Search PubMed⌕ Search

Biomedical subjects

A Lowe

Publications and source records attributed to A Lowe.

At least 37 records · Page 2Linked to original sources
PubMed1999

Diagnostic monitoring in anaesthesia using fuzzy trend templates for matching temporal patterns.

A technique based on the concept of a 'fuzzy trend template' has been developed to identify characteristic patterns in multiple time-series. The method has its foundation in fuzzy logic and allows for the intuitive and transparent description of 'templates', which preserve nuances of vagueness, temporal relationships and quantitative descriptors. Evaluation of fuzzy trend templates can provide both belief and plausibility information for use in diagnostic applications. The technique has been applied to the diagnosis of specific problems in anaesthesia and has demonstrated sensitivity and specificity of 95 and 65%, respectively. Evaluation of fuzzy trend templates is, computationally, relatively efficient and has allowed a real-time implementation. The technique has the potential to be useful in any domain that requires temporal pattern recognition based on linguistic rules.

Anesthesia↗
PubMed1999

Computer-enhanced diagnosis of malignant hyperpyrexia.

A computer program using fuzzy logic templates has been developed to enhance the diagnosis of malignant hyperpyrexia. When tested, retrospectively, against the physiological changes that occurred during the onset of a bona fide malignant hyperpyrexia episode it made the diagnosis about 10 minutes before the anaesthetist. When tested against the changes associated with laparoscopic surgery, which has certain similarities, the diagnosis of malignant hyperpyrexia was very transient. The use of this program may assist the anaesthetist in the diagnosis of this rare event.

Algorithms↗
PubMed1999

Diagnostic image quality of mobile neonatal chest X-rays and the radiation exposure incurred.

A study was undertaken to identify the variation of entrance skin doses (ESDs) in mobile neonatal chest radiography with regard to the European Commission (EC) reference dose and to examine potential relationships with image quality and radiographic techniques. Five sites from the former North West Thames region participated. All mobile neonatal radiographic techniques were surveyed. Dose-area product per examination was directly measured and the ESD calculated. Image quality criteria were developed from those published by the EC. Image quality was graded by two independent observers. Over the five sites, 144 examinations were recorded. Calculated ESDs ranged up to 160 microGy, with an appreciable variation not only between sites but also within sites. A clear relationship between actual rather than nominal speed and dose over all sites was demonstrated (r = -0.95, p = 0.013). No correlation between image quality and dose was noted (r = -0.044, p = 0.665). Neonatal imaging systems at participating sites, within the North Thames region, comply with EC guidelines on patient dose and image quality for mobile chest X-rays. Significant variation in ESDs was encountered between sites with no discernible relationship with image quality or the employed radiographic techniques as described by the EC. The strong inverse relationship between ESDs and actual rather than nominal speed suggests a neglected aspect of radiation protection.

England↗
PubMed1998

Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis.

BACKGROUND: Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. METHODS AND RESULTS: Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for > or =6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166+/-26 to 148+/-22 mm Hg and from 86+/-14 to 80+/-11 mm Hg, respectively; P<0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74+/-4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92+/-4%) baseline renal function, fair (74+/-7%) in those with mildly impaired renal function, and poor (52+/-7%) in patients with elevated baseline creatinine levels (> or =2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. CONCLUSIONS: Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival.

Actuarial Analysis↗
PubMed1998

A preliminary exploration of the interactional skills of trainee surgeons.

BACKGROUND: The interactional skills of 21 surgical trainees were studied in the areas of breaking bad news to patients and preparing patients for potentially threatening medical procedures. When compared to the established guidelines for dealing with these issues, the trainees performed poorly. METHODS: Trainees were videotaped using clinical histories delivered by simulated patients in simulated consulting rooms. All videos were scored on standard rating scales where the criteria for rating the specific interactional skills were adopted from existing guidelines. RESULTS: The proportion of trainees who could meet the guidelines when breaking bad news was low. The proportion of trainees who met the guidelines were: closing the the consultation (0%), provided patient information about prognosis (43%) and treatment (38%) and when they gave support (10%). There were also low numbers of trainees who could meet the guidelines when they prepared patients for potentially threatening procedures. Ten per cent of trainees followed the guidelines when providing information, 25% could establish treatment goals, 35% could give a prognosis and 0% could deal appropriately with psychosocial issues or close the consultation appropriately. CONCLUSIONS: It is concluded that there is a need for further formal training in interactional skills as part of surgical training.

Clinical Competence↗
PubMed1998

Stent revascularization for atherosclerotic renal artery stenosis. 1-year clinical follow-up.

