Creating a Canadian stroke system.
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Aged↗
Biomedical subjects
P J Stewart
Publications and source records attributed to P J Stewart.
Characterisation of adhesional properties of lactose carriers using atomic force microscopy.
The atomic force microscopy (AFM) colloid probe technique was investigated as a method for the characterisation of adhesional properties of pharmaceutical powder surfaces. Lactose carriers used in dry powder inhaler (DPI) formulations were chosen for investigation since adhesion between the carrier surface and drug particles has been proposed to affect the dispersion of drug particles. Individual adhesion forces were determined by measuring the detachment forces in air between the colloid probe and the lactose particle surface. The colloid probe consisted of a silica sphere (10 microm diameter) attached to a V-shaped silicon nitride cantilever (spring constant, k=0.42 N/m). Adhesion forces were calculated from individual force-distance curves using Hooke's Law. Individual forces measured at various adhesion sites were observed to be reproducible and stable over 10 min (coefficient of variation, CV below 5%). The adhesion force distribution determined from measurements at multiple sites (n>50) on each sample followed a log-normal relationship (regression coefficient, r(2) ranged between 0.95 and 0.99). This enabled characterisation in terms of the geometric mean adhesion force and a geometric standard deviation (GSD). Significant differences (P<0.001) in adhesion force were observed between samples, ranging from 37.47+/-1.95 to 117.48+/-2.20 nN. This study demonstrates the suitability of AFM as sensitive technique for the characterisation of adhesional properties of pharmaceutical particles.
Adhesiveness↗
An internship for college students in physical medicine and rehabilitation: effects on awareness, career choice, and disability perceptions.
OBJECTIVE: To show the impact that an internship program in Physical Medicine and Rehabilitation (PM&R) for college students has on their knowledge about the field, career choice, and perceptions about people with disabilities. DESIGN: Twelve students were selected to participate in the study. Students observed patient therapies and followed faculty and physiatry resident physicians. Students also participated in research studies in rehabilitation research. Group discussions regarding specific projects, research methods, career choice, and perceptions about disability were part of a didactic curriculum. Surveys about PM&R knowledge, attitudes toward people with disabilities, demographics, and course evaluations were administered. RESULTS: Results showed that the program increased knowledge about PM&R (P < 0.008). Premedical students missed significantly fewer questions (8.2 vs. 11.7; P = 0.04) on this survey than did other participants. Results also showed that this program affected their attitudes toward people with disabilities and student choice to pursue a career in health care. CONCLUSIONS: This type of internship experience provides an educational environment for college students to become acquainted with PM&R, interact positively with people with disabilities, and influence career choice in the allied health professions.
Adult↗
Female spirit cults as a window on gender relations in the highlands of Papua New Guinea.
Early writings on male cults in the highlands of Papua New Guinea tended to stress the exclusion of women and the collective agency of men. Looking at a subset of these cults from the Western and Southern Highlands Provinces, centering on Female Spirit figures, the authors argue that in these cases the cults are better understood as expressions of a collaborative model, in which gendered cooperation, both in practice and in terms of ritual symbolism, is activated in order to produce fertility and wealth. Positive collaboration is involved as well as structural complementarity. The collaborative model is therefore suggested as an alternative to the model of "male exclusivity" in the analysis of certain cult practices in these parts of the New Guinea highlands region.
Culture↗
Deaggregation during the dissolution of benzodiazepines in interactive mixtures.
