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Biomedical subjects

J Allen

Publications and source records attributed to J Allen.

At least 235 records · Page 13Linked to original sources
PubMed1994

Careers in academic general practice: problems, constraints, and opportunities.

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.

Academic Medical Centers↗
PubMed1994

Bone mineral density of total body, spine, and femoral neck in children and young adults: a cross-sectional and longitudinal study.

Bone mineral density (BMD) of total body (TBMD), lumbar spine (L2-4), and femoral neck was measured in 266 normal subjects (136 males) aged 4-27 years (mean 13 years) using dual-energy x-ray absorptiometry (DXA). BMD of all sites increased significantly with age until 17.5 years in males and 15.8 years in females, except for femoral neck BMD in females, which peaked at age 14.1 years. Males had higher peak TBMD, which was attributed to greater weight and lean tissue mass. In contrast, despite a later timing, peak L2-4 BMD in males was not different from that in females. Before peak BMD, weight was the best predictor of TBMD and L2-4 BMD in both sexes (r2 ranged from 0.77 to 0.88), whereas femoral neck BMD was predicted equally by height and weight. Longitudinal information collected from 53 (25 boys) of these children, aged 4-16.9 years, showed that the average annualized gain in TBMD was 0.047 g/cm2 for boys and 0.039 g/cm2 for girls. No significant difference in the association between age and BMD (slopes) was found between cross-sectional and longitudinal data for either sex. We conclude that the timing for peak BMD was consistent for total body, lumbar spine, and femoral neck for each sex. The earlier peak BMD in females is most likely related to earlier puberty. The cross-sectional normative data of this study are useful in serving as a standard for serial assessment in health and disease states.

Absorptiometry, Photon↗
PubMed1994

Dietary calcium intake in 18-year-old women: comparison with recommended daily intake and dietary energy intake.

Average dietary calcium intake and energy intake of 113 18-year-old university students in Western Australia was examined. Four-day, weighted diet records, including 1 weekend day, were completed by the subjects. A large proportion of the students (68%) had an average daily calcium consumption below the 800 mg recommended by the National Health and Medical Research Council of Australia. A strong positive association was also found between dietary calcium and dietary energy intakes. Many young women on self-imposed energy reduction diets are at risk of a dietary calcium intake deficit at a time when it should be enhanced. These findings are significant for nursing practice as they indicate the need for further health education concerning the importance of dietary calcium in young women.

Adolescent↗
PubMed1994

Simplified body-surface electrocardiographic maps with depolarization magnitude and direction.

A new technique is presented for extracting the magnitude and direction of ventricular depolarization at the body surface from surface electrocardiographic (ECG) map data. Bipolar electrocardiograms were obtained from 36 sites on the chest surface in five normal subjects. The direction and magnitude of depolarization as seen from the chest surface were calculated for 18 body-surface areas centred between electrode positions V1 and V6. Each area was bounded by three electrodes with an electrode spacing of 5 cm. A major depolarization component could be calculated for all triangular areas, with 48% of areas having a smaller second component. The area with the greatest magnitude in each subject had a depolarization vector pointing downwards and to the left, with an average angle to the horizontal of 55 degrees. This was consistent with an average angle of 51 degrees obtained from the subjects' 12-lead electrocardiograms. There was more variability in vector angle between adjacent areas on the right-hand side. At the V5/V6 areas, close to the cardiac apex, the vector component had an upwards orientation in all subjects, opposing the overall downward component of ventricular depolarization. The technique was able to determine local depolarization directions which were in agreement with the normal cardiac vector derived from standard electrocardiography. Reversal of the vector direction close to the cardiac apex and the collision of depolarization components from different directions could be detected. This simple form of body-surface mapping can reduce the essential features of depolarization to a single map, and provide information not directly available from a 12-lead electrocardiogram.

Adult↗
PubMed1994

Effects of maternal hospitalization in early childhood: anticipated anxiety associated with an analog separation for childbirth and surgery.

Assessed early childhood anticipation of anxiety in response to analog 3-day maternal hospitalization for surgery or childbirth. Reaction to analog nonhospital separation was also assessed. Within each condition, gender effects were examined. Participants were 120 first-grade children at four elementary schools. Between-groups comparisons showed maternal separation for surgery was anticipated as more anxiety provoking, whereas anxiety associated with separation for childbirth and nonhospital separation was anticipated as similar. In general, within each separation situation, girls and boys anticipated similar levels of anxiety.

Anxiety, Separation↗
PubMed1994

Effects of age and gender on dichotic sentence identification.

