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Biomedical subjects

M Kelly

Publications and source records attributed to M Kelly.

At least 145 records · Page 8Linked to original sources
PubMed1996

Levels of PCDDs, PCDFs and non-ortho PCBs in dietary supplement fish oil obtained in Spain.

Levels of PCDDs, PCDFs and non-ortho PCBs are reported for fish oils available in Spain which are consumed by the population as a dietary supplement. Trace enrichment methodology based on the use of modified silica and activated carbon chromatography was combined with on-column extraction (FMS 100) to separate PCDDs, PCDFs and PCBs from lipid material. The extracts were further cleaned up on disposable Florisil columns and analysed by HRGC/HRMS (PCDD/F and non-ortho PCB fractions). Mean levels found in the samples were 10.50 ppt for total PCDDs and 9.95 ppt for total PCDFs. Calculated PCDD/F I-TEQ values were found to be 2.11 ppt on a lipid weight basis. Total mean levels found for co-planar PCBs (#77, 126 and 169) were 18.26 ppt and the calculated I-TEQ value was 0.31 ppt on a lipid weight basis.

Benzofurans↗
PubMed1996

PCDDS and PCDFS in milk from farms in Derbyshire, U.K.

As part of a programme to establish the background levels of PCDD/Fs in milk in the U.K., samples of cows' milk were collected from farms in Derbyshire in 1990 and 1991. The concentrations of PCDD/Fs in the samples from two farms in the Bolsover area of Derbyshire were found to be significantly elevated compared with the normal range for PCDD/Fs in milk in the U.K. Details of the findings and the actions taken as a result are given. The concentrations of PCDD/Fs in milk from those farms previously supplying milk for human consumption are now below the Maximum Tolerable Concentration of 17.5 ng TEQ/kg fat.

Animals↗
PubMed1996

HIV counsellors' knowledge, attitudes and vulnerabilities to HIV in Lusaka, Zambia, 1994.

The objective of this study was to see how HIV affected counsellors in their personal and professional lives and how they coped. A total of 101 people who were currently working as HIV counsellors were interviewed. Of these, 70 had a relative who had died of HIV, but few had been able to discuss HIV with them. Seventy-two worried about their HIV status but only 24 had had a test. Fifty-three counsellors did not want to know their status. Women counsellors worried because of the sexual behaviour of their partners and often felt unable to discuss HIV with them. Although nearly all were in favour of promoting condoms as protection against HIV transmission only 27 had ever used one. Many HIV counsellors found it difficult to discuss sexual behaviour with their clients. HIV counsellors in Zambia worry about HIV in their personal lives and need continuing confidential support to help them cope with their own worries as well as the anxieties created by the job itself They need more help and training in discussing issues around sexual behaviour with their clients. Women counsellors, in particular, need support in dealing with their personal sexual life.

Adaptation, Psychological↗
PubMed1996

Sonicated vascular catheter tip cultures. Quantitative association with catheter-related sepsis and the non-utility of an adjuvant cytocentrifuge Gram stain.

Microbial quantification of potentially infected intravenous catheters is used to determine whether the removed device may be the source of sepsis. In this study, the authors defined a clinically significant colony count using the sonication technique to implicate the catheter as the source of sepsis. The utility of a cytocentrifuge-prepared Gram's stain of sonication broth as a rapid test for the accurate diagnosis of catheter-related bacteremia and fungemia was also evaluated. Initially, 230 consecutive vascular catheter cultures were performed. In 14 patients, the blood culture was found to grow in the same organism as the catheter culture. The eight blood-culture positive patients with probable catheter-related sepsis had four catheters with 10(4)-10(5), and four with more than 10(5) CFU derived from the catheter sonication broth. Six bacteremias not catheter related showed three catheters with < 10(3), two with 10(3)-10(4), and one with > 10(5) CFU. One catheter-related bacteremia had a negative culture. A subsequent validation study on 175 catheter specimens using 1,000 CFU as a cut-off between a positive and negative test fully separated eight patients with catheter-related bacteremia from six patients with infection at a distant site. Cytospin Gram stain, studied in the initial evaluation, was positive in 17 catheters with < 10(3) CFU, 4 at 10(3)-10(4), 4 at 10(4)-10(5) and 9 with > 10(5) CFU in the sonication broth. No correlation was found between this test and catheter-related sepsis. From these results, the authors concluded that those catheters with counts below 10(3) CFU in the catheter sonication broth do not appear to have an association with catheter-related sepsis, and that a Cytospin Gram stain done with the sonication technique does not correlate with the presence of catheter sepsis.

