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Biomedical subjects

J Anderson

Publications and source records attributed to J Anderson.

At least 55 records · Page 3Linked to original sources
PubMed2003

Homozygous factor V Leiden mutation in a patient with traumatic leg ulceration.

Factor V Leiden mutation is a well-established risk factor for venous thrombosis and ulceration. We report a 20-year-old male patient who presented with a traumatic left leg ulcer that responded poorly to therapy. He had no previous medical history. Following investigation it was discovered that the patient had extensive venous thrombosis of the left leg veins and was homozygous for the factor V Leiden gene mutation. This case demonstrates the need for detailed history taking and thorough investigation of any atypical ulcer in young adults.

Adult↗
PubMed2003

Gender politics and secure services for women: reflections on a study of staff understandings of challenging behaviour.

This paper discusses the findings of a Q methodological study that investigated the complexity of professional understandings of (attitudes towards) residents in a secure unit for women with learning disabilities and challenging behaviours. Particular attention is afforded to the critical debate regarding women in psychiatric and secure care, including the significant contribution made to this literature by feminist perspectives. A multiprofessional group of staff (n = 38) participated in the study and nine distinct accounts of women's challenging behaviour are described. Despite a considerable amount of recent policy concern with the position of women in psychiatric services, the findings of this research suggest that many front line staff are reluctant to highlight gender in their explanations of women's behaviour. This supports the assertion by Williams et al. (2001), who were involved in the National Gender Training Initiative (NGTI), that most critical theorizing about women's mental health has had minimal impact at the level of individuals' understandings of these important issues. This state of affairs suggests a powerful case for the expansion of staff training as provided in the NGTI, which makes gender central to understanding and emphasizes feminist perspectives.

Female↗
PubMed2003

The role of antiandrogen monotherapy in the treatment of prostate cancer.

The mainstay of hormonal therapy in prostate cancer has been medical or surgical castration, both of which are associated with loss of libido and impotence, and may not always be acceptable to the patient. Antiandrogen monotherapy is an alternative treatment option to castration. There are two types of antiandrogen, i.e. steroidal (cyproterone acetate, CPA), and nonsteroidal (bicalutamide, flutamide and nilutamide). Data comparing survival outcome with CPA and castration are limited and conflicting. Furthermore, CPA is associated with loss of libido and erectile dysfunction. Large phase III trials have established that monotherapy with bicalutamide 150 mg once daily provides a survival outcome that is not significantly different to that after castration in men with locally advanced, non-metastatic disease, while conferring significant advantages for sexual interest and physical capacity. Current data are inadequate to draw conclusions on the comparative efficacy of flutamide and castration, while nilutamide is not licensed for monotherapy. Recent data reveal that bicalutamide 150 mg given once daily in addition to standard care (radical prostatectomy, radiotherapy or 'watchful waiting') significantly delays the progression of early (localized or locally advanced) prostate cancer. Bicalutamide has a more favourable side-effect profile than the other antiandrogens and is more likely to promote compliance.

Androgen Antagonists↗
PubMed2003

An assessment of care of paediatric and adolescent patients with diabetes in a large district general hospital.

AIMS: To assess the process of clinical care and outcomes of young patients with diabetes attending clinics at a large district general hospital. METHODS: Retrospective analysis of data obtained from 106 case notes of patients aged 12-22 years attending the paediatric, combined adolescent or adult diabetes clinics between 1998 and 2000. The frequency of follow-up, rate of admission, glycaemic control, systolic blood pressure, weight change and screening for complications were assessed. RESULTS: The mean attendance rate was 78%. The admission rate was 91 admissions per 1000 patient years. Overall, the mean HbA1c was 9.1% with only 15% of paediatric and adolescent patients having mean HbA1c<or= 8.0%. Mean systolic blood pressure was 124 mmHg. There was a significant increase in obesity with mean weight for height at diagnosis increasing from 89% to 111% after 7 years of diabetes. Mean daily insulin dose was 1.51 U per kg body weight and decreased with increasing age. Screening for complications and associated conditions was variable: 91% for retinopathy, 86% for foot problems, 64% for thyroid dysfunction, 22% for coeliac disease and 10% for microalbuminuria. The overall rate of retinopathy was low at 4% of those screened. CONCLUSIONS: Providing satisfactory care for young people with diabetes remains a difficult challenge. Although the complication rate observed was low in this group, the most important issues are the need for improvement in glycaemic control, weight gain and high drop-out rate.

