Does undergraduate education have an effect on Edinburgh medical students' attitudes to psychiatry and psychiatric patients?
Explore the source record for details and available documents.
Attitude↗
Biomedical subjects
M Power
Publications and source records attributed to M Power.
Applications of comparative genomic hybridisation in constitutional chromosome studies.
G band cytogenetic analysis often leads to the discovery of unbalanced karyotypes that require further characterisation by molecular cytogenetic studies. In particular, G band analysis usually does not show the chromosomal origin of small marker chromosomes or of a small amount of extra material detected on otherwise normal chromosomes. Comparative genomic hybridisation (CGH) is one of several molecular approaches that can be applied to ascertain the origin of extra chromosomal material. CGH is also capable of detecting loss of material and thus is also applicable to confirming or further characterising subtle deletions. We have used comparative genomic hybridisation to analyse 19 constitutional chromosome abnormalities detected by G band analysis, including seven deletions, five supernumerary marker chromosomes, two interstitial duplications, and five chromosomes presenting with abnormal terminal banding patterns. CGH was successful in elucidating the origin of extra chromosomal material in 10 out of 11 non-mosaic cases, and permitted further characterisation of all of the deletions that could be detected by GTG banding. CGH appears to be a useful adjunct tool for either confirming deletions or defining their breakpoints and for determining the origin of extra chromosomal material, even in cases where abnormalities are judged to be subtle. We discuss internal quality control measures, such as the mismatching of test and reference DNA in order to assess the quality of the competitive hybridisation effect on the X chromosome.
Chromosome Banding↗
An approach to policy analysis and development of medical informatics.
There are three grand challenges for medical informatics policy: (1) What is it? (2) What should it be? (3) How can we influence its development? To address these challenges requires: (1) an historical analysis of medical informatics policies in a representative sample of countries. This should include an account of major events, the roles of technology, individuals, culture and social settings. Pioneers have been led by visions of what medical informatics should achieve. The role of these visions and the reactions to unmet expectations thus also need to be analysed; (2) a generally applicable medical informatics policy that places the needs of its stakeholders and clients first. Top priorities are to support quality health care delivery and quality management of health care facilities; (3) an explanation of how policies in medical informatics are created and implemented together with a strategy to guide medical informatics professionals in their lobbying efforts.
Humans↗
Distinct subdomains of the EphA3 receptor mediate ligand binding and receptor dimerization.
Eph receptor tyrosine kinases and their ligands (ephrins) are highly conserved protein families implicated in patterning events during development, particularly in the nervous system. In a number of functional studies, strict conservation of structure and function across distantly related vertebrate species has been confirmed. In this study we make use of the observation that soluble human EphA3 (HEK) exerts a dominant negative effect on somite formation and axial organization during zebrafish embryogenesis to probe receptor function. Based on exon structure we have dissected the extracellular region of EphA3 receptor into evolutionarily conserved subdomains and used kinetic BIAcore analysis, mRNA injection into zebrafish embryos, and receptor transphosphorylation analysis to study their function. We show that ligand binding is restricted to the N-terminal region encoded by exon III, and we identify an independent, C-terminal receptor-dimerization domain. Recombinant proteins encoding either region in isolation can function as receptor antagonists in zebrafish. We propose a two-step mechanism of Eph receptor activation with distinct ligand binding and ligand-independent receptor-receptor oligomerization events.
Animals↗
Recovery of swallowing after dysphagic stroke relates to functional reorganization in the intact motor cortex.
BACKGROUND & AIMS: The aim of this study was to determine the mechanism for recovery of swallowing after dysphagic stroke. METHODS: Twenty-eight patients who had a unilateral hemispheric stroke were studied 1 week and 1 and 3 months after the stroke by videofluoroscopy. Pharyngeal and thenar electromyographic responses to magnetic stimulation of multiple sites over both hemispheres were recorded, and motor representations were correlated with swallowing recovery. RESULTS: Dysphagia was initially present in 71% of patients and in 46% and 41% of the patients at 1 and 3 months, respectively. Cortical representation of the pharynx was smaller in the affected hemisphere (5 +/- 1 sites) than the unaffected hemisphere (13 +/- 1 sites; P </= 0.001). Nondysphagic and persistently dysphagic patients showed little change in pharyngeal representation in either hemisphere at 1 and 3 months compared with presentation, but dysphagic patients who recovered had an increased pharyngeal representation in the unaffected hemisphere at 1 and 3 months (15 +/- 2 and 17 +/- 3 vs. 9 +/- 2 sites; P </= 0.02) without change in the affected hemisphere. In contrast, thenar representation increased in the affected hemisphere but not the unaffected hemisphere at 1 and 3 months (P </= 0.01). CONCLUSIONS: Return of swallowing after dysphagic stroke is associated with increased pharyngeal representation in the unaffected hemisphere, suggesting a role for intact hemisphere reorganization in recovery.
