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Biomedical subjects

D Phillips

Publications and source records attributed to D Phillips.

At least 55 records · Page 3Linked to original sources

Constancy scaling and conflict when the Zöllner illusion is seen in three dimensions.

If a standard Zöllner illusion is seen as a staircase in depth, pairs of long lines flanking convex stair edges appear to diverge as usual, but divergence in pairs flanking concave edges can appear reduced. If the stair is reversed perceptually in the manner of the Schröder staircase, convex and concave shapes exchange and the extent of apparent divergence in the long line pairs exchanges with them. The effect is enhanced if explicit stair edges are added, and reduced if the standard Zöllner pattern is replaced by one in which segments of the long lines are offset in the direction of the usual illusory effect. The observations suggest that the three-dimensional potential of the pattern cannot be excluded from explanations of the illusion, and are compatible with the view of Gregory and Harris that inappropriate constancy scaling is its primary cause, triggered 'bottom-up' by pattern properties or 'top-down' by cognitive inference. However, these two mechanisms would have to be acting in conflict to generate suppression of divergence in the concave steps. Pattern processing for properties, such as orientation, that are not associated with the potential of the Zöllner illusion as a three-dimensional configuration, but that have been suggested as sources of the illusion in recent studies, could also be acting in opposition to hypothesis scaling in the concave steps.

Adolescent↗

Inequalities in mortality and illness in Trent NHS Region.

BACKGROUND: The Department of Health is encouraging health authorities to improve health status by tackling health inequalities. We defined ward level spatial health variations in Trent National Health Service Region, England, investigated urban and rural inequalities, and examined the relationship with deprivation, to identify the extent of small area health inequalities and to establish whether a quantifiable difference exists between urban and rural health as affected by deprivation. METHOD: A small area ecological study design was adopted and ward level (n=591) standardized ratios were calculated (population aged <75, n=3,900,000) for specific causes of death and limiting long-term illness. A classification was devised to assess ward health inequalities according to an urban-rural dimension. Deprivation was measured using the Townsend Index and the relationship with mortality and illness was analysed using Pearson product moment correlation. RESULTS: Wide variations in mortality and illness were evident at ward level, being widest for accident mortality (standardized mortality range 0-508). Stroke mortality accounted for the largest proportion of wards with standardized mortality ratios over 125 (36.2 per cent). Relative deprivation correlated strongly with limiting long-term illness (r=0.82) and all-cause mortality (r=0.68) across Trent, and in both urban and rural environments. CONCLUSION: The study set health inequalities within a regional context for Trent as an initiative to coincide with the Government's proposed health strategy for the next few years. Wide health inequalities were evident in Trent and the association between deprivation and health was of a similar magnitude in urban and rural wards. This small area approach allows health authorities access to ward level information in order to inform key debate on tackling health inequalities and distributing resources in relation to need.

Adolescent↗

Grading nuclear cataract: reproducibility and validity of a new method.

AIMS: To assess the reproducibility and validity of a new instrument for grading nuclear cataract-the laser slit lamp, by comparison with an established method of lens grading-the Lens Opacities Classification System III (LOCS III). METHODS: 62 volunteers (113 eyes) were examined on two occasions. At each visit, a video image of the anterior segment was captured with the laser slit lamp and stored digitally. A measure of lens opacity for each laser slit lamp image was calculated using image analysis software. Each lens was also photographed on both visits for LOCS III grading of nuclear colour and nuclear opalescence. RESULTS: There was a linear increasing relation between the laser slit lamp measure of nuclear lens opacity and the LOCS III nuclear opalescence scores. The overall reproducibility of the laser slit lamp measurement was comparable with LOCS III (intraclass correlation coefficient of 95% (95% CI 92.9-96.5) for the laser slit lamp method; 97% (95% CI 95. 6-97.9) for the LOCS III method). However, among healthy subjects, the reproducibility was lower (intraclass correlation for the laser slit lamp of 38.6% (95% CI 12.9-59.2) and 76.1% (95% CI 62.3-85.4) for LOCS III. CONCLUSION: The laser slit lamp appears to give a valid measurement of nuclear cataract. The reproducibility of the instrument was high and similar to that of LOCS III. Modifications to the design would have to be made to improve its reproducibility among healthy subjects. It is simpler than other objective instruments, and could be useful in large scale studies of cataract.

