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Nittrouer S, Crowther CS, Miller ME. The relative weighting of acoustic properties in the perception of [s] + stop clusters by children and adults. PERCEPTION & PSYCHOPHYSICS 1998; 60:51-64. [PMID: 9503911 DOI: 10.3758/bf03211917] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We examined the perceptual weighting by children and adults of the acoustic properties specifying complete closure of the vocal tract following a syllable-initial [s]. Experiment 1 was a novel manipulation of previously examined acoustic properties (duration of a silent gap and first formant transition) and showed that children weight the first formant transition more than adults. Experiment 2, an acoustic analysis of naturally produced say and stay, revealed that, contrary to expectations, a burst can be present in stay and that first formant transitions do not necessarily distinguish say and stay in natural tokens. Experiment 3 manipulated natural speech portions to create stimuli that varied primarily in the duration of the silent gap and in the presence or absence of a stop burst, and showed that children weight these stop bursts less than adults. Taken together, the perception experiments support claims that children integrate multiple acoustic properties as adults do, but that they weight dynamic properties of the signal more than adults and weight static properties less.
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Anderson RT, James MK, Miller ME, Worley AS, Longino CF. The timing of change: patterns in transitions in functional status among elderly persons. J Gerontol B Psychol Sci Soc Sci 1998; 53:S17-27. [PMID: 9469176 DOI: 10.1093/geronb/53b.1.s17] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Data from the Longitudinal Study on Aging (LSOA) were analyzed to describe the heterogeneity of functional status transitions over 2-years (single-state model), and to explore whether changes in status in the previous two to four year period enhance the prediction of a subsequent transition (two-state model). Multivariate logistic regression with a robust estimate of variance was used to analyze a 7-category nominal response of: functional status (4 levels), institutionalization, death, and missing. Weighted percentages for functional status transitions and stability (unchanged status) showed that unchanged or improved functioning were at least as common as death or worsened functional status. Initial disability level, morbidities, and self-rated health were the strongest predictors of disability status after 2-years. The two-state model revealed that a previous transition (positive or negative) increases the risk for a subsequent transition, independent of initial disability level. The predictive and explanatory quality of the two-state model is substantially improved over single-state models, particularly from its ability to identify subgroups of individuals with marked functional status instability.
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Byington RP, Miller ME, Herrington D, Riley W, Pitt B, Furberg CD, Hunninghake DB, Mancini GB. Rationale, design, and baseline characteristics of the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT). Am J Cardiol 1997; 80:1087-90. [PMID: 9352986 DOI: 10.1016/s0002-9149(97)00611-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial is the first angiographic clinical trial to be designed to test whether an agent can slow or even reverse the progression of early coronary atherosclerosis in patients with documented disease. In addition, a subset of patients are undergoing carotid ultrasound examinations, providing a unique opportunity to assess and correlate disease progression in 2 arterial beds.
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Baker LE, Virden TB, Miller ME, Sullivan CL. Time course analysis of the discriminative stimulus effects of the optical isomers of 3,4-methylenedioxymethamphetamine (MDMA). Pharmacol Biochem Behav 1997; 58:505-16. [PMID: 9300612 DOI: 10.1016/s0091-3057(97)00287-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The present study examined the discriminative stimulus effects of the MDMA optical isomers administered at different presession injection intervals. In the first experiment, male Sprague-Dawley rats were trained in a two-lever, food-reinforced operant procedure to discriminate either (+)-MDMA (1.25 mg/kg) or (-)-MDMA (3.50 mg kg) at either 20 or 90 min following injection. Animals administered (+)-MDMA or saline 90 min before training sessions failed to attain the discrimination criteria after 73 training sessions, whereas (-)-MDMA successfully established discriminative stimulus control at both the 20 min and the 90 min postinjection intervals. (+)-Amphetamine did not substitute for either isomer, although a significant amount of drug-appropriate responding occurred in animals trained to discriminate (+)-MDMA at 20 min and (-)-MDMA at 90 min. Sch 39166 partially reduced the discrimination of (+)-MDMA at 20 min and (-)-MDMA at 90 min, although this effect was not dose dependent. Sch 39166 had no effect on animals trained to discriminate (-)-MDMA at 20 min. Haloperidol did not alter the discrimination of (+)-MDMA at 20 min but partially reduced the discriminative stimulus control of (-)-MDMA at 20 min and (-)-MDMA at 90 min. Fenfluramine substituted for both isomers of MDMA. Pirenpirone completely blocked the discriminative stimulus effects of (-)-MDMA at 20 min, although (+)-MDMA at 20 min and (-)-MDMA at 90 min were only partly blocked. WAY 100,135 had little effect on drug-appropriate responding; however, the discrimination of (+)-MDMA at 20 min was partly reduced by this 5-HT1A antagonist. In a second experiment, rats trained to discriminate (+)-MDMA (1.5 mg/kg) or (-)-MDMA (3.0 mg/kg) from saline were administered substitution tests with both isomers 20, 60, 90 and 120 min after injection. Results confirmed those of the first experiment that (+)-MDMA appears to have a shorter duration of action than (-)-MDMA. These results are discussed in light of the training doses employed.
