The New England Pediatric Trauma Nurse Consortium.
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Education, Nursing, Continuing↗
Biomedical subjects
C Atkinson
Publications and source records attributed to C Atkinson.
Phyto-oestrogens: where are we now?
Phyto-oestrogens have emerged from their esoteric role in animal husbandry following the hypothesis that the human Western diet is relatively deficient in these substances compared with societies where large amounts of plant foods and legumes are eaten. Evidence is beginning to accrue that they may begin to offer protection against a wide range of human conditions, including breast, bowel, prostate and other cancers, cardiovascular disease, brain function, alcohol abuse, osteoporosis and menopausal symptoms. Of the two main classes of these weak oestrogens, the isoflavones are under intensive investigation due to their high levels in soyabean. Like the 'anti-oestrogen' Tamoxifen, these seem to have oestrogenic effects in human subjects in the cardiovascular system and bone. Although previously only available from food, isoflavones are now being marketed in health-food supplements or drinks, and tablets may soon be available over the counter as 'natural' hormone-replacement therapy. In cancer, anti-oestrogenic effects are thought to be important, although genistein especially has been shown to induce wide-ranging anti-cancer effects in cell lines independent of any hormone-related influence. There are few indications of harmful effects at present, although possible proliferative effects have been reported. In infants, the effects of high levels in soya milk formulas are uncertain. The second group, lignans, have been less investigated despite their known antioestrogenic effects and more widespread occurrence in foods. Investigation of the possible benefits of phyto-oestrogens is hampered by lack of analytical standards and, hence, inadequate methods for the measurement of low levels in most foods. This problem may prove to be a major dilemma for regulatory authorities, clinicians and others wishing to advise the general public on whether these compounds really do have the health benefits attributed to them.
Coronary Disease↗
Disproportionate fetal growth and fingerprint patterns.
Fingerprint whorl patterns are formed during fetal life. In a group of 180 term infants, those with more fingerprint whorls tended to have a small abdominal circumference (P = 0.09) and high ratio of head to abdominal circumference (P = 0.008). These associations were independent of the relation between the whorl counts of the mothers and their infants. We also found an independent correlation between the babies' whorl count and the combination of increasing subscapular (P = 0.03) and decreasing triceps (P = 0.02) skinfold thicknesses of the mothers. Whorl patterns are associated with adult hypertension; maternal nutritional status may influence their common origin during fetal development.
Adult↗
The impact of prostate cancer knowledge on cancer screening.
PURPOSE/OBJECTIVES: To test the effect of knowledge on participation in prostate cancer screening. DESIGN: Quasi-experimental design; PRECEDE framework. SAMPLE: 319 men, 82% African American. METHODS: Prostate cancer knowledge was measured with a Prostate Cancer Knowledge Questionnaire prior to a community-based educational program. Men were referred to their personal physicians for a free prostate cancer screening. Results were sent to the Prostate Cancer Project. MAIN RESEARCH VARIABLES: Prostate cancer knowledge and participation in free prostate screening with a digital rectal examination and prostate specific antigen. FINDINGS: Prostate cancer knowledge was a predictor in participation in screening (p = 0.05). IMPLICATIONS FOR NURSING PRACTICE: Nurses need to target educational interventions for African American men, who have the highest incidence of and mortality rates for prostate cancer, to significantly reduce mortality rates. This study documented the importance of providing educational programs to increase participation in prostate cancer screening.
Adult↗
Phenotypic characterisation of the dendritic cell infiltrate in prostate cancer.
PURPOSE: To investigate whether dendritic cells (DC), which as professional antigen presenting cells have the capacity to stimulate immune responses against tumour associated antigens, are recruited into and activated within prostate cancer. MATERIALS AND METHODS: Immunoenzyme and immunofluorescence labelling was used to identify leucocyte and DC subsets within 15 cases of prostate cancer. Cell numbers were compared with numbers in adjacent normal prostatic tissue. Total DC numbers were identified as CD45+ leucocytes not coexpressing any lineage specific markers. The Langerhans cell (LC) subset was detected using anti CD1a staining and activated DC were identified by their expression of either CD83, CD86 or CMRF44. RESULTS: DC were found to represent a small subset of leucocytes present in both benign and malignant prostatic tissue. Statistically there were significantly less DC and LC in prostate cancer compared with normal prostatic tissue. While only a small subset of DC expressed markers of activation in prostate cancer, this was significantly more than the virtual absence of activated DC in normal prostatic tissue. CONCLUSIONS: This is the first time that DC have been studied in prostate cancer using the relatively new DC specific monoclonal antibodies CD83 and CMRF-44. These findings suggest that there is no active recruitment of DC into prostate cancer and those DC present are only minimally activated.
