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Biomedical subjects

A Marsh

Publications and source records attributed to A Marsh.

At least 37 records · Page 2Linked to original sources
PubMed1998

The management of elderly patients with femoral fractures. A randomised controlled trial of early intervention versus standard care.

OBJECTIVE: To determine the effect of an early intervention program in an acute care setting on the length of stay in hospital of elderly patients with proximal femoral fractures. SETTING: Acute orthopaedic ward of a large teaching hospital. DESIGN AND PARTICIPANTS: A randomised controlled trial comparing 38 Intervention patients with 33 Standard Care patients. INTERVENTION: Early surgery, minimal narcotic analgesia, intense daily therapy and close monitoring of patient needs via a multidisciplinary approach versus routine hospital management. MAIN OUTCOME MEASURES: Length of stay (LOS); deaths; level of independent functioning. RESULTS: Mean LOS was shorter in the Intervention group than in the Standard Care group (21 days v. 32.5 days; P < 0.01). After adjusting for other factors that could affect LOS (eg, age, sex, pre-trauma functional levels, pre-trauma comorbidity and postsurgical complications), the Intervention program was significantly predictive of shorter LOS (P = 0.01). The Intervention group did not experience greater numbers of deaths, deterioration in function or need for social support than the Standard Care group. CONCLUSION: This early intervention program in an acute care setting results in significantly shorter length of hospital stay for elderly patients with femoral fractures.

Aged↗
PubMed1998

The Creation of a global telemedical information society.

Healthcare is a major candidate for improvement in any vision of the kinds of 'information highways' and 'information societies' that are now being visualized. The medical information management market is one of the largest and fastest growing segments of the healthcare device industry. The expected revenue by the year 2000 is US$21 billion. Telemedicine currently accounts for only a small segment but is expanding rapidly. In the USA more than 60% of federal telemedicine projects were initiated in the last 2 years. The concept of telemedicine captures much of what is developing in terms of technology implementations, especially if it is combined with the growth of the Internet and World Wide Web (WWW). It is foreseen that the World Wide Web (WWW) will become the most important communication medium of any future information society. If the development of such a society is to be on a global scale it should not be allowed to develop in an ad hoc manner. For this reason, the Euromed Project has identified 20 building blocks resulting in 39 steps requiring multi-disciplinary collaborations. Since, the organization of information is therefore critical especially when concerning healthcare the Euromed Project has also introduced a new (global) standard called 'Virtual Medical Worlds' which provides the potential to organize existing medical information and provide the foundations for its integration into future forms of medical information systems. Virtual Medical Worlds, based on 3D reconstructed medical models, utilizes the WWW as a navigational medium to remotely access multi-media medical information systems. The visualization and manipulation of hyper-graphical 3D 'body/organ' templates and patient-specific 3D/4D/and VR models is an attempt to define an information infrastructure in an emerging WWW-based telemedical information society.

Europe↗
PubMed1998

The creation of a global telemedical information society.

Healthcare is a major candidate for improvement in any vision of the kinds of "information highways" and "information societies" that are now being visualized. The medical information management market is one of the largest and fastest growing segments of the healthcare device industry. The expected revenue by the year 2000 is US$21 billion. Telemedicine currently accounts for only a small segment but is expanding rapidly. In the United States more than 60% of federal telemedicine projects were initiated in the last two years. The concept of telemedicine captures much of what is developing in terms of technology implementations, especially if it is combined with the growth of the Internet and World Wide Web (WWW). It is foreseen that the World Wide Web (WWW) will become the most important communication medium of any future information society. If the development of such a society is to be on a global scale it should not be allowed to develop in an ad hoc manner. The Euromed Project has identified 20 building blocks resulting in 39 steps requiring multi-disciplinary collaborations. Since, the organization of information is therefore critical especially when concerning healthcare the Euromed Project has also introduced a new (global) standard called "Virtual Medical Worlds" which provides the potential to organize existing medical information and provide the foundations for its integration into future forms of medical information systems. Virtual Medical Worlds, based on 3D reconstructed medical models, utilizes the WWW as a navigational medium to remotely access multimedia medical information systems. The visualisation and manipulation of hyper-graphical 3D "body/organ" templates and patient-specific 3D/4D/and VR models is an attempt to define an information infrastructure in an emerging WWW-based telemedical information society.

Humans↗
PubMed1997

Knowledge-based modeling of a bacterial dichloromethane dehalogenase.

