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Biomedical subjects

A Hughes

Publications and source records attributed to A Hughes.

At least 55 records · Page 3Linked to original sources

Increment and decrement detection on temporally modulated fields.

Increment and decrement probe thresholds were measured during the presentation of two types of temporal masking stimuli. In Experiment 1, we measured thresholds for increment or decrement rectangular probes presented during the presentation of an increment or decrement Gaussian masking stimulus. We find that thresholds are higher when the probe and the Gaussian mask are of the same sign (e. g. both increments). However, both types of Gaussian mask raised increment and decrement probe thresholds above steady state conditions. In Experiment 2, we presented increment or decrement probes at one of eight possible phases of a 1 Hz luminance-modulated sine wave. For both increment and decrement probes, threshold variation with phase is non-sinusoidal in shape, but increment and decrement probe thresholds vary as a function of the sinusoid phase. These experiments show that increment and decrement thresholds vary as a function of the adaptation state of the visual system, and as a function of the direction of change in the adaptation state. Data from both experiments are discussed in terms of a recent neurophysiological model [Hood & Graham (1998). Threshold fluctuations on temporally modulated backgrounds: a possible physiological explanation based upon a recent computational model. Visual Neuroscience, 15 (5), 957-967]. We find that the predicted ON- and OFF-pathway responses do not correlate in a straightforward manner with the psychophysical thresholds, suggesting that detection of increment and decrement probes may not be performed exclusively by one pathway. Our data have implications for modeling visual performance under conditions where visual adaptation is dynamic, such as when scanning complex images or natural scenes.

Adaptation, Physiological↗

Quantification and characterisation of arteries in retinal images.

A computerised system is presented for the automatic quantification of blood vessel topography in retinal images. This system utilises digital image processing techniques to provide more reliable and comprehensive information for the retinal vascular network. It applies strategies and algorithms for measuring vascular trees and includes methods for locating the centre of a bifurcation, detecting vessel branches, estimating vessel diameter, and calculating angular geometry at a bifurcation. The performance of the system is studied by comparison with manual measurements and by comparing measurements between red-free images and fluorescein images. In general an acceptable degree of accuracy and precision was seen for all measurements, although the system had difficulty dealing with very noisy images and small or especially tortuous blood vessels.

Diagnostic Imaging↗

The role of nurse practitioners in a primary care eye clinic.

This paper reports on a study conducted to audit the practice of nurse practitioners in a primary care eye clinic at St Paul's Eye Unit at the Royal Liverpool University Hospital, UK. The clinic deals with ophthalmic accidents and emergencies and routine referral patients from general practitioners. This was a prospective study of the case notes of 250 consecutive patients who attended the clinic without prior appointment. The study was completed in 1 week.

Eye Diseases↗

Therapy of estrogen receptor-positive micrometastases in the peritoneal cavity with Auger electron-emitting estrogens--theoretical and practical considerations.

Previous studies have demonstrated that Auger electron-emitting estrogens, when associated with the estrogen receptor (ER), can effect breaks in DNA and ER-dependent radiotoxicity. To evaluate the potential of [123I]-iodoestrogens, ([123I]-IE) to treat ER-positive human cancer cells, we have studied the effect of incubation of [123I]-IE with ER-positive MCF-7 breast cancer cells on cell survival in vitro and found that subnanomolar concentrations of [123I]-IE effectively reduce survival, with a mean lethal dose of about 800 decays per cell. MCF-7 cells incubated 30 min with 2 nM [123I]-IE (13 MBq/ml) showed a 2 log reduction in the ability to form tumors in immunodeficient mice. Evaluation of a mathematical model for [123I]-IE therapy for intraperitoneal micrometases in vivo in the mouse, based on variables related to the (a) specific activity of [123I]-IE; (b) its affinity for ER; (c) the characteristics of the uptake and retention of [123I]-IE by the target cells; (d) the concentration of ER in the tumor cells and (e) the tumor weight suggest that such therapy may be feasible.

Animals↗

Benchmarking in rehabilitation: comparing physiotherapy services.

