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Biomedical subjects

K O'Reilly

Publications and source records attributed to K O'Reilly.

At least 19 recordsLinked to original sources
PubMed2002

The emergency department versus the computer: which is the better electrocardiographer?

Electrocardiograms (ECGs) are frequently ordered in the pediatric emergency department (ED). Pediatric cardiologists are generally not asked to interpret every ECG; thus, ED patient management is often guided by the ED physicians' ECG interpretation. The objective of this study was to analyze the accuracy of ECG interpretation by ED physicians and a computer-generated interpretation and compare the two. A 12-month prospective study was performed in a pediatric ED. All patients (<22 years) who had an ECG in the ED were included. The ED physicians and the computer interpretation were compared to a reference standard. Each electrocardiographic diagnosis, as well as the ECG as a whole, was assigned to one of the following predetermined classes: I, normal sinus rhythm; II, minimal clinical significance; III, indeterminate clinical significance; IV, those of definite clinical significance. Both groups correctly interpreted all normal (class I) ECGs. The computer correctly interpreted approximately 75% of the class II and class III ECGs, whereas the ED physicians correctly interpreted 36% of both groups. For the class IV ECGs, both the computer and the ED physicians performed poorly, correctly interpreting just 14% and 28%, respectively. The computer proved to be more accurate than the ED physicians in interpreting ECGs of less than critical significance (classes II and III), but neither group was able to correctly interpret even a simple majority of the most significant abnormalities (class IV). We speculate that distributing the computer-generated interpretation to the ED physicians and formal review of all ED ECGs by a skilled interpreter may decrease the number of missed diagnoses.

Adolescent↗
PubMed2001

Role of the glutamate decarboxylase acid resistance system in the survival of Listeria monocytogenes LO28 in low pH foods.

The glutamate decarboxylase (GAD) acid resistance system of the foodborne pathogen Listeria monocytogenes plays a major role in its survival at low pH. It was found that survival of the wild-type strain. LO28, in acidified reconstituted skim milk, diluted to reduce free glutamate levels. improves in response to supplementation with monosodium glutamate. A mutant, in which the two listerial GAD homologs have been deleted (and in which there is no discernible GAD activity), did not respond to glutamate supplementation and displayed greatly enhanced sensitivity in a number of low pH foods, even when levels of free glutamate were as low as 0.22 mM. We thus show that the GAD system plays a major role in the survival of L. monocytogenes in acidic foods even when levels of free glutamate are low.

Colony Count, Microbial↗
PubMed2000

Effectiveness of HIV prevention interventions in developing countries.

OBJECTIVE: To review the effectiveness of projects and programs in developing countries that aim to reduce sexual transmission of HIV infection or transmission related to injection drug use. DESIGN: We identified 34 published studies undertaken in 18 developing countries that met rigorous inclusion criteria. These criteria included the length of follow-up, use of statistical analysis, the inclusion of a comparison group, and type of outcomes measured. RESULTS: We found that behavioral change interventions are effective when targeted to populations at high risk, particularly female sex workers and their clients. Few studies have evaluated harm reduction interventions in injecting drug users (IDUs). Evidence on the effectiveness of voluntary counseling and testing programs was promising, and VCT was most effective when directed at discordant couples. Treatment of sexually transmitted diseases (STD) appears highly effective in reducing HIV/STD transmission, particularly in the earlier stages of the epidemic. CONCLUSIONS: This review demonstrates that HIV prevention interventions can be effective in changing risk behaviors and preventing transmission in low and middle-income countries. When the appropriate mix of interventions is applied, they can lead to significant reductions in the prevalence of HIV at the national level. Additional research is needed to identify effective interventions, particularly in men who have sex with men, youth, IDUs and HIV-infected persons. Structural and environmental interventions show great promise, although more evaluation is needed.

Developing Countries↗
PubMed1999

Cerebrospinal fluid abnormalities in a phase III trial of Avonex (IFNbeta-1a) for relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group.

