Medicolegal aspects of vesicovaginal fistulae.
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Female↗
Biomedical subjects
G Williams
Publications and source records attributed to G Williams.
Early leptin response to a palatable diet predicts dietary obesity in rats: key role of melanocortin-4 receptors in the ventromedial hypothalamic nucleus.
We have investigated whether interactions between leptin and hypothalamic melanocortin-4 receptors (MC4-Rs) determine individual susceptibility to dietary obesity in rats. Animals with relatively high plasma leptin levels 1 week after presentation of palatable food, before weight increased significantly, subsequently showed lower food intake and weight gain after 8 weeks of palatable feeding than those with low early leptin levels. The rats with lesser weight gain also showed significantly greater down-regulation of MC4-Rs, which mediate hypophagia, in specific hypothalamic areas, namely, the arcuate, dorsomedial, and ventromedial (VMH) nuclei and the median eminence. We suggest that this reflects enhanced receptor exposure to endogenous alpha-melanocyte-stimulating hormone, an appetite-suppressing peptide produced by hypothalamic proopiomelanocortin neurones. It is striking that plasma leptin levels at 1 week were inversely correlated with MC4-R density in the VMH, suggesting that this is a key site of leptin action. The early leptin response to palatable feeding may therefore "program" subsequent feeding behaviour and weight gain by regulating neurones that project selectively to the VMH.
Animals↗
High incidence and regression rates of solar keratoses in a queensland community.
The presence of solar keratoses on the skin is one of the major risk factors for basal cell and squamous cell carcinomas, which constitute a growing public health problem in today's white populations. In spite of this, little is known of the natural history of solar keratoses. We conducted follow-up studies to monitor the incidence, regression, and recurrence rates of solar keratoses in a random sample (N = 96) of the Nambour community in Queensland. At baseline, 43 participants (46%) were diagnosed with at least one solar keratosis [26 men (55%), 17 women (37%)] with a total count of 494 prevalent solar keratoses. The distribution of lesions per person was highly skewed, with 11 individuals (12%) having 65% of the total number of solar keratoses. During 12 mo of follow-up, 614 incident solar keratoses were diagnosed (549 in men and 65 in women); 526 solar keratoses regressed and 53 prevalent solar keratoses recurred, giving a net 45% increase in solar keratosis numbers in men (from 354 to 512 solar keratoses) and a net 44% reduction in women (from 114 to 64). Regression rates were higher in prevalent (74%) than incident (29%) solar keratoses. Solar keratosis prevalence increased with age in both sexes, and individuals with solar keratoses at baseline were over seven times more likely to develop additional solar keratoses in the next 12 mo than those without prevalent solar keratoses at baseline. These results show that the natural history of solar keratoses in the community is one of high turnover and that a small percentage of susceptible individuals carry the major burden of solar keratoses in the community.
Adult↗
Unsuspected metastatic rectal cancer presented as an abnormal cervical smear.
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Journal Article↗
Relationships between environmental factors and lung function of asthmatic subjects in south east Queensland, Australia.
Few panel studies have investigated the relationships between air pollutants and air spora and lung function change in asthmatic subjects. This article examines the association of outdoor air pollutant concentrations and air spora with the decrease in lung function (measured by morning peak expiratory flow) of two groups of asthmatic subjects in the subtropical environment of South East Queensland, Australia. Lung function responses were stratified by age, allergy status, and location, and seasonal effects were examined. Allergy status and age were found to be important, with air pollutants such as ozone and particles associated with decreases in lung function in allergic individuals older than 15 years. Fungal spore counts were strongly associated with a decrease in lung function in allergic adults, especially in those over 54 years, only in seasons when these air spora peak. Analysis for the entire study period indicates that the effect of ozone on peak expiratory flow in the allergic group can sometimes be confounded by air spora effects, indicating that in a subtropical climate the impact of ozone on asthma severity can be accurately estimated only when the confounding effects of air spora are included.
Adolescent↗
Home safety assessment in the prevention of falls among older people.
OBJECTIVE: Home safety assessment was examined as part of a randomised trial of falls prevention interventions among older community dwellers. METHOD: Falls prevention strategies, including education and awareness-raising, exercise, home modifications and medical assessment, were trialed with 252 members of the National Seniors Association. Falls outcomes were monitored using a daily calendar diary during intervention and follow-up periods. RESULTS: The home assessment group was significantly more likely to modify their home environment than the controls (p < 0.0001). Participants, regardless of group allocation, reported a significant reduction in concern about falling (p < 0.0001). During the intervention, the home assessment group had lower incidence rates for falls and injuries than the control group, although differences were not significant. The lowered rates were sustained post-intervention. CONCLUSIONS: While the effect on falls incidence of a home safety intervention on its own could not be demonstrated, other benefits, including improved confidence attributable to awareness of such falls prevention measures, were recorded. IMPLICATIONS: The null effects of home modifications on falls prevention in this study may indicate that the program is more appropriate for the frail aged.
