Unified nomenclature for subunits of the Saccharomyces cerevisiae proteasome regulatory particle.
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Animals↗
Biomedical subjects
S Johnston
Publications and source records attributed to S Johnston.
Splitting versus sharing focal attention: comment on Castiello and Umiltà (1992).
A popular metaphor for visual attention is that of a spotlight that enhances perceptual processing within its beam. Many studies on the orienting of visual attention have addressed whether the beam is a unified structure or whether it can be split between noncontiguous locations in space. Although most of the evidence favors the unified model, U. Castiello and C. Umiltà (1992) claimed recently to have results that could most easily be accounted for by a model of visual attention in which resources can be allocated flexibly to independent locations in space. It is argued that Castiello and Umiltà used only indirect empirical evidence to support their position and that their results are not inconsistent with the unified model. Two studies are reported in which important aspects of Castiello and Umiltà's experiments were maintained and a probe procedure was implemented to assess directly if attention was split between 2 spatial locations or if a unified focus of attention was expanded to incorporate the 2 locations. The results clearly supported the latter position.
Attention↗
'Golf ball liver': a cause of chronic hepatitis?
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2,4-Dichlorophenoxyacetic Acid↗
Randomized phase II trial of infusional fluorouracil, epirubicin, and cyclophosphamide versus infusional fluorouracil, epirubicin, and cisplatin in patients with advanced breast cancer.
PURPOSE: We previously developed an inpatient regimen that consisted of infusional fluorouracil (5-FU), epirubicin, and cisplatin (ECisF), with a response rate of 86% in advanced breast cancer. The current phase II 2:1 randomized study investigated whether cyclophosphamide can be substituted for cisplatin (ECycloF) to reduce toxicity and allow the regimen to be administered on an outpatient basis without loss of efficacy. PATIENTS AND METHODS: Ninety-six women (median age, 49 years; range, 28 to 73) with breast cancer (59 metastatic, 37 locally advanced) received continuous infusional 5-FU (200 mg/m2/d via Hickman line) and six cycles of epirubicin (60 mg/m2 every 21 days) with either cyclophosphamide 600 mg/m2 every 21 days (38 metastatic, 24 locally advanced) or cisplatin 60 mg/m2 every 21 days (21 metastatic, 13 locally advanced). There were no significant differences in patient characteristics between these groups. RESULTS: ECycloF was better tolerated than ECisF in terms of lethargy (P = .005), stomatitis (P = .008), plantar palmar erythema (P = .02), constipation (P < .001), thrombosis (P = .0014), and nausea and vomiting (P = .05). Although there was a trend toward more anemia and leukopenia with ECisF (P =. 1), there was no significant difference in the rates of infection. Efficacy was comparable in terms of overall response (69% v 68%), complete response (CR; 13% v 15%), and median progression-free survival (9 v 8 months). CONCLUSION: ECycloF is an outpatient regimen with a lower incidence of severe nonhematologic toxicity than inpatient ECisF; it has comparable efficacy and is considerably more economical.
Adult↗
Intensive case management: a cost-effectiveness analysis.
OBJECTIVE: The objective of this study was to compare the outcomes and costs of intensive case management with routine case management for a group of severely disabled patients with a mental illness. METHOD: A cost-effectiveness analysis was conducted alongside a randomised controlled trial. Seventy-three patients, who reside in the eastern suburbs of Sydney, were randomly allocated to either intensive or routine case management. Staff providing intensive case management and substantially lower caseloads than staff providing routine case management. The main health outcome measured was patients' level of functioning as measured by the Life Skills Profile. Costing data were collected from hospital services, mental health services, general health services, community services and informal carers. RESULTS: At 12 months, outcome and costing data were analysed on 58 patients and hospitalisation data were analysed on 68 patients. Significantly more patients in the intensive case management group remained in treatment (chi 2 = 6.00, df = 1, p < 0.01) and showed a clinically significant improvement in functioning from baseline to 12 months (chi 2 = 4.50, df = 1, p < 0.05). The mean cost per patient was $7745 more in the intensive group than in the routine group (t = 1.49, df = 56, p > 0.01) over 12 months. The cost-effectiveness ratio indicated a cost of $27,661 per year for one additional patient in the intensive case management group to make a clinically significant improvement in functioning. CONCLUSION: Intensive case management led to an increased rate of retention in treatment and a clinically significant improvement in functioning. Further comparative cost-effectiveness studies are required to determine whether $27,661 per year for one patient to make a clinically significant improvement in functioning is a cost-effective use of mental health resources.
