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Biomedical subjects

D McCulloch

Publications and source records attributed to D McCulloch.

At least 19 recordsLinked to original sources
PubMed2003

Medical needs of people with intellectual disability require regular reassessment, and the provision of client- and carer-held reports.

BACKGROUND: Previous work has indicated a wide range of unmet medical health needs in people with intellectual disability (ID). METHODS: A profile of recorded medical needs was produced for 589 people with ID through a detailed search of individual medical and nursing case records. Specialist optometric and audiological assessments were offered, and reports were provided in technical and plain English terms. A Health Watch project delivered folders with copies of the plain English reports to 60 individuals and carers. RESULTS: The case record review indicated a wide range of medical disorders; however, exact diagnoses and counselling regarding underlying neurological conditions were seldom recorded. Assessed levels of hearing and vision loss were much greater than had been previously recognized. The Health Watch reports were welcomed by the clients and carers. CONCLUSIONS: If satisfactory healthcare is to be achieved for people with ID, medical needs must be monitored, regular specialist reassessments offered, access to specialist services facilitated and reports clearly explained to carers.

Adolescent↗
PubMed2001

Quality improvement in chronic illness care: a collaborative approach.

BACKGROUND: Despite rapid advances in the clinical and psycho-educational management of diabetes, the quality of care received by the average patient with diabetes remains lackluster. The "collaborative" approach--the Breakthrough Series (BTS; Institute for Healthcare Improvement [IHI]; Boston)--coupled with a Chronic Care Model was used in an effort to improve clinical care of diabetes in 26 health care organizations. METHODS: Descriptive and pre-post data are presented from 23 health care organizations participating in the 13-month (August 1998-September 1999) BTS to improve diabetes care. The BTS combined the system changes suggested by the chronic care model, rapid cycle improvement, and evidence-based clinical content to assist teams with change efforts. The characteristics of organizations participating in the diabetes BTS, the collaborative process and content, and results of system-level changes are described. RESULTS: Twenty-three of 26 teams completed participation. Both chart review and self-report data on care processes and clinical outcomes suggested improvement based on changes teams made in the collaborative. Many of the organizations evidencing the largest improvements were community health centers, which had the fewest resources and the most challenged populations. DISCUSSION: The initial Chronic Illness BTS was sufficiently encouraging that replication and evaluation of the BTS collaborative model is being conducted in more than 50 health care systems for diabetes, congestive heart failure, depression, and asthma. This model represents a feasible method of improving the quality of care across different health care organizations and across multiple chronic illnesses.

Aged↗
PubMed2001

Age-related macular degeneration: cost-of-illness issues.

Macular degeneration refers to the breakdown of cells in the centre of the retina. Some degeneration is an inevitable consequence of the aging process; however, when this is associated with loss of sight in the central part of the field of vision an underlying pathology is considered present. Among those aged 55 years, the prevalence of the disease in the US was estimated at 1% rising to approximately 15% among those aged 80 years. Other studies estimate the prevalence of the disease to be higher and to be increasing. The main effect of the disease is to reduce the ability of the individual to engage in everyday activities that require clear central vision. It may also be associated with elevated risks of depression and increased levels of dependency. Currently there is no effective treatment for the majority of patients. For a minority (< 10%) laser photocoagulation therapy may be effective in reducing the risk of severe vision loss. Another treatment, photodynamic therapy, is in development and many others are at an experimental stage. This review sought to establish current knowledge on the cost of illness associated with age-related macular degeneration (ARMD). A search of the literature, together with direct communication with researchers in related fields and patient support/advocacy groups, was undertaken to ascertain current knowledge on the cost of illness of ARMD. While literature on the disease is extensive and literature on treatments is emerging, no substantive information on direct or indirect costs was found although evidence that loss of earnings may occur is beginning to emerge. Some information does exist on cost of illness in diabetic retinopathy, a disease with similarities to ARMD, though even for this disease gaps in knowledge are apparent and wide variations exhibited. Given current knowledge, it is not possible to report on the cost of illness for ARMD with confidence. The lack of information on the cost of illness in ARMD presents difficulties for researchers and policy makers in assessing the cost effectiveness of the existing treatment, as well as new treatments as they become available. Given developments in treatments and the increasing prevalence of the disease, it is important that cost-of-illness information is gathered for ARMD.

