Fall protection. Networking with fall prevention experts.
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Accidental Falls↗
Biomedical subjects
J Patterson
Publications and source records attributed to J Patterson.
Power plant best practices.
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Accidents, Occupational↗
Hormonal and other factors in relation to survival among breast cancer patients.
We have examined the relationship between all-cause mortality and various hormonal and other factors in over 1,200 women with breast cancer recruited into 2 consecutive case-control studies between 1969 and 1984. The age at diagnosis ranged from 24 to 59 years, and the majority (74%) were pre-menopausal at diagnosis. Analyses were based on follow-up to 1 January 1994, by which time 608 (50%) of the women had died. Of the factors examined, weight was most strongly associated with survival, with a significant increase in the risk of death with increasing weight. Two hormonal factors, time since last birth and time since last oral contraceptive use, were also independently associated with survival. All of these associations remained after adjustment for stage and histological nodal status. Our findings provide new evidence to suggest that reproductive factors and exogenous hormones in the form of oral contraceptives may influence survival in women with breast cancer, even after differences in stage and nodal status have been taken into account.
Adult↗
Correlation of Parkinson's disease severity and duration with 123I-FP-CIT SPECT striatal uptake.
The variability in clinical features and the masking effects of drug therapy in Parkinson's disease (PD) can affect clinical assessment of disease severity. The aim of this study was to assess the imaging of dopamine transporters using 123I-FP-CIT SPECT and its correlation with disease staging, severity, and duration. Differences between the clinical severity of the onset and non-onset side and the corresponding striatal uptake ratios were also examined. Forty-one patients with PD (nine unilateral, 32 bilateral clinical features) were studied. Clinical severity was determined by using the Unified Parkinson's Disease Rating Score (UPDRS). Unilateral UPDRS was calculated from unilateral arm and leg resting and action tremor, rigidity, finger taps, hand movements, alternating movements, and leg agility. 123I-FP-CIT striatal uptake was expressed as the ratio of specific:nonspecific (SP:NS) uptake for defined brain areas. Patients with PD who had unilateral symptoms showed a significant difference between the ipsilateral and contralateral SP:NS ratios in both the caudate and putamen, but there was a considerable overlap between between the two sides. This result was repeated in patients with bilateral symptoms and there was overlap of SP:NS ratios between the two groups. For the whole group of patients with PD, striatum, caudate, and putamen SP:NS ratios correlated with disease severity assessed by UPDRS and duration of disease. The SP:NS ratios correlated with the bradykinesia subscore but not with rigidity or tremor subscore. In conclusion, this study provides further evidence that the SP:NS ratio is a robust measure of disease severity correlating with duration of PD. However, variability in uptake values suggest that factors other than nigrostriatal degeneration may contribute to disease severity. Correlation with bradykinesia but not with tremor may indicate an origin for tremor outwith the dopamine transporter system. 123I-FP-CIT SPECT offers significant potential in defining the nigrostriatal changes in PD.
Aged↗
Cutaneous epithelioid malignant nerve sheath tumor with rhabdoid features: a histologic, immunohistochemical, and ultrastructural study of three cases.
INTRODUCTION: Malignant rhabdoid tumors are morphologically defined as sheets of loosely cohesive cells with eccentric nuclei and hyaline, paranuclear inclusions. Although originally described as a distinctive renal neoplasm of childhood, these tumors have since been described in all age groups and in a variety of extrarenal sites. In the latter setting, it is thought that the rhabdoid phenotype is comprised of histogenetically unrelated tumors, that regardless of histogenesis, pursue a biologically aggressive behavior. METHODS: We report on the clinical, histologic, immunophenotypic, and ultrastructural characteristics of three cases of cutaneous malignant rhabdoid tumor. RESULTS: Each of the cases arose on the trunk or the extremity of elderly men. None of the patients had neurofibromatosis. All of the lesions histologically showed sheets of loosely cohesive polygonal cells with eccentric nuclei and hyaline paranuclear inclusions. Each of the cases showed the following immunophenotype: S-100 (+), synaptophysin(+), vimentin (+), alpha smooth muscle actin (-), CD-30 (-), HMB-45 (-), and pankeratin(-). Ultrastructure of two of the cases yielded similar results showing paranuclear filamentous aggregates of intermediate filaments, cell membrane dense plaques, and rudimentary cell junctions consistent with nerve sheath differentiation. Tonofilaments, dense bodies, microtubules, neurosecretory granules, and melanosomes were not identified. Each of the patients died of widely metastatic disease within 1 year of diagnosis. CONCLUSIONS: Cutaneous epithelioid malignant nerve sheath tumor is a potentially aggressive tumor capable of showing rhabdoid differentiation thus simulating a variety of neoplasms. Immunophenotyping and ultrastructural analysis reliably discriminates these lesions from melanoma, de-differentiated carcinoma, lymphoma, and rhabdomyosarcoma.
