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Biomedical subjects

A O'Brien

Publications and source records attributed to A O'Brien.

At least 19 recordsLinked to original sources
PubMed2006

Current provision of rheumatology education for undergraduate nursing, occupational therapy and physiotherapy students in the UK.

OBJECTIVES: Rheumatological conditions are common and all health professionals (HPs) therefore need sufficient knowledge and skills to manage patients safely and effectively. The aim of this study was to examine current undergraduate education in rheumatology for HPs in the UK. METHODS: A questionnaire was sent to curriculum organizers and clinical placement officers for all undergraduate courses in adult nursing, occupational therapy (OT) and physiotherapy (PT) in the UK to ascertain the nature and amount of rheumatology theory and clinical exposure provided. RESULTS: Of the 47 adult nursing, 26 OT and 30 PT undergraduate courses surveyed, 85-90% responded. Overall, rheumatology teaching is 5-10 h over 3 yr. Nursing students receive moderate/in-depth teaching on rheumatoid arthritis (RA) in only 52% of courses (OT 91%, PT 96%) and on osteoarthritis (OA) in 63% (OT 91%, PT 92%). Clinical experience of RA is probably/definitely available in only 56% of nursing courses (OT 72%, PT 88%), with similar results in OA. Overall, nursing students receive the least rheumatology exposure, particularly in psychosocial issues and symptom management, while PT students receive the most. OT students have limited opportunities for clinical exposure to psychosocial and joint protection issues. Use of local rheumatology clinical HP experts is variable (18-93%) and cross-disciplinary exposure is limited (0-36%). Many educators consider their rheumatology training to be insufficient (nursing 50%, PT 42%, OT 24%). CONCLUSIONS: Rheumatology training for undergraduate HPs is limited in key areas and often fails to take advantage of local clinical expertise, with nursing students particularly restricted. Clinical HP experts should consider novel methods of addressing these shortfalls within the limited curriculum time available.

Allied Health Occupations↗
PubMed2006

Hospital at home for chronic obstructive pulmonary disease: an integrated hospital and community based generic intermediate care service for prevention and early discharge.

Recent randomized controlled studies have reported success for hospital at home for prevention and early discharge of chronic obstructive pulmonary disease (COPD) patients using hospital based respiratory nurse specialists. This observational study reports results using an integrated hospital and community based generic intermediate care service. The length of care, readmission within 60 days and death within 60 days in the early discharge (9.37 days, 21.1%, 7%) and the prevention of admission (five to six days, 34.1%, 3.8%) are similar to previous studies. We suggest that this generic community model of service may allow hospital at home services for COPD to be introduced in more areas.

Aged↗
PubMed2005

Evaluation of migration models that might be used in support of regulations for food-contact plastics.

Materials and articles intended to come into contact with food must be shown to be safe because they might interact with food during processing, storage and the transportation of foodstuffs. Framework Directive 89/109/EEC and its related specific Directives provide this safety basis for the protection of the consumer against inadmissible chemical contamination from food-contact materials. Recently, the European Commission charged an international group of experts to demonstrate that migration modelling can be regarded as a valid and reliable tool to calculate 'reasonable worst-case' migration rates from the most important food-contact plastics into the European Union official food simulants. The paper summarizes the main steps followed to build up and validate a migration estimation model that can be used, for a series of plastic food-contact materials and migrants, for regulatory purposes. Analytical solutions of the diffusion equation in conjunction with an 'upper limit' equation for the migrant diffusion coefficient, D(P), and the use of 'worst case' partitioning coefficients K(P,F) were used in the migration model. The results obtained were then validated, at a confidence level of 95%, by comparison with the available experimental evidence. The successful accomplishment of the goals of this project is reflected by the fact that in Directive 2002/72/EC, the European Commission included the mathematical modelling as an alternative tool to determine migration rates for compliance purposes.

Diffusion↗
PubMed2004

Macrophage responses to vascular stent coatings.

Diamond-like carbon (DLC) films have been proposed as potential coatings for blood-contacting devices. In this study, tetrahedral amorphous carbon (ta-C) films deposited by filtered cathodic vacuum arc system (FCVA) were compared with commercially deposited polyurethane coatings (PU) and uncoated stainless steel samples. X-ray reflectivity (XRR) measurements were performed to check density and thickness of the ta-C coatings, and contact angles measurements were used to assess surface wettability. J774 macrophages were used to assess the cell responses to the materials. Cell number, metabolic activity, and hydrogen peroxide production were measured by using biochemical assays, and the cell attachment and morphology were determined by using scanning electron microscopy and confocal laser scanning microscopy. Wettability measurements showed that of the materials, the stainless steel was the most hydrophilic, and the ta-C coatings were the most hydrophobic. Although the initial attachment and morphology did not appear to be dependent on the wettability, the cell numbers did increase with increasing wettability. Macrophages on the stainless steel samples were the most active in producing hydrogen peroxide. These data show that ta-C samples performed as well as commercial PU-coated samples in blocking cell reactions to the substrate and may prove to be effective coatings for blood-contacting materials.