Accidental Falls↗
Enhanced left ventricular endocardial border delineation with an intravenous injection of SonoVue, a new echocardiographic contrast agent: A European multicenter study.
The safety and efficacy of SonoVue (also referred to as BR1), a new contrast agent for delineating endocardial border of the left ventricle after intravenous administration, was assessed. Two hundred and eighteen patients with suspected coronary artery disease undergoing fundamental echocardiography for the assessment of left ventricle were enrolled in a prospective multicenter, single blind, cross-over study with random sequence allocation of four different doses of SonoVue. Endocardial border definition in the apical and parasternal views was scored as 0 = not visible, 1 = barely visible, and 2 = well visualized before and after contrast enhancement. Analysis was performed by two pairs of off-site observers. Safety of SonoVue was also assessed. Results of our study indicated that the mean improvements in the endocardial border visualization score were as follows: 3.1 +/- 7.8 (95% CI, 2.5 and 3.7) for 0.5 ml, 3.4 +/- 8.0 (95% CI, 2.8 and 4.0) for 1 ml, 3.4 +/- 7.9 (95% CI, 2.8 and 4.0) for 2 ml, and 3.7 +/- 8.0 (95% CI, 3.1 and 4.3) for 4 ml (P < 0.05 for all doses from baseline). Changes from baseline in endocardial visualization scores were also seen in the apical views (P < 0.05) and they were dose-dependent (P < 0.001). Similar enhancements of endocardial visualization scores were observed in the apical views in patients with suboptimal baseline echocardiographic images. Diagnostic confidence for assigning a score and image quality also were significantly better following contrast enhancement. No significant changes in the laboratory parameters and vital signs were noted following contrast enhancement, and the side effects were minimal. It was concluded that SonoVue is safe and effective in delineating endocardial border, including in patients with suboptimal baseline images.
Aged↗
A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial.
STUDY OBJECTIVE: In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN: Four groups with approximately equal numbers of participants were randomly allocated to interventions. The prevention strategies included education and awareness raising of falls risk factors, exercise sessions to improve strength and balance, home safety advice to modify environmental hazards, and medical assessment to optimise health. The interventions combined the strategies in an add on approach. The first intervention group receiving the information session only was regarded as the control. The outcome of interest was the occurrence of a slip, trip or fall, monitored prospectively using a daily calendar diary. PARTICIPANTS AND SETTING: Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate. National Seniors clubs provide a forum for active, community dwelling Australians aged 50 and over to participate in policy, personal development and recreation. MAIN RESULTS: Using Cox's proportional hazards regression model, adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 (95% CI 0.17, 0.73) to 0.48 (0.25, 0.91) for slips; 0.29 (0.16, 0.51) to 0.45 (0.27, 0.74) for trips; and 0.60 (0.36, 1.01) to 0.82 (0.51, 1.31) for falls. While calendar monitoring recorded outcome, it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical nonintervened group. At one year after intervention, reductions in the probability of slips, trips and falls (61 (95% CI 54, 66)%; 56 (49, 63)%; 29 (22, 36)% respectively) were demonstrated. CONCLUSIONS: This study makes an important contribution to the priority community health issue of falls prevention by showing that effective, sustainable, low cost programmes can be introduced through community-based organisations to reduce the incidence of slips, trips and falls in well older people.
Accidental Falls↗
Brittle Addison's disease: a new variation on a familiar theme.
Unstable and unpredictable disease control in diabetes or asthma, with frequent hospitalisations, is frequently referred to as 'brittle'. We describe two cases of Addison's disease with recurrent hospitalisations in hypo-adrenal crises. Both patients had significant psychosocial disruption, and failure to take hydrocortisone replacement therapy was admitted in one and biochemically proven in the other. We propose that 'brittle' Addison's disease in these cases was due to poor treatment compliance related to psychosocial factors. These features have particular similarities with the syndrome of brittle diabetes.
Addison Disease↗
Individual severity of dietary obesity in unselected Wistar rats: relationship with hyperphagia.
