Fetal anomaly, the Internet and the 'informed' patient: a dangerous combination.
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Abnormalities, Multiple↗
Biomedical subjects
J M Johnson
Publications and source records attributed to J M Johnson.
Managing fatigue in operational settings. 1: Physiological considerations and countermeasures.
The authors consider three aspects of managing fatigue in the workplace. They provide a brief overview of important scientific findings related to sleep and circadian physiology that establish the psychobiological foundation of fatigue. Their major focus is on the relevance of these findings to operational settings. In addition, they provide examples to describe practical fatigue countermeasures that can be used in operational settings.
Circadian Rhythm↗
Managing fatigue in operational settings 2: An integrated approach.
The six domains that must be addressed in managing fatigue in operational settings are identified, and examples of how the aviation industry is dealing with the problems in each domain are given. Challenges facing healthcare providers in managing fatigue are also discussed.
Aviation↗
Growth, water relations and solute accumulation in osmotically stressed seedlings of the tropical tree Colophospermum mopane.
Root and hypocotyl elongation, water status and solute accumulation were studied in osmotically stressed seedlings of the tropical tree, Colophospermum mopane (Kirk ex Benth.) Kirk ex J. Léonard, which grows in hot arid areas of southern and central Africa. Seeds were imbibed for 24 h and then subjected to a polyethylene-glycol-generated osmotic stress of -0.03 (control), -0.2, -0.8, -1.6 or -2.0 MPa for 60 h. Seedlings subjected to moderate water stress (-0.2 MPa) had higher root growth rates (2.41 +/- 0.24 mm h(-1)), greater final root lengths (111 +/- 3.8 mm) and longer cells immediately behind the root elongation zone than control seedlings (1.70 +/- 0.15 mm h(-1) and 93 +/- 3.9 mm, respectively). Root lengths of seedlings in the -0.8 and -1.6 MPa treatments were similar to those of control seedlings, whereas the -2.0 MPa seedlings had significantly shorter roots. Both root and hypocotyl tissues exhibited considerable osmotic adjustment to the external water potential treatments. Seedlings in the -0.03, -0.2, and -0.8 MPa treatments had similar cell turgor pressures (0.69 +/- 0.10, 0.68 +/- 0.07 and 0.57 +/- 0.04 MPa, respectively), whereas the -2.0 MPa treatment lowered cell turgor pressure to 0.17 +/- 0.04 MPa. Root vacuolar osmotic pressures were generally similar to sap osmotic pressures, indicating that the increased root elongation observed in moderately water-stressed seedlings was not caused by increased turgor pressure difference. Neutral-fraction solute concentrations, including the osmoticum pinitol, increased approximately two-fold in root sap in response to a low external water potential. In hypocotyl sap of seedlings in the -2.0 MPa treatment, pinitol more than doubled, sucrose increased from about 2 to 75 mol m(-3) but glucose and fructose remained unchanged and, as a result, total sugars increased only slightly. The benefits of rapid early root elongation and osmoticum accumulation under conditions of water stress are discussed in relation to seedling establishment.
Journal Article↗
Control of skin blood flow by whole body and local skin cooling in exercising humans.
We examined the independent roles of whole body skin temperature (Tsk) and tissue temperature (local temperature, Tloc) in the control of skin blood flow (SBF) during cooling and the roles of the vasoconstrictor (VC) and active vasodilator (AVD) systems in mediating these effects. SBF was monitored by laser-Doppler flowmetry (LDF) at untreated sites and sites with local VC blockade by pretreatment with bretylium (BT). Seven subjects underwent four sessions of moderate bicycle exercise (20-30 min duration) at neutral Tsk and Tloc (34 degrees C), neutral Tsk and cool Tloc (27 degrees C), low Tsk (28 degrees C) and neutral Tloc, and low Tsk and Tloc. Cutaneous vascular conductance (CVC; LDF/mean arterial pressure) was expressed relative to the maximum. Cool Tsk increased the threshold level of internal temperature at which CVC began to rise equally at BT-treated and untreated sites (P < 0.05). The rate of increase in CVC relative to internal temperature was reduced by local cooling. BT pretreatment partially reversed this effect (P < 0.05). Thus a cool environment results in reflex inhibition of the onset of AVD activity by cool Tsk and a reduced rate of increase in CVC due, in part, to norepinephrine release stimulated by cool Tloc.
