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Showing papers by "Hospital for Sick Children published in 1998"


Journal ArticleDOI
TL;DR: In this article, the authors assess both the direct and indirect impact of certain pay policies upon the turnover intentions of paediatric nurses, finding that job satisfaction has only an indirect influence on the intention to quit, whereas organizational commitment has the strongest and most direct impact.
Abstract: A number of models have been developed to explain nurses' turnover behavior. The common theme that emerges from these models is that turnover behavior is a multistage process that includes attitudinal, decisional, and behavioral components. The purpose of this study was to assess both the direct and indirect impact of certain pay policies upon the turnover intentions of paediatric nurses. The two major questions addressed were: What was the relative impact of job satisfaction, pay satisfaction, and organizational commitment upon the turnover intentions of paediatric nurses eligible for these pay policies? What model accurately portrays the relationship among these three independent variables and turnover intentions? Exploration of the causal pathways among these variables and demographic factors revealed complex models of association. The results suggest that job satisfaction has only an indirect influence on the intention to quit, whereas organizational commitment has the strongest and most direct impact. A further finding that pay satisfaction had both direct and indirect effects on turnover intent was consistent with administrators' assumptions underlying the pay policies. Control variables such as having a degree, having children, and working 12-hour shifts were found to have both direct and indirect influences upon pay satisfaction and turnover intent. © 1998 John Wiley & Sons, Ltd.

740 citations


Journal ArticleDOI
TL;DR: The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function) and have the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.
Abstract: A cross-sectional, community-based survey of a random sample of 1750 of 242,311 Medicare recipients was performed. The patients were at least sixty-five years old and had had a primary or revision knee replacement (either unilaterally or bilaterally) between 1985 and 1989. Three samples were surveyed separately: a national sample (to reflect the United States as a whole) and samples from Indiana and the western part of Pennsylvania (sites chosen for convenience to assess the validity of the findings for the national sample on a regional level). Each sample was stratified by race, age, residence (urban or rural), and the year of the procedure. Valid and reliable questionnaires were used to elicit the participants' assessments of pain, physical function, and satisfaction two to seven years after the knee replacement. Of the 1486 patients who were eligible for inclusion in the survey, 1193 (80.3 per cent) responded. The mean age of the respondents was 72.6 years. Eight hundred and forty-nine respondents (71.2 per cent) were white, and 849 (71.2 per cent) were women. The participants reported that they had little or no pain in the knee at the time of the survey, regardless of the age at the time of the knee replacement, the body-mass index, or the length of time since the knee replacement. After adjustment for potential confounding variables, predictors of better physical function after the replacement were an absence of problems with the contralateral knee, primary knee replacement (rather than revision) (Indiana sample only), and a lower body-mass index (Indiana and western Pennsylvania samples). Four hundred and fifteen (85.2 per cent) of the 487 patients in the national sample were satisfied with the result of the knee replacement. In what we believe to be the first community-based study of the outcome of knee replacement, patients reported having significant (p = 0.0001) and persistent relief of pain, improved physical function, and satisfaction with the result two to seven years postoperatively. The findings of the present study suggest that age and obesity do not have a negative impact on patient-relevant outcomes (pain and physical function). Dissemination of these findings has the potential to increase appropriate referrals for knee replacement and thereby reduce the pain and functional disability due to osteoarthrosis of the knee.

641 citations


Journal ArticleDOI
TL;DR: It is indicated that most children younger than 9 years of age cannot be expected to consent or assent to clinical research in a meaningful way and the current age of 7 years for initiating assent (in addition to parental consent) is possibly not appropriate and should be reconsidered.
Abstract: This study examined the quality of children's assent to a clinical trial. In subjects younger than 9 years of age, understanding of most aspects of the study was found to be poor to non-existent. Understanding of procedures was poor in almost all subjects. In addition, voluntariness may have been compromised in many subjects by their belief that failure to complete the study would displease others. If the fact that a child's assent has been obtained is used to justify the exposure of that child to the potential harm of a non-therapeutic blood sample, the assent must be meaningful. In the nutrition study observed here, the quality of the assent of children younger than 9 years of age was very poor. The assent therefore did not provide a valid justification for requesting a blood sample from these children. This study indicates that most children younger than 9 years of age cannot be expected to consent or assent to clinical research in a meaningful way. The current age of 7 years for initiating assent (in addition to parental consent) is possibly not appropriate and should be reconsidered.

