Acute compartment syndrome.
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Acute Disease↗
Biomedical subjects
R Perkins
Publications and source records attributed to R Perkins.
Determining clinically meaningful cognitive impairment following traumatic brain injury.
AIMS: To study the reliability and validity of ratings of: neuropsychological impairment with test data from traumatically brain-injured patients. METHODS: Neuropsychological test results from 66 traumatically brain-injured adults and 27 orthopaedic controls were rated for neuropsychological impairment by an experienced neuropsychologist and three undergraduate students provided with brief training in test interpretation. Ratings were based on the discrepancy between a patient's current cognitive level and their estimated premorbid cognitive level. Decision making rules were utilised in making the ratings. The raters, who were blind with respect to the patients diagnostic group membership, independently rated test results. Test results were rerated using the same method approximately two weeks later. RESULTS: The ratings of novice raters were in good to very good agreement with the ratings of an expert. All raters evidenced very good to excellent test-retest reliability. Higher rates of neuropsychological impairment were found in the traumatically brain-injured group than in the orthopaedic control group. Discriminant function analysis suggested that raters employed information from all neuropsychological measures (with the exception of current intellectual level), in making their overall ratings of neuropsychological impairment. CONCLUSION: These findings provide encouraging preliminary evidence in support of the reliability and validity of individual case-based ratings of neuropsychological impairment. The high false positive rate in the control sample may reflect the relatively low specificity of neuropsychological impairment.
Adolescent↗
Effects of a body image curriculum for college students on improved body image.
OBJECTIVE: This study evaluated the effects of an undergraduate body image course, "Body Traps: Perspectives on Body Image," on decreasing body dissatisfaction, weight concern, and disordered eating behaviors. METHODS: Twenty-four undergraduate females enrolled in the body image course. Measures of body image and disordered eating patterns were assessed at baseline and at postintervention. RESULTS: Subjects significantly decreased the frequency and severity of their body dissatisfaction and disordered eating. No changes in body mass index or global self-esteem were observed. DISCUSSION: This is the first investigation to demonstrate that a formal, academic course can result in the reduction of both attitudinal and behavioral eating disorder risk factors. Future controlled studies need to be undertaken to substantiate this effect.
Adult↗
A comparison of the impact of hospital reform on medical subcultures in some Australian and New Zealand hospitals.
This article examines similarities and differences in the way that hospital staff in Australia and New Zealand are evaluating efforts to improve quality, clinical effectiveness and service integration, and to strengthen clinical accountability. We draw on data from a cross-national study of hospital staff in Australia and New Zealand. The results highlight the way in which respondents' views about reform are influenced by the interplay of two factors: the impact of respondents' occupational backgrounds (our findings point to differences in the profession-based subcultures of medicine, nursing and general management and the way that these are reflected in respondents' assessments of particular aspects of reform); and the way that the impact of professional subcultures may be mitigated by differences between the systems in which respondents were located, including differences between the programs of reform that have been pursued in each country. The implications of these findings are discussed.
Australia↗
Comparison of estrogen receptor alpha and beta subtypes based on comparative molecular field analysis (CoMFA).
A substantial body of evidence indicates that both humans and wildlife suffer adverse health effects from exposure to environmental chemicals that are capable of interacting with the endocrine system. The recent cloning of the estrogen receptor beta subtype (ER-beta) suggests that the selective effects of estrogenic compounds may arise in part by the control of different subsets of estrogen-responsive promoters by the two ER subtypes, ER-alpha and ER-beta. In order to identify the structural prerequisites for ligand-ER binding and to discriminate ER-alpha and ER-beta in terms of their ligand-binding specificities, Comparative Molecular Field Analysis (CoMFA) was employed to construct a three-dimensional Quantitative Structure-Activity Relationship (3D-QSAR) model on a data set of 31 structurally-diverse compounds for which competitive binding affinities have been measured against both ER-alpha and ER-beta. Structural alignment of the molecules in CoMFA was achieved by maximizing overlap of their steric and electrostatic fields using the Steric and Electrostatic ALignment (SEAL) algorithm. The final CoMFA models, generated by correlating the calculated 3D steric and electrostatic fields with the experimentally observed binding affinities using partial least-squares (PLS) regression, exhibited excellent self-consistency (r2 > 0.99) as well as high internal predictive ability (q2 > 0.65) based on cross-validation. CoMFA-predicted values of RBA for a test set of compounds outside of the training set were consistent with experimental observations. These CoMFA models can serve as guides for the rational design of ER ligands that possess preferential binding affinities for either ER-alpha or ER-beta. These models can also prove useful in risk assessment programs to identify real or suspected EDCs.
