Therapeutic treatment for physically abused children.
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Child↗
Biomedical subjects
J Roberts
Publications and source records attributed to J Roberts.
Current developments in midwifery in the USA.
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Certification↗
The Patient Care Travelling Record in palliative care: effectiveness and efficiency.
The Patient Care Travelling Record (PCTR) is a passport-like health-care summary that, in previous research by the authors, has been found to be a feasible and acceptable tool to convey important clinical information about the palliative care patient. This randomized controlled trial was conducted to determine the effectiveness and efficiency of this Record in improving patient mood, decreasing uncertainty, improving satisfaction with health care, reducing use of health-care services, and maximizing pain control. Eligible patients were randomized to receive or not receive the PCTR (completed by nurse or physician and reviewed jointly with the patient). As baseline entry into the study and then at 1 and 2 months, patients completed measures on level of certainty, mood states, satisfaction with care, levels of pain, and health-care services utilization. During the 2-year study period, only 20% (N = 61) of the patients enrolled in a palliative care program in Southern Ontario were eligible for the trial. Of these patients, 18 died, 15 declined to participate, and 7 were emotionally unable to complete the questionnaires. Thus 21 patients completed the trial. With the exception of those age 65 years and over, the patients using the Record reported decreased levels of uncertainty on follow-up. There was no additional use of health-care services, no differences in mood states, pain relief, or satisfaction with health care. It is significant that 80% of palliative patients were not eligible because their physical and psychological status rendered them insufficiently stable to participate in a research study. Because of their vulnerable status, these patients may be ideal for the utilization of the Record in clinical care. Although research in this palliative care population is challenging due to difficulties with recruitment and high dropout rates due to death, the PCTR, which was previously shown to be acceptable and feasible, has now been shown to be effective in reducing patient uncertainty, specifically for adults under 65 years. Indications for future research are described.
Female↗
The effects of technology on triage in A & E.
Within the specialty of Accident and Emergency (A & E) nursing, triage is a term meaning to classify or sort patients according to their need for care (Blythin 1988). Burgess (1992) views this process as a means of prioritizing patients in order, so that the more seriously ill or injured are seen first (Table 1). Triage performance is measured in the author's department by computer. This technological source is used to record the patient's arrival time and the time at which the patient is triaged. Technology is defined by the Oxford Dictionary (1996) as 'the study of mechanical arts and science, their application in industry'. This paper explores the impact of this technology and the related issues on the A & E triage nurse, and will focus on issues related to the Patients' Charter (1991), resource implications, safety and staff training. In conclusion, the quality of a patient's total care, in which the author participated, is discussed with reference to the related issues and implications for future practice.
Aged↗
Self-awareness in counselling.
Accident and Emergency (A & E) is a high-powered and diverse specialism (Casteldine 1993). Patients attend A & E for varied and complex reasons (Crouch & Dale 1994). The focus of this paper is to analyse the concept of self-awareness, how nurses learn to become self-aware and how self-awareness facilitates effective treatment interventions with specific reference to the role of the A & E nurse. The concept of the nurse's self and self-awareness is considered. A few aspects of verbal and non-verbal communication are used as examples to explore how effective helping can be achieved in the assessment of clients' needs in A & E through understanding the impact of the nurse's self in counselling in the A & E environment.
Awareness↗
Ocular status of boys with fragile X syndrome: a prospective study.
PURPOSE: The purpose of this study was to determine whether the high rates of ocular problems described in previous retrospective reports of individuals with fragile X syndrome were present in a prospective sample of young boys. Fragile X syndrome is currently considered the leading hereditary cause of mental retardation, with prevalence estimates of 1:2500 to 1:5000 males. METHODS: Forty-eight boys with fragile X syndrome between the ages of 2.5 and 11 years were evaluated for ocular abnormalities. They received complete ophthalmic evaluations including assessment of visual acuity, cycloplegic refraction, ocular motility assessment, and dilated fundus examination. RESULTS: Approximately 25% of the children had clinically significant ocular findings that included refractive errors (17%, primarily hyperopia and astigmatism) and strabismus (8%). Of the 42 children with quantifiable visual acuities, only 1 child, with diagnoses of nystagmus and hyperopia, had a Snellen visual acuity that was not within normal limits for his age. Three of the 5 children with gross measures of visual acuity had clinically significant findings: 2 had hyperopia greater than 3.5 diopters and 1 had esotropia. The other 2 children with gross measures of acuity and the 1 child without visual acuity assessment had cycloplegic refractions of +1.25 to +1.5 and ocular motility appeared normal. CONCLUSIONS: These results suggest that previous reports of high rates of vision problems, particularly strabismus, in boys with fragile X syndrome may have resulted from selection bias. Although we did observe a higher prevalence of strabismus than that found in the general population (8% vs 0.5% to 1%), the proportion of children having strabismus in our sample was much smaller than that reported in other studies of children with fragile X syndrome (30% to 40%). However, 17% of the sample did have significant refractive errors. In addition to evaluating the ocular motility of children with fragile X syndrome, cycloplegic refraction should also be performed to determine whether refractive problems are present.
