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Biomedical subjects

D R Williams

Publications and source records attributed to D R Williams.

At least 163 records · Page 9Linked to original sources
PubMed1992

A proposal for continuing audit of diabetes services. Home and Members of a Working Group of the Research Unit of the Royal College of Physicians and British Diabetic Association.

A working group was established in order to suggest the process and outcome variables most appropriate for the continuing audit of diabetes services. The proposed audit is being piloted in hospitals in selected United Kingdom Health Districts. The main process and outcome measures suggested are: waiting and consultation times; missed or cancelled appointments; information given to patients and the primary care team; knowledge of diabetes and risks of smoking; recording of key examinations and investigations, i.e. levels of glycosylated haemoglobin (or equivalent), serum cholesterol, body mass index, blood pressure, albumin excretion rate, presence and extent of retinopathy, history of coronary artery, cerebrovascular or peripheral vascular disease; history of severe hypoglycaemia; presence of foot problems; psychological well-being; patient satisfaction; admission rates and hospital bed days for hyperglycaemic and other diabetes related emergencies.

Diabetes Mellitus↗
PubMed1992

A prospective study of conization of the cervix in the management of cervical intraepithelial glandular neoplasia (CIGN)--a preliminary report.

OBJECTIVE: To assess the efficacy of cervical conization as primary management of cervical intraepithelial glandular neoplasia (CIGN). DESIGN: A multicentre prospective cohort study. SETTING: CRC Clinical Trials Unit, Birmingham. SUBJECTS: 84 women registered with the Unit between May 1986 and January 1989. After excluding 33 women, 51 who had been managed in accordance with the described protocol and had the presence of CIGN confirmed by central review of diagnostic histopathological material were included in the study. INTERVENTION/PROTOCOL: Women with CIGN diagnosed on a cervical cone specimen were managed in accordance with a specific protocol: (a) women with negative cone margins were managed conservatively and followed up with regular cervical cytological and colposcopic examinations; (b) women with involved cone margins were managed by hysterectomy. MAIN OUTCOME MEASURES: Presence or absence of CIGN at cone margins, results of cervical cytological examinations following conization, results of histopathological assessment of any surgical specimens taken after initial cone biopsy. RESULTS: Of the 51 women with confirmed CIGN, managed by conization, 14 (27%) were aged 30 or less and 15 (29%) were nulliparous. Thirty five women who had a cone biopsy showing margins free of CIGN have been managed by conization alone. After a median follow-up period of 12 months there is no apparent residual CIGN or invasive disease in this group. Thirteen women have had further surgical procedures (according to protocol) and two have had a hysterectomy for benign gynaecological disorders. Eight further procedures were carried out because the original cone biopsy had margins involved with CIGN, and only one of them was found to have residual CIGN. The other five procedures were carried out solely because of abnormal cytology, only one of them had a diagnosis of CIN 1. A total of 10 women had cytological abnormality following cone biopsy, one had CIGN, one had CIN 1 and a third had CIN 3. CONCLUSIONS: Our preliminary data suggests that when a diagnosis of CIGN is made upon a cone biopsy, further surgery is unnecessary in those women in whom the margins of the cone specimen are free of disease. Cytological and colposcopic follow up, including cytological sampling of the endocervical canal, is recommended for these women.

Adult↗
PubMed1992

Serum levels of tetracycline during treatment with tetracycline-containing fibers.

Four adult patients with at least 8 teeth that had attachment loss of 5 to 10 mm which bled on probing were included in this study. Polymeric tetracycline (TCN) containing fibers were placed and left in the pockets for a period of 10 days. Plasma samples were collected at baseline, 1 hour, 3 hours, 3 days, and 10 days after fiber placement. The mean length of fiber used averaged 187 cm with a range of 160 to 222 cm. The maximum TCN dose per patient averaged 105 mg with a range of 91 to 126 mg producing no detectable serum level greater than 0.1 micrograms/ml. This level was found in 3 of the 4 subjects at 3 hours after fiber placement and in 1 subject at 3 days after fiber placement. Transient and insignificant levels of TCN became available systemically shortly after the placement of multiple fibers. The dose of TCN in each patient was well tolerated and was not associated with any serious adverse effects.

Adult↗
PubMed1992

Black-White differences in blood pressure: the role of social factors.

This review summarizes current knowledge about the social sources of differences in blood pressure between blacks and whites in the United States. Genetic variables may play some role in explaining black-white differences in blood pressure, but social factors are more important than genetic ones. I review evidence linking stress, social integration, coping styles, and health behavior (including obesity) to high blood pressure, emphasizing that the distribution of these risk factors is shaped by larger social structures and processes. Effective efforts to reduce stress and improve health practices must not focus only on the individual but must seek to alter the social, economic, and political structures and arrangements that produce disease.

Adaptation, Psychological↗
PubMed1992

Heparin resistance after intraoperative platelet-rich plasma harvesting.

