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Biomedical subjects

M Donnelly

Publications and source records attributed to M Donnelly.

At least 55 records · Page 3Linked to original sources
PubMed1999

A home from hospital service for older people.

Current policy and practice emphasises much more than ever before a need for purchasers and providers to reduce appropriately the length of hospital stay. Consequently, a number of early discharge "schemes" have been developed. This paper presents the findings from an evaluation of a "home from hospital" (HFH) scheme. The HFH service provides a maximum of six weeks' intensive domiciliary care for older people on their discharge from hospital. The aim of the service is to facilitate early discharge from hospital and to assist patients to regain independence. The study reported here elicited the views and perceptions of clients and professionals involved in the HFH scheme about the quality, efficiency and effectiveness of the service. Seventy-five patients were discharged from hospital to the HFH scheme during a two month period and those who consented to participate in the study were interviewed after discharge from the HFH service (n = 40). Participants had attended hospital for various conditions but the largest group were fracture patients. Hospital staff and community based professionals completed a questionnaire about the service. Overall, patients and professionals perceived the HFH scheme as a beneficial service, though some minor problems existed at an individual level. Clients' dependency levels generally decreased during their time on the scheme. Research using a controlled design is necessary in order to draw firm conclusions about the cost-effectiveness of a HFH service. Overall, home-from-hospital appears to be an effective model of an early discharge scheme worthy of further attention.

Activities of Daily Living↗
PubMed1998

Retrograde cerebral perfusion results in flow distribution abnormalities and neuronal damage. A magnetic resonance imaging and histopathological study in pigs.

BACKGROUND: In the past few years, although significant efforts have been made to assess flow distribution during retrograde cerebral perfusion with microspheres, dye, or hydrogen clearance, flow distribution in real time is still undefined. We used MR perfusion imaging to monitor flow distribution in the brain during and after deep hypothermic circulatory arrest (DHCA) with antegrade or retrograde cerebral perfusion (ACP or RCP). METHODS AND RESULTS: Thirteen pigs were divided into 2 groups and exposed to 120 minutes of either RCP (n = 7) or ACP (n = 6) at 15 degrees C, followed by 60 minutes of cardiopulmonary bypass (CPB) at 37 degrees C. During DHCA, the brain was perfused antegradely through the common carotid artery or retrogradely through the superior vena cava at pressures of 60 to 70 mm Hg and 20 to 25 mm Hg in the ACP and RCP groups, respectively. Esophageal temperature was monitored continuously. MR perfusion images were acquired every 30 minutes before, during, and after DHCA. The brain was perfusion-fixed with formaldehyde solution for histopathology at the completion of each experiment. During initial normothermic CPB, MR perfusion imaging showed a nearly uniform distribution of flow in the brain. The same pattern was maintained with a significant increase in regional cerebral blood volume during ACP and reperfusion in the ACP group. RCP provided little or no detectable blood distribution to the brain, resulting in poor reperfusion of many areas of the brain on reflow with CPB at 37 degrees C. The total area suffering poor reperfusion was significantly higher in the RCP group than the ACP group. Histopathology showed no morphological changes in any area of the brain in the ACP group, whereas varying severity of neuronal damage was observed in different regions of the brain in the RCP group. CONCLUSIONS: ACP preserves uniform blood distribution and normal morphology of brain tissue after prolonged DHCA. RCP provides very little blood to the tissue of the brain. A 120-minute period of RCP results in abnormal flow distribution and neuronal damage during reperfusion. The damage resulting from shorter periods of RCP remains to be assessed.

Animals↗
PubMed1998

The cyclopean (stereoscopic) barber pole illusion.

