Driving, glaucoma, and the law. Patients need more information.
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Automobile Driving↗
Biomedical subjects
C Williams
Publications and source records attributed to C Williams.
Analysis of proteins from human breast epithelial cells using two-dimensional gel electrophoresis.
The human breast is a highly specialized, complex tissue comprised of a heterogeneous population of cells with varying functions. Interactions between the different cell types, changes in their relative abundance, state of differentiation and function in response to stimuli, as well as the alterations that lead to the aberrant growth associated with malignancy are poorly understood. Two-dimensional gel electrophoresis is being used to compare the proteins found in different breast cells in order to identify the gene products that are common or specific to particular cell types so as to provide markers that will be useful in studies of normal breast cell differentiation and the dedifferentiation or blocked differentiation characteristic of cancer. Protein patterns have been obtained from cells prepared for electrophoresis immediately after isolation from human milk, from cells cultured for fewer than ten passages after isolation from healthy breast tissue removed during reduction mammoplasty, and from cells maintained in long-term tissue culture after isolation from the pleural effusions of patients with breast carcinomas. Differential expression of cytokeratins 8, 18, and 19, shown previously to be predominantly expressed by epithelial cells in the luminal layer of breast tissue, was observed among the cells analyzed. Other non-cytokeratin proteins were also found to be differentially expressed in subsets of both the normal and tumor cells. A composite human breast cell protein pattern was created which includes all the commonly and specifically expressed proteins found in this study. This pattern will be the basis for continuing studies of proteins in the human breast.
Amino Acid Sequence↗
Influence of carbohydrate-electrolyte drinks on marathon running performance.
The aim of this study was to compare the effects of drinking two carbohydrate (CHO) electrolyte solutions and water on marathon running performance. Seven endurance-trained runners completed three 42.2-km treadmill time-trials which were randomly assigned and 4 weeks apart. On each occasion the subjects ingested 3 ml.Kg-1 body weight of either water (W), a 6.9% CHO solution (O) or a 5.5% CHO solution (L) immediately prior to the start of the run and 2 ml.kg-1 body weight every 5 km thereafter. The total volume of fluid ingested [mean (SEM)] was 1112 (42), 1116 (44) and 1100 (44) ml, respectively. Running times for W, O and L trials were 193.9 (5.0), 192.4 (3.3) and 190.0 (3.9) min, respectively. Performance time for the L trial was faster (P < 0.05) compared with that of the W trial. Running speed was maintained in the L trial, whereas it decreased after 10 km (P < 0.05) in the W and after 25 km (P < 0.05) in the O trial. Blood glucose and lactate, and hormonal responses to fluid ingestion were similar in all three trials. Higher plasma free fatty acid and glycerol concentrations were observed at the end of the W trial compared with those obtained after the O and L trials, respectively (P < 0.05). Plasma ammonia concentration was higher (P < 0.01) at the end of the L trial compared with the W trial. Plasma creatine kinase concentration was higher (P < 0.05) 24 h after the completion of the L trial than after the W trial.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Correlation between biliary alpha 1-acid glycoprotein concentration and cholesterol crystal nucleation time in gallstone disease.
A biliary form of the alpha 1-acid glycoprotein (AAG) promotes cholesterol crystallization in the lower-molecular-weight, concanavalin A-bound fraction of gallbladder bile. In addition, bile AAG concentration is higher in cholesterol gallstone patients with multiple stones than in control patients without gallstone disease. In this study we sought to determine whether the increased biliary concentration of AAG in cholesterol gallstone patients is accompanied by a more rapid nucleation time in patients with multiple stones. AAG concentration in native biles was measured by ELISA. Nucleation time was measured using a standard microscopy method. The concentration of biliary AAG was then related to nucleation time in biles from the same patients. Nucleation times were significantly shorter (< or = 5 days) in cholesterol gallstone patients with raised AAG concentrations (P < 0.03). There was a significant (P = 0.004) negative correlation (r = -0.53) between nucleation time and the AAG concentration in cholesterol gallstone patients with multiple stones. The concentration of biliary AAG appears to exert an important influence on the speed of cholesterol nucleation in bile in many patients with cholesterol gallstone disease.
