Biomedical subjects

S L Weaver

Publications and source records attributed to S L Weaver.

12 recordsLinked to original sources

PubMed2001

2-Amino-4,6-diarylpyridines as novel ligands for the estrogen receptor.

We have prepared a novel series of 2-amino-4,6-diarylpyridines that function as ligands of estrogen receptor alpha (ERalpha) and estrogen receptor beta (ERbeta). These compounds bind to both ERalpha and ERbeta with a modest selectivity for the alpha subtype. The most potent of these analogues, compound 19, has a K(i)=20nM at ERalpha. These molecules represent a novel template for designing potentially useful ligands for the estrogen receptor.

Bacteria↗

PubMed2000

Coping strategies and integrative meaning as moderators of chronic illness.

This study contrasted the moderating effects of deriving integrative meaning (a primary appraisal process) with the use of specific, cognitive-behavioral strategies (a secondary appraisal process) in confronting stressors involving harm or loss. Eighty young adults and eighty older participants with varying levels of chronic illness were assessed. Open-ended responses to recalled experiences with illness and death were coded for integrative meaning and use of specific cognitive-behavioral strategies. In young adults with higher levels of chronic illness, a greater tendency to use specific cognitive-behavioral strategies was related to higher morale. In older participants, a greater tendency to derive integrative meaning was related to increased morale, regardless of illness levels.

Adaptation, Psychological↗

PubMed1998

The sense of control as a moderator of social class differences in health and well-being.

The authors examined social class differences in 2 aspects of the sense of control (mastery and perceived constraints) in 3 national probability samples of men and women ages 25-75 years (N1 = 1,014; N2 = 1,195; N3 = 3,485). Participants with lower income had lower perceived mastery and higher perceived constraints, as well as poorer health. Results of hierarchical multiple regression analyses showed that for all income groups, higher perceived mastery and lower perceived constraints were related to better health, greater life satisfaction, and lower depressive symptoms. However, control beliefs played a moderating role; participants in the lowest income group with a high sense of control showed levels of health and well-being comparable with the higher income groups. The results provided some evidence that psychosocial variables such as sense of control may be useful in understanding social class differences in health.

Adaptation, Psychological↗

PubMed1998

Sociodemographic variations in the sense of control by domain: findings from the MacArthur studies of midlife.

Past research has focused on general control beliefs with little attention to whether control beliefs vary across domains. Also, most age-comparative studies have examined control beliefs in younger and older adults but not in middle-aged adults. This study examined assessments of control in 7 domains for a large probability sample of adults 25-75 years in age. Results revealed differential age patterns across domains: Increases in control by age were found for control over work, finances, and marriage, whereas decreases were found for control over relationship with children and sex life. Control beliefs in some domains also varied by gender and education, but the age patterns were consistent across these sociodemographic groups. Domain-specific control beliefs were significantly related to a variety of domain-relevant experiences and outcomes.

Adult↗

PubMed1996

Identifying adverse events caused by medical care: degree of physician agreement in a retrospective chart review.

OBJECTIVE: To 1) assess the degree of agreement among physicians on the cause of previously flagged adverse outcomes and 2) relate the findings to systems of quality assurance and performance assessment and proposals for no-fault compensation for medical injuries. DESIGN: Observational study of 7533 pairs of "structured implicit" reviews (subjective opinions based on guidelines) of medical records done by 127 physicians working independently. SETTING: Random sample of 51 inpatient facilities in New York State. PATIENTS: Random sample of inpatient medical records from the selected facilities. MEASUREMENTS: 1) Number of agreed-upon adverse events compared with the number of cases of extreme disagreement and 2) internally and indirectly standardized rates at which physician reviewers found adverse events (injuries to patients caused at least in part by medical management). RESULTS: In 12.9% of cases (971 of 7533), the two physicians in a pair had extreme disagreement about the occurrence of an adverse event. These cases outnumbered those in which both reviewers found an adverse event (10%; n = 757). Agreement was highest for wound infections and lowest for adverse events attributed to failure to diagnose or lack of therapy. The amount of experience the physicians had in reviewing records tended to increase the level of agreement. Even after standardization to the results of the entire sample, individual physicians' rates of finding at least slight evidence of an adverse event varied widely (range, 9.9% to 43.7%) (P < 0.001). CONCLUSIONS: Structured implicit reviews produced disagreement on the causes of adverse patient outcomes. If systems of quality assurance, performance audits, or no-fault patient compensation are to succeed, methods for overcoming the common tendency toward disagreement among experts must be developed.

