A solitary pulmonary nodule with zoonotic implications.
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Aged↗
Biomedical subjects
D Harrington
Publications and source records attributed to D Harrington.
Different response of patients with idiopathic and ischaemic dilated cardiomyopathy to exercise training.
We looked at the benefits and complications of a home-based exercise programme in patients with ischaemic and idiopathic dilated cardiomyopathy. Twenty-four patients with left ventricular end-diastolic dimension >6.5 cm and fractional shortening <25% entered a cross-over trial of 8 weeks training versus 8 weeks rest. Echocardiography, electrocardiogram and cardiopulmonary exercise testing were performed at baseline, after training and after detraining. Training resulted in a higher peak oxygen consumption (26.5 versus 21.3 ml/kg/min, P=0.004), a higher peak heart rate (161 versus 152 bpm, P=0.02) and improved well-being. Patients with idiopathic dilated cardiomyopathy showed a significant increase in exercise time (879 versus 828 s, P=0.03) and peak oxygen consumption (31.3 versus 24.3 ml/kg/min, P=0.02) and a decrease in left ventricular end-diastolic dimension (6.4 versus 6.9 cm, P=0.01) and end-systolic dimension (5.3 versus 5.8 cm, P=0.04) in contrast to those with coronary artery disease, who developed a reduction in septal excursion and shortening rate following training. Complications of training were more common in those patients with ischaemic cardiomyopathy, greater left ventricular dimensions, poorer exercise tolerance and greater ventilation drive at baseline, and included fluid retention and exercise-induced ventricular tachycardia. We found that this group of patients with a dilated, poorly functioning left ventricle can safely derive benefit from a home-based exercise programme, particularly those of idiopathic origin, but they should be closely monitored for the development of complications.
Adult↗
The effect of salbutamol on skeletal muscle in chronic heart failure.
We performed a randomised placebo-controlled trial to investigate the effects of the anabolic drug salbutamol on skeletal muscle and exercise capacity in chronic heart failure. Twelve patients received salbutamol slow-release 8 mg twice daily or placebo for 3 weeks. We assessed the effect of treatment on exercise capacity, quadriceps muscle bulk, maximal isometric strength and fatigue, respiratory muscle strength, spirometry and 24-h ECG (electrocardiogram). There was no significant change in the muscle indices, exercise time or peak oxygen consumption. The frequency of ventricular arrhythmias and spirometric measurements were also unchanged. Maximal expiratory mouth pressure, measured at total lung capacity and functional residual capacity, increased significantly (+29.7+/-10.6 vs. -0. 5+/-7.5 cm H(2)O [mean+/-S.E.M., change over 3 weeks treatment salbutamol vs. placebo] and +31.2+/-5.4 vs. +0.2+/-4.0 cm H(2)O both P<0.05). Maximal inspiratory pressures showed a trend towards increasing with treatment when measured from either lung volume (-22. 8+/-9.5 vs. -6.2+/-3.6 cm H(2)O, P=0.14 and -21.5+/-7.5 vs. -3.5+/-3. 4 cm H(2)O, P=0.054). Treatment with 3 weeks of salbutamol increases respiratory muscle strength in chronic heart failure but does not improve quadriceps abnormalities or exercise capacity. Salbutamol is unlikely to have a role in treating the muscle abnormalities in chronic heart failure.
Albuterol↗
Fathers and child neglect.
