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Biomedical subjects

W B Clark

Publications and source records attributed to W B Clark.

At least 19 recordsLinked to original sources
PubMed1995

Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room.

This study examines sensitivity and specificity figures associated with screens used to predict harmful drinking and alcohol dependence among current drinkers. The study population comes from a probability sample of emergency room patients in Jackson, MS. Data are presented by gender and injury status (injured versus noninjured) for Blacks and for Whites. The Composite International Diagnostic Interview was used to assess ICD-10 criteria for harmful drinking and alcohol dependence, which were taken as standards. Predictors include screening instruments (CAGE, AUDIT, brief MAST, TWEAK, and History of Trauma Scale), breathalyzer reading, self-reported consumption before the injury or noninjury event, quantity and frequency of drinking, and an abbreviated alcohol dependence experiences measure used in general population surveys. Single items from these screening instruments were also tested as predictors. Overall, the TWEAK and the AUDIT performed best in terms of sensitivity and specificity, but variation across subgroups suggests that the search for a good screening instrument for general use must be continued.

Adolescent↗
PubMed1995

Drinking-related problems in the United States: description and trends, 1984-1990.

OBJECTIVE: This study uses two national alcohol surveys to assess rates of drinking problems from 1984 to 1990, to examine any changes in reports of drinking problems within demographic subgroups, and to evaluate the role of alcohol use versus demographic variables in predicting drinking problems in the 1990 survey only. METHOD: Data were obtained from two national alcohol surveys that utilized household probability samples within the 48 contiguous states in 1984 and 1990. Weights to adjust for design effects and nonresponse were applied to both samples of current drinkers. RESULTS: No significant changes were found for reports of three or more dependence symptoms (6.7% in 1984, 7.6% in 1990) or two or more social consequences (10.9% in 1984, 12.8% in 1990). Significant increases in reports of two or more social consequences were found for younger people, never married individuals and respondents who were not employed. A significant increase in reports for three or more dependence symptoms was also found for the unemployed group. Based on a cross-sectional analysis of the 1990 survey only, alcohol use variables were significant predictors of drinking problems. With the exception of younger age, demographic characteristics did not significantly predict alcohol problems. CONCLUSIONS: Although drinking problems are pervasive, they may not be sensitive to immediate changes in alcohol consumption. One explanation may be the changing social climate around drinking to which most drinkers have been, and are continuing to be, exposed.

Adolescent↗
PubMed1995

Research, technology transfer, and dentistry.

The periodontal discipline illustrates the need for dentists to be doctors specializing in oral medicine. Research findings are tending toward more complex and possibly lengthy treatment with drugs and/or growth factors, necessitating a curriculum with more emphasis on pharmacology, medical management, critical review of clinical trial results, and evaluation of risk-benefit ratios.

Dental Restoration, Permanent↗
PubMed1994

Treatment of subjects with refractory periodontal disease.

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects diagnosed with refractory periodontal disease. 21 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. When disease activity was detected, a bacterial sample was taken and a whole plaque susceptibility test was performed. Before the outcome of the susceptibility test the subjects were assigned to either antibiotic or placebo therapy. All subjects received scaling and rootplaning prior to antibiotic or placebo therapy. Based on the susceptibility test, subjects in the antibiotic group were treated either with Augmentin or clindamycin. The results demonstrated that in subjects with refractory periodontal disease there was no significant difference (N.S.) in the proportion of sites losing attachment before and after treatment (11.3% and 12.4%, respectively) over a 2-year post therapy observation period. However, the proportion of sites showing gain of attachment increased from 0.9% before therapy to 5.1% (p = 0.029) following selective antibiotic therapy when combined with scaling and rootplaning. The remainder of sites showed no change between pre- and post-therapy monitoring periods. The progression of attachment loss in the active sites could not be completely stopped over the entire 2-year period. After 12-15 months following therapy, there was a tendency towards new loss of attachment and an increase of pocket depth. However, all 4 subjects treated with placebo drug demonstrated continuous deterioration and had to be retreated. Although the proportion of sites losing attachment decreased from 5.1% to 2.3% (N.S.), the proportion of sites gaining attachment also decreased from 2.0% to 1.0% (N.S.). The results suggest that scaling and rootplaning together with selected antibiotic therapy repeated every 12-15 months may be beneficial for these subjects although it may not completely stop progressive attachment loss.

Adult↗
PubMed1994

Modeling the relationship between clinical, microbiologic, and immunologic parameters and alveolar bone levels in an elderly population.

