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Biomedical subjects

D McCrea

Publications and source records attributed to D McCrea.

At least 19 recordsLinked to original sources
PubMed2005

The "OBS" chart: an evidence based approach to re-design of the patient observation chart in a district general hospital setting.

OBJECTIVE: The primary role of the patient bedside observation chart is to make clinicians aware of the deteriorating patient. Despite this, its performance has not been scrutinised. Many versions exist with different styles of data entry but the optimal format remains elusive. This paper hypothesised that chart design measurably influences function and that redesign and standardisation would improve the detection of physiological decline by clinical staff. DESIGN: Objective evaluation of existing charts (n = 5), evidence based redesign, and re-evaluation of new chart. SETTING: 250 bed district general hospital. RESULTS: Design of existing observation charts had a significant effect on the ability of clinical staff to detect patient deterioration, with detection rates of parameters indicating physiological decline ranging from 0% to 100%. Graphical plots portrayed information better than written values for all parameters being measured except tachypnoea. No single existing chart was best for all variables. A new chart was designed, implemented with training in its use, and re-evaluated. The new chart also incorporated an early warning scoring system. There were significant improvements in the average detection rates of parameters poorly identified on existing charts: detection rates of tachypnoea and hypoxia increased by 41% (p<0.05) and 45% (p<0.05) respectively. There were also significant improvements in detection rates of tachycardia and fever by 29% (p<0.05) and 16% (p<0.05) respectively. CONCLUSION: Evidence based redesign of the patient bedside observation chart coupled with specific training in its use significantly improves the detection of patient physiological deterioration.

England↗
PubMed2005

Risk communication related to animal products derived from biotechnology.

Previous chapters of this review have dealt with the key considerations related to the application of biotechnology in veterinary science and animal production. This article explores the theory and practice of risk communication and sets out the basic principles for good risk communication when dealing with new technologies, uncertainty, and cautious and sceptical consumers. After failure to communicate with consumers and stakeholders about the risk to human health from bovine spongiform encephalopathy (BSE) in the 1990s, Government Agencies in the United Kingdom have made significant improvements in risk communication. The official inquiry that followed the BSE crisis concluded that a policy of openness was the correct approach, and this article emphasises the importance of consultation, consistency and transparency. There are, however, many different factors that affect public perception of risk (religious, political, social, cultural, etc.) and developing effective risk communication strategies must take all of these complex issues into consideration.

Animals↗
PubMed2003

Risk communication of the transmissible spongiform encephalopathies.

Previous chapters of this review have dealt with the scientific basis of assessing the risks from transmissible spongiform encephalopathies and how those risks should be managed. The author explores the theory and practice of risk communication and sets out the basic principles for good risk communication when dealing with uncertainty.

Animals↗
PubMed1994

The prevalence of depression in geriatric medical outpatients.

One hundred and fifty-nine patients attending a geriatric medical outpatient clinic were screened for depression using the geriatric depression scale (GDS) and brief assessment schedule depression cards (BASDEC). Twenty-two (13.8%) patients screened positive with one or other test, 13 (8.2%) being positive with both screening tests. There was a highly significant correlation between the two screening tests but the BASDEC instrument was quicker and easier to administer. Eighteen of 22 patients who screened as positive proved to have clinical depression. On subsequent re-testing of 17 of these patients 4-6 weeks later, eight were still positive, but nine patients were now negative and subjectively felt better. These findings suggest the possibility of a transient mood disturbance occurring in elderly patients akin to recurrent brief depression seen in younger subjects, and have implications for starting therapy in apparently depressed elderly people.

Aged↗
PubMed1990

Light microscopical study of dendrites and perikarya of interneurones mediating la reciprocal inhibition of cat lumbar alpha-motoneurones.

Interneurones which mediate disynaptic inhibition from la muscle spindle afferents of the quadriceps nerve to lumbar alpha-motoneurones were stained with intracellular injection of horseradish peroxidase. Seven best stained and most satisfactorily preserved cells were selected for analysis, and the light microscopic morphology of their cell bodies and dendrites were quantitatively investigated in parasagittal sections. The perikarya were located dorsal or dorso-medial to the motoneurones; they had mean diameters of 51 x 27 microns and a mean volume of 35,820 microns 3. The cells had 3 to 7 dendrites, which were arranged asymmetrically around the parent somata. The dendrites extended mainly in the dorso-ventral direction, in which the mean tip to tip distance for each cell was 1742 microns. The dendrites had few spines and they branched almost only in bifurcations. On the average, each process divided 3.5 times and in each cell they gave rise to 14.9 branching points as well as a total combined length of more than 7000 microns. Primary dendrites had a mean length of 193 microns which was generally shorter than the lengths of the branches of higher order. A more detailed analysis of two cells revealed the mean width of primary dendrites to be 5.6 microns while that of the 5th order processes was 1.5 microns. The mean tapering of individual dendritic branches per unit length was 17%, being somewhat more pronounced for the distally located segments, while at branching points the sum of daughter processes approximately equalled the diameter of the parent process.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1990

Activity of interneurons within the L4 spinal segment of the cat during brainstem-evoked fictive locomotion.