BACKGROUND AND OBJECTIVE: This report provides results of CSF analyses done in a subset of relapsing remitting MS patients participating in a placebo-controlled, double-blind, phase III clinical trial of IFNbeta-Studies supported by the National Multiple Sclerosis Society (grants RG2019, RG2827),a (Avonex , Biogen). The clinical trial demonstrated that IFNbeta-1a treatment resulted in significantly reduced disability progression, annual relapse rate, and new brain lesions visualized by cranial magnetic resonance imaging. The objectives of the current study were to determine: (a) whether CSF abnormalities in MS patients correlated with disease or MRI characteristics, and (b) effects of IFNbeta-1a therapy on these CSF abnormalities. METHODS: CSF was analyzed from 262 (87%) of the 301 study subjects at entry into the clinical trial, and a second CSF sample was analyzed from 137 of these 262 subjects after 2 years of therapy. CSF cell counts, oligoclonal bands (OCB), IgG index, and free kappa light chains were measured using standard assays. Baseline CSF results were compared with demographic, disease, and MRI parameters. Differences in on-study relapse rate, gadolinium enhancement, and EDSS change according to baseline CSF status was used to determine the predictive value of CSF for subsequent clinical and MRI disease activity. Change in CSF parameters after 104 weeks were used to determine the effects of treatment. RESULTS: (1) At study baseline, 37% of the subjects had abnormal CSF WBC counts, 61% had abnormal levels of CSF free kappa light chains, 84% had abnormal IgG index values, and 90% were positive for OCB. (2) Baseline IgG index, kappa light chains, and OCB showed weakly positive, statistically significant correlations with Gd-enhanced lesion volume and T2 lesion volume. WBC showed a statistically significant correlation with Gd-enhancing lesion volume but was uncorrelated with T2 lesion volume. (3) There was an associated between baseline CSF WBC counts and on-study clinical and MRI disease activity in placebo recipients. (4) IFNbeta-1a treatment resulted in significantly reduced CSF WBC counts, but there was no treatment-related change in CSF IgG index, kappa light chains, or OCB, which remained relatively stable over time in both patient groups. CONCLUSIONS: The current study documents significant reductions in CSF WBC counts in patients treated with IFNbeta-1a for 104 weeks. This finding is considered relevant to the therapeutic response, since CSF WBC counts were found to be positively correlated with subsequent clinical and MRI disease activity in placebo-treated relapsing MS patients.

Adjuvants, Immunologic↗
PubMed1997

The ESRC review of government social classifications.

In this article we first discuss the background to the ESRC Review of Government Social Classifications and the recommendations of the Review Committee's initial report to the Office for National Statistics in 1995. Second, we discuss the work of Phase 2 of the review, including the derivation of an interim version of a proposed revised government social classification schema and the criterion and construct validation work so far undertaken using this schema. Finally, we indicate the further work required to establish the schema in its ultimate recommended form for use by ONS and others. The main purpose of the paper is to introduce users of government social classifications both to the ideas underlying the review and to the revised version of the current classifications which we shall be recommending to ONS.

Adolescent↗
PubMed1996

Prevention campaigns for hard-to-reach populations at risk for HIV infection: theory and implementation.

Using applied behavioral science techniques that have been successful in other areas of health promotion, community-level campaigns were implemented in 5 cities to prevent HIV infection among hard-to-reach, at-risk populations: men who have sex with men but do not self-identify as gay; women who engage in sex for money or drugs; injecting drug users (IDUs), female sex partners of IDUs; and youth in high-risk situations. Communication materials presented positive role models for risk-reducing behaviors, and peer networks prompted and reinforced the behavior change process. This article describes the first year of intervention experience and documents the practical application of theoretical concepts of persuasion and learning. The use of theory and data to develop 188 educational messages is illustrated and training methods and experiences are reported for 150 peer leaders, 104 other community networkers, and 22 outreach workers. These activities are feasible and appear to offer an effective, general approach for diverse, special populations.

