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D Wight

Publications and source records attributed to D Wight.

34 records · Page 2Linked to original sources
PubMed1993

Measuring the quality of care in psychogeriatric wards.

This paper discusses the way in which quality of care has been measured and in particular draws attention to the vagueness of concepts such as autonomy, individuality and dignity. In our research we have put forward a number of indicators for the quality of care received by patients and, in addition, we have constructed a method by which they can be measured, through the use of standardized observation schedules. This paper therefore describes our indicators and the data collection process followed. This aspect of our work is part of a larger study into work satisfaction and quality of care in psychogeriatric wards in Scotland. Ultimately, the data will allow us to identify factors affecting high and low levels of job satisfaction as well as factors influencing good and bad quality of care. Further, we will be able to examine any association between work satisfaction and the quality of care delivered to patients. The results of this research are due to be published shortly.

Activities of Daily Living↗
PubMed1993

A re-assessment of health education on HIV/AIDS for young heterosexuals.

Despite a fairly high level of public knowledge about HIV there has, apparently, been little behavioural response to the disease by heterosexuals. Condoms are still used by young people primarily for contraceptive purposes. There are serious cultural and structural factors that impede the practice of safer sex, and for most young people HIV has little salience. They associate the disease with socially distant, stigmatized groups and do not feel personally vulnerable. Increase evidence suggests that the risk of HIV infection in Britain to non-injecting heterosexuals in most geographical areas is currently very low, which undermines appeals to individuals' perceived vulnerability. An alternative approach to HIV/AIDS education would be to promote safer sex practices indirectly, by addressing other preexisting sexual concerns of young people, in particular the prevention of unwanted pregnancy. This might be achieved through a comprehensive sex education programme involving small group work to actively learn communication and negotiation skills and to empower young women. However, such an approach would need to be carefully evaluated.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Influence of human leukocyte antigen matching on liver allograft survival and rejection: "the dualistic effect".

To date only one published large series of human leukocyte antigen matching and liver allograft survival exists, and considerable confusion has arisen about the advantage or disadvantage of human leukocyte antigen matching. In the present study we have reinvestigated the relationship between human leukocyte antigen mismatch and graft survival in 466 first liver allografts, seeking to clarify the relationship between human leukocyte antigen and both acute rejection and the vanishing bile duct syndrome. In view of current criticism regarding the accuracy of serological tissue typing for human leukocyte antigen-DR, we have used both classic serology and restriction fragment length polymorphism analysis to ensure the accurate assignment of recipient DR types. In addition, we have used polymerase chain reaction amplification and allele-specific and sequence-specific oligonucleotide probes to retest the hypothesis that human leukocyte antigen class II matching may increase susceptibility to the vanishing bile duct syndrome. One-year graft survival was significantly lower in patients with zero or two human leukocyte antigen-A mismatches (52% and 63%, respectively) than in those with one human leukocyte antigen--A mismatch (69%) (p = 0.016 and p = 0.018). A similar effect of B mismatching was observed, with a 1-yr graft survival of 73% for those with one compared with 60% for those with two human leukocyte antigen-B mismatches. In contrast no correlation was found between DR mismatch and graft survival. Human leukocyte antigen class I matching appears to influence graft survival largely through the occurrence of acute rejection and the development of the vanishing bile duct syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Graft Rejection↗
PubMed1992

Impediments to safer heterosexual sex: a review of research with young people.

This article reviews the existing British literature on the micro-social details of young people's heterosexual encounters, emphasizing the cultural factors which impede the adoption of health education advice. Most of the findings cited come from qualitative projects that relied primarily on detailed interviews or group discussions. Six issues are highlighted: difficulties in talking about sex; the gender-role expectations brought to an encounter; the primary function of condoms as contraceptives; problems in buying, carrying and using condoms; how the stage of a particular relationship affects behaviour, and gendered power relations. Several important issues are not addressed in the existing literature. The survey data on sexual behaviour suggest that HIV has had little impact on sexual activity, apart from a reported increase in condom use. Qualitative studies reveal the moral categories, gender-role expectations, power inbalances and other cultural factors that prevent a high level of knowledge about HIV transmission from being translated into safer heterosexual behaviour. Their findings provide important insights into how realistic and practical safer sex messages are. They suggest that to promote health in respect to HIV it is necessary not only to advocate specific precautionary behaviour, such as using condoms, but also to address wider cultural issues relating to the taboos around the discussion of sex and the empowerment of women.

Adolescent↗
PubMed1990

Tracheal mucus clearance in high-frequency oscillation: effect of peak flow rate bias.

