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Biomedical subjects

R Richards

Publications and source records attributed to R Richards.

At least 19 recordsLinked to original sources
PubMed2006

Intravenous in-line filters for preventing morbidity and mortality in neonates.

BACKGROUND: Venous access is an essential part of caring for the sick neonate; however, problems such as contamination of fluids with bacteria, endotoxins and particulates have been associated with intravenous infusion therapy. Intravenous in-line filters claim to be an effective strategy for the removal of bacteria, endotoxins and particulates associated with intravenous therapy in adults and are increasingly being recommended for use in neonates. OBJECTIVES: To assess whether in-line filters on intravenous lines prevent morbidity and mortality in neonates. SEARCH STRATEGY: Searches were made of the electronic databases MEDLINE (from 1966 to September 2005), EMBASE (from 1980 to September 2005), CINAHL (from 1982 to September 2005) and the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3 2005 ). There was no language restriction. Further searching included cross references, abstracts, conferences, symposia proceedings, expert informants and journal handsearching. SELECTION CRITERIA: Randomized or quasi-randomized controlled trials that compared the use of intravenous in-line filters with placebo or nothing in neonates were included in the review. DATA COLLECTION AND ANALYSIS: The procedures of the Cochrane Neonatal Review Group (CNRG) were followed throughout. Titles and abstracts identified from the search were checked by the review authors. The full text of all studies of possible relevance were obtained. The review authors independently assessed the trials for their methodological quality and subsequent inclusion in the review. Statistical analysis followed the procedures of the Cochrane Neonatal Review Group. Dichotomous data is expressed as relative risk and 95% confidence intervals, and risk difference and 95% confidence intervals. MAIN RESULTS: There were three eligible studies, which recruited a total of 262 neonates. For most of the outcomes for this review, only one study of 88 neonates contributed eligible data. This review found no significant effect of in-line filters in any of the reported outcomes of overall mortality, proven and unproven septicaemia, phlebitis, necrotizing enterocolitis, duration of cannula patency, number of catheters inserted and financial costs. AUTHORS' CONCLUSIONS: There are insufficient data to determine whether or not the use of intravenous in-line filters prevent morbidity and mortality in neonates. The wide confidence intervals on outcomes indicate the imprecise estimates of treatment effect due to the small numbers of patients and events.

Catheterization, Peripheral↗
PubMed2006

Determination of geometric orientation of adsorbed cinchonidine on Pt and Fe and quiphos on Pt nanoclusters via DRIFTS.

Platinum nanoclusters modified with cinchonidine have been employed as 'quasi-homogeneous' catalysts for the hydrogenation of ethyl pyruvate and have demonstrated exceptional activities while the ee's of these systems are currently inferior to the traditional Pt/Al2O3 heterogeneous system. For the bulk systems it has been shown that the orientation of the modifier on the metal surface is a critical parameter influencing catalytically induced enantioselectivity. It has been speculated that the lower observed ee's for the nanocluster systems are a result of the modifier assuming an orientation unfavorable for inducing enantioselectivity due to the lack of large numbers of planar metal atoms. Using DRIFTS (diffuse reflectance infra-red Fourier transform spectroscopy) analysis of samples together with geometry optimization and IR modelling we have studied the orientation of cinchonidine on Pt and Fe nanoclusters and additionally the man-made ligand quiphos on Pt nanoclusters. It has been determined that cinchonidine can adsorb on Pt and Fe nanoclusters in both 'flat' and 'tilted' modes, while quiphos can be adsorbed on Pt only via the 'pi-bonded' mode. These studies thus provide an insight into modifier orientation on nanocluster surfaces that can be extended to a wide range of potential modifiers and facilitate a better understanding of the origin of enantioselectivity with these 'quasi-homogeneous' catalyst systems.

Journal Article↗
PubMed2006

Three-dimensional MRI of the male urethrae with implanted artificial sphincters: initial results.

The aim of this study was to develop a method for simultaneous 3D visualization of a new type of artificial urethral sphincter (AUS) and adjacent urinary structures. Serial MR tomograms were acquired from seven men after AUS implantation. 3D reconstruction was performed by thresholding original (positive) and inverted (negative) image intensity and by subsequently fusing positive and negative images. Results show that the bladder, cuff and balloons of the AUS of originally high intensity were imaged in 3D by thresholding the positive datasets. The urethrae and corpora cavernosa penis of originally low intensity were displayed in 3D by thresholding the negative datasets. Fusion of the positive and negative datasets allowed simultaneous visualization of the AUS complex and adjacent urinary structures. All the structures of interest were also clearly seen by interactive multiplanar reformatting. Coronal tomographic datasets provided better 3D and reformatted 2D images than sagittal and transverse datasets. This technique offers a simple means for evaluating the complex urethral anatomy and the AUS, and has potential for improved 3D visualization of many other complex morphological and pathological conditions.

