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Biomedical subjects

R Adams

Publications and source records attributed to R Adams.

At least 73 records · Page 4Linked to original sources
PubMed1996

Whole-body cooling of hyperthermic runners: comparison of two field therapies.

Severe exercise-induced hyperthermia requires rapid cooling. Of the many cooling modalities available, there is disagreement over which is the most effective. The purpose of this field study was to compare two cooling therapies for hyperthermic distance runners who had completed an 11.5-km summer foot race. Twenty-one distance runners (mean [+/- SE] initial rectal temperature 41.2 +/- 0.2 degrees C) were treated either by ice water immersion (1 to 3 degrees C, n = 14) or by air exposure while wrapped in wet towels (24.4 degrees C ambient, n = 7). Ice water immersion versus air exposure resulted in significantly different (P < .005) pretherapy to posttherapy changes in rectal temperature (-3.0 +/- 0.3 v -1.4 +/- 0.3 degrees C) and mean cooling rate (0.20 +/- 0.02 v 0.11 +/- 0.02 degrees C/min). Ice water immersion cooled approximately twice as fast as air exposure. These data refute the theory that ice water immersion is an inefficient cooling modality.

Adult↗
PubMed1996

Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards.

This study tested the theoretical proposition that qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards. The research was undertaken in a local district general hospital during January 1995. The project aimed to look at local practices of qualified nurses related to oral care of patients hospitalized in medical wards. Extent of knowledge and current practice of care was examined using a questionnaire. Open and closed style questions were used. The sample comprised nurses on one elderly care ward and three general medical wards and the sample size was 34. The results revealed gaps in knowledge of oral care procedures. In particular, a lack of assessment and documentation was highlighted. However, the nurses indicated a high level of interest at updating themselves in this area of nursing. The limitations of this study are discussed.

Aged↗
PubMed1996

A comparison of pisiform and thumb grips in stiffness assessment.

BACKGROUND AND PURPOSE: The purpose of this study was to determine whether two versions of the posteroanterior (PA) pressure test provide similar stiffness information. SUBJECTS: Twenty subjects were asked to judge the magnitude of five stiffness stimuli provided by a mechanical device. METHODS: Subjects were required to rate the stiffness magnitude on a five-point scale using both the thumb-grip and pisiform-grip versions of the PA pressure test. Using signal detection theory methods, measures of both a subject's ability to discriminate between the stiffness stimuli and a subject's bias in perceived stiffness magnitude due to the testing method were obtained. These values were compared using analysis of trend within an analysis of variance framework. RESULTS: The two methods of performing the PA central pressure had similar stimulus discriminability. With the thumb-grip method, however, a substantial bias occurred, making the mechanical stimuli appear to be stiffer than when the pisiform grip was used. CONCLUSION AND DISCUSSION: The method of performing the PA central pressure test affects the perceived magnitude of stiffness stimuli. This results suggests that the two versions of this clinical test should not be used interchangeably.

Adult↗
PubMed1996

In vivo model of adeno-associated virus vector persistence and rescue.

Gene therapy vectors based on human DNA viruses could be mobilized or rescued from individuals who are subsequently infected with the corresponding wild-type (wt) helper viruses. This phenomenon has been effectively modeled in vitro with both adenovirus (Ad) and adeno-associated virus (AAV) vectors but has not previously been studied in vivo. In the current study, we have developed an in vivo model to study the interactions of a recombinant AAV vector (AAV-CFTR) with wt AAV type 2 (AAV2) and a host range mutant Ad (Ad2HR405) for which monkey cells are permissive (D.E.Brough, S.A.Rice, S.Sell, and D.F.Klessig, J. Virol. 55:206-212, 1985). AAV-CFTR was administered to the respiratory epithelium of the nose or lung of rhesus macaques. Primary cells were harvested from the infusion site at time points up to 3 months after vector administration to confirm vector DNA persistence. Vector DNA was present in episomal form and could be rescued in vitro only by addition of wt AAV2 and Ad. In in vivo rescue studies, vector was administered before or after wt-AAV2 and Ad2HR405 infection, and the shedding of AAV-CFTR was examined. Ad2HR405 and wt-AAV2 infections were established in the nose with concomitant administration. wt-AAV2 replication occurred in the lung when virus was administered directly at a high titer to the lower respiratory tract. AAV-CFTR vector rescue was also observed in the latter setting. Although these studies were performed with small numbers of animals within each group, it appears that AAV-CFTR DNA persists in the primate respiratory tract and that this model may be useful for studies of recombinant AAV vector rescue.

