Context and complexity in working class language.
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Adolescent↗
Biomedical subjects
G Young
Publications and source records attributed to G Young.
Plasma amino acid concentrations in surgical patients.
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Amino Acids↗
Limitations of neurological assessment in mild head injury.
The authors have investigated two commonly used methods of assessing neurological status in patients with mild head injury to determine whether they can predict intracranial damage. Of 686 such patients with cranial computed tomography (CT) scans, scan results were recorded, along with total and motor components of the Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85). Despite relatively normal admission neurological examinations, 127 of the 689 patients (18.4%) had intracranial lesions, and 38 (5.5%) required surgery. There was no significant difference in distribution of the GCS in patients with and without intracranial lesions. The RLS85 was superior to the GCS in predicting intracranial pathology, and a significant association between RLS85 and lesions on CT scanning was noted. However, even this test was normal in 19 patients found to have intracranial pathology, including nine who required surgery. The authors conclude that a normal or near-normal mental status examination in a head-injured patient on arrival at the emergency room is inadequate to exclude a potentially serious intracranial lesion. It is unlikely that further refinements in the clinical evaluation will result in diagnostic accuracy comparable with that of CT scanning. Accordingly, we recommend that any patient who has suffered a loss of consciousness or amnesia following head injury have an urgent cranial CT scan.
Adult↗
Health services in the 1980s.
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State Medicine↗
Triage, transportation, and destination decisions by out-of-hospital emergency care providers.
INTRODUCTION: The effectiveness of a tiered emergency medical services system often hinges upon the ability of initial care providers with little or no formal training to identify emergent patient needs and determine the best means to meet those needs. OBJECTIVES: To determine if out-of-hospital emergency care providers consistently make appropriate triage, transportation, and destination decisions; and to determine if experience and training have an effect on these decisions. METHODS: A survey consisting of 14 patient-care scenarios was administered to certified and non-certified out-of-hospital emergency-care providers (n = 311) from 20 randomly selected EMS agencies. These agencies were part of EMS systems that utilize one, two, and three tiered responses by ambulance and fire-based commercial, municipal, and volunteer agencies. Participants were asked to select the most appropriate mode of transport and destination facility using the assumption that they had responded to each scenario in a basic life support ambulance. Answers included transporting the patient to various receiving facilities or requesting a more advanced-level unit to respond to the scene. Transport times to receiving facilities and estimated times of arrival for advanced-level units were provided with each choice. Eight emergency physicians unanimously had agreed upon the most appropriate answer for each scenario. A two-tailed t-test was used to compare the scores of the certified and non-certified groups; and Spearman's Correlation Coefficients were used to test the effects of experience and training. RESULTS: Non-certified providers (n = 108) had a mean score of 32.6% or 4.6 (SD = 1.84) correct answers; certified providers (n = 203) had a mean score of 41.1% or 5.76 (SD = 2.12) correct answers (p < 0.000001). Spearman's Correlation Coefficients were: 1) individual provider level--(0.3978); 2) agency provider level--(0.2741); 3) hours worked per week--(0.2505); 4) years in EMS--(-0.0821); 5) commercial or volunteer provider--(0.2398); 6) agency call volume--(0.2012); 7) agency location--(0.0685), and 8) transporting versus non-transporting agency--(0.2523). CONCLUSIONS: A need exists for further education of out-of-hospital emergency care providers with respect to triage, transportation, and destination decisions. Provider experience and level of certification do not appear to affect these critical patient-care decisions.
Caregivers↗
Effect of field capture on the measurement of cellular immune responses in wild ferrets (Mustela furo), vectors of bovine tuberculosis in New Zealand.