Algorithms↗
An evaluation of services for women with long-term mental health problems.
This paper presents the results of an evaluation study of services for women with long-term mental health problems. The study, which was conducted in a long-term rehabilitation and community care service, examined the adequacy, accessibility, and responsiveness of services provided for women users; explored differences between the men and women using the service and those newly admitted to it; and explored the views and experiences of service providers and the women users themselves. The results of the study confirm and extend those of previous studies and suggest a number of service recommendations. The unevenness in attention to the needs of women across services needs to be addressed. Services should be more attractive to women. Agencies and facilities for women outside mental health services should be supported to ensure that they can accommodate women with long-term mental health problems, and the women themselves need to be offered the support necessary to ensure they have access to such facilities. Finally, efforts must be made to ensure that services both recognize the losses that women with long-term mental health problems have experienced and foster their continued hopes and aspirations for the future.
Adult↗
'I wanted to be a nurse ... but I didn't get that far': women with serious ongoing mental health problems speak about their lives.
Within mental health services there are fewer women than men with serious mental health problems and there is evidence that their needs are relatively neglected resulting in specific deleterious effects. In research, as in services, the abilities of women with serious mental health problems appear to be under-estimated, and there is almost a total absence of research into the views and experiences of such women. This study aimed to explore the lives of women with serious ongoing mental health problems and their experience of services, to develop understanding of the context and impact of mental distress. In a series of 5 focus group interviews, the women, who were using a range of services for people with long-term mental health problems, described lives which, even before the onset of mental health problems, were marked by material, social and personal disadvantage. Their mental health problems led to numerous losses: loss of homes, jobs, relationships, children and loss of 'normality', yet the women retained hopes and aspirations for the future. The women clearly identified aspects of the service that they valued, in particular the support and company of women workers and other women service users. The implications of these findings are discussed in relation to planning and providing mental health services for women.
Activities of Daily Living↗
Pharmacokinetics of sparfloxacin in the serum and vitreous humor of rabbits: physicochemical properties that regulate penetration of quinolone antimicrobials.
We have used a recently described animal model to characterize the ocular pharmacokinetics of sparfloxacin in vitreous humor of uninfected albino rabbits following systemic administration and direct intraocular injection. The relationships of lipophilicity, protein binding, and molecular weight to the penetration and elimination of sparfloxacin were compared to those of ciprofloxacin, fleroxacin, and ofloxacin. To determine whether elimination was active, elimination rates following direct injection with and without probenecid or heat-killed bacteria were compared. Sparfloxacin concentrations were measured in the serum and vitreous humor by a biological assay. Protein binding and lipophilicity were determined, respectively, by ultrafiltration and oil-water partitioning. Pharmacokinetic parameters were characterized with RSTRIP, an iterative, nonlinear, weighted, least-squares-regression program. The relationship between each independent variable and mean quinolone concentration or elimination rate in the vitreous humor was determined by multiple linear regression. The mean concentration of sparfloxacin in the vitreous humor was 59.4% +/- 12.2% of that in serum. Penetration of sparfloxacin, ciprofloxacin, fleroxacin, and ofloxacin into, and elimination from, the vitreous humor correlated with lipophilicity (r2 > 0.999). The linear-regression equation describing this relationship was not improved by including the inverse of the square root of the molecular weight and/or the degree of protein binding. Elimination rates for each quinolone were decreased by the intraocular administration of probenecid. Heat-killed Staphylococcus epidermidis decreased the rate of elimination of fleroxacin. Penetration of sparfloxacin into the noninflamed vitreous humor was greater than that of any quinolone previously examined. There was an excellent correlation between lipophilicity and vitreous entry or elimination for sparfloxacin as well as ciprofloxacin, fleroxacin, and ofloxacin. There are two modes of quinolone translocation into and out of the vitreous humor: diffusion into the eye and both diffusion and carrier-mediated elimination out of the vitreous humor.
