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Biomedical subjects

C M Harris

Publications and source records attributed to C M Harris.

At least 163 records · Page 9Linked to original sources

A method to shorten the training phase of drug discrimination.

Rats were trained to discriminate "drug" from "no drug" in a two-lever, food-reinforced task. One group was trained with cocaine (10 mg/kg) and a second group was trained with pentylenetetrazol (20 mg/kg). A method designed to shorten the time required for the training phase of drug discrimination experiments was assessed in subgroups for each drug. In one subgroup, single training sessions were conducted daily. In the other subgroup, a second session (either drug or saline) was conducted on days for which the first condition was saline. The training conditions were presented in an irregular sequence, with the same condition occurring in no more than two consecutive sessions. Rats trained by the accelerated method learned the discrimination in fewer days, with no decrement in acquisition per session, suggesting that drug discrimination training can be accomplished more rapidly by reducing inter-session interval.

Animals↗

Differences in ambulatory test ordering in England and America. Role of doctors' beliefs and attitudes.

Forty-five American and English doctors were surveyed to determine whether differences in their beliefs about the incidence and morbidity of complications and the role of testing for patients with chronic hypertension could be contributing to the large cross-national differences previously demonstrated in ambulatory test use for such patients. For each of nine tests, the number the English doctors thought they "should order" was significantly less than that of the American group. English doctors also estimated a lower incidence for each of seven possible complications of hypertension, but there was no difference in perceived morbidity of the complications. Both groups thought results from testing would alter therapy for only a small proportion of patients; however, the English estimate was significantly smaller than the American (16 percent versus 27 percent: p less than 0.05). The reasons given for testing were very similar in the two countries except that American doctors ranked as more important the reason that patients used the quantity of test ordering as an indicator of quality care. These results suggest that differences in ambulatory test use are consistent with physicians' beliefs about the number of tests they should be ordering, disease incidence, the likelihood that testing will affect patient care, and patient expectations. Further study should be directed toward understanding the contributions that differences in physician beliefs about the natural histories of diseases and patient expectations make to variations in test ordering.

Ambulatory Care↗

Anxiety-like subjective effect of ethanol antagonist RO 15-4513 demonstrated in pentylenetetrazol discrimination.

Ro 15-4513, a benzodiazepine-receptor ligand which antagonizes ethanol, was tested in the pentylenetetrazol discrimination, a bioassay for anxiogenic drugs. Rats were trained with food reward to discriminate pentylenetetrazol (PTZ) from saline in a two-lever operant task. In lever-selection tests, rats selected the PTZ lever both after PTZ and after Ro 15-4513. The PTZ-like stimulus produced by Ro 15-4513 was blocked by diazepam and by the benzodiazepine receptor blocker Ro 15-1788. Substitution for the anxiogenic drug PTZ, and blockade by the anxiolytic diazepam, support the hypothesis that Ro 15-4513 is anxiogenic; blockade by Ro 15-1788 suggests that the PTZ-like stimulus produced by Ro 15-4513 occurs through its action at the benzodiazepine receptor.

Animals↗

Patterns of physicians' use of medical resources in ambulatory settings.

We studied British general practitioners' use of ambulatory resources to determine whether the quantities of different resources used were related to each other, and whether these quantities were associated with their personal characteristics. Rates of laboratory requests, referrals for specialty opinion, prescriptions, and visits per patient per year were examined for 21 physicians in seven practices over one year. Physicians who more frequently saw their patients referred and prescribed for them more often and ordered more tests, once the number of years they had practiced was taken into account. Doctors who ordered more tests referred their patients more frequently, regardless of how often they saw them. Doctors longer in practice saw and prescribed for their patients more frequently. Resource use was not related to other personal characteristics we studied. Greater frequency of patient-physician contact appears to increase costs not only through use of more professional time but also through greater use of other ambulatory resources. Attention to the use of only one type of resource may result in a distorted picture of how physicians care for their patients and the costs that such care incurs.

Clinical Laboratory Techniques↗

The case of the black-speckled dolls: an occupational hazard of unusual sulphur metabolism.