Bile↗
An integrated village maternity service to improve referral patterns in a rural area in West-Java.
The Regionalization of Perinatal Care, an intervention study carried out in Tanjungsari, a subdistrict in rural West Java, aimed to develop a comprehensive maternal health program to improve maternal and perinatal health outcomes. The main inputs included training at all levels of the health care system (informal and formal) and the establishment of birthing homes in villages to make services more accessible. Special attention was given to referral, transportation, communication and appropriate case management, A social marketing program was conducted to inform people of the accessible birthing homes for clean delivery, located near the women, and with better transportation and communications to referral facilities should complications arise. The study design was longitudinal, following all pregnant women from early pregnancy until 42 days postpartum in an intervention and a comparison area. The population was +/- 90,000 in the intervention area and 40,000 in the comparison area. Inclusion criteria were all mother and infant units delivered between June 1st, 1992 and May 31st, 1993. Analysis showed the following results: Most women sought antenatal care (> 95%). In Tanjungsari, nearly 90% sought such care from professional providers as versus 75% in the control area of Cisalak. Most women with bleeding or bleeding and edema during pregnancy sought professional assistance in both the study and control areas. However, fever for more than 3 days received more attention in the study area versus control area (93 vs. 69%). Greater than 85% of deliveries in both areas were conducted by TBAs. However, in the study area, nearly one-third of those with intrapartum complications (17%) delivered in a health facility compared to one-tenth in the control area. This meant a hospital delivery, primarily with assistance of a doctor or doctor/midwife combination. Overall referral rates by TBAs were low -13% of women with complications in Tanjungsari and 6% in Cisalak. More women with intrapartum complications were referred in the study area than in the control, and more complied when referred. Women who suffered intrapartum complications were more likely to have a perinatal death. Perinatal deaths declined in Tanjungsari, but not significantly. However, the trend over the period of the intervention shows an improvement in the deliveries managed by TBAs with more deaths resulting in the hands of professionals. Either women were arriving too late or the quality of care could not meet the needs. There was no change in the levels or place of perinatal deaths in Cisalak.
Adult↗
Quality assurance in the CHART clinical trial.
As part of the clinical trial of CHART (continuous hyperfractionated accelerated radiotherapy) a quality assurance programme was included. The technical part of this--which is reported in this paper--is a series of tests designed to check all aspects of treatment planning and delivery. The results of visits to the 13 participating centres--and repeat visits to some of these centres--are discussed. The main areas tested were as follows. The linear accelerator: mechanical, and optical, scales and indicators; radiation field size; flatness and symmetry. DOSIMETRY: output; wedge factor; beam energy; phantom measurements against a plan calculated by the centre. SIMULATOR: mechanical, optical scales and indicators. The results show these centres work within the tolerances chosen for most parameters. Flatness, wedge factor and energy were areas of weakness in some centres. This must be partly the cause of the spread of phantom measurements which, after removal of variations in output, still range from -7 to +6% between calculated and measured values.
Bronchial Neoplasms↗
Nasal and temporal retinal ganglion cells projecting to the midbrain: implications for "blindsight".