The purpose of this research was to investigate the influence of surfactants on the dissolution of benzodiazepines in interactive mixtures. The dissolution of ternary interactive mixtures consisting of micronized drugs (oxazepam, nitrazepam, and flunitrazepam) and micronized surfactants (sodium lauryl sulfate and cetrimide) adhered onto the surface of a lactose carrier (250-355 microm) was studied using the USP/NF paddle method. Dissolution was considered to occur from dispersed particle and aggregate fractions of the drugs, and data were modeled using multiexponential equations. The initial concentrations of the aggregates and dissolution rate constants were estimated using a Marquardt-Levenberg nonlinear least squares algorithm. The marked increase in dissolution rate which occurred with increasing concentrations of sodium lauryl sulfate and cetrimide resulted both from deaggregation of the benzodiazepine particles and from increases in the dissolution rate constants of the dispersed particle and aggregate fractions probably associated with an increased intrinsic dissolution rate. The presence of 5% sodium lauryl sulfate in the interactive mixture reduced the initial percent of aggregates from about 85% in a binary mixture to less than 10% and about doubled the dispersed particle dissolution rate constant. The presence of the surfactant in the surface particulate matrix of the interactive mixture was essential for its deaggregation effect. Sodium lauryl sulfate was more effective than cetrimide in achieving drug deaggregation.
Adhesiveness↗
Are special investigations of value in the management of patients with fecal incontinence?
PURPOSE: The aim of this study was to determine whether special investigations significantly alter either the diagnosis or the management plan of patients with fecal incontinence assessed on the basis of a structured history and physical examination alone. METHODS: Fifty consecutive patients with fecal incontinence were prospectively studied in a tertiary referral clinic. Each patient was assessed by two clinicians who independently formulated a diagnosis and treatment plan based on the history and physical examination. The resulting 100 patient assessments were then compared with the final diagnosis and treatment plan formulated on completion of endoanal ultrasound, anal manometry, external sphincter electromyography, and defecating proctography. RESULTS: In the assessment of fecal incontinence, the addition of special investigations altered the diagnosis of the cause of incontinence based on history and examination alone in 19 percent of cases. The management plan was altered in 16 percent of cases. Special investigations were most useful in separating neuropathy from rectal wall disorders and in demonstrating the unexpected presence of internal sphincter defects and neuropathy. CONCLUSIONS: Even experienced colorectal surgeons will misdiagnose up to one-fifth of patients presenting with fecal incontinence if assessment is based on the history and physical examination alone. However surgically correctable causes of incontinence are rarely missed on clinical assessment.
Anal Canal↗
Factors affecting survival after excision of the rectum for cancer: a multivariate analysis.
PURPOSE: The aim of this study was to identify and categorize the independent prognostic effects of patient, clinical, operative, and pathology variables on long-term survival after anterior resection or abdominoperineal excision of the rectum for cancer. METHODS: Proportional hazards regression analysis was used to analyze prospective data from 709 patients who underwent surgery at Concord Hospital during a 23-year period. No patient received adjuvant therapy. RESULTS AND CONCLUSIONS: After adjusting for age and clinicopathologic stage, significantly poorer survival was experienced by males, patients with extensive tumor adherent to other organ(s), those with a high-grade tumor or a tumor showing venous invasion, those who had a postoperative cardiovascular or respiratory complication, and those who did not undergo surgery by a colorectal surgeon specialist. The nature of the operation performed had no independent effect on survival.
Anastomosis, Surgical↗
Influence of the carrier on the intrinsic rate of dissolution of diazepam in interactive mixtures.
The use of interactive mixtures of drugs adhering to the surface of carriers can promote drug dissolution. The mechanism of dissolution of such mixtures has been studied using the rotating-disc method under conditions eliminating secondary influences such as carrier surface characteristics and drug particle aggregation. Levich plots were used to characterize the dissolution behaviour. Diazepam-compactrol interactive mixtures had initial dissolution rates similar to that of pure diazepam owing to the deposition of a continuous layer of diazepam on the disc surface from the interactive mixture. Linear Levich plots were produced at all drug loadings and the presence of compactrol in the disc slightly enhanced dissolution rates. Dissolution rates for diazepam-emcompress interactive mixtures were lower than those of pure diazepam. The Levich plots for these systems were non-linear with increasing negative curvature as the diazepam loading decreased. The rate of dissolution of diazepam in the lactose interactive mixture was markedly higher than that of pure diazepam, but high diazepam loadings in the lactose mixtures inhibited diazepam dissolution. Rapid carrier dissolution caused surface retraction of the disc, enhancing the dissolution rate. The Levich plots showed an upward curvature due to turbulence. Linear Levich plots for diazepam and other benzodiazepines and for diazepam-compactrol interactive mixtures showed that their dissolution in pH 5 phosphate buffer was diffusion-controlled. The Levich plots for diazepam-emcompress interactive mixtures were indicative of some interfacial control during dissolution, but the hypothesis of common ion precipitation of dissolved carrier, calcium phosphate, onto the disc surface did not fully explain this effect.
