Browse Health
Obstetrician & Gynecologist,
8 years of experience
Accepting new patients

Education ?

Medical School Score
Midwestern University at Glendale (2002)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Compassionate Doctor Recognition (2012)
Top Ten Doctors (2012)
Obstetrics and Gynecology
Resident Teacher of the Year - 2011 *

Affiliations ?

Dr. Bell is affiliated with 4 hospitals.

Hospital Affilations



  • St. Francis Hospital - Indianapolis
    Medical Oncology
    8111 S Emerson Ave, Indianapolis, IN 46237
    • Currently 4 of 4 crosses
    Top 25%
  • Franciscan St. Francis Health - Indianapolis
  • St. Francis Hospital - Mooresville
  • Franciscan St. Francis Health - Mooresville
  • * This information was reported to Vitals by the doctor or doctor's office.

    Publications & Research

    Dr. Bell has contributed to 74 publications.
    Title Brief Behavioral Activation and Problem-solving Therapy for Depressed Breast Cancer Patients: Randomized Trial.
    Date April 2012
    Journal Journal of Consulting and Clinical Psychology

    Major depression is the most common psychiatric disorder among breast cancer patients and is associated with substantial impairment. Although some research has explored the utility of psychotherapy with breast cancer patients, only 2 small trials have investigated the potential benefits of behavior therapy among patients with well-diagnosed depression.

    Title Uptake, Translocation and Metabolism of Aminocyclopyrachlor in Prickly Lettuce, Rush Skeletonweed and Yellow Starthistle.
    Date December 2011
    Journal Pest Management Science

    Aminocyclopyrachlor is a new herbicide proposed to control broadleaf weeds and shrubs in non-crop and rangeland systems. To gain a better understanding of observed field efficacy, the uptake and translocation of foliar-applied aminocyclopyrachlor (DPX-MAT28) and aminocyclopyrachlor methyl ester (DPX-KJM44) were evaluated in two annuals, prickly lettuce (Lactuca serriola L.) and yellow starthistle (Centaurea solstitialis L.), and one perennial, rush skeletonweed (Chondrilla juncea L.).

    Title Trim16 Acts As a Tumour Suppressor by Inhibitory Effects on Cytoplasmic Vimentin and Nuclear E2f1 in Neuroblastoma Cells.
    Date January 2011
    Journal Oncogene

    The family of tripartite-motif (TRIM) proteins are involved in diverse cellular processes, but are often characterized by critical protein-protein interactions necessary for their function. TRIM16 is induced in different cancer types, when the cancer cell is forced to proceed down a differentiation pathway. We have identified TRIM16 as a DNA-binding protein with histone acetylase activity, which is required for the retinoic acid receptor β(2) transcriptional response in retinoid-treated cancer cells. In this study, we show that overexpressed TRIM16 reduced neuroblastoma cell growth, enhanced retinoid-induced differentiation and reduced tumourigenicity in vivo. TRIM16 was only expressed in the differentiated ganglion cell component of primary human neuroblastoma tumour tissues. TRIM16 bound directly to cytoplasmic vimentin and nuclear E2F1 in neuroblastoma cells. TRIM16 reduced cell motility and this required downregulation of vimentin. Retinoid treatment and enforced overexpression caused TRIM16 to translocate to the nucleus, and bind to and downregulate nuclear E2F1, required for cell replication. This study, for the first time, demonstrates that TRIM16 acts as a tumour suppressor, affecting neuritic differentiation, cell migration and replication through interactions with cytoplasmic vimentin and nuclear E2F1 in neuroblastoma cells.

    Title Confidence in Critical Care Nursing.
    Date January 2011
    Journal Nursing Science Quarterly

    The purpose of the study was to gain an understanding of the nursing phenomenon, confidence, from the experience of nurses in the nursing subculture of critical care. Leininger's theory of cultural care diversity and universality guided this qualitative descriptive study. Questions derived from the sunrise model were used to elicit nurses' perspectives about cultural and social structures that exist within the critical care nursing subculture and the influence that these factors have on confidence. Twenty-eight critical care nurses from a large Canadian healthcare organization participated in semistructured interviews about confidence. Five themes arose from the descriptions provided by the participants. The three themes, tenuously navigating initiation rituals, deliberately developing holistic supportive relationships, and assimilating clinical decision-making rules were identified as social and cultural factors related to confidence. The remaining two themes, preserving a sense of security despite barriers and accommodating to diverse challenges, were identified as environmental factors related to confidence. Practice and research implications within the culture of critical care nursing are discussed in relation to each of the themes.

    Title Developing Evidence-based Interventions to Address the Leading Causes of Workers' Compensation Among Healthcare Workers.
    Date December 2010
    Journal Rehabilitation Nursing : the Official Journal of the Association of Rehabilitation Nurses

    Overexertion and slip, trip, and fall (STF) incidents are two of the leading sources of workers'compensation claims and costs in healthcare settings (Bell et al., 2008; Bureau of Labor Statistics [BLS], 2008). Working in conjunction with a team of international researchers, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research to demonstrate the effectiveness of comprehensive safe patient handling and STF-prevention programs. The purpose of this article is to summarize the research and outreach efforts of NIOSH and their partners to address the leading occupational injury hazards facing healthcare workers. This article also provides an overview of the changes that are occurring in the healthcare industry as a result of the evidence-based research on safe patient handling and STF prevention that has been conducted in recent years.

    Title A Comparison of Probe-level and Probeset Models for Small-sample Gene Expression Data.
    Date October 2010
    Journal Bmc Bioinformatics

    Statistical methods to tentatively identify differentially expressed genes in microarray studies typically assume larger sample sizes than are practical or even possible in some settings.

    Title Clinical Integration of Picture Archiving and Communication Systems with Pathology and Hospital Information System in Oncology.
    Date October 2010
    Journal The American Surgeon

    The complexity of our current healthcare delivery system has become an impediment to communication among caregivers resulting in fragmentation of patient care. To address these issues, many hospitals are implementing processes to facilitate clinical integration in an effort to improve patient care and safety. Clinical informatics, including image storage in a Picture Archiving and Communication System (PACS), represents a tool whereby clinical integration can be accomplished. In this study, we obtained intraoperative photographs of 19 cases to document clinical stage, extent of disease, disease recurrence, reconstruction/grafting, intraoperative findings not identified by preoperative imaging, and site verification as part of the Universal Protocol. Photographs from all cases were stored and viewed in PACS. Images from many of the cases were presented at our interdepartmental cancer conferences. The stored images improved communication among caregivers and preserved pertinent intraoperative findings in the patients' electronic medical record. In the future, pathology, gastroenterology, pulmonology, dermatology, and cardiology are just a few other subspecialties which could accomplish image storage in PACS. Multidisciplinary image storage in a PACS epitomizes the concept of clinical integration and its goal of improving patient care.

    Title Improved Glucose Control Associated with I.v. Chromium Administration in Two Patients Receiving Enteral Nutrition.
    Date June 2010
    Journal American Journal of Health-system Pharmacy : Ajhp : Official Journal of the American Society of Health-system Pharmacists

    The effect of i.v. chromium administration on glucose control in two patients receiving enteral nutrition is described.

    Title Design, Synthesis and Prostate Cancer Cell-based Studies of Analogs of the Rho/mkl1 Transcriptional Pathway Inhibitor, Ccg-1423.
    Date April 2010
    Journal Bioorganic & Medicinal Chemistry Letters

    We recently identified bis(amide) CCG-1423 (1) as a novel inhibitor of RhoA/C-mediated gene transcription that is capable of inhibiting invasion of PC-3 prostate cancer cells in a Matrigel model of metastasis. An initial structure-activity relationship study focusing on bioisosteric replacement of the amides and conformational restriction identified two compounds, 4g and 8, with improved selectivity for inhibition of RhoA/C-mediated gene transcription and attenuated cytotoxicity relative to 1. Both compounds were also capable of inhibiting cell invasion with equal efficacy to 1 but with less attendant cytotoxicity.

