Showing papers by "VA Palo Alto Healthcare System published in 2002"
TL;DR: Compared with conventional treatment, robot-assisted movements had advantages in terms of clinical and biomechanical measures and was justified into the use of robotic manipulation for motor rehabilitation.
1,111 citations
TL;DR: This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples and calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points.
Abstract: Brief interventions for alcohol use disorders have been the focus of considerable research. In this meta-analytic review, we considered studies comparing brief interventions with either control or extended treatment conditions. We calculated the effect sizes for multiple drinking-related outcomes at multiple follow-up points, and took into account the critical distinction between treatment-seeking and non-treatment-seeking samples. Most investigations fell into one of two types: those comparing brief interventions with control conditions in non-treatment-seeking samples (n = 34) and those comparing brief interventions with extended treatment in treatment-seeking samples (n = 20). For studies of the first type, small to medium aggregate effect sizes in favor of brief interventions emerged across different follow-up points. At follow-up after > 3-6 months, the effect for brief interventions compared to control conditions was significantly larger when individuals with more severe alcohol problems were excluded. For studies of the second type, the effect sizes were largely not significantly different from zero. This review summarizes additional positive evidence for brief interventions compared to control conditions typically delivered by health-care professionals to non-treatment-seeking samples. The results concur with previous reviews that found little difference between brief and extended treatment conditions. Because the evidence regarding brief interventions comes from different types of investigation with different samples, generalizations should be restricted to the populations, treatment characteristics and contexts represented in those studies.
1,091 citations
TL;DR: The results indicate that satellite cell activation results in a heterogeneous population of precursor cells with respect to Notch-1 activity and that the balance between NotCh-1 and Numb controls cellular homeostasis and cell fate determination.
895 citations
TL;DR: This work elucidate how energy produced by muscles is delivered to the crank through the synergistic action of other non-energy producing muscles; specifically, that a major function performed by a muscle arises from the instantaneous segmental accelerations and redistribution of segmental energy throughout the body caused by its force generation.
606 citations
TL;DR: Kappa coefficients are measures of correlation between categorical variables often used as reliability or validity coefficients, and development and definitions of the K by M (ratings) kappas (K x M) are recapitulate and the use of the recommended kappa with applications in medical research is illustrated.
Abstract: Kappa coefficients are measures of correlation between categorical variables often used as reliability or validity coefficients. We recapitulate development and definitions of the K (categories) by M (ratings) kappas (K x M), discuss what they are well- or ill-designed to do, and summarize where kappas now stand with regard to their application in medical research. The 2 x M(M>/=2) intraclass kappa seems the ideal measure of binary reliability; a 2 x 2 weighted kappa is an excellent choice, though not a unique one, as a validity measure. For both the intraclass and weighted kappas, we address continuing problems with kappas. There are serious problems with using the K x M intraclass (K>2) or the various K x M weighted kappas for K>2 or M>2 in any context, either because they convey incomplete and possibly misleading information, or because other approaches are preferable to their use. We illustrate the use of the recommended kappas with applications in medical research.
426 citations
TL;DR: Patients with BE were no more likely to be obese, consumers of tobacco or alcohol, report a family history of GERD, show association with toxic exposure, or use antacids more than once a month, compared with those without BE.
421 citations
TL;DR: Estimation of the relative contributions of Peri A and HSL in basal and PKA-mediated lipolysis in NIH 3T3 fibroblasts found that perilipin expression and phosphorylation state are critical regulators of lipid storage and hydrolysis in ACS1/FATP1 cells.
232 citations
TL;DR: Although the sophistication and flexibility of the statistical technology available to the data analyst have increased, some durable, simple principles remain valid and must still be considered when studies are designed.
Abstract: Although the sophistication and flexibility of the statistical technology available to the data analyst have increased, some durable, simple principles remain valid. Hypothesis-driven analyses, which were anticipated and specified in the protocol, must still be kept separate and privileged relative to the important, but risky data mining made possible by modern computers. Analyses that have a firm basis in the randomization are interpreted more easily than those that rely heavily on statistical models. Outcomes--such as quality of life, symptoms, and behaviors--that require the cooperation of subjects to be measured will come to be more and more important as trials move away from mortality as the main outcome. Inevitably, such trials will have to deal with more missing data, especially because of dropout and noncompliance. There are fundamental limits on the ability of statistical methods to compensate for such problems, so they must be considered when studies are designed. Finally, it must be emphasized that the availability of software is not a substitute for experience and statistical expertise.
