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Biomedical subjects

C Williams

Publications and source records attributed to C Williams.

At least 91 records · Page 5Linked to original sources
PubMed2001

Conflicting perceptions of the fetus: person, patient, 'nobody', commodity?

Different constructions of the fetus lie at the centre of reproductive, abortion and disability politics. Recent developments mean that, within the same hospital, a fetus may be perceived in contrasting and potentially conflicting ways. It is also argued that the status given to the fetus is directly relevant to the status given to pregnant women. During group discussions facilitated by an ethicist, health-care staff highlighted various perceptions of the fetus which included: person; patient; 'nobody'; commodity. Perhaps not surprisingly in view of the current legal situation, staff tended to claim that it is usually the pregnant women who decides how her fetus will be constructed, and the practitioner who responds to this. However, various ways in which practitioners might influence women's perceptions of their fetus are highlighted, as are some ways in which the perceptions of staff might be influenced. This paper illustrates how sensitive health-care staff will need to be if they are indeed to respond to, rather than shape, women's constructions of their fetus.

Attitude of Health Personnel↗
PubMed2001

Stereoacuity at age 3.5 y in children born full-term is associated with prenatal and postnatal dietary factors: a report from a population-based cohort study.

BACKGROUND: Observational studies suggested that breast-feeding benefits the visual development of preterm children, which has been attributed to the presence of docosahexaenoic acid (DHA) in breast milk but not most formula milks. Randomized studies showed that preterm children require a dietary supply of DHA in the first few weeks of life for optimal visual development, but it is unclear whether full-term children experience similar benefits from breast milk or DHA supplements. OBJECTIVE: The objective of this study was to compare stereoacuity at age 3.5 y in healthy, full-term children who were breast-fed and in similar children who had not been breast-fed after adjustment for socioeconomic status and maternal diet. DESIGN: Prospectively collected data on maternal diet during pregnancy (including intake of oily fish), the child's diet, and the socioeconomic status of the family were examined. Stereoacuity at age 3.5 y was assessed. RESULTS: Children who had been breast-fed for 4 mo were more likely to achieve high-grade stereopsis, or stereoscopic vision, than were children who had not been breast-fed (adjusted odds ratio: 2.77; 95% CI: 1.54, 4.97). The mother's antenatal blood DHA content was associated with her intake of oily fish (P < 0.0001). Children whose mothers ate oily fish during pregnancy were also more likely to achieve high-grade stereopsis than were children whose mothers did not eat oily fish (adjusted odds ratio: 1.57; 95% CI: 1.00, 2.45). CONCLUSIONS: The results of this study suggest that for full-term infants, breast-feeding is associated with enhanced stereopsis at age 3.5 y, as is a maternal DHA-rich antenatal diet, irrespective of later infant feeding practice.

Animals↗
PubMed2001

Written and computer-based self-help treatments for depression.

Patients and health purchasers are demanding the provision of effective and accessible mental health treatments. Psychotherapeutic approaches are popular with patients, but access to specialist psychotherapy services is often limited. Other ways of offering treatment within the time and resources available to most practitioners need to be considered. One possible solution is the use of structured self-help materials that address common mental disorders such as depression. Self-help treatments are available in a variety of formats such as books, CD-ROMS, audio and videotapes. Evidence exists for their effectiveness; however, a relatively neglected area has been a discussion of the educational aspects of such materials. Self-help materials aim to improve patient knowledge and skills in self-management. They require very clear educational goals and a content and structure that is appropriate for those who use them. Such work will enhance the credibility, take-up, and effectiveness of self-help materials within clinical settings.

Books↗
PubMed2001

Pre-registration house officers in general practice: the views of GP trainers.

BACKGROUND: Recent changes have led to an upsurge of interest in pre-registration rotations in general practice. In 1998, a national pilot programme of >40 new rotations incorporating general practice was implemented. OBJECTIVE: The aim of this study was to explore the experiences of GPs involved in the four pilot rotations established in South Thames region. METHODS: Semi-structured interviews were conducted with trainers and partners. RESULTS: The supervisory workload for pre-registration house officers (PRHOs) was much greater than that required by registrars. All GPs felt that increased remuneration was important for the future viability of the scheme. The majority of GPs remained supportive of the scheme, although a minority were concerned about the value of the experience gained by PRHOs. There were a few instances in which inadequacies in patient management had to be dealt with subsequently by trainers. The supervisory implications of such events will need to be addressed. CONCLUSION: This significant development in medical education has important implications for GPs and their patients which need further exploration through long-term evaluations.