Animals↗
Deliberate exposure to motor vehicle exhaust gas: the psychosocial profile of attempted suicide.
OBJECTIVE: Deliberate exposure to motor vehicle exhaust gas has become the second most commonly used method of suicide in Australia. In an attempt to understand the factors contributing to the rise in popularity of this method, the psychosocial profiles, factors influencing method choice and circumstances of the act of self-harm were examined in a group of survivors. METHOD: A cross-sectional cohort study of 30 patients presenting for hyperbaric oxygen treatment having survived deliberate exposure to car exhaust gas was undertaken. A structured clinical interview was administered together with scales measuring depression, hopelessness and suicidal intent. Daily assessment of mental state and cognitive function was performed. RESULTS: Factors common to the majority of subjects included male gender, age group of 20-50 years, and alcohol abuse. Relationship discord was the most common precipitating factor. Reasons given for choice of this method included the availability and accessibility of motor vehicles, painlessness, awareness that the method was lethal, knowledge of another person's successful suicide by this method and awareness of the method through media portrayal. Most of the cars used did not have engines fitted with catalytic converters, substantially increasing the risk of toxicity. Regret of the attempt, denial of further suicidal ideation after the event, and the absence of a suicide note were common findings. Most denied excessive time spent planning. The most common diagnosis in this group was adjustment disorder with depressed mood. Suicide intent scores were not high, inconsistent with the majority of patients being aware of the lethality of the method. CONCLUSION: Sociodemographic findings resemble those of psychological autopsy studies of subjects completing suicide by this method. Survival in this group was due to failure of the method or unexpected discovery rather than patient factors. This population described the method as highly acceptable and accessible emphasising the urgent need for reduction of access to this means of suicide in Australia.
Adjustment Disorders↗
In vitro activities of ciprofloxacin and rifampin alone and in combination against growing and nongrowing strains of methicillin-susceptible and methicillin-resistant Staphylococcus aureus.
We characterized the effects of ciprofloxacin and rifampin alone and in combination on Staphylococcus aureus in vitro. The effects of drug combinations (e.g., indifferent, antagonistic, or additive interactions) on growth inhibition were compared by disk approximation studies and by determining the fractional inhibitory concentrations. Bactericidal effects in log-phase bacteria and in nongrowing isolates were characterized by time-kill methods. The effect of drug combinations was dependent upon whether or not cells were growing and whether killing or growth inhibition was the endpoint used to measure drug interaction. Despite bactericidal antagonism in time-kill experiments, our in vitro studies suggest several possible explanations for the observed benefits in patients treated with a combination of ciprofloxacin and rifampin for deep-seated staphylococcal infections. Notably, when growth inhibition rather than killing was used to characterize drug interaction, indifference rather than antagonism was observed. An additive bactericidal effect was observed in nongrowing bacteria suspended in phosphate-buffered saline. While rifampin antagonized the bactericidal effects of ciprofloxacin, ciprofloxacin did not antagonize the bactericidal effects of rifampin. Each antimicrobial prevented the emergence of subpopulations that were resistant to the other.
Anti-Infective Agents↗
QSAR models for binding of estrogenic compounds to estrogen receptor alpha and beta subtypes.
We have developed Quantitative Structure-Activity Relationship (QSAR) models based on Comparative Molecular Field Analysis (CoMFA) for 31 estrogenic chemicals whose relative binding affinity (RBA) is available for both ER-alpha and ER-beta. The models demonstrated a significant correlation (r2>0.95) between the CoMFA-calculated steric/electrostatic fields and corresponding RBA data and a good predictive capability (q2>0.6) based on cross-validation. The CoMFA models and contour plots obtained for ER-alpha and ER-beta suggest a close similarity between the receptors in terms of mode of binding and provide a rational basis for ligand selectivity.
