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Biomedical subjects

A Faulkner

Publications and source records attributed to A Faulkner.

At least 55 records · Page 3Linked to original sources
PubMed1995

Effects of prolonged treatment of lactating goats with bovine somatotropin on aspects of adipose tissue and liver metabolism.

The effects of prolonged (22 weeks) treatment of lactating goats with bovine somatotropin on the metabolism of adipose tissue and liver has been investigated. Somatotropin treatment resulted in smaller adipocytes, decreased rate of fatty acid synthesis and decreased total acetyl-CoA carboxylase activity of adipocytes, but with no change in the proportion of this enzyme in the active state. The rate of acylglycerol glycerol synthesis from glucose of adipocytes tended to decrease as did total glucose utilization by the tissue. Glucose conversion to lactate was unchanged by somatotropin treatment but glucose conversion to other products was decreased. Maximum response of adipose tissue to insulin was unchanged but the sensitivity to insulin decreased on somatotropin treatment. Treatment with somatotropin had no effect on basal lipolysis and decreased maximum response to the beta-agonist isoproterenol, but this probably reflects the rate of isoproterenol-stimulated lipolysis varying with cell volume in adipocytes. No apparent change in response either to alpha 2-adrenergic agonists or to adenosine was apparent. The number of beta-adrenergic receptors was unchanged in adipocyte membranes but the number of alpha 2-adrenergic receptors increased. The rate of hepatic gluconeogenesis in vitro, the activity of key gluconeogenic enzymes and the modulation of the rate of gluconeogenesis by butyrate were unchanged except for the effect of this latter agent on gluconeogenesis from propionate. Hepatic ketogenic activity, as indicated by the activity of carnitine palmitoyl-CoA-transferase-1 and the concentrations of carnitine and acyl carnitines, was unchanged by treatment. Thus at the end of a prolonged period of treatment with somatotropin in lactating goats, lipid synthesis in adipose tissue is still decreased but no effects on liver lipid and carbohydrate metabolism were apparent.

Acetyl-CoA Carboxylase↗
PubMed1995

Voice-onset time and tone-onset time: the role of criterion-setting mechanisms in categorical perception.

Problems in modelling categorical perception (CP) and attempts to apply signal detection theory (SDT) to CP are reviewed. An approach based on SDT supplemented by a theory of criterion setting is presented. Criterion setting theory (CST) postulates mechanisms that reset the response criterion on each trial, and it accounts for sequential dependencies. A criterion setting model for discrimination is shown to fit data from the literature. The hypothesis that "sharp" category boundaries may arise from the suppression of noise caused by intertrial dependencies was examined in an experiment on the identification of [ba] and [pa] syllables, and tone combinations of varying tone-onset time. However, it was shown that both positive and negative intertrial dependencies were present. They could be fitted by the criterion-setting model; in this respect, CP resembles standard psychophysical judgements. Examination of the psychometric functions from the two CP tasks shows that they are not normal ogives, as in standard psychophysical tasks: these curves are steeper centrally and flatter at the extremes than a Gaussian ogive; we describe them as "hypersigmoid". The description of CP identification functions as hypersigmoid provides a new, qualitative characterization of the "sharp" category boundaries traditionally claimed for CP. Their causation remains to be determined.

Adult↗
PubMed1995

Quality assurance in palliative care: some of the problems.

This review considers some of the difficulties associated with quality assurance in the context of palliative care. In particular, it will focus on the key question of who should be responsible for assessing quality and the problems of over-reliance on one particular perspective. Problems encountered in formulating criteria, setting standards and developing outcome measures, many of which are exacerbated in the palliative care setting, are discussed. A review of some of the methods currently available for assessing quality and their limitations are delineated. Finally, attention is drawn to some of the practical and methodological difficulties currently confronting palliative care with regard to quality assurance.

Attitude of Health Personnel↗
PubMed1995

Improving the skills of doctors in giving distressing information.

In response to the growing awareness of the need to convey distressing information effectively, four workshops were held for doctors across Britain with the aim of improving skills, knowledge and attitudes. From the unexpectedly large response of 441 nominations, 20 participants were selected for each workshop. Participants identified four major concerns: how to do it; where to give distressing information; how to deal with collusion; and how to survive mentally in the work. After sessions on these areas, participants interviewed a simulated patient and were recorded on videotape for subsequent feedback. The results showed that after brief training, 91% of all participants gave a warning of distressing information, 85% gave the information at the patient's pace, but only 5% attempted to 'pick up the pieces'. Further work is required on this key aspect of clinical work.