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James MK, Miller ME, Anderson RT, Worley AS, Longino CF. Benefits of linkage to the National Death Index in the Longitudinal Study of Aging. J Aging Health 1997; 9:298-315. [PMID: 10182395 DOI: 10.1177/089826439700900302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To reduce the potential bias resulting from differential loss to follow-up in the Longitudinal Study of Aging (LSOA), information obtained from household contact methods was supplemented with information from the National Death Index (NDI). This article examines the degree of agreement in the vital status data from two sources (reinterview contacts and the NDI system) and evaluates the potential gains of using the NDI data as a supplement to define participants' vital status. Results reveal that NDI information, used to supplement reinterview information, can substantially reduce bias due to the differential loss of participants to follow-up. Reliance on reinterview information alone was less likely to capture those deaths occurring in study participants who at the initial contact lived alone, were below the poverty index, were interviewed without use of a proxy, did not supply a phone number, and did not own a home.
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Nittrouer S, Miller ME. Developmental weighting shifts for noise components of fricative-vowel syllables. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 1997; 102:572-580. [PMID: 9228818 DOI: 10.1121/1.419730] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Previous studies have convincingly shown that the weight assigned to vocalic formant transitions in decisions of fricative identity for fricative-vowel syllables decreases with development. Although these same studies suggested a developmental increase in the weight assigned to the noise spectrum, the role of the aperiodic-noise portions of the signals in these fricative decisions have not been as well-studied. The purpose of these experiments was to examine more closely developmental shifts in the weight assigned to the aperiodic-noise components of the signals in decisions of syllable-initial fricative identity. Two experiments used noises varying along continua from a clear /s/ percept to a clear /[symbol: see text]/ percept. In experiment 1, these noises were created by combining /s/ and /[symbol: see text]/ noises produced by a human vocal tract at different amplitude ratios, a process that resulted in stimuli differing primarily in the amplitude of a relatively low-frequency (roughly 2.2-kHz) peak. In experiment 2, noises that varied only in the amplitude of a similar low-frequency peak were created with a software synthesizer. Both experiments used synthetic /a/ and /u/ portions, and efforts were made to minimize possible contributions of vocalic formant transitions to fricative labeling. Children and adults labeled the resulting stimuli as /s/ vowel or /[symbol: see text]/ vowel. Combined results of the two experiments showed that children's responses were less influenced than those of adults by the amplitude of the low-frequency peak of fricative noises.
