Biomedical subjects
Publications and source records attributed to P Higgins.
Amnioinfusion is one of the most innovative techniques of the decade. The authors reviewed current literature, research indications, and nursing implications for amnioinfusion. Current technology has simplified the amnioinfusion procedure. This technique provides both therapeutic and prophylactic regimens for the intrapartum mother and her fetus, and it has many clinical implications for nursing.
OBJECTIVE: To examine synchronous changes in soluble interleukin-2 receptor (sIL-2R) levels, daily indicators of emotional stress, joint inflammation, and reported pain in patients with rheumatoid arthritis (RA). METHODS: Fourteen patients were studied on each of 6 occasions, 2 weeks apart. Measures included daily ratings of mood disturbance, undesirable events, and joint pain; clinical examination of joint swelling; and serum assays of sIL-2R. Pooled within-person correlations among these variables were calculated. RESULTS: Consistent with the results of previous research, joint inflammation covaried directly with sIL-2R levels. Changes in mood disturbance were unrelated to changes in joint inflammation, but increases in mood disturbance were linked with decreases in sIL-2R levels and increases in reported joint pain. CONCLUSION: These findings provide preliminary evidence that psychoimmune processes may be implicated in short-term changes in RA disease activity.
The immunogenicity and pathogenicity of a strain of respiratory syncytial (RS) virus modified by sequential induction of three temperature-sensitive (ts) mutations have been evaluated by intranasal administration to 22 adult volunteers. This modified virus, a triple ts mutant designated ts1C, was derived from a double mutant ts1B evaluated in a previous trial. The original isolate (strain RSS-2) and all its derivatives were propagated throughout in human diploid cells in a specially assigned laboratory. The triple mutant ts1C is unable to multiply in MRC-5 cells at 37 degrees C and above. Following nasal administration of ts1C, immune responses were observed in volunteers with low pre-existing neutralizing antibody titres. The ability of mutant ts1C to induce upper respiratory tract disease in adults was greatly diminished in comparison with the non-ts wild-type virus, but not markedly more so than a previously tested double ts mutant (ts1B) which replicates at 37 degrees C. Mutant ts1C, however, may have greater potential as a live vaccine in view of its inherently greater genetic stability.
For 75 consecutive days, 54 Ss with rheumatoid arthritis supplied daily reports of their mood and joint pain. After aggregating daily reports, the relation between chronic mood and chronic pain remained statistically significant when controlling for neuroticism, depression, disease activity, disability, and characteristic responses to increasing pain. Findings of a path analysis suggest that (a) individuals higher in neuroticism experience more chronic distress regardless of their responses to pain, their pain intensity, and depressive symptomatology, and (b) the relation between neuroticism and chronic pain is mediated by the propensity of high-neuroticism individuals to catastrophize their pain. Within-subject analyses that controlled for autocorrelation and linear trends in the time series revealed that 40% of the Ss experienced significantly worse moods on more painful days. Although individuals higher in neuroticism reported more intense pain and more negative mood, their daily mood was less strongly linked to their daily pain.
OBJECTIVE: The aim of this study was to determine the prevalence and clinical relevance of weight gain during clozapine treatment. Previous reports indicated clinically significant weight gain in 13% to 85% of patients and an average gain of 9.0 to 24.7 lb. METHOD: Twenty-one state hospital patients with treatment-resistant schizophrenia or schizoaffective disorder were weighed weekly for 12 weeks before clozapine treatment and during the first 16 weeks of treatment. Psychiatric symptoms were rated with a modified version of the Brief Psychiatric Rating Scale (BPRS). RESULTS: The mean weight gain for the entire group was 13.9 lb, or 8.9% of body weight. During the 16 weeks of clozapine treatment, 38% of the patients experienced marked weight gains and 29% had moderate weight gains. The improvements in BPRS total score and composite negative symptom score were significantly greater for the eight patients with marked weight gains than for the other 13 patients. CONCLUSIONS: Clozapine's propensity to induce weight gain may relate to the drug's efficacy and/or its unique neuropharmacologic effects. Increased attention to this phenomenon is important because of the morbidity associated with obesity.