Adult↗

Profiles of endogenous circulating cortisol and bone mineral density in healthy elderly men.

Exogenous glucocorticoids are known to increase the risk of osteoporosis. However, the contribution made by endogenous circulating cortisol concentrations to adult skeletal status remains unknown. We examined this issue in a sample of 34 healthy men, aged 61-72 yr. Venous blood samples were obtained under standard conditions every 20 min over a 24-h period. Measurements were made of serum cortisol and cortisol-binding globulin. Bone mineral density was measured at the lumbar spine and proximal femur using dual energy x-ray absorptiometry. Measurements were made at baseline and 4 yr later. There was a weak negative association between integrated cortisol concentration and lumbar spine bone density (r = -0.37; P < 0.05); similar relationships (P < 0.05) existed at three of five proximal femoral sites. There were also statistically significant positive associations between the trough cortisol concentration and bone loss rate at the lumbar spine (r = 0.38; P < 0.05), femoral neck (r = 0.47; P < 0.001), and the trochanteric region (r = 0.41; P = 0.02) over the 4-yr follow-up period. The cross-sectional relationships between cortisol concentration and bone density were removed by adjustment for body mass index, but the influence on bone loss rate remained significant after adjusting for adiposity, cigarette smoking, alcohol consumption, dietary calcium intake, physical activity, and serum testosterone and estradiol levels. These observations suggest that the endogenous cortisol profile of healthy elderly men is a determinant of their bone mineral density and their rate of involutional bone loss.

Aged↗

Identification of a skeleton using DNA from teeth and a PAP smear.

Identification of unknown living or deceased persons using dental treatment records is an established forensic technique. However, some cases remain unidentified, especially when antemortem dental records are not available for comparison to postmortem dental records. Cytological smears have been previously reported to be potential sources of DNA reference samples which can be compared to DNA recovered from found human remains. The case described here involves an adult skeleton which exhibited extensive, complex dental restorative treatment. A putative identification of the found skeleton as a missing woman was established using circumstantial evidence found at the scene. However, it became important to establish a positive identification using reliable scientific methods. When it was discovered that antemortem dental records were not available because the treatment was completed in another country and the treating dentist could not be found, cytological smears stained with Papanicolaou (PAP) stain obtained from the putative decedent's medical records were used as a reference DNA sample. DNA was recovered from the teeth of the skeleton using cryogenic grinding. Comparison of the genotypes resulted in the conclusion that the DNA originated from the same source. The use of PAP smears in this way is seen as a valuable resource in cases where positive identification using traditional dental and medical records is not possible.

Adult↗

Thallium-201 single-photon emission CT versus CT for the detection of recurrent squamous cell carcinoma of the head and neck.

BACKGROUND AND PURPOSE: Thallium-201 single-photon emission computed tomography (SPECT) can be used to detect primary squamous cell carcinoma (SCCA) of the head and neck. Nevertheless, there have very few studies performed to evaluate the ability of thallium-201 to depict recurrent SCCA. The purpose of this study was to compare the ability of thallium-201 SPECT with CT to enable detection of recurrent SCCA of the upper aerodigestive tract. METHODS: Thirty-three patients with a history of previously treated SCCA of the extracranial head and neck underwent thallium-201 SPECT imaging and contrast-enhanced CT. A neuroradiologist and nuclear medicine physician with knowledge of the primary site evaluated all thallium-201 studies for abnormal radiotracer uptake at the primary site. These results were correlated with histologic findings and clinical follow-up in all patients. All patients were followed up for a minimum of 2 years after completion of treatment. The McNemar test was used to determine statistical significance. RESULTS: The diagnostic accuracy of thallium-201 SPECT was as follows: sensitivity, 88%; specificity, 94%; positive predictive value, 93%; and negative predictive value, 89%. The diagnostic accuracy of CT was as follows: sensitivity, 100%; specificity, 24%; positive predictive value, 55%; and negative predictive value, 100%. The diagnostic accuracy of thallium was superior to CT (P = .01). CONCLUSION: Thallium-201 SPECT is superior to CT for differentiating recurrent tumor from post-treatment changes and may complement CT in the evaluation of previously treated SCCA of the extracranial head and neck.

