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Biomedical subjects

P Adams

Publications and source records attributed to P Adams.

At least 37 records · Page 2Linked to original sources
PubMed2000

The analysis of microbial proteomes: strategies and data exploitation.

Microbes present special opportunities for proteomic analysis that are not yet available for other types of organisms, due mainly to the relative abundance of information on their genomes, their low levels of functional redundancy and their experimental tractability. They are also being used to develop and validate powerful new experimental approaches that surmount some important current limitations in this field. The review surveys the different proteomic procedures that are available and considers the advantages and disadvantages of different experimental strategies. The ways in which microbiologists - and others - can exploit proteomic data are also discussed.

Animals↗
PubMed2000

Interventions for pathological gambling.

BACKGROUND: With the legalization of new forms of gambling there are increasing numbers of individuals who appear to have gambling related problems and who are seeking help. The individual and societal consequences are significant. Pathological gambling can result in the gambler jeopardizing or losing a significant relationship or job and committing criminal offences. Pathological gamblers may develop general medical conditions associated with stress. Increased rates have been reported for mood disorders, attention-deficit/hyperactivity disorder, substance abuse or dependence. There is a high risk of suicide and a high correlation with antisocial, narcissistic and borderline personality disorders and alcohol addiction. With increasing public awareness of gambling related problems health funders and practitioners are asking questions about the efficacy of treatments. Consequently quality research into gambling treatment is crucial. OBJECTIVES: The objective of this review was to complete a systematic review and meta-analysis of all randomised controlled trials (RCTs) of psychological and pharmacological treatments for pathological gambling, from both published and unpublished scientific reports. SEARCH STRATEGY: Published and unpublished RCTs of treatments of pathological gambling were identified by searches of electronic databases and hand searching journals likely to contain RCTs of gambling treatments. Researchers and gambling treatment centres were contacted by letter. Bibliographies of all identified research studies were scanned to identify other relevant references. SELECTION CRITERIA: All RCTs of treatments for pathological gambling were eligible for inclusion. DATA COLLECTION AND ANALYSIS: The data was entered into the Cochrane Review Manager software (REVMAN). The component RCTs were quality rated, with special emphasis on the concealment of treatment allocation and blinding. Relative risk analyses were conducted for the dichotomous outcome of controlled vs. uncontrolled gambling. The relative risks were aggregated using both fixed and random effects models. Tests for heterogeneity were undertaken. Both short-term (1 month or less) and long-term (6 months or longer) outcomes were considered. MAIN RESULTS: Only four RCTs of psychological treatments were identified. These RCTs were heterogeneous in terms of design, interventions, outcome measurement and follow-up periods. All had small numbers of participants. The studies had poor methodological quality features. The experimental interventions, behavioural or cognitive-behavioural therapy (BT/CBT), were more efficacious than the control interventions in the short-term (relative risk 0.44, 95% confidence interval (CI) 0.24-0. 81). There was a trend for long-term treatment with BT/CBT to be more efficacious than the control treatments, but the statistical significance of this was sensitive to the statistical model used for meta-analysis. With a fixed effect model the relative risk was 0.56 (95% CI 0.33-0.95); the relative risk with a random effects model was 0.61 (95% CI 0.25-1.47). REVIEWER'S CONCLUSIONS: This systematic review revealed a paucity of evidence for effective treatment of pathological gambling. As gambling is becoming more accessible in many countries and there is epidemiological evidence of increasing rates of pathological gambling, more rigorous RCTs are required.

Behavior Therapy↗
PubMed2000

Identification of transcription activators that regulate gonococcal adaptation from aerobic to anaerobic or oxygen-limited growth.

