Publications by authors named "Lester J"

Purpose: To evaluate patient discharge destination after elective endovascular or open surgical repair of infrarenal abdominal aortic aneurysm and to determine predictors for discharge to home or to a rehabilitation center.

Materials And Methods: All patients electively treated for infrarenal abdominal aortic aneurysm with endovascular repair (n = 182) or open surgery (n = 274) between January 1997 and September 1999 were included. From the hospital database, information on discharge destination, patient characteristics, complications, and length of stay was retrieved.

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Polybrominated diphenyl ether, PBDE, flame retardants are now a world-wide pollution problem reaching even remote areas. They have been found to bioaccumulate and there are concerns over the health effects of exposure to PBDEs, they also have potential endocrine disrupting properties. They are lipophilic compounds so are easily removed from the aqueous environment and are predicted to sorb onto sediments and particulate matter or to fatty tissue, aiding their distribution throughout the environment.

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Purpose: To determine and compare the average in-hospital costs of elective open surgical and endovascular repairs of infrarenal abdominal aortic aneurysms.

Materials And Methods: Total actual cost data for patients undergoing elective endovascular (n = 181) or open surgical (n = 273) repair of abdominal aortic aneurysms between 1997 and 1999 were retrieved. The mean total hospital cost (including stent-graft costs and excluding attending physician fees) and mean postoperative length of stay were calculated for each treatment group.

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Recent changes in the UK's coastal defence strategy have resulted in the introduction of Managed Realignment (MR), a technique which attempts to establish salt marshes on low-lying coastal farmland. This work investigates the impact of MR, in particular on the interactions between sediment movement, changes in heavy metal concentrations and salt marsh development. Pre- and post-inundation samples were collected and analysed between 1995 and 1997.

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Kappa-opioid receptor stimulation of the heart transiently increases twitch amplitude and decreases Ca2+-dependent actomyosin Mg2+-ATPase activity through an undetermined mechanism. One purpose of the present study was to determine if the increase in twitch amplitude is due to changes in myofilament Ca2+ sensitivity. We also wanted to determine if kappa-opioid receptor activation alters maximum actin-myosin ATPase activity and Ca2+ sensitivity of tension in a way consistent with protein kinase A or protein kinase C (PKC) action.

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A data set acquired to establish an inventory of pollutants in salt marsh sediments has been evaluated using two numerical techniques, principal component analysis and discriminant analysis. Results indicate that sites proximate to the River Thames exhibit a greater degree of contamination, and numerical analysis supports the hypothesis that the river has been the major source of contaminants to the region. The presence of the contaminants within salt marsh sediments may be of concern due to changes in flood defense techniques.

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Rationale And Objectives: The purpose of this study was to determine the inpatient cost of routine (ie, without emergent conversion to open repair during the hospital stay) endovascular stent-graft placement in a consecutive series of patients undergoing elective endovascular repair of abdominal aortic aneurysm (AAA) at a single institution.

Materials And Methods: Inpatient hospital costs of 91 patients who underwent initial elective endovascular repair of AAA were analyzed retrospectively. All patients had participated in clinical trials at the authors' institution during the previous 6 years.

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In 1998, the American Medical Informatics Association (AMIA) published a white paper entitled "Guidelines for the Clinical Use of Electronic Mail with Patients," which outlined a practical framework for this interaction. Interest in the use of other Internet-based tools, such as the World Wide Web, to enhance clinical communication is increasing. In such systems, static information can be made centrally available to patients and interactive tools such as messaging systems, schedules, and individualized care regimens can be integrated within the site.

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To determine whether selective impairment of cardiac sarcoplasmic reticulum (SR) Ca(2+) transport may drive the progressive functional deterioration leading to heart failure, transgenic mice, overexpressing a phospholamban Val(49) --> Gly mutant (2-fold), which is a superinhibitor of SR Ca(2+)-ATPase affinity for Ca(2+), were generated, and their cardiac phenotype was examined longitudinally. At 3 months of age, the increased EC(50) level of SR Ca(2+) uptake for Ca(2+) (0.67 +/- 0.

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Purpose: To determine the most cost-effective colorectal cancer screening strategy costing less than $100,000 per life-year saved and to determine how available strategies compare with each other.

Materials And Methods: Standardized methods were used to calculate incremental cost-effectiveness ratios (ICERs) from published estimates of cost and effectiveness of colorectal cancer screening strategies, and the direction and magnitude of any effect on the ratio from parameter estimate adjustments based on literature values were estimated.

Results: Strategies in which double-contrast barium enema examination was performed emerged as optimal from all studies included.

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Recent studies have generated conflicting data regarding the bioaccumulation and toxicity of leachates from preservative-treated wood. Due to the scale of the wood preserving industry, timber treated with the most common preservative, chromated copper arsenate (CCA), may form a significant source of metals in the aquatic environment. The existing literature on leaching of CCA is reviewed, and the numerous factors affecting leaching rates, including pH, salinity, treatment and leaching test protocols are discussed.

