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Biomedical subjects

J Latimer

Publications and source records attributed to J Latimer.

36 records · Page 2Linked to original sources

The nursing process re-examined: enrollment and translation.

The current paper proposes a different way of considering the nursing process. Extant theorizing of the nursing process as a framework to help teach or organize nursing is consistent with a 'diffusion model' of practice. In line with this view, it is assumed that a set of best practices can be assimilated by theorists and then, through a process of 'diffusion', implemented throughout hospitals and clinics (or wherever else nurses practise). Difficulties with implementing the nursing process are explained as due to inadequate resources, inadequate training or the 'context' of practice. The nursing process is considered in the current paper in relation to processes of 'enrolment' and 'translation'. As a model or framework the nursing process is both a technology and a set of artefacts through which nurses extend themselves in ways which help manage their interests and (re)constitute their identity. Rather than researching practice as if there is a model of nursing to which nurses should conform, a different view of the nursing process emerges as one in which nurses enrol, and are enrolled by, managerialist and performative devices in their organizing and identity work.

Communication↗

Systemic mucormycosis complicating acute renal failure: case report and review of the literature.

Mucormycoses is a fungus which increasingly has been reported as a cause of opportunistic infection during the last 40 years. This infection is most commonly associated with underlying predisposing conditions, particularly diabetic ketoacidosis, hematologic and other malignancies, steroid therapy, broad-spectrum antibiotic therapy, or various acquired and hereditary immunodeficient disease states. The present report is that of a previously healthy patient with acute renal failure secondary to a postviral rhabdomyolysis syndrome, who received corticosteroids and developed unsuspected and undiagnosed systemic mucormycosis. Autopsy revealed that he died as a consequence of a massive pulmonary hemorrhage due to disseminated invasive mucormycosis, involving both the lungs and kidneys. A review of the literature reporting disseminated mucormycosis in association with renal failure is provided. Mucormycosis should be considered in immunocompromised patients with renal failure and fevers of unknown origin so that early diagnosis and prompt surgical and medical therapy may be instituted.

Acute Kidney Injury↗

Consistent occurrence of hemagglutinin variants among avian influenza virus isolates of the H7 subtype.

Several field isolates of avian influenza virus of the H7 subtype were analyzed for the presence of hemagglutinin variants by labeling proteins in cells infected with virus clones, and reacting with monoclonal antibodies. Each strain was shown to contain two distinct electrophoretic variants of the uncleaved hemagglutinin. In the A/Tk/Ore/71 (H7N3) isolate, two variants remained in the population through 35 laboratory passages, indicating both are stable and may be important to expression of the viral phenotype. Nucleotide sequence analysis of the HA gene of these two variants demonstrated differences at several amino acid positions in the HA1 subunit including one glycosylation site. Three additional recent North American isolates were also each found to contain two electrophoretic variants occurring within populations as few as one embryo passage away from the original clinical specimen. Pulse-chase assays indicated none of the variant HA molecules were cleavable in chick embryo fibroblasts. In the highly pathogenic Australian isolate; A/Ck/Victoria/75, both HA variants are cleavable in fibroblasts, without added trypsin, and the differences are localized within the HA1 region. With all the strains tested, the slower migrating HA variant was associated with a consistently higher hemagglutinin titer in embryos. Finally, recent H7 isolates from imported birds (A/Soft Bill/Ill/92) also exhibit similar variants, indicating their occurrence is not limited to domestic poultry. This consistent presence of two distinct electrophoretic variants in several avian H7 isolates suggests multiple allelic forms of the H7 hemagglutinin.

Animals↗

Abductor digiti minimi transfer for the restoration of opposition in children.

Abductor digiti minimi transfer was used to restore opposition in 20 patients, the majority suffering from congenital anomalies of the hand. The transfer was shown to be effective in restoring abduction, but less effective in restoring the rotational component of opposition in these cases. The donor site was critically reviewed and found to be acceptable. The surgical techniques and benefits of this transfer are reviewed.

Adolescent↗

Management of the third stage of labour in women at low risk of postpartum haemorrhage.