Adult↗
Baroreceptor control of the cutaneous active vasodilator system.
We sought to identify whether reductions in cutaneous active vasodilation during simulated orthostasis could be assigned solely to cardiopulmonary or to carotid baroreflexes by unloading cardiopulmonary baroreceptors with low levels of lower body negative pressure (LBNP) or unloading carotid baroreceptors with external pressure applied over the carotid sinus area [carotid pressure (CP)]. Skin blood flow was measured at a site at which adrenergic function was blocked via bretylium tosylate iontophoresis and at an unblocked site. During LBNP of -5 and -10 mmHg in hyperthermia, neither heart rate (HR) nor cutaneous vascular conductance (CVC) at either site changed (P > 0.05 for both), whereas forearm vascular conductance (FVC) was reduced (-5 mmHg: from 21.6 +/- 4.8 to 19.8 +/- 4.1 FVC units, P = 0.05; -10 mmHg: from 22.3 +/- 4.0 to 19.3 +/- 3.7 FVC units, P = 0.002). LBNP of -30 mmHg in hyperthermia reduced CVC at both sites (untreated: from 51.9 +/- 5.7 to 43.2 +/- 5.1% maximum, P = 0.02; bretylium tosylate: from 60.9 +/- 5.4 to 53.2 +/- 4.4% maximum, P = 0.02), reduced FVC (from 23.2 +/- 3.6 to 18.1 +/- 3.3 FVC units; P = 0.002), and increased HR (from 83 +/- 4 to 101 +/- 3 beats/min; P = 0.003). Pulsatile CP (45 mmHg) did not affect FVC or CVC during normothermia or hyperthermia (P > 0.05). However, HR and mean arterial pressure were elevated during CP in both thermal conditions (both P < 0.05). These results suggest that neither selective low levels of cardiopulmonary baroreceptor unloading nor selective carotid baroreceptor unloading can account for the inhibition of cutaneous active vasodilator activity seen with simulated orthostasis.
Adult↗
Saturation diving as a submarine rescue tool.
The U.S. Navy Submarine Rescue Diving and Recompression System (SRDRS) uses saturation diving to provide human intervention at the hatch of a disabled submarine. The system incorporates the basic elements of traditional saturation diving platforms to provide life support to divers at the worksite as well as in a decompression chamber in between work assignments. The demands of the submarine rescue mission require that the system provide quick response to an emergency virtually anywhere in the world. To answer these demands, SRDRS uses a mixture of state-of-the-art diving technologies and traditional approaches to life support in a quickly mobilized, easily transportable diving system capable of operating in extremely harsh environments.
Air Conditioning↗
Urinary tract infections in elderly women.
Although bacteriuria is common in older women, it is important to differentiate between symptomatic and asymptomatic urinary tract infections. Recent evidence suggests that treatment of asymptomatic bacteriuria may not be necessary. Symptomatic bacteriuria may occur with low colony counts cultured from either clean-catch or catheter-obtained specimens. Although few studies have targeted elderly women, longer treatment with a broad-spectrum antibiotic is recommended for this group. To minimize recurrence, attention should be paid to predisposing factors, particularly impaired bladder emptying, genital prolapse, urolithiasis, estrogen depletion and perineal hygiene.
Aged↗
Use of pulsed-field gel electrophoresis for epidemiological study of Escherichia coli O157:H7 during a food-borne outbreak.
Food and patient isolates from an Escherichia coli O157:H7 outbreak associated with undercooked ground beef were characterized by pulsed-field gel electrophoresis and Shiga-like toxin genotype. Pulsed-field gel electrophoresis confirmed the epidemiologically implicated source of the two-state outbreak and differentiated between outbreak and sporadic strains.
Bacterial Toxins↗
Skin of the dorsal aspect of human hands and fingers possesses an active vasodilator system.
