Search PubMedSearch

Biomedical subjects

P Riley

Publications and source records attributed to P Riley.

At least 19 recordsLinked to original sources

Is admission chest radiography of any clinical value in acute stroke patients?

Chest radiographs are frequently requested on admission of patients with a clinical diagnosis of acute stroke. This study assesses their value in subsequent management of these patients. A retrospective analysis of 435 patients with a clinical diagnosis of acute stroke was made. All admission chest radiographs were reviewed to document both radiographic quality and any radiological abnormality. In those patients with an abnormal radiograph, clinical records were reviewed to assess their impact on clinical management. Eighty-six percent of patients had a chest radiograph performed on admission. 77.5% of these films were deemed to be technically unsatisfactory, the commonest problems being positioning and suboptimal inspiration. Radiological abnormality was demonstrated in 61 patients (16.4% of radiographs obtained). Clinical management was altered in 14 of the 61 patients (3.8% of the total number of patients radiographed). Radiological abnormality was missed by the admitting clinicians in four radiographs (1 hilar mass, 2 cases of consolidation, one of pulmonary oedema). One abnormality not clinically suspected was recorded (multiple metastases). We conclude that admission chest radiographs in patients with an acute stroke are not indicated in the absence of appropriate clinical indications.

Acute Disease

A fluoroscopy credentialling programme for orthopaedic surgeons.

We have developed a teaching programme for non-radiologists who use fluoroscopy, which includes techniques for reducing the radiation received by the patient and the surgeon during orthopaedic procedures. The techniques resolve around the radiation protection concepts of time, distance and shielding. The programme has been very successful in reducing the total fluoroscopy times of orthopaedic surgeons; in our institute, durations have been reduced to about 10% of those before the training started. We review the aims and content of our programme.

Education, Medical, Continuing

Fruit and vegetable food frequencies by fourth and fifth grade students: validity and reliability.

OBJECTIVE: Due to the increased emphasis on fruit and vegetable (F+V) consumption and a desire to use the simplest dietary assessment method appropriate to determine F+V intake, we assessed the reliability and validity of weekly and monthly fruit and vegetable food frequency questionnaires (F+V FFQ) among fourth and fifth grade students by comparing them to food records previously validated through school lunch observations. METHODS: The multiethnic sample (primarily African-American and Caucasian) included predominantly lower-middle socioeconomic students from 10 classes at one elementary school. F+V FFQ were printed on optical scanning forms and classroom administered on two occasions. Students completed preprinted food record forms at school and received new forms weekly. To allow comparison between the F+V FFQ and food records, a dietitian abstracted information from the records according to a written protocol and transferred it to F+V FFQ forms covering respective time periods. F+V FFQ were converted to estimated daily servings and aggregated to create five F+V indices plus three summary indices. Statistical analyses included Spearman correlations and paired t-tests. RESULTS: Students demonstrated acceptable reliability in completing food records as well as weekly and monthly F+V FFQ; however, validity was unacceptable for both F+V FFQ versions due to significant overreporting. CONCLUSION: Of the two methods studied, the food record procedure is preferred over the FFQ procedure for collecting self-reported F+V consumption data among fourth and fifth grade students.

Child

Accuracy of fourth- and fifth-grade students' food records compared with school-lunch observations.

Fourth- and fifth-grade students' food records completed by using a labor-intensive approach (with daily monitoring) or a less labor-intensive approach (with weekly monitoring) were compared with school-lunch observations. Records were completed at three elementary schools for 14-23 d by students in 26 classes. Record pages were printed forms with areas for recording items consumed, number of servings, and locations of meals. Students were randomly selected for lunch observation. Kappa coefficients and percent of agreement for interobserver reliability for both approaches combined ranged from 0.43 to 0.91 and 72.6% to 95.5%, respectively, on 24 observations. Pearson correlations for 117 record/observation matches were significant for eight and three of nine meal items for the daily and weekly monitoring approaches, respectively. Thus, students were reasonably accurate in keeping records and more accurate with the more labor-intensive approach. Researchers need to select an approach based on the degree of accuracy desired and available finances.

Child

Initiation of growth inhibition by TGF beta 1 is unlikely to occur in G1.

Type beta transforming growth factors represent a family of polypeptides that modulate growth and differentiation. They exert their effect on target cells through interaction with multiple cell surface receptors. Transforming growth factor-beta 1 has a strong inhibitory action on cell division in mink lung CC164 cells, a process that is initiated by immediate induction of junB and phosphorylation of nuclear protein followed by a reduced expression of cdk4. However, its signal transduction pathways are still unresolved. In this study we report a detailed analysis of cell kinetic events following addition of transforming growth factor-beta 1 to mink lung CCL64 cells. We show that transforming growth factor-beta 1 reduces [3H]thymidine incorporation after a delay of 8 hours, which reaches its nadir at 16 hours. The reduced growth rate is maintained for at least 48 hours as shown by flow cytometric analysis of DNA content. Using time-lapse video microscopy it was shown that control cells double on average every 14.4 hours, whereas the transforming growth factor-beta 1-treated cells have a doubling time of on average 20.3 hours. The difference in intermitotic time is a consequence of a prolonged G1 phase (a shift from 7.5 to 13.5 hours on average). However, changes in intermitotic times occur only after cells have undergone division in the presence of transforming growth factor-beta 1 and treated cells finish the ongoing cell cycle exactly like control cells. From these findings we conclude that transforming growth factor-beta 1 may change cell cycle parameters by interfering with cellular events prior to G1.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals

Electron transfer in P450 mechanisms. Microsomal metabolism of cyclopropylbenzene and p-cyclopropylanisole.

