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Credentials

Education ?

Medical School Score
The University of Texas at Galveston (1998)
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Awards & Distinctions ?

Appointments
University of Rochester School of Medicine and Dentistry
Clinical Asst Professor of Obstetrics and Gynecology
Associations
American Board of Radiology

Affiliations ?

Dr. Davis is affiliated with 27 hospitals.

Hospital Affiliations

Score

Rankings

  • Harris Methodist H E B
    1600 Hospital Pkwy, Bedford, TX 76022
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    Top 25%
  • Texas Health Presbyterian Hospital Plano
    6200 W Parker Rd, Plano, TX 75093
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    Top 25%
  • Texas Health Harris Methodist Hospital Southwest Fort Worth
    6100 Harris Pkwy, Fort Worth, TX 76132
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    Top 25%
  • Texas Health Presbyterian Hospital Allen
    1105 Central Expy N, Allen, TX 75013
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    Top 50%
  • Texas Health Presbyterian Hospital Of Dallas
    8200 Walnut Hill Ln, Dallas, TX 75231
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    Top 50%
  • Denton Regional Medical Center
    3535 S Interstate 35 E, Denton, TX 76210
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    Top 50%
  • Las Colinas Medical Center
    6800 N MacArthur Blvd, Irving, TX 75039
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  • Centennial Medical Center
    12505 Lebanon Rd, Frisco, TX 75035
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  • Methodist Richardson Medical Center
    401 W Campbell Rd, Richardson, TX 75080
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  • Medical Center Of Plano
    3901 W 15th St, Plano, TX 75075
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  • Harris Methodist - Springwood
    1608 Hospital Pkwy, Bedford, TX 76022
  • Medical Center Of Mckinney
    4500 Medical Center Dr, McKinney, TX 75069
  • Wise Regional Health System
    2000 S Fm 51, Decatur, TX 76234
  • Harris Continued Care Hospital
    1301 Pennsylvania Ave, Fort Worth, TX 76104
  • Denton Regional
  • Texas Health Alliance
  • Texas Health HEB
  • North Central Medical Center - West Park Campus
    130 S Central Expy, McKinney, TX 75070
  • Texas Health Allen
  • National Naval Medical Center
  • Texas Health Stephenville
  • Baylor Regional Medical Center at Plano
    4700 Alliance Blvd, Plano, TX 75093
  • Texas Health Flower Mound
  • Texas Health Plano
  • Naval Hospital
  • Texas Health Cleburne
  • Wise - East Campus
    609 Medical Center Dr, Decatur, TX 76234
  • Publications & Research

    Dr. Davis has contributed to 175 publications.
    Title High Incidence of Obesity Co-morbidities in Young Children: a Cross-sectional Study.
    Date April 2012
    Journal Journal of Paediatrics and Child Health
    Excerpt

    The prevalence of overweight and obesity in children is a public health problem because of future morbidity. However, the prevalence of medical complications in overweight and obese primary school children in Australia is not well documented. As part of the larger, prospective cohort Growth and Development Study, this report aimed to identify the medical complications of obesity in a population-based community sample of primary school-aged children.

    Title Endothelial Function and Carotid Intima-medial Thickness in Adolescents with Type 2 Diabetes Mellitus.
    Date December 2011
    Journal The Journal of Pediatrics
    Excerpt

    We assessed the effect of type 2 diabetes mellitus and obesity on flow-mediated dilation (FMD) and endothelial-dependent vasodilation and carotid intima-medial thickness (cIMT) in young people.

    Title Lower Cardiorespiratory Fitness in Children with Type 1 Diabetes.
    Date September 2011
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    AIMs: The present study aimed to compare cardiorespiratory fitness levels in children with and without Type 1 diabetes. In addition, the relationship between cardiorespiratory fitness and a range of physical and clinical factors was investigated.

    Title Type 2 Diabetes in Indigenous Australian Children and Adolescents.
    Date January 2011
    Journal Journal of Paediatrics and Child Health
    Excerpt

    Rates of type 2 diabetes are higher among Indigenous than non-Indigenous Australian children and adolescents. Presentation may be incidental, part of obesity investigation, symptomatic (polyuria and polydipsia) or in ketoacidosis. Investigation should include assessment of fasting insulin, c-peptide and autoantibodies, as well as assessment of diabetes complications and co-morbidities. Management is a challenge, particularly in a resource-limited setting. Management should involve the whole family and, in some cases, extended family, and community, local health-care providers are key, and a multidisciplinary team approach is essential. The primary initial intervention involves life-style change, but medications (oral and insulin) are frequently necessary. Screening of high-risk individuals is recommended. Waist circumference is a key component of risk assessment. Prevention strategies targeting children and adolescents from this high-risk population are urgently required.

    Title Fatness, Fitness, and Increased Cardiovascular Risk in Young Children.
    Date October 2010
    Journal The Journal of Pediatrics
    Excerpt

    To investigate the relationships between cardiorespiratory fitness and adiposity among young children, and their influence on a comprehensive cardiovascular risk profile.

    Title Manganese Toxicity to Chlorophyll Synthesis in Tobacco Callus.
    Date July 2010
    Journal Plant Physiology
    Excerpt

    Tobacco (Nicotiana tabacum) pith explants were grown on manganese containing medium. At moderate concentration (10 millimolar), manganese selectively inhibited chlorophyll synthesis, resulting initially in growth of white callus. Several weeks later the white callus turned brown due to the accumulation of a pigment identified as protoporphyrin IX by its elution profile using high performance liquid chromatography, by its absorption spectrum, and by its fluorescence properties. At a concentration of 100 millimolar manganese the pigment accumulated without growth of the explant.

    Title Birthweight and the Risk of Childhood-onset Type 1 Diabetes: a Meta-analysis of Observational Studies Using Individual Patient Data.
    Date April 2010
    Journal Diabetologia
    Excerpt

    We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes.

    Title Impaired Awareness of Hypoglycemia in a Population-based Sample of Children and Adolescents with Type 1 Diabetes.
    Date December 2009
    Journal Diabetes Care
    Excerpt

    To determine the prevalence and clinical associations of impaired awareness of hypoglycemia in a population-based sample of children and adolescents with type 1 diabetes.

    Title Glycaemic Impact of Patient-led Use of Sensor-guided Pump Therapy in Type 1 Diabetes: a Randomised Controlled Trial.
    Date September 2009
    Journal Diabetologia
    Excerpt

    The objective of this study was to assess the impact of patient-led sensor-guided pump management on glycaemic control, and compare the effect with that of standard insulin pump therapy.

    Title Stage Iii Diffuse Lamellar Keratitis Following Conductive Keratoplasty over a Lasik Flap.
    Date August 2009
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    A 48-year-old man who had conductive keratoplasty (CK) for consecutive hyperopia following myopic laser in situ keratomileusis (LASIK) developed progressive diffuse lamellar keratitis. To our knowledge, this is the first report of CK after LASIK that required surgical intervention for interface inflammation.

    Title A Predictive Model of Health State Utilities for Hiv Patients in the Modern Era of Highly Active Antiretroviral Therapy.
    Date July 2009
    Journal Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
    Excerpt

    Existing estimates of human immunodeficiency virus (HIV)-related health state utilities are inadequate for comparing alternative treatments on the basis of regimen-specific attributes such as dosing requirements or tolerability. The objective of this study was to examine the marginal impact of dosing, adverse events (AEs), and other factors on patients' health state utilities.

    Title Waist Circumference Predicts Cardiovascular Risk in Young Australian Children.
    Date May 2009
    Journal Journal of Paediatrics and Child Health
    Excerpt

    It has been shown that compared with healthyweight children, overweight and obese primary school-aged children have a higher incidence of hyperinsulinism, dyslipidaemia and hypertension. It is therefore important to investigate clinically relevant markers of cardiovascular risk in children. Waist circumference is a simple, non-invasive anthropometric measure, but its association with cardiovascular risk profile in young Australian children is not clear.

    Title The Role of Elective Perioperative Dialysis in Nondialysis Renal Failure Patients.
    Date April 2009
    Journal The Annals of Thoracic Surgery
    Excerpt

    Patients with renal insufficiency represent a difficult group. They show an increased morbidity and mortality after heart surgery. Nondialysis chronic kidney disease patients show higher mortality than patients receiving chronic dialysis. Their management is not standardized. This study was undertaken to determine whether elective perioperative dialysis in these patients improved outcomes.

    Title Strategies for Addressing Global Environmental Health Concerns.
    Date December 2008
    Journal Annals of the New York Academy of Sciences
    Excerpt

    While each region of the world faces unique public health challenges, environmental threats to vulnerable populations in Asia constitute a significant global public health challenge. Environmental threats to health are widespread and are increasing as nations in the region undergo rapid industrial development. One of the major predictors of ill health is poverty. Regional poverty puts large populations at risk for ill health, which exacerbates poverty and increases the exposure risk to environmental factors, such as pollution and disease. Patterns of illness have changed dramatically in the last century, and will continue to change in this century. Chemical toxicants in the environment, poverty, and little or no access to health care are all factors contributing to life-threatening diseases. Therefore, it is vital that we develop a better understanding of the mechanisms and interactions between nutrition, infectious disease, environmental exposures, and genetic predisposition in order to develop better prevention methods.

    Title The Onset and Course of Binge Eating in 8- to 13-year-old Healthy Weight, Overweight and Obese Children.
    Date November 2008
    Journal Eating Behaviors
    Excerpt

    This study aimed to (1) determine the prevalence of binge eating and overeating in 8- to 13-year-old children; (2) identify factors that cross-sectionally predict binge eating and overeating; and (3) identify factors that prospectively predict onset of binge eating and overeating.

    Title Overconcern with Weight and Shape is Not the Same As Body Dissatisfaction: Evidence from a Prospective Study of Pre-adolescent Boys and Girls.
    Date October 2008
    Journal Body Image
    Excerpt

    Overconcern with weight and shape and body dissatisfaction have both emerged as significant predictors of disordered eating. However, it is unclear how these constructs relate to each other, and if each has different antecedents and consequences. This study aimed to identify prospective predictors of each construct and to determine their relative importance in predicting dietary restraint and binge eating. Eight- to 13-year-old boys and girls (N=259) were assessed at baseline and one-year follow-up, using a range of measures that included the Child Eating Disorder Examination. Psychosocial variables predicted overconcern with weight and shape whilst objective weight predicted body dissatisfaction. Body dissatisfaction and weight and shape concern predicted restraint, and weight and shape concern and restraint predicted binge eating. Findings provide support for the theoretical differences between body dissatisfaction and overconcern with weight and shape, and highlight the importance of focusing on specific body image variables.

    Title Prevalence of Structural Central Nervous System Abnormalities in Early-onset Type 1 Diabetes Mellitus.
    Date September 2008
    Journal The Journal of Pediatrics
    Excerpt

    OBJECTIVE: To characterize the effects of severe hypoglycemia on the developing brain in children with early-onset type 1 diabetes mellitus (T1DM). STUDY DESIGN: Children diagnosed with T1DM before age 6 years were studied. Those with prospectively monitored severe hypoglycemia (coma/seizure; n = 32) were compared with age-matched peers (n = 30) with no history of such events using magnetic resonance imaging. Glycemic control (evaluated based on glycated hemoglobin [HbA(lc)] level), episodes of diabetic ketoacidosis (DKA), and clinical variables were monitored continuously since diagnosis in all subjects. RESULTS: Mean HbA(lc) from diagnosis and the duration of T1DM were similar in those with and without a history of severe hypoglycemia (9.0% +/- 0.9% vs 8.8% +/- 0.9%; 7.2 +/- 2.7 years vs 6.7 +/- 2.3 years). A high prevalence of central nervous system (CNS) structural abnormalities was detected (29%), and mesial temporal sclerosis (MTS) was detected in 16% of the total sample (n = 62). The presence of MTS was not associated with a history of severe hypoglycemia or DKA. Analysis of brain matter volumes suggested relatively less gray matter density in those subjects with a history of severe hypoglycemia. CONCLUSIONS: Early age of onset of T1DM per se is associated with a high incidence of CNS abnormalities, particularly MTS, suggesting hippocampal damage. Early-onset severe hypoglycemia may have an effect on gray matter volume.

    Title Angiotensinogen Gene T235 Variant: a Marker for the Development of Persistent Microalbuminuria in Children and Adolescents with Type 1 Diabetes Mellitus.
    Date August 2008
    Journal Journal of Diabetes and Its Complications
    Excerpt

    AIM: We examined genetic polymorphisms in the renin-angiotensin system (RAS) coding for angiotensin I-converting enzyme (ACE) insertion/deletion (I/D) for angiotensinogen (AGT) M235T and angiotensin II receptor type 1 (AGTR1) A1166C as predictors for the development of microalbuminuria (MA) in children with type 1 diabetes mellitus (T1DM). METHODS: Four hundred fifty-three (215 males, 238 females) T1DM children [median (interquartile range): age, 16.7 years (13.9-18.3); diabetes duration, 6.9 years (3.3-10.8); age at diagnosis, 9.1 years (5.8-11.8)] were followed prospectively from diagnosis until the development of MA (two of three consecutive overnight urine samples with albumin excretion rates of > or =20 and <200 microg/min). Kaplan-Meier survival curves and Cox proportional multivariate model estimated the probability of developing MA and the relative risk for MA among different variables. RESULTS: MA developed in 41 (9.1%) subjects. The frequencies of genotypes were as follows: ACE-II 112 (25%), ACE-ID 221 (49%), and ACE-DD 117 (26%) (n=450); AGT-MM 144 (32%), AGT-MT 231 (51%), and AGT-TT 77 (17%) (n=452); AGTR1-AA 211 (47%), AGTR1-AC 204 (45%), and AGTR1-CC 37 (8%) (n=452). The cumulative risk for the development of MA was higher in ACE-DD versus ACE-ID/II groups (log-rank test, P=.05), and a trend was noticed when AGT-TT was compared to AGT-MT/MM groups (log-rank test, P=.08). AGT-TT polymorphism conferred a fourfold increased risk for MA compared to AGT-MM/MT (hazard ratio=3.8; 95% confidence interval=1.43-10.3; P=.008). INTERPRETATION: Our findings suggest that RAS gene polymorphism at AGT M235T is a strong predictor for early MA in young T1DM subjects.

    Title Dutasteride Vs Finasteride: Assessment of Differences in Acute Urinary Retention Rates and Surgical Risk Outcomes in an Elderly Population Aged > or =65 Years.
    Date August 2008
    Journal The American Journal of Managed Care
    Excerpt

    OBJECTIVE: To determine comparative differences on rates of acute urinary retention (AUR) and prostate-related surgeries among patients aged > or =65 years treated with dutasteride or finasteride. METHODS: For this retrospective analysis, medical/pharmacy claims data from July 1, 2003, to June 30, 2006, were analyzed for enlarged prostate patients aged > or =65 years treated with 5-alpha reductase inhibitors (5ARIs) regardless of alpha-blocker use. Charlson Comorbidity Index, Thomson Medstat Disease Staging, and propensity score matching techniques were used for comparative analysis. RESULTS: A total of 5090 patients met selection criteria. After 1 year of 5ARI therapy, the AUR rate was lower for dutasteride (12%) when compared with finasteride (14.7%) (odds ratio [OR], 0.79; P = .0042). Risks for prostate-related surgeries were also lower among dutasteride-treated patients (3.9% vs 5.1%, respectively; OR, 0.77; P = .03). CONCLUSION: Important therapeutic outcome differences exist between dutasteride and finasteride. Patients treated with dutasteride were significantly less likely to experience AUR and prostate-related surgeries than finasteride patients.

    Title Comparative Analysis of Alpha-blocker Utilization in Combination with 5-alpha Reductase Inhibitors for Enlarged Prostate in a Managed Care Setting Among Medicare-aged Men.
    Date August 2008
    Journal The American Journal of Managed Care
    Excerpt

    OBJECTIVE: To evaluate the likelihood of alpha-adrenergic antagonist (alpha-blocker) discontinuation in combination with dutasteride or finasteride among patients aged > or =65 years with enlarged prostate. METHOD: This retrospective analysis used 2003-2006 data representing more than 30 million managed care members. Medical/pharmacy claims were used to select patients, matched 1:1 using propensity scoring. The proportion remaining on alpha-blocker therapy more than 12 months and time to discontinuation were compared between groups, controlling for covariates using survival analysis. RESULTS: The matched sample included 1674 patients. Alpha-blocker therapy discontinuation was observed at 90 days (86.9% dutasteride patients and 91.8% finasteride patients remained on alpha-blocker therapy). After 12 months, more dutasteride patients discontinued (38.1% remained) alpha-blocker therapy than finasteride patients (56.3% remained). CONCLUSIONS: Patients discontinued alpha-blocker therapy as early as 3 months. Those taking dutasteride were 64% more likely to discontinue alpha-blocker therapy than patients taking finasteride. Dutasteride's impact on discontinuation may have important implications and should be examined further.

    Title Hiv Patient Insight on Adhering to Medication: a Qualitative Analysis.
    Date August 2008
    Journal Aids Care
    Excerpt

    Research on HIV medication adherence has relied mainly on quantitative methods. The objective of this study was to explore factors associated with adherence from the HIV-infected patient's perspective. Six focus groups were convened with treatment-experienced HIV-positive individuals. The discussions focused on issues that make it easy or difficult to adhere to HIV regimens. Thirty-five patients participated in the focus groups, which were conducted in Washington, D.C., and Los Angeles. The mean age was 48; 66% were male; 63% were black; and 40% contracted HIV through heterosexual contact. Six major themes emerged from the data that influenced adherence to medication: regimen complexity/medication features (including number of pills), lifestyle fit, emotional impacts (including worry, anger, stress and anxiety), side effects, medication effectiveness, and communication (including information from friends, physicians, and published sources). The data informed a conceptual framework, illustrating the possible interactions among these themes that can potentially be used by clinicians when discussing HIV treatment options with patients. This is potentially one of the first focus group studies concentrating on HIV medication adherence. The findings highlight specific factors that should be considered when trying to improve adherence and may be helpful in clinical decision-making.

    Title Parents' Concern About Their Children's Weight.
    Date July 2008
    Journal International Journal of Pediatric Obesity : Ijpo : an Official Journal of the International Association for the Study of Obesity
    Excerpt

    Firstly, to investigate the degree of concern parents feel about their children's weight (parental concern). Secondly, to identify factors that influence this concern, and to test a model of parental concern using structural equation modeling.

    Title Clustering of Psychosocial Symptoms in Overweight Children.
    Date April 2008
    Journal The Australian and New Zealand Journal of Psychiatry
    Excerpt

    OBJECTIVE: The aims of the present study were to (i) examine the relationship between children's degree of adiposity and psychosocial functioning; and (ii) compare patterns of clustering of psychosocial measures between healthy weight and overweight/obese children. METHOD: Cross-sectional data from a population-based cohort of 158 healthy weight, 77 overweight, and 27 obese children aged 8-13 years were analysed. Height, weight depression, quality of life, self-esteem, body dissatisfaction, eating disorder symptoms, peer relationships and behavioural and emotional problems were measured. RESULTS: Multi-level analysis showed significant linear associations between child body mass index z-scores and the psychosocial variables, with increasing adiposity associated with increasing levels of psychosocial distress. Principal components analyses indicated subtle differences between the healthy weight and overweight/obese groups with regards to the clustering of psychosocial measures. In particular, in overweight/obese, but not in healthy weight children, global self-worth clustered with body image and eating disorder symptoms. CONCLUSIONS: The psychosocial burden of excess weight is significant and broad reaching, with overweight/obese children showing multiple significant psychosocial problems.

    Title Prevention and Treatment of Haze in Refractive Surgery.
    Date March 2008
    Journal International Ophthalmology Clinics
    Title Patient Preferences Among Third Agent Hiv Medications: a Us and German Perspective.
    Date February 2008
    Journal Aids Care
    Excerpt

    The objective is to assess patient preferences for attributes associated with third agent HIV medications, including fosamprenavir/ritonavir (FPVr), fosamprenavir (FPV), lopinavir/ritonavir (LPVr), atazanavir (ATZ), and efavirenz (EFV). Subjects with HIV were recruited in the US and Germany to complete a computerized adaptive conjoint survey that assessed 13 attributes, including moderate to severe side effects, regimen convenience, drug resistance and efficacy. Literature on the target third-agent HIV drugs was used to identify percentage risk and severity level descriptions for each attribute. The derived preference (utility) weights for each attribute level informed the calculation of relative importance estimates for each attribute and the desirability of combinations of attributes matching the respective target third agents. The analysis included 288 HIV-positive participants (US: 132; Germany: 156), 205 of whom were treatment-experienced and 83 of whom were treatment-naïve. Of the 13 medication attributes evaluated, developing drug resistance, the risk of lipodystrophy, the risk of gastronitestinal side effects (diarrhoea, nausea and vomiting) and regimen convenience had the greatest impact on preferences. The profile based on FPVr was most preferred. Differences in the risk of developing drug resistance, risk of lipodystrophy, risk of gastrointestinal side effects and regimen convenience would likely be most influential in the perceived relative value of a third-agent medication. Physicians may wish to consider these features, especially when discussing HIV treatment options with their patients.

    Title Biomarkers of Low-level Exposure to Soman Vapor: Comparison of Fluoride Regeneration to Acetylcholinesterase Inhibition.
    Date February 2008
    Journal Inhalation Toxicology
    Excerpt

    The nerve agent O-pinacolyl methylphosphonofluoridate, also known as soman or by its military designation GD, is a highly toxic organophosphorous compound that exerts its effects through inhibition of the enzyme acetylcholinesterase (AChE). In the present study, a fluoride ion based regeneration assay was developed to quantify the level of soman present in the blood of rats following a low-level whole-body inhalation exposure. It was hypothesized that the amount of regenerated nerve agent in the blood would be dose dependent in rats subjected to a whole-body inhalation exposure to a low-level dose of soman vapor, and that the fluoride ion-based regeneration method would be more sensitive for the detection of a low-level exposure to soman vapor than the measurement of whole blood AChE activity. Regenerated soman was dose-dependently detected in both the red blood cells (RBCs) and plasma of exposed rats at all concentrations tested (0.033-0.280 mg/m(3) for a 240-min exposure). Significant inhibition of whole blood AChE activity did not occur below a concentration of 0.101 mg/m(3), and was only depressed by approximately 10-25% at concentrations ranging from 0.101 mg/m(3) to 0.280 mg/m(3). This study is the first to utilize a fluoride ion-based regeneration assay to demonstrate the dose-dependent increases in soman in the blood following whole-body inhalation exposure to low levels of vapor. Additionally, the results of the present study demonstrate that the fluoride ion based regeneration assay was approximately threefold more sensitive than the measurement of AChE activity in the blood for the detection of exposure to soman, and also that miosis is a more sensitive marker of soman exposure than inhibition of AChE activity.

    Title Assessment of Risks of "lifestyle" Diseases Including Cardiovascular Disease and Type 2 Diabetes by Anthropometry in Remote Australian Aborigines.
    Date February 2008
    Journal Asia Pacific Journal of Clinical Nutrition
    Excerpt

    OBJECTIVE: To evaluate waist-to-height ratio (WTHR), waist girth and body mass index (BMI) as predictors of cardiovascular risk factors in Australian Aborigines. DESIGN: Indices were examined as predictors of mean blood pressures (BP), blood lipids, glucose, insulin and as predictors of hypertension, decreased HDL-cholesterol, elevated glucose and type 2 diabetes. SETTING: Aboriginal communities in remote north-west Australia. PARTICIPANTS: Four hundred and one adults. RESULTS: More than 80% of participants had WTHR > or = 0.5 or BMI > 22 kg/m2 and 78% had increased waist girth (> 90 cm men; > 80 cm women). Adverse BP, blood lipids, glucose and insulin were associated with classification above the cutpoint for each index. For fasting glucose > or = 5.6 mmol/L, sensitivity was 91% with WTHR, 87% with waist girth and 88% with BMI; respective specificities were 29%, 29% and 44%. Area under receiver operating characteristic (AUROC) curves gave only "fair" accuracy for any discriminatory variable. With diabetes AUROC for BMI (0.59, 95% CI 0.53, 0.65) was significantly lower than with other indices (WTHR 0.74, 95% CI 0.69, 0.79; girth 0.72, 95% CI 0.67, 0.78) but did not differ significantly for fasting glucose, HDL-cholesterol or hypertension. AUROC did not differ significantly between men and women for any outcomes. CONCLUSIONS: The indices did not discriminate well for diabetes or cardiovascular risk factors in these Aborigines, but waist girth or WTHR appeared more useful than BMI. Appropriate cutpoints are needed. WTHR is simple, does not need sex-specific cutpoints and could be useful in developing public health strategies.