    Title Odontogenic Ameloblast Associated Protein As a Novel Biomarker for Human Breast Cancer.
    Date October 2009
    Journal The American Surgeon

    Odontogenic Ameloblast Associated Protein (ODAM) is a protein isolated in ameloblasts during odontogenesis. ODAM expression was identified in breast cancer, but its significance remains unknown. The purpose of this study is to determine if ODAM expression can serve as a prognostic marker and provide information regarding treatment in human breast cancer. Breast cancer patients were identified from our tumor registry from 1993 to 2003. Archived breast cancer tissue from 243 patients (stage 0 = 53, stage I = 51, stage II = 53, stage III = 47, stage IV = 39) was stained using monoclonal antibody for ODAM. Presence or absence of immunostaining was correlated with stage, histologic grade, response to chemotherapy, and survival using chi2 and logistic regression analyses. Tumor nuclear staining for ODAM increased with increasing group stage (P < 0.001). Staining for ODAM did not correlate with histologic grade or chemotherapy (P = 0.558, P = 0.093). Improved outcomes within each stage were noted with ODAM staining, statistically significant for stages 0, I, and II (P < 0.001, P = 0.003, P = 0.003) and underpowered for stages III and IV (P = 0.724, P = 0.059). Survival benefit associated with tumor nuclear staining increased with advancing stage (P < 0.001). These results show that ODAM predicts survival in breast cancer. Research is ongoing to determine ODAM's clinical utility and role in carcinogenesis.

    Title The Estrogen-responsive B Box Protein (ebbp) Restores Retinoid Sensitivity in Retinoid-resistant Cancer Cells Via Effects on Histone Acetylation.
    Date April 2009
    Journal Cancer Letters

    Retinoids have significant clinical activity in several human cancers, yet the factors determining retinoid sensitivity in cancer cells are still unclear. Retinoid-induced expression of retinoic acid receptor (RAR) beta(2) is a necessary component of the retinoid anticancer signal in cancer cells. We have previously identified the Estrogen-responsive B Box Protein (EBBP), a member of the Tripartite Motif (TRIM) protein family, as a novel RARbeta2 transcriptional regulator in the retinoid signal. Here we examined the mechanism of the EBBP effect on the retinoid anticancer signal. We assessed retinoid-responsive RARbeta2 transcription in retinoid-resistant breast and lung cancer cells in the presence of chromatin modifying agents. A histone deacetylase (HDAC) inhibitor alone, or in combination with retinoid, was more effective than a demethylating agent in restoring RARbeta2 transcription in resistant cells. Overexpression of EBBP alone markedly increased histone acetylation. The effect of EBBP on retinoid-responsive transcription appeared to be limited to genes with the retinoic acid response element (betaRARE) regulatory sequence, such as CYP26A1. EBBP inhibited cell growth by effects on cyclin D1 and Phospho-Rb, and, reduced cell viability in retinoid-resistant cancer cells. The viability of non-cancer cells was unaffected by EBBP overexpression. Taken together our data suggests that EBBP acts to de-repress transcription of RARbeta2 and CYP26A1, by modifying histone acetylation in retinoid-resistant cancer cells, and, is an important target for drug discovery in retinoid-resistant cancers.

    Title Evaluating the Impact of an Intervention to Reduce Injuries Among Loggers in West Virginia, 1999-2007.
    Date April 2009
    Journal Journal of Agricultural Safety and Health

    The purpose of this study was to evaluate the efficacy of a video-based safety training intervention (VBSTI) to reduce injuries among loggers over an 8-year period. WV Workers' Compensation data were used to assess the trend in injury rates, medical and indemnity costs due to logging injuries. There were 1,435 logger injury claims reported and a modest decline in the minor nature of injuries. There was no significant decline in total injury rates or in "struck by object" incidents emphasized in the VBSTI. Among the severe injuries, "head and neck" injuries showed a statistically significant decrease (p = 0.0454), but "falls" showed a statistically significant inverse change (p < 0.05). Medical and indemnity costs showed a statistical significant decrement (p < 0.05). Due to potential confounding, it is inconclusive whether the modest decreases in the claims can be attributed to the VBSTI. There still remains a need to improve the safety of workers in this high-risk employment.

    Title Atp7a is a Novel Target of Retinoic Acid Receptor Beta2 in Neuroblastoma Cells.
    Date January 2009
    Journal British Journal of Cancer

    Increased retinoic acid receptor beta (RARbeta(2)) gene expression is a hallmark of cancer cell responsiveness to retinoid anticancer effects. Moreover, low basal or induced RARbeta(2) expression is a common feature of many human cancers, suggesting that RARbeta(2) may act as a tumour suppressor gene in the absence of supplemented retinoid. We have previously shown that low RARbeta(2) expression is a feature of advanced neuroblastoma. Here, we demonstrate that the ABC domain of the RARbeta(2) protein alone was sufficient for the growth inhibitory effects of RARbeta(2) on neuroblastoma cells. ATP7A, the copper efflux pump, is a retinoid-responsive gene, was upregulated by ectopic overexpression of RARbeta(2). The ectopic overexpression of the RARbeta(2) ABC domain was sufficient to induce ATP7A expression, whereas, RARbeta(2) siRNA blocked the induction of ATP7A expression in retinoid-treated neuroblastoma cells. Forced downregulation of ATP7A reduced copper efflux and increased viability of retinoid-treated neuroblastoma cells. Copper supplementation enhanced cell growth and reduced retinoid-responsiveness, whereas copper chelation reduced the viability and proliferative capacity. Taken together, our data demonstrates ATP7A expression is regulated by retinoic acid receptor beta and it has effects on intracellular copper levels, revealing a link between the anticancer action of retinoids and copper metabolism.

    Title Cognitive-behavior Therapy for Depressed Cancer Patients in a Medical Care Setting.
    Date September 2008
    Journal Behavior Therapy

    Major depression is the most common psychiatric disorder among cancer patients and is associated with decreased quality of life, significant deterioration in recreational and physical activities, relationship difficulties, sleep problems, more rapidly progressing cancer symptoms, and more metastasis and pain relative to nondepressed cancer patients. Although some research has explored the utility of psychological interventions with cancer patients, only one study to date has explored the potential benefits of cognitive-behavior therapy among cancer patients with well-diagnosed depression. Addressing this gap in the literature, this study represents an open clinical trial to assess the effectiveness of a brief Cognitive-Behavioral Treatment for Depression (CBTD) among depressed cancer patients in a medical care setting. Results revealed strong treatment integrity, good patient compliance, excellent patient satisfaction with the CBTD protocol, and significant pre-post treatment gains across a breadth of outcome measures assessing depression, anxiety, quality of life, and medical outcomes. These gains also were associated with strong effect sizes and generally maintained at 3-month follow-up. Behavioral activation interventions, especially when paired with cognitive techniques, may represent a practical medical care treatment that may improve psychological outcomes and quality of life among cancer patients. Study limitations and future research directions are discussed.

    Title The Phenomenology and Screening of Clinical Depression in Cancer Patients.
    Date February 2008
    Journal Journal of Psychosocial Oncology

    Clinical depression is the most common psychiatric disorder among cancer patients and is associated with significant functional impairment. Unfortunately, depression in cancer patients is often under- diagnosed and untreated, and studies examining the predictive utility of assessment instruments in detecting clinically depressed cancer patients are sparse. Using a structured interview, thirty-three patients with various cancer types were diagnosed as having major depression (n = 24) or no psychiatric diagnosis (n = 9). All patients were administered the Beck Depression Inventory-II (BDI-II), the Center for Epidemiological Studies in Depression Scale (CES-D), Hamilton Rating Scale for Depression (HRSD), Quality of Life Inventory (QOLI), a medical and psychosocial functioning questionnaire (SF-36), and given co-morbidity of depression with anxiety disorders, the Beck Anxiety Inventory (BAI). Depressed and non-depressed cancer patients were compared and contrasted across all assessment measures and accuracy of instruments was based on evaluating their sensitivity, specificity, and positive predictive values. Depressed cancer patients exhibited more severe depressive symptoms and poorer quality of life, increased anxiety and bodily pain, and decreased vitality and social functioning. All instruments exhibited strong predictive properties, with the CES-D and BDI-II considered most feasible given their time efficiency, administrative simplicity, and strong psychometric properties.