Humans↗

PubMed1995

Association models for periodontal disease progression: a comparison of methods for clustered binary data.

We investigate population-averaged (PA) and cluster-specific (CS) associations for clustered binary logistic regression in the context of a longitudinal clinical trial that investigated the association between tooth-specific visual elastase kit results and periodontal disease progression within 26 weeks of follow-up. We address estimation of population-averaged logistic regression models with generalized estimating equations (GEE), and conditional likelihood (CL) and mixed effects (ME) estimation of CS logistic regression models. Of particular interest is the impact of clusters that do not provide information for conditional likelihood methods (non-informative clusters) on inferences based upon the various methodologies. The empirical and analytical results indicate that CL methods yield smaller test statistics than ME methods when non-informative clusters exist, and that CL estimates are less efficient than ME estimates under certain conditions. Moreover, previously reported relationships between population-averaged and cluster-specific parameters appear to hold for the corresponding estimates in the presence of these clusters.

Cluster Analysis↗

PubMed1995

Comparing hospital mortality in adult patients with pneumonia. A case study of statistical methods in a managed care program.

OBJECTIVE: To compare and contrast a managed care program's analysis of differences in hospital mortality with results obtained by accepted statistical methods. DESIGN: A re-analysis of computerized discharge data using the same method used by a managed care program, and using conventional methods of categorical data analysis. One thousand computer simulations of a method for comparing hospitals by severity-adjusted mortality were done to determine the probability of falsely identifying hospitals as high-mortality outliers. SETTING: 22 acute care hospitals in central Pennsylvania. PATIENTS: All adult patients with pneumonia (n = 4587; diagnosis-related groups 089-090) less than 65 years of age who were discharged from the 22 hospitals in 1989, 1990, and 1991, excluding patients with the acquired immunodeficiency syndrome and transplant recipients. MEASUREMENTS: In-hospital mortality adjusted for age and severity of illness using MedisGroups admission severity group score. RESULTS: The hospital that had the highest mortality for adult pneumonia according to the managed care program's analysis did not, according to an appropriate analysis, differ significantly from other area hospitals (likelihood ratio test, P = 0.23). Random variation in this sample of patients with a low average mortality rate (3.5%) showed a 60% chance that 1 or more of the 22 hospitals would be falsely identified as a "high-mortality outlier" when simplistic statistical methods were used. CONCLUSION: Organizations seeking to compare the quality of hospitals and physicians through outcome data need to recognize that simplistic methods applicable to large samples fail when applied to the outcomes of typical patients, such as those admitted for pneumonia. Although these comparisons are much in demand, careful attention must be paid to their statistical methods to ensure validity and fairness.

Adolescent↗

PubMed1994

Secular trends in blood pressure among adult blacks and whites aged 18-34 years in two body mass index strata, United States, 1960-1980.

Secular trends in blood pressure among young adults reflect the proportion of the population at risk of developing hypertension and may be markers of progress in primary prevention. National health examination data from three successive surveys were analyzed to assess blood pressure trends for adult blacks and whites aged 18-34 years in two body mass index (BMI; weight (kg)/height (m)2) strata (< 25 or > or = 25). Blood pressure was categorized into a four-point ordinal scale using the weighted, within-sex 50th, 75th, and 90th percentiles for 18- to 24-year-old adults in the 1960-1962 survey. The effects were analyzed with cumulative logit models with alpha = 0.01. The systolic blood pressure decreased moderately for 25- to 34-year-old males and for females except those aged 25-34 years with a BMI of > or = 25. Diastolic blood pressure increased among males with a BMI of > or = 25 and among white males with a BMI of < 25, but did not show a significant overall trend among females. A BMI of > or = 25 was associated with substantially higher blood pressure in each survey, except for one age-sex-race subgroup. Racial differences within BMI were less consistent than the differences across BMI strata. In summary, the situation with respect to hypertension among females may have improved during this time period but for males may have worsened with respect to diastolic blood pressure. Data for both sexes support a need for population-wide obesity prevention to reduce the incidence of hypertension.

Adolescent↗

PubMed1994

Longitudinal evaluation of elastase as a marker for the progression of periodontitis.

