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Biomedical subjects

A James

Publications and source records attributed to A James.

At least 109 records · Page 6Linked to original sources
PubMed1994

The use of the axial CT scan in intra-articular fractures of the calcaneum.

The axial CT scan has become part of our routine management of os calcis fractures. This investigation helps distinguish between tongue and joint depression type fractures, gives important information regarding the fracture pattern in the anterior calcaneum and the degree of comminution of the sustentaculum tali and the subtalar joints. The scan is also useful in determining direction of movement of the body fragment.

Calcaneus↗
PubMed1994

The end of the second most expensive health care system in the world: some geographical implications.

In Canada, there has been an increasingly, vociferous debate over the future of a health care system which is based on 5 principles: comprehensiveness; public administration; universality; portability; and accessibility. In part, this debate is a policy tug-of-war among provincial governments, special interest groups and the public who on one side want to maintain the principles of the health care system and on the other want to control costs within the system. The outcome of this policy tug-of-war is demonstrated through an analysis of the funding of health care in the province of Ontario, Canada in general, and the closure of hospital beds specifically. The analysis shows that in attempting to restructure the system, rationalization and growing spatial inequality are occurring simultaneously. The analysis calls into question the whole strategy of bed closures as a method of controlling health care costs. These conclusions have implications for other national health care systems where hospital bed closures have also been used as a strategy in controlling health care costs.

Aged↗
PubMed1994

Adolescent onset psychosis. A clinical and outcome study.

58 psychotic adolescents between the ages of 12 and 17 diagnosed according to RDC criteria were matched with psychiatric comparisons and followed-up using a two stage design. Information upon the group as a whole was obtained using death records, criminal records and data from the Oxford Record Linkage System. A sub-sample of 21 matched pairs were interviewed using the Schedule for Affective Disorders and Schizophrenia--Life time version (SADS-L) and the Adult Personality Functioning Assessment (APFA). The outcome of adolescent schizophrenia was poor with 78% continuously ill and socially handicapped. Outcome was better for bipolar disorders and schizo-affective disorders and similar to psychiatric comparisons.

Adolescent↗
PubMed1994

Effects of lung volume and surface forces on maximal airway smooth muscle shortening.

The effects of lung volume and surface forces on airway smooth muscle shortening were studied in isolated perfused rat lungs. The lungs were inflated via the trachea with gas or Krebs solution (n = 12 each) to volumes equivalent to gas inflation pressures of 5 (low), 15 (medium), and 25 (high) cmH2O (n = 4 each). At each volume, two of the four lungs were perfused with methacholine (10(-2) M) and then all were perfused with Formalin for fixation. The amount of smooth muscle shortening present in transverse sections of the airways was determined by comparing the observed outer perimeter of the smooth muscle layer with its calculated relaxed perimeter. In the control lungs, mean shortening was < or = 10% in all groups except the liquid-filled lungs at low lung volumes [33 +/- 12% (SD)]. In the methacholine-stimulated lungs, mean shortening was between 45 and 56% at medium and low lung volumes in gas- and liquid-filled lungs, respectively, and approximated the degree of shortening required to cause airway closure. At high lung volume, less shortening was observed in the methacholine-stimulated lungs, either liquid (34 +/- 17%) or gas filled (16 +/- 19%; P < 0.05 compared with liquid filled). The effects of lung volume in liquid-filled lungs and the differences in response between gas- and liquid-filled lungs demonstrate, respectively, that both lung tissue recoil and surface forces act to oppose shortening of maximally stimulated smooth muscle.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1994

Reinjury prevention follow-through for clients with cumulative trauma disorders.

OBJECTIVES: Fifteen subjects with upper extremity work-related cumulative trauma disorders were involved in a quality improvement study to determine their self-reported degree of follow-through with reinjury prevention regimens. The effect of cuing was also studied. METHOD: During occupational therapy, subjects were involved in an educational session that focused on recommendations in ergonomic equipment, therapeutic maintenance techniques, body mechanics, and work simplification techniques. Follow-through with reinjury prevention education was evaluated and rated via telephone interviews approximately 2 weeks (T1) and 4 weeks (T2) after the educational session. Subjects did not know the questions they would be asked at T1, but were cued that their progress would be checked again at T2. Dependent t tests were conducted to compare the mean number of recommendations for which complete follow-through was expected with the mean number of recommendations at T1 and T2 that were implemented completely. RESULTS: A significantly lower degree was found of absolute completion of recommendations at T1 and T2 than had been anticipated (p < .002). No significant difference between T1 and T2 was found, indicating that cuing at T1 had little effect on subjects' actual follow-through rate. CONCLUSION: The implications of these findings for occupational therapists support the need for further research in reinjury prevention and employer education.