Adolescent↗
PubMed2003

Possible maternal inheritance of breast muscle morphology in turkeys at sixteen weeks of age.

During the study of inheritance of breast muscle morphology of turkeys during embryonic development and posthatch in two experiments, interesting results were obtained at 16 wk of age. In experiment 1, an experimental line (F) selected long term for increased 16-wk BW was crossed reciprocally with a commercial sire line (B). Samples of pectoralis major muscle were obtained from three males and three females of each genetic group. The F line was reciprocally crossed with a randombred control line (RBC2) in experiment 2, and p. major muscle samples were taken from 10 males and 10 females of each genetic group. The RBC2 line was the base population for the F line. The muscle samples were obtained in a manner to avoid contraction. After fixing, the muscle samples were stained with hematoxylin and eosin to view muscle morphology. Distinct morphological types were observed in the muscle samples for the B, F, and RBC2 lines. The pectoralis major muscle from the B line was, in general, characterized by large fibers with a well-defined extracellular matrix (perimysial and endomysial spaces). Similar to the B line, representative samples of the RBC2 line had a well-defined extracellular matrix but muscle fiber size was not as large as that of the B line. Representative samples of the F line were characterized by a greatly reduced extracellular matrix with the muscle fibers not well defined. For the reciprocal crosses in both experiments, representative samples indicated the offspring had breast muscle morphology similar to that of the female parent, suggesting maternal inheritance. There was no sex effect on breast muscle morphology in either experiment. In order to study the consistency of the results, muscle morphology of representative sections of muscle were subjectively rated by four individuals. The ratings ranged from 1 (little extracellar matrix and indistinct muscle fibers) to 5 (large extracellular space and distinct muscle fibers). Ratings of 2 to 4 were intermediate to these extremes. In experiment 1, ratings of the pure B line and the F sire x B dam cross were similar and higher than that of the pure F line and B sire x F dam cross, which did not differ in average rating. The results for experiment 2 were similar to those for experiment 1 in that the average ratings of the reciprocal crosses were similar to that of the female parental line. The results from the ratings support maternal inheritance of breast muscle morphology.

Animals↗
PubMed2003

Comparison of statistically derived ASAS improvement criteria for ankylosing spondylitis with clinically relevant improvement according to an expert panel.

OBJECTIVE: To investigate whether the recently developed (statistically derived) "ASsessment in Ankylosing Spondylitis Working Group" improvement criteria (ASAS-IC) for ankylosing spondylitis (AS) reflect clinically relevant improvement according to the opinion of an expert panel. METHODS: The ASAS-IC consist of four domains: physical function, spinal pain, patient global assessment, and inflammation. Scores on these four domains of 55 patients with AS, who had participated in a non-steroidal anti-inflammatory drug efficacy trial, were presented to an international expert panel (consisting of patients with AS and members of the ASAS Working Group) in a three round Delphi exercise. The number of (non-)responders according to the ASAS-IC was compared with the final consensus of the experts. The most important domains in the opinion of the experts were identified, and also selected with discriminant analysis. A number of provisional criteria sets that best represented the consensus of the experts were defined. Using other datasets, these clinically derived criteria sets as well as the statistically derived ASAS-IC were then tested for discriminative properties and for agreement with the end of trial efficacy by patient and doctor. RESULTS: Forty experts completed the three Delphi rounds. The experts considered twice as many patients to be responders than the ASAS-IC (42 v 21). Overall agreement between experts and ASAS-IC was 62%. Spinal pain was considered the most important domain by most experts and was also selected as such by discriminant analysis. Provisional criteria sets with an agreement of >or=80% compared with the consensus of the experts showed high placebo response rates (27-42%), in contrast with the ASAS-IC with a predefined placebo response rate of 25%. All criteria sets and the ASAS-IC discriminated well between active and placebo treatment (chi(2)=36-45; p<0.001). Compared with the end of trial efficacy assessment, the provisional criteria sets showed an agreement of 71-82%, sensitivity of 67-83%, and specificity of 81-88%. The ASAS-IC showed an agreement of 70%, sensitivity of 62%, and specificity of 89%. CONCLUSION: The ASAS-IC are strict in defining response, are highly specific, and consequently show lower sensitivity than the clinically derived criteria sets. However, those patients who are considered as responders by applying the ASAS-IC are acknowledged as such by the expert panel as well as by patients' and doctors' judgments, and are therefore likely to be true responders.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2003

A pilot study of the prevalence of lumbar disc degeneration in elite athletes with lower back pain at the Sydney 2000 Olympic Games.

