Biomedical subjects

C Phillips

Publications and source records attributed to C Phillips.

At least 55 records · Page 3Linked to original sources

PubMed1998

Environmental correlates of resident agitation in Alzheimer's disease special care units.

OBJECTIVE: To determine the point prevalence of agitated behaviors in a representative sample of Alzheimer's disease Special Care Units, and to determine the extent to which agitation is associated with aspects of the treatment environment. DESIGN: A cross-sectional study in which nonparticipant observers recorded 3723 observations of resident behaviors in 53 Alzheimer's disease Special Care Units. Observational data were gathered on the physical environment and staff treatment in these settings, and resident characteristics were extracted from a data base developed in the study states by the Health Care Financing Agency. Analyses studied the association between aspects of the staff and physical environment and resident agitation levels, controlling for resident cognitive and functional status. SETTING: Special Care Units in nursing homes in Kansas, Maine, Mississippi, and South Dakota. PARTICIPANTS: All residents and staff of the participating units. MAIN OUTCOME MEASURES: Eight specific agitated behaviors and two indexes of resident agitation were measured by direct observation by research assistants on three to four data collection walk-throughs in each of the study facilities. RESULTS: The most common agitated behaviors noted were repetitive mannerisms (4.5% of resident observations) and non-loud verbal excess (3.8%). Wandering, which frequently reflects agitation, was noted in 6.5% of resident observations. The proportion of residents exhibiting an agitated behavior varied from none in some units to 38% in one unit. Independent correlates of low unit agitation levels included favorable scores on measures of the physical environment and of staff treatment activities, low rates of physical restraint use, a high proportion of residents in bed during the day, small unit size, low levels of resident functional dependency, and fewer numbers of comorbid conditions. CONCLUSIONS: While the prevalence of agitation tends to increase as Alzheimer's disease progresses, modifiable treatment factors appear to have a strong influence on the prevalence of agitation. Both physical design and staff treatment appear to influence agitation rates, as do some measures consistent with a low stimulus approach to Alzheimer's care.

Activities of Daily Living↗

PubMed1998

Efficiency of multi-strand steel, superelastic Ni-Ti and ion-implanted Ni-Ti archwires for initial alignment.

In a clinical trial involving 155 dental arches with irregularity > 5 mm, the rate of alignment was used to compare the alignment efficiency of 16 mil superelastic Ni-Ti versus 17.5 mil triple-stranded steel archwires, and to determine whether ion implantation of the Ni-Ti wire improved its performance. Subjects were randomly assigned to archwire types; both 18 and 22 slot edgewise appliances were employed. Pre-treatment equivalence of the experimental groups was verified. Anterior irregularity was determined monthly (using Little's irregularity index) until it decreased below 2 mm, and the elastomeric ligatures were replaced at each appointment. Effective tooth movement occurred with each of the archwire types. There were no significant differences among wires, but the rate of alignment was significantly faster in the lower arch for subjects with the 22 slot appliance.

Adolescent↗

PubMed1998

A smoking cessation counsellor: should every hospital have one?

The study was performed in order to ascertain the sustained smoking cessation rate in hospital patients who received a structured programme of advice and support from a counsellor and to estimate the cost-effectiveness of such an intervention. Hospital in-patients out-patients were referred by their physician/surgeon to the smoking cessation counsellor who provided advice to reinforce that of the doctor and gave support by repeated follow-up sessions, weekly in the first month and thereafter at three, six and twelve months. Of 1,155 patients referred to the counsellor, 114 (13%) failed to keep the first appointment and 348 (30%) attended for advice on one occasion only. Among the latter, the self-reported sustained cessation rate at one year was 5%. In the 663 patients who participated in the programme the validated (expired air CO) 12-month, sustained cessation rate was 21%. Allowing 7.5% success rate among patients receiving a physician's advice only, the cost of each additional success achieved as a result of the programme is 851 Pounds and the cost per life year saved is between 340 Pounds and 426 Pounds. Assuming that after one year's abstinence relapse rates are relatively small, this represents a sound investment in the light of the cost of treating patients with smoking-related illnesses and compares favourably with other smoking cessation strategies and health care interventions.