Extracellular recordings from interneurons located in the L4 spinal segment were made during fictive locomotion produced by electrical stimulation of the mesencephalic locomotor region (MLR) in the paralysed decerebrate cat. Only interneurons within the L4 segment which received group II input from quadriceps, sartorius or the pretibial flexor muscle afferents and which had axonal projections to motor nuclei in L7 were selected for analysis. During the fictive step cycle two thirds of these interneurons fired action potentials during the time of activity in the ipsilateral hindlimb flexor neurograms. These cells were also less responsive to peripheral input during the extension phase of the fictive locomotion cycle. The remaining one third of the interneurons examined were not rhythmically active during locomotion. The possible contributions of the midlumbar interneurons to motoneuron activity during locomotion are discussed.

Action Potentials↗
PubMed1989

Comparison of effects of monoamines on transmission in spinal pathways from group I and II muscle afferents in the cat.

The actions of noradrenaline (NA) and 5-hydroxytryptamine (5-HT; serotonin) were compared with those of L-3,4-dihydroxyphenylalanine methyl ester (Methyl-L-DOPA) on transmission to spinal interneurones in mid-lumbar (L4 and L5) segments of the cat spinal cord. The drugs were applied ionophoretically and their effects were tested on monosynaptic field potentials evoked by nerve impulses in hindlimb group I and group II muscle afferent fibres and on responses of interneurones with synaptic input from these fibres. Of field potentials recorded at various locations, both NA and 5-HT depressed those evoked from group II fibres in the intermediate and ventral horn regions of the spinal cord but not, or only occasionally, in the dorsal horn. Field potentials of group I origin were not depressed. The tested interneurones were located where group II field potentials were affected. NA, 5-HT and Methyl-L-DOPA depressed responses to electrical stimulation of group II fibres but not responses evoked by group I fibres. The depression consisted of an increase in the latency and a decrease in the number of action potentials evoked by the stimuli. All three drugs were also found to decrease the amplitude of intracellularly recorded monosynaptic EPSPs of group II origin but not of monosynaptic EPSPs evoked in the same neurones by group I fibres. Interneuronal firing induced by DL-homocysteic acid was depressed as effectively as responses to electrical stimulation of peripheral nerves. The possibility of presynaptic and/or postsynaptic mechanisms of the selective depression of synaptic actions of group II origin are discussed.

Action Potentials↗
PubMed1987

Morphometric quantification of atherosclerotic plaques by computer-assisted image-analysis of histographs.

A method is described for quantifying the amount of atherosclerotic plaque in collapsible blood vessels by a computer-assisted image analysis of cross-sectional contours traced under microscopic visualization. The digitized contours are processed using a computer program that transforms the irregular image of the collapsed vessel into an ideal geometry and then calculates in vivo linear and areal parameters, variables, and ratios. The analysis is based on conventional stereologic principles and utilizes relatively inexpensive and widely available equipment: microscope with drawing tube attachment, digitizing board, microcomputer, monitor, and printer or plotter. Some of the output data include the fraction of vessel lumen occluded by plaque, average thickness of plaque, the fraction of wall surface area covered by plaque, and the ratio of the vessel bore to vessel wall volumes. The error and precision of measuring lumen occlusion and plaque surface area are assessed.

Animals↗
PubMed1984

Synaptic connections from large muscle afferents to the motoneurons of various leg muscles in man.

Cross-correlations between stimuli delivered to peripheral nerves and the discharges of single, voluntarily activated, motor units can provide information about facilitatory and inhibitory projections to single spinal motoneurons in man. The projection frequency, under the given circumstances, of a facilitatory or inhibitory pathway can be obtained from the proportion of the sampled motor units of a given muscle showing the facilitatory or inhibitory effect. Deductions about the shape and relative amplitude of the underlying post-synaptic potentials can be made from the profile of the changes in firing probability. This technique has been used to explore the projections of low threshold muscle afferents to motoneurons of various leg muscles in man. Homonymous facilitation was demonstrated to all the sampled motor units of soleus (SOL), medial gastrocnemius (MG), tibialis anterior (TA) and vastus medialis (VM) and is presumed to represent the effects of the composite muscle spindle group Ia EPSP. Heteronymous facilitation was demonstrated between certain synergists. The projection frequency was less and the magnitude of the change in firing probability was smaller than for homonymous facilitation. SOL motoneurons, however, were not facilitated from low threshold afferents in the medial gastrocnemius nerve. Reciprocal inhibition was demonstrated between certain antagonists. The majority of the sampled motor units of SOL, however, were facilitated from low threshold afferents in the common peroneal nerve. The threshold for this facilitation was higher than for the homonymous facilitation elicited from this nerve and thus a different class of afferents and/or intercalated interneurons may be involved. There are projections across the knee joint in man. Motor units in vastus medialis (VM) were facilitated from low threshold afferents in the common peroneal nerve. It is likely that these reflex connections, which differ from those in other species, reflect the functional relationships between various lower limb muscles in man.

