Biomedical subjects

C L Cox

Publications and source records attributed to C L Cox.

At least 37 records · Page 2Linked to original sources

PubMed1998

Cardiac and circulatory assessment in intensive care units.

As healthcare delivery changes in critical care, nursing continues to evolve and develop. Nursing skills are expanding to incorporate skills once seen as the remit of the medical profession. Nurses are now equipping themselves with the skills and knowledge that can enhance the care they provide to their patients. Assessment of patients is a major role in nursing and, by expanding assessment skills, nurses can ensure that patients receive the care most appropriate to their needs. Nurses in critical care settings are well placed to carry out a more detailed assessment, which can help to focus nursing care. This article describes the step-by-step process of undertaking a full and comprehensive cardiac and circulatory assessment in a clinical setting. It identifies many of the problems that patients may have and the signs that the nurse may note whilst undertaking the assessment.

Cardiovascular System↗

PubMed1998

Localization of CCK receptors in thalamic reticular neurons: a modeling study.

In an earlier experimental study, intracellular recording suggested that cholecystokinin (CCK) suppresses a K+ conductance in thalamic reticular (RE) neurons, yet the reversal potential of the CCK response, revealed using voltage clamp, was hyperpolarized significantly relative to the K+ equilibrium potential. Here, biophysical models of RE neurons were developed and used to test whether suppression of the K+ conductance, gK, can account for the CCK response observed in vitro and also to determine the likely site of CCK receptors on RE neurons. Suppression of gK in model RE neurons can reproduce the relatively hyperpolarized reversal potential of CCK responses found using voltage clamp if the voltage clamp becomes less effective at hyperpolarized potentials. Three factors would reduce voltage-clamp effectiveness in this model: the nonnegligible series resistance of the voltage-clamp electrode, a hyperpolarization-activated mixed cation current (Ih) in RE neurons, and the dendritic location of CCK-sensitive K+ channels. Although suppression of gK in the dendritic compartments of model RE neurons simulates both the magnitude and reversal potential of the CCK response, suppression of gK in just the somatic compartment of model RE neurons fails to do so. Thus the model predicts that CCK should effectively suppress K+ conductance RE neuron dendrites and thereby regulate burst firing in RE neurons. This may explain the potent effects of CCK on intrathalamic oscillations in vitro.

Animals↗

PubMed1997

Nucleus reticularis neurons mediate diverse inhibitory effects in thalamus.

Detailed information regarding the contribution of individual gamma-aminobutyric acid (GABA)-containing inhibitory neurons to the overall synaptic activity of single postsynaptic cells is essential to our understanding of fundamental elements of synaptic integration and operation of neuronal circuits. For example, GABA-containing cells in the thalamic reticular nucleus (nRt) provide major inhibitory innervation of thalamic relay nuclei that is critical to thalamocortical rhythm generation. To investigate the contribution of individual nRt neurons to the strength of this internuclear inhibition, we obtained whole-cell recordings of unitary inhibitory postsynaptic currents (IPSCs) evoked in ventrobasal thalamocortical (VB) neurons by stimulation of single nRt cells in rat thalamic slices, in conjunction with intracellular biocytin labeling. Two types of monosynaptic IPSCs could be distinguished. "Weak" inhibitory connections were characterized by a significant number of postsynaptic failures in response to presynaptic nRt action potentials and relatively small IPSCs. In contrast, "strong" inhibition was characterized by the absence of postsynaptic failures and significantly larger unitary IPSCs. By using miniature IPSC amplitudes to infer quantal size, we estimated that unitary IPSCs associated with weak inhibition resulted from activation of 1-3 release sites, whereas stronger inhibition would require simultaneous activation of 5-70 release sites. The inhibitory strengths were positively correlated with the density of axonal swellings of the presynaptic nRt neurons, an indicator that characterizes different nRt axonal arborization patterns. These results demonstrate that there is a heterogeneity of inhibitory interactions between nRt and VB neurons, and that variations in gross morphological features of axonal arbors in the central nervous system can be associated with significant differences in postsynaptic response characteristics.