Adult↗

Three cases of dengue 1 virus infection from islands in the Gulf of Thailand.

Three Australian tourists who recently travelled to islands in the Gulf of Thailand developed febrile illnesses associated with myalgias, thrombocytopenia, and atypical lymphocytosis. Dengue 1 virus was isolated from all three patients. The patients' clinical features and serological and virological investigations are presented. These cases highlight the need for awareness of dengue amongst travellers and the preventive precautions required when visiting endemic regions. After the urgent exclusion of malaria, dengue should be considered in the differential diagnosis of febrile persons who have recently returned from endemic regions.

Adult↗

Hypersensitivity pneumonitis: a sentinel event investigation in a wet building.

Hypersensitivity pneumonitis (HP) as a sentinel event implies a remediable exposure and an exposed cohort that require evaluation. A patient with HP convincingly related to her building led to a questionnaire survey in follow-up. Building coworkers demonstrated substantially higher symptom rates than did controls in five other buildings, although no further cases of disease were identified. It is likely that moisture sources in the building included an oversized cooling system and below-grade moisture, but the building met all applicable regulations and standards. Screening investigations for disease are not mandated by law and are often not conducted, in part because cost coverage is unclear. The absence of regulatory or professional standards that adequately address moisture in the built environment forces occupational health professionals to rely on disease documentation strategies to justify intervention.

Alveolitis, Extrinsic Allergic↗

Acoustic backscatter properties of the particle/bubble ultrasound contrast agent.

Bubble-based suspensions with diameters in the 1-5 microns range have been developed for use as ultrasound contrast agents. Bubbles of these dimensions have resonance frequencies in the diagnostic ultrasonic range, thus improving their backscatter enhancement capabilities. The durability of these bubbles in the blood stream has been found to be limited, providing impetus for a number of approaches to further stabilize them. One of the approaches has been the development of micrometer-size porous particles or 'nano-sponges' with properties suitable for the entrapment and stabilization of gas bubbles. However, the complex morphology and surface chemistry involved in the production of this type of agent makes it unfeasible to directly measure the volume of the entrained gas. A model based on acoustic scattering principles is proposed which indicates that only a small volume fraction of gas should be necessary to significantly enhance the echogenicity of this type of particle-based contrast agent. In the model, the effective scattering cross-section is evaluated as a function of the volume fraction of gas contained in the overall scatterer and the overall scatterer diameter. Initially, the volume fraction of gas is considered as a discrete entity of single bubble. Using common mixture rules, it is then shown that the gas can be considered to be distributed throughout the particle and still arrive at a result that is similar to that for a single, discrete volume of gas. The main contribution to the increased scattering cross-section is due to the compressibility difference between gas and water. The backscatter coefficient is computed as the product of the resulting differential scattering cross-section and the scatterer number density. This approach facilitates comparison with known backscatter coefficients of biological targets such as liver and blood. Simple experimental results are presented for comparison with the model, and the implications relevant to clinical use are suggested.

Animals↗

Structure, conformations, and repair of DNA adducts from dibenzo[a, l]pyrene: 32P-postlabeling and fluorescence studies.