Adult↗
PubMed1984

Influence of stretch-evoked synaptic potentials on firing probability of cat spinal motoneurones.

Shapes of post-synaptic potentials (p.s.p.s) in cat motoneurones were compared with the time course of correlated changes in firing probability during repetitive firing. Excitatory and inhibitory post-synaptic potentials (e.p.s.p.s. and i.p.s.p.s) were evoked by brief triangular stretches of the triceps surae-plantaris muscles. Depolarizing current was injected through the recording micro-electrode to evoke repetitive firing and the post-stimulus time histogram of motoneurone spikes was obtained. E.p.s.p.s (n = 80) of different sizes (30-1040 microV) and rise times (1.1-8.2 ms) were investigated in fifty-nine motoneurones. The majority of the e.p.s.p.s were recorded in triceps surae-plantaris motoneurones with high levels of synaptic noise (estimated peak-to-peak fluctuations of 1.5-3.5 mV). This noise was generated by keeping the triceps surae-plantaris muscles stretched to a near maximal degree. The remaining e.p.s.p.s were recorded in motoneurones to other hind-limb muscles with a low level of synaptic noise. The height of the primary peak of the correlogram with respect to base-line firing rate increased in proportion to both amplitude and rising slope of the e.p.s.p.s. Using normalization procedures or using e.p.s.p.s of constant amplitude but different slopes and vice versa, the relative peak height increased with e.p.s.p. peak derivative with a slope of around 6/mV per millisecond and with e.p.s.p peak amplitude with a slope of about 1/mV. The shape of the correlogram (peak and trough) seemed well described by a linear combination of the shape of the e.p.s.p. derivative and that of the e.p.s.p. itself. The relative e.p.s.p. contribution (e.p.s.p.:e.p.s.p. derivative ratio) varied with e.p.s.p. amplitude and noise level, being largest (mostly 0.25-1.0) for small e.p.s.p.s (100-300 microV) in high levels of synaptic noise and smaller (0-0.25) for larger e.p.s.p.s and for e.p.s.p.s in a low noise background. In conformity with the above finding, a leaky integration of the correlograms gave time courses that in most cases closely resembled the shape of the e.p.s.p.s. The time constant of the leaky circuit (= inverse value of e.p.s.p.:e.p.s.p. derivative ratio) varied with e.p.s.p. amplitude and noise level in the same manner as obtained by direct fitting of e.p.s.p. and e.p.s.p. derivative shape to correlogram shape. Stretch-evoked i.p.s.p.s (n = 10) of small amplitude (90-360 microV as measured close to firing level) were investigated in pre-tibial flexor motoneurones with low levels of synaptic noise. These i.p.s.p.s generated correlogram troughs closely resembling, albeit somewhat wider than, the shape of the i.p.s.p. derivatives.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗
PubMed1983

Postnatal dendritic development in motoneurons: evaluation by a Monte Carlo technique.

A Monte Carlo method was used to quantitate the dendritic characteristics of horseradish peroxidase-injected lumbar motoneurons (MNs) from kittens 44 to 73 days old (during the postnatal interval when motor cortical input/output linkages mature) and compared with those from adults. All of the 6 MNs analyzed were within the same range of somal sizes (40-61 micron) and dendritic domain volumes. However, two-dimensional distributions of dendritic diameter versus distance from the soma revealed that in the youngest MNs' (44 and 51 days) most dendritic processes (82 and 84%) were less than 2 micron in diameter, and had no dendrites greater than 5 micron. The adult MNs had large dendrites (20 and 24% were greater than 5 mu), while the kittens of intermediate age (66 and 73 days) exhibited both adult-like (6 and 13% greater than 5 micron) and immature (48 and 73% less than 2 micron) characteristics. "Hit probabilities" calculated from the Monte Carlo data suggest that immature MNs' dendrites may present denser targets per unit volume for ingrowing growth cones than adult MNs, and may facilitate the probability of contact with appropriate afferent axons.

Animals↗
PubMed1981

Pattern of 'non-reciprocal' inhibition of motoneurones by impulses in group Ia muscle spindle afferents in the cat.

