Biomedical subjects
Publications and source records attributed to M Clarke.
Two pre-eclamptic females were seen in consultation by the Renal Service. Both had Renal Tubular Acidosis (RTA). One case resulted from the possible exacerbation of Lupus Erythematosus. The other patient's RTA seemed to be related to ingestion of Dyazide for pre-eclampsia. Delivery of the child in the first case and discontinuance of Dyazide in the second resulted in the abrupt disappearance of RTA.
A survey was conducted in 1984-85, within Leicester City boundaries, which contains 64,535 children below the age of 15 years (20,267 Asian and 44,268 White Caucasian) to ascertain the prevalence of insulin-dependent diabetes mellitus (IDDM) using a central register maintained for the changeover to U-100 insulin, diabetic health visitor index cards, hospital admissions of diabetic children, and individual registers maintained by us. Overall prevalence per thousand for children aged 0-15 years was 0.54 for Asian and 0.99 for White Caucasians; for ages 10-15 years they were 0.97 and 1.87, and for ages 0-9 years, 0.31 and 0.38, respectively. This was not statistically different at the 5% level. Ours is the first population based study of its kind in Asian children, and challenges the view that there is a large difference in the prevalence of IDDM between Asians and White Caucasians. A wider analysis of this observation incorporating a large population base is suggested.
In a number of centers throughout the world, fetal nigral transplantation is being performed for the treatment of Parkinson's disease (PD). Clinical results have been inconsistent. One parameter that differs among transplant studies is the degree and manner by which patients are immunosuppressed following transplantation. Indeed, the role of the immune system following fetal grafting in humans is not well understood. Recently, two patients from our open label trial that received fetal nigral implants have come to autopsy. These patients were immunosuppressed with cyclosporin for 6 mo posttransplantation and survived for a total of 18 mo postgrafting. Robust survival of grafted dopamine-containing cells was observed in both cases. Immunostaining for HLA-DR revealed a dense collection of cells within grafts from both cases. HLA-DR staining was rarely observed within the host including nongrafted regions of the striatum. A more detailed analysis of immune markers was performed in Case 2. Numerous pan macrophages, T-cells, and B-cells were observed within graft sites located in the postcommissural putamen. In contrast, staining for these immune cells was not observed within the ungrafted anterior putamen. These findings suggest that even in healthy appearing functional nigral implants, grafts are invaded by host immune cells that could compromise their long-term viability and function. Alternatively, immune cells are known to secrete trophic factors, which may ultimately favor graft survival and function. Further work is needed to understand the role of the immune system in fetal grafting.
Children with physical impairments who cannot use intelligible speech are often recommended augmentative and alternative communication (AAC) systems. In England and Wales, it is usually the job of speech and language therapists to support development in AAC skills. This paper reports findings from discussion with children and young people who use AAC systems concerning their attitudes and opinions towards the organization of speech and language therapy, the role of the speech and language therapist in school and issues concerned with AAC systems themselves. Six young adults and 17 children from London education authorities were interviewed on a one-to-one basis and in focus groups. Children were interviewed who had a communication aid incorporating at least 20 symbols and/or pictures and/or written words, language understanding at the two-word level and above, i.e. they demonstrated understanding of adult requests with at least two information carrying words. For children using communication aids, it is conceivable that their communication systems do not contain appropriate symbol vocabulary to express complex ideas, opinions and feelings. Consequently, a symbol-based interview tool was designed to allow children to express complex issues through visual means. Most children interviewed reported that their AAC system was useful to them. Further analysis of opinions revealed that negative attitudes towards AAC systems were primarily associated with operational issues (technical skills required to operate an AAC system) and issues of self-image/identity, and to some degree, with a lack of perceived benefit in interaction. In apparent contrast to therapists' preferred models of working, children and young people identified a preference for therapy organized on a one-to-one basis targeting linguistic and operational skills. It is suggested that more acceptable and individualized design of AAC systems could have implications for their use in school and other contexts. The value of service users' views in service planning and evaluation are discussed.
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The ultimate stage of carcinogenesis in both human and mouse epithelial cells is the ability to invade surrounding tissues and metastasize to distant sites. In mouse skin tumours, the development of the invasive, spindle cell phenotype is associated with an imbalance of alleles on mouse chromosome 7, including the H-ras gene. In previous work, we have described clonally related squamous and spindle cell lines from the same primary tumour which differed substantially in morphology and behaviour, but showed the same series of mutations in H-ras and p53 genes. One of the events which takes place during this transition is disruption of cell-cell contacts, possibly due to the induced expression of metalloproteinases such as stromelysin-1 and disappearance of the cell adhesion molecule E-cadherin. Parallel studies using somatic cell hybrids have shown that the spindle cell phenotype is recessive in hybrids between squamous and spindle cells. We propose that an important epidermal differentiation-controlling gene is lost during the spindle cell transition.
Disadvantaged youth such as the homeless, the unemployed or recent immigrants are thought to be at high risk for dental problems, but data to support this hypothesis are rare. Using interviews and clinical examinations, this study measured the oral health status and treatment needs of a convenience sample of 478 disadvantaged adolescents aged 14 and older in North York, Ontario. Although the results cannot be generalized to the overall population, the data suggested that disadvantaged youth have high rates of oral disease. The adolescents reported a variety of symptoms, including oral pain and low rates of dental visiting. Clinically, high rates of periodontal disease, dental decay and urgent treatment needs were detected. If public health resources are to be directed to those most in need, efforts should be made to identify high-risk groups that may be overlooked in general surveys. Prevention, detection and treatment programs should be considered for high-risk adolescents.
The authors describe the implementation of the Nursing Interventions Classification (NIC), a standardized nursing language in five test sites: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Genesis Medical Center, Davenport, Iowa; Loyola University Medical Center, Maywood, Illinois; Oaknoll Retirement Residence, Iowa City, Iowa; and The University of Iowa Hospitals and Clinics, Iowa City, Iowa. A description of NIC is provided along with a discussion of implementation issues and recommendations for implementation.
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