To test for an active vasodilator system in human hand and finger skin, seven subjects had a small area of dorsal hand, palm, or dorsal finger pretreated with bretylium (BT) to block adrenergic vasoconstriction. Skin blood flow was monitored at a BT-treated site, a comparable untreated site, and the forearm by laser-Doppler flowmetry. Cutaneous vascular conductance (CVC) was evaluated from the ratio of blood flow to arterial pressure. Body cooling, to evaluate vasoconstrictor system blockade, caused CVC at untreated sites of forearm, palm, dorsal hand, and dorsal finger to fall by 45 +/- 4, 85 +/- 5, 51 +/- 9, and 63 +/- 7%, respectively (all P < 0.05). At BT-treated sites of palm, dorsal hand, and dorsal finger, reductions in CVC were only 13 +/- 3, 2 +/- 18, and 13 +/- 4%, respectively (dorsal hand not significant, others P < 0.05). With body heating, increases in CVC at untreated sites of forearm, palm, dorsal hand, and dorsal finger were 881 +/- 165, 779 +/- 368, 423 +/- 115, and 1,430 +/- 716%, respectively (all P < 0.05). At BT-treated sites of palm, dorsal hand, and dorsal finger, increases were 35 +/- 15, 342 +/- 107, and 343 +/- 34%, respectively (palm not significant, others P < 0.05). Increased CVC at the palm began after 1.2 +/- 0.2 min of heating, significantly earlier than forearm (11.8 +/- 2.5 min), dorsal hand (16.4 +/- 3.4 min), or dorsal finger (15.6 +/- 3.6 min), which did not differ significantly from one another.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Cutaneous vascular and sudomotor responses to isometric exercise in humans.
To identify whether isometric handgrip exercise (IHG) affects cutaneous vasoconstrictor and/or active vasodilator activities, seven subjects (6 men and 1 woman) performed 30% maximal voluntary contraction of a forearm under normothermic (1 bout) and hyperthermic (2 bouts) conditions. Skin blood flow was indexed by laser-Doppler flowmetry at a contralateral forearm site at which adrenergic vasoconstrictor function was blocked by iontophoresis of bretylium tosylate (BT) and therefore only has active vasodilation as a mechanism for reflex control. Skin blood flow was also monitored at an adjacent untreated site. Cutaneous vascular conductance (CVC) was calculated from the flow signal and noninvasive blood pressure. CVC was normalized to the value obtained from maximal vasodilation at that site. Sweat rate (SR) was measured at the same locations. During normothermia, IHG did not affect CVC at the control or BT-treated sites, nor did IHG affect SR (P > 0.05). The second bout of IHG in hyperthermia evoked significant reductions in CVC at the untreated (69.4 +/- 3.4 to 58.9 +/- 2.5% of maximum, P < 0.05) and BT-treated sites (75.4 +/- 6.1 to 64.4 +/- 6.2% of maximum, P < 0.05), whereas SR significantly increased (0.62 +/- 0.16 to 0.70 +/- 0.17 mg.cm-2.min-1, P < 0.05). These findings uniquely show that, in hyperthermia, IHG reduces active vasodilator activity while at the same time sudomotor activity is increasing. This suggests independent control of these effectors.
Adult↗
Cutaneous active vasodilation in humans is mediated by cholinergic nerve cotransmission.
During heat stress, increases in blood flow in nonglabrous skin in humans are mediated through active vasodilation by an unknown neurotransmitter mechanism. To investigate this mechanism, a three-part study was performed to determine the following: (1) Is muscarinic receptor activation necessary for active cutaneous vasodilation? We iontophoretically applied atropine to a small area of forearm skin. At that site and an untreated control site, we measured the vasomotor (laser-Doppler blood flow [LDF]) and sudomotor (relative humidity) responses to whole-body heat stress. Blood pressure was monitored. Cutaneous vascular conductance (CVC) was calculated (LDF divided by mean arterial pressure). Sweating was blocked at treated sites only. CVC rose at both sites (P < .05 at each site); thus, cutaneous active vasodilation is not effected through muscarinic receptors. (2) Are nonmuscarinic cholinergic receptors present on cutaneous arterioles? Acetylcholine (ACh) was iontophoretically applied to forearm skin at sites pretreated by atropine iontophoresis and at untreated sites. ACh increased CVC at untreated sites (P < .05) but not at atropinized sites. Thus, the only functional cholinergic receptors on cutaneous vessels are muscarinic. (3) Does cutaneous active vasodilation involve cholinergic nerve cotransmission? Botulinum toxin was injected intradermally in the forearm to block release of ACh and any coreleased neurotransmitters. Heat stress was performed as in part 1 of the study. At treated sites, CVC and relative humidity remained at baseline levels during heat stress (P > .05). Active vasodilator and sudomotor responses to heat stress were abolished by botulinum toxin. We conclude that cholinergic nerve activation mediates cutaneous active vasodilation through release of an unknown cotransmitter, not through ACh.
