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Biomedical subjects

R Adams

Publications and source records attributed to R Adams.

At least 37 records · Page 2Linked to original sources
PubMed2001

Quality of life in asthma: a comparison of community and hospital asthma patients.

This study compares the quality of life of a community sample of people with asthma in South Australia, using population norms, people suffering from other chronic diseases, and a sample of asthma patients from two hospital clinics. A representative population survey was performed by trained interviewers in spring 1995 of 3001 respondents aged > or = 15 years. A physician's diagnosis of current asthma was reported by 299 (9.9%). The hospital clinic sample had a physician's diagnosis and lung function evidence of asthma (n = 293). All completed the SF-36 health survey. Standardized SF-36 scores, adjusted for age, sex, and social class, were significantly lower for respondents with asthma, compared with population norms, across all subscales of the SF-36 (p < 0.05). Physical component summary (PCS) and mental component summary (MCS) scores were not significantly different in people in the community sample with asthma from scores in people with diabetes and arthritis. PCS and MCS scores did not differ for those with similar symptom frequency in the community and hospital asthma samples, except that hospital patients with frequent symptoms had significantly lower MCS scores (p < 0.01). Asthma has a major impact on the health-related quality of life in the community, comparable to other chronic diseases. The SF-36 performs uniformly in asthma in different situations.

Adolescent↗
PubMed2001

Changes in endothelial, leucocyte and platelet markers following contrast medium injection during angiography in patients with peripheral artery disease.

Peripheral artery angiography, a common diagnostic procedure, may cause early and late adverse reactions, such as anaphylaxis, thrombosis and possible progression of the underlying arterial disease. To test the hypothesis that radiographic contrast medium may contribute to these events by adversely affecting the endothelium, leucocytes and/or platelets, 19 subjects undergoing angiography for the investigation and/or treatment of lower limb atherosclerosis were recruited. Blood was obtained from the external iliac vein before, and at serial intervals after, the injection of radiographic contrast medium into the ipsilateral femoral artery for diagnostic use. Markers of endothelial cell injury (von Willebrand factor (vWf)), platelet activation (soluble P-selectin) and leucocyte activation (neutrophil elastase and soluble L-selectin) were measured in citrated plasma. Soluble intercellular adhesion molecule-1 (sICAM-1) and thromboxane B(2), which are non-specific markers of inflammation, were also measured. Compared with the sample prior to angiography, levels of soluble L-selectin and sICAM-1 were reduced (p<0.02) immediately after passage of the last bolus of contrast medium. 15 min later, levels returned to normal but the level of vWf had increased (p<0.02). After 30 min, only levels of thromboxane B(2) were increased (p<0.05). The following day both vWf (p<0.01) and soluble P-selectin (p<0.05) were increased. These data point to both early and late effects of contrast medium on markers of endothelial, platelet and leucocyte function.

Aged↗
PubMed2001

A randomized controlled trial of a passive accessory joint mobilization on acute ankle inversion sprains.

BACKGROUND AND PURPOSE: Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time. SUBJECTS: Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial. METHODS: Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment. RESULTS: The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. DISCUSSION AND CONCLUSION Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.

Acute Disease↗
PubMed2001

Monocytes are a rheologically heterogeneous population of cells.

The effect of increased adhesiveness and decreased deformability of leukocytes following activation can have a profound effect on flow through the microcirculation. Measurement of leukocyte deformability is therefore an important tool in the study of the pathology of vascular diseases. Although much work has been done on the rheological properties of lymphocytes and granulocytes, there is little information available on the larger mononuclear cells, the monocytes. To investigate monocyte rheology, attempts were made to purify monocytes by a variety of methods. Purified monocytes were then filtered through 5 microm polycarbonate filters, with flow profiles (change in volume with time) recorded over 300 seconds. The profiles were analysed by least squares fitting to an appropriate mathematical model. Analysis of filtration data demonstrated 3 distinct sub-populations of monocytes with differing rheological properties. Other workers have characterised monocytes into defined subsets on the basis of their size, phagocytic ability or expression of cell surface markers. The definition of monocytes into defined rheological subsets is a new and useful addition to these studies.

Cell Separation↗
PubMed2000

Morphology and growth patterns of developing thalamocortical axons.