The nature of stable DNA adducts derived from the very potent carcinogen dibenzo[a,l]pyrene (DB[a,l]P) in the presence of rat liver microsomes in vitro and in mouse skin in vivo has been studied using 32P-postlabeling and laser-based fluorescence techniques. Analysis of DB[a,l]P-DNA adducts via 32P-postlabeling has been obtained by comparison of the adduct patterns to those obtained from reactions of synthetic (+/-)-anti-, (+)-anti-, (-)-anti-, and (+/-)-syn-DB[a,l]P-11,12-diol 13,14-epoxide (DB[a,l]PDE) with single nucleotides and calf thymus DNA. anti-DB[a,l]PDE-dA adducts derived from the (-)-enantiomer are the major adducts formed in calf thymus DNA and in mouse skin DNA. The ratio of deoxyadenosine to deoxyguanosine modification is approximately 2:1 in mouse skin exposed to DB[a,l]P; activation by rat liver microsomes leads to a similar profile of adducts but with two additional spots. The conformations of DB[a,l]P adducts in native DNA, as well as the possibility of conformation-dependent repair, have been explored by low-temperature fluorescence spectroscopy. These studies have been performed using polynucleotides and calf thymus DNA reacted in vitro with DB[a,l]PDE and native DNA from mouse epidermis exposed to DB[a, l]P. The results show that adducts are heterogeneous, possess different structures, and adopt different conformations. External, external but base-stacked and intercalated adduct conformations are observed in calf thymus DNA and in mouse skin DNA samples. Differences in adduct repair rates are also revealed; namely, the analysis of mouse skin DNA samples obtained at 24 and 48 h after exposure to DB[a,l]P clearly shows that external adducts are repaired more efficiently than intercalated adducts. These results, taken together with those for B[a]P-DNA adducts [Suh et al. (1995) Carcinogenesis 16, 2561-2569], indicate that the repair of DNA damage resulting from PAH diol epoxides is conformation-dependent.

Animals↗

A new imaging science test object for performance measurements of ultrasonic imaging systems.

We propose a novel test object for ultrasound imaging. The test object, or phantom, is manufactured using thin film techniques allowing precise placement of 'digital scatterers' which can produce sophisticated test targets, similar to those that are widely used in imaging science to evaluate displays, printers and electronic imaging systems. These test objects can be used in conjunction with standard performance evaluation methods and devices to augment and enhance their capabilities and range of application.

Equipment Design↗

A case study and national database report of progressive systemic sclerosis and associated conditions.

We report the case of a 34-year-old white woman with a history of progressive systemic scleroderma (PSS) and diffuse alveolar hemorrhage (DAH) that may be either a rare complication of PSS or induced by D-penicillamine. The DAH progressed to hemoptysis and led to intubation for airway protection. The patient progressed to acute renal failure. Her chest x-ray revealed diffuse bilateral infiltrates. She developed pulmonary fibrosis with secondary pulmonary hypertension. She experienced a brief period of improvement of her respiratory status after steroid treatment. We also report a database of 21,442 decedents with PSS over a 15-year period from 1979 to 1994. Our report demonstrates that of over 21,000 decedents, only 0.2% had pulmonary hemorrhage or hemoptysis or both listed as a cause of death. The data also demonstrate that PSS was the underlying cause of death more frequently in younger people. Age-adjusted mortality rates were higher for blacks than for whites and for women than for men.

Acute Kidney Injury↗

Women patients' preferences for female or male GPs.

OBJECTIVE: We aimed to investigate general preferences to see a male or female GP either some or all of the time, and specific preferences to see a female primary health care (PHC) worker for individual health issues; to compare these preferences with reported consultation behaviour; and to explore women's evaluations of the quality of PHC services in relation to their preferences and consultation behaviour. METHOD: Results are reported on 881 women aged 16-65 years who had consulted their GP in the previous 6 months. Logistical regression analysis was undertaken to evaluate whether a general preference to see another woman is more important than specific women's health issues in determining why some women regularly choose to consult a female GP. RESULTS: General preference was 2.6 times more important than specific health issues in predicting choice of a female GP in a mixed-sex practice. Nearly a half (49.1 %) of women attending male-only practices stated that they wanted to see a female GP in at least some circumstances, compared with 63.8% of women in mixed-sex practices. In total, 65.5% of the sample stated that there was at least one specific health issue for which they would only want to be seen by a woman PHC worker. The most positive evaluations of the quality of GP services were made by women normally seeing a male GP in mixed-sex practices and the least positive evaluations were given by women in male-only GP practices CONCLUSIONS: In order to meet women's expressed preferences, every GP practice should have at least one female GP available at least some of the time and every GP practice should employ a female PHC worker.