OBJECTIVE: To compare active management with physiological management of the third stage of labour in women at low risk of postpartum haemorrhage. DESIGN: Randomised allocation of women in labour at low risk of postpartum haemorrhage to either physiological or active management of the third stage. SETTING: Labour ward in a district general hospital. PATIENTS: 193 Women with spontaneous vaginal delivery at term completed the study. Exclusion criteria were induction or augmentation of labour, antepartum or previous postpartum haemorrhage, premature rupture of membranes, previous caesarean section, raised blood pressure, cervical lacerations and third degree tears. INTERVENTIONS: Active management with syntometrine and controlled cord traction; or physiological management, where the cord was not clamped and the placenta was delivered by maternal effort. MEASUREMENTS: Blood loss was measured subjectively at delivery and estimated objectively by comparing the haemoglobin in labour with that on the third postpartum day. The duration of the third stage was also measured as was the incidence of retained placenta and blood transfusion. RESULTS: There was no significant difference in the estimated blood loss or haemoglobin drop between the two groups (P > 0.5). In addition the duration of the third stage was significantly longer in the physiological group (P < 0.001). Out of 90 women having physiological management, 7 received oxytocics for presumed postpartum haemorrhage. Only one case in the active group required further oxytocics and one other case in this group required a manual removal of placenta. CONCLUSIONS: This preliminary study confirms that active management results in a reduction in the length of the third stage of labour. However, it suggests that active management does not reduce blood loss when compared to physiological management in the woman at low risk of postpartum haemorrhage.

Delivery, Obstetric↗

The effect of manipulation on range of movement at the ankle joint.

Manipulation is commonly used by physiotherapists in the treatment of musculoskeletal disorders; however, there have been few studies evaluating its use in peripheral joints. The purpose of this study was to investigate the effect of manipulation on dorsiflexion range of movement at the ankle joint. Twenty asymptomatic subjects participated, one ankle acting as the experimental ankle and receiving the manipulation intervention, while the other ankle acted as the control. The manipulation studied was a longitudinal talocrural manipulation. Dorsiflexion range of movement was measured at 5 consecutive torque levels pre and post manipulation intervention in the experimental ankle and pre and post no intervention in the control ankle. These values were compared using analysis of trend within an analysis of variance framework. There was no statistically significant change in dorsiflexion range of movement following manipulation. It was concluded that in the case of asymptomatic subjects these results did not provide support for the experimental hypothesis that a single talocrural manipulation alters dorsiflexion range of movement. It was suggested that future research investigate the effects of manipulation in a symptomatic population.

Adult↗

Identification of a genetic locus of Haemophilus influenzae type b necessary for the binding and utilization of heme bound to human hemopexin.

The mechanism(s) used by Haemophilus influenzae to acquire the essential nutrient heme from its human host has not been elucidated. The heme carried by the high-affinity serum protein hemopexin is one potential source of this micronutrient in vivo. A colony-blot assay revealed that heme-human hemopexin-binding activity was shared among most capsular serotype b strains of H. influenzae but was uncommon among other strains. We have identified a recombinant clone binding heme-human hemopexin from a H. influenzae type b (Hib) genomic library expressed in Escherichia coli. Both the Hib strain and the heme-hemopexin-binding clone expressed a polypeptide of approximately 100 kDa that bound radiolabeled heme-hemopexin. Oligonucleotide linker insertion mutagenesis of the plasmid DNA from this recombinant clone was used to confirm that expression of the 100-kDa protein correlated with the heme-hemopexin-binding activity. Exchange of one of these mutant alleles into the Hib chromosome eliminated expression of both the 100-kDa protein and the heme-hemopexin-binding activity. Furthermore, this Hib mutant was unable to utilize heme-human hemopexin as a heme source.

Bacterial Proteins↗

An independent application accuracy evaluation of stereotactic frame systems.

The purpose of incorporating stereotactic methodology into neurosurgical procedures is to consistently achieve a high degree of accuracy and precision in localizing intracranial targets. Therefore, the limits of resolution for the therapeutic intervention itself are a function of the accuracy and precision inherent to the particular stereotactic frame system itself. The total clinically relevant error (application accuracy) comprises errors associated with each procedural step, including imaging, target selection, vector calculation and the mechanical errors of stereotactic frames. To evaluate these parameters, a systematic error analysis was carried out in the 4 most commonly used CT-compatible stereotactic devices: the Brown-Roberts-Wells, Cosman-Roberts-Wells, Kelly-Goerss Compass (modified Todd-Wells) and Leksell frames. Over 7,681 independent test measurements were made. The results suggest a potentially significant degree of error in application accuracy of all stereotactic instrumentation which is accentuated by imaging-associated error. These individual error values must be considered with every clinical use of stereotactic frames.

