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Biomedical subjects

J Allen

Publications and source records attributed to J Allen.

At least 73 records · Page 4Linked to original sources
PubMed2001

Family planning provision in the Trent health region: Is it accessible to school aged teenagers?

Strategies to combat existing high teenage pregnancy rates in the UK need to include contraceptive services that can be easily accessed by young people, including those who are still at school. This study concerns the availability of family planning services to young people who are still at school. One hundred and eight family planning clinics in the Trent region were surveyed to determine their clinic opening hours. Hours accessible to school aged young people were identified as being services provided during school lunch breaks, after school and at weekends. A total of 498 weekly hours of provision were identified, and 260.5 of these were accessible to school aged young people. There was a lot of variation between health authority areas both in terms of the number of hours accessible to this age group and also in terms of the percentage of clinics not offering any service accessible to school aged people. The recent report from the Social Exclusion Unit identified accessible contraceptive services as part of its strategy to reduce teenage pregnancy rates in the UK. Although these results are descriptive and do not intend to show any causal relationship, they do show that in all health authority areas there are clinics that are not providing any service that is accessible to school aged young people.

Adolescent↗
PubMed2001

The generalized aminoaciduria seen in patients with hepatocyte nuclear factor-1alpha mutations is a feature of all patients with diabetes and is associated with glucosuria.

Hepatocyte nuclear factor-1alpha (HNF-1alpha) mutations are the most common cause of maturity-onset diabetes of the young. HNF-1alpha homozygous knockout mice exhibit a renal Fanconi syndrome with glucosuria and generalized aminoaciduria in addition to diabetes. We investigated glucosuria and aminoaciduria in patients with HNF-1alpha mutations. Sixteen amino acids were measured in urine samples from patients with HNF-1alpha mutations, age-matched nondiabetic control subjects, and age-matched type 1 diabetic patients, type 2 diabetic patients, and patients with diabetes and chronic renal failure. The HNF-1alpha patients had glucosuria at lower glycemic control (as shown by HbA1c) than type 1 and type 2 diabetic patients, consistent with a lower renal glucose threshold. The HNF-1alpha patients had a generalized aminoaciduria with elevated levels of 14 of 16 amino acids and an increased mean Z score for all amino acids compared with control subjects (0.66 vs. 0.00; P < 0.0005). Generalized aminoaciduria was also present in type 1 diabetic (Z score, 0.80; P < 0.0001), type 2 diabetic (Z score, 0.71; P < 0.0002), and chronic renal failure (Z score, 0.65; P < 0.01) patients. Aminoaciduria was not associated with microalbuminuria or proteinuria but was associated with glucosuria (1.00 glucosuria vs. 0.19 no glucosuria; P = 0.002). In type 1 diabetic patients, urine samples taken on the same day showed significantly more aminoaciduria when glucosuria was present compared with when it was absent (P < 0.01). In conclusion, HNF-1alpha mutation carriers have a mutation-specific defect of proximal tubular glucose transport, resulting in increased glucosuria. In contrast, the generalized aminoaciduria seen in patients with HNF-1alpha mutations is a general feature of patients with diabetes and glucosuria. Glucose may depolarize and dissipate the electrical gradient of the sodium-dependent amino acid transporters in the proximal renal tubule, causing a reduction in amino acid resorption.

Adult↗
PubMed2001

Episodic-like memory in pigeons.

It has been proposed that memory for personal experiences (episodic memory, rather than semantic memory) relies on the conscious review of past experience and thus is unique to humans. In an attempt to demonstrate episodic-like memory in animals, we first trained pigeons to respond to the (nonverbal) question "Did you just peck or did you just refrain from pecking?" by training them on a symbolic matching task with differential responding required to the two line-orientation samples and reinforcing the choice of a red comparison if they had pecked and the choice of a green comparison if they had not pecked. Then, in Experiment 1, after providing the conditions for (but not requiring) the pigeons to peck at one new stimulus (a yellow hue) but not at another (a blue hue), we tested them with the new hue stimuli and the red and green comparisons. In Experiment 2, we tested the pigeons with novel stimuli (a circle, which they spontaneously pecked, and a dark response key, which they did not peck) and the red and green comparisons. In both experiments, pigeons chose the comparison appropriate to the response made to the test stimulus. Thus, the pigeons demonstrated that they could remember specific details about their past experiences, a result consistent with the notion that they have the capacity for forming episodic-like memories.

Animals↗
PubMed2001

Nurse practitioner practice patterns, compensation, and professional organization participation: western Massachusetts.