A cross-sectional periodontal study of 74 subjects aged 65 to 75 years was performed. Clinical data were collected and related to microbiological and immunological data. A statistical model (step-wise multiple regression) of factors related to bone loss was created initially using clinical data only; then by adding either the microbiologic or immunologic data; and then by using clinical, microbiologic, and immunologic data together. When only clinical data were considered, three factors were found to have significant positive correlations with bone loss. Tooth mobility accounted for 17% of the variability in the alveolar bone level measurements, probing depth for 12%(r2), and plaque index for 3%, for a total of 32% of the variability explained by these clinical factors. Tooth mobility and probing depth were clinical factors which remained significant in the model when the microbiological data were also considered. As percentages of the total cultivable microbiota, E. corrodens (r2 = 14%) and black-pigmenting Prevotella intermedia (r2 = 4%) correlated positively with alveolar bone loss. The addition of the microbiologic data only increased the r2 to 33%. When immunological data were considered with the clinical data, pocket depth and tooth mobility were the clinical parameters which remained in the model. IgG antibody levels to P. gingivalis W83 and/or 381 (r2 = 24%) A. actinomycetemcomitans 627 (r2 = 2%) were the significant immunologic measures having a positive correlation with bone loss. Anti-F. nucleatum levels had a significant negative correlation. A total of 50% of the variability in alveolar bone level was accounted for in the model by the addition of specific serum antibody levels to subgingival plaque microorganisms. When clinical, microbiological, and immunological measurements were all considered together, antibody to P. gingivalis W83 and/or 381 (r2 = 42%), percentage of B-lymphocytes (r2 = 3%), probing depth (r2 = 4%), anti-E. corrodens levels (r2 = 2%), and anti-P. gingivalis 33277 levels (r2 = 4%) all had significant positive correlation with loss of alveolar bone. The number of enteric bacteria, anti-F. nucleatum levels, and anti-P. intermedia levels each had a significant negative correlation with alveolar bone heights. The r2 for this model was 75%. These results indicated that antibody levels to subgingival plaque microorganisms and tooth mobility were the best predictors of bone loss in the elderly patients tested in this study.

Age Factors↗
PubMed1994

The demographic distribution of US drinking patterns in 1990: description and trends from 1984.

OBJECTIVES: Since 1981, per capita consumption of alcohol (based on sales figures) has decreased in the United States. This study describes drinking patterns in the 1990 national alcohol survey by demographic correlates and assesses changes in drinking patterns from the 1984 survey. METHODS: Data were obtained from a national household probability sample within the 48 contiguous states; face-to-face interviews were conducted with 2058 adults. The instrument contained questions pertaining to the respondent's background, attitudes toward alcohol, and use of alcohol. RESULTS: The proportions of current drinkers; current drinkers of wine, beer, and liquor; weekly drinkers; and drinkers who reported having five or more drinks per occasion at least once a week were significantly lower in 1990 than in 1984. These changes remained significant when demographic characteristics were controlled by logistic regression. The findings held for Whites only; there were no significant trends for Blacks or Hispanics. CONCLUSIONS: While there has been a downward turn in alcohol use in the United States, the correlates of alcohol use have not changed. How these shifts affect alcohol-related problems is an important area for future research.

Adolescent↗
PubMed1992

Phenotypic characteristics and DNA relatedness in Prevotella intermedia and similar organisms.

We have recently isolated from the gingival pockets, periapical lesions and saliva some anaerobic gram-negative, black-pigmented rods. Many of these isolates exhibited phenotypic characteristics similar to Prevotella intermedia (Bacteroides intermedius). However, several of these isolates, although resembling P. intermedia in most of the phenotypic expressions, were capable of fermenting lactose, a biochemical characteristic atypical of P. intermedia. These atypical clinical isolates (strains capable of fermenting lactose) and isolates exhibiting more typical phenotypic characteristics (i.e., lactose nonfermenting) were definitively identified as P. intermedia by DNA-DNA hybridization using a photoprobe biotin method. Quantitative hybridization of clinical isolates with labeled DNA of P. intermedia-type strains (ATCC 25611 and ATCC 33563) showed that almost all the clinical strains isolated from disease sites of adults belonged to the ATCC 25611 group, whereas strains isolated from the saliva of children belonged to the ATCC 33563 group. These data, together with the phenotypic characterization of the isolates, suggested that P. intermedia is a heterogeneous species both phenotypically and genetically.

Bacteroides↗
PubMed1992

Predictive power of various models for longitudinal attachment level change.

Several statistical models that have been suggested in the periodontal literature for describing longitudinal attachment level changes, such as the gradual loss, single-burst, multiple-burst, and random walk models as well as other models introduced in this paper are compared by their power to predict future attachment loss. The data used in this analysis is from 1061 sites of 8 subjects, with moderate to severe periodontal disease, monitored monthly for about a year. This study found that none of the suggested models could significantly outperform the naïve mean predictor, which predicts the future attachment level from the past mean. It was also found that no single model, such as the burst, gradual, or random walk, together with measurement error can fully explain the variation in the data. These results indicate that in the course of one year, the attachment level change may not follow the same model. Consequently, a model that fits well to past data cannot be accurately extended to the future.