A three-dimensional structural model of the dichloromethane dehalogenase (DCMD) from Methylophilus sp. DM11 is constructed based on sequence similarities to the glutathione S-transferases (GSTs). To maximize sequence identity and minimize gaps in the alignment, a hybrid approach is used that takes advantage of the increased homology found between DM11 and domain I of the sheep blowfly theta class GST (residues 1-79) and domain II of the human alpha class GST (residues 81-222). The resulting structure has C alpha root mean square deviations of 1.16 A in domain I and 1.83 A in domain II from the template GSTs, which compare well to those seen in other GST inter-class comparisons. The model is further applied to explore the structural basis for substrate binding and catalysis. A conserved network of hydrogen bonds is described that binds glutathione to the G site, placing the thiol group in a suitable location for nucleophilic attack of dichloromethane. A mechanism is proposed that involves activation through a hydrogen bond interaction between Ser12 and glutathione, similar to that found in the theta-GSTs. The model also demonstrates how aromatic residues in the hydrophobic site (H site) could play a role in promoting catalysis: His116 and Trp117 are ideally situated to accept a growing negative charge on a chlorine of dichloromethane, stabilizing displacement. This scheme is consistent with experimental results of single-point mutations and comparisons with other GST structures and mechanisms.

Amino Acid Sequence↗
PubMed1996

Evaluation in the Substance Abuse and Mental Health Services Administration.

The evaluation policy of the Substance Abuse and Mental Health Services Administration (SAMHSA) is described in this article. Three studies are presented that exemplify SAMHSA's evaluations. These include evaluations of a program to prevent substance abuse among pregnant and postpartum women and their infants; a Job Corps treatment enrichment program; and the McKinney program for homeless persons with severe mental illnesses. Each of these evaluations demonstrated the effectiveness of the programs in reducing substance abuse or homelessness and in improving the health and well-being of the consumers served. SAMHSA will use the results of these and similar evaluations to guide policy and program development. Through its evaluations, SAMHSA must identify effective approaches to prevention, treatment, and rehabilitation. By using its evaluation results to guide policy and program development, SAMHSA aims to improve the quality of the public system of substance abuse and mental health services.

Adolescent↗
PubMed1995

Radioimmunoassay of drugs of abuse in hair. Part 2: The determination of methadone in the hair of known drug users.

This communication addresses the analytical problems associated with the analysis of hair specimens from known users and misusers of the synthetic opioid methadone. An adapted radioimmunoassay and a previously developed preanalytical decontamination procedure have been applied to samples from known drug users. The removal of drugs from the hair surface by washing and the effect of proprietary hair treatments on methadone entrapped in the hair have also been investigated. Pre-analytical washing reduced methadone levels by up to 29%, whilst hair colouration and peroxide bleaching were found to reduce levels by up to 21% and 50% respectively. Methadone assay of extracts from dated hair segments were shown to provide long-term histories of methadone intake, under controlled and non-controlled conditions. Evidence that a dose relationship between hair drug levels and intake may exist is presented. Results of hair analysis, expressed as ng methadone/mg hair, from drug users (range 0.20-10.63) are compared to a pre-determined cut-off of 0.1 ng methadone/mg hair, obtained from the analysis of a known drug free population (n = 23).

Chemistry Techniques, Analytical↗
PubMed1995

Changes in drug use and HIV/AIDS risk-taking 1989-90.

The Australian National AIDS and Injecting Drug Use Study was designed to monitor the risk behaviour of Australian injecting drug users (IDUs) in a number of major cities, and to estimate the seroprevalence of those interviewed. Differences in risk behaviour found across 2 years in Perth are reported. One hundred and ninety-six Perth IDUs were interviewed in 1989, and 150 in 1990 using the same survey questionnaire, with a small cohort of 38 respondents being followed up across the 2 years.Significant injecting differences between 1989 and 1990 in both the cohort and independent samples were found. In general, these amounted to a greater likelihood that a new needle and syringe would be used on each injecting occasion, and a greater use of bleach in 1990 than in 1989. The most common response of respondents who said they had changed their drug use behaviour in 1990 was to report ceasing to share needles, while the most common response in 1989 was reduced sharing. There was an increased use of condoms for vaginal intercourse with all partners in both studies across the 2 years. Seropositivity for all new cases across the 2 years was 1.75%. It is apparent that there has been a significant shift in risky behaviour in the direction of greater safety across the 2 years. There is also objective corroborative evidence in increased demand for sterile injecting equipment sold through pharmacists, although there is no evidence that drug use increased significantly during the same period. It is concluded that the availability of sterile needles and syringes should be maintained and improved and that emphasis should be placed on encouraging safer sexual behaviour among IDUs.

Journal Article↗
PubMed1995

Sarcocystis falcatula from passerine and psittacine birds: synonymy with Sarcocystis neurona, agent of equine protozoal myeloencephalitis.

Equine protozoal myeloencephalitis (EPM) is a neurologic disease of horses caused by Sarcocystis neurona. The horse is a dead-end host for S. neurona and the definitive and intermediate hosts have not previously been identified. We hypothesized that S. neurona is actually Sarcocystis falcatula, a parasite that cycles in nature between Virginia opossums (Didelphis virginiana) and any of a variety of avian intermediate hosts. We extracted DNA from S. falcatula sarcocysts in the muscle of a brown-headed cowbird (Molothrus ater) and from schizonts in a fixed specimen of lung from a Moluccan cockatoo (Cacatua moluccensis). Three segments of the small subunit ribosomal RNA (SSURNA) gene, containing a total of 742 nucleotides, were amplified by the polymerase chain reaction, sequenced, and compared with the SSURNA sequence from two isolates of S. neurona. The S. falcatula sequence was identical to the sequence of the S. neurona isolate UCD-1 and differed in only 3 positions from isolate SN5. Recent evidence, also based on SSURNA sequences, implicates the opossum as the definitive host of S. neurona. Based on the SSURNA gene sequences S. falcatula and S. neurona are synonymous, thus the parasite cycles between opossums and birds maintaining a reservoir of the organism from which horses can be infected.

