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Biomedical subjects

D Thompson

Publications and source records attributed to D Thompson.

At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Health services reform and human resource management in Hong Kong public hospitals.

This article discusses the empirical study of reform in the human resource management function in the Hong Kong Hospital Authority. It describes the prior management of the hospitals based on the civil service administration model before looking at management reform in general. From this research, the creative tensions between the centrifugal and centripetal forces in the pursuit of 'effectiveness', 'efficiency' and 'economy' are explored in terms of decentralization. A survey of line managers, in eleven Hospital Authority hospitals, revealed the progress of decentralization: a majority of respondents felt that, over the previous five years, managers at their level had been given greater responsibility for human resource management issues. In spite of the widespread perception of increased decentralization, however, it was recognized that there are limits to decentralization. It was the routine administration rather than the policy formulation and interpretation which had been decentralized, and hospitals continued to rely on the Hospital Authority Head of Office for guidance on policy interpretation. Several barriers to the effective decentralization of responsibility for human resource management were identified, including a lack of management skill, knowledge and time, the attitudes of some managers and the tight control of budget.

Data Collection↗
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An improved vector for the expression of proteins in all three translational reading frames.

We have constructed a novel vector (pN-7) that is capable of producing large amounts of recombinant proteins in E. coli and requires minimal manipulation for the construction of recombinant expression vectors. This expression vector (pN-7) contains the tightly regulated lambda pL promoter, cII ribosome binding site, and initiator condon ATG. The pN-7 vector also contains cleavage sites for the restriction enzymes SmaI, EcoRV, and HpaI that provide blunt ends in all three reading frames. Thus after cleavage with the appropriate restriction enzyme, this novel vector can be directly ligated to the DNA fragment that contains the open reading frame without further manipulation.

Base Sequence↗
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Nonenteral routes of administration for psychiatric medications. A literature review.

In the treatment of psychiatric patients with complicating medical illness, clinicians may encounter patients who cannot take oral medications. This review will acquaint the practicing clinical psychiatrist with psychotropic medications available by nonenteral routes of administration. A computerized MEDLINE search was conducted of the literature 1981 to 1997. All articles citing nonenteral routes of psychotropic medication administration were reviewed. The results are summarized according to drug class and specific routes of administration (intravenous, intramuscular, sublingual, rectal). Psychotropic medications now available by these alternative routes are also listed in table form. The majority of the information available comes from small case series or case reports. Intravenous and intramuscular routes of administration of psychotropics are the most common. In addition, certain psychotropics are available by less common routes, such as sublingual or rectal administration. Consideration of alterations in pharmacokinetics, including poorer absorption and slower metabolism, are discussed. Clinicians may need to consider these novel routes of medication administration when dealing with patients unable to take oral medications.

Drug Administration Routes↗
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Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS).

BACKGROUND: Women genetically predisposed to breast cancer often develop the disease at a young age when dense breast tissue reduces the sensitivity of X-ray mammography. Our aim was, therefore, to compare contrast enhanced magnetic resonance imaging (CE MRI) with mammography for screening. METHODS: We did a prospective multicentre cohort study in 649 women aged 35-49 years with a strong family history of breast cancer or a high probability of a BRCA1, BRCA2, or TP53 mutation. We recruited participants from 22 centres in the UK, and offered the women annual screening with CE MRI and mammography for 2-7 years. FINDINGS: We diagnosed 35 cancers in the 649 women screened with both mammography and CE MRI (1881 screens): 19 by CE MRI only, six by mammography only, and eight by both, with two interval cases. Sensitivity was significantly higher for CE MRI (77%, 95% CI 60-90) than for mammography (40%, 24-58; p=0.01), and was 94% (81-99) when both methods were used. Specificity was 93% (92-95) for mammography, 81% (80-83) for CE MRI (p<0.0001), and 77% (75-79) with both methods. The difference between CE MRI and mammography sensitivities was particularly pronounced in BRCA1 carriers (13 cancers; 92%vs 23%, p=0.004). INTERPRETATION: Our findings indicate that CE MRI is more sensitive than mammography for cancer detection. Specificity for both procedures was acceptable. Despite a high proportion of grade 3 cancers, tumours were small and few women were node positive. Annual screening, combining CE MRI and mammography, would detect most tumours in this risk group.

Adult↗
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Metabolic activation of eugenol by myeloperoxidase and polymorphonuclear leukocytes.

Eugenol has recently been associated with the toxic effects of clove cigarettes on human lungs. We have studied the metabolism and adverse effects of eugenol on human polymorphonuclear leukocytes (PMNs). Myeloperoxidase, isolated and purified from human PMNs, catalyzed the oxidation of eugenol to a reactive intermediate which is likely to be a quinone methide. Eosinophil peroxidase, lactoperoxidase, prostaglandin H synthase, horseradish peroxidase, and rat intestinal peroxidase also supported this hydrogen peroxide dependent reaction. Glutathione inhibited the formation of this metabolite, resulting in the formation of glutathione disulfide and a small amount of eugenol-glutathione conjugates. In cellular incubations, phorbol ester stimulated PMNs catalyzed the covalent binding of [3H]eugenol to cellular protein, which was partially inhibitable by azide. Intracellular glutathione levels decreased by 90% over a period of 30 min in phorbol ester stimulated PMNs exposed to 100 microM eugenol compared with decreases of 30% (phorbol ester alone) or 5% (eugenol alone) in control incubations. In addition, eugenol was more cytotoxic to PMNs in the presence of phorbol ester than in its absence, and eugenol inhibited the phorbol ester stimulated oxidative burst in PMNs as reflected by a decrease in oxygen consumption, superoxide formation, and hydrogen peroxide formation. These results suggest that PMNs are capable of activating eugenol to a reactive intermediate and also suggest a mechanism whereby eugenol can potentially interfere with and adversely affect vital PMN functions.

