Low cost concept--Ambulatory Care Centre, Ft. Washington, Maryland, USA.
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Ambulatory Care Facilities↗
Biomedical subjects
R Barnes
Publications and source records attributed to R Barnes.
Use of registers and population censuses as sampling frames in Great Britain.
The use of official data sources as sampling frames for numerous government surveys in the United Kingdom is described. "The great majority of these surveys use registers of various kinds as sampling frames. Some of these registers are intended to cover all addresses in the country in which there are private households. Other registers relate to specific sub-groups of the population. Each of the general registers has advantages and disadvantages but none is ideal for sampling purposes. In recent years nearly all samples required of the general population have been drawn, by automated means, from the Postcode Address File, although the balance of advantages of this system need to be continually monitored and evaluated." Reasons why the census is not often used as a sampling frame are considered.
Censuses↗
Busulphan and cyclophosphamide cause little early toxicity during displacement bone marrow transplantation in fifty children.
Fifty children were induced with busulphan and cyclophosphamide before bone marrow transplantation. Our standard dose of cyclophosphamide was 2 g/m2 daily for 4 days, but this dosage was reduced if necessary so as not to exceed 75 mg/kg/day. A basal pulse rate that increased by more than 20 beats/min or a reduction in ECG voltage were indications for stopping cyclophosphamide. As a consequence, the fourth dose of cyclophosphamide was omitted for four children. One child died of cardiac arrest related to cyclophosphamide. We used busulphan at a dosage of 4 mg/kg/day for 4 days; neither 'busulphan lung' nor veno-occlusive disease occurred in any patient. The use of busulphan and cyclophosphamide did not guarantee freedom from interstitial pneumonitis, but this seemed to be related rather to the nature of prior treatment and the cytomegalovirus antibody status of the patient. Thus, we have developed a safe chemotherapy schedule for transplantation that avoids the need for radiotherapy and can, if necessary, be repeated after a 3-month interval.
Adolescent↗
The association of dyslipoproteinemia with symptoms and signs of peripheral arterial disease. The Lipid Research Clinics Program Prevalence Study.
Intermittent claudication, leg pain during a graded exercise test (GXT), and resting systolic pressures in the upper and lower extremities were recorded as indicators of peripheral arterial disease at visit 2 of the Lipid Research Clinics (LRC) Prevalence Study. Systolic pressures of the upper and lower extremities were measured in a subsample of participants. We compared lipid levels of persons with and without claudication and with or without GXT-induced leg pain. We also compared lipid levels between groups with high and low arm:ankle systolic blood pressure ratios. Twenty-one (1.0%) men, 10 (1.0%) female nonusers and six (1.0%) female users of gonadal hormones had intermittent claudication determined by standardized questionnaire. Men with claudication had lower high-density lipoprotein (HDL)-cholesterol (35.6 vs 46.4 mg/dl), and their mean triglyceride level and cigarette consumption were higher and regular exercise less frequent. Men with type IIb dyslipoproteinemia were more likely to report claudication. One hundred sixty-nine (4.0%) men, 101 (3.8%) female nonusers, and 47 (4.1%) female users of hormones stopped the GXT because of leg pain. Mean HDL-cholesterol levels were lower for those with GXT-induced leg pain in all three sex-hormone usage groups (42.0 vs 46.9, p less than .001; 53.9 vs 59.4, p less than .001; 65.3 vs 67.2, p = NS) and mean low-density lipoprotein cholesterol levels were higher in those with leg pain on GXT in two of three groups (146.4 vs 146.2, p = NS; 155.7 vs 144.6, p less than .01; 144.4 vs 133.5, p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Changes in hormone levels in relation to breeding behavior in male bullfrogs (Rana catesbeiana) at the individual and population levels.
