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Biomedical subjects

S Bailey

Publications and source records attributed to S Bailey.

At least 127 records · Page 7Linked to original sources
PubMed1996

An evaluation of a group follow-up scheme for new NHS hearing aid users.

Group follow-up of hearing aid patients has been implemented in a number of Audiology departments in the UK. This paper describes a retrospective analysis to investigate the efficiency and effectiveness of group follow-up sessions compared with individual follow-up sessions for new NHS hearing aid users in one such department. Questionnaires were sent to 98 patients; half had attended group follow-up (GF) and half had attended individual follow-up (IF) sessions. The questionnaire assessed their use of, self-rated performance and satisfaction with the hearing aid. The two follow-up systems were also analysed with respect to staff time, costs and attendance rates. Results showed a significant difference between groups for self-rated performance (GF better than IF) but none for hours of use or satisfaction. GF attendees were generally more positive about their hearing aid, required fewer additional follow-up appointments and reported more benefit in various listening situations. Although GF sessions cost less to run, there is a minor capital cost in setting them up. Attendance rates were significantly poorer for GF sessions but this study did not address the reasons for this finding. Overall, results suggest that GF is a cost effective method of following up typical new hearing aid users and may convey distinct advantages to patients that attend. However, a group follow-up session may be a less attractive option than individual follow-up for some new hearing aid users.

Correction of Hearing Impairment↗
PubMed1996

The chief scientist reports.... Prevalence of psychiatric disorder, cognitive impairment and functional disability among homeless people resident in hostels.

This cross-sectional survey was performed to estimate the prevalence of psychiatric disorder among homeless residents of hostels in Edinburgh and to relate it to functional impairment. Full diagnostic assessments were completed on 136/198 (69%) of the subjects. Thirty-one per cent of subjects (95% CI 25, 42) had significant functional impairment and this was most strongly associated with the presence of functional psychosis and cognitive impairment. Few of the cognitively impaired subjects were in contact with health or social services.

Adult↗
PubMed1996

Preliminary discussion paper on credentialling in critical care nursing.

The purpose of this preliminary discussion paper is to provide a broad overview and raise issues relevant to the concept of credentialling. It presents issues relevant to the implementation of the process of credentialling by CACCN Inc. and seeks to obtain comments and feedback from members. It is intended not to represent the position of CACCN Inc. but, rather, to present a variety of possibilities for our future direction. Furthermore, it is not intended to provide an exhaustive description of all related issues and concepts. It is considered that much of the detail required will emerge as we further develop our ideas and thinking on these important issues. Your response, therefore, is vital. Credentialling refers to the establishment of a self-regulatory process instituted by the appropriate professional body to determine and acknowledge that an individual has demonstrated the described competence of the relevant specialist nursing role.

Australia↗
PubMed1995

HIV positive patients first presenting with an AIDS defining illness: characteristics and survival.

OBJECTIVES: To study the presentation and survival of patients who present with their first diagnosis of being HIV positive at the same time as their AIDS defining illness. DESIGN: Retrospective study of patients presenting with AIDS between 1991 and 1993. SETTING: Department of genitourinary medicine, St Mary's Hospital, London. MAIN OUTCOME MEASURES: AIDS defining illness at presentation and survival after diagnosis of AIDS. RESULTS: Between January 1991 and December 1993, 97 out of 436 patients (22%) presented with their first AIDS defining illness coincident with their first positive result of an HIV test (group B). The remaining 339 patients (78%) had tested positive for HIV-1 infection within the previous eight years and had consequently been followed up in clinics before developing their first AIDS defining illness (group A). The two groups of patients did not differ in age and sex distribution, risk factors for HIV-1 infection, nationality, country of origin, or haematological variables determined at the time of the AIDS defining illness. However, the defining illnesses differed between the two groups. Illnesses associated with severe immunodeficiency (the wasting syndrome, cryptosporidiosis, and cytomegalovirus infection) were seen almost exclusively in group A whereas extrapulmonary tuberculosis and Pneumocystis carinii pneumonia were more common in group B. The survival of patients in group B after the onset of AIDS was significantly longer than that of patients in group A as determined by Kaplan-Meier log rank analysis (P = 0.0026). CONCLUSIONS: Subjects who are HIV positive and present late are a challenge to the control of the spread of HIV infection because they progress from asymptomatic HIV infection to AIDS without receiving health care. The finding that presentation with an AIDS defining illness coincident with a positive result in an HIV test did not have a detrimental effect on survival gives insights into the effects of medical intervention on disease progression after a diagnosis of AIDS.