We investigated the relative importance of overeating, thermogenesis, and uncoupling protein (UCP) expression in determining the severity of obesity in male Wistar rats fed a highly palatable diet. After 2 wk of feeding, body weight did not differ significantly from controls (248 +/- 4 vs. 229 +/- 3 g; P > 0.3), but rectal temperature, brown adipose tissue (BAT) mass, UCP3 expression in gastrocnemius muscle, and UCP2 expression in white adipose tissue (WAT) were all elevated in diet-fed animals. In a further study, rats fed a palatable diet for 8 wk exhibited higher energy intake and rectal temperature than controls. Dietary-obese rats were divided into high (427-490 g; n = 8) and low (313-410 g; n = 10) weight gainers. The high gainers ate significantly more than the low gainers, and energy intake was positively correlated with weight gain (r(2) = 0.72, P < 0.01). UCP2 and UCP3 mRNA levels in gastrocnemius muscle were significantly increased above lean controls in all diet-fed animals, whereas UCPs in WAT and BAT did not differ significantly from controls. Whereas rats fed palatable food exhibited a thermogenic response, there was no significant difference in core temperature between high and low gain groups (37. 5 +/- 0.1 vs. 37.6 +/- 0.1 degrees C; P > 0.5). We conclude that a higher energy intake is the critical factor determining susceptibility to dietary obesity in unselected Wistar rats.
Adipose Tissue, Brown↗
TSPY variants in six loci on the human Y chromosome.
We have studied the structure, organization, and evolution of the human TSPY gene family by mapping three sequence variants identified through RT-PCR analysis onto genomic clones derived from two different YAC contigs. TSPY gene family members occur in at least six locations on the human Y chromosome, and each cluster contains a unique combination of variants. Our data further suggest that an 18-bp tandem duplication found in TSPY exon 1 originated from an unequal sister chromatid exchange between two tandemly arranged TSPY clusters.
Cell Cycle Proteins↗
Safety and risk issues in using telecare.
The increasing adoption of technology to support independent living at home through the extended use of community alarms and, ultimately, second-generation telecare systems poses some safety problems. The implications of any failure of the technology must be addressed in order to provide a safe and reliable care service. The risks of using home-based technology can be assessed by standard techniques under three categories: environmental factors; human factors; and technological factors. A safety classification system for telecare devices is proposed leading to a range of design guidelines which represent good practice. An example of the use of these design principles is a prototype second-generation telecare system, MIDAS, which is currently undergoing trials. In order to reduce the risks associated with device failure, the system incorporates distributed intelligence, built-in self-testing and redundancy. Potentially hazardous situations can therefore be controlled.
Accidental Falls↗
Teaching children with autism to ask questions about hidden objects.
We taught 2 4-year-old children with autism to ask questions of an adult who held a closed box with a toy inside. The treatment package (modeling, prompting, and reinforcement) was evaluated with a multiple baseline design across the three question forms during training, generalization, and follow-up evaluations. The first question form ("What's that?") produced the name of the hidden item. The second form ("Can I see it?") produced sight of it, and the third form ("Can I have it?") produced the item itself. Both children learned to ask questions about hidden objects.
Autistic Disorder↗
Resveratrol induces vasorelaxation of mesenteric and uterine arteries from female guinea-pigs.
Naturally occurring hydroxystilbenes have been shown to induce vasorelaxation. Here, we studied the mechanism of resveratrol-induced vasorelaxation in different types of blood vessels, namely mesenteric (resistance) and main uterine (conductance) arteries, from female guinea-pigs on day 7 and day 15 of the oestrous cycle. Resveratrol (5-70 micromol/l) induced concentration-dependent relaxation of both mesenteric and uterine arteries preconstricted with either noradrenaline (NA; 10 micromol/l) or KCl (125 mmol/l). Resveratrol was 2-fold more potent in inducing relaxation of mesenteric arteries than of uterine arteries. Its effects on uterine arteries from both day-7 and day-15 guinea-pigs were similar, irrespective of the constrictor used, but it was significantly (P<0.01) more potent in inducing relaxation of mesenteric arteries contracted with NA compared with those constricted with KCl. In day-7 arteries precontracted with NA, N(G)-nitro-L-arginine methyl ester (L-NAME; 10 micromol/l) had no effects on the time course of resveratrol-induced vasorelaxation in either mesenteric or uterine arteries. However, indomethacin (50 micromol/l) significantly (P<0.05) potentiated resveratrol's effect on mesenteric, but not uterine, arteries. Indomethacin had no effect on resveratrol-induced vasorelaxation of arteries contracted with KCl, whereas L-NAME significantly (P<0.05) reduced the effects of resveratrol on uterine, but not on mesenteric, arteries. In day-15 arteries, L-NAME significantly (P<0.01) attenuated the effects of resveratrol on mesenteric arteries contracted with NA. Indomethacin had no effect on resveratrol activity. This study indicates that: (a) the effect of resveratrol on resistance arteries is greater than that on conductance arteries; (b) the effects of resveratrol are not mediated via prostanoids, but NO may play a role; and (c) the stage of the oestrous cycle has no influence on resveratrol-induced vasorelaxation.
