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Biomedical subjects

A Browne

Publications and source records attributed to A Browne.

At least 19 recordsLinked to original sources
PubMed2002

What distinguishes unintentional injuries from injuries due to intimate partner violence: a study in Greek ambulatory care settings.

OBJECTIVES: Intimate partner violence (IPV) is an important sociocultural and public health problem. This study aims to assess sociodemographic and injury characteristics of IPV victims among adults in a traditional southern European population. SETTING: Accident and emergency departments of three sentinel hospitals in Greece participating in the Emergency Department Injury Surveillance System (EDISS). METHODS: Data on sociodemographic variables, as well as event and injury characteristics were retrieved from the EDISS database during the three year period 1996-98. Out of a total of 27 319 injured women aged 19 years or more, 312 (1.1%) were reported as IPV related and were compared with 26 466 women with unintentional injuries. Among the 35 174 men with injuries 39 (0.1%) were reported as IPV related and were compared with 34 049 men with unintentional injuries. The data were analyzed through simple cross tabulations and multiple logistic regression. Positive predicted values for selected injury characteristics were also calculated. RESULTS: IPV is more common in rural than in urban areas of Greece. Women are 10 times more frequently IPV victims but men are also IPV victims; younger women and older men are disproportionately affected by IPV. The relative frequency of the phenomenon increases during the late evening and night hours. Certain types of injuries, notably multiple facial injuries, and presentation of the injured person on his/her own at the emergency department or combinations of predictive characteristics are strongly indicative of IPV. CONCLUSIONS: Injuries due to IPV are not uncommon in Greece, not withstanding the traditional structure of the society and the tendency of under-reporting. Certain injury characteristics have high positive predictive values and could be used in screening protocols aiming at the correct identification of the underlying external cause in injuries that may be caused by IPV.

Adult↗
PubMed2001

Intra-abdominal abscess after laparoscopic appendectomy for perforated appendicitis.

HYPOTHESIS: The incidence of postoperative intra-abdominal abscess is higher after laparoscopic compared with open appendectomy for perforated appendicitis. METHODS: A historical cohort study of pediatric patients operated on for suspected appendicitis by open appendectomy or laparoscopic appendectomy compares the incidence of postoperative intra-abdominal abscess for each procedure. SETTING: A tertiary care center. PATIENTS: Five hundred thirty-eight pediatric patients were operated on for suspected appendicitis at our institution between 1974 and 1999. Of these, 453 were included in the study. Of the excluded patients, 9 had incomplete medical records, 69 had normal or interval appendectomies, and 7 had appendixes removed by methods other than laparoscopy or right lower quadrant incision. INTERVENTIONS: Open appendectomy performed through a right lower quadrant incision or laparoscopic appendectomy performed through a 3-trocar approach by 1 of 3 pediatric surgeons at our institution. MAIN OUTCOME MEASURE: The incidence of postoperative intra-abdominal abscess after laparoscopic vs open appendectomy. RESULTS: In perforated appendicitis (170 patients), the incidence of postoperative abscess after laparoscopic appendectomy was 24% vs 4.2% after open appendectomy. The relative risk ratio of developing a postoperative abscess after perforated appendicitis was 5.6 (confidence interval, 2.1-16.0) after laparoscopic vs open appendectomy. The results remained significant when controlled for age, sex, intraoperative irrigation, and preoperative antibiotics. Postoperative abscess in all acute, gangrenous, and perforated appendicitis after laparoscopic appendectomy was 6.4% vs 3.0% after open appendectomy. This was not statistically significant. CONCLUSION: There is a significant increase in the incidence of postoperative intra-abdominal abscess with perforated appendicitis after laparoscopic compared with open appendectomy in pediatric patients.

Abdominal Abscess↗
PubMed2001

Connectionist inference models.

The performance of symbolic inference tasks has long been a challenge to connectionists. In this paper, we present an extended survey of this area. Existing connectionist inference systems are reviewed, with particular reference to how they perform variable binding and rule-based reasoning and whether they involve distributed or localist representations. The benefits and disadvantages of different representations and systems are outlined, and conclusions drawn regarding the capabilities of connectionist inference systems when compared with symbolic inference systems or when used for cognitive modelling.