174 citations


Journal ArticleDOI
TL;DR: A liposomal hydrogel system that significantly reduces bacterial adhesion to silicone catheter material shows promise as a prophylactic and/or treatment for catheter-related infection.

132 citations


Book ChapterDOI
TL;DR: The structural features of Notch receptors and the proteins with which they interact are highlighted, which may help to explain their role in integrating many extracellular signals to control cell fate determination, differentiation, proliferation and cell survival.
Abstract: The Notch gene was first identified in Drosophila as a locus required for development of many structures (Poulson 1937). The diversity of biological processes regulated by Notch in Drosophila and its varied relatives from C. elegans to man is only now becoming clear. Indeed the Notch receptor system may be used to regulate development and homeostasis of every tissue in complex animals. Some of these processes have been analyzed in great detail and we refer readers to several excellent recent reviews focused on more biological aspects of Notch function (Artavanis-Tsakonas et al. 1995; Kopan and Turner 1996; Lardelli et al. 1995). Genetic analysis of invertebrate Notch family receptors has highlighted a role of Notch proteins as transmembrane transcription factors which require proteolytic activation and nuclear translocation for activity. Numerous proteins which participate in the Notch signaling pathway have been discovered. These varied proteins include ligands for Notch, regulators of Notch ligand-binding specificity, regulators of Notch signaling efficiency, and transcription factors which cooperate with Notch to control gene expression. In this article we will highlight the structural features of Notch receptors and the proteins with which they interact. These structures are conserved in all Notch-family receptors and their partners. Through the analysis of structure and function together, we hope to highlight some important features of these signaling proteins which may help to explain their role in integrating many extracellular signals to control cell fate determination, differentiation, proliferation and cell survival.

125 citations


Journal ArticleDOI
TL;DR: In pediatric patients with SLE there is a significant relationship between the presence of a lupus anticoagulant and thrombotic events, and a significant proportion of patients have antiphospholipid antibodies.
Abstract: The purpose of this study was to evaluate pediatric patients with systemic lupus erythematosus (SLE) to determine 1) the incidence of thrombosis, 2) the incidence of antiphospholipid antibodies, and 3) whether there is an association between the presence of antiphospholipid antibodies and thrombosis. We performed a cross-sectional cohort study in 59 consecutive SLE patients who had been managed at rheumatology clinics in two pediatric hospitals. A history, questionnaire, and chart review were completed by the study nurse blinded to laboratory results. Only the thrombotic events that could be substantiated by review of radiographic tests were accepted. The presence of antiphospholipid antibodies was determined by prospective analysis for a lupus anticoagulant and anticardiolipin antibodies on two separate occasions at least 3 mo apart. Patients were considered to be positive if one or more tests were positive on both occasions. Thirteen thrombotic events occurred in 10 of the 59 patients (17%). Fourteen patients (24%) were classified as positive for lupus anticoagulant, and 19 patients (27%) were classified as positive for anticardiolipin antibodies. A significant relationship between the presence of a lupus anticoagulant and a thrombotic event was shown: odds ratio 28.7 (95% confidence interval 4.03-138.2, p < 0.001). A nonsignificant trend was seen for the presence of an anticardiolipin antibody and a thrombotic event: odds ratio 2.12 (95% confidence interval 0.71-22.8, p=0.08). We conclude that in pediatric patients with SLE: 1) a significant proportion of patients have thrombotic events, 2) a significant proportion of patients have antiphospholipid antibodies, and 3) there is a significant relationship between the presence of a lupus anticoagulant and thrombotic events.