Aged↗
PubMed2006

Very low-dose computed tomography for planning and outcome measurement in knee replacement. The imperial knee protocol.

Surgeons need to be able to measure angles and distances in three dimensions in the planning and assessment of knee replacement. Computed tomography (CT) offers the accuracy needed but involves greater radiation exposure to patients than traditional long-leg standing radiographs, which give very little information outside the plane of the image. There is considerable variation in CT radiation doses between research centres, scanning protocols and individual scanners, and ethics committees are rightly demanding more consistency in this area. By refining the CT scanning protocol we have reduced the effective radiation dose received by the patient down to the equivalent of one long-leg standing radiograph. Because of this, it will be more acceptable to obtain the three-dimensional data set produced by CT scanning. Surgeons will be able to document the impact of implant position on outcome with greater precision.

Ankle Joint↗
PubMed2005

Intramedullary fixation of Neer type 2 fractures of the distal clavicle with an AO/ASIF screw.

BACKGROUND: Neer 2 fractures of the distal clavicle are notorious for their high rates of non-union and numerous methods of fixation are recommended. We review a simple method of fixation of these fractures with an intramedullary AO/ASIF malleolar screw. METHOD: Ten patients with Neer type 2 fractures of the distal clavicle were treated between 1996 and 2002. All had open reduction and internal fixation with an intramedullary 4.5 mm AO/ASIF malleolar screw. In all cases the coraco-clavicular ligaments were not repaired, and the screws were removed once the fractures had united. RESULTS: All fractures united at between 6 and 12 weeks. All patients had a good functional result, with an excellent to good Oxford Shoulder score. CONCLUSION: This is a simple technique with a universally available implant and good fracture healing. We report no cases of screw breakage or migration and we question the necessity to repair the coraco-clavicular ligaments.

Adolescent↗
PubMed2005

Sponsorship and fund-raising in New Zealand schools: implications for health.

OBJECTIVE: To examine school participation in sponsorship, incentive and fundraising initiatives and to describe feedback about potential health implications and possible solutions from key stakeholders in the health and education sectors. METHODS: All secondary/area schools and 15% of primary/intermediate schools were randomly selected from six geographical regions of New Zealand. School principals completed a self-report questionnaire. Survey findings were summarised in a discussion document and forwarded to 53 key stakeholders for comment. RESULTS: Most schools reported participation in sponsorship, incentive and fundraising initiatives (83% of primary/intermediate and 85% of secondary/area schools). Some partnerships delivered positive health messages to students, but others were linked with products or activities potentially deleterious to health. Examples of the latter included provision of foods high in fat and sugar to students and funding from organisations whose profits were generated from gambling and alcohol sales. Key stakeholder concerns included the undermining of classroom health education and perceptions that schools were endorsing product consumption. Suggestions to address these concerns included increasing co-ordination and awareness, alternative sources of funding, and policy guidelines or legislation. CONCLUSIONS: Most schools were involved in some sort of sponsorship, incentive and fundraising initiatives, some of which had the potential to have a negative impact on the health of students. IMPLICATIONS: There is an urgent need for co-operation between the health and education sectors to ensure that these funding partnerships do not compromise student health.

Fund Raising↗
PubMed2004

Fine forecasts: encouraging the media to include ultraviolet radiation information in summertime weather forecasts.

Melanoma and skin cancer are largely attributable to over-exposure to solar ultraviolet radiation (UVR). Reports of UVR levels within media weather forecasts appear to be well received by the public and have good potential to communicate the need for appropriate sun protection to a broad audience. This study describes provision of UVR messages by New Zealand newspapers, radio and TV stations over a 4-year period, and examines the impact of an intervention which aimed to address media concerns about the financial costs of accessing UVR information for broadcast. Newspaper and radio presentation of UVR information increased immediately after these costs were removed; however, among radio stations it dropped in subsequent years. Among those media that were presenting UVR, this information was broadcast throughout the summer period and repeated throughout the day. Furthermore, most reports included concomitant, behavioral sun protection messages. At the final assessment (summer 2001/02), 66% of radio stations, both TV channels and 48% of newspapers reported UVR information in summertime weather reports. Efforts to further increase UVR presentation will need to address media concerns about time constraints on weather forecasts and media perceptions of poor audience demand or understanding of some UVR messages.

Female↗
PubMed2003

Extensive somatosensory innervation in infants with obstetric brachial palsy.