Child↗
Phonological skills of children with specific expressive language impairment (SLI-E): outcome at age 3.
Naturalistic speech samples of 29 3-year-olds diagnosed with specific expressive language delay (SU-E) were compared to those produced by 19 age-matched normally developing peers in order to determine their improvement in phonological skills since age 2, when Rescorla and Ratner (1996) studied them. Specifically, the groups were compared with regard to vocalization rate, verbalizations, fully intelligible utterances, phonetic inventories, percentages of consonants correct (PCC), phonological processes, and mean length of utterance (MLU). Results revealed that there was no significant difference between the groups in their numbers of vocalizations (as there had been at age 2), although there continued to be differences in their phonetic inventories, PCC scores, and overall intelligibility. These findings suggest that at age 2 the children with SU-E were not only less phonologically skilled but less talkative, whereas by age 3 they were equally vocal. Analysis of the phonetic inventories of the children demonstrated that for most consonants, the SLI-E group followed the some pattern of development as the comparison children, but more of the normally developing group had productive control of each consonant, consistent with findings of Rescorla and Ratner. There continued to be differences in intelligibility as measured by rates of verbalization (those utterances with at least one intelligible word) and fully intelligible utterances. Using these measures, we found that approximately half the SU-E children had caught up with their normally developing peers in terms of articulation, whereas half of them continued to be significantly delayed. Finally, although some of the late-bloomer group had caught up to the comparison children in language skills, as measured by MLU, many had not, suggesting that there was a tendency for the children to catch up in some articulation skills before catching up in language abilities.
Child, Preschool↗
Recovery of Cryptosporidium oocysts from small and large volume water samples using a compressed foam filter system.
A novel filter system comprising open cell reticulated foam rings compressed between retaining plates and fitted into a filtration housing was evaluated for the recovery of oocysts of Cryptosporidium from water. Mean recoveries of 90.2% from seeded small and large volume (100-2000 l) tap water samples, and 88.8% from 10-20 l river water samples, were achieved. Following a simple potassium citrate flotation concentrate clean-up procedure, mean recoveries were 56.7% for the tap water samples and 60.9% for river water samples. This represents a marked improvement in capture and recovery of Cryptosporidium oocysts from water compared with conventional polypropylene wound cartridge filters and membrane filters.
Animals↗
HMG CoA lyase deficiency: identification of five causal point mutations in codons 41 and 42, including a frequent Saudi Arabian mutation, R41Q.
The hereditary deficiency of 3-hydroxy-3-methylglutaryl (HMG) CoA lyase (HL; OMIM 246450 [http://www3.ncbi.nlm.nih. gov:80/htbin-post/Omim/dispmim?246450]) results in episodes of hypoketotic hypoglycemia and coma and is reported to be frequent and clinically severe in Saudi Arabia. We found genetic diversity among nine Saudi HL-deficient probands: six were homozygous for the missense mutation R41Q, and two were homozygous for the frameshift mutation F305fs(-2). In 32 non-Saudi HL-deficient probands, we found three R41Q alleles and also discovered four other deleterious point mutations in codons 41 and 42: R41X, D42E, D42G, and D42H. In purified mutant recombinant HL, all four missense mutations in codons 41 and 42 cause a marked decrease in HL activity. We developed a screening procedure for HL missense mutations that yields residual activity at levels comparable to those obtained using purified HL peptides. Codons 41 and 42 are important for normal HL catalysis and account for a disproportionate 21 (26%) of 82 of mutant alleles in our group of HL-deficient probands.
Base Sequence↗
Does cell type influence post-esophagectomy survival in patients with esophageal cancer?
The change in the prevalence of esophageal cancer by cell type from predominantly squamous cell carcinoma to adenocarcinoma has been well documented in the USA, UK, and Western Europe. The objective of this study was to determine if this shift in cell type resulted in a change in survival in patients treated by esophagectomy without neoadjuvant therapy. Our study group included 106 consecutive esophageal cancer patients who underwent esophagectomy without neoadjuvant therapy. Cell type was adenocarcinoma in 76, and squamous cell in 30 patients. For stage 1 tumors there was a trend towards survival advantage for patients with adenocarcinoma, but this did not reach significance. For stage 2-4 tumors and overall, there was no statistical difference in survival as a function of cell type. Therefore, the observed shift in cell type to a higher prevalence of adenocarcinoma does not alter expected post-surgical outcome.
Adenocarcinoma↗
Effect of age, gender, rat strain, and dietary restriction, on norepinephrine release from cardiac synaptosomes.
