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Biomedical subjects

B Williams

Publications and source records attributed to B Williams.

At least 613 records · Page 34Linked to original sources
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Domestic water treatment appliances and the fluoride ion.

Specific ion metering of fluoride ion levels of water samples obtained after passage through water softeners and a conditioner showed no alteration in concentration when compared with controls. Similar comparison of water samples passed through water filters demonstrated that highly significant amounts of fluoride ion were removed. In one filter tested, 90% of the fluoride content was lost in the filtration process. The findings of this study suggest that, in a household using a filter, it may be necessary to increase the fluoride supplement or in some cases to initiate use of fluoride supplements as children are not receiving as much fluoride as was thought. New guidelines are required to take account of this surprising effect.

Filtration↗
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Virus sterilization in platelet concentrates with psoralen and ultraviolet A light in the presence of quenchers.

The virucidal and functional effect of the treatment of platelet concentrates (PCs) with long-wave ultraviolet light (UVA) and the psoralen derivative 4'-aminomethyl-4,5',8-trimethylpsoralen (AMT) was studied. Cell-free vesicular stomatitis virus (VSV) was completely inactivated (greater than or equal to 6.5 log10) on treatment of PCs with 25 micrograms per mL (85 microM) of AMT and with 20.7 J per cm2 (30 min) of UVA in the presence of air, or with 82.8 J per cm2 (2 hours) of UVA under conditions of reduced oxygen tension. When treatment was in air, the extent and rate of platelet aggregation in response to collagen measured after overnight storage were reduced to about 70 and 50 percent of control values, respectively; however, aggregation responses were similar to those of controls when PCs were treated under reduced oxygen tension. As a means of eliminating the necessity of oxygen depletion during AMT and UVA treatment, we examined the effects of the addition of quenchers of reactive oxygen species. The presence of 2 mM (2 mmol/L) mannitol during treatment of PCs with 25 micrograms per mL of AMT and 20.7 J per cm2 of UVA in air significantly improved the aggregation response and other in vitro indicators of platelet function and had little or no effect on VSV inactivation. Less benefit was observed with the other quenchers examined. Thus, the nucleic acid specificity of psoralen photoinactivation under reduced oxygen conditions may also be attainable when selected free radical scavengers such as mannitol are present during treatment in air.

Blood Platelets↗
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Prehospital interventions in children.

OBJECTIVES: Frequently performing procedures assists in skill maintenance. This study was conducted to characterize frequency and types of basic and advanced prehospital interventions performed on children. METHODS: A retrospective study was conducted over a three-month period from emergency medical services (EMS) units working in central Michigan. Data were collected for age, sex, at-scene time, total run time, basic procedures (e.g., spinal immobilization), and advanced procedures (e.g., venous access). RESULTS: A total of 535 EMS runs were reviewed. Runs were excluded for transport refusal (105) and site-to-site transfer (6). Of the remaining 424 children, 287 received an intervention (group 1) and 137 did not (group 2). Group 1 (9.5 +/- 5.6 years) was older (p < 0.001) than group 2 (6.0 +/- 5.8 years). There was no gender predominance between group 1 and group 2 (p = 0.06). In group 1 there were 104 patients who received multiple procedures. Basic procedures (n = 382) included spinal immobilization (149), oxygen administration (123), splinting (27), wound care (24), use of military anti-shock trousers (4), and cardiopulmonary resuscitation (1). Advanced procedures (n = 112) included venous access (65), medications of all routes (26), and cardiacoximetry monitoring (21). No child had an intraosseous line started and no child was successfully intubated. Only 82 of the 424 children (19.3%) had an advanced procedure. Group 1 at-scene times (16.1 +/- 8.1 min) were longer (p < 0.001) than those of group 2 (11.1 +/- 6.6 min). Total run times for group 1 (35.7 +/- 15.5 min) were longer (p < 0.001) than those for group 2 (26.7 +/- 11.3 min). CONCLUSIONS: Advanced EMS procedures were performed on only 19.3% of children. Opportunities to perform critical interventions (e.g., intubation) were rarely present. Children receiving procedures were older and had longer scene and run times.

