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Biomedical subjects

C M Wright

Publications and source records attributed to C M Wright.

At least 55 records · Page 3Linked to original sources
PubMed1994

What is a normal rate of weight gain in infancy?

We have retrieved weights from the Child Health records of an annual cohort of 3418 full-term children, aged 18-30 months in order to define a lower limit of normality for weight gain for both clinical and research purposes. There was a strong tendency for children at the extremes of the distribution to move inwards towards the average: only 26% of those below the 3rd centile for weight at six weeks were still below it at one year. We describe a method based on conditional standards to correct for this "regression to the mean" and produce a measure of the discrepancy between a child's predicted and actual growth: the "thrive index". The value of the thrive index below which only a minority of children fell provided a lower threshold for normality. While most children below the 3rd centile for weight at 9-24 months of age also had subnormal weight gain, 41% of those with subnormal weight gain had not fallen below the 3rd centile.

Child, Preschool↗
PubMed1994

Effect of deprivation on weight gain in infancy.

Weights were retrieved from child health records for an annual cohort of 3418 children, aged 18-30 months, to explore the relationship between deprivation and weight gain. Their level of deprivation was classified, using census data for their area of residence, as affluent (11%), intermediate (69%) or deprived (20%). Children from deprived areas were smaller at all ages with a widening gap: by one year of age, they were three times as likely as affluent children to be below the third centile for weight. The thrive index, a measure of the degree of centile shift, showed a slight gain over the first year in affluent and intermediate children, while in deprived children it decreased (p = 0.001). Deprived children were 2.2 times more likely than intermediate children to have failure to thrive, as manifest by subnormal thrive index values (p = 0.00008). Unexpectedly, children from affluent areas also showed slightly increased rates. We suggest that this may be explained by higher rates of breast feeding in affluent areas.

Child, Preschool↗
PubMed1993

Comparison of the use of Tanner and Whitehouse, NCHS, and Cambridge standards in infancy.

The British (Tanner and Whitehouse) and American (National Center for Health Statistics, NCHS) growth standards are widely used internationally, although the data are now over 30 years old. Routine weight data was retrieved from the child health records of a complete annual cohort of 3418 children aged 18-30 months to test the validity of these standards for modern infants. Compared with the Tanner and Whitehouse standards, Newcastle children rose initially and then fell a mean of 0.7 SDs between 6 weeks and 18 months, resulting in a threefold difference in the proportion of children below the 3rd centile at different ages. NCHS standards showed a similar pattern. When compared with modern standards from the Cambridge growth study, there was a much closer match, although Newcastle children showed a slight gain by the age of 1 year. Existing standards for weight introduce inaccuracy into the estimation of centile position in the early months of life. As both standards show similar problems this probably represents a real secular change due to changes in infant nutrition. These findings support the need to develop new national growth reference standards.

Anthropometry↗
PubMed1993

Information technology boosts managed care's 'bottom line'.

Too often physicians, clinics and hospitals affiliated with managed-care organizations pick up the tab for procedures that should be considered shared risk. Information systems can save millions if they're geared toward catching these billing faux pas.

Computer Communication Networks↗
PubMed1992

A comparison of height, weight and head circumference of primary school children living in deprived and non-deprived circumstances.

Heights, weights and head circumferences were obtained from two groups of primary school children: 1016 children from throughout Oxfordshire, a rural county with few areas of deprivation, and 219 children from an economically deprived part of the city of Newcastle on Tyne. Compared to Tanner and Whitehouse standards, Oxfordshire children were significantly taller, but not heavier, while the Newcastle children were significantly shorter and markedly lighter. Mean head circumference values were lower in the Newcastle than the Oxfordshire children. Existing national growth standards are outdated when applied to children in acceptably advantaged circumstances while impoverished children still fall below these standard in a pattern suggestive of under nutrition.

Body Height↗
PubMed1991

Changes in the recruitment pool: the Australian experience.

This paper examines the changes in the recruitment pool from which we draw nursing students. In New South Wales, the change in venue from hospital to college institutions has significantly accelerated a change which began more than 20 years ago. College programmes attract more males directly from school and less mature age males than hospital programmes. There is a difference in the socioeconomic level of the household from which nursing draws its recruits in hospital and college programmes. College programmes attract more recruits from lower socioeconomic level households than hospital programmes. In New South Wales, this was found to be particularly so for the female group but not for the male group. From the national perspective, where students had the choice to enter either a hospital or higher education programme to attain a nursing qualification, it was found that there was no difference in the socioeconomic level of the household of origin between students who choose to enter a hospital programme which paid a wage while training and students who choose to enter a higher education programme which offered no such financial reward. This finding remained consistent when the study sample was cross-tabulated by state, gender and age group (young vs mature).

Adolescent↗
PubMed1990

An innovation in a diploma program: the future potential of mentorship in nursing.