AIDS Serodiagnosis↗
PubMed1995

Synthesis and in vivo evaluation of prodrugs of 9-[2-(phosphonomethoxy)ethoxy]adenine.

A number of esters and amides of the anti-HIV nucleotide analogue 9-[2-(phosphonomethoxy)-ethoxy]adenine (1) have been synthesized as potential prodrugs and evaluated for oral bioavailability in mice. Dialkyl esters 17-20 were prepared via a Mitsunobu coupling of alcohols 8-11 with 9-hydroxypurine 12 whereas (acyloxy)alkyl esters 25-33 and bis-[(alkoxycarbonyl)methyl] and bis(amidomethyl) esters 34-39 were obtained by reaction of 1 with a suitable alkylating agent. Phosphonodichloridate chemistry was employed for the preparation of dialkyl and diaryl esters 42-65, and bis(phosphonoamidates) 66 and 67. Following oral administration to mice, most of the dialkyl esters 17-20 were well-absorbed and then converted to the corresponding monoesters, but minimal further metabolism to 1 occurred. Bis[(pivaloyloxy)methyl] ester 25 displayed an oral bioavailability of 30% that was 15-fold higher than the bioavailability observed after dosing of 1. Methyl substitution at the alpha carbon of the bis[(pivaloyloxy)methyl] ester 25 (33) increased the oral bioavailability of 1 to 74%. Some of the diaryl esters also showed improved absorption properties in comparison with that of 1. In particular, the crystalline hydrochloride salt of diphenyl ester 55 was well-absorbed and efficiently converted to the parent compound with an oral bioavailability of 50%. On the basis of these results as well as the physicochemical properties of the prodrugs and their stability in mouse duodenal contents, the hydrochloride salt of diphenyl ester 55 was identified as the preferred prodrug of 1.

Adenine↗
PubMed1995

Violent incidents in an adolescent forensic unit.

Violent incidents in psychiatric institutions have been the focus of much study over the past few decades. But there has been little work looking at similar incidents in child and adolescent units. The authors set out to examine whether some of the patterns observed in adult populations are true of adolescent groups. The Gardener Unit was considered appropriate in light of reports of a higher frequency of assaultative behaviour among younger clients and because of the nature of problems presented by clients needing a secure environment. All violent incidents are automatically recorded. The violent incident register was examined between 1 June 1991 and 1 June 1992 and the information cross-checked with case notes and nursing reports. Demographic details, etc. were obtained from case notes. The results indicated a slightly higher daily incident rate than adult studies. At least half of the population were involved in some form of violent episode over the 12-month period. The majority of incidents were minor in nature. Nursing staff were the most frequent targets, although females showed an excess of inwardly directed aggression (self harm). A prior history of violent behaviour did not serve as a realistic predictor of frequency of violent incidents in this study. With increasing concern regarding the care of this disturbed group of young people, it was felt important to look closely at the nature of and handling of violent incidents on this unit. A second paper will consider in detail how these incidents were dealt with.

Adolescent↗
PubMed1995

Patterns of T lymphocyte clonal expansion in HLA-typed patients with juvenile rheumatoid arthritis.