Records of anticoagulation for cardiopulmonary bypass from 58 patients who underwent elective coronary artery revascularization were analyzed to determine whether the harvesting of autologous platelet-rich plasma produces heparin resistance. The effect of preoperative heparin therapy on anticoagulation for cardiopulmonary bypass after harvesting of platelet-rich plasma was also evaluated. Patients were grouped by presence of preoperative heparin therapy and type of blood component harvested before cardiopulmonary bypass, including platelet-rich plasma, autologous whole blood, both, or neither. The dose of heparin required to initiate and to maintain anticoagulation for cardiopulmonary bypass was determined for each patient, and the groups were compared by two-way analysis of variance. Significantly more heparin was required to maintain anticoagulation for cardiopulmonary bypass in the platelet-rich plasma group than in the groups receiving autologous whole blood or no blood products. More heparin was also required to initiate and to maintain anticoagulation for cardiopulmonary bypass after preoperative heparin therapy. These results reinforce the concept that anticoagulation during cardiopulmonary bypass must be carefully monitored, and increased vigilance may be warranted in patients after harvesting of platelet-rich plasma.

Analysis of Variance↗
PubMed1992

Marital status and psychiatric disorders among blacks and whites.

This paper examines the association between marital status and psychiatric disorder for Blacks and explores the extent to which these patterns differ from those for Whites. Widowed and separated/divorced Black males and females have higher rates of disorder than the married; never-married Blacks do not have an elevated risk of psychiatric illness. The association between marital status and disorder for White males is similar and stronger than that observed for Blacks. For White women, the separated/divorced have a higher risk of disorder than the married, and unmarried White females have higher rates of the substance abuse disorders, but lower rates of the anxiety disorder than the married. Across all marital status groups, Black males and White males have higher rates of disorder (except for depression), than females. A complex pattern emerges when gender differences in the relative rates of disorder for unmarried Blacks compared to married Blacks are considered. Separated/divorced Black men, widowed Black women, and never-married Black men are worse off than their respective peers. Except for the separated/divorced, opposite patterns are evident for Whites. Directions for further research are outlined.

Adult↗
PubMed1991

Height and glucose tolerance in adult subjects.

In a prospective study concerning the pathogenesis of impaired glucose tolerance and Type 2 (non-insulin-dependent) diabetes mellitus, 346 subjects with no clinical history of diabetes were given a standard 75 g oral glucose tolerance test. The expected positive associations between 120-min plasma glucose concentration and age and body mass index were observed in both sexes and between 120-min plasma glucose and waist/hip ratio in male subjects. An unexpected negative correlation was found between 120-min plasma glucose and height in both sexes (r = -0.23, (95% confidence interval, -0.38 - -0.07) p less than 0.007 for male subjects and r = -0.24, (-0.37 - -0.11) p less than 0.006 for female subjects). These negative associations with height remained significant after controlling for age and body mass index in male subjects but not in female subjects. In the latter a highly significant negative relationship of height with age was recorded (r = -0.33, (-0.45 - -0.20) p less than 0.0001). Comparison between individuals with impaired glucose tolerance and control subjects matched for sex, age and body mass index showed that subjects with impaired glucose tolerance are significantly shorter. Mean (+/- SEM) height in the male subjects with impaired glucose tolerance (n = 29) was 173.4 +/- 1.1 cm vs 176.9 +/- 1.3 cm in control subjects, p = 0.02. In the female subjects (n = 39) mean (+/- SEM) height was 159.4 +/- 1.0 cm vs 162.4 +/- 1.0 cm in control subjects, p = 0.02. The negative relationship between height and glucose tolerance is a new epidemiological observation which has not been previously reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

An impression technique following hard palate repair using tongue grafts.

Tongue-based flaps have proved to be satisfactory for closing palatal defects. The bulk of grafted tissue, however, may present problems for the prosthodontist in construction of removable partial dentures. These problems include lack of space and denture support and physical properties of the graft. Careful design of the denture is needed to optimize available space and support. An impression technique that allows differential loading of parts of the oral mucosa is described.

Alginates↗
PubMed1991

Nonlinear distortion of gratings at the foveal resolution limit.

Aliasing by the foveal cone mosaic causes high frequency interference fringes to look like bright and dark zebra stripes (primary zebra stripes) [Williams, Vision Research, 25, 195 (1985); Vision Research, 28, 433 (1988)]. Some observers report another type of zebra stripes defined by variations in chromaticity as well as brightness, which we call secondary zebra stripes. The conditions required to see the secondary zebra stripes are almost identical to those required to see the primary zebra stripes, except that they are seen at approximately half the spatial frequency. We consider the hypothesis that the secondary zebra stripes arise from aliasing by a particular packing arrangement of the M and L cone submosaics, but present evidence favoring an alternative hypothesis based on a known local nonlinearity in the visual system.

Color Vision Defects↗
PubMed1991

Accumulation of a poly(hydroxyalkanoate) copolymer containing primarily 3-hydroxyvalerate from simple carbohydrate substrates by Rhodococcus sp. NCIMB 40126.