OBJECTIVE: To examine the association between father involvement and child neglect. DESIGN: Cohort study. SETTING: Participants were recruited from an inner-city pediatric primary care clinic and a clinic for children at risk for human immunodeficiency virus infection in a teaching hospital. PARTICIPANTS: Mothers and fathers or father figures, and 244 five-year olds participating in a longitudinal study. MAIN OUTCOME MEASURES: Child neglect measured via home observation, a videotaped mother-child interaction, and child protective services reports. RESULTS: A father or father figure was identified for 72% of the children. Rates of neglect ranged between 11% and 30%. Father absence alone was not associated with neglect. However, in families with an identified and interviewed father, a longer duration of involvement (P<.01), a greater sense of parenting efficacy (P<.01), more involvement with household tasks (P<.05), and less involvement with child care (P<.05) were associated with less neglect. The overall model explained 26.5% of the variance in neglect. CONCLUSIONS: There is substantial involvement of fathers in a subset of this high-risk sample, although more than a quarter of the children lacked a father or father figure. The mere presence of a father did not significantly influence the neglect of the children; rather, the nature of his involvement did. Fathers who felt more effective as parents were less likely to have neglected their children. A greater sense of efficacy may reflect parenting skills and be important in enhancing the contribution of fathers to their children's well-being. Pediatric health care providers can play a valuable role in enhancing the involvement and skills of fathers.
Child Abuse↗
Characterization of acid phosphatase activities in the equine pathogen Streptococcus equi.
Acid phosphatases hydrolyse phosphomonoesters at acidic pH in a variety of physiological contexts. The recently defined class C family of acid phosphatases includes the 32 kDa LppC lipoprotein of Streptococcus equisimilis. To define further the distribution of acid phosphatases in the genus Streptococcus we have examined the equine pathogens Streptococcus equi subsp. equi and Streptococcus equi subsp. zooepidemicus. Whole cell assays indicated that these organisms possess two acid phosphatases with activity optima at pH 5.0 and pH 6.0-6.5 and that only the former of these was, like LppC, resistant to EDTA. Western blotting with a polyclonal anti-LppC antiserum revealed the presence of a cross-reactive 32 kDa protein in both organisms. The cross-reactive protein in S. equi was shown to be a surface accessible lipoprotein as its processing was inhibited by the antibiotic globomycin and it was released from whole cells by treatment with trypsin. The presence of DNA sequences homologous to the S. equisimilis lppC gene were confirmed by PCR. These data strongly suggest that Streptococcus equi subsp. equi and Streptococcus equi subsp. zooepidemicus produce a lipoprotein acid phosphatase homologous to LppC of S. equisimilis.
Acid Phosphatase↗
Identification of methionine-processed HPr in the equine pathogen Streptococcus equi.
Using preparative electrophoresis, a low molecular weight protein has been partially purified from a cell extract of the equine pathogen Streptococcus equi susp. equi. N-terminal sequence analysis and Western blotting revealed the protein to be HPr, a central component of the phosphoenolpyruvate:sugar phosphotransferase system (PTS). Interestingly, the only form of the HPr protein detected in S. equi was one with the amino-terminal methionine removed, a modification that has previously been associated with surface localization of streptococcal HPr proteins.
Animals↗
Thermal inactivation of Listeria monocytogenes and Yersinia enterocolitica in minced beef under laboratory conditions and in sous-vide prepared minced and solid beef cooked in a commercial retort.
D-values were obtained for Listeria monocytogenes and Yersinia enterocolitica at 50, 55 and 60 degrees C in vacuum-packed minced beef samples heated in a laboratory water-bath. The experiment was repeated using vacutainers, which allowed heating of the beef to the desired temperature before inoculation. D-values of between 0.15 and 36.1 min were obtained for L. monocytogenes. Pre-heating the beef samples significantly affected (P < 0.05) the D60 value only. D-values for Y. enterocolitica ranged from 0.55 to 21.2 min and all the D-values were significantly different (P < 0.05) after pre-heating. In general, the D-values obtained for core inoculated solid beef samples were significantly higher (P < 0.05) than those generated in minced beef when heated in a Barriquand Steriflow commercial retort.
Animals↗
The relationship between hide cleanliness and bacterial numbers on beef carcasses at a commercial abattoir.