Animals↗
PubMed1994

Radioimmunoassay of drugs of abuse in hair. Part 1: Methadone in human hair, method adaptation and the evaluation of decontamination procedures.

A method suitable for the determination of methadone in human hair is presented. Adaptation and evaluation of a solid-phase I125 radioimmunoassay, designed for the quantitative measurement of methadone in urine, and development of a pre-analytical wash procedure has enabled a specific, sensitive and accurate analytical procedure to be developed. The specificity of the antiserum towards other drugs or biologically active compounds is evaluated up to a concentration of 100,000 ng ml-1 and accuracy covering a range of 0-450 ng ml-1 is found to be within 6% of expected methadone concentrations prepared in both drug free hair extract and urine. Inter-assay relative standard deviation (RSD) at concentrations of 5.1, 76.0 and 247 ng ml-1 methadone are 5.5, 2.5 and 3.6% respectively (n = 10) and intra-assay RSD at concentrations 2.3, 25.2 and 217 ng ml-1 are 5.3, 3.6 and 6.8% (n = 5). The limit of detection is 0.5 ng ml-1. Extraction of control drug free hair samples spiked with methadone at concentrations of 100, 250 and 400 ng ml-1 achieved recoveries of 86, 80 and 89%, respectively. Control hair samples contaminated with methadone are examined under differing wash procedures to assess their effectiveness in the removal of methadone contaminant. A suitable pre-analytical wash regime is proposed for removal of contaminant derived from external or environmental sources. The mechanics of the wash action and contaminant application to the hair is discussed. It is concluded that the adapted radioimmunoassay and developed pre-analytical decontamination procedure is a suitable technique to employ for the measurement of methadone in human hair, be it prescribed or abused, with concentrations expressed as ng methadone per mg hair.

Decontamination↗
PubMed1994

A bridge too near? Injecting drug users' sexual behaviour.

One-hundred-and-fifty injecting drug users were interviewed about their sexual behaviour, and types of sexual relationships and partners in the past year. The aims of the study were to assess the extent of changes in sexual HIV-risk behaviour patterns and to understand aspects of respondents' sexual relationships, as well as HIV/AIDS knowledge. We found few changes in sexual behaviour. The ability to assess personal HIV-risk varied widely across the sample and intoxication during sexual activity was widely reported. Whilst the use of condoms was infrequent, young respondents were more likely to use condoms, but have more sexual partners, hence a likely erosion of any net gain may have occurred. Over half of the respondents were in sexually monogamous relationships and there were no significant gender-related differences in respect of regular partners' IDU-status. Estimated rates of seroprevalence in Perth are low and with the effectiveness of deterrence dependent on visible negative outcomes, it may be difficult to ensure safer-sex messages are heeded. These concerns are raised and facilitation of safer-sex among IDUs are discussed. Further areas of research are recommended.

Adolescent↗
PubMed1993

Challenging declarations of abstinence by the determination of morphine in hair by radioimmunoassay.

Morphine extracted from dated hair segments and analysed by adaptation of a specific solid-phase 125I radioimmunoassay for the measurement of morphine in urine has provided long term histories of the heroin usage of individual patients. Results expressed as ng morphine/mg hair are compared with a pre-determined cut-off level of 0.3 ng morphine/mg hair, from a known drug-free population (n = 21). Morphine concentrations in hair samples from known heroin abusers are found to be above the cut-off limit (range 0.6-9.4 ng morphine/mg hair), and suggest a possible correlation between heroin intake and concentration of morphine in hair. Intra-assay relative standard deviation (RSD), at morphine levels of 9.27 and 1.12 ng morphine/mg hair are 2.4 and 5.5%, respectively, and acceptable recoveries from drug-free hair spiked with morphine are also achieved. The developed segmental hair analysis regime has been used successfully to challenge a self-declaration of heroin abstinence. Routine cumulative urine screening was unable to provide such evidence. The potential for hair drug analysis is discussed.

Hair↗
PubMed1992

Isolation of calicivirus from the joint of a kitten with arthritis.

Calicivirus was isolated from the joint of a kitten that had pyrexia, upper respiratory tract disease, and severe shifting-limb lameness. Marked mononuclear inflammation was found in the synovial fluid. Calicivirus infection or live-virus vaccination previously had been associated with arthropathy, but virus had not been recovered from affected joints. Calicivirus infection should be considered as a diagnosis in kittens with fever and arthralgia, especially if there is a history of recent vaccination or upper respiratory tract disease. Lameness associated with calicivirus infection may be severe, but appears to be self-limiting and is associated with an excellent prognosis for recovery.

Animals↗