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Biomedical subjects

E O'Brien

Publications and source records attributed to E O'Brien.

At least 145 records · Page 8Linked to original sources
PubMed1994

Thoracic and lumbar spine injuries in children: different than in adults.

A study of 38 patients, ages birth through 17 years, is reported that was performed to identify patterns of thoracic and lumbar spine injuries and healing in children in order to make appropriate treatment recommendations and avoid unnecessary surgery. This retrospective/prospective study, which is the largest review of children's thoracic and lumbar spine injuries in the orthopaedic literature, supports several accepted concepts regarding children's spine fractures. In addition, the periosteal sleeve fracture mimicking lumbar dislocations in small children, which has not been reported previously in the clinical setting, is described. Thoracic and lumbar spine injuries in children have distinct differences from these injuries in adults, and the treatment should take these differences into consideration.

Adolescent↗
PubMed1994

A comparison of the British Hypertension Society and Association for the Advancement of Medical Instrumentation protocols for validating blood pressure measuring devices: can the two be reconciled?

BACKGROUND: Experience with the original protocols of the Association for the Advancement of Medical Instrumentation (AAMI) and the British Hypertension Society (BHS) for validating blood pressure has provided valuable insight into the methodological problems associated with device validation and has influenced both the BHS and the AAMI in revising their protocols. OBJECTIVES: To review the revisions of the original BHS and AAMI protocols; to compare the protocols; and, using the BHS protocol as a framework for validation, to determine how it should be modified to a protocol that will fulfil the criteria of both the AAMI and the BHS. CONCLUSIONS: The revised protocols have many similarities but there are some important differences. These differences merit consideration so as to facilitate manufacturers seeking to validate devices for acceptance in both Europe and the United States. Of the two protocols, the BHS protocol is the more elaborate in that (1) it takes particular care to ensure that observers are trained to a very high standard, (2) it makes provision for special group validation and (3) it recommends in-use validation of all devices. By modifying the BHS protocol, it is possible to validate blood pressure measuring devices (ambulatory devices require special consideration) to satisfy the criteria of both protocols.

Blood Pressure Determination↗
PubMed1994

Supporting parental bonding in the NICU: a care plan for nurses.

New and improved technology in the NICU has assisted in supporting critically ill neonates, especially those born at very low birth weights. These small patients require the dedicated hand of the NICU staff, but also the love and support of their parents. Family bonding in the NICU is often a very difficult process, which is interrupted by separation of parent and child at birth and continued by the physical constraints of this highly complex critical care environment. Neonatal nurses are most often the front line managers and coordinators of family care in the NICU. They are charged with the challenge of understanding and providing "state of the art" technological care in an environment that must also adapt to the ever changing needs of parents and families who cannot be considered visitors, but an integral part of their infants' care and survival. Each infant and family in the NICU requires individualized assessment and nursing care. This article reviews the process of parental bonding as it relates to the premature or ill infant and provides for nurses a plan of care written to foster and support family bonding in the NICU. Stages of bonding with a sick or premature infant are explored in the context of a theoretical framework of adaptation provided by Sister Callista Roy.

Humans↗
PubMed1994

Linkage disequilibrium patterns vary with chromosomal location: a case study from the von Willebrand factor region.

Linkage disequilibrium analysis has been used as a tool for analyzing marker order and locating disease genes. Under appropriate circumstances, disequilibrium patterns reflect recombination events that have occurred throughout a population's history. As a result, disequilibrium mapping may be useful in genomic regions of < 1 cM where the number of informative meioses needed to detect recombinant individuals within pedigrees is exceptionally high. Its utility for refining target areas for candidate disease genes before initiating chromosomal walks and cloning experiments will be enhanced as the relationship between linkage disequilibrium and physical distance is better understood. To address this issue, we have characterized linkage disequilibrium in a 144-kb region of the von Willebrand factor gene on chromosome 12. Sixty CEPH and 12 von Willebrand disease families were genotyped for five PCR-based markers, which include two microsatellite repeats and three single-base-pair substitutions. Linkage disequilibrium and physical distance between polymorphisms are highly correlated (rm = -.76; P < .05) within this region. None of the five markers showed significant disequilibrium with the von Willebrand disease phenotype. The linkage disequilibrium/physical distance relationship was also analyzed as a function of chromosomal location for this and eight previously characterized regions. This analysis revealed a general trend in which linkage disequilibrium dissipates more rapidly with physical distance in telomeric regions than in centromeric regions. This trend is consistent with higher recombination rates near telomeres.