Across two experiments, this study found that the barber pole illusion (i.e. grating pattern appearing to move in the direction of the long axis of a rectangular aperture) is perceived with stereoscopic (cyclopean) motion. The grating and aperture comprising the barber pole display were created from binocular disparity differences embedded in a dynamic random-dot stereogram or from luminance differences. In Experiment 1, observers viewed a square-wave grating moving through a rectangular aperture of 2:1 or 4:1 aspect ratio and indicated whether the grating appeared to move in a direction perpendicular to its orientation or in the direction of the long axis of the aperture. For both stereoscopic and luminance stimuli equally, the grating appeared to move in the direction of the aperture (i.e. the barber pole illusion) more often with the larger aspect ratio than with the smaller aspect ratio. The condition for which a stereoscopic grating moved through a luminance rectangular aperture was also examined: the grating appeared to move in the direction of the aperture (inter-attribute barber pole illusion). In Experiment 2, observers viewed a square-wave grating moving through a rectangular aperture of 3:1 aspect ratio whose sides were indented in order to change the local direction of motion of the line terminators. For both stereoscopic and luminance stimuli, the grating appeared to move more frequently in a direction perpendicular to its orientation with the indented aperture (i.e. the illusion was diminished). Thus, local velocity signals from moving stereoscopic line terminators play a role in the production of the barber pole illusion similar to that of luminance motion signals. This suggests that the generation and propagation of motion signals at cyclopean levels of vision play a part in the representation of coherently-moving rigid surfaces.

Depth Perception↗
PubMed1998

Service utilisation by former long-stay psychiatric patients in Northern Ireland.

The shift from hospital to community care for people with mental health problems places continuing demands on community-based services. However, comparatively little is known about the patterns of service use among those previously resident in psychiatric hospitals. In this study, a total of 145 former long-stay psychiatric patients in Northern Ireland (NI) - most with a diagnosis of schizophrenia and aged under 60 - were followed up one year after discharge to identify the type and frequency of service use during the previous six months. Although a wide range of services was used, GPs, CPNs and social workers respectively were central to client care outside hospital. However, access to, and use of, services influenced, in part, by the unique integrated health and social services structure in NI - varied widely across types and sectors of accommodation. The findings have implications both for the successful management of community placement for former long-stay patients and for the planning and implementation of services for future more dependent cohorts.

Adult↗
PubMed1997

Asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia.

To further elucidate the incidence and potential mechanism of asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia (ALL), we serially obtained fasting lipid and lipoprotein studies on 38 of the 43 consecutively diagnosed children with ALL before, during, and after asparaginase therapy. We also evaluated a second population of 30 long-term survivors of childhood ALL; a fasting lipid and lipoprotein profile was obtained once at study entry. The mean peak triglyceride level during asparaginase of 465 mg/dL (standard deviation [SD] 492) was significantly higher (P = .003) than the level of 108 mg/dL (SD 46) before the initiation of asparaginase therapy. Sixty-seven percent of the newly diagnosed patients had fasting triglyceride levels greater than 200 mg/dL during asparaginase therapy; 15 patients (42%) had levels greater than 400 mg/ dL, 7 with levels greater than 1,000 mg/dL. The incidence of hypertriglyceridemia did not vary by type of asparaginase or risk status of ALL (defined by white blood cell count and age). None of the 7 patients with triglyceride levels greater than 1,000 mg/dL developed pancreatitis. In contrast, 4 of the 13 patients without triglyceride elevation developed pancreatitis; 3 of the 4 patients had fasting studies at the height of their abdominal pain. Nuclear magnetic resonance analysis of lipid subclasses showed a significant increase in the smaller, denser forms of very low density lipoprotein (VLDL) and negligible chylomicron fraction in a subset of patients with marked triglyceride elevation. Lipoprotein lipase activity was consistently above normative values for all levels of triglyceride and could not be explained by obesity or hyperglycemia. Apolipoprotein B(100) levels increased during asparaginase therapy, although the mechanism of this remains unclear. LDL reciprocally decreased with increased VLDL during asparaginase therapy. After asparaginase therapy, triglyceride levels (mean, 73 mg/dL [SD 33]) were significantly lower than levels obtained during asparaginase therapy. Triglyceride levels for survivors did not differ from the normal range or postasparaginase levels in the newly diagnosed patients. These data show a striking temporal association between asparaginase therapy and hypertriglyceridemia. Changes in cholesterol, in contrast, were not temporally related to asparaginase treatment. Cholesterol levels were elevated (>200 mg/dL) in 20% of the patients after asparaginase, which may be due to continued treatment with corticosteroids. The mean cholesterol level of long-term survivors of 177 mg/dL was significantly higher than the norm (P = .045). High-density lipoprotein (HDL) levels were significantly lower than normal at all time periods and for both populations; 25% of survivors had HDL levels less than 35 mg/dL. We conclude that modifications in asparaginase therapy are not necessary. In cases of triglyceride elevation greater than 2,000 mg/dL when the risk of pancreatitis is increased, close clinical monitoring is imperative. Larger studies are needed to determine the incidence of dyslipidemia in long-term survivors of ALL as well as the relationship between lipid abnormalities and other late effects of treatment, notably obesity and cardiomyopathies.