Adenoviridae↗
PubMed1996

Alpha-V/beta-3 and alpha-V/beta-5 integrin distribution in neoplastic kidney.

Integrins are transmembrane glycoproteins that mediate cell-cell and cell-matrix interactions. Altered integrin expression may contribute to tumor progression, invasiveness and metastases. The alpha-V/beta-3 (alpha v beta 3; osteopontin/ vitronectin receptor) has recently been implicated in neovascularization and tumor-induced angiogenesis. alpha v-Subunit also associates with beta 5 to form an alpha v beta 5-complex, another vitronectin receptor. We studied tissue distribution of alpha v beta 3-and alpha v beta 5-integrins, as well as alpha 1- and beta 1-subunits in nephrectomy samples from 7 subjects with localized renal cell carcinoma. Grossly and histologically uninvolved regions ('normal') from the same nephrectomy specimens were used for comparison. Integrin expression was studied with specific monoclonal antibodies and the immunoperoxidase technique. alpha v beta 3 was expressed in the glomerular epithelial cells, Bowman's capsule, vascular endothelium, and weakly in tubular epithelial cells. alpha v beta 5 had a similar distribution except for minimal expression on vascular endothelium. alpha 1-Expression was observed in mesangium and but weakly in Bowman's capsule. beta 1-Expression was seen in glomerular epithelial cells, Bowman's capsule, vascular epithelium and tubular epithelial cells. Unlike in 'normals', neoplastic expression was more heterogeneous alpha v beta 3 was expressed in tumor cells in 4/7 cases, vascular endothelium in 6/6, and in stroma in 4/7. alpha v beta 5 was weakly expressed in tumor cells in 4/5, vascular endothelium in 5/5, and stroma in 4/5 cases. alpha 1-Expression was seen in tumor cells in 3/7, vascular endothelium in 4/7 and in stroma in 7/7 cases. beta 1-Expression was seen in tumor cells in 7/7 cases, vascular endothelium in 7/7, and in stroma in 4/7 cases. This study delineates the pattern of expression of the alpha v beta 3-and alpha v beta 5-integrins in 'normal' and neoplastic human kidney. Variations in alpha v beta 3-and alpha v beta 5-integrin expression may play a role in normal and neoplastic processes of the kidney.

Adult↗
PubMed1996

Safety of single-dose administration of an adeno-associated virus (AAV)-CFTR vector in the primate lung.

Gene therapy for cystic fibrosis (CF) would ideally be accomplished with a vector capable of long-term expression of the cystic fibrosis transmembrane conductance regulator (CFTR) in the absence of a host inflammatory response. Recombinant adeno-associated virus (AAV)-CFTR vectors possess these characteristics in rabbits. Because the utility of AAV vectors as gene transfer agents has only been recognized recently, AAV vector-mediated transduction has never been modeled in a primate host, which is an important step before its use in humans. In order to test the safety and biological activity of AAV-CFTR, single doses of AAV-CFTR vector were administered by fiberoptic bronchoscopy to the posterior basal segment of the right lower lobe (RLL) of the lungs of 10 rhesus macaques with four matched vehicle-treated controls. Animals were followed for 10, 21, 90 or 180 days following vector instillation. Vector DNA transfer occurred in bronchial epithelial cells in the RLL of each animal that received vector as assessed by in situ DNA PCR. Vector mRNA was detectable for 180 days after administration as detected by RT-PCR and by RNase protection assay. Safety of vector administration was determined by measurements of pulmonary mechanics, arterial blood gas analysis, chest radiographs, and bronchoalveolar lavage (BAL) fluid analysis including cell count and quantification of inflammatory cytokines. Gross and microscopic pathologic examination were also performed. There was no evidence of inflammation or other toxicity, although vector DNA was found in extrapulmonary organs of some animals. These results indicate that transduction of the primate airway epithelium with the AAV-CFTR mediates long-term CFTR cDNA transfer and is relatively safe.

