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PubMed1993

Progesterone receptor expression in meningiomas.

The possibility that the female sex steroid progesterone plays a role in meningioma proliferation has been suggested by a number of investigators; and it had been shown that many meningiomas have high affinity progesterone binding sites. The aim of this study was to examine the expression of progesterone receptor mRNA and correlate it with the nuclear localization of progesterone receptor by immunocytochemistry in a large number of meningiomas. Thirty-three meningiomas were examined for the presence of measurable amounts of progesterone receptor mRNA by Northern blot analysis and 11 of these were analyzed for receptor protein by immunohistochemistry. These were compared with normal arachnoid and an arachnoid cell line. Sixty-four % of the meningiomas expressed progesterone receptor mRNA. This occurred in a similar pattern to what has previously been shown for T-47 D cells, a breast carcinoma cell line with 11.4-, 6.1-, 5.2-, 4.5-, 3.2-, and 2.5-kilobase mRNA species. This suggests that progesterone receptor expression is not tumor specific. There was a marked predominance of women among those patients whose tumors expressed progesterone receptor; 81% were female and 19% were male. The immunohistochemistry data correlate well with the Northern blot analysis. The staining was clearly nuclear, suggesting that the receptor is in a location to be activated. These data suggest that progesterone receptor mRNA and protein is expressed in meningiomas and support the concept that progesterone may play an important role in meningioma growth.

Adult↗

PubMed2006

Poor correlation of supratherapeutic international normalised ratio and vitamin K-dependent procoagulant factor levels during warfarin therapy.

Patients with a supratherapeutic international normalised ratio (ST-INR) are at risk for bleeding. ST-INR is corrected by withholding warfarin therapy and often by supplementing vitamin K or providing vitamin K-dependent factors; the exact therapeutic decision is based on the extent of the prolonged INR. Currently, ST-INRs are frequently observed in clinical practice due to the use of sensitive recombinant tissue thromboplastin reagents and automation. However, there are scant data correlating an ST-INR with various vitamin K-dependent factors. This prospective cohort study, set in a large tertiary care teaching hospital for the University of Texas Southwestern Medical Center at Dallas, defined the relationship between ST-INR (>5.0) and measured vitamin K-dependent procoagulant factors. Prothrombin time, INR and vitamin K-dependent factors II, VII, IX and X were measured in 78 patients with an INR > 5.0 (ST-INR) who were on warfarin therapy for more than 2 months. There was no significant relationship between the ST-INR and levels of important vitamin K-dependent factors II and X. These data support the recent guidelines that the management of an INR > 5.0 should be driven by the clinical determinants rather than specific INR values per se.

Adult↗

PubMedDate not supplied

Background levels of bromide in human blood.

A total of 183 random, whole-blood specimens was collected from healthy individuals within the State of Queensland (Australia), and the bromide concentration was determined by wavelength-dispersive X-ray fluorescence spectrometry (WDXRF). The intensity of the tube Compton scatter line was used to account for differences in matrices between the aqueous calibration standard and whole-blood specimens. Technical details of the WDXRF method are included in the experimental section of the paper. The overall mean for bromide in human blood was 5.3 +/- 1.4 mg/L and ranged from 2.5 to 11.7 mg/L. Associations between bromide levels and variables including age, gender, weight, height, and postcode address were examined by ANOVA and Pearson's correlation. Data indicate that aged persons (45-65+ years) are more likely to have higher bromide levels than younger persons (15-25 years). Our results also suggest differences in bromide levels between the sexes in similar age groups. Average levels were higher in females in most age groups. The reason for this difference requires further detailed investigation. No correlation was observed between bromide levels and height or weight of donors. No significant differences in bromide levels were found in persons living in the highly populated southeast region of Queensland compared with those living in the less urbanized northern parts of the state.

Adolescent↗

PubMed2000

Nonparametric rank-based methods for group sequential monitoring of paired censored survival data.