Cost of Illness↗
PubMed2000

Characterization of Amorphous Materials by Electron Diffraction and Atomistic Modeling.

The technique of energy selected electron diffraction gives information about amorphous structures which can be used to characterize amorphous materials in terms of their structure. The diffraction data can be used to refine models obtained using molecular dynamics, resulting in physically reasonable models consistent with the diffraction data.

Journal Article↗
PubMed2000

Managing diabetes for improved health and economic outcomes.

The contribution of postprandial glucose to diabetes progression and diabetes-related complications lends a new perspective to diabetes management. It has been long understood that tightly controlled glucose levels improve diabetes outcomes. Clinical studies and simulated models have estimated the impact of improved glycemic control on the economic outcomes of this disease, reporting that these cost benefits can be both short term and long term. The new economics of diabetes management emphasizes improved management through strategies such as better adherence to frequency of monitoring guidelines. The health and economic benefits have been demonstrated incrementally with improved glycemic status. Of additional importance to realizing economic benefits is the use of therapies that maintain lower glucose levels while minimizing side effects, hypoglycemic episodes, and long-term diabetes-related complications. Fast-acting insulins and the newer classes of insulin secretagogues, which target postprandial glucose, may pose distinct therapeutic advantages in this regard.

Blood Glucose↗
PubMed1999

The use of automated data to identify complications and comorbidities of diabetes: a validation study.

We evaluated the accuracy of administrative data for identifying complications and comorbidities of diabetes using International Classification of Diseases, 9th edition, Clinical Modification and Current Procedural Terminology codes. The records of 471 randomly selected diabetic patients were reviewed for complications from January 1, 1993 to December 31, 1995; chart data served to validate automated data. The complications with the highest sensitivity determined by a diagnosis in the medical records identified within +/-60 days of the database date were myocardial infarction (95.2%); amputation (94.4%); ischemic heart disease (90.3%); stroke (91.2%); osteomyelitis (79.2%); and retinal detachment, vitreous hemorrhage, and vitrectomy (73.5%). With the exception of amputation (82.9%), positive predictive value was low when based on a diagnosis identified within +/-60 days of the database date but increased with relaxation of the time constraints to include confirmation of the condition at any time during 1993-1995: ulcers (88.5%); amputation (85.4%); and retinal detachment, vitreous hemorrhage and vitrectomy (79.8%). Automated data are useful for ascertaining potential cases of some diabetic complications but require confirmatory evidence when they are to be used for research purposes.

Adolescent↗
PubMed1999

Effect of sleep state on the flash visual evoked potential. A case study.

Controversy exists regarding the influence of sleep state on the flash visual evoked potential. This study recorded the visual evoked potential in a new-born infant in four different sleep states; wakefulness. drowsiness, active sleep and quiet sleep over a five hour period. The infant's heart rate, breathing rate and breathing regularity were also recorded. It was clear that when this subject was awake the VEPs recorded differed substantially from those recorded when sleeping. Two of the four main components had shorter peak latencies, one component was prolonged and one of the peak to trough amplitudes was consistently smaller when alert. This study highlights an important and often overlooked aspect of developmental research that the state of the infant may affect developmental measures.

Evoked Potentials, Visual↗
PubMed1998

Rhodopsin-family receptors associate with small G proteins to activate phospholipase D.

G-protein-coupled receptors of the rhodopsin family transduce many important neural and endocrine signals. These receptors activate heterotrimeric G proteins and in many cases also cause activation of phospholipase D, an enzyme that can be controlled by the small G proteins ARF and RhoA. Here we show that the activation of phospholipase D that is induced by many, but not all, Ca2+-mobilizing G-protein-coupled receptors is sensitive to inhibitors of ARF and of RhoA. Receptors of this type were co-immunoprecipitated with ARF or RhoA on exposure to agonists, and the effects of GTP analogues on ligand binding to the receptor changed to a profile that is characteristic of small G proteins. These receptors contain the amino-acid sequence AsnProXXTyr in their seventh transmembrane domain, whereas receptors capable of activating phospholipase D without involving ARF contain the sequence AspProXXTyr. Mutation of this latter sequence to AsnProXXTyr in the gonadotropin-releasing hormone receptor conferred sensitivity to an inhibitor of ARF, and the reciprocal mutation in the 5-HT2A receptor for 5-hydroxy-tryptamine reduced its sensitivity to the inhibitor. Receptors carrying the AsnProXXTyr motif thus seem to form functional complexes with ARF and RhoA.