OBJECTIVE: The presence of clonally expanded T lymphocytes appears to be a characteristic feature of autoimmune diseases, including juvenile rheumatoid arthritis (JRA), although the relevance of such clones to immunopathogenesis is not clear. Identification of clones specific for a disease and/or particular MHC haplotypes should help differentiate those of pathogenic importance. METHODS: A reverse transcriptase polymerase chain reaction assay for T cell receptor (TCR) complementarity determining region 3 (CDR3) length heterogeneity and cDNA sequencing were used to identify clonal expansion in synovial fluid (SF) samples obtained from 36 patients with JRA. RESULTS: The majority of patients had multiple synovial T cell clones using different TCR V beta families. Fifty-eight percent of these clonally expanded T cell populations used one of six TCR V beta families (V beta 2, V beta 8, V beta 14, V beta 16, V beta 17, and V beta 20). Patients with polyarticular, as opposed to pauciarticular, JRA had higher numbers of clones in joints. TCR V beta 8, V beta 14, V beta 16, and V beta 17 families were most frequently found in these clones. Overall, the most frequently used V beta family was V beta 20, which was observed in 18 of 36 SF samples. Of 18 patients exhibiting TCR V beta 20 clonal expansion, 14 (78%) had pauciarticular onset JRA. The V beta 20 association was especially strong in patients who possessed HLA-DR8+ haplotypes (p = 0.01, Fisher's exact test). SF from the patients who had other types of JRA (and other MHC haplotypes) did not show this association. CONCLUSION: The distinct clinical subtypes of JRA are characterized by different patterns of synovial T cell clonality. These findings imply that different molecular pathways underlie the development of arthritis in each subtype of JRA.

Amino Acid Sequence↗
PubMed1995

The effect of Polyethylene Glycol-Superoxide Dismutase on gastric mucosa and survival in shock with tissue injury.

Oxygen-derived free radicals may play an important role in the pathogenesis of organ injury and death following hemorrhagic shock. This study was designed to test the effects of Polyethylene Glycol-Superoxide Dismutase (PEG-SOD) on gastric mucosal injury and survival in an animal model of hemorrhagic shock and tissue trauma. Reproducible tissue trauma was produced by IM injection of turpentine (1.4 microliters/g). A standardized hemorrhagic shock model with an LD 90 was employed. This model consisted of the following sequence of events: phlebotomy to 60 per cent blood volume, 45-minute shock period, resuscitation using Lactated Ringers (LR) at two times shed volume over 60 minutes. Twenty rats were randomly assigned to receive LR (control) or PEG-SOD (5.36 mg/kg). Immediately following the death or at 72 hours, the stomach was removed. Computer image analysis was used to determine the lesion area as a per cent of total gastric mucosal surface area. Our results show no statistical difference in gastric mucosal lesion area between groups (1.83% vs 1.75%, respectively). Survival at 72 hours was significantly higher for PEG-SOD animals vs controls (70% vs 10%, P = 0.0001). This data suggests that IV administration of PEG-SOD during resuscitation is a potentially effective means of improving survival following severe hemorrhagic shock and tissue injury.

Animals↗
PubMed1995

The outcome of familial adenomatous polyposis in the absence of a polyposis registry.

From 1964 to 1990, 70 patients with familial adenomatous polyposis were diagnosed at an institution without a polyposis registry. Those with symptoms at diagnosis were older (mean 34 v. 24 years) and more often had large-bowel cancer (7/30 v. 1/30, 23% v. 3%). The introduction of systematic screening significantly increased the number of cases diagnosed annually, from 2,3 to 5 per year, reduced the median age at diagnosis from 29 to 21 years and increased the proportion of cases diagnosed without symptoms from 52% to 90%. A colectomy with an ileorectal anastomosis achieved a low incidence of rectal cancer at 20 years (1/15, 7%) despite imperfect follow-up and annual sigmoidoscopy in only 40%. However, bowel cancer caused at least 35% of all deaths and 62% of deaths due to a known cause. A registry which maintained a screening programme should therefore prevent most large-bowel cancers and improve the life expectancy of patients with familial adenomatous polyposis who are managed at this institution. It might also refine the current method of screening by sigmoidoscopy alone, by facilitating the use of ophthalmoscopy and blood tests for DNA markers.

