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C Stewart

Publications and source records attributed to C Stewart.

At least 37 records · Page 2Linked to original sources
PubMed2001

Audiologic aspects of the search for DFNA20: a gene causing late-onset, progressive, sensorineural hearing loss.

OBJECTIVE: The purpose of this research was to identify the gene responsible for a novel form of nonsyndromic, late-onset, bilateral, progressive, sensorineural hearing loss in a Michigan family of English descent. This report describes the audiologic aspects of the search. DESIGN: Fifty-eight members of the family served as subjects for the study. Family pedigree information was gathered from family interviews, family records, birth and death registration records and census data. Audiologic evaluation was used to describe the hearing loss (phenotype) and classify family members as affected or unaffected based on hearing status. These data then were used in a linkage analysis, a process in which the inheritance of a trait is compared with the inheritance of genetic markers and statistically significant associations are sought. RESULTS: The team mapped the hearing loss to the long arm of chromosome 17 at band 17q25. The pattern of inheritance is autosomal dominant. The search for the gene is continuing using a candidate gene approach. CONCLUSIONS: The hearing loss demonstrated by this mid-Michigan family is a novel form of nonsyndromic, genetic, late-onset, bilateral, progressive, sensorineural hearing loss. The locus of the gene, the 20th for autosomal dominant hearing loss, is at band 17q25 of chromosome 17.

Adolescent↗
PubMed2001

The influence of spirituality on substance use of college students.

OBJECTIVES: The issue of substance use and the problems resulting from that use has become a major concern in the United States. The past decade has seen several new trends in substance use by college students and an increase in the effort to try and determine factors that may ameliorate the problem. Spirituality is one possible factor that may have some role in the phenomenon. Some research has been conducted on the relationship of spirituality to substance use but the results are mostly descriptive and concerned with religiosity rather than spirituality. The purpose of this study was to explore the relationship between a student's spiritual and religious beliefs and the impact of those beliefs on the decision to use substances. METHOD: A sample of 337 university students was surveyed using the CORE Alcohol and Drug Survey and several supplemental questions. RESULTS: In general, spirituality had a moderate buffering effect upon the decision to use alcohol and marijuana. This general protective effect exists for both alcohol use and binge drinking but dissipated as the students reached upper-class levels. CONCLUSION: Spirituality may play a significant role in the decision of college students to use substances. Further research should focus on this important factor. Also, implementation of spiritual aspects into university prevention and treatment programs may help boost efficacy rates.

Adolescent↗
PubMed2001

Alteration of mood state after a single bout of noncompetitive and competitive exercise programs.

This study evaluated the effects of three popular physical activities on the psychological well-being of university students. 44 students in three physical activity classes enrolled in the Fitness for Life Program at Montana State University which included circuit training, weight training, and racquetball were administered the Profile of Mood States scale 5 min. before and 5 min. after one bout of physical activity. Two of the three activities appeared to be associated positively with scores on certain subscales. The results supported positive psychological well-being of students after physical activity. Implications for research are presented.

Affect↗
PubMed2001

A phase II multicenter study of CAMPATH-1H antibody in previously treated patients with nonbulky non-Hodgkin's lymphoma.

CAMPATH-1H is a humanized antilymphocyte monoclonal antibody (mAb) directed against the CD52 antigen expressed on normal and malignant lymphocytes. We report the results of a multicenter phase II trial using intravenous CAMPATH-1H in previously treated patients with nonbulky non-Hodgkin's lymphoma (NHL) or minimal residual NHL. Sixteen previously treated patients with nonbulky NHL and two patients with minimal residual NHL, were treated with CAMPATH-1H. Changes in peripheral blood lymphocyte subsets were analyzed by multiparameter flow cytometric techniques in eleven patients. The 18 patients enrolled in the studies received CAMPATH-1H for a median duration of 6 weeks (range, 3 to 14 weeks), and a median cumulative dose of 470 mg (range, 180 to 1185 mg). Two of the sixteen patients with nonbulky NHL achieved a complete response (CR) and one patient achieved a partial response (PR). One of the two patients with minimal residual NHL achieved a molecular CR. Infusional complications were seen with the majority of patients but were more common with initial infusions. Significant hematologic toxicity was also observed with grade (3/4) thrombocytopenia (n=10), grade (3/4) neutropenia (n=4) and grade 3 anemia (n=3). Due to excessive infectious complications observed with the patients enrolled, the trials were terminated early. Anti-tumor activity was demonstrated in a small subset of previously treated low-grade lymphoma patients with nonbulky or minimal residual disease. Future studies evaluating the effect of different drug schedules, modes of mAb administration, and concurrent use of prophylactic antibiotics/antiviral/antifungal agents to optimize anti-tumor activity and limit infectious toxicities are planned.