    Title Exercise Alone Reduces Insulin Resistance in Obese Children Independently of Changes in Body Composition.
    Date January 2008
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    CONTEXT: The number of obese children with insulin resistance and type 2 diabetes is increasing, but the best management strategy is not clear. OBJECTIVE: The objective of this study was to assess the effect of a structured 8-wk exercise training program on insulin resistance and changes in body composition in obese children. DESIGN: The study was 8 wk of structured supervised exercise intervention with outcome measures before and after the exercise period. SUBJECTS: Fourteen obese children (12.70 +/- 2.32 yr; eight male, six female) with high fasting insulin levels were enrolled into the study. Intervention: Intervention consisted of 8 wk of supervised circuit-based exercise training, composed of three fully supervised 1-h sessions per week. OUTCOME MEASURES: Outcome measures were assessed pretraining program and posttraining program and included insulin sensitivity (euglycemic-hyperinsulinemic clamp studies), fasting insulin and glucose levels, body composition using dual energy x-ray absorptiometry scan, lipid profile, and liver function tests. RESULTS: Insulin sensitivity improved significantly after 8 wk of training (M(lbm) 8.20 +/- 3.44 to 10.03 +/- 4.33 mg/kg.min, P < 0.05). Submaximal exercise heart rate responses were significantly lower following the training (P < 0.05), indicating an improvement in cardiorespiratory fitness. Dual energy x-ray absorptiometry scans revealed no differences in lean body mass or abdominal fat mass. CONCLUSION: An 8-wk exercise training program increases insulin sensitivity in obese children, and this improvement occurred in the presence of increased cardiorespiratory fitness but is independent of measurable changes in body composition.

    Title Will Emergency Health Care Providers Respond to Mass Casualty Incidents?
    Date October 2007
    Journal Journal of Healthcare Protection Management : Publication of the International Association for Hospital Security
    Excerpt

    Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. HYPOTHESIS: Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. METHODS: Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a non-transmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. RESULTS: A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. CONCLUSIONS: As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

    Title The Relationship Between Ace Genotype and Risk of Severe Hypoglycaemia in a Large Population-based Cohort of Children and Adolescents with Type 1 Diabetes.
    Date October 2007
    Journal Diabetologia
    Excerpt

    AIMS/HYPOTHESIS: Genetic factors may account for familial clustering related to diabetes complications. Studies have shown a significant relationship between the presence of the deletion (D) allele of the gene encoding ACE and risk of severe hypoglycaemia. This large prospective cohort study assesses this relationship in a large sample of children and adolescents with type 1 diabetes. SUBJECTS AND METHODS: We studied 585 children and adolescents (mean age 11.9 +/- 4 years, 48.4% males). The frequency of severe hypoglycaemia (an event leading to loss of consciousness or seizure) was prospectively assessed over the 13-year period 1992-2004. Patients were seen with their parents every 3 months and data recorded at each visit. The ACE gene was detected using PCR. RESULTS: In our cohort of 585 children, 186 (31.8%) had at least one episode of severe hypoglycaemia, and of these 28.0% had the II genotype, 48.9% had the ID genotype and 23.1% had the DD genotype. This was in agreement with the Hardy-Weinberg proportion. A total of 477 severe hypoglycaemic episodes was recorded with a total of 3,404 person-years of follow-up, giving a total incidence of 14 per 100 patient-years. No significant increase in risk for DD genotype (incidence rate ratio = 0.97, 95% CI 0.61-1.55) relative to II genotype was observed. CONCLUSIONS/INTERPRETATION: This large prospective study concludes that the presence of the D allele of the ACE gene does not predict a significantly higher risk of severe hypoglycaemia in type 1 diabetic children and adolescents.

    Title Why Do Some Overweight Children Experience Psychological Problems? The Role of Weight and Shape Concern.
    Date October 2007
    Journal International Journal of Pediatric Obesity : Ijpo : an Official Journal of the International Association for the Study of Obesity
    Excerpt

    To examine the associations between weight status, weight and shape concern, self-esteem, body dissatisfaction and depression in children.

    Title Incidence of Neonatal Herpes Simplex Virus Infections in a Managed-care Population.
    Date October 2007
    Journal Sexually Transmitted Diseases
    Excerpt

    To determine the incidence of possible neonatal herpes simplex virus (HSV) infections, HSV infection status of women with infected infants, and use of measures to reduce risk of HSV transmission to the neonate in a large US managed-care population.

    Title Perinatal Risk Factors for Childhood Type 1 Diabetes in Western Australia--a Population-based Study (1980-2002).
    Date September 2007
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    AIMS: To investigate perinatal risk factors for childhood Type 1 diabetes in Western Australia, using a complete population-based cohort. METHODS: Children born between 1980 and 2002 and diagnosed with Type 1 diabetes aged < 15 years (n = 940) up to 31 December 2003 were identified using a prospective population-based diabetes register with a case ascertainment rate of 99.8%. Perinatal data were obtained for all live births in Western Australia from 1980 to 2002 (n = 558 633) and record linkage performed to identify the records of cases. RESULTS: The incidence of Type 1 diabetes increased by 13% for each 5-year increase in maternal age [adjusted incidence rate ratio (IRR) 1.13, 95% confidence interval (CI) 1.05, 1.21], by 13% for every 500-g increase in birth weight (adjusted IRR 1.13, 95% CI 1.04, 1.23). The incidence decreased with increasing birth order (adjusted IRR 0.89, 95% CI 0.82, 0.96) and increasing gestational age (adjusted IRR 0.84, 95% CI 0.77, 0.93). A higher incidence of Type 1 diabetes was associated with an urban vs. non-urban maternal address at the time of birth (adjusted IRR 1.38, 95% CI 1.18, 1.63), but no association was found with socio-economic status of the area. CONCLUSIONS: A higher incidence of Type 1 diabetes was associated with increasing maternal age, higher birth weight, lower gestational age, lower birth order and urban place of residence at the time of birth.

    Title The Role of Family and Maternal Factors in Childhood Obesity.
    Date July 2007
    Journal The Medical Journal of Australia
    Excerpt

    OBJECTIVE: To investigate the relationship between a child's weight and a broad range of family and maternal factors. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional data from a population-based prospective study, collected between January 2004 and December 2005, for 329 children aged 6-13 years (192 healthy weight, 97 overweight and 40 obese) and their mothers (n=265) recruited from a paediatric hospital endocrinology department and eight randomly selected primary schools in Perth, Western Australia. MAIN OUTCOME MEASURES: Height, weight and body mass index (BMI) of children and mothers; demographic information; maternal depression, anxiety, stress and self-esteem; general family functioning; parenting style; and negative life events. RESULTS: In a multilevel model, maternal BMI and family structure (single-parent v two-parent families) were the only significant predictors of child BMI z scores. CONCLUSION: Childhood obesity is not associated with adverse maternal or family characteristics such as maternal depression, negative life events, poor general family functioning or ineffective parenting style. However, having an overweight mother and a single-parent (single-mother) family increases the likelihood of a child being overweight or obese.

    Title Glucose Requirements to Maintain Euglycemia After Moderate-intensity Afternoon Exercise in Adolescents with Type 1 Diabetes Are Increased in a Biphasic Manner.
    Date May 2007
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    CONTEXT: Exercise increases the risk of hypoglycemia in type 1 diabetes. OBJECTIVE: This study aimed to investigate how the amount of glucose required to prevent an exercise-mediated fall in glucose level changes over time in adolescents with type 1 diabetes. SETTING: The study took place at a tertiary pediatric referral center. DESIGN, PARTICIPANTS, AND INTERVENTION: Nine adolescents with type 1 diabetes mellitus (five males, four females, aged 16 +/- 1.8 yr, diabetes duration 8.2 +/- 4.1 yr, hemoglobin A1c 7.8 +/- 0.8%, mean +/- SD) were subjected on two different occasions to a rest or 45 min of exercise at 95% of their lactate threshold. Insulin was administered iv at a rate based on their usual insulin dose, with similar plasma insulin levels for both studies (82.1 +/- 19.0, exercise vs. 82.7 +/- 16.4 pmol/liter, rest). Glucose was infused to maintain euglycemia for 18 h. MAIN OUTCOME MEASURES: Glucose infusion rates required to maintain euglcycemia and levels of counterregulatory hormones were compared between rest and exercise study nights. RESULTS: Glucose infusion rates to maintain stable glucose levels were elevated during and shortly after exercise, compared with the rest study, and again from 7-11 h after exercise. Counterregulatory hormone levels were similar between exercise and rest studies except for peaks in the immediate postexercise period (epinephrine, norepinephrine, GH, and cortisol peaks: 375.6 +/- 146.9 pmol/liter, 5.59 +/- 0.73 nmol/liter, 71.9 +/- 14.8 mIU/liter, and 558 +/- 69 nmol/liter, respectively). CONCLUSIONS: The biphasic increase in glucose requirements to maintain euglycemia after exercise suggests a unique pattern of early and delayed risk for nocturnal hypoglycemia after afternoon exercise.

    Title Subcutaneous Glucose Sensor Values Closely Parallel Blood Glucose During Insulin-induced Hypoglycaemia.
    Date April 2007
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    AIMS: To assess the accuracy of the Minimed continuous glucose monitoring system (CGMS) in estimating blood glucose concentration during a controlled reduction in blood glucose. RESEARCH DESIGN AND METHODS: We studied nine adolescent diabetics (age 14 +/- 1.5 years) wearing the CGMS during hyperinsulinaemic hypoglycaemic clamp studies. The glucose values obtained by the CGMS were compared with the venous blood samples taken during the studies and measured at the bedside using a glucose oxidase technique. RESULTS: Blood glucose was lowered from euglycaemia to a mean of 2.8 mmol/l over 120 min and maintained at that level for a further 40 min. A total of 429 paired glucose measurements were available for analysis. Analysis using weighted Deming regression and t-tests revealed small differences between the methods, with blood glucose levels slightly higher than interstitial fluid levels. The mean difference across all values was 0.13 mmol/l. The observed difference was greatest at blood glucose values < 3.3 mmol/l. CONCLUSIONS: This study suggests that during a fall in systemic glucose the subcutaneous glucose sensor provides an accurate reflection of blood glucose. However, a small difference is apparent at blood glucose values < 3.3 mmol/l.

    Title Suppressive Valacyclovir Therapy: Impact on the Population Spread of Hsv-2 Infection.
    Date March 2007
    Journal Sexually Transmitted Diseases
    Excerpt

    Recent trial results demonstrate that the transmission probability of HSV-2 in monogamous couples is nearly halved by the use of valacyclovir as suppressive therapy.

    Title Will Emergency Health Care Providers Respond to Mass Casualty Incidents?
    Date March 2007
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    INTRODUCTION: Emergency response plans often call on health care providers to respond to the workplace outside of their normal working pattern. HYPOTHESIS: Providers will report to work during a mass casualty emergency regardless of family duties, type of incident, or availability of treatment. METHODS: Survey of emergency personnel needed to respond to a mass casualty incident. Two scenarios were presented: one involving the release of a nontransmissible biological agent with proven treatment and the other the release of a transmissible biological agent with no treatment. At critical time points, participants were asked whether they would report to work. Additional questions considered the effect of commonly used treatment dissemination methods. RESULTS: A total of 186 surveys were issued and returned. (45 physicians, 29 nurses, 86 EMS personnel, and 20 support staff); 6 were incomplete and excluded. Initial commitment rates were 78%. The highest commitment rate identified was 84% and the lowest was 18%. Any treatment dissemination method excluding providers' family members led to decreases in commitment rate, as did agents identified to be transmissible. CONCLUSIONS: As an event develops, fewer health care providers will report to work and at no time will all providers report when asked. This conclusion may be generalizable to several types of incidents ranging from pandemic influenza to bioterrorism. Identification of the causative agent is a major decision point for providers to return to or stay away from work. Offering on-site treatment of providers' family increases commitment to work. These factors should be considered in emergency planning.

    Title Interpersonal Support Evaluation List (isel)--college Version: Validation and Application in a Greek Sample.
    Date March 2007
    Journal The International Journal of Social Psychiatry
    Excerpt

    a) To validate the Interpersonal Support Evaluation List (ISEL)--college version in a Greek population sample and b) To test the hypothesis that students scoring high on the ISEL present stronger resistance to stressful experiences and fewer psychological or physical problems.

    Title Increasing Body Mass Index Z-score is Continuously Associated with Complications of Overweight in Children, Even in the Healthy Weight Range.
    Date March 2007
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    CONTEXT: Overweight/obesity in children is increasing. Incidence data for medical complications use arbitrary cutoff values for categories of overweight and obesity. Continuous relationships are seldom reported. OBJECTIVES: The objective of this study is to report relationships of child body mass index (BMI) z-score as a continuous variable with the medical complications of overweight. DESIGN: This study is a part of the larger, prospective cohort Growth and Development Study. SETTING: Children were recruited from the community through randomly selected primary schools. Overweight children seeking treatment were recruited through tertiary centers. PARTICIPANTS: Children aged 6-13 yr were community-recruited normal weight (n = 73), community-recruited overweight (n = 53), and overweight treatment-seeking (n = 51). Medical history, family history, and symptoms of complications of overweight were collected by interview, and physical examination was performed. Investigations included oral glucose tolerance tests, fasting lipids, and liver function tests. MAIN OUTCOME MEASURE: Adjusted regression was used to model each complication of obesity with age- and sex-specific child BMI z-scores entered as a continuous dependent variable. RESULTS: Adjusted logistic regression showed the proportion of children with musculoskeletal pain, obstructive sleep apnea symptoms, headaches, depression, anxiety, bullying, and acanthosis nigricans increased with child BMI z-score. Adjusted linear regression showed BMI z-score was significantly related to systolic and diastolic blood pressure, insulin during oral glucose tolerance test, total cholesterol, high-density lipoprotein, triglycerides, and alanine aminotransferase. CONCLUSION: Child's BMI z-score is independently related to complications of overweight and obesity in a linear or curvilinear fashion. Children's risks of most complications increase across the entire range of BMI values and are not defined by thresholds.

    Title Development of Miotic Cross-tolerance Between Pyridostigmine and Sarin Vapor.
    Date March 2007
    Journal Journal of Ocular Pharmacology and Therapeutics : the Official Journal of the Association for Ocular Pharmacology and Therapeutics
    Excerpt

    The organophosphorous nerve agent sarin (GB) and the carbamate pyridostigmine bromide (PB) both inhibit acetylcholinesterase (AChE), leading to overstimulation of muscarinic receptors. Both GB and PB produce miosis through stimulation of ocular muscarinic receptors. This study investigated 2 hypotheses: (1) that the miotic response to PB would decrease following repeated injections; and (2) that repeated administration of PB would result in tolerance to the miotic effect of GB vapor. Rats were injected intramuscularly with saline, 0.04 mg/kg, 0.5 mg/kg, or 1.4 mg/kg of PB twice daily for 8 consecutive days. After day 3, animals injected with 1.4 mg/kg PB developed miotic tolerance. Twenty-four (24) h following the final PB injection, the rats were exposed to GB vapor (4.0 mg/m(3)). A similar magnitude of miosis was observed in all groups after GB exposure. However, the rate of recovery of pupil size in animals pretreated with 0.5 and 1.4 mg/kg PB was significantly increased. Twenty (20) h following exposure to GB vapor, the pupils of animals pretreated with 1.4 mg/kg PB had recovered to 77% +/- 4% of their pre-exposure baseline, whereas the saline-injected controls had recovered to only 52% +/- 2% of their pre-exposure baseline. The increased rate of recovery does not appear to be a result of protection of pupillary muscarinic receptors by the higher doses of PB, as there was no longer PB present in the animal at the time of GB exposure. These results demonstrate the development of tolerance to the miotic effect of PB following repeated exposures, and also suggest that cross-tolerance between PB and GB occurs. However, because the magnitude of the response was not reduced, the PB pretreatment and its associated miotic cross-tolerance does not appear to diminish the effectiveness of miosis as a biomarker of acute exposure to nerve agent vapor.

    Title Prevalence and Risk Factors for Microalbuminuria in a Population-based Sample of Children and Adolescents with T1dm in Western Australia.
    Date November 2006
    Journal Pediatric Diabetes
    Excerpt

    OBJECTIVE: To define the prevalence and describe the natural history of microalbuminuria (MA) in a population-based sample of children with type 1 diabetes mellitus (T1DM). METHODS: Children with T1DM diagnosed <or=16 yrs and screened for MA were identified through the Western Australia diabetes register. Three-monthly hemoglobin (HbA1c) was performed from diagnosis. MA screening (albumin excretion rate in three timed overnight samples) was performed yearly after 10 yrs of age or after 5 yrs from diagnosis. Cox proportional model assessed the risk of different variables on the occurrence of MA. Kaplan-Meier survival analyses (log-rank test) estimated the probability of developing MA. RESULTS: Nine hundred and fifty-five T1DM children (462 male), mean diabetes duration of 7.6 yrs and mean age at onset of diabetes of 8.5 yrs were selected for the study. MA, mean albumin excretion rate >or=20 and <200 microg/min, developed in 128 subjects (13.4%) at mean diabetes duration of 7.6 yrs. Cumulative probability for MA was 16% after 10 yrs. Determinants for MA were HbA1c [hazard ratio (HR) 1.21; 95% confidence interval (CI) 1.05-1.38; p = 0.007], onset of puberty (HR 8.01; 95% CI 3.18-20.16; p < 0.001) and age at diagnosis (HR 1.25; 95% CI 1.18-1.33; p < 0.001). Females had a higher probability for MA during puberty than males (p = 0.03). The total incidence of MA (subjects with MA/100 person-years) was 1.26, 1.85 and 2.44 for those who developed diabetes at ages <5 yrs, 5-11 yrs and >11 yrs, respectively. CONCLUSIONS: Onset of puberty, diabetes duration and metabolic control are major factors predisposing the development of MA. Children diagnosed with T1DM at younger ages have a prolonged time for developing MA.

    Title Abdominal Complications After Heart Surgery.
    Date November 2006
    Journal The Annals of Thoracic Surgery
    Excerpt

    BACKGROUND: Up to 3% of patients undergoing heart surgery suffer from an intraabdominal complication (IAC). These complications carry a high mortality besides adding to the morbidity and cost. This review was undertaken to see if a subset of patients with increased risk of IAC could be identified. METHODS: Medical records of 7,731 consecutive patients undergoing heart surgery in a single center were screened for identification of postoperative IAC. One hundred and twenty (120) cases were found. One hundred and six (106) cases were compared with the same number of matched controls. RESULTS: Significant predictors of the development of IAC were increased cardiopulmonary bypass times (> 99 minutes), peripheral vascular disease, chronic steroid use, and low left ventricular ejection fraction. Patients on postoperative antiplatelet therapy or warfarin had a lower risk of IAC. Significant predictors of mortality in IAC were increased cardiopulmonary bypass times (> or = 120 minutes.), use of inotropes, cerebral vascular disease, and incremental age. CONCLUSIONS: A subset of patients can be identified who are at higher risk for IAC and an associated adverse outcome. Patients who have prolonged cardiopulmonary bypass, have a low left ventricular ejection fraction, are on steroids, and suffer from other vascular disease should be observed carefully for development of IAC. Postoperative anticlotting strategies may be helpful. Early diagnosis and intervention are essential for improving outcomes in cases of IAC.

    Title Task Analysis of the Preincision Surgical Period: an Independent Observer-based Study of 1558 Cases.
    Date October 2006
    Journal Anesthesia and Analgesia
    Excerpt

    Intense production pressure has focused on the preincision period (from patient-on-table to incision) as an important component of overall operating room efficiency. We conducted a prospective study in which trained independent observers measured the performance of anesthesiologists, surgeons, and nursing staff to determine anesthesia release time (ART, patient-on-table until release for surgical preparation) and surgical preparation time (SPT, start surgical preparation to incision) and the factors, including delays, that affect their duration. We enrolled 1558 patients undergoing elective surgery in a tertiary medical center. The mean ART was 21 +/- 16 min. Mean SPT was 22 +/- 13 min, and mean case length was 207 +/- 123 min. Significant variation was seen in both ART (range, 1-115 min) and SPT (range, 1-130 min). Multivariate regression analysis revealed ASA physical status, age, level of resident training, invasive monitoring, case length, and case number in the room were all positive predictors of ART duration (P < 0.05). In contrast, gender, body mass index, number of anesthesia personnel concurrently in the room, and number of rooms covered per anesthesia attending were not predictors for ART (P > 0.05). Delays affected both ART and SPT and were encountered in 24.5% of all procedures (surgery 66.8%, anesthesiology 21.7%, and logistical 11.5%). For operating room scheduling purposes, we conclude that assigning a constant fixed duration for anesthetic induction is inappropriate and will result in creating erroneous administrative expectations.

    Title Task Analysis of the Preincision Period in a Pediatric Operating Suite: an Independent Observer-based Study of 656 Cases.
    Date October 2006
    Journal Anesthesia and Analgesia
    Excerpt

    We designed this cross-sectional investigation to assess anesthesia release time (ART = patient-on-table until release for surgical preparation) and surgical preparation time (start of surgical preparation to incision) of children undergoing anesthesia and surgery (n = 656). Data collected by trained independent observers included variables such as age, ASA physical status, anesthetic technique, and placement of invasive monitoring. We found that mean ART was 11.0 +/- 9.7 min and the mean surgical preparation time was 11.1 +/- 10.0 min. Also, ART ranged from 7 +/- 7 min (for mask anesthesia) to 52 +/- 18 min (general anesthesia/endotracheal tube and invasive hemodynamic monitoring). The percentage of ART of the total case length was 15% +/- 7%, with a wide variability depending on the total case length. We also found that there is a significant variability in ART as a function of the surgical service involved (analysis of variance; P = 0.0001), ASA physical status (P = 0.0001), and age. For example, younger children had a significantly longer ART as compared with older children (P = 0.001). Room coverage ratio by the attending anesthesiologist and training level of the anesthesia resident did not impact ART (P = not significant). We conclude that ART in children undergoing surgery is highly variable and is a function of factors such as the surgical service involved, age of the child, and ASA physical status of the child. These factors should be considered when scheduling a surgical case.

    Title Resident Teaching Versus the Operating Room Schedule: an Independent Observer-based Study of 1558 Cases.
    Date October 2006
    Journal Anesthesia and Analgesia
    Excerpt

    Efforts to improve operating room efficiency may threaten clinician training. Therefore, we designed a prospective, observational study to determine the actual time spent teaching anesthesiology residents during the interval from patient-on-table to skin incision and to determine whether anesthesia teaching in the peri-induction period increases the time to surgical incision. This study was conducted in an inpatient operating room suite of a tertiary academic medical center. Of 1558 cases examined, 75% had an element of teaching (mean percent teaching per case = 46.4). A 33% decrease in teaching occurs when the attending anesthesiologist concurrently directed care in 2 rooms (P < 0.001). The percent teaching significantly increased as a function of ASA physical status classification and time of day of surgical case (P = 0.001). Teaching accounted for a mean increase of time to incision of 4.5 +/- 3.2 min, but represented only 3% of the mean surgical case length (207 +/- 132 min). We conclude that teaching occurs in the majority of cases in the operating room and although it contributes to increased time to incision, this increase is insignificant compared with the time required to complete the surgical procedure.

    Title Can the Attending Anesthesiologist Accurately Predict the Duration of Anesthesia Induction?
    Date October 2006
    Journal Anesthesia and Analgesia
    Excerpt

    In a prospective, observational study, the attending anesthesiologists' prediction of anesthesia release time (ART) of the patient to the surgical team was highly correlated with actual ART (r = 0.77; P < or = 0.001). However, this was true only in the aggregate (n = 1265 patients). Indeed, offsetting degrees of under- and over-predicting (24% each) reduced accuracy to only 53% per individual case. For example, under-prediction was associated with ASA physical status IV, a regional anesthetic technique, age >65 yr, and the use of invasive hemodynamic monitoring (P = 0.006). In fact, as the degree of case difficulty increased, the correlation coefficient between predicted and actual ART decreased, indicating a poor predictive value with more difficult inductions (r = 0.82 to r = 0.44; P < or = 0.004). We conclude that knowledge of the presence of specific factors that lead to inaccurate predictions of time required for induction of anesthesia may enhance the accuracy of the operating room schedule.