Analysis of the Neisseria gonorrhoeae DNA sequence database revealed the presence of two genes, one encoding a protein predicted to be 37. 5% identical (50% similar) in amino acid sequence to the Escherichia coli FNR protein and the other encoding a protein 41% and 42% identical (54 and 51% sequence similarity) to the E. coli NarL and NarP proteins respectively. Both genes have been cloned into E. coli and insertionally inactivated in vitro. The mutated genes have been transformed into gonococci and recombined into the chromosome. The fnr mutation totally abolished and the narP mutation severely diminished the ability of gonococci to: (i) grow anaerobically; (ii) adapt to oxygen-limited growth; (iii) initiate transcription from the aniA promoter (which directs the expression of a copper-containing nitrite reductase, AniA, in response to the presence of nitrite); and (iv) reduce nitrite during growth in oxygen-limited media. The product of nitrite reduction was identified to be nitrous oxide. Immediately upstream of the narL/narP gene is an open reading frame that, if translated, would encode a homologue of the E. coli nitrate- and nitrite-sensing proteins NarX and NarQ. As transcription from the aniA promoter was not activated during oxygen-limited growth in the presence of nitrate, the gonococcal two-component regulatory system is designated NarQ-NarP rather than NarX-NarL. As far as we are aware, this is the first well-documented example of a two-component regulatory system working in partnership with a transcription activator in pathogenic neisseria. A 45 kDa c-type cytochrome that was synthesized during oxygen-limited, but not during oxygen sufficient, growth was identified as a homologue of cytochrome c peroxidases (CCP) of other bacteria. The gene for this cytochrome, designated ccp, was located, and its regulatory region was cloned into the promoter probe vector pLES94. Transcription from the ccp promoter was repressed during aerobic growth and induced during oxygen-limited growth and was totally FNR dependent, suggesting that the gonococcal FNR protein is a transcription activator of at least two genes. However, unlike AniA, synthesis of the CCP homologue was insensitive to the presence of nitrite during oxygen-limited growth.

Adaptation, Physiological↗
PubMed2000

Increased risk for posttransplant lymphoproliferative disease in recipients of liver transplants with hepatitis C.

Posttransplant lymphoproliferative disease (PTLD) is associated with immunosuppression and lymphotrophic viral infections. Hepatitis C virus (HCV) has been identified as a risk factor for non-Hodgkin's lymphoma, but no association between HCV and PTLD has been shown. To investigate this possibility, we identified patients with HCV who received their first orthotopic liver transplant at our unit between January 1, 1992, and December 31, 1996, and compared them with contemporary liver transplant recipients without HCV for incidence and risk factors for PTLD and survival. Fifty-seven patients with HCV and 127 patients without HCV were compared. There was no age difference (52 v 53 years; P =.85), but there were more men in the HCV group (man-woman ratio, 2.1:1 v 0.9:1; P =.006). No difference was observed in the follow-up period, graft survival, rejection episodes, or use of different immunosuppressive regimes (P >.05 for all). Four patients with HCV (7%) developed PTLD compared with 1 patient without HCV (0.8%; P =.02). The relative odds for developing PTLD in patients with HCV were 9.5. All patients who developed PTLD were administered OKT3 induction therapy. These data suggest that PTLD may be more prevalent in patients undergoing liver transplantation for HCV-related liver disease who also receive OKT3, and that HCV infection may be a risk factor for developing PTLD.

Adolescent↗
PubMed2000

Pregnancy and Kawasaki disease.

The management of a pregnant mother at 20 weeks' gestation presenting with ventricular fibrillation and her subsequent elective caesarean section at 38 weeks' gestation are described. Investigation showed the presence of coronary artery aneurysms due to Kawasaki disease. The pregnancy was further complicated by placenta praevia (grade IV).

Journal Article↗
PubMed2000

An interdisciplinary approach to the management of complex medical and dental conditions.

Dental and medical practice often requires an interdisciplinary approach integrating the knowledge, skills and experience of all the disciplines of dentistry, medicine and its associated fields into comprehensive treatment to maximize results. Rapid and comprehensive scientific and technological advances have made it difficult for dental and medical practitioners to keep up to date in their fields; thus, to decrease practitioner frustration and increase patient benefits, an interdisciplinary approach has become essential. This report illustrates how therapy was coordinated for a young medically compromised patient with dental phobia and significant dental problems. The latest advances in dental techniques and materials, medical technology and pharmacology are highlighted. The communication and cooperation of team members with each other and with the patient and guardians is illustrated. The astute observation by a medical practitioner in an unrelated discipline led to the improvement in the quality of life for a patient.

Adolescent↗
PubMed2000

Insight: a mental health prevention intervention.

