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Biomedical subjects

J Kennedy

Publications and source records attributed to J Kennedy.

At least 19 recordsLinked to original sources
PubMed2006

The clinical features, MRI findings, and outcome of optic neuritis in children.

BACKGROUND: Optic neuritis (ON) in childhood is thought to be more likely bilateral and less likely to lead to multiple sclerosis (MS) vs ON in adults. METHODS: The authors evaluated clinical features, maximal visual deficit and recovery, visual evoked potentials (VEPs), neuroimaging, and outcome in a cohort of children with ON. RESULTS: Records of 36 children (female/male ratio 1.6), ages 2.2 to 17.8 (mean 12.2) years, were reviewed. ON was unilateral in 58% and bilateral in 42%. Maximal visual deficit was severe in 69%, but full recovery occurred in 39 of 47 affected eyes (83%). VEPs were abnormal in 88%. Neurologic abnormalities in addition to those associated with ON were documented in 13 children. Neuroimaging studies of the optic nerve were abnormal in 55%. Brain MRI in 35 children demonstrated white matter lesions separate from the optic nerves in 54%. Follow-up is 2.4 years (0.3 to 8.3 years). To date, 13 children (36%) have been diagnosed with MS and 1 has Devic disease. Bilateral ON was more likely to be associated with MS outcome (p = 0.03). All 13 children with MS had white matter lesions on brain MRI. None of the children with a normal brain MRI have developed MS to date. CONCLUSIONS: Contrary to expectations, optic neuritis (ON) in childhood was more likely to be unilateral, multiple sclerosis (MS) risk was high (36% at 2 years), and bilateral rather than unilateral ON was associated with a greater likelihood of MS. Clinical findings extrinsic to the visual system on baseline examination (p < 0.0001) and MRI evidence of white matter lesions outside the optic nerves (p < 0.0001) were strongly correlated with MS outcome.

Adolescent↗
PubMed2006

Eye-hand co-ordination skills in very preterm infants <29 weeks gestation at 3 years: Effects of preterm birth and retinopathy of prematurity.

INTRODUCTION: Preterm infants are known to have low gross motor and fine motor skills. We questioned whether poor eye-hand coordination skills are associated with moderate to severe stages of Retinopathy of Prematurity (ROP). AIMS: The aim of this study was to examine development, with specific reference to eye-hand coordination skills, among preterm infants <29 weeks gestation with different stages of ROP at 3 years of age. METHODS AND MATERIALS: Fifteen preterm infants (<29 weeks gestation) who developed Stage 3 ROP were matched for gestation, birthweight and gender with infants who developed Stage 2 and Stage 1/no ROP. Developmental (Griffiths Mental Development Scales and Peabody Developmental Motor Scales) and ophthalmic assessments in the 3 matched groups of 15 were performed at 3 years of age. RESULTS: 1) Whilst the eye-hand coordination scores and Peabody fine motor scores were lower in the Stage 3 ROP group, they were not significantly lower than the other ROP groups. 2) Locomotor, Peabody gross motor skills and hearing and speech were significantly lower in the infants with Stage 3 ROP. The other developmental domains were not significantly different to the severe ROP group. 3) All 3 groups (of preterm infants) had lower eye-hand coordination and Peabody fine motor scores compared to test norms. 4) There were 8 of 15 infants with Stage 3 ROP who developed moderate visual problems by 3 years of age. CONCLUSION: In preterm infants, low eye-hand coordination/fine motor scores are likely to be due to their extreme prematurity.

Child, Preschool↗
PubMed2006

Age at onset of multiple sclerosis may be influenced by place of residence during childhood rather than ancestry.

Multiple sclerosis (MS) most commonly affects individuals of Northern European descent who live in countries at high latitude. The relative contributions of ancestry, country of birth and residence as determinants of MS risk have been studied in adult MS, but have not been explored in the pediatric MS population. In this study, we compare the demographics of pediatric- and adult-onset MS patients cared for in Toronto, Ontario, Canada, a multicultural region. The country of birth, residence during childhood, and ancestry were compared for 44 children and 573 adults. Our results demonstrate that although both the pediatric and adult cohorts were essentially born and raised in the same region of Ontario, Canada, children with MS were more likely to report Caribbean, Asian or Middle Eastern ancestry, and were less likely to have European heritage compared with individuals with adult-onset MS. The difference in ancestry between the pediatric and adult MS cohorts can be explained by two hypotheses: (1) individuals raised in a region of high MS prevalence, but whose ancestors originate from regions in which MS is rare, have an earlier age of MS onset, and (2) the place of residence during childhood, irrespective of ancestry, determines lifetime MS risk -- a fact that will be reflected in a change in the demographics of the adult MS cohort in our region as Canadian-raised children of recent immigrants reach the typical age of adult-onset MS.

