A 69-year-old man with anger and angina.
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Aged↗
Biomedical subjects
R B Williams
Publications and source records attributed to R B Williams.
Esophagopharyngeal acid regurgitation: dual pH monitoring criteria for its detection and insights into mechanisms.
BACKGROUND & AIMS: A valid technique for the detection of esophagopharyngeal acid regurgitation would be valuable to evaluate suspected reflux-related otolaryngologic and respiratory disorders. The aim of this study was to derive pH criteria that optimally define esophagopharyngeal acid regurgitation and to examine patterns of regurgitation. METHODS: In 19 healthy controls and 15 patients with suspected regurgitation, dual or quadruple pH sensors were used to monitor pharyngeal and esophageal pH. For each combination of the 2 variables, DeltapH and nadir pH, proportions of pH decreases that occurred during or independent of esophageal acidification were calculated to determine the likelihood that an individual pharyngeal pH decrease was a candidate regurgitation event or a definite artifact. RESULTS: Overall, 92% of pharyngeal pH decreases of 1-2 pH units and 66% of pH decreases of this magnitude reaching a nadir pH of <4 were artifactual. Optimal criteria defining a pharyngeal acid regurgitation event were a pH decrease that occurred during esophageal acidification, had a DeltapH of >2 units, and reached a nadir of <4 units in less than 30 seconds. Regurgitation occurred more frequently in subjects in an upright (32 of 35) than in a supine (3 of 35 events; P </= 0.0001) position and was more frequently abrupt (synchronous with esophageal acidification) than delayed (P </= 0.05). CONCLUSIONS: Accepted criteria for gastroesophageal reflux are not applicable to the detection of esophagopharyngeal acid regurgitation, and most regurgitation occurs abruptly and in upright position.
Adult↗
The efficacy and economic benefits of Paracox, a live attenuated anticoccidial vaccine, in commercial trials with standard broiler chickens in the United Kingdom.
The first large-scale broiler trials under modern commercial conditions of Paracox, a live attenuated anticoccidial vaccine administered in the drinking-water, are reported from the United Kingdom. The vaccine, comprising all seven of the species of Eimeria that parasitise the domesticated fowl, was compared with anticoccidial drug shuttles (halofuginone then salinomycin, or nicarbazin then monensin) in nine trials comprising over 936000 chickens, all of which also received the digestive enhancer virginiamycin. No clinical diseases were diagnosed in vaccinated birds in any of the trials. Necrotic enteritis occurred in the medicated controls (anticoccidial drug shuttles) of 2/9 trials and coccidiosis occurred concurrently with one of these outbreaks. Using additional criteria that particularly reflected economic benefits, the vaccine performed overall at least as well as the drug shuttles. The crucial results for vaccinated and medicated birds were: feeding costs (pence per kg liveweight of birds that were processed), 33.9 pence (vaccinated) and 33.7 pence (medicated) (P=0.549); feed conversion ratios, 2.01 (vaccinated) and 1.96 (medicated) (P=0.025); coefficient of variation in mean bird weight before processing, 9.3% (vaccinated) and 9.0% (medicated) (P=0.300); birds found dead, 3.0% (vaccinated) and 3.8% (medicated) (P<0.001); culled birds 4.0% (vaccinated) and 3.8% (medicated) (P=0.483); birds rejected during processing, 1.1% (vaccinated) and 1.2% (medicated) (P=0.271). In addition, the mean total water consumptions per chick were 7.82 L (vaccinated) and 7.76 L (medicated) (P=0.611), whilst the mean percentages of dry matter in the litter were 76.2% (vaccinated) and 75.2% (medicated) (P=0.195). Accumulation of oocysts in the litter of chicks vaccinated at 5 days of age peaked at 21 and 35 days, compared with medicated controls which showed a single higher peak at 35 days. Hence, the use of Paracox vaccine may control clinical coccidiosis in broilers and also achieve performances at least equal to anticoccidial drugs, particularly where drug resistance might result in failure to control disease.
Animals↗
A compartmentalised model for the estimation of the cost of coccidiosis to the world's chicken production industry.