Patients who had undergone stent revascularization of renal artery stenosis for poorly controlled hypertension, preservation of renal function, or both were monitored to assess the procedure's effect upon subsequent renal function and blood pressure control. At 1-year follow-up, systolic and diastolic blood pressures had significantly decreased (166 +/- 26 to 156 +/- 25 mmHg and 86 +/- 14 to 80 +/- 13 mmHg, respectively; P < 0.05), and creatinine levels decreased or remained stable in approximately two thirds of the patients. Renal artery stent revascularization appears to have a beneficial effect upon blood pressure control and a nondeleterious effect upon renal function in the majority of patients.

Aged↗
PubMed1997

The beta3-adrenergic receptor in the obesity and diabetes prone rhesus monkey is very similar to human and contains arginine at codon 64.

The beta3-adrenergic receptor (ADRbeta3) is a seven-membrane spanning, G-protein linked receptor expressed in brown adipose tissue in rodents, and visceral adipose tissue in humans. Stimulation of the receptor by norepinephrine leads to lipolysis and thermogenesis. In rodent models of obesity and diabetes, administration of beta3-agonists results in weight loss and improved glucose tolerance. Studies indicate that the pharmacological properties of the ADRbeta3 differ markedly between rodents and humans, making generalizations of rodent studies to humans difficult. We hypothesized that the obesity and diabetes prone rhesus monkey (Macaca mulatta) would provide an excellent animal model to study the role of the ADRbeta3 in the development of obesity and diabetes as well as for assessment of the therapeutic efficacy of beta3-agonists. We sequenced the entire coding region of the rhesus ADRbeta3 gene. Like humans, the rhesus ADRbeta3 has two exons. There is 89% amino acid (aa) identity between human and rhesus compared to 82% aa identity between human and mouse. A single base deletion results in divergence of the intracellular carboxy terminus accounting for 26 of the 45 aa changes and 10 additional aa. Of the 15 rhesus monkeys studied, all were homozygous for Arg64. In humans, Arg64 (rather than Trp) is associated with increased body mass index, insulin resistance, and an earlier onset of type II diabetes mellitus. We conclude that the rhesus ADRbeta3 is more similar to the human ADRbeta3 than to the rodent ADRbeta3 suggesting that this primate model may be more appropriate for physiologic and therapeutic studies of the ADRbeta3 axis, and that Arg64 may influence susceptibility in this species to obesity, insulin resistance, and type II diabetes.

Amino Acid Sequence↗
PubMed1997

[Clinical monitoring. A method for quality control].

Clinical monitoring approximates the quality control standards that have been developed by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and utilizes clinical indicators to measure the relative quality of the health care given. This method can be used to compare the quality of desired care against actual day by day care. To demonstrate how it can be applied, an example of clinical monitoring performed in a U.S. hospital is presented.

Humans↗
PubMed1997

Measuring outcomes: a nursing report card.

Balancing quality health care with the pressures of managed care and restructuring requires monitoring and measuring outcomes. The "nursing report card" organizes data in an informative manner, allowing nursing's contributions to patient outcomes to be assessed and reported to all customers in an ongoing fashion.

Humans↗
PubMed1996

The vesicle-associated membrane protein family of proteins in rat pancreatic and parotid acinar cells.

BACKGROUND & AIMS: The vesicle-associated membrane protein (VAMP) family of proteins may play an important role in regulating enzyme secretion from pancreatic and parotid acini. The purpose of this study was to characterize the isoforms produced in pancreatic and parotid acini and determine their subcellular locations. METHODS: Using a battery of specific antisera and recombinant tetanus toxin light chain (which cleaves VAMP-2 and cellubrevin), the presence of each VAMP molecule in the acini was determined by immunoblotting of subcellular membrane fractions; their localization was determined by confocal immunofluorescence microscopy and immunogold electron microscopy. RESULTS: Both VAMP-2 and cellubrevin were present on both the zymogen granule membrane and plasma membrane. VAMP-1 was not present in the acinar cell but was found in the nerve endings innervating the acini. As expected, pancreatic acinar VAMP-2 and cellubrevin were sensitive to cleavage by recombinant tetanus toxin. CONCLUSIONS: VAMP-2 and cellubrevin may play integral roles in exocytosis of the pancreatic and parotid acinar cells, whereas VAMP-1 is restricted to nerves that innervate the acini and may function to modulate exocrine activity.

Animals↗
PubMed1996

Severe autosomal dominant hypertension and brachydactyly in a unique Turkish kindred maps to human chromosome 12.