Animals↗
PubMed2000

Intelligent control of a cryogenic cooling plant based on blackboard system architecture.

Intelligent system techniques have been rapidly assimilating into process control engineering, with many applications reported in the last decade. Intelligent control is bringing a new perspective as well as new challenges to process control. In this paper, a software architecture for a Blackboard for Integrated Intelligent Control Systems (BIICS) is described. The system is designed to simultaneously support multiple heterogeneous intelligent methodologies, such as neural networks. expert systems, fuzzy logic, neural networks and genetic algorithms. It will be shown how such methodologies can be readily assimilated into the software architecture. The BIICS system represents a multi-purpose platform for design and simulation of intelligent control paradigms for different kinds of processes. Currently the system utilizes intelligent control techniques (neuro-fuzzy and genetic optimization) for controlling a cryogenic plant used for superconductor testing at temperatures below 100 K.

Journal Article↗
PubMed2000

Mechanisms of vasorelaxation induced by eicosapentaenoic acid (20:5n-3) in WKY rat aorta.

The vasorelaxant activity of eicosapentaenoic acid (EPA, 20:5n-3), the omega-3 polyunsaturated fatty acid, was investigated in isolated Wistar Kyoto (WKY) rat aortae by measuring isometric tension. Eicosapentaenoic acid (1 - 100 microM) relaxed rat aortae contracted with high K(+) (80 mM) or noradrenaline (NA, 1 microM) in a concentration-dependent manner. Contractions induced by Bay K 8644 or increasing concentrations of calcium were unaffected by EPA. The relaxant effect of EPA (3 - 100 microM) was significantly inhibited by indomethacin (10 microM), the cyclo-oxygenase inhibitor, but not by the nitric oxide (NO) synthesis inhibitor, N(omega)-nitro-L-arginine methyl ester hydrochloride (L-NAME, 100 microM). Removal of the endothelium did not alter EPA-induced relaxations. In Ca(2+)-free, EGTA 2 mM solution, EPA (10 - 30 microM significantly inhibited NA-sustained contractions. Incubation with EPA (5, 10 microM) diminished both NA-induced (1 microM) phasic and sustained contractions. The vasorelaxant effects of EPA (> or =30 microM) on NA-induced (1 microM) contractions were significantly inhibited by the K(+) channel blocker, glibenclamide (10 microM), but not tetraethylammonium (1 mM). Moreover, indomethacin and glibenclamide combined significantly inhibited EPA-induced (1 - 100 microM) responses. These results indicate EPA exerts its endothelium-independent vasorelaxant effects in WKY rat aortae through production of prostanoids which activate K(+)(ATP) channels. Inhibition of Ca(2+) mobilization from intracellular pools and influx through the non-L-type, but not the L-type, Ca(2+) channel are also possible mechanisms action of EPA's.

Animals↗
PubMed2000

Mycosis fungoides bullosa simulating pyoderma gangrenosum.

A patient with mycosis fungoides (MF) bullosa had a rapidly growing, painful necrotic mass on the left ankle which extended by peripheral bulla formation, clinically resembling pyoderma gangrenosum. Histopathology confirmed MF bullosa with both intraepidermal and subepidermal bulla formation.

Antineoplastic Agents, Phytogenic↗
PubMed2000

The ethics of elective (non-therapeutic) ventilation.

Elective ventilation (EV) is ventilation applied, not in the interest of patients, but in order to secure transplantable organs. It carries with it a small risk that patients who would otherwise have died will survive in a persistent vegetative state. Is EV ever justifiable? We argue: (1) The only thing which can justify exposing patients to risk not taken for their benefit is their consent, and we cannot rely on implied consent or third party consent in the case of EV. Thus absent explicit consent of patients, EV is not justifiable. (2) It is not clear that explicit consent should be sought, or where it is offered honoured, given the potential EV has for deterring organ donors and causing stress to staff and families.