98 citations


Book ChapterDOI
TL;DR: This review will focus on recent developments in the understanding of TGFβ signaling and on the multiple roles these factors play in controlling inductive interactions and patterning during development.
Abstract: Transforming growth factor β (TGFβ) was initially identified based on its ability to induce the anchorage-independent growth of normal rat kidney fibroblasts (Roberts et al. 1981). It is now apparent that TGFβ is the founding member of a superfamily of growth and differentiation factors that includes almost 40 members from animals as diverse as C. elegans, Drosophila and humans. The superfamily is generally subdivided into three groups, the prototypic TGFβs, the activins and the bone morphogenetic proteins (BMPs). However, with new members constantly being identified these divisions are becoming increasingly difficult to define. Nevertheless, the study of the biology of this large family has provided us with some interesting and surprising insights into how these factors can regulate a staggering array of diverse developmental and physiological processes. In addition, major advances have been made in elucidating the mechanism of signaling by TGFβ-like factors. In this review we will focus on recent developments in our understanding of TGFβ signaling and on the multiple roles these factors play in controlling inductive interactions and patterning during development.

95 citations


Journal ArticleDOI
TL;DR: It is concluded that most genetic alterations in DAX1 are frameshift or nonsense mutations and speculate that the codon deletion and missense mutations give insight into the structure and function ofDAX1.
Abstract: Summary The DAX1 protein is an orphan nuclear hormone receptor based on sequence similarity in the putative ligand-binding domain (LBD). DAX1 mutations result in X-linked adrenal hypoplasia congenita (AHC). Our objective was to identify DAX1 mutations in a series of families, to determine the types of mutations resulting in AHC and to locate single–amino-acid changes in a DAX1 structural model. The 14 new mutations identified among our 17 families with AHC brought the total number of families with AHC to 48 and the number of reported mutations to 42; 1 family showed gonadal mosaicism. These mutations included 23 frameshift, 12 nonsense, and six missense mutations and one single-codon deletion. We mapped the seven single–amino-acid changes to a homology model constructed by use of the three-dimensional crystal structures of the thyroid-hormone receptor and retinoid X receptor α. All single–amino-acid changes mapped to the C-terminal half of the DAX1 protein, in the conserved hydrophobic core of the putative LBD, and none affected residues expected to interact directly with a ligand. We conclude that most genetic alterations in DAX1 are frameshift or nonsense mutations and speculate that the codon deletion and missense mutations give insight into the structure and function of DAX1.

92 citations


Journal ArticleDOI
TL;DR: Iron-loaded patients with beta-thalassemia are at greatly increased risk for severe yersiniosis, even when their body iron burden is only moderately elevated and they are not receiving iron-chelating therapy with deferoxamine.
Abstract: Over 15 years, 14 patients with yersiniosis in two North American comprehensive thalassemia clinics (0.6 cases per 100 patient-years) presented with fever (100%), diarrhea (86%), right-lower-quadrant abdominal pain (71%), bacteremia (57%), a palpable abdominal mass (36%), and pharyngitis (28%). Clinically apparent infection occurred within 10 days of blood transfusion in 57% of patients. Nine patients (64%) had only a modest elevation in serum level of ferritin (< 2,000 micrograms/L). Patients with focal abdominal findings had a higher body iron burden, as estimated by the serum ferritin level, and significant intraabdominal suppurative complications. Two patients were not receiving iron-chelating therapy with deferoxamine; one patient was receiving the experimental chelator deferiprone (L1). Iron-loaded patients with beta-thalassemia are at greatly increased risk for severe yersiniosis, even when their body iron burden (as indicated by the serum ferritin level) is only moderately elevated and they are not receiving iron-chelating therapy with deferoxamine.