This report presents outcome data from 3,176 consecutive prospective patients referred to physiotherapy for the treatment of soft tissue injuries. The results detailed here are part of a larger study collecting data from different NHS trusts in a benchmarking study. The Therapy Outcome Measure was used to collect data on each patient in four domains: Impairment, Disability/activity, Handicap/participation, and Distress/wellbeing on the entry and the exit from physiotherapy. The study concludes that patients do not have equal opportunity of accessing therapy for their specific condition according to their abilities and needs. Therapy provided in the Trusts did not produce similar changes in the patients' abilities and some dimensions appeared to improve more significantly in some locations. Furthermore this study would suggest that there are no common criteria for discharge of patients with similar conditions from physiotherapy across the Trusts as measured by the Therapy Outcome Measure.

Age Factors↗

Randomised trial of iodine intake and thyroid status in preterm infants.

BACKGROUND: Low levels of circulating thyroid hormones have been associated with poorer general and neurodevelopmental outcome in preterm babies and it has been speculated that the association is causal. Low levels of circulating thyroid hormone have been reported after inadequate intake of iodine in preterm infants being fed milk formula. AIM: To investigate whether increased iodine intake from supplemented preterm formula would improve thyroid hormone levels in preterm babies (this study) and hence improve neurodevelopmental status (planned subsequent study). METHOD: A total of 121 preterm infants were entered into a randomised controlled trial of standard (68 microg/l) versus increased (272 microg/l) iodine in preterm formula. RESULTS: The two groups were comparable at recruitment. No evidence of an effect of the intervention on thyroid hormone levels was seen up to 41 weeks after conception. CONCLUSION: Calls for increased iodine content of preterm infant formulas are not justified by this study.

Female↗

What clinical features are most useful to distinguish definite multiple system atrophy from Parkinson's disease?

OBJECTIVES: Few studies have attempted to identify what premortem features best differentiate multiple system atrophy (MSA) from Parkinson's disease (PD). These studies are limited by small sample size, clinical heterogeneity, or lack of postmortem validation. We evaluated the sensitivity and specificity of different clinical features in distinguishing pathologically established MSA from PD. METHODS: One hundred consecutive cases of pathologically confirmed PD and 38 cases of pathologically confirmed MSA in one Parkinson's disease brain bank were included. All cases had their clinical notes reviewed by one observer (AH). Clinical features were divided into two groups: those occurring up to 5 years after onset of disease and those occurring up to death. Statistical analysis comprised multivariate logistic regression analysis to choose and weight key variables for the optimum predictive model. RESULTS: The selected early features and their weightings were: autonomic features (2), poor initial levodopa response (2), early motor fluctuations (2), and initial rigidity (2). A cut off of 4 or more on the ROC curve resulted in a sensitivity of 87.1% and specificity of 70.5%. A better predictive model occurred if the following features up to death were included: poor response to levodopa (2), autonomic features (2), speech or bulbar dysfunction (3), absence of dementia (2), absence of levodopa induced confusion (4), and falls (4). The resulting ROC curve based on individual scores showed a best cut off score of at least 11 of 17 (sensitivity 90.3%, specificity 92.6%). CONCLUSIONS: Predictive models may help differentiate MSA and PD premortem. Hitherto poorly recognised features, suggestive of MSA, included preserved cognitive function and absence of psychiatric effects from antiparkinsonian medication. Diagnostic accuracy was higher in those models taking into account all clinical features occurring up to death. Further studies need to be based on new incident cohorts of parkinsonian patients with subsequent neuropathological evaluation.

Adult↗

Infection control issues in the orthopaedic theatre environment.

This article is the First Prize winning entry in the Essay Section of the Alison Bell Memorial Writer's Award 2000, sponsored by NATN and Regent. It is based on an essay submitted for the Evidence Based Practice Module of the post-graduate programme in Health Promotion and Health Studies at Bath Spa University College, Bath.

Evidence-Based Medicine↗

Anticholinesterases in the treatment of Alzheimer's dementia--the first year's experience in Argyll & Clyde.

