Biomedical subjects
Publications and source records attributed to J French.
Where services are resource-limited, they will be targeted at those in poverty. The HA will invest in programmes that provide the maximum health gain and the greatest reduction in health inequality. The HA will map and audit the distribution of poverty and of service provision and redirect services to reflect identifiable need. The HA will adopt an 'anti-poverty effect' measure as an indicator of service quality.
PURPOSE: The objective of this prospective study was to compare the usefulness of a sleep-deprived electroencephalogram (EEG) versus a computer-assisted 16-channel ambulatory EEG in patients with historical information consistent with epilepsy but with a normal or non-diagnostic initial routine EEG. METHODS: A total of 46 patients had both a 30-60 min sleep-deprived EEG and a computer-assisted ambulatory 24 h EEG. Each EEG was assigned a number and reviewed independently by two board-certified electroencephalographers for the presence of interictal epileptiform discharges and seizures. RESULTS: Both the sleep-deprived EEG and ambulatory EEG improved detection of epileptiform discharges by a similar amount (24% versus 33%); however, the ambulatory EEG detected seizures in 7/46 (15%) patients, and in three patients the seizures were solely detected by the computer. CONCLUSIONS: we conclude that the computer-assisted ambulatory EEG offers greater benefit than a sleep-deprived recording because in addition to detecting interictal epileptiform discharges, it may also capture seizures. The discovery of unsuspected seizures can significantly impact clinical management.
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We examined differences over time in Sydney gay men's unprotected anal intercourse, particularly with a view to investigating any behavioural changes after the recent improvements in antiretroviral therapies. Trends in unprotected anal intercourse were monitored through the Sydney Gay Community Periodic (cross-sectional) Surveys which were conducted at six-monthly intervals between February 1996 and February 1998. Gay men (n = 2,863) were recruited and self-completed a short questionnaire at three gay venues and a sexual health clinic. There was a significant increase in unprotected anal intercourse with casual partners (but not with regular partners), applicable to both HIV positive and HIV negative men. Sexual practice was generally unrelated to ideas about recent advances in viral load testing and combination therapies.
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Renal malacoplakia is an uncommon condition with a variety of radiological characteristics which may initially suggest an alternative diagnosis. Three cases of renal malacoplakia were diagnosed in our hospital during a 2 year period. This apparent cluster of cases probably reflects the increased use of imaging and biopsy in the investigation of elderly hospitalized patients. It is important to make a definitive diagnosis as correct management may result in cure.
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Diet contributes to over one-third of cancer deaths in the Western world, yet the factors in the diet that influence cancer are not elucidated. A reduction in caloric intake dramatically slows cancer progression in rodents, and this may be a major contribution to dietary effects on cancer. Insulin-like growth factor I (IGF-I) is lowered during dietary restriction (DR) in both humans and rats. Because IGF-I modulates cell proliferation, apoptosis, and tumorigenesis, the mechanisms behind the protective effects of DR may depend on the reduction of this multifaceted growth factor. To test this hypothesis, IGF-I was restored during DR to ascertain if lowering of IGF-I was central to slowing bladder cancer progression during DR. Heterozygous p53-deficient mice received a bladder carcinogen, p-cresidine, to induce preneoplasia. After confirmation of bladder urothelial preneoplasia, the mice were divided into three groups: (a) ad libitum; (b) 20% DR; and (c) 20% DR plus IGF-I (IGF-I/DR). Serum IGF-I was lowered 24% by DR but was completely restored in the IGF-I/DR-treated mice using recombinant IGF-I administered via osmotic minipumps. Although tumor progression was decreased by DR, restoration of IGF-I serum levels in DR-treated mice increased the stage of the cancers. Furthermore, IGF-I modulated tumor progression independent of changes in body weight. Rates of apoptosis in the preneoplastic lesions were 10 times higher in DR-treated mice compared to those in IGF/DR- and ad libitum-treated mice. Administration of IGF-I to DR-treated mice also stimulated cell proliferation 6-fold in hyperplastic foci. In conclusion, DR lowered IGF-I levels, thereby favoring apoptosis over cell proliferation and ultimately slowing tumor progression. This is the first mechanistic study demonstrating that IGF-I supplementation abrogates the protective effect of DR on neoplastic progression.