Adenomatous Polyposis Coli↗
PubMed1994

Comparison of prevalence of schizophrenia among residents of hostels for homeless people in 1966 and 1992.

OBJECTIVE: To determine whether the prevalence of schizophrenia among the homeless population of Edinburgh resident in hostels has changed between 1966 and 1992. DESIGN: Comparison of two cross sectional surveys. SETTINGS: Hostels for homeless people in Edinburgh. SUBJECTS: In 1966 a random sample of 98 residents of three common lodging houses. In 1992 a random sample of 198 residents of nine hostels. MAIN OUTCOME MEASURE: Prevalence of schizophrenia. RESULTS: The prevalence of schizophrenia in 1992 was 12/136 (9%) compared with 20/79 (25%) in 1966 (odds ratio 0.29; 95% confidence interval 0.13 to 0.62; P = 0.001). Adjustment for confounding by age, current hostel, and duration of unemployment by means of logistic regression produced an adjusted odds ratio of 0.22 (0.08 to 0.58). CONCLUSIONS: The prevalence of schizophrenia was lower in 1992 even after other changes in the population resident in hostels occurring between 1966 and 1992 were taken into account. The findings are not consistent with an increase in the prevalence of schizophrenia among homeless people despite a 66% reduction in adult psychiatric beds in the region during 1966-92.

Adolescent↗
PubMed1994

Structure of trypanothione reductase from Crithidia fasciculata at 2.6 A resolution; enzyme-NADP interactions at 2.8 A resolution.

Trypanothione reductase is an FAD-dependent disulfide oxidoreductase which catalyses the reduction of trypanothione using NADPH as co-factor. The enzyme is unique to protozoan parasites from the genera Trypanosoma and Leishmania and is an important target for the design of improved antitrypanocidal drugs. We present details of the structure of trypanothione reductase from Crithidia fasciculata solved by molecular replacement, using human glutathione reductase as a search model, and refined to an R factor of 16.1% with data between 8.0 and 2.6 A resolution. The model comprises two subunits (one containing 487 residues, the other 486), an FAD prosthetic group, plus 392 solvent molecules. The last four C-terminal residues are not seen in either subunit and the density is poor for the N-terminal residue of subunit B. The model has a root-mean-square deviation from ideality of 0.016 A for bond lengths and 3.2 degrees for bond angles. Each subunit was independently refined in the latter stages of the analysis but the subunits remain similar as indicated by the root-mean-square deviation of 0.35 A for C(alpha) atoms. Trypanothione reductase has 36% sequence identity with human glutathione reductase and the root-mean-square deviation between the 462 C(alpha) atoms in the secondary structural units common to the two proteins is 1.1 A. However, there are large differences in the loop regions and significant shifts in the orientation of the four domains within each subunit. Domain II, which binds the dinucleotide co-factor, and domain IV, which forms the interface between the two subunits, are both rotated by approximately 5 degrees with respect to domain I, which binds the FAD moiety, when compared with glutathione reductase. Crystals of trypanothione reductase have been soaked in the dinucleotide co-factor NADPH and N(1)-glutathionylspermidine disulfide substrate and the structure of the resulting complex determined at 2.8 A resolution. Strong density is observed for the adenosine end of the co-factor which forms many charged interactions with the protein though the density for the nicotinamide moiety is more diffuse. The mode of binding indicates that NADP is bound to the enzyme in a similar conformation to that observed with human glutathione reductase.

Journal Article↗
PubMed1994

Crystallization and preliminary X-ray analysis of C-reactive protein from rat.

