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PubMed2001

Do poison center triage guidelines affect healthcare facility referrals?

BACKGROUND: The purpose of this study was to determine the extent to which poison center triage guidelines influence healthcare facility referral rates for acute, unintentional acetaminophen-only poisoning and acute, unintentional adult formulation iron poisoning. METHODS: Managers of US poison centers were interviewed by telephone to determine their center's triage threshold value (mg/kg) for acute iron and acute acetaminophen poisoning in 1997. Triage threshold values and healthcare facility referral rates were fit to a univariate logistic regression model for acetaminophen and iron using maximum likelihood estimation. RESULTS: Triage threshold values ranged from 120-201 mg/kg (acetaminophen) and 16-61 mg/kg (iron). Referral rates ranged from 3.1% to 24% (acetaminophen) and 3.7% to 46.7% (iron). There was a statistically significant inverse relationship between the triage value and the referral rate for acetaminophen (p < 0.001) and iron (p = 0.0013). The model explained 31.7% of the referral variation for acetaminophen but only 4.1% of the variation for iron. CONCLUSION: There is great variability in poison center triage values and referral rates for iron and acetaminophen poisoning. Guidelines can account for a meaningful proportion of referral variation. Their influence appears to be substance dependent. These data suggest that efforts to determine and utilize the highest, safe, triage threshold value could substantially decrease healthcare costs for poisonings as long as patient medical outcomes are not compromised.

Acetaminophen↗

PubMed2001

Peer influences and susceptibility to smoking among California adolescents.

Using data from a diverse statewide sample of 10th-grade adolescents in California, in 1996-97, this study investigated the associations between peer influence variables and susceptibility to smoking. Peer influence variables included attitudes about the social consequences of smoking and subjective norms, as described by the Theory of Reasoned Action. Among never-smokers (N=2681) and ever-smokers (N=4248), attitudes about social consequences of smoking and subjective norms each were associated with an increased risk of susceptibility to smoking. The model explained a larger proportion of the variance in susceptibility among ever-smokers than among never-smokers. Results indicate that peer influences, including perceptions of the social consequences of smoking and perceived social norms, may make adolescents susceptible to smoking.

Adolescent↗

PubMed2005

A bio-behavioral model of addiction treatment: applying dual representation theory to craving management and relapse prevention.

A bio-behavioral approach to drug addiction treatment is outlined. The presented treatment model uses dual representation theory as a guiding framework for understanding the bio-behavioral processes activated during the application of expressive therapeutic methods. Specifically, the treatment model explains how visual processing techniques can supplement traditional relapse prevention therapy protocols, to help clients better manage cravings and control triggers in hard-to-treat populations such as chronic substance-dependent persons.

Art Therapy↗

PubMed1980

Chloroquine inhibits lysosomal enzyme pinocytosis and enhances lysosomal enzyme secretion by impairing receptor recycling.

Adsorptive pinocytosis of acid hydrolases by fibroblasts depends on phosphomannosyl recognition markers on the enzymes and high-affinity pinocytosis receptors on the cell surface. In this study, beta-glucuronidase binding to the cell surface of attached fibroblasts was found to be saturable and inhibitable by mannose-6-phosphate (Man-6-P). Dissociation of cell-bound beta-glucuronidase occurred very slowly at neutral pH, but was greatly accelerated by lowering the pH below 6.0, or by exposure to Man-6-P. Comparison of the maximal cell surface binding and the observed rate of enzyme pinocytosis suggests that the pinocytosis receptors are replaced or reused about every 5 min. Enzyme pinocytosis was not affected by inhibition of new protein synthesis for several hours, suggesting a large pool of internal receptors and/or reuse of internalized receptors. Chloroquine treatment of normal human fibroblasts had three effects: (a) greatly enhanced secretion of newly synthesized acid hydrolases bearing the recognition marker for uptake, (b) depletion of enzyme-binding sites from the cell surface, and (c) inhibition of pinocytosis of exogenous enzyme. Only the third effect was seen in I-cell disease fibroblasts, which were also less sensitive than control cells to this effect. These observations are consistent with a model for transport of acid hydrolases that proposes that delivery of newly synthesized acid hydrolases to lysosomes requires the phosphomannosyl recognition marker on the enzymes, and intracellular receptors that segregate receptor-bound enzymes into vesicles for transport to lysosomes. This model explains how chloroquine, which raises intralysosomal pH, can disrupt both the intracellular pathway for newly synthesized acid hydrolases, and the one for uptake of exogenous enzyme by cell surface pinocytosis receptors.