Nurse practitioners (NPs) require current information pertinent to their local areas, often not reflected fully in national salary survey data, when they negotiate salary, benefits, and practice responsibilities. Professional NP organizations require membership data for success in planning events, particularly educational programs, that may be sponsored by pharmaceutical companies, an issue that may be uncomfortable for some members. This article describes personal characteristics, practice patterns, salaries and benefits, and organizational membership characteristics from a sample of NPs surveyed in western Massachusetts. Factors affecting salary, such as experience, work setting, geographic location, and certification, were presented. Salary and benefits reflect salaries at or somewhat more than national and regional averages (northeastern United States), with benefit packages varying among type of practice sites and location. The greatest predictor of salary was years in practice. NPs in school health had the heaviest patient and administrative work loads but earned less than NPs in other settings. Part-time NPs often had no benefits, but the hourly salary was about the same as for full-time NPs. Respondents reported a high degree of organizational membership and participation.

Adult↗
PubMed2000

Induction paclitaxel in previously untreated, resectable, advanced squamous cell carcinomas of head and neck.

BACKGROUND: Previous Phase II trials evaluating paclitaxel as a single agent have produced objective response rates of 38-40%. However, in these studies patients had recurrent disease and had received previous treatment with chemotherapy, radiation, surgery, or some combination of the same. To the authors' knowledge, the study reported here is the first to examine the role of paclitaxel in affecting objective antitumor response, as a single agent, in a previously untreated patient population. METHODS: Patients with untreated, resectable, advanced squamous cell carcinoma of the head and neck were eligible for this Phase II trial. The treatment plan included paclitaxel 250 mg/m(2) administered by 24-hour intravenous infusion every 21 days for a total of 3 courses and primary prophylaxis with colony stimulating factor during each course of chemotherapy. Surgical resection was performed after recovery from the final course of chemotherapy. After adequate wound healing, patients received external beam radiotherapy (median dose to primary site, 55.8 Gray [Gy]; median dose to neck sites, 50.4 Gy). RESULTS: Forty-five patients were registered. Thirty-eight patients completed the planned chemotherapy, 41 patients underwent surgical resection, and 37 patients completed the intended radiotherapy. The objective response rate was 50% (10% complete response; 40% partial response). Severe or life-threatening (Grade 3 or higher) granulocytopenia or thrombocytopenia occurred in 78% and 27% of patients, respectively. Two patients died of sepsis. Seventy-one percent, 67%, and 91% of patients were free of local, lymph node, and distant recurrence, respectively, with a median follow-up of 37 months. The 4-year overall survival and disease-related survival rates were 44.4% and 52.9%, respectively. CONCLUSION: The authors conclude that paclitaxel is an active agent in patients with advanced head and neck carcinoma. However, the overall disease control, achieved by using paclitaxel as induction therapy, did not appear to be better than that achieved with standard treatment methods. Combined modality regimens with concurrent chemotherapy and radiotherapy have demonstrated more promise.

Adult↗
PubMed2000

Noninvasive assessment of reperfusion after fibrinolytic therapy for acute myocardial infarction.

Assessment of reperfusion by the 12-lead electrocardiogram (ECG) or biochemical markers is limited by suboptimal sensitivity and/or specificity. Body surface mapping (BSM) improves the spatial sampling of the 12-lead ECG. Serial 12-lead ECGs and 64-lead anterior BSMs were recorded from 67 patients with acute myocardial infarction undergoing coronary angiography 90 minutes after fibrinolytic therapy. ECG-1 and BSM-1 were recorded before/shortly after therapy (median 18 minutes). ECG-2 and BSM-2 were recorded after the 90-minute angiogram (median 30 minutes). The maximum ST elevation on ECG-1 was noted and > or = 30% ST resolution on ECG-2 was taken to represent partial/complete reperfusion. Patients were randomly divided into a training set and validation set. Isointegral and isopotential ST-T variables from BSMs of training-set patients were compared with Thrombolysis In Myocardial Infarction (TIMI) trial flow using discriminant analysis to identify which variables best classified reperfusion. Reperfusion (TIMI 2/3 flow) occurred in 32 of 34 training-set patients and in 29 of 33 validation-set patients. In the training set, > or = 30% ST resolution correctly classified reperfusion with 72% sensitivity (23 of 32) and 50% specificity (1 of 2). In the validation set, > or = 30% ST resolution classified reperfusion with 59% sensitivity (17 of 29) and 50% specificity (2 of 4). In comparison, a model containing 24 BSM variables correctly classified all training-set patients, and when prospectively tested in the validation-set, correctly classified 28 of 29 patients who achieved reperfusion (97% sensitivity) and all 4 patients who failed to reperfuse (p = 0.035). In conclusion, BSM is more useful than the 12-lead ECG for noninvasive assessment of reperfusion after fibrinolytic therapy for acute myocardial infarction.