Diazepam↗
The need for a community-wide approach to promote healthy babies and prevent low birth weight.
A community-wide approach offers a potentially more effective way to promote healthy babies in healthy families and to prevent low birth weight. It can address the many factors associated with preterm birth and intrauterine growth restriction, the need to include all members of the community in effecting meaningful change in the incidence rate of adverse outcomes and the development of an effective mechanism to plan and coordinate the delivery of programs. Physicians have an essential role to play in this approach. The evaluation of such a program would complement current biomedical research on the prevention of preterm birth and intrauterine growth restriction. The work for this paper was supported by the Community Health Research Unit, funded by the Ontario Ministry of Health.
Community Health Services↗
Effect of refeeding and exercise in restoration of body protein in anorexia nervosa.
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Adipose Tissue↗
Intra-operative ultrasound for the detection of hepatic metastases from colorectal cancer.
The aim of this study was to compare the accuracy of intra-operative ultrasound (IOUS) with other imaging modalities and with surgical palpation in detecting liver metastases from colorectal cancer (CRC). Intra-operative ultrasound was performed in 100 patients undergoing surgery for CRC. All patients had pre-operative liver function tests, transcutaneous ultrasound and computerized tomography (CT) scan of the liver. The liver was palpated intra-operatively by a surgeon who was unaware of the pre-operative findings. The liver was then assessed by IOUS. Intra-operative ultrasound detected more patients with metastases than either CT scan, transcutaneous ultrasound or surgical palpation. It also detected a greater number of smaller metastases in these patients and allowed better anatomical definition compared with pre-operative investigations.
Adult↗
Parathyroid hormone (1-34) and Nleu8,18Tyr34-parathyroid hormone, (3-34) amide increase diacylglycerol in neonatal mouse calvaria.
Previously, we and others have presented evidence that a calcium second messenger system is involved in the action of parathyroid hormone (PTH) on bone. In the present report, the effects of PTH(1-34) and PTH(3-34)amide treatment on diacylglycerol (DG) in neonatal mouse calvaria are described. PTH(1-34) produced a rapid (within 5 minutes) increase in calvarial incorporation of 3H-arachidonic acid into DG. The effect was maximal at 0.1 nMPTH(1-34), the lowest concentration tested. The 3-34 amide analogue of PTH increased DG to the same extent as PTH(1-34). The effect was maximal at 10 nM PTH(3-34)amide, the lowest concentration tested. These concentrations were lower than those required to elicit maximal effects on bone resorption. In contrast to effects on cyclic AMP, where the 3-34 amide inhibited the increase elicited by PTH, combined treatment of calvaria with PTH(1-34) and PTH(3-34)amide did not inhibit effects on resorption or diacylglycerol.
Animals↗
Complications following closure of loop ileostomy.
The morbidity and mortality of 50 patients undergoing closure of loop ileostomy was reviewed. The patients had a mean age of 57.9 years and significant intercurrent disease. There were no in-hospital deaths or anastomotic leakage at the site of closure. Small bowel obstruction occurred in 12% of patients, all of whom responded to conservative treatment. The wound infection rate was 14%, but the development of a wound infection did not result in a significantly longer hospital stay. We conclude that, when a careful technique of sharp dissection is used, closure of a loop ileostomy is associated with an acceptably low incidence of complications even in elderly and often unwell patients.
Adolescent↗
Frequency of intermediate admissions and place of death of patients with advanced colorectal cancer.