Fluctuations in plasma androgen (testosterone and 5 alpha-dihydrotestosterone), corticosterone (B), and luteinizing hormone (LH) of male bullfrogs in central California were measured during the spring mating season. Androgen and LH levels generally increased in the population prior to the initiation of chorusing and establishment of territories, whereas plasma B peaked in a 2-week period at the start of heavy chorusing; this coincided with a transitory, 1 week decline in androgen. Individual males showed fluctuations in plasma androgen and LH levels throughout the breeding season, often within 1 day, but there was no clear correlation between changes in the two hormones. No time of day effect was apparent on any of the hormones. B and androgen levels were significantly but weakly correlated, (r = 0.35) but LH and androgen were not. Although the seasonal trend of increasing androgen corresponded with the start of intense chorusing (and presumably sexual activity) by the population, behavior of individuals and their circulating androgen levels did not correlate. After acquiring territories, males showed no overall trend of increased plasma androgen. Moreover, males that showed no vocal or territorial behavior had significantly higher androgen and lower B levels than calling males. Increased B levels suggest that territorial behavior and especially direct agonistic encounters represent stresses that could have an inhibitory effect on androgen secretion.
Androgens↗
Management of the repeatedly suicidal patient.
Although repetitive suicidal behaviour is commonly encountered, a relatively small number of very difficult patients engage in it. These individuals suffer primarily from severe personality disorders, as well as alcoholism and drug abuse. They are at high risk for eventual suicide. Although as a group they receive a great deal of hospital treatment, inpatient management is fraught with difficulties. Extended inpatient treatment is unlikely to be of benefit and may perpetuate the behaviour by leading to regression and excessive dependence on hospitalization. A model of management is described which couples the use of a brief-stay, crisis, inpatient unit and community-based outpatient treatment. Communication between institutions and agencies involved in the patient's care as well as coordination of services is essential. Acceptance by therapists of the risk of suicide and the realistic limitations to meeting these patients' needs can help such patients assume more responsibility and independence.
Adolescent↗
An evaluation of an inpatient cardiac patient/family education program.
A study to (1) evaluate the impact of a patient education program on the patient's knowledge regarding his/her illness and (2) identify obstacles to compliance behavior after discharge was conducted over a 2-year period. A population of 342 patients with ischemic heart disease was assigned to an inpatient cardiac patient education program consisting of five daily 1-hour classes. The following patient data were gathered: (1) assessment of the individual's knowledge of his/her illness; (2) selected sociodemographic information, (3) measures of general intelligence and problem-solving ability, and (4) motivation to alter risk factors. A measure of compliance with the prescribed treatment plan was obtained by telephone for all patients 4 weeks after discharge. Patients were randomly assigned such that one group received a pretest and a posttest assessment of knowledge while a second group received only the posttest assessment. A difference score t test on knowledge scores was statistically significant. A regression analysis of predictors of overall compliance scores after discharge demonstrated that indicators of motivation were most highly correlated with compliance. It was concluded that additional research is needed to identify: (1) types of information that enhance the patient's awareness of his/her illness and (2) program structures and techniques that enhance patient motivation to comply with a prescribed treatment plan.
Adult↗
Mediastinal and supraclavicular lymphadenitis and pneumonitis due to Chlamydia trachomatis serovars L1 and L2.
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Adult↗
Unexpected occupational exposure to asbestos.
A 44-year-old woman with mesothelioma of the pleura presented for possible compensation to the Workers' Compensation (Dust Diseases) Board of New South Wales. No obvious asbestos exposure could be obtained from examination of the occupational history, yet examination of lung tissue revealed the presence of elevated levels of brown asbestos (amosite).
Adult↗
Calorie and protein intake and balance of men and women consuming self-selected diets.
The calorie and protein intakes of 16 women and 13 men consuming self-selected diets over a 1-yr period were determined. During four 7-day balance periods, corresponding to the four seasons of the year, duplicates of diets consumed and urine and feces excreted were collected for analysis and calculations of available energy and nitrogen balance. During the four balance periods, the food intakes and thus the calorie and protein intake of the subjects decreased as documented by 7-day food records immediately before and after the balance periods. This unexpected decrease in food consumption made the nitrogen (N) balance results difficult to interpret. The energy digestibility of these diets ranged from 87 to 98% (mean +/- SD, 93.7 +/- 2.3). The nitrogen digestibility of the diets ranged from 80 to 96% (mean +/- SD, 88.6 +/- 3.4). The analyzed calorie values (heats of combustion) of the diet composites were approximately the same as calorie values of these diets calculated from diet records using food tables. This is surprising since calorie values in food tables are available energies which have been corrected by a coefficient of availability.