It is increasingly evident that the actions of guidance factors depend critically on the cellular and molecular context in which they operate. For this reason we examined the growth cone morphology and behavior of thalamic fibers in the relatively natural environment of a slice preparation containing the entire pathway from thalamus to cortex. Axons were labeled with DiI crystals and imaged with a laser-scanning confocal microscope for up to 8 hr. Their behavior was analyzed in terms of morphology, extension rates, shape of trajectory, frequency of branching, and percentage of time spent in advance, pause, and retraction. Thalamic fibers had distinct and stereotyped growth patterns that related closely to their position; within the striatum growth cones were small and elongated, rarely extending filopodia or side branches. Axons grew quickly, in straight trajectories, with minimal pauses or retractions. When they reached the ventral intermediate zone, axons slowed down, often coming to a complete stop for up to several hours, and their growth cones became larger and more complex. During pauses there were continuous extensions and retractions of filopodia and/or side branches. When advance resumed, it was often to a different direction. These results demonstrate consistent regional variations in growth patterns that identify an unexpected decision region for thalamic axons. They provide the basis for examining the roles of guidance cues in an accessible yet intact preparation of the thalamocortical pathway and allow for an evaluation of previously suggested pathfinding mechanisms.

Animals↗
PubMed2000

Rapid-sequence tandem transplant for children with high-risk neuroblastoma.

BACKGROUND: The majority of patients with high risk neuroblastoma (NB) still relapse. PROCEDURE: We designed a Phase II trial for children with advanced NB utilizing a program of induction chemotherapy followed by tandem high-dose chemoradiotherapy with stem cell rescue (HDC/SCR) in rapid sequence. Fifty-five patients were evaluable, ages 1-14 years, and 97 cycles of HDC/SCR have been completed to date. Pheresis was possible for every patient, despite their young age, with an average of 7.2 x 10(6) CD34+ cells/kg available to support each HDC/SCR cycle. RESULTS: Engraftment was rapid, with median time to neutrophil engraftment of 11 days. Five patients who completed the first HDC course did not complete the second and there were four toxic deaths. With a median follow-up of 24 months from diagnosis, 38 of 55 patients (3-year EFS 59%) remain event-free. A subset of the patients received stem cells purged by CD34 selection. The engraftment and EFS of these patients are similar to the overall group. CONCLUSION: This work demonstrates that a tandem transplant regimen for high-risk NB is a feasible treatment strategy in children and may improve disease-free survival.

Adolescent↗
PubMed2000

Home care by outreach nursing for chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow obstruction, worsening exercise performance and deterioration in health. It is associated with significant morbidity, mortality and costs to health care systems. Care strategies, such as outreach nursing in the community, may reduce this burden. OBJECTIVES: To evaluate the effectiveness of outreach respiratory health care worker programmes for patients with COPD in terms of improving lung function, exercise tolerance and health related quality of life (HRQL) of patient and carer, and reducing mortality and hospital service utilisation. SEARCH STRATEGY: A search was carried out using the Cochrane Airways Group database. Bibliographies of identified RCTs were searched for additional relevant RCTs. Authors of identified RCTS were contacted for other published and unpublished studies. SELECTION CRITERIA: Only randomised control trials of patients with COPD were included. The intervention was an outreach nurse visiting patients in their homes, providing support, education, monitoring patient status and providing liaison with physicians. Interventions that used nurse practitioners who provided therapeutic intervention were also included. Studies in which the therapeutic intervention under test was physical training were not included. DATA COLLECTION AND ANALYSIS: Data extraction and study quality assessment were performed independently by two reviewers. Where further or missing data was required, authors of studies were contacted. MAIN RESULTS: Four studies were found. Three assessed mortality following twelve months of care (n=96, 152 and 301), and one after seven months(n=75). Meta-analysis demonstrated that mortality was not significantly reduced by the intervention, Peto Odds Ratio 0.72; 95 % confidence interval 0.43, 1.21. Post hoc subgroup analysis suggested that mortality was reduced by the outreach nursing programme in patients with less severe disease. Significant improvements in health related quality of life were reported in one study in moderate COPD, but not in a study in patients with severe disease. No changes in lung function or exercise performance were found in the studies where data were available. Hospital admissions were reported in only one study in patients with severe disease and no benefit was observed. REVIEWER'S CONCLUSIONS: Patients with moderate COPD may have mortality and health related quality of life gains from a nursing outreach programme, but there are no data about reductions in hospital utilisation. Patients with severe COPD do not appear to have benefit from such programmes and one large study found no reduction in hospital admissions in such patients.

