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Biomedical subjects

C Byrne

Publications and source records attributed to C Byrne.

At least 55 records · Page 3Linked to original sources
PubMed1999

The quick response initiative in the emergency department: who benefits?

OBJECTIVES: This collaborative project between two community hospitals, a Metropolitan Home Care Program and the University, was designed to quantify the applicability (who is eligible for) and acceptability (who will likely comply with) Home Care services, provided through a Quick Response Program (QRP) initiative as compared to usual hospital care services, to patients, families and physicians. METHODS: During a 6 week period of sampling (5 days per week, 8 hours per day) in two Emergency Departments (ED) in moderately sized community hospitals in a major metropolitan city, all patients triaged to the urgent category were assessed for eligibility for QRP services by on-site Home Care Coordinators using specific criteria. Patients meeting the criteria initially were reviewed by the ED physician for approval for QRP services and then randomized to experimental and control conditions. Patients not meeting the eligibility criteria were managed by the usual ED services procedures. Demographic and clinical data were obtained on all urgent category patients at presentation to the ED. Additionally, the nature and cost of all health care services used by the ED patients during the ED event and 10 days follow up, were obtained through hospital and Home Care record abstraction and compared among the different sample groups. RESULTS: The QRP Initiative was applicable to 2% of the total ED patient population and 5% of the urgent category of patients triaged in the ED. It was acceptable to 97% of this eligible group. One hundred and fifty-five patients who initially qualified for QRP were excluded from eligibility at a subsequent assessment. Ninety of these patients were admitted to hospital and 65 were discharged home. In the total "exclusion" group, 37 refused Home Care services including the QRP. HEALTH CARE PRACTICE IMPLICATIONS: The sampling results raise important questions about broader system issues concerning the role of the hospital and community in providing health care services and the social value or utility that guides the allocation of health care funds. What level of applicability and acceptability would justify priority services for certain target groups. In the future, policy makers will need to be able to show that it is in the best interest of patients and society to prioritize mixtures of services to certain target groups.

Adult↗
PubMed1999

Economic evaluations of community-based care: lessons from twelve studies in Ontario.

A series of 12 studies (five historic cohort and seven randomized trials) examined clients in community settings in Southern Ontario suffering from a variety of chronic physical and mental health conditions. These studies are appraised using a framework for evaluating possible outcomes of economic evaluation. In the 12 studies, sample composition and size varied. Each study was designed to quantify the well-being outcomes and expenditures associated with different community-based approaches to care provided in the context of a system of national health insurance. As a collective, these studies represent increasing methodological rigour. Multiple-perspective client well-being outcome measures were used. In two studies, caregiver burden also was analysed. A common approach to quantification and evaluation of expenditures for service consumption was used in all 12 studies. The nature of community-based health services (health vs. disease care orientation) was found to have direct and measurable impact on total expenditures for health service utilization and client well-being outcomes. In most cases, a recurring pattern of equal or better client outcomes, yet lower expenditures for use of community based health services, was associated with well-integrated health oriented services. Integrated services aimed at factors which determine health are superior when compared to individual, fragmented, disease oriented, and focused approaches to care. The main lessons from the 12 studies are that it is as or more effective and as or less expensive to offer complete, proactive, community health services to persons living with chronic circumstance than to provide focused, on-demand, piecemeal services. Complete services would have a psychosocial and mental health focus included with the physical care approach. Furthermore, people with coexisting risk factors (age, living arrangements, mental distress and problem-solving ability) are the ones who most benefit at lower expense from health oriented, proactive interventions.

Cohort Studies↗
PubMed1999

Barrier formation in the human fetus is patterned.

We recently demonstrated patterned stratum corneum maturation and skin barrier formation during fetal development in rodents and rabbit. The presence of skin patterning in these mammals led us to predict patterned barrier formation during human infant development. Here we extend our mammalian study and demonstrate patterned stratum corneum development and skin barrier formation in the pre-term human infant. Surprisingly, we show initiation of human barrier regionally as early as 20-24 wk gestational age (22-26 wk menstrual age), bringing barrier formation close to the time of periderm disaggregation. We use the mouse model to show that patterns of periderm disaggregation mirrors barrier formation. Periderm disaggregation follows and recapitulates barrier pattern, suggesting a relationship between the processes. This work reveals regional patterning in skin maturation and barrier formation in the human infant and demonstrates that initiation of human skin barrier formation in utero coincides with the current lower limit of viability of the pre-term infant.