An analysis was made of the place of death and the degree of institutional support required following surgery in patients with colorectal cancer (CRC) who had distant metastases. There was a high incidence of intermediate admissions to an acute hospital, and most patients died in an acute hospital bed. The number of readmissions and the place of death were not influenced by the patients' age, sex, site of tumour or their home situation at the time of diagnosis. In view of the high demand for acute surgical beds, there is a need to develop more appropriate facilities to care for patients in the terminal phase of this disease.
Aged↗
Interest in alternative birthplaces among women in Ottawa-Carleton.
Birthing rooms, birth centres and home birth have been proposed as alternatives to the traditional in-hospital caserooms to meet the needs of women and their families more effectively. We performed a descriptive survey to determine the level of interest of childbearing women in the Ottawa-Carleton region in these birthplaces and to examine the characteristics of women who express an interest in using them. Of the 1629 women who gave birth between July 1 and Aug. 28, 1987, 1115 (68.4%) completed a self-administered questionnaire during the pregnancy, in the early postpartum period in hospital or at home. Of the respondents 577 (53.1%) said they would choose the caseroom, 316 (29.1%) the birthing room, 165 (15.2%) the birth centre and 30 (2.8%) home birth. The women who expressed an interest in a birthplace other than the caseroom were more likely than the others to be older, married, well-educated and interested in midwifery services and to breastfeed their babies (p less than 0.05). They were also more likely to have had a low-intervention vaginal birth (p less than 0.05). The interest expressed in birthing rooms, birth centres and home birth suggests that these alternatives should be considered for inclusion in the health care system.
Adolescent↗
Diagnosis of dystocia and management with cesarean section among primiparous women in Ottawa-Carleton.
We carried out a chart review study to determine the rate of diagnosis of dystocia (abnormal progress) and the use of cesarean section to treat dystocia among 3887 primiparous women who gave birth to a single baby in the vertex presentation at four hospitals in Ottawa-Carleton in 1984. Of the 3740 women who had some labour 1127 (30.1%) were given a diagnosis of dystocia. Cesarean section for dystocia was done during all phases of labour (41% of procedures in the latent phase, 38% in the active phase and 21% in the second stage). The cesarean section rate varied among the hospitals from 11.8% to 19.6%. A total of 75% of the cesarean sections were for dystocia, disproportion or failed induction. The findings suggest that cesarean section is being done for disproportion without a trial of labour beyond the latent phase and for dystocia in the absence of fetal distress. If these practices were modified the cesarean section rate could be reduced from 16% to about 8%, the rate found in some other centres and that observed in Canada in the early 1970s.
Adult↗
Midwifery in Ontario: a survey of interest in services.
Maternity care for women in Ontario is provided almost exclusively by physicians, the majority of whom are obstetricians. Using a self-administered questionnaire, pregnant women in one Ontario city were surveyed about their interest in midwifery care as an alternative to physician care. Although 3 percent of the women surveyed had used a midwife, 60 percent expressed an interest in midwifery care, particularly the counseling and support aspects. Over 11 percent showed an interest in complete primary midwifery care.
Attitude to Health↗
Cyclosporines: correlation of immunosuppressive activity and inhibition of bone resorption.
Cyclosporine A (CsA) is a potent immunosuppressive agent that inhibits stimulated bone resorption in vitro. To study the mechanism of this effect, we have compared CsA with several cyclosporine analogs that vary in immunosuppressive potency. CsA as well as another potent immunosuppressive analog, CsG, inhibited parathyroid hormone (PTH) and interleukin-1 (IL-1)-stimulated resorption of fetal rat limb bones. The nonimmuno-suppressive analogs CsH and CsF did not inhibit PTH or IL-1-stimulated bone resorption. Likewise, the weakly immunosuppressive analog CsD did not significantly inhibit PTH-stimulated bone resorption. Although other mechanisms cannot be excluded, our data are consistent with the concept that bone resorption may involve an immune cell-derived mediator.
Animals↗