Bacteremia↗
PubMed1996

Uptake of cervical screening in general practice: effect of practice organisation, structure, and deprivation.

OBJECTIVES - To investigate associations between uptake for cervical screening in general practice and the organisation of screening, features of practice structure, and deprivation. SETTING - Greater Glasgow Health Board area in the west of Scotland, which covers a socioeconomically varied population. METHODS - General practice questionnaire survey and interview based study. The main outcome measure was the uptake rate for each participating practice over the five and a half years ending 31 December 1993. This was used to determine whether practices achieved 80% uptake to trigger maximum payment for cervical screening services. RESULTS - Forty seven percent (n = 92) of all practices in the Greater Glasgow Health Board area agreed to take part in the research, with complete data collected for 87 practices. Participation varied according to number of partners in the practice and the average deprivation score of the practice. Uptake rates ranged from 48-2% to 92-9% (median 77.5%, interquartile range 69.8% to 83.4%). Thirty seven practices (43%) achieved the 80% target. None of the recommended features of good organisation of cervical screening showed any statistically significant association with uptake rates. In stepwise multiple regression four variables were shown to have independent associations with uptake. These were the number of partners in the practice, the average deprivation of the practice, the presence of a female general practitioner, and using a practice's own lists for sending out letters of invitation. In stepwise logistic regression just two of these variables contributed to the prediction of achieving 80% uptake namely, average deprivation and number of partners. There were no significant interactions between deprivation and the organisation of screening in relation to uptake. CONCLUSIONS - Organising cervical screening in general practice according to accepted standards is less important in predicting uptake than more intractable features of the practice such as the size of the partnership, its average deprivation level, the presence of a female general practitioner, and using their own (presumed more accurate) register of addresses to call women. A flexible incentive scheme may more fairly reward the efforts of those general practitioners who achieve high uptake rates but who do not trigger remuneration at the 80% level.

Family Practice↗
PubMed1996

Costs and remuneration for cervical screening in general practice in the west of Scotland.

OBJECTIVES: To investigate associations between costs and remuneration for cervical screening in general practice in relation to skill mix, features of practice structure and deprivation levels in the local area; and, to identify efficient policies for organising cervical screening in general practice. METHOD: Questionnaire survey and interview study in 87 general practices in Greater Glasgow Health Board an area in the west of Scotland which covers a socio-economically varied population. The main outcome measures were remuneration to cost ratios (RCRs) for cervical screening and their natural logarithms (logRCRs). RESULTS: Both the costs of cervical screening and RCRs varied widely between the 87 practices taking part. RCRs ranged from 0.29 to 14.67 (mean 2.64, median 2.18, interquartile range 1.15-2.98). Twenty-one per cent (18) of practices earned less than they spent on the organisation of screening, whilst 9% (8) of practices had PCRs of more than 5:1. RCRs were significantly lower if medical staff were involved in either taking smears or dealing with results. RCRs did not vary by social deprivation score, despite uptake being lower in practices in more deprived areas. This was explained by nurses working in practices in deprived areas being more likely to take smears than nurses working in more affluent areas. Sensitivity analyses were undertaken, altering key time and cost assumptions. As a result, the absolute values of the RCRs changed, although the overall pattern of association did not, with the exception of doctor involvement in processing results which was no longer significant when average general practitioners' income was substituted for locum rates. CONCLUSIONS: Practices in deprived areas may be responding to greater pressure of work by making optimal use of skill mix within the primary health care team. A more graduated incentive payment scheme may more fairly reward practices in deprived areas which are less likely to achieve 80% uptake due to relatively intractable features of practice structure. Assuming that practice nurses provide an equivalent quality of service to that provided by general practitioners, results suggest that doctor-nurse substitution would be cost-effective for general practice based cervical screening. Resource savings (principally doctor's time) could be redeployed to other areas of primary health care.

Clinical Competence↗
PubMed1996

The effects of recombinant human erythropoietin on functional health and well-being in chronic dialysis patients.