Adolescent↗
PubMed1997

A 3- to 6-year follow-up of former long-stay psychiatric patients in Northern Ireland.

Little is known about the first patients who left hospital before and during the official implementation of the hospital discharge policy in Northern Ireland. This study describes patterns of residential provision for former long-stay patients (approximately two-thirds of whom had an ICD-9 diagnosis of schizophrenia) discharged from the six major psychiatric hospitals in Northern Ireland between 1987 and 1990 (n = 321). It also employs several instruments within a retrospective survey design to examine outcomes for a 35% sample of people (112/321) discharged between 1997 and 1990 and followed up in 1993. Almost two-thirds (61%) had been discharged to independent living or low-staffed statutory settings. None of the group was homeless, one person was in prison and three people had committed suicide during the first 2 years after discharged. Almost one-third had to be re-admitted at some stage during the 6-year period and 13% had died. 'Moderate' to 'major problems' with most daily living skills were reported for less than 25% of people, while 15% or less had problem behaviour. Approximately 90% or more were satisfied with most aspects of their new homes and most also reported feeling happier (77%), healthier (63%) and more independent (78%) since discharge. However, social, recreational and occupational opportunities were limited. Purchasers, providers and practitioners need to review ways in which former long-stay patients might be empowered to live more meaningful and integrated lives in the community, particularly as the current government strategy for health and social well-being (1997-2002) in Northern Ireland points to the closure of existing psychiatric hospitals.

Activities of Daily Living↗
PubMed1997

Speed discrimination of stereoscopic (cyclopean) motion.

This study investigated the degree to which speed of stereoscopic translational motion (i.e. moving binocular disparity information) can be discriminated in a display that minimizes position information. Observers viewed dynamic random-element stereograms depicting arrays of randomly positioned stereoscopic dots that moved bidirectionally. Two tasks were performed: a speed discrimination task and a displacement discrimination task. Across a range of conditions, speed could be discriminated under conditions in which displacement could not. Thus, speed of stereoscopic motion can be discriminated when position information is minimal. This result indicates that stereoscopic motion is sensed in a way that cannot be explained by feature tracking or by inferring the motion from memory of position and time.

Depth Perception↗
PubMed1997

Direction discrimination of cyclopean (stereoscopic) and luminance motion.

This study compared direction discrimination of cyclopean (stereoscopic) and luminance motion involving stimuli equated for effective strength. The stimuli were random-walk cinematogram (RWC) displays whose signal and noise discs were created from binocular disparity differences embedded in a dynamic random-dot stereogram or from luminance differences. Experiment 1 measured global motion detection thresholds for cyclopean and luminance stimuli by manipulating the proportion of signal to noise discs. Detection thresholds for cyclopean motion were about 25% whereas detection thresholds for luminance motion were 5%, thus five times more cyclopean motion events than luminance events were necessary to elicit threshold responding. Experiment 2 measured thresholds for discriminating the direction of cyclopean and luminance motion under conditions of equal stimulus strength by presenting the motion displays at equal multiples of detection threshold. Direction discrimination thresholds (ranging from about 5-30 deg, depending upon conditions) were similar for cyclopean and luminance motion, thus the precision with which the pooling of local motion events in one direction can be discriminated from the pooling of events in a slightly different direction is the same for cyclopean and luminance stimuli. The finding that cyclopean motion information is pooled is consistent with the idea that the direction of cyclopean motion is coded in the responses of a population of directionally selective mechanisms.

Depth Perception↗
PubMed1997

The cost-effectiveness of community care for adults with learning disabilities leaving long-stay hospital in Northern Ireland.