This research gives methods for nonparametric sequential monitoring of paired censored survival data in the two-sample problem using paired weighted log-rank statistics with adjustments for dependence in survival and censoring outcomes. The joint asymptotic closed-form distribution of these sequentially monitored statistics has a dependent increments structure. Simulations validating operating characteristics of the proposed methods highlight power and size consequences of ignoring even mildly correlated data. A motivating example is presented via the Early Treatment Diabetic Retinopathy Study.

Biometry↗

PubMed2003

Convergent validity of the MCMI-III personality disorder scales and the MMPI-2 scales.

The MCMI-III personality disorder scales (Millon, 1994) were empirically validated in a sample of prisoners, psychiatric inpatients, and outpatients (N = 477). The scale intercorrelations were congruent with those obtained by Millon, Davis, and Millon (1997). We conclude that our Flemish/Dutch version shows no significant differences with the original version of the MCMI-III as far as intercorrelations are concerned. Convergent validity of the MCMI-III personality disorder scales was evaluated by the correlational data between the MCMI-III personality disorder scales and the MMPI-2 clinical (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) and personality disorder (Somwaru & Ben-Porath, 1995) scales. Improved convergence was obtained compared with previous versions of the MCMI-I. Only the compulsive MCMI-III personality disorder scale remains problematic. The scale even showed negative correlations with some of the related clinical scales and with the corresponding personality disorder scales of the MMPI-2.

Adolescent↗

PubMed2004

Validity of dietary restraint among 5- to 9-year old girls.

Dietary restraint is defined as the cognitive tendency to restrict intake and is often accompanied by the breakdown of restraint, referred to as disinhibition, leading to overeating and overweight in adults. Given recent evidence suggesting that dietary restraint and disinhibition are emerging as early as middle childhood, this study examined the validity of the restraint construct as measured in girls between the ages of 5 and 9. Dietary restraint was assessed longitudinally by questionnaire and validity was established by correlating restraint with measures previously reported to be related to restraint including weight concerns, body esteem, self-reported dieting, and measures of dietary intake when girls were ages 5, 7, and 9. Participants were 153 girls from predominately middle class, and exclusively non-Hispanic white families living in central Pennsylvania. Correlational data were used to assess relationships between dietary restraint and weight concerns, body esteem, dietary intake, and dieting. Results from this study indicate that there is evidence for the validity of the dietary restraint construct among girls by age 9. Specifically, dietary restraint was highly and positively associated with body mass index, weight concerns and body dissatisfaction and negatively correlated with dietary intake, findings similar to those reported in the adult literature.

Body Image↗

PubMedDate not supplied

Vitreous base classification of retinal tears: clinical application.

The abundant data about retinal tears has shown that they are prevalent in the general population and that the vast majority of retinal tears do not lead to retinal detachment. What remains to be clarified are the criteria for identifying the few retinal breaks which require prophylactic surgery to prevent their progression to retinal detachment. Numerous reports have identified clinical features which correlate with the risk the retinal detachment. These correlative data offer at best only a suggestion about the need for treatment of any specific retinal break. This paper-demonstrates how the categorization of a retinal tear on the basis of vitreoretinal anatomic detail may be used clinically to make an objective and nonstatistical judgment about the prognosis of any specific retinal break. The application of this new categorization offers an advance in the care of patients with retinal tears.

Cataract Extraction↗

PubMed2006

Carbonate effects and pH-dependence of uranium sorption onto bacteriogenic iron oxides: kinetic and equilibrium studies.

