Biomedical subjects
Publications and source records attributed to D Greaves.
Two patients with underlying neuromuscular disorders developed varying degrees of paralysis after a single dose of cyclizine, one necessitating full mechanical ventilation. These cases appear to be unique in the literature and represent an increasing spectrum of adverse reactions seen with the greater use of cyclizine.
OBJECTIVE: To investigate the occurrence of geometrical asymmetries in the macro-architecture of left and right femurs from Thoroughbred racehorses previously used in competitive training and racing in New South Wales, Australia. METHODS: Detailed postmortem measurements were made of 37 characteristics of left and right femurs from eleven Thoroughbred racehorses euthanased for reasons unrelated to the study. Measurements focused on articulating surfaces and sites of attachment of muscles and ligaments known to be associated with hindlimb locomotion. RESULTS: Five measurements were significantly larger in left compared to right femurs (P < 0.05). The regions showing significant differences between left and right limbs were proximal cranial and overhead medio-lateral widths, greater trochanter depth, depth of the fovea in the femoral head and distal inter-epicondylar width. CONCLUSION: The left-right differences in femoral morphology were associated with sites of muscle and ligament attachment known to be involved with hindlimb function in negotiating turns. These differences may be the result of selection pressure for racing performance on curved race tracks and/or adaptations related to asymmetrical loading of the outside hindlimb associated with repeated negotiation of turns on such tracks.
BACKGROUND: To develop design criteria for consumer products, based on foreign body injury and fatality data, to prevent airway obstruction injuries to children. METHOD: Beginning in 1988, RAM Consulting has created a worldwide database of foreign body injuries. This ongoing project now includes approximately 7000 data points from 51 children's hospitals in 15 countries located on five continents. Statistical analysis of these data, especially in terms of size, shape and consistency of the object and obstruction location and severity of injury for the patient has allowed the creation of an injury prevention criterion. RESULTS: Analysis of these data reveals that adoption of an injury prevention criteria based on the use of a 1.50 in. (38.10 mm) diameter gauge for non-spherical objects and a 1.75 in. (44.50 mm) diameter gauge for spherical objects would greatly reduce airway obstruction injuries to children. Furthermore, the data show that this criterion is independent of country and culture. However, the data suggest that a child's exposure to the "mix" of objects that may cause airway obstruction varies with the country and culture of the child. For example, coins are well represented in the database, however, some countries make more coins than other countries and the exposure level may have made the difference in the occurrence of incidents. CONCLUSIONS: Airway obstruction injuries from consumer products could be greatly decreased by the adoption of the presented injury prevention criteria that is founded in a statistical analysis of known objects that have caused injury. This criteria is dependent on object characteristics and is independent of the country or culture of the child.
Since the nineteenth century the theory and practice of mainstream Western medicine has been grounded in the biomedical model. In the later years of the twentieth century, however, it has faced a range of serious problems, which when viewed collectively, remain unresolved despite a variety of responses. The question we now face is whether these problems can be dealt with by modifying and extending the principles underlying the biomedical model, or whether a more radical solution is required. Recent critiques of Western medicine have focused mainly on the biopsychosocial model in relation to the former approach, but it will be contended that this cannot deal adequately with the challenges that medicine currently faces, because although it addresses both the scientific and humanistic aspects of medicine it fails to harmonise them. I shall therefore argue for the necessity of a more radical approach, and suggest that what is required to accomplish this is the development of a new medical cosmology, rooted in an older and more global framework. Such a fundamental change would inevitably involve a long term process which it is not yet possible to fully comprehend let alone specify in detail. Some of the necessary features of such a new medical cosmology can, however, already be distinguished and the outline of these is described.
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The UK's first taught master's degree in medical humanities involves a field of inquiry that is frequently philosophical, pursuing interests and questions traditionally arising in medical philosophy and ethics, but on a larger interdisciplinary canvas, drawing upon literature and the visual arts, sociology and anthropology, social history and politics, and theological and religious perspectives.