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Baker LE, Miller ME, Svensson KA. Assessment of the discriminative stimulus effects of the D3 dopamine antagonist PNU-99194A in rats: comparison with psychomotor stimulants. Behav Pharmacol 1997; 8:243-52. [PMID: 9833019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The present study examined the discriminative stimulus effects of the D3 dopamine receptor antagonist PNU-99194A [5,6-di-methoxy-2-(dipropylamino)indan-hydrochloride] in male Sprague-Dawley rats. Eight rats were trained to discriminate cocaine (10 mg/kg, i.p.) from saline in a two-choice, water-reinforced drug discrimination procedure. In tests of stimulus generalization, PNU-99194A (1.25-40.0 mg/kg, s.c. and i.p.) did not substitute for cocaine. PNU-99194A (5.0-20 mg/kg) also did not significantly block the discrimination of cocaine (10 mg/kg), nor did it potentiate a low dose (1.25 mg/kg) of cocaine. A separate group of eight rats were trained to discriminate PNU-99194A from saline. These subjects met the discrimination criterion within an average of 68 (S.E.M. = 6.5) training sessions; the ED50 for PNU-99194A was 2.6 mg/kg. In stimulus generalization tests, cocaine (1.25-10 mg/kg) did not substitute for PNU-99194A, when administered by either i.p. or by s.c. injection. In addition, neither amphetamine (0.25-1.0 mg/kg) nor caffeine (8.0-64 mg/kg) produced stimulus generalization in these rats. These results indicate that D3 receptors do not play a critical role in the discriminative stimulus effects of cocaine. Furthermore, although PNU-99194A is capable of establishing and maintaining discriminative stimulus control in rats, the effects of this D3-preferring antagonist are dissimilar from those of psychomotor stimulants. Given the unique behavioral profile of D3 receptor antagonists, the potential utility of these agents as adjunctive treatments for psychostimulant abuse is discussed.
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Bruton BD, Miller ME. Occurrence of Vine Decline Diseases of Melons in Honduras. PLANT DISEASE 1997; 81:696. [PMID: 30861874 DOI: 10.1094/pdis.1997.81.6.696c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A survey of vine decline diseases of melons (Cucumis melo L.) was conducted on three geographically separate farms (12 fields) in the area of San Lorenzo, Honduras, during the spring of 1996. Symptoms were typical of the vine declines in that the leaves began yellowing and collapsing in the crown just prior to harvest and the decline radiated outward. Crown lesions, typical of many of the vine declines, were observed infrequently. Most plants exhibited no crown lesion. Roots exhibited brown lesions and root corking, and were generally lacking root hairs, although the roots were not macerated. Fruit were small sized, low in sugars, and sunburned. Isolations were made from the crown area, primary root, and secondary roots of affected plants by excising 3- to 5-mm pieces and surface sterilizing for 30 to 60 s with 0.5% sodium hypochlorite. Four tissue pieces from each plant part were placed on 2.0% water agar plus 0.1 g of streptomycin sulfate per liter and their identity maintained. Plates were examined for fungal growth daily for 5 days and hyphal tips from all colonies were transferred to potato dextrose agar and Synthetischer nährstoffärmer agar (2) to allow for sporulation. Rhizoctonia solani Kühn was the predominant fungus isolated from affected plants in several fields, with an incidence as high as 75%. A Pythium sp. was isolated from primary and secondary roots of 50% of the plants on the Santa Rosa farm. Vines exhibiting tan to light brown crown lesions either on one side of the vine or encompassing the crown, but without gumming, always produced colonies of Fusarium semitectum Berk. & Ravenel. Fusarium solani (Mart.) Appel & Wollenweb. emend. W. C. Snyder & H. N. Hans. was isolated from roots of more than 30% of the plants, although this is not unusually high. Crown lesions typical of charcoal rot were observed in some fields, with Macrophomina phaseolina (Tassi) Goidanich being isolated from 65% of the plants in one field. Charcoal rot was a minor problem in all fields but one. Didymella bryoniae (Auersw.) Rehm was not isolated from any of the plants. A Stagonospora-like fungus, which has been demonstrated recently as a potential contributor to vine decline (1), was isolated on 17% of the plants from five fields on the Embarcadero Farm. Monosporascus cannonballus Pollack & Uecker was isolated infrequently in one field on the Santa Rosa Farm. This is the first report of M. cannonballus and a Stagonospora-like fungus in Honduras. References: (1) M. E. Miller et al. Phytopathology 86:S3, 1996. (2) H. I. Nirenberg. Mitt. Biol. Bundesanst. Land Forstwirtsch. Berlin-Dahlem. 169:1, 1976.