    Title Acute Effects of Hyperglycaemia in Children with Type 1 Diabetes Mellitus: the Patient's Perspective.
    Date October 2006
    Journal Journal of Pediatric Endocrinology & Metabolism : Jpem
    Excerpt

    INTRODUCTION: This study presents the results of a systematic examination of how parents and patients perceive the effects of acute hyperglycaemia on mood and on intellectual and fine-motor performance. METHODS: A random sample of parents and children with type 1 diabetes mellitus (n = 380) were asked via questionnaire about their perception of the effects of hyperglycaemia. RESULTS: Answers were received from 368 children and parents (97%); mean age was 12.5 years (range 3.7 to 19.8 years). Blood glucose levels between 15-18 mmol/l were reported by 68% to affect thinking performance, by 75% to affect mood and emotions and by 53% to affect coordination. The symptoms most commonly associated with hyperglycaemia were (in decreasing order): irritable (64%), short-tempered (60%), moody (56%), unreasonable (43%), aggressive (37%), hyperactive (31%), sad/depressed (27%) confused (23%), clumsy (18%). Homework was thought to be affected by hyperglycaemia in 36%, sport in 25%, play activity in 32%. Higher mean HbA1c since diagnosis was associated with higher reporting of effects on feeling/mood (p <0.001). Parents were especially concerned about the effects of hyperglycaemia on school and social interaction. CONCLUSIONS: The effects of hyperglycaemia on immediate performance are of concern to children and parents. Hyperglycaemia (15-18 mmol/l) is reported to influence emotion and behaviour more than intellectual and fine-motor performance. This may contribute to the adverse psychological consequences of type 1 diabetes mellitus in children.

    Title Independent Effects of Socioeconomic Status and Place of Residence on the Incidence of Childhood Type 1 Diabetes in Western Australia.
    Date September 2006
    Journal Pediatric Diabetes
    Excerpt

    OBJECTIVE: To analyze the incidence of type 1 diabetes in 0- to 14-year olds in Western Australia, from 1985 to 2002, by region and socioeconomic status. METHODS: Primary case ascertainment was from the prospective population-based Western Australian Diabetes Register, and secondary case ascertainment was from the Western Australian Hospital Morbidity Data System. The address at diagnosis was used to categorize cases into urban, rural and remote areas and into five socioeconomic groups using the Index of Relative Socioeconomic Disadvantage. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyze the incidence rates by area and socioeconomic status. RESULTS: There were a total of 1143 cases (904 urban, 190 rural and 49 remote). Case ascertainment was estimated to be 99.8% complete. The mean annual age-standardized incidence from 1985 to 2002 was 18.1 per 100,000 person years in urban (95% CI: 16.3-19.9), 14.3 per 100,000 in rural (95% CI: 11.4-7.3) and 8.0 per 100,000 in remote areas (95% CI: 5.8-10.3). The incidence was significantly higher in urban compared with rural (rate ratio 1.27, p = 0.001) and remote (rate ratio 2.28, p < 0.001) areas. The incidence increased with higher socioeconomic status. The incidence in the highest socioeconomic group was 56% greater than the lowest socioeconomic group (rate ratio 1.56, p < 0.001). These differences in incidence by socioeconomic status and region were independent of each other. CONCLUSIONS: Higher socioeconomic status and residence in the urban area are independently associated with an increased risk of childhood type 1 diabetes in Western Australia.

    Title Impact of Obesity on Diastolic Function in Subjects < or = 16 Years of Age.
    Date September 2006
    Journal The American Journal of Cardiology
    Excerpt

    The aim of this study was to investigate the impact of obesity on diastolic function in children and adolescents. Echocardiographic measurements were compared in 28 obese subjects (14 males, 14 females) and 15 age- and gender-matched lean controls (8 males, 7 females). Two-dimensional ultrasound imaging, M-mode imaging, and pulse-wave conventional and tissue Doppler measurements were used to assess cardiac structure and function at rest. No differences were evident between lean and obese subjects in age (13.3 +/- 0.5 vs 12.4 +/- 0.4 years), height (163 +/- 4 vs 159 +/- 2 cm), or systolic blood pressure (119 +/- 3 vs 123 +/- 2 mm Hg). Body mass (54.6 +/- 4.0 vs 85.8 +/- 3.6 kg, p < 0.0001) and body mass index (20.5 +/- 0.7 vs 33.3 +/- 1.0 kg/m2, p < 0.00001) were significantly greater in the obese subjects, whereas measurements of wall thickness (interventricular septal wall 0.86 +/- 0.04 vs 0.89 +/- 0.02 cm, posterior wall 0.83 +/- 0.04 vs 0.91 +/- 0.02 cm) and fractional shortening (38.6 +/- 1.2% vs 38.8 +/- 1.2%) did not significantly differ. The E/E' ratio (6.86 +/- 0.20 vs 8.30 +/- 0.32, p < 0.01), E' (13.93 +/- 0.38 vs 12.29 +/- 0.44 cm/s, p < 0.05), the E'/A' ratio (2.49 +/- 0.17 vs 2.05 +/- 0.09, p < 0.05), and the deceleration time of early transmitral blood flow velocity (125.3 +/- 7.7 vs 154.5 +/- 6.8 ms, p < 0.01) were significantly different between the groups, suggesting reduced diastolic function in the obese subjects. In conclusion, these data suggest that indexes of diastolic function, including tissue Doppler measures, are significantly impaired in obese young subjects.

    Title An Aboriginal-driven Program to Prevent, Control and Manage Nutrition-related "lifestyle" Diseases Including Diabetes.
    Date September 2006
    Journal Asia Pacific Journal of Clinical Nutrition
    Excerpt

    Type 2 diabetes and other nutrition-related so-called "lifestyle" diseases, including obesity, and cardiovascular and chronic renal disease, are very prevalent in Australian Aboriginal people and contribute to their high rates of chronic illness and premature mortality. An Aboriginal-driven, community-based health protection, health promotion and improved disease detection, management and care program was introduced in four remote, discrete communities in the far north of Western Australia (WA) in order to attempt to prevent these disorders through community-based lifestyle modification. More energetic screening for early risk factors is involved as well as early dietary and exercise interventions and medical treatment, when indicated. Distinctive features of this program include its Aboriginal initiatives and perspectives, committed partnerships between the communities, the Unity of First People of Australia of Australia (UFPA) and its carers, the communities' health care providers, external clinical specialists, other external agencies and a locally-operated point-of-care (POC) pathology testing capability that is conducted by local and UFPA personnel. The POC component is quality managed by Flinders University. These features have ensured the viability of the program in three of the communities; the other one decided not to continue with the program despite risks of serious long-term health consequences. The pre-program prevalence of diabetes in screened adults was almost 40% and in adults aged (35 years was almost 60%. After several months of the program's operation, there have been positive changes in knowledge about food, nutrition, exercise and disease and altered attitudes and behaviours related to dietary and exercise patterns. There have also been improvements in weight control and in pathology test results relevant to the risk of subsequent development of diabetes and cardiovascular disease.

    Title Is Re-dosing of Vancomycin Necessary?
    Date August 2006
    Journal The Annals of Thoracic Surgery
    Title West Nile Virus in Horses, Guatemala.
    Date July 2006
    Journal Emerging Infectious Diseases
    Title Do Skinfolds Accurately Assess Changes in Body Fat in Obese Children and Adolescents?
    Date July 2006
    Journal Medicine and Science in Sports and Exercise
    Excerpt

    PURPOSE: Obesity is epidemic in Western societies, with rapid rates of increase in the young. Various methods exist for the assessment of body composition, but these have not been compared in obese children and adolescents. This study compared methods of body composition assessment in obese young people to determine whether changes in various measures of body composition as a result of exercise training were correlated. METHODS: Multiple anthropometric measures (weight, height, body mass index (BMI), skinfolds, waist and hip girths) and dual-energy x-ray absorptiometry (DEXA) were undertaken in 38 obese children and adolescents (12.7 +/- 2.1 yr) at baseline and following 8 wk of exercise training. RESULTS: At baseline, there were strong relationships (all P < 0.01) between DEXA total fat and weight (r = 0.83), BMI (r = 0.86), waist girth (r = 0.81), hip girth (r = 0.88), sum of six skinfolds (sum6, r = 0.79), and percent body fat (percent body fat) calculated using a four-skinfold equation (EQ4; r = 0.69). Similar relationships (all P < 0.001) existed between DEXA abdominal fat and weight (r = 0.79), waist girth (r = 0.83), hip girth (r = 0.69), and height (r = 0.71). Neither skinfold sums, nor percent body fat calculated from skinfold equations, were selected as independent predictors of DEXA total or abdominal fat by stepwise hierarchical linear regression. The reductions in DEXA total and abdominal fat following exercise were not predicted by changes in skinfolds or percent body fat calculated from skinfolds. CONCLUSION: These data suggest that body fat derived from skinfold measures is poorly predictive of abdominal and total fat derived from DEXA in obese children and adolescents. This finding highlights the limitations of skinfolds in obese subjects and questions the validity of their use to assess changes in body composition with interventions such as exercise training.

    Title An Examination of Treatment Patterns and Costs of Care Among Patients with Benign Prostatic Hyperplasia.
    Date May 2006
    Journal The American Journal of Managed Care
    Excerpt

    To examine utilization and costs of care for benign prostatic hyperplasia (BPH)-related services in a large cohort of commercially insured persons.

    Title Toxicity of Emerging Energetic Soil Contaminant Cl-20 to Potworm Enchytraeus Crypticus in Freshly Amended or Weathered and Aged Treatments.
    Date April 2006
    Journal Chemosphere
    Excerpt

    We investigated the toxicity of an emerging polynitramine energetic material hexanitrohexaazaisowurtzitane (CL-20) to the soil invertebrate species Enchytraeus crypticus by adapting then using the Enchytraeid Reproduction Test (ISO/16387:2003). Studies were designed to develop ecotoxicological benchmark values for ecological risk assessment of the potential impacts of accidental release of this compound into the environment. Tests were conducted in Sassafras Sandy Loam soil, which supports relatively high bioavailability of CL-20. Weathering and aging procedures for CL-20 amended into test soil were incorporated into the study design to produce toxicity data that better reflect soil exposure conditions in the field compared with the toxicity in freshly amended soils. Concentration-response relationships for measurement endpoints were determined using nonlinear regressions. Definitive tests showed that toxicities for E. crypticus adult survival and juvenile production were significantly increased in weathered and aged soil treatments compared with toxicity in freshly amended soil, based on 95% confidence intervals. The median effect concentration (EC50) and EC20 values for juvenile production were 0.3 and 0.1 mg kg-1, respectively, for CL-20 freshly amended into soil, and 0.1 and 0.035 mg kg-1, respectively, for weathered and aged CL-20 soil treatments. These findings of increased toxicity to E. crypticus in weathered and aged CL-20 soil treatments compared with exposures in freshly amended soils show that future investigations should include a weathering and aging component to generate toxicity data that provide more complete information on ecotoxicological effects of emerging energetic contaminants in soil.

    Title Description and Evaluation of a Pilot Physician-directed Emergency Medical Services Diversion Control Program.
    Date April 2006
    Journal Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
    Excerpt

    OBJECTIVES: To describe the characteristics and feasibility of a physician-directed ambulance destination-control program to reduce emergency department (ED) overcrowding, as measured by hospital ambulance diversion hours. METHODS: This controlled trial took place in Rochester, New York and included a university hospital and a university-affiliated community hospital. During July 2003, emergency medical services (EMS) providers were asked to call an EMS destination-control physician for patients requesting transport to either hospital. The destination-control physician determined the optimal patient destination by using patient and system variables as well as EMS providers' and patients' input. Program process measures were evaluated to characterize the program. Administrative data were reviewed to compare system characteristics between the intervention program month and a control month. RESULTS: During the intervention month, 2,708 patients were transported to the participating hospitals. EMS providers contacted the destination-control physician for 1,866 (69%) patients. The original destination was changed for 253 (14%) patients. Reasons for redirecting patients included system needs, patient needs, physician affiliation, recent ED or hospital care, patient wishes, and primary care physician wishes. During the intervention month, EMS diversion decreased 190 (41%) hours at the university hospital and 62 (61%) hours at the community hospital, as compared with the control month. CONCLUSIONS: A voluntary, physician-directed destination-control program that directs EMS units to the ED most able to provide appropriate and timely care is feasible. Patients were redirected to maximize continuity of care and optimally use available emergency health care resources. This type of program may be effective in reducing overcrowding.

    Title Minimizing Resistance Consequences After Virologic Failure on Initial Combination Therapy: a Systematic Overview.
    Date April 2006
    Journal Journal of Acquired Immune Deficiency Syndromes (1999)
    Excerpt

    OBJECTIVE: To identify optimal first-line therapies based on the rate of virologic success (VS) and the preservation of future treatment options in antiretroviral therapy (ART)-naive subjects. DESIGN: Systematic overview of genotypic resistance mutations from clinical trials of combination ART. METHODS: Various sources were searched for studies in ART-naive subjects providing virologic response rates and genotypes from subjects with virologic failure. The International AIDS Society-USA genotypic resistance guidelines were used to calculate regimen resistance cost (RCreg) and number of active drug (AD) scores for each regimen and to rank the regimens. RESULTS: Intra- and interstudy comparisons showed higher VS rates for nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens (range: 51%-76%) and boosted protease inhibitor (boosted PI) regimens (range: 55%-79%). Boosted PI failures had the lowest RCreg (range: 0.12-0.21) and the highest AD (range: 19.80-20.18) scores. NNRTI failures had higher RCreg (range: 0.00-1.22) and lower AD (range: 16.83-21) scores. CONCLUSIONS: NNRTI and boosted PI regimens provide the highest rates of VS in treatment-naive HIV-infected persons. Treatment option scores were higher in subjects who failed boosted PI- containing regimens versus NNRTI-containing regimens, however.

    Title Phakic Intraocular Lenses.
    Date March 2006
    Journal Current Opinion in Ophthalmology
    Excerpt

    Laser in-situ keratomileusis has been tremendously successful in treating patients with mild and moderate ametropias. For patients with high degrees of refractive error, however, phakic intraocular lenses provide superior quality of vision without the risk of corneal ectasia. Early international results, as well as United States Food and Drug Administration clinical trials, have demonstrated the early safety and efficacy of phakic intraocular lenses. Nevertheless, long-term corneal endothelium cell density and crystalline lens clarity remain a concern.

    Title Cognitive Functioning in Children with Early Onset Type 1 Diabetes and Severe Hypoglycemia.
    Date January 2006
    Journal The Journal of Pediatrics
    Excerpt

    OBJECTIVE: To investigate whether severe hypoglycemia in young children with early-onset type 1 diabetes (T1DM) is associated with subsequent abnormalities in cognitive status. STUDY DESIGN: Recruitment was from a large population-based database of children and adolescents with T1DM. Children and adolescents with early-onset T1DM (<6 years) were eligible for the study. Diabetic individuals (n = 41) with a prospectively documented history of seizure or coma were compared with peers with no history of severe hypoglycemic events (n = 43). A comprehensive test battery of learning and memory was used together with intellectual and behavioral measures. RESULTS: No significant group differences were revealed on the intellectual, memory, or behavioral measures. Similarly, those participants with a history of early first seizure did not differ from their peers with no seizures. There were no significant group differences on the memory subtests that were examined given their potential sensitivity to compromised hippocampal function. CONCLUSIONS: There was no clear evidence from this cohort that episodes of seizure or coma, even those occurring in very early childhood, resulted in broad cognitive dysfunction, nor was there evidence of specific memory difficulties at the time of testing in children and adolescents with early-onset T1DM.

    Title Exercise Training in Obese Children and Adolescents: Current Concepts.
    Date October 2005
    Journal Sports Medicine (auckland, N.z.)
    Excerpt

    Childhood obesity has reached epidemic proportions worldwide and is associated with increased cardiovascular mortality and morbidity in adult life. The increase in fat mass in children and adolescents has occurred concomitantly with a decline in reported time for exercise. Evidence suggests that non-physically active children are more likely to become non-physically active adults and that encouraging the development of physical activity habits in children helps establish patterns that continue into adulthood. Dietary treatment of obesity is relatively ineffective in adults and it has been suggested that prevention of obesity in childhood and adolescence should emphasise increased physical activity rather than diet because of fears relating to the adverse effects of inappropriate eating patterns. Despite this, there are very few randomised controlled studies investigating the efficacy of exercise training in obese children or adolescents and many of the extant studies have been poorly controlled and have not specifically stratified the independent effect of exercise versus dietary modification.This review focuses on the well designed controlled trials that have evaluated the effect of exercise training in obese children and adolescents on body composition, haemodynamic and metabolic variables, cardiovascular fitness, muscular strength and vascular function. These studies indicate that, although exercise training does not consistently decrease bodyweight or body mass index, it is associated with beneficial changes in fat and lean body mass, emphasising the importance of comprehensive assessment of body composition in future exercise-training studies. Exercise training improves cardiovascular fitness and muscular strength; however, it seems to have little effect on blood lipid profile or blood pressure in obese young people. Importantly, recent studies have demonstrated that exercise training improves vascular endothelial function, an important surrogate measure that may predict future atherosclerotic risk in obese children and adolescents. Given that improvement in vascular function in these training studies occurred in the absence of changes in lipid fractions, haemodynamic variables or glucose metabolism, exercise appears to have a direct beneficial effect on the vasculature, in addition to its putative benefits through risk-factor modification.

    Title Induction with Abacavir/lamivudine/zidovudine Plus Efavirenz for 48 Weeks Followed by 48-week Maintenance with Abacavir/lamivudine/zidovudine Alone in Antiretroviral-naive Hiv-1-infected Patients.
    Date September 2005
    Journal Journal of Acquired Immune Deficiency Syndromes (1999)
    Excerpt

    The ESS40013 study tested 4-drug induction followed by 3-drug maintenance as initial antiretroviral therapy (ART) to reduce HIV RNA rapidly and then to simplify to an effective yet more convenient and tolerable regimen.

    Title Tolerance to the Miotic Effect of Sarin Vapor in Rats After Multiple Low-level Exposures.
    Date August 2005
    Journal Journal of Ocular Pharmacology and Therapeutics : the Official Journal of the Association for Ocular Pharmacology and Therapeutics
    Excerpt

    Inhibition of acetylcholinesterase (AChE) by the organophosphorous compound sarin (GB) results in the accumulation of acetylcholine and excessive cholinergic stimulation. There are few data in the literature regarding the effects of multiple low-level exposures to GB and other organophosphorous compounds via relevant routes of exposure. Therefore, the present study was undertaken, and is the first, to investigate the effect of low-level repeated whole-body inhalation exposures to GB vapor on pupil size and cholinesterase activity in the eyes and blood. Male Sprague-Dawley rats were exposed to 4.0 mg/m3 of GB vapor for 1 h on each of 3 consecutive days. Pupil size and cholinesterase activities were determined at various points throughout the exposure sequence. The results demonstrate that multiple inhalation exposures to GB vapor produce a decrease in the miotic potency of GB in rats. This tolerance developed at a dose of GB that produced no overt signs of intoxication other than miosis. AChE and butyrylcholinesterase activity did not increase throughout the exposure sequence, suggesting that the tolerance cannot be attributed to a reduced inhibitory effect of GB. A decrease in the amount of GB present in the eye occurred after the third exposure. However, this change is insufficient to explain the tolerance, as there was no corresponding increase in AChE activity. Thus, the mechanism mediating the miotic tolerance observed after multiple inhalation exposures to the nerve agent GB remains uncertain, although several possibilities can be excluded based on the results of the present study.

    Title Point-of-care Testing of Hba1c and Blood Glucose in a Remote Aboriginal Australian Community.
    Date August 2005
    Journal The Medical Journal of Australia
    Excerpt

    OBJECTIVES: To assess the accuracy of point-of-care (POC) measurements of capillary blood glucose and glycosylated haemoglobin (HbA(1c)) levels in a remote Aboriginal community with high diabetes prevalence. DESIGN: Cross-sectional study comparing POC capillary glucose and HbA(1c) results with those from corresponding venous samples measured in a reference laboratory. PARTICIPANTS AND SETTING: 152 residents aged 11-76 years (representing 76% of population aged over 11 years) had POC glucose measurement in November 2003; 88 with POC glucose level > or = 5.0 mmol/L, or self-reported diabetes, had POC HbA(1c) and laboratory glucose and HbA(1c) measurements. MAIN OUTCOME MEASURES: POC fasting capillary levels of glucose (HemoCue Glucose 201 analyser, Medipac Scientific, Sydney) and HbA(1c) (DCA 2000+ analyser, Bayer Australia, Melbourne); correlation and mean difference between capillary POC and venous blood laboratory measurements of glucose and HbA(1c). RESULTS: Mean and median POC capillary glucose levels were 7.99 mmol/L and 6.25 mmol/L, respectively, while mean and median laboratory venous plasma glucose concentrations were 7.63 mmol/L and 5.35 mmol/L. Values for POC capillary HbA(1c) and laboratory HbA(1c) were identical: mean, 7.06%; and median, 6.0%. The correlation coefficient r for POC and laboratory results was 0.98 for glucose and 0.99 for HbA(1c). The mean difference in results was 0.36 mmol/L for glucose (95% CI, 0.13-0.62; limits of agreement [LOA], - 2.07 to 2.79 mmol/L; P = 0.007) and < 0.01% for HbA(1c) (95% CI, - 0.07% to 0.07%; LOA, - 0.66% to 0.66%; P = 0.95), respectively. CONCLUSIONS: POC capillary HbA(1c) testing, in particular, offers an accurate, practical, community-friendly way of monitoring diabetes in rural and remote clinical settings. POC capillary glucose results should be confirmed by a laboratory test of venous plasma if the results are likely to significantly influence clinical decisions.

    Title Validation of Using Ems Dispatch Codes to Identify Low-acuity Patients.
    Date August 2005
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: To validate the predictive ability of previously derived emergency medical services (EMS) dispatch codes to identify patients with low-acuity illnesses. METHODS: This prospective descriptive study was conducted in Rochester, New York. An expert panel reviewed and modified a previously derived set of low-priority EMS dispatch codes. Patients assigned these 21 codes between July 2002 and June 2003 were included for further analysis. Dispatch data and level of EMS care were recorded for each dispatch code. The proportion of low-acuity patients (i.e., those who received only basic life support (BLS) care or those who were not transported using lights and sirens) was determined using previously established definitions. Codes were defined as associated with low-acuity patients if the lower bound of the 95% confidence interval (CI) exceeded 90%. Medical records for patients identified as high-acuity were reviewed to evaluate whether the advanced life support (ALS) level care that was provided had a clinical impact. RESULTS: Emergency medical services cared for 43,602 patients during the study, and 7,540 were dispatched as low-priority. We found that 7,197 (95%; 95% CI: 95-96%) of these patients met low-acuity criteria and that 11 of the evaluated codes were validated, with low-acuity care provided at least 90% of the time. Of the 343 patients identified as high-acuity, 62 (18%; 95% CI: 14-23%) were determined to have received interventions that had a clinical impact. CONCLUSIONS: This study prospectively validates 11 EMS dispatch codes as being associated with low-acuity patients. These codes could be used to triage EMS patients based on dispatch information.