Adult↗
PubMed2001

Hospital at home services for acute exacerbation of chronic obstructive pulmonary disease: a survey of British practice.

OBJECTIVES: To identify the prevalence of and attitudes towards hospital at home services for acute exacerbation of chronic obstructive pulmonary disease (COPD) in Great Britain. To identify the models of service in existence, in particular staff numbers and the workload experienced. DESIGN: A postal survey was used to locate existing schemes. Telephone interviews were conducted with each of the hospital at home services identified. SUBJECTS & SETTING: A questionnaire was sent to one consultant in each of 223 respiratory departments in Great Britain. Thirty six departments were subsequently contacted by telephone. OUTCOME MEASURES: Awareness and prevalence of hospital at home services. Perceived problems with starting a service. Details of organisation of existing services. RESULTS: We received 186 replies to the postal questionnaire. Of these respiratory departments, 179 (96%) were aware of hospital at home services for acute exacerbation of COPD and, in November 1999, 30 (16%) were running such a service. Difficulty in obtaining funding was the main reason for not setting up a service rather than lack of evidence of benefit or unsuitability of local circumstances. Median staffing level was two nurses (range one to six) looking after a median number of new patients of five per week (range 0.5 to 12). There was wide variation in the organisation of services. CONCLUSIONS: Despite lack of objective evidence of effectiveness, there was a high level of awareness of and interest in starting hospital at home services for acute exacerbation of COPD in British respiratory departments when assessed in November 1999.

Acute Disease↗
PubMed2000

Activation of MHC class I, II, and CD40 gene expression by histone deacetylase inhibitors.

Epigenetic mechanisms are involved in regulating chromatin structure and gene expression through repression. In this study, we show that histone deacetylase inhibitors (DAIs) that alter the acetylation of histones in chromatin enhance the expression of several genes on tumor cells including: MHC class I, II, and the costimulatory molecule CD40. Enhanced transcription results in a significant increase in protein expression on the tumor cell surface, and expression can be elicited on some tumors that are unresponsive to IFN-gamma. The magnitude of induction of these genes cannot be explained by the effect of DAIs on the cell cycle or enhanced apoptosis. Induction of class II genes by DAIs was accompanied by activation of a repressed class II transactivator gene in a plasma cell tumor but, in several other tumor cell lines, class II was induced in the apparent absence of class II transactivator transcripts. These findings also suggest that the abnormalities observed in some tumors in the expression of genes critical to tumor immunity may result from epigenetic alterations in chromatin and gene regulation in addition to well-established mutational mechanisms.

Animals↗
PubMed2000

Interobserver agreement among sleep scorers from different centers in a large dataset.

STUDY OBJECTIVES: To evaluate epoch by epoch agreement in sleep stage assignment between scorers from different laboratories. DESIGN: N/A. METHODS: 62 NPSGs were selected for analysis from 3 sleep centers (38 diagnostic studies for sleep disordered breathing [SDB], 10 studies during CPAP titration, and 14 studies in subjects with no sleep related complaints or sleep pathology). The sleep recording montage consisted of at least 2 EEG leads, left and right EOG and a submental EMG. Scoring was performed manually by 5 experienced sleep technologists. No scorer had knowledge of any other scorers' results. Agreement was tabulated both for sleep stage distribution and on an epoch by epoch basis for the entire data set and the normal and SDB subsets. MEASUREMENTS AND RESULTS: The mean epoch by epoch agreement between scorers for all records was 73% (range 67-82%). Agreements were higher in the normal subset (mean 76%, range 65-85%) than in the SDB subset (mean 71%, range 65-78%). There was significant variability in agreement between records and between pairs of scorers. Overall, 75% of epochs had at least 4 of the 5 scorers in agreement on the sleep stage and 96% of epochs had agreement of at least 3 of the 5 scorers. CONCLUSIONS: The level of agreement in sleep stage assignment varies between scorers, by diagnosis, and by record. The level of agreement between laboratories is lower than what can be maintained between scorers within the same laboratory. This warrants caution when comparing data scored in separate laboratories. The lower agreement in SDB patients supports the generally held view that sleep fragmentation makes application of the R&K rules less reliable.