A number of taxonomically-related bacteria have been identified which accumulate poly(hydroxyalkanoate) (PHA) copolymers containing primarily 3-hydroxyvalerate (3HV) monomer units from a range of unrelated single carbon sources. One of these, Rhodococcus sp. NCIMB 40126, was further investigated and shown to produce a copolymer containing 75 mol% 3HV and 25 mol% 3-hydroxybutyrate (3HB) from glucose as sole carbon source. Polyesters containing both 3HV and 3HB monomer units, together with 4-hydroxybutyrate (4HB), 5-hydroxyvalerate (5HV) or 3-hydroxyhexanoate (3HHx), were also produced by this organism from certain accumulation substrates. With valeric acid as substrate, almost pure (99 mol% 3HV) poly(3-hydroxyvalerate) was produced. N.m.r. analysis confirmed the composition of these polyesters. The thermal properties and molecular weight of the copolymer produced from glucose were comparable to those of PHB produced by Alcaligenes eutrophus.

Glucose↗
PubMed1991

Religion and psychological distress in a community sample.

This paper examines the effect of religious attendance and affiliation on psychological distress in a longitudinal community study of 720 adults. Religious affiliation is unrelated to mental health status. In contrast, although religious attendance does not directly reduce psychological distress, it buffers the deleterious effects of stress on mental health. That is, in the face of stressful events and physical health problems, religious attendance reduces the adverse consequences of these stressors on psychological well-being.

Adult↗
PubMed1991

The Coventry Diabetes Study: prevalence of diabetes and impaired glucose tolerance in Europids and Asians.

The Coventry Diabetes Study compared the prevalence of diabetes and impaired glucose tolerance in adult Asians and Europids in relation to age, sex and body mass index. The study involved a cross-sectional house to house screening for diabetes in the electoral ward of Foleshill, Coventry, a traditional area for migration into the city. Subjects with a high blood glucose and 10 per cent of others were referred for a 75 g oral glucose tolerance test. Of the 10,304 adult residents aged 20 years or above, 3529 (64 per cent) of 5508 Europids and 3692 (84 per cent) of 4395 Asians were either screened for diabetes or already diabetic and 719 (65 per cent) of 1114 Europids and 780 (72 per cent) of 1084 Asians invited to glucose tolerance test attended. Although the prevalence of insulin-dependent diabetes was similar, the age-adjusted prevalence of non-insulin-dependent diabetes was 3.2 per cent (95 per cent confidence interval (CI): 2.6-4.0) and 4.7 per cent (CI per cent 4.0-5.5) in Europid males and females but 12.4 per cent (CI 11.0-13.8) and 11.2 CI per cent (10.0-12.5) in Asian males and females giving prevalence ratios of 3.9 per cent (3.1-5.0) in males and 2.4 per cent (2.0-2.9) in females. These differences were not due to differences in body mass index. The prevalence of impaired glucose tolerance was also higher in Asians aged below 60 years, and in 65 per cent of Europids and 40 per cent of Asians non-insulin-dependent diabetes was previously undiagnosed. The non-insulin-dependent diabetes/impaired glucose tolerance ratio was significantly higher in Asians than Europids. Non-insulin-dependent diabetes in Asians differs from that in Europids. Besides the higher overall prevalence, there is a greater proportion of males, a lower proportion undiagnosed disease, a younger age at diagnosis and a greater proportion of abnormal glucose tolerance that is due to non-insulin-dependent diabetes.

Adult↗
PubMed1991

A randomized control trial of two cervical spatulas.

The sampling efficacy of the Ayre and Rocket cervical spatulas was compared in a randomized controlled trial involving 533 women who were attending a colposcopy clinic either for investigation of cytological abnormality or for review after treatment of CIN. Smears were compared with respect to the presence of cytological abnormality and two types of normal cervical epithelial cells (endocervical and immature metaplastic cells) which are considered indicators of adequate cytological sampling. Smears taken with the Rocket spatula were significantly less likely to contain immature metaplastic cells (95% CI on difference in proportion; 5-30%), but more likely to contain endocervical cells (95% CI 16-36%). No significant difference was found in the proportion of smears containing one or other type of indicator cell or in the yield of abnormal smears. It is concluded that the Rocket spatula offered no advantage when used in these circumstances. This study illustrates how spurious conclusions of sampling efficacy can be drawn if only one type of indicator cell is used as an endpoint.

Adult↗
PubMed1991

Structural change and the aggregate poverty rate.

This paper measures the extent to which recent increases in the aggregate poverty rate are attributable to the changing distribution of employment across industries. We decompose the total poverty rate change over the 1976-1983 period into components attributable to changes in employment shares and changes in the incidence of poverty within industries. Our results show that the poverty rate increase resulted primarily from the decline in employment rates in general and from increases in the incidence of poverty within all industries, rather than from the shift of employment opportunities between sectors. The growth of service sector employment in particular has not contributed to the increased incidence of poverty in the United States.

Employment↗