Brain Death↗
PubMed1999

The ethics of blood testing as an element of doping control in sport.

Sport authorities continue to confront a variety of perplexing issues as they attempt to address effectively and efficiently the problems posed by doping. The emergence of the phenomena of blood doping and the administration of erythropoietin have added to the challenges faced by doping control authorities. Some sport organizations have introduced blood tests in an attempt to deal with these issues despite the absence of any effective test for the detection of the administration of homologous blood products or eythropoietin. A number of ethical issues are raised by such developments. Even in the presence of an effective test it is suggested that the decision to implement a specific testing approach can be reached by considering the wishes of a hypothetical "Fair Competitor" and an analysis of the costs involved. In this respect the Fair Competitor assumes in the sport community the role that the "reasonable person" occupies in law, permitting an analysis of a proposed course of action. In making any decision regarding the implementation of any test, a Fair Competitor would be guided by considerations of the postulated advantage and incidence of a doping technique, the likelihood of false positive and negative results, the risk of unwanted consequences of a testing process, and a concern that a specific test not accelerate the likelihood of the use of other doping methods. This approach is applied to a consideration of the appropriateness of blood testing in sport. It is concluded, using such an analysis, that in their present state of development, blood tests should not be implemented. It is recognized that certain sport authorities currently use blood tests to exclude competitors whose blood values exceed certain predetermined levels on the grounds of concerns regarding health and safety. Screening of this kind is beyond the purview of this discussion.

Doping in Sports↗
PubMed1999

Infection in chronic wounds: controversies in diagnosis and treatment.

Chronic wounds all have bacterial contamination, which will not impair healing. Wound contamination must be distinguished from wound colonization and infection. Bacterial infection in wounds depends on the number of organisms present, their virulence, and host resistance. The most important indicators of infection are both local and systemic host characteristics and a holistic assessment of the patient. Several specimen collection and culture techniques are available to measure bacterial burden in the chronic wound. Advantages and disadvantages of each one discussed along with a rational approach to systemic antibiotic therapy. The presence of foreign material such as skin grafts or skin substitutes may lower the bacterial burden that may impair healing from 1.0 x 10(6) colony-forming units to 1.0 x 10(5) or less. The benefits of wound debridement, wound irrigation, and local nonantibiotic modes of treatment have been proven but the use of topical antibiotics and antiseptics requires further assessment. More widespread use of multiple nonantibiotic modalities of treatment for infected chronic wounds and rational antibiotic prescribing should reduce the risk of future antimicrobial resistance such as MRSA.

Anti-Bacterial Agents↗
PubMed1999

Advance directives: a third option.

As autonomy can only be exercised when a person is competent, advance directives give the potential to extend autonomy during incapacity. Most advance directives specify when intervention measures are not to be used. The elderly, or those with a fatal or chronic illness commonly give these directions. This type of advance directive does not satisfy he concerns of the younger and healthier segment of the population, and may be unsuitable for the older person. Healthy people are less concerned with procedures; they are concerned with outcome. All groups are concerned with certainty. These concerns may be better addressed by combining an instructional and a proxy directive, and for the healthy, by emphasizing ends rather than means. An example of such a directive is proposed.

Advance Directives↗
PubMed1998

Audit of computer literacy and skills.

Information technology (IT) has radically changed the way that many people work and think. This audit was designed to evaluate the IT skills and training needs of different professional groups. Most clerical staff but only about 33% of medical and nursing staff were able to use the current patient information system. 72% of the staff were interested in further training in information technology skills. The local college agreed to come to the hospital to run the CLAIT (Computer Literacy and Information Technology) course on our premises.

Attitude to Computers↗
PubMed1998

Responding to the needs of low-income and homeless women who are survivors of family violence.

Americans have started to recognize interpersonal violence as a major health care issue. Increasingly, clinicians are beginning to recognize both the high rate of victimization among extremely poor women and its health consequences. However, most clinical responses focus on the immediate effects of child abuse, partner abuse, and rape. The long-term medical and mental health consequences and the relationship between early victimization and adult problems are still largely ignored. This article focuses on medical and mental health needs of extremely poor women survivors of interpersonal violence. It begins by documenting the extent and nature of violence against low-income women. Special attention is focused on the long-term sequelae of childhood abuse and on identifying and managing complex trauma responses in these women. The article concludes by discussing obstacles to care and the necessity of advocating for increased resources to respond to women living in extreme poverty.