Adolescent↗
PubMed2006

Synchronized, interactive teleconferencing with digital cardiac images.

St James's Hospital is a tertiary referral center for percutaneous intervention and cardiothoracic surgery for a number of referring hospitals. This article reports on the development and implementation of a synchronized, interactive teleconferencing system for cardiac images that links St. James's Hospital with a remote site (Sligo General Hospital) and overcomes the problems of transmission of large image files. Teleconferencing was achieved by setting up lossless auto transmission of patient files overnight and conferencing the next morning with linked control signals and databases. As a suitable product was not available, a commercially new software was developed. The system links the imaging databases, monitors and synchronizes progress through imaging sequences, and links a range of image processing and control functions. All parties to the conference are ensured that they are looking at the same images as they are played or at specific aspects of an image that the other party is highlighting. The system allows patient management decisions to be made at a weekly joint teleconference with cardiothoracic surgeons and interventional cardiologists from both sites. Rapid decision making was facilitated with 70% of decisions obtained within 24 h, and 88% within 1 week of their procedure. In urgent cases, data can be transmitted within 20 min of the diagnostic procedure. The system allows increased access to angiography for patients living in rural areas, and provides a more focused referral for revascularization. Participation of the referring cardiologist has improved the quality of decision making.

Academic Medical Centers↗
PubMed2006

Resurfacing the nasomaxillary cavity for management of epistaxis in Osler-Rendu-Weber disease.

Recurrent massive epistaxes due to heriditary haemorrhagic telangectasia were managed in two patients by ablation of the mucosa of the nasal and maxillary cavities and resurfacing with radial forearm fasciocutaneous free flaps. Both patients had undergone multiple procedures attempting to control the epistaxes prior to the definitive procedures described. Both patients remained epistaxis free postoperatively and retained their nasal airways. Olfactory function was preserved in the second patient due to preservation of the superior turbinate and cribriform olfactory mucosa.

Aged↗
PubMed2006

Standard data model representation for taxonomic information.

The names used by biologists to label the observations they make are imprecise. This is an issue as workers increasingly seek to exploit data gathered from multiple, unrelated sources on line. Even when the international codes of nomenclature are followed strictly the resulting names (Taxon Names) do not uniquely identify the taxa (Taxon Concepts) that have been described by taxonomists but merely groups of type specimens. A standard data model for exchange of taxonomic information is described. It addresses this issue by facilitating explicit communication of information about Taxon Concepts and their associated names. A representation of this model as a XML Schema is introduced and the implications of the use of Globally Unique Identifiers discussed.

Classification↗
PubMed2006

Clinicopathologic factors predicting complete pathological response to neoadjuvant chemoradiotherapy in esophageal cancer.

Multimodal therapy comprising neoadjuvant chemotherapy and radiation therapy prior to radical resection is increasingly utilized in gastroesophageal cancer. The achievement of a complete pathological response (pCR) or a major response is associated with an improved survival. However, up to 70% of patients show an incomplete or no response to the neoadjuvant regimen, and the identification of factors which predict a response would be of considerable clinical benefit. A retrospective analysis of a prospectively updated esophageal cancer database was performed. The predictive values of the following clinicopathological factors were investigated: age, sex, tobacco, alcohol, weight, clinical history, tumor type, site, length, width, morphology and differentiation. Statistical analysis was performed using Chi-square test with Pearson's test or Kruskal-Wallis test. One hundred and seventy-six patients were identified who had undergone neo-adjuvant chemoradiotherapy at St James's Hospital Dublin, between January 1990 and June 2003. A complete pathological response was seen in 40 cases (23%). There was a significant (P < 0.05) relationship between response to chemoradiotherapy and pretreatment tumor length. The median tumor length in the pCR group was 2 cm (1-5 cm) compared with 3 cm (2-7 cm) in non-responders (P < 0.05). Body weight, sex, tobacco or alcohol usage, tumor site, or differentiation were not predictive of response, although a trend (P = 0.08) was observed for squamous cell cancer compared with adenocarcinoma. Smaller tumor length was predictive of a greater response to chemotherapy and radiation therapy. This may reflect different tumor biology, perhaps with acquired resistance to treatment-induced apoptosis in the larger tumors. A simpler explanation is that the existing dose and treatment schedule for combination chemoradiotherapy is suboptimal in patients with larger tumors.

