PubMed Health⌕ Search

Biomedical subjects

John Morton

Publications and source records attributed to John Morton.

15 recordsLinked to original sources

Choosing the lesser of two evils, the better of two goods: specifying the roles of ventromedial prefrontal cortex and dorsal anterior cingulate in object choice.

The ventromedial prefrontal cortex (vmPFC) and dorsal anterior cingulate cortices (ACd) are considered important for reward-based decision making. However, work distinguishing their individual functional contributions has only begun. One aspect of decision making that has received little attention is that making the right choice often translates to making the better choice. Thus, response choice often occurs in situations where both options are desirable (e.g., choosing between mousse au chocolat or crème caramel cheesecake from a menu) or, alternatively, in situations where both options are undesirable. Moreover, response choice is easier when the reinforcements associated with the objects are far apart, rather than close together, in value. We used functional magnetic resonance imaging to delineate the functional roles of the vmPFC and ACd by investigating these two aspects of decision making: (1) decision form (i.e., choosing between two objects to gain the greater reward or the lesser punishment), and (2) between-object reinforcement distance (i.e., the difference in reinforcements associated with the two objects). Blood oxygen level-dependent (BOLD) responses within the ACd and vmPFC were both related to decision form but differentially. Whereas ACd showed greater responses when deciding between objects to gain the lesser punishment, vmPFC showed greater responses when deciding between objects to gain the greater reward. Moreover, vmPFC was sensitive to reinforcement expectations associated with both the chosen and the forgone choice. In contrast, BOLD responses within ACd, but not vmPFC, related to between-object reinforcement distance, increasing as the distance between the reinforcements of the two objects decreased. These data are interpreted with reference to models of ACd and vmPFC functioning.

Adult↗

New Zealand's Christchurch Hospital at night: an audit of medical activity from 2230 to 0800 hours.

OBJECTIVE: To audit medical activity at Christchurch Hospital New Zealand between 2230 and 0800 hours; specifically, to measure the volumes of tasks requiring completion overnight and to identify the competencies required for this as well as the level of teamwork that existed. DESIGN: After a pilot study tested possible methods, Resident Medical Officers (RMOs) responsible for the care of adult patients at night were linked by a shift coordinator to recorders (mostly nursing students) trained to register the tasks performed, together with task urgency (as judged by the RMO) and duration. This information, checked each morning for completeness, was entered immediately into a database and analysed later. Telephonists logged all outbound calls through the hospital switchboard to on-call medical staff; theatre and admission records were recorded as usual. Anaesthetic and Radiology Registrar activity was self-recorded. SETTING: Christchurch Hospital is a 650 bed tertiary centre, which covers most specialties. MAIN OUTCOMES: In the absence of leadership, the RMOs were not working as a team. Consequently some were overextended while others were inactive. House officer tasks were largely generic--not specialty specific; there was no formal handover from the afternoon or day shifts and the level of hospital medical staffing did not reflect the activity levels over the time period studied. A review of the beep policy is urgently needed. A third of the admissions were to General Medicine, and basic medical activities (including admitting, reviewing, and prescribing drugs and fluids) for patients admitted under all specialties represented the majority of the night workload. Medical registrars had reduced some of the traditional multiple clerking by admitting patients themselves. The workload and its distribution over time was remarkably similar to that found at the 17 pilot sites in the United Kingdom, where Out of Hours Multidisciplinary Teams (OoHMT) were introduced. CONCLUSION: We recommend that Christchurch Hospital use these data to plan the composition and leadership of an OoHMT.

Hospitals, Public↗

Exhaled breath condensate nitrite/nitrate and pH in relation to pediatric asthma control and exhaled nitric oxide.

