Biomedical subjects
D Simpson
Publications and source records attributed to D Simpson.
Liggett comes clean.
Explore the source record for details and available documents.
USA: tobacco is a drug--official.
Explore the source record for details and available documents.
Comparison of polyclonal and monoclonal assays for routine screening of urines for amphetamines.
Explore the source record for details and available documents.
Preoperative facial nerve studies predict paresis following cerebellopontine angle surgery.
Facial paresis or paralysis following resection of cerebellopontine angle tumors can occur despite intraoperative cranial nerve monitoring. In an attempt to identify preoperatively those patients at greatest risk for postoperative facial nerve dysfunction, we have prospectively evaluated 30 patients with clinically normal facial function using preoperative facial nerve conduction, electromyography, and the blink reflex. Surgical approach, tumor size, tumor histology, and postoperative facial nerve function were correlated with the preoperative electrophysiologic data to determine the utility of preoperative facial nerve tests as predictors of postoperative facial nerve function. Nineteen patients (Group 1) had normal preoperative facial nerve studies, while 11 patients (Group 2) had abnormal results. Fourteen patients in Group 1 were Grade I immediately after surgery, and five were Grade II. All 19 patients were Grade 1 at 6 months. The 11 patients in Group 2 had immediate postoperative facial nerve function graded as follows: I, three patients; II, five patients; III, one patient; VI, two patients. After 6 months, facial nerve function was graded as follows: I, six patients; II, two patients; III, one patient; VI, two patients. The blink reflex was the single most accurate predictor of facial nerve involvement preoperatively.
Psychological problems and client engagement in methadone treatment.
Client attendance at individual counseling sessions in community-based methadone treatment programs was more frequent among clients with self-reported psychological problems at intake. These problems included anxiety, depression, suicidal ideation, and other symptoms suggesting psychopathology (hallucinations, difficulty controlling violence, etc.). The sample consisted of 462 clients in treatment at least 90 days, divided into two groups of no psychological problems reported at intake (no problems group, N = 341) and two or more problems reported (high problems group, N = 121). The high problems group was twice as likely to attend the treatment program's recommended minimum number of individual counseling sessions (two per month) than was the no problems group, and was more likely to discuss psychological issues in their individual counseling sessions. The high problems group showed significant decreases in drug use and illegal activity in the first 3 months after admission and did not differ significantly from the no problems group on drug-positive urines or illicit activity at month 3. Within the high problems group, clients who attended at least two individual sessions per month reported less cocaine and speedball use during treatment than those who attended fewer sessions.
Screening for drugs of abuse. I: Opiates, amphetamines and cocaine.
(1) In order to provide an efficient and reliable service for drugs of abuse screening in urine, the laboratory should analyse 20-30 samples per week, and the staff should include a scientist with special expertise in the subject. (2) Turnaround times should be between 2-3 days of sample collection. To achieve this aim it may be necessary to make special arrangements for the delivery of samples to the laboratory. Results should preferably be transmitted by electronic mail or facsimile with the necessary precautions for security and confidentiality: hardcopy reports may also be required. (3) Good communications between the requesting clinician and the laboratory are essential. An advisory service should be provided by the laboratory and clinicians should be encouraged to discuss requests and results with laboratory staff. It is important that the laboratory inform doctors of the range of substances detected and the sensitivity and specificity of laboratory assays. (4) Assays should be performed according to the manufacturer's protocols, or by modified methods that have been rigorously validated. Quality control samples should be included in each analytical run and participation in an external quality assessment scheme, e.g. UKNEQAS, is essential to provide independent confirmation and confidence that results compare with those from other laboratories. Other requirements include adequate training and supervision of staff, and careful recording of samples and results. (5) Drugs to be tested will depend on the drug 'scene' in the area but should include those drugs regularly prescribed for maintenance therapy (e.g. methadone, dihydrocodeine, benzodiazepines), and drugs frequently misused (e.g. heroin, buprenorphine, amphetamines, cocaine). (6) Positive results obtained by preliminary screening methods e.g. EMIT, should be confirmed by another analytical technique, e.g. TLC, GC or GC-MS. If there are potentially serious or legal implications, and in employment and preemployment testing, confirmation of positive results is mandatory. In some cases, e.g. checking for methadone or benzodiazepine compliance, it may be considered unnecessary to confirm positive results although possible spiking of samples cannot be excluded without checking for the presence of metabolites by a chromatographic procedure.
