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Biomedical subjects

C S Smith

Publications and source records attributed to C S Smith.

At least 55 records · Page 3Linked to original sources
PubMed1995

Labor force planning issues for allied health in Australia.

The aim of this paper is to discuss labor force planning issues for allied health professionals in Australia. Health system reform and changes in the demand for health labor, combined with key characteristics of the professions, will have a profound influence on future needs for career development of allied health professionals. Key issues include the increasing need for allied health professionals to undertake business management and public health training, the growing trend of multiskilling versus specialization, and the need for the professions to diversify their skill base to ensure a range of career options in a changing health care system. The challenge for allied health professions is to improve tools of analysis in relation to labor force planning and to systematically investigate various factors influencing labor force supply and demand, on both a short-term and long-term basis.

Allied Health Personnel↗
PubMed1994

Cytokine regulation by platelet-activating factor in a human B cell line.

TNF-alpha is an inflammatory cytokine produced by B cells that also impacts B cell differentiation and Ig secretion. We have investigated the regulation of the TNF-alpha gene in a human B cell line in response to platelet-activating factor (PAF), a potent phospholipid often produced in inflammatory reactions. We report here that PAF increases the RNA levels for the TNF-alpha gene in the human B cell line Ramos. This is mediated by an increase in the transcription rate and a longer half-life of the TNF-alpha transcripts. Induction of the TNF-alpha gene is rapid in these cells and independent of new protein synthesis. Despite increasing RNA for the TNF-alpha gene, PAF increases TNF-alpha protein levels only in the presence of a costimulus, such as PMA. We hypothesize that PAF acts at the transcriptional level to increase TNF-alpha RNA, but a post-transcriptional block acts to regulate protein production. We also report that PAF enhances PMA-induced TNF-alpha production from human peripheral B cells. This increase is maximal at 0.1 microM PAF and is blocked by PAF receptor antagonists. The ability of PAF to modulate cytokine production from human B cells provides further evidence that PAF has a role in B cell biology and suggests it may be important in conditions involving B cell-derived cytokines.

B-Lymphocytes↗
PubMed1994

Cyclosporin A blocks induction of tumor necrosis factor-alpha in human B lymphocytes.

The effects of cyclosporin A (CSP) on tumor necrosis factor-alpha (TNF-alpha) RNA levels and protein production in human B cells and a B cell line were studied. The ability of CSP to block induction of RNA was compared to its inhibition of protein production in response to anti-IgM, phorbol ester (PMA) and platelet-activating factor (PAF). PAF is a phospholipid which has recently been found to activate human B cells. CSP blocks PAF-induced TNF-alpha RNA from the Ramos cell line, as well as inhibiting the enhancement of TNF protein production from both freshly isolated and Ramos B cells. CSP also blocks anti-Ig induced TNF-alpha RNA and protein but does not inhibit PMA-induced TNF-alpha. We conclude that B cells, like T cells, have CSP-independent and CSP-dependent signaling pathways and that PAF signaling is dependent upon a CSP-sensitive factor.

B-Lymphocytes↗
PubMed1994

Activation of NF-kappa B and immunoglobulin expression in response to platelet-activating factor in a human B cell line.

Nuclear factor kappa B (NF-kappa B) has been shown to be an important transcriptional regulatory protein in multiple cell types in response to a number of physiological signals. In lymphocytes it has been implicated in transcriptional regulation of the kappa light chain, MHC, IL-6, and IL-2 receptor genes, depending on the differentiation state of the cell. In the present study we demonstrate that platelet-activating factor (PAF), a phospholipid molecule, activates NF-kappa B and increases kappa light chain mRNA in a human B cell line. Treatment of Ramos cells with PAF (10(-9) to 10(-6) M) increased RNA levels of the NF-kappa B p50 precursor, known as p105, in a dose-dependent manner. p105 RNA levels increased to a maximum observed at 8-10 hr and then diminished by 24 hr; this induction was not blocked by cycloheximide (CHX). PAF induced nuclear kappa B binding at similar concentrations, but more rapidly, attaining maximal levels within 15 min. CHX did not block this activity either. PAF treatment of Ramos cells also resulted in increased levels of RNA for kappa light chain. These results suggest that PAF activates NF-kappa B by at least two mechanisms in these cells, one at the level of post-translational protein activation and the other by increasing the level of RNA for NF-kappa B p105.

