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Biomedical subjects

B James

Publications and source records attributed to B James.

At least 19 recordsLinked to original sources
PubMed2001

Decreased mortality after implementation of a treatment guideline for community-acquired pneumonia.

PURPOSE: We developed a pneumonia guideline at Intermountain Health Care that included admission decision support and recommendations for antibiotic timing and selection, based on the 1993 American Thoracic Society guideline. We hypothesized that guideline implementation would decrease mortality. SUBJECTS AND METHODS: We included all immunocompetent patients > 65 years with community-acquired pneumonia from 1993 through 1997 in Utah; nursing home patients were excluded. We compared 30-day mortality rates among patients before and after the guideline was implemented, as well as among patients treated by physicians who did not participate in the guideline program. RESULTS: We observed 28,661 cases of pneumonia, including 7,719 (27%) that resulted in hospital admission. Thirty-day mortality was 13.4% (1,037 of 7,719) among admitted patients and 6.3% (1,801 of 28,661) overall. Mortality rates (both overall and among admitted patients) were similar among patients of physicians affiliated and not affiliated with Intermountain Health Care before the guideline was implemented. For episodes that resulted in hospital admission after guideline implementation, 30-day mortality was 11.0% among patients treated by Intermountain Health Care-affiliated physicians compared with 14.2% for other Utah physicians. Analysis that adjusted by logistic regression for age, sex, rural versus urban residences, and year confirmed that 30-day mortality was lower among admitted patients who were treated by Intermountain Health Care-affiliated physicians (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.49 to 0.97; P = 0.04) and was somewhat lower among all pneumonia patients (OR: 0.81; 95% CI: 0.63 to 1.03; P = 0.08). CONCLUSION: Implementation of a pneumonia practice guideline in the Intermountain Health Care system was associated with a reduction in 30-day mortality among elderly patients with pneumonia.

Aged↗
PubMed2001

Clinical comparison of frequency doubling technology perimetry and Humphrey perimetry.

AIM: To determine the number of missed points on frequency doubling technology (FDT) perimetry that optimise the sensitivity and specificity of the test and to determine the topographical accuracy of the test in a clinical setting. METHODS: In a prospective study, the perimetric data from 99 patients who underwent both FDT perimetry in the screening mode and Humphrey 24-2 (H24-2) were used to determine the sensitivity and specificity of the FDT perimetry compared with the full threshold H24-2 as the gold standard. RESULTS: Missed points on the FDT perimetry correlated with both the mean deviation and the corrected pattern standard deviation on the Humphrey perimetry. A score assigned to abnormal points on the FDT perimetry and the Humphrey total deviation plot showed a significant correlation for both the location and the depth of the defect. In comparing the Humphrey hemifield test with the FDT perimetry results, if at least one missed point on the frequency doubling test was considered as abnormal then the overall sensitivity of the test was 78.1% and the specificity was 89.1%. CONCLUSION: FDT perimetry in the screening mode performed in a clinical setting was highly specific, exhibited reasonable sensitivity, and accurately determined the location and depth of scotomas when compared with the full threshold Humphrey 24-2.

Aged↗
PubMed2000

Effects on subject response of information brochures and small cash incentives in a mail-based case-control study.