Humans↗

Support services in Canadian schools for the hearing impaired: 10 years later.

In January of 1977, a questionnaire regarding existing and desired professional support services was distributed to 20 schools for the hearing-impaired across Canada. Respondents were requested to provide information pertaining to the last few months of 1976. In December of 1986, a similar questionnaire was distributed to these schools, in order to update the information received 10 years earlier, and to compare current services to those desired 10 years ago. The survey also presented an opportunity to examine changes in focus, client population and number of schools for the hearing impaired in Canada. Despite the disparity between available and needed services in the schools, as well as the differences in support staff between them, it is clear that the schools are, for the most part, fairly well staffed by a good range of professionals. There is, however, a continued need for the review of current and future needs. The change from residential to day students, as well as the increase in the number of additionally handicapped students, requires changes in and re-assessment of support services. Continued research may assist in defining priorities in the area of support services as the needs of the schools change over time.

Audiology↗

Evaluation of 9-chloro-9-[4-(diethylamino)phenyl]- 9,10-dihydro-10-phenylacridine hydrochloride (C-390) in broth and agar media for identification of Pseudomonas aeruginosa.

Brain heart infusion broth and Mueller-Hinton agar containing the compound 9-chloro-9-[4-(diethylamino)phenyl]- 9,10-dihydro-10-phenylacridine hydrochloride (C-390) were evaluated as selective media for identifying Pseudomonas aeruginosa. Of the 192 Pseudomonas spp. and 68 additional oxidase-positive or glucose-nonfermenting gram-negative organisms tested, only P. aeruginosa (120 of 121 isolates) and certain strains of Pseudomonas cepacia, Aeromonas hydrophila, and Achromobacter xylosoxidans were able to grow in brain heart infusion broth containing 15 micrograms of C-390 per ml. When production of green or yellow-green pigment after overnight growth on Mueller-Hinton agar containing 30 micrograms of C-390 per ml was used as the criterion for identification, only P. aeruginosa produced a positive test (96% sensitivity and 100% specificity). The agar medium, therefore, can provide a single differential medium for the overnight identification of P. aeruginosa.

Acridines↗

Linkage of cystic fibrosis locus and polymorphic DNA markers in 14 families.

Linkage relationships between the cystic fibrosis (CF) locus and three polymorphic DNA markers were examined in 14 families, five of which were of Hispanic origin. Tight linkage was found between the CF locus and MET (maximum lod score = 7.16 at theta = .001), and between CF and pJ3.11 (maximum lod score = 3.87 at theta = .001). We observed two recombinations between CF and collagen, yielding a maximum lod score of 0.359 at theta = .125, and one recombination in the cluster CF-MET-pJ3.11. Analysis by the seriation method indicates the order COL-pJ3.11-CF-MET.

Cystic Fibrosis↗

Patency and reintervention rates during routine TIPSS surveillance.

PURPOSE: To assess the medium-term outcome of transjugular intrahepatic portosystemic stent shunts (TIPSS) by measuring the incidence of shunt obstruction or failure during routine surveillance and the number of interventions performed. METHODS: This is a retrospective study covering a 4-year period, from 1992 to 1996, during which 102 TIPSS procedures were performed. Indications for treatment were variceal bleeding (76%) and refractory ascites (24%). Follow-up protocol after TIPSS included transfemoral or transjugular portal venography and measurement of portosystemic pressure gradient (PPG) at 3 months, 12 months, and then at yearly intervals. The results of the first 155 venograms on 62 patients (mean follow-up 14 months) have been reviewed and Kaplan-Meier analysis performed. RESULTS: One hundred and thirty-seven of 155 (88%) examinations showed patent shunts. Fifty-six of 137 (41%) of the patent TIPSS had elevated PPG with signs of stenosis. The majority (41/56) of shunt stenoses with elevated pressure gradients were related to neointimal hyperplasia in the hepatic venous aspect of the shunt. Interventions used to reduce the pressure gradient or to restore patency included: angioplasty (62/102 interventions), additional stents (21/102), a second TIPSS procedure (2/102), and thrombolysis or thrombectomy (4/102). The primary patency rate was 66% at 1 year (52% at 2 years). Primary assisted patency was 72% at 1 year (58% at 2 years). Secondary patency was 86% at 1 year (63% at 2 years). CONCLUSION: The majority of TIPSS shunts will remain patent when regular portal venography, with appropriate intervention, is undertaken. Although there is a high reintervention rate this mainly takes the form of balloon angioplasty.