As a component of the open-label, multicenter National Cooperative Recombinant Human Erythropoietin (Epo) Study, the health-related quality-of-life effects of Epo therapy were assessed in 484 dialysis patients who had not previously been treated with Epo therapy (New-to-Epo) and 520 dialysis patients who were already receiving Epo therapy at the time of study enrollment (Old-to-Epo). Using scales from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36), health-related quality of life was assessed on study enrollment (baseline) and at an average of 99 days follow-up. At baseline, SF-36 scores for Old- and New-to-Epo patients were well below those observed in the general population, reflecting substantial impairments in functional status and well-being among patients with chronic renal failure. Significant improvements from baseline to follow-up were observed among New-to-Epo patients in vitality, physical functioning, social functioning, mental health, looking after the home, social life, hobbies, and satisfaction with sexual activity (P < 0.05 for each). The mean improvements in hematocrit values among New-to-Epo and Old-to Epo patients were 4.6 and 0.3, respectively. At the time of follow-up, SF-36 scores for New-to-Epo patients were comparable with those observed among Old-to-Epo patients, whose scores did not change significantly from baseline to follow-up. Analysis of the relationship between Epo therapy, hematocrit values, and health-related quality of life suggest that some of the beneficial quality-of-life effects of Epo are mediated through a change in hematocrit level.

Activities of Daily Living↗
PubMed1996

Chemokines and T lymphocyte recruitment to lymph nodes in HIV infection.

Recruitment of T lymphocytes to lymph nodes in patients with HIV infection is critical to the pathogenesis of disease. Chemokines are a family of cytokines, which are potent regulators of leukocyte migration. We studied the leukocyte populations and expression of chemokines known to be active upon T cells in lymph nodes of four HIV infected patients and seven control subjects using in situ hybridization, immunohistochemistry, and FACS analysis. The HIV lymph nodes showed CD8+ T lymphocyte accumulation and strongly enhanced chemokine expression, notably for the CD8+ T cell chemoattractant, macrophage inflammatory protein (MIP)-1 alpha. Resident macrophages appeared to be a major cellular source of chemokines in the HIV nodes. RANTES expression was present in both HIV and control lymph nodes, suggesting a physiological role for this chemokine in T lymphocyte recirculation. Chemokines may be important determinants of T lymphocyte accumulation in lymphoid tissue of patients with HIV/AIDS.

Adult↗
PubMed1996

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Emergency Medical Service Communication Systems↗
PubMed1996

Primary care across clinical settings.

This article discusses the role of the Family Nurse Practitioner. It is a personal account of the nurse practitioner role across the clinical spectrum of office, infirmary, hospital, and home care settings. General information is provided on professional liability, prescriptive authority, and other practice issues. An evaluation of the multi-faceted role of the nurse practitioner is provided.

Humans↗
PubMed1996

Bone marrow and chelatable iron in patients with protein energy malnutrition.

OBJECTIVES: To examine the iron status of malnourished children by comparing bone marrow iron deposits in children with protein energy malnutrition with those in well-nourished controls, and measuring chelatable urinary iron excretion in children with kwashiorkor. DESIGN: Bone marrow iron was assessed histologically in postmortem specimens from children with kwashiorkor or marasmus, and from controls. Twenty-four-hour urinary iron was measured in children with severe kwashiorkor, half of whom received 10 mg/kg of intramuscular desferrioxamine (DFO) on admission. SETTING: Red Cross War Memorial Children's Hospital, Cape Town. SUBJECTS: Thirteen children with kwashiorkor, 6 with marasmus and 16 well-nourished children underwent bone marrow examination. Urinary iron excretion was assayed in 17 children with kwashiorkor. RESULTS: Stainable iron was present in the bone marrow of half the children with kwashiorkor but in only 1 child in each of the other groups. The median iron excretion was 945.5 micrograms/24 hours in the DFO group compared with 28.5 micrograms/24 hours in the non-DFO group. CONCLUSIONS: There is an apparent excess of iron which may predispose to bacterial infections and free radical-mediated injury in children with kwashiorkor.

Bone Marrow↗
PubMed1995

Crystal structure of the membrane-exposed domain from a respiratory quinol oxidase complex with an engineered dinuclear copper center.