227 citations
TL;DR: Robotic devices for movement therapy are moving closer to becoming commercially available tools for aiding in stroke rehabilitation and a commercialization effort based on these results is described.
Abstract: Robotic devices for movement therapy are moving closer to becoming commercially available tools for aiding in stroke rehabilitation. Robotic technology offers a range of functions that will augment current clinical practice by leveraging therapists' time, cost effectively extending therapy programs, providing new measures of impairment, and offering new therapy protocols. In this article, we review work from several research laboratories that supports the clinical value of stroke therapy systems. A commercialization effort based on these results is described. We also discuss challenges to achieving clinical acceptance and practical implementation of these devices.
215 citations
TL;DR: Residents' daytime sleepiness in both baseline and post-call conditions was near or below levels associated with clinical sleep disorders, and the residents were subjectively inaccurate determining EEG-defined sleep onset.
Abstract: Purpose. To assess the levels of physiologic and subjective sleepiness in residents in three conditions: (1) during a normal (baseline) work schedule, (2) after an in-hospital 24-hour on-call period, and (3) following a period of extended sleep. Method. In 1996, a within-subjects, repeated-measures study was performed with a volunteer sample of 11 anesthesia residents from the Stanford University School of Medicine using three separate experimental conditions. Sixteen residents were recruited and 11 of the 16 completed the three separate experimental conditions. Daytime sleepiness was assessed using the Multiple Sleep Latency Test (MSLT). Results. MSLT scores were shorter in the baseline (6.7 min) and post-call (4.9 min) conditions, compared with the extended-sleep condition (12 min, p = .0001) and there was no significant difference between the baseline and post-call conditions (p = .07). There was a significant main effect for both condition (p = .0001) and time of day (p = .0003). Subjects were inaccurate in subjectively identifying sleep onset compared with EEG measures (incorrect on 49% of EEG-determined sleep episodes). Conclusion. Residents' daytime sleepiness in both baseline and post-call conditions was near or below levels associated with clinical sleep disorders. Extending sleep time resulted in normal levels of daytime sleepiness. The residents were subjectively inaccurate determining EEG-defined sleep onset. Based on the findings from this and other studies, reforms of residents' work and duty hours are justified.
198 citations
TL;DR: The characteristics of the selective pathway, and the molecular properties, localization, regulation, anchoring sites and potential mechanisms of action of SR-BI in facilitating cholesteryl ester uptake by steroidogenic cells are described.
TL;DR: There is evidence that the issue of fatigue in health care is coming to prominence on a national level, and the report from the Agency for Healthcare Research and Quality included a review chapter on sleep, fatigue, and medical errors.
Abstract: HEALTHCARE delivery takes place 24 h a day, 7 days a week, and is colloquially termed a “24/7” operation. Anesthesia providers are required to deliver critical around-the-clock care to a variety of patients. This parallels the situation in many other domains that provide such services, e.g., transportation, law enforcement, communications, fire fighting, technology, manufacturing, and the military. Even “convenience” industries (e.g., gas stations and grocery stores) now provide uninterrupted access. These continuous operational demands present unique physiologic challenges to the humans who are called on to provide safe operations within these systems. Human physiologic design dictates circadian patterns of alertness and performance and includes a vital need for sleep. Human requirements for sleep and a stable circadian clock can be, and often are, in direct opposition to the societal demand for continuous operations. Recently, patient safety has taken center stage in health care. The Institute of Medicine’s report “To Err Is Human: Building a Safer Health System,” revealed that medical errors contribute to many hospital deaths and serious adverse events. The response to this report was widespread and included the Quality Interagency Coordination Task Force’s response to the President of the United States, “Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact.” 2 This report listed more than 100 action items to be undertaken by federal agencies to improve quality and reduce medical errors. One action promised by the Agency for Healthcare Research and Quality was “the development and dissemination of evidence-based, best safety practices to provider organizations.” In addition to the multiple recommendations to improve patient safety, the report from the Agency for Healthcare Research and Quality included a review chapter on sleep, fatigue,# and medical errors.** There is evidence that the issue of fatigue in health care is coming to prominence on a national level. In April 2001, Public Citizen (a consumer and health advocacy group) and a consortium of interested parties petitioned the Occupational Safety and Health Administration to implement new regulations on resident work hours (table 1). The primary intent of the regulations is to provide more humane working conditions, which the petitioners declare will result in a better standard of care for all patients. Also, the Patient and Physician Safety and Protection Act of 2001, which would limit resident physician work hours, was introduced in Congress. Recently, the Accreditation Council on Graduate Medical Education, the accrediting organization for residency training programs in the United States, has approved common program requirements for resident duty and rest hours that will take effect in July 2003.†† This article is accompanied by an Editorial View. Please see: Lydic R: Fact and fantasy about sleep and anesthesiology. ANESTHESIOLOGY 2002; 97:1050–1.