Abdomen↗
Long-term symptomatic follow-up after lind fundoplication
AIMS: Few published studies have detailed the long-term results of antireflux surgery. The aim of this study was to assess the long-term success of open Lind fundoplication in controlling the symptoms of gastro-oesophageal reflux disease. METHODS: One hundred and thirty-two patients with reflux symptoms underwent a primary Lind fundoplication between April 1986 and February 1994; all operations were supervised or performed by one surgeon. The median age at operation was 47 (range 17-77) years. All patients attended for follow-up in the early postoperative period. It was possible to conduct a telephone interview to assess long-term symptom control, at a median time of 9.5 (range 5-13) years following operation, in 112 of the 124 patients who were still alive. RESULTS: Ninety-one patients underwent oesophageal pH studies before and soon after operation. The oesophageal pH was less than 4 for a mean 14.9 per cent of the time before operation, falling to 2.4 per cent in the early postoperative period (P < 0.001, Wilcoxon test). At early postoperative assessment, two patients complained of mild reflux symptoms and 44 (33 per cent) complained of postfundoplication symptoms (dysphagia, epigastric bloating and early satiety). At telephone interview, 106 patients (95 per cent) were symptom free with regard to heartburn and regurgitation. Six patients have developed recurrent reflux symptoms, in four of whom symptoms are controlled by a proton pump inhibitor. Two patients have required further antireflux surgery, one within 2 months of the first procedure for severe dysphagia and the other for recurrent reflux. Significant postfundoplication symptoms persist (dysphagia with or without gas bloat) in three patients (3 per cent). CONCLUSIONS: Open Lind fundoplication appears to be effective in the long-term control of gastro-oesophageal reflux in 95 per cent of patients and represents a standard against which the long-term results of laparoscopic surgery will need to be compared.
Journal Article↗
The health of students in institutes of higher education: an important and neglected public health problem?
BACKGROUND: A survey of students in three UK higher education establishments was undertaken to obtain information about students' physical and emotional well-being, their attitudes to, and beliefs about health, and the prevalence of risk factors for future ill health. METHODS: Health was measured by the prevalence of longstanding illness and by the SF-36 health status measurement tool. Survey results were compared with equivalent data for 18- to 34-year-olds in the local population. The prevalence of long-standing illness was also compared with two national surveys. RESULTS: The survey achieved a 49 per cent response rate. More than one-third of respondents reported a long-standing illness, a higher prevalence than in all comparison surveys. Students scored significantly worse than their peers in the local population on all eight SF-36 dimensions. The greatest difference was for role limitations as a result of emotional problems. The main sources of emotional distress were study or work problems and money. CONCLUSION: The poor response rate in this survey dictates the need for caution in interpretation of the results. However, they suggest that the health of students is poor relative to that of their peers, and that their emotional health is more of a problem than their physical health. Public health practitioners might want to pay more attention to the health of this important and relatively neglected group. Worries about studies and money appear to be affecting students' academic work, and this should be of concern to higher education establishments.
Adolescent↗
Spiritual issues in family therapy: a graduate-level course.
With the advent of the biopsychosocial approach in family therapy, the domain of spiritual issues is increasingly being recognized as important to families. This article will describe a graduate-level seminar on Spiritual Issues in Family Therapy at the University of San Diego that offers family therapy students the opportunity to examine issues of spirituality, religion, and meaning and their place in therapy. One premise of the course is that research has demonstrated that most clients consider their spiritual life to be relevant to personal problems and would prefer a therapist who is comfortable with such topics. The goals of the course include (1) training in opening a dialogue with individuals and families about spiritual issues and discerning when referral may be appropriate; (2) expanding an awareness of wisdom traditions through use of comparative religions material; and (3) identifying from current practice many of the spiritual issues that may arise in the clinical setting.