Aged↗
Bone markers: overuse and much abuse.
Explore the source record for details and available documents.
Biomarkers↗
Collagen cross-links levels and bone density in postmenopausal coeliac patients.
Explore the source record for details and available documents.
Aged↗
Tolerance and pharmacokinetic interactions of rifabutin and clarithromycin in human immunodeficiency virus-infected volunteers.
This study evaluated the tolerance and potential pharmacokinetic interactions between clarithromycin (500 mg every 12 h) and rifabutin (300 mg daily) in clinically stable human immunodeficiency virus-infected volunteers with CD4 counts of <200 cells/mm3. Thirty-four subjects were randomized equally to either regimen A or regimen B. On days 1 to 14, subjects assigned to regimen A received clarithromycin and subjects assigned to regimen B received rifabutin, and then both groups received both drugs on days 15 to 42. Of the 14 regimen A and the 15 regimen B subjects who started combination therapy, 1 subject in each group prematurely discontinued therapy due to toxicity, but 19 of 29 subjects reported nausea, vomiting, and/or diarrhea. Pharmacokinetic analysis included data for 11 regimen A and 14 regimen B subjects. Steady-state pharmacokinetic parameters for single-agent therapy (day 14) and combination therapy (day 42) were compared. Regimen A resulted in a mean decrease of 44% (P = 0.003) in the clarithromycin area under the plasma concentration-time curve (AUC), while there was a mean increase of 57% (P = 0.004) in the AUC of the clarithromycin metabolite 14-OH-clarithromycin. Regimen B resulted in a mean increase of 99% (P = 0.001) in the rifabutin AUC and a mean increase of 375% (P < 0.001) in the AUC of the rifabutin metabolite 25-O-desacetyl-rifabutin. The usefulness of this combination for prophylaxis of Mycobacterium avium infections is limited by frequent gastrointestinal adverse events. Coadministration of clarithromycin and rifabutin results in significant bidirectional pharmacokinetic interactions. The resulting increase in rifabutin levels may explain the increased frequency of uveitis observed with concomitant use of these drugs.
Acquired Immunodeficiency Syndrome↗
Growth variation in common marmoset monkeys (Callithrix jacchus) fed a purified diet: relation to care-giving and weaning behaviors.
Significant relations were observed between select infant-care and weaning behaviors and growth in body weight in common marmoset monkeys (Callithrix jacchus). The patterns of these relations suggest that earlier occurrence of developmental milestones, such as cessation of transport (being off carriers) and weaning to solid food, were associated with slower growth during the subsequent period. In contrast, more frequent nursing bouts during the period in which weaning was initiated were associated with higher growth rates. In the case of being off carriers, these effects did not carry over to older ages, suggesting that any deficits in growth were temporary. In the case of earlier, more frequent consumption of solid food, there was some suggestion that there were longer-term effects, followed by catch-up growth. The knee-to-heel length of subjects was not related to the measured behaviors. There was no relation between early weaning to solid food and leanness at day 75, suggesting that, although this behavior was affecting overall weight, it did not affect relative gains of fat versus lean mass. There were, however, significant correlations between cessation of transport or frequency of nursing bouts during the weaning period and leanness, with earlier cessation of transport and less frequent nursing associated with leaner infants, after weaning. Our results differed from those of a previous study that found a relation between linear growth and abuse in this species, with abuse defined as physical injury by other members of the group. We found no differences in growth between abused and nonabused infants. However, abused infants had lower birth weight.
Animals↗
Social support in patients with anorexia nervosa and bulimia nervosa.
OBJECTIVE: To investigate the social support networks of patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD: Social support was measured using the Significant Others Scale for 44 patients with AN, 81 patients with BN, and 86 polytechnic students. RESULTS: Eating disorder patients had smaller social networks than the students. AN patients were significantly less likely than BN patients to have a spouse or partner as a support figure. Both AN and BN patients reported less actual emotional and practical support than students. AN patients perceived their social support to be adequate, whereas BN patients were dissatisfied with their support. Patients set lower ideals for support than the students. Social support was not correlated with duration of illness. DISCUSSION: AN and BN patients have deficient social networks. In BN patients there is disturbance in both the size and perceived adequacy of social relationships.