TL;DR: The changes reported here, together with those reported in bone marrow stroma with age, suggest that a default program may be activated in mesenchymal cells with increasing age resulting in a more adipogenic-like phenotype.
TL;DR: The hypothesis that growth-generated strains and pressures in developing tissues regulate morphogenesis throughout development is presented and future lines of research are suggested that may give rise to a more integrated mechanobiological view of early embryonic musculoskeletal morphogenesis.
TL;DR: In this article, the Borelli Lecture shows how dynamical simulations derived from musculoskeletal models reveal muscle-induced segmental energy redistribution and muscle co-functions and synergies.
TL;DR: This study tested the hypothesis that PTSD patients suffer a greater proportion of sleep problems according to comorbid diagnoses, and found that this effect appears unique to panic, rather than other general anxiety disorder or depression.
Journal Article•
TL;DR: Functional disability in AS progresses more rapidly in older patients and smokers, and less rapidly in those who regularly do back exercises and have better social support.
Abstract: OBJECTIVE: To identify patient characteristics that predict the short term (5 yr) rate of progression of functional disability in ankylosing spondylitis (AS). METHODS: In a prospective longitudinal study, 212 patients with AS reported information on health status on biannual mailed questionnaires. The median duration of followup was 5 yrs (range 1-7.5 yrs). Functional disability was measured using the Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S; possible range 0-3). Predictors of the rate of change in the HAQ-S over time included demographic characteristics, number of comorbid conditions, age at onset of AS, peripheral arthritis, smoking, body mass index, social support (measured by the Interpersonal Support Evaluation List, ISEL), current and past physical activity at work, current and past recreational activity, severity of pain and stiffness, nonsteroidal antiinflammatory drug use, and frequency of back exercise. Associations between the predictors and the rate of progression of functional disability (HAQ-S units/yr) were tested using pooled time series regression analysis. RESULTS: Patients were mostly middle-aged (mean 48 yrs), male (70%), white (86%), and well educated (mean 15.5 yrs), with an average duration of AS of 20 yrs and little functional disability at study entry (mean HAQ-S 0.66). Over a median of 5 yrs, the HAQ-S increased at an average rate of 0.0168 units/yr. In multivariate analyses, older age (change in slope +0.0007 units/yr of age; p = 0.0008) and smoking (change in slope +0.0313 units/yr; p
TL;DR: A role for the PI3K/AKT pathway in the propagation of cell‐survival signals mediated by the DGC is supported and new insight is provided into the molecular pathogenesis associated with the development of muscular dystrophies.