Animals↗
PubMed1996

Options in asthma management.

This paper emphasises the strategies that can be used by general practitioners in the management of asthma and reviews the new medications available for the severe asthmatic population. The principles of asthma management involve the assessment of asthma severity and the assessment of risk factors. An effective review process entails: identification of immediate patient concerns; a review of symptoms; lung function; and detection of altered compliance. In the setting of poor compliance additional strategies can be applied. Three relatively new medications are available. Salmeterol (long acting beta 2 agonist) and fluticasone (inhaled corticosteroid) are for use in the small proportion of asthmatics who have severe asthma. Nedocromil sodium is a cromoglycate-like drug mainly suitable for treatment of milder asthmatics.

Administration, Inhalation↗
PubMed1996

Vascular endothelial lesion in patients undergoing bone marrow transplantation.

Changes in endothelial cell activity are likely to play a role in the thrombotic complications of bone marrow transplantation (BMT) such as the development of veno-occlusive disease. Accordingly, we measured established plasma endothelial cell markers von Willebrand factor (vWf), soluble thrombomodulin (sTM), soluble ICAM-1 (sICAM-1), and possible inducers of these molecules, TNF alpha and elastase, in the plasma of 25 patients, 1 week before as well as 1 and 3 weeks after BMT. Compared to healthy age and sex-matched controls, patients exhibited increased vWf and sTM. One week after transplantation, there were significant increases in vWf and sICAM-1, with a significant fall in elastases. Three weeks after the transplantation, sICAM-1 and, to a lesser extent, vWf increased still further, whereas elastases were unchanged. There were no significant changes in sTM and in TNF alpha through the serial study. Our data suggest that before conditioning, vascular endothelium is damaged by both injury and activation, as seen by the variations of vWf and sTM. After transplantation, the enhancement of this damage seems to be more specifically related to activation, since we observed a strong subsequent increase in vWf and markedly in sICAM-1.

Adolescent↗
PubMed1995

The effect of phenylephrine on Müller muscle. A blepharogram study of eyelid motion.

PURPOSE: The blepharogram technique is used to study the effect of a drug on blinking. The authors show that ocular instillation of phenylephrine, a stimulant of Müller muscle of the eyelid, accelerates the up phase of the blink. METHODS: Motion of a tiny search coil glued to the eyelid moving in a weak magnetic field modifies an induced alternating current which is amplified and used to display the position of the upper eyelid in degrees on the ordinate of a graph with time in milliseconds on the abscissa. The graph is called a blepharogram. Blepharogram studies and individual blink analysis show the effect of phenylephrine on eyelid motion (blinking). RESULTS: Instillation of phenylephrine accelerated the up phase of the blink in all ten experimental subjects. In 65% of subjects, phenylephrine also produced or increased newly described N and M blepharogram patterns. CONCLUSION: This is the first instrumental detection of the effect of a pharmacologic agent on eyelid motion. The blepharogram technique provides insight into eyelid physiology and can be used to study any neuromuscular condition that affects eyelid motion.

Adult↗
PubMed1995

Modulation of a recombinant glycine transporter (GLYT1b) by activation of protein kinase C.