Cost-Benefit Analysis↗

PubMed1998

Culturally sensitive validation of screening questionnaires for depression in older African-Caribbean people living in south London.

BACKGROUND: We tested the validity of two screens for depression in older African-Caribbean adults, the 15-item Geriatric Depression Scale (GDS) and a new Caribbean Culture-Specific Screen for emotional distress (CCSS). Two independent criteria were used for validity: (a) a psychiatric diagnosis derived from GMS-AGECAT, and (b) a culturally sensitive assessment of mental disorder, derived from a tool developed with local African-Caribbean religious healers. METHOD: One hundred and sixty-four consecutive African-Caribbean primary care users, aged 60 years or older, were screened with the GDS and the CCSS. Diagnostic interviews were carried out on 80% of high scorers and 20% of low scorers. RESULTS: The number of cases detected by the two separate diagnostic approaches was similar. However, the agreement between who was and who was not a case was only modest. At a cut-off of > or = 5, the GDS was an adequate case detector for psychiatric depression, and, at a cut-off of > or = 4, for 'depressed/lost spirit', as defined by culture-specific criteria. It performed as well as the new CCSS. CONCLUSIONS: At a cut-off of > or = 4 the 15-item GDS can be recommended as a case detector for significant forms of depression in older African-Caribbean people living in south London.

Aged↗

PubMed1998

Teaching the microscopic examination of urine sediment to second year medical students using the Urinalysis-Tutor computer program.

The microscopic examination of urine sediment is a common diagnostic tool taught to medical students, medical technologists, and others. The urine microscopic exam is difficult to teach because supervised instruction and textbook-based teaching suffer from numerous drawbacks. Here, we describe Urinalysis-Tutor, a computer program that uses digitized microscope images and computer-based teaching techniques to systematically teach the urine microscopic exam. In addition, we report the results of a 2-year study that evaluated the effectiveness of the program in 314 second year medical students who were required to use the program. The program contained two, 20-question exams. In the first year of the study (1996), one of the exams was chosen as the pretest and the other as the posttest; the pretest had to be completed before the students viewed the contents of the program, and the posttest was taken after finishing the tutorial. In 1997, the order of the two exams was reversed. In 1996, 159 students completed the study. The mean pretest score was 34% (SD, 14%), the mean posttest score was 71% (SD, 13%), and the improvement was significant (P <0.001, paired t-test). In 1997, 155 students participated. The mean pretest score was 41% (SD, 11%), the mean posttest score was 71% (SD, 13%), and the improvement was significant (P <0.001, paired t-test). The study shows that Urinalysis-Tutor helps medical students learn to interpret the microscopic appearance of urine sediment and that it is feasible to implement this tutorial in a medical school class.

Computer-Assisted Instruction↗

PubMed1998

Ultrastructural, cell culture and karyotype study of bone marrow in a patient with congenital dyserythropoietic anaemia (CDA)-type III presenting with recurrent still-births.

A 28 year old female patients presented with refractory anaemia since childhood and recurrent still-births at 28-30 weeks of gestation. One still-born child was hydropic at birth. Bone marrow showed characteristic morphological changes of congenital dyserythropoietic anaemia (CDA)-Type III. Electron microscopy showed disruption of the nuclear membrane, spongy appearance of nuclei, stacks of microtubules in intermediate normoblasts and myelin figures in erythroid cells. In vitro culture and karyotype data from the bone marrow of the patient is presented. Recurrent still-births in association with congenital dyserythropoietic anaemia has rarely been reported in the literature.

Adult↗

PubMed1998

Role of speech therapy and sign language prior to cochlear implantation.

The speech therapist should assess and develop the communication skills of the deaf child prior and after a cochlear implantation. The goals are first the acquisition of a useful communication system by the deaf child (for avoiding a cognitive stimulation lack) and parallely the acquisition of good oral language competencies. The different modes of communication useable in the profoundly deaf education are presented. Exclusive sign language use is not indicated in implanted children. It is well demonstrated that an exclusive oral communication is associated with an insufficient knowledge of the oral language. The total communication (combination of listening, speech reading, signing with or without finger spelling) is a defective communication mode with a bad representation of the morpho-syntactic and the phonologic aspects of the oral language. The best choice seems to be the simultaneously use of a spoken language and a manually coding of their phonological structures. The limits of this alternative are discussed.