Crystals of C-reactive protein from rat have been grown both with and without calcium. Two major components of the protein have been resolved on the basis of their calcium-dependent fine specificity for monophosphate esters. Crystals grown without calcium are tetragonal, space group P42(1)2 with unit cell parameters a = b = 163.81(9)A and c = 125.21(6)A, and diffract X-rays to 3.0 A resolution. The rotation function specifies a molecular 5-fold symmetry axis at 24 degrees away from c in the (110) plane.

Animals↗
PubMed1994

Neurological crisis in hereditary tyrosinaemia and complete reversal after liver transplantation.

A 19 month old Indian girl with tyrosinaemia developed a severe generalised neuropathy involving both phrenic nerves. Treatment with haemarginate failed to improve her condition. After liver transplantation the raised concentrations of the neurotoxin delta amino-laevulinic acid returned to normal and gradual but complete neurological recovery occurred over a period of 13 months.

Amino Acid Metabolism, Inborn Errors↗
PubMed1994

Mental health problems of the Edinburgh 'roofless'.

BACKGROUND: The roofless have not been previously surveyed in detail looking specifically at their psychiatric status. METHOD: All roofless people in a discrete area were interviewed in their 'skippers' using a semi-structured interview. Other roofless people helped in case finding and diagnostic validity was confirmed using a computerised case register. RESULTS: Sixty-five people were interviewed. High rates of substance abuse (n = 48, 75%), and very low rates of psychotic illness (n = 2, 3%) were found. High rates of serious physical morbidity, of imprisonment and of being the victim of a crime were found. CONCLUSION: The roofless have multiple severe medical, social, and psychiatric problems. These all must be addressed when considering the provision of services.

Adolescent↗
PubMed1993

Fate of lesion-related side branches after coronary artery stenting.

OBJECTIVES: The aim of this study was to assess the immediate and long-term patency of lesion-associated side branches after coronary artery stenting. BACKGROUND: The possible adverse effects related to implantation of coronary stents are not completely known. An important potential complication of stenting is side branch occlusion due to mechanical obstruction or thrombosis. METHODS: Serial coronary angiography was performed in 153 patients (167 lesions) at baseline, after conventional balloon angioplasty, immediately after Palmaz-Schatz stent placement and at 6 months. The patency of side branches, where present, was analyzed at each of these points. RESULTS: Of 167 lesions stented, 57 stent placements spanned 66 side branches with a diameter > or = 1 mm. Twenty-seven (41%) of these side branches had > or = 50% ostial stenosis before standard balloon angioplasty. Six side branches became occluded after standard balloon angioplasty and remained occluded after stenting. Of the 60 side branches patent after conventional angioplasty, 57 (95%) remained patent immediately after stenting. All three side branches that became occluded after stenting had > or = 50% ostial stenosis at baseline. All 60 side branches, including the 3 initially occluded after stenting, were patent at 6-month follow-up. CONCLUSIONS: These findings demonstrate that 1) acute side branch occlusion due to coronary stenting occurs infrequently; 2) when side branch occlusion occurs, it is associated with intrinsic ostial disease; and 3) the patency of side branch ostia is well maintained at long-term follow-up.

Adult↗
PubMed1993

Trypanosoma cruzi trypanothione reductase. Crystallization, unit cell dimensions and structure solution.

We have reproducibly crystallized recombinant trypanothione reductase from Trypanosoma cruzi. Yellow tetragonal crystals in the shape of elongated prisms have unit cell dimensions of a = 92.8 A, c = 156.6 A, Laue symmetry of 4/m and are suitable for a detailed structural analysis. Diffraction data to 2.7 A resolution have been recorded using synchrotron radiation at the Daresbury laboratory. The structure has been solved by molecular replacement calculations using this synchrotron data and our previously determined Crithidia fasciculata enzyme structure as a search model. The space group has been identified as P4(3) with a homodimer of approximate molecular mass of 108 kDa in the asymmetric unit. Diffraction beyond 2.5 A has been recorded when large freshly grown crystals are exposed to X-rays. Refinement of the structure is in progress.

Animals↗