This paper reports on the processes used to facilitate the implementation of a mentored elective placement for final year nursing students and the results of the evaluative phase of this innovation. The mentors were experienced clinical practitioners who formed mentored relationships with final year students in a selected area of nursing practice and had been prepared for their role by a program organized and conducted by the Faculty. The evaluation phase incorporated the multi-method approach of triangulation to gather data during the implementation phase of the mentored placement. The results tend to be strongly supportive of a continuation of this innovation and were based on data gathered from both the mentor and mentee perspectives. The final evaluation tool aimed to assist in clarifying the role of the mentor and was administered to the mentees at the completion of the placement. Factor analyses of the mentees' responses generated four underlying constructs to mentorship, namely, the quality of the relationship, professional role acquisition, socialisation into the work role, and a need to promote mentor relationships in nursing.

Education, Nursing, Diploma Programs↗
PubMed1989

Tachyphylaxis with amrinone therapy: association with sequestration and down-regulation of lymphocyte beta-adrenergic receptors.

STUDY OBJECTIVE: To determine whether intravenous therapy with amrinone changes number, location or function of the beta-adrenergic receptors on lymphocytes. DESIGN: Case series. SETTING: Veterans hospital coronary care unit. PATIENTS: Eleven patients with decompensated class III or IV heart failure. INTERVENTIONS: A bolus of intravenous amrinone followed by a continuous infusion at 10 micrograms/kg.min for 72 hours. MEASUREMENTS AND MAIN RESULTS: At 24 to 36 hours there was a reduction in pulmonary capillary wedge pressure (35%), right atrial pressure (20%), and systemic vascular resistance (25%) with an increase in cardiac output (30%). By 72 hours all these parameters had returned nearly to baseline levels. This partial cardiovascular tolerance to amrinone was accompanied by a 126% increase in the plasma epinephrine, a 182% increase in norepinephrine, a 31% decrease in the number of beta-adrenergic receptors on lymphocytes, and a 36% decrease in isoproterenol-stimulated cyclicadenosine monophosphate on lymphocytes. The number of sequestered receptors doubled during the treatment, and the extent of sequestration correlated well with the extent of receptor down-regulation. CONCLUSIONS: The hemodynamic responses to amrinone had virtually returned to baseline by 72 hours. This tolerance was accompanied by increased plasma catecholamines, and a down-regulation, desensitization, and sequestration of beta-adrenergic receptors on lymphocytes. We suggest that these receptor changes also occur in cardiovascular tissues and may in part account for the tolerance to amrinone.

Aged↗
PubMed1987

Medical treatment of patients with severe exertional and rest angina: double blind comparison of beta blocker, calcium antagonist, and nitrate.

The role of medical treatment of patients who had resting nocturnal angina as well as exertional angina was investigate. The effects of atenolol 100 mg a day, nifedipine 20 mg three times a day, and isosorbide mononitrate 40 mg twice a day were investigated in a double blind, triple dummy randomised study. Nine patients with coronary artery disease, early positive exercise tests, and transient daytime and nocturnal ambulatory ST segment changes were initially assessed off all antianginal medication. They were then treated with each drug for three five day periods. Angina diaries were reviewed and maximal treadmill exercise tests and 48 hour ambulatory ST segment monitoring were performed at the end of each treatment period. Resting and exercise heart rate and blood pressure were significantly lower on atenolol than on either isosorbide mononitrate or nifedipine. The duration of exercise to 1 mm ST segment depression was significantly greater on atenolol than on isosorbide mononitrate. Only one patient had an improvement in exercise tolerance on nifedipine that was greater than the improvement on atenolol; this patient had single vessel disease. The total number and duration of episodes of ST segment change during ambulatory monitoring were significantly lower with atenolol than on either isosorbide mononitrate or nifedipine. Nocturnal ST segment changes were abolished in six patients on atenolol, in six patients on nifedipine, and in five patients on isosorbide mononitrate. When nocturnal ST segment changes occurred, their frequency was reduced with all three drugs. Pain was abolished in four patients on atenolol and pain relief was significantly better on atenolol than on isosorbide mononitrate. There was no significant difference in pain relief between isosorbide mononitrate and nifedipine. Thus beta receptor blockade with atenolol was the most effective means of reducing myocardial ischaemia both during exercise and at rest at night without causing deterioration in any patient. Nocturnal myocardial ischaemia in patients with severe coronary artery disease can be effectively treated with beta receptor antagonists and vasodilators.

Aged↗
PubMed1986

Expression and characterization of the trans-activator of HTLV-III/LAV virus.