ADP-Ribosylation Factors↗
PubMed1998

Stimulus duration, neural adaptation, and sweep visual evoked potential acuity estimates.

PURPOSE: Results in several studies have suggested that the visual evoked potential (VEP) amplitude can vary with stimulus duration. The purpose of this study was to determine whether acuity estimates obtained by extrapolation of the sweep VEP are altered by this adaptation effect. METHODS: Sweep VEP data were obtained from 16 healthy observers under binocular viewing conditions. Data were acquired with a commercially available VEP unit using standard electrode recording techniques. Three sweeps (high spatial frequencies, medium spatial frequencies, and low spatial frequencies) were run. The subjects' visual acuity at the monitor distance was 6/6 for the high spatial frequency sweep. For the medium and low spatial frequency sweeps, the subjects were dioptrically blurred to 6/15 (medium spatial frequencies) or 6/30 (low spatial frequencies) at the monitor distance. Each sweep consisted of six spatial frequencies (contrast 80%; temporal frequency (TF) = 7.5 Hz; screen luminance = 100 candela [cd]/m2). For each spatial frequency, the stimulus duration was 8 seconds, partitioned into 1-second bins. A minimum of eight sweeps were obtained per subject. An acuity estimate was obtained for each second's data by fitting a line to the high spatial frequencies (excluding noise) and extrapolating this line to the x-axis. With this technique, estimates could not be obtained for 29 of 384 possible acuities. RESULTS: The sweep VEP acuities for the 16 subjects did not change significantly over the 8 seconds of data collection for the high, medium, or low spatial frequency sweep (repeated measures analysis of variance [ANOVA]: high, P = 0.25; medium, P = 0.50; low, P = 0.23). In any given subject, there was a 1- to 2-octave range in acuity estimates over the 8 seconds of stimulus presentation (high, 1.23+/-0.417 octaves; medium, 1.41+/-0.593 octaves; low, 1.52+/-0.475 octaves; mean +/- SD). CONCLUSIONS: These results suggest that there is not a significant change in sweep VEP acuity estimates over an 8-second stimulus presentation. Thus, neural adaptation does not significantly affect the clinical use of the sweep VEP.

Adaptation, Physiological↗
PubMed1996

Cortical visual dysfunction in children: a clinical study.

Damage to the cerebral cortex was responsible for impairment in vision in 90 of 130 consecutive children referred to the Vision Assessment Clinic in Glasgow. Cortical blindness was seen in 16 children. Only 2 were mobile, but both showed evidence of navigational blind-sight. Cortical visual impairment, in which it was possible to estimate visual acuity but generalised severe brain damage precluded estimation of cognitive visual function, was observed in 9 children. Complex disorders of cognitive vision were seen in 20 children. These could be divided into five categories and involved impairment of: (1) recognition, (2) orientation, (3) depth perception, (4) perception of movement and (5) simultaneous perception. These disorders were observed in a variety of combinations. The remaining children showed evidence of reduced visual acuity and/ or visual field loss, but without detectable disorders of congnitive visual function. Early recognition of disorders of cognitive vision is required if active training and remediation are to be implemented.

Adolescent↗
PubMed1995

Clinical assessment, optic disk measurements, and visual-evoked potential in optic nerve hypoplasia.

PURPOSE: Because there is a broad spectrum of visual dysfunction in eyes with optic nerve hypoplasia, we determined whether any clinical observations, including optic disk measurements, could predict visual outcome in eyes with hypoplastic optic nerves. METHODS: We prospectively studied the eyes of 19 children (eight consecutive and 11 randomly selected), ages 7 to 92 months, in whom a diagnosis of optic nerve hypoplasia was made by an ophthalmologist. Clinical assessment included visual acuity, pupillary responses, and nystagmus. The ratio of the horizontal disk diameter to the disk-macula distance was calculated from fundus photographs. The amplitude and latency of the flash visual-evoked potential as well as the threshold response to pattern reversal checks were recorded. RESULTS: Visual acuity was associated with pupil reactivity, nystagmus, the ratio of the horizontal disk diameter to the disk-macula distance, pattern visual-evoked potential threshold, and flash visual-evoked potential amplitude (P < .001 for all parameters). All eyes with a ratio of the horizontal disk diameter to the disk-macula distance greater than .30 had good visual acuity, and all eyes with a ratio of the horizontal disk diameter to the disk-macula distance less than .30 had poor visual acuity. No eye with a ratio of the horizontal disk diameter to the disk-macula distance less than or equal to .15 had visual acuity better than light perception. CONCLUSIONS: Visual-evoked potential and photogrammetric measurement of relative disk size can be used to approximate visual acuity in eyes with optic nerve hypoplasia. This finding could lead to a diagnostic criterion or a severity classification for optic nerve hypoplasia.