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Bruton BD, Miller ME. Occurrence of Vine Decline Diseases of Muskmelon in Guatemala. PLANT DISEASE 1997; 81:694. [PMID: 30861865 DOI: 10.1094/pdis.1997.81.6.694a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Central American countries have become major production areas of melons (Cucumis melo L.) destined for export to Europe and the United States during the winter months. Double cropping in the same fields year after year has created serious vine decline diseases in melons grown in the Capco area of Guatemala. Vines typically appear healthy until the fruit are approaching maturity, when the crown leaves begin to turn yellow and collapse and the decline gradually radiates outward. There was evidence of slightly water-soaked lesions in the crown of some plants; however, the symptoms were not similar to charcoal rot or gummy stem blight. The roots exhibited some decay, lesions, and discoloration, but were not macerated and rotten. A minimum of 10 affected plants were collected from each of nine fields in the Capco area of Guatemala. Isolations were made from the crown area, primary root, and secondary roots of selected plants by excising 3- to 5-mm pieces and surface sterilizing them for 30 to 60 s with 0.5% sodium hypochlorite. The isolations were made on 2% water agar plus 0.1 g of streptomycin sulfate per liter. Plates were examined for fungal growth daily for 5 days with hyphal tips from all colonies transferred to potato dextrose agar and Synthetischer nährstoffärmer agar (2) and allowed to sporulate. Isolations revealed the presence of several fungi capable of causing vine decline or suspected of being involved in the vine decline complex. Rhizoctonia solani Kühn and Fusarium semitectum Berk. & Ravenel were isolated from more than 50% of plants in some fields. F. semitectum, R. solani, and a Stagonospora-like fungus were isolated from 38, 18, and 17% of the total plants, respectively. R. solani was isolated from the crown more often than from the roots, but its role is not understood. With one exception, F. semitectum was always isolated from the crown area, which may suggest a more significant role in the vine decline complex than suspected previously. The Stagonospora-like fungus, isolated from 30% of the plants from one field, has been reported as a pathogen of cantaloupe that may contribute to the vine decline complex (1). Monosporascus cannonballus Pollack & Uecker and Fusarium oxysporum Schlechtend.:Fr. emend. W. C. Snyder & H. N. Hans. were isolated from 60% of the plants from one field. It was the only field in which M. cannonballus was isolated. Plectosporium tabacinum (van Beyma) M. E. Palm, W. Gams et Nirenberg, a cucurbit pathogen, was isolated infrequently. This is the first report of M. cannonballus, P. tabacinum, and the Stagonospora-like fungus in Guatemala. References: (1) M. E. Miller et al. Phytopathology 86:S3, 1996. (2) H. I. Nirenberg. Mitt. Biol. Bundesanst. Land Forstwirtsch. Berlin-Dahlem. 169:1, 1976.
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Nittrouer S, Miller ME. Predicting developmental shifts in perceptual weighting schemes. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 1997; 101:2253-2266. [PMID: 9104027 DOI: 10.1121/1.418207] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Recent models of developmental changes in speech perception suggest that the weights assigned to acoustic properties change as children gain experience with a native language. Empirical evidence supports this position, but few suggestions have been offered as to what guides this shift. These three experiments were designed to improve our ability to predict how perceptual weighting schemes change with development. The specific hypothesis explored was twofold: (1) the weight assigned by adults to any one acoustic property differs across phonetic environments according to how informative that property is in each environment; and (2) the weight assigned by children to any one acoustic property differs less across phonetic environments because children have not fully learned the patterns of covariation between phonetic informativeness and environment for each property. Experiment 1 replicated previous findings of age-related differences in the weights assigned to noise spectra and formant transitions in labeling of syllable-initial fricatives (/s/ or /[symbol: see text]/). In experiment 2 the variation in F3-onset frequency associated with place of fricative constriction was eliminated. This property differs more (i.e., is more informative) in /u/ than in /a/. Accordingly adults' transition effect was reduced more for /u/ than for /a/ from experiment 1. Children's transition effect was similarly reduced across vowel environments. In experiment 3, F3-onset frequency was appropriately manipulated for both vowels, and adults transition effect increased more for /u/ than for /a/ from experiment 2. The increase in children's transition effect was more similar across vowels. We conclude that the children had not fully learned how information provided by F3 transitions varies across /a/ and /u/ environments, and suggest that developmental weighting shifts may be guided by children learning the relation between phonetic informativeness and environment.