PURPOSE: To investigate the impact on subject response of an information brochure and cash incentives included with mailed questionnaires in case-control studies. METHODS: A randomized trial was carried out within a case-control study investigating cancer in the Province of Ontario. Brochures were included with half of the mailed questionnaires sent to 7487 cases and 2561 controls. Controls were also sent cash incentives of $2, $5, or no money. RESULTS: With the brochure, response changed from 75.0% to 75.8% in cases, and from 70.3% to 71.1% in controls. Adjusting for differences in age, residence, sex, and cancer site/status, the change was 0.2% [95% confidence interval (CI) = -1.7-2.1] in cases, and 0.6% (95% CI = -3.1-4.3) in controls. The $2 and $5 incentives increased overall response in controls from 61.9% to 72.8% and 77.2%, respectively, i.e., by 10.9% (95% CI = 6.1-15.6) and 15.1% (95% CI = 10.4-19.7), after adjustment. This effect was largely confined to urban areas (for $2 and $5, respectively: 5.5% and 14.2% in Toronto, 15.3% and 20.4% in other urban areas vs. 2.7% and 1.0% in rural areas; p = 0.02). Response time showed little or no improvement when the brochure was included, but was markedly reduced for both the $2 and $5 incentives. CONCLUSIONS: Cash incentives can improve subject response in epidemiologic studies, whereas information brochures do not appear to have an effect.

Adult↗
PubMed1999

Spire contains actin binding domains and is related to ascidian posterior end mark-5.

Spire is a maternal effect locus that affects both the dorsal-ventral and anterior-posterior axes of the Drosophila egg and embryo. It is required for localization of determinants within the developing oocyte to the posterior pole and to the dorsal anterior corner. During mid-oogenesis, spire mutants display premature microtubule-dependent cytoplasmic streaming, a phenotype that can be mimicked by pharmacological disruption of the actin cytoskeleton with cytochalasin D. Spire has been cloned by transposon tagging and is related to posterior end mark-5, a gene from sea squirts that encodes a posteriorly localized mRNA. Spire mRNA is not, however, localized to the posterior pole. SPIRE also contains two domains with similarity to the actin monomer-binding WH2 domain, and we demonstrate that SPIRE binds to actin in the interaction trap system and in vitro. In addition, SPIRE interacts with the rho family GTPases RHOA, RAC1 and CDC42 in the interaction trap system. Thus, our evidence supports the model that SPIRE links rho family signaling to the actin cytoskeleton.

Actins↗
PubMed1998

Idiopathic intracranial hypertension presenting with gaze-evoked amaurosis.

PURPOSE: Gaze-evoked amaurosis is transient monocular visual loss induced by an eccentric position of gaze, most frequently associated with orbital mass lesions. To our knowledge, there has been no reported case of idiopathic intracranial hypertension as a cause of gaze-evoked amaurosis. We present the hypothesis that in an eccentric position of gaze, ischaemic compression of a tense dilated optic nerve sheath results in further elevation of intrasheath pressure compromising blood flow to the retina. METHOD: We describe a case of unilateral gaze-evoked amaurosis and headaches in a 46 year old man diagnosed with idiopathic intracranial hypertension. He did not respond to medical treatment and had optic nerve sheath decompressions. RESULT: Following surgery, this patient's visual function improved with resolution of his gaze-evoked amaurosis. CONCLUSION: Raised intracranial pressure associated with a tense dilated optic nerve sheath should be considered in the differential diagnosis of gaze-evoked amaurosis.

Blindness↗
PubMed1998

White-centred retinal haemorrhages (Roth spots).

Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be provided, along with the work-up of the differential diagnosis.

Endocarditis, Subacute Bacterial↗
PubMed1996

Ultrastructure study of the intramolluscan stages of Meiogymnophallus minutus (digenea: gymnophallidae) in Scrobicularia plana (bivalvia) from Portugal.

The ultrastructure of the tegument of the sporocyst and contained cercariae of Meiogymnophallus minutus found in Scrobicularia plana collected in Ria de Aveiro estuary (Portugal) were studied by scanning (SEM) and transmission electron microscopy (TEM). TEM revealed microvilli extending from the surface of the sporocyst tegument that contributed to the lacetrimmed surface morphology observed by SEM. The cercarial surface was papilliform and covered densely with single-pointed tegumental spines. On TEM, besides the spines and several mitochondria, translucid and electrondense spherical secretory vesicles were evident in the matrix of the tegument but were not seen on the sporocyst tegument. Uniciliate sensory receptors found in the cercaria of M. minutus were examined under SEM and TEM. Structural differences between the oral and the ventral sucker were observed. On the lip of the ventral sucker, large and strong spines were arranged in concentric rows, and two groups of six sensory papillae were placed concentrically and equidistantly. The oral sucker, surrounded by a crown of dense and long microvilli, exhibited a ring of uniciliate sensory papillae and some tegumental spines along the lip. The surface morphology of the M. minutus cercaria is compared with that of other Gymnophallidae cercariae.