We placed pellets of horseradish peroxidase in the superior colliculus of four macaque monkeys and retrogradely labelled the retinal ganglion cells of both eyes. The ratio of labelled cells in the contralateral nasal retina and the ipsilateral temporal retina was no different from the ratio found after implants in the optic nerve, which label the entire afferent pathway. Our finding therefore invalidates the proposal that prominent differences in the properties of "blindsight" in monocular nasal and temporal visual fields arise from differences in the projection from the nasal and temporal retina to the midbrain. We also measured the size of the soma and dendritic field of the labelled ganglion cells (mostly gamma cells) and compared them with those of alpha and beta cells that project to the dorsal lateral geniculate nucleus. Soma size was very close to that of beta cells at all eccentricities but was much smaller than that of alpha cells. Dendritic field size was significantly larger than that of beta cells but was smaller than that of alpha cells. The number of primary dendrites was counted for cells labelled from the midbrain and in samples of alpha and beta cells labelled from the optic nerve. At eccentricities of 3-7 mm there was a consistent and prominent difference between beta and gamma cells. The results show that at intermediate eccentricities even ganglion cells whose distal dendrites are too poorly labelled to reveal their morphological class can never the less be categorized as alpha, beta or gamma by using a combination of soma size and number of primary dendrites. This is particularly useful when attempting to classify retinal ganglion cells following microinjections into selected target nuclei of optic axons.
Animals↗
Ketorolac versus meperidine-plus-promethazine treatment of migraine headache: evaluations by patients.
This study was designed to compare and contrast the speed and efficacy of meperidine (75 mg)/promethazine (25 mg) intramuscularly to ketorolac (60 mg) intramuscularly, in a double-blind study in reducing the symptoms of migraine headache. Forty-two patients who presented to the emergency department between July 1992 and February 1993, with previous diagnoses of migraine headache, were considered for this study. Patients subjectively evaluated parameters of their migraine headaches (eg, pain and nausea) using a numeric scale and were later asked to reevaluate these same parameters at 30, 60, and 360 minutes after a single intramuscular injection of either ketorolac (60 mg) or meperidine (75 mg)/promethazine (25 mg). Sixty-eight percent of patients given meperidine/promethazine responded whereas 55% of patients given ketorolac responded. The responder group showed a statistically significant reduction in headache within 30 minutes with both drug regimens. There was no statistically significant difference between the number of responders in either group. The responders from both groups had relief that lasted 6 hours after injection. In the nonresponder groups, most of the patients withdrew within 1 hour after treatment. As determined by patient response to treatment of their migraine headaches, there was no statistically significant difference between the ketorolac and the meperidine/promethazine groups.
Adult↗
European School of Oncology Advisory report to the Commission of the European Communities for the "Europe Against Cancer Programme" cost-effectiveness in cancer care.
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Cost-Benefit Analysis↗
Influence of ingesting a carbohydrate-electrolyte solution on endurance capacity during intermittent, high-intensity shuttle running.
The aim of this study was to examine the effects of ingesting a carbohydrate-electrolyte solution on endurance capacity during a prolonged intermittent, high-intensity shuttle running test (PIHSRT). Nine trained male games players performed two exercise trials, 7 days apart. On each occasion, they completed 75 min exercise, comprising of five 15-min periods of intermittent running, consisting of sprinting, interspersed with periods of jogging and walking (Part A), followed by intermittent running to fatigue (Part B). The subjects were randomly allocated either a 6.9% carbohydrate-electrolyte solution (CHO) or a non-carbohydrate placebo (CON) immediately prior to exercise (5 ml kg-1 body mass) and every 15 min thereafter (2 ml kg-1 body mass). Venous blood samples were obtained at rest, during and after each PIHSRT for the determination of glucose, lactate, plasma free fatty acid, glycerol, ammonia, and serum insulin and electrolyte concentrations. During Part B, the subjects were able to continue running longer when fed CHO (CHO = 8.9 +/- 1.5 min vs CON = 6.7 +/- 1.0 min; P < 0.05) (mean +/- S.E.M.). These results show that drinking a carbohydrate-electrolyte solution improves endurance running capacity during prolonged intermittent exercise.
Adult↗
Macronutrients and performance.