Domestic Violence↗
PubMed1997

Intimate violence in the lives of homeless and poor housed women: prevalence and patterns in an ethnically diverse sample.

In a study of 436 homeless and poor housed mothers, nearly two-thirds reported severe physical violence by a childhood caretaker, 42% reported childhood sexual molestation, and 61% reported severe violence by a male partner. Comparisons of homeless and housed women are presented, and implications for prevention and intervention are discussed in light of recent welfare reform legislation.

Adult↗
PubMed1997

Homelessness in female-headed families: childhood and adult risk and protective factors.

OBJECTIVES: To identify risk and protective factors for family homelessness, a case-control study of homeless and low-income, never-homeless families, all female-headed, was conducted. METHODS: Homeless mothers (n = 220) were enrolled from family shelters in Worcester, Mass. Low-income housed mothers receiving welfare (n = 216) formed the comparison group. The women completed an interview covering socioeconomic, social support, victimization, mental health, substance use, and health domains. RESULTS: Childhood predictors of family homelessness included foster care placement and respondent's mother's use of drugs. Independent risk factors in adulthood included minority status, recent move to Worcester, recent eviction, interpersonal conflict, frequent alcohol or heroin use, and recent hospitalization for a mental health problem. Protective factors included being a primary tenant, receiving cash assistance or a housing subsidy, graduating from high school, and having a larger social network. CONCLUSIONS: Factors that compromise an individual's economic and social resources are associated with greater risk of losing one's home.

Adolescent↗
PubMed1996

The characteristics and needs of sheltered homeless and low-income housed mothers.

OBJECTIVE: To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains. DESIGN: Case-control study. SETTING: Community of Worcester, Mass. PARTICIPANTS: A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare. MAIN OUTCOME MEASURES: Income, housing, life events, social support, history of abuse and assault, and mental and physical health. RESULTS: Comparison of homeless and housed mothers revealed some important similarities and differences. The proportion of homeless mothers with annual incomes of less than $7000 was 46% vs 17% for housed mothers (P<.O1). Homeless mothers experienced more residential instability than the housed mothers (3.8 moves vs 1.8 moves; P<.001) and had smaller support networks (P<.001). More homeless mothers reported severe physical and sexual assault over the lifespan than housed mothers (91.6% vs 81.1 %; P<.003). No significant differences were found between the groups in mental and physical health. However, the lifetime prevalence of major depressive disorder, posttraumatic stress disorder, and substance use disorders was overrepresented compared to the general female population. Both groups had lower physical functioning compared to the general population and a higher prevalence of chronic health conditions. CONCLUSIONS: Sheltered homeless mothers had fewer economic resources and social supports and higher cumulative rates of violent abuse and assault over their lifespans than their housed counterparts. However, both groups faced extreme adversity that compromised family well-being. Practitioners and social policymakers need to be cognizant of the multiple economic, psychosocial, and physical health needs of these mothers in providing treatment and developing program interventions.

Adolescent↗
PubMed1996

Health, hygiene and maternal education: evidence from The Gambia.

The paper explores the ways in which women's education influences domestic hygiene practices and use of health care services in a traditional agricultural village in The Gambia. The "environment of health" is one of poverty, high morbidity and low levels of female literacy. A detailed household survey was undertaken in the rainy season when agricultural work is demanding of people's time and energy and morbidity rates are high. Mothers with and without formal education and with at least one child under 5 were included in the study. Small differences were found between the educated and uneducated group in the knowledge and practice of household hygiene. The healthcare services in the village were utilised by all women regardless of whether or not they had been to school, but educated mothers appeared to have a better understanding of health education messages. The case study illustrates the synergy between health, hygiene and maternal education and discusses the implications of the findings.

Adolescent↗