    Title Insulin Pump Therapy in Children and Adolescents: Improvements in Key Parameters of Diabetes Management Including Quality of Life.
    Date April 2005
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    AIMS: To determine the impact of insulin pump therapy (continuous subcutaneous insulin infusion) on key parameters of diabetes management including quality of life in children and adolescents with Type 1 diabetes mellitus (T1DM). METHODS: All patients started on insulin pump therapy were prospectively followed before and after institution of insulin pump therapy. Data collected included age, duration of diabetes, glycated haemoglobin levels (HbA1c), anthropometric data and episodes of severe hypoglycaemia defined as hypoglycaemia resulting in coma or convulsion. A subset of patients also completed the Diabetes Quality of Life Instrument (DQOL) and Self-Efficacy for Diabetes Scale (SED) questionnaires to assess quality of life. RESULTS: At the time of analysis, 100 patients had been managed with insulin pump therapy. The mean age when starting pump therapy was 12.5 (3.9-19.6) years. Duration of therapy ranged from 0.2 to 4.0 years (mean 1.4 years, median 1.5 years). HbA1c decreased from 8.3 +/- 0.1% prior to pump therapy to 7.8 +/- 0.1% (P < 0.0001). Episodes of severe hypoglycaemia decreased from 32.9 to 11.4 per 100 patient years. Components of quality of life measures showed improvement on pump treatment. BMI standard deviation scores (z scores) did not increase. CONCLUSIONS: Pump therapy is proving an effective means of insulin therapy in the young patient that shows promise to improve glycaemic control with a reduction in hypoglycaemia frequency. Quality of Life measures suggest that psychosocial outcomes may be improved.

    Title Continued Increase in the Incidence of Childhood Type 1 Diabetes in a Population-based Australian Sample (1985-2002).
    Date April 2005
    Journal Diabetologia
    Excerpt

    AIMS/HYPOTHESIS: Our aim was to determine the incidence of Type 1 diabetes in children who were 0 to 14 years of age in Western Australia from 1985 to 2002, and to analyse the trends in incidence rate over the same period. METHODS: Primary case ascertainment was from a prospective population-based diabetes register that was established in 1987, and secondary case ascertainment was from the Western Australia Hospital Morbidity Data System. Denominator data were obtained from the Australian Bureau of Statistics. Poisson regression was used to analyse the incidence rates by calendar year, sex and age at diagnosis. RESULTS: There was a total of 1144 cases (560 boys, 584 girls). Using the capture-recapture method, case ascertainment was estimated to be 99.8% complete. The mean age standardised incidence from 1985 to 2002 was 16.5 per 100,000 person years (95% CI 14.7-18.2), ranging from 11.3 per 100,000 in 1985 to 23.2 per 100,000 in 2002. The incidence increased on average by 3.1% (95% CI 1.9%-4.2%) a year over the period ( p<0.001). No significant difference was found between boys and girls. A significant increase in incidence was found in all age groups, with no disproportionate increase found in the 0 to 4-year-olds. CONCLUSIONS/INTERPRETATION: The incidence of childhood-onset Type 1 diabetes in Western Australia has increased significantly over the past 18 years and shows no signs of abating. In contrast to other studies, a higher rate of increase was not found in the youngest children.

    Title Differential Regulation by At(1) and At(2) Receptors of Angiotensin Ii-stimulated Cyclic Gmp Production in Rat Uterine Artery and Aorta.
    Date April 2005
    Journal British Journal of Pharmacology
    Excerpt

    1. In the present study we determined whether angiotensin II (Ang II) could increase cyclic GMP levels in two blood vessels that exhibit markedly different angiotensin II receptor subtype expression: rat uterine artery (UA; AT(2) receptor-predominant) and aorta (AT(1) receptor-predominant), and investigated the receptor subtype(s) and intracellular pathways involved. 2. UA and aorta were treated with Ang II in the absence and presence of losartan (AT(1) antagonist; 0.1 microm), PD 123319 (AT(2) antagonist; 1 microm), NOLA (NOS inhibitor; 30 microm), and HOE 140 (B(2) antagonist; 0.1 microm), or in combination. 3. Ang II (10 nm) induced a 60% increase in UA cyclic GMP content; an effect that was augmented with PD 123319 and HOE 140 pretreatment, and abolished by cotreatment with losartan, as well as by NOLA. 4. In aorta, Ang II produced concentration-dependent increases in cyclic GMP levels. Unlike effects in UA, these responses were abolished by PD 123319 and by NOLA, whereas losartan and HOE 140 caused partial inhibition. 5. Thus, in rat UA, Ang II stimulates cyclic GMP production through AT(1) and, to a less extent, AT(2) receptors. In rat aorta, the Ang II-mediated increase in cyclic GMP production is predominantly AT(2) receptor-mediated. In both preparations, NO plays a critical role in mediating the effect of Ang II, whereas bradykinin has differential roles in the two vessels. In UA, B(2) receptor blockade may result in a compensatory increase in cyclic GMP production, whilst in aorta, bradykinin accounts for approximately half of the cyclic GMP produced in response to Ang II.

    Title Changes in Contrast Sensitivity After Artisan Lens Implantation for High Myopia.
    Date February 2005
    Journal Ophthalmology
    Excerpt

    PURPOSE: To determine the effects of Artisan lens implantation on contrast sensitivity. DESIGN: Prospective consecutive interventional case series. PARTICIPANTS AND CONTROLS: Forty-nine eyes of 30 patients with myopia and myopia with astigmatism, who underwent implantation of the Artisan iris-fixated phakic intraocular lens. Preoperative testing served as the control. INTERVENTION: Implantation of the Artisan phakic intraocular lens to correct myopia. MAIN OUTCOME MEASURES: Refractive predictability and Snellen visual acuity were evaluated preoperatively and at least 4 months postoperatively. Additionally, photopic and mesopic contrast sensitivities were measured at 1.5, 3, 6, 12, and 18 cycles per degree, with and without glare testing. RESULTS: The mean preoperative spherical equivalent (SE) was -12.16 diopters (D) (range, -6.88 to -18.00). The mean postoperative SE was -0.46+/-0.58 D (range, +0.50 to -1.75). Ninety percent of eyes were within 1.00 D of the predicted result, and 39% gained > or =1 lines of best-corrected visual acuity (BCVA). When compared with preoperative measurements, postoperative contrast sensitivity was increased under photopic conditions and slightly decreased under mesopic conditions. Adverse events were one wound leak requiring resuturing in the immediate postoperative period and one subluxed lens after significant blunt trauma. No eyes lost > or =2 lines of BCVA. CONCLUSIONS: Artisan implantation for the correction of high myopia seems to be a predictable procedure. Increases in photopic contrast sensitivity values after implantation of this phakic intraocular lens stand in distinction to the decreases in photopic contrast sensitivity previously reported after LASIK correction of this degree of myopia.

    Title The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-based Cohort of Children with Type 1 Diabetes.
    Date February 2005
    Journal Diabetes Care
    Excerpt

    OBJECTIVE: To determine the impact of changes to treatment on the incidence of severe hypoglycemia and its risk factors in a large population-based cohort of children with type 1 diabetes. RESEARCH DESIGN AND METHODS: The cohort consisted of 1,335 children (age at entry 9.5 +/- 4.3 years [mean +/- SD], range 0-18), yielding 6,928 patient-years of data. The mean follow-up period was 4.7 +/- 3.1 years (range 0-10.7). Prospective assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made between 1992 and 2002. Patients were reviewed every 3 months. Data were analyzed using the negative binomial regression model. RESULTS: A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29% per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA1c significantly decreased (by 0.2% per year) over the whole follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA1c, younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia. CONCLUSIONS: Severe hypoglycemia remains a major problem for children and adolescents with type 1 diabetes. Recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycemia but further monitoring will be important.

    Title Evaluating Risk Factors Associated with Severe Hypoglycaemia in Epidemiology Studies-what Method Should We Use?
    Date November 2004
    Journal Diabetic Medicine : a Journal of the British Diabetic Association
    Excerpt

    AIMS: To determine the most appropriate regression models to use when assessing risk factors for severe hypoglycaemia and to investigate the impact of model misspecification and its clinical implications. METHODS: A total of 1229 children with Type 1 diabetes (mean age 11.7 years sd 4.1), of which 605 (49.2%) were males, were studied. Prospective assessment of severe hypoglycaemia (an event leading to loss of consciousness or seizure) was made over the 9-year period, 1992-2001. Patients were seen every 3 months and episodes of hypoglycaemia along with clinical data were recorded. Over 70% of children never experienced a severe hypoglycaemic event. Data were analysed using the Poisson regression, negative binomial, zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models. The over-dispersion and likelihood ratio statistics were calculated and the analytical methods compared. RESULTS: The Poisson regression model did not fit the data well. The negative binomial and the zero inflated Poisson and negative binomial models fitted the data better than Poisson. CONCLUSIONS: The commonly used Poisson regression models to analyse hypoglycaemia epidemiology may lead to biased parameter estimates and incorrect determination of risk factors for hypoglycaemia. We recommend the use of the negative binomial or zero inflated models to examine any risk factors associated with severe hypoglycaemia. Careful consideration must be given to the interpretation of hypoglycaemia surveys and their analysis.

    Title An Evaluation of Paramedics' Ability to Screen Older Adults During Emergency Responses.
    Date October 2004
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    This study evaluated the feasibility of using the emergency medical services (EMS) system as a public health provider by having paramedics screen older adults (age >or= 65 years) for influenza immunization status during emergency responses. It also determined the proportion of older-adult EMS patients who lacked an influenza vaccination.

    Title Lack of Effect of Oral Glucose Loading on Conduit Vessel Endothelial Function in Healthy Subjects.
    Date September 2004
    Journal Clinical Science (london, England : 1979)
    Excerpt

    The aim of the present study was to investigate the impact of an oral glucose load on circulating insulin and glucose levels and arterial function in healthy non-diabetic subjects. Thirty-nine non-obese, healthy subjects (24 female, 15 male), aged 21.0+/-1.8 years of age, were randomly assigned to undergo either an OGTT (oral glucose tolerance test; 75 g of glucose) or administration of a placebo. Analyses of lipids, liver function and HbA(1c) (glycated haemoglobin) at baseline revealed results which were within the standard reference range. Insulin and glucose levels as well as vascular function [FMD (flow-mediated dilation)] were measured at 0, 60 and 120 min. Compared with baseline, the control subjects did not exhibit any significant changes in glucose or insulin levels, whereas, in the OGTT group, blood glucose levels at both 60 (5.4+/-1.7 mmol/l) and 120 (5.0+/-1.1 mmol/l) min increased significantly relative to baseline (4.1+/-0.4 mmol/l; both P<0.001) and, similarly, insulin levels were higher at both 60 (30.1+/-21.3 m-units/l) and 120 (34.9+/-23.6 m-units/l) min compared with baseline (4.7+/-4.3 m-units/l; both P<0.001). Although blood glucose and insulin levels changed, FMD did not significantly differ between time-points or between groups. In summary, despite significantly elevated glucose and insulin concentrations in these subjects, we observed no change in vascular function, suggesting that acute elevations of glucose and insulin within the clinically normal range are not associated with impaired vascular function in vivo.

    Title Functional Deletion of the Calcium-sensing Receptor in a Case of Neonatal Severe Hyperparathyroidism.
    Date September 2004
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    Heterozygous inactivating mutations of the calcium-sensing receptor (CaR) cause familial hypocalciuric hypercalcemia, whereas homozygous or compound heterozygous inactivating mutations normally cause neonatal severe hyperparathyroidism. In a case of neonatal severe hyperparathyroidism characterized by moderately severe hypercalcemia and very high PTH levels, coupled with evidence of hyperparathyroidism and effects on brain development not previously demonstrated, we detected point mutations on separate alleles of the CaR, resulting in premature stop codon substitutions at G94 and R648. This led to severely truncated receptors and an effective so-called knockout of functional CaR. FLAG-tagged, truncated receptors were expressed in HEK293 cells for functional analysis. Confocal microscopy demonstrated cytoplasmic localization of the G94stop receptor, whereas the R648stop receptor was present both in the cytoplasm and associated with the cell membrane. Only the R648stop receptor could be detected by Western analysis. Functional assays in which R648stop and wild-type receptor were cotransfected into HEK293 cells demonstrated a reduction in wild-type Ca(2+)-responsiveness by the R648stop receptor, even at physiological Ca(2+) levels, thus simulating familial hypocalciuric hypercalcemia in relatives of the infant who were heterozygous for the R648stop mutation. The R648stop receptor alone was nonresponsive to Ca(2+). This case contributes to our understanding of the clinical manifestation of a CaR knockout.

    Title Functional Role of Angiotensin Ii At2 Receptor in Modulation of At1 Receptor-mediated Contraction in Rat Uterine Artery: Involvement of Bradykinin and Nitric Oxide.
    Date August 2004
    Journal British Journal of Pharmacology
    Excerpt

    The aim of the present study was to explore the mechanisms underlying angiotensin II AT2 receptor modulation of AT1 receptor-mediated vasoconstriction in the rat isolated uterine artery, since previous studies have suggested that AT2 receptors may oppose AT1 receptor-mediated effects. Segments of uterine artery were obtained from Sprague-Dawley rats and mounted in small vessel myographs. Concentration-response (CR) curves to angiotensin II (0.1 nm-0.1 microM) were constructed in the absence and presence of PD 123319 (AT2 antagonist; 1 microM), HOE 140 (bradykinin B2 antagonist; 0.1 microM), Nomega-nitro-l-arginine (NOLA) (NOS inhibitor; 30 microM), as well as combinations of these inhibitors. Contractile responses to angiotensin II were expressed as a percent of the response to a K+ depolarizing solution. PD 123319 (1 microM) potentiated angiotensin II-induced contractions; reflected by a significant four-fold leftward shift of the angiotensin II CR curve. HOE 140 (0.1 microM) significantly increased the pEC50 of the angiotensin II CR curve. The combination of HOE 140 plus PD 123319 did not produce additive potentiation. NOLA (30 microM) significantly enhanced sensitivity to angiotensin II, seen as a five-fold leftward shift of the curve, and an augmented maximum contractile response. Combinations of PD 123319 (1 microM) plus NOLA, and of HOE 140 (0.1 microM) plus NOLA, both induced a similar magnitude of potentiation. Cyclic GMP measurements confirmed angiotensin II-induced activation of the nitric oxide (NO) pathway. In conclusion, AT2 receptor-mediated inhibition of angiotensin II-induced contraction of the rat uterine artery involves NO production; a component of which occurs through a bradykinin B2 receptor pathway.

    Title Emergency Management of Patients with Implanted Pain Control Devices.
    Date July 2004
    Journal Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association
    Title Patients with Head Injuries Refusing Emergency Medical Services Transport.
    Date July 2004
    Journal Brain Injury : [bi]
    Excerpt

    PRIMARY OBJECTIVE: To characterize patients with head injury who refuse emergency medical services (EMS) transport to an emergency department (ED). To identify predictors of patients with head injury who refuse EMS transport. RESEARCH DESIGN: Retrospective chart review. METHODS: Patients with a head injury cared for by EMS during 2001 were identified. Medical records were abstracted for demographic and clinical information and reasons for refusing transport. Patients accepting transport were compared to those refusing. Reasons for refusing transport were described. RESULTS: Three hundred and thirty-three patients with head injuries were identified. Sixteen per cent refused EMS transport. Patients refusing transport were more likely to be male, younger and victims of assault and less likely to have lost consciousness. Patients refusing transport often felt they did not need care or could obtain care later. CONCLUSIONS: Patients with head injuries frequently refuse EMS transportation. Individuals accepting care differ significantly from those refusing care. Sufficient awareness of the risk of head injury seems to be lacking among patients.

    Title Exercise Training Normalizes Vascular Dysfunction and Improves Central Adiposity in Obese Adolescents.
    Date June 2004
    Journal Journal of the American College of Cardiology
    Excerpt

    OBJECTIVES: We sought to characterize the impact of obesity on vascular function in adolescents and to determine whether an exercise program reverses abnormalities in endothelial function. BACKGROUND: Obesity, a major modifiable risk factor for cardiovascular disease, is epidemic in Western societies, with rapid rates of increase in the young. Atherosclerosis begins in childhood, and endothelial dysfunction is its earliest detectable manifestation. METHODS: The influence of eight weeks of circuit training (CT) was examined in 19 obese subjects (14.3 +/- 1.5 years), using a randomized, crossover protocol. Functional capacity and muscular strength were assessed by standard techniques. Body composition was examined using anthropometric measures and dual-energy X-ray absorptiometry. Conduit vessel endothelial function was assessed using high-resolution ultrasound and flow-mediated dilation (FMD) of the brachial artery. RESULTS: Circuit training decreased abdominal and trunk fat and significantly improved fitness and muscular strength (p < 0.05). In the obese group, FMD was significantly impaired relative to control subjects (n = 20) at entry (5.3 +/- 0.9% vs. 8.9 +/- 1.5%, p < 0.05) and was normalized after CT (8.8 +/- 0.8%, p < 0.05). CONCLUSIONS: Circuit training improved functional capacity, muscular strength, and body composition in obese adolescents. Furthermore, conduit vessel function was normalized after exercise training. If vascular dysfunction is an integral component of the pathogenesis of vascular disease, this study supports the value of an exercise program in the management of obese adolescents.

    Title Increase in Type 2 Diabetes in Children and Adolescents in Western Australia.
    Date June 2004
    Journal The Medical Journal of Australia
    Excerpt

    OBJECTIVES: To document diagnosis rates of type 2 diabetes mellitus in children and adolescents in Western Australia over the past 12 years, the clinical characteristics of these patients and any comorbidities. DESIGN: Review of a prospectively recorded diabetes database. SETTING: Tertiary paediatric referral centre (the only such centre in WA). PATIENTS: All children and adolescents aged < 17 years diagnosed with type 2 diabetes between 1990 and 2002 and managed by Princess Margaret Hospital Diabetes Unit. MAIN OUTCOME MEASURES: Anthropometric and demographic data; glycohaemoglobin (HbA(1c)) level; blood pressure; lipid levels; presence of acanthosis nigricans. RESULTS: 43 patients (15 males and 28 females) were diagnosed with type 2 diabetes. Age (SD) at diagnosis was 13.6 (1.8) years. The rate of diagnosis has been progressively increasing (average annual increase in the unadjusted overall rates of type 2 diabetes was 27%). Twenty-three patients (53%) were of Indigenous origin and 18 (42%) resided in rural areas. The mean (SD) HbA(1c) level at diagnosis was 10.0% (3.2%). Seventy-two per cent of patients had acanthosis nigricans, 59% had hypertension, and 24% had hyperlipidaemia. CONCLUSIONS: There has been an increase in the diagnosis rate of type 2 diabetes in children and adolescents in WA. Comorbidities are frequent.

    Title Effects of Exercise Training on Vascular Function in Obese Children.
    Date June 2004
    Journal The Journal of Pediatrics
    Excerpt

    OBJECTIVES: Atherosclerosis is a disease that begins in childhood; endothelial dysfunction is its earliest detectable manifestation, and primary prevention strategies are likely to be most effective if instituted early. The aim of this study was to characterize the impact of obesity on vascular function in young children and to determine whether an exercise program improves abnormalities in vascular function. STUDY DESIGN: The influence of 8 weeks of exercise training was examined in 14 obese subjects, 8.9 +/- 0.4 years of age, with the use of a randomized crossover protocol. Conduit vessel endothelial function was assessed by means of high-resolution ultrasound and flow-mediated dilation of the brachial artery (FMD). RESULTS: Exercise training did not change subcutaneous fat mass, body weight, or body mass index. FMD in the obese group was significantly impaired relative to matched control subjects at entry (6.00% +/- 0.69% to 12.32% +/- 3.14%, P <.0001). FMD significantly improved with exercise training (7.35% +/- 0.99%, P <.05) in the obese group. CONCLUSIONS: Conduit vessel FMD, a validated surrogate measure of early atherosclerosis, was impaired in obese children but improved as a result of exercise training. This study supports the value of an exercise program in the treatment of obese children in a primary prevention setting.

    Title Derivation of Emergency Medical Services Dispatch Codes Associated with Low-acuity Patients.
    Date February 2004
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    To identify emergency medical services (EMS) dispatch codes associated with basic life support (BLS) level of prehospital care, a proxy for low illness acuity.

    Title Hypoglycemia in Children with Type 1 Diabetes: Current Issues and Controversies.
    Date January 2004
    Journal Pediatric Diabetes
    Excerpt

    Hypoglycemia is a common complication of insulin therapy, particularly in the young. For children and adolescents with diabetes, the risk of hypoglycemia may not only prevent optimal glycemic control but can also add significantly to the psychosocial burden of the disease. Recently, surveys employing prospective monitoring techniques have allowed more precise information to be gained about rates of hypoglycemia, its clinical associations, and the impact of new therapies and technologies. A number of reports have estimated rates of hypoglycemic comas and convulsions to be approximately 20 events per 100 patient years in children on current conventional therapy. There is evidence that the introduction of new analog short- and longer-acting insulins and the more widespread use of continuous subcutaneous infusion therapies may allow improvements in glycemic control to occur without the usual increased rate of severe hypoglycemic episodes. The use of glucose sensor technology has brought into focus the widespread occurrence of asymptomatic hypoglycemia. Asymptomatic hypoglycemia has long been recognized, particularly at night, when the combination of excessive insulin action and suppressed counter-regulatory hormone responses put children at special risk of hypoglycemia. Hypoglycemia unawareness is common in the young and is associated with an increased risk of severe hypoglycemia. Whether episodes of severe hypoglycemia have long-term consequences is controversial. Early studies suggesting that the developing brain is sensitive to permanent neurological damage as a result of hypoglycemia have not been confirmed in more recent reports. Many studies have not found convincing evidence of neurological sequelae of the hypoglycemic events that are an inevitable complication of insulin therapy. The question, however, remains under active investigation. Continued prospective monitoring of hypoglycemia rates and consequences has become an essential component of diabetes management.

    Title Nomogram Considerations with the Technolas 217a for Treatment of Myopia.
    Date January 2004
    Journal Journal of Refractive Surgery (thorofare, N.j. : 1995)
    Excerpt

    PURPOSE: To determine whether surgeon-specific nomogram adjustments are useful when using the Technolas 217A excimer laser for treating myopia and myopic astigmatism. METHODS: We conducted a prospective evaluation of 216 consecutive eyes with 6 months follow-up after treatment of myopia or myopic astigmatism with the Technolas 217A laser. Attempted vs. achieved change in refraction was analyzed with a statistical analysis software program. Factors such as age, corneal thickness (pachymetry), preoperative spherical equivalent refraction, preoperative cylinder, and optical zone were studied to evaluate their role in predicting refractive outcome at 6 months after LASIK. RESULTS: The mean value of attempted spherical equivalent refraction was -5.32 +/- 2.72 D. The mean achieved refractive correction at 6 months was -5.55 +/- 2.78 D, with a mean spherical equivalent of 0.13 +/- 0.54 D. The percent achieved effect at 1 month was 105%, and at 6 months, 103%. Preoperative spherical equivalent refraction and optical zone size were strong predictors of 6-month LASIK outcome. There was a 9% difference in the percent achieved effect between a 4 and 7-mm optical zone. There was no correlation between age, preoperative cylinder, or surgeon and 6-month outcome. CONCLUSIONS: Surgeons using the planoscan software on the Technolas 217A may experience a small initial overcorrection. There may be a benefit to reducing the treatment given with larger optical zones and smaller corrections.

    Title A Case Series of Low-dose Fenoldopam in Seventy Cardiac Surgical Patients at Increased Risk of Renal Dysfunction.
    Date December 2003
    Journal Journal of Cardiothoracic and Vascular Anesthesia
    Excerpt

    OBJECTIVE: To evaluate the usefulness of low-dose fenoldopam mesylate in patients at risk of developing renal dysfunction after cardiac surgery requiring cardiopulmonary bypass. DESIGN: A prospective, single-center, observational study. SETTING: University teaching hospital. PARTICIPANTS: Seventy patients scheduled for elective cardiac surgery with one or more predefined risk factors for renal dysfunction. INTERVENTIONS: After induction of anesthesia, fenoldopam (0.03 microg/kg/min) was administered throughout surgery and into the postoperative period, until the patient was stable and weaned from all other vasoactive agents. Perioperatively, fenoldopam was also used as a second-line antihypertensive agent as required. MEASUREMENTS AND MAIN RESULTS: No patient developed renal failure that required dialysis, whereas 7.1% (5/70) developed non-dialysis-dependent renal dysfunction. Four out of these 5 patients had 2 or more risk factors (9.5%). Higher preoperative creatinine levels, a history of hypertension, myocardial infarction within 5 days of surgery, and a preoperative diagnosis of chronic renal insufficiency were all good predictors of postoperative non-dialysis-dependent renal dysfunction. Discharge serum creatinine levels were lower than preoperative levels (1.16 +/- 0.36 mg/dL v 1.26 +/- 0.34 mg/dL, p < 0.05). CONCLUSION: These findings suggest that renal function was preserved in patients at increased risk for renal dysfunction after cardiac surgery when low-dose fenoldopam was used in the perioperative period. However, a randomized, controlled trial is required to establish efficacy.