Action Potentials↗

PubMed1997

Peptidergic modulation of intrathalamic circuit activity in vitro: actions of cholecystokinin.

Cholecystokinin (CCK)-mediated actions on intrathalamic rhythmic activities were examined in an in vitro rat thalamic slice preparation. Single electrical stimuli in the thalamic reticular nucleus (nRt) evoked rhythmic activity (1-15 sec duration) in nRt and the adjacent ventrobasal nucleus (VB). Low CCK concentrations (20-50 nM) suppressed rhythmic oscillations in 43% of experiments but prolonged such activities in the remaining slices. Higher CCK concentrations (100-400 nM) had a predominantly antioscillatory effect. Suppression of oscillations was associated with a relatively large membrane depolarization of nRt neurons that changed their firing mode from phasic (burst) to tonic (single-spike) output. This decreased burst discharge of nRt neurons during CCK application reduced inhibitory drive onto VB neurons from multiple peaked inhibitory postsynaptic currents (IPSCs) to single peaked inhibitory events. We hypothesize that suppression of inhibitory drive onto VB neurons decreases their probability of burst output, which, together with a reduction of nRt burst output, dampens the oscillatory activity. Low CCK concentrations, which produced little or no depolarization of nRt neurons, did not alter the firing mode of the nRt neurons. However, the probability of burst output from nRt neurons in response to subthreshold stimuli was increased in low CCK concentrations, presumably leading to an increase in the number of nRt neurons participating in the rhythmic activity. Our findings suggest that the neuropeptide CCK, by altering the firing characteristics of nRt neurons, has powerful modulatory effects on intrathalamic rhythms; the ultimate action was dependent on CCK concentration and resting state of these cells.

Animals↗

PubMed1997

Development of invasive adenocarcinoma in a long-standing Kock continent ileostomy: report of a case.

The first case of adenocarcinoma developing in a continent ileostomy is reported. A healthy, 39-year-old man with a continent ileostomy for 17 years developed subacute obstructive symptoms and was found on endoscopy to have a large adenocarcinoma involving the intussusception valve. At operation, he was found to have a large tumor originating in the valve, extending through the reservoir, and involving the afferent ileal limb. A number of metastatic lymph nodes were identified in the mesentery of the small bowel. He underwent excision of the pouch and formation of an end ileostomy. He is currently undergoing adjuvant chemotherapy. Biochemical and morphologic changes in the ileal pouch, both in the pelvis and the continent ileostomy, are discussed. The implications of this apparent de novo cancer arising in an ileal pouch are discussed.

Adenocarcinoma↗

PubMed1997

A new method for predicting crashworthiness.

Consumer information concerning the predicted 'safeness' of a new car model is based on the results of crash tests. Unfortunately, because it allows comparisons only within size/weight groups, the information is somewhat incompatible with the normal car-purchase decision process since consumers often consider cars within different groups. In addition, based on past research, the association of the crash-test information with real-world crash outcomes is, at best, somewhat limited. The goal of this study was to explore a methodology for improving this information, a methodology which incorporates not only the crash-test information, but also information concerning real-world occupant injury experience in prior crashes involving similar vehicles ('clones'). The clone information included both driver injury severity in past clone crashes from the North Carolina accident file and various indicators of relative driver injury in clones extracted from published insurance-related data from the Highway Loss Data Institute (HLDI). Final models developed included both measures of the Head Index Criteria (HIC) from the crash test and some measure of clone performances as significant predictors. While the North Carolina clone data is intuitively 'cleaner' in that it describes injury level per crash rather than per insured year, the medical claims indices from the HLDI data consistently were shown to be the stronger predictors. Future research will need to look at ways of better combining the crash-test variables and of possible modifications to the HLDI indices. In general, the analyses generated encouraging results that appear to point to possible improvements in the crashworthiness information.

Accidents, Traffic↗

PubMed1997

Heterotopic neural tissue in the pharynx of a 7-week-old kitten.