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There has been a modern epidemic of heart attacks in the western world, and this paper is concerned with this 'new' medical condition and how it arose. Two competing theories are commonly proposed, relating either to conventional accounts of medical science, or to social construction. Whilst recognising that aspects of both theories have some validity, it is claimed that neither is wholly adequate. This issue has particular relevance for heart attacks and is explored in some detail, but it also points to some more general conclusions. First that medical knowledge cannot be separated into 'scientific' and 'social' compartments but is united by its human aspect; and second that although medical knowledge has a special dimension, when understood in this way, it may also resonate with a more general re-examination of the relationship between scientific and human knowledge.
We describe a quasi-experimental trial of time-limited family therapy with veterans and families of veterans who served in Europe, outside the war zone, during Operation Desert Storm (ODS). Family systems therapy was provided both to individuals and conjointly to couples or families during the acute postwar readjustment period. The intervention adapted strategies from structural, strategic, intergenerational, and behavioral family therapies in a brief-treatment protocol for systemic stressor resolution. Veterans given family system therapy were able to resume functional levels of psychosocial adjustment and reduce the risk of long-term (chronic or delayed) psychosocial impairment. Based on these preliminary findings, controlled evaluation of family systems therapy appears warranted for individuals and families exposed to subtraumatic stressors such as wartime non-war-zone military deployment.
Time-limited psychotherapy conducted 2 to 9 months after demobilization was evaluated with Persian Gulf Theater veterans of Operation Desert Storm (ODS). Thirty five treatment-seeking veterans were contrasted with 20 non-treatment-seeking ODS Persian Gulf veterans in a repeated measures design at pretest, posttest, and 6-week followup assessments. In addition, psychotherapy participants at followup were contrasted with 80 non-treatment-seeking ODS Persian Gulf veterans from the same military units who were assessed one time at a comparable time point. Time-limited psychotherapy was associated with sustained improved psychosocial functioning and reduced levels of psychiatric and stress-related symptomatology.
During the past thirty years a high proportion of all long stay hospital beds have been closed. The responsibility for those who would have occupied those beds previously has to a large extent been transferred from health to social services departments, or to family, voluntary and private care. The overall effect has been to prioritize acute medical care, and to expose the public provision and funding of long term residential care, whether medical or social, to the direct determination of political and economic forces. These policy changes have been introduced under the banner of community care, but are dependent on complex concepts which are morally contentious and often obscure. The purpose of this paper is to analyse these processes as a prerequisite to devising better policies in future.
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Macrophage molecules involved in adhesion, signalling, secretion and interactions with pathogens and T-helper lymphocytes have been cloned and defined using monoclonal antibodies and genetic disruption. Studies of the regulation of macrophage differentiation and activation by cytokines have yielded insights into the heterogeneity of their functions in natural and acquired immunity, including immunity to infections by mycobacteria and HIV.
The preimplantation diagnosis of a HbSA-globin transgene in biopsied trophectoderm cells and blastomeres in embryos using a transgenic mouse model for the trait of human sickle-cell anaemia has been undertaken. A sensitive procedure was developed for the amplification of the human beta-globin gene sequence flanking the sickle mutation. Polymerase chain reaction (PCR) assays were undertaken on one to five biopsied trophectoderm cells and isolated blastomeres of the preimplantation mouse embryo. After biopsy the blastocysts were cultured whilst the cells were analysed for the presence of the transgene, and a high proportion (82-91%) were viable as assessed by the presence of a blastocoele cavity within a 5-h period. The majority of the biopsied cultured blastocysts were frozen and used to confirm the diagnosis; 90 biopsied cultured blastocysts were transferred to pseudopregnant recipients and 34% established pregnancy. Material from day 13.5 post-coitum fetuses was also used to confirm the original diagnosis. The time (4-5 h) required to carry out the analysis obviates a need for extended culture or cryopreservation of the biopsied embryo. In individual experiments under optimal conditions, the presence of the transgene in biopsied cells was detected with 100% accuracy, and the PCR analysis was sensitive at the 1-cell level. The overall success rate of diagnosis and confirmation of the presence or absence of the human beta-globin sequence in the biopsied embryo was 70%. Over the entire experimental period (14 months) DNA contamination from a variety of sources did occasionally occur; the methods used to overcome this problem are discussed.