91 citations


Journal ArticleDOI
TL;DR: The results indicate that a proportion of sporadic DBA cases are caused by deletions in the 19q13 region, and it is shown that a gene region on chromosome 19q segregates with the disease in the majority of familial cases.
Abstract: Summary Diamond-Blackfan anemia (DBA) is a rare pure red-cell hypoplasia of unknown etiology and pathogenesis. A major DBA locus has previously been localized to chromosome 19q13.2. Samples from additional families have been collected to identify key recombinations, microdeletions, and the possibility of heterogeneity for the disorder. In total, 29 multiplex DBA families and 50 families that comprise sporadic DBA cases have been analyzed with polymorphic 19q13 markers, including a newly identified short-tandem repeat in the critical gene region. The results from DNA analysis of 29 multiplex families revealed that 26 of these were consistent with a DBA gene on 19q localized to within a 4.1-cM interval restricted by loci D19S200 and D19S178; however, in three multiplex families, the DBA candidate region on 19q13 was excluded from the segregation of marker alleles. Our results suggest genetic heterogeneity for DBA, and we show that a gene region on chromosome 19q segregates with the disease in the majority of familial cases. Among the 50 families comprising sporadic DBA cases, we identified two novel and overlapping microdeletions on chromosome 19q13. In combination, the three known microdeletions associated with DBA restrict the critical gene region to ∼1 Mb. The results indicate that a proportion of sporadic DBA cases are caused by deletions in the 19q13 region.

81 citations


Journal ArticleDOI
TL;DR: It is proposed that the language skills that are impaired in hydrocephalus are those that require context to derive meaning, while those that are intact may function relatively independent of particular discourse contexts.

Journal ArticleDOI
TL;DR: Hydroxyurea in children is associated with sustained excellent compliance and monitoring this compliance is uncomplicated, and splenic function in most hydroxyurea-treated children did not change over 1 year of therapy.
Abstract: PURPOSE Hydroxyurea therapy reduces clinical complications in sickle cell disease. While evaluating the clinical and laboratory responses to hydroxyurea in children with sickle cell disease, we concurrently objectively monitored, for the first time during such treatment, compliance with therapy. Because most deaths in affected children are related to infection, we also evaluated the impact of hydroxyurea on splenic function, estimated by the percentage of red cells containing endocytic vacuoles ("pitted" cells) over 1 year of therapy. PATIENTS AND METHODS Seventeen children with a history of > or = 3 hospital admissions in the previous year, aged (mean +/- standard error of mean) 12.3 +/- 1.2 years, were treated with hydroxyurea. Clinical and laboratory assessments monitored efficacy and toxicity. Compliance was monitored using computerized pill bottles containing cap microprocessors which monitor the frequency of bottle openings. RESULTS Over 18.5 +/- 2.1 months, compliance with hydroxyurea (as determined by percent of the prescribed drug actually taken) was 96 +/- 2%, resulting in increases in mean fetal hemoglobin from 7.7 +/- 1.6% to 16.7 +/- 1.8% (p < 0.005). In 11 patients who reached maximum tolerated doses, an increase to 18.8 +/- 2.5% (p = 0.0001) was observed. Pitted red cell counts did not change. Annual rates of vaso-occlusive crisis (p = 0.0105), acute chest syndrome (p = 0.0417), transfusions administered (p = 0.0168), and days in hospital (p = 0.0017) all decreased significantly. CONCLUSIONS Hydroxyurea in children is associated with sustained excellent compliance and monitoring this compliance is uncomplicated. Splenic function in most hydroxyurea-treated children did not change over 1 year of therapy.

