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Biomedical subjects

R L Berg

Publications and source records attributed to R L Berg.

At least 19 recordsLinked to original sources
PubMed1991

Cancer prevention and screening in light of health promotion and prevention of disability for the second 50 years. A report from the Institute of Medicine of the National Academy of Science.

Increased attention is needed to the prevention of disability resulting from cancer in promoting the health of aged persons. This will require enhanced concern from the medical profession, the general adoption of a taxonomy of disability, and more efficient use of health-care resources. Little is known in quantitative terms of the relative effectiveness (for example, as measured by Quality Life Years) and costs of health-care interventions that reduce disability resulting from cancer. Considerable research will be needed on outcome benefits to make possible rational allocation decisions.

Aged↗
PubMed1991

Cancer control and the older person. Prevention and detection in older persons.

Older persons are appropriate targets for a range of prevention and early detection interventions, however, greater emphasis should be given to structuring the delivery of prevention and detection services to the special needs of this population. This may require research and program development to reach older persons in the most effective and cost-effective manner. The American Cancer Society and other program efforts must accommodate the heterogeneity and special needs of segments of the older population. Racial and cultural minorities, impoverished persons, the cognitively impaired, and the physically impaired are four groups requiring special attention. Early detection guidelines specific to older persons should be developed.

Aged↗
PubMed1991

Design and statistical issues of the Modification of Diet in Renal Disease Trial. The Modification of Diet in Renal Disease Study Group.

The Modification of Diet in Renal Disease Trial is a multicenter randomized clinical trial for men and women aged 18-70 years with chronic renal disease who are not on dialysis and who have not had a kidney transplant. Study participants are randomized in a 2 x 2 factorial design to diets containing different amounts of protein and phosphorus and to two levels of blood pressure control. The prescribed modifications differ depending on the level of a patient's kidney function. The primary outcome variable to compare diet or blood pressure groups is each patient's slope (or the change) in glomerular filtration rate with time. This paper describes the study design with particular emphasis on sample size determination. Special statistical analysis issues that arise with slope as the outcome are also discussed.

Adolescent↗
PubMed1991

Glomerular function in Pima Indians with noninsulin-dependent diabetes mellitus of recent onset.

Differential solute clearances were used to characterize glomerular function in 20 Pima Indians with noninsulin-dependent diabetes mellitus (NIDDM) of less than 3 yr duration. 28 Pima Indians with normal glucose tolerance served as controls. In the diabetic group, the glomerular filtration rate (GFR, iothalamate clearance) exceeded the control value by 15% (140 +/- 6 vs. 122 +/- 5 ml/min, P less than 0.01). A corresponding 12% increase in renal plasma flow (RPF) was not statistically significant and did not account fully for the observed hyperfiltration, suggesting a concomitant elevation of the ultrafiltration pressure or coefficient. The median albumin excretion ratio in NIDDM exceeded control by almost twofold (10.1 vs. 5.8 mg/g creatinine), a trend which just failed to achieve statistical significance (P = 0.06). Fractional clearances of dextrans of broad size distribution were also elevated in diabetic subjects, significantly so for larger dextrans of between 48 and 60 A radius. A theoretical analysis of dextran transport through a heteroporous membrane revealed glomerular pores in NIDDM to be uniformly shifted towards pores of larger size than in controls. We conclude that an impairment of barrier size selectivity combined with high GFR elevates the filtered protein load in NIDDM of recent onset. We propose that enhanced transglomerular trafficking of protein may predispose to sclerosis of glomeruli in those Pima Indians with NIDDM who ultimately develop diabetic nephropathy.

Adolescent↗
PubMed1989

Creatinine filtration, secretion and excretion during progressive renal disease. Modification of Diet in Renal Disease (MDRD) Study Group.

The Modification of Diet in Renal Disease (MDRD) Study is a multicenter, randomized, controlled trial to determine acceptance, safety, and efficacy of low protein and phosphorus diets in patients with progressive renal disease. During the feasibility phase, 96 patients aged 18 to 75 years, with previously declining reciprocal serum creatinine concentration (1/PCr) and current glomerular filtration rate (GFR) from 7.5 to 80 ml/min/1.73 m2, were randomly assigned four study diets. After randomization, 91 patients were followed for a mean duration of 14.1 months. GFR, 1/PCr and creatinine clearance (CCr) were measured every three months. In an earlier report, we demonstrated relatively weak correlations of rates of change in GFR and 1/PCr during the feasibility phase; the proportion of variability in 1/PCr slopes that was explained by variability in GFR slopes (r2) was only 0.49 to 0.55. In this study, we examined the relationship of GFR and 1/PCr to other determinants of the serum creatinine concentration, including filtration (GFCr), secretion (TSCr), and total renal excretion (UCrV) of creatinine. Our results show that these parameters varied widely among individuals and changed over time. These findings may explain, in part, the relatively weak correlations. These results strengthen our previous suggestion that the rate of change in 1/PCr may not be an accurate index of the rate of change in GFR and raise questions about the validity of conclusions from other studies in which the efficacy of dietary modification in retarding the progression of renal disease was based principally on measurements of 1/PCr.

Adolescent↗
PubMed1988

Emergency department violence in United States teaching hospitals.

