Biomedical subjects
J Graham
Publications and source records attributed to J Graham.
The devastating medical results of US embargo against Cuba.
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Modification of the standard method used in the United Kingdom for counting Escherichia coli in live bivalve molluscs.
The standard method for counting Escherichia coli in live bivalve molluscs is labour intensive and takes three days to obtain a result. Modifications to the standard method were investigated in a collaborative trial conducted in five centres. No significant difference was found between results based on the presence of acid at 24 hours (h) in first stage tests and those based on the presence of acid and gas after 48 h (standard method). The use of the chromogenic medium BCIG (5-bromo-4-chloro-3-indolyl-beta-D glucuronide) agar incubated at 44 degrees C to confirm first stage tests was also found to give equivalent results to conventional confirmation tests. The preferred, modified method removes the presence of gas as a criterion of detection, uses a chromogenic agar medium to confirm the presence of E. coli, and gives results within 48 h. A distribution of simulated samples and selected strains of E. coli to other laboratories using the PHLS external quality assurance scheme for shellfish found no significant difference between results obtained by the standard and modified methods.
Photographic documentation of syndrome diagnosis.
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Segregation and linkage analysis of a quantitative versus a qualitative trait in large pedigrees.
Goals of this analysis were to map loci contributing to variation in the quantitative trait, Q1, using the lod-score method on data set 1, and to explore the difference in power to map genes when considering the discrete vs. quantitative phenotype. Segregation analyses, after covariate adjustment, correctly suggested two contributing loci. The major gene on chromosome 5 was successfully mapped, but the major gene on chromosome 8 was not. Comparison of linkage analyses for the qualitative and quantitative traits confirmed that the quantitative trait is more informative, suggesting that localizing disease genes with a qualitative trait would be more difficult in these pedigrees.
The beta cell glucokinase promoter variant is an unlikely risk factor for diabetes mellitus. Diabetes Incidence Study in Sweden (DISS).
Glucokinase plays an important role in the regulation of insulin secretion and is therefore an attractive candidate gene for both insulin dependent (IDDM) and non-insulin-dependent (NIDDM) diabetes mellitus. A single G-A nucleotide polymorphism at the -30 position of the beta-cell specific promoter region of the glucokinase gene was previously associated with reduced beta-cell function. In the present study we analysed 268 consecutive newly diagnosed Swedish patients classified with either IDDM (n = 205), NIDDM (n = 31) or unclassifiable (n = 32) diabetes between the ages of 15 and 35 years along with a group of 158 age- and sex-matched control subjects. The beta-cell promoter region was amplified by the polymerase chain reaction and the G-A variant identified by single strand conformational polymorphism. There was no significant difference in allele frequencies of G and A between any of the subject groups and likewise, no significant difference in the frequencies of the G/G, G/A, or A/A genotypes. Eight subjects were homozygous for the less common A allele, five had IDDM and three were control subjects. Our results suggest that the -30 beta-cell glucokinase promoter variant is not associated with IDDM.
Fear of water in children and adults: etiology and familial effects.
Water-fearful children (non-swimmers. 5-8 yrs and adults (non-swimmers or late learners, 23-73 yr) were compared with non-fearful controls of similar swimming ability. Parallel assessments were carried out with children and adults to investigate water-related experiences, water fear and competence in parents and siblings, and the relationship of water fear to other fear dimensions. Children were assessed behaviorally and by self and mother's report, adults by self-report. In neither children nor adults was there clear evidence that fearful and non-fearful groups differed in incidence of aversive water-related experience before fear onset. Parents usually believed that children's fear was present at first contact. In both samples, we found parent-offspring and sibling resemblances in fear. Analysis of details of children's contact with parents suggested that social learning within the family decreased water fear rather than increasing it; when both child and parent showed fear, that was as likely to reflect genetic influences as modeling. Young children's water fear forms part of a generic cluster, fear of the Unknown or Danger, while in adults it becomes independent of generic fears.
Mental health of hospital consultants.
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Pre- and postimplantation dynamic mechanical properties of silastic HP-100 finger joints.
Dynamic mechanical properties of Silastic HP-100 finger joint implants were studied. Sixteen sections of unimplanted and 14 sections of retrieved implants were analyzed with standard thermal analysis techniques. Results show that implantation does not alter the viscoelastic properties of Silastic HP-100 elastomers. The authors conclude that fracture of Silastic HP-100 implants cannot be attributed to changes in rheologic properties of the implanted elastomer.
Histopathologic features seen with different animal models following cutaneous sulfur mustard exposure.
