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Biomedical subjects

J Clegg

Publications and source records attributed to J Clegg.

At least 19 recordsLinked to original sources
PubMed2002

Challenging behaviour and insecure attachment.

BACKGROUND: The present authors investigated a database about people with severe intellectual disability (ID) to explore whether secure/insecure attachment plays a role in challenging behaviour. METHODS: The study took the form of a survey of staff and carers involved with a cohort of 54 school-leavers with severe ID. RESULTS: Thirty-four per cent of students were rated by placement staff as 'over-investing in one or a few relationships which become a source of jealousy'. Students without such problems were significantly less likely to show challenging behaviours, while those with them were significantly more likely to be living outside the family home. CONCLUSIONS: These preliminary results justify more detailed and longitudinal research into the relationship between attachment status and challenging behaviour.

Adult↗
PubMed2001

Internal fixation of children's fractures using the Fixclip system.

Thirty five fractures were treated using the Fixclip (Corin medical) system of wires and retaining clips. Union occurred in all instances. In the region of the growth plate, the implant enabled small fragments of bone to be captured and the epiphysis to be secured to the metaphysis without transgression of the physis. In the case of metaphyseal and diaphyseal injuries, the Fixclip allowed stabilisation of fractures with minimal disturbance of the fracture site and soft tissues. This combined with the flexibility inherent in the construct encourages secondary healing with the formation of abundant external callus. On four occasions, a wire escaped from the clip although this led to further intervention in only one instance. In each of these cases, a single retaining clip had been used suggesting that at least two clips should be used for each construct.

Adolescent↗
PubMed2001

Bullying and people with severe intellectual disability.

Although bullying has been shown to reduce quality of life in many spheres, anti-bullying strategies have yet to be incorporated into services for adults with severe intellectual disability (ID). The present study employed a survey of staff and parent concerns about 54 previously surveyed students who had left a school for pupils with severe ID. A content analysis of follow-up interviews was performed in 10 cases. Staff identified 19% of the survey sample as bullying others and 11% as being picked on. Neither gender nor communication ability had an impact. There was no significant change in bully or victim status over time, although some people did change. Parents or staff raised bully/victim problems in more than half of the interviews. There is sufficient evidence of bullying behaviour to warrant the adoption of anti-bullying strategies.

Adult↗
PubMed2001

Severe intellectual disability and transition to adulthood.

Institutional and psychological aspects of transition were explored with parents and staff involved with five young adults with severe intellectual disability whose challenging behaviour diminished after they made the transition, and five whose challenging behaviour remained high. They were selected from a previously surveyed cohort. Grounded theory analysis of interviews suggested little connection between the perspectives of parents and staff. The impact these differences have on communication about challenging behaviour was explored, and recommendations for service changes are made.

Adult↗
PubMed2000

Beyond ethical individualism.

Contemporary ethical debate about clinical practice centres primarily on the individual resolution of dilemmas, an approach which is incompatible with the social constructionist focus on human interdependence. Many constructionists argue that virtue ethics (VE) offers a more useful perspective on ethics than either consequentialism or deontology. From this perspective, the purpose of ethics is not to specify the right act in a particular situation, but to understand ethical and unethical practices conceptually, i.e. how these are learned, and how these contribute to and develop the ethical life in an ethical environment. Criticisms of VE are considered alongside discussion of its implications for clinical practice with people who have intellectual disability.

Ethics, Professional↗
PubMed1999

Impact of gene flow from cultivated beet on genetic diversity of wild sea beet populations

Gene flow and introgression from cultivated plants may have important consequences for the conservation of wild plant populations. Cultivated beets (sugar beet, red beet and Swiss chard: Beta vulgaris ssp. vulgaris) are of particular concern because they are cross-compatible with the wild taxon, sea beet (B.vs. ssp. maritima). Cultivated beet seed production areas are sometimes adjacent to sea beet populations; the numbers of flowering individuals in the former typically outnumber those in the populations of the latter. In such situations, gene flow from cultivated beets has the potential to alter the genetic composition of the nearby wild populations. In this study we measured isozyme allele frequencies of 11 polymorphic loci in 26 accessions of cultivated beet, in 20 sea beet accessions growing near a cultivated beet seed production region in northeastern Italy, and 19 wild beet accessions growing far from seed production areas. We found one allele that is specific to sugar beet, relative to other cultivated types, and a second that has a much higher frequency in Swiss chard and red beet than in sugar beet. Both alleles are typically rare in sea beet populations that are distant from seed production areas, but both are common in those that are near the Italian cultivated beet seed production region, supporting the contention that gene flow from the crop to the wild species can be substantial when both grow in proximity. Interestingly, the introgressed populations have higher genetic diversity than those that are isolated from the crop. The crop-to-wild gene flow rates are unknown, as are the fitness consequences of such alleles in the wild. Thus, we are unable to assess the long-term impact of such introgression. However, it is clear that gene flow from a crop to a wild taxon does not necessarily result in a decrease in the genetic diversity of the native plant.

Journal Article↗
PubMed1999

Financial justification for routine ultrasound screening of the neonatal hip.

We have analysed the patterns of management of developmental dysplasia of the hip (DDH) in Coventry over a period of 20 years during which three different screening policies were used. From 1976 to the end of 1985 we relied on clinical examination alone. The mean surgical cost for the treatment of DDH during this period was Pound Sterling 5110 per 1000 live births. This was reduced to Pound Sterling 3811 after the introduction of ultrasound for infants with known risk factors. Since June 1989 we have routinely scanned all infants at birth with a mean surgical cost of Pound Sterling 468 per 1000 live births. This reduction in cost is a result of the earlier detection of DDH with fewer children requiring surgery. In those who do, fewer and less invasive procedures are needed. The overall rate of treatment has not increased and regular review of patients managed in a Pavlik harness has allowed us to avoid the complication of avascular necrosis. When we add the cost of running the screening programme to the expense of treating the condition, the overall cost for the management of DDH is comparable for the different screening policies.