OBJECTIVES: To observe the prevalence of lumbar intervertebral disc degeneration in elite athletes as compared with published literature of changes seen in non-athletes-that is, normal population. METHODS: The lumbar spines of 31 Olympic athletes who presented to the Olympic Polyclinic with low back pain and/or sciatica were examined using magnetic resonance imaging. Three criteria were looked at: (a) the loss of disc signal intensity; (b) the loss of disc height; (c) the presence of disc displacement. The results were then recorded and correlated with the lumbar levels. RESULTS: The disc signal intensity was progressively reduced the more caudal the disc space. It was most common at the L5/S1 level, and, of the abnormal group, 36% (n = 11) showed the most degenerative change. Disc height reduction was also found to be most common at the L5/S1 level. However, the most common height reduction was only mild. A similar trend of increased prevalence of disc herniation was noted with more caudal levels. At the L5/S1 level, 58% were found to have an element of disc displacement, most of which were disc bulges. Compared with changes seen in the normal population (non-athletes) as described in the literature, disc degeneration defined by the above criteria was found to be significantly more severe in these Olympic athletes. CONCLUSIONS: Although the study was limited, the results suggest that elite athletes have a greater prevalence and greater degree of lumbar disc degeneration than the normal population. A more detailed follow up study should be considered to investigate which particular training activities have the most impact on the lumbar spine, and how to modify training methods so as to avoid the long term sequelae of degenerative disc disease of the lumbar spine.

Adult↗
PubMed2003

Clinical experience of galantamine in dementia: a series of case reports.

OBJECTIVE: To use case studies to add the benefit of personal experience with galantamine to published literature and to demonstrate the type of patients that may benefit from this treatment. METHODS: We describe eleven patients, aged 57-90 years, fulfilling the consensus diagnostic criteria for probable Alzheimer's disease, mixed dementia, vascular dementia, Lewy body dementia or Parkinson's dementia. All patients were treated with galantamine that may enhance cholinergic function in the brain by inhibiting acetylcholinesterase and potentiating the effects of acetylcholine at nicotinic acetylcholine receptors. Clinical features were rated according to eight assessment scales in old age psychiatry and additional information was obtained from family and other carers. In some cases caregiver distress was measured. RESULTS: All patients described showed a general improvement in cognition and neuropsychiatric symptoms, although observed improvements and effects were not always reflected by the results of formal assessments. Several patients became more independent, particularly in their activities of daily living, and treatment was felt to have helped maintain independence in their home environment, either alone or with their family or carers. One man continued in employment. Adverse events included nausea and vomiting. CONCLUSIONS: Outcomes in this case series indicate that galantamine is well tolerated and highlight aspects of the different side-effect profiles of the anticholinesterase inhibitors. Subjective benefits were not always apparent from objective measures. These case studies demonstrate the type of patients that may benefit from galantamine.

Aged↗
PubMed2003

Integrated urban water planning: big picture planning is good for the wallet and the environment.

The demands on governments and local authorities are changing in response to community expectations for environmentally sustainable outcomes. To reverse declining water quality in rivers and ensure sustainable use in the 21st century, the State Government in New South Wales has introduced a package of Water Reforms. The introduction of integrated water, sewerage and drainage planning is one of the Water Reform initiatives. Traditionally, government and local authorities have managed their water supply, sewerage and stormwater drainage systems as separate entities. Integrated urban water planning is a structured planning process to evaluate concurrently the opportunities to improve the management of water, sewerage and drainage services within an urban area in ways which are consistent with broader catchment and river management objectives. The New South Wales Department of Land & Water Conservation (DLWC) has developed an integrated urban water planning process through a number of recent pilot studies. The process links urban water management objectives to overall catchment and river management objectives. DLWC is currently developing a set of guidelines for integrated urban water plans. DLWC has developed the Integrated Urban Water Planning methodology through three pilot studies in the New South Wales towns of Finley, Goulburn and Bombala. The pilot studies have shown that an integrated approach to water, sewerage and stormwater planning can identify opportunities that are not apparent when separate strategies are developed for each service. The result is better-integrated, more sustainable solutions, and substantial cost savings for local communities.