The local experience of the introduction of a new anticholinesterase treatment for Alzheimer's dementia is described, including the use of a protocol to introduce the use of these drugs. The results in the first 233 patients seen are reported. The protocol seemed to anticipate SMAC. guidelines and to be easy to operate; the drug appeared to have clear clinical effect.

Activities of Daily Living↗

Provision and staffing of NHS occupational health services in England and Wales.

OBJECTIVES: To establish the extent of Occupational Health (OH) service provision in the National Health Service (NHS). METHODS: Two postal questionnaires were used to obtain information from purchasers and providers in the NHS in England and Wales. RESULTS: 99.6% of trust and health authority employers claim to provide some form of OH service to their employees indicating widespread recognition of need, but virtually no service is provided to other staff such as general practitioners (GPs), general dental practitioners (GDPs), and their staff. There is a wide variability in the range and quality of OH services, suggested by the enormous differences in medical staffing levels, and the contractual restrictions where the OH service is provided by another NHS employer. Only about a third (highest estimate) to a quarter (lowest estimate) of NHS staff have access to a specialist occupational physician. CONCLUSIONS: Substantial inequality of access to OH services exists for the NHS workforce, despite previous guidance. There is no real evidence to suggest why the extent of provision of OH services varies so greatly between institutions.

England↗

Epic as an effective, low toxicity salvage therapy for patients with poor risk lymphoma prior to beam high dose chemotherapy and peripheral blood progenitor cell transplantation.

We treated 33 patients with relapsed or refractory non-Hodgkin's lymphoma (NHL) or Hodgkin's disease (HD) with a combination of etoposide, prednisolone, ifosfamide and carboplatin (EPIC). After a median of two courses (range 1-5) complete response was achieved in 7 (22%) patients and partial response in 12 (37%) patients, an overall response rate of 59%. The regimen was well tolerated with myelosuppression being the most common toxicity. There were no toxic deaths. 25 (78%) patients were able to proceed to high dose therapy (BEAM) with peripheral blood progenitor cell transplantation either immediately post EPIC or following further salvage therapy. Most patients mobilised peripheral blood progenitor cells well and 24 out of 25 patients subsequently undergoing autologous transplantation had rapid regeneration of counts. EPIC is an effective salvage therapy in the majority of patients with relapsed or refractory lymphoma and does not appear to be toxic to stem cells. Although severe, myelosuppression is of short duration and the generally low toxicity enables patients to proceed to successful peripheral blood stem cell harvest and transplantation.

Adult↗

Radiotoxicity of Auger electron-emitting estrogens in MCF-7 spheroids: a potential treatment for estrogen receptor-positive tumors.

To approach treatment of micrometastases of steroid receptor-rich cancers using estrogen receptor-directed therapy with Auger electrons, multicellular spheroids of the estrogen receptor-rich human breast cancer cell line, MCF-7, were prepared and exposed to a range of concentrations of an Auger electron-emitting estrogen, E-17alpha-[123I]-iodovinyl-11beta-methoxyestradiol, [123I]IVME2, in vitro. After washing, the treated spheroids were dissociated to single cells and plated for assay of colony survival, whereby we observed a dose-dependent reduction in survival that was inhibited by inclusion of an excess of unlabeled estradiol in the initial incubation with [123I]IVME2. Spheroids of a range of sizes from 40 to 280 microm showed similar sensitivity to the Auger electron-emitting estrogen. The mean lethal dose was approximately 700 decays per cell and corresponded to an initial [123I]IVME2 concentration of less than 0.5 nM. If the control and treated spheroids were not trypsinized but rather were allowed to grow intact, there was not only a significant reduction in the growth of the treated spheroids, but in 18 days nearly half became necrotic, while few control spheroids were necrotic. Considering the low concentrations of Auger electron-emitting estrogen required for a significant reduction in survival, we believe this approach has merit to pursue in vivo, especially in cases where it may be possible to target the steroid receptor-rich micrometastases directly, such as ovarian cancer.

Animals↗