Audiovisual Aids↗
PubMed1995

Outpatients revisited: subjective views and clinical decisions in the management of general surgical outpatients in south west England.

STUDY OBJECTIVE: To assess the scope for reducing unnecessary outpatient reattendances, using a benchmark an acute specialty at a site recognised to have an especially low ratio of repeat to new attendances. DESIGN: This was a survey of the re-attendance workload at general surgery outpatient clinics over a three month period. Patient re-booking and discharge rates for different grades of staff; clinicians' perception of the ability of the GP to have managed the patient; perception of the value of individual re-attendances; reason given for discharging/re-booking; and outcome of attendance for patients in relation to diagnostic category were determined. SETTING: General surgery outpatients clinics with re-attendance rates that were 50% below average, in Taunton and Somerset Hospital, a non-teaching district general hospital. PATIENTS: Altogether 454 patients who made 470 second or subsequent visits (re-attendances) within the same episode of outpatient care. MAIN RESULTS: Thirty eight percent (178/470) of visits were perceived as manageable by the GP, 45% (79, 17% of total re-attendances) of which were also thought to have been of marginal or little value. A substantial group of patients was being followed up largely for reasons of convention and traditional policy. Re-booking rates were higher among junior staff. Subjective views of the value of attendance at the hospital outpatient clinic and the ability of the GP to have seen the patient varied systematically between consultants and junior staff. Judgements varied to some extent according to the diagnostic group. CONCLUSION: The numbers of patients being followed up equivocally at most general surgical outpatient departments will be 50% more an average than those in this benchmark department. A department seeing 2000 new patients per annum will have 3600 reattendances, 25.5% (918) of which may be avoidable on the basis of these results. A variety of approaches can be used to increase the proportion of patients seen appropriately by GPs. In some cases this might be achieved without the intensive commitment required to plan and develop shared care protocols or new formal discharge guidelines, but by encouraging GPs to manage some patients, increasing of hospital clinicians' access to knowledge of local general practices, and internal clinic review of 'routine' follow up policies as shown in this study. This type of review of outpatient practice can also help prioritise conditions likely to repay the effort of developing and implementing clinical management guidelines and local protocols.

Delivery of Health Care↗
PubMed1994

Communication skills in palliative care: development and modification of a rating scale.

A complex rating scale has been used to evaluate the verbal communication skills of health professionals before and after training. The scale has been modified in order to decrease the useage time, to improve its accuracy and to develop a rating tool available to teachers. This paper describes the process of the modification and discusses the consequent validation of the scale.

Communication↗
PubMed1994

Dealing with anger in a patient or relative: a flow diagram.

Anger from any cause can block effective interaction between the patient and the carer. It has many possible causes, which may be rational, irrational (i.e. inappropriate or misdirected) or pathological. This flow diagram suggests strategies for handling anger in patients with advanced disease.

Anger↗
PubMed1994

Breaking bad news--a flow diagram.

Breaking bad news is neither an easy nor a popular task. Properly handled, however, it can be given in a positive way that the individual can both accept and understand. There may be a range of emotions and concerns following the telling of bad news. These need to be explored and worked through with each individual. This flow diagram describes the steps in this important process.

Adaptation, Psychological↗
PubMed1994

Handling difficult questions in palliative care--a flow diagram.

Patients with advanced disease ask many difficult questions, some of which have painful answers, some of which have answers which contain uncertainty, and some of which have no answers. They should be able to ask their questions in an environment that allows them to disclose their true worries, have the opportunity to talk them through, and look for options. Health professionals need to develop the relevant skills to help patients and their families to disclose and discuss difficult issues, while handling their own emotions.

Adaptation, Psychological↗
PubMed1993

Effects of glucagon-like peptide-1(7-36)amide on the concentrations of insulin and glucose in sheep.

1. The effects of glucagon-like peptide-1(7-36)amide (GLP-1) and/or glucose on the concentration of insulin in fed and starved sheep were studied. Insulin concentrations in starved sheep increased with increasing doses of GLP-1 (0.23-2.27 nmol) when given together with glucose. 2. Hyperglycaemia was necessary for GLP-1 to stimulate increases in serum insulin but the level required was low (0.4 mmol/l or less). 3. In fed sheep hyperglycaemia alone caused an increase in serum insulin. 4. GLP-1 improved the ability of both fed and starved sheep to remove exogenous glucose from the circulation. 5. GLP-1 did not augment insulin secretion in response to other known insulin secretagogues.