Cities↗
PubMed2002

Passive stiffness changes in soleus muscles from desmin knockout mice are not due to titin modifications.

Passive stiffness was found to be increased in mouse soleus muscles lacking desmin. Because titin is considered to be the major source of muscle elasticity, the stiffening might be explainable by titin adaptation. To test this, passive mechanical properties of single skinned fibres of soleus muscles from desmin knockout and control mice were analysed by using various extension tests. Titin expression was studied by SDS-gel electrophoresis. Absence of desmin did not modify either electrophoretic mobility of the titin band (3700 kDa) or optical density-unit ratios between bands for titin and nebulin (congruent with 0.3) and bands for titin and myosin heavy chain (congruent with 0.08). Elastic properties of fibres were not altered in the absence of desmin since passive tensions were similar under quasi-static (56-66 kN m(-2)) and dynamic (100-118 kN m(-2)) conditions whatever the kind of fibre. Thus, titin is unlikely to be responsible for the large increase in passive stiffness observed in whole soleus muscles when desmin is lacking.

Animals↗
PubMed2002

The quantitative evaluation of functional neuroimaging experiments: mutual information learning curves.

Learning curves are presented as an unbiased means for evaluating the performance of models for neuroimaging data analysis. The learning curve measures the predictive performance in terms of the generalization or prediction error as a function of the number of independent examples (e.g., subjects) used to determine the parameters in the model. Cross-validation resampling is used to obtain unbiased estimates of a generic multivariate Gaussian classifier, for training set sizes from 2 to 16 subjects. We apply the framework to four different activation experiments, in this case [(15)O]water data sets, although the framework is equally valid for multisubject fMRI studies. We demonstrate how the prediction error can be expressed as the mutual information between the scan and the scan label, measured in units of bits. The mutual information learning curve can be used to evaluate the impact of different methodological choices, e.g., classification label schemes, preprocessing choices. Another application for the learning curve is to examine the model performance using bias/variance considerations enabling the researcher to determine if the model performance is limited by statistical bias or variance. We furthermore present the sensitivity map as a general method for extracting activation maps from statistical models within the probabilistic framework and illustrate relationships between mutual information and pattern reproducibility as derived in the NPAIRS framework described in a companion paper.

Adult↗
PubMed2002

Models of skeletal muscle to explain the increase in passive stiffness in desmin knockout muscle.

Absence of desmin in skeletal muscle was found to induce an increase in passive stiffness. The present study aimed at developing rheological models of passive muscle to explain this stiffening. Models were elaborated by using experimental data depicting muscle viscoelastic behaviour. The experimental protocol included stepwise extension tests applied on control and desmin knockout soleus muscles from mice. Linear and non-linear models were composed of elastic and viscous elements. They were constructed with the aim at taking the presence or absence of desmin into account by simulating desmin as an elastic element. Furthermore, associated adaptation of connective tissues in absence of desmin was modelled as an additional elastic element. Differences in passive behaviour induced by absence of desmin were predicted by using a linear model and a non-linear one. The non-linear model was selected because: (1) it is able to predict experimental viscoelastic kinetics accounting for the increase in passive stiffness in muscles lacking desmin, (2) its design is consistent with morphological data, and (3) stiffness characteristics of its elements are in accordance with the literature. Finally, this modelling approach demonstrates that both absence of desmin and adaptation of connective tissue are required to explain the increase in passive stiffness in desmin knockout muscles.

Animals↗
PubMed2002

The control of rinderpest in Tanzania between 1997 and 1998.