The purpose of the present study was to determine if dietary restriction affected NE release from cardiac synaptosomes obtained from old male F344 rats. Female F344 rats and male and female B/N rats were also examined to determine if age-related changes in norepinephrine (NE) release capacity in the heart are strain- and/or gender-specific. F344 and Brown-Norway (B/N) rats were examined at 6, 12, and 24 months; B/N rats were also examined at 28-30 months. K(+)-induced NE release significantly declined with age in male F344 and B/N rats; this decline was attenuated in female rats and in dietary restricted rats, especially at 24 months. The present study demonstrates that aging reduces the capacity of cardiac adrenergic nerve terminals to release NE, this age-related change is not strain specific, and that dietary restriction and gender alter the extent of this change with age.
Adrenergic Fibers↗
Body mass index: a comparison between self-reported and measured height and weight.
BACKGROUND: Body mass index is used to measure obesity in individuals and to monitor trends in population obesity. Some observers use self-reported height and weight to assess body mass index; others use measured parameters. This paper reports on a study to compare body mass index when calculated from self-reported and measured heights and weights. METHODS: A randomized postal questionnaire survey and follow-up clinical measurement study were carried out in a geographically defined population in the rural South West of England; subjects were 6000 residents of Somerset health district aged 16-64 years selected from the Family Health Services Authority register. RESULTS: The response rate for the postal questionnaire was 57.6 per cent. A total of 73.3 per cent of responders agreed to clinical measurements; 84 per cent of measured volunteers had over-reported their height and 74 per cent under-reported their weight. The difference between body mass indices based on self-reported and measured values of height and weight is highly statistically significant for the whole population and for most age-sex and body mass groups. CONCLUSIONS: Self-reported heights and weights are unreliable and if used for monitoring health targets should be treated with caution.
Adolescent↗
Effect of aging on A1-adenosine receptor-mediated inhibition of norepinephrine release in the rat heart.
Adenosine inhibits norepinephrine (NE) release from cardiac adrenergic nerves and reduces the postsynaptic beta-adrenergic mediated actions of NE, leading to decreased myocardial force of contraction. The actions of adenosine are mediated by pre- and postsynaptic adenosine A1 receptors (A1-AdoR). We reported that adenosine inhibition of postsynaptic beta-adrenergic receptor-mediated cyclic adenosine monophosphate (cAMP) production declines with age in male F344 rat hearts. In this study, cardiac synaptosomes, isolated intact adrenergic nerve terminals, were used to examine the effect of age on adenosine inhibition of NE release. Cardiac synaptosomes were prepared from the hearts of 6- and 24-month-old male F344 rats, loaded with [3H]NE, and placed in a superfusion system. [3H]NE release was induced by high [K+] exposure in the presence of varying concentrations of adenosine or the specific A1-AdoR agonist, N6-p-sulfophenyladenosine (SPA). [3H]NE release was significantly reduced in old rats compared with young rats. Inhibition of [3H]NE release by adenosine and SPA was significantly greater in young rats compared with old rats. The A1-AdoR antagonist, 8-(p-sulfophenyl)-theophylline, blocked the actions of adenosine on [3H]NE release, and the specific adenosine A2-receptor agonist, cyclopropylcarboxamidoadenosine, had no effect on [3H]NE release. Our data suggest that presynaptic A1-AdoR-mediated inhibition of NE release in the rat heart declines with age.
Adenosine↗
Influence of age and dietary restriction on norepinephrine uptake into cardiac synaptosomes.
The purpose of this study was to determine whether aging alters neuronal uptake of norepinephrine (NE) in the rat heart and if dietary restriction influenced the effect of age on this system. Cardiac synaptosomes were prepared from 6-, 12- and 24-month-old male F344 rats fed ad libitum (AL) or a diet restricted (DR) to 60% of AL intake. Cardiac synaptosomes were incubated with 50, 100, 200, or 400 nM [3H]NE for 10 min at 37 degrees C with and without desmethylimipramine (DMI), a selective neuronal-uptake blocker. DMI-sensitive [3H]NE uptake was calculated as the difference between samples with and without DMI. NE uptake was adjusted for the number of cardiac synaptosomes in each sample by dividing by the endogenous NE content in each sample. The Vmax for uptake ([3H]NE/min/ng NE) declined significantly between 6 and 12 months in AL rats and between 12 and 24 months in DR rats. Km was not significantly different between age or diet groups. The change in Vmax with age suggests that the number of NE transporters per synaptosome may decline with age and that DR delays this effect of age. There were no differences in the sensitivity to DMI between age or diet groups.
Adrenergic Uptake Inhibitors↗
Variability of cutaneous lymphatic flow rates in melanoma patients.
