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Biomedical subjects

R Allen

Publications and source records attributed to R Allen.

At least 91 records · Page 5Linked to original sources

Cost-effectiveness issues for home i.v. therapy in the United States.

The popularity of home infusion therapy is increasing as it becomes recognized as a cost-effective alternative to hospitalization with the added benefit of improving patient quality of life. Selection of appropriate candidates for home i.v. therapy requires consideration of many variables pertaining to the medical and psychosocial suitability of the patient. Innovations in drug delivery devices have created opportunities for patients to receive parenteral therapy at home who would otherwise be considered inappropriate candidates for this treatment option. The cost of providing home IV therapy is mainly attributable to pharmacy and nursing services. Other contributing cost factors include the expense of ancillary supplies, supply delivery and management, and those costs created by administrative and regulatory requirements. When appropriately managed, home administration of IV medications can be a cost-effective way of delivering safe, effective, and quality care to an increasing population of patients.

Anti-Bacterial Agents

Juvenile chronic arthritis--diagnosis and management.

Juvenile chronic arthritis (JCA) is actually a collection of conditions that together constitute the major forms of chronic arthritis in childhood. The author outlines the diagnosis and management of this condition, which should be considered as a distinct entity from the arthritides of adulthood.

Adolescent

Who will practise emergency medicine? Survey of family medicine graduates.

A survey of recent family medicine graduates showed that two thirds were doing no emergency work. Those who had originally planned to practise emergency medicine were more likely to be doing it than those who had not. More women than men dropped their plans to do emergency work. Two thirds of those who had dropped their plans thought their training had influenced the decision.

Attitude of Health Personnel

Cigarette smoking during pregnancy: acute effects on uterine flow velocity waveforms.

OBJECTIVE: To determine the acute effects of smoking during pregnancy on selected characteristics of the flow velocity waveform of the uterine artery. METHODS: We studied 19 chronic smokers at a mean (+/- standard error) gestational age of 28 +/- 1 weeks. After informed consent was given, the uterine artery was located using ultrasound imaging with color flow mapping. The characteristic waveform was imaged by pulsed Doppler ultrasonography. Maternal heart rate and blood pressure and the systolic-diastolic ratio (S/D) and resistance index of the uterine artery were measured before (-10 and -1 minutes), during (+5 and +10 minutes), and after (+20 and +30 minutes) smoking two standard cigarettes in succession. RESULTS: Maternal heart rate increased 27%, systolic blood pressure increased 8%, and diastolic blood pressure increased 19% with smoking (P < .001). The uterine artery S/D and resistance index decreased from 2.33 to 2.02 and from 0.55 to 0.49, respectively (P < .001). CONCLUSION: The acute effects of smoking on maternal systemic hemodynamics probably influence the flow velocity waveform of the uterine artery and preclude any definitive interpretation of acute changes in downstream resistance.

Adult

Targeted disruption of the mouse transforming growth factor-beta 1 gene results in multifocal inflammatory disease.

Transforming growth factor-beta 1 (TGF-beta 1) is a multifunctional growth factor that has profound regulatory effects on many developmental and physiological processes. Disruption of the TGF-beta 1 gene by homologous recombination in murine embryonic stem cells enables mice to be generated that carry the disrupted allele. Animals homozygous for the mutated TGF-beta 1 allele show no gross developmental abnormalities, but about 20 days after birth they succumb to a wasting syndrome accompanied by a multifocal, mixed inflammatory cell response and tissue necrosis, leading to organ failure and death. TGF-beta 1-deficient mice may be valuable models for human immune and inflammatory disorders, including autoimmune diseases, transplant rejection and graft versus host reactions.

Animals

Phase II study of Edatrexate in stage III and IV non-small-cell lung cancer.

A total of 49 patients with advanced, previously untreated non-small-cell lung cancer (NSCLC) were treated with a new antifolate, Edatrexate (10-ethyl-10-deaza-aminopterin; 10-EdAM). Patients received 80 mg/m2 weekly for 12 weeks, and responders received a further 6 cycles at 2-week intervals. Dose reductions were carried out for haematological toxicity and mucositis. Response was assessed prior to each treatment according to WHO criteria. Among the 45 evaluable patients, 6 [13.3%; 95% confidence interval (CI), 6%-26%] achieved a partial response (PR) and 9 (20%; 95% CI, 11%-34%) showed a minor response (MR; 25%-50% reduction in the sum of 2 perpendicular tumour diameters). In those receiving four or more cycles of treatment, the PR and MR rates were 17.6% and 26.4%, respectively. The resultant toxicity mainly constituted skin rash, mucositis and myelosuppression. Edatrexate is active against NSCLC and produces toxicity profile similar to that of methotrexate.