Animals↗
PubMed1999

A comparison of drop jump training methods: effects on leg extensor strength qualities and jumping performance.

The purpose of this study was to determine the effects of two drop jump (DJ) training methods on the strength qualities of the leg extensors and vertical jumping performance. Thirty-five males were allocated to either a control group or one of two training groups, required to perform 72-90 DJ per week for 6 weeks: DJ for maximum rebound height (DJ-H) or DJ for maximum height and minimum ground contact time (DJ-H/t). The subjects were tested before and after the training on leg extensor function for maximum strength and speed-strength under concentric and stretch-shortening cycle muscular actions, and on vertical jumps from a standing position and a run-up. ANOVA with repeated measures showed that a 20% gain in reactive strength (RS) for the DJ-H/t group was significantly greater (p < 0.05) than the other groups, however, this did not transfer to vertical jumping performance. The DJ-H group did not achieve a significant training effect. It was concluded that DJ-H/t method was effective for the development of RS, but training with DJ-H was not intense and/or specific enough to stimulate gains in strength qualities of the leg extensors or jumping performance.

Adult↗
PubMed1999

Association of age and reproductive factors with benign breast tissue composition.

Reproductive breast cancer risk factors are hypothesized to act by increasing exposure of the breast to endogenous estrogens, but few studies have quantitatively examined the association of these risk factors with breast tissue composition. This study is part of a case-control study of breast histological characteristics and breast cancer risk, nested within the Nurses' Health Study, a prospective study of 121,700 registered nurses. We studied 300 women who had not been diagnosed with breast cancer, but for whom we obtained slides from a prior benign breast biopsy. We used a computer-assisted image analysis technique to assess the proportion of epithelial and fibrous stromal tissue on benign breast biopsy slides, excluding obvious mass lesions. Mean epithelial proportion was 5.3% (0.1-23%), and mean stromal proportion was 58.7% (3-93%). Women with proliferative breast disease without atypia had higher epithelial and stromal proportions than women with nonproliferative breast disease (P < 0.001). Postmenopausal women had a lower epithelial proportion (P = 0.01), and increasing age at biopsy was associated with decreasing stromal proportion among postmenopausal parous women (P = 0.004). Among premenopausal women, increasing years since last birth was associated with lower epithelial proportion (P < 0.001). Other reproductive risk factors were not independently associated with epithelial or stromal proportion. Epithelial and stromal breast tissue were associated with different factors with the exception of proliferative breast disease, which was associated with an increase in both epithelial and stromal proportion. The quantitative measurement of epithelial and stromal proportion may be useful for measuring changes in breast composition.

Age Factors↗
PubMed1999

Randomized controlled trial of general practitioner versus usual medical care in a suburban accident and emergency department using an informal triage system.

We determined if care provided by general practitioners (GPs) to non-emergency patients, in a suburban accident and emergency (A&E) department using an informal triage system, differs significantly from care provided by usual A&E staff. One thousand eight hundred and seventy-eight patients participated. By comparison with usual A&E staff, GPs prescribed significantly more often (percentage relative difference [% RD] = 12 [95% confidence interval = 1-23]) and referred more patients to hospital (% RD = 21 [95% CI = 9-33]). This is the first study to report that sessional GPs working in an A&E department utilize similar or more resources than usual A&E staff. It emphasizes the need for the continued audit of initiatives that have been introduced into new settings.

Emergency Service, Hospital↗
PubMed1999

Relationship between strength qualities and performance in standing and run-up vertical jumps.

BACKGROUND: The purpose of this investigation was to determine the relationships between the strength qualities of the leg extensor musculature and performance in vertical jumps (VJ) performed from a standing position and a run-up. METHODS: Twenty-nine males with experience in jumping activities were tested for vertical jumping capacities with a standing VJ (double leg takeoff) and run-up jumps from a 1, 3, 5 and 7 stride approach (single leg takeoff). The speed-strength and maximum strength qualities of the leg extensors were assessed by tests involving concentric, stretch-shortening cycle (SSC) and isometric muscular actions. Pearson's correlations and stepwise multiple regression was performed to describe the relationships with jumping performance. RESULTS: The speed-strength tests correlated significantly with both jump types (r = 0.55-0.82), but maximum strength did not. A drop jump test considered to measure reactive strength correlated more strongly with the run-up jump than the standing VJ. The standing VJ was best predicted by a low stretch load SSC test, whereas the run-up jump was best predicted by a model that also including the test of reactive strength. CONCLUSION: The role of maximum strength in jumping performance was not clear but speed-strength qualities were considered important. It was concluded that reactive strength is relatively more important for jumping from a run-up than for the standing VJ, and this should be reflected by appropriate training methods and test protocols for the assessment of athletes who jump.

