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Biomedical subjects

W Carr

Publications and source records attributed to W Carr.

17 recordsLinked to original sources
PubMed2005

Prevalence of Helicobacter pylori in United States Navy submarine crews.

Helicobacter pylori prevalence is elevated in German submarine crews and in United States Navy (USN) surface fleet personnel, but H. pylori prevalence in USN submariners was unknown. The goal of the study was to determine the prevalence of H. pylori in the crews of USN nuclear submarines compared to other military personnel and to the general US population. The presence of H. pylori IgG antibodies was determined in serum samples using a commercial ELISA. Only 47 out of 451 submariners (9.4%) were H. pylori positive, which is similar to that of the US general population with a similar level of education. In contrast, H. pylori prevalence is significantly higher in US Army recruits (26%), USN surface fleet personnel (25%), and German diesel submariners (38%). These data demonstrate that submarine service (and by inference activity requiring isolation and close contact, per se) is not a risk factor for H. pylori infection.

Adolescent↗
PubMed2002

Collaboration Between Athletic Training Clinical and Classroom Instructors.

OBJECTIVE: The education of an athletic training student involves a balance between theory and application, which can be stated as a balance between classroom and clinical education. The instructors in these settings should work together to promote the overall educational process. Our primary purpose was to measure the observations and perceptions of physical presence, cooperation, and communication between clinical and classroom instructors and secondarily to determine if these have a perceived effect on the education of the student. SUBJECTS: Clinical instructors, classroom instructors, and athletic training students in Commission on Accreditation of Allied Health Education Programs-accredited and National Athletic Trainers' Association-approved athletic training education programs. MEASUREMENTS: Data were analyzed using various correlation techniques, a general linear model, and a one-way analysis of variance. DESIGN AND SETTING: We designed a questionnaire to measure the observations and perceptions of physical presence, cooperation, and communication between the clinical and classroom instructors. RESULTS: Of the 30 athletic training educational programs solicited for involvement in this study, 19 responded (63%). A total of 737 questionnaires were distributed, and 547 were returned (74%). Classroom instructors rated observations of cooperation between clinical and classroom instructors at a significantly higher frequency than did clinical instructors. Students rated observations of communication at a significantly lower frequency than did the clinical and classroom instructors. All 3 groups agreed that the physical presence, cooperation, and communication between the clinical and classroom instructors has a large effect upon the education of the student. CONCLUSIONS: Clinical instructors must be educators as well as care providers. At the same time, classroom instructors must make efforts to include clinical instructors in all aspects of the educational process. Also, athletic training students should be exposed to the inner workings of their educational programs, so they may have a better understanding and appreciation of how theory and application tie together.

Journal Article↗
PubMed2001

Comparison of once- and twice-daily clarithromycin in the treatment of adults with severe acute lower respiratory tract infections.

BACKGROUND: Although the modified-release (MR) formulation of clarithromycin has demonstrated bioequivalence to the immediate-release (IR) formulation and thus can be prescribed for lower respiratory tract infections (LRTIs), a MEDLINE search from 1995 through 1998 and information on file with the manufacturer indicate that no data are available on the effectiveness of this new formulation in the treatment of severe LRTIs such as community-acquired pneumonia. OBJECTIVE: This study was designed to compare clinical success rates (percentage of patients with clinical cure or improvement) with once- and twice-daily regimens of clarithromycin in the treatment of patients with severe, acute LRTIs requiring oral antibiotic therapy. METHODS: In this multicenter, investigator-blinded, randomized, parallel-group study, adult patients with clinical evidence suggesting severe, acute LRTI were recruited from 22 general practices in the United Kingdom. Patients were randomly allocated to receive either clarithromycin 500 mg BID (IR tablets) or clarithromycin 1 g OD (two 500-mg MR tablets) for 7 to 14 days. The outcome measures were resolution of or improvement in clinical signs and symptoms (including resolution of cough), unscheduled visits for the same symptom, days to resumption of normal activities, and improvements in quality of life (assessed using the EQ-5D version of the EuroQoL questionnaire). Clinical, microbiologic, and serologic assessments were performed before, during, and after treatment. Efficacy and safety data were analyzed on an intent-to-treat basis. RESULTS: One hundred sixty men (n = 83) and women (n = 77) between the ages of 19 and 88 years took part in the study, 78 receiving clarithromycin 500 mg BID and 82 receiving clarithromycin 1 g OD. At 4 weeks after the start of treatment, the high clinical success rates were comparable between groups: 84.6% with clarithromycin 500 mg BID and 90.2% with clarithromycin 1 g OD. No significant differences in outcome measures were noted between the 2 regimens. Both treatments were well tolerated, with taste disturbance being the most commonly reported adverse event (10.6% vs 6.1% with clarithromycin 500 mg BID and 1 g OD, respectively). CONCLUSIONS: The 2 clarithromycin regimens were equally efficacious and well tolerated in the treatment of severe, acute LRTIs. However, caution should be exercised in applying these results to the general population, because the study excluded certain categories of patients who would normally be treated. In addition, the small sample size may have obscured clinically significant differences between the 2 regimens.