Analysis of Variance↗
PubMed2000

Early diagnosis of right ventricular or posterior infarction associated with inferior wall left ventricular acute myocardial infarction.

Right ventricular (RV) or posterior infarction associated with inferior wall left ventricular acute myocardial infarction (AMI) has important therapeutic and prognostic implications. However, RV and posterior chest leads in addition to the 12-lead electrocardiogram are required for accurate detection. Body surface mapping (BSM) has greater spatial sampling and may further improve inferior wall AMI classification. Consecutive patients with chest pain lasting <12 hours were assessed to identify those with AMI and > or =0.1 mV ST elevation in > or =2 contiguous inferior leads of the 12-lead electrocardiogram (bundle branch block or left ventricular hypertrophy excluded). A 12-lead electrocardiogram, RV leads (V(2)R, V(4)R), posterior chest leads (V(7), V(9)), and a BSM were recorded. From each BSM, the 12 electrodes overlying the RV region (regional RV map) and 10 electrodes overlying the posterior wall (regional posterior map) were assessed for ST elevation. Infarct size was estimated by serial cardiac enzymes. AMI occurred in 173 of 479 patients. Of the 62 patients with inferior wall AMI, ST elevation > or =0.1 mV occurred in 26 patients (42 in V(2)R or V(4)R compared with 36 patients (58%) in > or =1 electrode on the regional RV map (p = 0.0019). ST elevation > or =0.1 mV occurred in 1 patient (2%) in V(7) or V(9) compared with 17 patients (27%) in > or =1 electrode on the regional posterior map (p = 0.00003). ST elevation > or =0.05 mV occurred in 6 patients (10%) in V(7) or V(9) compared with 22 patients (36%) in > or =1 electrode on the regional posterior map (p = 0.00003). Patients with ST elevation on regional RV and/or posterior maps had a trend toward larger infarct size (mean peak creatine kinase 1,789+/-226 vs. 1,546+/-392 mmol/L; p = NS). Thus, BSM, when compared with RV or posterior chest leads, provides improved classification of patients with inferior wall AMI and RV or posterior wall involvement.

Body Surface Potential Mapping↗
PubMed2000

Association between teenage pregnancy rates and the age and sex of general practitioners: cross sectional survey in Trent 1994-7.

OBJECTIVE: To examine variations in teenage pregnancy rates in Trent region and to determine possible associations with local general practice characteristics such as the age and sex of the doctors. DESIGN: Cross sectional survey. SETTING: All 826 general practices in Trent region in existence between 1994 and 1997. SUBJECTS: All pregnancies of teenagers aged 13 to 19 between 1994 and 1997 that resulted in an admission to an NHS hospital. MAIN OUTCOME MEASURES: Pregnancy rates for teenagers aged 13 to 19 and general practice characteristics: presence of a female or young doctor (under 36 years old), number of whole time equivalent practice nurses, Townsend score, vocational training status, list size per whole time equivalent doctor, fund-holding status, and partnership size. RESULTS: On multivariate analysis, lower teenage pregnancy rates were associated with the presence of a female or young doctor and more nurse time. Practices in deprived areas had higher teenage pregnancy rates. CONCLUSION: General practices with female doctors, young doctors, or more nurse time had lower teenage pregnancy rates. The findings may have implications for the mix of health professionals within primary care.

Abortion, Therapeutic↗
PubMed2000

Ex vivo canine lens capsular sac explants.

BACKGROUND: Lens capsular sac explants from human cadaver eyes were used to investigate posterior capsular opacification (PCO). The purpose of this study was to characterize a similar model using canine tissue and to determine whether transferrin (Tf), transforming growth factor beta-2 (TGF-beta2), and insulin-like growth factor-1 (IGF-1) are secreted by lens epithelial cells (LEC) of these ex vivo sacs. METHODS: The lens from canine eyes was removed by extracapsular cataract extraction, the lens sac dissected free, pinned to a petri dish, and cultured in either serum-supplemented or serum-free medium. Morphologic characteristics and growth rate to confluence on the posterior capsule were studied by phase-contrast microscopy. Vimentin, alpha smooth muscle actin, and panTGF-beta expression by LEC were determined by immunohistochemistry. Tf, TGF-beta2, and IGF-1 levels were measured by ELISA in the supernatant of sacs cultured in serum-free medium. RESULTS: The mean time to confluence of LEC onto the posterior capsule was 5.4+/-1.1 days (n=22) and 14.7+/-3.7 days (n=14) for sacs in serum-supplemented and serum-free medium, respectively. Following development of confluence, explants displayed opacification and light scatter from cellular proliferation and capsular contraction. Confluent LEC expressed vimentin, alpha smooth muscle actin, and TGF-beta2, and both Tf and TGF-beta2 were secreted into the culture supernatant. CONCLUSION: Canine lens sac explants have characteristics virtually identical to those of human origin, and appear to be a useful alternative tissue source for this model when human cadaver eyes are unavailable. Tf and TGFbeta-2, but not IGF-1, are secreted by LEC in explanted lens sacs and may influence the proliferation and metaplasia of LEC during the development of PCO.