Child↗
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Health care improvement and cost reduction opportunities in hypertensive Medicaid beneficiaries.

Hypertension and its complications are more frequent and occur about a decade earlier in life among high-risk groups, especially in the Southeast. Moreover, socioeconomic status is inversely related to hypertension and cardiovascular complications. Low-income, young and middle-aged adults living in the Southeast may be at especially high risk. Data on inpatient admissions among hypertensive Medicaid beneficiaries living in this region may provide insights on the burden of hypertension-related disease and on opportunities for successful intervention. A study of hospitalization rates and costs among 44,440 hypertensive Medicaid beneficiaries in South Carolina from 1993-1996 showed that 16,883 (38%) were continuously enrolled in Medicaid. Of this group, 63% were African American and 74% were women. Among the continuously enrolled patients, 7637, or about 45%, were hospitalized during the 4-year period. These 7637 individuals accounted for 20,698 hospital admissions, i.e., 2.7 admissions per person, over the 4-year interval. Nearly two thirds of the hospitalizations included a cardiovascular or renal diagnosis. Hospital claims paid reached nearly $90 million for the 7637 hypertensive Medicaid recipients during the 4-year period. Among patients discharged from the hospital with congestive heart failure, 33% filled a prescription for an angiotensin-converting enzyme inhibitor within 90 days; 13% of patients discharged with an acute myocardial infarction filled a prescription for a beta blocker within 90 days. The data confirm that hypertensive Medicaid beneficiaries in the Southeast are hospitalized at high rates. Cardiovascular and renal morbidity account for the majority of the inpatient admissions. The findings suggest that the application of evidence-based guidelines would improve health, avoid cost, and reduce racial disparities in health outcomes.

Cardiovascular Diseases↗
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Effects of age, parity, and adherence on pelvic muscle response to exercise.

OBJECTIVE: To examine factors that affect pelvic muscle response to 12 weeks of pelvic muscle exercise. DESIGN: Repeated measures design in which intravaginal pressures during pelvic muscle contractions were recorded at baseline and after four exercise levels. SETTING: College of Nursing research site in Gainesville, Florida. PARTICIPANTS: Eighty-five parous, community-dwelling women, aged 35-78 years and without incontinence as a primary concern. INTERVENTIONS: A 12-week graded program of regular (three times per week, every other day) pelvic muscle exercise at home. MAIN OUTCOME MEASURES: The hypotheses were that younger age, lower parity, higher baseline intravaginal pressures, and adherence to the pelvic muscle exercise program each would result in significant improvement in maximum intravaginal pressures. RESULTS: The only factor showing significance in predicting a successful outcome was age (t = -2.29, df = 41, one-tail probability = .0136). CONCLUSIONS: Regular, graded exercise over several weeks is needed to build pelvic muscles, and some women who exercise do not improve. Although the reasons for not improving are unclear, age is a significant factor.

Adult↗
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Differential effects of vascular endothelial growth factor-C and placental growth factor-1 on the hydraulic conductivity of frog mesenteric capillaries.