Animals↗
PubMed2004

Interleukin-2, interferon-alpha and 5-fluorouracil immunotherapy for metastatic renal cell carcinoma: the all Ireland experience.

OBJECTIVE: To analyse the long-term efficacy of combined interferon-alpha (IFN-alpha) and interleukin-2 (IL-2) subcutaneously, with 5-fluorouracil (5-FU) intravenously in a general multicentre setting, as treatment for metastatic renal cell carcinoma (RCC). METHODS: Fifty-nine patients with metastatic RCC were scheduled to receive an 8-week cycle of immunotherapy. Karnofsky score ranged from 70 to 100 (median 90). Thirty-one patients at presentation had metastases of which 14 underwent nephrectomy. Metastases occurred in multiple organs (lung 74%, mediastinal lymphadenopathy 22%, bone 21%). Therapeutic response and survival were analysed. RESULTS: Nine patients died from disease progression prior to completion of one full cycle. Six cases (10%) have stable disease at a follow-up of 51 months (range 20-88 months). Currently 11 patients (19%) are alive at a mean follow-up of 45 months (range 18-88 months). Forty-eight patients (81%) died of their disease at a mean follow-up of 10 months (range 0.5-46 months). Survival rate at 1 year was 53%, at 2 years 21%, at 3 years 16% and at 5 years 5%. Overall median survival is 10 months. CONCLUSION: IL-2 and IFN-alpha with 5-FU based immunotherapy achieve durable survival rates at 3 years in a minority of patients. Addition of 5-FU does not increase survival in our group. This study population is very different to other reported series. However it reflects better the entire population with metastatic RCC though results are subsequently poorer. Identifying patients that will respond is paramount.

Adult↗
PubMed2002

Practical experience in the use of mathematical models to predict migration of additives from food-contact polymers.

To reduce the amount of compliance-specific migration testing for food-contact polymers, the use of migration modelling has been evaluated. The paper describes experimental work carried out on a range of plastics and compares measured migrations against predictions obtained using mathematical models. A large number of experimental migration data have been obtained and used to evaluate a Fickian-based migration model in the prediction of specific migration of additives into olive oil. All tests were conducted using olive oil, representing the most severe case for fatty foods with test conditions including 2h at 121 degrees C, 6h at 70 degrees C, 2h at 70 degrees C, 2h at 60 degrees C and 10 days at 40 degrees C, representing short-term exposures at high temperatures and room temperature storage. Predicted migrations were calculated by inputting the measured initial concentration of additive in the polymers (Cp,0) into the equations together with known variables such as additive molecular weight, temperature and exposure time. The results indicate the Piringer migration model, using the 'exact' calculations of the Migratest Lite program, predicted migrations into olive oil that were close to or in excess of the experimental results and gave an overestimation for > 95% of the migrations generated here.

Food Contamination↗
PubMed2001

Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction.

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.

Administration, Inhalation↗
PubMed2001

"Anorexia saved my life": coincidental anorexia nervosa and cerebral meningioma.

OBJECTIVE: We report on a 13-year-old girl with coincidental occult intracranial tumor and early-onset anorexia nervosa. METHOD: The cerebral meningioma was discovered fortuitously as the result of a research project using SPECT imaging to locate a neurobiological substrate in patients with anorexia nervosa. Without SPECT, the meningioma would have remained undiagnosed until it had become symptomatic. The two conditions appear to have been completely unrelated. RESULTS AND DISCUSSION: The case highlights two important points. First, intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective.

Adolescent↗
PubMed2001

Determination of wave speed and wave separation in the arteries.

Considering waves in the arteries as infinitesimal wave fronts rather than sinusoidal wavetrains, the change in pressure across the wave front, dP, is related to the change in velocity, dU, that it induces by the "water hammer" equation, dP=+/-rhocdU, where rho is the density of blood and c is the local wave speed. When only unidirectional waves are present, this relationship corresponds to a straight line when P is plotted against U with slope rhoc. When both forward and backward waves are present, the PU-loop is no longer linear. Measurements in latex tubes and systemic and pulmonary arteries exhibit a linear range during early systole and this provides a way of determining the local wave speed from the slope of the linear portion of the loop. Once the wave speed is known, it is also possible to separate the measured P and U into their forward and backward components. In cases where reflected waves are prominent, this separation of waves can help clarify the pattern of waves in the arteries throughout the cardiac cycle.

Arteries↗
PubMed2001

Compliance with CPAP therapy in older men with obstructive sleep apnea.