Adolescent↗
Metabolic index in peritoneal dialysis.
To define protein anabolism or catabolism in our patients we retrospectively studied the 24-hour balances (B24 h), dietary protein intake (DPI), anthropometric parameters [body mass index (BMI), tricipital skin fold thickness (TF), and muscular arm circumference (MAC), using the rating scheme: undernourished (U): percentile (pc) < 15; normal (N): pc > 15 to pc < 85; obese (O): pc > 85], and urea kinetics (protein equivalent of nitrogen appearance) [PNA = PCR according to the Gotch-Borah (G), Blumenkrantz (B), and Randerson (R) formulas]. Nitrogen-balance [N-B = DPI(N)-PNA(N)], metabolic ratio (MR = DPI/PNA), and metabolic index (MI = IDPI/nPNA) were calculated as metabolic indicators. There were 215 evaluations (B24 h) in 44 patients, of whom 29 were male and 15 female, 35 on continuous ambulatory peritoneal dialysis (PD), 9 on automated PD, age 58.2 +/- 15.6 years, followed-up for 15.3 +/- 10.2 months. Undernourished patients (BMI) showed higher N-B, MR, and MI irrespective of the formula used, but MR was only significant using the Blumenkrantz formula. For N-balance and metabolic index, analysis of variance (ANOVA) was significant with all formulas. The mean metabolic index (Randerson) in subgroups was: U: 1.09 +/- 0.27, n = 54; N: 0.90 +/- 0.25, n = 135; O: 0.87 +/- 0.27, n = 26 (ANOVA: P < 0.0001). The U-N and U-O subgroup comparison was significant (Newman-Keuls P < 0.01). We concluded that: (1) The metabolic index is more discriminating for protein metabolism than N-balance or metabolic ratio. (2) Most of the undernourished patients (BMI) are anabolic according to metabolic index and N-balance, and this indicates recovery. (3) Undernourished (low BMI) patients with metabolic index < 1 deserve special attention due to the risk of remaining malnourished.
Anthropometry↗
[HIV infection. Dietetic nutritional intervention during the symptomatic phase].
This article analyzes some of the causes and the mechanisms which provoke malnutrition during the symptomatic phase of AIDS. Dietetic advise to follow is specified for the following circumstances: weight loss; diarrhea; esophagus-related problems or difficulty in swallowing; if a patient suffers nausea or vomiting; when a patient suffers from anorexia or the feeling of being full quickly. This article also deals with nutritional supplements which may be used with these patients, when enteral or parenteral nutrition is indicated, and other treatment strategies which call for the use of appetite stimulating products and anabolic agents.
Appetite↗
Linkage analysis of candidate regions for coeliac disease genes.