Violence in the emergency department is a common concern. However, most aspects of this problem remain unstudied because no organization or government agency tracks such data and no regulatory or administrative guidelines adequately address its management. We surveyed 170 US teaching hospital ED medical directors with respect to violence and security issues and received responses from 127 (74.7%). Among other findings, 41 institutions report at least one verbal threat each day, and 23 report at least one threat with a weapon each month. Four-point physical restraint is used by 125 of the 127 facilities. Personnel in 32 of these facilities restrain at least one patient each day. Seventeen institutions report having significantly injured a patient during restraint in the last five years, resulting in one death. Twenty institutions report involvement with litigation with respect to restraint. Only 51 institutions provide ED nurses with formal training in recognition and management of aggression and violence, and only 79 institutions have security personnel present in the ED 24 hours a day. A sizable number of facilities receiving frequent threats and batteries are not among those with 24-hour-a-day security personnel. A preventative, risk-management approach that addresses environmental factors, training policies, restraint, security arrangements, and legal precedents is suggested.

Data Collection↗
PubMed1987

Restriction of P-element insertions at the Notch locus of Drosophila melanogaster.

P elements move about the Drosophila melanogaster genome in a nonrandom fashion, preferring some chromosomal targets for insertion over others (J. C. J. Eeken, F. H. Sobels, V. Hyland, and A. P. Schalet, Mutat. Res. 150:261-275, 1985; W. R. Engels, Annu. Rev. Genet. 17:315-344, 1983; M. D. Golubovsky, Y. N. Ivanov, and M. M. Green, Proc. Natl. Acad. Sci. USA 74:2973-2975, 1977; M. J. Simmons and J. K. Lim, Proc. Natl. Acad. Sci. USA 77:6042-6046, 1980). Some of this specificity may be due to recognition of a particular DNA sequence in the target DNA; derivatives of an 8-base-pair consensus sequence are occupied by these transposable elements at many different chromosomal locations (K. O'Hare and G. M. Rubin, Cell 34:25-36, 1983). An additional level of specificity of P-element insertions is described in this paper. Of 14 mutations induced in the complex locus Notch by hybrid dysgenesis, 13 involved P-element insertions at or near the transcription start site of the gene. This clustering was not seen in other transposable element-induced mutations of Notch. DNA sequences homologous to the previously described consensus target for P-element insertion are not preferentially located in this region of the locus. The choice of a chromosomal site for integration appears to be based on more subtle variations in chromosome structure that are probably associated with activation or expression of the target gene.

Animals↗
PubMed1978

Effect of interval between booster vaccination and time of breeding on protection against campylobacteriosis (vibriosis) in cattle.

Thirteen heifers (group A) given a booster vaccination with Campylobacter fetus 4 1/2 months before breeding to bulls infected with the homologous strain had a pregnancy rate of 54%, compared with a pregnancy rate of 92% for 12 heifers (group B) given a booster vaccination 10 days before the 63-day breeding period began. None of 7 nonvaccinated heifers became pregnant, and all remained infected for at least 136 days. All three groups of heifers were bred by the same infected bulls. Nine of the heifers in group A, but none of the heifers in group B, became infected during the first estrus. Blood serum agglutination titers peaked 2 weeks after the first vaccination but decreased to prevaccination titers 6 weeks later. Titers more than double those produced by one vaccination peaked between 2 and 3 weeks after booster vaccination but in most heifers had decreased to low titers 7 weeks later. When the breeding period began, the median antibody titer was 640 for heifers in group A and 10, 240 for heifers in group B. Indications of an anamnestic response due to natural challenge were not found in any of the 9 infected heifers in group A when serum titers were determined 27 and 34 days after breeding began. Therefore, it appears that in many heifers and cows, only the antibodies produced by booster vaccination will be available to provide protection. Inasmuch as vaccinal antibody titers decrease rapidly, it was concluded that booster vaccinations should be given approximately 10 days before breeding so that titers will be high during the breeding period.

Animals↗
PubMed1976

Difficult issues in health planning, development, and review.

To give an overview of the kinds of issues expected to be encountered by the new Health Systems Agencies being established in conformity with Public Law 93-641, the authors draw from the experiences of the Comprehensive Health Planning agency and Regional Medical Program of an Upstate New York area. Problems faced together in the years 1972 to 1975 in health planning, development, review, and public policy are described. The unusual geographic and working relationship of these agencies makes them, together, a useful prototype of the HSA to examine.

Female↗
PubMed1976

Neglected aspects of the quality of life.

Health status indexes have focused on physical function such as the activities of daily living, perhaps because the National Health Survey provides data of this sort or because it is the object of rehabilitation programs. In an attempt to elicit values concerning loss of function, 150 health workers were asked to assign weights from zero to 10 for 50 abilities or functions. Serious methodological problems were encountered in finding terms describing functional loss that were simple and meaningful to a wide range of workers. In addition, an open-ended request was made to identify other functions not included in the list. The largest average values were assigned to ability to use one's mental abilities, to see, to think clearly, to love and be loved in return, to make decisions for oneself, to live at home, to walk, to maintain contact with family and friends, and to talk. Some of the functional loss implied in these responses may not be amenable to cure or rehabilitation but may be preventable and thus needs to be included in outcome measures.

Activities of Daily Living↗
PubMed1973

Community medicine.

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Comprehensive Health Care↗