Ammonium Chloride↗

PubMed1971

Antibody-mediated activation of a defective beta-D-galactosidase. II. Immunological relationship between the normal and the defective enzyme.

Two closely related protein antigens were used to study immunogenic competition. Namely, normal beta-D-galactosidase of Escherichia coli (Z) and a genetically defective beta-D-galactosidase (AMEF) which seems to differ from the normal in one amino acid substitution. A unique characteristic of this pair of antigens is that, although they are indistinguishable in precipitation and absorption tests with antibodies, the enzymatic activity of AMEF is specifically increased several-hundredfold in the presence of antibodies directed against Z. The following results show that Z and AMEF also differ in their immunogenic ability: (a) antibodies directed against Z activated AMEF; antibodies directed against AMEF did not activate, but competed specifically with activating antibodies. (b) Animals immunized with AMEF failed to produce activating antibodies when they were subsequently challenged with Z, although the presence of some cells primed to produce activating antibodies could be demonstrated by adoptive transfer. (c) Animals preimmunized with Z were stimulated in their production of activating antibodies by AMEF challenge, although not as efficiently as with Z. A model explaining these observations by competition for the immunogenic site among antigen-sensitive cells carrying cross-reacting receptors is presented.

Adoptive Transfer↗

PubMed1998

Genetic analysis of meiotic recombination in humans by use of sperm typing: reduced recombination within a heterozygous paracentric inversion of chromosome 9q32-q34.3.

To investigate patterns of genetic recombination within a heterozygous paracentric inversion of chromosome 9 (46XY inv[9] [q32q34.3]), we performed sperm typing using a series of polymorphic microsatellite markers spanning the inversion region. For comparison, two donors with cytogenetically normal chromosomes 9, one of whom was heterozygous for a pericentric chromosome 2 inversion (46XY inv[2] [p11q13]), were also tested. Linkage analysis was performed by use of the multilocus linkage-analysis program SPERM, and also CRI-MAP, which was adapted for sperm-typing data. Analysis of the controls generated a marker order in agreement with previously published data and revealed no significant interchromosomal effects of the inv(2) on recombination on chromosome 9. FISH employing cosmids containing appropriate chromosome 9 markers was used to localize the inversion breakpoint of inv(9). Analysis of inv(9) sperm was performed by use of a set of microsatellite markers that mapped centromeric to, telomeric to, and within the inversion breakpoints. Three distinct patterns of recombination across the region were observed. Proximal to the centromeric breakpoint, recombination was similar to normal levels. Distal to the telomeric breakpoint, there was an increase in recombination found in the inversion patient. Finally, within the inversion, recombination was dramatically reduced, but several apparent double recombinants were found. A putative model explaining these data is proposed.

Adult↗

PubMedDate not supplied

Effects of body mass and reproduction on the basal metabolic rate of brown long-eared bats (Plecotus auritus).

We measured basal metabolic rate (BMR) of nonreproductive and of breeding (pregnant and lactating) female brown long-eared bats (Plecotus auritus) to investigate the effects of intra- and interindividual variation in body mass and of reproduction on metabolism. The BMR of six nonreproductive females was measured between five and seven times at approximately 2-wk intervals over a period of 2.5 mo. There was a highly significant effect (P<0.001) of body mass on BMR of these nonreproductive females. The pooled within-individual scaling exponent (1.88) significantly exceeded the established mammalian interspecific exponent (0.75). In addition, we made single observations on 14 nonreproductive females to establish the effects of differences in mass between individuals. The mean BMR across all 14 individuals was 82 mW (+/-24 SD). There was a significant positive relationship between BMR and body mass across these individuals (r2=0.39), with a between-individual scaling exponent of 0.75. Inter- and intraindividual effects of mass on BMR were combined in a regression analysis that included mean body mass and deviation from mean mass on any given day as predictors. This regression model explained 55% of the variation in BMR. We made longitudinal measurements of BMR throughout reproduction and compared these with the predicted BMR of nonreproductive bats of the same body mass. Reproductive females exhibited temporal flexibility in BMR. BMR during pregnancy increased on a whole-animal basis but was significantly lower (by, on average, 15%) than BMR predicted for nonreproductive females of the same mass. Over a period of 1-75 d following birth, whole-animal BMR was greater than that during pregnancy, even though body mass declined after parturition. Hence, postbirth BMR was greater than the level predicted for nonreproductive females of the same mass. This study indicates that the scaling of BMR with body mass differs significantly within and between individuals and that there is a reduction of BMR in pregnancy and an elevation of BMR during lactation.