Adult↗
SPECIAL SECTION: Perspectives of the Scientific Community on the Status of Ecological Risk Assessment
/ Views from a wide variety of practicing environmental professionals on the current status of ecological risk assessment (ERA) indicate consensus and divergence of opinion on the utility and practice of risk assessment. Central to the debate were the issues of whether ERA appropriately incorporates ecological and scientific principle into its conceptual paradigm. Advocates argue that ERA effectively does both, noting that much of the fault detractors find with the process has more to do with its practice than its purpose. Critics argue that failure to validate ERA predictions and the tendency to over-simplify ecological principles compromise the integrity of ERA and may lead to misleading advice on the appropriate responses to environmental problems. All authors felt that many improvements could be made, including validation, better definition of the ecological questions and boundaries of ERA, improved harmonization of selected methods, and improvements in the knowledge base. Despite identified deficiencies, most authors felt that ERA was a useful process undergoing evolutionary changes that will inevitably determine the range of environmental problems to which it can be appropriately applied. The views expressed give ERA a cautious vote of approval and highlight many of the critical strengths and weaknesses in one of our most important environmental assessment tools.KEY WORDS: Ecological risk assessment; Ecology; Probability
Journal Article↗
Immunological effects of grain dust.
Explore the source record for details and available documents.
Agricultural Workers' Diseases↗
Turner syndrome: a cytogenetic and molecular study.
Two hundred and eleven patients with a clinical diagnosis of Turner syndrome were studied. We report (i) the cytogenetic results, (ii) the frequency of cryptic mosaicism and (iii) the parental age and the parental origin of the abnormality. We scored 100 cells from blood cultures and found 97 patients to have a 45,X constitution, 15 to be 45,X/46,XX or 45,X/47,XXX mosaics, 86 to have a structurally abnormal X and 13 to have a structurally abnormal Y chromosome. Molecular methods were used to look for cryptic X and Y chromosome mosaicism in patients with a 45,X constitution. Two cryptic X but no cryptic Y mosaics were detected. In 74% of the 45,X patients the X was maternal in origin. The i(Xq)s were approximately equally likely to involve the paternal or maternal chromosome, while the majority of deletions and rings and virtually all the abnormal Y chromosomes were paternal in origin. We suggest that the preponderance of paternal errors in Turner syndrome may result from the absence of pairing along the greater part of the XY bivalent during paternal mei I, which may make the sex chromosomes particularly susceptible to both structural and non-disjunctional errors during male gametogenesis.
Adolescent↗
Most patients attending a 'walk-in' clinic at Red Cross War Memorial Children's Hospital could safely be managed at primary care level.
OBJECTIVES: (i) To ascertain what proportion of patients attending the general medical outpatient service at Red Cross War Memorial Children's Hospital (RXH) could safely be managed at peripheral primary care facilities; and (ii) to measure the effect of the introduction of free health care for children under 6 years of age on requirements for levels of care ranging from home to super-specialist referral centres. DESIGN: Prospective survey of patients attending on a stratified, randomised sample of 7 days in March 1994 (N = 1 962) and again in November 1994 (N = 1 404)-before and after the introduction on 6 June 1994 of free care for children under 6 years of age. SETTING: The general outpatient department of an academic/referral children's hospital. PATIENT SELECTION: All patients attending the outpatient department on the study days (7h00 to 6h59 the following day), excluding those who were referred, returning for follow-up, attending a specialist clinic or attending the surgical outpatient department. QUESTIONNAIRE: The questionnaire completed by medical officers recorded the following: patient's name, folder number, date and time of arrival, whether referred, clinic, treating doctor, disposal, diagnoses, home suburb and the level of care required: (i) home: (ii) clinic without a doctor; (iii) clinic with a doctor; (iv) hospital with non-specialists; (v) hospital with general paediatricians; or (vi) super-specialist hospital. MAIN RESULTS: In March 1994 the percentages of unreferred patients requiring the 6 levels of care defined for the study were 0.3, 25, 62, 8, 3 and 1, respectively. In November 1994 the percentages were 4, 41, 43, 8, 4 and 1. The graph of the number of patients seen at the outpatient department each month shows a large month-to-month variation but the trend is clearly towards an increase. CONCLUSIONS: The general medical outpatient department at RXH provides care to a large number of children, 48% of whom are unreferred. Of the unreferred patients 95% could be treated (more appropriately for the health services and more conveniently for their families) at a local primary health care facility. The situation has been aggravated by the introduction of free care for children under 6 years of age, who constitute 83% of the unreferred workload.
