Medicine and Health Sciences Commons^™

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

Identifying Global Anatomical Differences: Deformation-Based Morphometry, J Ashburner, C Hutton, R Frackowiak, Ingrid Johnsrude, C Price, K Friston

Brain and Mind Institute Researchers' Publications

The aim of this paper is to illustrate a method for identifying macroscopic anatomical differences among the brains of different populations of subjects. The method involves spatially normalizing the structural MR images of a number of subjects so that they all conform to the same stereotactic space. Multivariate statistics are then applied to the parameters describing the estimated nonlinear deformations that ensue. To illustrate the method, we compared the gross morphometry of male and female subjects. We also assessed brain asymmetry, the effect of handedness, and interactions among these effects.

Is Mammography Useful In Screening For Local Recurrences In Patients With Tram Flap Breast Reconstruction After Mastectomy For Multifocal Dcis?, A P Salas, M A Helvie, E G Wilkins, H A Oberman, P W Possert, Alan M. Yahanda Md, Facs, A E Chang

PCI Publications and Projects

BACKGROUND: Skin-sparing mastectomy with immediate transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction is being used more often for the treatment of breast cancer. Mammography is not used routinely to evaluate TRAM flaps in women who have undergone mastectomy. We have identified the potential value of its use in selected patients.

METHODS AND RESULTS: We report on four women who manifested local recurrences in TRAM flaps after initial treatment for ductal carcinoma in situ (DCIS) or DCIS with microinvasion undergoing skin-sparing mastectomy and immediate reconstruction. All four patients presented with extensive, high-grade, multifocal DCIS that precluded breast conservation. Three of four …

Initial Multicenter Experience With Double Nucleoside Therapy For Human Immunodeficiency Virus Infection During Pregnancy., N S Silverman, D H Watts, J Hitti, D M Money, E Livingston, J Axelrod, J M Ernest, D Robbins, M M Divito

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications.

METHODS: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV …

Extraskeletal Mesenchymal Chondrosarcoma Of The Rectus Sheath., D B Johnson, W Breidahl, J S Newman, K Devaney, Alan M. Yahanda Md, Facs

PCI Publications and Projects

Mesenchymal chondrosarcomas (MSCs) are a rare form of chondrosarcoma which usually arise in bone. Extraskeletal chondrosarcomas constitute a minority (14-25%) of MSCs. We describe the imaging features of an extraskeletal mesenchymal chondrosarcoma that arose from the rectus abdominus muscle.

Auditory Filters Measured At Neighboring Center Frequencies, Marc A. Fagelson, C. A. Champlin

ETSU Faculty Works

Auditory filters were derived in 20 normal-hearing human listeners at center frequencies (CFs) of 913, 1095, 3651, and 4382 Hz using the roex (p,r) method. Comparisons were made between slopes of the filters' skirts at the neighboring CFs with filter output levels of 45 and 70 dB. The same comparisons were made with regard to filter equivalent rectangular bandwidth (ERB). In the 1000-Hz region, the low-frequency slopes (Pl) of filters centered at 913 and 1095 Hz were significantly correlated at both stimulus levels, while the high-frequency slopes (Pu) were similar only at the high test level. In the 4000-Hz region, …

Computed Tomography In Staging Of Patients With Melanoma Metastatic To The Regional Nodes., T M Johnson, D J Fader, A E Chang, Alan M. Yahanda Md, Facs, J W Smith, K R Hamlet, V K Sondak

PCI Publications and Projects

BACKGROUND: This study addresses the yield and clinical impact of computed tomography (CT) imaging in otherwise asymptomatic patients with stage III melanoma metastatic to the regional nodes.

METHODS: The database from the University of Michigan Mutlidisciplinary Melanoma Clinic was reviewed and identified 127 asymptomatic patients with stage III melanoma (regional nodal disease) who received CT scans of the head, chest, abdomen, and/or pelvis. Scans were confirmed as true positive, false positive, and normal.

RESULTS: Four hundred twenty-six head and body CT scans were performed at the time of presentation of stage III disease. Twenty patients had a true-positive CT scan …

Glanzmann Thrombasthenia. Cooperation Between Sequence Variants In Cis During Splice Site Selection., Ying Jin, Harry C. Dietz, Robert A. Montgomery, William R. Bell, Iain Mcintosh, Barry Coller, Paul F. Bray

Cardeza Foundation for Hematologic Research

Glanzmann thrombasthenia (GT), an autosomal recessive bleeding disorder, results from abnormalities in the platelet fibrinogen receptor, GP(IIb)-IIIa (integrin alpha(IIb)beta3). A patient with GT was identified as homozygous for a G-->A mutation 6 bp upstream of the GP(IIIa) exon 9 splice donor site. Patient platelet GP(IIIa) transcripts lacked exon 9 despite normal DNA sequence in all of the cis-acting sequences known to regulate splice site selection. In vitro analysis of transcripts generated from mini-gene constructs demonstrated that exon skipping occurred only when the G-->A mutation was cis to a polymorphism 116 bp upstream, providing precedence that two sequence variations …