1. Inhibitory post-synaptic potentials (i.p.s.p.s) evoked by adequate stimulation of group Ia muscle spindle afferents of triceps surae and plantaris and by near-threshold electrical stimulation of quadriceps and hamstring nerves were recorded in a number of motoneurone species. The aim of the study was to compare the pattern of non-reciprocal Ia inhibitory actions on hind-limb motoneurones with the pattern of inhibition evoked from group Ib tendon organ afferents.2. In all the motoneurone species analysed in which i.p.s.p.s were evoked by electrical stimulation maximal for both group Ia and Ib afferents of triceps surae and plantaris, they were also evoked when these muscles were stretched and the amplitude of the stretch (10-35 mum) was below threshold for Ib afferents; 70-100% of motoneurones with Ib i.p.s.p.s showed stretch-evoked i.p.s.p.s. The stretch-evoked i.p.s.p.s appeared with latencies compatible with disynaptic and trisynaptic linkage. Since these latencies were too short to allow their mediation by group II afferents the i.p.s.p.s are attributed to a selective action of Ia afferents. The i.p.s.p.s did not appear after the nerves to triceps surae and plantaris had been cut.3. Electrical stimulation of quadriceps and hamstring nerves which was near threshold for Ia afferents and well below threshold for either the Ib component of the incoming volley or group II afferents, similarly evoked non-reciprocal i.p.s.p.s. They were found in those motoneurones in which inhibition was evoked by stimulation maximal for group I afferents. Such Ia i.p.s.p.s were evoked both in homonymous motoneurones and in motoneurones of four other hind-limb muscles. Their latencies corresponded to di- and trisynaptic coupling.4. In some motoneurones of the pretibial flexors (anterior tibial, extensor digitorum longus and peroneus longus), disynaptic i.p.s.p.s evoked from triceps surae and/or plantaris which were depressed by a conditioning ventral root stimulation (i.e. Ia reciprocal i.p.s.p.s) were followed by trisynaptic i.p.s.p.s which were not depressed in this way (Ia ;non-reciprocal' i.p.s.p.s). It thus appears that the same motoneurones may be inhibited by impulses in group Ia afferents via different spinal pathways.5. The study leads to the conclusion that the non-reciprocal inhibition from group Ia muscle spindle afferents operates in parallel with the inhibition from group Ib tendon organ afferents in all motoneurone species tested.

Animals↗
PubMed1981

Oligosynaptic excitation of motoneurones by impulses in group Ia muscle spindle afferents in the cat.

1. Intracellular recording from hind-limb motoneurones was used to investigate whether di- and trisynaptic (oligosynaptic) excitatory post-synaptic potentials (e.p.s.p.s) are evoked from group Ia muscle spindle afferents in those motoneurones in which such potentials are evoked from Ib tendon organ afferents or entire group I afferents. Ia afferents of triceps surae and plantaris were activated either selectively by single brief stretches of these muscles, or together with Ib afferents by electrical stimuli applied to the nerves.2. Muscle stretches below threshold for Ib afferents (10-35 mum) evoked e.p.s.p.s which appeared with latencies compatible with disynaptic and trisynaptic coupling between the afferents and the motoneurones. The latencies of a majority of these e.p.s.p.s were too short to allow their mediation by group II afferents, if any were activated by the applied stretches. They were also too short to be compatible with effects attributable to dorsal root reflexes. These e.p.s.p.s are thus attributed to oligosynaptic actions of Ia afferents.3. Stretch-evoked di- and trisynaptic Ia e.p.s.p.s were found in 83% of motoneurones in which e.p.s.p.s were evoked by stimuli which activated both Ia and Ib afferents; in five motoneurone species they were found in more than 90%. These observations lead to the conclusion that group Ia muscle spindle afferents evoke not only inhibitory but also excitatory actions in parallel with group Ib tendon organ afferents.4. The distribution of Ia oligosynaptic stretch-evoked excitation from ankle and toe extensor muscles was compared with the distribution of Ia non-reciprocal inhibition as described by Jankowska, McCrea & Mackel (1981b). Excitation pre-dominated in posterior biceps-semitendinosus motoneurones and inhibition in other species of motoneurones investigated, except those of intrinsic foot muscles (tibial motoneurones); similar proportions of the latter showed excitation and inhibition.5. Occurrence of oligosynaptic e.p.s.p.s as well as inhibitory post-synaptic potentials (i.p.s.p.s) of Ia origin in some motoneurone species, and in particular in individual motoneurones, is indicative of a number of reflex pathways between group I afferents and these motoneurones. Furthermore, the disappearance of some of the e.p.s.p.s evoked by near-threshold electrical stimulation following stronger stimuli indicates interactions between various functional groups of interneurones mediating group I actions.

Animals↗