In the pre-operative screening of infants with obstetric brachial palsy (OBP), the results of routine electromyography are often overly optimistic when compared to the peri-operative findings. This prompted us to include investigation of the sensory innervation of these infants using the N20 (the first cortical response to a peripheral stimulation) of the somatosensory evoked potentials (SSEP). Three to seven months after birth, SSEP were recorded at the skull after stimulation of the thumb and middle finger in infants with obstetric rupture of the upper trunk or avulsion of roots C5, C6, or C7, and in whom no clinical improvement of motor function was observed in the biceps brachii and deltoid muscles. In most infants, a normal N20 could be evoked, indicating the existence of peripheral sensory pathways. From the thumb, these sensory pathways would necessarily bypass the upper trunk and dorsal roots of spinal nerves C5 and C6, and from the middle finger bypass the middle trunk and dorsal root C7, before extending into the dorsal column and projecting toward the thalamus and cerebral cortex. These data suggest that in infancy the segmental sensory innervation of the hand is more diverse than is described in most textbooks.

Birth Injuries↗
PubMed2003

Knowledge of disease notification among doctors in government hospitals in Benin City, Edo State, Nigeria.

STUDY OBJECTIVE: Notifiable diseases are conditions where regular, frequent and timely reporting of individual cases is considered necessary for the prevention and control of the disease. They can be classified into immediate, routine, international, and occupational notifiable diseases. Despite its importance, notification suffers some setbacks, as shown by worldwide studies. This study was carried out from August to November 1999 to assess the knowledge of disease notification among doctors at the University of Benin Teaching Hospital and Central Hospital, Benin City, Edo State, Nigeria. DESIGN: A cross-sectional study design was used, and a self-administered questionnaire, which was pretested, was used to collect data. SETTING: All doctors from the University of Benin Teaching Hospital and Central Hospital, Benin City, Edo State, Nigeria were included in the study. PARTICIPANTS: In total, 134 doctors participated in the study. MAIN RESULT: Only 11.9% of doctors had a good knowledge of disease notification. Thirty-one (23.1%) doctors knew where to obtain notification forms, and 32 (23.9%) knew how to complete these forms. CONCLUSION: Knowledge of disease notification among doctors in these major institutions is poor. It has therefore been recommended that quarterly seminars should be conducted to update doctors' knowledge and serve as reminders about disease notification.

Cross-Sectional Studies↗
PubMed2002

Identifying the position of an ear from a laser scan: the significance for planning rehabilitation.

Laser scanning techniques are used to plan the construction of prosthetic ears as dimensional measurements between anthropometric points can be accurately measured on a screen image. The aim of this study was to determine if these techniques could be used to assess the position of ears on the face. Computer-generated images were created from laser scans of 20 subjects. Frames of reference were constructed by locating a series of anthropometric points on the face from which three orthogonal planes were constructed. A central reference point was identified at the intersection of the three orthogonal planes. Dimensional measurements were made between anthropometric points on the ear and the reference planes. The differences between anthropometric points and the reference planes on the left and right sides of the face were small. It was possible to describe the location of points three-dimensionally with respect to a central reference point. The development of frames of reference and a central reference point would appear to offer many advantages in the assessment and description of ear position for patients requiring reconstruction with prostheses.

Adolescent↗
PubMed2001

Sun protection practices, knowledge and attitudes to tans among New Zealand adolescents, 1991-1997.

AIMS: To examine change in the self-reported sun protection, knowledge and attitudes to tans amongst fourth form students from 1991 to 1997. METHODS: Questionnaires were mailed to 20 New Zealand secondary schools, where 20 students were randomly selected to participate in each school. RESULTS: The proportions of adolescents who reported getting sunburnt over summer, and sunbathing for the purpose of tanning increased significantly from 1991 to 1997, while there were decreases in the proportions who reported getting a suntan, wearing clothing for sun protection and having heard of melanoma. There was also some evidence of a decrease in the attribution of positive qualities to a tan. CONCLUSIONS: Some positive changes in attitudes to tanning among New Zealand adolescents were present over the 1991-1997 period. Although these changes are promising there was little change in utilisation of sun protection measures, in fact, there was evidence that this had worsened.

Adolescent↗
PubMed2001

Obesity, hypertension, and the heart.

Hypertension occurs more commonly in obese than in lean persons at virtually every age. A variety of endocrine, genetic, and metabolic mechanisms have been linked to the development of obesity hypertension. These include insulin resistance and hyperinsulinemia, increased serum aldosterone levels, salt sensitivity and expanded plasma volume in the presence of increased peripheral vascular resistance, a genetic predisposition, and possibly increased leptin levels. Pressure and volume overload are present in obese hypertensives. This leads to a mixed eccentric-concentric form of left ventricular hypertrophy and increases the predisposition to congestive heart failure. Weight loss, even in modest decrements, is effective in reducing obesity-hypertension, possibly by ameliorating several of the proposed pathophysiologic mechanisms. There are currently no specific recommendations concerning pharmacotherapy of obesity-hypertension because each drug group has pros and cons.

