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Biomedical subjects

D S James

Publications and source records attributed to D S James.

At least 19 recordsLinked to original sources
PubMed1999

Biomechanics of judicial hanging: a case report.

A prisoner in Washington State in the United States of America appealed against sentence of death by hanging on the grounds that it was 'cruel and unusual' and hence contravened the Eighth Amendment of the US Constitution. The man weighed 184 kg (406 lb) and it was suggested that the 'drop' proposed to effect judicial hanging might result in decapitation. This hypothesis was tested by applying simple biodynamic principles to the available data from past hangings. It was concluded that decapitation was a significant possibility.

Adult↗
PubMed1997

Safety knowledge of users and non-users of the lap belt on two-point motorized belt systems.

A field study of 1146 drivers and passengers of vehicles equipped with motorized passive belts was conducted in shopping malls and other locations in the states of Arizona and Indiana. The Indiana data was collected the summer of 1994 and the Arizona data the summer of 1995. Shoulder belt use by drivers and passengers was 93.4% in Indiana and 87.8% in Arizona. Lap belt use was 65% in Indiana and 69.9% in Arizona. Over 99% of drivers in both states knew that a manually fastened lap belt was provided along with the motorized shoulder belt. Most drivers agreed that they are supposed to wear the lap belt (96.3% in Indiana and 94.3% in Arizona) and said that the vehicle they were driving provided a warning signal when the lap belt was not fastened (75.7% in Indiana and 79.4% in Arizona). Most drivers were also aware of warning labels telling them to use their lap belt (63.9% in Indiana and 68.2% in Arizona).

Adult↗
PubMed1997

The still video camera: a suitable and convenient method of demonstrating post mortem findings.

The post mortem demonstration continues to play an important role in medical education at both undergraduate and postgraduate levels. However, for a variety of reasons its format needs to be adaptable in order to maximize the educational benefit and increasingly to comply with legislation. We have developed a method of demonstration based upon a still video camera system which we have found is acceptable to our students and overcomes some of the problems associated with other formats. In this paper we describe the system itself, compare it with other systems, discuss its potential applications and present the results of a questionnaire-based survey of the first groups of medical students to be taught in this way. These results confirm that the technique is popular with students and that it appears to be a useful teaching modality worthy of further development.

Autopsy↗
PubMed1997

Ethnic differences in the prevalence of nonmalignant respiratory disease among uranium miners.

OBJECTIVES: This study (1) investigates the relationship of nonmalignant respiratory disease to underground uranium mining and to cigarette smoking in Native American, Hispanic, and non-Hispanic White miners in the Southwest and (2) evaluates the criteria for compensation of ethnic minorities. METHODS: Risk for mining-related lung disease was analyzed by stratified analysis, multiple linear regression, and logistic regression with data on 1359 miners. RESULTS: Uranium mining is more strongly associated with obstructive lung disease and radiographic pnuemoconiosis in Native Americans than in Hispanics and non-Hispanic Whites. Obstructive lung disease in Hispanic and non-Hispanic White miners is mostly related to cigarette smoking. Current compensation criteria excluded 24% of Native Americans who, by ethnic-specific standards, had restrictive lung disease and 4.8% who had obstructive lung disease. Native Americans have the highest prevalence of radiographic pneumoconiosis, but are less likely to meet spirometry criteria for compensation. CONCLUSIONS: Native American miners have more nonmalignant respiratory disease from underground uranium mining, and less disease from smoking, than the other groups, but are less likely to receive compensation for mining-related disease.

Colorado↗
PubMed1996

A randomized, double-blind comparison of donor tolerance of 400 mL, 200 mL, and sham red cell donation.

BACKGROUND: Volume replacement could allow the safe collection of twice the normal amount of red cells in a standard donation. Studies in small numbers of donors have shown that a temporary decrease in red cell mass is well tolerated when donors give twice the usual amount (170-225 mL) of red cells in a standard 405- to 495-mL donation. Sham-donation control groups have not been included in previous studies of increased red cell donation, and perceptions of donation effects could have been biased. STUDY DESIGN AND METHODS: In the study reported here, 17 male and 13 female volunteers were randomly assigned to make a sham donation, 1-unit donation, or 2-unit donation on an automated blood cell separator. Donor tolerance was assessed by ambulatory heart rate monitoring and by a poststudy interview. Hemoglobin, hematocrit, ferritin, serum iron, total iron-binding capacity, red cell 2,3 DPG, and serum erythropoietin were measured before and after donation for comparison of the erythropoietic responses in the three study groups. RESULTS: Red cells collected totaled 206 +/- 10 mL in the 1-unit group and 414 +/- 21 mL in the 2-unit group. Changes in heart rate, systolic blood pressure, and diastolic blood pressure with donation and changes in heart rate recorded by ambulatory monitoring did not differ for the experimental groups. Postdonation changes from baseline values were evaluated on Days 2, 7, and 14. Changes in hemoglobin were significantly different between groups (p < 0.017) in all postdonation tests. There were differences between groups in erythropoietin response, red cell 2,3 DPG, ferritin levels, and hemoglobin synthesis. Hemoglobin synthesis and mean changes in 2,3 DPG, erythropoietin, ferritin, and postdonation hemoglobin were greater in the 2-unit group than in the 1-unit group. CONCLUSION: Donor tolerance of red cell donations of 414 +/- 21 mL, a volume of red cells twice that in a standard 450-mL blood donation, does not differ from donor tolerance of standard or sham donations. Physiologic adjustments and the hematopoietic response to reduced red cell mass were greater in the 2-unit group, but the donation of 1 unit or 2 units did not cause detectable symptoms of reduced oxygen-carrying capacity.