Curriculum↗
The use of statistical parametric mapping (SPM96) as a decision aid in the differential diagnosis of dementia using 99mTc-HMPAO SPECT.
In this study standard patterns of cerebral perfusion based on classifications described in the literature have been chosen and the ability of experienced imaging specialists to categorise the 99m Tc HMPAO SPECT scans of patients referred to the department for investigation of dementia has been compared before and after the calculation of Statistical Parametric Maps (SPM - Wellcome Dept of Cognitive Neurology). The primary aim was to investigate whether SPM is an effective decision aid and whether it impacts on the confidence of image reporting. The secondary aim was to examine the influence of SPM on the agreement between image reporting and clinical diagnosis. The results showed that there was a slight decrease in agreement between the imaging specialists after the introduction of additional information from SPM (K=0.57 to K=0.5) and that agreement between imaging reporting (including information from SPM) and clinical diagnosis was moderate (K=0.28). This study was able to confirm that SPM is capable of producing meaningful significance maps of individual patients in a routine clinical environment. However, there was no overwhelming evidence that SPM was able to resolve many of the dilemmas associated with the use of SPECT for the differential diagnosis of dementia. In particular, interpretation of SPECT perfusion patterns in dementia is a bigger problem than the initial identification of abnormalities.
Journal Article↗
Surgical pearl: use of the cutaneous punch for the removal of lipomas.
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Angiolipoma↗
Preliminary results from the Canadian Veterinary Urolith Centre.
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Animals↗
Accurate differentiation of parkinsonism and essential tremor using visual assessment of [123I]-FP-CIT SPECT imaging: the [123I]-FP-CIT study group.
OBJECTIVE: To evaluate whether visual assessment of [123I]-FP-CIT (DaTSCAN, Nycomed Amersham, plc) single photon emission computerized tomography (SPECT) images can differentiate between parkinsonism and essential tremor (ET). METHODS: [123I]-FP-CIT SPECT imaging was conducted in a six-center study of 158 patients with a clinical diagnosis of parkinsonism compared with 27 ET cases and 35 healthy volunteers. Striatal uptake of the radioligand was graded normal or abnormal, and abnormal images were further graded to three levels of severity. An institutional read whereby each center visually assessed the images blinded to the clinical data and a consensus blinded read by a panel of five was undertaken. RESULTS: The institutional reading scored 154 of 158 cases of parkinsonism abnormal, all 27 cases of ET as normal, and 34 of 35 healthy volunteers as normal compared with the consensus blinded read scoring 150 cases of parkinsonism as abnormal, 25 ET cases as normal, and 33 healthy volunteers as normal. Sensitivity for the clinical diagnosis of parkinsonism was 97% and specificity for ET was 100% for the institutional read, whereas sensitivity was 95% and specificity 93% for the consensus blinded read. Semiquantitative analysis of specific: nonspecific caudate and putamen uptake were consistent with the results of visual inspection. CONCLUSION: Visual assessment of [123I]-FP-CIT SPECT images is an easily applied diagnostic test which is helpful in the differential diagnosis of tremor disorders and in confirming a clinical diagnosis of a hypokinetic-rigid syndrome.
Adult↗
De novo amyloid proteins from designed combinatorial libraries.
Amyloid deposits are associated with several neurodegenerative diseases, including Alzheimer's disease and the prion diseases. The amyloid fibrils isolated from these different diseases share similar structural features. However, the protein sequences that assemble into these fibrils differ substantially from one disease to another. To probe the relationship between amino acid sequence and the propensity to form amyloid, we studied a combinatorial library of sequences designed de novo. All sequences in the library were designed to share an identical pattern of alternating polar and nonpolar residues, but the precise identities of these side chains were not constrained and were varied combinatorially. The resulting proteins self-assemble into large oligomers visible by electron microscopy as amyloid-like fibrils. Like natural amyloid, the de novo fibrils are composed of beta-sheet secondary structure and bind the diagnostic dye, Congo red. Thus, binary patterning of polar and nonpolar residues arranged in alternating periodicity can direct protein sequences to form fibrils resembling amyloid. The model amyloid fibrils assemble and disassemble reversibly, providing a tractable system for both basic studies into the mechanisms of fibril assembly and the development of molecular therapies that interfere with this assembly.