Aged

Sequence of a small subunit rRNA gene of Schistosoma mansoni and its use in phylogenetic analysis.

The complete sequence of a small ribosomal RNA gene of Schistosoma mansoni contained within plasmids pSM389 and pSM889 is presented. It was found to be 1992 bp in length, larger than that of most eukaryotes. Extra nucleotides occur in regions known to be variable (V4 and V7). The predicted secondary structure of the nucleotides 660-853 revealed additional helices which have been designated E21-1A and E21-1B. The other region to differ from higher eukaryotes lies between nucleotides 1457 and 1569. Secondary structure prediction demonstrated that a single extended helix may be formed from this part of the schistosome small subunit rRNA sequence. Nucleotides that could be unambiguously aligned with those of 12 other eukaryotes were used to estimate phylogenetic relationships. The consensus tree obtained by Maximum Parsimony analysis showed the schistosome as a sister taxon to the flatworm Dugesia tigrina.

Amino Acid Sequence

Structure of Sm25, an antigenic integral membrane glycoprotein of adult Schistosoma mansoni.

Sm25 is the principal antigen recognised by antibodies from mice protectively vaccinated with isolated tegumental membranes of adult Schistosoma mansoni. The full-length amino acid sequence of this protein has been deduced from the sequence of two cDNAs, one isolated by screening a cDNA library and the other, including the 5' end of the gene, amplified directly from adult worm RNA using the polymerase chain reaction. The predicted sequence represents a nascent polypeptide of Mr 21,500. Following cleavage of a predicted signal sequence, the Mr of the resulting polypeptide is 17,600. The polypeptide contains 2 potential sites for N-linked glycosylation and a hydrophobic domain at the C-terminus that could facilitate membrane association. Analysis of the mature gene product confirmed that Sm25 is an N-glycosylated integral membrane protein and that the Mr of the deglycosylated polypeptide is between 15,000 and 20,000.

Amino Acid Sequence

Molecular cloning and characterisation of the 22-kilodalton adult Schistosoma mansoni antigen recognised by antibodies from mice protectively vaccinated with isolated tegumental surface membranes.

A cDNA clone from an adult Schistosoma mansoni lambda gt11 expression library (A12) encoding an antigenic polypeptide of 22 kDa is described. A12 is 797 bp long and has one open reading frame encoding a protein of 190 amino acids which does not contain a signal sequence or membrane anchor motif and has no homologies with any sequences on the currently available data bases. Its product (sm22.6) is recognised by antibodies from mice protectively vaccinated with purified adult S. mansoni tegumental membranes and by serum from S. mansoni-infected Brazilians. It is present in all post-snail life cycle stages except the egg, is not sex-specific, and is found in 9 species of Schistosoma, but not in a range of other helminths. Data are presented which suggest that sm22.6 is a soluble, peripheral membrane protein.

Amidohydrolases

Shoulder dystocia recognition: differences in neonatal risks for injury.

Shoulder dystocia (SD) is an event whose current diagnostic approach is based on subjective criteria alone. Since the risk for immediate neonatal morbidity is critically linked to recognition and appropriate management of this obstetric emergency, we hypothesized that infants having injuries consistent with SD are frequently delivered without the intrapartum identification of this condition. A retrospective analysis of 26,033 vaginal births from January 1979 to April 1987 identified 162 maternal cases in which SD was diagnosed during delivery (incidence, 0.62%). Within this subset of patients, 24 neonates (15%) were identified as having either brachial plexus or fractured clavicle injuries associated with delivery. An additional 60 neonates were identified as having similar injuries immediately following delivery but without obstetric recognition of SD. Therefore 71% of all the injured infants were the product of deliveries without SD recognition. A comparison was made of maternal and neonatal variables for three groups (SD, uninjured; SD, injured; unrecognized SD, injured). The SD, injured group distinguishes itself from the other two groups by significant differences in the degree to which variables previously associated with SD are present. Conversely, both other groups are similar in all parameters except for accepted SD maneuvers utilized. These results support our hypothesis that SD is underreported in the obstetric literature and that unrecognized SD is associated with an increased risk of neonatal injury. Efforts to define objectively the threshold forces associated with neonatal injury and to develop SD teaching models should improve this clinical dilemma.