Child Health Services↗
Levels and alternative splicing of amyloid beta protein precursor (APP) transcripts in brains of APP transgenic mice and humans with Alzheimer's disease.
Abnormal expression of human amyloid precursor protein (hAPP) gene products may play a critical role in Alzheimer's disease (AD). Recently, a transgenic model was established in which platelet-derived growth factor (PDGF) promoter-driven neuronal expression of an alternatively spliced hAPP minigene resulted in prominent AD-type neuropathology (Games, D., Adams, D., Alessandrini, R., Barbour, R., Berthelette, P., Blackwell, C., Carr, T., Clemens, J., Donaldson, T., Gillespie, F., Guido, T., Hagopian, S., Johnson-Wood, K., Khan, K., Lee, M., Leibowitz, P., Lieberburg, I., Little, S., Masliah, E., McConlogue, L., Montoya-Zavala, M., Mucke, L., Paganini, L., and Penniman, E. (1995) Nature 373, 523-527). Here we compared the levels and alternative splicing of APP transcripts in brain tissue of hAPP transgenic and nontransgenic mice and of humans with and without AD. PDGF-hAPP mice showed severalfold higher levels of total APP mRNA than did nontransgenic mice or humans, whereas their endogenous mouse APP mRNA levels were decreased. This resulted in a high ratio of mRNAs encoding mutated hAPP versus wild-type mouse APP. Modifications of hAPP introns 6, 7, and 8 in the PDGF-hAPP construct resulted in a prominent change in alternative splice site selection with transcripts encoding hAPP770 or hAPP751 being expressed at substantially higher levels than hAPP695 mRNA. Frontal cortex of humans with AD showed a subtle increase in the relative abundance of hAPP751 mRNA compared with normal controls. These data identify specific intron sequences that may contribute to the normal neuronspecific alternative splicing of APP pre-mRNA in vivo and support a causal role of hAPP gene products in the development of AD-type brain alterations.
Aged↗
Perinatal mortality in the Cape Province, 1989-1991.
OBJECTIVE: To determine the number of deliveries, the low-birth-weight rate and the perinatal mortality rate at provincial and province-aided hospitals and clinics in each planning region of the Cape Province. DESIGN: A record of the number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in provincial and province-aided hospitals and clinics in each planning region of the Cape Province between 1 January 1989 and 31 December 1991. SETTING: All provincial and province-aided hospitals and clinics in the Cape Province. PARTICIPANTS: Hospital and clinic staff of all provincial and province-aided hospitals and clinics in the Cape Province. MAIN OUTCOMES MEASURED: Number of deliveries, low-birth-weight infants, stillbirths and early neonatal deaths in each planning region of the Cape Province. RESULTS: A total of 373,768 births were recorded during the 3-year period with a low-birth-weight rate of 14.7%, a stillbirth rate of 17.9 per 1,000 and an early neonatal mortality rate of 9.1 per 1,000. All rates differed widely between regions. The regions with the highest perinatal mortality rates were in the northern and eastern Cape. CONCLUSION: The perinatal demographics of most regions in the Cape Province are typical of a developing country. Regions which have been identified as having the highest low-birth-weight, stillbirth and early neonatal mortality rates are in greatest need of improved perinatal health care.
Demography↗
A health informatics policy for South Africa?
Explore the source record for details and available documents.
Forecasting↗
Developing a health informatics policy for South Africa.
In a developing country, is it possible to produce a comprehensive national policy for health informatics in a rational and democratic way? This report argues that it is--if close attention is paid to the process of policy development. Although we have recently started our journey down this road, it is possible to draw useful conclusions. With sufficient funding to cover meeting costs and a supportive environment, such a project has a good chance of succeeding. The process should involve key stakeholders; agreement on definitions, purpose and scope should be obtained early. The policy should contain a strategy for implementation, measurable goals, plans for training and long term maintenance, and specifications for regular review. Health information systems should not be promoted as panaceas. Debates arising from the policy development process should promote realistic expectations shared by policy makers, system implementers, and managers. The process itself has significant benefits for the participants who both learn and establish networks with other people. Although developing countries depend on aid from international agencies, unexpected management problems may arise.
Health Policy↗