BACKGROUND: Hypertrophic cardiomyopathy (HCM) is associated with mutations of genes coding for major sarcomeric proteins, but the mechanism of hypertrophy is unknown. As hypertrophy may not develop until adolescence, an altered response to physiological growth stimuli may regulate the hypertrophy process. AIMS: This study examined the relationship between age and changes in left ventricular (LV) wall thickness in patients with HCM. METHODS: Forty-three patients who had definite electrocardiographic and echocardiographic evidence of HCM were studied with serial 2D and M-mode echocardiograms at least two years apart (mean interval 5.5 +/- 3.0 years). LV cavity dimensions, septal and posterior wall thicknesses, and LV mass indices were compared with data from an age- and gender-matched control group. RESULTS: In patients with HCM aged ten to 20 years (n = 9), there was an increase in septal wall thickness during the study period from 15.9 +/- 6.2 mm to 19.3 +/- 2.1 mm (p < 0.01). This increase (3.4 +/- 2.5 mm) greatly exceeded the change in septal thickness observed in the control group between the ages of ten and 20 years (0.8 +/- 0.3 mm, p < 0.01). There was a lesser increase in posterior wall thickness from 9.8 +/- 2.1 mm to 11.5 +/- 3.5 mm (p = 0.07). In patients with HCM aged 21-40 years (n = 11), there was also an increase in septal wall thickness during the study period from 16.0 +/- 2.2 mm to 17.8 +/- 3.0 mm (p < 0.05), but no change in septal thickness in the control group. In contrast, the patients aged > 40 years (n = 23) showed no significant change in either septal or posterior wall thickness during the study period. LV mass index increased in the ten to 20 years age group from 128 +/- 24 g/m2 to 164 +/- 20 g/m2 (p = 0.01), but this increase was not observed in the older age groups. CONCLUSIONS: LV hypertrophy is progressive, particularly in the septum, during adolescence and early adult life in patients with HCM. As progressive hypertrophy may continue after somatic growth has ceased, an abnormal myocardial response to physiological growth regulators is less likely to be the principal stimulus to hypertrophy. Gene-gene interactions, changes in haemodynamic load or environmental factors may modulate the development of hypertrophy. Serial measurements of ventricular wall thickness in the first two decades of life, and probably until the fourth decade of life are advisable in patients suspected of having HCM.
The aim of this study was to provide current data on the sexual practices in a broad cross-sectional sample of gay and homosexually active men in Sydney. Anonymous, short questionnaires were completed by 1611 gay men recruited at the 1996 Gay and Lesbian Mardi Gras Fair Day or at one of six venues (including two sexual health centres) across the metropolitan area during the following week. The sample was diverse, but the men tended to be of Anglo-Australian background, well educated, professionally employed, attached to gay community and gay identified. They mainly had sex with other men rather than with men and women. Most (86.0 per cent) had been tested for human immunodeficiency virus. Excluding 241 men recruited in sexual health centres, 11.2 per cent were HIV-positive and 73.4 per cent were negative. Where it occurred in regular relationships, unprotected anal intercourse was usually between seroconcordant partners (78.5 per cent). Unprotected anal intercourse between discordant or nonconcordant regular partners was much less common, and in about half the cases involved withdrawal prior to ejaculation exclusively rather than ejaculation inside. Almost 12 per cent of the men had at least 'occasionally' engaged in unprotected anal intercourse with a casual partner in the previous six months, with approximately half of these men having adopted a withdrawal strategy on every occasion. We conclude that short surveys can provide valuable and timely data on sexual practices in a broad cross-sectional sample of gay and homosexually active men. Key messages for those involved in gay men's education are the high rates of unprotected anal intercourse between casual partners and the extensive practice of withdrawal.
BACKGROUND: The purpose of this study was to evaluate the shift-specific sleep, general activity levels, mood and cognitive performance of air traffic controllers (ATCs) working a forward 2-2-2 rapid rotation shift schedule. HYPOTHESIS: ATCs are more fatigued on the night-shift. METHODS: ATCs recorded their sleep, oral temperature and subjective fatigue levels, took a computerized cognitive performance battery (n = 13) and completed the Profile of Mood States questionnaire (POMS) (n = 12). Actigraphs were used to objectively monitor general activity levels and score sleep and the restfullness of scored sleep (n = 9). Analyses were made on the basis of duty shift, post-shift, day of shift, and duty location. RESULTS: There was significantly more actigraph scored sleep (85 min, p = 0.038), subjectively reported sleep (26 min, p = 0.009) and subjectively measured fatigue (p < 0.001) and confusion (p = 0.003) for the ATCs while they were on-duty on the night-shift. The night-shift was also associated with decreased vigor (p = 0.039) and general activity levels (p = 0.017). Significantly more sleep was reported (7.6 h, p = 0.01) and scored by actigraph (4.7 h, p = 0.02) following the swing-shift than following the day-shift. The radar approach ATCs reported greater confusion (p = 0.019) and less vigor (p = 0.002) than the tower ATCs. Insufficient trials were available for direct performance analysis. CONCLUSIONS: ATCs on the night-shift of a forward rapid rotation shift schedule appear to be falling asleep and report increased confusion and fatigue. Further study is indicated.