To determine whether elastase levels in gingival crevicular fluid (GCF) could serve as a marker for the progression of periodontitis, we monitored GCF elastase and periodontal status in selected sites in 32 periodontally healthy volunteers and 31 periodontitis patients at intervals over a 6-month period. Clinical measurements included plaque index, gingival index, bleeding on probing, suppuration, probing depth, clinical attachment level, and relative attachment level measured with an automated disk probe. GCF elastase, detected by reaction with a fluorescent substrate, was assessed visually against fluorescence standards and quantitatively with a fluorometer. Bone loss was detected by subtraction radiography of standardized vertical bite-wing radiographs at baseline and 6 months. Mean visual elastase scores (VES) and quantitative elastase measurements were significantly higher (P < 0.001) in sites from periodontitis patients than in sites from healthy volunteers. When bone loss was used as the criterion for disease progression, significantly higher (P < 0.001) visual and quantitative GCF elastase levels were found at progressing sites than in nonprogressing sites in the periodontitis patients. The odds ratios (OR) for the event of developing bone loss with positive 4-minute and 8-minute VES tests were 4.2 (P < 0.001) and 7.4 (P < 0.001), respectively. When corrected for the tendency of progressing sites to be clustered within a subpopulation of patients, the OR for developing bone loss with the 4-minute and 8-minute VES tests were 3.1 (P < 0.007) and 4.9 (P < 0.001), respectively. These data indicate that sites with high levels of elastase are at significantly greater risk for progressive bone loss as assessed by digital subtraction radiography.

Adult↗

PubMed1993

Relationship between malpractice claims and cesarean delivery.

OBJECTIVE: To investigate whether an association exists between the probability of a cesarean delivery and the level of malpractice claims risk faced by hospitals and physicians. DESIGN: Survey of computerized discharge data linked with physician and hospital malpractice claims records based on stratified, random sample of hospitals. SETTING: Acute care hospitals in New York State in 1984. POPULATION: All deliveries (60 490) at 31 hospitals. RESULTS: After controlling for the clinical risk of a cesarean delivery, patient socioeconomic status, and physician and hospital characteristics, cesarean delivery was positively associated with physician malpractice premiums (odds ratio [OR], 3.00; 95% confidence interval [CI], 2.13 to 4.24 for the difference between upstate and New York City levels), with the number of physician claims opened per 100 physicians at the hospital level (OR, 1.15; 95% CI, 1.02 to 1.30 for a 1-SD change), and with the number of hospital claims opened per 1000 discharges (OR, 1.26; 95% CI, 1.10 to 1.43 for a 1-SD change). Measures of physician-perceived risk of suit also showed a significant association with cesarean delivery (OR, 1.96; 95% CI, 1.53 to 2.52, upstate vs New York City). Within hospitals, there was no significant association (OR, 1.15; P = .126) between the odds of cesarean delivery and the claims history (none vs one or more) of an individual physician. CONCLUSION: Results support previous speculations of a positive association between malpractice claims risk and the rate of cesarean delivery.

Cesarean Section↗

PubMed1992

Improving memory and control beliefs through cognitive restructuring and self-generated strategies.

Memory problems are a major source of concern among older adults. The goal of this research was to evaluate methods for improving memory performance and beliefs about memory ability and control. Men and women between the ages of 60 and 85 were randomly assigned to one of five treatment groups: (1) cognitive restructuring to promote adaptive beliefs about memory, (2) memory skills training, (3) combined cognitive restructuring and memory skills training, (4) practice on memory tasks, and (5) a no-contact control group. Beliefs about memory (ability and control) and memory performance (working memory, recall of text materials, categorizable word list, and names and faces) were assessed at a pretest and two posttests. As predicted, those receiving the combined treatment showed the greatest increases in their sense of control and perceived ability to improve memory. Results indicated that all groups improved equally on the memory tasks, although those who had received memory training were more likely to report at the second posttest that they had begun using new strategies for remembering things.

Adaptation, Psychological↗

PubMed1989

Young children's knowledge of their memory span: effects of task and experience.

This study investigated the hypothesis that young children have knowledge about their memory that they may be unable to articulate, but are able to reflect on and use in problem-solving. Forty-eight kindergarteners made one of two types of judgments about their memory span for words. Half of the children made prospective verbal predictions about the number of words they thought they could recall from a list of 10. The other half made concurrent, nonverbal predictions by listening to words on a tape and manually stopping the tape when they heard as many words as they thought they could recall. Children's actual recall for words was then assessed. All children participated in multiple trials to assess the effect of task experience on their predictions. Analyses revealed that predictions made in the concurrent task were significantly more accurate than those made in the prospective task. All children lowered their predictions across trials, although only in the concurrent task were children's final-trial predictions not significantly greater than their actual recall. No meaningful effects or interactions were associated with actual recall scores. These results revealed that young children manifested greater memory knowledge when this knowledge was assessed through their concurrent problem-solving behavior rather than through their prospective verbal predictions.

Child↗