Animals↗
Quantitative structure-activity relationships (QSARs) for estrogen binding to the estrogen receptor: predictions across species.
The recognition of adverse effects due to environmental endocrine disruptors in humans and wildlife has focused attention on the need for predictive tools to select the most likely estrogenic chemicals from a very large number of chemicals for subsequent screening and/or testing for potential environmental toxicity. A three-dimensional quantitative structure-activity relationship (QSAR) model using comparative molecular field analysis (CoMFA) was constructed based on relative binding affinity (RBA) data from an estrogen receptor (ER) binding assay using calf uterine cytosol. The model demonstrated significant correlation of the calculated steric and electrostatic fields with RBA and yielded predictions that agreed well with experimental values over the entire range of RBA values. Analysis of the CoMFA three-dimensional contour plots revealed a consistent picture of the structural features that are largely responsible for the observed variations in RBA. Importantly, we established a correlation between the predicted RBA values for calf ER and their actual RBA values for human ER. These findings suggest a means to begin to construct a more comprehensive estrogen knowledge base by combining RBA assay data from multiple species in 3D-QSAR based predictive models, which could then be used to screen untested chemicals for their potential to bind to the ER. Another QSAR model was developed based on classical physicochemical descriptors generated using the CODESSA (Comprehensive Descriptors for Structural and Statistical Analysis) program. The predictive ability of the CoMFA model was superior to the corresponding CODESSA model.
Environmental Exposure↗
The "gail force winds" of healthcare reform.
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Critical Care↗
Aqueous and vitreous penetration of ciprofloxacin following different modes of systemic administration.
The overall importance of the peak or the mean serum concentrations as predictors of ocular drug penetration is unknown. To address this fundamental question with an agent which shows promise as adjunctive therapy in the treatment of endophthalmitis, we studied the penetration of ciprofloxacin into the aqueous and vitreous humors following three different modes of systemic administration. New Zealand white rabbits received either a single bolus dose (40 mg kg-1), three intermittent doses of 13.33 mg kg-1 evenly spaced over an 8 hr period, or a continuous infusion of 40 mg kg-1 over an 8 hr period. Pharmacokinetic analysis was performed using RSTRIP II, a non-linear, least square regression model analysis program. The serum area under the concentration-time curve (AUC) values for each mode of drug administration were similar: 32.9 micrograms hr ml-1 for single dose, 31.9 micrograms hr ml-1 for intermittent dose, and 33.8 micrograms hr ml-1 for continuous infusion modes. The percentage penetration into the aqueous and vitreous were also similar; 30.5% and 6.5% for a single dose, 31.6% and 7.4% for intermittent doses and 30.0% and 7.5% for continuous infusion. The penetration into the aqueous and vitreous humors was not influenced by mode of administration. As with other quinolones we have studied, elimination rates were similar for the central and peripheral compartments in the post-distributive phase. Vitreous humor ciprofloxacin concentrations achieved were below that which inhibits most Staphylococcus epidermidis, the most common isolate in patients with post-operative endophthalmitis.
Animals↗
The recovery of 5-HT immunoreactivity in lumbosacral spinal cord and locomotor function after thoracic hemisection.
To determine the role of serotonin (5-HT) in recovery from spinal cord injury, we examined spinal cord 5-HT immunohistologically and assessed locomotor recovery after thoracic (T8) spinal cord hemisection in 68 rats. Forty eight rats had laminectomy and hemisection, while the remaining 20 rats received laminectomy only. All rats were evaluated every other day for 4 weeks, using a 0-14 point scale open field test. Hemisection markedly reduced mean hindlimbs scores from 14 to 1.5 +/- 0.32 and 5.6 +/- 0.31 (mean +/- standard error of mean) in the ipsilateral and contralateral side, respectively. The rats all recovered apparently normal walking by 4 weeks. The 5-HT immunohistological study revealed a marked reduction of 5-HT-containing terminals in the ipsilateral but not the contralateral lumbosacral cord by 1 week after hemisection. By 4 weeks after hemisection, 5-HT immunoreactive fibers and terminals returned to the ipsilateral lumbosacral cord, with many 5-HT fibers crossing over the central canal at thoracic level. We estimated the recovery of 5-HT neural elements in lumbosacral ventral horn by ranking 5-HT staining intensity and counting 5-HT terminals. The return of 5-HT immunoreactivity of the lumbosacral ventral horn correlated with locomotor recovery. Locomotory recovery invariably occurred when the density of 5-HT terminals approached 20% of control values. These results indicate that return of 5-HT fibers and terminals predict the time course and extent of locomotory recovery after thoracic spinal cord hemisection.