Alleles↗
PubMed1994

Genetic structure of the Utah Mormons: comparison of results based on RFLPs, blood groups, migration matrices, isonymy, and pedigrees.

The genetic structure of the Utah Mormon population is examined using 25 blood group and 47 RFLP alleles obtained from 442 subjects living in 8 geographic subdivisions. Nei's GST was 0.013 (p < 0.002) for the RFLP data and 0.012 (p > 0.4) for the blood group data, showing that only 1% of the genetic variance in this population can be attributed to subdivision effects. A comparison of intersubdivision distance matrices based on blood groups, RFLPs, migration matrices, isonymy, and pedigrees shows that genetic distances have relatively low and nonsignificant correlations with the other three types of data. However, the correlations based on RFLPs are considerably higher than those based on blood groups. Relationship matrices based on interindividual allele sharing were compared with known genealogical kinship coefficients between each pair of individuals. The correlation between the blood group and RFLP relationship matrices was small but marginally significant using the Mantel test (r = 0.014, p < 0.06). The RFLP relationship matrix correlated more highly with genealogical kinship than did the blood group relationship matrix (r = 0.023, p < 0.0001 and r = 0.012, p < 0.001, respectively). These correlations increased by approximately one order of magnitude when pairs of subjects having zero kinship coefficients were excluded. These results show that genetic distances derived from RFLPs correlate more strongly with other types of kinship than do distances based on blood groups. This probably reflects the fact that RFLPs are more neutral, have frequencies that are more accurately estimated, and contain more information about DNA sequence variation.

Blood Group Antigens↗
PubMed1994

Founder effect: assessment of variation in genetic contributions among founders.

We present a Monte Carlo method for determining the distribution of founders' genetic contributions to descendant cohorts. The simulation of genes through known pedigrees generates the probability distributions of contributed genes in recent cohorts of descendants, their means, and their variances. Genealogical data from three populations are analyzed: the Hutterite population of North America, the island population of Sottunga from the Aland archipelago, and the large Utah Mormon population. Two applications of the Monte Carlo method are presented. First we investigate the relative opportunity for founder effect in the three populations, which have dissimilar pedigree structures and dissimilar disease gene frequencies. Second, we measure the reproductive success of population founders in terms of the number of genes they contribute to a cohort some number of generations descendant and compare the effects of polygyny versus monogamy on reproductive success. The distribution of Hutterite founder contributions describes the context for a classic founder effect. Hutterite founders have a higher probability of leaving no genes in the population (72%) than Sottunga (48%) and Mormon (48%) founders. However, founder genes that survive among Hutterite descendants do so in larger numbers on average than founder genes in the other two populations. Greater variation among monogamous Hutterite founders compared with Mormon polygynous founders demonstrates that polygyny alone does not maximize the variance in reproductive success; other population characteristics are at least as important for determining variability among individuals in their genetic contributions to a gene pool. Our findings make it difficult to appreciate the reproductive advantage of polygyny in the Mormon population. Although the expected gene contributions and their variances were larger for polygynous founders compared with other Mormons, the main effect of polygyny was to increase the probability that any polygynist left a few genes among descendants. Furthermore, only 12% of the variation in the genetic contributions of Mormon founders is explained by their number of offspring. We conclude that shallow genealogical data (from one or a few generations) provide a poor measure of long-term reproductive success.

Alleles↗
PubMed1993

Cloning from the thyroid of a protein related to actin binding protein that is recognized by Graves disease immunoglobulins.