There is converging evidence that aging causes a progressive decline in the central processing of speech and that this decline is greater for left-ear than for right-ear input. In the present paper we investigated, by means of a dichotic sentence identification paradigm, some parameters of the "left-ear effect." We analyzed the clinical records of 356 individuals, 203 males and 153 females, to whom the Dichotic Sentence Identification (DSI) Test had been administered as part of routine audiometric assessment. Subjects ranged in age from 9 to 91 yr. The DSI test was always carried out in two modes: free report (FR) and directed report (DR). In the FR mode the subject reported what was heard in both ears. In the DR mode the subject reported only what was heard in one precued ear. In half of the trials the right ear was precued, in the other half the left ear was precued. Findings confirm a progressively larger right-ear advantage, or left-ear deficit, with increasing age. We document this effect in both the FR and DR modes, then demonstrate that the effects cannot be attributed to interaural asymmetries in threshold sensitivity. Comparison of male and female data suggest a gender difference in the effect of age on the left-ear deficit. Males show a larger effect then females in both modes of test administration. Finally, we propose a model of dichotic listening performance that attempts to explain ear asymmetry as the linear combination of an auditory/structural component and a task-related/cognitive component. We then show how these hypothetical components change with age in the present sample.

Adolescent↗
PubMed1994

Linear IgA disease: a heterogeneous disease.

Data from our series of 70 patients support the hypothesis that linear IgA disease is a heterogeneous disease as regards clinical features, target antigens and immunogenetics. The clinical presentation varies as regards age of onset and severity of skin and mucosal involvement and scarring. The use of split skin and of the novel substrate cylindroma has identified 2 target antigens. The majority of patients have a target antigen associated with epidermal cells and possibly cylindroma hemidesmosomes. A minority have a dermal antigen which resembles collagen VII on cylindroma. There is an association with HLA-B8, -DR3, Cw7 and with the linked rare tumour necrosis factor alpha allele, but this is not universal. These differences do not correlate with each other.

Adolescent↗
PubMed1994

Linear IgA disease: cylindroma demonstrates heterogeneity of the target antigens.

Serum from 58 patients with linear IgA disease was tested by indirect immunofluorescence on the novel substrate cylindroma, which produces an abundance of basement membrane components. The use of split skin and of cylindroma has identified 2 target antigens. The majority of patients have a target antigen associated with epidermal cells and similar in distribution on cylindroma to hemidesmosome proteins. A minority have a dermal antigen with the distribution of collagen VII on cylindroma. These data support the hypothesis that linear IgA disease is a heterogeneous disease with regard to the target antigens.

Adenoma↗
PubMed1994

Molecular overlap of the IgA target antigens in the subepidermal blistering diseases.

Linear IgA disease (LAD) has circulating IgA auto-antibodies which have been found to be associated with epidermal- and dermal-derived antigens. The localization and molecular weight(s) of the IgA target antigen(s) implicated in LAD and their relationship to the target antigens for the IgA antibodies in bullous pemphigoid (BP) and cicatricial pemphigoid (CP) are unknown. Sera from patients with all 3 diseases who had circulating IgA antibodies were studied by immunoblotting with both epidermal and dermal extracts. Our findings indicate that there is heterogeneity in the localization and molecular weights of the target antigen(s), with multiple bands demonstrated with some sera. Three principal target antigens were identified with molecular weights of 110-120, 160-180 and one approximately 285 kD. These antigens were common to all 3 diseases and were found in 25 patients. These results suggest that the target antigens for IgA basement membrane zone antibodies in LAD, BP and CP are multiple, complex in composition and may differ from the conventional BP antigens.

Autoantibodies↗
PubMed1993

The academic base for general practice: the case for change.

University departments of general practice and the postgraduate education system for general practice have developed separately over the past 30 years. This separation is now impeding the academic development of the discipline and causes difficulties with recruitment and career progression. These problems could be eased by the creation of integrated departments. This would establish a critical mass for research and educational development, allow human and other resources to be used more flexibly and effectively, and provide a strong base for undergraduate education, vocational training, higher professional training, and continuing education. It could encourage collaborative ventures with other disciplines and also lead to higher standards of patient care.

Education, Medical, Graduate↗
PubMed1993

The M gamma chain of human fetal hemoglobin is an A gamma chain with an in vitro modification of gamma 141 leucine to hydroxyleucine.