B-Lymphocytes↗
PubMed1994

The role of economic appraisal in health technology assessment: the Australian case.

This paper examines the role and importance of economic appraisal of health technology in Australia, particularly those appraisals conducted under the auspices of a Federal Committee. Eight specific examples are considered: extracorporeal shock wave lithotripsy, office pathology testing, magnetic resonance imaging, cervical cancer screening, bone mineral assessment, automated implantable cardiac defibrillators, liver transplantation and extracorporeal membrane oxygenation. It was found that in most cases the appraisal influenced policy, but that it was harder to assess whether there had been changes in practice or final health outcomes. It is concluded that the roles and relationships of the various players in technology assessment need to be clear, that appropriate incentives are required if socially desirable priorities are to be achieved and that the application of economic appraisal techniques needs to be timely and relevant.

Absorptiometry, Photon↗
PubMed1994

Unilateral renal aplasia in X-linked Kallmann's syndrome.

Unilateral renal agenesis is an uncommon association with Kallmann's syndrome (KS) (hypogonadotrophic hypogonadism and olfactory defect). We have investigated affected individuals from six pedigrees: five with X-linked KS, and one with X-linked KS and X-linked ichthyosis (XLI). Seventeen affected individuals have had renal imaging performed, and six scans demonstrated only one kidney. In addition, two pedigrees had males who died in the neonatal period with bilateral renal agenesis. Only two of the four affected individuals in the family with X-linked KS and X-linked ichthyosis (Pedigree 6) showed unilateral renal agenesis, despite all four patients demonstrating an interstitial deletion within the short arm of the X-chromosome. These data indicate that unilateral renal agenesis is much commoner than previously suspected in patients with X-linked Kallmann's syndrome, but that it may have incomplete penetrance within a family.

Genetic Linkage↗
PubMed1994

Implementation of a relational patient record with integration of educational and reference information.

The clinician must identify pertinent diagnostic information and develop appropriate medical management plans in the context of rapidly changing research information, new therapeutic options and expanding diagnostic modalities. To assist in recognition of patterns relevant to diagnostic or therapeutic interventions, the medical record must be presented in a format that emphasizes important data interrelationships. Reference and educational information specifically pertinent to the case being reviewed must be immediately accessible. A system that presents point of care patient centered clinical information, a summarized patient record, in a relational format with linked reference information has been developed. Data is acquired from the VA patient information database and provided over a PC network. At the time of data transfer, preliminary analysis and reorganization of data is performed such that interrelationships between laboratory, pharmacy and diagnostic information can be rapidly recognized. During data compilation reference and educational information is linked with patient data such that it can be accessed with a mouse click ("hotspot") when the record is subsequently reviewed. The medical record and CD-ROM based reference databases are then made available to users on a PC network in a Windows (tm) environment. Initial experience with the system is very favorable and suggests that evaluation of patient data may be significantly enhanced.

Computer Communication Networks↗
PubMed1994

Target heart rates for the development of cardiorespiratory fitness.

The American College of Sports Medicine (ACSM) recommends the use of 40%, 60%, 80%, and 85% of maximal oxygen consumption (VO2max) as target values in developing exercise prescriptions. Further, the ACSM states that 55%, 70%, 85%, and 90% of maximal heart rate (HRmax) may be used as indices of these respective levels of % VO2max for the general population. The current study evaluated this relationship between %HRmax and %VO2max in apparently healthy, young adults. Eighty-one men and 81 women between the ages of 18 and 34 engaged in an incremental exercise test to exhaustion. Linear regressions of %HRmax and %VO2max were performed on each subject. From these regressions, target values of %HRmax were computed for each individual. Mean percentages of HRmax were 63%, 76%, 89%, and 92% at 40%, 60%, 80%, and 85% of VO2max, respectively. At all of these values of %VO2max, the values obtained for %HRmax were significantly greater (P < 0.001) than those used by the ACSM. Fitness affected these results, particularly among men. High fit men averaged 2% higher in %HRmax than low fit men at any given value of %VO2max.