In an effort to understand the pathophysiology of sulfur mustard (2,2' dichlorodiethyl sulfide, HD)-induced cutaneous lesions, a number of animal models have been used. Animal models have been and will continue to be used in the development of therapeutic strategies to protect against and/or moderate lesions, and to potentiate wound healing after HD exposure. Upon reviewing the histopathologic features seen after HD-exposure, we propose roles for different animal models in HD-research. Hematoxylin and eosin slides from protocols done originally as dose response studies for either liquid or vapor HD-exposures were examined. The animal models reported include the hairless guinea pig (HGP), weanling pig (WP), mouse ear (ME) and hairless mouse (HM). In all these animal models. HD induces subepidermal blister formation as well as epidermal cell death. The HGP appears to be the most sensitive model for epidermal necrosis. The HGP and, to a lesser degree, the HM react with a marked neutrophilic infiltrate. The ME provides a quantitative measure for HD effects and a mild inflammatory infiltrate similar to what is seen in human skin. Doses necessary to produce microblister formation in the WP are usually associated with more significant stromal and vascular changes than in other animal models. In addition to a quantitative measure of the HD effect and a mild inflammatory response, the cost, as well as the availability of specific antibodies, and DNA and RNA probes and primers gives the ME advantages for both drug screening and for the study of the pathophysiology of HD-induced cutaneous lesions. The sensitivity of the HGP and the abundant experience with vapor exposures establishes a place for this animal model in barrier cream and drug screening. The similarity of WP skin to human skin is important in the study of wound healing after HD exposure, as well as in the study of the pathophysiology of the cutaneous lesion and in more definitive therapeutic studies.
Acute pulmonary oedema complicating laryngospasm.
Pulmonary oedema is an uncommon but important complication of laryngeal spasm which in turn occurs more commonly in ENT practice than in most other surgical specialties. A case is reported and the literature reviewed, with particular reference to the proposed pathophysiological mechanism of this phenomenon.
Surgical aspects of paediatric cochlear implantation.
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Sympathetic response during cardiopulmonary bypass: mild versus moderate hypothermia.
OBJECTIVE: To determine the sympathetic response during cardiopulmonary bypass at mild (34 degrees C) and moderate (28 degrees C) hypothermia. DESIGN: A randomized study. SETTING: Tertiary university hospital. PATIENTS: Adults undergoing elective coronary artery bypass graft surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Plasma norepinephrine, epinephrine, and neuropeptide Y concentrations were measured. Moderate, but not mild, hypothermic cardiopulmonary bypass evoked a significant sympathetic response with increases in plasma norepinephrine and neuropeptide Y concentrations. A significantly higher incidence of postoperative atrial fibrillation was also observed in the moderate hypothermic compared with the mild hypothermic group. CONCLUSIONS: Our results indicate that the degree of hypothermia significantly influences the sympathetic response during cardiopulmonary bypass. The higher incidence of postoperative atrial fibrillation in the moderate hypothermic group suggests that the enhanced sympathetic response might be one contributing factor in the development of atrial fibrillation.
Congenital malformations of the ear and cochlear implantation in children.
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Piperacillin-tazobactam as empiric monotherapy in febrile neutropenic patients with haematological malignancies.
The efficacy of piperacillin-tazobactam as first line empiric therapy was assessed in 54 febrile neutropenic episodes in 42 patients (27 male, 15 female) with haematological malignancy. Nineteen (35%) episodes were bacteraemias (15 Gram-positive, 4 Gram-negative), 5 (9%) were clinically documented (Hickman line sites) and 30 (56%) were pyrexias of unknown origin. Study therapy was initiated after a median of 4 days of neutropenia (range 1-30). Eighteen (33%) episodes responded to piperacillin-tazobactam without a need for treatment modification. Four (7%) episodes initially responded to piperacillin-tazobactam but required treatment modification for fungal superinfection. Of the 19 bacteraemias, 6 (32%) were eradicated or presumed eradicated by piperacillin-tazobactam. Of the 32 (60%) episodes which failed to respond to piperacillin-tazobactam, 11 (34%) responded to anti-fungal therapy; 14 (44%) responded to a glycopeptide and 5 (16%) responded to a second-line broad spectrum antibacterial agent. Two (6%) patients died, both in the presence of progressive malignancy. There was no significant toxicity associated with piperacillin-tazobactam. We conclude that piperacillin-tazobactam is effective as empiric monotherapy in neutropenic fever and may reduce the requirement for glycopeptides.
FACCT (Foundation for Accountability): a large measure of quality.
The founders of the Foundation for Accountability (FACCT) believe that the people who buy and use healthcare should hold the system accountable for its performance. Here's what this group is doing to articulate the interests of consumers and purchasers in acquiring better information about healthcare quality.
Using a reflective model of nursing and guided reflection.
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