Adenocarcinoma↗
PubMed2006

Inter- and intra-rater reliability for classification of medication related events in paediatric inpatients.

BACKGROUND: In medication safety research studies medication related events are often classified by type, seriousness, and degree of preventability, but there is currently no universally reliable "gold standard" approach. The reliability (reproducibility) of this process is important as the targeting of prevention strategies is often based on specific categories of event. The aim of this study was to determine the reliability of reviewer judgements regarding classification of paediatric inpatient medication related events. METHODS: Three health professionals independently reviewed suspected medication related events and classified them by type (adverse drug event (ADE), potential ADE, medication error, rule violation, or other event). ADEs and potential ADEs were then rated according to seriousness of patient injury using a seven point scale and preventability using a decision algorithm and a six point scale. Inter- and intra-rater reliabilities were calculated using the kappa (kappa) statistic. RESULTS: Agreement between all three reviewers regarding event type ranged from "slight" for potential ADEs (kappa = 0.20, 95% CI 0.00 to 0.40) to "substantial" agreement for the presence of an ADE (kappa = 0.73, 95% CI 0.69 to 0.77). Agreement ranged from "slight" (kappa = 0.06, 95% CI 0.02 to 0.10) to "fair" (kappa = 0.34, 95% CI 0.30 to 0.38) for seriousness classifications but, by collapsing the seven categories into serious versus not serious, "moderate" agreement was found (kappa = 0.50, 95% CI 0.46 to 0.54). For preventability decision, overall agreement was "fair" (kappa = 0.37, 95% CI 0.33 to 0.41) but "moderate" for not preventable events (kappa = 0.47, 95% CI 0.43 to 0.51). CONCLUSION: Trained reviewers can reliably assess paediatric inpatient medication related events for the presence of an ADE and for its seriousness. Assessments of preventability appeared to be a more difficult judgement in children and approaches that improve reliability would be useful.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Risk of ventriculoperitoneal shunt infections due to gastrostomy feeding tube insertion in pediatric patients with brain tumors.

OBJECTIVE: To determine the risk of ventriculoperitoneal (VP) shunt infections after percutaneous retrograde gastrostomy feeding tube (GT) placement in children with brain tumors. PATIENTS AND METHODS: All children (age 0-18 years) with primary brain tumors diagnosed and treated at the Hospital for Sick Children, Toronto, Canada, were subjected to a retrospective analysis. Two groups were identified: the study group included children with a VP shunt and a GT; the control group included children with VP shunts only. Each study patient was matched with 2 controls to compare the rate of infections (cohort comparative study). RESULTS: There were 1,167 children diagnosed and treated with primary brain tumors during the study period (1988-2003); 174 (15%) had a VP shunt and 23 (2%) children had both, a VP shunt and a GT. In the study group (n=17), GTs were inserted at a median time of 80 days (range 6-204 days) after VP shunts. VP shunt infection rate was 23.5% (4/17) compared to 8.8% (3/34) in the control group (OR 3.18; 95% CI 0.622-16.54, p=0.16). Three (75%) of the infection episodes in the study group presented with an ascending VP shunt infection directly related to the GT insertion or manipulation in the first 6 weeks. These GTs were inserted at 13, 47 and 49 days after VP shunt insertion. CONCLUSION: Placement of percutaneous retrograde GTs, in the acute phase, in children with brain tumors and VP shunts may increase the risk of ascending meningitis especially if there are early GT-related complications.

Adolescent↗
PubMed2005

Simultaneous carotid endarterectomy and coronary artery bypass surgery in Canada.

Stroke neurologists are commonly asked to review patients who require coronary artery bypass grafting (CABG) but who also have comorbid severe carotid stenosis; such patients may be offered simultaneous carotid endarterectomy (CEA). In Canada, 0.51% of CABG procedures were combined CEA-CABG. The adjusted stroke and death rate was 2.67-fold greater in the combined CEA-CABG group compared to CABG alone. Randomized trials of the combined procedure are needed.

Brain Ischemia↗
PubMed2005

A disorder resembling pseudoachondroplasia but without COMP mutation.

Pseudoachondroplasia (PA) is an autosomal dominant skeletal dysplasia characterized by disproportionate short stature, generalized ligamentous laxity, irregular epi-metaphyseal ossification, and vertebral anomalies that regress with age. It usually manifests in the second year of life or later. The clinically and radiographically variable disorder is caused by mutations in the COMP gene. Parental gonadal mosaicism may lead to recurrence of the disorder in children of unaffected parents. Here, we describe sibs with bone changes similar to those seen in very severe PA born to clinically and radiographically unaffected parents. Sequencing of all 19 exons of the COMP gene failed to disclose a mutation. The sibs appear to be affected by a disorder resembling PA but resulting from a defect of an extracellular matrix protein other than COMP. It may be suspected in patients with unusually severe dwarfism, severe epi-metaphyseal abnormalities, and persistent platyspondyly.