Human actin binding protein (ABP) links specific membrane glycoproteins to cytoskeletal actin microfilaments. In human platelets and leukocytes, ABP directly links, respectively, the membrane glycoproteins GPIb and the high-affinity Fc receptor for IgG (Fc gamma IR) to cytoskeletal actin microfilaments. Similar interaction between the thyrotropin (TSH) receptor and ABP in endocrine cells might explain the rapid and profound disruption of actin microfilaments induced by TSH in cultured thyroid follicular cells. By screening a thyroid lambda gt11 cDNA expression library with serum from a Graves disease patient, we identified a clone encoding a protein, designated truncated ABP (TABP), that shares extensive homology (approximately 70%) with ABP. TABP is a truncated ABP-like protein with an open reading frame of 195 aa that encodes a protein of approximately 21 kDa. TABP lacks an actin binding domain but contains two predicted beta-sheet repeats within which is a putative dimerization domain and between which lies a putative glycoprotein binding site containing a consensus site for phosphorylation by Ca(2+)-calmodulin kinase II. TABP contains a unique C-terminal insertion within which lies a hydrophobic predicted membrane-associated region, absent from ABP. Although TABP mRNA is expressed widely, immunoblot analysis demonstrated the presence of TABP antibodies specifically in the sera of a minority of subjects with autoimmune thyroid disease. A 24-residue sequence of similarity was identified between the TSH receptor and platelet glycoprotein GPIb alpha that may represent a transmembrane ABP binding site. We suggest, therefore, that signal transduction by TSH in the thyroid involves direct linkage of the TSH receptor to actin microfilaments by ABP and that TABP may interact with ABP to mediate TSH-induced actin microfilament disruption.

Amino Acid Sequence↗
PubMed1993

Measurement error in the Hawksley random zero sphygmomanometer: what damage has been done and what can we learn?

The Hawksley random zero sphygmomanometer is used in all aspects of blood pressure research, from clinical trials to evaluation of new blood pressure recorders. It is designed to reduce observer bias in blood pressure measurement. The problem is that it also underestimates blood pressure. Furthermore, this was first reported more than two decades ago. In this paper Rónán Conroy and colleagues explore the consequences of using an inaccurate instrument for important research and why prestigious organisations like the World Health Organisation continue to use it.

Blood Pressure Determination↗
PubMed1993

Relationship between blood pressure measured in the clinic and by ambulatory monitoring and left ventricular size as measured by electrocardiogram in elderly patients with isolated systolic hypertension.

OBJECTIVE: To assess the additional diagnostic precision conferred by ambulatory blood pressure monitoring on clinic blood pressure measurement in evaluating the severity of isolated systolic hypertension. METHODS: The association between left ventricular size as determined by ECG voltages [R-wave voltages in lead V5 (RV5) and S-wave voltages in lead V1 (SV1)] and blood pressure as assessed by clinic measurements and ambulatory blood pressure monitoring was studied in 97 elderly patients included in the placebo run-in phase of the Syst-Eur trial. The additional diagnostic precision conferred by ambulatory monitoring on clinic blood pressure measurements was assessed by relating the residual ambulatory blood pressure level to the ECG-left ventricular size. The residual ambulatory blood pressure level was calculated by subtracting the predicted ambulatory blood pressure level for each patient (using the linear regression equation relating both techniques for the group) from the observed ambulatory blood pressure. RESULTS: Clinic systolic blood pressure was on average 20 mmHg higher (P < 0.001) than daytime ambulatory blood pressure while diastolic blood pressure was similar with both techniques. The sum of SV1 + RV5 was significantly related to clinic systolic pressure (r = 0.25), and 24-h (systolic, r = 0.37; diastolic, r = 0.29), daytime (systolic, r = 0.30; diastolic, r = 0.19) and night-time (systolic, r = 0.33; diastolic, r = 0.28) ambulatory blood pressure levels. These findings were not affected by adjustment for gender, age and the body mass index. The sum of SV1 + RV5 was significantly related to the residual 24-h (systolic, r = 0.30; diastolic, r = 0.31), daytime systolic (r = 0.20) and night-time (systolic, r = 0.31; diastolic, r = 0.29) ambulatory blood pressure monitoring levels. CONCLUSION: Ambulatory blood pressure monitoring adds to the diagnostic precision of clinic blood pressure measurement in assessing the severity of hypertension in this population. The ongoing side project on ambulatory blood pressure monitoring in the Syst-Eur study should establish whether these findings hold true for morbidity and mortality.