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An immunological approach has been used to identify embryo-specific products that can be used as molecular markers of embryogenesis. Immunoadsorption of antisera to remove antigens common to embryos, meristematic cells and callus, revealed one major embryo-specific antigen, a polypeptide of 17 kDa. The antigen appeared at mid-stages of zygotic embryo formation and remained at similar levels up to six days post-germination of the seedling. The polypeptide could not be detected by protein staining, suggesting it is a non-abundant product. Appearance of the antigen could be induced by culture of zygotic embryos in vitro on abscisic acid (1 microM) or mannitol (9% mass/vol.). Cross-reactive products of near-identical molecular mass were observed in embryos of wheat, rye and oats but not distantly related cereals, nor embryos from dicotyledonous species. The timing of the appearance of the antigen was different in embryos formed from microspores during anther culture in vitro. In the cultured material, the 17-kDa polypeptide preceded the appearance of morphologically distinct embryonic structure.
Explored the distribution and temporal patterning of daily pain reported by 47 patients with rheumatoid arthritis (RA) for 75 consecutive days. Approximately half the pain series were significantly positively skewed, trended significantly across the recording period, or both. One fourth of the sample had relatively painful "outlier" days that clustered together. Most series displayed a significant autocorrelation in pain intensity across successive days even when the series were detrended. Patients with more active disease had pain that was more intense but more predictable from day to day and reported fewer painful outlying days and briefer episodes of atypically severe pain. Patients describing themselves as more depressed on the Center for Epidemiological Stress Depression Scale also reported more intense pain across the recording period, independent of their level of disease activity and disability. Implications for daily process studies of RA pain are discussed.
"OBJECTIVE--To assess general practitioners' involvement with long term mentally ill patients and attitudes towards their care. DESIGN--Postal questionnaire survey. SETTING--General practices in South West Thames region. SUBJECTS--507 general practitioners, 369 (73%) of whom returned the questionnaire. MAIN OUTCOME MEASURES--The number of adult long term mentally ill patients whom general practitioners estimate they have on their lists and general practitioners' willingness to take responsibility for them. RESULTS--110 respondents had noticed an effect of the discharge of adult long term mentally ill patients on their practices. Most (225) respondents estimated that they had 10 or fewer such patients each on their lists. Having higher numbers was significantly associated with practising in Greater London or within three miles of a large mental hospital and having contact with a psychiatrist visiting the practice. 333 general practitioners would agree to share the care of long term mentally ill patients with the psychiatrist by taking responsibility for the patients' physical problems. Only 59 would agree to act as a key worker, 308 preferring the community psychiatric nurse to do it. Only nine had specific practice policies for looking after long term mentally ill patients and 287 agreed that such patients often come to their general practitioner's attention only when there is a crisis. CONCLUSIONS--The uneven distribution of long term mentally ill patients suggests that community psychiatric resources might be better targeted at those practices with higher numbers of such patients. Most general practitioners seem to be receptive to a shared care plan where the consultant takes responsibility for monitoring psychiatric health with the community nurse as key worker. The lack of practice policies for reviewing the care of long term mentally ill patients must limit general practitioners' ability to prevent crises developing in their care."
An influenza B virus was passaged in man (virus A) and then in human embryo trachea (C) and into embryonated eggs (D) or directly into eggs (B). Virus A, B, and C had the same (cell-like) haemagglutinin phenotype on reaction with selected monoclonal antibodies while D had an "egg-like" phenotype. The viruses were administered at a dose of 1,000 TCD50 (for MDCK cells) by intranasal inoculation to groups of 27 or 28 volunteers. Viruses A, B, and C all produced disease in six to eight volunteers, whereas D produced no illness and only four volunteers were infected. The viruses shed by the volunteers were indistinguishable from those with which they were inoculated. The haemagglutinin genes of the viruses were sequenced and changes were detected indicating amino acid substitutions at position 196-198 in the attenuated egg-grown virus D whereby a potential glycosylation site present in the other viruses was lost.
