value of interviews about injury to their young children. SETTING: District of Columbia, 1 October 1995 to 30 September 1996. METHODS: Trained research assistants telephoned the parents of children seen in an emergency department or admitted to the hospital after an injury. To be eligible for inclusion the child must have been <3 years of age and a resident of the District of Columbia at the time of the event. After collection of sociodemographic information and circumstances of injury, the respondents were asked if the interview caused them to feel angry, offended or threatened, and if participation in the study was considered worthwhile. RESULTS: Seventy eight per cent of eligible families were contacted. Among those contacted, 93% completed the interview. Eighty two per cent of respondents were mothers and 11% fathers. Ninety per cent (95% confidence interval (CI) 88.4 to 91.6) of the respondents reported that the interview did not make them feel angry, offended, or threatened. Only 13 (1%; 95% CI 0.5 to 1.5) reported being very angry and 7.1% (95% CI 5.8 to 8.5) reported being a little angry. The majority of participants (61.2%, 95% CI 58.6 to 63.8) felt that participation in the study was definitely worthwhile and only 5.5% (95% CI 4.3 to 6.7) felt that it was not at all worthwhile. Parents of children with intentional injuries were more likely to report feelings of anger than parents of children with unintentional injuries (24% v 8%; p=0.02). The per cent of respondents reporting any anger was greater when the interview was conducted within 14 days of the hospital visit compared with later interviews (11% v 7%; p=0.02). CONCLUSIONS: In similar populations most parents of young, injured children are neither upset nor threatened by interviews that probe for details about how their children become injured. In general, collecting data aimed to prevent injuries is perceived as worthwhile, and parents readily cooperate with providing this information. Investigators and review committees should consider that interviews about infant and young child injuries are of no or minimal risk.

Adult↗
PubMed1995

Factors determining reopening of the ductus arteriosus after successful clinical closure with indomethacin.

OBJECTIVE: To examine the role of ductus arteriosus (DA) constriction and loss of luminal blood flow in producing permanent closure of the DA in human infants. METHODS: We studied 77 newborn infants (gestational age, 23 to 33 weeks) with asymptomatic patent ductus arteriosus (PDA), who had "complete clinical closure" (defined as the disappearance of all PDA signs) after treatment with indomethacin (three doses within 36 hours). All infants had an echocardiogram 24 to 36 hours after the last dose of indomethacin. They were then followed for the development of ductus reopening. RESULTS: Despite the absence of clinical signs, 18 (23%) of 77 infants still had some residual luminal blood flow according to their echocardiograms. The failure to obliterate luminal blood flow completely was directly related to the infant's postnatal age when treatment was begun and to the amount of fluid administered before treatment. Subsequently the DA reopened in 16 (21%) of 77 infants. As predicted, infants with residual luminal blood flow after indomethacin treatment had a higher rate of subsequent clinical reopening than did those with no luminal flow. In addition, immature infants had a significantly higher reopening rate than did more mature infants. The increased risk of reopening in immature infants was seen even when indomethacin caused complete obliteration of ductus luminal blood flow. CONCLUSION: The DA of immature infants is resistant to the constriction-induced ischemic damage that is necessary for subsequent permanent closure of the vessel.

Ductus Arteriosus↗
PubMed1991

Patent ductus arteriosus increases lung fluid filtration in preterm lambs.

Previous studies showed that increased pulmonary blood flow from a patent ductus arteriosus had little or no effect on the amount of fluid in the lungs of mechanically ventilated preterm lambs. The purpose of this study was to examine the effect of a patent ductus arteriosus on lung vascular permeability and to see whether increased pulmonary lymph flow might compensate for the increased rate of fluid filtration. Using a model that allows mechanical control of ductus patency, we studied the effects of increased pulmonary blood flow on lung vascular pressures in six mechanically ventilated premature lambs at 136 +/- 2 d gestation (mean +/- SD) (term = 145 d). We measured lung lymph flow and protein concentrations in lymph and plasma to assess pulmonary vascular fluid filtration and protein permeability. We studied each lamb during sequential steady state periods, first with the ductus open and then with it closed. When the ductus was open, pulmonary blood flow was twice what it was when the ductus was closed. Mean pulmonary artery pressure and left ventricular end-diastolic pressure were greater with the ductus open [40 +/- 5 torr (5.3 +/- 0.7 kPa) and 8 +/- 3 torr (1.1 +/- 0.4 kPa), respectively] than when it was closed [24 +/- 3 torr (3.2 +/- 0.4 kPa) and 4 +/- 2 torr (0.5 +/- 0.3 kPa), respectively]. When the ductus was open, lymph flow was 68% greater and lymph protein concentration was 17% lower than when the ductus was closed. Lymph protein clearance (lymph flow x lymph protein concentration/plasma protein concentration) was 39% greater when the ductus was open.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Human microvascular endothelial cells use beta 1 and beta 3 integrin receptor complexes to attach to laminin.