Child↗
PubMed1987

Binocular VEP summation in infants and adults with abnormal binocular histories.

Visual evoked potentials (VEPs) were recorded under binocular and monocular viewing conditions in 19 2- to 10-month-old infants, 19 stereodeficient adults, and 12 normal adults. VEPs were elicited by medium contrast, phase-alternated checkerboards with check sizes ranging from 10-52 min of arc. Binocular VEP summation was defined as the percentage by which the binocular VEP amplitude exceeded the mean of the two monocular VEP amplitudes. In the stereonormal adults, binocular VEP summation was significantly greater than zero and significantly less than 100%. In the stereodeficient adults, binocular VEP summation was not significantly greater than zero. These findings support the hypothesis that the magnitude of binocular VEP summation reflects the activation of binocular cortical neurons. However, binocular VEP summation in the infants averaged approximately 95%. Moreover, infants under 5 months of age, many younger than the reported age of onset for stereopsis, showed binocular VEP summation of nearly 145%. The significantly higher level of binocular VEP summation in the infants was the result of much larger binocular VEP amplitudes, while monocular VEP amplitudes were equivalent to those of stereonormal and stereodeficient adults. These results support the hypothesis that VEP amplitude is mediated by two independent pools of monocular cortical neurons and that binocular VEP amplitude in stereonormal and stereodeficient adults saturates at a lower level than in infants. Thus, it is hypothesized that binocular VEP summation is not representative of the activation of binocular cortical neurons.

Adult↗
PubMed1986

Effect of low-level, 60-Hz electromagnetic fields on human lymphoid cells: I. Mitotic rate and chromosome breakage in human peripheral lymphocytes.

Dividing human peripheral lymphocytes from 10 normal adults (5 males and 5 females) were exposed in vitro to low level 60-Hz electromagnetic fields for 69 hours. The current density of the electrical field was 30 microA/cm2, while the magnetic field was either 1 or 2 gauss. The cytological endpoints measured were mitotic rate and chromosome breakage. No statistically significant differences, indicative of a field effect, were observed between treated and control cells whether exposed to an electric field, a magnetic field, or to various combinations of the two.

Adult↗
PubMed1986

The effect of low-level 60-Hz electromagnetic fields on human lymphoid cells. II. Sister-chromatid exchanges in peripheral lymphocytes and lymphoblastoid cell lines.

Dividing human peripheral lymphocytes from 10 normal adults (5 males and 5 females) as well as lymphoid cell lines from patients with the chromosomal instability syndromes were exposed to low-level 60-Hz sinusoidal electromagnetic fields (EMF). The current density of the electrical field was 30 microA/cm2 while the strength of the magnetic field was either 1 or 2 gauss. The cytological endpoints measured included the frequency of sister-chromatid exchanges per chromosome; the distribution of first-, second-, and third-division cells and chromosome breakage (lymphoblastoid cells only). No statistically significant differences, indicative of EMF effects were observed between the treated and control cells regarding SCE frequency, cell cycle progression or chromosome breakage.

Cell Line↗
PubMed1985

Far-field 2.45 GHz irradiation system for cellular monolayers in vitro.

A 2.45-GHz microwave exposure facility was developed for long-term TEM irradiation of cellular monolayers. Culture flasks with cells attached to the inside bottom surface were filled with medium, submerged in a 60 X 60 X 12-cm water bath on the field central axis, and exposed in the far-field 2 m below the ceiling-mounted antenna. A quarter-wave transformer plate increased the power transmitted into the water bath, and treatment temperatures were maintained by closed circulation with an external temperature control reservoir. Power density mapped below the quarter-wave plate indicated uniform TEM fields in the 25 X 25-cm region where flasks were located. With 1 kW of forward power to the antenna, the SAR [W/kg] = 45 exp(-0.607d) where d [cm] is the depth in water at any point within this area.

Animals↗