A patient who made reproduction antique china dolls complained that wherever she touched the dolls' heads when painting them, black speckles appeared after the subsequent firing. Investigation by means of mass spectrometry and X-ray fluorescence showed that the clay was rich in iron, that the patient's sweat contained volatile sulphides whenever she ate garlic, and that the speckles consisted of iron and sulphur. The patient was shown to be a poor sulphoxidiser and was therefore unlikely to be able to excrete sulphur-containing breakdown products of garlic in her urine. The speckling phenomenon, which is not uncommon in 19th-century china dolls, is an example of an occupational hazard where the risk is to the product rather than the patient.

Adolescent↗

Withdrawal from chronic nicotine substitutes partially for the interoceptive stimulus produced by pentylenetetrazol (PTZ).

Rats were trained on an FR10 schedule of food reinforcement to press one lever after pentylenetetrazol (PTZ), 20 mg/kg, IP, and an alternate lever after saline. After acute nicotine, 0.64 mg/kg, SC, 35% of the rats pressed the PTZ-lever. Diazepam, 5 mg/kg, IP, blocked the stimulus produced by PTZ, and mecamylamine, 5 mg/kg, IP, blocked the stimulus produced by nicotine. Training was then suspended and rats were treated with nicotine, at 8-h intervals, 0.64 mg/kg on the 1st day, and 1.25 mg/kg on subsequent days, for 21 days. To determine whether nicotine withdrawal substitutes for the stimulus produced by PTZ, rats were tested with saline at various times after chronic nicotine injections. Data from this part of the study were replicated in another group given nicotine for 15 days. Saline at 8 h after nicotine (five determinations each group) produced a small but stable degree of PTZ lever selection (35 +/- 4%). At 48 h after termination of nicotine treatment, the percentage of rats selecting the PTZ lever (50%) was greater than that in a control group tested after an equivalent period without training. The PTZ-like stimulus detected after chronic nicotine was not altered by mecamylamine, was additive with PTZ, and was blocked by diazepam. These data suggest that withdrawal from chronic nicotine produces a weak PTZ-like stimulus, which can be antagonized by an anxiolytic drug.

Animals↗

Association between consultations for depression and for other conditions in patients aged 45 years and over.

There is little evidence of any association, either positive or negative, between the occurrence of depression and other clinical conditions. It would be particularly useful in general practice to identify any positive association between depression and other illness as this would make depression less likely to be missed in the consultation. Morbidity data recorded in the UK second national morbidity study were analysed, attention being confined to patients aged 45 years and over, who would be more likely to be suffering from chronic illness. During the year December 1971 to November 1972, there were 4 911 patients recorded as having depression who also consulted with other conditions. Morbidity codings were analysed to discover whether any of these conditions was recorded more or less frequently than might have happened by chance in the depressed group. Examples of conditions both positively and negatively associated with depression were revealed, the former being the more highly significant statistically. Validation of these findings should be sought in a similar analysis of the data from the UK third national morbidity survey, soon to be published.

Aged↗

Pre-registration posts in general practice.

Though the UK Medical Act of 1978 made the creation of pre-registration house officer posts in general practice in the UK a serious proposition there have been few attempts to explore the possibility. The absence of agreed educational objectives for the year makes it impossible to conduct the properly evaluated experiments that might assuage existing doubts about the appropriateness of introducing general practice as a setting in an objective way. Experience so far shows that carefully designed schemes are both feasible and worthwhile in the opinion of those involved. The implications for general practice are explored, the need for new educational thinking is discussed and suggestions about criteria for the approval of practices are put forward.

Education, Medical, Undergraduate↗

Curiosity.

Explore the source record for details and available documents.

Adolescent↗

Family practitioner committee records--a neglected resource. 1. An information service for general practitioners based on claims for fees.

Data held by a London family practitioner committee for the purpose of paying general practitioners' capitation and item of service fees were analysed every quarter for one year to provide an information service for general practices in the area. Each practice received a quarterly printout showing the age structure of its patient population, the numbers of new registrations and removals and data about items of service. These were expressed as rates which could be compared with those of the area as a whole, and with the highest and lowest rates found in individual practices. A survey at the end of the year showed that the service was welcomed and found useful by the practices. A fully computerized family practitioner committee could provide a similar service without great difficulty, and could make it more informative by linking items of service to specific age groups; data about prescribing and use of hospital and district services could also be incorporated when the relevant agencies are fully computerized too.