Adult↗
Compensable asbestos-related disease in New South Wales.
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Adult↗
Relation between acute pituitary responsiveness to gonadotropin releasing hormone (GnRH) and the ovarian cycle in the bullfrog, Rana catesbeiana.
Freshly captured female bullfrogs (Rana catesbeiana) were challenged with a standard dose (2 micrograms) of gonadotropin-releasing hormone (GnRH) shortly before and at the onset of the spawning season (in early April and mid-May) to examine the relationship between pituitary responsiveness and ovarian stage; males were also tested in April. As shown previously, increments in plasma gonadotropins induced by GnRH were consistently lower in females than in males. There was little difference in average responsiveness between the two collections of females and results for these were similar to those obtained at other times of the year. A wide range of ovarian stages was represented at both collection times as evidence by plasma steroid profiles, but there was no correlation between the GnRH-induced increments in plasma FSH and LH and plasma levels of androgens (testosterone and 5 alpha-dihydrotestosterone), estradiol-17 beta, or progesterone in the 71 females tested. Thus, there is no evidence of a feedback effect of ovarian steroids on the pituitary responsiveness to acute GnRH stimulation in the frog as has been demonstrated in mammals.
Animals↗
Seasonal and stress related changes in plasma gonadotropins, sex steroids, and corticosterone in the bullfrog, Rana catesbeiana.
Studies of seasonal gonadal cycles combined with direct measurements of plasma levels of the two gonadotropins (FSH and LH), several gonadal steroids (estrogen, E; progesterone, P; testosterone, T; and 5 alpha-dihydrotestosterone, DHT), and the interrenal steroid corticosterone (B) were made in male and female bullfrogs in central California over a 5-year period (between 1976 and 1981). During the course of these studies, we discovered that levels of plasma gonadotropins and steroids are highly labile and particularly sensitive to the effects of captivity, especially in males. In animals captured and sampled repeatedly in the field over a 3-day period, hormone levels remained constant, but if held in collecting sacks, gonadotropin and gonadal steroids began to drop within 2--4 hr and usually reached "baseline" levels within 20 hr. This effect was apparent in all seasons, except occasionally in early spring when hormone levels dropped by only about half. Hormone levels were also generally depressed by the time commercially collected frogs reached local supply houses. Plasma B increased within 30 min of capture and remained high for days in captive animals. Blood samples taken from several hundred animals at the time of capture reveal pronounced seasonal cycles in all hormones measured. These changes are discussed in connection with other gross changes in gonadal condition and with regard to possible interactions among gonadotropins and steroids. Both sexes show a general elevation of hormone levels in spring and early summer, but the sexes differ somewhat both in timing and in magnitude of the changes, as well as in the nature of the dominant steroids. Pronounced "surges" in gonadotropins are evident around the time of gamate release in bot sexes, but the temporal pattern of these surges is not the same for ovulation and spermiation; an elevation in plasma P is associated with the periovulatory surge in gonadotropins. Results were not entirely consistent with expectation of pituitary--gonadal relationships. Levels of plasma gonadotropins and steroids did not show the reciprocal relationship expected from a simple negative feed-back between gonadal and pituitary secretion, nor did changes in gonadotropins and gonadal activities show the consistent positive correlation expected from a direct dependence of gonadal function on circulating gonadotropins. In females, plasma T, but not E, correlated with ovarian growth. Plasma T in females reached much higher levels than in males, but DHT was higher in males. Androgens were generally elevated during the period of sexual activity in males, but absolute levels did not correlate well with individual differences in sexual behavior. Thus, seasonal changes in testicular and ovarian activities cannot be accounted for solely by seasonal cycles in circulating gonadotropin levels.