A compartmentalised model is presented for the estimation of the monetary losses suffered by the world's poultry industry resulting from coccidiosis of chickens and costs of its control. The model is designed so that the major elements of loss may be separately quantified for any chicken-producing entity, e.g., a farm, a poultry company, a country, etc. Examples are presented and the sources, reliability and geographical relevance of the data used for each parameter are provided. Loss elements for specific geographical areas should be recalculated at appropriate intervals to take into account local and international fluctuations in costs of chicks feed, labour, financial inflation and world currency exchange rates. Equations are given for relationships among numbers of chickens, liveweights, weights of carcasses, feed consumptions, feed conversion ratio (FCR), prices of feeds, prices of anticoccidial therapeutic and prophylactic drugs, values of chickens, chicken rearing costs; and effects of coccidiosis on mortality, weight gain and FCR. Using these equations, it is theoretically possible for an international team of representatives, each using reliable local data, to calculate simultaneously each relevant loss element for their respective countries. Addition of these elements could give, for the first time, an accurate global estimate of the losses due to chicken coccidiosis. The total cost of coccidiosis in chickens in the United Kingdom in 1995 is estimated to have been at least GB pound silver 38 588 795, of which 98.1% involved broilers (80.6% due to effects on mortality, weight gain and feed conversion, and 17.5% due to the cost of chemoprophylaxis and therapy). The costs of poor performance due to coccidiosis and its chemical control totalled 4.54% of the gross revenue from UK sales of live broilers. This model includes a new method for comparing the profitabilities of different treatments in commercial trials. providing actual costs rather than the arbitrary numerical scores of other methods. Although originally designed for the study of coccidiosis, the model is equally applicable to any disease. It should be of value to agricultural economists, the animal feed and poultry industries, animal health companies, and to research scientists (particularly for preparing grant applications).
Animal Husbandry↗
Three enzymes newly identified from the genus Eimeria and two more newly identified from E. maxima, leading to the discovery of some aliphatic acids with activity against coccidia of the domesticated fowl.
Nine enzymes were detected in sporulated oocysts of Eimeria tenella and E. maxima, parasites of the domesticated fowl (Gallus gallus). Three enzymes, hydroxybutyrate dehydrogenase, alanine aminotransferase and gamma-glutamyltransferase, all identified for the first time in Eimeria of fowl, occurred both in E. tenella and in E. maxima. The remaining enzymes assayed had previously been found in various Eimeria species of fowl, although creatine kinase and glutamate dehydrogenase were hitherto unknown from E. maxima. The three enzymes newly recorded from Eimeria of fowl are of interest as potential genetic markers, and also as potential chemotherapeutic targets. The discovery of hydroxybutyrate dehydrogenase led to the demonstration of anticoccidial activity by some aliphatic acids. The paper also includes a list of the enzymes detected in Eimeria of fowl in previous studies.
5'-Nucleotidase↗
The association between self-rated health and mortality in a well-characterized sample of coronary artery disease patients.
BACKGROUND: The relationship between self-rated health and mortality after adjustment for sociodemographic variables, physician-rated comorbidities, disease severity, health-related quality of life (HRQOL), and psychosocial measures (depression, social support, and functional ability) was examined in the Mediators of Social Support (MOSS) study. SUBJECTS: The sample consisted of 2,885 individuals (mean age, 62.5 years) who had significant heart disease based upon heart catheterization. RESULTS. Using Cox proportional survival analysis, individuals who rated their health as "fair" or "poor" had a significantly greater likelihood of all-cause mortality (OR = 2.13; CI = 1.40-3.23; OR = 4.92; CI = 3.24-7.46, respectively) across follow-up (mean, 3.5 years) than those who rated their health as "very good" after considering sociodemographic factors. After adjustment for comorbidities, disease severity, HRQOL, psychosocial factors, and demographic variables, only those who rated their health as poor had a significant greater risk of mortality (OR = 2.96, CI = 1.80-4.85). A similar pattern was observed for coronary artery disease (CAD)-related mortality; increased adjustment of variables weakened the relationship between self-rated health and mortality. Individuals who rated their health as poor had a significantly greater risk of CAD-related mortality than did those who rated their health as very good (poor vs. very good OR = 3.58, CI = 2.13-6.02) after adjustment for all available mortality risk factors. CONCLUSIONS: This study indicates that it is important to include self-rated health when studying risk factors for mortality. Not adjusting for relevant factors may provide an overestimation of the effects of self-rated health on mortality in a sample of CAD patients.