    Title The Role of P38 Mitogen-activated Kinase (mapk) in the Mechanism Regulating Cyclooxygenase Gene Expression in Equine Leukocytes.
    Date December 2007
    Journal Veterinary Immunology and Immunopathology

    The goal of this study was to define the role for p38 mitogen-activated kinase (MAPK) in the signaling mechanism regulating pro-inflammatory cyclooxygenase (COX) gene expression in lipopolysaccharide (LPS)-activated equine leukocytes for the purposes of identifying novel targets for anti-inflammatory therapy in endotoxemic horses. The p38 MAPK has been shown to positively regulate inflammatory gene expression in human leukocytes and can be activated by a variety of stimuli including LPS, TNF-alpha, and IL-1. Activation-associated phosphorylated p38 MAPK has been implicated in the up-regulation of several inflammatory genes, including COX-2 which ultimately results in the production of prostanoids that are responsible for the pathophysiology associated with endotoxemia. Our hypothesis is that activation of p38 MAPK is essential for LPS-induced COX-2 expression in equine peripheral blood leukocytes. We tested our hypothesis by investigating the effects of the specific p38 MAPK inhibitors SB203580 and SB202190 on LPS-induced COX-2 protein expression and PGE(2) production in equine leukocytes. LPS stimulation activated p38 MAPK and increased COX-2 expression in a dose-dependent manner with maximal activation observed after 30min and 4h, respectively, at a concentration of 10 ng/ml LPS. In contrast, LPS stimulation did not affect COX-1 protein expression. Pretreatment with SB203580 or SB202190 significantly inhibited LPS-induced activation-associated p38 MAPK phosphorylation, COX-2 mRNA and protein levels, and PGE(2) production in equine leukocytes. Maximal inhibition of LPS-induced COX-2 protein expression was achieved at a concentration of 10 microM SB203580. We concluded that p38 MAPK is essential for LPS-induced COX-2 expression suggesting that p38 MAPK is a potential target for anti-inflammatory therapy during equine endotoxemia.

    Title Breast Health Education for Working Women in Appalachia: Insights from Focus Group Research.
    Date October 2007
    Journal Cancer Control : Journal of the Moffitt Cancer Center

    This study seeks to understand rural working women, their knowledge of health systems, and how breast health issues fit into their lives. A key aim of this study was to identify regionally and culturally specific factors that influence how these women approach breast health and to identify ways that more positive breast health behaviors can be achieved.

    Title Evaluating the Effectiveness of a Logger Safety Training Program.
    Date May 2006
    Journal Journal of Safety Research

    Logger safety training programs are rarely, if ever, evaluated as to their effectiveness in reducing injuries.

    Title The Trapezius Port: a Novel Approach for Port Access.
    Date August 2005
    Journal The American Surgeon

    Placement of long-term central venous access in breast cancer patients who have undergone bilateral mastectomy presents a unique challenge. The standard anterior chest wall placement of the port may be compromised by factors such as a fresh surgical site, the possibility of postoperative radiation therapy, or the immediate reconstruction field. To avoid the potential for complications that impact the surgical field or subsequent therapy, we have developed a unique new technique for central venous port placement: the trapezius port. By placing the port in a subcutaneous pocket over the trapezius muscle, the risk of infection or cross-contamination of the surgical site is avoided.

    Title Assessing Safety Awareness and Knowledge and Behavioral Change Among West Virginia Loggers.
    Date December 2004
    Journal Injury Prevention : Journal of the International Society for Child and Adolescent Injury Prevention

    To determine if a video used during logger training influences safety attitude, knowledge, and workplace habits.Method: From April 2002 to October 2003, loggers receiving training through the West Virginia Division of Forestry were given a new safety module. This consisted of a pre-training survey, viewing video, brief introduction to field safety guide, and an immediate post-training survey. Six months after training, loggers were contacted by telephone to assess workplace behavioral changes.

    Title Laboratory Testing Policies and Their Effects on Routine Surveillance of Community Antimicrobial Resistance.
    Date August 2004
    Journal The Journal of Antimicrobial Chemotherapy

    OBJECTIVE: To investigate the effects of laboratory testing policies, particularly selective testing, rule-based reporting and isolate identification, on estimates of community antimicrobial resistance.Materials and methods: Antibiotic resistance estimates were analysed from an all-Wales dataset for approximately 300 000 community isolates of common pathogens. RESULTS: Selective testing policies were often associated with markedly increased resistance, particularly for second-line testing. Site-specific testing tended to yield variant resistance estimates for eye and ear isolates. Estimates from rule-based reporting deviated markedly from test-result-based reporting. Urinary isolates reported as Escherichia coli showed greater susceptibility than those reported as undifferentiated urinary 'coliforms'. The proportion of isolates tested for an antibiotic by a laboratory was a useful indicator of selective testing in this dataset. Selective testing policies had invariably been applied where the proportion of isolates of a species tested against an antibiotic was <90%. As this proportion fell with increasingly selective policies, divergence from pooled-all-Wales non-selective estimates tended to increase, with a bias to increased resistance. CONCLUSIONS: Selective testing, rule-based reporting and urinary coliform identification policies all had significant effects upon resistance estimates. Triage based upon the proportion of isolates tested seemed a useful tool in assigning analysis resources. Where <20% of isolates were tested, selective policies with inherent bias to increased resistance were common, the low number of isolates gave high potential sampling errors, and little confidence could be placed in the resistance estimate. Where 20-90% of isolates were tested, detailed analysis sometimes revealed resistance estimates that might be usefully retrieved. Where >/=90% of isolates were tested, there was no evidence of selective testing, and inter-laboratory variation in estimates appeared to be safely ascribable to other effects, e.g. methodology or real variation in resistance levels.

    Title Surgical Resection for Gastric Cancer in Elderly Patients: is There a Difference in Outcome?
    Date June 2004
    Journal The Journal of Surgical Research

    BACKGROUND: Early and long-term outcome of gastrectomy for gastric cancer in elderly adults has been a subject of controversy and debate. MATERIALS AND METHODS: Clinical information was reviewed for patients undergoing gastrectomy for gastric cancer during an 11-year period (1990-2000) at the University of Tennessee Medical Center at Knoxville. Patient demographics, tumor characteristics, operative mortality and morbidity, survival, and length of hospitalization were reviewed. RESULTS: Of 48 patients who underwent gastric resection for gastric adenocarcinoma, 24 were older than 70 and 24 younger than 70. There were no differences between the two groups regarding tumor characteristics, including location, tumor size, grade, gross pathology, lymph node involvement, lymphovascular invasion, and stage. In the elderly group, 75% underwent subtotal gastrectomy and 25% had total gastrectomy with or without resection of adjacent organs. In the younger patients, these numbers were 66.6% and 33.3%, respectively, which was statistically insignificant (P = 0.5). Five-year survival was 16.6% among elderly patients compared to 20.8% in the younger patients (P = 0.45). Half of the elderly patients and 39% of young patients had other comorbidities (P = 0.45). Postoperative mortality and morbidity was 8.33% and 33.3% in elderly patients, compared to 4.2% and 33.3%, respectively, in the younger group. These results were statistically insignificant (P = 0.4). The median postoperative length of stay was 15 days (95 percent confidence interval, 11-19 days) in younger patients compared to 18 days (95 percent confidence interval, 13-22 days) in the elderly group (P = 0.3). CONCLUSION: This study suggests that gastrectomy can be carried out safely in elderly patients. The early and long-term outcomes in elderly patients (over age 70) are comparable to younger patients (under age 70). Age alone should not preclude gastric resection in elderly patients.

    Title Non-fatal Injuries in the West Virginia Logging Industry: Using Workers' Compensation Claims to Assess Risk from 1995 Through 2001.
    Date March 2004
    Journal American Journal of Industrial Medicine

    The logging industry has a high rate of both fatal and non-fatal injuries in comparison to other industries, and plays a vital role in WV's economy.

    Title Solid-pseudopapillary Tumor of the Pancreas: Two Cases in Male Patients.
    Date March 2004
    Journal The American Surgeon

    Solid-pseudopapillary tumor (SPT) of the pancreas is a rare lesion with low malignant potential occurring predominantly in young women. This is a report of two cases in young male patients. Clinical data were retrieved retrospectively from a prospective database of patients with pancreatic tumors. The two patients were caucasian males, ages 34 years (Pt1) and 41 years (Pt2) at the time of diagnosis. Pt1 presented with intermittent epigastric pain, nausea, and vomiting. Computed tomography (CT) scan showed a 9-cm mass involving the pancreatic head. He underwent pancreaticoduodenectomy, with en bloc segmental colectomy due to mesocolon involvement. Pt2 was asymptomatic, diagnosed with abdominal mass by screening ultrasound. He had an 11-cm tumor involving the pancreatic tail encasing the splenic vessels on CT. He underwent distal pancreatectomy with splenectomy en bloc. Pathology in both cases was reviewed by staff pathologists as well as outside consultants. SPT is a rare tumor of the pancreas that is diagnosed primarily in young women. The cases presented here demonstrate SPT of the pancreas in two men. In both cases, the clinical presentation was relatively unremarkable. Both have had benign late postoperative courses, consistent with the low malignant potential of this lesion.

    Title Logging Injuries for a 10-year Period in Jilin Province of the People's Republic of China.
    Date October 2003
    Journal Journal of Safety Research

    Logging continues to be a major source of injuries in northeast China. This paper describes logging-related injuries in the Jilin Province of the People's Republic of China.