Animals↗
Tympanic membrane reconstruction using formaldehyde-formed autogenous temporalis fascia: twenty years' experience.
This study describes 20 years' experience with autogenous temporalis fascia that is formed and shaped by formaldehyde cross-linking with special Fasciaform (Hear America, Palo Alto, Calif.) molds in the repair of large tympanic membrane perforations. One hundred twenty operations in 113 patients were performed between 1973 and 1993 to close large perforations in patients with intact ossicular chains. All perforations were successfully closed by this technique. Audiometric studies indicated that the postoperative air-borne gap was closed to within 0 to 10 dB in 63% and to within 0 to 20 dB in 97%. One patient had a 15-dB sensorineural hearing impairment. Graft lateralization requiring revision occurred in three patients, two of whom had previous unsuccessful tympanoplasties. Comparisons of adult vs. pediatric groups and primary vs. revision groups were made. The technique ensures the removal of any ectopic epithelium on the medial surface of the tympanic membrane remnant and provides for easy graft placement and stability during healing without the use of middle ear Gelfoam (Upjohn Co., Kalamazoo, Mich.). The formaldehyde-formed fascia graft or Fasciaform graft technique provides an effective method of closing large perforations with excellent functional results and minimal complications.
Adolescent↗
Earlens tympanic contact transducer: a new method of sound transduction to the human ear.
This article is an initial report on a new method of transducing sound to the human ear. The report describes the shortcomings of conventional acoustic amplification devices, the potential advantages afforded by the Earlens system (ReSound Corp., Redwood City, Calif.), a description of the system, and preliminary clinical results. The system is composed of two elements: a transducer that is composed of a magnet mounted on a thin, conical silicone platform and a device that generates a magnetic field which causes the Earlens to vibrate. The Earlens transducer is placed on the umbo area of the tympanic membrane and maintains its position there by floating on a droplet of mineral oil. Two configurations of the magnetic field device are described: one that is placed within the external auditory canal and another that is worn around the neck. This feasibility study was done in seven patients during a 3-month period. All patients in the study maintained the position of the transducer for the duration of the study, and the tympanic membranes showed no evidence of inflammation or other problems. The presence of the transducer caused an average 5-dB threshold depression in the speech frequencies. In the neck-worn device, maximum mean functional gain was 25 dB at 2000 Hz. Variability in the functional gain at different frequencies was noted with poorer gain above 2000 Hz.
Feasibility Studies↗
Postoperative use of pediatric pain scales: children's self-report versus nurse assessment of pain intensity and affect.
The purpose was to examine nurses' use of pediatric pain scales and to compare their estimate of the child's pain intensity and affect with the child's self-report. The Analog Chromatic Continuous Scale (ACCS) was used for pain intensity and the McGrath Affective Faces Scale (MAFS) for pain affect. Self-report of pain was obtained from 124 hospitalized postoperative children aged 5 to 17 years and compared with estimates of 44 pediatric nurses randomly assigned to either an experimental or control group. Experimental nurses used the ACCS and MAFS to obtain pain ratings whereas control nurses made estimates according to their customary method of assessment. Findings revealed that only 36% of the nurses had at any time used a pediatric pain scale. Correlations between the experimental nurses' ratings and the child's self-report were significantly higher than the control nurses' estimates and the child's self-report. The correlation between the child's self-report of pain intensity on the ACCS and of affect on the MAFS was r = .612, suggesting that nurses' use of both an intensity and affect pediatric pain scale would more accurately reflect the child's pain experience.
Affect↗