Blood Transfusion↗
PubMed1997

Embryos of Artemia franciscana survive four years of continuous anoxia: the case for complete metabolic rate depression

Encysted gastrula embryos of the crustacean Artemia franciscana have acquired an array of adaptations that enable them to survive a wide variety of environmental extremes.The present paper shows that at least 60 % survive 4 years of continuous anoxia at physiological temperatures (20­23 °C) when fully hydrated. Although these embryos appear to carry on a metabolism during the first day of anoxia, no evidence for a continuing metabolism throughout the subsequent 4 years was obtained. During this period, there were no measurable changes in the levels of their stored, mobilizable carbohydrates (trehalose, glycogen, glycerol). Calculations indicate that, if these carbohydrates are being utilized at all during anoxia, the rate is at the least 50 000 times lower than the aerobic rate (lower limit of detection). Indications of proteolysis during prolonged anoxia were sought but not found. Under starvation conditions, the life span of larvae produced from embryos that had undergone 4 years of anoxia was not significantly different from that of larvae produced by embryos that had not experienced anoxia. Thus, all substrates and other metabolites required to support embryonic development to the nauplius, as well as endogenous (unfed) larval growth and molting, are retained during 4 years of anoxia. It is not possible to prove experimentally the absence of a metabolic rate in anoxic embryos under physiological conditions of hydration and temperature. Nevertheless, on the basis of the results presented here, I will make the case that the anoxic embryo brings its metabolism to a reversible standstill. Such a conclusion requires that these embryos maintain their structural integrity in the absence of measurable biosynthesis and free energy flow and are thus an exception to a major biological generality. Potential mechanisms involved in their stability are discussed.

Journal Article↗
PubMed1997

Effect of anaerobiosis on cysteine protease regulation during the embryonic-larval transition in

Hydrated encysted embryos of the brine shrimp Artemia franciscana have the ability to withstand years in anaerobic sea water using metabolic strategies that enable them to inactivate all cell metabolic activities and then to resume development when placed in aerobic sea water. However, this unique characteristic of Artemia franciscana embryos is lost during a very short period, at the embryonic­larval transition period of development, coincident with the appearance of prenauplius larvae. Thus, while encysted embryos show complete inhibition of proteolysis over at least 4 years under anoxia, control of this activity, together with resistance to anoxia, is lost in newly hatched nauplius larvae after only a few days in anaerobic sea water. In contrast to encysted embryos, young larvae in anaerobic sea water produce large amounts of lactic acid, which reaches a concentration of nearly 50 mmol l-1 within 12 h of incubation. The accumulated lactic acid is believed to reduce the intracellular pH (pHi) to considerably less than 6.3, the value found in encysted embryos after 5 months in anaerobic sea water. We find that larvae, in contrast to embryos, lose cytoplasmic proteins at the rate of 4­5 ng h-1 larva-1 upon transfer to anaerobic sea water, while yolk proteins are not degraded in either embryos or larvae under anoxic conditions. The decline in cytoplasmic protein levels in anaerobic larvae may be due to activation of an endogenous cysteine protease (CP) as the pHi becomes acidic. Contributing to the apparent uncontrolled CP activity is a decrease in the level of cysteine protease inhibitor (CPI) activity during the embryonic­larval transition period, resulting in an increase in the CP/CPI ratio, from approximately 0.5 in embryos to greater than 1.0 in newly hatched larvae. Finally, data are presented to suggest that loss of the 26 kDa stress protein from embryos during the embryonic­larval transition may also contribute to the loss in resistance of young nauplius larvae of A. franciscana to anaerobic conditions.

Journal Article↗
PubMed1994

Routine ultrasound screening for neonatal hip instability. Can it abolish late-presenting congenital dislocation of the hip?

We have undertaken routine ultrasound screening for neonatal hip instability in Coventry since June 1989. Of the 14,050 babies scanned during the first three years, 847 (6%) had ultrasound abnormalities. A grading system, based on the percentage of femoral head coverage, is presented. The proportion of abnormal hips decreased gradually so that by nine weeks, 90% had normal ultrasound appearances. Abnormality was more common in babies with a family history of CDH and in breech presentations. All babies with clinically abnormal hips had an abnormal first ultrasound examination. Five babies not diagnosed by clinical examination and with no risk factors had abnormal ultrasound appearances and were subsequently found to have clinically abnormal hips. Routine ultrasound screening has detected cases which would otherwise have presented late.

Female↗
PubMed1989

A simple method of identifying loosening or infection of hip prostheses in nuclear medicine.

Joint replacement is now established as a reliable orthopaedic procedure for the relief of many painful degenerative conditions of the hip. When successful it enhances hip movement and relieves pain with a concomitant improvement in function and well being for the patient. When unsuccessful the persistence of pain usually signifies loosening or infection. Loosening may result from mechanical failure or infection. Accurate distinction between septic and aseptic loosening is important for planning and executing surgical intervention. The experience of the Department of Nuclear Medicine in Coventry assessing pathology in painful hip prostheses was retrospectively reviewed in 47 patients. These patients were imaged from 1985 to 1987 and all had good clinical follow-up enabling the diagnosis of loosening, infection or normal to be made with confidence. All patients had three phase bone imaging and some had additional gallium imaging. The images were reviewed with particular emphasis on the pattern of uptake in the late bone image and congruence of abnormal uptake in the early bone image and gallium image. It is concluded that for the majority of patients simple three phase bone imaging will provide the required diagnostic information.

Aged↗