    Title Hand Lacerations and Job Design Characteristics in Line-paced Assembly.
    Date October 2003
    Journal Journal of Occupational and Environmental Medicine / American College of Occupational and Environmental Medicine

    This study investigated risk factors for laceration injuries among workers employed in line-paced manufacturing assembly operations. Most lacerations (76% of 576) occurred on the hands and fingers (grouped as "hand" lacerations). On average, 37% of surveyed workers reported at least one laceration to the hand in the preceding year, resulting in an overall hand laceration rate of 83 per 100 workers per year. An inverse relationship was found between level of job routinization and hand lacerations, with progressively higher rates of hand lacerations occurring among workers assigned to less routine (more variable) work patterns. Fabricated metal parts handling and job variability may be related to increased risk of hand lacerations in line-paced work environments where personal protective equipment is the primary strategy to control exposure to sharp objects.

    Title In Vitro Inhibition of Growth and Induction of Apoptosis in Cancer Cell Lines by Thymoquinone.
    Date June 2003
    Journal International Journal of Oncology

    Thymoquinone (TQ) is likely responsible for the chemotherapeutic effects of N. sativa extract; however, the cellular mechanisms remain ill-defined. TQ-induced cytotoxicity was investigated using canine osteosarcoma (COS31), its cisplatin-resistant variant (COS31/rCDDP), human breast adenocarcinoma (MCF7), human ovarian adenocarcinoma (BG-1) and Madin-Darby canine (MDCK) cell lines. TQ-induced cytotoxicity was determined using a proliferation assay (MTT assay) and apoptosis assays. Effects of TQ on the cell cycle were determined using flow cytometry. COS31/rCDDP resistant cells were the most sensitive cell line to TQ and MDCK cells were the least sensitive. TQ (25 micro M) induced apoptosis of COS31 cells 6 h after treatment and decreased the number of COS31 cells in S-phase and increased cells in G1-phase, indicating cell cycle arrest at G1. These results suggest that TQ kills cancer cells by a process that involves apoptosis and cell cycle arrest. Non-cancerous cells are relatively resistant to TQ.

    Title Changes in Logging Injury Rates Associated with Use of Feller-bunchers in West Virginia.
    Date January 2003
    Journal Journal of Safety Research

    It is well documented that logging is one of the most dangerous occupations and industries in which to work, and trees fellers are at greatest risk of injury. The objective of this study was to determine whether West Virginia (WV) logging companies experienced a reduction in injuries after beginning to use feller-bunchers (tree cutting machines, which replace some of the work done with a chainsaw) during harvesting operations.

    Title Mems-based Sample Preparation for Molecular Diagnostics.
    Date July 2002
    Journal Analytical and Bioanalytical Chemistry

    Completion of the Human Genome Project is driving the rapid development of molecular diagnostics in the laboratory. To accelerate the penetration of genetic tests and other nucleic acid-based tests into clinical markets, simple, compact, automatic sample-preparation systems for molecular diagnostics must be developed. Microelectromechanical systems (MEMS) is a promising approach for the development of automated sample preparation for the clinical laboratory or point-of-care setting. This review discusses MEMS-based components that could be applied to the different stages of the sample-preparation process such as cell separation, nucleic acid purification, and nucleic acid amplification. Examples of functional component integration are given. Issues discussed include partitioning of functions between the instrument and disposable unit, methods of propulsion of fluids and particles, vapor and liquid barriers, and sample size. Although further evaluation and development are needed to provide practical solutions to some of these issues, we conclude that MEMS-based components might contribute to some components in a sample-preparation system consisting of modular instruments and disposable units, but will not provide a generic or a totally integrated solution.

    Title Palpable Breast Abnormalities Must Be Resolved Histologically.
    Date June 2002
    Journal Radiology
    Title Co-expression of Beta-adrenergic Receptors and Cyclooxygenase-2 in Pulmonary Adenocarcinoma.
    Date October 2001
    Journal International Journal of Oncology

    Pulmonary adenocarcinoma (PAC) is the leading type of lung cancer and is highly resistant to conventional cancer therapy. A better understanding of the regulatory mechanisms which control the growth of this deadly malignancy are urgently needed to develop more effective cancer intervention strategies. Recent studies have shown that PAC frequently overexpresses cyclooxygenase-2 (COX-2). This enzyme converts arachidonic acid (AA) into several metabolites, some of which have been identified as modulators of mitogenesis and apoptosis. Accordingly, the AA cascade and COX-2 are currently widely studied as potential targets for lung cancer prevention. Recent studies by our research group have shown that cell lines derived from human PACs express beta1- and beta2-adrenergic receptors, which regulate the release of AA and DNA synthesis. Moreover, we have demonstrated that an antagonist for beta-adrenergic receptors or aspirin inhibited the development of experimentally induced PAC in a hamster model. These findings suggest that beta-adrenergic receptors may serve as upstream regulators of AA and COX-2-mediated PAC growth. However, no information is currently available on the expression of beta-adrenergic receptors and its possible correlation with the expression of COX-2 in tissue samples from human PAC, casting some doubt on the significance of these findings in vitro and in an animal model. In the current study, we have therefore analyzed tissue samples of human PACs for the expression of beta1-and beta2-adrenergic receptors as well as COX-2 by reverse transcription polymerase chain reaction (RT-PCR) or immunohistochemistry. Our data show that seven out of eight samples co-expressed COX-2 and one or both of these beta-adrenergic receptors, supporting the experimental evidence for a functional link between these neurotransmitter receptors and the AA cascade in the regulation of human PAC.

    Title Bradykinin B2 Receptors Activate Na+/h+ Exchange in Mimcd-3 Cells Via Janus Kinase 2 and Ca2+/calmodulin.
    Date July 2001
    Journal The Journal of Biological Chemistry

    We used a cultured murine cell model of the inner medullary collecting duct (mIMCD-3 cells) to examine the regulation of the ubiquitous sodium-proton exchanger, Na+/H+ exchanger isoform 1 (NHE-1), by a prototypical G protein-coupled receptor, the bradykinin B2 receptor. Bradykinin rapidly activates NHE-1 in a concentration-dependent manner as assessed by proton microphysiometry of quiescent cells and by 2'-7'-bis[2-carboxymethyl]-5(6)-carboxyfluorescein fluorescence measuring the accelerated rate of pH(i) recovery from an imposed acid load. The activation of NHE-1 is blocked by inhibitors of the bradykinin B2 receptor, phospholipase C, Ca2+/calmodulin (CaM), and Janus kinase 2 (Jak2), but not by pertussis toxin or by inhibitors of protein kinase C and phosphatidylinositol 3'-kinase. Immunoprecipitation studies showed that bradykinin stimulates the assembly of a signal transduction complex that includes CaM, Jak2, and NHE-1. CaM appears to be a direct substrate for phosphorylation by Jak2 as measured by an in vitro kinase assay. We propose that Jak2 is a new indirect regulator of NHE-1 activity, which modulates the activity of NHE-1 by increasing the tyrosine phosphorylation of CaM and most likely by increasing the binding of CaM to NHE-1.

    Title Hepatic Angiosarcoma: Long-term Survival After Complete Surgical Removal.
    Date January 2001
    Journal The American Surgeon

    Angiosarcoma of the liver constitutes 2 per cent of all primary tumors of the liver. This lesion has demonstrated an intimate relationship between the environment and potential malignant transformation. The CT appearance of hepatic angiosarcoma is nonspecific, whereas arteriography provides the best imaging tool for diagnosis. Hepatic resection is rarely feasible but should be considered if the disease is limited and the remainder of the liver is relatively normal. The prognosis of patients with this malignancy is poor with a median survival of 6 months. A patient with a hepatic angiosarcoma is described. Complete surgical resection was possible and was associated with a prolonged (10-year) postoperative survival.

    Title Risk Factor Analysis for Breast Cellulitis Complicating Breast Conservation Therapy.
    Date December 2000
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America

    Women who undergo breast conservation therapy for early-stage breast cancer can develop breast cellulitis, a complication for which risk factors are undefined. A matched case-control investigation was conducted to identify risk factors for the development of breast cellulitis among patients who have undergone breast conservation therapy. Patients comprised 17 patients with cases of breast cellulitis diagnosed after partial mastectomies that had been performed from 1992 through 1997 and 34 control patients who were matched to case-patients by date of breast lumpectomy and by primary surgeon. Statistical analyses indicated the following factors were associated with breast cellulitis: drainage of a hematoma (P=.010); postoperative ecchymosis (P=.021); lymphedema (odds ratio [OR], 10. 154; 95% confidence interval [CI], 1.348-208.860); resected breast tissue volume (OR, 1.456; 95% CI, 1.035-2.168); and previous number of breast seroma aspirations (OR, 3.445; 95% CI, 1.036-19.771). This is the first matched case-control study to identify risk factors for the development of breast cellulitis after breast conservation therapy.