1. The metabolism of cyclopropylbenzene (1a) and 4-cyclopropylanisole (1b) was studied using liver microsomal preparations from control, phenobarbital- and beta-naphthoflavone treated rats. 2. With all three types of microsomes 1a was metabolized by benzylic hydroxylation to give 1-phenylcyclopropanol and by aromatic hydroxylation at C-4; the former predominated by a factor of 2-4. BNF-induced microsomes also formed 2-cyclopropylphenol. No cyclopropyl ring-opened metabolites of 1a, including benzoic acid, were detected in any of the incubations. 3. With PB-induced microsomes 1b underwent O-demethylation (90%) and benzylic hydroxylation; no other metabolites were detected. 4. Progress curves for metabolism of 1a are markedly nonlinear after only limited conversion of substrate, suggesting the possibility that 1a, like other cyclopropyl compounds, could be a suicide substrate for one or more isozymes of P450. 5. For both 1a and b, metabolite formation and enzyme inactivation can be explained by conventional P450 reaction mechanisms not involving electron abstraction.

Animals

Predicting outcome in high-risk newborns with a neonatal neurobehavioral assessment.

OBJECTIVES: Effective medical management and rehabilitation efforts in neonates at risk depend on early identification of underlying brain injury. The aim of this study was to determine the prognostic value of the Einstein Neonatal Neurobehavioral Assessment Scale (ENNAS) in high-risk neonates, and to compare its predictive validity at two stages in development (i.e., 1 and 3 years of age). METHOD: Twenty-three healthy neonates (control group) and 51 high-risk neonates (high-risk group) were assessed at term and were followed longitudinally. At 1 and 3 years, subjects in both groups were evaluated in a blind fashion by a psychologist and a pediatric neurologist. RESULTS: Developmental delays became more apparent as high-risk newborns matured; the percentage of subjects with an abnormal Griffiths general quotient increased from 1 year (13.7%) to 3 years (39%). Analysis revealed that a normal neonatal performance on the ENNAS in high-risk subjects accurately predicted a favorable outcome at 1 year and 3 years of age. Although an abnormal ENNAS was not consistently associated with a poor outcome, the positive predictive value improved markedly from 1 year to 3 years of age. CONCLUSION: The findings indicate that a normal neonatal neurobehavioral assessment is reassuring, as most of these children are free of neurodevelopmental sequelae at 3 years of age. For many persons, the ENNAS may provide early evidence of a pattern of brain injury that is manifested only as the child is challenged by more complex skill acquisition such as language, memory, and perceptual-motor tasks. The ability of this assessment to predict behavioral and academic skills at school age remains to be determined. Early identification of developmental deficits enables occupational therapists to direct infants to appropriate early intervention programs, thus optimizing their functional potential.

Brain Damage, Chronic

Nasopharyngeal grass foreign body in eight cats.

Nasopharyngeal grass foreign bodies were diagnosed in 8 indoor/outdoor cats. Each cat was anesthetized with xylazine/ketamine, and the foreign bodies were extracted from the nasopharynx by use of mosquito forceps.

Animals

Measuring fruit and vegetable preferences among 4th- and 5th-grade students.

BACKGROUND: Achievement of the nation's Year 2000 fruit and vegetable goal of five or more daily servings may relate to children's preferences for fruits and vegetables. There are, however, no easily administered instruments for measuring preferences for fruits and vegetables among children. METHODS: An initial questionnaire systematically varied preparation methods after focus group discussions had indicated that this had an impact on fruit and vegetable preferences. The three-part questionnaire (fruits, vegetables, fruit and/or vegetable snacks) was classroom administered. Internal consistencies and test-retest reliabilities were acceptable. Principal components analyses, however, revealed food-specific rather than preparation factors; thus, preparation was eliminated from a revised questionnaire. RESULTS: Repeat classroom administration of the revised questionnaire yielded acceptable internal consistencies and test-retest reliabilities. Preferences were higher for fruits than vegetables. Principal components analyses indicated single fruit and vegetable factors and a two-factor solution for snacks (vegetables, fruits). Pearson correlations between preferences and consumption were significant, but accounted for only a small fraction of the variance. Correlations between fruit exposure and preferences, and between vegetable exposure and preferences were 0.55 and 0.51, respectively. CONCLUSION: The revised questionnaire provides a reliable, valid, and simple tool for assessing fruit and vegetable preferences of 4th- and 5th-grade students. The relationship between these preferences and actual consumption is weak; however, making fruits and vegetables more available may enhance preferences.

Child

Transfer of embryos into the uterus: how much do technical factors affect pregnancy rates?