Measuring Hospital Use Without Claims: A Comparison Of Patient And Provider Reports., R E. Clark, S K. Ricketts, G J. Mchugo

Dartmouth Scholarship

We compared the validity of hospital admission and length of stay reports from patients, outpatient providers, and hospitals, and we examined possible sources of error. Data were collected from people enrolled in a randomized trial of treatment for severe mental illness and substance use disorders, from community mental health centers (CMHCs), and from hospitals. Reports for each of the 74 study participants covered two-year time periods beginning and ending at various times between 1989 and 1993. We compared reports from the various sources and constructed a hybrid with data from all three sources. Using parametric and non-parametric statistics, we compared …

Impact Of Spinal Cord Injury On The Life Roles Of Women., M Claire Quigley

Department of Occupational Therapy Faculty Papers

This qualitative study was conducted to explore and describe the role experience of five women whose lives were disrupted by a traumatic spinal cord injury and who later returned to their communities after completing intensive rehabilitation programs. In-depth interviews and participant observations were used to examine the experiences of these women. The findings exemplify how the women's use of adaptation and negotiation and the development of a new role as self-advocate facilitated the reestablishment of their life roles. As the women's occupational roles were redefined, the processes of adaptation and negotiation were evident in three aspects of their lives: daily …

Mentorship Experiences In A Group Of Occupational Therapy Leaders., Ruth Levine Schemm, Theodore Bross

Department of Occupational Therapy Faculty Papers

OBJECTIVES: The development of occupational therapy leaders is a long-held goal of many members of the American Occupational Therapy Association and of state associations. The initiation of mentor programs is a common means to accomplish this goal. These programs take time and effort, and, although occupational therapists have described how mentorship programs work in the literature, there are few articles that describe the actual mentorship experiences of occupational therapy leaders.

METHOD: To study the experiences of elected occupational therapy leaders, a 30-item questionnaire was distributed at the annual meeting of the Committee of State Association Presidents and completed by 53 …

Comparison Of Cytotoxic Properties Of Neonatal And Adult Neutrophils And Monocytes And Enhancement By Cytokines., E . R. Stiehm, R. L. Roberts, B. J. Ank, S. Plaeger-Marshall, N. Salman, L. Shen, M. W. Fanger

Dartmouth Scholarship

We studied cytotoxic capabilities of newborn polymorphonuclear leukocytes (PMNs) and monocytes and their enhancement by cytokines and antibodies. Umbilical cord PMNs were assessed for their ability to kill various target cells spontaneously, after activation with phorbol myristate acetate, in the presence of antiserum (antibody-dependent cellular cytotoxicity), and in the presence of dually specific antibody (heteroantibody-mediated cytotoxicity). Target cells included the K562 cell line (natural killer cell target), chicken erythrocytes (CRBCs), and herpes simplex virus-infected CEM cell lines. Newborn PMNs were equivalent to adult PMNs in their cytotoxic capacity in several cytotoxicity assays. Neither adult nor newborn PMNs lyse tumor cell …

Elevated Expression Of Type Vii Collagen In The Skin Of Patients With Systemic Sclerosis. Regulation By Transforming Growth Factor-Beta., Lidia Rudnicka, John Varga, Angela M. Christiano, Renato V. Iozzo, Sergio A. Jimenez, Jouni Uitto

Department of Dermatology and Cutaneous Biology Faculty Papers

A hallmark of systemic sclerosis (SSc) is the development of tissue fibrosis. Excessive production of several connective tissue components normally present in the dermis, including type I, III, V, and VI collagens as well as fibronectin and proteoglycans, is a consistent finding in the skin of SSc patients. Type VII collagen is a major constituent of anchoring fibrils, present in the skin at the dermal-epidermal basement membrane zone. TGF-beta has been shown to upregulate the expression of the type VII collagen gene. In this study, we assessed the expression of type VII collagen and TGF-beta in the skin of patients …

Sequencing Of Cdna From 50 Unrelated Patients Reveals That Mutations In The Triple-Helical Domain Of Type Iii Procollagen Are An Infrequent Cause Of Aortic Aneurysms., Gerard Tromp, Yuli Wu, Darwin J. Prockop, Swarna L. Madhatheri, Caren Kleinert, James J. Earley, Jiapiao Zhuang, Orjan Norrgård, R. Clement Darling, William M. Abbott, C. William Cole, Pekka Jaakkola, Markku Ryynanen, William H. Pearce, James S.T. Yao, Kari Majamaa, Stanton N. Smullens, Zoran Gatalica, Robert E. Ferrell, Sergio A. Jimenez, Charles E. Jackson, Virginia V. Michels, Michael Kaye, Helena Kuivaniemi