Child↗

PubMed1997

The murine IgM secretory poly(A) site contains dual upstream and downstream elements which affect polyadenylation.

Regulation of polyadenylation efficiency at the secretory poly(A) site plays an essential role in gene expression at the immunoglobulin (IgM) locus. At this poly(A) site the consensus AAUAAA hexanucleotide sequence is embedded in an extended AU-rich region and there are two downstream GU-rich regions which are suboptimally placed. As these sequences are involved in formation of the polyadenylation pre-initiation complex, we examined their function in vivo and in vitro . We show that the upstream AU-rich region can function in the absence of the consensus hexanucleotide sequence both in vivo and in vitro and that both GU-rich regions are necessary for full polyadenylation activity in vivo and for formation of polyadenylation-specific complexes in vitro . Sequence comparisons reveal that: (i) the dual structure is distinct for the IgM secretory poly(A) site compared with other immunoglobulin isotype secretory poly(A) sites; (ii) the presence of an AU-rich region close to the consensus hexanucleotide is evolutionarily conserved for IgM secretory poly(A) sites. We propose that the dual structure of the IgM secretory poly(A) site provides a flexibility to accommodate changes in polyadenylation complex components during regulation of polyadenylation efficiency.

Alternative Splicing↗

PubMed1997

Report of the European DNA profiling group (EDNAP): an investigation of the complex STR loci D21S11 and HUMFIBRA (FGA).

This paper describes a collaborative exercise which was intended to demonstrate whether uniformity of DNA profiling results could be achieved between European laboratories using two complex short tandem repeat (STR) loci. The loci D21S11 and HUMFIBRA (FGA) were chosen because they are commonly used by different European laboratories. D21S11 has approximately 14 common alleles (f > 0.001), whereas HUMFIBRA has 19 common alleles. Laboratories were asked to test seven blood stains, one of which was a known control, and to report the results to the coordinating laboratory. The exercise demonstrated that complex STRs were amenable to standardisation.

Alleles↗

PubMed1997

Processing of vowels in supratemporal auditory cortex.

The auditory evoked neuromagnetic fields elicited by synthesized vowels of two different fundamental frequencies F0 were recorded in six subjects over the left and right temporal cortices using a 37-channel biomagnetometer. Single equivalent current dipole modeling of the fields elicited by all vowel types localized activity to a well-circumscribed area in supratemporal auditory cortex in both hemispheres. There were hemisphere asymmetries in the amplitude and latency of the M100 response. We also observed changes in M100 latency related to vowel type, but not to F0. There was no clear effect of vowel type or F0 on dipole localization for the M100, but a possible vowel type by latency interaction. These M100 data provide further evidence that vowels are processed independently of their pitch.

Adult↗

PubMed1997

Fibrinolysis, inhibitors of blood coagulation, and monocyte derived coagulant activity in acute malaria.

Different parameters of fibrinolytic systems like t-PA, PAI, D-dimer, and inhibitors of blood coagulation, i.e., protein C (PC), protein S(PS), and antithrombin III (AT-III), have been studied in cases of acute malaria due to Plasmodium falciparum and plasmodium vivax infection, and these patients were followed up. It was observed that the plasma PAI-1 was very high in cases of P. falciparum malaria infection as compared to normal controls and P. vivax infection. The changes in complicated cases of P. falciparum were remarkable as compared to uncomplicated ones. The PC, PS, and AT-III levels were also low in P. falciparum, particularly so in complicated cases, and were normal in P. vivax infection. The factor VIII R:Ag levels were invariably high in acute malaria. On follow-up of some of these cases the values came back to normal after the antiparasite treatment. The monocyte procoagulant activity was found to be significantly higher in P. falciparum infection as compared to that of P. vivax infection. All these findings therefore contribute towards the production of a hypercoagulable state in P. falciparum infection and partly explain the complications of P. falciparum infection like cerebral malaria.

Antithrombin III↗

PubMed1997

A qualitative study of breast cancer self-help groups.