Community-Institutional Relations↗
PubMed2000

Comparing wobble board and jump-landing training effects on knee and ankle movement discrimination.

The effects of two training programs on movement discrimination ability, at the ankle and knee, were assessed from the left and right lower limbs of forty-four football players. All players in three Under 18 Victorian Football League (VFL) squads were allocated to either wobble board training, jump landing training, or no-training conditions. Pre-tests to assess discrimination of extent for active movements made while standing were carried out on both ankles and knees of all subjects, using an automated device to accurately set the different movement stop points. Five distances were used, between 10.5 degrees and 14.5 degrees from horizontal for ankle inversion, and between 30.3 degrees and 31.7 degrees from vertical for knee flexion. From a series of 50 inversion movements and 50 knee flexion movements, matrices of absolute judgement by actual movement extent were produced. Non-parametric signal detection analysis was applied to the discrimination score. All subjects were retested after eight weeks. Improvement in discrimination of ankle movements into inversion from pre-test (0.65) to post test (0.70) for the wobble board trained group was significantly larger than the change in the jump-landing trained and the untrained groups (Jump Landing: Pretest: 0.64 to Post-test: 0.64 and Control; Pretest: 0.63 to Post-test: 0.64). Discrimination of knee flexion movements improved significantly from pre-test to post-test in all three groups. These data demonstrate that wobble board training can improve discrimination of discrete ankle inversion movements, an effect interpreted as enabling greater accuracy in the making of inversion movements in foot preparation prior to ground contact.

Adolescent↗
PubMed2000

Mode structure and ray dynamics of a parabolic dome microcavity

We consider the wave and ray dynamics of an electromagnetic field in a parabolic dome microcavity. The structure of the fundamental s wave involves a main lobe in which the electromagnetic field is confined around the focal point in an effective volume of the order of a cubic wavelength, while modes with finite angular momentum have a structure that avoids the focal area and have correspondingly larger effective volumes. The ray dynamics indicate that the fundamental s wave is robust with respect to small geometrical deformations of the cavity, while the higher order modes are unstable, giving rise to optical chaos. We discuss the incidence of these results on the modification of the spontaneous emission dynamics of an emitter placed in such a parabolic dome microcavity.

Journal Article↗
PubMed2000

Tandem high-dose therapy in rapid sequence for children with high-risk neuroblastoma.

PURPOSE: Advances in chemotherapy and supportive care have slowly improved survival rates for patients with high-risk neuroblastoma. The focus of many of these chemotherapeutic advances has been dose intensification. In this phase II trial involving children with advanced neuroblastoma, we used a program of induction chemotherapy followed by tandem high-dose, myeloablative treatments (high-dose therapy) with stem-cell rescue (HDT/SCR) in rapid sequence. PATIENTS AND METHODS: Patients underwent induction chemotherapy during which peripheral-blood stem and progenitor cells were collected and local control measures undertaken. Patients then received tandem courses of HDT/SCR, 4 to 6 weeks apart. Thirty-nine patients (age 1 to 12 years) were assessable, and 70 cycles of HDT/SCR were completed. RESULTS: Pheresis was possible in the case of all patients, despite their young ages, with an average of 7.2 x 10(6) CD34(+) cells/kg available to support each cycle. Engraftment was rapid; median time to neutrophil engraftment was 11 days. Four patients who completed the first HDT course did not complete the second, and there were three deaths due to toxicity. With a median follow-up of 22 months (from diagnosis), 26 of 39 patients remained event-free. The 3-year event-free survival rate for these patients was 58%. CONCLUSION: A tandem HDT/SCR regimen for high-risk neuroblastoma is a feasible treatment strategy for children and may improve disease-free survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Magnitude estimation of manually assessed elastic stiffness: stability of the exponent.

Magnitude estimations were obtained for manual assessments of pure elastic stiffness stimuli (metal springs). 20 subjects of varied experience in manual assessment of spinal stiffness volunteered to participate. The mean exponent of the power function relating perceived magnitude of elastic stiffness to measured physical magnitude was 1.65. Exponents varied across the 20 individuals but were stable across testing sessions held at least 2 weeks apart, and the size of the exponent was not related to prior experience.