    Title Slip and Fall-related Injuries in Relation to Environmental Cold and Work Location in Above-ground Coal Mining Operations.
    Date August 2000
    Journal American Journal of Industrial Medicine

    The association between slip and fall-related injuries and environmental temperature was examined for mostly enclosed (inside vehicles, machinery, or buildings), outdoor (outside, not enclosed), and enclosed/outdoor jobs in the coal mining industry to see if differences existed among the three work locations that had varying exposure to cold temperatures.

    Title Complex Enterocutaneous Fistula: Closure with Rectus Abdominis Muscle Flap.
    Date July 2000
    Journal Southern Medical Journal

    Most enterocutaneous fistulas are caused by complications of abdominal surgery that may result from anastomotic failure, poor blood supply, or iatrogenic bowel injuries. Mortality rates are high when associated sepsis and malnutrition are uncontrolled. Fistulas that occur late and those that recur spontaneously present more difficulty and may close spontaneously in less than 30% of cases. Mortality rates in patients with complex enterocutaneous fistulas may reach 60% to 80%. When traditional conservative surgeries of fistulous tract excision, bowel mobilization, and resection with primary end-to-end anastomosis fail, a more aggressive approach is required. The rectus abdominis muscle flap has been extensively studied and used in a wide variety of abdominal, vaginal, and perineal repairs. We report successful closure of complex enterocutaneous fistulas with a rectus abdominis muscle flap in a complicated case.

    Title A Dna Probe for Identification of Larvae of the Commercial Surfclam (spisula Solidissima).
    Date July 1998
    Journal Molecular Marine Biology and Biotechnology

    A molecular DNA probe was developed for identification of larvae of the commercial surfclam Spisula solidissima (family Mactridae), to distinguish early-stage veligers from larvae of other common bivalve species in a study of surfclam settlement and recruitment on the New Jersey continental shelf. For discrimination of S. solidissima from other common bivalve species at the study site (almost all of which belong to different families), an oligonucleotide designed from the nucleotide sequence of the 18S ribosomal RNA gene provides a useful and sensitive family-specific probe and primer. For discrimination between S. solidissima and Mulinia lateralis (both members of Mactridae), the 18S rRNA gene was examined by restriction fragment length polymorphism (RFLP) analysis. A combination of the DNA probe and RFLP analysis provides a positive identification of S. solidissima and M. lateralis larvae in coastal plankton samples.

    Title Breast Cellulitis Following Breast Conservation Therapy: a Novel Complication of Medical Progress.
    Date April 1998
    Journal Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America

    Breast cellulitis is a novel complication of the recently accepted practice of breast conservation therapy. This phenomenon represents an anatomic shift from ipsilateral upper extremity cellulitis seen in past years when mastectomy with axillary lymph node dissection was performed for treatment of limited disease due to breast cancer. Thirteen episodes of breast cellulitis in nine women who underwent breast conservation therapy for stage I or II breast cancer are presented. The mean duration from the end of radiotherapy to the initial episode of cellulitis was 4.9 months. Eighty-three percent of episodes occurred in patients who had radiologically demonstrated fluid collections at the surgical lumpectomy site prior to the onset of cellulitis. Eight (61.5%) of 13 episodes occurred within 3 months of a follow-up mammogram of the treated breast. Two patients developed recurrent cellulitis within a 6-month period. Breast cellulitis may be more commonly seen in clinical practice as an increasing number of patients undergo breast-sparing procedures for treatment of limited disease due to cancer.

    Title Preparation of Dna from Numerous Individual Microscopic Organisms for Pcr-based Assays of Environmental Samples.
    Date February 1998
    Journal Biotechniques
    Title Ductal Carcinoma in Situ of the Breast: Correlation of Pathologic and Mammographic Features with Extent of Disease.
    Date December 1997
    Journal The American Surgeon

    Optimal treatment of ductal carcinoma in situ (DCIS) of the breast requires an improved understanding of its pathologic extent and propensity for local recurrence. This study was performed to analyze mammographic and pathologic features of DCIS that might predict the extent of disease within the breast and facilitate treatment selection between lumpectomy alone, lumpectomy and radiotherapy, and mastectomy. At our institution, 60 cases of DCIS were diagnosed in 59 patients from June 1985 to February 1995 and form the basis of this retrospective study. Demographic and treatment-related information was obtained from hospital and tumor registry records. Mammograms were reviewed and size estimates of the abnormalities were determined. Pathologic slides from all cases were reviewed and classified according to size group, focality, nuclear grade, necrosis, and histologic subtype. DNA ploidy status and proliferation indices were available for 28 patients. Pathologically, 43 (72%) cases were < 15 mm, 14 (23%) were 16 to 40 mm, and 3 (5%) were > 40 mm. Five (8%) of the lesions were multicentric, 28 (47%) focal, and 27 (45%) multifocal. Thirty-three (55%) patients were treated by mastectomy, 16 (27%) by lumpectomy alone, and 11 (18%) by lumpectomy and radiation therapy. Mammographic size, histologic grade, presence or absence of necrosis, histologic subtype, DNA ploidy, and proliferative index were compared with pathologic size and focality by chi 2 analysis. Mammographic size correlated significantly with pathologic size (chi 2 = 11.3; P = 0.02) but underestimated the extent of disease in 9 cases. Although focality correlated significantly with pathologic size (chi 2 = 15.8; P = 0.003), the remaining histopathologic features did not significantly correlate with pathologic size or focality. Histopathologic features, including DNA studies, do not reliably predict the pathologic extent of DCIS, but mammographic size and focality do significantly correlate with pathologic size. Nevertheless, most cases of DCIS are small focal or multifocal lesions that are amenable to breast conservation approaches; further studies are needed to determine the appropriate use of lumpectomy, radiation therapy, and mastectomy in the treatment of DCIS.

    Title Perineal Hernia Repair Using Gracilis Myocutaneous Flap.
    Date February 1997
    Journal Southern Medical Journal

    Perineal hernia formation is an infrequent but well-recognized complication of major pelvic surgery. Various methods of perineal reconstruction have been reported. This report describes one technique of perineal hernia repair using a unilateral gracilis myocutaneous flap. The gracilis myocutaneous flap provides well-vascularized tissue that is useful in many situations requiring reconstruction of the pelvis and perineum, especially when the area has been irradiated.

    Title Expression of Epstein-barr Virus Nuclear Antigen-1 Induces B Cell Neoplasia in Transgenic Mice.
    Date August 1996
    Journal The Embo Journal

    The Epstein-Barr virus (EBV) nuclear antigen-1 (EBNA-1) is a pleiotropic protein which has been characterized extensively both biochemically and functionally. It is the only one of the identified latent protein-encoding genes to be consistently expressed in viral-associated endemic Burkitt's lymphoma cells. As such, it is the only candidate viral protein to possibly perform a maintenance function in the tumour pathology. Despite this, no oncogenic activity has been attributed to the protein in tissue culture assays. The experiments described here were initiated to explore the activity of the protein in B cells in vivo. EBNA-1 transgenic mice were generated with transgene expression directed to the B cell compartment using the mouse Ig heavy chain intron enhancer. Transgene expression was demonstrated in the lymphoid tissues of mice of two independent lines. Transgenic positive mice of both lines succumb to B cell lymphoma. The B cell tumours are monoclonal, frequently of follicular centre cell origin and remarkably similar to those induced by transgenic c-myc expression. These results demonstrate that EBNA-1 is oncogenic in vivo and suggest that the gene product may play a direct role in the pathogenesis of Burkitt's lymphoma and possibly other EBV-associated malignancies.