Adult↗
PubMed1998

Surviving social assistance: 12-month prevalence of depression in sole-support parents receiving social assistance.

BACKGROUND: Although it is generally recognized that poverty and depression can coexist among single parents receiving social assistance, there is insufficient research on this topic. The goals of this study therefore were to investigate the prevalence, correlates and health care expenditures associated with depression among sole-support parents receiving social assistance. METHODS: Sole-support parents who had applied for social assistance in 2 regions of southwestern Ontario were included in the study. Depression was diagnosed with the 1994 University of Michigan Composite International Diagnostic Interview short forms. RESULTS: The 12-month prevalence rate of depressive disorder among the parents interviewed was 45.4% (345/760). A total of 247 (32.5%) had major depressive disorder alone, 19 (2.5%) had dysthymia, and 79 (10.4%) had both major depressive disorder and dysthymia ("double depression"). Those with major depressive disorder, particularly double depression, had significantly higher rates of coexisting psychiatric disorder than those without depressive disorders. Parents with depression reported higher rates of developmental delay and behaviour problems in their children than parents without depression. Expenditures for health care services were higher for parents with depression and for their children than for parents without depressive disorder and their children. INTERPRETATION: Single parents receiving social assistance have high rates of depression. Such parents with depression also have higher rates of other psychiatric disorders and higher expenditures for health care services, and their children have higher rates of developmental delay and behaviour problems.

Adaptation, Psychological↗
PubMed1998

Control of a nosocomial outbreak of vancomycin resistant Enterococcus faecium in a paediatric oncology unit: risk factors for colonisation.

UNLABELLED: In order to determine the extent of vancomycin resistant enterococcus (VRE) colonisation within a paediatric oncology unit, the risk factors for the acquisition of the organism, the molecular epidemiology of the isolates and the impact of infection control measures, extensive patient and environmental surveillance was undertaken with identification, antibiotic susceptibility testing and pulsed-field gel electrophoresis (PFGE) of all VRE isolates. A matched case control study was carried out. Fourteen patients (19% of screened patients) with VRE colonisation were identified (12 with Enterococcus faecium). All isolates manifested the Van A phenotype. Extensive environmental contamination with VRE was present. PFGE of E. faecium isolates from 10 patients and from five of six environmental cultures revealed patterns suggesting genetic relatedness. Following comparison of the 14 cases with 41 controls matched for age (+/- 4 years) and cohabitation on the oncology unit, risk factors for colonisation with VRE included duration of neutropenia, (OR, 3.72; 95% CI, 1.0-13.1), and antibiotic therapy, (OR, 4.07; 95% CI, 1.08-15.3), the number of antibiotic agents received, (OR, 8.4; 95% CI, 1.34-34.3) and the duration of therapy with amikacin, (OR, 10.7; 95% CI, 1.4-81.5), ceftazidime, (OR, 11.5; 95% CI, 2.2 59.9) or teicoplanin, (OR, 12.3; 95% CI, 2.25-67.4). Implementation of stringent infection control measures reduced environmental contamination from 25% of samples in week 1 to none in week 11. Two additional colonised patients were identified during the subsequent 6 months. CONCLUSION: Risk factors for VRE colonization in paediatric oncology patients included duration of neutropenia, duration of any antibiotic therapy, exposure to ceftazidime, amikacin or teicoplanin and the number of antibiotics used. The study suggests that environmental contamination played an important role in patient-to-patient transmission of VRE and interventions including implementation of infection control measures were associated with a decreased incidence of gastro-intestinal colonisation.

Adolescent↗
PubMed1998

The AEP T-complex to synthesised musical tones: left-right asymmetry in relation to handedness and hemisphere dominance.