Cattle were visually inspected in the lairage of a commercial abattoir and assigned to a category ranging from 1 (very clean) to 5 (very dirty) depending on the observed cleanliness of the hide. Animals from categories 2, 3 and 5 were slaughtered and total viable counts (TVCs) enumerated at five sites (hock, brisket, cranial back, bung and inside round) on the subsequent carcasses. The TVCs at the hock were significantly higher on category 5 than on category 2 carcasses (P < 0.05). Similarly, TVCs at the brisket were significantly higher on categories 3 and 5 than on category 2 carcasses (P < 0.05). There were no differences in counts among the categories at any of the other sites. The TVCs averaged over the five carcass sites were higher for category 5 than for category 2 carcasses (P < 0.05). The TVCs at the brisket were significantly higher than all other sites (P < 0.01). In general, carcasses from category 2 animals slaughtered in a batch with dirtier animals (categories 3 and 5) did not have higher TVCs than carcasses of category 2 animals slaughtered at the beginning of the day in the absence of dirtier animals. The introduction of improved hygienic practices during the dehiding of category 4 animals resulted in reduced TVCs at the brisket (P < 0.001).
Abattoirs↗
beta -amyloid precursor protein positive axonal bulbs may form in non-head-injured patients.
Since the early 1980s axonal bulbs staining positively for beta-amyloid precursor protein (betaAPP) have been used as a marker of diffuse axonal injury (DAI), bulb formation been attributed to shearing forces generated during rotational acceleration/deceleration head injury. This study draws attention to the observation that they may form in the absence of a head injury and, thus, axonal injury cannot be assumed to result from mechanical injury alone. Out of 20 cases with no history of head injury studied, which only showed evidence of neuronal hypoxic change, 11 (55%) showed variable positive staining for betaAPP in a similar anatomical distribution to that previously described for DAI. The role of hypoxia in the formation of axonal bulbs, as well as the possible role of betaAPP as an acute phase protein, are discussed. These observations further clarify the pattern and relationship between neuronal and axonal staining observed following a brain insult and emphasize the possible role of betaAPP as a neuroprotective protein.
Journal Article↗
Anticoagulation for cardiac surgery in patients receiving preoperative heparin: use of the high-dose thrombin time.
UNLABELLED: Patients receiving heparin infusions have an attenuated activated clotting time (ACT) response to heparin given for cardiopulmonary bypass (CPB). We compared patients receiving preoperative heparin (Group H) to those not receiving heparin (REF group) with respect to ACT, high-dose thrombin time (HiTT), and markers of thrombin generation during CPB. Sixty-five consecutive patients (33 Group H, 32 REF group) undergoing elective CPB were evaluated. ACT and HiTT were measured at multiple time points. Plasma levels of thrombin-antithrombin III complex and fibrin monomer were determined at baseline, during CPB, and after protamine administration. Transfusion requirements and postoperative blood loss were measured and compared. ACT values after heparinization increased less in Group H and were significantly lower than those in the REF group (P < 0.01). HiTT values did not differ significantly between the two groups. Blood loss and transfusion requirements were not significantly different between the two groups. Plasma levels of thrombin-antithrombin III complexes and fibrin monomer also did not differ between groups at any time, despite a lower ACT in Group H after heparinization and during CPB. Our data suggest that thrombin formation and activity are not enhanced in patients receiving heparin therapy, despite a diminished ACT response to heparin. The utility of ACT and the threshold values indicative of adequate anticoagulation for CPB are relatively undefined in patients receiving preoperative heparin. HiTT should be investigated as a safe and accurate monitor of anticoagulation for CPB in patients receiving preoperative heparin therapy. IMPLICATIONS: The diminished activated clotting time response to heparin, in patients receiving preoperative heparin therapy, poses difficulties when attempting to provide adequate anticoagulation for cardiopulmonary bypass. Current data suggest that heparin resistance is not observed when high-dose thrombin time is used to monitor anticoagulation and that a lower activated clotting time value in these patients may be safe.
Anticoagulants↗
Re: The management of interim analyses in drug development by Karen M. Facey and John A. Lewis, Statistics in Medicine, 17, 1801-1809 (1998)
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Drug Approval↗
Quality management in Irish health care.
This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.