Disease Susceptibility↗
PubMed1992

Reproducibility of an electronic probe in relative attachment level measurements.

4 probing designs have been employed to investigate the reproducibility of the Florida Probe. 3 groups (each composed of 10 subjects) were selected for the study: healthy adults, gingivitis subjects, and periodontitis subjects. The 4 probing designs were as follows: (a) the probe tip was left in the sulcus between successive probings; (b) the probe tip was removed from the gingival margin between probings but the next probing followed immediately; (c) successive whole-mouth probings were interrupted by a 5-min interval and a mouthrinse; (d) there was a 4-week interval between each probing. 3 measurements were taken for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation was found to be around 0.3 mm, which is considerably smaller than that found in most previous studies. The errors associated with the periodontal condition and probing effect were also estimated. The variance components obtained here can be used for determining the sample size in controlled clinical studies.

Adult↗
PubMed1992

The effect of 3 mouthrinses on plaque and gingivitis development.

The aim of this study was to evaluate the effect of 3 mouthrinses, Listerine Antiseptic (thymol), Peridex (chlorhexidine), Perimed (povidone iodine and hydrogen peroxide), and a placebo (water) on the development of dental plaque and gingivitis, when used as the only oral hygiene procedure for 14 days. 71 subjects were entered into a randomized, double-blind study. At the baseline examination, papillary bleeding score (PBS), and plaque index (PI) were registered, after which subjects received supragingival prophylaxis and were assigned to 1 of 4 study cells. Subjects were asked to refrain from all oral hygiene procedures except for the supervised 14-day 2 x daily rinsing with the assigned preparation. At day 14, the same clinical parameters were again registered. Statistical analysis was performed by a one-way analysis of variance (ANOVA) to compare the 4 groups, followed by Duncan's multiple range test to determine specific group differences. At baseline, average PBS and PI scores were similar for all 4 groups. After 14 days, the average PBS for Peridex and Perimed was significantly lower than for Listerine Antiseptic and water. The frequency of interdental units with a PBS greater than 2 was significantly lower for Peridex and Perimed than for Listerine Antiseptic and water. We concluded that both Peridex and Perimed were effective in reducing plaque and gingivitis when used as a 2 x daily mouthrinse by subjects refraining from other oral hygiene procedures. In vitro, a synergistic effect was assumed when inhibition was achieved with Perimed at the same or greater dilution than was achieved with povidone-iodine alone.

Actinomyces viscosus↗
PubMed1992

Isolation and characterization of Actinomyces viscosus mutants defective in binding salivary proline-rich proteins.

Recent studies have provided evidence for human salivary proline-rich proteins (PRPs) serving as potential receptors in the acquired pellicle for Actinomyces viscosus type 1 fimbriae. We report here the isolation of mutants derived from A. viscosus T14V-J1 which are defective in binding to PRPs partially purified from parotid gland saliva. Mutagenesis with ethyl methanesulfonate preceded enrichment for cells nonreactive with PRPs by successive adsorptions with PRP-treated latex beads. Screening was accomplished by random selection of 250 isolated colonies from each of four enrichment cycles and reaction with PRP-treated latex beads in microtiter plates. Two mutants of independent origin were examined for adherence to hydroxyapatite treated with either PRPs, proline-rich glycoproteins, deglycosylated proline-rich glycoproteins, or whole saliva. Additional surface properties that were examined included agglutination with polyclonal antisera to type 1 and type 2 fimbriae, agglutination by a monoclonal antibody to type 1 fimbriae that inhibits adherence of the parent strain to saliva-treated hydroxyapatite, the ability to bind monoclonal antibody to the type 1 fimbrial subunit, and lactose-reversible coaggregation with Streptococcus sanguis 34. Both mutants exhibited reduced binding to hydroxyapatite treated with whole saliva or salivary protein preparations but were still capable of reaction with antiserum to type 1 and type 2 fimbriae. In addition, these mutants possessed the ability to bind monoclonal antibody to the type 1 fimbrial subunit in amounts comparable to the amount bound by the parent strain but were not agglutinated by the adherence-inhibiting monoclonal antibody. When considered with previously published data, these results suggest that an adhesive molecule is probably associated with type 1 fimbriae and allows for the interaction of A. viscosus with constituents in the salivary pellicle.

Actinomyces viscosus↗
PubMed1992

Measuring clinical attachment: reproducibility of relative measurements with an electronic probe.