Auditory evoked potentials were recorded to onset and offset of synthesised instrumental tones in 40 normal subjects, 20 right-handed for writing and 20 left-handed. The majority of both groups showed a T-complex which was larger at the right temporal electrode (T4) than the left (T3). In the T4-T3 difference waveforms, the mean potential between latencies of 130 and 165 ms was negative in all right-handed subjects except two for whom the waveforms were marginally positive-going. Amongst the left-handers, however, this converse asymmetry was seen in 7 subjects, 5 of them more than 2 standard deviations from the mean of the right-handed group. The degree of asymmetry was not significantly correlated with the degree of left-handedness according to the Edinburgh Handedness Inventory. Asymmetry of the T-complex to instrumental tones appears to reflect the lateralisation of auditory 'musical' processing in the temporal cortex, confirming evidence from other sources including PET that this is predominantly right-sided in the majority of individuals. The proportion of left-handers showing the converse laterality is roughly in accordance with those likely to be right-hemisphere-dominant for language. If linguistic and 'musical' processes are consistently located in opposite hemispheres, AEPs to complex tones may prove a useful tool in establishing functional lateralisation.

Acoustic Stimulation↗
PubMed1998

GM-CSF receptor targeted treatment of primary AML in SCID mice using Diphtheria toxin fused to huGM-CSF.

The severe combined immunodeficient (SCID) mouse model may be used to evaluate new approaches for the treatment of acute myeloid leukemia (AML). We have previously demonstrated the killing of SCID mouse leukemia initiating cells by in vitro incubation with human GM-CSF fused to Diphtheria toxin (DT-huGM-CSF). In this report, we show that in vivo treatment with DT-huGM-CSF eliminates AML growth in SCID mice. Seven cases of AML were studied. SCID mice were treated intraperitoneally with the maximally tolerated dose of 75 microg/kg/day for 7 days. Antileukemic efficacy was determined at days 40 and 80 after transplantation, by enumerating the percentages of human cells in SCID bone marrow using flow cytometry and short tandem repeat polymerase chain reaction (STR-PCR) analysis. Four out of seven AML cases were sensitive to in vivo treatment with DT-huGM-CSF at both evaluation time points. In three of these cases, elimination of human cells was demonstrated by flow cytometry and STR-PCR. One AML case showed moderate sensitivity for DT-huGM-CSF, and growth of the two remaining AML cases was not influenced by DT-huGM-CSF. Sensitivity was correlated with GM-CSFR expression. Our data show that DT-huGM-CSF can be used in vivo to reduce growth of AML and warrant further development of DT-huGM-CSF for the treatment of human AML.

Animals↗
PubMed1998

Patterned acquisition of skin barrier function during development.

Skin barrier function is conferred by the outer layer of epidermis, the stratum corneum, and is essential for terrestrial life. Quantitative trans-epidermal water loss assays show that barrier forms late in embryogenesis, permitting the foetus to survive a terrestrial environment at birth. Using qualitative in situ assays for skin permeability, we show that barrier forms in a patterned manner late in mouse gestation. Barrier forms at specific epidermal sites, then spreads around the embryo as a moving front. The moving front of permeability change is accompanied by multiple changes in the outer, stratum corneum-precursor cells. We use the permeability assays to show that final stages of cornified envelope assembly are coordinated with initial stages of barrier formation. Hence the whole-mount permeability assays record developmental acquisition of a known, essential component of the adult barrier. We demonstrate the authenticity of the whole-mount assays after maternal glucocorticoid therapy (known to accelerate barrier formation) and in additional species including the rat where barrier formation is well characterized by TEWL assay (Aszterbaum, M., Menon, G. K., Feingold, K. R. and Williams, M. L. Pediatr. Res. 31, 308-317). The demonstration of patterned barrier formation in other species suggests patterned change as the universal mode of embryonic barrier acquisition. These results highlight the importance of patterning as a mode of epidermal maturation during development.

Animals↗
PubMed1998

Predictors of dietary heterocyclic amine intake in three prospective cohorts.