Animals↗

PubMed2002

Relations between frame size and body composition and bone mineral status.

BACKGROUND: Frame size is a description of the supportive structure of the skeleton that is used to adjust for skeletal mass and size in measures of body composition and weight. OBJECTIVE: Data from the Fels Longitudinal Study were used to investigate the relation between bicristal, elbow, knee, biacromial, and wrist breadths and measures of total body fat (TBF), fat-free mass (FFM), bone mineral content (BMC), and bone mineral density (BMD) from dual-energy X-ray absorptiometry. DESIGN: The sample consisted of cross-sectional data from 224 white men and 277 white women aged 23-65 y. Multiple regressions were conducted with stature-adjusted measures of body composition and bone mineral status as dependent variables and age and frame size as independent variables. RESULTS: Frame-size measures were significantly and positively associated with all body-composition and bone mineral measures in bivariate analyses. In both men and women, the significant models explained more of the variance in measures of TBF (R2 = 0.51 and 0.66, respectively) and FFM (R2 = 0.35 and 0.39, respectively) than in measures of BMC (R2 = 0.18 and 0.23, respectively) and BMD (R2 = 0.08 and 0.18, respectively). Bicristal, knee, and wrist breadths were associated with TBF, and biacromial, knee, and wrist breadths were positively associated with FFM. Biacromial breadth was positively associated with BMC and BMD. CONCLUSIONS: Frame size was more closely associated with TBF and FFM than with BMC and BMD. The association between frame size and body composition seems to be more structural than substantive. The relations between frame size and BMC and BMD are weak and apparently not related to body composition.

Absorptiometry, Photon↗

PubMed2006

The two sides of associative plasticity in writer's cramp.

Neuronal plasticity is to be kept within operational limits to serve its purpose as a safe memory system that shapes and focuses sensory and motor representations. Temporal and spatial properties of motor cortical plasticity were assessed in patients with writer's cramp using a model of long-term potentiation (LTP) and long-term depression (LTD) of synaptic efficacy. Paired associative stimulation (PAS) combined repetitive electric stimulation of the median or ulnar nerve (MN or UN) with subsequent transcranial magnetic stimulation of the contralateral dominant motor cortex at 21.5 ms (MN-PAS21.5; UN-PAS21.5) or 10 ms (MN-PAS10). Motor-evoked potentials were recorded from abductor pollicis brevis (APB) muscle and abductor digiti minimi (ADM) muscles in 10 patients with writer's cramp and 10 matched healthy control subjects. Following MN-PAS21.5 or UN-PAS21.5 in non-dystonic subjects, motor responses increased if the afferent PAS-component came from a homologous peripheral region and remained stable with a non-homologous input. In contrast, following either MN-PAS21.5 or UN-PAS21.5, both APB- and ADM-amplitudes increased in patients. Compared with controls, this increase started earlier, its magnitude was larger and its duration longer. Following MN-PAS10 in controls, APB-amplitudes decreased, while ADM-amplitudes increased. In writer's cramp, the decrease of APB-amplitudes started earlier and lasted longer. Of note, ADM-amplitudes were decreased, too. LTP-like as well as LTD-like plasticity is abnormal with respect to both gain and spatial organization. These findings may help to develop a pathophysiological model explaining core features of focal dystonia.

Adult↗

PubMed2003

A role for neural integrators in perceptual decision making.

Decisions based on uncertain information may benefit from an accumulation of information over time. We asked whether such an accumulation process may underlie decisions about the direction of motion in a random dot kinetogram. To address this question we developed a computational model of the decision process using ensembles of neurons whose spiking activity mimics neurons recorded in the extrastriate visual cortex (area MT or V5) and a sensorimotor association area of the parietal lobe (area LIP). The model instantiates the hypothesis that neurons in sensorimotor association areas compute the time integral of sensory signals from the visual cortex, construed as evidence for or against a proposition, and that the decision is made when the integrated evidence reaches a threshold. The model explains a variety of behavioral and physiological measurements obtained from monkeys.