Aged↗
PubMed1993

Comparative accuracy of six ambulatory devices according to blood pressure levels.

OBJECTIVE: To assess the accuracy of six ambulatory blood pressure measuring systems at low, medium and high blood pressures. RESULTS: The CH-Druck, Profilomat, SpaceLabs 90207 and Novacor DIASYS 200R, having previously achieved A to C grading for systolic and diastolic blood pressures according to the British Hypertension Society (BHS) protocol and having fulfilled the criteria of the Association for the Advancement of Medical Instrumentation, have been recommended for measurement of ambulatory blood pressure in clinical practice; the Pressurometer IV and Takeda TM-2420, achieved only C and D grades and failed to satisfy the Association for the Advancement of Medical Instrumentation criteria. In this study the data from the original validations are re-analysed for three pressure ranges of systolic and diastolic blood pressures: low range < or = 130/80 mmHg, medium range 130-160/80-100 mmHg and high range > or = 160/100 mmHg. All six devices maintained their overall grading or improved them slightly in the low and medium blood pressure ranges, but in the high blood pressure range the CH-Druck slipped from an overall A/A grading to B/C, the Profilomat from B/A to C/D, the SpaceLabs from B/B to C/C and the Pressurometer IV from C/D to D/D. The Takeda remained unchanged with a D grading, but the results within this grading were worse in the higher blood pressure range, and the Novacor rose from C/C to C/B. CONCLUSIONS: This analysis suggests that the CH-Druck is the most accurate ambulatory system across the pressure range, although it does not perform as well in the high blood pressure range as in the medium and low blood pressure ranges. The SpaceLabs 90207 is accurate in the low and medium blood pressure ranges and reasonably accurate in the high blood pressure range. If blood pressures only in the low and medium ranges are to be measured, a wider selection of ambulatory systems becomes available because, in addition to the CH-Druck and SpaceLabs 90207, the Profiloat and Novacor DIASYS 200R are accurate.

Blood Pressure↗
PubMed1993

Twenty-four-hour ambulatory blood pressure measurement in a primigravid population.

OBJECTIVE: To establish the profiles of 24-h non-invasive ambulatory blood pressure measurement (ABPM) during the trimesters of pregnancy and the puerperium in normotensive healthy primigravidae. DESIGN: A prospective study in which 24-h ABPM was performed on five occasions in each subject: in the first trimester between 9 and 16 weeks' gestation; in the second trimester between 18 and 24 weeks; in the third trimester between 26 and 32 weeks and between 33 and 40 weeks; and finally at 6 weeks post partum. METHOD: One hundred and six Caucasian primigravid women who were normotensive at their first booking visit were recruited consecutively from the antenatal clinic and had 24-h ABPM performed with the SpaceLabs 90207 ambulatory system. RESULTS: Of the 106 women recruited, 98 completed 24-h ABPM on four of the five measurement occasions. Four women delivered prematurely before 33 weeks' gestation, thereby missing one ABPM measurement. Changes during pregnancy and the puerperium were assessed against the ABPM performed in the first trimester. There was no difference for daytime or night-time systolic blood pressure between 9 and 33 weeks, but it rose significantly from 33 to 40 weeks. At 6 weeks post partum, systolic blood pressure was not significantly different from the daytime pressure in the first-trimester ABPM but was raised significantly at night. Diastolic blood pressure decreased significantly between 18 and 24 weeks for both daytime and night-time. From 33 to 40 weeks it increased in parallel with systolic blood pressure, and at 6 weeks post partum it was raised significantly compared with first-trimester values for daytime and night-time. The nocturnal fall in blood pressure was preserved throughout pregnancy with a significant difference between daytime and night-time measurements present on all measurement occasions for systolic, diastolic and mean blood pressures and heart rate. There were significant differences between daytime ABPM and clinic blood pressure for both systolic and diastolic blood pressure up to 33 weeks. From 33 weeks until 6 weeks post partum there was no significant difference between daytime ambulatory and clinic blood pressures. CONCLUSION: This study provides reference values for ABPM in healthy primigravidae with generally uncomplicated pregnancies.

Adult↗