Department of Biochemistry and Molecular Biology Faculty Papers

Detailed DNA sequencing of the triple-helical domain of type III procollagen was carried out on cDNA prepared from 54 patients with aortic aneurysms. The 43 male and 11 female patients originated from 50 different families and five different nationalities. 43 patients had at least one additional blood relative who had aneurysms. Five overlapping asymmetric PCR products, covering all the coding sequences of the triple-helical domain of type III procollagen, were sequenced with 28 specific sequencing primers. Analysis of the sequencing gels revealed only two nucleotide changes that altered the structure of the protein. One was a substitution of threonine for …

Regulation Of Human Lung Fibroblast Alpha 1(I) Procollagen Gene Expression By Tumor Necrosis Factor Alpha, Interleukin-1 Beta, And Prostaglandin E2., Arturo Diaz, Elena Munoz, Rosemary Johnston, Joseph H. Korn, Sergio A. Jimenez

Department of Medicine Faculty Papers

We investigated the participation of prostaglandin (PG) E2 in the regulation of the alpha 1(I) procollagen gene expression by tumor necrosis factor alpha (TNF alpha), and interleukin-1 beta (IL-1 beta) in normal adult human lung fibroblasts. TNF alpha (100 units/ml) and IL-1 beta (100 units/ml) stimulated the production of PGE2 and caused a dose-dependent inhibition of up to 54 and 66%, respectively, of the production of type I procollagen. Preincubation of cultures with indomethacin partially reversed the inhibition of procollagen production induced by the cytokines. Cytokine-stimulated endogenous fibroblast PG accounted for 35 and 68% of the inhibition induced by TNF …

Comparison Of Laryngographic Waveforms Of An Adult And Child, Elaine Hicken

Undergraduate Honors Capstone Projects

The ability to accurately identify and differentially diagnose voice disorders is an important concern for the speech-language pathologist. This need has resulted in the development of methods which focus on identifying "objective, reliable, valid procedures for assessing voice disorders" (Costello, 1985). Several methods that allow direct observation of the laryngeal mechanism are invasive and time consuming. A method that is noninvasive and that provides valuable information about the vocal fold movement pattern is needed for clinical use.

Home Adaptations For Persons With Chronic Disabilities: An Educational Model., Ruth E. Levine, Laura N. Giltin

Department of Occupational Therapy Faculty Papers

This paper offers a method by which to train students in the provision of culturally relevant, in-home environmental adaptations for persons with chronic disabilities. On the basis of a theoretical framework, the student therapist learns about the client's life-style and offers adaptations that evolve from a collaborative problem-solving process. The training process has been developed and refined over a 3-year period. A case study illustrates the student's application of theory and practice and the outcome for the client of this service provision approach.

Osteogenesis Imperfecta. The Position Of Substitution For Glycine By Cysteine In The Triple Helical Domain Of The Pro Alpha 1(I) Chains Of Type I Collagen Determines The Clinical Phenotype., Barbra J. Starman, David Eyre, Harry Charbonneau, Maria Harrylock, Mary Ann Weis, Lester Weiss, John M. Graham Jr., Peter H. Byers

Dartmouth Scholarship

Skin fibroblasts grown from three individuals with osteogenesis imperfecta (OI) each synthesized a population of normal type I collagen molecules and additional molecules that had one or two alpha 1(I) chains that contained a cysteine residue within the triple-helical domain, a region from which cysteine normally is excluded. The patients had very different phenotypes. One patient with OI type I had a population of alpha 1(I) chains in which glycine at position 94 of the triple helix was substituted by cysteine; a patient with OI type III had a population of alpha 1(I) chains in which glycine at position 526 …

Maternal-Neonatal Serum Vitamin A Concentrations., Girish S. Shirali, D G. Oelberg, K P. Mehta

Manuscripts, Articles, Book Chapters and Other Papers

Prevention of neonatal vitamin A deficiency is related to the adequacy of maternal vitamin A stores. In this study we investigated maternal and cord serum vitamin A and retinol-binding protein (RBP) values in an Indian population including, for the first time, clinically vitamin A-deficient mothers. Twenty-eight maternal-neonatal pairs were selected from maternal cohorts of high socioeconomic status without clinical evidence of vitamin A deficiency (group I) and low socioeconomic status with conjunctival xerosis and Bitot's spots (group II). Maternal education, caloric and vitamin A intakes, weight, height, hemoglobin, and birth weight were significantly lower in group II. Serum vitamin A …