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The central objectives of this study were to evaluate the cognitive, psychomotor and subjective effects of two anti-emetic drugs of established value in the prophylaxis of radiation induced nausea and vomiting. The drugs of interest were granisetron (Kytril, SmithKline Beecham Pharmaceuticals, Philadelphia, PA; 1 mg tablets/2 mg dose) and ondansetron (Zofran, Glaxo Welcome, Inc., Research Triangle Park, NC; 8 mg tablets/8 mg dose). The experimental approach, involving 24 active-duty military subjects, was a placebo controlled, double blind, crossover design with a positive control (prochlorperazine, 10 mg tablets/10 mg dose) condition. Testing was accomplished during the evening and early morning hours, between 1630 hours and 0230 hours. Therefore, fatigue stemming from an extended work period and a disrupted work/rest cycle was also part of the study design. Data were collected on the following: cognitive and psychomotor effects, affective state changes, temperature, serum drug levels, and side effects. The drugs of interest, granisetron and ondansetron, were extremely well tolerated, with no obvious side effects when compared to the placebo condition. Two of five cognitive tests detected a positive control effect and nearly all of the measurement instruments demonstrated a general fatigue effect, independent of the drug. There was no evidence of any cognitive, psychomotor or subjective state changes caused by either granisetron or ondansetron. It was concluded the anti-emetic drugs, granisetron or ondansetron, would not interfere with performance when given prophylactically to personnel at risk of exposure to radiation.
BACKGROUND: The objectives of this study were to evaluate the effects of two anti-emetic drugs, granisetron (1 mg tablets/2 mg oral dose) and ondansetron (8 mg tablets/8 mg oral dose) on flying and mission performance in an F-16 research simulator. METHODS: The experimental approach, involving 9 pilots, was a placebo controlled, double blind, crossover design. Each pilot flew three defensive counter air missions. Data on nine measures of flying performance were collected via the simulator data recorder. In addition, ratings on mission and flying performance were recorded by simulator instructor pilots. Data were also collected on symptoms and side effects, mood, and vigilance. RESULTS: This study, carried out in the context of a simulated tactical air-to-air combat mission, produced no significant differences between the effects of the target drugs and placebo on any of the nine objective flying performance measures, including a composite measure of landing performance. There were no differences in evaluator ratings of routine mission flying or air combat performance. Pilots could not distinguish active drug from placebo and there were no differences on any of the mood scales. CONCLUSIONS: These results confirm our earlier findings that the drugs of interest are well tolerated and produce no cognitive, psychomotor or subjective state changes. In this study, there was no evidence of performance degradation caused by either granisetron or ondansetron when tested in a complex, military task environment.
AIM: To analyse the utilisation of therapies in coronary care units for patients with acute myocardial infarction. METHODS: An evaluation form was completed prospectively by a designated nurse in each coronary care unit of the four Auckland hospitals in 1993. RESULTS: One thousand and eighty one patients who were admitted with definite or probable acute myocardial infarction had a coronary care unit stay of 63.4 (SD 49.3) hours, and hospital stay of 7.3 (5.1) days. The mortality for definite myocardial infarction was 13.7% (< 70 years 7.1%). Coronary angiography was performed on 10% of patients during their hospital admission, and 4.9% underwent revascularisation. Thrombolytic therapy was administered to 52% (495/948) of patients with definite infarction and 4% had contraindications. Patients aged > or = 70 years (47% vs 55% p = 0.02) or diabetics (46% vs 56%, p = 0.04) were less likely to receive thrombolysis. The utilisation of aspirin and oral beta-blockers was 86% and 40%, respectively, in patients with definite infarction and both were used less frequently in patients > or = 70 years. Intravenous beta-blockers were administered to < 1% of patients. Angiotensin converting enzyme (ACE) inhibitors were prescribed in 21%, intravenous or long acting nitrates in 41% and calcium antagonists in 14%; the latter two therapies were used more frequently in patients > or = 70 years. There was no evidence of gender or ethnic bias for either investigation or treatment. CONCLUSION: On the basis of results of recent clinical trials, there may be under utilisation of some treatments for acute myocardial infarction including aspirin, thrombolytic therapy, beta-blockers and ACE inhibitors, while calcium antagonists may be over used.
The structure-based design and subsequent chemical synthesis of novel, urea-containing FKBP12 inhibitors are described. These compounds are shown to disrupt the cis-trans peptidylprolyl isomerase activity of FKBP12 with inhibition constants (Ki,app) approaching 0.10 microM. Analyses of several X-ray crystal structures of FKBP12-urea complexes demonstrate that the urea-containing inhibitors associate with FKBP12 in a manner that is similar to, but significantly different from, that observed for the natural product FK506.
There is a stereotypical pattern of primary afferent terminations within the mature spinal cord; however, this pattern is not immutable. Peripheral axotomy causes A fibers to sprout into lamina II, a region from which they are normally excluded. We have investigated the role of neurotrophins in this response. Rats which had undergone sciatic axotomy were treated intrathecally with NGF, BDNF, or NT-3. A fibers were visualized using transganglionic labeling with cholera toxin B subunit; small fibers were visualized using CGRP immunostaining. NGF (12 microg/day for 2 weeks), but not NT-3 or BDNF, prevented both the axotomy-induced reduction in CGRP staining within lamina II and the sprouting of A fibers into this region. It is likely that the prevention of A fiber sprouting is a secondary consequence of NGF rescuing small fibers. This effect of NGF on dorsal horn sprouting has implications both for our understanding of the maintenance of CNS connectivity and for the treatment of neuropathic pain states.