Abstract: Dystroglycan is a component of the dystrophin-glycoprotein complex (DGC) in muscle and a cell surface receptor for laminin. Numerous muscular dystrophies are the result of disruption of proteins comprising the DGC, but the underlying pathogenetic mechanisms are unknown. Because apoptosis is an early feature of muscular dystrophy in vivo, and perturbation of cell-extracellular matrix associations is known to induce apoptosis, we investigated the role of dystroglycan-laminin interactions in the propagation and maintenance of cell survival signals in muscle cells. We found that disrupting the interaction between alpha-dystroglycan and the extracellular matrix protein laminin induces apoptosis in muscle cells. This increase in apoptosis is mediated in part by caspase activation and can be blocked by a caspase-3 inhibitor. We demonstrate a role for the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) pathway in muscle cell-survival signaling using a pharmacological inhibitor of PI3K. Treatment with this inhibitor resulted in decreased phosphorylation of AKT and its downstream effector glycogen synthase kinase (GSK)-3beta and induced apoptosis in muscle cell cultures. Disruption of dystroglycan-laminin interactions resulted in decreased phosphorylation of AKT and GSK-3beta. Furthermore, activation of AKT prior to the disruption of dystroglycan-laminin protected the muscle cells from the induction of apoptosis. These results support a role for the PI3K/AKT pathway in the propagation of cell-survival signals mediated by the DGC and provide new insight into the molecular pathogenesis associated with the development of muscular dystrophies.
TL;DR: A relatively high level of RSA among depressed individuals predicts a more pernicious course of illness than do lower RSA levels, even when statistically controlling for initial depression severity, age and medication use.
TL;DR: It is hypothesized that peak moment arms of the elbow flexor and extensor muscles scale with the shorter distance between the elbowflexion axis and a muscle's origin and insertion, and this work advances the understanding of the variability and scaling dimensions for elbow muscle moment arms across subjects of different sizes.
Journal Article•
TL;DR: 18F-FDG is formed through radiochemical synthesis from cyclotron-produced 18F through conditions of a stereospecific second-order nucleophilic substitution reaction, which produces no-carrier-added 18F- FDG.
Abstract: The estimated absorbed doses from a bolus intravenous administration of 18F-FDG are given in [Table 1][1]. The data and assumptions used in these calculations are presented as follows.
View this table:
TABLE 1
Estimated Absorbed Doses from Intravenous Administration of 18F-FDG (Mean ± SD)
18F
TL;DR: This review focuses on the oxidative stress theory, which states that the final common pathway of muscle cell death in these diseases involves oxidative damage.
Abstract: The muscular dystrophies represent a diverse group of diseases differing in underlying genetic basis, age of onset, mode of inheritance, and severity of progression, but they share certain common pathologic features. Most prominent among these features is the necrotic degeneration of muscle fibers. Although the genetic basis of many of the dystrophies has been known for over a decade and new disease genes continue to be discovered, the pathogenetic mechanisms leading to muscle cell death in the dystrophies remain a mystery. This review focuses on the oxidative stress theory, which states that the final common pathway of muscle cell death in these diseases involves oxidative damage.
TL;DR: A representative survey of 1,227 practitioners of the American Psychological Association yielded information about current patterns of practice with older adults, sources of training in geropsychology, perceived need for continuing education (CE) in the field, and preferred CE formats as discussed by the authors.
Abstract: Rapid population growth among older adults means an increased need for psychologists prepared to provide mental health services to this population. A representative survey of 1,227 practitioner members of the American Psychological Association yielded information about current patterns of practice with older adults, sources of training in geropsychology, perceived need for continuing education (CE) in geropsychology, and preferred CE formats. Most respondents provided some services to older adults, but typically very little. The services provided are inadequate to meet projected demand. Most respondents lacked formal training in geropsychology and perceived themselves as needing additional training. CE workshops at the regional level and distance education were the most popular formats. These data serve as a call to the field to expand training opportunities at all levels of training, with an emphasis on the need for empirically based, broadly accessible CE offerings.
TL;DR: Specific symptoms occurring during panic attacks differ by gender, and the pathophysiology of these symptom differences may involve gender differences in sensitivity to CO(2) and in the threshold for panic attacks during hypoxic and hypercapnic states.
Abstract: OBJECTIVE: Several epidemiological studies have demonstrated a higher prevalence of panic disorder in women than in men. This study explored whether the prevalence of specific panic symptoms differs by gender. METHOD: National Comorbidity Survey data from 609 respondents who met DSM-III-R criteria for panic disorder or panic attacks were analyzed to test for gender differences across 18 panic symptoms. RESULTS: Among National Comorbidity Survey respondents with panic disorder or panic attacks, female respondents were more likely than male respondents to experience respiration-related difficulties during panic attacks. CONCLUSIONS: Specific symptoms occurring during panic attacks differ by gender. The pathophysiology of these symptom differences may involve gender differences in sensitivity to CO2 and in the threshold for panic attacks during hypoxic and hypercapnic states.