Achondroplasia↗
PubMed2005

An investigation of the thermal inactivation of Staphylococcus aureus and the potential for increased thermotolerance as a result of chilled storage.

AIMS: The aims of this study were; (i) to provide thermal inactivation data for Staphylococcus aureus; (ii) to examine the kinetics, including decimal reduction times (D-value) and rate constants (k), that describe the thermal inactivation of Staph. aureus and to compare two different methods of calculating D-values and (iii) to determine whether or not chilled storage would toughen these microorganisms resulting in increased thermotolerance. METHODS AND RESULTS: Isolates of Staph. aureus recovered from domestic refrigerators were grown in shaken culture for 8 h at 37 degrees C, recovered and washed by centrifugation and combined to form a cocktail of five strains. Samples from this cocktail were (a) heat treated at 50, 55 and 60 degrees C or (b) held under simulated domestic refrigeration conditions for 72 h and then heat treated as above. The numbers of Staph. aureus in heat treated and chill held, heat treated samples were enumerated by direct selective plating onto Baird Parker Agar (BPA) and recovery plating on Tryptone Soya Agar (TSA) subsequently overlaid with BPA. D-values were obtained using two different methods both of which may be used when the thermal inactivation follows first order kinetics. In the first method D-values are obtained by plotting the Log(10) of the surviving cells against time and using the equation D = -1/slope. The second method uses the rate constant (k) which is obtained from the slope of a plot of ln N/N(0)vs time and D is obtained using the equation D = 2.303 k(-1). D(50), D(55) and D(60) values ranged from 94.3 to 127.9 min, 13 to 21.7 min and 4.8 to 6.5 min. Prechilling did not enhance thermal resistance. The method of calculation did not affect the D-values obtained because the thermal inactivation of Staph. aureus in this study followed first order kinetics with r(2) values of 0.91-0.99. CONCLUSIONS: The thermal inactivation of Staph. aureus in tryptone soya broth (TSB) follows first order kinetics and in general chilling of these bacteria does not increase the resistance to thermal destruction during subsequent thermal processes such as cooking. SIGNIFICANCE AND IMPACT OF THE STUDY: This study provides much needed data on the thermal resistance of Staph. aureus and validates chilling as a food storage activity which does not cause toughening of the microorganisms to subsequent cooking. However, the data generated strongly suggests that Staph. aureus is more thermotolerant than Listeria monocytogenes and should be used as the target microorganism in designing mild thermal treatments for food, in which case the current recommendations for pasteurization (70 degrees C for 2 min, minimum) should be revised.

Colony Count, Microbial↗
PubMed2005

Food safety knowledge of consumers and the microbiological and temperature status of their refrigerators.

The objectives of this study were to examine domestic food safety knowledge levels of consumers, establish the levels and incidence of bacterial contamination and operational temperatures in domestic refrigerators, and identify areas in which consumer food safety education is necessary in Ireland. A food safety knowledge questionnaire applied to a representative sample of households (n = 1,020) throughout the island of Ireland found the gaps in consumer food safety knowledge. Analysis of swab samples (n = 900) recovered from the domestic refrigerators in these households showed average total viable counts of 7.1 log CFU/cm2 and average total coliform counts of 4.0 log CFU/cm2. Analysis of swab samples also detected the incidence of Staphylococcus aureus (41%), Escherichia coli (6%), Salmonella enterica (7%), Listeria monocytogenes (6%), and Yersinia enterocolitica (2%). Campylobacter jejuni and E. coli O157:H7 were not detected in domestic refrigerators. The temperature profiles of a subset of the sampled refrigerators (100) were monitored for 72 h, and 59% were found to operate, on average, at temperatures above the recommended 5 degrees C. Knowledge and temperature survey results varied considerably, but consumers who scored better in terms of basic food safety knowledge had reduced levels of bacterial contamination in their refrigerators and reported a reduced incidence of food-associated illnesses. This study confirms the effect of basic food hygiene knowledge on hygienic practice and identifies specific areasfor emphasis in the development and delivery of effective food safety risk communication messages to consumers.