Capitation Fee↗

Family practitioner committee records--a neglected resource. 2. Drawing the profile of an area.

Capitation and item of service fees paid by a family practitioner committee can be analysed to produce a profile of the area which covers list sizes, age structure and mobility of the population and the extent of various practice activities. Such an analysis was made for Kensington, Chelsea and Westminster, an area for which it was particularly appropriate to consider these variables in terms of partnership size and doctor's age. Practices with one or two principals had lower rates of claiming for items of service than the larger partnerships, and within these smaller groupings it was the practices with elderly doctors that had the lowest rates. The findings indicate a problem associated with elderly doctors but wider conclusions are not necessarily justified. Profiles produced in the way described should be available for local planning but must be interpreted with caution.

Age Factors↗

Further observations on seasonal variation. 1. Osteoarthritis.

In an earlier study of morbidity in a group of inner London practices, consultations for osteoarthritis were shown to be most frequent in the late spring and late autumn months. Though this pattern agreed with the results of experiments with controlled meteorological variables, it contradicted widely-held beliefs and was not supported by the medical literature. Confirmatory evidence was therefore sought in two other sources of data. Analyses were performed on monthly figures provided by the Department of Health and Social Security of dispensed non-steroidal antiinflammatory preparations and on five years of general practice morbidity records held by the Office of Population Censuses and Surveys. These analyses largely confirmed the earlier finding, particularly that of a spring peak for consultations for osteoarthritis, though there was some variation in the timing from year to year in both sets of data.

Drug Prescriptions↗

Further observations on seasonal variation. 2. Depression.

In an earlier study consultations for depression in general practice were shown to peak in the late spring and autumn, the pattern being similar to that found in hospital admission data and suicide statistics. There were differences, however, and these gave grounds for speculation about differences between the milder depressions typical of general practice and more severe depressions. To test the reliability of the findings, national prescribing figures over three years and general practice morbidity recordings over five years held by the Office of Population Censuses and Surveys were analysed. In these larger data sets the differences were no longer apparent, but there was evidence of a precipitating factor which varied in timing and magnitude from year to year, particularly in the autumn. This might account for inconsistencies in the seasonal variation noted in studies of hospital and suicide data.

Depressive Disorder↗

Family practitioner committee records--a neglected resource. 3. Three inner city areas compared.

Data from the family practitioner committees of three inner city areas - Kensington, Chelsea and Westminster; Lambeth, Lewisham and Southwark; and Manchester - were compared. The information about general practitioners over one year included number of principals, distribution by partnership size and numbers working from health centre premises. Data about practices covered the five years 1979-83, with figures for mean list size, registrations and removals, temporary residents and claims for various items of service. Comparisons between the three areas showed great differences for which no convincing explanation could be found. The possibility that people living in these areas have different primary care health services suggests that comparisons should be made nationally; this requires family practitioner committees to be fully computerized and to collect their data in the same way.

Age Factors↗

Preregistration rotation including general practice at St Mary's Hospital Medical School.

A rotation for the preregistration year which included medicine, surgery, and general practice started at St Mary's Hospital Medical School in August 1981. Initially approved by London University for an experimental period of three years, in 1984 it became an established rotation subject to normal review. Special arrangements were made for clinical work, supervision, prescribing, teaching, and other aspects of the general practice component. Data relating to the general practice consultations of the nine participating house officers show that they obtained wide experience, and their comments on the post itself were generally favourable. The four months spent in general practice were needed to allow time for the house officers to adapt to the new setting but did not seem to have an important effect on their experience in medicine and surgery.

Attitude of Health Personnel↗

On the dielectrically observable consequences of the diffusional motions of lipids and proteins in membranes. 1. Theory and overview.