Preoperative lymphoscintigraphy was performed in 198 consecutive patients with cutaneous melanoma prior to their definitive surgical treatment. After intradermal injection of antimony sulphide colloid labelled with technetium-99m, lymphatic flow rates were measured in each patient and found to vary according to the location of the primary tumour. The fastest flow rates occurred from melanoma sites on the distal limbs, particularly the lower limbs. The slowest flow rates were from the head and neck region and the proximal limbs, especially the upper arms and shoulders. Lack of flow in the early dynamic images occurred most commonly for tumours on the upper arms and shoulders. These results can be used to optimize the timing of blue dye injection prior to surgery and may influence the sentinel node biopsy method to be used in individuals who show no early drainage.
Antimony↗
Cisplatin induces N-acetyl cysteine suppressible F2-isoprostane production and injury in renal tubular epithelial cells.
In the low intracellular chloride milieu, chloride ions of cisplatin may exchange for cellular SH moieties resulting in glutathione depletion, H2O2 accumulation, and lipid peroxidation. Cisplatin-induced lipid peroxidation, in addition to causing direct cellular injury, may further contribute to cisplatin-induced renal dysfunction by generating vasoconstrictive E2- and F2-isoprostanes. The aim of this study was to determine whether cisplatin-induced renal epithelial (LLC-PK1 and primary human proximal tubular) cell injury is associated with increased production of isoprostanes, and whether this can be suppressed with a thiol donor, N-acetyl cysteine. It was confirmed that incubation of renal epithelial cells with cisplatin resulted in N-acetyl cysteine-inhibitable glutathione depletion, H2O2 accumulation, lipid degradation, and lactate dehydrogenase release. In additional experiments, incubation of cells with cisplatin for 48 h was accompanied by a dose-related increase in total (free plus esterified) F2-isoprostanes. An increase in F2-isoprostanes was discernible at 16.5 microM cisplatin and doubled at 66.0 microM. N-Acetyl cysteine at 50 microM concentration effectively suppressed 66.0 microM cisplatin-induced increase in isoprostanes. Similar findings were also obtained in human cells. Thus, cisplatin-induced tubular cell injury is accompanied by increased isoprostane production through a mechanism involving thiol depletion. On the basis of this new finding, it is hypothesized that these arachidonic acid peroxidation products may be partially responsible for the cisplatin-induced renal vasoconstriction demonstrable in the in vivo models.
Acetylcysteine↗
Health or uni-disciplinary informatics initiatives--why are we where we are today?
This paper looks at the development of health informatics from a segregated uni-disciplinary beginning to an environment in which multi-disciplinary health informatics and uni-disciplinary work co-exist reasonably harmoniously. However, the paper considers some of the catalysts and inhibitors which have made the transition not as smooth or wide ranging as the technological developments could have supported. Organisational and cultural factors appear to have played a part in the migration as it has emerged. Identification and understanding of the key issues may help in progressing health informatics towards a mature state.
History, 20th Century↗
Phase Ib trial of bryostatin 1 in patients with refractory malignancies.
A Phase Ib trial of bryostatin 1, a macrocyclic lactone and protein kinase C (PKC) activator, was conducted in patients with refractory nonhematological malignancies with the primary goal of determining whether down-regulation of peripheral blood mononuclear cell (PBMNC) PKC activity could be achieved in vivo in humans. Patients (four patients/cohort) received bryostatin 1 (25 microg/m2) as a 1-h infusion weekly three times every 4 weeks, but to study the schedule dependence of pharmacokinetics and pharmacodynamics, the first dose was administered according to one of three schedules: (a) a 1-h infusion; (b) a 24-h infusion; or (c) a split course (12.5 microg/m2 as a 30-min infusion) on days 1 and 4. Conventional toxicities (grades I-III) included myalgias, fever, anemia, fatigue, phlebitis, and headache; in addition, two patients in cohort 3 experienced transient elevations in liver function tests, although these patients had preexisting liver metastases. No objective clinical responses were encountered. Effects on PBMNC PKC activity were heterogeneous. Several patients in cohorts 1 and 2 experienced significant declines in activity (approximately 50%) that were sustained in some cases for periods of > or = 72 h. Comparison of 72-h with baseline values for all three patient cohorts combined revealed a trend toward PKC down-regulation (P = 0.06; signed rank test). For each schedule, plasma bryostatin 1 levels were below the level of detection of a platelet aggregation-based bioassay (3-4 nm). Bryostatin 1 administration failed to produce consistent alterations in lymphocyte immunophenotypic profiles, interleukin 2-induced proliferation, or cytotoxicity, although two of three samples from patients in cohort 3 did show significant posttreatment increases in proliferation. Moreover, in some patients, bryostatin 1 treatment increased lymphokine-activated killer cell activity. These findings indicate that bryostatin 1 doses of 25 microg/m2 can induce in vivo PBMNC PKC down-regulation in at least a subset of patients and raise the possibility that higher bryostatin 1 doses may be more effective in achieving this effect.
Adult↗