    Title Interval Mammography After Needle Localization Biopsy of Breast Abnormalities That Are Pathologically Benign.
    Date October 1995
    Journal American Journal of Surgery

    BACKGROUND: Needle localization biopsy is commonly performed for the diagnosis of mammographic abnormalities. Routine specimen radiography is generally recommended, but the value of routine short-interval postbiopsy mammography has not been analyzed. PATIENTS AND METHODS: We performed a retrospective review of 299 consecutive localized biopsies in 286 women from March 1989 to November 1993. Of these biopsies, 217 from the basis for this study; all yielded a benign pathologic diagnosis and had both specimen radiography and 3-month interval mammograms performed. RESULTS: A total of 192 (88%) of postbiopsy mammograms were interpreted as negative, while 22 (10%) were suspicious. Three patients had second biopsies and all had benign diagnoses, 16 had follow-up mammograms that were interpreted as normal or stable, and 3 patients were lost to follow-up. A suspicious postbiopsy mammogram had no significant relationship to initial mammographic abnormality or pathologic diagnosis, but did correlate with specimen radiograph interpretation (P = 0.02) by chi-square comparison). CONCLUSIONS: In a series of needle localization biopsies with intraoperative specimen radiography, postbiopsy mammography failed to reveal any missed cancers. Short-interval follow-up mammography is unnecessary to assess for residual abnormalities when specimen radiography confirms excision of the abnormality.

    Title Traumatic Event Debriefing: Service Delivery Designs and the Role of Social Work.
    Date March 1995
    Journal Social Work

    Traumatic events are incidents that lie outside the range of usual human experience and are so powerful that they are capable of overwhelming any person's normal coping abilities and causing severe stress reactions. Traumatic event debriefing (TED), conducted 24 to 72 hours after exposure to the traumatic event, uses a form of intensive group crisis intervention. The method is designed to help reduce acute stress symptoms and accelerate the recovery process, thereby diminishing the subsequent development of posttraumatic stress disorder. Social workers have the precise constellation of skills, social-environmental perspectives, and practice methodologies indispensable both to developing TED teams and to leading the debriefings. This article addresses the evolution of debriefing-type psychological interventions for trauma victims, the debriefing process itself, three environment-specific debriefing team designs, and the unique qualifications of social workers to develop and lead the teams.

    Title Optimizing Local Control in Soft Tissue Sarcoma of the Extremity.
    Date November 1994
    Journal Oncology (williston Park, N.y.)

    Extremity soft tissue sarcoma is a rare malignancy in which a high rate of local control can be achieved with multimodal regimens and without excessive treatment-related morbidity. This article reviews the current status of evaluation, staging, and local treatment of these tumors. Evidence shows that surgical approaches that maximize local control have little effect on the development of distant metastasis and overall survival. The goal of local treatment, therefore, is a balance of adequate local control with limb salvage and minimal therapeutic morbidity. A variety of limb-sparing approaches using various adjuvant modalities in addition to conservative resection are discussed, including reported local control and complication rates. Treatment paradigms are then presented for the management of extremity soft tissue sarcoma of varying stages. Further studies are needed to define precisely the role, type, and timing of chemotherapy and radiotherapy in addition to surgery in the management of this disease with respect to local control and distant metastasis.

    Title Rickets in Nigerian Children: a Consequence of Calcium Malnutrition.
    Date February 1991
    Journal Metabolism: Clinical and Experimental

    Eleven Nigerian children with clinically and radiologically proven rickets were assessed biochemically. The children had low or low normal concentrations of total and corrected calcium, and elevated plasma alkaline phosphatase (ALP) activity, but normal plasma phosphate concentrations. Their serum 25-hydroxyvitamin D (25-OHD) and 1,25-dihydroxyvitamin D (1,25-(OH)2D) concentrations were not significantly different from those in controls, but the ratio of 1,25-(OH)2D to 25-OHD was significantly greater than that in controls. Parathyroid hormone (PTH) concentrations were greater in rachitic children, and there was a significant correlation between 1,25-(OH)2D and PTH concentrations. Osteocalcin concentrations in rachitic children were not significantly different from those in controls, but they were markedly elevated in the three patients with the highest 1,25-(OH)2D and PTH concentrations. One child, from whom a sample of bone (from a corrective osteotomy) was available for histological examination, showed markedly thickened osteoid seams, characteristic of rickets. All the rachitic children had a calcium intake of less than 150 mg daily. Treatment of these rachitic children with calcium gluconate (1 g/d) led to clinical, radiological, and biochemical healing of rickets. We conclude that rickets in Nigerian children is not due to vitamin D deficiency, but to a lack of calcium. This observation has implications regarding the pathogenesis, treatment, and prevention of rickets/osteomalacia in Nigeria and possibly other African and tropical countries.

    Title Speaking of Sex.
    Date January 1991
    Journal The American Journal of Nursing
    Title Outpatient Percutaneous Central Venous Access in Cancer Patients.
    Date January 1991
    Journal American Journal of Surgery

    A 1-year experience of percutaneous subclavian catheterization in outpatients with cancer was reviewed to document reliability, safety, and cost. There were 763 catheter insertions attempted with prospective documentation of complications in 664 consecutive patients. Catheter insertion was successful in 722 attempts (95%). There were only 13 pneumothoraces (2%). Thirty catheters required repositioning (4%). The average catheter duration was 191 days (range: 0 to 892 days). Fifty-six catheters (8%) were removed because of suspected infection. Documented catheter sepsis occurred in 21 patients (3%); catheter site infection occurred in 8 patients (1%). Thus, only 0.22 infections per catheter year occurred during this 382 catheter-year experience. The estimated cost of catheter insertion was $562, which is one-third the estimated cost for tunneled catheters ($1,403) and for reservoir devices ($1,738). In our experience, percutaneous subclavian catheterization is a reliable, cost-effective method compared with tunneled or reservoir devices, with an equivalent incidence of catheter-related infections. The cornerstone of our success with this program is a staff dedicated to catheter care and intensive patient education. In centers where a large number of patients require central venous access, percutaneous catheterization should be the technique of choice.

    Title Hydraulically-induced Convective Solute Transport Across the Rabbit Peritoneum.
    Date September 1990
    Journal Kidney International

    Transport of solutes during osmotically-induced transperitoneal ultrafiltration is less than would be predicted based upon rates of transperitoneal solute diffusion. Previous workers have hypothesized that osmotically-induced convective solute transport occurs only in small pores at the arteriolar end of peritoneal capillaries, whereas solute diffusion occurs only through large venular pores. We tested this heteroporosity hypothesis in the eviscerated New Zealand White rabbit by determining sieving coefficients (S) for creatinine, p-aminohippurate (PAH) and neutral dextran during hydraulically-induced transperitoneal ultrafiltration (N = 13). A hydraulically-induced driving force directs convective solute transport through the same capillary pores employed for diffusion; therefore S for all solutes should approach unity if the heteroporosity hypothesis is valid. S for creatinine and PAH were respectively 0.72 +/- 0.03 and 0.67 +/- 0.05, values lower than unity and not different from those previously determined during osmotically induced ultrafiltration. Mean S for dextran were relatively independent of molecular size, ranging from 0.50 at 13 A to 0.40 at 50 A. Thus, dextran S were higher than those previously determined during osmotically induced ultrafiltration yet still less than unity. Control experiments (N = 6) suggested that only surface area and not transport characteristics were altered by evisceration. These observations demonstrate that the heteroporosity hypothesis fails to completely describe both diffusive and convective transport properties of the peritoneum.

    Title Effect of Starvation and Sampling Time on Plasma Alkaline Phosphatase Activity and Calcium Homeostasis in the Rat.
    Date July 1989
    Journal Laboratory Animals

    The effect of starvation and sampling time on plasma alkaline phosphatase activity, total plasma calcium concentration and whole blood ionized calcium concentration was determined in the rat. Starvation caused a significant fall in total and ionized calcium concentrations as well as in alkaline phosphatase activity. These changes were accompanied by a fall in whole blood pH and an increase in the anion gap and a decrease in urinary excretion of calcium. These indices were restored to normal following refeeding. There was no change in serum 25-OH vitamin D concentrations following starvation for 3 days. Alkaline phosphatase activity showed a pattern compatible with the presence of a circadian rhythm when sampling took place between 0800 and 1800 h. Total and ionized calcium concentrations did not show such a rhythm when animals were fed the present diet.

    Title Disopyramide and N-monodesalkyl Disopyramide in Serum and Breast Milk.
    Date June 1989
    Journal Dicp : the Annals of Pharmacotherapy

    Maternal serum and breast milk were obtained to determine the concentration of disopyramide (DP) and its metabolite N-monodesalkyl disopyramide (NMD) from a woman requiring antidysrhythmic drug therapy. Infant serum and urine were also obtained for drug concentrations. DP 450 mg tid resulted in peak maternal serum concentrations of 4.0 micrograms/mL and 2.2 micrograms/mL for DP and NMD, respectively. Breast milk concentrations averaged 1.06 and 6.24 times the serum levels for DP and NMD, respectively. No DP was measurable in the infant's serum except for cord blood, which contained 0.7 micrograms/mL DP, 26 percent of simultaneous maternal concentration, and 0.9 micrograms/mL NMD, which represented 43 percent of the maternal concentration. Infant urine collected over an eight-hour period contained 3.3 micrograms/mL of DP and 3.7 micrograms/mL of NMD.