Use of drugs at 'raves'.
Widespread use of drugs at the currently popular 'raves' has caused concern principally because of an increasing number of cases of serious toxicity and even death. The availability and use of drugs at raves, mainly in the Edinburgh area, have been investigated and self-reported use of drugs compared with results of urine screening. Use of Ecstasy and LSD have been confirmed and there is evidence to support the use of Khat. A new preparation, Herbal Ecstasy, is readily available at Edinburgh raves and appears to be widely used. All urines tested positive for one or more drugs or drug metabolites and in general analytical results correlated well with self-reported use of drugs.
Treatment of myasthenia gravis by immunoadsorption of plasma.
We treated 16 patients with moderately severe to severe generalized myasthenia gravis (MG) by immunoadsorption (perfusion through a resin that adsorbs proteins) of 2,500 ml plasma on each of four alternate days. Fourteen patients who completed treatment all had significant improvement in strength (6 excellent, 6 good, and 2 fair), which began a mean of 42 hours after the first immunoadsorption, reached a maximum 4 days after the fourth immunoadsorption (mean, 250% of baseline strength), and returned to baseline over a mean of 2 months. Thirty-seven grams of plasma proteins were removed during each immunoadsorption, which required no replacement, compared with 175 grams during plasma exchange, which requires replacement with albumin. Serum or plasma concentration of all proteins fell, more so for most of the larger proteins than for the smaller ones: acetylcholine receptor antibody (AChR Ab) fell to a mean of 23% of original level, fibrinogen to 26%, C4 to 29%, IgM to 33%, IgG to 35%, CH50 to 41%, C3 to 42%, IgA to 54%, and albumin to 76%. All proteins, including AChR Ab, returned to their original levels within 1 to 3 weeks after the last immunoadsorption, while improvement in strength lasted a mean of 6 weeks longer. One seronegative patient had excellent improvement lasting more than a month. Activated complement C5a and white blood cell count rose during each immunoadsorption, while activated complement C3a fell, and each returned to its original level within hours. Eight patients had transient symptomatic hypotension attributable to withdrawal of blood more rapidly than it was returned; this hypotension was prevented or ameliorated by intravenous saline.(ABSTRACT TRUNCATED AT 250 WORDS)
All Africa conference on tobacco control.
Although the health hazards of smoking are now generally accepted in most Western countries, the arguments have not had much impact on poorer nations. A conference on tobacco control held in Harare, Zimbabwe, in November last year was the largest to tackle this problem. The conference heard how threats of epidemics of tobacco related disease in the distant future held little weight with governments of countries that often already had massive public health problems. More immediate effects needed to be emphasised. Speakers gave three cogent arguments; firstly, the loss of capacity for foreign trade in essential goods, since most African countries are net importers of tobacco; secondly, the extensive deforestation which is occurring to fuel the flue curing of tobacco; thirdly, evidence from Papua New Guinea that raising taxation on tobacco provides governments with increased income for many years before a decrease begins.
Identification of factors that influence the menu at child care centers: a grounded theory approach.
OBJECTIVE: This study was conducted to identify factors that influence what is on the menu at child care centers. DESIGN: Quantitative and qualitative data on menus, food preparation, and foodservice were collected during site visits to child care centers. Grounded theory methods were used to develop an explanation of child care menu planning that is "grounded" in data. SAMPLE AND SETTING: Three child care centers were selected in each of three communities representing different ethnic cultures in Texas. MAIN OUTCOME MEASURE: Quality of child care menus, as measured by nutrient content and variety and amount of food served, constituted the core category or main phenomenon. ANALYSES: Open and axial coding of the qualitative data were performed to identify significant themes and concepts and to explore their interrelationships in order to produce an explanation of the quality of child care menus. RESULTS: The patterns of strengths and weaknesses in the menus were similar in all three ethnic/geographic regions that were visited and were similar to findings in other states. The factors that have the most direct influence on the menus are food program requirements, staff perceptions of children's food preferences, history of the food program at the center, and cost. APPLICATIONS/CONCLUSIONS: The data and theory support three broad conclusions: (a) child care menus need to be improved; (b) training for child care staff needs to be sensitive to the missions and cultures of different kinds of child care centers; and (c) because lack of staff knowledge has only an indirect influence on the menus, changes in program requirements and strategies for assisting and monitoring food programs in child care centers may also be needed.