Attitude of Health Personnel↗
Recombinant human granulocyte colony-stimulating factor for treatment of puppies with neutropenia secondary to canine parvovirus infection.
OBJECTIVE: To determine the effect of treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) for puppies with neutropenia secondary to canine parvovirus infection. DESIGN: Randomized controlled clinical trial. ANIMALS: 23 puppies. PROCEDURE: Diagnosis was confirmed by use of an ELISA for detection of canine parvovirus antigen in feces, and all puppies received standard treatment for parvoviral enteritis. All puppies had neutropenia (< 1,000 neutrophils/microliter) at the time of admission to the hospital or within 4 days afterward. Eleven puppies were treated with rhG-CSF daily until neutrophil count was > 1,500 cells/microliter; the remaining 12 puppies were not treated with rhG-CSF. RESULTS: We did not detect any significant differences between groups regarding duration of hospitalization, neutrophil count when neutropenia was first detected, lowest neutrophil count, or time until neutrophil count was > 1,500 cells/microliter. CLINICAL IMPLICATIONS: Results suggest that treatment with rhG-CSF may not be beneficial in puppies with neutropenia secondary to canine parvovirus infection.
Animals↗
Distribution of 5-hydroxytryptamine-immunoreactive boutons on alpha-motoneurons in the lumbar spinal cord of adult cats.
Recent studies have shown that at least some of the functional effects of serotonin (5-HT) on motoneuron excitability are direct and are mediated via postsynaptic 5-HT receptors on motoneurons. To determine the spatial distribution of direct inputs from the serotonin system on the proximal and distal dendrites of individual motoneurons, we examined identified motoneurons in vivo with a combination of immunohistochemical localization of 5-HT-immunoreactive boutons and intracellular staining with horseradish peroxidase. Seventeen intracellularly stained motoneurons from 12 adult cats were analyzed with light microscopy. Quantitative analysis of 5-HT boutons apposed to dendrites of five representative motoneurons that were entirely reconstructed in three dimensions (each from the lumbosacral spinal cord of a different animal) revealed a total of 7,848 contacts (1,570+/-487 contacts/postsynaptic neuron; mean +/- SD) over the dendrites of these cells. Analysis of contacts on the soma of two of these cells, and on the somas of an additional 12 intracellularly stained motoneurons, revealed a wide range of somatic contacts (11-211 contacts/cell) on motoneuron cell bodies, with an average of 52 contacts/cell. These results indicate that the vast majority of 5-HT-immunoreactive boutons are apposed to dendritic branches rather than to the somatic surface of motoneurons. The spatial distribution of contacts essentially matched the distribution of surface membrane area of the postsynaptic neuron, resulting in a relatively uniform density of contacts (<1/100 microm2) on proximal and distal dendrites. Consequently, the frequency of contacts was higher on the proximal dendritic compartments where available membrane area is greater. There was no preferential distribution of contacts to particular dendrites. Light/electron microscopic correlations were performed on 21 boutons that contacted dendrites (n = 7) of three motoneurons from different animals. At the electron microscope level, most appositions (18/21; 85.7%) selected by our light microscopic criteria were confirmed as direct contacts when the 5-HT boutons were examined through serial sections. Synaptic junctions, generally small and symmetric, were positively identified in only a subset of these cases (n = 6; 28.6%), in part due to the obscuring effects of the peroxidase histochemical precipitate present in both pre- and postsynaptic profiles. A few 5-HT boutons (3/21; 14.3%) selected as contacts by our light microscopic criteria were in fact separated from the adjacent labeled dendrites; in two of these three cases, the separation was due to intrusion of very thin glial lamellae (<0.3 microm in cross section). These results indicate that the bulbospinal serotonergic system(s) provide a significant, direct synaptic input to spinal motoneurons that innervate hindlimb muscles. The nature of the modulatory actions exerted by such widespread synaptic inputs will affect all regions of the somatodendritic membrane and will ultimately depend on the nature of the 5-HT receptors present over different parts of the postsynaptic neuron's dendritic tree.