Administration, Oral↗
PubMed1998

Mental representations of large and small spatial layouts are orientation dependent.

Previous research on spatial memory indicated that memories of small layouts were orientation dependent (orientation specific) but that memories of large layouts were orientation independent (orientation free). Two experiments investigated the relation between layout size and orientation dependency. Participants learned a small or a large 4-point path (Experiment 1) or a large display of objects (Experiment 2) and then made judgments of relative direction from imagined headings that were either the same as or different from the single studied orientation. Judgments were faster and more accurate when the imagined heading was the same as the studied orientation (i.e., aligned) than when the imagined heading differed from the studied orientation (i.e., misaligned). This alignment effect was present for both small and large layouts. These results indicate that location is encoded in an orientation-dependent manner regardless of layout size.

Female↗
PubMed1992

Variations in asthma hospitalizations and deaths in New York City.

BACKGROUND: Recent reports have identified New York City as having asthma mortality rates that are substantially higher than expected based on US rates. This study investigates the problems of asthma morbidity and mortality in New York City. METHODS: Data on asthma hospitalizations (1982 to 1986) and deaths (1982 to 1987) among persons aged 0 to 34 years were studied. Descriptive and multivariate techniques were used to examine differences in rates among subgroups and across geographic areas. RESULTS: The average annual hospitalization rate was 39.2 per 10,000; the mortality rate was 1.2 per 100,000. Hospitalization and death rates among Blacks and Hispanics were 3 to 5.5 times those of Whites. Large geographic variations in hospitalizations and mortality occurred. Asthma hospitalization and mortality rates were highly correlated (r = .67), with the highest rates concentrated in the city's poorest neighborhoods. Household income, percentage of population Black, and percentage of population Hispanic were significant predictors of area hospitalization rates (adjusted R2 = .75). CONCLUSION: These findings provide a basis for focusing investigations of the causes of variations in asthma outcomes and targeting interventions to reduce the disproportionate morbidity and mortality borne by poor and minority populations.

Abstracting and Indexing↗
PubMed1989

Sentinel health events as indicators of unmet needs.

It is vitally important to be able to assess the impact of the health care system on the populations it serves. This paper explores whether sentinel health events--negative health states, such as death, disability, and disease, that might have been avoided given current medical and public health knowledge and technology--can be used as sociomedical indicators to assess levels of unmet needs and to evaluate health system performance. Using hospital discharge data, the occurrence of sentinel health events in New York State and differences among population subgroups are examined. Among hospitalized residents of New York State in 1983, more than 17,000 deaths occurred that were possibly avoidable. More than 336,000 instances of disease were found that were potentially preventable. Significantly higher rates and ratios for many sentinel events were found among blacks, Medicaid recipients, and users of public hospitals than were found for comparison groups. The sentinel events approach proved to be useful and practical. However, refinements and adaptations of the sentinel events method are needed, including the development of one or more smaller sets of indicators--tracer sentinel events--that can be used to profile aspects of health status and the health system.

Black or African American↗
PubMed1988

Measuring avoidable deaths and diseases in New York State.