Journal ArticleDOI
TL;DR: It is confirmed that OA1 is the major locus for X-linked ocular albinism, with 26 (approximately 90%) of 29 probands had detectable alterations of OA 1, thus confirming that O a1 isThe major loci for X,linked OA.
Abstract: X-linked ocular albinism (OA1), Nettleship-Falls type, is characterized by decreased ocular pigmentation, foveal hypoplasia, nystagmus, photodysphoria, and reduced visual acuity. Affected males usually demonstrate melanin macroglobules on skin biopsy. We now report results of deletion and mutation screening of the full-length OA1 gene in 29 unrelated North American and Australian X-linked ocular albinism (OA) probands, including five with additional, nonocular phenotypic abnormalities (Schnur et al. 1994). We detected 13 intragenic gene deletions, including 3 of exon 1, 2 of exon 2, 2 of exon 4, and 6 others, which span exons 2-8. Eight new missense mutations were identified, which cluster within exons 1, 2, 3, and 6 in conserved and/or putative transmembrane domains of the protein. There was also a splice acceptor-site mutation, a nonsense mutation, a single base deletion, and a previously reported 17-bp exon 1 deletion. All patients with nonocular phenotypic abnormalities had detectable mutations. In summary, 26 (approximately 90%) of 29 probands had detectable alterations of OA1, thus confirming that OA1 is the major locus for X-linked OA.

Book ChapterDOI
TL;DR: Three different approaches to unravel the GLUT4 translocation mechanism are reported, including specific pertubation of the insulin and/or contraction signaling pathways, characterization of the protein composition ofGLUT4-containing vesicles with the expectation that knowledge of the constituent proteins of the vesicle may help in understanding their trafficking.
Abstract: Studies in mammalian cells have established the existence of numerous intracellular signaling cascades that are critical intermediates in the regulation of various biological functions. Over the past few years considerable research has shown that many of these signaling proteins are expressed in skeletal muscle. However, the detailed mechanisms involved in the regulation of glucose transporter (GLUT4) translocation from intracellular compartments to the cell surface membrane in response to insulin and contractions in skeletal muscle are not well understood.

Journal ArticleDOI
TL;DR: Treatment with oral Sodium phenylbutyrate alone, sodium phenylbytyrate combined with hydroxyurea, and hydroxyUREa alone, has augmented fetal hemoglobin production and increased total hemoglobin concentration as much as 5 g/dl over baseline eliminating transfusion requirement in two patients.
Abstract: Pharmacological stimulation of fetal hemoglobin production is of considerable interest as an alternative approach to therapy for Cooley's anemia. While intravenous compounds have been effective in inducing short-term increases in fetal hemoglobin in a few patients, long-term elimination of transfusion requirement has not been reported. In patients with Cooley's anemia, treatment with oral sodium phenylbutyrate alone, sodium phenylbytyrate combined with hydroxyurea, and hydroxyurea alone, has augmented fetal hemoglobin production and increased total hemoglobin concentration as much as 5 g/dl over baseline eliminating transfusion requirement in two patients. Parallel declines in circulating nucleated red cell count, and concentrations of serum transform receptor and erythropoietin, are consistent with more effective erythropoiesis. Over extended periods of treatment, no induction of other fetal proteins and no adverse effects were observed. Particular disease mutations and other genetic factors may be of prime importance in determining the response to agents that induce production of fetal hemoglobin.

Journal ArticleDOI
TL;DR: It is postulate that these milder changes in ABPM represent an earlier phase to that observed in the adult population and that taken together, the adolescent and adult data suggests a specific order in the development of ABPM changes in diabetic subjects.
Abstract: The aim of our study was to compare ambulatory blood pressure monitoring (ABPM) measures (mean systolic/diastolic blood pressure, diurnal rhythm, and pressure burden) in matched normo- and microalbuminuric (IDDM) adolescents and healthy controls. Twenty-four hour monitoring was undertaken in 39 normotensive (normal clinic blood pressure measurements) IDDM adolescents (22 normo- and 17 microalbuminuric subjects) and 23 controls. Subjects were matched for age, body-mass index, gender, and IDDM duration. Microalbuminuria was diagnosed on the basis of a urinary albumin excretion rate greater than 15 but less than 200 μg/min in two of the three 24-h urine collections. The microalbuminuric patients differed from the normoalbuminuric subjects and controls in having higher mean 24-h and overnight systolic pressure, loss of systolic diurnal rhythm and increased systolic and diastolic pressure burden. There were no differences between the three groups in diastolic blood pressure. The normoalbuminuric group differed from the controls only with respect to an increased systolic pressure burden. Microalbuminuric IDDM adolescents show similar, albeit milder changes in ABPM, to those reported in adults with microalbuminuria. We postulate that these milder changes represent an earlier phase to that observed in the adult population and that taken together, the adolescent and adult data suggests a specific order in the development of ABPM changes in diabetic subjects.