Action Potentials↗

PubMed2004

Evaluation of deuterium isotope effects in normal-phase LC-MS-MS separations using a molecular modeling approach.

Molecular modeling of stationary phases presents a unique challenge because there is little available experimentally derived structural information. Verified interaction mechanisms at a molecular level with analytes are also rare. Molecular mechanics calculations using the Tripos force field were carried out to qualitatively and quantitatively assess stationary phase interactions. Binding energy values of -15.40, 15.28, -12.53, and -12.34 kcal/mol, respectively, are obtained for olanzapine (OLZ), OLZ-D3, des-methyl olanzapine (DES), and DES-D8 that corresponded to the retention behavior of the four compounds observed using liquid chromatography-mass spectrometry (MS)-MS. The model explains, semiquantitatively, the deuterium isotope effect in the normal-phase chromatographic separation of these compounds.

Journal Article↗

PubMed1998

Binary specification of nonsense codons by splicing and cytoplasmic translation.

Premature translation termination codons resulting from nonsense or frameshift mutations are common causes of genetic disorders. Complications arising from the synthesis of C-terminally truncated polypeptides can be avoided by 'nonsense-mediated decay' of the mutant mRNAs. Premature termination codons in the beta-globin mRNA cause the common recessive form of beta-thalassemia when the affected mRNA is degraded, but the more severe dominant form when the mRNA escapes nonsense-mediated decay. We demonstrate that cells distinguish a premature termination codon within the beta-globin mRNA from the physiological translation termination codon by a two-step specification mechanism. According to the binary specification model proposed here, the positions of splice junctions are first tagged during splicing in the nucleus, defining a stop codon operationally as a premature termination codon by the presence of a 3' splicing tag. In the second step, cytoplasmic translation is required to validate the 3' splicing tag for decay of the mRNA. This model explains nonsense-mediated decay on the basis of conventional molecular mechanisms and allows us to propose a common principle for nonsense-mediated decay from yeast to man.

Codon, Nonsense↗

PubMed2002

TRIPTYCHON and CAPRICE mediate lateral inhibition during trichome and root hair patterning in Arabidopsis.

Trichome patterning in Arabidopsis is a model for the generation of a spacing pattern from initially equivalent cells. We show that the TRIPTYCHON gene that functions in lateral inhibition encodes a single-repeat MYB-related transcription factor that lacks a recognizable activation domain. It has high sequence similarity to the root hair patterning gene CAPRICE. Both genes are expressed in trichomes and act together during lateral inhibition. We further show that TRIPTYCHON and CAPRICE act redundantly in the position-dependent cell fate determination in the root epidermis. Thus, the same lateral inhibition mechanism seems to be involved in both de novo patterning and position-dependent cell determination. We propose a model explaining trichome and root hair patterning by a common mechanism.

Arabidopsis↗

PubMed1997

Correlates of performance-based measures of muscle function in the elderly: the Cardiovascular Health Study.

BACKGROUND: It is unknown how much age-related changes in muscle performance represent normal aging versus the effects of chronic disease and life style. We examined the correlates of four performance measures-gait speed, timed chair stands (TCS), grip strength, and maximal inspiratory pressure (MIP)-using baseline data from the Cardiovascular Health Study (CHS), a population-based study of risk factors for heart disease and stroke in persons > or = age 65. METHODS: We analyzed data from the 5,201 CHS participants. Variables were arranged into nine categories: Personal Characteristics, Anthropometry, Physical Condition, Reported Functional Status, Subjective Health, Psychological Factors, Symptoms, Cognitive Status, Habits and Lifestyle, and Prevalent Disease. Independent correlates were identified using stepwise linear regression. RESULTS: The regression models explained 17.7-25.4% of the observed variability. Although age significantly correlated with each measure, it explained little of the variability (< or = 5.7%). Anthropometric features plus physical condition explained 14.0-17.4% of the variability for grip strength and MIP, but 2.8-12.9% of the variability for gait speed and the log of TCS. Subjective health and psychological factors explained 1.8-9.4% of the variability in gait speed and the log of TCS, but < or = 1.2% of the variability in grip strength and MIP. Variables for prevalent disease explained < or = 1.3% of the variability in each measure. CONCLUSIONS: After age 64, age explained little of the variability in muscle performance in a large sample of mostly functionally intact, community-dwelling older persons. Complex measures such as gait speed were more associated with subjective factors than were direct measures of strength. Prevalent disease contributed surprisingly little to muscle performance.