Modern health care systems are grasping the financial benefit of illness prevention programs. In mental illness prevention, psychiatric and mental health nurses are challenged to demonstrate efficacy in meeting the needs of the public and maintaining its position as one of the core mental health professions. The Center of Advanced Nursing Practice's Evidence-Based Practice Model provided the framework for guiding a pilot study intervention program, Insight, that facilitated a depression prevention program for women by an advanced practice nurse. Preliminary findings support the efficacy of Insight in a community setting and with program modifications.

Adult↗
PubMed2000

Hospital-wide intravenous initiative.

During a 6-month period under the leadership of a clinical nurse specialist, a Midwestern tertiary care hospital explored the need for standardizing a hospital-wide intravenous infusion system, based on best practice. The Center for Advanced Nursing Practice's Evidence-Based Practice Model guided the process for successful design, implementation, and reporting of results. The new system contributed to positive outcomes identified in project goals: (1) to minimize patient risk from interruption of intravenous lines; (2) to increase clinician satisfaction by improved user safety and system standardization; and (3) to demonstrate responsible organizational financial stewardship. Ultimately, the standardized hospital-wide intravenous initiative empowered bedside clinicians by providing an infrastructure for best practice.

Education, Nursing, Continuing↗
PubMed2000

Guided imagery: replication study using coronary artery bypass graft patients.

Replication of a guided imagery study, based on the work of D. Tusek and colleagues, was initiated for coronary artery bypass graft patients, using the Center for Advanced Nursing Practice's Evidence-Based Practice Model. Through the leadership of clinical nurse specialists and the support of perioperative and postoperative bedside clinicians, this initiative offered benefits to patients and served as a template for program expansion to other patient populations.

Aged↗
PubMed1999

Clinical priorities. Points make prizes.

Assessing patients for non-urgent surgery according to a numeric priority system has rationalised waiting times in three specialties in a pilot project. Traditional scoring systems result in little relation between urgency and waiting times. Enlisting doctors' support for a scoring system takes time.

Elective Surgical Procedures↗
PubMed1999

Depressed adolescents grown up.

CONTEXT: Major depressive disorder (MDD) that arises in adolescence impairs functioning and is associated with suicide risk, but little is known about its continuity into adulthood. OBJECTIVE: To describe the clinical course of adolescent-onset MDD into adulthood. DESIGN AND PARTICIPANTS: Prospective case-control study. Seventy-three subjects had onset of MDD based on systematic clinical assessment during adolescence (Tanner stage III-V) and 37 controls had no evidence of past or current psychiatric disorders, and also were assessed in adolescence (assessment years: 1977-1985). Follow-up was conducted 10 to 15 years after the initial assessment by an independent team without knowledge of initial diagnosis (follow-up years: 1992-1996). SETTING: Cases were identified at Columbia Presbyterian Hospital, New York City, NY; controls were recruited from the community. MAIN OUTCOME MEASURES: Suicide and suicide attempts, psychiatric diagnoses, treatment utilization, and social functioning. RESULTS: Clinical outcomes of adolescent-onset MDD into adulthood compared with control subjects without psychiatric illness include a high rate of suicide (7.7%); a 5-fold increased risk for first suicide attempt; a 2-fold increased risk of MDD, but not other psychiatric disorders; an increased occurrence of psychiatric and medical hospitalization; and impaired functioning in work, social, and family life. Thirty-seven percent of those with adolescent MDD survived without an episode of MDD in adulthood vs 69% of the control participants (relative risk, 2.2 [95% confidence interval, 1.0-4.7; P<.05]). CONCLUSION: There is substantial continuity, specificity, morbidity, and potential mortality from suicide into adulthood in adolescent-onset MDD patients. Now that empirically based guides to their treatment are becoming available, early identification and treatment seems warranted.

Adolescent↗
PubMed1999

Children with prepubertal-onset major depressive disorder and anxiety grown up.