Animals↗
PubMed1996

Purtscher's retinopathy.

Purtscher's retinopathy presents to the clinician as loss of vision in a patient with a history of a possible precipitating event such as recent major trauma, pancreatitis, childbirth or renal failure. The ophthalmological picture is one of ischaemia at the posterior pole with white patches of oedema and haemorrhages concentrated around the optic disc. The most probable pathological cause is embolisation of the peripapillary terminal arterioles supplying the superficial peripapillary capillary net. The nature of the embolic particles remains uncertain. Complement-mediated aggregates, fat, air, fibrin clots and platelet clumps may all be involved in what is most likely to be a multifactorial process. There is at present no recognised treatment for the condition.

Embolism↗
PubMed1996

Seasonal affective disorder: some epidemiological findings from a tropical climate.

OBJECTIVE: To determine whether a predominantly summer-focussed pattern of seasonal affective disorder (SAD) exists in tropical northern Australia. METHOD: A mail survey containing a modified form of the Seasonal Pattern Assessment Questionnaire (SPAQ) was administered to 176 households in the city of Townsville (latitude: 19 degrees south). RESULTS: Using previously reported screening criteria, 9% of respondents reported a degree of summer impairment indicative of SAD, while the incidence rate for winter SAD was 1.7%. This summer-winter ratio is typically reversed in more temperate latitudes. CONCLUSIONS: Excessive heat and humidity were reported to be the two most influential environmental factors affecting mood and behaviour. It is likely that respondents meeting criteria for summer SAD represent the extreme end of a spectrum of summer-related mood and behaviour change that affects many individuals in northern Australia. Strategies for further clinical and epidemiological research on SAD in tropical climates are proposed.

Adolescent↗
PubMed1995

Cappuccino, a Drosophila maternal effect gene required for polarity of the egg and embryo, is related to the vertebrate limb deformity locus.

We report the molecular isolation of cappuccino (capu), a gene required for localization of molecular determinants within the developing Drosophila oocyte. The carboxy-terminal half of the capu protein is closely related to that of the vertebrate limb deformity locus, which is known to function in polarity determination in the developing vertebrate limb. In addition, capu shares both a proline-rich region and a 70-amino-acid domain with a number of other genes, two of which also function in pattern formation, the Saccharomyes cerevisiae BNI1 gene and the Aspergillus FigA gene. We also show that capu mutant oocytes have abnormal microtubule distributions and premature microtubule-based cytoplasmic streaming within the oocyte, but that neither the speed nor the timing of the cytoplasmic streaming correlates with the strength of the mutant allele. This suggests that the premature cytoplasmic streaming in capu mutant oocytes does not suffice to explain the patterning defects. By inducing cytoplasmic streaming in wild-type oocytes during mid-oogenesis, we show that premature cytoplasmic streaming can displace staufen protein from the posterior pole, but not gurken mRNA from around the oocyte nucleus.

Amino Acid Sequence↗
PubMed1994

Tourette's syndrome in New Zealand. A postal survey.

It has become increasingly evident that Tourette's syndrome (TS) is not as rare as was once thought and substantial cohorts from various parts of the world have been reported. The clinical characteristics seem independent of culture as they appear to occur with some degree of uniformity irrespective of the country of origin. We investigated the point prevalence and report the clinical characteristics of TS in New Zealand. Forty probable cases were identified and the symptoms were similar to those described in cohorts from other parts of the world.

Adolescent↗