Antihypertensive Agents↗
PubMed2001

Sunburn and sun protection among New Zealand adolescents over a summer weekend.

OBJECTIVE: To examine predictors of sunburn and sun protection practices during summer weekends within a sample of NZ adolescents. METHOD: Phone interviews were conducted with 203 participants aged 12-17 years. Questions were asked about behaviour from 11am to 4pm during the previous weekend. RESULTS: Less than half of the sample outside during peak radiation hours wore sunscreen and only a quarter wore hats. Sunburn was experienced by 31% of adolescents and was associated with spending longer times outside and use of sunscreen without reapplication. Wearing a sunhat was predicted by being younger and male, while sunscreen use was predicted by being female. CONCLUSIONS: There is a lack of appropriate sun protection among many NZ adolescents, and correspondingly high rates of sunburn. Possible opportunities to address this are through increasing the efficacy of sunscreen and sun hat use, and creating outdoor environments that support sun avoidance.

Adolescent↗
PubMed2001

p53 protein overexpression in low grade dysplasia (LGD) in Barrett's esophagus: immunohistochemical marker predictive of progression.

OBJECTIVES: The presence of low grade dysplasia (LGD) within Barrett's esophagus (BE) has a multitude of ramifications. Identification of markers that could risk stratify LGD would be of great clinical benefit. We aimed to prospectively evaluate the prognosis of the immunohistochemical overexpression of p53 protein in BE colocalized to LGD. METHODS: Consecutive BE patients in whom LGD was found had a repeat esophagogastroduodenoscopy within 8-12 wk per an ongoing prospective study. At each esophagogastroduodenoscopy, a therapeutic scope was used in conjunction with the Seattle Biopsy Protocol. Patients were observed until development of multifocal high grade dysplasia (mHGD), presence of an HGD dysplasia-associated lesion or mass (DALM) lesion, or frank adenocarcinoma. p53 protein overexpression was determined by computerized immunoquantitation using image analysis software on step serial-sectioned specimens of BE segment(s) harboring LGD. Kaplan-Meier survival curves were made on the ability of p53 staining colocalized to areas of LGD to predict progression to mHGD, HGD DALM, or cancer during prospective follow-up. RESULTS: Forty-eight BE patients with LGD were observed for a mean of 41.2+/-22.5 months. During this period, five of 48 patients progressed to mHGD with a focus in which intramucosal cancer could not be excluded (one), mHGD/DALM with one or more foci in which intramucosal cancer could not be excluded (two), cancer (one), or mHGD (one). Twelve had persistent LGD and 31 had regressed to no dysplasia. p53 staining was positive and colocalized to areas of LGD in 4/31 of patients that regressed, 3/12 that persisted, and 3/5 that progressed. Kaplan-Meier curves differed significantly between p53 positive and negative patients for outcome defined as progression of LGD. CONCLUSIONS: p53 colocalization with LGD at index LGD diagnosis is a risk factor for progression of LGD. This can potentially be used to risk stratify BE LGD patients in terms of surveillance intervals or enrollment into secondary prevention studies.

Adult↗
PubMed2001

A clinico-pathological study of Cushing's syndrome at the University Hospital of the West Indies and a review of the literature.

Cushing's syndrome is an uncommon but important disease. Twenty-one confirmed cases of spontaneous Cushing's syndrome were documented at the University Hospital of the West Indies over a 21-year period. They were predominantly young females (F:M ratio of 17:4; mean age 25 years and 3 months). The commonest presenting symptoms were amenorrhoea (41%) and obesity (19%). Common clinical features were cushingnoid features (95%), hypertension (76%) and hirsutism (82%). Twenty-nine per cent had frank hyperglycaemia. Cushing's syndrome was due to Cushing's disease in 10 cases, adrenal adenoma in 3 and adrenal carcinoma in 2 cases. In 4 cases with presumed adrenal hyperplasia, the histology was either unavailable or was not consistent with the diagnosis. Two cases appear now to have had the ectopic ACTH Syndrome. Adrenalectomy was the commonest treatment offered. There were no intra-operative or post-operative deaths but recurrence was common after subtotal adrenalectomy in Cushing's disease. Twenty-seven per cent of the patients developed Nelson's syndrome, which was fatal in 50%. Long-term hormone replacement therapy was unnecessary after surgery for adrenal adenomas. Treatment of Cushing's syndrome was well tolerated by the patients.

ACTH Syndrome, Ectopic↗