TL;DR: Multivariate analysis indicates that intravenous drug use and anti-HBs reactivity are independent risk factors for HCV infection,HCV infection for anti-hepatitis B surface antibody reactivity, and older age for PPD positivity.
Abstract: Goals: To determine the prevalence of four common infectious diseases-hepatitis B, hepatitis C, human immunodeficiency virus (HIV), and tuberculosis-as well as co-infection rates and risk factors in a homeless population. Background: The prevalence of infectious diseases, especially viral hepatitis, among the homeless population is largely unknown. Study: This study consists of a retrospective analysis of the history and laboratory data collected from all homeless veterans admitted to a Veterans Administration (VA) domiciliary from May 1995 to March 2000. Results: Of the homeless veterans admitted to a VA domiciliary program, 597 of 829 were screened for markers of all four infectious diseases. The overall prevalence of anti-hepatitis C virus (HCV) antibody, and positive result for purified protein derivative (PPD), anti-HIV antibody, and hepatitis B surface antigen (HbsAg) were 41.7%, 20.6%, 1.84% and 1.17%, respectively. At least one of the four markers was positive in 52.6% and more than one in 12%. Co-infection with HCV occurred commonly in veterans who were positive for anti-HIV (72.7%) and HBsAg (57.1%). Four self-reported major risk factors (intravenous drug use, alcohol abuse, previous imprisonment, and prior stay in a shelter) were evaluated. Multivariate analysis indicates that intravenous drug use and anti- HBs reactivity are independent risk factors for HCV infection, HCV infection for anti-hepatitis B surface antibody reactivity, and older age for PPD positivity. Conclusions: Chronic hepatitis C and co-infections are common among the homeless population. Patients infected with HIV and hepatitis B virus frequently are coinjected with HCV. Infections frequently are associated with certain identifiable risk factors.
TL;DR: A mechanobiological relationship between endochondral ossification and mechanical loading provides valuable insight into bone development and morphology and also the ontogenetic development of the bicondylar angle in growing children.
TL;DR: Recommendations are presented to increase the degree of standardization in the research application and publication of mechanical lung function measurements in psychophysiology.
Abstract: Studies in psychophysiology and behavioral medicine have uncovered associations among psychological processes, behavior, and lung function. However, methodological issues specific to the measurement of mechanical lung function have rarely been discussed. This report presents an overview of the physiology, techniques, and experimental methods of mechanical lung function measurements relevant to this research context. Techniques to measure lung volumes, airflow, airway resistance, respiratory resistance, and airflow perception are introduced and discussed. Confounding factors such as ventilation, medication, environmental factors, physical activity, and instructional and experimenter effects are outlined, and issues specific to children and clinical groups are discussed. Recommendations are presented to increase the degree of standardization in the research application and publication of mechanical lung function measurements in psychophysiology.
TL;DR: In this article, the authors measured the motion of muscle tissue within the rectus femoris and vastus intermedius during knee extension in 10 unimpaired control subjects and 6 subjects (10 limbs) after Rectus Femoris transfer using cine phase-contrast magnetic resonance imaging.
TL;DR: It is indicated that spatially restricted Ras/Raf signaling divides epidermis into an undifferentiated proliferative compartment and a differentiating post-mitotic compartment and suggest a new role for Ras in tissue homeostasis.
Abstract: While important in carcinogenesis, the role of Ras in normal self-renewing tissues such as epidermis is unclear. To address this, we altered Ras function in undifferentiated and differentiating epidermal layers. Ras blockade within undifferentiated basal epidermal cells leads to decreased integrin expression, diminished growth capacity and induction of differentiation. Ras blockade in post-mitotic suprabasal epidermis exerts no effect. In contrast, regulated Ras and Raf activation inhibits differentiation. These findings indicate that spatially restricted Ras/Raf signaling divides epidermis into an undifferentiated proliferative compartment and a differentiating post-mitotic compartment and suggest a new role for Ras in tissue homeostasis.