BACKGROUND: The continuity in adulthood of major depressive disorder (MDD) first arising before puberty is largely unknown. This information could guide early treatment and clarify the appropriateness of including children with MDD in genetic studies. METHODS: Eighty-three subjects with onset of MDD, 44 subjects with anxiety disorder and no MDD, and 91 subjects with no evidence of past or current psychiatric disorders were assessed by two psychiatrists before puberty (Tanner stage < III) and were evaluated 10 to 15 years later as adults by an independent team without knowledge of the initial diagnosis. RESULTS: The clinical outcome of children with prepubertal-onset MDD in adulthood includes a high risk of suicide attempts (nearly 3-fold compared with normal controls and 2-fold compared with children with anxiety) and bipolar disorder. Compared with controls, both the children with MDD and those with anxiety went on to have increased risk of substance abuse and conduct disorder but not other disorders, increased use of longterm psychiatric and medical services, and overall impaired functioning. Children with prepubertal-onset MDD with a recurrence of MDD during follow-up had higher rates of MDD in their first-degree relatives. CONCLUSIONS: There is high morbidity in clinically referred children with prepubertal-onset MDD and anxiety, but continuity and specificity of MDD or anxiety disorder in adulthood is less clear. Caution is warranted in selecting clinically referred children with prepubertal-onset MDD for inclusion in genetic studies unless they have a family history of MDD and recurrence of MDD over time.

Adolescent↗
PubMed1999

Defining protease specificity with proteomics: a protease with a dibasic amino acid recognition motif is regulated by a two-component signal transduction system in Salmonella.

Microbial proteases play diverse and important roles in bacterial virulence but their detection and characterisation is often hampered by their limited abundance or lack of expression in the absence of suitable environmental signals. We describe here a sensitive proteomic approach to detect proteases that are under the control of a virulence regulator and to characterise their recognition motifs. Using MG++-depleted growth media or a mutant strain of Salmonella in which the PhoP-PhoQ virulence regulatory system is constitutively active, truncated forms of DnaK, elongation factor G, elongation factor Tu and ribosomal protein S1 proteins were detected. Two other global regulatory mutants and cells exposed to acid or to oxidative stress failed to produce the truncated proteins, indicating specific control of the protease activity by the PhoP-PhoQ system. Our results suggest that at least two proteases are induced. To define the proteolytic cleavage sites of one of the proteases, peptides from each of the truncated proteins were identified by tryptic mass fingerprinting/nanoelectrospray mass spectrometry and mapped onto the sequence of the intact protein. Alignment of the regions around the cut site indicates that the protease recognises a dibasic amino acid motif characteristic of the omptin protease family. The induction of such proteases in bacteria depleted of Mg++ ions may contribute to the PhoPQ-mediated resistance of Salmonella to cationic antimicrobial peptides. Additionally, our results suggest it would be prudent to keep the concentration of this ion above micromolar levels during bacterial sample preparation for proteomic analyses.

Acids↗
PubMed1999

Giardia duodenalis cysts of genotype A recovered from clams in the Chesapeake Bay subestuary, Rhode River.

Filter-feeding molluscan shellfish can concentrate zoonotic and anthroponotic waterborne pathogens. Cysts of Giardia sp. were detected by immunofluorescent antibodies in tissues of the clams Macoma balthica and M. mitchelli from Rhode River, a Chesapeake Bay (Maryland) subestuary. Molecular tests identified the cysts as Giardia duodenalis Genotype A, the most common genotype recovered from humans. Macoma clams are burrowers in mud or sandy-mud substrata and preferentially feed on the surface sediment layer. Waterborne Giardia cysts settle rapidly to the bottom in slow-moving waters and contaminate the sediment. Macoma clams do not have economic value, but can serve as biologic indicators of sediment contamination with Giardia sp. cysts of public health importance. These clams can be used for sanitary assessment of water quality.

Animals↗
PubMed1998

Hebb and Darwin.

It is proposed that vertebrate brains, especially those of mammals, operate according to an algorithm subsumable as "synaptic Darwinism". The key postulate is that genes and synapses follow the same rules, because they act as autocatalytic, hypercyclic, units of selection. Synapses replicate by quantally strengthening, and mutate by connecting new cells. Because synapses relate pre- and post-synaptic firing, they perform a translation operation. Furthermore the product of this operation, conjoint firing, favors replication (by Hebb's Rule). The result is that variants are selected and patterns of connection automatically adopt optimal configurations. These configurations are determined by scalar neuromodulatory "reward" signals applied globally to layers of neurons, which reduce spike frequency adaptation and enhance Hebbian replication. Global or local control of mutation rates provides further improvements in the Darwinian algorithm. All the processes and circuits postulated have plausible, and often obvious, implementations. The result is that brains evolve and adapt like large ecosystems.

Animals↗