Blood Donors↗
PubMed1996

Cardiopulmonary manifestations of hantavirus pulmonary syndrome.

OBJECTIVE: To describe the clinical characteristics of a group of patients infected with the newly recognized hantavirus in the Southwestern United States. DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: All patients with confirmed hantavirus infection admitted to the University of New Mexico Hospital between May 1, 1993 and January 1, 1994. INTERVENTIONS: Records of patients with hantavirus infection were reviewed to collect all pertinent clinical data. MEASUREMENTS AND MAIN RESULTS: Pulmonary disease in these patients was characterized by hypoxemia covering a wide range of severity. The cause of hypoxemia was an increased permeability (noncardiac) pulmonary edema which could be differentiated from hydrostatic (cardiac) pulmonary edema by its association with low pulmonary artery occlusion pressures and increased protein content of edema fluid. Hemodynamic measurements in severe cases showed a shock state characterized by a low cardiac index (range 1.6 to 3.0 L/min/min2), a low stroke volume index (range 10.5 to 29 mL/m2), and high systemic vascular resistance index (range 1,653 to 2,997 dyne.sec/cm5.m2). Progression to death was associated with worsening cardiac dysfunction unresponsive to treatment and causing oxygen debt and lactic acidosis. CONCLUSIONS: The two major life-threatening pathophysiologic changes in Hantavirus Pulmonary Syndrome are increased permeability pulmonary edema, and an atypical form of septic shock caused by myocardial depression and hypovolemia.

Adolescent↗
PubMed1996

Information on death certificates: cause for concern?

AIMS: To assess the frequency with which the cause of death on death certificates included the relevant details requested of certifying doctors, especially in deaths due to malignant disease, but also including certain other deaths where specific information would be expected to be included. METHODS: Consecutive series of certificates attributing death to malignancy, pneumonia, an acute cerebrovascular event, and renal failure were inspected and compared with the categories identified in the International Classification of Disease. Review of clinical notes and of laboratory data was used to determine the number of cases in which detailed histological diagnoses were available. RESULTS: A histological diagnosis was available in 79.1% of cases of deaths due to malignancy, but was recorded on only 23.6% of certificates. Haematologists performed best (69.6%) and general surgeons worst (2.8%). The sites of primary tumours were recorded in detail in only 23 of 89 cases of tumours of the large bowel (22/36), lung (1/35) and stomach (0/18). In cases of pneumonia the causative organism was recorded in only 4 of 330. In cases of an acute cerebrovascular event one of 70 was recorded as being due to haemorrhage. A distinction between cerebral or precerebral arterial occlusion (embolism/thrombosis) and cerebral haemorrhage was not recorded in any of the other cases. In cases of renal failure a cause was not recorded in 75 of 95. CONCLUSIONS: Despite consistent encouragement to record all relevant details on death certificates this study shows that doctors fail to do so in most cases. Such a failure diminishes information available to the Office of Population Censuses and Surveys, affecting mortality statistics and gives further cause for concern about standards of certification. Means by which the standard of certification might be improved are discussed, including screening of certificates by a medically qualified person prior to registration.

Acute Disease↗
PubMed1995

Significance of chronic tonsillar herniation in sudden death.

The Chiari I malformation is a congenital abnormality of the cerebellum strongly associated with syringomyelia and also associated with bony abnormalities of the base of the skull and the cervical spine. This review examines the case of a 25 year old man who collapsed and died following a blow to the face and was found at post mortem to have a Chiari I malformation and syringomyelia but no gross or microscopic evidence of fresh brain or spinal cord injury. The occurrence of sudden and unexpected deaths in this condition is discussed especially in the context of apparently minor coincident trauma.

Adult↗
PubMed1994

Silicosis and lung cancer risk in underground uranium miners.

The presence of radiographic silicosis as a risk factor for lung cancer was assessed in a case-control study conducted within a study cohort of New Mexico underground uranium miners. Chest radiographs were interpreted for the presence of silicosis for 65 lung cancer cases and 216 controls. The presence of silicosis on the chest radiograph taken closest to the start of employment or on the latest radiograph available was not associated with lung cancer risk after adjustment for cumulative exposure to radon progeny. The odds ratio associated with the presence of any type of opacity indicative of pneumoconiosis on the chest x ray closest to the start of employment was 1.33 (95% confidence interval, 0.31-5.72). For the most recent available chest x ray, the corresponding odds ratio was 1.16 (95% confidence interval, 0.35-3.84). Although the findings are limited by the relatively small number of subjects, the lack of association of silicosis with lung cancer suggests that silica exposure should not be regarded as a major uncertainty in extrapolating radon risk estimates from miners to the general population.