Acetylcholine↗
Determinant-regulated onset of experimental autoimmune encephalomyelitis: distinct epitopes of myelin proteolipid protein mediate either acute or delayed disease in SJL/J mice.
In the present study we address the question of whether distinct self-determinants can target alternative autoimmune disease patterns in experimental autoimmune encephalomyelitis (EAE), an animal model widely used for studying multiple sclerosis. We have found that the clinical course of EAE can be determined by the target peptide selected for induction of disease. In SJL/J mice, actively induced and passively transferred EAE mediated by the immunodominant PLP determinants p139-151 and p178-191 consistently produced a rapid onset of severe clinical signs. In contrast, a delayed onset of both active and passive EAE is associated with the nondominant cryptic PLP determinant p104-117. The delayed disease induced with p104-117 is not associated with any unusual peptide feature, with bystander immunoregulation, with inept class II MHC binding, or with failure to induce T cell expression of CD44, VLA-4, or IL-2 receptor upon activation. However, delayed disease is associated with innate qualities of the T cell repertoire responding to the p104-117 determinant. T cell lines responding to the cryptic p104-117 show limited TCR-V beta utilization compared to the diverse repertoire responding to the dominant p139-151 determinant. The repertoire deletions are accompanied by low level production of pathogenic Th1 cytokines (IFN gamma; IL-2) and increased production of regulatory Th2 (IL-4) cytokine in activated p104-117 primed T cells. Thus, the delayed encephalitogenicity of p104-117 may be due to TCR-V beta deletions and activation defects in the responding T cell repertoire. The development of "slow disease" mediated by autoreactivity against hidden self-determinants may have important implications in the pathogenesis of both relapsing and chronic autoimmune demyelinating disease.
Acute Disease↗
Dosimetric effects of abutting extended source to surface distance electron fields with photon fields in the treatment of head and neck cancers.
PURPOSE: In the management of head and neck cancer, it is often necessary to junction photon and electron fields. When patients are treated supine, electron cones or applicators may have to be positioned at source to surface distance (SSD) greater than the standard 100 cm because of the patient's shoulders. We have studied the dosimetric effects of abutting 6 MV photon fields with 9 MeV electron fields at extended SSDs to assess changes in the 90% isodose width, dose uniformity in the target, and the extent of hot and cold spots in the junction region. METHODS AND MATERIALS: Four independent film studies were conducted, in a polystyrene phantom, for evaluation of the dose distribution in the junction region. Measured distributions were also compared with computer generated distributions using a treatment planning computer system. RESULTS: At the junction line between photon and extended SSD electron beams, hot and cold spots were observed. A 20% hot spot occurred on the photon side because of the electron scatter from the adjoining field. The width of this hot spot increased in dimension but not in magnitude as electron SSDs were increased. The cold spot occurred on the electron side due to the decrease in 90% isodose width at extended electron SSDs. This cold spot was minimal (less than 10%) at shorter electron SSDs, but increased as electron SSDs approached 120 cm. Computer dosimetry underestimated these results because of limitations of the electron beam treatment planning algorithm. CONCLUSION: These hot and cold spots may be clinically acceptable compared to the loss of treatment accuracy and the added possibility of more extensive hot or cold spots if the patient were to be removed from the original supine position and repositioned on his/her side.
Electrons↗
Feto-maternal plasma phenylalanine concentration gradient from 19 weeks gestation to term.
Plasma phenylalanine concentrations in fetal blood, obtained by cordocentesis, were compared with simultaneous peripheral venous plasma phenylalanine levels in mothers. The feto-maternal phenylalanine concentration ratio showed a gradual decrease from 19 weeks of gestation to term with an overall ratio of 1.35 +/- 0.42 (mean +/- S.D., n = 14).
Chromatography, Ion Exchange↗
Reflex control of active cutaneous vasodilation by skin temperature in humans.
