Biomedical subjects
Publications and source records attributed to M Sharpe.
With high-tech remediation technologies proving too expensive for all but the most seriously polluted sites, scientists and regulators are looking to the restorative powers of Nature to clean-up contamination. Effective implementation of so-called 'natural attenuation' techniques relies crucially on high quality environmental analysis.
Amongst the mass of academic papers and policy reports it is easy to forget that scientists and regulators are not the only ones concerned about the environment. The public has an interest too. Aided by modern technology and increasing legal rights, the man in the street has access to environmental information as never before. In this article we review recent developments in public assess and what these mean for 'the experts'.
To restore its authority in the GM debate science has to face up to uncertainty, public mistrust and fierce commercial pressures.
Nineteen-ninety eight was a frantic year in the hormone-disruptor debate, with a whole series of studies and initiatives pushing the hormones issue up the policy agenda. As policy-makers weigh the options, the environmental monitoring community has an important opportunity to shape future policies.
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Cognitive behavior therapy (CBT) is a form of non-pharmacologic treatment. It is based on a model of chronic fatigue syndrome (CFS) that hypothesizes that certain cognitions and behavior may perpetuate symptoms and disability--that is, act as obstacles to recovery. Treatment emphasizes self-help and aims to help the patient to recover by changing these unhelpful cognitions and behavior. There is now good evidence from 2 independent randomized clinical trials to support the efficacy of CBT in patients with CFS. The treatment effect is substantial, although few patients are cured. The urgent clinical need is to make this form of treatment available to patients with CFS. One approach is to incorporate the principles of CBT into routine clinical practice. The preliminary evaluation of these simpler forms of CBT are promising, although the results of controlled trials are awaited. At present, intensive individual CBT administered by a skilled therapist remains the treatment of choice for patients with CFS.
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BACKGROUND: Impairments in both basal activity and activation of the hypothalamic-pituitary-adrenal axis (HPA) have been reported in chronic fatigue syndrome (CFS; neurasthenia). We sought to replicate these findings and examined basal activity of the HPA in a carefully selected sample of patients with CFS. METHODS: Basal activity of the HPA was assessed using salivary and urinary cortisol collection over a 24-hour period in 22 (12 male; 10 female) patients meeting criteria for CFS and appropriate controls. RESULTS: Salivary and urinary cortisol measures did not differ between CFS patients and controls. CONCLUSIONS: Basal activity of the HPA was not reduced in CFS patients. Reasons for the failure to replicate previous findings are discussed.
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Nitric oxide (NO) has recently been recognized as an important biological mediator that inhibits respiration at cytochrome c oxidase (CcO). This inhibition is reversible and shows competition with oxygen, the Ki being lower at low oxygen concentrations. Although the species that binds NO in turnover has been suggested to contain a partially reduced binuclear center, the exact mechanism of the inhibition is not clear. Recently, rapid (ms) redox reactions of NO with the binuclear center have been reported, e.g., the ejection of an electron to cytochrome a and the depletion of the intermediates P and F. These observations have been rationalized within a scheme in which NO reacts with oxidized CuB leading to the reduction of this metal center and formation of nitrite in a very fast reaction. Electron migration from CuB to other redox sites within the enzyme is proposed to explain the optical transitions observed. The relevance of these reactions to the inhibition of CcO and metabolism of NO are discussed.
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BACKGROUND AND PURPOSE: Although the physical and, to a lesser extent, emotional outcome of stroke survivors has been well documented, there are far fewer data relating to the outcomes of those who care for them. We aimed to describe the outcome of those caring for stroke patients and to identify both patient and caregiver factors that are associated with poor caregiver outcomes. METHODS: As part of a randomized trial to evaluate a stroke family care worker, we identified 417 patients (67% of all referrals to our institution). We followed up 376 survivors of whom 246 identified a caregiver at a 6-month follow-up interview. The patients and caregivers were asked to complete 2 measures of emotional distress ( 30-item General Health Questionnaire [GHQ-30] and Hospital Anxiety and Depression [HAD] Scale). A regression analysis was used to identify factors that were independently associated with poor caregiver outcomes. RESULTS: Fifty-five percent of responding caregivers scored more than 4 on the GHQ-30, indicating that emotional distress is common in this group. Caregivers were more likely to be depressed if the patients were severely dependent (P<0.01) or emotionally distressed themselves (P<0.01). Female caregivers reported more anxiety (median HAD=8) than male caregivers (median HAD=5; P<0.01) but caregivers' levels of anxiety were not so clearly related to the patients' degree of physical disability as their levels of depression. Caregivers suffered more emotional distress if the patients had been dependent before their strokes. CONCLUSIONS: These data may help to identify those caregivers at greatest risk of poor emotional outcomes and thus help in the planning of trials and delivery of interventions aimed at preventing or treating distress among caregivers.
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A small proportion of patients use a disproportionate amount of general practitioners' (GPs') time. We demonstrate here that such frequent attending behaviour tends to persist through five-year follow-up, suggesting the need for the development of specific management strategies. We also show that, at any rate in one practice, total workload is increasing dramatically, and that frequent consulters make up a large part of the increase.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.