The removal of U(VI) from groundwaters by adsorption onto bacteriogenic iron oxides (BIOS) has been investigated under batch mode. The adsorbent dosage, the uranium concentration, the concentration of carbonate and the use of a real groundwater spiked with uranium comprised the examined parameters. In addition, the effect of pH was examined in two different water matrixes, i.e., in distilled water and in real groundwater. Equilibrium studies were carried out to determine the maximum adsorption capacity of BIOS and the data correlated well with the Langmuir and Freundlich models. The presence of carbonate affected adversely the adsorption of U(VI) onto BIOS. The maximum adsorption capacity of BIOS was 9.25 mg g(-1) at 0.1mM carbonate concentration and decreased to 6.93 mg g(-1) at 0.5mM carbonate concentration, whereas at carbonate concentration of 2mM practically no adsorption occurred. The data were further analyzed using the pseudo-second order kinetic equation, which fitted best the experimental results. The initial adsorption rate (h) was found to increase with decreasing the concentration of carbonate in all cases. When experiments were accomplished in the absence of carbonate, the pH values did not have an effect on the adsorption of U(VI). However, the extent of U(VI) adsorption was strongly pH-dependent when the experiments were carried out in the real groundwater. The maximum adsorption capacity increased sharply as the pH decreased and optimum removal was obtained in the pH range 3.2-4.0, thus bacteriogenic iron oxides can found application in the removal of U(VI) by adsorption from low pH or low carbonate waters.

Adsorption↗

PubMedDate not supplied

Ambient atmospheric particles in the airways of human lungs.

Epidemiologic studies linking particulate matter (PM) air pollution and adverse respiratory and cardiovascular effects have focused attention on the interactions of PM and lung cells. Information on the types, numbers, composition, sizes, and distribution of ambient particles in the airways is potentially useful for correlations with pathological and/or physiological changes, but relatively little is known about the extent to which ambient particles actually enter airway epithelial cells and are retained in airway walls and even less information is available about correlations with pathologic changes. Since many ambient particles are colorless and/or well below the level of resolution of light microscopy, definitive evaluation of particle burden in the airway wall requires analytical electron microscopy. Studies from the authors' laboratory suggest that in Vancouver, a city with relatively low PM levels, particle loads in the airway mucosa are nonetheless numerically substantial, typically in the range of 10(7) particles/g dry tissue. In most individuals particle concentrations in the larger airways show a clear increase in concentration with increasing airway generation (smaller airway diameter) as expected from deposition models; however, smoking disrupts this pattern in some subjects. Respiratory bronchioles accumulate particularly high particle loads, typically 25-100 times the concentrations seen in the mainstem bronchus. Similarly high concentrations are found in the large airway carinas, suggesting that these locations are likely sites for particle toxicity. The majority of particles in the airways in Vancouver lungs appear to be crustal in origin, with particular accumulation of silica in the airways compared to the parenchyma. Ultrafine particles, which have been postulated to be important in PM toxicity, are present in small numbers as singlet particles and are largely metals, perhaps representing combustion products, but carbonaceous chain aggregates are rarely found. Mean particle aerodynamic diameters vary from about 0.3 to 0.6 microm in different parts of the airways and, overall, the airways retain PM2.5 rather than PM10, a finding supporting the observation that, in some studies, adverse health effects appear to correlate better with PM2.5 than with PM10 concentrations. Preliminary examination of lungs of subjects from Mexico City, a location with relatively high ambient particle concentrations, indicates that the airway mucosa retains relatively large numbers of carbonaceous chain aggregates of ultrafine particles that appear to be combustion products and that presumably produce the numerous adverse effects documented for such products. Limited published data correlating visible particle load and airway mucus secretion, inflammation, and mural fibrosis suggest that high levels of air pollutant particles can induce chronic fibrotic responses in the airways, a phenomenon that might be linked to chronic airflow obstruction; this observation needs confirmation as well as correlation with specific types of particles.