Microvascular endothelial cells (MEC) use a set of surface receptors to adhere not only to the vascular basement membrane but, during angiogenic stimulation, to the interstitium. We examined how cultured human MEC interact with laminin-rich basement membranes. By using a panel of monoclonal antibodies, we found that MEC cells express a number of integrin-related receptor complexes, including alpha 1 beta 1, alpha 2 beta 1, alpha 3 beta 1, alpha 5 beta 1, alpha 6 beta 1, alpha V beta 3. Attachment to laminin, a major adhesive protein in basement membranes, was studied in detail. Blocking monoclonal antibodies specific to different integrin receptor complexes showed that the alpha 6 beta 1 complex was important for MEC adhesion to laminin. In addition, blocking antibody also implicated the vitronectin receptor (alpha V beta 3) in laminin adhesion. We used ligand affinity chromatography of detergent-solubilized receptor complexes to further define receptor specificity. On laminin-Sepharose columns, we identified several integrin receptor complexes whose affinity for the ligand was dependent on the type of divalent cation present. Several beta 1 complexes, including alpha 1 beta 1, alpha 2 beta 1, and alpha 6 beta 1 bound strongly to laminin. In agreement with the antibody blocking experiments, alpha V beta 3 was found to bind well to laminin. However, unlike binding to its other ligands (e.g., vitronectin, fibrinogen, von Willebrand factor), alpha V beta 3 interaction with laminin did not appear to be Arg-Gly-Asp (RGD) sensitive. Finally, immunofluorescent staining demonstrated both beta 1 and beta 3 complexes in vinculin-positive focal adhesion plaques on the basal surface of MEC adhering to laminin-coated substrates. The results indicate that both these subfamilies of integrin heterodimers are involved in promoting MEC adhesion to laminin and the vascular basement membrane.

Antibodies, Monoclonal↗
PubMed1981

Developmental follow-up of hyperventilated neonates: preliminary observations.

A group of 13 newborn infants greater than 37 weeks' gestation were selected to be hyperventilated because of severe hypoxemia refractory to conventional mechanical ventilation, ie, failure to maintain PaO2 greater than 50 torr with an FIO2 of 1.0, despite PaCO2 less than or equal to 40 torr and pH greater than or equal to 7.40. Eleven survived; nine were available for follow-up evaluations. As a group, the nine infants were exposed to a PaCO2 less than or equal to 20 torr for 51.8 +/- 11.8 (mean +/- SEM) hours, to PaCO2 less than or equal to 15 torr for 11.8 +/- 3.3 hours, to a pH greater than 7.50 for 64.4 +/- 18.6 hours, and to a pH greater than or equal to 7.60 for 6.1 +/- 2.9 hours. One infant was lost to follow-up after a normal assessment at nine months. the other eight infants (seven AGA, one markedly SGA) were at least 1 1/4 years old at the time of evaluation. The seven AGA infants had a normal developmental quotient (mean 110 [range 96-130] by Stanford-Binet or Bayley assessment); the one SGA infant had a Bayley score of 89. All eight had normal neurologic examinations. These preliminary findings are reassuring with respect to neurologic and developmental outcome following prolonged hyperventilation.

Child Development↗
PubMed1978

Follow-up families who experience a perinatal death.

We conducted a retrospective study by telephone interview (10 to 22 months later) of 26 families who had experienced a perinatal death. Six of 26 mothers had a prolonged grief reaction (12 to 20 months). Those mothers with a surviving twin or subsequent pregnancy less than five months following the death were at higher risk for a prolonged grieving period than were those without subsequent pregnancy or one more than six months later. Half of the families obtained information about the cause of death and risk of recurrence only during hospitalization; subsequent contact, weeks to months later, provided additional information for the other half. Twenty-two of 26 mothers met predetermined criteria for having an adequate understanding of cause of death and risk of recurrence; four of 26 knew neither. Sixty percent of the mothers who had adequate understanding and who had no prolonged grief response felt totally dissatisfied or only partially satisfied with the information they received and the way they received it. Follow-up contact by phone or in person increased understanding significantly; mothers who had had in-person follow-up were more likely to be satisfied with the information they received.

Attitude to Death↗
PubMedDate not supplied

Visual acuity development in normal and abnormal preterm human infants.

The grating acuity of preterm infants was determined by measurements of the visual evoked potential (VEP) produced by phase alternation of sinusoidal luminance gratings. The development of visual acuity in healthy preterm infants appears to be accelerated when compared with full term infants of the same post-conceptual age. Cortical insults and the more advanced stages of retinopathy of prematurity may adversely affect acuity development as indexed by the VEP. Preterm twins also appear to have lower acuity than preterm monoparous infants.

Evoked Potentials, Visual↗