This study reports on the experience of women in four community breast cancer self-help groups in Ontario, Canada. Semi-structured interviews were conducted with 24 women, asking them about benefits and limitations of their group involvement, and about their perspectives on group processes and structures. Overall, participants reported their group involvement to be extremely helpful for navigating the short and long-term impact of breast cancer. Emotional support benefits included connecting with other breast cancer survivors, feeling understood and sharing experiences, providing hope, and sharing healing laughter. Informational and practical support benefits included sharing of important information and learning how to get what you want. Even where there were concerns about limitations or tensions of group experience, these occurred against a backdrop of appreciation and commitment. From the discussion of group processes and structures, a number of issues were identified as problematic. Most notable were how to deal with deaths of group members and how to balance the group's primary purpose of providing mutual support with secondary goals of dealing with group business and engaging in meaningful advocacy.

Adaptation, Psychological↗

PubMed1997

Mechanisms of drug-induced lupus. III. Sex-specific differences in T cell homing may explain increased disease severity in female mice.

OBJECTIVE: To determine if sex-specific differences in lymphocyte trafficking could contribute to increased disease severity in female mice. METHODS: A lupus-like disease was induced by injecting male and female mice with procainamide-treated T cell clones. Trafficking was examined by labeling the injected cells with 51Cr or 5-chloromethylfluorescein diacetate. RESULTS: Females developed more autoimmune liver disease and greater titers of anti-DNA antibodies than did males, and 2-7 times more cells accumulated in the female spleens. Splenectomy prevented the development of autoantibodies and renal and liver disease. Oophorectomy decreased the splenic homing, autoantibody titer, and liver disease severity, to levels found in males. CONCLUSION: T cells traffic differently to the spleen in male and female mice, and the spleen appears to be essential in the disease process. This suggests that differences in T cell homing could contribute to sex-specific disease severity in this murine model, and also possibly in human disease.

Adoptive Transfer↗

PubMed1997

PDZ domains: targeting signalling molecules to sub-membranous sites.

PDZ (also called DHR or GLGF) domains are found in diverse membrane-associated proteins including members of the MAGUK family of guanylate kinase homologues, several protein phosphatases and kinases, neuronal nitric oxide synthase, and several dystrophin-associated proteins, collectively known as syntrophins. Many PDZ domain-containing proteins appear to be localised to highly specialised submembranous sites, suggesting their participation in cellular junction formation, receptor or channel clustering, and intracellular signalling events. PDZ domains of several MAGUKs interact with the C-terminal polypeptides of a subset of NMDA receptor subunits and/or with Shaker-type K+ channels. Other PDZ domains have been shown to bind similar ligands of other transmembrane receptors. Recently, the crystal structures of PDZ domains, with and without ligand, have been determined. These demonstrate the mode of ligand-binding and the structural bases for sequence conservation among diverse PDZ domains.

Amino Acid Sequence↗

PubMed1997

A biomechanical study of the flexor digitorum superficialis: effects of digital pulley excision and loss of the flexor digitorum profundus.

Many reports have been devoted to characterizing the significance of the pulleys for the flexor digitorum profundus (FDP). However, no comparable work has been published on the flexor digitorum superficialis (FDS). This study characterized the FDS in a human cadaver model. Eleven fresh-frozen cadaver hands were used. By using a tensiometer, data were gathered for tendon excursion, tendon load, and work of flexion. Changes in efficiency were caused by excision of annular pulleys A1, A2, A3, and the palmar aponeurotic pulley. We also measured the effect of FDP excision on FDS efficiency. Sectioning of the A2 and A3 pulleys together caused statistically significant losses of efficiency in all three parameters (work, load, and excursion). When the FDP was removed from a finger with an intact pulley system, losses in both work and excursion efficiencies were significant. Removing the FDP while cutting different pulleys caused significant decrease in FDS excursion efficiency. We conclude that A2 and A3 are the most important pulleys for maintaining normal FDS function, and that the presence of the FDP in the digital sheath is essential for optimal FDS excursion efficiency.

Biomechanical Phenomena↗

PubMed1997

Influences on the outcome of early treatment for Class II malocclusion.