Androgens↗
Hepatic oxygen and glucose metabolism in the fetal lamb. Response to hypoxia.
Although the fetal liver is an active metabolic organ, its oxygen and glucose requirements have not previously been described. We measured hepatic blood flows and the oxygen and glucose differences across the liver in 12 late gestation fetal lambs in utero. Four animals were studied at least 1 wk postsurgically and again 2-5 d later to assess daily variations in hepatic blood flow and metabolism (group I). A second group of eight animals was studied 3-5 d postsurgically during a control period and during acute fetal hypoxia (group II). Under control conditions total hepatic blood flow averaged 400 ml/min per 100 g in both groups, and 75-80% was of umbilical origin. Liver blood flow and oxygen consumption were usually similar during repeated measurements, but in one animal varied considerably. During periods of normoxia, oxygen consumption for both the right and left lobes of liver was 4 ml/min per 100 g. Oxygen consumption of the whole liver accounted for 20% of total fetal oxygen consumption. This was achieved with oxygen extraction of 10-15%, so that hepatic venous blood was well oxygenated and provided an important source of oxygen for other fetal tissues. Under control conditions we could demonstrate no net hepatic uptake or release of glucose suggesting that the liver ultimately utilizes another carbon source to support its oxidative metabolism. During acute hypoxia total liver blood flow and its umbilical venous contribution both fell by 20%. Blood flow to the right lobe of the liver fell twice as much as that to the left lobe. Hepatic oxygen consumption was linearly related to oxygen delivery during the control and hypoxic periods. Consequently, right hepatic oxygen uptake fell by 45% whereas left hepatic oxygen uptake was unchanged, suggesting a functional difference between the lobes. During hypoxia glucose was released from both liver lobes; 6 mg/min per 100 g for the right lobe and 9 mg/min per 100 g for the left lobe. Total hepatic release of glucose was estimated to nearly equal umbilical uptake, so that 45% of the glucose available to fetal tissues was of hepatic origin. We conclude that the fetal liver responds to acute hypoxia by reducing its own oxygen consumption and releasing glucose to facilitate anaerobic metabolism.
Animals↗
The relative importance of smoking compared to occupation in decreased pulmonary function.
This paper reports a study comparing the forced vital capacity (FVC) and forced expiration volume in one second (FEV1) of 684 workers grouped according to smoking habits and to disability from pneumoconiosis. The study was longitudinal and, although the pulmonary function tests decreased with age, as expected, the fall was greater in smokers without occupational lung disease than in non-smokers with occupational lung disease.
Adult↗
Actions of agonistic and antagonistic analogs of gonadotropin releasing hormone (Gn-RH) in the bullfrog Rana catesbeiana.
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Age Factors↗
Dexamethasone suppression test and cortisol circadian rhythm in primary degenerative dementia.
Before the dexamethasone suppression test (DST) can be accepted as a valid diagnostic tool for differentiating depression from dementia, it must be demonstrated that dementing illnesses per se are not associated with a positive DST. The authors studied cortisol circadian rhythm and the overnight DST in 15 nondepressed patients with advanced primary degenerative dementia and 15 normal control subjects. Seven dementia patients and no control patients were DST positive. The DST-positive dementia patients had a blunted predexamethasone circadian cortisol rhythm. These results cast doubt on the utility of the DST in diagnosing depression that complicates advanced primary degenerative dementia.
Aged↗
Cardiovascular and antidepressant effects of imipramine in the treatment of secondary depression in patients with ischemic heart disease.
The authors report on 12 men with ischemic heart disease who developed secondary depression following myocardial infarction or coronary artery bypass-graft surgery and were treated with imipramine hydrochloride for 4 weeks. Imipramine had an antiarrhythmic effect, manifested by reduction in premature ventricular contractions during treatment. This drug did not produce clinically significant disturbances in cardiac conduction, but orthostatic hypotension led to early termination of the drug treatment in 1 subject. Imipramine treatment was associated with significant improvement in both observer-rated and patient-rated depression scales.
Adult↗