Adult↗
PubMed1996

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Racial influence in renal stone disease: a Saskatchewan story.

Data was obtained from two separate governement sources in an effort to review the prevalence of kidney stone disease in the province of Saskatchewan for the years 1983-1988 inclusive. The data revealed a statistally significant difference in prevalence rate among different ethnic groups within the population. Aboriginal people were found to have a prevalence rate approximately one-third that of the nonaboriginal (non-native) population. A renal stone episode prevalence of 0.858 per 1000 population compared to 0.222 per 1000 population in aboriginal people (p.<.001). The reasons for this difference could not be retrospectively associated with geographical variation. A discussion of other possible causes in association is offered, but it is felt that, in the end, more research into this area is required.

Journal Article↗
PubMed1995

Comparison of in-hospital mortality from myocardial infarction in the pre- and post-thrombolysis eras at the Royal University Hospital, Saskatoon, Saskatchewan.

PURPOSE: To compare in-hospital mortality of acute myocardial infarction (AMI) in two groups of patients in the pre- (1978-79) and post- (1990-91) thrombolysis era via a retrospective study. DATA SOURCE: Hospital files of patients discharged from the Royal University Hospital (RUH) in Saskatoon, Saskatchewan with the diagnosis of AMI. RESULTS: The diagnosis of AMI was established in 125 patients in 1978-79 and in 164 patients in 1990-91. The two groups were comparable with exceptions noted in the recorded family history of myocardial infarction and hypercholesterolemia. The overall in-hospital mortality decreased from 21.6% (1978-79) to 11.0% (1990-91; P = 0.05). The difference was more significant for patients admitted directly to the RUH, 24.0% (1978-79) versus 7.0% (1990-91; P = 0.05), and for patients over the age of 70 years. Marked differences were observed in the treatments provided to patients between these two decades. CONCLUSIONS: The in-hospital mortality of patients with AMI has decreased considerably in the past two decades. The use of thrombolytic agents, acetylsalicylic acid, heparin and beta-blockers may have contributed to these changes. A worse prognosis was observed with advancing age, hypotension on admission and the development of congestive heart failure, malignant arrhythmias or shock.

Age Factors↗
PubMed1994

Risking everything? Risk behavior, behavior change, and AIDS.

Inquiry into the determinants of risk-related sexual behavior is important for the development of interventions to reduce the incidence of new cases of human immunodeficiency virus infection. Recent social and behavioral research has revealed much about the individual and social factors influencing risk-taking. Findings from these studies have been important in the development of new educational and community-based interventions for communities at risk in the developed and developing worlds.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Expression of inducible stress protein 70 in rat heart myogenic cells confers protection against simulated ischemia-induced injury.

Myocardial ischemia markedly increases the expression of several members of the stress/heat shock protein (HSP) family, especially the inducible HSP70 isoforms. Increased expression of HSP70 has been shown to exert a protective effect against a lethal heat shock. We have examined the possibility of using this resistance to a lethal heat shock as a protective effect against an ischemic-like stress in vitro using a rat embryonic heart-derived cell line H9c2 (2-1). Myogenic cells in which the heat shock proteins have been induced by a previous heat shock are found to become resistant to a subsequent simulated ischemic stress. In addition, to address the question of how much does the presence of the HSP70 contribute to this protective effect, we have generated stably transfected cell lines overexpressing the human-inducible HSP70. Embryonal rat heart-derived H9c2(2-1) cells were used for this purpose. This stably transfected cell line was found to be significantly more resistant to an ischemic-like stress than control myogenic cells only expressing the selectable marker (neomycin) or the parental cell line H9c2(2-1). This finding implicates the inducible HSP70 protein as playing a major role in protecting cardiac cells against ischemic injury.

Animals↗