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Ortiz-Carranza O, Miller ME, Adragna NC, Lauf PK. Alkaline pH and internal calcium increase Na+ and K+ effluxes in LK sheep red blood cells in Cl--free solutions. J Membr Biol 1997; 156:287-95. [PMID: 9096069 DOI: 10.1007/s002329900208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We examined the effects of pH, internal ionized Ca (Ca2+i), cellular ATP, external divalent cations and quinine on Cl-independent ouabain-resistant K+ efflux in volume-clamped sheep red blood cells (SRBCs) of normal high (HK) and low (LK) intracellular K+ phenotypes. In LK SRBCs the K+ efflux was higher at pH 9.0 (350%) than at pHs 7. 4 and 6.5, and was inhibited by external divalent cations, quinine, and cellular ATP depletion. The above findings suggest that the increased K+ efflux at alkaline pH is due to the opening of ion channels or specific transporters in the cell membrane. In addition, K+ efflux was activated (100%) when Ca2+i was increased (+A23187, +Ca2+o) into the microm range. However, in comparison to human red blood cells, the Ca2+i-induced increase in K+ efflux in LK SRBCs was fourfold smaller and insensitive to quinine and charybdotoxin. The Na+ efflux was also higher at pH 9.0 than at pH 7.4, and activated (about 40%) by increasing Ca2+i. In contrast, in HK SRBCs the K+ efflux at pH 9.0 was neither inhibited by quinine nor activated by Ca2+i. These studies suggest the presence in LK SRBCs, of at least two pathways for Cl--independent K+ and Na+ transport, of which one is unmasked by alkalinization, and the other by a rise in Ca2+i.
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Miller ME, Welch WP, Wong HS. Exploring the relationship between inpatient facility and physician services. Med Care 1997; 35:114-27. [PMID: 9017950 DOI: 10.1097/00005650-199702000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility and inpatient physician services per admission, few studies directly explore the relationship between these services. Theoretically, inpatient facility and physician services may be complements or substitutes. That is, an increase in facility services may lead to an increase or decrease in physician services and vice versa. This article contributes to the existing literature by exploring directly the relationship between facility and physician services. METHODS Medicare physician claims were linked to inpatient hospital stays using data from the Medicare hospital cost reports, the Medicare Patient Analysis and Review file, and the Medicare National Claims History System. RESULTS In multivariate regression analyses, the (partial) correlations between facility and physician services were positive, which is consistent with complementarity. Standardized regression coefficients indicate that physician services are the single most important determinant of facility services; however, facility services are a less important determinant of physician services. A 10% increase in physician services is associated with at least a 3.0% increase in facility services. CONCLUSIONS Proposals that reduce inpatient physician expenditures also would reduce facility expenditures in the long-run.
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Miller ME, Cairns BR, Levinson RS, Yamamoto KR, Engel DA, Smith MM. Adenovirus E1A specifically blocks SWI/SNF-dependent transcriptional activation. Mol Cell Biol 1996; 16:5737-43. [PMID: 8816487 PMCID: PMC231574 DOI: 10.1128/mcb.16.10.5737] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Expression of the adenovirus E1A243 oncoprotein in Saccharomyces cerevisiae produces a slow-growth phenotype with accumulation of cells in the G1 phase of the cell cycle. This effect is due to the N-terminal and CR1 domains of E1A243, which in rodent cells are involved in triggering cellular transformation and also in binding to the cellular transcriptional coactivator p300. A genetic screen was undertaken to identify genes required for the function of E1A243 in S. cerevisiae. This screen identified SNF12, a gene encoding the 73-kDa subunit of the SWI/SNF transcriptional regulatory complex. Mutation of genes encoding known members of the SWI/SNF complex also led to loss of E1A function, suggesting that the SWI/SNF complex is a target of E1A243. Moreover, expression of E1A in wild-type cells specifically blocked transcriptional activation of the INO1 and SUC2 genes, whose activation pathways are distinct but have a common requirement for the SWI/SNF complex. These data demonstrate a specific functional interaction between E1A and the SWI/SNF complex and suggest that a similar interaction takes place in rodent and human cells.