Case-Control Studies↗
PubMed1993

Sources of variability in posterior rhinomanometry.

Sources of variability in nasal airway resistance measured by posterior rhinomanometry were studied in 5 subjects tested on 5 different days and 56 subjects tested on 2 different days. On each day, a questionnaire on upper airway health and nasal symptoms was completed. The mean individual difference in nasal airway resistance between the 2 test days in the group of 56 subjects was 5.3% (SD 52.7%). Between-subject variability accounted for 74.9% and 72.5% of the total variability in the group of 5 and the group of 56 subjects, respectively. For the 5 subjects, by accounting for a change in upper airway symptoms or upper respiratory tract infection that occurred over the 5 test days, there was a significant decrease in the between-subject variability. The difference in sources of variation due to a change in upper airway symptoms was not seen in the group of 56 subjects. We conclude that the largest source of variability in nasal airway resistance is due to between-subject differences.

Adult↗
PubMed1993

Assessment of heart rate as a predictor of ventilation.

The rate of ventilation and route of breathing (i.e., nasal versus oronasal) are potential determinants of pollutant doses to target sites in the lung. However, the lack of accurate methods for ambulatory measurement of ventilation has hindered estimation of exposure and dose in freely ranging individuals, complicating the interpretation of the relationships among exposure, dose, and response in epidemiological studies. The goal of this project was to develop and validate a method of monitoring ventilation for large-scale epidemiologic investigations. We estimated ventilation for individual subjects from ambulatory heart rate monitoring, using the relationship between ventilation and heart rate that had been obtained during exercise testing. Fifty-eight subjects participated in the study, which included healthy adults and children, and subjects with lung and heart disease. Subjects performed cycle exercise and tasks involving lifting and vacuuming. Work loads of progressive and variable order were used in the testing. Conventional methods were used to measure heart rate and total ventilation, and a sampling mask was developed to measure the partitioning of breathing between oral and nasal routes. The minute ventilation-heart rate relation was evaluated under steady-state and varying work loads. In a second phase, subjects wore wristwatch monitors that recorded their heart rates, minute by minute, throughout the day. Subjects recorded activities, locations, and levels of exertion. Two 16-hour monitoring periods were obtained from each subject. The laboratory findings documented considerable intersubject variability in the minute ventilation-heart rate relation with a two- to five-fold range in the coefficients describing the change in ventilation relative to heart rate. This variation implies that individual testing is required to derive accurate predictive equations. Minute ventilation-heart rate regressions for the maximal progressive exercise test and for the test with a nonprogressive submaximal work load sequence were comparable, indicating that varying the sequence of work loads does not substantially affect the minute ventilation-to-heart rate ratio. During upper body work (e.g., lifting), the minute ventilation-to-heart rate ratio was one-third greater than during lower body exercise. Diverse patterns of partitioning breathing between oral and nasal routes were observed with increasing oral ventilation in most subjects as work load increased. In the field, heart rate and activity patterns were monitored successfully in adults and children with low rates of instrument failure and noncompliance.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Rapid death due to group A streptococcal infections. Necrotizing fasciitis and acute bacterial myositis.

Soft tissue infections due to the group A Streptococcus are difficult to diagnose and rapidly fatal. They may present to the forensic pathologist as an "obscure autopsy". Death may occur within or outside the hospital and with or without a history of fulminant infection or predisposing factors. It is important for the pathologist to exclude this condition through awareness of its existence and by appropriate dissection with retention of materials for microbiological and histological examination.

Adult↗
PubMed1985

Survey of hypnotic drug use in nursing homes.

The prescribing patterns for hypnotic medications were surveyed in 765 patients of three skilled-nursing facilities and two intermediate-care facilities. Seven per cent of the patients received a hypnotic routinely; an additional 3 per cent had as-needed orders for a hypnotic medication. Temazepam, flurazepam, and triazolam were, in descending order, the three most commonly prescribed hypnotics and accounted for 79 per cent of the hypnotic prescriptions. The average duration of use for triazolam, temazepam, and flurazepam was 11 weeks, 24 weeks, and 82 weeks, respectively. Seventy-six per cent of the flurazepam prescriptions were given seven days a week; 31 per cent of these prescriptions were for 30 mg doses. Medications that were not hypnotics but did have sedative side-effects were prescribed with bedtime orders for 11 per cent of the patients. The three most commonly prescribed drugs in this class were diphenhydramine, thioridazine, and haloperidol. Possible explanations for the lower frequency of hypnotic use observed in this study as compared to the frequencies reported in the literature are discussed, as are possible hazards of high-dose and long-term use of hypnotics.

Aged↗