Attitude of Health Personnel↗
PubMed2001

Lymphocytic hypophysitis in a man presenting with hypercalcemia.

A 59-year-old man with a 30-year history of type 2 diabetes mellitus presented with fatigue, confusion, and weight loss over a 3-month period. He was found to be hypercalcemic (11.8 mg/dL) and dehydrated, and his hypercalcemia improved with intravenous fluids. While in the hospital, he developed hyponatremia, hypoglycemia, and hypotension. He was found to have a subnormal cortisol level of 2.3 microg/dL at baseline, which increased to only 5.6 microg/dL 60 minutes after a 250-microg corticotropin intravenous stimulation test. The patient developed pneumonia and adult respiratory distress syndrome and died of an acute myocardial infarction. During the autopsy, he was found to have lymphocytic hypophysitis with a severe reduction in corticotropin-producing anterior pituitary cells. No malignancy was identified at autopsy. He is the first male patient to be described in the literature who presented with hypercalcemia caused by lymphocytic hypophysitis.

Autopsy↗
PubMed2001

Multicenter phase II study of gemcitabine in previously untreated patients with advanced epithelial ovarian cancer.

Gemcitabine has activity in advanced ovarian cancer, with responses in platinum-resistant disease. This study assessed the activity of gemcitabine in previously untreated patients with advanced epithelial ovarian cancer. All patients had histologically verified invasive epithelial ovarian cancer, International Federation of Gynecology and Obstetrics (FIGO) stage III/IV disease and no prior chemotherapy. Patients received gemcitabine 1250 mg/m(2) on days 1, 8 and 15 of a 28-day cycle. Radiological response was assessed after two cycles. Between December 1992 and October 1995, 35 patients were enrolled. Of 33 evaluable patients, there was one complete response and five partial responses, for an overall response rate of 18% (95% confidence interval 7-36%). Forty-two percent of patients had a greater than 50% decrease in their CA-125 levels. Of the 25 patients who received platinum-based chemotherapy following treatment with gemcitabine, 12 achieved an overall response rate of 48%. Toxicity was mild, with two episodes of WHO grade 4 neutropenia (not associated with fever) and two episodes of grade 4 thrombocytopenia (not associated with bleeding). Gemcitabine has single-agent activity for poor-prognosis patients with advanced ovarian cancer. Similar results with subsequent platinum-based therapy indicate a lack of cross-resistance. This, combined with gemcitabine's favorable toxicity profile, warrants testing in comparative trials.

Adult↗
PubMed2001

Threading of a glycosylated protein loop through a protein hole: implications for combination of human chorionic gonadotropin subunits.

Chorionic gonadotropin (hCG) is a heterodimeric placental glycoprotein hormone essential for human reproduction. Twenty hCG beta-subunit residues, termed the seatbelt, are wrapped around alpha-subunit loop 2 (alpha 2) and their positions "latched" by a disulfide formed by cysteines at the end of the seatbelt (Cys 110) and in the beta-subunit core (Cys 26). This unique arrangement explains the stability of the heterodimer but raises questions as to how the two subunits combine. The seatbelt is latched in the free beta-subunit. If the seatbelt remained latched during the process of subunit combination, formation of the heterodimer would require alpha 2 and its attached oligosaccharide to be threaded through a small beta-subunit hole. The subunits are known to combine during oxidizing conditions in vitro, and studies described here tested the idea that this requires transient disruption of the latch disulfide, possibly as a consequence of the thioredoxin activity reported in hCG. We observed that alkylating agents did not modify either cysteine in the latch disulfide (Cys 26 or Cys 110) during heterodimer formation in several oxidizing conditions and had minimal influence on these cysteines during combination in the presence of mild reductants (1--3 mM beta-mercaptoethanol). Reducing agents appeared to accelerate subunit combination by disrupting a disulfide (Cys 93--Cys 100) that forms a loop within the seatbelt, thereby increasing the size of the beta-subunit hole. We propose a mechanism for hCG assembly in vitro that depends on movements of alpha 2 and the seatbelt and suggest that the process of glycoprotein hormone subunit combination may be useful for studying the movements of loops during protein folding.

Alkylating Agents↗
PubMed2001

Prolonged vitamin C supplementation and recovery from demanding exercise.