Air Pollutants↗

PubMed2002

Modifiable cardiovascular risk factors in adults with diabetes: prevalence and missed opportunities for physician counseling.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in adults with diabetes mellitus (DM). Counseling by physicians is effective in inducing lifestyle modification. OBJECTIVE: To determine the prevalence of modifiable CVD risk factors and counseling by physicians among adults with DM. METHODS: Data on 9496 adults with DM and 150 493 adults without DM from the 1999 Behavioral Risk Factor Surveillance System were analyzed to yield estimates of CVD risk factors and counseling by physicians during routine visits. Multiple logistic regression was used to adjust estimates for age, sex, ethnicity, education, and income. Population estimates were created using software for the statistical analysis of correlated data (SUDAAN) because of the complex survey design of the Behavioral Risk Factor Surveillance System. RESULTS: Diabetes mellitus was more prevalent in adults aged 55 and older and in blacks and Hispanic or other ethnicities (both P<.001). Modifiable CVD risk factors, such as hypertension (56% vs 22%), high cholesterol (41% vs 20%), obesity (78% vs 57%), and insufficient physical activity (66% vs 56%), were more prevalent in adults with DM (all P<.001) and differed by ethnicity, sex, and age. Counseling about weight loss (50% vs 21%, P<.001), smoking cessation (78% vs 67%, P =.01), eating less fat (78% vs 71%, P<.001), and increasing physical activity (67% vs 36%, P<.001) was less than ideal in both groups and did not change after adjusting for age, sex, ethnicity, education, and income with multiple logistic regression. CONCLUSIONS: Although adults with DM have a high prevalence of modifiable CVD risk factors, counseling by physicians about lifestyle modification is less than optimal. There is a need to improve patient counseling for lifestyle modification by primary care physicians.

Adult↗

PubMed2006

Customer satisfaction with patient care: "Where's the Beef?".

STUDY OBJECTIVE: This was an attempt to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical practice. Hopefully this information will be synthesized to generate a cogent approach to correlate customer service with quality. METHODS: Articles were obtained by an English language search of MEDLINE from January 1976 to July 2005. This computerized search was supplemented with literature from the author's personal collection of peer reviewed articles on customer service in a medical setting. This information was presented in a qualitative fashion. RESULTS: There is a significant lack of objective data correlating customer service objectives, patient satisfaction, and quality of care. Patients present predominantly for the convenience of emergency department care. Specifics of satisfaction are directed to the timing, and amount of "caring." Demographic correlates including symptom presentation, practice style, location, and physician issues directly impact on satisfaction. It is most helpful to develop a productive plan for the "difficult patient" emphasizing communication and empathy. CONCLUSION: The current emergency medicine customer service dilemmas are a complex interaction of both patient and physician factors specifically targeting both efficiency and patient satisfaction. Awareness of these issues can help to maximize efficiency, minimize subsequent medicolegal risk and improve patient care.

Benchmarking↗

PubMed1994

Lipoprotein(a) concentrations in cord and capillary blood from newborns and in serum from in-patient children, adolescents and adults.

Investigations have been made upon the distribution of lipoprotein(a) concentrations in cord and capillary blood from newborns and in serum from in-patient children and adults. Full-term neonates (n = 123), children aged 1 month to 16 years (n = 331) and adults aged between 17 and 88 years (n = 252) of age were included in the study. Lipoprotein(a) was determined using an immunoluminometric assay and a single lot of reagents. The assay had an effective measuring range of 1-800 mg/l. Lipoprotein(a) could be measured either in cord or capillary blood in the majority of cases. Problems arose in isolated cases, in each of which there was a large concentration difference in lipoprotein(a) between mother and child. The correlation data was: r = 0.897, n = 37, log (capillary blood) = 0.874 log (cord blood) + 0.165. The median lipoprotein(a) concentrations in cord and capillary blood were 13.9 and 10.2 mg/l respectively. Median lipoprotein(a) concentrations increased from birth up until the 6th decade (159 mg/l), decreasing to 95 mg/l during the 9th decade of life. In mature newborns, the median lipoprotein(a) concentrations correlated with gestational age. The distribution of lipoprotein(a) concentrations in serum is skewed throughout life, the ratio mean/median being 2.07 at birth, 2.71 in children and 2.72 in adults. The percentage of children with lipoprotein(a) concentrations above 250 mg/l was 23.0 (male) and 23.8 (female). The corresponding figures for adults was 38.2 for males and 28.2 for females respectively. In the group of newborns 27.7 percent had concentrations above 25 mg/l.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2006

Customer satisfaction.