In January 1997, Tanzania requested international assistance against rinderpest on the grounds that the virus had probably entered the country from southern Kenya. Over the next few months, a variety of attempts were made to determine the extent of the incursion by searching for serological and clinical evidence of the whereabouts of the virus. At the clinical level, these attempts were hampered by the low virulence of the strain, and at the serological level by the lack of a baseline against which contemporary interpretations could be made. Once it became apparent that neither surveillance tool was likely to produce a rapid result, an infected area was declared on common-sense grounds and emergency vaccination was initiated. The vaccination programme had two objectives, firstly to prevent any further entry across the international border, and secondly to contain and if possible eliminate rinderpest from those districts into which it had already entered. On the few occasions that clinical rinderpest was subsequently found, it was always within this provisional infected area. Emergency vaccination campaigns within the infected area ran from January to the end of March 1997 but were halted by the onset of the long rains. At this time, seromonitoring in two districts showed that viral persistence was still theoretically possible and therefore a second round of emergency vaccination was immediately organized. Further seromonitoring then indicated a large number of villages with population antibody prevalences of over 85%. These populations were considered to have been 'immunosterilized'. Although no clinical disease had been observed in them, it was decided to undertake additional vaccination in a group of districts to the south of the infected area. Serosurveillance indicated that rinderpest could have been present in a number of these districts prior to vaccination. Serosurveillance in 1998 suggested that numerous vaccinated animals had probably moved into districts outside the infected and additional vaccination areas, but did not rule out the continued presence of field infection.

Animals↗
PubMed2002

Paediatric training for family doctors: principals and practice.

BACKGROUND: There is controversy as to how best to train general practitioners for the paediatric challenges they will meet in practice, in particular what should be included in training, what should be left out and how long should it last? SUBJECTS AND METHODS: All 615 general practice principals referring to 6 hospitals were surveyed (40% response rate). SETTING: West Midlands region of England. STUDY DESIGN: Postal questionnaire. STATISTICS: Quantitative and qualitative assessment of responses. Quantitative responses were analysed by hospital, decade of qualification, and duration of paediatric training. Qualitative responses were analysed using grounded theory. RESULTS: Satisfaction with training was directly related to its duration, with low levels of satisfaction for less than 6 months paediatrics, moderate levels for 6-11 months, and high levels with 12 months or more. The most important item of training was recognition of the sick child. Acute and chronic paediatrics was generally well covered. Psychosocial aspects, public health and immunisation were poorly addressed. Neonatal resuscitation and first day checks were seen as relevant, but neonatal intensive care was not. CONCLUSIONS: At least 6 months of paediatrics is necessary for GPs in training, but longer paediatric exposure further increases their satisfaction with training. GPs have a biopsychosocial rather than biomedical approach to their child patients, suggesting potential benefits from a greater emphasis on psychosocial and public health aspects at the expense of neonatal intensive care. Recognition of the sick child is essential, and acute and chronic organic illness should be covered in breadth. Possible future models for GP training in paediatrics are discussed.

Education, Medical↗
PubMed2002

Combined MR imaging and numerical simulation of flow in realistic arterial bypass graft models.

We report methods for (a) transforming a three-dimensional geometry acquired by magnetic resonance angiography (MRA) in vivo, or by imaging a model cast, into a computational surface representation, (b) use of this to construct a three dimensional numerical grid for computational fluid dynamic (CFD) studies, and (c) use of the surface representation to produce a stereo-lithographic replica of the real detailed geometry, at a scale convenient for detailed magnetic resonance imaging (MRI) flow studies. This is applied to assess the local flow field in realistic geometry arterial bypass grafts. Results from a parallel numerical simulation and MRI measurement of flow in an aorto-coronary bypass graft with various inlet flow conditions demonstrate the strong influence of the graft inlet waveform on the perianastomotic flow field. A sinusoidal and a multi harmonic coronary flow waveform both with a mean Reynolds number (Re) of 100 and a Womersley parameter of 2.7 were applied at the graft inlet. A weak axial flow separation region just distal to the toe was found in sinusoidal flow near end deceleration (Re = 25). At the same location and approximately the same point in the cycle (Re = 30) but in coronary flow, the axial flow separation was stronger and more spatially pronounced. No axial flow separation occurred in steady flow for Re = 100. Numerical predictions indicate a region in the vicinity of the suture line (where there is a local narrowing of the graft) with a wall shear magnitude in excess of five times that associated with fully developed flow at the graft inlet.

Computer Simulation↗