OBJECTIVE: Our objective was to identify the effect on outcome of (a) ultrasound-assisted embryo transfer, (b) the use of different embryo transfer catheters, and (c) the length of time the patients remain in the supine position after embryo transfer. SETTING: The setting was a private fertility center. SUBJECTS: This was a prospective study of 178 in vitro fertilization and embryo transfers (IVF-ET) and 63 frozen embryo replacements (FER). RESULTS: The pregnancy rate was 28.7% following IVF-ET and 31.8% for FER. Ultrasound-assisted transfer did not affect the outcome (29 vs 30.3%). There was no difference in the performance of the Wallace and Frydman catheters with regard to outcome (30.3 vs 30.7%). Although there was an increase in pregnancy rate as the time interval in the supine position after ET increased, this needs a larger study. CONCLUSION: The parameter studies did not affect the outcome of IVF/ET or FER. Some factors encouraged us to recommend ultrasound-assisted transfer in some cases, and the use of a Frydman catheter for transfer and to encourage the supine position after transfer for longer periods.

Abdomen

Factors predicting long-term outcome after chronic benzodiazepine therapy.

41 patients who took part in a withdrawal programme from long-term treatment with diazepam in a controlled clinical trial were followed up five years later. Assessments were made of outcome derived from clinical symptomatology, formal psychiatric diagnosis, psychotropic drug use and frequency of contact with both primary care and psychiatric services. Using discriminant function analysis it was found that better outcome was associated with younger patients, fewer symptoms at time of withdrawal and, more particularly, six months later, less personality disturbance, and longer duration of diazepam use before withdrawal. The implications are discussed with particular reference to policies for withdrawing benzodiazepines.

Adult

Ritual burns--the Buddhist tradition.

The mystical significance of fire is common to many cultures and religions. For the Buddhist community acts of self-mutilation by burning reflect a tradition for which the direct precedent is set in the ancient scriptures of the Lotus Sutra. Burns are produced by contact with incense and treated with oil and vegetable dressings. Two cases are presented and discussed with reference to early Buddhist beliefs.

Adult

Contact burns due to thermoplastic road paint.

Thermoplastic road markings are used at similar temperatures to tar and bitumen and spillage onto skin causes similar contact burns. Most of these occupational burn injuries can be avoided by adherence to the manufacturer's recommendations about the wearing of protective clothing. Management and foremen of contractors using these materials need to ensure that their workers comply with safe procedures and wear the specified protective clothing.

Accidents, Occupational

The Benzodiazepine Withdrawal Symptom Questionnaire.

A self-report questionnaire is described which records the main symptoms experienced during withdrawal from benzodiazepines in pharmacologically dependent patients. The questionnaire consists of 20 items; evidence is given that these are reasonably independent and are sensitive in detecting withdrawal symptoms from a study of 68 patients undergoing slow withdrawal from benzodiazepines.

Anti-Anxiety Agents

Ice-skating injuries to the hand.

166 patients with injuries due to ice-skating were seen in the local accident and emergency department over a six-month period; 60% of these involved the upper limb. 28 of the upper limb injuries were closed fractures and 24 were lacerations, almost all to the dorsum of the hand. The use of protective gloves would help to prevent these potentially avoidable injuries. "On-site" first-aid facilities help to reduce the demand on the local accident service.

Adult

The brainstem auditory evoked potential asymmetry is replicable and reliable.

Lateralization of neural function is generally thought to occur only at the level of the cerebral cortex and perhaps the thalamus. Levine and McGaffigan [EEG Clin. Neurophysiol. 55, 532-537, 1983] challenged this view by identifying a neural asymmetry at the level of the brainstem. They analyzed brainstem auditory evoked potentials (BAEPs) and found that peak III(+) amplitude (baseline-to-peak) was significantly larger in response to right than to left ear stimulation. The current paper demonstrates that this BAEP asymmetry is (a) reliable within and between subjects, (b) present for 33/sec and 10/sec click rates, and (c) more reliable when amplitude is measured peak-to-peak. This brainstem asymmetry may reflect the general tendency of humans to orient rightward and/or may be a precursor of higher level asymmetries.

Adult

Prognostic significance of the auditory brainstem evoked response in high-risk neonates.

The prognostic significance of the auditory brainstem evoked response (ABR) was examined in this prospective study of neonates at risk for neurodevelopmental sequelae. ABR testing was performed in the neonatal period (37 to 45 weeks conceptional age) and at two and/or six months corrected age. 34 high-risk newborns and 14 controls were followed to one year of age, when they received neurological and developmental assessments. Increased I to III and I to V interwave latencies predicted gross motor delay at one year, with a positive predictive power of 83 per cent and a specificity of 94.7 per cent. Increased brainstem conduction, dispersal of waves III to V and V/I amplitude ratio abnormalities predicted abnormal neurological findings at one year, with positive predictive values of 100, 100 and 80 per cent, respectively. A standard clinical examination of the newborn, performed on the at-risk and control infants at 40 weeks conceptional age, was not found to be strongly predictive of neurodevelopmental deficits at one year.

Brain Stem