Animals↗
PubMed1993

Eliciting the current problems of the patient with cancer--a flow diagram.

The assessment of a patient is an integral part of clinical management. It should be conducted in a way which maximizes the likelihood of patients disclosing all their main problems, whether physical, social or psychological in nature. Unfortunately, professional carers can be uncertain of their ability to do this. This flow diagram leads the carer through key points in the assessment interview.

Algorithms↗
PubMed1993

Managing the anxious patient with advancing disease--a flow diagram.

Anxiety can be one aspect of the psychological reaction to cancer and may be present at a clinical level. It can hinder or even prevent the diagnosis and management of other problems and when it develops into an anxiety state it can be disabling. This flow diagram describes the key clinical decisions involved in diagnosing and helping a patient troubled with anxiety.

Algorithms↗
PubMed1993

Handling the withdrawn patient--a flow diagram.

The withdrawn patient challenges effective communication. Some patients are naturally introverted or quiet, but for others the withdrawal represents a change with many possible causes. This flow diagram describes the approach to a withdrawn patient and outlines management.

Algorithms↗
PubMed1993

Effects of consumption of milk and milk constituents on plasma concentrations of gastric inhibitory polypeptide and metabolites in preruminant goat kids.

Plasma concentrations of gastric inhibitory polypeptide (GIP) were measured in preruminant goat kids before and after consumption of milk, skimmed milk or solutions of milk fat, lactose, glucose or casein plus lactose. GIP concentrations increased significantly within 1 h of consumption of milk or milk fat, and were elevated for the remainder of the 5-h sampling period. The integrated mean change in GIP concentration during this period did not differ between these two meals. GIP levels were slightly increased above basal values 5 h after skimmed milk consumption, probably reflecting the absorption of a small amount of fat, but overall there was no significant GIP response to this or to any of the other test meals. The marked increase in GIP concentration after a milk feed indicates a physiological role for the hormone in preruminants but, in contrast to the situation in simple-stomached animals, carbohydrate absorption does not elicit GIP secretion in the preruminant goat. The data strongly suggest that fat is the major nutrient to stimulate GIP secretion in these animals.

Administration, Oral↗
PubMed1993

New developments in speech pattern element hearing aids for the profoundly deaf.

Two new developments in speech pattern processing hearing aids will be described. The first development is the use of compound speech pattern coding. Speech information which is invisible to the lipreader was encoded in terms of three acoustic speech factors; the voice fundamental frequency pattern, coded as a sinusoid, the presence of aperiodic excitation, coded as a low-frequency noise, and the wide-band amplitude envelope, coded by amplitude modulation of the sinusoid and noise signals. Each element of the compound stimulus was individually matched in frequency and intensity to the listener's receptive range. Audio-visual speech receptive assessments in five profoundly hearing-impaired listeners were performed to examine the contributions of adding voiceless and amplitude information to the voice fundamental frequency pattern, and to compare these codings to amplified speech. In both consonant recognition and connected discourse tracking (CDT), all five subjects showed an advantage from the addition of amplitude information to the fundamental frequency pattern. In consonant identification, all five subjects showed further improvements in performance when voiceless speech excitation was additionally encoded together with amplitude information, but this effect was not found in CDT. The addition of voiceless information to voice fundamental frequency information did not improve performance in the absence of amplitude information. Three of the subjects performed significantly better in at least one of the compound speech pattern conditions than with amplified speech, while the other two performed similarly with amplified speech and the best compound speech pattern condition. The three speech pattern elements encoded here may represent a near-optimal basis for an acoustic aid to lipreading for this group of listeners. The second development is the use of a trained multi-layer-perceptron (MLP) pattern classification algorithm as the basis for a robust real-time voice fundamental frequency extractor. This algorithm runs on a low-power digital signal processor which can be incorporated in a wearable hearing aid. Aided lipreading for speech in noise was assessed in the same five profoundly hearing-impaired listeners to compare the benefits of conventional hearing aids with those of an aid which provided MLP-based fundamental frequency information together with speech+noise amplitude information. The MLP-based pattern element aid gave significantly better performance in the reception of consonantal voicing contrasts from speech in pink noise than that achieved with conventional amplification and consequently, it also gave better overall performance in audio-visual consonant identification.(ABSTRACT TRUNCATED AT 400 WORDS)

Algorithms↗