Finding genes that cause human hypertension is not straightforward, since the determinants of blood pressure in primary hypertension are multifactorial. One approach to identifying relevant genes is to elucidate rare forms of monogenic hypertension. A relevant mutation may provide a rational starting point from which to analyse the pathophysiology of a condition affecting 20% of the world's population. In 1973 a family with autosomal dominantly inherited brachydactyly and severe hypertension, where the two traits cosegregated completely, was described. We have now re-examined this kindred, and localized the hypertension and brachydactyly locus to chromosome 12p in a region defined by markers D12S364 and D12S87. As the renin-angiotensin-system and sympathetic nervous system respond normally in this form of hypertension, the condition resembles essential hypertension. This feature distinguishes this form of hypertension from glucocorticoid remediable aldosteronism and Liddle's syndrome, which are salt-sensitive forms of monogenic hypertension with very low plasma renin activity. We suggest that identification of the gene involved in hypertension and brachydactyly and its mutation will be of great relevance in elucidating new mechanisms leading to blood pressure elevation.

Adult↗
PubMed1996

Cultural aspects of African American eating patterns.

The high mortality from diet-related diseases among African Americans strongly suggests a need to adopt diets lower in total fat, saturated fat and salt and higher in fiber. However, such changes would be contrary to some traditional African American cultural practices. Focus group interviews were used to explore cultural aspects of eating patterns among low- and middle-income African Americans recruited from an urban community in Pennsylvania. In total, 21 males and 32 females, aged 13-65+ years were recruited using a networking technique. Participants identified eating practices commonly attributed to African Americans and felt that these were largely independent of socioeconomic status. They were uncertain about links between African American eating patterns and African origins but clear about influences of slavery and economic disadvantage. The perception that African American food patterns were characteristically adaptive to external conditions, suggest that, for effective dietary change in African American communities, changes in the food availability will need to precede or take place in parallel with changes recommended to individuals. Cultural attitudes about where and with whom food is eaten emerged as being equivalent in importance to attitudes about specific foods. These findings emphasize the importance of continued efforts to identify ways to increase the relevance of cultural context and meanings in dietary counseling so that health and nutrition interventions are anchored in values as perceived, in this case, by African Americans.

Adolescent↗
PubMed1996

Reducing variation in patient care. Nursing responds to capitation.

As managed care and capitation methods of payment become more common to hospitals, a strategy to improve quality and reduce costs is introduced in response to these new pressures. Nursing leaders must take the initiative and respond to these changes by reducing the variations in patient care. The author describes seven initiatives undertaken by the nursing leaders of The St. Joseph Healthcare System in Albuquerque. New Mexico during a 3-year period. The success of these initiatives and their universal application is discussed.

Capitation Fee↗
PubMed1995

Bond strength, interfacial characterization, and fracture surface analysis for a new stress-breaking bonding agent.

Three commercial dentin bonding systems were analyzed by tensile bond testing, area analysis of fractured surfaces, and SEM analysis of the tooth-resin interfaces. Tensile bond strengths in megapascals(SD) were Tenure-Marathon V ([T-M]; 8.86[3.02]), new system with low-viscosity resin ([K-LVR-P]; 6.50[2.01]), and new system without low-viscosity resin ([K-P] = 7.28[1.75]), which were significantly greater than Scotch-bond 2-P50 ([SB-P50]; 3.96[1.02]). Gaps that ranged up to 5.6 microns (mean for the group) were observed around most of the restorations at dentin surfaces and less so at enamel surfaces, where some of the restorations remained free of gaps. The gaps near the dentin margin were significantly smaller for K-LVR-P than for SB-P50. The tensile test revealed mixed failure modes in all systems, and in the cross sections of class V restorations, the gaps were confined to the dentin-resin junction.

Analysis of Variance↗
PubMed1995

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's parameters for the practice of sleep medicine in North America. The 21 publications selected for this review describe 320 patients treated with oral appliances for snoring and obstructive sleep apnea. The appliances modify the upper airway by changing the posture of the mandible and tongue. Despite considerable variation in the design of these appliances, the clinical effects are remarkably consistent. Snoring is improved and often eliminated in almost all patients who use oral appliances. Obstructive sleep apnea improves in the majority of patients; the mean apnea-hypopnea index (AHI) in this group of patients was reduced from 47 to 19. Approximately half of treated patients achieved an AHI of < 10; however, as many as 40% of those treated were left with significantly elevated AHIs. Improvement in sleep quality and sleepiness reflects the effect on breathing. Limited follow-up data indicate that oral discomfort is a common but tolerable side effect, that dental and mandibular complications appear to be uncommon and that long-term compliance varies from 50% to 100% of patients. Comparison of the risk and benefit of oral appliance therapy with the other available treatments suggests that oral appliances present a useful alternative to continuous positive airway pressure (CPAP), especially for patients with simple snoring and patients with obstructive sleep apnea who cannot tolerate CPAP therapy.

Evaluation Studies as Topic↗