Treatment of human embryonic kidney cells (HEK 293 cells) expressing the mouse glycine transporter 1 (GLYT1b) with the protein kinase C (PKC) activator phorbol 12-myristate 13-acetate (PMA) decreased specific [3H]glycine uptake. This down-regulation resulted from a reduction of the maximal transport rate and was blocked by the PKC inhibitors 1-(5-isoquinolinylsulfonyl)-2-methylpiperazine (H7) and staurosporine. The inhibitory effect of PMA treatment was also observed after removing all five predicted phosphorylation sites for PKC in GLYT1b by site-directed mutagenesis. These data indicate that glycine transport by GLYT1b is modulated by PKC activation; however, this regulation may involve indirect phosphorylation mechanisms.

Amino Acid Transport Systems, Neutral↗
PubMed1995

Efficacy and safety of fluconazole prophylaxis for fungal infections after marrow transplantation--a prospective, randomized, double-blind study.

A randomized, double-blind, placebo-controlled trial assessed the efficacy and toxicity of 400 mg/day fluconazole in preventing fungal infections during the first 75 days after marrow transplantation. During prophylaxis, systemic fungal infections occurred in 10 (7%) of 152 fluconazole-treated patients compared with 26 (18%) of 148 placebo-treated patients (P = .004). There were no Candida albicans infections in fluconazole recipients compared with 18 in placebo recipients (P < .001) and no significant increase in Candida infections other than C. albicans. Fluconazole also significantly reduced the incidence of superficial fungal infections (P < .001), fungal colonization (P = .037), and empiric amphotericin B use (P = .005). The probability of survival was improved in fluconazole recipients, in whom 31 deaths occurred up to day 110 after transplantation compared with 52 deaths in placebo recipients (P = .004). No clinically significant toxicity was detected with fluconazole use. Prophylactic fluconazole was safe and significantly reduced systemic fungal infections with other benefits, including improved survival at day 110 after marrow transplantation.

Adolescent↗
PubMed1995

Is the clinical concept of spinal stiffness multidimensional?

BACKGROUND AND PURPOSE: This study investigated whether the poor reliability of judgments of posteroanterior (PA) spinal stiffness is due to rater bias or is a consequence of raters each having individual concepts of PA stiffness. SUBJECTS: Three pairs of manipulative physical therapists with a minimum of 5 years of experience took part in the study. METHODS: The raters were required to make stiffness judgments of a series of metal springs, and their performance at this task was compared with that obtained when they rated the PA stiffness of patients with low back pain. A range of reliability indices were calculated and evaluated to establish whether rater bias contributed to poor reliability in either task. The relationship between each rater's estimates of the magnitude of the stimuli and the measured stiffness of the springs was also assessed using the Pearson Product-Moment Correlation Coefficient. RESULTS: The average intraclass correlation coefficient (2, 1) for rating spring stiffness was found to be .60, whereas for human spines it was found to be .19. There was no evidence of rater bias contributing to poor reliability for rating stiffness of human spines. The average correlation between the rater's estimates of the magnitude of the stimuli and the measured stiffness of the stimuli was .80. CONCLUSION AND DISCUSSION: Physical therapists demonstrated much better ability to judge spring stiffness than the PA stiffness of human spines. This difference in performance implies that mechanical stiffness is not equivalent to the clinical concept of PA stiffness. Posteroanterior stiffness may have more than one dimension, and individual interpretation of stiffness as a construct may lead to rater disagreement in the clinic. The reliability of judgments of PA spinal stiffness may be enhanced in the future if its dimensions can be identified, defined, and taken into account during clinical procedures.

Biomechanical Phenomena↗
PubMed1994

Llama neonatology.

Recognition of the risk factors that predispose the neonate to disease should prompt early diagnosis of potential disease problems and lead to a higher rate of neonatal survival. Understanding the normal physiologic changes of this adaptive period provides insight into the problems that may develop and a basis for rational therapeutic treatment.

Adaptation, Physiological↗
PubMed1994

Reliability of pain and stiffness assessments in clinical manual lumbar spine examination.