Adult↗

An investigation of the relationship between low back pain and lumbar posteroanterior stiffness.

OBJECTIVE: To investigate the relationship between low back pain (LBP) and lumbar posteroanterior (PA) stiffness. DESIGN: A repeated-measures design was used to measure lumbar posteroanterior stiffness on two occasions in subjects with and without LBP. SUBJECTS: Twenty-five subjects with acute or subacute LBP and twenty-five pain-free subjects participated. Pain subjects reported pain on the application of a manual PA force to the lumbar spine and had no contraindication to PA stiffness testing. Pain-free subjects reported no history of LBP requiring treatment, and obtained a score of 0 on the McGill Pain Questionnaire. METHODS: PA stiffness was measured in subjects with LBP when (a) they first presented with pain and (b) when pain had resolved by more than 80%. Pain-free subjects, matched with pain subjects on gender, age, vertebral level to be tested and time between tests, were also measured on two occasions, to control for the effects of repeated stiffness testing and the passing of time. RESULTS: In subjects with low back pain stiffness decreased by 1.21 N/mm between test 1 and test 2. A paired t test found a significant difference between the tests (t = 3.04, df = 24, p = .006). In subjects without pain, there was an increase in stiffness of 0.74 N/mm between test 1 and test 2; a paired t test found no significant difference between the tests (t = -1.673, df = 24, p = .107). CONCLUSIONS: Subjects with LBP showed increased PA stiffness compared with when they had little or no pain, whereas pain-free subjects showed unchanged PA stiffness over time.

Adult↗

Normal response to large posteroanterior lumbar loads--a case study approach.

OBJECTIVE: Characterization of the responses to spinal posteroanterior loading has involved measuring the gradient of the linear region of the force-displacement relationship between 30 N and 100 N of applied force. However, forces applied during manual assessment of stiffness may reach 300 N. This study investigated whether the force-displacement relation remains linear above 100 N. DESIGN: A single-case-study design with replication was used. SUBJECTS: Two male subjects, with no history of low back pain requiring treatment over the preceding twelve months, participated in this study. METHODS: Posteroanterior loads of 275 N were applied to the 1.3 vertebra of both subjects using a mechanical device. The force-displacement responses in these subjects were measured and analyzed to examine the linearity of the data. RESULTS: The responses from the two subjects were similar. In both cases, the responses were approximately linear at all levels of load up to 275 N. Because of the small degree of nonlinearity, there was a tendency for the stiffness to show moderate increases as the load increased. Stiffness was approximately 25% greater when calculated between 30 N and 275 N than when calculated between 30 N and 100 N. CONCLUSION: In these two subjects, the force-displacement relation was approximately linear for all three force intervals considered, although there was some increasing stiffness with increasing force.

Adult↗

The effects of high and low loading forces on measured values of lumbar stiffness.

OBJECTIVE: One explanation for the poor reliability of manual judgments of posteroanterior (PA) stiffness may be that if manual therapists use different forces when testing, different stiffness is perceived. This study was conducted to examine measurements of lumbar PA stiffness obtained using a device programmed to generate different loading forces. SUBJECTS: Twenty-five subjects with no history of low back pain and a mean age of 23.5 yr were measured. METHODS: Measures of lumbar PA stiffness were obtained using a mechanical device that applied a testing force of 200 N to the skin overlying the L3 spinous process. Six stiffness coefficients were determined from the force/displacement curve obtained from each subject by performing linear regressions from 30-80 N, 30-150 N, 30-200 N, and from 30-83.3 N, 83.3-136.7 N, and 136.7-200 N. Intraclass correlation coefficients and repeated measures analysis of variance were used to analyze the data. RESULTS: Although moderate reliability [ICC 2,1 = 0.67] was found for stiffness measures arising from increasingly wide force-interval regressions (30-80 N, 30-150 N, 300-200 N), poor reliability [ICC (2,1) = 0.39] was found for stiffness measures arising from same-width, higher force regressions (30-83.3 N, 83-137 N, 137-200 N). In both cases there were significant differences between the obtained K stiffness values corresponding to different force intervals. CONCLUSION: These results show that if therapists push harder, different stiffnesses will be felt. Studies using instrumental measurement of spinal stiffness to obtain 'K' values should report the force intervals used. Also, revised protocols for manually judging PA stiffness should ensure that stiffness is assessed by sampling specified force intervals rather than the raters determining their own force limits.

Adult↗