Biotransformation↗
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Perceived stress and coping resource availability as predictors of life satisfaction in young, middle-aged, and older adults.

Global satisfaction with life across three age groups (18 to 40 years, 41 to 65 years, and 66 years and above) was investigated. Multiple regressions were computed to examine the separate and joint effects of perceived stress and coping resource availability upon life satisfaction across the three age groups (N = 189). Age differences in perceived stress, coping resource availability, and life satisfaction, were also investigated. Results of this cross-sectional investigation indicated that self-appraisal measures of perceived stress and coping resource effectiveness served as moderate predictors of global life satisfaction, and that for the total sample the combined effects of perceived stress and coping resource effectiveness were better predictors of life satisfaction than either variable considered separately. Perceived stress was found to be a better predictor of life satisfaction for younger adults, and coping resource effectiveness was a better predictor of satisfaction with life for middle-aged and older adults. Significant age differences in life satisfaction, perceived stress, and coping resources were also found. The assessment of perceived stress and coping has important implications for life satisfaction among all age groups, and has particular significance to older adults. By identifying age differences in variables associated with satisfaction with life, more effective efforts can be made to promote physical and psychological well-being in late adulthood.

Adaptation, Psychological↗
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Clutch effects explain heart rate variation in embryonic frogs (Cave Coqui, Eleutherodactylus cooki).

Few physiological studies to date have focused on whether variation among sibling groups during development can account for often large, intraspecific physiological variation. In this study, we measured heart rate in the direct-developing frog Eleutherodactylus cooki throughout its embryonic development and examined heart rate variation among egg clutches comprising from 10 to 40 eggs. Clutches were collected in the wild in Yubucoa, Puerto Rico, and individual eggs were maintained under equivalent conditions in the lab. Heart rate showed large increases during development, rising from about 40 beats min(-1) in the earliest stages to about 110 beats min(-1) at hatching. The effect of stage (averaged across clutches) was highly significant (P<0.001). However, repeated-measures MANOVA also revealed that there were highly significant effects on heart rate associated with both clutch (variation among clutches averaged across development; P<0.001) and clutch-stage interactions (differences among clutches in the developmental change in heart rate; P<0.0001). These effects and interactions reveal that throughout development, heart rate in siblings is much more similar than in nonsiblings and that sib groups follow different heart rate trajectories during their development. Collectively, these data indicate that "clutch effects" caused by genetic and/or maternal influences can strongly affect patterns of heart function during development within cave coqui populations. This phenomenon also occurs in bird eggs and armadillo neonates, suggesting that physiological variation attributable to clutch effects might be a widespread phenomenon in vertebrates.

Animals↗
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Intravenous procaine as a supplement to general anesthesia for carbon dioxide laser resection for carbon dioxide laser resection of laryngeal papillomas in children.

Procaine suppresses the cough reflex, decreases laryngeal irritability, and has general anesthetic properties. For these reasons, 14 pediatric patients undergoing CO2 laser resection of laryngeal papillomas were studied in which an intravenous infusion of procaine (1 mg/kg/min) was added to N2O-O2 halothane/enflurane general anesthesia immediately following endotracheal intubation. These patients were compared to nine patients receiving the same anesthesia without procaine. The mean age of both groups was 11 years. There was no difference between the groups in duration of anesthesia or surgery. Emergence, however, averaged 15 minutes in study patients compared to 36 minutes in the control group (p less than 0.01). There was no difference in anesthetic concentrations required to maintain satisfactory operative conditions in the two groups. Muscle relaxants were required intraoperatively in seven control patients but in none of the study patients. The surgeon ranked the operative conditions excellent in all study patients but poor in seven of the nine control patients. Five of the latter required postoperative treatment of laryngeal complications, including reintubation in three. Only one of the study patients had postoperative stridor. No evidence of procaine toxicity was noted in the study patients with total doses ranging from 500--3600 mg. Intravenous procaine is useful in pediatric patients having endoscopic laryngeal operations.

Anesthesia, Inhalation↗
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Electrophysiological and eye-movement abnormalities in children with the Bardet-Biedl syndrome.

We investigated 17 patients with clinical features of Bardet-Biedl syndrome by electroretinogram (ERG), visual-evoked potentials (VEP), and electro-oculographic (EOG) eye movement assessment. The ERGs were grossly abnormal in 16 cases. Pattern VEPs were generally well preserved, but showed a tendency to increase in latency and decrease in amplitude with age. These results confirm other reports that the retinopathy appears to be a progressive rod-cone dystrophy initially affecting mainly extramacular areas but involving the macula at later stages. Seven of 11 patients showed abnormalities of either optokinetic nystagmus, vestibulo-ocular reflex, or both. These eye-movement abnormalities have not been reported previously, and are further evidence of central nervous system involvement in this syndrome.

Adolescent↗
PubMedDate not supplied

Estimated economic costs of obesity to U.S. business.

OBJECTIVE: To estimate the economic costs of obesity to U.S. business. METHODS: Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as "nonobese" (BMI < 25 kg/m2), "mildly obese" (BMI = 25-28.9 kg/m2), or "moderately to severely obese" (BMI > or = 29 kg/m2). RESULTS: The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively. CONCLUSIONS: The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.

Adult↗