During the past few years, improvements in detecting longitudinal changes in clinical attachment or alveolar bone density have been introduced. For example, constant-force electronic probes and computer-assisted subtraction analysis of longitudinal radiographs have been reported to be more sensitive and reproducible in detecting changes in clinical attachment or alveolar bone density, respectively. Use of these new technologies requires that sources of measurement error be identified and their contribution quantified. This study investigated the reproducibility of a constant-force electronic probe in a careful clinical setting. Measurements were performed from individually fabricated acrylic stents. Three groups of subjects were selected for the study: 10 adults without oral disease, 10 adults with gingivitis, and 10 adults with moderate periodontitis. Four probing designs were employed to investigate the reproducibility of the probe. In design A, the probe tip was left in the sulcus between successive probings. In design B, the probe tip was removed from the gingival margin between probings but the next probing followed immediately. In design C, successive whole-mouth probings were interrupted by a 5-minute interval and a mouth rinse. In design D there was a 4-week interval between each successive probing. Three measurements were taken at each site for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation ranged from 0.2 to 0.3 mm depending on the periodontal health of the subject. This level of variation is considerably smaller than that found in most previous studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Evaluation of statistical methods for monitoring periodontal disease.

Three methods for detecting the progression of periodontal disease based on the change in attachment level on teeth are compared from a statistical point of view. Regardless of gradual or burst disease progression theories, the regression method is found to be the most efficient way to detect changes. The exact false alarm rate is computed when the decision is based on the maximum regression coefficient at all sites during several visits.

Epithelial Attachment↗
PubMed1991

Malignant cyst of the lateral aspect of the neck: branchial cleft carcinoma or metastasis?

A 58-year-old man had a left jugulodigastric mass, which was found to be cystic by computed tomography, and no evidence of other lesions. Grossly and histologically, the surgical specimen consisted of a thin-walled, fluid-filled cyst lined by squamous epithelium that varied in appearance from benign to invasive squamous cell carcinoma. The findings supported a differential diagnosis of branchial cleft carcinoma (BCCA) versus cystic growth of a lymph node metastasis from an occult malignancy. On this basis, guided biopsies of the upper aerodigestive tract were performed, with strong suspicion of a tonsillar bed lesion. Microscopic examination revealed the primary tumor within tissue excised from the left tonsillar fossa. Comparison of the current case with cases of BCCA and cystic tonsillar metastases from the literature illustrated the potential pitfalls in rendering a diagnosis of BCCA. Recognition of this lesion as a distinctive clinical variant of oropharyngeal carcinoma is warranted.

Branchioma↗
PubMed1991

Immunochemical and functional studies of Actinomyces viscosus T14V type 1 fimbriae with monoclonal and polyclonal antibodies directed against the fimbrial subunit.

Each of five monoclonal antibodies (mAbs) prepared against the type 1 fimbriae of Actinomyces viscosus T14V reacted with a 54 kDa cloned protein previously identified as a fimbrial subunit. This purified protein completely inhibited the reaction of a specific anti-type-1-fimbria rabbit antibody with A. viscosus whole cells. Maximum values for the number of antibody molecules bound per bacterial cell ranged from 7 x 10(3) to 1.2 x 10(4) for the different 125I-labelled mAbs and was approximately 7 x 10(4) for 125I-labelled rabbit IgG or Fab against either type 1 fimbriae or the 54 kDa cloned protein. Although the different mAbs, either individually or as a mixture, failed to inhibit the type-1-fimbria-mediated adherence of A. viscosus T14V to saliva-treated hydroxyapatite, each rabbit antibody gave 50% inhibition of adherence when approximately 5 x 10(4) molecules of IgG were bound per cell. However, binding of each corresponding rabbit Fab had no significant effect on bacterial attachment unless much higher concentrations were used. These findings suggest that antibodies directed solely against the 54 kDa fimbrial subunit do not react with the putative receptor binding sites of A. viscosus T14V type 1 fimbriae. Instead, inhibition of attachment by the polyclonal antibodies may depend on an indirect effect of antibody binding that prevents the fimbria-receptor interaction.

Actinomyces viscosus↗
PubMed1991

Reproducibility of attachment level measurements with two models of the Florida Probe.

Clinical assessment of the progression of periodontitis is based on the measurement of periodontal probing attachment levels over time. In calculating these changes, duplicate measurements from fixed reference points, including cemento-enamel junctions and acrylic stents, have been used to assist in detecting progressive disease. The Florida Probe has been previously shown to improve the reproducibility of these measurements when used with an acrylic stent. The objective of the present study was to evaluate the reproducibility of 2 models of the Florida Probe, the original stent model and the modified disk model, in measuring attachment level. The disk probe differs from the stent probe in that it uses the occlusal surface of the tooth as a static reference point in calculating changes in attachment level measurements. In 10 subjects, sites were probed 2 x by 2 examiners using both types of probe. Standard deviations and intra- and inter-examiner correlations were calculated. These results demonstrate that the new disk probe yields reproducible measurements similar to the stent probe and is therefore suitable for use in longitudinal clinical studies.

Equipment Design↗