The aim of the present study was to investigate whether 2 weeks of vitamin C supplementation affects recovery from an unaccustomed bout of exercise. Sixteen male subjects were allocated to either a placebo (P; n = 8) or vitamin C group (VC; n = 8). The VC group consumed 200 mg of ascorbic acid twice a day, whereas the P group consumed identical capsules containing 200 mg of lactose. Subjects performed a prolonged (90-min) intermittent shuttle-running test 14 days after supplementation began. Post-exercise serum creatine kinase activities and myoglobin concentrations were unaffected by supplementation. However, vitamin C supplementation had modest beneficial effects on muscle soreness, muscle function, and plasma concentrations of malondialdehyde. Furthermore, although plasma interleukin-6 increased immediately after exercise in both groups, values in the VC group were lower than in the P group 2 hours after exercise (p < .05). These results suggest that prolonged vitamin C supplementation has some modest beneficial effects on recovery from unaccustomed exercise.

Administration, Oral↗
PubMed2001

Effect of soluble CD4 on exposure of epitopes on primary, intact, native human immunodeficiency virus type 1 virions of different genetic clades.

We have used a virus-binding assay to examine conformational changes that occur when soluble CD4 (sCD4) binds to the surface of intact, native, primary human immunodeficiency virus type 1 virions. The isolates examined belong to seven genetic clades (A to H) and are representative of syncytium-inducing and non-syncytium-inducing phenotypes. Conformational changes in epitopes in the C2, V2, V3, C5, and CD4 binding domain (CD4bd) of gp120 and the cluster I and II regions of gp41 of these viruses were examined using human monoclonal antibodies that are directed at these regions. The studies revealed that sCD4 binding causes a marked increase in exposure of epitopes in the V3 loop, irrespective of the clade or the phenotype of the virus. Sporadic increases in exposure were observed in some epitopes in the V2 region, while no changes were observed in the C2, C5, or CD4bd of gp120 or the cluster I and II regions of gp41.

CD4 Antigens↗
PubMed2001

Glutamine supplementation promotes anaplerosis but not oxidative energy delivery in human skeletal muscle.

The aims of the present study were twofold: first to investigate whether TCA cycle intermediate (TCAI) pool expansion at the onset of moderate-intensity exercise in human skeletal muscle could be enhanced independently of pyruvate availability by ingestion of glutamine or ornithine alpha-ketoglutarate, and second, if it was, whether this modification of TCAI pool expansion had any effect on oxidative energy status during subsequent exercise. Seven males cycled for 10 min at approximately 70% maximal O2) uptake 1 h after consuming either an artificially sweetened placebo (5 ml/kg body wt solution, CON), 0.125 g/kg body wt L-(+)-ornithine alpha-ketoglutarate dissolved in 5 ml/kg body wt solution (OKG), or 0.125 g/kg body wt L-glutamine dissolved in 5 ml/kg body wt solution (GLN). Vastus lateralis muscle was biopsied 1 h postsupplement and after 10 min of exercise. The sum of four measured TCAI (SigmaTCAI; citrate, malate, fumarate, and succinate, approximately 85% of total TCAI pool) was not different between conditions 1 h postsupplement. However, after 10 min of exercise, SigmaTCAI (mmol/kg dry muscle) was greater in the GLN condition (4.90 +/- 0.61) than in the CON condition (3.74 +/- 0.38, P < 0.05) and the OKG condition (3.85 +/- 0.28). After 10 min of exercise, muscle phosphocreatine (PCr) content was significantly reduced (P < 0.05) in all conditions, but there was no significant difference between conditions. We conclude that the ingestion of glutamine increased TCAI pool size after 10 min of exercise most probably because of the entry of glutamine carbon at the level of alpha-ketoglutarate. However, this increased expansion in the TCAI pool did not appear to increase oxidative energy production, because there was no sparing of PCr during exercise.

Adult↗
PubMed2001

A comparison of bone remodelling around hydroxyapatite-coated, porous-coated and grit-blasted hip replacements retrieved at post-mortem.