Adolescent↗
PubMed2000

Determining the validity of advance directives.

We examine the ethical principles underpinning advance directives (ADs) and the legal duties of doctors in determining their validity. A physician attending an incompetent patient with an acute life-threatening illness, and an AD refusing treatment, should ensure that the AD is legally valid before making the treatment decision. Treatment against a patient's wishes, as expressed in a valid AD, compromises patient autonomy and may constitute battery. Conversely, withholding treatment in accordance with an AD that is not legally valid risks substantial harm to the patient and may constitute breach of the duty of care and negligence. Legally valid directives should be respected. If an AD is not legally valid, the patient should be treated in his or her best interests. If uncertain, the physician should treat according to the patient's best interests while seeking legal advice.

Acute Disease↗
PubMed2000

Comparative in vitro activity of gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin and trovafloxacin against 4151 Gram-negative and Gram-positive organisms.

Gatifloxacin, grepafloxacin, moxifloxacin and trovafloxacin are fluoroquinolones with enhanced Gram-positive activity while retaining broad-spectrum activity against Gram-negative pathogens. Levofloxacin and ciprofloxacin are older quinolones with broad activity against Gram-negative pathogens and borderline activity against some Gram-positive organisms. We compared the in vitro activity of these compounds against 4151 Gram-negative and -positive organisms. Gatifloxacin, grepafloxacin, moxifloxacin and trovafloxacin were highly active against penicillin sensitive and resistant Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes and Streptococcus agalactiae. Ciprofloxacin and levofloxacin were active but less potent. All compounds were highly active (overall) against Gram-negative pathogens with ciprofloxacin being the most active agent against Pseudomonas aeruginosa. Our data indicate that the advanced fluoroquinolones will be important compounds for treating infections caused by Gram-positive and Gram-negative pathogens.

Anti-Infective Agents↗
PubMed2000

Setting up a multidisciplinary clinic.

Chronic pelvic pain can be a perplexing and complex problem, frustrating to both clinicians and patients. The traditional medical and surgical model does not always relieve symptoms, and many patients suffer years of pain and undergo multiple surgical procedures without long-term benefit. The biopsychosocial model for chronic pelvic pain gives clinicians the opportunity to broaden the scope for management. A multidisciplinary team can offer simultaneous assessment and management of somatic, behavioural and psychosocial components of the pain. Key members of the team are identified and their roles explored. Practical aspects of operating a multidisciplinary clinic are discussed. A multidisciplinary approach comprises many elements. Further research is needed to identify which are the essential elements to secure optimum outcome for the individual patient.

Chronic Disease↗
PubMed2000

Challenges in the dietary treatment of cystic fibrosis related diabetes mellitus.

Cystic fibrosis related diabetes mellitus is an increasingly recognized problem as survival in patients with cystic fibrosis improves. In a 5 year retrospective study of 627 children and adults attending Toronto cystic fibrosis clinics, we identified 57 (9%) patients with cystic fibrosis related diabetes mellitus; four (1.3%) of 301 children (<18 years) and 53 (16%) of 326 adults. The development of this complication of cystic fibrosis is associated with increased mortality, deteriorations in both respiratory and nutritional status, and the development of late microvascular, but not macrovascular, diabetic complications. Unfortunately, systematic review of the literature provides few well designed studies that provide sound evidence for clinical practice. Recommendations are therefore often based on anecdote, rather than physiological or outcomes research. Dietary therapy combines the principles of the dietary management of both cystic fibrosis and diabetes mellitus, but emphasizes the need for a high energy diet (> 100% of recommended daily intake) in patients with cystic fibrosis related diabetes mellitus. The importance of calories from fat is emphasized, with no restriction on total carbohydrate intake. Insulin intake mirrors carbohydrate intake. Routine dietary therapy is straightforward, but challenges occur due to both complications of cystic fibrosis and advancing disease. If a patient with cystic fibrosis related diabetes mellitus is malnourished, overnight enteral tube feeding is often used, with an adjusted insulin regimen. There is a great need for both physiological and outcomes research to provide sound scientific evidence for the dietary treatment of cystic fibrosis related diabetes mellitus.