Among the many questions concerning the replacement of long-stay hospital services with community-based care are those of cost and cost-effectiveness. Is community care more expensive than hospital care? Are levels of expenditure associated with clients' needs and changes in their well-being? By following a cohort of people discharged from seven long-stay hospitals in Northern Ireland, this wide-ranging evaluation was able to address such cost-related questions. Although nearly three-quarters of the sample were living in private sector residential or nursing homes, a six-fold variation in the total costs of support was found. However, at the mean, community care was less expensive than hospital care. For only ten people in our sample of 192 clients did the costs of community care exceed the average cost of long-stay inpatient care. Multivariate analysis revealed that the costs of community care 'packages' were linked to some client needs, but higher spending was not unequivocally associated with better client outcomes. Care in the community is reasonably cost-effective in Northern Ireland when compared with long-term hospital care. However, there is a case for increasing expenditure on community care for people with learning difficulties, to increase use of services provided outside the accommodation and enhance staffing arrangements within the accommodation facilities. Distributing resources appropriately and targeting resources on priority needs through coordination will hep to continue to improve clients' quality of life.

Community Health Services↗
PubMed1997

The experience of caring for former long-stay psychiatric patients.

This study investigated the experiences and the mental health status of the informal carers (usually relatives) of 38 former long-stay psychiatric patients. According to the GHQ-12, 45 per cent of carers were classified as minor psychiatric 'cases'. Women were significantly more likely than men to experience poor mental health. Most carers reported personal and social restrictions, but cases were significantly more likely than non-cases to report personal, physical and financial burden.

Adult↗
PubMed1997

A three- to six-year follow-up of former long-stay residents of mental handicap hospitals in Northern Ireland.

OBJECTIVES: Little is known about the first cohorts of long-stay hospital residents with learning disabilities who moved to the community. This study describes the pattern of residential reprovision for all former long-stay residents discharged from the three mental handicap hospitals in Northern Ireland between 1987 and 1990 (N = 283) as well as describing aspects of quality of life for a smaller sample of people. METHOD: The study employs a retrospective survey design and the method and findings are discussed within a quality of life framework. Information about destinational outcomes between 1987 and 1993 was collected for each former resident. Several instruments were also used to assess material, emotional and social well-being and development and activity for a 40 per cent sample of people (114/283) discharged from hospital during 1987-1990 and followed up in 1993. RESULTS: Approximately 70 per cent of residents were discharged to, and subsequently remained in, highly supported settings such as residential and nursing homes. Only 3 per cent were discharged to 'independent living' with their own families or foster families. Few of the sample had 'major' problems with daily living skills and serious behavioural problems were uncommon. Former patients were also more satisfied with their new homes and reported feeling happier, healthier and more independent since discharge. However, social networks were poor and there was no evidence to suggest that people were undertaking new or 'ordinary' daytime activities. CONCLUSION: Although the material needs of former hospital residents (many of whom may have been 'cream skimmed' from the long-stay population) appeared to be met and they were content with their new homes in the community, they had a limited choice of mainly private sector accommodation and few opportunities for personal and social development.

Activities of Daily Living↗
PubMed1997

An exploration of attitudes on sexuality at a northeastern urban university.

This study was conducted to assess the prevalence of scores on homophobia among 104 college students at a northeastern urban university. Participants reported their attitudes regarding homosexuals and homosexual behavior on Hudson and Rickett's Index of Homophobia. The 33 men indicated more negative attitudes about homosexuals and homosexual situations than the 71 women.

Adult↗
PubMed1996

Altered insulin-like growth factor-II (IGF-II) level and IGF-binding protein-3 (IGFBP-3) protease activity in interstitial fluid taken from the skin lesion of psoriasis.