In the first phase of a randomized clinical trial of early versus late Class II treatment, statistically significant differences were observed between the treatment and observation groups. However, there were wide variations in response. The change in jaw relationship (categorized as the annualized reduction in ANB angle) was favorable or highly favorable in 76% of the headgear, 83% of the functional appliance, and 31% of control (observation only) groups. The patient's initial skeletal severity, age/maturity at the outset of treatment, growth pattern, and cooperation with treatment were examined as possible influences on early growth modification treatment. Correlations between the annualized change in the ANB angle and any of the possible influences were close to zero and not statistically significant. We conclude that there is little to be gained from precisely timing early treatment to specific age/maturity markers and that a favorable reduction in Class II skeletal problems can occur for patients in a broad range of skeletal severity and growth patterns. Cooperation, measured as the number of hours of reported wear, or the clinical assessment of compliance, explained little of the variation in treatment response. The wide variation in growth seen in the untreated patients highlights the importance of well-controlled studies if clinicians are to improve their ability to select children with the greatest chances of a favorable treatment response.

Activator Appliances↗

PubMed1997

The effect of early intervention on skeletal pattern in Class II malocclusion: a randomized clinical trial.

Early treatment for Class II malocclusion is frequently undertaken with the objective of correcting skeletal disproportion by altering the growth pattern. Because the majority of previous studies of growth modification for Class II malocclusion have been based on retrospective record reviews, the efficacy of such an approach has not been well established. In this controlled clinical trial, patients in the mixed dentition with overjet > or = 7 mm were randomly assigned to either early treatment with headgear, or modified bionator, or to observation. All patients were observed for 15 months with no other appliances used during this phase of the trial. The three groups, who were equivalent initially, experienced statistically significant differences (p < 0.01) in skeletal change. There was considerable variation in the pattern of change within all three groups, with about 80% of the treated children responding favorably. Although patients in both early treatment groups had approximately the same reduction in Class II severity, as reflected by change in the ANB angle, the mechanism of this change was different. The headgear group showed restricted forward movement of the maxilla, and the functional appliance group showed a greater increase in mandibular length. The permanence of these skeletal changes and their impact on the subsequent treatment remains to be evaluated.

Analysis of Variance↗

PubMed1997

Changes in hospitalization associated with introducing the Resident Assessment Instrument.

OBJECTIVE: To compare the rates of hospitalization among cohorts of nursing home residents assembled before and after the implementation of the federally mandated Resident Assessment Instrument (RAI). SAMPLE: Subjects were nursing home residents chosen from 268 facilities in major Metropolitan Statistics Areas in 10 states and representing more than 1500 facilities and 60,000 residents. Two resident cohorts (1990 and 1993) were sampled (8 to 16 residents per facility, depending upon facility size) as part of an evaluation of the impact of implementing the RAI. METHODS: Research nurses reviewed records, interviewed staff, observed patients, and completed an RAI at baseline and 6 months later. All transitions during this interval (hospital admissions, nursing home transfers, returns home, death, etc.) were tracked. Using polytomous logistic regression, we tested the effect of cohort on the probability of being hospitalized in light of the competing risks of dying or remaining in the home, controlling for demographic and casemix variables, and having a DNR order in the chart. RESULTS: A total of 4196 residents were studied, 2118 in 1990 (age 81.3, female 77.7%, LOS 6+ months 49.8%) and 2078 in 1993 (age 81.7, females 75.5%, LOS 6+ months 50.2%). The unadjusted probability of hospitalization dropped from .205 to .151. Multivariate analyses revealed a significant adjusted odds of hospitalization of .74 (95% CI .60-.91) and no cohort effect on home discharge or death. Among severely cognitively impaired residents, the adjusted odds of hospitalization in 1993 compared with the 1990 cohort was 0.74 (.53-1.03). Finally, among survivors in both cohorts who had a follow-up MDS performed, and whose ADL remained stable, 15.9% were hospitalized in 1990, whereas only 10.9% were hospitalized in 1993. On the other hand, ADL decliners were more likely to have been hospitalized in 1993 than in 1990 (40.6% vs 25.2%). CONCLUSIONS: Although other changes in the industry, clinical practice, and health care policy may have influenced hospitalization of nursing home residents, the substantial reductions observed among the cognitively impaired and those with stable ADL suggest superior and uniform assessment information in the form of the RAI contributed significantly to this decline.

Activities of Daily Living↗