    Title Impact of Hcv 3.0 Eia Relative to Hcv 2.0 Eia on Blood-donor Screening.
    Date October 2003
    Journal Transfusion
    Excerpt

    In 1996, the Ortho HCV Version 3.0 ELISA Test System (HCV 3.0 EIA) was licensed in the United States for donor screening but was neither mandated nor universally implemented. Data from two studies comparing the differential performance of HCV 3.0 EIA and HCV 2.0 EIA are presented. The first study evaluated the differential performance in a cross-section of screened whole-blood donors after implementation of HCV 3.0 EIA; the second study evaluated the differential performance of HCV 3.0 EIA in plasma donors acutely infected with HCV, identified during routine Abbott HCV 2.0 EIA and HCV NAT (using Roche Ampliscreen plate assay) donor screening.

    Title Immunohistochemical Detection of Polychlorinated Biphenyls in Field Collected Damselfish (abudefduf Sordidus; Pomacentridae) Embryos and Larvae.
    Date March 2003
    Journal Environmental Pollution (barking, Essex : 1987)
    Excerpt

    Antibodies against polychlorinated biphenyls (PCBs) were used to determine if immunohistochemical methods could detect PCBs in embryos and larvae of a territorial coral reef fish (Abudefduf sordidus; Pomacentridae) collected from Johnston Atoll, Central Pacific Ocean. Sites with differing levels of contamination were sampled, one with relatively high sediment PCB concentrations of up to 389.0 ng/g and another with low PCB concentrations of only 0.5 ng/g. Immunostaining suggested that PCB concentrations were higher in fish larvae from the PCB contaminated site and that PCB concentrations within abnormal embryos were higher than normal embryos from the same nest. This technique will be useful for detecting exposed populations in the field and assessing correlations with adverse effects, particularly in potential indicator organisms such as Abudefduf sordidus.

    Title Tilt and Tumble Phacoemulsification.
    Date February 2003
    Journal Developments in Ophthalmology
    Title Lasik Enhancements: a Comparison of Lifting to Recutting the Flap.
    Date December 2002
    Journal Ophthalmology
    Excerpt

    PURPOSE: To compare the visual outcomes and incidence of complications of lifting with recutting the lamellar flap in laser in situ keratomileusis (LASIK) enhancement surgery. DESIGN: Retrospective case-control study. PARTICIPANTS: Two hundred twelve consecutive eyes undergoing a LASIK enhancement procedure at a single surgery location during a 5-year period. METHODS: Charts of participants were obtained and outcome measures obtained. MAIN OUTCOME MEASURES: Uncorrected visual acuity, best-corrected visual acuity, refractive error, complications. RESULTS: Relifting of flaps was performed in 164 of 212 eyes (77.4%), and recutting of flaps was performed in 48 of 212 eyes (22.6%). There were no significant differences in early visual outcomes between the two groups. At 1 year patients had significantly better uncorrected vision if the flap was lifted rather than recut (20/24.7 vs. 20/31.3, P < 0.008). In addition, the flap lift group had a significantly more stable refraction at 1 year than did the recut group (change in spherical equivalent: +0.05 diopters (D) vs. -0.57 D). The incidence of complications did not significantly differ between the two groups. CONCLUSIONS: LASIK enhancement surgery can be performed safely and effectively by either lifting or recutting a flap. Lifting the flap may show better long-term stability of refractive error and uncorrected acuity.

    Title Economic Impact of Asthma Therapy with Fluticasone Propionate, Montelukast, or Zafirlukast in a Managed Care Population.
    Date August 2002
    Journal Pharmacotherapy
    Excerpt

    To compare asthma-related health care expenditures among patients newly prescribed fluticasone propionate 44 or 110 microg, montelukast 5 or 10 mg, or zafirlukast 20 mg.

    Title Prospective Randomized Study of Carotid Endarterectomy with Polytetrafluoroethylene Versus Collagen-impregnated Dacron (hemashield) Patching: Perioperative (30-day) Results.
    Date March 2002
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    PURPOSE: Several studies have reported that carotid endarterectomy (CEA) with patch angioplasty has results that are superior to primary closure. Polytetrafluoroethylene (PTFE) patching has been shown to have results comparable with autogenous vein patching; however, it requires a prolonged hemostasis time. Therefore, many surgeons are using collagen-impregnated Dacron patching (Hemashield [HP]). This study is the first prospective randomized trial comparing CEA with PTFE patching versus HP patching. METHODS: Two hundred CEAs were randomized into two groups, 100 PTFE and 100 HP patching. All patients underwent immediate postoperative and 1-month postoperative color duplex ultrasound scanning studies. Demographic and clinical characteristics were similar in both groups, including the mean operative diameter of the internal carotid artery. RESULTS: The perioperative stroke rates were 0% for PTFE, versus 7% for HP (4 major and 3 minor strokes, P =.02). The combined perioperative stroke and transient ischemic attack rates were 3% for PTFE, versus 12% for HP (P =.047). The operative mortality rate for PTFE was 0%, versus 2% for HP (P =.477). Five perioperative carotid thromboses were noted in patients undergoing HP patching, versus none in patients undergoing PTFE patching (P =.07). After 1 month of follow-up, 2% of patients in the PTFE group had a 50% or more restenosis, versus 12% of patients in the HP group (P =.013). The mean operative time for PTFE patching was 119 minutes, versus 113 minutes for HP patching (P =.081). The mean hemostasis time was significantly higher for PTFE patching than for HP patching, 14.4 versus 3.4 minutes (P <.001). CONCLUSION: CEA with HP patching had a higher incidence of perioperative strokes, carotid thrombosis, and 50% or more early restenosis than CEA with PTFE patching. However, the mean hemostasis time was higher for PTFE patching than for HP patching.

    Title Astigmatism Management: Ablation Patterns.
    Date October 2001
    Journal Current Opinion in Ophthalmology
    Excerpt

    Treatment of astigmatism is possible with the excimer laser. Results with this technology are more predictable and accurate than with incisional techniques. Ablation profiles differ for the various types of astigmatism, and the best approach is the one in which the least amount of tissue is removed from the cornea. Surgical success requires appropriate preoperative counseling, careful preoperative measurements, and meticulous intraoperative technique. Reported outcomes are excellent and future developments will lead to even better results.

    Title Psychometric Evaluation of Four Hiv Disease-specific Quality-of-life Instruments.
    Date September 2001
    Journal The Annals of Pharmacotherapy
    Excerpt

    To provide a comparative evaluation of psychometric properties for three or more HIV disease-specific quality-of-life (QoL) instruments.

    Title Experimental Confirmation of the Predicted Shallow Donor Hydrogen State in Zinc Oxide.
    Date June 2001
    Journal Physical Review Letters
    Excerpt

    We confirm the recent prediction that interstitial protium may act as a shallow donor in zinc oxide, by direct spectroscopic observation of its muonium counterpart. On implantation into ZnO, positive muons--chemically analogous to protons in this context--form paramagnetic centers below about 40 K. The muon-electron contact hyperfine interaction, as well as the temperature and activation energy for ionization, imply a shallow level. Similar results for the cadmium chalcogenides suggest that such shallow donor states are generic to the II-VI compounds. The donor level depths should serve as a guide for the electrical activity of interstitial hydrogen.

    Title Neurotrophic Keratitis.
    Date March 2001
    Journal International Ophthalmology Clinics
    Title Laser in Situ Keratomileusis After Intracorneal Rings. Report of 5 Cases.
    Date January 2001
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To examine the results of laser in situ keratomileusis (LASIK) after removal of intracorneal ring (ICR) segments. SETTING: Active refractive surgery practice. METHODS: The effect of ICR (0.45 mm) placement, the rapidity of refractive recovery after explantation, and the results of subsequent LASIK were examined in 5 eyes. RESULTS: Four eyes developed induced astigmatism after ICR implantation. In 2 of these eyes, retained astigmatism was evident by manifest refraction or corneal topography even after ICR explantation. In 1 eye, the ICR procedure was aborted because of an intraoperative complication. All 5 eyes had subsequent uneventful LASIK. CONCLUSIONS: Intracorneal rings can induce astigmatism that may be retained even after explantation. Careful wound manipulation may reduce the incidence of this complication. Laser in situ keratomileusis after ICR removal appears to be safe and effective.

    Title Lasik Complications.
    Date December 2000
    Journal International Ophthalmology Clinics
    Title Corneal Thickness and Visual Acuity After Phacoemulsification with 3 Viscoelastic Materials.
    Date November 2000
    Journal Journal of Cataract and Refractive Surgery
    Excerpt

    PURPOSE: To determine whether differences exist in visual acuity and corneal thickness after phacoemulsification using various viscoelastic substances. SETTING: Phillips Eye Institute, Minneapolis, Minnesota, USA. METHODS: Fifty patients having routine phacoemulsification cataract extraction and intraocular lens implantation by a single surgeon using the same technique were randomly assigned to receive intraoperative administration of 1 of 3 viscoelastic substances: Amvisc Plus(R) (sodium hyaluronate 1.6%), OcuCoat(R) (hydroxypropyl methylcellulose 2%), or Viscoat(R) (chondroitin sulfate 4%-sodium hyaluronate 3%). Visual acuity and corneal thickness on the first postoperative day were compared between groups. RESULTS: Patients with a best corrected visual acuity (BCVA) of 20/40 or better 1 day postoperatively had significantly thinner corneas (596 microm) than those with a BCVA worse than 20/40 (639 microm). There were no differences in postoperative BCVA or percentage increase in central corneal pachymetry among the 3 viscoelastic groups. CONCLUSION: Viscoat, Amvisc Plus, and OcuCoat were comparable in their ability to produce clear corneas and good vision after routine phacoemulsification.

    Title The Triple Procedure--is It the Best Approach for the Patient? The Triple Procedure May Be Superior to Sequential Surgery.
    Date March 2000
    Journal Archives of Ophthalmology
    Title Combination Pharmacotherapy with Delayed Countershock Vs Standard Advanced Cardiac Life Support After Prolonged Ventricular Fibrillation.
    Date January 2000
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: To test the hypothesis that combination pharmacotherapy with delayed countershock would produce higher rates of return of spontaneous circulation (ROSC) and one-hour survival when compared with standard Advanced Cardiac Life Support (ACLS) therapy. METHODS: A prospective, block-randomized, blinded, laboratory experiment was conducted in an established swine model of prolonged ventricular fibrillation (VF). Fifty-six female domestic swine were anesthetized, instrumented, and shocked into VF with a bipolar pacing catheter. The VF was untreated for 8 minutes, then basic CPR was done mechanically for 1 minute. At 9 minutes of VF, the animals were randomized to treatment with one of seven therapies: group 1, combination pharmacotherapy with epinephrine (0.20 mg/kg), lidocaine (1.0 mg/kg), bretylium (5.0 mg/kg), propranolol (1.0 mg), and U-74389G (3.0 mg/kg); group 2, epinephrine (0.20 mg/kg); group 3, lidocaine (1.0 mg/kg) and bretylium (5.0 mg/kg); group 4, propranolol (1.0 mg); group 5, U-74389G (3.0 mg/kg); group 6, normal saline solution (volume equal to that for group 1); and group 7, standard ACLS (first countershock at 9 minutes of VF). Initial countershocks for groups 1-6 were given after 11 minutes of VF. Data were analyzed with two-tailed Fisher's exact test, with alpha set at 0.05. RESULTS: Return of spontaneous circulation occurred in group 1 = 8/8 (100%); group 2 = 7/8 (88%); group 3 = 3/8 (38%); group 4 = 3/8 (38%); group 5 = 5/8 (63%); group 6 = 4/8 (50%); and group 7 = 3/8 (38%). One-hour survival occurred in group 1 = 8/8 (100%); group 2 = 5/8 (63%); group 3 = 2/8 (25%); group 4 = 2/8 (25%); group 5 = 3/8 (38%); group 6 = 2/8 (25%); and group 7 = 1/8 (13%). CONCLUSIONS: Combination pharmacotherapy with delayed countershock (group 1) produced significantly higher rates of ROSC (p = 0.03) and one-hour survival (p = 0.001) when compared with standard ACLS in this porcine model of prolonged VF.

    Title Mutants of Glucokinase Cause Hypoglycaemia- and Hyperglycaemia Syndromes and Their Analysis Illuminates Fundamental Quantitative Concepts of Glucose Homeostasis.
    Date November 1999
    Journal Diabetologia
    Excerpt

    AIMS/HYPOTHESIS: Mutations of the glucokinase gene cause hyperglycaemia or hypoglycaemia. A quantitative understanding of these defects of glucose homeostasis linked to the glucokinase gene was lacking. Therefore a database of kinetic variables of wild-type and 20 missense mutants of glucokinase was developed and used in mathematical modelling to predict the thresholds for glucose-stimulated insulin release. METHODS: Recombinant human glucokinase was generated in E. coli. The k(cat), glucose S(0.5), ATP K(m), and Hill number of glucokinase were determined. Inhibition by Stearoyl CoA and glucokinase regulatory protein and thermal stability were assayed for all mutants kinetically similar to wild-type glucokinase. A mathematical model predicting the threshold for glucose-stimulated insulin release was constructed. This model is based on the two substrate kinetics of glucokinase and the kinetic variables of the database. It is assumed that both glucokinase gene alleles are equally expressed in beta-cells and that induction of glucokinase occurs as a function of basal blood glucose. RESULTS: Large changes, varying greatly between mutants were found in nearly all variables. Glucokinase flux at threshold for glucose-stimulated insulin release was about 25 % of total phosphorylating potential in the normal beta-cell and this was used to predict thresholds for the mutant heterozygotes. Clinical data for maturity onset diabetes of the young type linked to the glucokinase gene and familial hyperinsulinaemic hypoglycaemia linked to the glucokinase gene and the glucokinase kinetic data of this study were used to test the model. The model predicts fasting blood glucose between 3 and 7 mmol/l in these cases. CONCLUSION/INTERPRETATION: A kinetics database of wild-type and 20 mutants of glucokinase was developed. Many kinetic differences were found for the mutants. The mathematical model to calculate the threshold for glucose-stimulated insulin release predicts fasting blood glucose between 3 and 7 mmol/l in subjects with glucokinase gene mutations. [Diabetologia 42: 1175-1186]

    Title Cell-biological Assessment of Human Glucokinase Mutants Causing Maturity-onset Diabetes of the Young Type 2 (mody-2) or Glucokinase-linked Hyperinsulinaemia (gk-hi).
    Date October 1999
    Journal The Biochemical Journal
    Excerpt

    Mutations in the glucokinase (GK) gene cause type-2 maturity-onset diabetes of the young type 2 (MODY-2) and GK-linked hyperinsulinaemia (GK-HI). Recombinant adenoviruses expressing the human wild-type islet GK or one of four mutant forms of GK, (the MODY-2 mutants E70K, E300K and V203A and the GK-HI mutant V455M) were transduced into glucose-responsive insulin-secreting beta-HC9 cells and tested functionally in order to initiate the first analysis in vivo of recombinant wild-type and mutant human islet GK. Kinetic analysis of wild-type human GK showed that the glucose S(0. 5) and Hill coefficient were similar to previously published data in vitro (S(0.5) is the glucose level at the half-maximal rate). E70K had half the glucose affinity of wild-type, but similar enzyme activity. V203A demonstrated decreased catalytic activity and an 8-fold increase in glucose S(0.5) when compared with wild-type human islet GK. E300K had a glucose S(0.5) similar to wild-type but a 10-fold reduction in enzyme activity. E300K mRNA levels were comparable with wild-type GK mRNA levels, but Western-blot analyses demonstrated markedly reduced levels of immunologically detectable protein, consistent with an instability mutation. V455M was just as active as wild-type GK, but with a markedly reduced S(0.5). The effects of the different GK mutants on glucose-stimulated insulin release support the kinetic and expression data. These experiments show the utility of a combined genetic, biochemical and cell-biological approach to the quantification of functional and structural changes of human GK that result from MODY-2 and GK-HI mutations.

    Title Structural Model of Human Glucokinase in Complex with Glucose and Atp: Implications for the Mutants That Cause Hypo- and Hyperglycemia.
    Date September 1999
    Journal Diabetes
    Excerpt

    Mutations in human glucokinase are implicated in the development of diabetes and hypoglycemia. Human glucokinase shares 54% identical amino acid residues with human brain hexokinase I. This similarity was used to model the structure of glucokinase by analogy to the crystal structure of brain hexokinase. Glucokinase was modeled with both its substrates, glucose and MgATP, to understand the effect of mutations. The glucose is predicted to form hydrogen bond interactions with the side chains of glucokinase residues Thr 168, Lys 169, Asn 204, Asp 205, Asn 231, and Glu 290, similar to those observed for brain hexokinase I. The magnesium ion is coordinated by the carboxylates of Asp 78 and Asp 205 and the gamma-phosphate of ATP. ATP is predicted to form hydrogen bond interactions with residues Gly 81, Thr 82, Asn 83, Arg 85, Lys 169, Thr 228, Lys 296, Thr 332, and Ser 336. Mutations of residues close to the predicted ATP binding site produced dramatic changes in the Km for ATP, the catalytic rate, and a loss of cooperativity, which confirmed our model. Mutations of residues in the glucose binding site dramatically reduced the catalytic activity, as did a mutation that was predicted to disrupt an alpha-helix. Other mutations located far from the active site gave smaller changes in kinetic parameters. In the absence of a crystal structure for glucokinase, our models help rationalize the potential effects of mutations in diabetes and hypoglycemia, and the models may also facilitate the discovery of pharmacological glucokinase activators and inhibitors.

    Title Institution of a Police Automated External Defibrillation Program: Concepts and Practice.
    Date April 1999
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    The authors have successfully implemented automated external defibrillation (AED) training in police departments that function as first responders. The initial elements are to think the project through, and to develop clear policies and procedures for the police as they relate to dispatching so there is timeliness of notification, because response time is such a critical element. Roles for all of the participants must be clearly defined and understood by all parties for such aspects as scene management, scene responsibility of care, and transfer of care to the receiving facilities. Communication to the entire health care community that the police have an expanded role in defibrillation is desirable. A system to evaluate training, compliance with protocol, and efficacy must be developed and closely monitored. While this is a tremendous amount of work and a large time investment, the result can be a dramatic increase in patient survival.

    Title Modulation of At1 Receptor-mediated Contraction of Rat Uterine Artery by At2 Receptors.
    Date March 1999
    Journal British Journal of Pharmacology
    Excerpt

    The aim of this study was to characterize the angiotensin II receptors in isolated uterine arteries from non pregnant and pregnant rats, since it has been reported from binding studies that ovine uterine arteries contain AT2 receptors. Uterine arterial segments were obtained from virgin, non-pregnant and late pregnant (18-21 days) Sprague-Dawley rats and mounted in small vessel myographs. Concentration-response curves were constructed to angiotensin II (1 nM-10 microM) in the absence and presence of various angiotensin II receptor subtype selective compounds. These included losartan (AT1 antagonist; 1, 10 and 100 nM), PD 123319 (AT2 antagonist; 1 microM) and CGP 42112 (AT2 agonist; 1 microM). Responses to angiotensin II were measured as increases in force (mN) and expressed as a per cent of the response to a K+ depolarizing solution. Losartan (1, 10 and 100 nM) caused significant concentration-dependent rightward shifts of the angiotensin II concentration-response curve in uterine arteries from non-pregnant and pregnant rats. The pA2 values calculated from these data were 9.8 and 9.2, respectively, although the slope of the Schild plot in the non-pregnant group was less than unity. PD 123319 (1 microM) caused significant 6- and 3 fold leftward shifts of the angiotensin II concentration-response curve in uterine arteries from non-pregnant and pregnant rats, respectively. In vessels from pregnant rats, PD 123319 also significantly increased the maximum response to angiotensin II. CGP 42112 (1 microM) attenuated the response to angiotensin II of uterine arteries from non-pregnant rats. This was reflected by a 14 fold rightward shift of the angiotensin II concentration-response curve and a decrease in the maximum response. In uterine arteries from pregnant rats, CGP 42112 (1 microM) caused a 3 fold rightward shift of the angiotensin II concentration-response curve, but had no effect on the maximum response. PD 123319 (1 microM) and CGP 42112 (1 microM) had no effect on the concentration-response curves to phenylephrine (PE) of uterine arteries from non-pregnant or pregnant rats. In addition, CGP 42112 (1 nM-1 mM) had no vasodilator effect on tissues precontracted with phenylephrine. These results suggest that the contractile responses of the rat uterine artery are mediated by the AT1 receptor. Furthermore, in this vascular preparation, the AT2 receptor appears to inhibit the response mediated by the AT1 receptor, although, this is not uniform between the non-pregnant and pregnant states.

    Title A Comparison of the Development of Renal Hypertension in Male and Female Rats.
    Date January 1999
    Journal Clinical Science (london, England : 1979)
    Excerpt

    1. The objective of this study was to determine the influence of gender on the development of renal hypertension in Sprague-Dawley rats using the Goldblatt two-kidney, one-clip (2K1C) model. In addition, this study examined the effect of ovariectomy upon the development of hypertension in female rats.2. At 10 weeks of age, male, intact female and ovariectomized female rats underwent clipping of the right renal artery or sham operation. Tail-cuff plethysmography was used to monitor the systolic blood pressure of all animals for 7 weeks post-clipping or sham operation. Rats were sub-grouped according to whether or not they developed hypertension (systolic blood pressure >=150 mmHg).3. Within 2 to 3 weeks of clipping, hypertension was induced in only 53% (n=120) of the intact female 2K1C rats, but in 83% (n=18) of the male and 78% (n=18) of the ovariectomized female rats.4. Seven weeks after right renal artery clipping, plasma renin activity was determined in a subset of each group and was found to be 5-6 fold higher in male (17.29+/-4.04 ng angiotensin I.h-1.ml-1) and ovariectomized female (9.71+/-1.25 ng angiotensin I.h-1.ml-1) hypertensive rats compared with their respective normotensive or sham-operated counterparts (3.39+/-0.58 ng angiotensin I.h-1.ml-1 and 1.60+/-0.41 ng angiotensin I.h-1.ml-1 respectively) (P<0.05, analysis of variance). In contrast, the plasma renin activity measured in intact female hypertensive rats was not significantly different from that measured in the corresponding 2K1C normotensive or sham-operated groups.5. These results indicate that the success rate of inducing renal hypertension in Sprague-Dawley rats is higher in males than in intact females. Furthermore, these results suggest that the induction of 2K1C hypertension may be influenced by ovarian hormones.

    Title Hypoglycemia in Children with Diabetes: Incidence, Counterregulation and Cognitive Dysfunction.
    Date September 1998
    Journal Journal of Pediatric Endocrinology & Metabolism : Jpem
    Excerpt

    Hypoglycemia remains a critical problem in the treatment of IDDM and often limits our ability to consistently achieve excellent glycemic control. Ongoing studies will be important to increase our understanding of the factors responsible for its occurrence and the impact that hypoglycemia may have, particularly for the brain. Significant differences have been documented between adults and children in the incidence of this complication of insulin therapy as well as in the counterregulatory hormone responses to hypoglycemia and its effects on the CNS. While children with diabetes still need insulin treatment, the prevention of hypoglycemia will be a central aim of management. This will depend on effective and expert diabetes education and support for the patient and his or her family along with better efforts to achieve more physiological insulin replacement.