Activities of Daily Living↗
Cricopharyngeal myotomy does not increase the risk of esophagopharyngeal acid regurgitation.
OBJECTIVE: It is not known whether cricopharyngeal myotomy predisposes to esophagopharyngeal regurgitation. Using ambulatory, dual pharyngeal, and esophageal pH monitoring before and after cricopharyngeal myotomy, our aim was to determine the effect, if any, of myotomy on the frequency of esophagopharyngeal acid regurgitation. METHODS: We studied prospectively 18 patients who underwent cricopharyngeal myotomy for pharyngeal dysphagia (10 Zenker's, eight neurogenic dysphagia), of whom 17 agreed to undergo dual pH monitoring preoperatively, and 10 who agreed to both pre- and postoperative monitoring. RESULTS: Symptoms of gastroesophageal reflux disease were present in 30%. Cricopharyngeal myotomy significantly reduced basal upper esophageal sphincter pressure by 49%, from 37+/-5 mm Hg to 19+/-3 mm Hg (p = 0.007). Esophagopharyngeal regurgitation was a rare event and the frequency of it did not differ between patients and healthy controls. Preoperatively, three regurgitation events in two patients did not differ from the postoperative frequency of a total of two events in the same two patients. CONCLUSIONS: Increased esophageal acid exposure is common and esophagopharyngeal regurgitation is rare in unselected patients undergoing cricopharyngeal myotomy for pharyngeal dysphagia. Myotomy does not increase the frequency of esophagopharyngeal acid regurgitation in such patients.
Adult↗
The relationship between self-rated health and health status among coronary artery patients.
OBJECTIVES: This study examined the descriptive relationship of self-rated health (SRH) with various psychosocial measures, sociodemographic variables, coronary artery disease (CAD) diagnostic/clinical measures, and medically abstracted comorbidities. METHODS: The sample was 2,855 individuals from the Mediators of Social Support (MOSS) study who had at least 75% narrowing in more than one vessel, as indicated by a cardiac catheterization. RESULTS: After adjusting for sociodemographic factors, individuals who rated their health as poor/fair had significantly worse performance on all psychosocial measures and were more likely to be female, non-White, and of a lower socioeconomic status than those who rated their health as being good or better. There were few differences on SRH across various diagnostic/clinical measures of health. DISCUSSION: A single item measure of SRH may be useful; the generalizability of the item must be considered. In this sample of CAD patients, SRH was related more to psychosocial factors than to clinical and disease indicators.
Adult↗
Social ties and health.
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Health Promotion↗
Lower socioeconomic status and increased mortality: early childhood roots and the potential for successful interventions.
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Adult↗
Epidemiological aspects of the use of live anticoccidial vaccines for chickens.
This review address the epidemiology (epizootiology) of coccidiosis in commercial chickens with emphasis on the effects on the use of live vaccines. Surveys suggest that all seven valid species of chicken coccidia (Eimeria acervulina, Eimeria brunetti, Eimeria maxima, Eimeria mitis, Eimeria necatrix, Eimeria praecox and Eimeria tenella) are ubiquitous. All species are pathogenic to various extents. New results are presented on the pathogeneicities of E. acervulina, E. mitis and E. Praecox. Unless ingested by chickens, oocysts in poultry-house litter may die after about 3 weeks. Oocyst sporulation may be better in drier, rather than wetter, litter. Whether sporulated or not, up to 20% of ingested oocysts may pass undamaged through a chicken's intestine. The excreted, sporulated oocysts can be immediately reingested to initiate an infection; the unsporulated oocysts can still sporulate after passing through the intestine. The seven species differ in their times of appearance in commercial flock; hence particular vaccines may be designed for rearing standard broilers for up to about 6 weeks or for breeding stock. Attenuated, precocious lines of Eimeria in vaccines have low reproductive potentials, thus avoiding crowding, developing optimally, and stimulating immune response with minimal tissue damage. Cross-immunity between Eimeria species is probably minimal. There is reciprocity between the immune status of chicken and their excretion of oocysts for each species, ensuring continual stimulation of immune responses in birds on litter. Paracox vaccine, comprising all seven Eimeria species, is shown here to stimulate immunity to each of them independently. Total oocyst accumulation in litter following Paracox vaccination at 1 week comprises a small peak of vaccinal oocysts at 2-4 weeks, then a higher peak of the local virulent population at 4-7 weeks, which rapidly wanes. The attenuated drug-sensitive vaccinal oocysts probably interbreed with the corresponding wild species, reducing both virulence and drug-resistance in the local population. Anticoccidial vaccines may not induce complete immunity in chickens with lowered immunocompetence due to stressors, including certain viral disease. Future development of live vaccines for standard broilers may be expected in the relatively short term. The useful lives of anticoccidial drugs might be extended by rotating them with live vaccines.