A 7-week-old male kitten had a pharyngeal mass (1 x 2 cm) causing displacement of the tongue. The surgically resected tissue was seen to be a moderately discrete subepithelial mass comprising islands of neuroglia and neurons separated by dense collagenous connective tissue. It is not known whether this mass retained any connection with the brain. Histochemical and immunohistochemical examination confirmed the presence of neurons and a pleocellular glial population, supporting a diagnosis of heterotopic neural tissue. The cat remained well 20 months after surgical treatment. Heterotopic neural tissue is well-recognized in man but has not been described in animals.

Animals↗

PubMed1997

Reducing anxiety: the employment of Therapeutic Touch as a nursing intervention.

Patient anxiety is frequently associated with admission and treatment in Critical Care Units. In Critical Care, one aim is the promotion of comfort so that anxiety experienced by patients can be reduced. In this article, a quasi-experimental design which attempted to determine the effectiveness of Therapeutic Touch as a nursing intervention is described. It was hypothesized that Therapeutic Touch would promote comfort and reduce anxiety. Before implementation of the project, a semi-structured interview was conducted amongst nurses (n = 18) from an Intensive Care Unit in a District General Hospital in East London. Interviews were conducted in order to determine the nurses' perceptions of the effectiveness of Therapeutic Touch as a complementary therapy. Initial findings of nurse interviews, a nurse's personal experiences of administering Therapeutic Touch and a case study indicate there may be a place for Therapeutic Touch as an intervention for promoting comfort and reducing anxiety in Critical Care.

Adult↗

PubMed1997

Willingness to sacrifice in close relationships.

The authors advance an interdependence analysis of willingness to sacrifice. Support for model predictions was revealed in 6 studies (3 cross-sectional survey studies, 1 simulation experiment, 2 longitudinal studies) that used a novel self-report measure and a behavioral measure of willingness to sacrifice. Willingness to sacrifice was associated with strong commitment, high satisfaction, poor alternatives, and high investments; feelings of commitment largely mediated the associations of these variables with willingness to sacrifice. Moreover, willingness to sacrifice was associated with superior couple functioning, operationalized in terms of level of dyadic adjustment and probability of couple persistence. In predicting adjustment, willingness to sacrifice accounted for significant variance beyond commitment, partially mediating the link between commitment and adjustment; such mediation was not significant for persistence.

Adult↗

PubMed1997

Advancing discourse on health promotion: beyond mainstream thinking.

Attention must be redirected toward health promotion as nursing evaluates the goal of health for all. Confusion regarding health promotion behavior is illustrated by terms with diverse meanings and uses. In a process of critical analysis, five multidisciplinary experts in health promotion responded to a survey targeting the distinction of health promotion, health promotion behavior, health protection behavior, disease prevention behavior, preventive health behavior, health behavior, and healthy lifestyle. Descriptors of health promotion were derived from a multidimensional conception of well-being. Disagreement existed concerning health protection and health behavior. Nursing interventions are linked to reflective discourse regarding health promotion behavior.

Health Behavior↗

PubMed1997

Investigation of hearing impairment in Cavalier King Charles spaniels using auditory brainstem response audiometry.

Auditory brainstem response audiometry was used to investigate nine Cavalier King Charles spaniels with a history of hearing impairment. Successful recordings were made in all cases. In eight of the dogs, the hearing impairment was between 40 and 85 decibels re normal hearing level. In addition to confirming the degree of impairment in each ear, information was obtained concerning the site of the lesion. The auditory brainstem technique may have an important role to play in assessing treatment outcome. Other applications include screening animals used in breeding programmes as well as working dogs requiring good binaural hearing.

Animals↗

PubMed1997

Normative auditory brainstem response data for hearing threshold and neuro-otological diagnosis in the dog.

There is growing interest in the application of auditory brainstem response (ABR) audiometry for hearing assessment in dogs. The technique is far from standardised, however, resulting in large discrepancies between studies. This study aimed to obtain normative data, under clearly defined conditions, for two breeds of significantly different size; head size being a potential factor determining ABR latency values. The subjects, 20 dalmatians and 20 Jack Russell terriers, were sedated prior to ABR testing, and subcutaneous scalp electrodes used to detect the evoked potential elicited by a click stimulus presented via insert earphones. The mean ABR thresholds for the two breeds, 0 and -5 decibels re normal hearing level (dB nHL), respectively, were very similar to those for humans. The latency values of the main ABR waves and the interval between them were statistically significantly smaller for the smaller breed, but there was no correlation with head size within either breed. The results provide a baseline to assist with confirmation of hearing impairment and neuro-otological diagnosis in the dog.