The human T-lymphotropic retrovirus HTLV-III/LAV encodes a trans-activator that increases viral gene expression. We expressed this trans-activator in animal cells and studied its structural and functional characteristics. The putative trans-activator protein was immunoprecipitated from overproducing stable cell lines and shown to migrate as a 14-kilodalton polypeptide on sodium dodecyl sulfate-polyacrylamide gels. S1 nuclease mapping experiments showed that the trans-activator increases the levels of steady-state messenger RNA transcribed from the viral long terminal repeat promoter. Sequences within the R region of the HTLV-III/LAV long terminal repeat are essential for trans-activation. Quantitations of messenger RNA and protein showed that the protein increase was greater than the messenger RNA increase in CV1 and HeLa cells, indicating that more than one mechanism was responsible for the trans-activation and that cell type-specific factors may determine the final level of trans-activation.

Cell Line↗
PubMed1986

Accessory mitral valve tissue causing left ventricular outflow tract obstruction.

Although left ventricular outflow tract obstruction is commonly associated with congenitally corrected transposition of the great vessels, this obstruction is seldom caused by accessory mitral valve tissue. Three cases in which accessory mitral valve tissue caused left ventricular outflow tract obstruction in children are described. Two had congenitally corrected transposition and one had normally connected great vessels. The accessory leaflet tissue, which was identified by echocardiography and angiography, was attached by chordae tendineae to normally sited papillary muscles and herniated into the left ventricular outflow tract during systole. Operation was successful in these patients. The accessory valve tissue was excised via an arteriotomy in the great vessel that arose from the left ventricle. The obstructive tissue was excised close to its peripheral attachments in the outflow tract and its chordae tendineae were divided. Resection was performed without injury to the abnormally placed conduction system or to the normal valve structures.

Adolescent↗
PubMed1986

Bifonazole 1% gel in the treatment of superficial dermatophytoses and erythrasma of the feet and groin.

An open, non-comparative study was carried out by four general practitioners into the efficacy and tolerability of a new antifungal preparation, bifonazole 1% gel. The preparation was used once daily to treat clinically diagnosed, superficial dermatophytoses and erythrasma of the feet or groin in 91 patients of which 51 were confirmed by mycological examination. A complete mycological evaluation was available for 28 patients and a cure was recorded in 23 (89%) of these cases. Four patients reported discomfort and burning on application of the preparation and changed to alternative treatments.

Adolescent↗
PubMed1985

The effects of exogenous thymidine on endogenous deoxynucleotides and mutagenesis in mammalian cells.

The intracellular deoxyribonucleoside triphosphate pools in mammalian cells affect diverse biological functions including the spontaneous or induced mutability. We have isolated from murine T-lymphosarcoma S49 cells, a mutant that is unable to convert dCMP to dUMP, contains deranged intracellular dNTP pools, and exhibits a mutator phenotype. The enzymatic defect in araC-6-1 cells is a deficiency of deoxycytidylate deaminase, which accounts for the high dCTP and low TTP intracellular pools. The addition of increasing concentrations of exogenous thymidine to araC-6-1 cells alters these dNTP pools in a predictable manner: increasing the TTP and diminishing the dCTP. Concomitant with this reversal of the dCTP:TTP ratio is a marked decrease in the mutation rate followed by an increase in the mutation rates at higher exogenous thymidine concentrations. This response of the mutation rate is in contrast to that seen in the control cell line containing normal deoxycytidylate deaminase. In the latter case, increasing thymidine concentration induces an enhanced mutation rate that parallels the later phase of the thymidine-induced mutation rate in araC-6-1 cells. The deficiency of deoxycytidylate deaminase, the endogeneous dNTP pool alterations, and the mutator phenotype of araC-6-1 cells are all recessive traits in cell-cell hybrids. These observations allow one to predict whether exogenous thymidine will be mutagenic, antimutagenic, or both for a given cell line and provide a basis for understanding conflicting reports in the literature concerning the effects of the thymidine on genomic stability.

Animals↗
PubMed1985

How important is a history of chest pain in determining the degree of ischaemia in patients with angina pectoris?

Since therapeutic decisions in patients with angina pectoris are usually based on the reported frequency of exertional and rest pain the relations between the historical frequency of chest pain and objective evidence of myocardial ischaemia during normal daily activity were investigated in 100 patients by 48 hour ambulatory ST segment monitoring. Of these 100 consecutive patients with chest pain, 91 had typical pain and nine some atypical features. Twenty six patients had normal coronary arteries and 52 of the 74 with significant coronary disease had ambulatory ST segment changes. There was no relation between the frequency of reported exertional or rest pain and (a) the severity of coronary artery disease or (b) the frequency of daytime or nocturnal ST segment changes. Twelve patients had nocturnal ST segment changes but only four complained of nocturnal angina. Most patients had both painful and painless episodes of ST segment changes, but a substantial number had either painless or painful episodes only. These differences were not related to the severity of coronary artery disease. Chest pain after the onset of ST segment change was perceived with wide interpatient and intrapatient variability. Thus the frequency of pain is a poor indicator of the frequency of significant cardiac ischaemia. Individual differences in the perception of pain may be more important.

Angina Pectoris↗