Animals↗
Symptoms of depression and changes in body weight from adolescence to mid-life.
OBJECTIVE: To investigate the relationship of symptoms of depression to weight changes in healthy individuals of normal weight across a follow-up of over 20 y. PARTICIPANTS AND DESIGN: College students (3885 men and 841 women) were administered a self-report depression measure in the mid-1960s. Their baseline body mass index (BMI) was calculated from their college medical records. Participants were contacted by mail in the late 1980s and asked to report their current height and weight as well as their smoking and exercise habits. Another measure of depressive symptoms was obtained from 3560 individuals at follow-up. Multiple regression models were used to relate changes in weight to depression scores while controlling for background (gender, baseline BMI and the gender by BMI interaction) and behavioral (exercise and smoking) predictors. RESULTS: The relationship between depressive symptoms and body weight change took the form of an interaction with baseline BMI (P < 0.001). Those with high baseline depression scores gained less weight than their nondepressed counterparts if they were initially lean, but more if they were initially heavy. This trend was especially strong in those with high depression scores at both baseline and follow-up. CONCLUSIONS: The findings support the hypothesis that depression exaggerates pre-existing weight change tendencies. This pattern would not have been detected by an examination of main effects alone, illustrating the need to move toward more complicated interactive models in the study of psychological factors and weight.
Adolescent↗
The management of seborrhoeic keratoses by general practitioners, surgeons and dermatologists.
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Cryotherapy↗
Cutaneous T-cell lymphoma with intracerebral and bilateral intraocular spread.
Brain metastasis from systemic or cutaneous lymphoma is infrequently encountered. We present a case report of cutaneous T-cell lymphoma (CTCL) that metastasized to the brain. A literature review identified fourteen other cases of brain infiltration with CTCL. This report focuses attention on the typical presentation and markedly poor prognosis that characterize this rare problem. It also emphasizes the suspicion with which a brain mass in a lymphoma patient with neurological changes should be regarded.
Aged↗
The effects of excessive humidity.
Humidification devices and techniques can expose the airway mucosa to a wide range of gas temperatures and humidities, some of which are excessive and may cause injury. Humidified gas is a carrier of both water and energy. The volume of water in the gas stream depends on whether the water is in a molecular form (vapor), particulate form (aerosol), or bulk form (liquid). The energy content of gas stream is the sum of the sensible heat (temperature) of the air and any water droplets in it and the heat of vaporization (latent energy) of any water vapor present. Latent heat energy is much larger than sensible heat energy, so saturated air contains much more energy than dry air. Thus every breath contains a water volume and energy (thermal) challenge to the airway mucosa. When the challenge exceeds the homeostatic mechanisms airway dysfunction begins, starting at the cellular and secretion level and progressing to whole airway function. A large challenge will result in quick progression of dysfunction. Early dysfunction is generally reversible, however, so large challenges with short exposure times may not cause irreversible injury. The mechanisms of airway injury owing to excess water are not well studied. The observation of its effects lends itself to some general conclusions, however. Alterations in the ventilation-perfusion ratio, decrease in vital capacity and compilance, and atelectasis are suggestive of partial or full occlusion of small airways. Changes in surface tension and alveolar-arterial oxygen gradient are consistent with flooding of alveoli. There also may be osmotic challenges to mucosal cell function as evidenced by the different reaction rates with hyper- and hypotonic saline. The reaction to nonisotonic saline also may partly explain increases in specific airway resistance. Aerosolized water and instilled water may be hazardous because of their demonstrated potential for delivering excessive water to the airway. Their use for airway humidification or toilet should be eliminated or minimized. Water vapor is the best form of humidification because it is unlikely to deliver sufficient water to cause pulmonary injury. The mechanisms of thermal injury in epidermal cells have been well studied, although specific observations of injury mechanisms in the airway are sparse. The findings of the epidermal studies can readily be applied to airway mucosal