We have reported previously that high-frequency oscillation of the chest wall (HFO/CW) enhances the tracheal mucus clearance rate (TMCR) in dogs. This enhancement of TMCR may be due in part to the expiratory bias in peak flow rate (VE/VI greater than 1) that occurs during HFO/CW. We examined this factor in 8 anaesthetized, spontaneously breathing dogs by comparing TMCR during the following manoeuvers: 1) HFO/CW, applied by means of a thoracic cuff; 2) symmetric high-frequency oscillation via the airway opening (HFO/AO), applied by means of a piston pump driven by sinusoidal signal; 3) HFO/AO with an expiratory bias in peak flow, and 4) HFO/AO with an inspiratory bias in peak flow. All manoeuvers were of 5 min duration and were performed at 13 Hz and an oscillatory tidal volume of 1.5 ml.kg-1. In the latter two manoeuvers, the piston pump was driven by a nonsinusoidal signal such that peak VE/VI was greater than and less than unity, respectively. A high-impedance, cross-current flow of warmed, humidified air was provided at the tracheal tube. The order of manoeuvers 2, 3 and 4 was randomized, while manoeuver 1 was repeated at the end. TMCR was determined by direct bronchoscopic visualization of charcoal particle transport. Each HFO manoeuver was bracketed by a control period of spontaneous breathing. We found that TMCR during HFO/CW was 2.4 x control (p less than 0.001), in line with previous results.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1988

Tympanostomy tubes: long-term effects.

Eighty children ranging from five to 17 years of age, representing 159 ears, were evaluated for hearing loss following tympanostomy tube extrusion. The tubes had been extruded for one to eight years. Slightly more than 96 percent of the ears scored better than 20 dB on pure tone audiometry. On interview, virtually all parents or guardians indicated that they would consent to the procedure again if presented with similar circumstances.

Adolescent↗
PubMed1988

Hepatic transplantation with perioperative and long term anticoagulation as treatment for Budd-Chiari syndrome.

Conventional medical and surgical management of Budd-Chiari syndrome is often unsuccessful. In this communication, we report the results of 19 hepatic transplants done for 17 patients suffering from Budd-Chiari syndrome. The first patient who had a transplant did not receive anticoagulant therapy during the postoperative period, and recurrent thrombosis of the hepatic veins in the newly transplanted liver rapidly developed. Sixteen patients who subsequently underwent transplantation were managed using a philosophy of early postoperative anticoagulant treatment when feasible. Using this approach, the cumulative proportion of patients surviving at one and three years was 88 per cent, and no recurrent hepatic vein thrombosis occurred during a mean follow-up period of 28.2 months. Forty-four per cent of the patients who were deliberately given anticoagulant medication experienced a hemorrhagic complication in the postoperative period, but there were no associated deaths. In spite of anticoagulant therapy, 31 per cent of the patients on anticoagulantion medication experienced a thrombotic complication that did not involve the hepatic veins; one early and one late death resulted, and a third patient required urgent retransplantation. Despite the difficulties in patient management, a carefully selected population of patients with hepatic failure secondary to Budd-Chiari syndrome appear to be well served by hepatic transplantation with early postoperative and long term anticoagulant therapy.

Adolescent↗
PubMed1985

Peripheral mucociliary clearance with high-frequency chest wall compression.

We investigated the effects of high-frequency chest wall compression (HFCWC) on peripheral and tracheal mucus clearance in anesthetized spontaneously breathing dogs. HFCWC was achieved by oscillating the pressure in a thoracic cuff with a piston pump. Regional lung retention of a technetium-99m sulfur colloid aerosol was monitored with a gamma camera. A peripheral mucus clearance index (PMCI) was defined for each region of interest. The tracheal mucus clearance rate (TMCR) was determined by bronchoscopic visualization of marker particle transport. Phase I: In seven dogs, 30 min of HFCWC at 13 Hz with peak cuff pressure (Pcuff) 100-120 cmH2O was found to significantly enhance PMCI in regions immediately under the cuff. (delta PMCI = 24.4 +/- 4.6 in the basal peripheral region.) Phase II: Because of subpleural hemorrhage in phase I, the effect of HFCWC on TMCR at various Pcuff levels was studied in five dogs. The enhancement of TMCR by HFCWC reached a plateau level at Pcuff = 50 cmH2O. Phase III: HFCWC at 13 Hz with Pcuff = 50-60 cmH2O was found to significantly enhance PMCI in five dogs without the consequence of hemorrhage. Correlations were found between the enhancement of PMCI and TMCR by HFCWC. These results demonstrate that HFCWC is effective in enhancing both peripheral and central mucus clearance in dogs and safe when moderate pressures are applied.

Animals↗
PubMed1984

Alkaline phosphatase and gamma-glutamyl transpeptidase as polarization markers during the organization of LLC-PK1 cells into an epithelial membrane.