In the present study, we have investigated insulin-like growth factors (IGFs) and their binding proteins (IGFBPs) in serum and artificially raised blister fluid from uninvolved and involved areas of nine patients with psoriasis. Both levels of IGFs and IGFBP-3, and profiles of IGFBP in serum and fluid from the uninvolved areas of these patients were comparable to those seen in normal subjects. In fluid from the involved areas, the IGF-II but not IGF-I level was significantly elevated. Among five molecular forms of IGFBP, the density of 41.5- and 38.5-kDa forms of IGFBP-3 were apparently increased in fluid from the involved areas, shown by Western ligand blotting. Radioimmunoassay further showed that the IGFBP-3 concentration in the involved areas was significantly raised. Immunoblotting revealed that the predominant form of IGFBP-3 in fluid from the uninvolved areas was a 29-kDa proteolytically modified product. In contrast, intact doublet IGFBP-3 was the main form of IGFBP-3 in fluid from the involved areas. Fluid from the involved areas but not the matched serum concentration-dependently inhibited the degradation of 125I-labeled nonglycosylated IGFBP-3 (ngIGFBP-3) caused by fluid from the uninvolved areas, suggesting the presence of an IGFBP-3 protease inhibitor(s) in psoriatic skin lesion. These findings suggest that the alterations in IGF/IGFBP system may contribute to the pathogenesis of psoriasis.

Adult↗
PubMed1996

One and two year outcomes for adults with learning disabilities discharged to the community.

BACKGROUND: Long-stay patients with learning disabilities (n = 214) were assessed in hospital and 12 and 24 months after discharge in order to examine the effects of relocation. METHOD: Each resident acted as his/her own control in a prospective repeated-measures design. Skills and behavioural problems were assessed by keyworkers. Self-perceived quality of life was obtained during interviews with researchers who also completed an environmental checklist of the residents' accommodation. RESULTS: There was little or no change in people's low pre-discharge skill levels. Certain aspects of problem behaviour improved after 12 months, although socially unacceptable behaviour increased slightly. People were less depressed (P < or = 0.01) 12 months after discharge (N = 119) and were more satisfied (P < or = 0.05) with their new 'homes' (n = 108). There were few changes in the pattern of activities or the social networks of people 12 months later. Little or no further change in outcomes was reported 24 months after discharge. CONCLUSIONS: The implementation of the deinstitutionalisation policy in Northern Ireland has been limited by the predominance of residential and nursing homes and the lack of 'ordinary' accommodation. There is a need for purchasers and providers to give more attention to ways in which the principles of normalisation could be incorporated in the process of contracting and delivering services.

Activities of Daily Living↗
PubMed1996

Assessing variability of HIV transmission attitudes and behaviors at an urban northeastern university.

Teenagers in the United States are one of the populations whose HIV infection rates are increasing most rapidly. This study was designed to measure college students' knowledge of HIV transmission methods using Kittleson and Venglarcik's HIV Transmission Survey. Participants (N= 167) were divided into two groups, 99 students from a rural background and 68 students from an urban background. Students from an urban background were significantly more knowledgeable about documented HIV transmission modes than students from a rural background. Men were significantly less aware of documented HIV transmission modes than women. These results suggest that education about AIDS needs to be improved. The current educational procedures do not properly inform students in a fashion which exhibits the true risk of infection and those behaviors which increase risk. Fifteen years after the discovery of the HIV virus students are still largely unaware that they are at risk for contracting a fatal disease.

Adolescent↗
PubMed1995

Frequent loss of heterozygosity at the TEL gene locus in acute lymphoblastic leukemia of childhood.

TEL is a new member of the ETS family of transcription factors which is rearranged in a number of hematologic malignancies with translocations involving chromosome band 12p13. In some cases, both TEL alleles are affected, resulting in loss of wild-type TEL function in the leukemic cells. In addition, 5% of children with acute lymphoblastic leukemia (ALL) have 12p12-p13 deletions, suggesting that a tumor suppressor gene resides on 12p. These observations led us to consider whether TEL loss of function may contribute to the pathogenesis of ALL. In this report we show that the TEL gene maps between the polymorphic markers D12S89 and D12S98, and we use these flanking markers to screen paired diagnosis and remission samples from 81 children with ALL for loss of heterozygosity (LOH) at the TEL gene locus. Fifteen percent of informative patients showed TEL LOH which was not evident on cytogenetic analysis. Detailed examination of patients with LOH at this locus showed that the critically deleted region included two candidate tumor suppressor genes: TEL and KIP1, the gene encoding the cyclin-dependent kinase inhibitor p27. These studies show that LOH at the TEL locus is a frequent finding in childhood ALL.

Adolescent↗