    Title Fibronectin Concentrations in Plasma in Peripheral Vascular Disease.
    Date January 1989
    Journal Clinical Chemistry

    Fibronectin (Fn) concentrations were measured immunoturbidimetrically in plasma of normal subjects and patients with peripheral vascular disease (PVD) before and after venous compression, which caused Fn concentrations to increase in both normal subjects and PVD patients. Basal Fn concentrations and those after 10-min compression were not significantly different in normal subjects and PVD patients. Five minutes after the release of compression, Fn had consistently declined in normal subjects and reverted to baseline values; in contrast, in PVD patients values either increased further or decreased inconsistently. Thus the Fn concentration at 15 min was significantly (P less than 0.001) greater in PVD patients than in normal subjects. Plasma albumin concentrations, measured in parallel to ensure that changes in Fn concentrations were not nonspecific, increased to a greater extent in normal subjects than in PVD patients and reverted to normal after the removal of compression. The Fn/albumin ratio remained unchanged in normal subjects after venous compression, whereas that in PVD patients increased and remained higher, even after decompression. The sustained increase in plasma Fn concentrations and in the Fn/albumin ratio in PVD patients after venous compression may indicate endothelial injury.

    Title Economic Impact of Reducing Hospitalization for Mastectomy Patients.
    Date October 1988
    Journal Annals of Surgery

    In 1985, two policies designed to reduce hospitalization charges for mastectomy patients were instituted at the M.D. Anderson Cancer Center at Houston. The first was a policy of "same-day" admissions for elective surgery patients, and the second was early postoperative discharge for mastectomy patients with suction catheter drains in place. The economic savings resulting from these policies was analyzed by comparing demographics, operation, stage of disease, hospital stay, hospital charges, and complications for two groups of patients. Fifty-nine consecutive mastectomy patients treated between 1983 and 1984, before these policy changes, had "standard management" consisting of hospital admission 24 hours before surgery and discharge only after the surgical drains were removed. Sixty-one consecutive mastectomy patients treated between 1986 and 1987, after these policy changes went into effect, were admitted from the recovery room after surgery and were discharged with drainage catheters in place, usually within 72 hours. All operations were performed by the same faculty surgeon as a representative experience of the General Surgery faculty. The average hospital stay was reduced from 10.5 to 4.3 days. A mean 39% reduction in hospital charges (from $4867.00 to $2981.00) was achieved by instituting the policies of "same-day" admission and early postoperative discharge with drainage catheters in place. Complication rates were not changed. Implementation of this policy resulted in an estimated savings of $750,000.00 in the hospital care of approximately 400 patients treated at the M.D. Anderson Cancer Center at Houston each year. Adjustments in patient care delivery systems from a predominantly inpatient to an outpatient setting required changes in outpatient nursing responsibilities (although not in new personnel). Patient education and written instructions for home care of surgical wounds and drainage catheters were essential for implementing an early discharge policy. With these facts in mind, hospital admission on the day of operation and early postoperative discharge with drainage catheters in place should be the goal for most mastectomy patients.

    Title Effect of Starvation on Biochemical Indices of Renal Function in the Rat.
    Date March 1988
    Journal British Journal of Experimental Pathology

    The effect of starvation on urinary output and biochemical indices of renal function was investigated in rats. Starvation resulted in a marked fall in water intake. Urinary output paradoxically increased during the first day following starvation, but fell dramatically thereafter. Urinary creatinine excretion and creatinine clearance fell markedly, but plasma creatinine concentration did not alter. Plasma urea concentration and urinary urea excretion fell. Plasma sodium concentration increased, whilst plasma potassium concentration did not alter; urinary sodium and potassium excretion fell. Plasma bicarbonate concentration fell marginally, but the anion gap increased to a greater extent. Following re-feeding, water intake and urine output increased, as did urinary creatinine excretion and creatinine clearance. Plasma urea and urinary urea concentrations, as well as sodium and potassium excretion, increased. Plasma bicarbonate increased and the anion gap decreased. These indices improved within 2 days of re-feeding and were restored to normal in 5 days.

    Title Determination of Free Digoxin Concentrations in Serum for Monitoring Fab Treatment of Digoxin Overdose.
    Date October 1987
    Journal Clinical Chemistry

    A rapid method for assessing the free digoxin concentration in the serum of digoxin-overdosed patients receiving treatment with digoxin-specific Fab fragments has been developed. For this method, a protein-free ultrafiltrate is prepared from the patient's serum, and the digoxin in the ultrafiltrate (free digoxin) is measured by fluorescence polarization immunoassay. Both the inaccuracies associated with measurements of total digoxin by immunoassay in the presence of Fab and the long turnaround time associated with measurements of free digoxin by equilibrium dialysis were avoided. Good correlation was observed between measurements of free digoxin by this ultrafiltration technique and by equilibrium dialysis. The ultrafiltration method was used to evaluate the concentrations of free digoxin in a digoxin-overdosed patient treated with Fab at our hospital. In retrospect, the results suggest that her hospital stay could have been shortened by a timely appreciation of her increased concentration of free digoxin. Using the ultrafiltration method, one can determine free digoxin concentrations quickly, conveniently, and accurately in the clinical laboratory. This procedure therefore should be a valuable aid in monitoring the efficacy and adequacy of Fab treatment.

    Title Warfarin Administration Increases Uric Acid Concentrations in Plasma.
    Date September 1986
    Journal Clinical Chemistry

    The effect of warfarin administration on plasma uric acid was investigated. A representative sample of patients on long-term warfarin treatment had a significantly higher concentration of uric acid in plasma than did age-matched patients with comparable plasma urea concentrations who were not taking warfarin. In women, this association was observed only in patients with normal values for plasma urea, not in those with high values. In contrast, in men this association was present in both groups (normal and high plasma urea). In a longitudinal study involving patients, their plasma uric acid significantly increased after warfarin administration. There was no significant change in the renal clearance of uric acid after a single dose of warfarin in normal, healthy volunteers; this contrasts with the increase observed with other coumarin anticoagulants. Our findings suggest that the increase in plasma uric acid noted with warfarin administration is probably due to an increase in uric acid production and may predispose to gout those patients who are on long-term therapy with warfarin.

    Title Immunoturbidimetric Assay of Slight Albuminuria with a Centrifugal Analyzer.
    Date August 1986
    Journal Clinical Chemistry
    Title Penetrating Cardiac Trauma.
    Date March 1984
    Journal The Journal of Trauma

    During a 10 1/2 year interval ending in June 1980, 47 patients with penetrating cardiac trauma were managed at The University of Alabama Medical Center. Thirty-nine patients (83%) were male. Mean age was 31 years (range, 13 to 69). Thirty-two patients (68%) sustained stab wounds (SW) and 15 patients (32%) gunshot wounds (GSW). Forty-two patients (89%) arrived hypotensive (systolic blood pressure less than 90 mm Hg). Twenty-seven patients (57%) had evidence of cardiac tamponade (central venous pressure greater than 15 cm H2O) and 25 of these 27 patients were also in shock. Forty patients (85%) presented with a normal sinus rhythm and seven patients (15%) had an idioventricular rhythm or asystole. Overall mortality was 23% (11 of 47 patients). Forty-three per cent of the patients sustaining GSW (6/14) died compared to 17% (5/33) of the patients with SW (p = 0.04). Mortality for the patients in shock was 26% and for those with cardiac tamponade 15%. Mortality was 16% for the patients with both shock and cardiac tamponade. Thirteen per cent of the patients in normal sinus rhythm died, while 87% of the patients with idioventricular rhythm or asystole died (p less than 0.0001). Mortality in penetrating cardiac trauma remains high, particularly in patients with GSW and in those patients presenting with an idioventricular rhythm or asystole.

    Title Environmental Effects on Urinary Volumes, Biochemical Constituents and Their Inter-relation.
    Date March 1984
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry

    This study has found low 24-h urine volumes in British expatriates in Saudi Arabia and suggests the possibility of urate stone formation in spite of the air-conditioned environment in which they were living. Urine volume was shown to be significantly correlated with calcium excretion in both sexes and to urate and sodium in males. Differences in 24-h urine concentrations of some but not all constituents between British-born subjects living in Britain and Saudi Arabia have been demonstrated.