The barley 60 kDa jasmonate-induced protein (JIP60) is a novel ribosome-inactivating protein.
The N-terminal region of a 60 kDa, jasmonate-induced protein of barley leaves (JIP60) is shown to be homologous to the catalytic domains of plant ribosome-inactivating proteins (RIP). Western blotting of leaf extracts and in vitro reconstitution experiments indicate that JIP60 is synthesized as a precursor which is processed in vivo. This is in keeping with in vitro translation experiments indicating that a deletion derivative of the N-terminal region, but not the putative precursor, strongly inhibits protein synthesis on reticulocyte ribosomes. The inhibition of ribosome function is associated with depurination of 26S rRNA, characteristic of plant RIPs. This indicates that JIP60 is a novel ribosome-inactivating protein requiring at least two processing events for full activation. JIP60 derivatives do not significantly inhibit in vitro protein synthesis on wheat germ ribosomes. These and other results suggest that JIP60 may be involved in plant defence.
Neurotrauma without neurosurgeons?
Explore the source record for details and available documents.
Health workforce planning: an analysis of employer demand pertaining to the Victorian medical record administration & diagnostic coding workforces.
In 1990, LaTrobe University introduced the world's first Post-Graduate Diploma in Nosology, in response to unmet demand for diagnostic coders in Victoria. After the first graduates entered employment, a two-part study was undertaken. The composition, employment levels and projected institutional demand for the coding workforce (comprising medical record administrator coders, Nosologists and "unqualified" coders) were ascertained. In parallel, the current employment levels and projected demand for the institutional medical record administrator workforce also were investigated. The institutional variables of major health care role, annual inpatient discharges and operating sector were found to impact upon employment levels and demand for both workforces by current, prospective and non-employers. The study identified a minimal projected demand for nosologists, the reasons for which are postulated, and negligible projected demand for nonqualified coding personnel. The results highlight a health current and projected employer demand for both medical record administrators and medical record administrator coders.
When communities are in crisis: planning for response to suicides and suicide attempts among American Indian tribes.
Explore the source record for details and available documents.
Influence of sleep deprivation on learning among surgical house staff and medical students.
BACKGROUND: Sleep deprivation as a result of in-house night call may alter capacity to learn. Surgical residents and medical students, in both sleep-deprived and rested states, read surgical journal articles and later answered questions regarding their content as a measure of ability to learn while participating in scheduled night call. METHODS: Medical students (n = 35) and residents (n = 21) rotating on surgical services kept logs of hours slept during a 4-week study period. Subjects read six selected articles at separate early morning sittings during weeks 1 and 3. A multiple choice test was given 1 week after each session to assess short-term recall, and all tests were given again 3 months later to assess retention of information over the longer term. Scores were compared with the sleep data. Subjective measures of fatigue and motivation elicited from subjects also were evaluated. RESULTS: Sleep deprivation (4 hours or less uninterrupted sleep per night) resulted in increased fatigue and decreased motivation among medical students and residents (p < 0.05, t test). Objective scores on tests administered 1 week and 3 months after reading did not show an effect attributable to sleep deprivation (p > 0.05, t test). CONCLUSIONS: Sleep deprivation leads to subjective feelings of increased fatigue and decreased motivation. Residents and medical students, however, whether sleep deprived or not, obtain comparable scores on objective tests measuring both short-term and long-term retention of newly learned material. The ability to learn medically relevant information does not appear to be significantly altered by the degree of sleep deprivation associated with clinical rotations on surgical services.
Major incident planning.
Explore the source record for details and available documents.
Protocols for vegetative patients.
Explore the source record for details and available documents.