Journal ArticleDOI
16 Jul 1998-Oncogene
TL;DR: A second distinct locus, in addition to the previously defined WT2, on chromosome 11p15.5, appears to play a role in the development of Wilms tumors.
Abstract: Loss of heterozygosity (LOH) on the short arm of chromosome 11 is the most frequent genetic alteration in Wilms tumors, indicating that one or more tumor suppressor genes that map to this chromosomal region are involved in the development of the disease. The WT1 gene located on 11p13 has been characterized but mutations in this gene occur in only about 10% of Wilms tumors. A second locus (WT2) at chromosome 11p15 has also been described in Wilms tumors but thus far efforts to clone the WT2 gene(s) have been frustrated by the large size (approximately 10 Mb) of this region. Using a high-density marker LOH analysis of 11p15.5-15.4, we have refined the location of a Wilms tumor suppressor gene between the markers D11S1318-D11S1288 (approximately 800 kb) within 11p15.5. We have also identified a second, novel region of LOH that spans the markers D11S1338-D11S1323 (approximately 336 kb) at 11p15.5-p115.4. Thus a second distinct locus, in addition to the previously defined WT2, on chromosome 11p15.5, appears to play a role in the development of Wilms tumors.

Journal ArticleDOI
TL;DR: Un plus grand nombre de nourrissons souffrant de troubles alimentaires qui n'ont pas reagi au traitement presentaient des problemes anatomiques et mecaniques des voies aeriennes superieures, telle que the fistule tracheo-oesophagienne, ou de maladies pulmonaires telle that the dysplasie broncho-pulmonaire.
Abstract: L'objectif de cette etude est de veritier si des problemes de comportements alimentaires specifiques, chez les nourrissons souffrant de troubles d'alimentation post-traumatiques, laissent prevoir les resultats du traitement. Dans cette serie de cas, vingt-quatre enfants âges entre sept semaines et trente-quatre mois ont ete traites en trois etapes pour leurs troubles alimentaires post-traumatiques. Les trois composantes du traitement etaient constitutees (1) de changements physiologiques et environmentaux pour regulariser les cycles de faim-satiete et promouvoir de bonnes routines et habitudes alimentaires, (2 ) d'un suivi nutritionnel et (3) d'une therapie du comportement (gavage). Les nourrissons souffrant de troubles alimentaires post-traumatiques qui demontraient un refus passif d'avaler la nourriture mise dans leur bouche en ne mastiquant pas, ne sucant pas ou ne bougeant pas la nourriture dans leur bouche pendant plus de cinq secondes etaient moins susceptibles de respondre au traitment que les nourrissons souffrant de ces troubles qui ne presentaient pas ces comportements. De plus, un plus grand nombre de nourrissons souffrant de troubles alimentaires qui n'ont pas reagi au traitement presentaient des problemes anatomiques et mecaniques des voies aeriennes superieures, telle que la fistule tracheo-oesophagienne, ou de maladies pulmonaires telle que la dysplasie broncho-pulmonaire que les nourrissons souffrant de troubles d'alimentation post-traumatiques qui ont reagi positivement au traitement. Les decouvertes ont un impact direct sur l'evaluation et le traitement des troubles post-traumatiques alimentaires dans la petit enfance.