The purpose of this study was to examine whether reflex effects of changes in whole body skin temperature (Tsk) on cutaneous vasculature are mediated through the vasoconstrictor or the active vasodilator arm of the sympathetic nervous system. In six subjects, reflex responses in forearm skin blood flow (SkBF) to changes in Tsk were monitored by laser-Doppler flowmetry. SkBF was monitored at a control site and at a 0.6-cm2 site where bretylium (BT) had been iontophoretically applied to abolish sympathetic vasoconstrictor control. Reflex control of SkBF at BT-treated sites is solely through active vasodilator activity. An index of cutaneous vascular conductance (CVC) was calculated from the blood flow signal and mean arterial pressure, measured noninvasively. Data are expressed relative to maximum CVC (CVCmax) achieved by local warming of measurement sites to 42 degrees C at the end of each study. Tsk was controlled with a water-perfused suit covering the entire body except for the head and arms. Esophageal temperature (Tes) was measured as an index of internal temperature. In part A (rest), raising Tsk at rest from 31.9 +/- 0.3 to 36.7 +/- 0.2 degrees C increased CVC at control sites from 3 +/- 0.2 to 5 +/- 0.6% of CVCmax. CVC did not change at BT-treated sites, suggesting that at rest, with a normal internal temperature, reflex effects of raising Tsk on SkBF are mediated through vasoconstrictor withdrawal. In part B (exercise), exercise at a low Tsk increased Tes to 37.49 +/- 0.1 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Altered thermoregulatory responses after 15 days of head-down tilt.
To determine whether extended exposure to a simulation of microgravity alters thermoregulatory reflex control of skin blood flow, six adult males (mean age 40 +/- 2 yr) were exposed to 15 days of 6 degrees head-down tilt (HDT). On an ambulatory control day before HDT exposure and on HDT day 15, the core temperature of each subject was increased by 0.5-1.0 degree C by whole body heating with a water-perfused suit. Mean skin temperature, oral temperature (Tor), mean arterial pressure, and forearm blood flow were measured throughout the protocol. Forearm vascular conductance (FVC) was calculated from the ratio of forearm blood flow to mean arterial pressure. After HDT exposure, the Tor threshold at which reflex thermally induced increases in FVC began was elevated (36.87 +/- 0.06 to 37.00 +/- 0.09 degrees C; P = 0.043), whereas the slope of the Tor-FVC relationship after this threshold was reduced (13.7 +/- 2.3 to 9.5 +/- 1.1 FVC units/degrees C; P = 0.038). Moreover, normothermic FVC and FVC at the highest common Tor between pre- and post-HDT trials were reduced after HDT (normothermic: 4.2 +/- 0.5 to 3.0 +/- 0.4 ml.100 ml-1.min-1.100 mmHg-1, P = 0.04; hyperthermic: 12.4 +/- 1.0 to 7.8 +/- 0.7 ml.100 ml-1.min-1.100 mmHg-1, P < 0.001). These data suggest that HDT exposure reduces thermoregulatory responses to heat stress. The mechanisms resulting in such an impaired thermoregulatory response are unknown but are likely related to the relative dehydration that accompanies this exposure.
Adult↗
When academic assistance is not enough: addressing the mental health issues of adolescents and adults with learning disabilities.
This article focuses on an answer to a critical question for adolescents and adults with learning disabilities: How can professionals assist students with learning disabilities who have psychosocial issues that appear to be affecting their academic progress and life adjustment? Inherent in this inquiry are other, equally important issues, such as: How do learning disabilities service providers know when to involve other service providers? What are the steps in referring a student for further assistance with different mental health issues? When are team interventions necessary? How are team interventions conducted in either secondary or postsecondary settings? How should learning disabilities service providers establish the boundaries of their professional expertise and/or responsibilities to adequately meet the needs of individuals with learning disabilities? This article illustrates answers to these questions by providing examples of interventions and case studies from two federally funded research/demonstration projects at the University of Minnesota: the Learning Disabilities Transition Project and Project Extra. The authors describe theoretical models for mental health services that address the psychosocial issues frequently encountered in academic or vocational settings. Recommendations are also included that discuss how the models can be personalized to fit the reader's home institution or agency.
Adolescent↗