Adult↗
PubMed1994

Activities of daily living capabilities and values of long-term-care facility residents.

OBJECTIVE: The Minimum Data Set for Nursing Home Resident Assessment and Care Screening was used to compare staff-report and self-report of residents' capabilities in eight activities of daily living (ADLs) in one long-term-care facility (LTCF). METHOD: The relative values residents placed on independence in each of the eight ADLs were compared with their self-reported capabilities in those ADLs. Subjects were 30 LTCF residents ranging in age from 45 to 96 years. RESULTS: Residents perceived themselves to be significantly more capable than did staff members for dressing (p < .05), toileting (p < .01). locomotion (p < .05), and personal hygiene (p < .001). For five of the ADLs, residents tended to report high capability in the ALDs they valued most. CONCLUSION: These findings support the need to include resident self-assessment in treatment planning, because staff members' and residents' perceptions of ADL capabilities may differ.

Activities of Daily Living↗
PubMed1993

Transform or die.

Regions have an uncertain future in the new NHS. But if they make the right changes, they may yet play a key role, says Ann James.

Regional Health Planning↗
PubMed1993

Variability of the plateau response to methacholine in subjects without respiratory symptoms.

BACKGROUND: Interpretation of measurements of limited maximal airway narrowing, or plateau response, requires knowledge of its variability within subjects and between methods. METHODS: The repeatability of the plateau response to inhaled methacholine with a dosimeter (D) method (maximal dose 210 mumol) and a tidal breathing (T) method (730 mumol), and the agreement of the two methods, were measured in 16 subjects with mild or no asthma. Two tests by each method (D1,D2,T1,T2) were performed in random order over four consecutive days, with a third dosimeter (D3) test one week later. The dose producing a decrease in forced expiratory volume in one second (FEV1) of 10% (PD10) and the plateau were calculated from each dose-response curve. RESULTS: A plateau was reached in all five tests in 12 subjects and in all tests except D3 in 14 subjects. PD10 was inversely related to the plateau (r = -0.95 for D, r = -0.77 for T). The 95% ranges for differences between two determinations of the plateau in a subject were +/- 11.9% (change in FEV1), +/- 19.2%, and +/- 20.3%, estimated from D1-2 and 1-3, and T1-2 tests, respectively. From the same tests the 95% ranges for the difference of a single determination from an individual's true mean value were +/- 8.3%, +/- 13.6%, and +/- 14.3%. The limits of agreement between methods indicated that 95% of the measurements of the plateau by tidal breathing ranged from 15.2% below to 13.3% above those obtained by dosimeter. There was no significant bias between methods. Tachyphylaxis over 24 hours occurred with PD10 but not with the plateau response. CONCLUSIONS: The plateau response is a subject characteristic which is independent of the method of inhalation challenge testing. Repeatability of the plateau is low in this group of subjects with low airway responsiveness.

Adult↗
PubMed1993

The structure of large and small airways in nonfatal and fatal asthma.

Asthma is characterized by excessive airway narrowing and airway wall inflammation. In cases of fatal asthma, increased thickness of the airway wall is observed and may account for excessive airway narrowing when smooth muscle contracts. This study was undertaken to examine airway dimensions in large and small airways in both fatal and nonfatal cases of asthma. Airway wall areas (total, inner, and outer relative to smooth muscle layer), epithelial integrity, smooth muscle shortening, and the areas of smooth muscle, cartilage, and mucous glands were compared in transverse sections of large and small airways of subjects dying of asthma (fatal asthma, n = 11), those dying suddenly of nonrespiratory diseases and having a definite history of asthma (nonfatal asthma, n = 13), and those dying suddenly without any history of respiratory illness (control, n = 11). Airways were grouped by size using the basement membrane perimeter for comparison. All areas were expressed as areas per millimeter of basement membrane. In cartilaginous airways, the cases of fatal asthma had greater (p < 0.05) total wall, inner wall, outer wall, smooth muscle, mucous gland and cartilage areas than did control and nonfatal cases. The inner wall area was greater in the fatal and nonfatal cases than in the control cases (p < 0.05) in the small cartilaginous airways and membranous bronchioles (MB). In small MB (perimeter < 2 mm), the total and outer wall areas were greater (p < 0.05) in cases of fatal and nonfatal asthma than in control cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Has the process causing noninsulin dependent diabetes start at birth? Evidence in neonates from a population with a high prevalence of diabetes.