Aging↗

PubMed1989

Gender differences in caregiving: why do wives report greater burden?

Women typically report greater burden associated with caregiving than do men. We used data from interviews with 131 older spouse caregivers to explore potential explanations for this difference. A linear regression model explained 35% of the variance in caregiver burden. The patient's cognitive and behavioral difficulties emerged as the most important predictor of burden, followed by caregiver age, unpleasant social contacts, caregiver sex, and overall coping effectiveness. Findings suggest that age differences in male and female caregivers contribute to the observed differences in burden.

Adaptation, Psychological↗

PubMed1996

Factors associated with screening mammography and breast self-examination intentions.

The factors associated with the use of two methods for the early detection of breast cancer were assessed using a theoretical framework derived from the theory of reasoned action and the Health Belief Model. Telephone interviews were conducted with 170 women aged between 50 and 70 years, randomly selected from the telephone directory of a provincial city in Victoria, Australia. The model explained 47% of the variance in intentions to have a mammogram and 22% of the variance in intentions to practise breast self-examination (BSE). The data supported the prediction that different variables would be associated with each method of early detection of breast cancer. Intentions to have a mammogram were associated with perceived susceptibility to breast cancer, knowing a woman who has had a mammogram, previous mammography history and Pap test history. Intentions to do BSE were associated with self efficacy, knowledge of breast cancer issues, concern about getting breast cancer and employment status. Both screening methods were associated with prior behaviour and concern about getting breast cancer.

Aged↗

PubMed1991

Development of a strategy to encourage attendance for screening mammography.

The present study describes a method for the data-driven structuring of interventions to increase participation in screening mammography. We interviewed 668 randomly selected women from the target population of an Australian pilot screening mammography program before this Program commenced. The aims of the study were to use cross-sectional data to determine factors which predicted women's intentions regarding attendance at the Program, and on the basis of these results to develop optimal strategies to encourage attendances. Of the sample, 64% said they intended to go to the Program, while 11% were unsure. A number of variables were significantly associated with intention and regression analysis was used to determine the best model for predicting intention. Ten variables entered the final regression model: the intensity of thought about getting breast cancer; a belief that early detection is extremely desirable and that screening mammograms are accurate; having had a Pap test within the last 2 years; a belief that health is controlled by chance; perceived ease of getting to the hospital; subjective familiarity with the hospital location of the Program; age; having heard about screening mammography; and a feeling of personal susceptibility to breast cancer. This model explained 20% of the variance in intention to have a mammogram (R 2 = 0.20, F(10,492) = 12.08; P less than 0.0001). The practical applications of these findings are discussed in this report. It is recommended that if a campaign were to concentrate on changing women's perceptions on the dimensions found to be significantly associated with intention, then it would have maximum chance of encouraging attendance amongst women in the target population. The strategies we have developed based on these findings are discussed in this paper.

Aged↗

PubMed1994

The role of age and an expanded Health Belief Model in predicting skin cancer protective behavior.

Skin cancer (SC), the most common form of cancer in the US, with a rapidly growing incidence, has become a target for health education. Sun exposure protective behavior (SEPB) is currently believed to be the best means to prevent it. Focusing on age differences, this paper applies an expansion of the Health Belief Model (HBM) to the prediction of engagement in SC protective behaviors in four age-groups, following an intervention program. It is based on data collected by a structured questionnaire completed by 509 members of four kibbutzim in Israel. The results indicate that the proposed model explains the SC-related protective behaviors of the older age-groups (45+) much better than that of the younger groups (15-44). The older age-groups are also more likely to change risky behavior following the intervention. The youngest age-group (15-29), although being highest at risk for SC due to sun exposure habits, is least likely to change them and least likely to participate in the intervention. Beliefs about sun tanning, sun exposure habits (barriers) and degree of exposure to the intervention are the best predictors of the likelihood to engage in SEPB in the younger age-groups, while among the older groups the best predictors are the value of health and appearance. These findings suggest that health education programs should develop different messages for different age-groups. Regarding SC, it seems especially important to focus prevention efforts on adolescents and young adults by recruiting the beauty and fashion industries as well as legislation. The merits of age group analyses in the research of health behavior are discussed.

Adolescent↗