Adolescent↗

A mathematical model for the assessment of hemodynamic parameters using quantitative contrast echocardiography.

A mathematical model for the assessment of hemodynamic parameters using quantitative echocardiography is presented. The method involves the intravenous injection of an ultrasonic echo contrast agent. The relative enhancement of the backscattered ultrasound intensity is measured as a function of time (the time-intensity curve). From this measurement, the volume flow rate (cardiac output) and the mixing volume are calculated. Relevant acoustic properties of the ultrasound contrast agent are discussed. An in vitro experiment is performed to corroborate the theory presented.

Calibration↗

Biopsy-negative malignant esophageal stricture: diagnosis by endoscopic ultrasound.

Endoscopic ultrasound (EUS) of the esophagus has been used primarily in staging biopsy-proven cancers. Its use as a primary diagnostic modality for esophageal malignancy has not been previously described. We report our recent experience in four patients with dysphagia and endoscopic biopsies negative for malignancy, including one patient with clinical and manometric features suggestive of achalasia. In all cases, EUS revealed a large infiltrating tumor invading through the esophageal wall into the surrounding tissues, and in one case into the aorta. Computed tomography suggested the possibility of a tumor in only one of the cases. Two patients underwent esophagectomy and were found to have adenocarcinoma. Two patients underwent repeat biopsy with alternative aggressive biopsy techniques and were found to have squamous cell carcinoma. We conclude that EUS is useful in the diagnosis of esophageal cancer and should be performed in selected patients with esophageal strictures whose biopsies are negative for malignancy; i.e., those with suspicious endoscopic or radiographic appearance, atypical presentation (e.g., profound weight loss, short duration of symptoms, or advanced age), and failure to respond to treatment.

Adenocarcinoma↗

Transition from school to adult life for physically disabled young people.

The transition process for young physically disabled people (n = 87) was studied in three districts to determine how it varied between schools, and how it was perceived by the disabled and their carers. The experiences of the young people were compared with guidelines for good practice based on relevant legislation. Results showed that young disabled people experienced a poor handover to adult services if they had no "statement of special educational need" or if they went to further education college. Young people with cerebral palsy or complex multiple problems fared less well than those with spina bifida or juvenile chronic arthritis. There are several deficiencies in the legislation. Physically disabled young people should receive a transition review regardless of whether they have a "statement". The range of severity and type of disorders among the young physically disabled argues for a range of services--the category is too broad to be useful for research, service planning, and provision.

Adolescent↗

Age differences in women's verdicts on the quality of primary health care services.

BACKGROUND: One aim of the Patients' Charter initiative is to ensure that general practitioner (GP) services become more sensitive to the expressed needs of patients. Most studies in this area have concentrated on the personal and professional attributes of the GP, and few studies have explored in detail the specific views of women patients. AIM: To examine age differences in the views of women under the age of 65 years on the quality of different aspects of primary health care services. METHOD: A random sample of 1251 women aged 16-65 years was surveyed by postal questionnaire on their use of and satisfaction with primary health care services. Analyses were undertaken of women's verdicts on the best and worst aspects of the services provided. RESULTS: There is a strong inverse relationship between age and negative evaluations of primary health care services. On each of 20 items ['what are the worst things about the GP surgery?'], older women consistently scored lower than younger women. The results were not so clear-cut among the 20 positive items ('what are the best things about the GP surgery'). On nine items, there was a significant positive association with age (the highest being on 'receptionists are approachable' and 'practice nurse is approachable and easy to talk to'). On nine items, there was no significant age difference, and on the item with the highest overall positive ranking, 'not far to travel to GP surgery', the association was in the opposite direction to that expected, i.e., a larger proportion of women under 40 years of age (72.5%) answered positively than did women over the age of 40 years (64.9%). CONCLUSIONS: It is likely that the relationship between age and positive evaluations of primary health care service is less straightforward than has been assumed previously. Although older women are consistently less willing to criticize primary health care services across the board, they are more discriminating in giving and withholding praise.

Adolescent↗