Animals↗

PubMed1997

Normative auditory brainstem response data for bone conduction in the dog.

Auditory brainstem response (ABR) is a valuable tool for the diagnosis of hearing disorders in dogs, but is hampered by the lack of published normative data. The aim of the present study was to obtain normative data for bone conduction, without masking, under clearly defined conditions. Subjects comprised 20 Dalmatians and 20 Jack Russell terriers. Two methods were investigated: holding the bone vibrator against the head by hand or by applying a 500 g weight. The results revealed no difference in hearing threshold between the two breeds or for the two methods of applying the bone vibrator to the head. The mean hearing threshold was close to 0 decibels re normal hearing level (dB nHL), which is the biological norm for humans. Hence, bone conduction thresholds can be used for confirmation of conductive hearing impairment in the dog, in the same way as in humans.

Animals↗

PubMed1997

The effect of head size on the auditory brainstem response for two breeds of dog.

Many studies have shown that the auditory brainstem response (ABR) is influenced by the sex of the subject. The explanation offered most often for this sex difference is the smaller head size and brain dimensions in the female. Since breeds of dog have different head sizes, this makes them useful subjects to test the hypothesis that ABR latency covaries with head size. Subjects comprised 20 Dalmatians and 20 Jack Russell terriers. The maximum width of the head was 123 +/- 8 mm in the Dalmatian and 88 +/- 5 mm in the Jack Russell. An auditory brainstem response was carried out using a click stimulus at 75 dB nHL. The latency of wave V and the I-V interval was longer (0.3 and 0.17 ms respectively) in the Dalmatian, although the correlation of these measurements with head size (which ranged from -0.2 to +0.3) was not statistically significant. These findings do not support the theory that differences in ABR latency are due to differences in head size per se. Correlation of latency with body temperature and with age was also weak and not statistically significant.

Animals↗

PubMed1996

Heterogeneous axonal arborizations of rat thalamic reticular neurons in the ventrobasal nucleus.

The gamma-aminobutyric acid (GABA)-containing neurons of the thalamic reticular nucleus (nRt) are a major source of inhibitory innervation in dorsal thalamic nuclei. Individual nRt neurons were intracellularly recorded and labelled in an in vitro rat thalamic slice preparation to investigate their projection into ventrobasal thalamic nuclei (VB). Camera lucida reconstructions of 37 neurons indicated that nRt innervation ranges from a compact, focal projection to a widespread, diffuse projection encompassing large areas of VB. The main axons of 65% of the cells gave rise to intra-nRt collaterals prior to leaving the nucleus and, once within VB, ramified into one of three branching patterns: cluster, intermediate, and diffuse. The cluster arborization encompassed a focal region averaging approximately 25,000 mu m2 and contained a high density of axonal swellings, indicative of a topographic projection. The intermediate structure extended across an area approximately fourfold greater and also contained numerous axonal swellings. The diffuse arborization of nRt neurons covered a large region of VB and contained a relatively low density of axonal swellings. Analysis of somatic size and shape revealed that diffuse arborizations arose from significantly smaller, fusiform-shaped somata. Cytochrome oxidase reactivity or parvalbumin immunoreactivity was used to delineate a discontinuous staining pattern representing thalamic barreloids. The size of a cluster arborization closely approximated that of an individual barreloid. The heterogeneous arborizations from nRt neurons may reflect a dynamic range of inhibitory influences of nRt on dorsal thalamic activity.

Animals↗

PubMed1995

Aural cholesterol granuloma in a dog.

A five-year-old female Irish setter was referred for surgery for a left-sided aural mass. The dog was generally well, but had signs of left-sided otalgia for one week. Biopsy identified the lesion as a cholesterol granuloma. The mass was removed three weeks later by a total canal ablation/lateral bulla osteotomy. The dog recovered from surgery without any complications. Ten months later, there was no evidence of recurrence. The purpose of this paper is to report the clinical and histopathological findings of this unusual form of granuloma which has not previously been reported in the canine ear.