Vascular endothelial growth factors (VEGFs) are known to increase vascular permeability. VEGF-A acts on two receptor tyrosine kinases, VEGF receptor-1 (VEGF-R1 or flt-1) and VEGF receptor-2 (VEGF-R2, flk-1 or KDR). VEGF-C acts only on VEGF-R2 on vascular endothelial cells, whereas placental growth factor-1 (PlGF-1) acts only on VEGF-R1. The effects of perfusion of these receptor-specific proteins on hydraulic conductivity (L(p)) was measured in frog mesenteric capillaries. The effect of PlGF on L(p) was not conclusive, and overall fluid flux did not increase during that time. VEGF-C acutely and transiently increased L(p) (4.5 +/- 0.9-fold), which was more obvious in a subset of vessels, in a similar manner to that reported for VEGF-A. In the subset of vessels in which VEGF-C significantly increased L(p) acutely, there was a sustained 12-fold increase in L(p) 20 min after perfusion, but this was not seen in those vessels which did not respond acutely to VEGF-C, or in vessels exposed to PlGF-1. L(p) was also increased 24 h after perfusion with VEGF-C, but not with PlGF-1. Western blot analysis showed that VEGF-R1 and VEGF-R2 are both present in frog tissue. These data show that the VEGFs that stimulate VEGF-R2 chronically increase L(p), but not those that stimulate VEGF-R1 only. This supports the hypothesis that chronic increases in microvascular permeability induced by VEGF are mediated via activation of VEGF-R2 rather than VEGF-R1.

Animals↗
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Creating alliances for disease management in industrial settings: a case study of HIV/AIDS in workers in South African gold mines.

The epidemic of HIV/AIDS is at an advanced stage in many African countries, but little attention has been given to the impact that this will have in industrial settings. Using the Southern African mining industry as a case study, the authors consider the state of the HIV epidemic and discuss programs that have been undertaken to manage HIV. They critically analyze the reasons current interventions have had little impact on HIV among mine workers, tracing the lack of success to neglect of the social and community contexts within which HIV transmission takes place, as well as the lack of attention to the psychosocial processes and mechanisms underlying disease transmission. Finally, they present an intervention that aims to address the limitations of existing industrial programs and improve the management of sexually transmitted diseases (STDs), including HIV, in a particular occupational setting through creating alliances between a wide range of community stakeholders. The intervention aims not only to reduce STDs, promote awareness of HIV risks, and distribute condoms, as existing programs have done, but also to address the broader social, cultural, and community contexts that facilitate HIV transmission.

Acquired Immunodeficiency Syndrome↗
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The Pendine pathways project in the independent sector.

Recruitment and retention of staff, and the drive to provide quality care are challenges currently faced by nursing and residential homes in the independent sector. This article describes an innovative approach to tackling these issues. Under a teaching company scheme, a partnership was formed between the Pendine Park Nursing Home and the Centre for Learning Development to develop care and career pathways that are specific to the independent sector.

Career Mobility↗
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Recent trends in the use of domiciliary oxygen in England and Wales.

The volume of oxygen supplied to patients at home increased four-fold in the period 1982-89, largely due to the availability of oxygen concentrators on prescription since 1985. By 1989, health service expenditure on domiciliary oxygen reached 18 pounds million. Most users of long-term oxygen therapy suffer from chronic obstructive pulmonary disease, and many patients, eligible in terms of Department of Health and Social Security guidelines to receive long-term oxygen treatment, do not do so. However, the majority of those who receive oxygen, do so in amounts and for periods of the day which are below the levels known to prolong life or improve psychosocial functioning. A consensus of clinical opinion about the use of long-term oxygen therapy is needed. Without it, the use of this expensive service cannot be meaningfully audited.

Clinical Protocols↗
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Emerging role of the pediatric nurse practitioner in acute care.

The pediatric nurse practitioner role in the tertiary setting is one of several emerging roles gaining recognition in the various groups of advanced practice nursing programs today. The advanced practice nurse (APN) who is a pediatric nurse practitioner (PNP) in an acute care setting helps to provide cost-effective, quality patient care for critically and chronically ill children who are in these settings. The foundation of advanced practice nursing in this role incorporates the general role expectations of advanced nursing preparation, including case management, clinical pathway development, consultation and education, research, and collaboration, with the specific knowledge and skills of the pediatric nurse practitioner to function effectively with sick children in the acute care areas.

Case Management↗
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Someone to turn to.

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Humans↗
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Medication education.

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Drug Therapy↗