Athletes should eat a well-balanced diet made up of a wide variety of foods in sufficient quantity to cover their daily energy expenditures. Carbohydrate-containing foods should provide approximately 60-70% of their daily energy intake, protein approximately 12-15%, with the remainder being provided by fat. The higher carbohydrate intakes, however, are only recommended during preparation for, and immediate recovery from, heavy training and competition. Adopting nutritional strategies to increase muscle and liver glycogen stores before, during and after exercise can improve performance. The protein requirements of most athletes are fulfilled when their daily intake is between 1.2 and 1.7 g per kg body mass. This amount of protein is provided by a diet which covers the athlete's daily energy expenditure. Although fat metabolism contributes to energy production during exercise, and the amount increases with endurance training, there is no evidence to suggest that athletes should increase their fat intake as a means of improving their performance.
Dietary Carbohydrates↗
Haemoglobin--is more better?
Quality of life is closely linked to our ability to meet the exercise challenges imposed on us by our daily round of activities and those we select as leisure time activities. Aerobic metabolism of fat and carbohydrates provides the energy to support our activities. An increase in aerobic capacity extends the range and duration of activities we can undertake without the premature onset of fatigue. An adequate oxygen delivery, especially to skeletal muscles, is central to the effective aerobic support of energy metabolism. Frequent exercise improves our aerobic capacity by a relatively modest increase in oxygen transport and a large improvement in the capacity of muscle to use oxygen delivered. This is achieved by an increase in mitochondrial density as well as an increase in capillarisation of skeletal muscles. A decrease in oxygen delivery, in active people, produces the same type of adaptive increases in aerobic capacity. Therefore, even though more haemoglobin is clearly better for active healthy individuals, frequent exercise can improve the capacity of renal patients to make the most effective use of their anaemia-imposed reduced oxygen delivery system.
Altitude↗
Ketorolac versus fentanyl for postoperative pain management in outpatients.
OBJECTIVE: The purpose of this study was to compare the efficacy and safety of i.v. ketorolac and fentanyl for moderate to severe postoperative pain in patients undergoing elective surgery in an ambulatory surgery unit. DESIGN: A double-blind randomized trial. SETTING: An ambulatory surgery unit in a university-affiliated hospital. PATIENTS: Sixty-nine patients undergoing elective laparoscopy, inguinal hernia repair, or knee arthroscopy were enrolled. INTERVENTION: Patients were randomly assigned to receive intravenous ketorolac 30 mg (n = 38) or fentanyl 50 micrograms (n = 31) for moderate to severe postoperative pain. OUTCOME MEASURES: Pain, assessed using a 100-mm visual analog scale and a 5-point verbal pain scale; adverse effects, as well as vital signs were recorded every 15 min for 150 min or until discharge from the postanesthesia care unit, 6 and 24 h after discharge. RESULTS: Pain reduction on both visual analog and verbal scales was significantly greater with fentanyl than ketorolac at 15 min. In addition, the proportion of patients requiring remedication at the 15-min time point was significantly greater in the ketorolac group. However, there were no significant differences between fentanyl and ketorolac between 30 and 150 min after surgery. Notably, pain reduction was significantly greater with ketorolac on the verbal scale at the 6 h measurement. CONCLUSIONS: Ketorolac appears not be as effective as fentanyl in treating early postoperative pain. Although fentanyl still appears to be the drug of choice in the early postoperative period, the parenteral use of ketorolac was more effective during the later postoperative period in providing longer lasting analgesia.
Adult↗
Impact parameter selected excited state populations for 36Ar+197Au reactions at E/A=35 MeV.
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Journal Article↗
Space-time characteristics of fragment emission in the E/A=30 MeV 129Xe+natCu reaction.
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Journal Article↗
Accessory cells do not contribute to G-CSF or IL-6 production nor to rapid haematological recovery following peripheral blood stem cell transplantation.