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Abstract
Although physicians are all too familiar with the psychologic impact of having multiple responsibilities, the associated impact on practice styles has not been examined systematically. To provide some data on the effects of "work dispersion," we examined the hypothesis that the inpatient resource use of physicians would rise with the number of hospitals in which they work. Data for 1991 from Medicare's National Claims History File were used to profile a sample of attending physicians (n = 33,756) in seven states. The attending physician "profile" was the case mix-adjusted relative value of all physician services (regardless of who delivered them) that were delivered during each patient's hospital stay. Relative value was measured in relative value units, used by Medicare in determining physician payments. The authors then categorized physicians in terms of the number of hospitals to which they admitted patients. Physician profiles were adjusted further to control for geography, physician specialty, and characteristics of the physician's primary (ie, most used) hospital. One third of the physicians in the sample had admissions to more than one hospital. Physicians working in one hospital had inpatient practice profiles 2.1% below the sample mean. Additional hospital affiliations were associated with progressively higher profiles: two hospitals, 2.3% above the mean; three hospitals, 4.5% above; four hospitals, 8.2% above; and five or more hospitals, 11.5% above (all P < 0.01). The practice of medicine in more than one hospital is associated with higher inpatient profiles and shows a dose-response relationship. Physicians and policy makers will need to consider carefully whether there are any associated benefits to justify the increased cost.
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Abstract
Work sampling is an observational technique that produces counts representing the number of times that an individual has been observed performing each of several tasks. These data are collected using either systematic or random times of observation, and typically exhibit correlation between repeated observations on the same individual, with the degree of correlation being a function of the amount of time elapsed between measurements. Using several recently developed statistical techniques, we illustrate how it is possible to carry out analyses of these nominal outcomes that account for the correlation between repeated outcomes. We use description of a work sampling study to motivate the techniques and we compare empirically results from analyses based on several different underlying assumptions.
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Cook CA, Freedman JA, Freedman LD, Arick RK, Miller ME. Screening for social and environmental problems in a VA primary care setting. HEALTH & SOCIAL WORK 1996; 21:41-7. [PMID: 8626157 DOI: 10.1093/hsw/21.1.41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Social workers are in an ideal position to identify and treat social and environmental problems early in the continuum of care. Information on these problems will facilitate informed decision making on the development and reallocation of resources to better meet patients needs. This study assessed the social and environmental problems of 132 patients seen in a primary care clinic at a university-affiliated Veterans Affairs (VA) medical center. The most prevalent social problems were financial difficulties, personal stress, family problems, legal concerns, and employment concerns. When asked, nearly one-third of all respondents requested social work services or information about services related to their problems. The findings suggest a clear need for social work interventions in VA primary care clinics that focus on both psychosocial problems.
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Bernstein GS, Miller ME. Behavior therapy with lesbian and gay individuals. PROGRESS IN BEHAVIOR MODIFICATION 1996; 30:123-136. [PMID: 7567673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
We report the case of a 55-year-old male who experienced cough, dyspnea, wheezing, and nasal congestion immediately upon exposure to FD&C Blue Dye No. 2 (Indigotine) at work. The patient had worked for 10 years mixing and grinding powdered synthetic red, yellow, and blue dyes for use in foods; symptoms had occurred for 2 years and only with exposure to Indigotine (C16H8N2Na2O8S2), a free flowing blue powder. Prick testing to Indigotine (20 mg/mL) was negative. ELISA failed to detect specific IgE, IgA, IgM, or IgG to Indigotine-HSA conjugates. Bronchial challenge was done according to the method of Pepys et al. beginning with 4 x 10(-4) lactose dilution of Indigotine powder. After 5 minutes of exposure to 4 gm Indigotine/100 gm lactose, the patient developed dyspnea and audible wheezing. At 20 minutes postexposure, there was a 20% decline in FEV1 from prechallenge baseline; no late phase response was observed. A second bronchial challenge with sodium sulfate, the major nondye product additive was negative. To our knowledge, this is the first documented case of occupational asthma due to FD&C Blue Dye No. 2. The pathogenesis is uncertain but does not appear to be IgE mediated.