Actins↗
PubMed2000

Acquired aphasia in children after surgical resection of left-thalamic tumors.

Five children (three males, two females; four right-, one left-handed; age range 6 to 14 years) who developed aphasia after gross-total excision of left predominantly thalamic tumors are reported. Three patients had Broca aphasia, one had mixed transcortical aphasia, and one patient had conduction aphasia. In the months after surgery, three children improved while receiving radiation and/or chemotherapy, although none recovered completely. Two patients with malignant tumors developed worsening aphasia when the tumor recurred, and later died. Two of three patients tested had visuospatial difficulties in addition to language deficits. Attention and executive functioning were affected in three of three patients tested. Memory, verbal and/or visual functioning, were affected in four of four patients tested. Both patients who were tested showed transient right hemineglect. Two of two patients tested were probably apraxic. The wide range of deficits in these children highlights the importance of the thalamus and other subcortical structures in developing cognition.

Adolescent↗
PubMed2000

Lack of effect of acupuncture upon signs and symptoms of delayed onset muscle soreness.

The effect of acupuncture upon experimentally induced delayed onset muscle soreness (DOMS) was assessed in a placebo-controlled study under blinded conditions. Volunteers (n = 48; 24 M & 24 F) were randomly allocated to one of four groups: control (20 min rest), placebo (minimal needling at non-acupuncture points), treatment group 1 (acupuncture at classic acupuncture points) and treatment group 2 (acupuncture at 'tender' points). DOMS was induced in the elbow flexors of the non-dominant arm using a standardized eccentric exercise regime. Measurements of elbow range of movement (flexion, extension, relaxed angle), and pain as well as visual analogue scores (VAS), tenderness (using a pressure algometer) were employed as indices of treatment efficacy. Measurements of elbow range of movement and tenderness were made prior to DOMS induction on the first day, and repeated pre- and post-treatment on subsequent days; pain was assessed using visual analogue scales post-induction and post-treatment on the first day, and pre- and post-treatment thereafter. For all conditions, subjects rested supine for a period of 20 min, during which treatment was delivered according to group allocation. Repeated measures and one-way analysis of variance (ANOVA) demonstrated no significant interactive (AB) effects, except for visual analogue scores (P = 0.0483); one factor ANOVA on the second day of the experiment (pre-treatment) indicated significant differences between the control and all other groups. However, such differences were not found on any other day of the experiment. It is concluded that acupuncture has little effect upon the cardinal signs and symptoms of DOMS, at least under the conditions of the current experiment.

Acupuncture Analgesia↗
PubMed2000

Self-care self-efficacy, quality of life, and depression after stroke.

OBJECTIVE: To determine the relationship of self-care self-efficacy to functional independence, quality of life, and depression after stroke. METHODS: Longitudinal, descriptive correlational design. SETTING: Inpatient rehabilitation facility at 1 month after stroke and home at 6 months after stroke. PARTICIPANTS: Sixty-three stroke survivors. MAIN OUTCOME MEASURES: Four instruments: Strategies Used by People to Promote Health, Quality of Life Index--Stroke Version, Center for Epidemiologic Studies Depression Scale, and Functional Independence Measure. RESULTS: Self-care self-efficacy increased after stroke and was strongly correlated with quality of life measures and depression at both 1 and 6 months after stroke. Functional independence and quality of life increased over time, while depression decreased. Functional independence was modestly correlated with quality of life at 6 months after stroke, but not at 1 month after stroke. CONCLUSIONS: Self-care self-efficacy is strongly related to quality of life and to depression. Clinicians and family may encourage stroke patients' self-confidence, expectations for self-care, and self-efficacy behaviors, thereby improving patients' quality of life.

Activities of Daily Living↗