Animals↗

PubMed1995

Cholecystokinin depolarizes rat thalamic reticular neurons by suppressing a K+ conductance.

1. The thalamic reticular nucleus (nRt) is innervated by cholecystokinin (CCK)-containing neurons and contains CCK binding sites. We used tight-seal, whole cell recording techniques with in vitro rat thalamic slices to investigate the action of CCK on neurons in nRt and ventrobasal thalamus (VB). 2. Brief applications of the CCK agonist cholecystokinin octapeptide (26-33) sulfated (CCK8S) evoked prolonged spike discharges in nRt neurons but had no direct effects on VB neuron activity. This selective excitatory action of CCK8S in nRt resulted from a long-lasting membrane depolarization (2-10 min) associated with an increased input resistance. Voltage-clamp recordings revealed that CCK8S reduced membrane conductance by 0.6-3.8 nS, which amounted to 5-54% of the resting conductance of these neurons. 3. The conductance blocked by CCK8S was linear over the range of -50 to -100 mV and reversed near the potassium equilibrium potential. Modifications of extracellular K+ concentration altered the reversal potential of the conductance as predicted by the Nernst equation. The K+ channel blocker Cs+, applied either intracellularly or combined intra- and extracellularly, blocked the response to CCK8S. 4. The CCK8S-induced depolarization persisted after suppression of synaptic transmission by either tetrodotoxin or a low-Ca2+, high-Mg2+ extracellular solution, indicating that the depolarization was primarily due to activation of postsynaptic CCK receptors and not mediated through the release of other neurotransmitters. 5. The selective CCKA antagonists L364,718 and Cam-1481 attenuated the CCK8S-induced depolarization, whereas the CCKB antagonist L365,260 had little or no effect on the depolarization. 6. Our findings indicate that CCK8S, acting via CCKA-type receptors, reduces a K+ leak current, resulting in a long-lasting membrane depolarization that can presumably modify the firing mode of nRt neurons. Through this effect, CCK actions in nRt may strongly influence thalamocortical function.

Action Potentials↗

PubMed1994

Modulation of cellular excitability in neocortex: muscarinic receptor and second messenger-mediated actions of acetylcholine.

Muscarinic-type acetylcholine (ACh) receptor are involved in a variety of cortical functions. ACh "activates" neocortex; simultaneously modifying spontaneous subthreshold activity, intrinsic neuronal oscillations and spike discharge modes, and responsiveness to fast (putative glutamatergic) synaptic inputs. However, beyond the general involvement of muscarinic receptors, a mechanistic understanding of integrated cholinergic actions, and interactions with non-cholinergic transmission, is lacking. We have addressed this problem using intracellular recordings from the in vitro auditory neocortex. First, we investigated cholinergic modification of responses to the excitatory amino acid glutamate. ACh, or the muscarinic agonist methacholine, produced a lasting enhancement of glutamate-mediated membrane depolarizations. Muscarinic receptors of the M1 and/or M3 subtype, rather than M2 or nicotinic receptors, mediated this enhancement. Subsequently, we investigated whether second messenger systems contribute to observed muscarinic actions. Activation of protein kinase C with phorbol 12,13-dibutyrate (4 beta-PDBu), enhanced neuronal responses to glutamate. The effect of 4 beta-PDBu was attenuated by the kinase antagonist H7. Finally, we attempted to identify postsynaptic actions of endogenous ACh. Tetanic stimulation of cholinergic afferents elicited voltage-dependent effects, including reduced spike frequency adaptation and reduced slow afterhyperpolarization (sAHP) elicited by transmembrane depolarizing stimuli. These effects were mimicked by methacholine, enhanced by eserine, and antagonized by muscarinic receptor antagonists. These data suggest that cholinergic modulation in neocortex likely involves the integrated actions of diverse mechanisms, primarily gated by muscarinic receptors, and at least partly involving second messenger systems.

Acetylcholine↗