Amino Acid Sequence↗
Measles virus infection in a transgenic model: virus-induced immunosuppression and central nervous system disease.
Measles virus (MV) infects 40 million persons and kills one million per year primarily by suppressing the immune system and afflicting the central nervous system (CNS). The lack of a suitable small animal model has impeded progress of understanding how MV causes disease and the development of novel therapies and improved vaccines. We tested a transgenic mouse line in which expression of the MV receptor CD46 closely mimicked the location and amount of CD46 found in humans. Virus replicated in and was recovered from these animals' immune systems and was associated with suppression of humoral and cellular immune responses. Infectious virus was recovered from the CNS, replicated primarily in neurons, and spread to distal sites presumably by fast axonal transport. Thus, a small animal model is available for analysis of MV pathogenesis.
Animals↗
Recruiting comparative crosslinguistic evidence to address competing accounts of agrammatic aphasia.
Several hypotheses have been advanced whose aim has been to provide a descriptive generalization of comprehension patterns in agrammatic aphasia in terms of current linguistic theory, most notably, the Trace-Deletion Hypothesis. The basic insight of these syntactic accounts of aphasia is that chains are disrupted. In this paper, we seek to confront the Trace-Deletion Hypothesis (TDH) and one of its variants, the Double-Dependency Hypothesis (DDH), with discriminating, crosslinguistic data. We adduce evidence that on raising constructions both hypotheses are able to derive Spanish agrammatic data correctly. However, neither the TDH nor the DDH are able to account for above-chance performance on SV or VS truncated passives. Finally, only the DDH explains the observed data on passive constructions in which a postverbal subject follows the by phrase (V-by phrase-S). The VS word order data are the critical cases because focusing simply on English would not allow these structures to be tested and, in the case of the V-by phrase-S passive, both hypotheses make different predictions. While the data on raising constructions extend the range of both the TDH and the DDH, the VS data suggest that modifications are required.
Aphasia, Broca↗
Impact of emergency medicine resident training in ultrasonography on ultrasound utilization.
Training programs in bedside ultrasound for emergency physicians often encounter considerable resistance, partly because of concern that the number of radiology-interpreted studies ordered from the ED may decrease. This study attempted to determine the effect of instituting an ED training program in ultrasound on the ordering of formal studies from a department of radiology. This retrospective, computer-assisted review compared all abdominal sonograms ordered from the ED of a busy community hospital in the 3 years before introduction of an ultrasound training program (1992 through 1994) with those ordered in the 2 years after the program's inception (1995, 1996). The number of formal studies significantly increased after institution of the training program, both in terms of absolute numbers (annual mean 181 v 95, P < .001) and as a percentage of all outpatient sonograms ordered at the institution (9.8% v 5.1%, P < .001). Introduction of a teaching program in emergency ultrasound appears to increase utilization of formal ultrasound services, at least during the training period.
Abdomen↗
Niacin reaction: common vitamin, uncommon ED diagnosis.
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Adult↗
Mastery of fundamental motor skills among New South Wales school students: prevalence and sociodemographic distribution.
Mastery of fundamental motor skills among children and adolescents is a potentially important contribution to satisfying participation in sports, games and other physical activities and may enhance the development of an active lifestyle. However, few attempts have been made to determine the prevalence of fundamental motor skill mastery among young Australians. The NSW Schools Fitness and Physical Activity Survey, 1997 (N = 5518) randomly selected schools proportionally from all three education sectors and selected students in Years 4, 6, 8 and 10. Performance on six fundamental motor skills (run, vertical jump, catch, overhand throw, forehand strike and kick) was assessed qualitatively. The prevalence of mastery and near mastery of each skill and mastery of each skill component is reported for boys and girls in each school year. The findings indicate that the prevalence of mastery and near mastery of each of the fundamental motor skills was generally low. There were no differences between students from urban or rural schools and the prevalence of skill mastery was directly associated with socioeconomic status more consistently among girls than among boys. Greater curriculum time and resourcing and training of teachers is required to increase the proportion of students who have mastered the skills fundamental to common sports, games and other physical activities.
Female↗