Six months after discharge, 94 mothers described their memories of their infant's hospitalization on an NICU. Mothers of sicker infants, those who had claimed difficulties with NICU staff, and those who felt less attached to their infant more often described painful reminders of this crisis. Pleasurable reminders were reported more often by mothers who had perceived greater personal control over their infant's recovery and had construed a purpose in this crisis. Mothers described several benefits of their memories and were more likely to do so when they had perceived a purpose in their misfortune.
Most Doppler ultrasound investigations of the umbilical artery circulation have been confined to beyond 16 weeks' gestation. The purpose of this study is to explore the evolution of this circulation in human pregnancies of less than 21 weeks' gestation. We studied 169 low-risk pregnant women (125 longitudinally and 44 cross-sectionally) with a pulsed Doppler system on 357 separate occasions between 9 and 20 weeks of gestation. Systolic/diastolic (S/D) ratios were used for waveform analysis. We obtained umbilical waveforms as early as 9 weeks. Before 13 weeks, all fetuses had absent end-diastolic velocity (AEDV), then progressive development of end-diastolic velocity (EDV) appeared from 13 to 18 weeks. At 18 weeks, all fetuses had developed EDV. S/D ratios progressively declined from 13 to 20 weeks (y = 17.67 - 1.26x + 0.3x2; r2 = .95). A cross-sectional evaluation of fetal heart rate in 136 fetuses revealed a significant negative second-order polynomial relationship with gestational age between 9 and 20 weeks y = 245.84 - 10.33x + 0.27x2; r2 = .93). In 136 fetuses, 185 measurements of S/D ratios and their corresponding fetal heart rate revealed no relationship (weighted linear regression, r2 = .005). Mean fetal heart rate was significantly higher when EDV was absent (164.6 +/- 10.8 standard deviation [SD], n = 74) than when EDV was present (150.1 +/- 5.8 SD; n = 62; P = .000). Thus, upstream factors may be of little importance in the generation of umbilical artery velocity waveforms in early pregnancy. Umbilical Doppler velocimetry in the first half of pregnancy gives a functional assessment of the vascular development of the umbilical-placental circulation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Single temperature-sensitive (ts) mutants of a subgroup A strain of respiratory syncytial (RS) virus whose multiplication is restricted at 39 degrees C in MRC-6 cells and double ts mutants that are restricted at 38 degrees C, were obtained following mutagenesis using 5-fluorouracil and acridine-like compounds. Isolation and propagation of the parental RSS-2 strain of RS virus and its derived ts mutants were carried out entirely in MRC-5 human diploid cells. The immunogenicity and disease-producing ability of four of these mutants and the parental unmodified strain have been assessed by intranasal administration into groups of about 20 adult volunteers. The results of these trials indicate that the capacity of the parental RSS-2 strain to produce upper respiratory tract infection in adults was not diminished by limited propagation in MRC-5 cells. The mutants on the other hand were impaired in this respect to varying extents. The double mutant tslB in particular has characteristics that suggest that it may be suitable for further development as a live RS virus vaccine. It retained near normal immunogenicity and replicative ability in the upper respiratory tract, while exhibiting greatly reduced disease-producing potential.
The effects of three doses of interferon alpha (1.5 Mu, 0.5 Mu and 0.1 Mu) on performance were studied. The injection of 1.5 Mu IFN produced symptoms and performance changes which closely resembled those found in volunteers with influenza. Specifically, volunteers were slower at responding when they were uncertain when a target stimulus would appear, but were not impaired on a pursuit tracking task or syntactic reasoning task. The results suggest that interferon-induced changes in CNS function provide a plausible explanation for the selective effects of influenza on performance.
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