Ferrets are recognised as significant wildlife vectors of bovine tuberculosis (Tb) in New Zealand. Disease management strategies, such as the development of a protective wildlife vaccine, could be assisted by the ability to measure pertinent cellular immune responses among wild animals. In the present study, we investigated whether it is possible to measure in vitro lymphocyte reactivity in wild-caught ferrets, and also determined levels of physiological stress in these animals, and we compared these responses to those observed in laboratory-maintained domesticated ferrets. Over a 12-month period, 80 ferrets were live-captured from a Tb-endemic region (Otago, southern New Zealand); cardiac blood was withdrawn on-site, and mononuclear cell cultures were successfully established from 75 of these animals. Lymphocyte transformation (LT) responses to T cell and T/B cell mitogens (Concanavalin A [Con A] and pokeweed mitogen) were measured via uridine incorporation assay. The magnitude of these responses did not differ significantly between animals that had been captured in wire-framed cage traps and those captured using soft-jawed leg-hold traps. Levels of serum cortisol and glucose (as indicators of physiological and oxidative stress, respectively) were highest in animals captured using leg-hold traps. In comparison to domesticated ferrets, wild-caught ferrets had lower overall LT responses to Con A, but significantly higher levels of serum cortisol. Finally, 10/80 animals captured from the wild were severely diseased (Tb+), as evidenced by gross tuberculous lesions at autopsy. Successful mononuclear cell cultures were established from nine of these animals; LT responses to Con A were significantly lower in Tb+ ferrets than in either wild-caught/non-diseased (Tb-) or domesticated ferrets. These results demonstrate that it is possible to measure cellular immune responses from the blood of wild-caught ferrets, but that field capture and disease status may have detrimental effects on in vitro T cell function, possibly due to the influence of physiological stress.
Animals↗
Tumor cell expression of CD59 is associated with resistance to CD20 serotherapy in patients with B-cell malignancies.
The anti-CD20 chimeric monoclonal antibody rituximab (Rituxan) is used to treat patients with various B-cell tumors, including patients with plasma cell dyscrasias who have CD20+ disease. Many patients with CD20+ disease have either primary unresponsive disease or progress after initially responding to rituximab; therefore, understanding how tumor cells are, or become, resistant to rituximab is of clinical relevance. In this report, we determined whether tumor cells express antigens that block complement-mediated lysis or antibody-dependent cell-mediated cytotoxicity (ADCC) and thereby contribute to rituximab resistance. We demonstrate that expression of the complement regulator CD59 is associated with resistance to rituximab-mediated complement lysis of multiple myeloma (MM) and non-Hodgkin's lymphoma (NHL) cell lines. Moreover, neutralization of CD59 using a blocking monoclonal antibody reversed resistance to rituximab-mediated complement lysis of CD20++ CD59++ ARH-77 MM cells. In addition, we demonstrate the presence of CD59 and rituximab binding on viable tumor cells from patients with MM and Waldenstrom's macroglobulinemia with progressive disease despite rituximab therapy. Last, we also examined MM and NHL B-cell lines, as well as patient tumor cells, for the expression of other antigens that may have a role in blocking ADCC activity, such as Fas ligand (FasL), MUCI, or TRAIL. FasL, MUC1, and/or TRAIL were coexpressed with complement regulators on many of these cells. These studies therefore show that complement regulators, particularly CD59 and antigens that may block ADCC, are present on various B-cell tumors and associated with rituximab resistance in patients. A prospective, clinical study is assessing the role of these antigens in mediating rituximab resistance.
Animals↗
Neuroblastoma presenting as central nervous system disease.
Neuroblastoma may be extremely difficult to recognize, particularly when the tumor presents as a primary central nervous system disease. Central nervous system involvement may be considered as primary intracerebral neuroblastoma, metastases to the cranium from an occult primary, primary intraorbital neuroblastoma originating in the ciliary ganglion, metastatic intraorbital neuroblastoma from an occult primary, primary intraspinal neuroblastoma originating in dorsal root ganglia, intraspinal metastatic disease, and distant effects such as myoclonic encephalopathy. Primary neuroblastoma within the ciliary ganglion and primary intraspinal neuroblastoma are extremely rare entities. Illustrative cases the demonstrate the broad spectrum of neurologic presentations are offered. The second known report of neuroblastoma in association with primary pulmonary hypoventilation (Ondine curse) is included.
Brain Neoplasms↗
A screening programme for people over 75.
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Aged↗