Cystic Fibrosis↗
PubMed2000

Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial.

BACKGROUND: We have previously reported the use of a hospital based respiratory nurse service (Acute Respiratory Assessment Service, ARAS) to support home treatment of patients with exacerbations of chronic obstructive pulmonary disease (COPD). A controlled trial was undertaken to compare early discharge with home treatment supported by respiratory nurses with conventional hospital management of patients admitted with exacerbations of COPD. METHODS: Patients with COPD admitted as emergencies were identified the next working day. They were eligible for inclusion in the study if the differential diagnosis included an exacerbation of COPD, but were excluded if other medical conditions or acidotic respiratory failure required inpatient investigation or management. Of 360 patients reviewed, 209 were being assessed for other active medical problems and were excluded, 33 potential participants were already involved in research studies and so were ineligible, and 37 did not wish to participate in the study. Eighty one patients were randomised to receive conventional inpatient care (n=40) or to planned early discharge the next working day (n=41). Those discharged early continued treatment at home under the supervision of specialist respiratory nurses. Outcome measures were readmission, additional hospital days, and deaths within 60 days of initial admission. Process measures included number of visits, duration of follow up by the respiratory nurse, and additional treatment provided to support early discharge. RESULTS: On an intention to treat basis, a policy of early discharge reduced inpatient stay from a mean of 6.1 (range 1-13) days with conventional management to 3.2 (1-16) days with an early discharge policy. Twelve patients (30% conventional management, 29.3% early discharge) were readmitted in each group giving a mean difference in readmission of 0.7% (95% CI of the difference -19.2 to 20.6). In the conventional management group readmitted patients spent a mean of 8.75 additional days in hospital compared with 7.83 days in the early discharge group, giving a mean difference of 0.92 days (95% CI of the difference -6.5 to 8.3). There were two deaths (5%) in the conventional management group and one (2.4%) in the early discharge group, a mean difference of 2.6% (95% CI of the difference -5.7 to 10.8). CONCLUSIONS: Patients with acute exacerbations of COPD uncomplicated by acidotic respiratory failure or other medical problems can be discharged home earlier than is current practice with support by visiting respiratory nurses. No difference was found in the subsequent need for readmission.

Aged↗
PubMed2000

Urinary tract infection prophylaxis using Escherichia coli 83972 in spinal cord injured patients.

PURPOSE: Escherichia coli 83972 was previously shown to establish bladder colonization in select patient groups. We evaluate the safety and feasibility of using bacterial interference with E. coli 83972 to prevent urinary tract infection in spinal cord injured patients. MATERIALS AND METHODS: A total of 21 men and women with neurogenic bladder secondary to spinal cord injury underwent intravesical inoculation with E. coli 83972. Frequency of symptomatic urinary tract infection before and after colonization was compared. RESULTS: Successful long-term bladder colonization was achieved in 13 study participants. Mean duration of colonization was 12.3 months (range 2 to 40). Subjects had no symptoms of urinary tract infection while colonized with E. coli 83972 (0 infection per 18.4 patient-years). Successfully colonized subjects had experienced a mean of 3.1 symptomatic urinary tract infections per year (range 2 to 7) before colonization. Symptomatic infection also occurred in 4 subjects who were not successfully colonized with E. coli 83972 and in 7 others after spontaneous loss of colonization. Colonized subjects reported subjective improvement in quality of life with respect to urinary tract infection while colonized. CONCLUSIONS: E. coli 83972 may be safely used to establish long-term asymptomatic bladder colonization in spinal cord injured subjects. Preliminary findings suggest that colonization with E. coli 83972 may reduce the frequency of urinary tract infection in patients with neurogenic bladder secondary to spinal cord injury.

Adult↗
PubMed2000

Maxillofacial trauma.

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Emergency Medical Services↗