    Title The Prevalence of Diabetes Mellitus in Male Saudi Arabs.
    Date January 1983
    Journal Diabetologia

    The prevalence of diabetes mellitus in 1385 males in the Al-Kharj area of Saudi Arabia was studied using the WHO criteria for screening and interpretation of glucose tolerance tests[1]. The prevalence was found to increase with age. No diabetic patients were found in the less than or equal to 24 year age group and only one (0.3%) in the age range: 25-34 years. There were seven (2.6%) in the age range: 35-44 years, 17 (9.6%) in the age range: 45-54 years, six (11%) in the age range: 55-64 years and three (23%) in the age range: greater than or equal to 65 years. The cases detected were relatively symptom free, but 65% of the diabetic patients were overweight.

    Title Instant Access: Patient Information is Just a Keystroke Away.
    Date January 1983
    Journal Group Practice Journal
    Title In Memoriam: Sumner L. Koch: 1888-1976.
    Date October 1977
    Journal The Journal of Hand Surgery
    Title Serum Enzyme Changes in Patients Receiving Antituberculosis Therapy with Rifampicin or P-aminosalicylic Acid, Plus Isoniazid and Streptomycin.
    Date August 1976
    Journal Tubercle
    Title Evaluation of the Vickers D300 for Routine Analysis of Urea, Bilirubin, Total Protein and Albumin in Plasma.
    Date January 1974
    Journal Clinica Chimica Acta; International Journal of Clinical Chemistry
    Title Purification and Comparative Properties of Isoenzymes of Nicotinamide-adenine Dinucleotide Phosphate-isocitrate Dehydrogenase from Rat Heart and Liver.
    Date May 1973
    Journal The Biochemical Journal

    1. Rat liver and heart major isoenzymes of NADP-isocitrate dehydrogenase have each been purified about 100-fold by a combination of ammonium sulphate fractionation and chromatography on ion-exchange cellulose and their properties compared. 2. The properties were similar in respect of pH, inhibition by Hg(2+) and Michaelis constants for isocitrate and NADP. 3. Some of the properties of the isoenzymes were different. 4. The heart isoenzyme was activated about 210% by 0.8m-ammonium sulphate whereas the liver isoenzyme was unaffected. The heart isoenzyme showed greater sensitivity to inactivation by heat (30 degrees C for 30min), whereas the liver isoenzyme was more sensitive to inactivation by p-chloromercuribenzoate and by Cu(2+). 5. The Michaelis constants with 3-acetylpyridine-adenine dinucleotide phosphate showed a twofold difference between liver and heart isoenzyme. 6. The differential sensitivity to heat and its mainly non-cytoplasmic location may be an explanation of the failure of plasma isocitrate dehydrogenase activity to increase after a myocardial infarction.

    Title Hand Ischemia: Hypothenar Hammer Syndrome.
    Date June 1972
    Journal The Proceedings of the Institute of Medicine of Chicago
    Title A Comparative Study of the Isoenzymes of Mammalian Alpha-amylase.
    Date September 1971
    Journal Enzyme
    Title Hypothenar Hammer Syndrome: Posttraumatic Digital Ischemia.
    Date January 1971
    Journal Surgery
    Title An Autoanalyzer Method for Estimating Serum Glyceride Glycerol Using a Glycerokinase Procedure.
    Date December 1970
    Journal Journal of Clinical Pathology

    THE GLYCERIDE GLYCEROL ANALYSIS DEPENDS, AFTER SAPONIFICATION OF TRIGLYCERIDES, ON A LINKED ENZYMATIC PROCEDURE USING GLYCEROKINASE, PYRUVATE KINASE, AND LACTATE DEHYDROGENASE: the final conversion of NADH to NAD(+) is followed fluorimetrically. Twenty analyses can be performed per hour on the AutoAnalyzer; recoveries of added triglycerides ranged between 90 and 104%. In a mixed male and female group the normal range for glyceride glycerol was 2.5 to 15.5 mg/100 ml (0.2-1.4 mmol/l) fasting, and 2.5 to 18.0 mg/100 ml (0.2-1.6 mmol/l) postprandially using fresh serum. There was a significant rise postprandially in older men.

    Title Comparative Study of Immunological Tests for Pregnancy Diagnosis.
    Date July 1969
    Journal Journal of Clinical Pathology

    The reliability of five commercially produced immunological pregnancy diagnosis methods has been investigated. The tests used were Pregnosticon (a tube test) and four slide tests, Hyland, Pregslide, Gravindex, and Planotest. In the series described, Planotest gave 0.5% false positives, Gravindex had 2.1%, Pregnosticon 2.6%, and Pregslide 4.7%, Hyland A (sensitivity 4,500 iu/l.) gave 3.6% and Hyland B (sensitivity 2 to 3,000 iu/l.) had 8.7% false positives. Pregnosticon had 0.5% false negatives, Planotest 2.0%, Gravindex 3.5%, Hyland B 6.5%, Pregslide 9%, and Hyland A 19.5% false negatives. Planotest and Pregnosticon were found to be less influenced by protein and blood in the urine than the other pregnancy tests investigated.

    Title Subcellular Distribution of the Isoenzymes of Nadp Isocitrate Dehydrogenase in Rat Liver and Heart.
    Date January 1969
    Journal Enzymologia Biologica Et Clinica
    Title The Potential of F-18-fdg Pet in Breast Cancer. Detection of Primary Lesions, Axillary Lymph Node Metastases, or Distant Metastases.
    Journal Clinical Positron Imaging : Official Journal of the Institute for Clinical P.e.t

    This retrospective study was done to evaluate the utility of 2-[F-18]fluoro-2-deoxy-D-glucose positron emission tomography (F-18-FDG PET) in identifying primary and recurrent breast cancer and lymph node metastases. One hundred whole-body PET scans of 87 patients were reviewed. PET results obtained with F-18-FDG and an ECAT/EXACT-921 or an ECAT-931 (Siemens/CTI) were based on visual interpretation, or standardized uptake values (SUVs), related to histology and also compared to computerized tomography (CT) and mammography results. The sensitivity for PET in detecting primary (N = 35 studies) and recurrent breast cancer (N = 65 studies) was 96% and 85% with a specificity of 91% and 73%. The sensitivity for lymph node metastases at the time of initial diagnosis was 100% with a specificity of 100%. Quantitative SUV information did not improve the accuracy of F-18-FDG PET in identifying primary breast cancers. The results suggest that whole-body PET is useful in detecting recurrence or metastases, may be useful in detecting lymph node metastases prior to initial axillary lymph node dissection, but is less sensitive in excluding axillary lymph nodes metastases later in the course of the disease.

    Title Evaluation of a Comprehensive Slip, Trip and Fall Prevention Programme for Hospital Employees.
    Journal Ergonomics

    In 2007, the Bureau of Labor Statistics reported that the incidence rate of lost workday injuries from slips, trips and falls (STFs) on the same level in hospitals was 35.2 per 10,000 full-time equivalents (FTE), which was 75% greater than the average rate for all other private industries combined (20.2 per 10,000 FTEs). The objectives of this 10-year (1996-2005) longitudinal study were to: 1) describe occupational STF injury events in hospitals; 2) evaluate the effectiveness of a comprehensive programme for reducing STF incidents among hospital employees. The comprehensive prevention programme included analysis of injury records to identify common causes of STFs, on-site hazard assessments, changes to housekeeping procedures and products, introduction of STF preventive products and procedures, general awareness campaigns, programmes for external ice and snow removal, flooring changes and slip-resistant footwear for certain employee subgroups. The hospitals' total STF workers' compensation claims rate declined by 58% from the pre-intervention (1996-1999) rate of 1.66 claims per 100 FTE to the post-intervention (2003-2005) time period rate of 0.76 claims per 100 FTE (adjusted rate ratio = 0.42, 95% CI: 0.33-0.54). STFs due to liquid contamination (water, fluid, slippery, greasy and slick spots) were the most common cause (24%) of STF claims for the entire study period 1996-2005. Food services, transport/emergency medical service and housekeeping staff were at highest risk of a STF claim in the hospital environment. Nursing and office administrative staff generated the largest numbers of STF claims. STF injury events in hospitals have a myriad of causes and the work conditions in hospitals are diverse. This research provides evidence that implementation of a broad-scale prevention programme can significantly reduce STF injury claims.

    Title Eleven Years of Occupational Mortality in Law Enforcement: The Census of Fatal Occupational Injuries, 1992-2002.
    Journal American Journal of Industrial Medicine

    Occupational injury deaths remain high for Law Enforcement Officers (LEOs). This study describes and compares intentional and transportation-related fatality rates in US LEOs between 1992 and 2002.

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