AIMS: to investigate whether differences in the glucose-insulin axis are present at birth in neonates from ethnic groups at high risk of diabetes. METHODS: fructosamine samples were taken from Maori, European and Pacific Island expectant mothers at their 28 week appointment at the public outpatients clinic at National Women's Hospital, Auckland. Umbilical cord samples for insulin, C-peptide and fructosamine assay were taken at delivery and babies had their subscapular skinfold fat thickness measured by callipers. RESULTS: the mean maternal 28 week fructosamine was similar in the three populations in spite of a higher prevalence of gestational diabetes among Pacific Islanders. Of the 1066 deliveries, cord samples were available for 207 Europeans, 81 Maoris and 113 Pacific Islanders. Both Pacific Island and Maori babies had higher cord fructosamine concentrations than European babies. However, Pacific Island babies were also heavier, and had higher cord insulin concentrations and subscapular skinfold thickness than European babies. CONCLUSIONS: the elevated cord fructosamine concentrations suggest that Maori and Pacific Island babies, who share a high risk of noninsulin dependent diabetes mellitus later in life, are hyperglycaemic at birth. The paradoxical insulin results and the cause for the relative neonatal hyperglycemia warrant further investigation.

Adult↗
PubMed1992

A model of airway narrowing in asthma and in chronic obstructive pulmonary disease.

We have examined the effect of airway wall thickening, loss of lung recoil, and airway smooth muscle shortening on the increase in airway resistance using a model of the human tracheobronchial tree. The values for airway wall thickening were determined morphometrically on the postmortem or surgically resected lungs of normal subjects, patients with moderate chronic obstructive pulmonary disease, and patients with severe asthma. Loss of recoil was simulated by deflating airways along their pressure-area curves by 1 to 3 cm H2O. Values of smooth muscle shortening between 20 and 40% were used in the model to generate sigmoidal-shaped "dose-response" curves. The analysis shows that moderate amounts of airway wall thickening, which have little effect on baseline resistance, can profoundly affect the airway narrowing caused by smooth muscle shortening--especially if the wall thickening is localized in peripheral airways. The combination of a loss of recoil and airway wall thickening are more than additive in their effect on simulated airway responsiveness. We conclude that airway wall thickening and a loss of lung recoil can partially explain the airway hyperresponsiveness observed in patients with chronic obstructive lung disease and asthma.

Airway Resistance↗
PubMed1992

Maximal airway narrowing in a general population.

To characterize airway responses in a population sample, respiratory symptoms, smoking habits, and changes in FEV1 (delta FEV1) to inhaled methacholine (maximal cumulative dose of 196 mumol or maximal decrease in FEV1 of 50%) were recorded in 201 subjects. From each dose-response curve the plateau (delta FEV1 less than or equal to 5% over two or more dose steps) response, the maximal response (average of responses on the plateau or maximal delta FEV1 when no plateau was present), slope, and PD20 (dose required to cause delta FEV1 greater than 20%) were derived. The pattern of dose-response curves was a continuous change from being flat (maximal delta FEV1 less than or equal to 5%), becoming steeper with a plateau that occurred at a greater change in FEV1 as the curves were shifted more to the left, to being the steepest without a plateau response. Maximal delta FEV1 was significantly related to the PD20 (r = -0.64, p less than 0.001) and the slope (r = 0.63, p less than 0.001). A history of doctor-diagnosed asthma or wheeze in the last 12 months was related to the level of the maximal delta FEV1 and to PD20. Likelihood ratios [LR = sensitivity/(1-specificity)] for asthma or wheeze were higher for a maximal delta FEV1 of 50% plus a PD20 of 4 mumol (LR = 6.5) or 1 mumol (LR = 7) than for either alone. Subjects without reported asthma or wheeze more often had a plateau on the dose-response curve (76%) than those with a positive history (49%, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Asthma↗