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Macias WL, Alaka KJ, Murphy MH, Miller ME, Clark WR, Mueller BA. Impact of the nutritional regimen on protein catabolism and nitrogen balance in patients with acute renal failure. JPEN J Parenter Enteral Nutr 1996; 20:56-62. [PMID: 8788264 DOI: 10.1177/014860719602000156] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with acute renal failure are in substantial negative nitrogen balance as a result of their extremely high protein catabolic rates. We prospectively evaluated a series of patients with acute renal failure managed with continuous venovenous hemofiltration to determine which nutritional and nonnutritional variables might influence protein catabolism and nitrogen balance. METHODS Forty consecutive patients (aged 52 +/- 20 years; mean +/- SD) were monitored for 357 treatment days (average treatment duration 8.9 +/- 8.6 days). All data (including nutritional regimen, laboratory values, APACHE II score, administered blood products, hemofiltration parameters, and medications) were collected daily. RESULTS For all patients, the mean normalized protein catabolic rate was 1.4 +/- 0.5 g/kg per day. The rate did not differ between those who received nutrition support and those who did not. The net nitrogen deficit was less in those patients receiving nutrition support (-6.0 +/- 5.2 vs -14.0 +/- 5.6 g N/d; p = .02). Using regression techniques (adjusted for the within-person correlation and the previous day's normalized protein catabolic rate), the level of protein and energy provision and the interaction between protein and energy provision were predictive of the normalized protein catabolic rate. Predicted values, using this equation, suggest that at low protein administration rates (< 1 g/kg per day), increasing energy provision may reduce the protein catabolism. However, at this level of protein provision, patients remain in negative nitrogen balance. At protein administration rates necessary to achieve nitrogen balance (approximately 1.5 to 1.8 g/kg per day), protein catabolism may increase. Providing relatively low levels of energy may diminish the magnitude of this increase. CONCLUSION These results suggest that the optimal nutritional regimen for patients with acute renal failure may require a high-protein (approximately 1.5 to 1.8 g/kg per day) and a relatively low-energy (approximately 25 to 35 kcal/kg per day) content.
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96
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Dores GM, Miller ME, Schwartz S, Benditt JO. Review of Hodgkin's disease and lung cancer following non-Hodgkin's lymphoma in Rhode Island and review of the literature. RHODE ISLAND MEDICINE 1995; 78:317-319. [PMID: 8547721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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97
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Yells DP, Prendergast MA, Hendricks SE, Miller ME. Monoaminergic influences on temporal patterning of sexual behavior in male rats. Physiol Behav 1995; 58:847-52. [PMID: 8577879 DOI: 10.1016/0031-9384(95)00130-b] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We evaluated the effects of the serotonin (5-HT) presynaptic uptake blocker fluoxetine (FLX) and the dopamine (DA)/noradrenaline (NE) releaser amantadine (AMA), separately and in combination, on the temporal patterning of male rat sexual behavior. FLX alone increased intermount-bout intervals, time-outs, grooming time, ejaculation latency, number of mounts per mount bout, and number of mount bouts per ejaculation. AMA alone had the opposite effect on these measures. Additionally, AMA, when given in combination with FLX, completely reversed the FLX-induced deficits in copulatory behavior. We interpret our results as suggesting an interaction between 5-HT and catecholamines in the temporal patterning of male rat copulatory behavior.