Adult↗
PubMed1999

Inter-segmental co-ordination in sit-to-stand: an age cross-sectional study.

BACKGROUND AND PURPOSE: Being able to sit-to-stand (STS) effectively is an important functional skill, but there is little information available on the changes that occur with growth and maturity. This study aimed to investigate the inter-segmental co-ordination of STS in three different age groups (12-18 months, 4-5 years and 9-10 years). METHOD: The children studied wore reflective markers and were videotaped as they stood up from a height-adjustable seat that straddled a forceplate. Segmental kinematics and vertical ground reaction force were determined from the co-ordinate and forceplate data. RESULTS: Even at the earliest developmental stage the children had mastered the basic inter-segmental pattern observed in adults. The youngest children, however, were not able to end the movement in quiet standing; rather they raised up on their toes or took a step forward. Performance varied both within and between subjects. Although there was a similarity in the motor pattern used by the younger subjects to that of the older subjects, developmental trends were evident on the videotapes and on examination of the kinematic and kinetic variables. Movement time, amplitude and peak angular velocity of trunk flexion increased with age. Whereas the children in the older age groups displayed a pattern of vertical ground reaction force similar to that reported for adults, the youngest children tended to reach peak force gradually, often with fluctuations. Although there were characteristic trajectories in the phase-plane plots for each group, the overall trend was for the percentage of smooth plots representing a co-ordinated movement, to increase with age. CONCLUSIONS: Differences in inter-segmental co-ordination between the ages studied may relate to the child's ability to control horizontal momentum and to balance.

Age Factors↗
PubMed1999

Sitting balance I: trunk-arm coordination and the contribution of the lower limbs during self-paced reaching in sitting.

The effects of reach distance and type of task on the functional relationship between the trunk, upper limb segments and the lower limbs during self-paced reaching in sitting were examined. Two-dimensional kinematic, kinetic and electromyography (EMG) data were collected as six healthy subjects reached forward under three distance (60, 100, 140% arm's length) and two task (reaching to press a switch, reaching to grasp a glass) conditions. The results demonstrate that type of task affected primarily the temporal aspects of coordination, with the grasp task taking consistently longer than the press task. In contrast, reach distance affected both the spatio-temporal aspects of coordination between the trunk and arm segments and the active contribution of the lower limbs. As reach distance increased, the magnitude of trunk and upper-arm segmental motion increased, whereas forearm segmental motion decreased. However, at each reach distance the path of the hand was relatively straight and there was remarkable consistency in the relationship between trunk and arm segments both within and between subjects suggesting that despite the presence of redundant degrees of freedom, the individual uses a parsimonious coordinative pattern. The vertical ground reaction force (GRF) and EMG data demonstrated that the lower limbs actively contributed to support the body mass when the object was located at 140% arm's length.

Adult↗
PubMed1999

Pre-emptive use of aerosolized ribavirin in the treatment of asymptomatic pediatric marrow transplant patients testing positive for RSV.

Respiratory syncytial virus is a common virus which frequently causes severe lower tract disease in immunocompromised patients. The mortality rate in bone marrow transplant patients with lower tract disease varies from 31% to 100%, depending upon the treatment used, time before initiation of treatment, and whether patients are pre- or post-engraftment. Therapy with inhaled ribavirin has been used with limited success in decreasing mortality rate. Because of concern about conversion from upper respiratory tract disease to lower respiratory tract disease, we conducted a pilot study using aerosolized ribavirin in asymptomatic RSV-positive patients. Patients had NP washes performed on a weekly basis during the RSV season, for the presence of RSV. If patients were positive, but asymptomatic, and could have their transplant postponed, they were treated with ribavirin until negative. Patients who could not be postponed received aerosolized ribavirin, and began transplant conditioning. During this study, we performed 145 nasal aspirations for RSV on 25 patients; 10 aspirates were positive in seven asymptomatic patients. All positive events were successfully treated with ribavirin, which cleared the RSV for a minimum of 3 weeks. No patients became symptomatic. Thus, we conclude that ribavirin can clear asymptomatic infections in immunocompromised pediatric transplant patients.

Adolescent↗