    Title Performance of Police First Responders in Utilizing Automated External Defibrillation on Victims of Sudden Cardiac Arrest.
    Date September 1998
    Journal Prehospital Emergency Care : Official Journal of the National Association of Ems Physicians and the National Association of State Ems Directors
    Excerpt

    OBJECTIVE: Rates of resuscitation from cardiac arrest are directly tied to time to defibrillation. To maximize results, the first arriving care provider should be equipped and trained to defibrillate. This would include police in those systems where they serve this function; to date, no training program has been examined for effectiveness in this group. The purpose of this study was to evaluate a training program designed to train police first responders in the use of an automated external defibrillator (AED). METHODS: One hundred seventy police officers previously trained to the level of first responders underwent a four-hour course to teach incorporation of the AED in their practice. The evaluation of police performance was assessed by written tests prior to, immediately after, and six months post initial training. Actual field use was evaluated by using separate data collection forms filled out at the time of the resuscitation by both police and EMS providers. Each trip sheet was also reviewed. Cassette tapes from the AED were reviewed for continuous ECG tracings and audio recordings to validate and confirm the previous data. RESULTS: One hundred twenty-eight police cases were reviewed. The officers performed with few errors in AED operation, with the only problem areas being incorrect airway management and delay in performance of CPR to use the AED to reanalyze a nonshockable rhythm. These results were compared with those of the only two other studies examining the performance of first responders, which were EMTs and firefighters. The police results compared favorably with, and in some instances exceeded, those results. CONCLUSION: Police first responders trained in the use of AEDs performed at a level equivalent or superior to that in other reported studies. Future training strategies should stress proper integration of airway and CPR skills.

    Title Use of Automated External Defibrillators by Police Officers for Treatment of Out-of-hospital Cardiac Arrest.
    Date August 1998
    Journal Annals of Emergency Medicine
    Excerpt

    OBJECTIVE: To determine the feasibility of police officers providing defibrillation with automated external defibrillators (AEDs) and to assess the effectiveness of this strategy in reducing time to defibrillation of victims of out-of-hospital sudden cardiac arrest. METHODS: This was a prospective, interventional cohort study with historical controls conducted in 7 suburban communities in which police usually arrived at the scene of medical emergencies before EMS personnel. All adult patients who suffered cardiac arrest before EMS arrival and on whom EMS personnel attempted resuscitation were enrolled. Police officers who were trained to use and equipped with AEDs during the intervention phase were dispatched simultaneously with EMS to medical emergencies. Police were instructed to use the AED immediately on determination of pulselessness. Outcome measures were the difference between control and intervention phases in interval from the time the call was received at dispatch to the time of first defibrillation and in rate of survival to hospital discharge for patients initially in ventricular fibrillation. RESULTS: EMS personnel attempted 183 resuscitations in the control phase and 283 during the intervention; of these, 80 (44%) and 127 (45%), respectively, involved patients with initial ventricular fibrillation rhythms. Mean time to defibrillation decreased from 11.8+/-4.7 minutes in the control phase to 8.7+/-3.7 minutes in the intervention phase (P<.0001). Survival to hospital discharge of patients in ventricular fibrillation did not differ between phases (6% control versus 14% intervention, P=.1). When police arrived before EMS personnel, shock administered by police compared with shock administered by EMS was associated with improved survival (26% [12/46] versus 3% [1/29], P=.01). Logistic regression analysis revealed AED use was an independent predictor of survival to hospital discharge. CONCLUSION: In 7 suburban communities, police use of AEDs decreased time to defibrillation and was an independent predictor of survival to hospital discharge.

    Title Prolonged Discordant Xenograft Survival by Inhibition of the Intrinsic Coagulation Pathway in Complement C6-deficient Recipients.
    Date June 1998
    Journal The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
    Excerpt

    BACKGROUND: Xenotransplantation of vascularized organs between unmodified discordant species results in hyperacute graft rejection within minutes to hours after graft reperfusion. This process is due to the presence of natural xenoreactive antibodies and complement activation, which lead to vessel injury, thrombosis, and hemorrhage. Because multiple components of the coagulation and complement cascades interact with each other, we have investigated the effects of inhibiting these systems together. The recombinant Kunitz type serine protease inhibitor (KPI-BG022) tested in these experiments inhibits factor XIIa, kallikrein, and plasmin. METHODS: Cardiac xenografts from male Hartley guinea pigs were heterotopically grafted into male PVG rats that were either sufficient (C6[+]) or deficient (C6[-]) for the complement component C6 and thus formation of the membrane attack complex. Experimental animals received KPI 5 mg/kg intravenously before reperfusion, and control animals received saline placebo. RESULTS: C6(+) recipients rejected their grafts hyperacutely, without a significant difference between KPI-treated (0.12+/-0.05 hours) and placebo-treated (0.13+/-0.06 hours) recipients (n = 10). As expected, C6(-) recipients showed prolonged graft survival (17.65+/-3.45 hours, n = 5). However, a single intravenous bolus of KPI before releasing the clamps further delayed graft rejection in C6(-) recipients (46.2+/-3.3 hours; n = 5). Histologic examination at 2, 6, and 12 hours after transplantation showed platelet aggregation and inflammatory infiltrates were significantly decreased in KPI-treated (C6[-]) recipients. However, intragraft hemorrhage was apparent at 6 and 12 hours. CONCLUSIONS: We conclude that in vivo inhibition of the intrinsic clotting cascade by functional inactivation of factor XIIa has a synergistic effect with inhibition of membrane attack complex formation in preventing hyperacute discordant xenograft rejection.

    Title Decreased Epinephrine Responses to Hypoglycemia During Sleep.
    Date June 1998
    Journal The New England Journal of Medicine
    Excerpt

    BACKGROUND: In patients with type I diabetes mellitus, hypoglycemia occurs commonly during sleep and is frequently asymptomatic. This raises the question of whether sleep is associated with reduced counterregulatory-hormone responses to hypoglycemia. METHODS: We studied the counterregulatory-hormone responses to insulin-induced hypoglycemia in eight adolescent patients with type I diabetes and six age-matched normal subjects when they were awake during the day, asleep at night, and awake at night. In each study, the plasma glucose concentration was stabilized for 60 minutes at approximately 100 mg per deciliter (5.6 mmol per liter) and then reduced to 50 mg per deciliter (2.8 mmol per liter) and maintained at that concentration for 40 minutes. Plasma free insulin, epinephrine, norepinephrine, cortisol, and growth hormone were measured frequently during each study. Sleep was monitored by polysomnography. RESULTS: The plasma glucose and free insulin concentrations were similar in both groups during all studies. During the studies when the subjects were asleep, no one was awakened during the hypoglycemic phase, but during the final 30 minutes of the studies when the subjects were awake both the patients with diabetes and the normal subjects had symptoms of hypoglycemia. In the patients with diabetes, plasma epinephrine responses to hypoglycemia were blunted when they were asleep (mean [+/-SE] peak plasma epinephrine concentration, 70+/-14 pg per milliliter [382+/-76 pmol per liter]; P=0.3 for the comparison with base line), as compared with when they were awake during the day or night (238+/-39 pg per milliliter [1299+/-213 pmol per liter] P=0.004 for the comparison with base line, and 296+/-60 pg per milliliter [1616+/-327 pmol per liter], P=0.004, respectively). The patients' plasma norepinephrine responses were also reduced during sleep, whereas their plasma cortisol concentrations did not increase and their plasma growth hormone concentrations increased slightly. The patterns of counterregulatory-hormone responses in the normal subjects were similar. CONCLUSIONS: Sleep impairs counterregulatory-hormone responses to hypoglycemia in patients with diabetes and normal subjects.

    Title Ocular Manifestations of Multiple Sclerosis.
    Date May 1998
    Journal International Ophthalmology Clinics
    Title Impact of Improved Glycaemic Control on Rates of Hypoglycaemia in Insulin Dependent Diabetes Mellitus.
    Date May 1998
    Journal Archives of Disease in Childhood
    Excerpt

    Increased emphasis on strict glycaemic control of insulin dependent diabetes mellitus (IDDM) in young patients may be expected to cause increases in rates of significant hypoglycaemia. To evaluate whether this is the case for a large population based sample of IDDM children and adolescents rates of severe (coma, convulsion) and moderate (requiring assistance for treatment) hypoglycaemia were studied prospectively over a four year period. A total of 709 patients were studied yielding 2027 patient years of data (mean (SD) age: 12.3 (4.4); range 0-18 years, duration IDDM: 4.9 (3.8) years). Details of hypoglycaemia were recorded at clinic visits every three months when glycated haemoglobin (HbA1c) was also measured. Overall the incidence of severe hypoglycaemia was 7.8 and moderate was 15.4 episodes/100 patient years. Over the four years mean (SD) clinic HbA1c steadily fell from 10.2 (1.6)% in 1992 to 8.8 (1.5)% in 1995. In parallel with this there was a dramatic increase in the rate of hypoglycaemia, especially in the fourth year of the study, when severe hypoglycaemia increased from 4.8 to 15.6 episodes/100 patient years. This increase was particularly marked in younger children (< 6 years) in whom severe hypoglycaemia increased from 14.9 to 42.1 episodes/100 patient years in 1995. It is concluded that attempts to achieve improved metabolic control must be accompanied by efforts to minimise the effects of significant hypoglycaemia, particularly in the younger age group.

    Title Refractive and Keratometric Results After the Triple Procedure: Experience with Early and Late Suture Removal.
    Date April 1998
    Journal Ophthalmology
    Excerpt

    OBJECTIVE: The objective of this study was to determine the outcome of early and late suture removal after the triple procedure (i.e., penetrating keratoplasty, cataract extraction, lens implant). DESIGN AND PARTICIPANTS: The refractive and keratometric results of 106 eyes undergoing the triple procedure were reviewed. The target postoperative refractive error was -1 diopter (D). RESULTS: Average length of follow-up was 40.3 months. Twenty eyes had sutures removed early (<18 months after surgery), 39 had sutures removed late (> or = 18 months after surgery), and 47 had sutures still intact at last follow-up. A best spectacle-corrected visual acuity of 20/40 or better was achieved in 90% of eyes with sutures removed early, 82.1% with sutures removed late, and 70.2% with sutures in place. For all eyes, the mean spherical equivalent at last follow-up was -2.50 D, with 75% of eyes falling between -4 and +2 D. The mean final refractive error was -3.40 +/- 3.53 D for eyes with sutures removed early and -1.79 +/- 3.99 D for eyes with sutures removed late. Eyes with sutures remaining had a mean final refractive error of -0.33 +/- 2.25 D. There was an overall decrease in refractive and keratometric astigmatism after both early and late suture removal with no significant difference between groups. However, there was a wide range of change with some eyes experiencing a decrease and others an increase in astigmatism. Mean postoperative K readings increased significantly for both groups after suture removal (final mean K, 47.00 D) but remained stable for eyes with sutures in. CONCLUSION: The authors data suggest that the final refractive error and net change in refractive and keratometric astigmatism after the triple procedure are not dependent on the timing of suture removal.

    Title Coactivators and Tafs of Transcription Activation in Wheat.
    Date January 1998
    Journal Plant Molecular Biology
    Excerpt

    Transcription regulation often activates quiescent genes in a tissue-specific or developmental manner. Activator proteins bind to a DNA sequence upstream of the promoter, interact with the general transcription proteins via bridging proteins, and elevate transcription levels. One group of bridging proteins, the coactivators, have been characterized in animals as polypeptides tightly associated with the general transcription factor TATA-binding protein (TBP). They are referred to as TAFs (TBP-associated factors), and together with TBP comprise general transcription factor IID. We provide biochemical evidence that wheat IID contains coactivators. An activator protein with an acidic activation domain facilitates the binding of IID to the template, and potentiates activated in vitro transcription with wheat IID, but not with wheat TBP. Using antibodies to wheat TBP, we demonstrate that wheat IID also contains TAFs. This is the first demonstration that a plant contains coactivators and TAFs.

    Title The Use of Biothesiometry to Detect Neuropathy in Children and Adolescents with Iddm.
    Date December 1997
    Journal Diabetes Care
    Excerpt

    OBJECTIVE: To develop clinically useful reference ranges for vibration perception thresholds (VPTs), using biothesiometry in children and adolescents and to assess the reliability of the technique to identify subclinical neuropathy in subjects with IDDM at this age and to examine a large population-based sample of pediatric patients. RESEARCH DESIGN AND METHODS: VPTs were measured using a handheld biothesiometer at the medial malleolus and hallux in 232 nondiabetic children and adolescents aged 7-18 years (12.9 +/- 4.2 years) and a population-based sample of 307 young IDDM patients (13.3 +/- 4.6 years of age). The mean of three readings at each site was correlated with height, pubertal status, and age for all subjects and, in addition for the IDDM sample, with the duration of IDDM, ambient blood glucose, and mean HbA1c from diagnosis. Those IDDM subjects found to have elevated VPTs (> 97th percentile), and a control group of patients with IDDM underwent nerve conduction studies to determine the sensitivity and specificity of biothesiometry to detect abnormal neural function in children. Interoperator reliability was assessed in a separate trial in which two operators measured VPTs independently in the same 11 children. RESULTS: In the nondiabetic control subjects, height demonstrated the best correlation with VPT measures, and a reference range was thus established with percentile charts, using mean VPT and height. VPTs were higher in the diabetic sample, compared with the nondiabetic sample (P < 0.05). Of the children, 28 (9.1%) had VPT values > 97th percentile developed from studies of the nondiabetic subjects; of these, 11 were younger than 11 years and 8 were prepubertal. Nerve conduction studies confirmed reduced conduction velocity and prolonged distal latencies in those with abnormal VPTs, compared with normal control subjects and IDDM patients with normal VPTs. Sensitivity of biothesiometry to reflect abnormal nerve function was estimated as 82% and specificity as 75% at this age. Interoperator variation was small (7.25% of total variance). CONCLUSIONS: Biothesiometry is a useful noninvasive tool for the detection of subclinical neuropathy in children and adolescents. The use of height-related reference ranges may make screening for neuropathy more feasible in younger patients and allow large-scale longitudiral analysis of its development.

    Title The Role of Cd11b/cd18 Mediated Neutrophil Adhesion in Complement Deficient Xenograft Recipients.
    Date December 1997
    Journal Clinical Transplantation
    Excerpt

    Hyperacute rejection (HAR) of discordant xenografts is dependent on local complement activation. The formation of a functional complex of the complement components C5b-9 (membrane attack complex, MAC) causes endothelial injury and activation leading to coagulation and inflammation. In PVG rats which selectively lack the C6 component of complement, the MAC complex is not formed, whereas early split products of the complement cascade are produced normally. We reported previously that HAR is averted in C6 deficient xenograft recipients, and that subsequent accelerated acute rejection (AAR) can be delayed by inhibition of CD11b/CD18 (Mac-1) dependent neutrophil adhesion using leumedin, a member of a novel class of anti-inflammatory agents. Here we report the in vivo effects of a dose-response study using 2 new members of another class of Mac-1 directed agents designated nactins. Discordant cardiac xenografts from Hartley guinea pigs were heterotopically grafted into PVG(C6-) and PVG(C6+) rats. Experimental animals were divided into 3 groups receiving leumedin (group 1) or nactin (groups 2 and 3). Control animals received intravenous saline solution only. All C6(+) rats rejected their grafts hyperacutely within 10 to 15 min, irrespective of mode or dosage of treatment. C6 deficient controls rejected grafts within 17.7 +/- 3.5 h (n = 10). Treatment with leumedin/nactin prolonged graft survival up to 61.0 +/- 4.7 h (n = 4-6), with dose dependent differences in effectiveness among the 3 compounds tested. Histology showed that treatment was associated with less edema, hemorrhage, and neutrophil infiltrate at 2, 6, and 12 h. The marked decrease in hemorrhage seen in nactin-treated animals may reflect an interaction of Mac-1 with blood coagulation factors. Our data confirm that the neutrophil adhesion pathway is involved in AAR, especially when complement mediated injury due to MAC is restricted.

    Title Hypoglycemia: Incidence and Clinical Predictors in a Large Population-based Sample of Children and Adolescents with Iddm.
    Date July 1997
    Journal Diabetes Care
    Excerpt

    OBJECTIVE: To determine the frequency of moderate and severe hypoglycemia and to identify clinical predictors associated with its occurrence in a large population-based sample of children and adolescents with IDDM. RESEARCH DESIGN AND METHODS: A total of 657 patients (age: 12.1 +/- 4.4 years, mean +/- SD) were included in the study, yielding 1,449 patient-years of data. A prospective assessment of severe hypoglycemia (an event resulting in a seizure or coma) and moderate hypoglycemia (an event requiring assistance of another, excluding severe episodes) was made over a 3-year period. Patients and caregivers detailed episodes of significant hypoglycemia (moderate and severe events) and these were recorded at each 3-month clinic visit along with HbA1c. Data were analyzed using generalized estimating equation models fitted with the exchange correlation structure. RESULTS: The overall incidence of severe events was 4.8/100 patient-years and of moderate events was 13.1/100 patient-years. Over 3 years, severe events occurred in 8.5% of children and moderate events occurred in 26.9%. Significant hypoglycemia was rare in the first 12 months after diagnosis. Rates of hypoglycemia were increased in children < 6 years of age versus > 6 years of age (40.9 vs. 16.6/100 patient-years, age < or = 6 years vs. age > 6 years, P < 0.001). Rates of hypoglycemia doubled when HbA1c fell below 8%, and children with HbA1c < 7% had a threefold increase in both moderate and severe hypoglycemia (e.g., severe episodes 14.9 vs. 4.1/100 patient-years, HbA1c < or = 7% vs. HbA1c > 7%, P < 0.001). Most severe events were seizures, and 75% of them occurred at night. The majority of events were related to missed meals or increased activity. However, in 38% no predisposing factor was evident. CONCLUSIONS: Newly diagnosed children appear to be protected from severe hypoglycemia. Rates increase with lower glycated hemoglobin, especially when mean HbA1c is < 8.0%. Younger children, who may be more susceptible to the adverse effects of neuroglycopenia, are at a particular risk of significant hypoglycemia.

    Title Law Enforcement Agencies and Out-of-hospital Emergency Care.
    Date May 1997
    Journal Annals of Emergency Medicine
    Excerpt

    STUDY OBJECTIVE: We sought to assess the involvement of law enforcement agencies in out-of-hospital emergency medical care and their attitudes toward expanded roles in emergency medical services (EMS) systems. METHODS: We mailed a 20-question survey to 800 police chiefs and sheriffs randomly selected from a list of all law enforcement agencies in the United States. The questions focused on the characteristics of each law enforcement agency, its current level of involvement in providing out-of-hospital emergency medical care, and the characteristics of its associated community and local EMS system. The survey concluded with four statements to assess officer attitudes toward an expanded role in EMS-related activities. We used the chi 2 or Fisher exact test to analyze differences in proportions. The alpha-error rate was set at .05. RESULTS: Seventeen surveys were returned as undeliverable. Of the remaining 783 surveys, we received 602 responses (77%). Five hundred forty-nine (70.1%) of the respondents were the primary law enforcement agencies in their communities; they make up the final sample. The median number of officers per agency was 12 (range, 1 to 2,623), and the median population served was 6,936 (range, 150 to 1,500,000). Responses indicated that 442 (80.7%) agencies responded to one or more specific types of medical emergencies and 263 (50.3%) provided some level of patient care. Law enforcement officers frequently arrived at the scene of medical emergencies before EMS personnel (81.5%), with a roll-time interval of less than 8 minutes (87.2%). Only 14 agencies (2.6%) used automatic external defibrillators. Fifty-three percent agreed with the statement that EMS-related activities would interfere with their law enforcement duties. However, more than 60% of respondents agreed that law enforcement agencies should be involved in providing emergency medical services for life-threatening emergencies, that their officers would be willing to undertake extra medical training and that EMS-related activities would improve their public images. CONCLUSION: Many law enforcement agencies are involved to some extent in providing out-of-hospital emergency medical care, and most of the agencies we surveyed would support additional medical training and new or expanded roles for themselves in EMS systems.

    Title Overcoming Rejection in Pig-to-primate Cardiac Xenotransplantation.
    Date April 1997
    Journal Transplantation Proceedings
    Title Acute Hyperglycaemia Impairs Cognitive Function in Children with Iddm.
    Date February 1997
    Journal Journal of Pediatric Endocrinology & Metabolism : Jpem
    Excerpt

    OBJECTIVE: The effects of acute hyperglycaemia on cognitive function in children remain controversial. This study was designed to investigate the suggestion that acute hyperglycaemia impairs cognition in IDDM children. DESIGN: To examine this question we studied 12 randomly selected children with IDDM (6 boys, 6 girls, mean age 12.4 years). Cognitive performance was assessed on two occasions at least six months apart (7.4 +/- 1.4 mths, range: 6.3-11.1 mths) under randomised conditions of hyperglycaemia (20-30 mmol/l) on one occasion and euglycaemia (5-10 mmol/l) on the other. Target glucose levels were achieved using a modified clamp technique with subjects and psychologist blinded to the glycaemic level. Cognitive tests chosen to assess performance skills were subtests from the Wechsler Intelligence Scale for Children-3rd Edition (WISC-111). RESULTS: No significant learning effect was present. However, there was a reduction in performance IQ at hyperglycaemia compared with euglycaemia (106 +/- 4.3 vs 112 +/- 4.5 IQ points respectively, p < 0.05). Under hyperglycaemic conditions the mean decrease in percentile score for performance IQ was 9.5%. Of the 12 children tested, 8 had a decrease in IQ when hyperglycaemic, which was independent of duration of diabetes and long term metabolic control assessed by HbA1c. CONCLUSION: Acute hyperglycaemia results in impairment of complex cognitive function in children with IDDM. This may have important implications for school performance.

    Title Bioprosthetic Versus Mechanical Prostheses for Aortic Valve Replacement in the Elderly.
    Date December 1996
    Journal Circulation
    Excerpt

    BACKGROUND: Many centers advocate bioprosthetic valves in the elderly to avoid anticoagulation, in particular when patient survival is less than the expected valve durability. Because expected survival in the elderly is increasing and age-specific risk of anticoagulation in the elderly is not known, we examined valve- and anticoagulation-related morbidity in elderly patients after aortic valve replacement (AVR) with bioprostheses or mechanical prostheses. METHODS AND RESULTS: Between January 1980 and June 1994, 211 patients age > or = 70 years underwent isolated AVR; there were 109 men (52%) and 102 women (48%). Mean age was 75.9 +/- 4.8 years. Aortic stenosis was present in 194 (92%) patients. Bioprostheses were used in 145 (69%) and mechanical prostheses were used in 66 (31%). Chronic anticoagulation was maintained in all patients with a mechanical valve and in 18 patients (12%) with a bioprosthetic valve. Follow-up data were obtained for 98% (194 of 197) of hospital survivors at a mean follow-up of 3.8 years. Operative mortality was 6.6%; survival at 3 and 5 years was 75.3 +/- 3% and 64.6 +/- 4%, respectively. There was no significant difference in operative or late mortality between patient groups. Rates of freedom from thromboembolic events, endocarditis and anticoagulant-related hemorrhage for bioprosthetic and mechanical valve patients were similar. Prosthetic failure was identified in three bioprosthetic valves (2%); furthermore, the 4 patients in the series who required reoperation had received bioprostheses at the first operation. CONCLUSIONS: In conclusion, (1) elderly patients undergoing isolated AVR can be managed with either mechanical or bioprosthetic valves with similar early and late risk, as long as there are no specific contraindications to anticoagulation; (2) anticoagulation-related risk of hemorrhage is low in this group of elderly patients; and (3) the low but significant risk of reoperation following the use of bioprostheses suggests that mechanical valves may be underused in the elderly.

    Title Inhibition of Complement, Evoked Antibody, and Cellular Response Prevents Rejection of Pig-to-primate Cardiac Xenografts.
    Date December 1996
    Journal Transplantation
    Excerpt

    Complement (C) inhibition alone using a recombinant soluble form of complement receptor type 1 (sCR1) prevents hyperacute rejection but not subsequent irreversible accelerated acute rejection of discordant pig-to-cynomolgus monkey cardiac xenografts, which occurs within 1 week. To inhibit accelerated acute rejection, which is associated with a rise in serum xenoreactive antibody (Ab) and a cellular infiltrate, triple therapy with standard immunosuppressive agents (cyclosporine, cyclophosphamide, and steroids [CCS]) was combined with continuous C inhibition using sCR1. Each of two monkeys that received sCR1 + CCS showed minimal evidence of rejection when killed on days 21 and 32 in comparison to a monkey that received sCR1 + subtherapeutic CCS (rejected at 11 days) and a control that received CCS alone (rejected at 38 min). Prolonged xenograft survival was associated with low Ab levels and a minimal cellular infiltrate, suggesting that combined inhibition of C, xenoreactive Ab responses, and cellular immunity may be a useful approach in overcoming the immune barriers to discordant xenotransplantation.