Acetylcholine↗
Congenital radioulnar synostosis in an active duty soldier: case report and literature review.
Congenital radioulnar synostosis (CRS) is a developmental deformity that interferes with pronation and supination of the upper extremity. CRS often results in functional, cosmetic, and cultural limitations. The purpose of this paper is to present a patient with CRS who is currently functioning as a generator mechanic in the U.S. Army and to review the literature for current treatment options. We know of no other individual in the U.S. Army who is on active duty status with this deformity.
Adolescent↗
The lived experiences of adult female victims of child abuse.
The purpose of this study was to investigate the lived experiences of female victims of domestic violence who also identified themselves as victims of physical abuse as children. There have been numerous studies of identifying perpetrators of violence as having a history of experienced violence in the family of origin. However, few studies address the victims/survivors of domestic violence and the historical significance of abuse in the family of origin. It is estimated that greater than 50% of the victims of domestic violence were also victims of abuse as a child. The research design partially followed the qualitative ethnonursing methodology. This pilot project consisted of seven females between the ages of 37 and 58. These women were members of a long-standing support group for battered women. The Pitts-Williams Inventory was used to obtain data. The instrument contained six major research questions, with sub questions. Data analysis was done by identifying major themes that emerged. Eight themes were identified. The majority of the women identified their mother as the perpetrator. They described a continuous cluster of violence, which included several different forms of violence being used consistently in order to maintain control and foster isolations. This type of violence continued in throughout their childhood and adult life.
Adult↗
Absenteeism and the impact of a 38-hour week, rostered day off option.
We undertook a comparative analysis of nurses working in two consecutive years: one in a 40-hour standard working week and the other in a 38-hour week with a rostered day off per month, in order to determine whether there was any effect on absenteeism. We found that total absenteeism between the two years fell significantly from 4.58% to 4.36% (chi 2 = 5.09, P = 0.024). Sick leave decreased but not to a significant degree. We conclude that the change to the 38-hour week and 19-day month (rostered day off) arrangements led to a significant reduction in overall absenteeism but not in sick leave. However, the cost in implementing a 19-day month is far in excess of any savings made through absenteeism reductions.
Absenteeism↗
The association between telomerase activity and hormone receptor status and p53 expression in breast cancer.
BACKGROUND: Telomerase is a ribonucleoprotein enzyme that seems to play an important role in cellular immortality and carcinogenesis. p53 mutations account for approximately 50% of human cancers and represent the most frequent genetic lesion in breast cancer. AIMS: This study aims to examine the association between telomerase reactivation and hormonal receptor status and p53 expression in invasive breast cancer. METHODS: Using a polymerase chain reaction-based assay, telomerase activity was determined in 47 invasive breast carcinomas and 21 adjacent non-cancerous breast tissue specimens (stored at -80 degrees C) prospectively collected from 47 women undergoing elective surgical treatment in our centre. The histopathological features of the tumour were determined by experienced breast pathologists using light microscopy and haematoxylin and eosin staining. Oestrogen receptor (ER), progesterone receptor (PR) and p53 expressions were determined using immunohistochemistry techniques. RESULTS: Telomerase activity was detected in 34 (72%) of 47 breast carcinomas and in none of the adjacent non-cancerous breast specimens. There was a significant association between telomerase reactivation, tumour size and nodal status. Telomerase positive tumours were more likely to be poorly differentiated (65% versus 46%), but this association failed to reach statistical significance. There was no significant difference in ER expression (68% versus 85%). PR expression (62% versus 62%) and p53 expression (19% versus 27%) between telomerase positive and telomerase negative cancers. CONCLUSION: Telomerase reactivation is associated with important prognostic factors such as tumour size and nodal status in invasive breast cancer and seems to be independent of hormonal receptor status and p53 expression.
Biopsy, Needle↗