Haemopoietic recovery is more rapid after peripheral blood stem cell (PBSC) transplantation than after autologous bone marrow transplantation, and the aim of this study was to assess the role of the large number of lymphocytes and monocytes (accessory cells) in a PBSC leukapheresis product in this rapid regeneration. Haematological recovery was therefore assessed in 10 PBSC recipients with lymphoma or myeloma in whom monocytes and T cells were depleted by a median of 2.3 and 3.3 logs by CD34+ cell selection using the CEPRATE SC stem cell concentration system and compared with recovery in 59 recipients who received whole PBSC. After allowing for the number of progenitor cells reinfused, there was no significant delay in engraftment induced by accessory cell depletion. Plasma levels of granulocyte-colony stimulating factor (G-CSF), granulocyte/monocyte-colony stimulating factor (GM-CSF), interleukin-6 (IL-6), stem cell factor (SCF) and macrophage-inhibition factor-alpha (MIP-1-alpha) during the transplant procedure were similar whether or not accessory cells were given. The G-CSF and IL-6 levels rose between days 5 and 14 post transplantation to approximately 1 ng/ml and 50 pg/ml respectively. This study indicates that accessory cells reinfused with PBSC collections are not responsible for the subsequent cytokine profile or rapid haematological recovery.
Adolescent↗
The process and outcomes of care for major depression in rural family practice settings.
Although primary care physicians provide the majority of care for rural residents with major depression, little is known about the quality of the care they provide. The aim of this study was to characterize the process and outcomes of care for rural patients with major depression, and to examine the relationship between the process and outcomes of care in this population. Six hundred and thirty-one patients in 21 primary care practices in small towns were screened; 47 patients (7.4% of patients screened) meeting DSM-III-R criteria for current major depression were recruited into the study, and 38 (81.0% of patients recruited) were followed an average of five months later using the Depression Outcomes Module (Rost, Smith, Burnam, & Burns, 1992). While 24 (63.1%) of the 38 depressed subjects received a prescription for one or more antidepressants between the index visit and follow-up, only 11 (28.9%) received pharmacologic treatment in concordance with the new Agency for Health Care Policy and Research (AHCPR) guidelines; 26 (68.4%) of 38 depressed patients continued to meet criteria for major depression at five months. Those who received pharmacologic treatment concordant with AHCPR guidelines showed more improvement at follow-up. The findings suggest that outcomes for major depression may be worse in rural family practice settings than in urban settings. The study also demonstrates that AHCPR guidelines define effective treatment for major depression in the study sample. The Depression Outcomes Module appears to be a reliable and valid instrument for monitoring the outcomes of care for major depression in family practice settings.
Arkansas↗
The influence of ingesting a carbohydrate-electrolyte beverage during 4 hours of recovery on subsequent endurance capacity.
Recovery from prolonged exercise involves both rehydration and replenishment of endogenous carbohydrate stores. The present study examined the influence of ingesting a carbohydrate-electrolyte (CE) solution following prolonged running, on exercise capacity 4 hr later. Twelve men and 4 women were divided into two matched groups, which were randomly assigned to either a control (P) or a carbohydrate (CHO) condition. Both groups ran at 70% of maximal oxygen uptake (VO2max) on a level treadmill for 90 min or until volitional fatigue (R1), and they ran at the same % VO2max to exhaustion 4 hr later to assess endurance capacity (R2). The CHO group ingested a 6.9% CE solution providing 1.0 g CHO.kg body weight-1 immediately post-R1 and again 2 hr later. The P group ingested equal volumes of a placebo solution. Run times (mean +/- SEM) for R1 did not differ between the groups (P 86.3 +/- 3.8 min; CHO 87.5 +/- 2.5 min). The CHO group ran 22.2 (+/- 3.5) min longer than the P group during R2 (P 39.8 +/- 6.1 min; CHO 62.0 +/- 6.2 min) (p < .05). Thus, ingesting a 6.9% carbohydrate-electrolyte beverage following prolonged, constant-pace running improves endurance capacity 4 hr later.
Adult↗