Antigens, CD↗
NASA tests composters for space.
For long term missions, composters may be an integral part of a life support system that provides edible food crops, extracts nutrients from plant biomass and removes contaminants from the recycling stream.
Biodegradation, Environmental↗
Involvement of multiple Cryptococcus neoformans strains in a single episode of cryptococcosis and reinfection with novel strains in recurrent infection demonstrated by random amplification of polymorphic DNA and DNA fingerprinting.
We compared the abilities of random amplification of polymorphic DNA and DNA fingerprinting, with oligonucleotide probes, to type five pairs of Cryptococcus neoformans clinical isolates recovered from five separate human immunodeficiency virus-positive patients in London, England. The two techniques had comparable discriminatory abilities when applied to these isolates. A total of eight different isolate types were demonstrated in these patients. No isolate type was observed in more than one patient. Two of the isolate pairs recovered from single episodes of cryptococcosis within 1 day of each other were genotypically indistinguishable by both methods. The other three pairs of isolates were all distinguishable. One of these isolate pairs was obtained from a single episode of cryptococcosis, while the other two were obtained from recurrent infections. These results indicate that multiple strains of C. neoformans may be responsible for a single episode of cryptococcosis and that recurrent infection may occur as a result of reinfection with a novel strain.
Base Sequence↗
Controversies in the management of laryngeal cancer: results of an international survey of patterns of care.
Cancer of the larynx is the most prevalent non-cutaneous malignancy of the head neck region and its treatment presents a threat to both natural speech and survival. This study examines the manner in which two separate specialties in the same and different geographic regions vary in their opinions about the treatment of glottic laryngeal cancer. The goal was to define options available to patients and to classify controversies about optimal treatment which might be resolved in clinical trials. Questionnaires depicting different presentations of glottic larynx cancer were mailed to 1649 otolaryngologists and radiation oncologists in North America, Europe and Australasia. Half the doctors were asked to describe their preferred treatment for a patient while the others were asked to imagine that they themselves were the patient. In all the disease situations opinions varied significantly with respect to the treatment modality advised (whether to employ surgical or radiotherapy approaches) and in more extensive disease situations the intention of treatment also varied depending on whether a curative approach should involve conservation or loss of the larynx. Doctors also recommended similar treatment for their patients as they would for themselves. Apart from disease extent the most significant variables influencing recommendations were the physicians' specialty (P = 0.0001) and where they practice (P = 0.0001). These findings demonstrate diversity of opinion which is influenced more profoundly by the traditions of the specialties and geographic location of practice than by the reported results of treatments for laryngeal cancer. Convictions about optimal management have become barriers to the assessment of the relative value of different treatments and to ensuring that patients are fully informed about management options. The profession should regard as a high priority efforts to resolve these therapeutic conflicts which are associated with major differences in quality of life.
Attitude of Health Personnel↗
Expression of members of the heat-shock protein 70 family in the exoerythrocytic stages of Plasmodium berghei and Plasmodium falciparum.
Exoerythrocytic stages of Plasmodium berghei cultured in HepG2-A16 hepatoma cells and those of P. falciparum in human hepatocytes transplanted under the kidney capsule of CB-17/ICr scid/scid mice were used to evaluate expression of heat-shock-related stress proteins. Although undetectable in the sporozoites, the expression of proteins similar in sequence of a heat-shock protein of 70 kDa and a glucose-regulated protein of 78 kDa was markedly induced in the hepatic stages of malaria parasites. Expression of these proteins in the exoerythrocytic stages of the malaria parasite warrants a systematic evaluation of their potential role in eliciting cellular immune responses directed against infected hepatocytes.
Animals↗
Stress and the memory T-cell response to the Epstein-Barr virus in healthy medical students.
This study investigated the memory T-cell proliferative response to several early and late Epstein-Barr virus (EBV) polypeptides. Blood samples were collected twice, 1 month before a 3-day block of examinations and again on the last day of the exam series. Ss were 25 healthy, EBV seropositive medical students. The proliferative response to 5 of the 6 EBV polypeptides significantly decreased during examinations. In addition, Ss high (above the median) in seeking support, as measured by the COPE, had lower proliferative responses to 3 EBV polypeptides (p17, p52/50, and p85), as well as higher levels of antibody to EBV virus capsid antigen. The data provide further evidence that psychological stress can modulate the cellular immune response to latent EBV.
Adult↗
Stress-associated modulation of proto-oncogene expression in human peripheral blood leukocytes.