BACKGROUND AND PURPOSE: The purpose of this study was to determine the intertherapist reliability of judgments of stiffness and pain at L-1 to L-5 made using posteroanterior (PA) central pressure testing. SUBJECTS: Three pairs of manipulative physical therapists with a minimum of 5 years of experience were asked to rate pain and stiffness in a total of 90 patients with low back pain. METHODS: Each pair of therapists assessed 30 patients within their own clinic, using their preferred technique to perform an examination using the PA central pressure test at the five lumbar levels. Each pair of therapists recorded their ratings of pain and stiffness. Reliability of judgments was evaluated by intraclass correlation coefficients (ICC) and percentage of exact agreement scores. RESULTS: The ICC values for pain judgments for the group as a whole ranged from .67 to .72, with agreement scores ranging from 31% to 43%. The ICC values for stiffness judgments ranged from .03 to .37, with agreement scores ranging from 21% to 29%. CONCLUSION AND DISCUSSION: Judgments of stiffness made by experienced manipulative physical therapists examining patients in their own clinics were found to have poor reliability, whereas pain judgments had good reliability. Further investigation of this test is required in order to develop a more reliable method of assessing PA stiffness.

Adult↗
PubMed1994

The contribution of quality of life to developing therapeutic nursing in special hospitals.

Many changes have been made to the management of special hospitals (state hospitals which house patients for an indeterminate stay who are mentally ill, who may have committed a serious offence, and who are considered to be a danger to society and/or to themselves). A key objective of the authority which currently manages these hospitals is to ensure a good quality of life (QoL) for patients and staff. This paper argues first that in order to meet their obligation to treat detained patients, mental health nurses in special hospitals must aim to improve the QoL of those in their care. This viewpoint is echoed by Coid (1993), who considers that society has a moral responsibility, which should be expressed formally in legislation to ensure that detained patients have a high QoL. The paper then addresses the issues involved in attaining an adequate QoL for detained patients, examines the methodological problems in QoL research and its indications for nurses working in this field, and outlines appropriate indicators for examining QoL for patients living in special hospitals. The intention is to initiate debate and outline an approach for mental health nurses towards development of a QoL measure for use in special hospitals. This is considered a necessary first stage if an adequate QoL is to be attained for detained patients.

Hospitals, Psychiatric↗
PubMed1994

A study of chromium induced allergic contact dermatitis with 54 volunteers: implications for environmental risk assessment.

Over the past 60 years, dose-response patch test studies by various methods have been conducted in an attempt to identify the minimum elicitation threshold (MET) concentration of hexavalent chromium (Cr(VI)) that produces an allergic response in Cr(VI) sensitive subjects. These data are not adequate, however, to provide an accurate estimate of the MET because of the variability in the patch testing techniques and the variability in diagnostic criteria used. Furthermore, the data were not reported in terms of mass of allergen per surface area of skin (mg Cr/cm2-skin), which is necessary for conducting occupational or environmental health risk assessments. Thus the purpose of this study was to determine the MET (mg allergen/cm2) for Cr(VI) and trivalent chromium (Cr(III)) by patch testing techniques. A patch test method that delivers a controlled amount of allergen per surface area of skin was used. A group of 54 Cr(VI) sensitised volunteers were patch tested with serial dilutions of Cr(VI) and Cr(III) to determine the cumulative response rate at several concentrations. The results indicate that the 10% MET for Cr(VI) based on the cumulative response was 0.089 micrograms Cr(VI)/cm2-skin. Only one of the 54 volunteers may have responded to 33 micrograms Cr(III)/cm2-skin, otherwise Cr(III) was unable to produce allergic contact dermatitis in these highly sensitive volunteers. Two supplemental studies were also conducted to assess whether the surface area of the patch and the concentration of Cr(VI) in the patch (related to patch thickness) were likely to influence the results. The data from these studies were used to assess the risk of developing allergic contact dermatitis due to contact with Cr(VI) and Cr(III) in soil. The findings indicated that soil concentrations at least as high as 450 ppm Cr(VI) and 165,000 ppm Cr(III) should not pose an allergic contact dermatitis hazard for at least 99.99% of the people in the community who might be exposed.

Adult↗