Adolescent↗
PubMed2003

Multilaboratory comparison of proficiencies in susceptibility testing of Helicobacter pylori and correlation between agar dilution and E test methods.

Susceptibility testing was performed at seven Canadian microbiology laboratories and the Helicobacter Reference Laboratory, Halifax, Nova Scotia, Canada, to assess susceptibility testing proficiency and the reproducibility of the results for clarithromycin and metronidazole and to compare the Epsilometer test (E test) method to the agar dilution reference method. Control strain Helicobacter pylori ATCC 43504 (American Type Culture Collection) and 13 clinical isolates (plus duplicates of four of these strains including ATCC 43504) were tested blindly. The National Committee for Clinical Laboratory Standards (NCCLS) guidelines for agar dilution testing were followed, and the same suspension of organisms was used for agar dilution and E test. Antimicrobials and E test strips were provided to the investigators. Methods were provided on a website (www.Helicobactercanada.org). Each center reported MICs within the stated range for strain ATCC 43504. Compared to the average MICs, interlaboratory agreements within 2 log(2) dilutions were 90% (range, 69 to 100%) for clarithromycin by agar dilution, with seven very major errors [VMEs], and 85% (range, 65 to 100%) by E test, with three VMEs. Interlaboratory agreements within 2 log(2) dilutions were 83% (range, 50 to 100%) for metronidazole by agar dilution, with six VMEs and eight major errors (MEs), and 75% (range, 50 to 94%) by E test, with four VMEs and four MEs. At lower and higher concentrations of antibiotic, E test MICs were slightly different from agar dilution MICs, but these differences did not result in errors. When a standardized protocol based on NCCLS guidelines was used, most participants in this study correctly identified clarithromycin- and metronidazole-susceptible and -resistant strains of H. pylori 93% of the time by either the agar dilution or E test method, and the numbers of errors were relatively equivalent by both methods.

Clarithromycin↗
PubMed2003

Effect of genetic merit and concentrate supplementation on grass intake and milk production with Holstein Friesian dairy cows.

A total of 48 high genetic merit (HM) and 48 medium merit (MM) cows, each given a low (LC), medium (MC), or high (HC) level of concentrate supplementation, were used in a split-plot design experiment, which was run in three consecutive years, to evaluate animal production responses. Individual cow intakes were estimated twice each year while at pasture; measurement period 1 (MP1) was in May/June, and measurement period 2 (MP2) was in early September, corresponding on average to d 110 and 200 of lactation, respectively. In MP1, cows were offered 0 (LC), 3 (MC), and 6 kg (HC), whereas in MP2 the levels were 0 (LC), 0 (MC), and 4 kg (HC) of concentrate daily. Genotype had a significant effect on all milk production parameters in MP1 and MP2. The HM cows had the highest yield of milk, fat, protein, and lactose, whereas the MM cows had the highest milk fat, protein, and lactose concentrations. The HM cows had significantly higher grass dry matter intake (GDMI) estimates. In MP1, the average responses, per kg concentrate dry matter, was +1.10 kg of milk, +0.038 kg of protein, +0.032 kg of fat. The corresponding values in MP2 were +0.94 kg of milk, +0.037 kg of protein, and +0.025 kg of fat. The response to concentrate was linear and independent of preexperimental milk yield. In MP1, the partial regression coefficients relating daily GDMI to an increase in 1 kg of preexperimental milk yield (PMY), preexperimental BW (PBW), and concentrate intake (CI) were 0.123, 0.006, and -0.54, respectively, whereas the corresponding values in MP2 were 0.190,0.007, and-0.444, respectively. This study indicates that with high yielding dairy cows, on gras only GDMI of 17 kg of supporting milk yield of 30-kg/d is achievable. In this scenario, concentrate supplementation will result in lower substitution rates, and higher milk yield response than previously published with lower yielding cows.

Animal Nutritional Physiological Phenomena↗
PubMed2003

Capillary electrophoresis for characterization of low molecular weight heparins.

In many instances, low molecular weight heparins (LMWH) have replaced unfractionated heparins for prevention and treatment of venous thromboembolism. Each LMWH is a specific compound with its own physicochemical and pharmacological properties. These properties are critical in determining the therapeutic efficacy of the product. In recent times, capillary electrophoresis (CE) has emerged as a means of analytical separation of biological molecules. There are few reports, however, detailing the separation of whole heparins by capillary electrophoresis. This paper reports the use of CE to characterize LMWH without prior oligosaccharide release, labeling, or derivatization. The paper also focuses on the advantages of CE separation for the monitoring of product consistency.

Electrophoresis, Capillary↗