    Title Inhibition of Neutrophil Adhesion and the Membrane Attack Complex of Complement Synergistically Prolongs Cardiac Xenograft Survival.
    Date September 1996
    Journal The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
    Excerpt

    BACKGROUND: Hyperacute xenograft rejection is affected by activation of the complement cascade. Split products of early complement components influence the localization, activation, and effector function of platelets, granulocytes, and lymphocytes, whereas the formation of the membrane attack complex (C5b-9) leads to direct cellular injury. In a unique strain of PVG rats deficient in the C6 component of complement, the terminal membrane attack complex is not formed. However, production of the chemotactic and vasoactive components C3a and C5a proceeds normally. Guinea pig cardiac xenografts in these C6-deficient rats have prolonged survival, and at the time of rejection the inflammatory infiltrate is composed primarily of neutrophils. NPC 15669, a member of a class of antiinflammatory agents called leumedins, is known to inhibit neutrophil adhesion. The purpose of this study was to determine whether inhibition of neutrophil recruitment in animals incapable of membrane attack complex formation would prolong cardiac xenograft survival. METHODS: Cardiac xenografts from male Hartley guinea pigs were heterotopically grafted into PVG (C-) and PVG (C+) male rats. Experimental animals received 20 mg/kg of NPC 15669 i.v. before cross-clamp release and 10 mg/kg of NPC 15669 intravenously on postoperative day 1. Control animals received intravenous saline solution only. RESULTS: Complement sufficient PVG (C+) rats rejected cardiac xenografts hyperacutely despite mode of treatment: PVG (C+) rats which received saline solution (n = 5) rejected their xenografts at 10.8 +/- 2.6 minutes, and those receiving NPC 15669 (n = 5) rejected at 13.9 +/- 5.3 minutes. Histologic examination showed edema, platelet aggregation, and hemorrhage but no cellular inflammatory infiltrate. As expected, complement-deficient PVG (C-) rats had markedly longer xenograft survival in the saline solution-treated group (n = 5) with graft function being sustained 14.7 +/- 6.1 hours. NPC 15669 treatment (n = 4) further prolonged graft function to 61.0 +/- 4.7 hours. In addition to edema, platelet aggregation, and hemorrhage, histologic analysis of these grafts at the time of rejection was characterized by an infiltration of neutrophils. CONCLUSIONS: We conclude that neutrophils play a critical role in cardiac xenograft rejection when complement activation is restricted. Combined inhibition of complement and neutrophil adhesion prolongs xenograft survival longer than inhibition of either component alone.

    Title Esophagectomy for Benign Disease: Trends in Surgical Results and Management.
    Date August 1996
    Journal The Annals of Thoracic Surgery
    Excerpt

    BACKGROUND. Esophagectomy for benign disease is uncommon. METHODS. From July 1987 to April 1995, 45 consecutive patients (30 men, 15 women; mean age, 50 years) were evaluated in whom the senior author (R.F.H.) performed an esophagectomy, esophageal reconstruction, or both. The study period was divided into two time intervals, July 1987 to January 1992 (time 1) and February 1992 to April 1995 (time 2). RESULTS. Indications for operation included obstruction (23 patients, 51%), benign neoplasia (17.38%), and perforation (5 patients, 11%). A nonthoracotomy approach was used in 19 (42%) patients: 15 transhiatal and 4 substernal. Thoracotomies were performed in 26 (58%) patients through a left thoracoabdominal or multiincisional techniques. Morbidity occurred in 15 (33%) patients, and there was one operative death (2%). CONCLUSIONS. Despite an operative morbidity of 33%, esophagectomy for benign disease may be performed with acceptably low mortality. We observed the following trends: (1) an increase in patients with benign neoplasia and a decline in patients with obstruction, (2) an increased use of transhiatal esophagectomy, (3) a decreased use of colon, an increased use of stomach for esophageal replacement; and (4) a decreased length of hospital stay.

    Title Aortic Aneurysm Complicating Bacterial Endocarditis in Childhood.
    Date July 1996
    Journal Journal of Paediatrics and Child Health
    Excerpt

    Bacterial endocarditis is an uncommon diagnosis in childhood with significant morbidity and mortality. Aortic aneurysm as a complication is well described in adults but there are few reports in the paediatric literature. Two children with bacterial endocarditis are described, whose illnesses were complicated by aortic aneurysm formation requiring surgical intervention.

    Title Induction of Heat Shock Protein in Cardiac Allograft Rejection--a Cyclosporine-suppressible Response.
    Date April 1996
    Journal Transplantation
    Excerpt

    The cellular response to a wide variety of stresses results in the synthesis of a family of proteins termed heat shock proteins (HSPs). To determine if acute allograft rejection could induce these proteins in a transplanted graft, we examined the HSP response to acute cardiac allograft rejection and analyzed the effect of immunosuppression upon this response. Donor hearts obtained from either Lewis (LEW) or ACI rats were heterotopically transplanted in recipient LEW rats. There were 4 experimental groups: untreated isografted (LEW to LEW) animals (n = 14), untreated allografted (ACI to LEW) animals (n = 14), cyclosporine-treated (10 mg/kg SQ/day) isografted animals (n = 12), and cyclosporine-treated allografted animals (n = 12). Animals were sacrificed on posttransplantation day 2, 4, or 6 (time of rejection for untreated allografts); n = 4-5 for each time point per group. At these times tissue obtained from the transplanted heart was examined histologically and analyzed for HSP72 by quantitative Northern and Western blots. The level of HSP72 in the untreated allografts progressively increased between 2, 4, and 6 days posttransplantation and was significantly greater than that of the untreated isografts at all time points. The HSP72 response in cyclosporine-treated allografts was significantly reduced at 4 and 6 days posttransplantation compared with the untreated allografts. In contrast, there was no difference in the HSP response in treated versus untreated isografts. Additionally, there was no difference in HSP levels in cyclosporine-treated isografts and allografts. These findings demonstrate that HSP expression in the transplanted heart correlates directly with the evolution of acute allograft rejection, and that immunosuppressive therapy inhibits the HSP response. These studies also raise the possibility of a functional role for HSPs in the allogeneic immune response.

    Title Basics of Research (part 5): Ethics and Human Rights.
    Date March 1996
    Journal Air Medical Journal
    Title Basics of Research (part 2): Reviewing the Literature.
    Date August 1995
    Journal Air Medical Journal
    Title Functionality of Sugars: Physicochemical Interactions in Foods.
    Date July 1995
    Journal The American Journal of Clinical Nutrition
    Excerpt

    Basic and selected functional properties of simple sugars, sugar alcohols, corn and maple syrups, honey, and high-fructose corn syrups are discussed. Properties that relate to sweetness and properties that play roles in component interaction as a basis for product formulation are described. The implications of such functionality are illustrated for the development of low-energy foods and for the microwave heating of foods. Among the properties discussed are solubility, hygroscopicity, crystallinity, and viscosity. Interrelations among water mobility, water activity, and hydration of proteins, lipids, and carbohydrates are described in the context of food formulation. Application of polymer chemistry principles to explain functional properties of amorphous molecules is reviewed.

    Title Attenuated 5-hydroxytryptamine Receptor-mediated Responses in Aortae from Streptozotocin-induced Diabetic Rats.
    Date July 1994
    Journal British Journal of Pharmacology
    Excerpt

    1. This study was designed to examine further the attenuated contractile responses to 5-hydroxytryptamine (5-HT) previously observed in aortae from diabetic rats. 2. Cumulative concentration-response curves to 5-HT, and the 5-HT receptor agonists, alpha-methyl 5-HT (alpha-Me-5-HT, 5-HT2/1C agonist), (+/-)-1-(2,5-dimethoxy-4-iodophenyl)-2- aminopropane (DOI, 5-HT2/1C agonist) and 5-carboxamidotryptamine (5-CT, 5-HT1A/1B/1D agonist), were examined in endothelium-intact and -denuded aortae from 2-week streptozotocin (STZ)-diabetic and control rats. 3. In endothelium-intact and -denuded aortae from diabetic rats, maximum responses to 5-HT and alpha-Me-5-HT were significantly reduced compared to those of aortae from control rats. Responses to these agonists were inhibited by the 5-HT2/1C receptor antagonist, ketanserin (0.1 microM). 4. The attenuated responses to 5-HT of aortae from diabetic rats were normalized by chronic insulin treatment of the rats (5 units day-1, s.c.), but not by altering the glucose concentration of the bathing fluid. 5. The nitric oxide synthase inhibitor N-nitro-L-arginine (NOLA, 0.1 mM) significantly potentiated responses to both 5-HT and alpha-Me-5-HT in endothelium-intact aortae. However, the difference between maximum responses of aortae from diabetic and control rats was still evident in the presence of NOLA. 6. Endothelium-intact rings, in the presence of ketanserin (0.1 microM) and preconstricted with the thromboxane A2-mimetic, U46619 (0.1-0.3 microM), from control and diabetic rats, did not relax to cumulative additions of 5-HT (1 nM-30 microM). 7. Contractile responses to DOI were obtained only in endothelium-denuded aortae, and in endothelium-intact aortae in the presence of NOLA, from control rats.8. Contractile responses to 5-CT were obtained only in endothelium-denuded aortae from both control and diabetic rats, and in endothelium-intact aortae in the presence of NOLA, from control rats.9. [3H]-ketanserin binding studies showed that there was no significant change in the affinity or density of [3H]-ketanserin for binding sites in membrane preparations of aortae from control and diabetic rats.10. These results suggest that 5-HT contracts aortae from rats via 5-HT2/1c receptor activation.However, the simultaneous release of EDRF from endothelial cells in response to 5-HT does not appear to be receptor-mediated. The attenuated contractile responses observed to 5-HT in aortae from 2-week diabetic rats do not appear to be mediated by changes in either endothelial cell function or an alteration in 5-HT receptor affinity or density.

    Title Factors Influencing the Implementation of the Cns Role in a Private Practice.
    Date March 1994
    Journal Clinical Nurse Specialist Cns
    Excerpt

    Factors to be considered by the CNS before implementing the role in private practice with a physician are discussed. Four CNSs were interviewed regarding their experiences in such a practice. The CNS subroles of expert practitioner, educator, consultant, and researcher are described as they apply in private practice with a physician. A four-step process is proposed to guide the CNS considering entry into private practice. The steps discussed are: self-assessment, evaluation of the legal and financial aspects, development of marketing and cost-justification strategies, and negotiating for a position. A method for cost justification is proposed, and some elements of marketing and negotiating are reviewed.

    Title The Utilization of Quality Assurance Methods in Emergency Medical Services.
    Date August 1993
    Journal Prehospital and Disaster Medicine : the Official Journal of the National Association of Ems Physicians and the World Association for Emergency and Disaster Medicine in Association with the Acute Care Foundation
    Excerpt

    The concept of the necessity of a good quality assurance (QA) plan for emergency medical services (EMS) is well-accepted; guidelines as how best to achieve this and how current systems operate have have not been defined. The purpose of this study was to survey EMS systems to discover current methods used to perform medical control and QA and to examine whether the existence of an emergency medicine residency affected these components.

    Title Long-term Complications Following Bone Marrow Transplantation in Children.
    Date July 1993
    Journal Journal of Paediatrics and Child Health
    Excerpt

    Seventeen children who underwent bone marrow transplantation (BMT) between 1975 and 1985 and survived for more than 2 years were evaluated for growth and development. The patients had a follow up of 2.1-13.1 years. Prior to transplant, children with malignancy had received multi-agent chemotherapy and nine had also received central nervous system irradiation. Transplant preparation for malignancy (group 1; n = 13) included high-dose cyclophosphamide (CPA) 120-200 mg/kg and total body irradiation (TBI) 10-13.2 Gy, whereas conditioning for non-malignant disorders (group 2; n = 4) included high-dose CPA 200 mg/kg with or without busulphan. Patients in group 1 showed a steady decline in height velocity following initial chemotherapy and cranial irradiation and the decline was even greater following BMT. Growth hormone (GH) deficiency developed in eight of nine children tested, hypergonadotrophic hypogonadism developed in 11 who reached puberty, thyroid hormone abnormalities were encountered in four out of 10 tested and 11 of 13 developed cataracts. Patients in group 2 did not show decline in linear growth rate, thyroid hormone abnormalities or cataracts after BMT. The only child tested had normal GH levels and the two patients who reached puberty showed delayed but complete gonadal recovery. Our data demonstrate that TBI leads to significant late effects on growth and gonadal function. Contrary to previous reports, a high incidence of cataract formation is observed after fractionated TBI. Conditioning regimens TBI should be considered in children undergoing BMT.

    Title Wheat Tfiid Tata Binding Protein.
    Date May 1993
    Journal Nucleic Acids Research
    Title Reliability of the Glasgow Coma Scale when Used by Emergency Physicians and Paramedics.
    Date March 1993
    Journal The Journal of Trauma
    Excerpt

    We sought to determine the reliability of the Glasgow Coma Scale (GCS) when used by emergency physicians and paramedics. We performed a prospective sequential trial in a classroom setting, with subjects blinded to others' scoring. Nineteen university-affiliated emergency physicians and 41 professional paramedics from an urban EMS system voluntarily participated. Participants viewed four videotaped scenes in which a patient is assessed by a paramedic. The first three scenes represented severe, intermediate, and no/mild alteration in level of consciousness (LOC). The findings in the fourth scene were identical to the first, allowing determination of intrarater reliability. The Kappa statistic was used to determine interrater reliability; the reliability coefficient determined intrarater reliability. Kappa was significant (p < 0.0001) for severe (kappa = 0.48), intermediate (kappa = 0.34), and no/mild (kappa = 0.85) conditions. Intrarater reliability (r1,2) for emergency physicians was 0.66 (p < 0.01) and for paramedics was 0.63 (p < 0.01). The GCS shows statistically significant reliability (i.e., significant agreement) between emergency physicians and emergency medical technician-paramedics. It also has a significant level of intrarater reliability.

    Title Valvular Disease in the Elderly: Influence on Surgical Results.
    Date March 1993
    Journal The Annals of Thoracic Surgery
    Excerpt

    Aortic valve disease in the elderly is primarily calcific stenosis with preservation of left ventricular function. In contrast, mitral valve disease in the elderly often is ischemic in nature with damage occurring to both valve and myocardium. The present study was undertaken to compare results of aortic (AVR) and mitral valve replacement (MVR) in the elderly and to ascertain predictors of poor outcome. Because patients who had concomitant coronary artery bypass grafting (CABG) are included (51% for AVR, 55% for MVR), patients who had isolated CABG were used as a comparison group. Between January 1, 1984, and June 30, 1991, 1,386 patients aged 70 years and older underwent CABG (n = 1,043), AVR (n = 245), or MVR (n = 98). The operative mortality rates were 5.3% for AVR, 20.4% for MVR, and 5.8% for CABG. Late follow-up of patients undergoing operation in 1984 and 1985 was available for 98% (231/237). Overall survival was comparable for all three groups through the first 5 years of follow-up (AVR, 68% +/- 8%; MVR, 73% +/- 8%; CABG, 78% +/- 3%). After 5 years, survival for patients having AVR and MVR was less than that for those having CABG. Patient age, sex, New York Heart Association functional class, concomitant CABG, prosthetic valve type, native valve pathology, and preoperative catheterization data were examined as possible predictors of outcome by multivariate logistic regression.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title An Experimental Algorithm Versus Standard Advanced Cardiac Life Support in a Swine Model of Out-of-hospital Cardiac Arrest.
    Date March 1993
    Journal Annals of Emergency Medicine
    Excerpt

    STUDY OBJECTIVE: To compare an experimental algorithm with standard advanced cardiac life support in a swine model of out-of-hospital cardiac arrest. DESIGN: Randomized, controlled experimental trial. SETTING/TYPE OF PARTICIPANT: Animal laboratory using swine. INTERVENTIONS: Eighteen swine (17.8 to 23.7 kg) were sedated, intubated, anesthetized, and instrumented for monitoring of arterial and central venous pressures and ECG. Ventricular fibrillation was induced using a bipolar pacing catheter. Animals were randomized to treatment with the experimental algorithm or standard advanced cardiac life support therapy after eight minutes of untreated ventricular fibrillation. The experimental algorithm consisted of starting CPR; giving high-dose epinephrine (0.20 mg/kg), lidocaine (1.0 mg/kg), bretylium (5.0 mg/kg), and propranolol (0.5 to 1.0 mg) by peripheral IV; hyperventilating (20 to 25 breaths per minute); and delaying countershock (5 J/kg) 60 seconds after completion of drug delivery. Data were analyzed with the Student's t-test and Fisher's exact test. MEASUREMENTS AND MAIN RESULTS: Outcome variables were arterial and central venous pressures, return of spontaneous circulation, and one-hour survival. Hemodynamics were not different between groups during CPR. Return of spontaneous circulation occurred in seven of nine swine (77%) in the experimental algorithm group versus two of nine swine (22%) in the advanced cardiac life support group (P = .057). Four of nine swine (44%) in the experimental algorithm group survived to one hour versus none of the animals in the advanced cardiac life support group (P = .041). CONCLUSION: In this swine model of out-of-hospital cardiac arrest, animals treated with an experimental algorithm had a significant improvement in one-hour survival compared with those treated with advanced cardiac life support.

    Title Absorbable Suture Improves Growth of Venous Anastomoses.
    Date December 1992
    Journal Journal of Vascular Surgery : Official Publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
    Excerpt

    Growth of vascular anastomoses is desirable in pediatric vascular surgery, especially in pediatric organ transplantation. Although absorbable suture has been shown to be superior to nonabsorbable suture in permitting growth of arterial anastomoses, the optimal suture material for venous anastomoses has not been established. To examine this in a porcine model, we performed bilateral primary end-to-end anastomoses of transected external jugular veins in 10, 4-week-old piglets. In each piglet one anastomosis was constructed with continuous absorbable 8-0 polyglyconate suture, whereas the contralateral anastomosis was constructed with continuous nonabsorbable 8-0 polypropylene suture. After 6 months the veins were excised, pressure fixed at 15 mm Hg for 2 hours, and examined grossly and histologically. Vein diameter was measured by contrast radiography at the anastomosis and 1 cm proximal and distal to the anastomosis. Vein cross-sectional area 1 cm from the anastomosis was similar in the two groups: polyglyconate 95.7 +/- 12.3 mm2 versus polypropylene 95.3 +/- 9.7 mm2. However, polyglyconate anastomoses had greater cross-sectional area (polyglyconate 72.8 +/- 7.9 mm2 vs polypropylene 51.8 +/- 6.0 mm2; p < 0.05). In addition, at 6 months polyglyconate anastomoses had a greater percentage of growth (polyglyconate 207% vs polypropylene 118%; p < 0.05) compared with native vein cross-sectional area (23.7 +/- 0.39 mm2) from control pigs at 4 weeks of age. On histologic examination, polyglyconate had dissolved entirely in six cases and was present but in varying degrees of dissolution in the other four; in contrast, polypropylene was identifiable at all anastomoses.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Cardiopulmonary Bypass and the Blood-brain Barrier. An Experimental Study.
    Date November 1992
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    The diffuse inflammation produced by cardiopulmonary bypass might disrupt the blood-brain barrier and lead to the transient neurologic dysfunction occasionally seen after cardiac operations. To evaluate this possibility, blood-brain barrier integrity was measured by carbon 14-aminoisobutyric acid tracer technique after 2 hours of cardiopulmonary bypass in piglets. Six animals were cooled to 28 degrees C on cardiopulmonary bypass and then rewarmed to 38 degrees C before carbon 14-aminosisobutyric acid was injected intraarterially. A control group of six animals underwent median sternotomy and heparinization but were not placed on cardiopulmonary bypass. Blood-to-brain transfer coefficients for carbon 14-aminosisobutyric acid were calculated for multiple brain regions; higher coefficients reflect greater flux of carbon 14-aminosisobutyric acid and suggest loss of blood-brain barrier integrity. The brain regions examined and their transfer coefficients (cardiopulmonary bypass versus control mean +/- standard error of the mean ml/gm/min) were middle cerebral artery territory cortex (0.0032 +/- 0.0002 versus 0.0030 +/- 0.0002; p = 0.42), diencephalon (0.0031 +/- 0.0003 versus 0.0029 +/- 0.0002; p = 0.50), midbrain (0.0028 +/- 0.0002 versus 0.0027 +/- 0.0002; p = 0.86), cerebellum (0.0036 +/- 0.0003 versus 0.0029 +/- 0.0002; p = 0.22), and spinal cord (0.0035 +/- 0.0003 versus 0.0041 +/- 0.0008; p = 0.48). There were no significant differences in transfer coefficients between animals placed on cardiopulmonary bypass and control animals in any brain region examined. The pituitary gland lacks a blood-brain barrier and had a correspondingly high coefficient in control animals and those undergoing cardiopulmonary bypass (0.077 +/- 0.012 versus 0.048 +/- 0.008; p = 0.07). Two hours of moderately hypothermic cardiopulmonary bypass does not disrupt the blood-brain barrier.

    Title Pulmonary Embolism in the Cardiac Surgical Patient.
    Date June 1992
    Journal The Annals of Thoracic Surgery
    Excerpt

    Pulmonary embolism (PE) is thought to occur infrequently after cardiac operations, possibly because systemic heparinization during cardiopulmonary bypass prevents deep vein thrombosis. This retrospective study was undertaken to determine the actual incidence of PE after cardiac operations and to identify risk factors. Between January 1, 1985, and December 31, 1989, 5,694 adult patients (greater than 18 years old) had open heart operations at the Johns Hopkins Hospital. Thirty-two patients (20 men and 12 women) had PE within 60 days of operation, an overall PE incidence of 0.56%. The diagnosis of PE was established by ventilation/perfusion scan, pulmonary angiogram, or autopsy. Mortality among patients with PE was 34%. Using a case-control method, preoperative and postoperative risk factors for PE were identified by multivariate and multiple logistic regression analyses. Preoperative risk factors included bed rest (p less than 0.003), prolonged hospitalization before operation (p less than 0.004), and cardiac catheterization performed through the groin within 15 days before operation (p less than 0.01). Post-operative risk factors were congestive heart failure (p less than 0.008), prolonged bed rest (p less than 0.05), and deep vein thrombosis (p less than 0.03). This study demonstrates that PE is an unusual complication after cardiac operations, has a high mortality rate, and is often related to perioperative immobility and recent groin catheterization. These results also suggest that minimizing preoperative hospital stay may be important in PE prophylaxis.

    Title Hypothermic Circulatory Arrest As a Surgical Adjunct: a 5-year Experience with 60 Adult Patients.
    Date March 1992
    Journal The Annals of Thoracic Surgery
    Excerpt

    As a surgical adjunct, the technique of hypothermic circulatory arrest (HCA) is well established in pediatric cardiac surgery but is used less frequently in adults. This study was undertaken to review the application, utility, and safety of HCA in adult surgery at a single institution. Between January 1985 and October 1990, 60 adult patients (greater than 18 years old) underwent surgical procedures that included HCA. There were 30 men and 30 women; mean patient age was 56.4 years (range, 20 to 81 years). Operative procedures were thoracic aortic aneurysm repair (35 patients, 58%), resection of intraabdominal malignancy (15 patients, 25%), coronary artery bypass (4 patients, 7%), and other miscellaneous procedures (6 patients, 10%). Eighty-two percent of the procedures were elective, whereas 18% were emergencies. Mean circulatory arrest time was 28.5 minutes (range, 2 to 64 minutes). Operative mortality was 15%; by multivariate analysis, risk factors for death included prolonged cardiopulmonary bypass time (p less than 0.05), higher post-HCA rectal temperature (p less than 0.05), and intraoperative hypotension (p less than 0.001). Patient age, sex, emergency status, duration of HCA, and perfusion variables on cardiopulmonary bypass did not predict operative mortality. The incidence of perioperative neurologic injury was 15%. The only risk factor for neurologic injury was intraoperative hypotension (p less than 0.05). One- and 3-year actuarial survival for patients undergoing operation on the heart or great vessels was 75.9% and 70%, respectively, whereas patients with intraabdominal malignancy had 75% and 23.4% 1- and 3-year survival.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Medicinal Uses of Licorice Through the Millennia: the Good and Plenty of It.
    Date December 1991
    Journal Molecular and Cellular Endocrinology
    Title Transcription Factor Iia of Wheat and Human Function Similarly with Plant and Animal Viral Promoters.
    Date August 1990
    Journal Nucleic Acids Research
    Excerpt

    Eucaryotic transcription initiation by RNA polymerase II involves protein:DNA interactions during the formation of a transcription complex. In addition to RNA polymerase II there are at least five other general transcription factors necessary for initiation with the adenovirus major late promoter. One of these, TFIIA, is involved in the earliest events during transcription complex assembly. We have purified TFIIA from wheat germ and characterized it in an in vitro transcription system. Wheat TFIIA is a single polypeptide of Mr approximately 35 kd which functionally replaces human (HeLa) TFIIA to form a wheat/HeLa transcription system. [This polypeptide can be eluted from a SDS-polyacrylamide gel, refolded to a native conformation, and will function as wheat TFIIA in the heterologous system.] The heterologous system requires a lower optimal incubation temperature than the HeLa system. Biochemical characterization, using the adenovirus major late promoter, indicates that transcription reaction parameters for both wheat and HeLa TFIIA are similar but the kinetics of transcription for both TFIIAs are somewhat dissimilar. A plant viral promoter, the cauliflower mosaic virus 35S promoter, accurately and efficiently directs in vitro transcription in both the wheat/HeLa and HeLa systems with identical transcription kinetics. We conclude that TFIIA function has been conserved during evolution.