A strong HLA association is seen in coeliac disease [specifically to the DQ(alpha1*0501,beta1*0201 heterodimer], but this cannot entirely account for the increased risk seen in relatives of affected cases. One or more genes at HLA-unlinked loci also predispose to coeliac disease and are probably stronger determinants of disease susceptibility than HLA. A recent study has proposed a number of candidate regions on chromosomes 6p23 (distinct from HLA), 6p12, 3q27, 5q33.3, 7q31.3, 11p11, 15q26, 19p13.3, 19q13.1, 19q13.4 and 22cen for the location of a non-HLA linked susceptibility gene. We have examined these regions in 28 coeliac disease families by linkage analysis. There was excess sharing of chromosome 6p markers, but no support for a predisposition locus telomeric to HLA. No significant evidence in favour of linkage to coeliac disease was obtained for chromosomes 3q27, 5q33.3, 7q31.3, 11p11, 19p13.3, 19q13.1, 19q13.4 or 22cen. There was, however, excess sharing close to D15S642. The maximum non-parametric linkage score was 1.99 (P = 0.03). Although the evidence for linkage of coeliac disease to chromosome 15q26 is not strong, the well established association between coeliac disease and insulin dependent diabetes mellitus, together with the mapping of an IDDM susceptibility locus (IDDM3) to chromosome 15q26, provide indirect support for this as a candidate locus conferring susceptibility to coeliac disease in some families.
Celiac Disease↗
The sonographic finding of persistent umbilical cord cystic masses is associated with lethal aneuploidy and/or congenital anomalies.
Advancements in sonographic technology have led to improved prenatal detection of fetal anomalies. Umbilical cord cystic masses are being detected prenatally and several case reports have appeared in the literature. We report three new cases in which umbilical cord cystic masses were detected prenatally; two cases in the later half of pregnancy and one case in the first trimester. The literature was reviewed and summaries of the 23 reported cases of persistent second- and third-trimester umbilical cord cystic masses and their implications are discussed. There is a high association (18 of 23 cases) with lethal chromosomal anomalies and/or congenital malformations suggesting that the finding of an isolated umbilical cord cystic mass should lead to further detailed sonographic evaluation.
Adult↗
Laparoscopic surgery in weightlessness.
BACKGROUND: Performing a surgical procedure in weightlessness has been shown not to be any more difficult than in a 1g environment if the requirements for the restraint of the patient, operator, and surgical hardware are observed. The feasibility of performing a laparoscopic surgical procedure in weightlessness, however, has been questionable. Concerns have included the impaired visualization from the lack of gravitational retraction of the bowel and from floating debris such as blood. METHODS: In this project, laparoscopic surgery was performed on a porcine animal model in the weightlessness of parabolic flight. RESULTS: Visualization was unaffected due to the tethering of the bowel by the elastic mesentery and the strong tendency for debris and blood to adhere to the abdominal wall due to surface tension forces. CONCLUSIONS: There are advantages to performing a laparoscopic instead of an open surgical procedure in a weightless environment. These will become important as the laparoscopic support hardware is miniaturized from its present form, as laparoscopic technology becomes more advanced, and as more surgically capable crew medical officers are present in future long-duration space-exploration missions.
Abdomen↗
Aspects of cognitive status as predictors of mobility following geriatric rehabilitation.
This study aimed to determine the specific aspects of cognitive functioning which are related to geriatric rehabilitation treatment-outcome, and was based on a within-subject repeated measures design. In the setting of the inpatient Geriatric Rehabilitation Program (GRP) of the SCO Hospital in Ottawa, Canada 40 patients underwent six weeks of physiotherapy treatment for mobility training, on a twice daily schedule. Measurements were performed by the Clinical Outcome Variables Scale (COVS) and a mental status battery composed of five neuropsychological tests. Patients with a poorer mobility status at admission were significantly more depressed, more apraxic, less educated and had greater memory problems than their counterparts. The extent of treatment gains achieved by discharge was significantly related to a single aspect of cognition, namely procedural memory. Longer-term maintenance of treatment gains, however, was predicted by cognitive functioning more globally, including measures of praxis, declarative memory and reasoning. Together, the measures of cognition explained 52% of the variance in functional mobility outcome. In conclusion, patients with mild-to-moderate difficulties of cortically-based higher-order cognitive functions may still achieve significant gains in mobility function following geriatric rehabilitation. However, these patients may not be able to maintain their gains over time to the same extent as their cognitively healthier counterparts. Thus, from an empirical viewpoint, the decision to include or exclude cognitively impaired patients in GRPs varies with the definition of "treatment success" selected (i.e., short-term vs long-term gains). Alternatively, cognitively impaired patients may require more frequent follow-up rehabilitation services in order to maintain their gains.