Confluent monolayers of LLC-PK1 cells, an epithelial cell derived from a normal pig kidney, contain high levels of alkaline phosphatase and gamma-glutamyl transpeptidase activities. Inhibition studies show a close similarity between alkaline phosphatase and the so-called liver-bone-kidney isoenzyme. Nearly complete recovery of both activities in the microsomal fraction demonstrates the membrane-bound characteristics of these enzymes. Histochemical localization of the enzymes activities on the apical membrane of LLC-PK1 cells confirms this observation. The activity of both enzymes decreases to very low levels when the cells are in exponential growth. Confluent monolayers of LLC-PK1 cells plated at saturation density with cells that were in active growth show a progressive increase in the activity of alkaline phosphatase and gamma-glutamyl transpeptidase. This increase is dependent on the synthesis de novo of RNA and protein and supports the conclusion that the activity of both enzymes is regulated at the transcriptional level. The development of these enzymes is delayed with respect to the development of the occluding junctions. This delay and the direct appearance of alkaline phosphatase activity in the apical membrane indicate that the different components of this membrane are inserted after the limits of the membrane have been established by the synthesis and assembly of the occluding junctions. Alkaline phosphatase activity of confluent monolayers can be further induced by reducing the concentration of phosphate in the medium. When the junctions are dissociated by incubating the monolayers in Ca2+-free medium, the alkaline phosphatase activity migrates freely beyond the limits of the apical membrane until it covers the entire cell surface. Both enzymes are synthesized even in the absence of contact between the cells, suggesting that the occluding junctions in LLC-PK1 monolayers are involved in the polarized distribution, but not in the modulation, of the synthesis of these enzymes. In addition, the progressive decrease in enzyme synthesis that is obtained by reducing the cell-substratum adhesion supports the idea that it is the cell-to-substrate and not the cell-to-cell interaction which is involved in the modulation of these enzymatic markers of the apical membrane.

Alkaline Phosphatase↗
PubMed1984

Hypotension secondary to balloon inflation of a pulmonary artery catheter.

Inflation of a balloon-tipped catheter for measurement of pulmonary artery wedge pressure caused a decrease in systemic arterial blood pressure in a mechanically ventilated patient after pneumonectomy. Obstruction by the balloon of a significant proportion of the cross-sectional area of the pulmonary circulation results in increased right ventricular afterload with subsequent decreased cardiac output and left atrial pressure. This decreased left atrial pressure can be measured accurately by the inflated balloon-tipped catheter but may be falsely low.

Aged↗
PubMed1983

Effect of tension and timing of contraction on the blood flow of the diaphragm.

An open-chest animal model was developed to study the diaphragmatic blood flow (Qdi) during bilateral electrophrenic stimulation. Two patterns of stimulation were used, continuous and intermittent, and both patterns were held at various transdiaphragmatic pressures (Pdi). The contractions were nearly isometric and held at an initial length of supine functional residual capacity (FRC). Qdi was measured in six dogs by catheterizing a branch of the diaphragmatic vein and by counting the blood drops with an infrared cell. During continuous contractions Qdi increased as a function of Pdi up to 70 +/- 12 ml . 100 g-1 . min-1 at 20% Pdimax. At higher levels Qdi decreased progressively and approached zero at 75% of Pdimax. A postcontraction hyperemia occurred at Pdi values greater than 20% Pdimax and increased as a function of Pdi. During intermittent contractions Qdi was a unique function of the diaphragmatic tension-time index (TTdi), a product of Pdi times the duty cycle (contraction time/total cycle time). Qdi increased progressively up to a TTdi of 25% Pdimax and decreased above that point toward zero at TTdi of 80% Pdimax. The postcontraction hyperemia appeared at a TTdi of about 15% of Pdimax and increased as a function of TTdi. It is concluded that Qdi is limited beyond a TTdi of about 20% Pdimax, as indicated by the increase in postcontraction hyperamia, and that Qdi is a function of both Pdi and the timing of contraction.

Animals↗
PubMed1983

Liver transplantation in the rat. Biochemical and histological evidence of complete tolerance induction in non-rejector strains.

Orthotopic liver allografts in the rat survive indefinitely without immunosuppressive agents, despite incompatibility between donor and recipient for antigens of the major histocompatibility complex. This is strain-dependent. In the DA to PVG strain combination, liver grafts are never rejected. This is not due to failure of the recipient to mount an immune response against the donor tissue, because there is unequivocal histological evidence of a rejection response during the first few weeks after grafting. This response is moderate and disappears to leave a histologically normal liver, apart from mild bile duct proliferation. Liver function tests show evidence of damage during the phase of cellular infiltration, but these test results also return to normal levels within a few weeks. In the DA to BN strain combination liver grafts are rapidly rejected, and this process is accompanied by histological signs of a violent and progressive destructive cellular response with gross alterations in liver function test results that are progressive until the death of the recipients. F1 hybrid recipients between these two strains (BN X PVG)F1 show intermediate levels of both histological damage and elevated liver function values, but they do not reject their grafts. Recovery from the rejection episode appears to be complete, as judged histologically. However, biochemical values remain slightly elevated, indicating either that the original damage was so severe that it was inconsistent with complete functional recovery or that there is continuous damage that is not visible histologically.

Alanine Transaminase↗
PubMed1976

The use of diagnostic ultrasound in evaluation of the abdomen in primates with emphasis on the rhesus monkey (Macaca mulatta).

To characterize the sonographic appearance of the abdominal organs in primates, a program of routine imaging and diagnostic evaluation was undertaken. Compound B-mode methodology with bistable and grey scale machines was employed utilizing a 2.25- to 3.5-MHZ transducer focused at 7 cm. Visualization of the liver, gallbladder, spleen, kidney and of intraabdominal pathology are described. The stage, position, and condition of a pregnancy can be determined by this methodology.

Abdomen↗