PURPOSE: This paper seeks to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical practice. Hopefully, this information will be synthesized to generate a cogent approach to correlate customer service with quality. DESIGN/METHODOLOGY/APPROACH: Articles were obtained by an English language search of MEDLINE from January 1976 to July 2005. This computerized search was supplemented with literature from the author's personal collection of peer-reviewed articles on customer service in a medical setting. This information was presented in a qualitative fashion. FINDINGS: There is a significant lack of objective data correlating customer service objectives, patient satisfaction and quality of care. Patients present predominantly for the convenience of emergency department care. Specifics of satisfaction are directed to the timing, and amount of "caring". Demographic correlates including symptom presentation, practice style, location and physician issues directly impact on satisfaction. It is most helpful to develop a productive plan for the "difficult patient", emphasizing communication and empathy. Profiling of the customer satisfaction experience is best accomplished by examining the specifics of satisfaction, nature of the ED patient, demographic profile, symptom presentation and physician interventions emphasizing communication--especially with the difficult patient. ORIGINALITY/VALUE: The current emergency medicine customer service dilemmas are a complex interaction of both patient and physician factors specifically targeting both efficiency and patient satisfaction. Awareness of these issues particular to the emergency patient can help to maximize efficiency, minimize subsequent medicolegal risk and improve patient care if a tailored management plan is formulated.

Communication↗

PubMed2002

Partly folded states of members of the lysozyme/lactalbumin superfamily: a comparative study by circular dichroism spectroscopy and limited proteolysis.

The partly folded states of protein members of the lysozyme (LYS)/alpha-lactalbumin (LA) superfamily have been analyzed by circular dichroism (CD) measurements and limited proteolysis experiments. Hen, horse, dog, and pigeon LYSs and bovine LA were used in the present study. These are related proteins of 123- to 129-amino-acid residues with similar three-dimensional structures but low similarity in amino acid sequences. Moreover, notable differences among them reside in their calcium-binding properties and capability to adopt partly folded states or molten globules in acid solution (A-state) or on depletion of calcium at neutral pH (apo-state). Far- and near-UV CD measurements revealed that although the structures of hen and dog LYS are rather stable in acid at pH 2.0 or at neutral pH in the absence of calcium, conformational transitions to various extents occur with all other LYS/LA proteins herewith investigated. The most significant perturbation of tertiary structure in acid was observed with bovine LA and LYS from horse milk and pigeon egg-white. Pepsin and proteinase K were used as proteolytic probes, because these proteases show broad substrate specificity, and therefore, their sites of proteolysis are dictated not by the specific amino acid sequence of the protein substrate but by its overall structure and dynamics. Although hen LYS at pH 2.0 was fully resistant to proteolysis by pepsin, the other members of the LYS/LA superfamily were cleaved at different rates at few sites of the polypeptide chain and thus producing rather large protein fragments. The apo-form of bovine LA, horse LYS, and pigeon LYS were attacked by proteinase K at pH 8.3, whereas dog and hen LYSs were resistant to proteolysis when reacted under identical experimental conditions. Briefly, it has been found that the proteolysis data correlate well with the extent of conformational transitions inferred from CD spectra and with existing structural informations regarding the proteins herewith investigated, mainly derived from NMR and hydrogen exchange measurements. The sites of initial proteolytic cleavages in the LYS variants occur at the level of the beta-subdomain (approximately chain region 34-57), in analogy to those observed with bovine LA. Proteolysis data are in agreement with the current view that the molten globule of the LYS/LA proteins is characterized by a structured alpha-domain and a largely disrupted beta-subdomain. Our results underscore the utility of the limited proteolysis approach for analyzing structure and dynamics of proteins, even if adopting an ensemble of dynamic states as in the molten globule.

Amino Acid Motifs↗

PubMedDate not supplied

Getting the most out of advertising and promotion.

Until recently, believing in the effectiveness of advertising and promotion was largely a matter of faith. Despite all the data collected by marketing departments, none measured what was really important: the incremental sales of a product over and above those that would happen without the advertising and promotion. Thanks to a qualitatively new kind of marketing data, that situation is changing. "Single source" data correlate information on actual consumer purchases (available from universal-product-code scanners used in supermarkets and drug-stores) with information on the corresponding television advertising those consumers receive or on the promotion events they see. This allows managers to measure the incremental impact of advertising and promotion and to improve marketing productivity. To take advantage of the new single-source data, however, managers have to throw out much of the conventional wisdom about advertising and promotion that has grown up over the years. They must learn how to evaluate marketing differently by continually examining the appropriate balance between advertising and promotion. They must also train their sales force to do a different and extremely important job: to demonstrate to retailers the consumer pull of the company's advertising and promotion programs, as well as the effect of these programs on retailer profitability.