Aged↗
Delivery of medication to psychiatric patients in community health services in New South Wales.
OBJECTIVE: We investigated the supply and monitoring of medication to patients who attend community mental health services in NSW. METHOD: The staff at four metropolitan and one rural community centre health service were interviewed. Information sought included policies and procedures concerning medication, the delivery of medication to patients, and staff reports concerning their knowledge and practice related to the legal requirements of the New South Wales Poisons Act 1966. RESULTS: Sixty-five (62%) of 104 coordinators, medical officers and staff who were responsible for case managing patients were interviewed. The centres all differed in their existing policies and practices and the extent to which they were supported by their local hospital and retail pharmacies. Only one centre had a designated pharmacist and this was a part-time position. CONCLUSIONS: The delivery of medication at most centres is a fairly ad hoc arrangement with staff organising medication as best as they can. At times the supply of medication to patients fails to comply with legal and New South Wales Department of Health requirements.
Community Mental Health Services↗
Length/serum creatinine ratio does not predict measured creatinine clearance in critically ill children.
OBJECTIVE: Information regarding renal function is important in critically ill children to adjust the dosage of drugs that are eliminated by the kidneys. Methods for estimating glomerular filtration rate (GFR) based on age and serum creatinine level have shown good agreement with measured creatinine clearance (CLCR) in children without critical illness but have not been examined in critically ill children. METHODS: CLCR (24 hours) was measured (CLCR-measured) in 100 individuals (aged 5.6 years [range, 0.1 to 20.8 years]) admitted to a pediatric intensive care unit. Urine was collected by indwelling bladder catheters. Serum levels were determined. CLCR was calculated (CLCR-measured) according to the standard formula. GFR was estimated (CL-estimated) according to a published method, in which GFR is based on serum creatinine levels, patient length, and a constant that varies with the age and sex of the child. For each patient, the percentage difference between methods was calculated as the difference between the methods divided by the average obtained by the two methods and expressed as a percentage. Bias was calculated as the absolute value of the percentage difference. RESULTS: CLCR-measured and CL-estimated were significantly correlated (CLCR-measured = 0.57 CL-estimated + 16.8; r = 0.68; p < 0.001). However, CL-estimated was greater than CLCR-measured in 84 patients. The difference ranged from -230 to +123 ml/min/1.73 m2 (mean -25.9 ml/min/1.73 m2 [95% confidence interval, -18.1 to 33.7 ml/min/1.73 m2]). The mean percentage difference between the methods was also large (-38.1% [95% confidence interval, -47.1% to 29.2%]) and ranged from -153.2% to 102.1%. The mean bias was 45.2% (95% confidence interval, 37.7% to 52.8%). In 36 of 100 patients the discrepancy between the two methods was greater than 50%. Adjusting for weight percentile, as a proxy for abnormal muscle mass, did not improve the model. CONCLUSION: A method to estimate GFR in children that is based on age and sex, but not critical illness, does not correspond with measured 24-hour CLCR. Use of this method to adjust dosage of drugs eliminated by the kidney might result in significant overdosage in most critically ill children.
Adolescent↗
The occurrence of Mycobacterium bovis infection in cattle in and around an area subject to extensive badger (Meles meles) control.