Adolescent↗
PubMed1993

Clinical comparison of oral nifedipine and subcutaneous terbutaline for initial tocolysis.

In search of further "first line" alternatives for reducing premature uterine irritability and contractions, oral nifedipine, a type II dihydropyridine calcium channel blocking agent, was selected for a prospective randomized comparison trial with an established subcutaneous terbutaline protocol. Patients without primary exclusion criteria for tocolysis, with gestational ages between 20 and 35 weeks, were eligible for the study. In this report, data from 52 patients have been collated and have undergone appropriate tests of significance (28 patients receiving nifedipine and 24 patients receiving terbutaline). Both agents were found to be highly effective for tocolysis, with a success rate of 68% for nifedipine and 71% for terbutaline. Although not statistically significant, a tendency toward a decrease in side effects was noted with nifedipine when compared with terbutaline. No deleterious maternal or fetal side effects were reported. Based on these data, nifedipine, given as a one time, 30 mg oral dose, proved to be as effective as the subcutaneous terbutaline injection protocol.

Administration, Oral↗
PubMed1993

Perirenal extravasation with blunt trauma from rupture of a calyceal fornix.

Perirenal extravasation of urine with an intact renal parenchyma and with dye visualized in the ureter was seen on an excretory urogram (IVP) and computed tomographic (CT) scan in two patients (bilateral in one) with multiple injuries following blunt trauma. Expectant management with no invasive procedures resulted in disappearance of the extravasation within 3 to 5 days. Traumatic rupture of a calyceal fornix is thought to be the cause of the extravasation similar to the perirenal extravasation seen with renal colic from a ureteral calculus.

Adult↗
PubMed1993

Factors influencing the success of conventional root canal therapy--a five-year retrospective study.

This retrospective study on the outcome of conventional root canal therapy was carried out on patients attending the Eastman Dental Hospital between 1970 and 1982. A minimum follow-up period of 5 years was required for patients to be included in the survey. The characteristics of the resulting sample group, the techniques for canal preparation and obturation and the obturating materials used were analysed. The type of obturating material used had no demonstrable effect on success rate but sex, age, preoperative vitality and periapical pathology were associated with significantly differing success rates. Technique also influenced success rate; the method of canal preparation and the position of the apical seal relative to the radiographic apex were both found to be significant. The overall success rate was 84.29%, representing 692 of 821 teeth included in the survey.

Adolescent↗
PubMed1993

Smoking in diabetic teenagers.

The prevalence of smoking amongst a group of 77 diabetic teenagers aged 11-18 years attending two paediatric clinics was determined using a questionnaire and urine cotinine assay. Five individuals were identified as definite smokers with two further individuals being probable smokers, all of whom were aged 15 years or more. This low prevalence (9%) is in contrast to a 48% prevalence in a young adult diabetic clinic. Many diabetic teenagers appear to acquire a regular smoking habit after leaving the paediatric clinic so it is important that health education is targeted at this group.

Adolescent↗
PubMed1993

Depressive symptomatology and interaction behaviors of mothers having a child with disabilities.

Previous research has indicated that parents who raise children having disabilities report greater emotional distress than other parents. To investigate the association between symptoms of depression and maternal behaviors, interactions between 48 mothers and children having disabilities were rated. Measures of maternal depression and child functioning were also administered. Analyses indicated that mothers reported a relatively large number of symptoms often associated with depression. However, reports of depressive symptomatology were not meaningfully related to the children's developmental status or parent-child interaction behaviors.

Adult↗
PubMed1993

Hepatocellular carcinoma. Identifying and screening populations at increased risk.

Hepatocellular carcinoma appears to be associated with hepatitis B and C infections and is common in patients with cirrhosis caused by chronic viral hepatitis. Screening for hepatocellular carcinoma can lead to early detection and surgical intervention, resulting in improved survival rates. Patients with cirrhosis or unexplained elevation of alphafetoprotein levels should be examined every 3 to 6 months. Patients with chronic viral hepatitis but no underlying liver disease and normal levels of alpha fetoprotein may be examined yearly. Seronegative contacts of hepatitis B virus carriers should be immunized.

Adult↗