OBJECTIVES: Factors specifically affecting compliance with continuous positive airway pressure (CPAP) in older patients with obstructive sleep apnea (OSA) have not been described. The purpose of this study is to determine which factors are associated with compliance and noncompliance in older patients, a growing segment of the population. DESIGN: A retrospective chart review of older male patients prescribed CPAP therapy for OSA over an 8-year period. SETTING: Veterans Affairs Medical Center. PARTICIPANTS: All patients age 65 and older for whom CPAP therapy had been prescribed for treatment of OSA in the past 8 years. MEASUREMENTS: Records of all older male patients prescribed CPAP therapy for OSA over the last 8 years were reviewed. Compliance was defined by time-counter readings averaging 5 or more hours of machine run-time per night. RESULTS: Of 33 older male patients with OSA studied, 20 were found to be compliant and 13 noncompliant with nasal CPAP therapy. The mean age (+/- SEM) at the time of diagnosis of OSA in the compliant group was 68 (+/-1) years, whereas that of the noncompliant group was 72 (+/-1) years (P <.05). Of the compliant patients, 95% attended a CPAP patient education and support group, whereas only 54% of noncompliant patients attended (P =.006). Resolution of initial symptoms of OSA with CPAP therapy was significantly associated with compliance. Symptom resolution occurred in 90% of compliant patients and in only 18% of noncompliant patients (P <.0002). Factors that were significantly associated with noncompliance with CPAP were cigarette smoking, nocturia, and benign prostatic hypertrophy (BPH). Of noncompliant patients, 82% complained of nocturia, whereas only 33% of compliant patients complained of nocturia (P =.02). BPH was diagnosed in 62% of noncompliant patients and in only 15% of compliant patients (P =.004). Diuretic use was more common in the compliant group and, therefore, was not a cause of increased nocturia in noncompliant patients. CONCLUSION: In older male patients with OSA, compliance with CPAP therapy is associated with attendance at a patient CPAP education and support group. Resolution of symptoms with therapy also appears to be associated with enhanced compliance. In addition, we found an association between nocturia and the existence of BPH in older men with OSA who are not compliant with nasal CPAP. Larger observational studies should be performed to confirm these findings, and, if so confirmed, then further studies to determine whether treatment of BPH in older men with OSA improves compliance with CPAP.

Age Factors↗
PubMed2001

Polymer additive migration to foods--a direct comparison of experimental data and values calculated from migration models for polypropylene.

To reduce the amount of compliance testing for food contact polymers the use of migration modelling is under discussion and being evaluated by an EU Commission funded project (Evaluation of Migration Models No. SMT4-CT98-7513). The work reported in this paper was exclusively funded by industry to provide data for the independent evaluation of a diffusion based model using eight different samples of polypropylene (PP) covering the range of polymers specification and five commonly used plastics additives. One hundred and fifty experimental migration data have been obtained in triplicate and used to evaluate a Fickian-based migration model in the prediction of specific migration of five additives into olive oil. All tests were conducted using olive oil, representing the most severe case for fatty foods, with test conditions of 2h at 121 degrees C, 2h at 70 degrees C and 10 days at 40 degrees C, representing short term exposures at high temperatures and room temperature storage. Predicted migration values were calculated using the Piringer 'Migratest Lite' model by entering the measured initial concentration of additive in the polymers(Cp.0) in to the equations together with known variables such as additive molecular weight, temperature and exposure time. Where necessary the data generated in this study have been used to update the model. The results indicate the Piringer migration model, using the 'exact' calculations of the Migratest Lite program, predicted migration values into olive oil close to, or in excess of, the experimental results for > 97% of the migration values generated in this study. For all measurements, the predicted migration from the Migratest Lite program was greater than 70% of the observed value. This study has identified the possibility, that random co-polymers of propylene and ethylene give higher migration than other grades of polypropylenes and could be treated as a separate case. However, further work on more samples of random co-polymers is required to confirm this finding.

Chromatography, High Pressure Liquid↗
PubMed2001

The linguistic and cognitive profile of Down syndrome: evidence from a comparison with fragile X syndrome.

In this paper, we report on the results of our research, which is designed to address two broad questions about the cognitive and linguistic profile of Down syndrome: (1) Which domains of functioning are especially impaired in individuals with Down syndrome? and (2) Which aspects of the language and cognitive profile of Down syndrome are syndrome specific? To address these questions, we focused on three dimensions of the Down syndrome profile--receptive language, expressive language, and theory of mind--and made comparisons to individuals with fragile X syndrome, which is an X-linked form of intellectual disability. We identified Down syndrome impairments on all three dimensions that were substantially greater than those seen in nonverbal cognition and that were not shared by individuals with fragile X syndrome. Clinical implications of these findings are considered.

Cognition Disorders↗