A system consisting of any array of cylindrical, polytopic membrane proteins (or protein complexes) possessed of a permanent dipole moment and immersed in a closed, spherical phospholipid bilayer sheet is considered. It is assumed that rotation of the protein (complex) in a plane normal to the membrane, if occurring, is restricted by viscous drag alone. Lateral diffusion is assumed either to be free and random or to be partially constrained by barriers of an unspecified nature. The dielectric relaxation times calculated for membrane protein rotation in a suspension of vesicles of the above type are much longer than those observed with globular proteins in aqueous solution, and fall in the mid-to-high audio frequency range. If the long range lateral diffusion of (charged) membrane protein complexes is essentially unrestricted, as in the "fluid mosaic" membrane model, dielectric relaxation times for lateral motions will lie, except in the case of the very smallest vesicles, in the sub-audio (ELF) range. If, in contrast, the lateral diffusion of membrane protein complexes is partially restricted by "barriers" or "long-range" interactions (of unspecified nature), significant dielectric dispersions may be expected in both audio- and radio-frequency ranges, the critical (characteristic) frequencies depending upon the average distance moved before a barrier is encountered. Similar analyses are given for rotational and translational motions of phospholipids. At very low frequencies, a dispersion due to vesicle orientation might in principle also be observed; the dielectrically observable extent of this rotation will depend, inter alia, upon the charge mobility and disposition of the membrane protein complexes, as well as, of course, on the viscosity of the aqueous phase. The role of electroosmotic interactions between double layer ions (and water dipoles) and proteins raised above the membrane surface is considered. In some cases, it seems likely that such interactions serve to raise the dielectric increment, relative to that which might otherwise have been expected, of dispersions due to protein motions in membranes. Depending upon the tortuosity of the ion-relaxation pathways, such a relaxation mechanism might lead to almost any characteristic frequency, and, even in the absence of protein/lipid motions, would cause dielectric spectra to be much broader than one might expect from a simple, macroscopic treatment.

Cell Membrane↗

On the dielectrically observable consequences of the diffusional motions of lipids and proteins in membranes. 2. Experiments with microbial cells, protoplasts and membrane vesicles.

The dielectric properties of suspensions of intact cells of Methylophilus methylotrophus, Paracoccus denitrificans and Bacillus subtilis have been measured in the frequency range 1 kHz to 13 MHz. All possess a pronounced dispersion corresponding in magnitude and relaxation time to the "beta-dispersion" in a terminology defined by Schwan [Adv. Biol. Med. Phys. 5:147-209 (1957)]. The latter two strains, but not M. methylotrophus, also possess a substantial alpha-dispersion. The relaxation time of the beta-dispersion of B. subtilis is significantly lower than that of the other two strains, due to the higher internal K+ content of this Gram-positive organism. Treatment of P. denitrificans or B. subtilis with lysozyme greatly reduces the magnitude of the alpha-dispersion; in the latter case it is virtually abolished. The magnitude of both the alpha- and beta-dispersions of protoplasts of these organisms is significantly decreased by treatment with the cross-linking reagent glutaraldehyde, indicating that diffusional motions of the lipids and/or proteins in the protoplast membranes contribute to the dielectric relaxations observed in this frequency range. Such motions cannot be unrestricted, as in the "fluid mosaic" model, since the relaxation times of the lipids and proteins, if restricted by hydrodynamic forces alone, should then correspond, in protoplasts of this radius (0.4-0.5 micron), to approximately 10 Hz. Even after treatment of the (spherical) protoplasts with glutaraldehyde, the breadth of the remaining beta-dispersion is still significantly greater than (a) that of a pure Debye dispersion and (b) that to be expected solely from a classical Maxwell-Wagner-type mechanism. It is recognised that the surfaces of the protein complexes in such membranes extend significantly beyond the membrane surface as delineated by the phospholipid head-groups; such molecular granularity can in principle account for the broadened dielectric relaxations in the frequency range above 1 kHz, in terms of the impediment to genuinely tangential counterion relaxation caused by the protruding proteins themselves. The relaxation time of a previously observed, novel, low-frequency, glutaraldehyde-sensitive (mu-) dispersion in bacterial chromatophore suspensions, as well as that of their alpha-dispersion, is significantly increased by increasing the aqueous viscosity with glycerol. This finding is consistent with the view that, from a dielectric standpoint, the motions of charged proteins (and lipids) in biological membranes are rather tightly coupled to those of the adjacent ions and dipoles in the electric double layer.(ABSTRACT TRUNCATED AT 400 WORDS)

Bacillus subtilis↗