Changes in the cellular immune response associated with psychological stress were studied by using an academic stress model with medical students. The authors examined the expression of 2 proto-oncogenes, c-myc and c-myb, in peripheral blood leukocytes (PBLs) obtained from medical students at the time of examinations and at a baseline period approximately 1 month prior to the examinations. The level of messenger ribonucleic acid (mRNA) expression of both protooncogenes was significantly lower in PBLs obtained during examinations than in those from the baseline period. In addition, a significant decrease in the level of mRNA to the glucocorticoid receptor and gamma interferon was also found in the same preparations. The decrease in mRNA content of c-myc, c-myb, the glucocorticoid receptor, and gamma interferon in PBLs obtained from subjects during examinations is consistent with data from previous studies using the same model that have demonstrated a down-regulation of T-lymphocyte activation and proliferation in response to mitogens.
Adult↗
Nutrition Screening Initiative and the Louisiana Food for Seniors experience.
The Nutrition Screening Initiative (NSI), an interdisciplinary agency, has developed three levels of nutritional screening for the elderly. Nutritionists from the Office of Public Health and the Orleans Parish Nutrition Commodity Service screened 104 Commodity Supplemental Food Program--Food for Seniors (CSFP) participants utilizing the NSI's checklist. Anthropometric measures were also obtained and the Body Mass Index (BMI), a measure of total body fat, was calculated. Eighty percent of the participants were at moderate or high nutritional risk. Fifty percent of the obese participants (BMI > 30) were at high nutritional risk; whereas 83% of underweight participants (BMI < 21) were at high nutritional risk. Results suggest the need for further evaluation and nutritional intervention among low-income seniors.
Age Factors↗
Managing change in primary care. Strategies for success.
Explore the source record for details and available documents.
Family Practice↗
Open to suggestions.
A survey of patients' attitudes to GP opening hours produced strong evidence for extending surgery times for patients' convenience and to meet specific health needs, say Chris Atkinson and Marjorie Gardner.
Appointments and Schedules↗
Carbon monoxide diffusing capacity is a poor predictor of clinically significant bleomycin lung. New Zealand Clinical Oncology Group.
In a retrospective analysis, serial lung function tests from 81 patients receiving bleomycin were studied to determine the accuracy of carbon monoxide diffusing capacity (DLCO) as a predictor of clinically significant bleomycin lung. Six of 81 patients developed clinically significant bleomycin lung, and the DLCO predicted its development in only one patient (sensitivity, one of six patients; 16.7%). Respiratory symptoms and chest x-ray abnormalities were the earliest manifestations in the other five patients. Seventy-five of 81 patients did not develop clinically significant bleomycin lung, and 12 of these had major falls (greater than or equal to 35% pretreatment level) in DLCO (specificity, 63 of 75 patients; 84.0%). In eight patients, bleomycin was continued after a major fall in DLCO, and none developed clinically significant lung toxicity. In this study, the DLCO failed to predict the development of serious bleomycin lung toxicity in all but one case. Furthermore, in some patients, it would appear that bleomycin may be stopped inappropriately after low DLCO measurements. It is important to monitor for respiratory symptoms and chest x-ray abnormalities during bleomycin treatment as these will be the earliest signs of lung toxicity in most cases.
Adolescent↗
The management of change in general practice.
The final article in our practice management series suggests a structured approach to the management of change.
Family Practice↗
Surveillance for stage I non-seminomatous germ cell tumours of the testis: the optimal protocol has not yet been defined.
Forty-six patients with clinical stage I testicular non-seminomatous germ cell tumours were followed up according to a protocol of active surveillance between 1979 and 1987. The median follow-up time was 40+ months. Thirteen patients (28%) relapsed, predominantly in retroperitoneum and/or lung. Ten of these relapses (76%) occurred within 8 months of orchiectomy. Relapses occurred in 7/35 T1 tumours and 5/10 T2 to T4 tumours. No correlation was detected between the histological type and relapse rate. Three late relapses were diagnosed at 23, 29 and 36 months. Eleven of the relapsed patients remain in prolonged complete remission after PVB chemotherapy +/- surgery; one patient, who initially refused treatment at the time of relapse, has died. Another relapsed with predominant elements of rhabdomyosarcoma intermingled with malignant teratoma in a bone metastasis. He had a partial response to PVB chemotherapy but subsequently died. Thirty-four patients (74%) did not undergo lymphography (LG) and had a higher relapse rate (11/34) than those who had LG (2/12); this was not a statistically significant difference in this small series. The policy of active surveillance is not yet the "state of the art" and should be under constant scrutiny with respect to safety and practice.
Adult↗