Journal ArticleDOI
TL;DR: Platelet crossreactive antibodies in HIV infection are primarily alkaline‐sensitive and are associated predominantly with HIV p24 antibody; these antibodies may play a role in the immune thrombocytopenia of HIV‐infected haemophiliacs.
Abstract: Sera from HIV-1-infected haemophiliacs were examined for human immunodeficiency virus (HIV) specific antibodies and for platelet crossreactive antibodies. Using HIV sepharose 4B affinity columns for serum absorption, antibodies against various HIV antigens, including HIV lysate, HIV-p24 and HIV-gp120, were eluted either by low or by high pH buffer. The eluates were examined by ELISA for HIV specificity and by flow cytometry for platelet crossreactivity. Two types of HIV antibodies could be eluted, i.e. acid-sensitive and alkaline-sensitive antibodies. HIV antibodies were obtained in 26/29 acid eluates and in 25/29 of the alkaline eluates from HIV-lysate columns; 96% (25/26) of the acid-eluted antibodies were HIV-specific but 48% (12/25) of the alkaline-eluted antibodies also showed crossreactivity to platelets. Of the 20 alkaline-eluted HIV-p24 antibodies, 40% (8/20) reacted specifically with HIV-p24 and 60% (12/20) were platelet crossreactive. In contrast, of the alkaline-eluted HIV-gpl20 antibodies (n=17), 88% (15/17) were HIV gpl20-specific and only 12% (2/17) were platelet crossreactive. Western blot analysis of platelets demonstrated that the anti-p24 antibodies recognized three bands with approximate molecular weights of 72 000 to 95 000. 69% of the serum antiplatelet antibodies showed platelet glycoprotein IIbIIIa specificity. Anti-HIV antibodies could be eluted from platelets. Hence, platelet crossreactive antibodies in HIV infection are primarily alkaline-sensitive and are associated predominantly with HIV p24 antibody; these antibodies may play a role in the immune thrombocytopenia of HIV-infected haemophiliacs.

Journal Article
TL;DR: The effects of extra-alveolar duration and storage conditions on the healing of the periodontal ligament (PL) of avulsed teeth following replantation and a critical assessment of the so-called "reconstitution theory" for PL cells is presented.
Abstract: This literature review examines the effects of extra-alveolar duration and storage conditions on the healing of the periodontal ligament (PL) of avulsed teeth following replantation. A critical assessment of the so-called "reconstitution theory" for PL cells is also presented. The ideal treatment for an avulsed tooth is immediate replantation (i.e. less than five minutes). Unfortunately, immediate replantation is not the norm, and most avulsed teeth experience delayed replantation. The greatest risk to the vitality of the PL cells attached to the root of an avulsed tooth is desiccation. Not surprisingly, storage media affect PL healing. Storing avulsed teeth in an isotonic liquid is superior to dry storage. Numerous studies support the use of Modified Eagle's Medium, Hank's Balanced Salt Solution (HBSS), ViaSpan, saline, milk, and saliva as storage media. A recent study has suggested that chicken egg white may also prove to be a suitable storage medium for avulsed teeth. Of these media, only saliva is always present at the scene of an accident, however. Milk can usually be obtained on short notice, but even 10 minutes of desiccation can affect the outcome of replantation. From a practical standpoint, milk packed in ice seems to be the best alternative for the temporary storage of avulsed teeth, due to its wide availability and the minimal detrimental effects it has on PL cells. There is no evidence to support the suggestion that HBSS or any other media will "reconstitute" the PL cells when the extra-alveolar duration of avulsed teeth is greater than 30 minutes.


Journal ArticleDOI
TL;DR: In this paper, the authors propose a method to solve the problem of "uniformity" and "uncertainty" in the context of health care, and propose a solution.

Journal ArticleDOI
TL;DR: All observers align, on average, with the measured location of their egocenter when asked to perform a monocular task without visual cues, and binocular observers show the Cyclops effect, regardless of age.