Cooking meat creates heterocyclic amines (HCAs) through pyrolysis of amino acids and creatinine. Although recognized as mutagenic, the etiological role of HCA in human cancer is unclear, due to the lack of information on the effect of typical food cooking methods on HCA concentrations and on variation in HCA exposure in populations. We estimated overall daily dietary HCA intake and variation in intake between individuals, using recent data on HCA concentrations in various meats prepared by cooking methods, temperatures, and times common in United States in the 1990s. Random samples of 250 participants from each of three large prospective cohorts were mailed a questionnaire to assess frequency of consumption, cooking method, and typical outside appearance of pan-fried, broiled, and grilled or barbecued chicken, fish, hamburger, and steak; fried, microwaved, and broiled bacon; fried sausage; roast beef; and homemade gravy. The 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQx), 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine (PhIP), and 2-amino-3,4,8-trimethylimidazo[4,5,f]quinoxaline (DiMeIQx) concentrations, measured in composite samples by solid-phase extraction and high-performance liquid chromatography, were assigned to each food, cooking method, and doneness level. The dietary reports showed approximately 30-fold relative variation in 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline intake, 20-fold for 2-amino- -methyl-6-phenylimidazo[4,5-b]pyridine, and over 110-fold for 2-amino-3,4,8-trimethylimidazo[4,5,f]quinoxaline, when the 10th and 90th percentiles of HCA intake were compared (90th/10th percentile value). These reported variations in HCA exposure among participants in these three large cohorts indicates that estimation of HCA intake and determination of association with disease risk are feasible, if additional information on meat cooking methods is obtained.

Adult↗
PubMed1997

Geographic variation in breast cancer incidence rates in a cohort of U.S. women.

BACKGROUND: Breast cancer mortality and incidence rates vary by geographic region in the United States. Previous analytic studies have measured mortality, not incidence, and have used regional prevalences to control for geographic variation in risk factors rather than adjusting for risk factors measured at the level of the individual. We prospectively evaluated regional variation in breast cancer incidence rates in the Nurses' Health Study and assessed the influence of breast cancer risk factors measured at the individual level. METHODS: The Nurses' Health Study cohort was established in 1976 when 121700 female nurses aged 30-55 years living in 11 U.S. states were enrolled. These states represent all four regions of the continental United States. We identified 3603 incident cases of invasive breast cancer through 1992 (1794565 person-years of follow-up). We calculated relative risks (RRs) adjusted for age and for age and established risk factors (i.e., multivariate-adjusted analysis), comparing California, the Northeast, and the Midwest with the South. RESULTS: For premenopausal women, there was little evidence of regional variation in breast cancer incidence rates, either in age-adjusted or in multivariate-adjusted analyses. For postmenopausal women in California, age-adjusted risk was modestly elevated (RR = 1.24; 95% confidence interval [CI] = 1.05-1.47); after adjusting for age and for established risk factors, the excess rate in California was attenuated by 25% (RR = 1.18; 95% CI = 1.00-1.40). No excess of breast cancer incidence was observed for postmenopausal women in either the Northeast or the Midwest. CONCLUSIONS: Little regional variation in age-adjusted breast cancer incidence rates was observed, with the exception of a modest excess for postmenopausal women in California. Adjustment for differences in the distribution of established risk factors explained some of the excess risk in California.

Adult↗
PubMed1997

Effect of a covalently attached synergistic anion on chelator-mediated iron-release from ovotransferrin: additional evidence for two concurrent pathways.

The mechanism by which the iron-transport protein transferrin releases its iron in vivo is presently unclear. In vitro studies have implicated two concurrent chelator-mediated iron-release pathways: one which is hyperbolic in nature, involving a conformational change in the protein as a rate limiting step, and a second which has been proposed to be first-order in nature and to involve initial release of a synergistic anion. We have examined the effect that an affinity-label analog of the synergistic anion has on chelator-mediated iron-release from this protein. A covalently attached anion would inhibit iron-release via any pathway in which anion release is a prerequisite to iron release. The present investigation examined the effect that the covalently attached anion had on iron-release to pyrophosphate (PPi) and N, N-bis(phosphonomethyl)glycine (DPG), two chelators which are believed to utilize both pathways concurrently. Results show that when the affinity-label anion is utilized, strictly hyperbolic data are obtained, with similar observed kmax values. This is strong support for the hypothesis of a common, chelator-independent rate-limiting step for the one available pathway. These results also support strongly the hypothesis that synergistic anion removal is a prerequisite step to iron-release via the second pathway.

Anions↗