Animals↗
Effect of altering the daily herbage allowance to cows in mid lactation on the composition, ripening and functionality of low-moisture, part-skim Mozzarella cheese.
Milk was collected from three spring-calving herds, on different daily herbage allowances (DHA) of perennial rye-grass (16, 20 or 24 kg dry matter (DM)/cow for a 17 week period. On five occasions, at weekly intervals in the middle of the period, the three different milks were converted into low-moisture part-skim Mozzarella cheese. Increasing the DHA resulted in significant increases in the concentrations of protein in the cheesemilk (P < 0.05) and cheese whey (P < 0.02). The moisture-adjusted cheese yield increased significantly (P < 0.01) on raising the DHA from 16 to 24 kg grass DM/cow. DHA had no significant effects on any of the gross compositional values of the cheese (although moisture and fat-in-DM levels tended to decrease and increase respectively with increasing DHA). The hardness of the uncooked cheese and functionality of cooked cheese (i.e. melt time, flowability, stretch and viscosity) were not significantly influenced by DHA over the 115 d ripening period at 4 degrees C.
Animals↗
Child neglect: relation to child temperament and family context.
Relationships among neglect and child and family characteristics were examined in a sample of 121 urban, low-income families with a child under 30 months. Maternal reports of more difficult child temperament predicted emotional neglect; family context was indirectly related, as mothers in well functioning families with more support reported their children as being less difficult. Neither child temperament nor family context was related to physical neglect.
Adult↗
Mitochondrial DNA in idiopathic cardiomyopathy.
AIMS: To investigate the frequency of pathogenic mitochondrial DNA mutations in idiopathic cardiomyopathy. METHODS AND RESULTS: We investigated the occurrence of seven previously reported pathogenic mitochondrial DNA point mutations in 52 patients with idiopathic dilated cardiomyopathy (blood n=33, myocardium n=19), 10 patients with hypertrophic cardiomyopathy (blood n=7, myocardium n=3), 67 controls with ischaemic heart disease (blood n=53, myocardium n=14) and eight controls with no overt cardiac disease (blood n=4, myocardium n=4). Total DNA or cell lysates were studied by polymerase chain reaction amplification and restriction fragment length polymorphism analysis for the identification of the following mitochondrial DNA point mutations: A3243G, A3252G, A3260G, A4269G, A8344G, T8993G/C and T9997C. None of these point mutations were detected in the blood or myocardium of any of the individuals with dilated or hypertrophic cardiomyopathy or in the controls. In addition we investigated the occurrence of major deletions of mitochondrial DNA in eight patients with dilated cardiomyopathy (myocardium n=7, skeletal muscle n=1), three patients with ischaemic heart disease (myocardium n=3) and one control myocardium by Southern blot analysis. Deletions were not detected in any of the patients. CONCLUSION: The results suggest that although these mutations are known to be associated with specific cardiomyopathies, they are not a common feature of idiopathic cardiomyopathy.
Aged↗
Quantitative cardiac SPECT in three dimensions: validation by experimental phantom studies.
A mathematical framework for quantitative SPECT (single photon emission computed tomography) reconstruction of the heart is presented. An efficient simultaneous compensation approach to the reconstruction task is described. The implementation of the approach on a digital computer is delineated. The approach was validated by experimental data acquired from chest phantoms. The phantoms consisted of a cylindrical elliptical tank of Plexiglass, a cardiac insert made of Plexiglass, a spine insert of packed bone meal and lung inserts made of styrofoam beads alone. Water bags were added to simulate different body characteristics. Comparison between the quantitative reconstruction and the conventional FBP (filtered backprojection) method was performed. The FBP reconstruction had a poor quantitative accuracy and varied for different body configurations. Significant improvement in reconstruction accuracy by the quantitative approach was demonstrated with a moderate computing time on a currently available desktop computer. Furthermore, the quantitative reconstruction was robust for different body characteristics. Therefore, the quantitative approach has the potential for clinical use.
Body Composition↗