We have reanalyzed the structure of the gamma T-15 peptide from the minor M gamma chain of human hemoglobin (Hb) F. Amino acid analysis confirmed that the Leu 141 residue was missing from position 9 of this peptide, and liquid secondary ion mass spectrometry indicated that it was replaced, not by methionine (residue mass 131) as previously believed, but by an amino acid of mass 129. By analogy with the recently reported oxidation of the corresponding leucine at position gamma 141 of the unstable Hb Atlanta, it appears that the M gamma chain also results from the oxidation of gamma 141 to hydroxyleucine (residue mass 129). The finding that the proportion of the M gamma chain increased when red cell lysates were prepared with carbon tetrachloride prompted us to reinvestigate the oxidation mechanism involved in the formation of beta 141 hydroxyleucine in Hb Atlanta. Oxidation of the beta 141 residue could be detected when carbon tetrachloride was used in the lysis protocol, while conversion of oxyhemoglobin to carbon monoxyhemoglobin prior to carbon tetrachloride treatment prevented oxidation. It therefore appears that the hydroxylation of Leu 141 is not an in vivo process in the circulating red cell. Perhaps leucine at position 141 of the beta, gamma, and delta chains (and at position 136 of the alpha chain), which forms a contact with heme and is located directly across the heme plate from the E helix, is oxidized to hydroxyleucine at a very low rate forming minute amounts of modified chains; this process is accelerated by treatment with agents such as carbon tetrachloride and prolonged exposure to air.

Adult↗
PubMed1993

Development of a neural network screening aid for diagnosing lower limb peripheral vascular disease from photoelectric plethysmography pulse waveforms.

An artificial neural network (ANN) was trained to classify photoelectric plethysmographic (PPG) pulse waveforms for the diagnosis of lower limb peripheral vascular disease (PVD). PPG pulses from the lower limbs, and pre- and post-exercise Doppler ultrasound ankle to brachial systolic blood pressure ratio measurements were obtained from patients referred to a vascular investigation laboratory. A single PPG pulse from the big toe of each leg was processed and normalized, and used as input data to the ANN. The ANN outputs represented the diagnostic classifications (normal, significant PVD and major PVD) and the ANN was trained with the ankle to brachial pressure indices (ABPI). The ANN structure consisted of an input layer (50 neuron units from the PPG pulse input), a single hidden layer (15 neurons) and an output layer (3 neurons for the PVD diagnoses). The back-propagation learning algorithm was used to train the ANN for 500 epochs with a PPG training set of pulses from 100 legs. Test data for network assessment comprised pulses from a further 50 legs (20 normal and 30 PVD, of which 15 were categorized as having major disease). A network sensitivity of 93% and specificity of 85% was achieved with respect to the Doppler ABPI standard, giving a diagnostic accuracy of 90%. The results of this study indicate that a neural network can be trained to distinguish between PPG pulses from normal and diseased lower limb arteries. The simplicity of PPG measurement and neural network classification holds promise for the screening of lower limb arterial PVD.

Humans↗
PubMed1993

Bullous systemic lupus erythematosus--a variable disease.

We describe a patient with the rare diagnosis of 'Bullous Systemic Lupus Erythematosus'. She is unusual in presenting with classical dermatitis herpetiformis, before the emergence of systemic features. In addition, on indirect immunofluorescence on sodium chloride split skin, there was epidermal binding. Immunoblotting was negative for type VII collagen.

Adult↗
PubMed1993

Carboplatin and vincristine for recurrent and newly diagnosed low-grade gliomas of childhood.

PURPOSE: This study investigates the response rate to and toxicity of carboplatin and vincristine in children with recurrent low-grade gliomas (LGGs) or patients younger than 60 months with newly diagnosed LGGs. PATIENTS AND METHODS: Twenty-three children with recurrent and 37 children with newly diagnosed LGGs were treated with a 10-week induction cycle of carboplatin and vincristine, followed by maintenance treatment with the same drugs. Patients were evaluated for response to treatment and toxicity. RESULTS: Twelve of 23 (52% +/- 10%; 95% confidence interval [CI], 0.32 to 0.72) assessable children with recurrent disease had an objective response to treatment, which included a greater than 50% reduction in tumor size in seven of 23 (30% +/- 10%; 95% CI, 0.10 to 0.50). Twenty-three of 37 (62% +/- .08; 95% CI, 0.46 to 0.78) of newly diagnosed patients had an objective response, 16 of 37 (43% +/- 0.08%; 95% CI, 0.27 to 0.59) with greater than 50% reduction in tumor size. The majority of those with an objective response had diencephalic tumors (n = 29), but children with thalamic (n = 2), cortical (n = 1), and brain stem (n = 2) LGGs also responded to treatment. Of the 35 patients with objective response to treatment, the maximum response was seen in 25 after completion of induction and in the remaining 10 after two to six cycles of maintenance treatment. Forty-nine of 53 (92% +/- .04%) patients who were stable or improved after induction remain without progressive disease (PD). Hematologic toxicity was common, but resulted in cessation of therapy in only one patient. Six children have been removed from the study because of allergic reactions, which were considered to be carboplatin-associated. CONCLUSION: Carboplatin and vincristine have activity in children with recurrent and newly diagnosed progressive LGGs. Objective responses to treatment after chemotherapy can be seen. This drug regimen is relatively well tolerated, and further studies are indicated to define the role of this combination of drugs in children with newly diagnosed LGGs.

Adolescent↗