    Title Transcription Factor Iia of Wheat and Human Interacts Similarly with the Adenovirus-2 Major Late Promoter.
    Date June 1990
    Journal Biochemical and Biophysical Research Communications
    Excerpt

    Transcription factor IIA (TFIIA) is a necessary component of many RNA polymerase II transcription complexes. Assembly of the transcription complex begins when TFIIA interacts with the promoter. We have previously purified wheat germ TFIIA to homogeneity and demonstrated that it substitutes for human TFIIA in a human in vitro transcription system which utilizes the adenovirus-2 major late promoter (Ad-2 MLP). We now show, by gel retardation assays, that wheat TFIIA interacts with the Ad-2 MLP. Extensively purified human (HeLa) TFIIA interacts with the Ad-2 MLP similarly. Both wheat and human TFIIA interact with a DNA fragment comprising the minimal promoter region (-51/+32) but not with upstream or downstream regions. With both TFIIAs multiple complexes form; the fastest wheat TFIIA/DNA complex appears to be larger than the corresponding human TFIIA/DNA complex. Limited point mutation analysis of the Ad-2 MLP demonstrates that changes at -30 (TATAA region), +1, and -1 diminish TFIIA binding, but a change at -40 does not. DNA footprint analysis of this region is not definitive, but does indicate that following TFIIA binding there are changes in the pattern of hypersensitive sites.

    Title Early Events of Rna Polymerase Ii Transcription Initiation.
    Date April 1990
    Journal Life Sciences
    Excerpt

    We have investigated the earliest stages of assembly of an RNA polymerase II transcription complex. General transcription factors from HeLa cells were partially purified and assayed using the adenovirus-2 major late promoter. Preincubation of either all the transcription factors (TF) with the DNA or only the subset consisting of TFIIA, TFIID, and DNA overcame the 15-20 min lag normally observed. The kinetics demonstrate that TFIIA first interacts with the template over a 5 min. period, and then TFIID interacts with the IIA:DNA complex over a 2 min. period. The remainder of the necessary transcription factors then interact with the IIA:IID:DNA complex. There are apparently interactions between IIA and IID, as a pre-incubation of these factors (without DNA) overcomes the lag period. Both IIA:DNA and IIA:DNA:IID interactions are temperature sensitive, resulting in slower kinetics at 0 degree C. Thus, the kinetics of transcription involve activation processes in addition to DNA binding.

    Title Beta-adrenoceptors in Circular and Longitudinal Myometrial Membranes and in Lung Membranes from Dioestrous and Post-partum Guinea-pigs.
    Date March 1990
    Journal Clinical and Experimental Pharmacology & Physiology
    Excerpt

    1. We have examined the binding of (-)[125]-cyanopindolol ((-)[125I]-CYP) to membranes prepared from uterus and lung of dioestrous and post-partum (1-6 days) guinea-pigs. 2. The densities of beta-adrenoceptor binding sites in circular and longitudinal myometrium from dioestrous animals were similar, and approximately one-eight of those in the lung. Ascorbate and ethylenediaminetetraacetic acid in the incubation medium did not affect binding. 3. The numbers and affinities of beta-adrenoceptor binding sites in both myometrial layers and in lung parenchyma from post-partum animals were similar to those in corresponding tissues from dioestrous animals. 4. The distribution of beta-adrenoceptor binding sites in the post-partum uterus was examined using receptor autoradiography. Binding to circular and longitudinal muscle layers and to the endometrium was inhibited by (-)-propranolol (1 mumol/l), by the beta 2-adrenoceptor selective antagonist ICI 118,551 (70 nmol/l), but not by the beta 1-adrenoceptor selective antagonist CGP 20712A (100 nmol/l), indicating that the beta-adrenoceptor present was of the beta 2-subtype. 5. The ability of isoprenaline to compete for (--)[125]-CYP binding sites in uterine membranes from post-partum animals was approximately twice that in corresponding preparations from dioestrous animals. 6. Changes in the numbers or affinity of beta 2-adrenoceptors cannot account for the marked and selective enhancement of the actions of sympathomimetic amines at beta-adrenoceptors previously observed in longitudinal myometrium taken from post-partum guinea-pigs. It is suggested that enhancement of later steps in the chain of events between beta-adrenoceptor occupancy and uterine relaxation, and/or a decrease in the contribution of alpha-adrenoceptors to the net effect of the amine might provide alternative explanations.

    Title Drug Inhibitors of Rna Polymerase Ii Transcription.
    Date February 1990
    Journal Dna (mary Ann Liebert, Inc.)
    Excerpt

    Transcription by RNA polymerase II occurs after formation of a transcription complex. This complex is assembled in stages by the interaction of transcription factors with the template and/or with each other. We report on the ability of six drugs to inhibit the assembly of the RNA polymerase II transcription complex. Assembly of the complex on the adenovirus major late promoter requires several transcription factors. The normal assembly process requires that the DNA first interact with TFIIA, then with TFIID, and finally with at least four additional transcription factors (one of which is RNA polymerase II). We observed that streptolydigin (10 micrograms/ml) inhibits association of ILA and IID, and at higher concentrations (100 micrograms/ml) inhibits that IIA/IID complex from binding to DNA. Streptovaricin (100 micrograms/ml) appears to inhibit the IIA/IID interaction with DNA and prevents reinitiation (at 500 micrograms/ml). Adriamycin (1 microgram/ml) inhibits the interaction of TFIID with the IIA/DNA complex and inhibits an additional event immediately prior to, or during, elongation. Daunorubicin may be an elongation inhibitor. Heparin at 10 micrograms/ml inhibits further assembly after the IIA/IID/DNA complex has formed, and at 100 micrograms/ml also inhibits a late event in the assembly process and blocks reinitiation. Rifamycin AF/013 (100 micrograms/ml) inhibits the early events necessary to form the IIA/IID/DNA complex and (at 10 micrograms/ml) an assembly event following formation of the IIA/IID/DNA complex. Therefore, these compounds should be useful as probes for further examination of the assembly process.

    Title Rna Polymerase Ii Transcription Complexes Are Destabilized by Atp or Gtp.
    Date September 1989
    Journal Biochemical and Biophysical Research Communications
    Excerpt

    In vitro transcription by RNA polymerase II requires hydrolysis of the beta-gamma bond of ATP after the transcription complex forms, prior to RNA synthesis. It was observed that the presence of ATP during transcription complex formation inhibits subsequent transcription when the remaining 3 rNTPs are added. We now report that ATP or GTP inhibits transcription if either is present during transcription complex formation to added to preformed complexes. This inhibition is not due to purine rNTP degradation and occurs if as little as 2 mM ATP or 50 mM GTP is added to forming or preformed complexes. Deoxy derivatives of ATP inhibit similarly. AMP-PNP, a beta-gamma imido derivative, neither satisfies the energy requirement nor inhibits transcription if added to incubations of forming or of preformed transcription complexes.

    Title Emergency Department Approach to Vertigo.
    Date April 1988
    Journal Emergency Medicine Clinics of North America
    Excerpt

    The patient presenting to the Emergency Department with the complaint of "dizziness" is one of the most common as well as most challenging problems confronting the emergency physician today. Because many of these patients are seeking medical help for the first time, it is imperative to have a solid knowledge base of the multiple potential areas capable of producing this symptom. This article is a review of these problems and their specific symptoms.

    Title Cutting the Nation's Health Care Costs.
    Date December 1987
    Journal Journal of the National Medical Association
    Excerpt

    In 1984 health care expenditures totaled $387.4 billion, and may reach $757.9 billion by 1990. The following factors and their annual cost overrun price tags are the prime forces behind this rapidly growing expense: professional liability insurance, litigations, and defensive medicine, $30 billion; hospital administrative management and employee excess, $6.3 billion; community hospital profits, $8.3 billion; oversupply and duplication of drugs and drug sundries, $22.5 billion; the oversupply of physician specialists, at least $10 to $15 billion; unsolicited physician interpretation of routine, unsophisticated tests, $13.2 billion; and, finally, an American lifestyle adversely affected by illicit drugs ($60 billion), alcohol ($117 billion), and automobile accidents ($43.3 billion), for a total cost of $220 billion yearly.The intent of this article is to educate the public in an open and responsible fashion, and to demonstrate that the health care industry in the United States can save approximately $334.0 billion yearly.

    Title The Effect of Epinephrine Versus Methoxamine on Regional Myocardial Blood Flow and Defibrillation Rates Following a Prolonged Cardiorespiratory Arrest in a Swine Model.
    Date October 1987
    Journal The American Journal of Emergency Medicine
    Excerpt

    Recent studies in swine have shown that larger doses of epinephrine than those currently employed for cardiopulmonary resuscitation (CPR) significantly improve regional myocardial blood flow following prolonged cardiac arrest. The dose-response effect of a pure alpha-adrenergic agonist, methoxamine, on regional myocardial blood flow has not been investigated in this setting. This study compared the effect of high-dose epinephrine with graded doses of methoxamine on regional myocardial blood flow, oxygen delivery/utilization, and defibrillation rates during CPR. Twenty swine were instrumented for regional myocardial blood flow measurements using radiolabeled tracer microspheres. Measurements of regional myocardial blood flow, oxygen delivery, and oxygen consumption were made during normal sinus rhythm. Ventricular fibrillation was then induced. Following 10 minutes of ventricular fibrillation, CPR was initiated with a pneumatic compressor. Regional myocardial blood flow, oxygen delivery, and oxygen consumption were then measured during CPR. Following 3 minutes of CPR, the swine were allocated to one of four treatment groups (five per group): group I, epinephrine 0.2 mg/kg; group II, methoxamine 0.1 mg/kg; group III, methoxamine 1.0 mg/kg; and group IV, methoxamine 10.0 mg/kg. One minute after drug administration, regional myocardial blood flow, oxygen delivery, and oxygen consumption measurements again were made. Three and one half minutes after drug administration, defibrillation was attempted. Regional myocardial blood flow following drug administration was compared using an analysis of covariance. Epinephrine (0.2 mg/kg) significantly improved myocardial blood flow (P less than .002) for all tissues examined compared with all doses of methoxamine.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Methoxamine Versus Epinephrine on Regional Cerebral Blood Flow During Cardiopulmonary Resuscitation.
    Date July 1987
    Journal Critical Care Medicine
    Excerpt

    The improvement in cerebral blood flow (CBF) during CPR after epinephrine administration has been attributed to epinephrine's alpha-adrenergic properties. Methoxamine, a pure alpha-1 agonist, has only been shown to be comparable to epinephrine in restoring circulation after cardiac arrest in a canine model. This study compares the effectiveness of equipotent doses of epinephrine and methoxamine in improving CBF during CPR after a prolonged cardiac arrest in a swine model. Twenty-five swine, weighing 15.9 to 28.2 kg, underwent instrumentation for regional CBF using tracer microspheres. CBF was determined during normal sinus rhythm. After 10 min of ventricular fibrillation, CPR was begun with a pneumatic compressor. CBF measurements were again made during CPR. After 3 min of CPR, the swine were randomized to receive 0.02 or 0.2 mg/kg epinephrine, 0.1, 1.0, or 10.0 mg/kg methoxamine. Five swine were allocated to each group. CBF measurements were determined after drug administration and compared using a Bonferroni multiple comparison procedure. A p-value less than .05 was considered statistically significant. This study demonstrated that, after a 10-min cardiac arrest, CBF was extremely low, averaging less than 7 ml/min X 100 g during external CPR. There were no clinically significant improvements in regional CBF after 0.02 mg/kg of epinephrine, or the two lowest doses of methoxamine. The addition of 10 mg/kg of methoxamine clinically improved blood flow only to the most caudal CNS structures, including the pons, medulla, and cervical spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS)

    Title The Effect of High-dose Phenylephrine Versus Epinephrine on Regional Cerebral Blood Flow During Cpr.
    Date July 1987
    Journal Annals of Emergency Medicine
    Excerpt

    Prior studies have not found the alpha agonist phenylephrine, in a dose of 0.1 mg/kg, to be as effective as 0.20 mg/kg of epinephrine in improving regional cerebral blood flow (CBF) during CPR in swine. We undertook this study to assess whether higher doses of phenylephrine might improve regional CBF. Fifteen swine were allocated to receive either epinephrine 0.2 mg/kg, phenylephrine 1.0 mg/kg, or phenylephrine 10 mg/kg. Regional CBF measurements were made during normal sinus rhythm, during CPR, and during CPR following drug administration. Epinephrine 0.2 mg/kg was significantly better in improving regional CBF to the left and right cerebral cortices, cerebellum, midbrain, and cervical cord than was phenylephrine 1.0 mg/kg. There was no significant difference in regional CBF between the animals receiving epinephrine 0.2 mg/kg and phenylephrine 10 mg/kg. The study shows that large doses of epinephrine and phenylephrine may be required during CPR to improve regional cerebral blood flow following a prolonged arrest.

    Title Abdominal Pain and Seizures in a Young Man.
    Date April 1987
    Journal Annals of Emergency Medicine
    Title The Comparative Effects of Epinephrine Versus Phenylephrine on Regional Cerebral Blood Flow During Cardiopulmonary Resuscitation.
    Date March 1987
    Journal Resuscitation
    Excerpt

    Epinephrine in larger doses than currently recommended during cardiopulmonary resuscitation (CPR) has been shown to improve cerebral blood flow (CBF) following a 10-min arrest in a swine model. The purpose of this pilot study was to measure CBF during CPR, comparing high-dose epinephrine to a pure alpha-1 agonist, phenylephrine. Ten swine each weighing greater than 15 kg, were instrumented for regional CBF measurements using tracer microspheres. CBF was measured during normal sinus rhythm (NSR). Following 10 min of ventricular fibrillation, CPR was begun and regional CBF was again measured. Following 3 min of CPR, the swine were randomized to receive either epinephrine (0.2 mg/kg), or phenylephrine (0.1 mg/kg), through a peripheral intravenous line. Regional CBF was again measured 1 min after drug administration. Regional CBF following drug administration was compared using an analysis of covariance. Adjusted CBFs are expressed in ml/min per 100 g for epinephrine and phenylephrine, respectively: left cerebral cortex (12.5 vs. 2.3, P = 0.002); right cerebral cortex (13.0 vs. 2.8, P = 0.003); cerebellum (32.9 vs. 4.1, P = 0.004); midbrain (35.7 vs. 2.6, P = 0.0004), pons (30.3 vs. 2.9, P = O.006); medulla (49.5 vs. 13.6, P = 0.02) and cervical spinal cord (49.6 vs. 14.1, P = 0.003).

    Title The Effects of Graded Doses of Epinephrine on Regional Myocardial Blood Flow During Cardiopulmonary Resuscitation in Swine.
    Date February 1987
    Journal Circulation
    Excerpt

    Although epinephrine has been shown to improve myocardial blood flow during cardiopulmonary resuscitation (CPR), the effects of standard as well as larger doses of epinephrine on regional myocardial blood flow have not been examined. In this study we compared the effects of various doses of epinephrine on regional myocardial blood flow after a 10 min arrest in a swine preparation. Fifteen swine weighing greater than 15 kg each were instrumented for regional myocardial blood flow measurements with tracer microspheres. Regional blood flow was measured during normal sinus rhythm. After 10 min of ventricular fibrillation, CPR was begun and regional myocardial blood flow was determined. Animals were then randomly assigned to receive 0.02, 0.2, or 2.0 mg/kg epinephrine by peripheral injection. One minute after drug administration, regional myocardial blood flow measurements were repeated. The adjusted regional myocardial blood flows (ml/min/100 g) for animals given 0.02, 0.2, and 2.0 mg/kg epinephrine, respectively, were as follows: left atrium, 0.9, 67.4, and 58.8; right atrium, 0.3, 46.2, and 38.5; right ventricle, 0.7, 82.3, and 66.9; right interventricular septum, 1.7, 125.5, and 99.1; left interventricular septum, 2.8, 182.8, 109.5; mesointerventricular septum, 16.8, 142.2, and 79.2; left ventricular epicardium, 19.2, 98.5 and 108.7; left ventricular mesocardium, 22.8, 135.0, and 115.8; and left ventricular endocardium, 2.5, 176.1, and 132.9). All comparisons between the groups receiving 0.02 and 0.2 mg/kg epinephrine were statistically significant (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)

    Title Comparative Effect of Graded Doses of Epinephrine on Regional Brain Blood Flow During Cpr in a Swine Model.
    Date October 1986
    Journal Annals of Emergency Medicine
    Excerpt

    Cerebral blood flow (CBF) with conventional closed-chest cardiopulmonary resuscitation (CCPR) has been measured at only 2% to 11% of prearrest values. The purpose of our study was to determine whether the peripheral administration of higher doses of epinephrine than currently recommended during CCPR following a prolonged cardiac arrest improves CBF compared to CCPR using a standard dose of epinephrine. Fifteen swine were randomized to receive CCPR plus 0.02 mg/kg, 0.2 mg/kg, or 2.0 mg/kg epinephrine through a peripheral IV line following a ten-minute cardiopulmonary arrest and three minutes of CCPR. Regional CBF measurements were made by radionuclide microsphere technique during normal sinus rhythm (NSR), CCPR, and following epinephrine administration. The adjusted regional blood flows (in mL/min/100 g) following epinephrine administration for the 0.02-, 0.2-, and 2.0-mg/kg groups were, respectively, left cerebral cortex (3.3, 13.1, 11.8); right cerebral cortex (3.9, 13.8, 12.2); cerebellum (9.2, 32.0, 33.1); midbrain/pons (9.9, 32.1, 32.3); medulla (10.6, 61.5, 54.2); and cervical spinal cord (12.2, 53.8, 35.8). In this swine model, 0.2 mg/kg and 2.0 mg/kg epinephrine significantly increased regional CBF over that seen with standard doses. Because neuronal survival is dependent on flow rates of 10 to 15 mL/min/100 g, this preliminary evidence suggests that these higher doses of epinephrine may help improve neurological outcome in CCPR.

    Title Journal Club: Use of Leukocyte Count and Differential in the Evaluation of Abdominal Pain.
    Date October 1986
    Journal The American Journal of Emergency Medicine
    Title Working Together. Staff at a Psychogeriatric Day Unit Found a Closer Working Relationship with Ambulancemen a Valuable Asset.
    Date July 1982
    Journal Nursing Times
    Title Scanning and Transmission Electron Microscopy of Normal and Pse Porcine Muscle.
    Date April 1982
    Journal Scanning Electron Microscopy
    Excerpt

    Structural differences between normal and pale, soft, exudative (PSE) longissimus dorsi (LD) muscle from purebred and crossbred pigs were observed using scanning and transmission electron microscopy. The effect of severe freeze-thaw contraction on the muscle samples was observed. The membranes of many different organelles (sarcoplasmic reticulum, mitochondria, sarcolemma and connective tissue) appeared markedly disrupted after cryofracture of PSE muscle with frequent breaks especially near the Z-lines. In addition, there was little definition of the M-line and H-zones in either the PSE or intermediate animals.

    Title Acute Rupture of the Peroneal Retinaculum.
    Date August 1976
    Journal The Journal of Bone and Joint Surgery. American Volume
    Excerpt

    The anatomy of the superior peroneal retinaculum at the ankle includes a sheath somewhat distinct from a fibrous lip extending from the periosteum of the fibula at the lateral aspect of the lip of the groove. In seventy-three cases of injury to the retinaculum, three grades of injury were recognized. Surgical repair was quite successful except in three cases.

    Title Effects of Rapid Infusion of Ethanol on Some Factors Controlling Blood Sugar Levels in Man.
    Date December 1972
    Journal Quarterly Journal of Studies on Alcohol
    Title An Improved Technique for the Repair of the Intrahepatic Inferior Vena Cava and Hepatic Veins.
    Date December 1971
    Journal The Journal of Trauma
    Title Some Cardiovascular Effects of Ketamine in Man.
    Date June 1971
    Journal British Journal of Pharmacology
    Title Some Factors Controlling Step-wise Variation of Organelle Number in Euglena Gracilis.
    Date June 1971
    Journal Experimental Cell Research
    Title The Architecture of the Superficial Layer of the Gastric Mucosa.
    Date October 1969
    Journal Journal of Anatomy
    Title The Three Dimensional Architecture of the Islets of Langerhans.
    Date August 1969
    Journal Acta Anatomica
    Title Phosphorylation Coupled to the Oxidation of Sulfite and 2-mercaptoethanol in Extracts of Thiobacillus Thioparus.
    Date October 1967
    Journal Canadian Journal of Microbiology
    Title Frequency-dependent Conductivity in Sputtered Amorphous Phosphorus Thin Films.
    Date
    Journal Physical Review. B, Condensed Matter
    Title Extended-state Mobility and Its Relation to the Tail-state Distribution in A-si:h.
    Date
    Journal Physical Review. B, Condensed Matter
    Title Field Dependence of the Longitudinal Muon Polarization for Anomalous Muonium.
    Date
    Journal Physical Review. B, Condensed Matter
    Title Structure of Negatively Charged Muonium in N-type Gaas.
    Date
    Journal Physical Review. B, Condensed Matter
    Title Erratum: Structure of Negatively Charged Muonium in N-type Gaas
    Date
    Journal Physical Review. B, Condensed Matter
    Title Resistance Training and Diastolic Myocardial Tissue Velocities in Obese Children.
    Date
    Journal Medicine and Science in Sports and Exercise
    Excerpt

    PURPOSE: The primary purpose of this study was to determine the effects of resistance exercise training on early diastolic myocardial velocities (E') in an obese pediatric population. METHODS: Twenty-three obese adolescents were selected to participate in either a resistance-based training program (RT; n = 13, 12.2 +/- 0.4 yr, body mass index [BMI] = 32.5 +/- 1.9 kg m(-2)) or a nonexercise control intervention (n = 10, 13.6 +/- 0.7 yr, BMI = 30.2 +/- 2.6 kg m(-2)) for 8 wk. All subjects had repeated echocardiographic assessments to determine left ventricular (LV) geometry, early transmitral flow velocity (E), and E'. RESULTS: LV mass and wall thicknesses did not significantly change with training or in controls. RT improved E' (11.9 +/- 0.5 to 13.3 +/- 0.5 cm s(-1), P< 0.01) in the presence of a decrease in E/E' (8.17 +/- 0.39 to 7.06 +/- 0.30 cm s(-1), P < 0.01), a marker of left atrial pressure. No changes were evident in the inactive control subjects. CONCLUSIONS: A supervised 8-wk RT exercise program improved early diastolic tissue velocity in obese children, independent of changes in LV morphology.

    Title Improving Epinephrine Responses in Hypoglycemia Unawareness with Real-time Continuous Glucose Monitoring in Adolescents with Type 1 Diabetes.
    Date
    Journal Diabetes Care
    Excerpt

    To determine whether real-time continuous glucose monitoring (CGM) with preset alarms at specific glucose levels would prove a useful tool to achieve avoidance of hypoglycemia and improve the counterregulatory response to hypoglycemia in adolescents with type 1 diabetes with hypoglycemia unawareness.

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