Book ChapterDOI
01 Jan 1998
TL;DR: Benefits of chronic peritoneal dialysis include effective control of uremia, a supplemental source of calories from Dialysate glucose absorption, liberalization of dietary restriction, and the potential to use amino acid dialysate for replacement of peritoneAL protein and amino acid losses.
Abstract: Children on peritoneal dialysis are often thin, malnourished, and exhibit poor growth. Peritoneal dialysis (PD) can have both positive and negative influences on the nutritional status of patients. Benefits of chronic peritoneal dialysis (CPD) include effective control of uremia, a supplemental source of calories from dialysate glucose absorption, liberalization of dietary restriction, and the potential to use amino acid dialysate for replacement of peritoneal protein and amino acid losses. On the other hand, losses of nutrients (protein, amino acids, vitamins) into the dialysate, the catabolic effect of peritonitis, and anorexia related to glucose absorption, gastrointestinal disturbances, and dysgeusia may contribute to protein/energy malnutrition, and impaired growth and development (1,2).


Journal Article
TL;DR: Whether or not a mother had chickenpox in childhood often does not accurately determine her immunity, so a rapid test, such as the latex agglutination test, is useful.
Abstract: QUESTION: Every year several of my pregnant patients ask me what to do about being exposed to a child who later comes down with chickenpox. What is your recommendation? ANSWER: Whether or not a mother had chickenpox in childhood often does not accurately determine her immunity. A rapid test, such as the latex agglutination test, is useful. If test results are negative, or if testing is not feasible, varicella zoster immunoglobulin should be administered within 96 hours of exposure.

Journal ArticleDOI
TL;DR: This paper offers a general review of deaths attributed to Dr. Jack Kevorkian's PAD practice in an attempt to answer two questions: Why do persons seek physician assisted death, and, to what extent does induced death seem, in retrospect, a reasonable and perhaps necessary medical response to specific patient complaints.
Abstract: To those defining euthanasia as a battle for the principle of self-determination, persons seeking physician assisted death (PAD) are soldiers in the fight for patient autonomy. The reasons they seek it, or the potential of other, non-life-threatening interventions is less important than this principle: individuals have the right not only to choose death (suicide), but to be assisted in dying. They should not be second guessed or denied on the basis of another's distaste for that decision. This paper offers a general review of deaths attributed to Dr. Jack Kevorkian's PAD practice in an attempt to answer two questions: Why do persons seek physician assisted death, and, to what extent does induced death seem, in retrospect, a reasonable and perhaps necessary medical response to specific patient complaints?

Journal ArticleDOI
TL;DR: A computer program is described that employs DECtalk, a highlevel speech synthesizer, to narrate instruction involving intensive training in identifying whole words or in identifying and blending word segments corresponding to onsets, rimes, and phonemes.
Abstract: Talking computers employing computer-generated speech feedback have been used to remediate the literacy skills of dyslexic readers. A computer program is described that employs DECtalk, a highlevel speech synthesizer, to narrate instruction involving intensive training in identifying whole words or in identifying and blending word segments corresponding to onsets, rimes, and phonemes. Procedures for developing individualized instruction are described as well as for constructing and editing the speech and graphics features of the program. Neurologically impaired dyslexic children trained with this program achieved greater acquisition and transfer of word recognition skill when their training involved segmented rather than whole word feedback.

Book ChapterDOI
01 Jan 1998
TL;DR: A safe and effective dosing regimen is one that delivers the appropriate drug in the optimal manner, producing the desired pharmacologic response while minimizing the undesirable drug effects.
Abstract: Prescribing a safe and effective dose of a medication for a child receiving peritoneal dialysis can be problematic as both end-stage renal disease (ESRD) and peritoneal dialysis (PD) can modify the absorption, distribution, metabolism and elimination of many drugs. A safe and effective dosing regimen is one that delivers the appropriate drug in the optimal manner, producing the desired pharmacologic response while minimizing the undesirable drug effects. Achieving the goal of successful drug therapy requires a clear understanding of the therapeutic objective coupled with an awareness of the factors governing drug disposition and action. Failure to clearly define the therapeutic objective or to account for those factors which produce variability in either pharmacokinetics and/or pharmacodynamics can culminate in drug toxicity or inadequate treatment.