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Caregivers for dependent, elderly community dwellers are frequently themselves at risk for illnesses exacerbated by stress. This study evaluates a videotape scenario intervention designed to increase self-care behaviors in three groups of caregivers randomly assigned to a control or to one of two experimental groups. Within the 6- to 8-week trial, attitudes toward self-care became more positive in the experimental groups, and all groups reported endorsement of behavioral changes related to self-care.

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We previously demonstrated that both adenosine receptor activation and direct activation of protein kinase C (PKC) decrease unloaded shortening velocity (V(max)) of rat ventricular myocytes. The goal of this study was to further investigate a possible link among adenosine receptors, phosphoinositide-PKC signaling, and V(max) in rat ventricular myocytes. We determined that the adenosine receptor agonist R-phenylisopropyladenosine (R-PIA, 100 microM) and the alpha-adrenergic receptor agonist phenylephrine (Phe, 10 microM) increased turnover of inositol phosphates.

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Phospholamban (PLB) can be phosphorylated at Ser(16) by cyclic AMP-dependent protein kinase and at Thr(17) by Ca(2+)-calmodulin-dependent protein kinase during beta-agonist stimulation. A previous study indicated that mutation of S16A in PLB resulted in lack of Thr(17) phosphorylation and attenuation of the beta-agonist stimulatory effects in perfused mouse hearts. To further delineate the functional interplay between dual-site PLB phosphorylation, we generated transgenic mice expressing the T17A mutant PLB in the cardiac compartment of the null background.

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Sequential extraction methods were used to determine the effect of saline inundation on partitioning behaviour of metals in soils at Orplands Managed Retreat site, Essex, UK. A suite of metals (Al, Ca, Cr, Cu, Fe, K, Li, Mn, Ni, Pb and Zn) were analysed in sequential extracts from samples of soil cores extracted immediately before breaching of sea walls in 1995 and 1 year after. Generally, partitioning of most metals was dominated by associations with the residual fraction and an absence of associations with the exchangeable fraction indicating a relatively uncontaminated environment.

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In the aquatic environment, a number of techniques are available to evaluate environmental benefits arising from improvements in water quality. However, such techniques do not account for the environmental costs of implementing a given quality change, for example those associated with the construction and operation of necessary treatment processes. Life cycle assessment is a technique that enables the nature of environmental impacts arising from the construction and operation of processes to be established.

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Transgenic mice were generated with cardiac-specific overexpression of the monomeric, dominant-acting, superinhibitory L37A and I40A mutant forms of phospholamban (PLN), and their phenotypes were compared with wild-type (wt) mice or 2-fold overexpressors of wt PLN (wtOE). The level of PLN monomer in cardiac microsomes was increased 11-13-fold, and the apparent affinity of the sarco(endo)plasmic reticulum Ca(2+)-ATPase for Ca(2+) was decreased from pCa 6.22 in wt or 6.

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Anomalous origin of the left main coronary artery from the right sinus of Valsalva with retropulmonary course is a rare congenital abnormality. It is associated with a high incidence of sudden cardiac death, particularly among young, athletic individuals. Many of these individuals do not have symptoms before sudden death, and the diagnosis is usually made at postmortem examination.

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In February 1993, the South Coast Air Basin (SCAB) was redesignated as a "serious" nonattainment area for PM10. To improve the understanding and characterization of fine particulate matter in the SCAB, the South Coast Air Quality Management District (SCAQMD) initiated a comprehensive PM Technical Enhancement Program (PTEP). Using enhanced PTEP monitors (specially designed multichannel/multifilter samplers), a one-year fine particulate matter (PM) monitoring program was initiated in January 1995.

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The Partners Healthcare Epilepsy Service hosts an epilepsy 'Webforum'. In this paper, we describe our observations regarding who uses it, what kind of information is exchanged, how much misinformation is present and how we can better serve our patients. We examined a sample of 155 posts to the forum and 342 responses to those posts.

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Context: Breast cancer is the second largest cause of cancer death among women in the United States. Given the fear associated with its morbidity and mortality, patients might seek a variety of alternative treatments. No careful description of breast cancer patients' interest in or use of these therapies appears to exist.

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Participants were 4 groups of early adolescents from middle-class backgrounds (European and Chinese Americans in southern California and Chinese in Taipei, Taiwan, and Beijing, China). The 591 adolescents (M age = 13.8 years) completed questionnaires about their involvement in misconduct and about family and peer characteristics.

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With breast cancer affecting more than 180,000 women per year in the United States, improvements in diagnosis and treatment are paramount. Nurses and members of the interdisciplinary care team can actively support education, treatment, and research in development of new techniques and therapies.

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Objective: Our goal was to develop a software system that allows easy and rapid input of digital radiology images and text reports, at the time of interpretation, into an easily searchable electronic teaching file database using the Internet and the World-Wide Web protocols, servers, and browsers.

Conclusion: Using the Internet, the World-Wide Web, and our software system, we can rapidly input digital radiology images and associated text reports into an easily searchable database accessed by privileged users. This inexpensive and simple method for building a digital teaching file database allows cross-platform access for users who have a Web browser.

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