Community-Based Occupational Therapy With A Head-Injured Adult., Elizabeth Depoy

Department of Occupational Therapy Faculty Papers

In the early 1970s, the National Head Injury Foundation identified 422,000 adults with permanent brain damage caused by traumatic head injury. It is estimated that 400,000 new cases of varying severity are treated in hospitals each year, the majority of whom are previously employed young adult men. Although many persons with traumatic brain injuries are able to return to productivity, approximately 35% of the adults who have been rated as mildly head injured on the Glascow Coma Scale (Teasdale & Jennet, 1974) never return to work and have difficulty reentering society after restorative efforts are discontinued (Rosenthal, Griffith, Bond, & …

Haemophilus Influenzae In Adults: An Analysis Of Incidence, Serotype, Biotype, Beta-Lactamase Production And Clinical Spectrum, Mildred Ramsey Norris

MSN Research Projects

A selective medium, chocolate agar with vancomycin, bacitracin, and clindamycin, was used to enhance the recovery of Haemophilus influenzae from adult patients. Cultures of the 634 respiratory specimens yielded 130 (20.5 percent) H. influenzae isolates, representing 93 patients. The serotype, biotype, and Beta-lactamase production of all isolates were determined. Of 103 distinct isolates, nine percent were serotypable and included serogroups a ,b ,d ,and e. Although biotypes I, II, III, V, and VI were represented, 81.5 percent of the isolates were in the II/III group. Twenty-six percent of the isolates were Beta-lactamase producers and, therefore, ampicillin resistant. The clinical characteristics …

Heterogeneity Of Clonogenic Cells In Acute Myeloblastic Leukemia., Kert D. Sabbath, Edward D. Ball, Peter Larcom, Roger B. Davis, James D. Griffin

Dartmouth Scholarship

The expression of differentiation-associated surface antigens by the clonogenic leukemic cells from 20 patients with acute myeloblastic leukemia (AML) was studied with a panel of seven cytotoxic monoclonal antibodies (anti-Ia, -MY9, -PM-81, -AML-2-23, -Mol, -Mo2, and -MY3). The surface antigen phenotypes of the clonogenic cells were compared with the phenotypes of the whole leukemic cell population, and with the phenotypes of normal hematopoietic progenitor cells. In each case the clonogenic leukemic cells were found within a distinct subpopulation that was less "differentiated" than the total cell population. Clonogenic leukemic cells from different patients could be divided into three phenotype groups. …

Genetics And Epidemiology Of Gallbladder Disease In New World Native Peoples, K M Weiss, R E Ferrell, C L Hanis, P N Styne

Faculty, Staff and Student Publications

Native peoples of the New World, including Amerindians and admixed Latin Americans such as Mexican-Americans, are highly susceptible to diseases of the gallbladder. These include cholesterol cholelithiasis (gallstones) and its complications, as well as cancer of the gallbladder. Although there is clearly some necessary dietary or other environmental risk factor involved, the pattern of disease prevalence is geographically associated with the distribution of genes of aboriginal Amerindian origin, and levels of risk generally correspond to the degree of Amerindian admixture. This pattern differs from that generally associated with Westernization, which suggests a gene-environment interaction, and that within an admixed population …

The Common Intestinal Roundworm Of Swine, H. M. Martin

Nebraska Agricultural Experiment Station: Historical Circulars

The large intestinal roundworm of pigs is a very common parasite, and is probably present in every hog raising district of Nebraska. Until the last few years the true nature of this parasite was unknown. Little did we realize the actual harm done by this worm; but through the scientific investigations of Stewart, Ransom, and others we now know that this parasite causes heavier losses to the breeder and feeder of swine than any other now common in Nebraska.

The Common Intestinal Roundworm Of Swine, H. M. Martin

Nebraska Agricultural Experiment Station: Historical Circulars

The large intestinal roundworm of pigs is a very common parasite, and is probably present in every hog raising district of Nebraska. Up until the last few years the true nature of this parasite was unknown. Little did we realize the actual harm done by this worm; but through the scientific investigations of Stewart, Ransom, and others we now know that this parasite causes heavier losses to the breeder and feeder of swine than any other now common in Nebraska.

The Common Intestinal Roundworm Of Swine (Ascaris Lumbricoides), H. M. Martin

Nebraska Agricultural Experiment Station: Historical Circulars

The large intestinal roundworm of pigs is a very common parasite and is probably present in every hog raising district of Nebraska. Up until the last few years the true nature of this parasite was unknown. Little did we realize the actual harm done by this worm; but through the scientific investigations of Stewart, Ransom, and others we now know that this parasite causes heavier losses to the breeder and feeder of swine than any other now common in Nebraska.