The measurement of sentinel health events--avoidable deaths and diseases--is a practical and valuable method for assessing the state of the community's health and the performance of the health system in meeting the needs of the population. A comprehensive framework for identification of sentinel health events has been defined by the Working Group on Preventable and Manageable Diseases. The Working Group developed lists that include more than 120 medical conditions for which death or disease is deemed to be potentially avoidable through primary prevention activities or timely and appropriate treatment. Hospital discharge abstract data offer a unique perspective for examining these potentially avoidable negative health outcomes. Such data, available in New York State through the Statewide Planning and Research Cooperative System (SPARCS), are a source of detailed and accessible information on a wide range of morbidity-producing conditions and associated deaths. Among the findings of this sentinel health events study, based on an analysis of SPARCS data, are the following: Among hospitalized residents of New York State in 1983, more than 19,000 deaths occurred that were potentially avoidable. More than one-third of these deaths occurred among persons under age 65. More than 336,000 instances of disease were found that were potentially preventable, amounting to 123 disease occurrences per 1,000 discharges. In the category of sentinel events where each event may be avoidable, only three conditions alone were associated with 75 percent of the deaths and 60 percent of the disease occurrences--malignant neoplasm of the trachea, bronchus, and lung; emphysema or chronic obstructive lung disease(s); and malignant neoplasm of the bladder. In the category of events where some proportion of events may be avoidable, one diagnosis--vascular complications associated with hypertensive disease(s)--was linked with 45 percent of the deaths. Significantly higher rates and ratios for many sentinel events were found among blacks, Medicaid recipients, and users of public hospitals than were found for comparison groups. For example, among patients hospitalized for colon and related neoplasms, black patients were more than twice as likely to die than white patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed1985

Health expenditures in New York City, 1983.

HIGHLIGHTS OF THE STUDY. Health expenditures in New York City totalled roughly $15.7 billion in 1983. Those expenditures represented 13.5 percent of the gross city product. Expenditures for personal health care services amounted to more than $1,900 per city resident. Despite comparatively high levels of health expenditures in New York City, such expenditures have risen much less dramatically over time than health expenditures nationally; from 1976 to 1983, city expenditures increased by 74.6 percent, compared with a national increase of 137.7 percent. More than one half (55.3%) of health expenditures in the city were accounted for by public funds. Nearly 50 percent of personal care expenditures were associated with the delivery of hospital services, for which expenditures totalled $6.9 billion. Fifty-five percent of Medicaid hospital outlays and 86 percent of Medicare hospital outlays went to private sector hospitals. More than $400 per capita was spent on physicians' services in New York City in 1983. Public sources of funds accounted for more than 80 percent of the $1.7 billion in long term care services expenditures; this contrasts with a much smaller proportion of public funding for such services nationally. More details on health expenditures in New York City follow. Data sources, definitions, study methods, and limitations are described in an appendix to this report.

Data Collection↗
PubMed1976

Unmet needs as sociomedical indicators.

This paper discusses the Meharry Medical College Study of Unmet Needs designed to measure the effectiveness of alternative health care delivery systems: (a) comprehensive care with broad outreach, (b) comprehensive care with limited outreach, and (c) traditional care. Unmet needs are defined as the differences between services judged necessary to deal appropriately with health problems and services actually received. The central hypothesis is that comprehensive health programs will be more effective than traditional care in reducing unmet needs. Unmet needs are viewed as measures of program outcome and are one of several types of sociomedical indicators which use factors other than biomedical or biological states as measures of outcome. The distinction is made between unmet needs are discussed and the relatively limited focus of these is contrasted with the more comprehensive Meharry approach. Household interviews and clinical examinations provide the data base for deriving professional judgements of unmet needs in the medical, dental, nursing, and social services areas. The Meharry work suggests several areas in which further work on unmet needs would be useful.

Comprehensive Health Care↗
PubMed1966

Hemodynamic response to exercise after beta-adrenergic blockade with propranolol in patients with mitral valve obstruction.

Propranolol (P) .13 mg./kg. was given to seven patients with mitral valve obstruction the changes in resting and exercise hemodynamics were followed by means of combined right and left heart catheterization. Changes were variable. At rest there was a decrease in heart rate of 10 beats/min. with no consistent change in stroke volume, cardiac output, left ventricular systolic (LVS) or left atrial (LA) pressure after P. Mean left ventricular end-diastolic (LVED) pressure was increased 3 mm., mean pulmonary artery (PA) pressure was increased 4 mm., and mean mitral valve gradient was reduced 3 mm. Hg by P. During exercise, mean LVS pressure was decreased 31 mm., mean LVED pressure increased 3 mm., mean LA pressure decreased 3 mm., and mean mitral valve gradient was reduced 5 mm. Hg after P. Mean exercise PA pressure was unchanged, cardiac output was reduced 0.9 1./min., and mean heart rate was reduced 37 beats/min., while stroke volume increased 3 ml./beat after P. Exercise pulmonary vascular resistance was increased from 6.1 to 8.2 units by P. Despite a slower heart rate, the diastolic filling period was not increased. P has no place in the treatment of the majority of patients with mitral stenosis because it further reduces cardiac performance below normal.

1-Propanol↗