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98
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Miller ME, Engel DA, Smith MM. Cyclic AMP signaling is required for function of the N-terminal and CR1 domains of adenovirus E1A in Saccharomyces cerevisiae. Oncogene 1995; 11:1623-30. [PMID: 7478587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We have constructed yeast vectors in which derivatives of the adenovirus E1A gene are expressed from the GAL1 promoter. Cells expressing E1A289 grow poorly and accumulate cells with a 1C DNA content. Using a series of E1A deletion mutants, we have identified three regions within the E1A protein that are necessary for the G1 growth phenotype; each deletion partially relieves the growth defect. These deletions span residues 4-25, 38-60 and 140-186, which fall within the N-terminal, CR1 and CR3 domains of E1A respectively. Expression of the first 82 residues of E1A, spanning just the N-terminal and CR1 domains, strongly inhibits yeast cell growth in G1 showing that these domains can function independently of other domains of E1A. Using this strong growth inhibition, we isolated a yeast mutant in the net1 gene that conferred resistance to the expression of E1A1-82. The mutant was insensitive to expression of both E1A1-82 and full length E1A, but remained sensitive to the toxicity caused by over-expression of a Gal4p-VP16 fusion. Finally, we found that the function of E1A in yeast depends on the cyclic AMP signaling pathway, providing a striking parallel with the action of E1A at the c-fos promoter in mammalian cells. These results suggest that a genetic analysis of the yeast model system will provide relevant new insights into mechanisms of gene regulation by E1A proteins.
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99
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Guo WJ, Callif-Daley F, Zapata MC, Miller ME. Clinical and cytogenetic findings in seven cases of inverted duplication of 8p with evidence of a telomeric deletion using fluorescence in situ hybridization. AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 58:230-6. [PMID: 8533823 DOI: 10.1002/ajmg.1320580307] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report on the clinical and cytogenetic findings in 7 cases of inverted duplication of region 8p11.2p23. The phenotype of inv dup (8p) compiled from this series and the literature (N = 29) consists of severe mental retardation (100%), minor facial alterations (97%), agenesis of the corpus callosum (80%), hypotonia (66%), orthopedic abnormalities (58%), scoliosis/kyphosis (40%), and congenital heart defect (26%). A telomeric deletion of region 8p23.3-pter was confirmed in 3 of our cases studied using fluorescent in situ hybridization with a telomeric probe for 8p. Thus, these karyotypes are inv dup del(8) (qter-->p23.1::p23.1-->p11.2:). Our findings suggest that most cases of inv dup(8p) probably have a telomeric deletion.
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100
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Smith DM, Martin DK, Langefeld CD, Miller ME, Freedman JA. Primary care physician productivity: the physician factor. J Gen Intern Med 1995; 10:495-503. [PMID: 8523152 DOI: 10.1007/bf02602400] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To model physician productivity as a function of clinic (support system) characteristics and physician characteristics and to model the time a physician spends with the patient as a function of patient characteristics. DESIGN Observational study. SETTING A general medicine clinic of a university-affiliated Veterans Affairs medical center. PATIENTS A cohort of 2,520 patients having 2,721 consecutive outpatient visits to 56 physicians. MAIN OUTCOME MEASURES Physician productivity defined as patients seen/physician/hour and time (minutes) spent with the patient. RESULTS Physicians saw a mean (+/- SD) of 1.62 +/- 0.68 patients/hour. Clinic characteristics explained 8.2% of the variability of session-specific physician productivity. Controlling for clinic characteristics, a factor representing the physician explained an additional 55.4%. A model for overall physician productivity, using physician characteristics, explained 84.9% of the variance, and time spent with the patient was an important predictor. Modeling physician time with patients, patient characteristics accounted for only 7% of the variability. Controlling for patient characteristics, the individual physician again provided the greatest explanatory power, an additional 22.8% of the variability. CONCLUSIONS Physicians' practice patterns, rather than clinic or patient characteristics, may account for most of the variation in physician productivity. Given the magnitude of the influence of individual practice patterns, interventions to increase productivity need to consider methods to affect physician behavior.
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