Advertising↗

PubMed1995

Models of comorbidity for multifactorial disorders.

We develop several formal models for comorbidity between multifactorial disorders. Based on the work of D. N. Klein and L. P. Riso, the models include (i) alternate forms, where the two disorders have the same underlying continuum of liability; (ii) random multiformity, in which affection status on one disorder abruptly increases risk for the second; (iii) extreme multiformity, where only extreme cases have an abruptly increased risk for the second disorder; (iv) three independent disorders, in which excess comorbid cases are due to a separate, third disorder; (v) correlated liabilities, where the risk factors for the two disorders correlate; and (vi) direct causal models, where the liability for one disorder is a cause of the other disorder. These models are used to make quantitative predictions about the relative proportions of pairs of relatives who are classified according to whether each relative has neither disorder, disorder A but not B, disorder B but not A, or both A and B. For illustration, we analyze data on major depression (MD) and generalized anxiety disorder (GAD) assessed in adult female MZ and DZ twins, which enable estimation of the relative impact of genetic and environmental factors. Several models are rejected--that comorbid cases are due to chance; multiformity of GAD; a third independent disorder; and GAD being a cause of MD. Of the models that fit the data, correlated liabilities, MD causes GAD, and reciprocal causation seem best. MD appears to be a source of liability for GAD. Possible extensions to the models are discussed.

Adult↗

PubMed2006

Measuring and evaluating interferon beta-induced antibodies in patients with multiple sclerosis.

Administration of interferons (IFNs) may induce antibodies that interfere with therapeutic efficacy. We have optimized and validated methods for large-scale economic screening. Sera from patients with relapsing-remitting multiple sclerosis (MS) were investigated for binding antibody (BAb) by protein-G affinity-chromatography radioimmunoassay and a commercially available enzyme immunoassay (EIA). Neutralizing antibody (NAb) was investigated by cytopathic effect assays (CEA) using both fixed amount and serially diluted sera. BAb correlated with log10-transformed titres obtained by EIA (r=0.70, P<0.0001); the latter, however, failed to demonstrate low-level BAb. Comparison of clinical significance of NAb-positivity measured by biological assays with different sensitivities demonstrated an optimal odds ratio for relapse rate using 10 laboratory units (LU)/mL. Purification of IgG prior to CEA removed toxicity from toxic sera. The neutralizing capacity data correlated linearly with logl0-transformed titres obtained by a Kawade 10-to-1 LU/mL CEA (r=0.77, P<0.0001). In conclusion, neutralizing capacity CEA utilizing a fixed amount of serum predicts differences in relapse rates in IFNbeta-treated MS patients and correlates with NAb titres of the 10-to-1 LU/mL CEA. Neutralizing capacity CEA is less laborious and more economical than titre-based NAb assays and suitable for large-scale screenings of MS patients.

Antibodies↗

PubMed1990

Electron backscattering. Implication to electron dosimetry.

Plane-parallel electron chambers have structures made of plastic materials of low atomic number which do not provide the same scattering into the sensitive volume as water and suitable correction factors are therefore required to allow for this effect. Hunt et al. (1988) measured electron backscatter in low atomic number materials and this data was, in this work, analyzed together with the experimental data obtained for higher atomic number materials published earlier (Klevenhagen et al., 1982). It was found that both sets of data correlate well and fit to an empirical exponential expression for which the necessary calculation parameters were derived. This expression enables suitable backscatter correction factors to be calculated for materials of atomic numbers between 4 and 82, including plastics, and electron energies between 3 and 35 MeV. The deficiency of backscatter was evaluated for the most popular materials used in the construction of electron chambers and this data may be used for corrections.

Electrons↗