The occurrence of Mycobacterium bovis infection in cattle herds during the period 1966-92 in two geographically related areas in South-West England is compared. In one area comprising 104 km2 all badgers were systematically destroyed from 1975-81, after which recolonization was allowed; in the other, comprising 116 km2, small scale, statutory badger removal operations were undertaken from 1975 onwards where specific herds were detected with M. bovis infection. In the area with total clearance, no further incidents with M. bovis isolation occurred from 1982-92. Survival analysis and proportional hazards regression indicated that the risk of herds being identified with infection was less once badgers had been cleared from their neighbourhood, whereas it was greater in herds with 50 or more animals, and once cattle in a herd had responded positively to the tuberculin skin test, even though infection with M. bovis was not confirmed subsequently. The study provides further evidence that badgers represent an important reservoir of M. bovis infection for cattle and that badger control is effective in reducing incidents of cattle infection with M. bovis if action is thorough and recolonization is prevented.
Animals↗
Initiation and repair of intentional communication acts by adults with severe to profound cognitive disabilities.
This study assessed the communication initiation and repair behaviors of 28 individuals with severe to profound mental retardation in a variety of experimental conditions. All of these individuals communicated through nonsymbolic gestures. The experimental procedures were devised to simulate the conditions that typically evoke two different types of initiations: comments and requests. Each subject initiation was followed by an experimenter response that indicated a communication breakdown to determine if and how these subjects would attempt to repair such breakdowns. Different indicators of communication breakdown were systematically varied in these scripted interactions, including explicit requests for repair (verbal and gestural) and implicit requests for repair (failure to respond or inappropriate response to the subject's communication act). All subjects initiated at least one communication act, and all but three subjects repaired at least one communication act following a breakdown. Significantly more subjects initiated protoimperative than protodeclarative communication acts, despite equal opportunities for both types of acts. Across all conditions, additions were observed to occur significantly less often than recasts or repetitions. There were no significant differences in the number of subjects repairing communication following the different types of communication breakdown.
Adult↗
Patient knowledge and prescription of ulcer healing drugs in medical inpatients.
If patients on ulcer healing drugs are ill-informed about their medication or diagnosis their lack of knowledge may prejudice them from receiving potentially beneficial treatment, such as thrombolytic therapy, because of concern about upper gastrointestinal side effects. Furthermore because ulcer healing drugs are safe and effective there is a tendency to prescribe these drugs inappropriately. We therefore assessed patients' knowledge about their ulcer healing drugs and whether the prescriptions were appropriate or not. Consecutive patients on ulcer healing drugs admitted as emergencies to the general medical take-in underwent a structured interview designed to assess knowledge of drugs prescribed prior to admission. Patient responses (fully correct, partially correct or incorrect) and appropriateness (appropriate, possibly appropriate or inappropriate) of the prescriptions were graded by reference to information obtained from hospital notes and/or general practitioner. Seventy-nine out of a total of 537 patients (15%) were on ulcer healing drugs. Mean age was 64 years (range 26-91). Fifty-five (70%) of these patients could be analysed for correctness and 62 (78%) for the appropriateness. Patients gave an incorrect indication for 18% of ulcer healing drugs but only for 10% of non-ulcer healing drugs (P < 0.05). Factors associated with a poorer knowledge of drugs overall, were increasing age and impaired mental test score but not the number of drugs the patient was taking. The trends were similar for ulcer healing drugs alone. Sixteen out of 62 (26%, 95% CI 16-39%) prescriptions for ulcer healing drugs were deemed inappropriate. Our findings demonstrate a need for greater attention to patient education about drugs, especially ulcer healing drugs.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Individual social skills training and co-worker training for supported employees with dual sensory impairment. Two case examples.
Two case studies examined the efficacy of two social enhancement procedures--individual social skills training (SST) and co-worker intervention for two employees with dual sensory impairment who were working in competitive employment settings but who were socially isolated from contact with their nondisabled co-workers. A variety of measures, including direct behavioral observations and social validation ratings, examined social interaction and the formation of social networks in the workplace. Results showed that the number and duration of social interactions improved with each of the social enhancement programs. Social validation data and anecdotal reports indicated that the employees with disabilities became more socially competent, interactive, and included in the social network of the workplace. Interestingly, SST followed by co-worker training resulted in greater increases in social responding as compared to co-worker training followed by SST.
Adult↗