We investigated the implant-bone interface around one design of femoral stem, proximally coated with either a plasma-sprayed porous coating (plain porous) or a hydroxyapatite porous coating (porous HA), or which had been grit-blasted (Interlok). Of 165 patients implanted with a Bimetric hip hemiarthroplasty (Biomet, Bridgend, UK) specimens were retrieved from 58 at post-mortem. We estimated ingrowth and attachment of bone to the surface of the implant in 21 of these, eight plain porous, seven porous HA and six Interlok, using image analysis and light morphometric techniques. The amount of HA coating was also quantified. There was significantly more ingrowth (p = 0.012) and attachment of bone (p < 0.05) to the porous HA surface (mean bone ingrowth 29.093 +/- 2.019%; mean bone attachment 37.287 +/- 2.489%) than to the plain porous surface (mean bone ingrowth 21.762 +/- 2.068%; mean bone attachment 18.9411 +/- 1.971%). There was no significant difference in attachment between the plain porous and Interlok surfaces. Bone grew more evenly over the surface of the HA coating whereas on the porous surface, bone ingrowth and attachment occurred more on the distal and medial parts of the coated surface. No significant differences in the volume of HA were found with the passage of time. This study shows that HA coating increases the amount of ingrowth and attachment of bone and leads to a more even distribution of bone over the surface of the implant. This may have implications in reducing stress shielding and limiting osteolysis induced by wear particles.

Aged↗
PubMed2001

Computer problems: are some people jinxed?

To examine the popular notion that some people are 'jinxed' when using computers 111 undergraduate psychology students were 'jinxed' whilst trying to complete a task over the Internet. No evidence was found to support that notion.

Adolescent↗
PubMed2001

When being included is being excluded: a note on complement set focus and the inclusion relation.

Some negative quantifiers lead to pronominal reference patterns that are different from those obtained with positive quantifiers (Moxey & Sanford, 1993). This has been interpreted as meaning that the negatives give rise to a focus on the complement set (Moxey & Sanford, 1987); so, given few of the children enjoyed the trip, focus is on those who did not enjoy the trip. To date, this interpretation has depended on subjective judgments as to which set an anaphoric plural pronoun is referring to, allowing other interpretations of the data to be given by discourse semanticists. In two studies, we use the attachment patterns associated with the expression including, thereby circumventing the judgment problem. We show that a case like not many people enjoyed the race, including John leads to a representation in which John maps into the set of individuals who did not enjoy the race. We test and support the earlier claim that complement set focus is driven by denials associated with some negative quantifiers.

Attention↗
PubMed2001

Cytokeratin 20 as an immunocytochemical marker for detection of urothelial carcinoma in atypical cytology: preliminary retrospective study on archived urine slides.

Previous studies have shown that expression of cytokeratin 20 (CK20), a constituent of intermediate filaments, is increased in malignant versus benign urine samples. To evaluate whether immunocytochemical staining of CK20 on archived urine slides could be used as a potential adjunct marker for triage of atypical urine cytology, we analyzed a total of 77 archived urine slides obtained from a spectrum of patients with various risks of developing urothelial carcinoma. These patients were divided into four groups on the basis of initial urine cytologic results and subsequent follow-up biopsy findings; group 1 had negative results in both evaluations, whereas the results in group 4 were positive for both cytology and biopsy. Groups 2 and 3 had a diagnosis of atypical urine cytology; however, patients in group 3 had a positive follow-up biopsy, and patients in group 2 did not. The Papanicolaou-stained archived urine slides were destained and then restained immunocytochemically with monoclonal antibody against CK20. With 5% positively stained nonumbrella cells as a threshold, CK20 was positive in 94.4% of group 3 or 4 patients. In contrast, CK20 was positive in 27.3% of group 2 patients and in 10.5% of group 1 patients. The overall sensitivity and specificity for CK20 for the detection of urothelial carcinoma in this population of patients were 94.4% and 80.5%, respectively. This study demonstrated that immunocytochemical analysis of CK20 on archived urine slides could be used to triage atypical urine cytology into low- and high-risk categories and that CK20 might be a simple and useful early detection marker for urothelial carcinoma.

Adult↗
PubMed2001

Empowerment: a view of two low-income African-Americans communities.

Field theory and empowerment were used as guiding conceptual frameworks to address empowerment issues in two low-income inner city African-Americans communities. Field theory and empowerment provided a conceptualization of these communities in terms of the possible impact of the physical environment of these communities on their residents and the health care professionals who worked with these residents. The most likely response is learned helplessness and depression that are antithetical to empowerment. These frameworks also were helpful in generating strategies to foster empowerment among these community residents. These strategies include helping residents to redefine their behavior as ways of coping with a hostile environment that confronts them with poverty and racism and to reconnect with natural supports in the community for the purpose of enhancing community coalitions and alliances.

Black or African American↗