Adult

Neuropeptide Y radio-immunoassay: characterization and application.

1. A sensitive and specific neuropeptide Y (NPY) radio-immunoassay has been developed. This radio-immunoassay does not detect the NPY-related peptides pancreatic polypeptide or peptide YY. NPY extracted from rat plasma using sequential C18 sorbent and affinity chromatography co-eluted with synthetic rat NPY when applied to high pressure liquid chromatography. 2. The procedure of stabilization of platelets followed by high speed centrifugation reduced basal values of NPY by 60%, and this may be consistent with removal of platelets that release NPY. Administration of the cholinesterase inhibitor physostigmine (0.3 mg/kg), intravenously, produced a small but significant increase (39%) from basal concentrations of NPY. 3. NPY concentrations in young (2-3-month-old) Sprague-Dawley and Fisher 944 rats were similar; however, NPY concentrations were significantly increased (55%) in 2-year-old Fisher 944 rats. Similar to plasma concentrations of noradrenaline, NPY levels increase with age.

Aging

Addressing racism in psychiatry: is the therapeutic community model applicable?

Several reports have documented the failure of statutory psychiatric services in Britain to provide for the needs of clients from minority ethnic groups. Black clients are particularly underrepresented in Psychotherapy for reasons which are complex and varied, but include the institutionalised racism which pervades British society. We argue that the Therapeutic Community (TC) model of treatment (or aspects of it deployed in other mental health situations) provides a potential for a less racist service. Using the Henderson Hospital TC as a case in point, we argue that the TC is an approach which can meet the needs of black peoples. However, it is acknowledged that despite the ideological suitability of the TC model for black clients, in practice the Henderson Hospital is not fulfilling its role in providing therapy to this group. We discuss possible explanations and suggest the practical changes necessary, so that Henderson Hospital can meet the needs of clients in a multi-cultural Britain.

Black or African American

Infant care and wives' depressive symptoms.

Although some investigators show that division of child care between spouses is related to the psychological well-being of wives, little attention has been given to the relevance of specific dimensions of child care or to nonemployed as well as employed wives. In this study we differentiate basic child care tasks, i.e., those that are essential for the family's physical well-being from other, more supplemental, or auxiliary tasks. We hypothesize that husbands' failure to perform auxiliary child care will be distressing for wives, regardless of employment status because it contributes to perceptions of marital inequity. On the other hand, husbands' lack of participation in the more time-consuming, basic, tasks will be most distressing for employed wives because it results in an increased overall work load. We also hypothesize that when employed mothers are responsible for arranging child care, and when such care entails financial strains, they are more likely to experience psychological distress. To evaluate these hypotheses we use data drawn from a mail survey of a sample of mothers of infants. Using multiple regression analysis, we find that husbands' involvement in child care and housework, especially in the time-consuming tasks, is relatively low and that the most consistent predictor of husbands' involvement is wives' relative income. In terms of the impact of husbands' involvement on wives' well-being, lower levels of husbands' participation in auxiliary, but not basic, child care are associated with increases in reported symptoms, regardless of wives' employment status. When child care is relatively more costly, employed wives report increased symptoms of depression. We discuss these results in terms of the role played by expectations of husbands and wives about parental responsibility for child care.

Age Factors

Closure of a bronchopleural fistula with bronchoscopic instillation of tetracycline.

Persistent bronchopleural fistulas (BPF) due to infection, trauma, or thoracic surgical procedures are often difficult to manage. We report a patient with fulminant Staphylococcus aureus pneumonia complicated by chronic BPF formation which prevented weaning from mechanical ventilation due to severe air leak. Fistula closure was obtained by instillation of tetracycline into the fistula via a fiberoptic bronchoscope using a balloon catheter and blood clot occlusion technique. This closed the BPF and allowed successful weaning from mechanical ventilation.

Adolescent