cells, however. This work demonstrates that it is prudent to avoid raising the average tracheal mucosal temperature above approximately 43 degrees C to 45 degrees C. Thus respiratory gases that arrive at the tracheal end of the endotracheal tube should average less than 43 degrees C to 45 degrees C and 100% RH. It should be noted that to deliver temperatures of this magnitude in the trachea would require higher gas temperatures at the circuit wye. These temperatures are much greater than the upper temperature limits imposed on humidifiers by international standards. Additionally, the reports to date of pulmonary thermal injury associated with humidifiers have been solely as the result of equipment malfunction or misuse--a situation that is increasingly less likely to occur with the control and monitoring features of modern devices. In summary, to avoid the injurious effects of excess heat and water in the airway, inspiratory gases should be delivered to the patient's airway at core temperature and 100% RH. This gas condition is the only one that is neutral to the airway mucosa and poses no water volume and heat energy challenge. Humidifiers, however, do not measure the gas temperature at the patient airway but only at the circuit wye. To compensate for any cooling of the gas as it passes from the wye to the patient the gas temperature at the wye must be set higher than core temperature. To safely avoid the risk that this higher temperature may accidentally reach the patient and cause an injury, the average gas temperature at the wye should restricted to less than 43 degrees
Animals↗
Laboratory tests of phenolic disinfectants as oocysticides against the chicken coccidium Eimeria tenella.
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Ammonia↗
Psychosocial correlates of job strain in a sample of working women.
BACKGROUND: This study identifies potential mediators of job strain effects on health by determining whether psychosocial factors known to predict an increased risk of cardiovascular disease and all-cause mortality are higher among women who report high levels of job strain. METHODS: Measures of job strain and other psychosocial risk factors were obtained in a sample of 152 female employees of a local corporation. Canonical correlation and analyses of covariance were used to assess relationships between job demands and decision latitude and other psychosocial risk factors. RESULTS: A significant (P = .002) solution to the canonical correlation analysis showed that high job demands and low decision latitude were correlated with a pattern of psychosocial factors consisting of (1) increased levels of negative emotions like anxiety, anger, depression, and hostility; (2) reduced levels of social support; and (3) a preponderance of negative compared with positive feelings in dealings with coworkers and supervisors. This pattern was confirmed by analyses of covariance that adjusted for demographic and specific job characteristics. CONCLUSIONS: The canonical correlation analysis results provide empirical support for the job strain construct. The most important finding is that health-damaging psychosocial factors like job strain, depression, hostility, anxiety, and social isolation tend to cluster in certain individuals.
Adult↗
The mode of action of anticoccidial quinolones (6-decyloxy-4-hydroxyquinoline-3-carboxylates) in chickens.
The anticoccidial mode of action of quinolones (6-decyloxy-4-hydroxyquinoline-3-carboxylates) against Eimeria tenella and E. acervulina in chickens has been investigated, using decoquinate and M&B 15,584 as examples. The well known static effect on sporozoites of relatively high continuous drug concentrations in the food masked other components of the mode of action, newly described here. Lower concentrations of quinolones allowed sporozoites to continue their development. First-stage schizonts were susceptible to a secondary cidal effect, although later schizonts seemed to be rather refractory. Furthermore, the sporulation of oocysts produced by E. tenella that completed its life cycle in the presence of suboptimal concentrations of quinolones was inhibited: this probably reflects a drug effect on gametocytes. Quinolones were absorbed rapidly from the chicken intestine, probably in less than 1 h. Drug withdrawal experiments showed that quinolones persisted in chicken tissues at active concentrations for up to 48 h. Despite their static effect on sporozoites, they may nevertheless be expected to exert a therapeutic effect against drug-sensitive coccidia in interrupted regimes that allow the later cidal effect to come into play. This allows immunity to coccidiosis to develop in the presence of drug. These new results, with the previously available data have been combined in an updated account of the anticoccidial mode of action of quinolones in the chicken.
Animals↗