Cytochrome oxidase is a membrane protein complex that catalyzes reduction of molecular oxygen to water and utilizes the free energy of this reaction to generate a transmembrane proton gradient during respiration. The electron entry site in subunit II is a mixed-valence dinuclear copper center in enzymes that oxidize cytochrome c. This center has been lost during the evolution of the quinoloxidizing branch of cytochrome oxidases but can be restored by engineering. Herein we describe the crystal structures of the periplasmic fragment from the wild-type subunit II (CyoA) of Escherichia coli quinol oxidase at 2.5-A resolution and of the mutant with the engineered dinuclear copper center (purple CyoA) at 2.3-A resolution. CyoA is folded as an 11-stranded mostly antiparallel beta-sandwich followed by three alpha-helices. The dinuclear copper center is located at the loops between strands beta 5-beta 6 and beta 9-beta 10. The two coppers are at a 2.5-A distance and symmetrically coordinated to the main ligands that are two bridging cysteines and two terminal histidines. The residues that are distinct in cytochrome c and quinol oxidases are around the dinuclear copper center. Structural comparison suggests a common ancestry for subunit II of cytochrome oxidase and blue copper-binding proteins.

Amino Acid Sequence↗
PubMed1995

Health checks and coronary risk: further evidence from a randomised controlled trial.

OBJECTIVE: To determine the effectiveness of a health check and assess any particular benefits resulting from feedback of plasma cholesterol concentration or coronary risk score, or both. DESIGN: Randomised controlled trial in two Glasgow work sites. SUBJECTS: 1,632 employees (89% male) aged 20 to 65 years. INTERVENTIONS: At the larger work site, (a) health education; (b) health education and feedback on cholesterol concentration; (c) health education and feedback on risk score; (d) health education with feedback on cholesterol concentration and risk score (full health check); (e) no health intervention (internal control). At the other work site there was no health intervention (external control). MAIN OUTCOME MEASURES: Changes in Dundee risk score, plasma cholesterol concentration, diastolic blood pressure, body mass index and self-reported behaviours (smoking, exercise, alcohol intake, and diet) in comparison with internal and external control groups. RESULTS: Comparisons between the full health check and the internal control groups showed a small difference (0.13 mmol/l) in the change in mean cholesterol concentration (95% confidence interval 0.02 to 0.22, P = 0.02) but no significant differences for changes in Dundee risk score (P = 0.21), diastolic blood pressure (P = 0.71), body mass index (P = 0.16), smoking (P = 1.00) or exercise (P = 0.41). Significant differences between the two groups were detected for changes in self-reported consumption of alcohol (41% in group with full health check v 17% in internal control group, P = 0.001) fruit and vegetables (24% v 12%, P < 0.001), and fat (30% v 9%, P < 0.001). Comparison of all groups showed no advantage from feedback of cholesterol concentration or risk score, or both. CONCLUSIONS: The health check only had a small effect on reversible coronary risk. It was effective in influencing self reported alcohol consumption and diet. Feedback on cholesterol concentration and on risk score did not provide additional motivation for a change in behaviour.

Adult↗
PubMed1995

Cloning of the mouse gonadotropin beta-subunit-encoding genes, I. Structure of the follicle-stimulating hormone beta-subunit-encoding gene.

More than 16kb of genomic sequence encompassing the mouse follicle-stimulating hormone beta subunit (FSH beta)-encoding gene was isolated from a 129SvEv mouse genomic library. Comparisons of the nucleotide and deduced amino-acid sequences to the FSH beta sequences of other mammalian species confirm an evolutionarily conserved role of this important protein in reproduction.

Amino Acid Sequence↗
PubMed1995

Comparison of recombinant cyclooxygenase-2 to native isoforms: aspirin labeling of the active site.

The search for isoform-specific enzyme inhibitors has been the focus of much recent research effort. Towards this goal, human recombinant cyclooxygenase-2 (EC 1.14.99.1, prostaglandin H synthase) was expressed in insect cells and purified to > 98% purity. Recombinant enzyme was characterized both by physical methods and activity measurements and shown to be fully active with kinetic properties similar to native COX-2 and COX-1. After detergent extraction, the enzyme had hydrodynamic properties indistinguishable from native bovine COX-1 and corresponded to the enzyme dimer as measured with size-exclusion chromatography. Peptide mapping via Lys-C protease identified a site of N-linked glycosylation and the aspirin covalent modification site. In the presence of heme, aspirin-specifically acetylated Ser-516. The enzyme will be suitable for biophysical studies and may lead to isoform-specific enzyme inhibitors.

Amino Acid Sequence↗