BACKGROUND: Combining exhaled breath condensate (EBC) and exhaled nitric oxide (eNO) may be a useful, non-invasive method to assess airway inflammation in pediatric asthma. This cross-sectional study evaluated the relationship of both EBC nitrite/nitrate (NOx) and EBC pH with asthma control and eNO in asthmatic, normal, and atopic children. METHODS: A total of 92 children were recruited, comprising 62 with asthma, 14 with atopy only, and 16 who were normal and non-atopic. All completed a questionnaire for asthma symptoms and control. Variables measured were spirometry, EBC NOx, pH, and eNO. RESULTS: EBC NOx in those with asthma (mean 8.4 microM, CI 7.5-9.4) was significantly elevated when compared with normal (4.8 microM, CI 3.4-6.2, P = 0.0007) and atopic children (6.5 microM, CI 4.0-9.1, P = 0.02). The mean level of eNO was significantly higher in those with asthma (43.7 ppb, CI 34.7-51.1, P < 0.001) and atopy (24 ppb, CI 16.7-31.2, P < 0.05) when compared with normal children (11.5 ppb, CI 6.7-16.2). There was a significantly lower pH in those with asthma and a FEV(1) < 80% predicted (P = 0.03), but no significant overall differences in EBC pH between the three groups of children. There was a significant correlation between eNO and EBC NOx in the group as a whole, but not between eNO and EBC pH. CONCLUSIONS: Mean EBC NOx levels differ between children with asthma, atopy, and those who are normal, but it is not interchangeable with eNO. EBC pH may be an additional marker of asthma control.

Asthma↗

Methamphetamine use following bariatric surgery in an adolescent.

Bariatric surgery is increasingly popular as a therapeutic strategy for morbidly obese adolescents. Adolescence represents a sensitive period of psychosocial development, and children with considerable weight loss may experience greater peer acceptance, accompanied by both positive and negative influences. Substance abuse exists as one of these negative influences. We present the case of an adolescent bariatric surgical patient who abused methamphetamines in the postoperative period, with consequent nutritional instability. A concerted effort must be made in the preoperative assessment of adolescent bariatric patients to delineate a history of illicit drug use, including abuse of diet pills and stimulants. Excessive postoperative weight loss or micronutrient supplementation non-compliance should raise a suspicion of stimulant use and appropriate screening tests should be performed. The consequent appetite suppression may manifest with signs of malnutrition such as bradycardia, hypotension, and weakness. Inpatient nutritional rehabilitation and psychiatric assessment should be considered.

Adolescent↗

Representative case series from public hospital admissions 1998 II: surgical adverse events.

AIMS: To examine a representative case series of surgical adverse events in New Zealand public hospitals with a view to assessing their occurrence, causation, patient impact and preventability. METHODS: An analysis was carried out on 326 surgical adverse events classified by reviewing physicians. These were identified from among 850 adverse events determined by two-stage retrospective review of a representative sample of 6579 medical records drawn from 13 public hospitals in 1998. RESULTS: From the four surgical categories--operative, fracture management, therapeutic, and system--there were 326 surgical adverse events, 38.4% of all adverse events identified. Surgical events had the same profile as adverse events overall. Four-fifths of surgical events were directly related to a surgical operation; these affected older patients and were less preventable than adverse events overall. A third of operative events were attributable to technical problems, another third to infections, with the remainder divided between haemorrhagic and cardiovascular complications. Therapeutic and system events had high preventability, and a significant proportion was related to delay in treatment. Half of events in fracture management were infection-related, patients were younger and, system events apart, had fewer extra bed days than other surgical events or events overall. The major causes of preventable events were avoidable delay in treatment (19.9%) and inadequate monitoring and supervision (13.6%), followed by personnel practising outside their expertise (8.0%) and inappropriate treatment (7.4%). CONCLUSIONS: On average, surgical events are associated with an extra 9.9 days in hospital, but they have a lower level of preventability than adverse events overall. Problems of infection, delay, and other aspects of the quality of care are identified for further consideration.

Adult↗

Risk factors for an intensive care unit admission in children with asthma.

An admission to an intensive care unit (ICU) with asthma is a marker of asthma severity and may be a precursor of asthma death. The aim of this study was to investigate risk factors for acute severe asthma needing an ICU admission. We hypothesized that children admitted to the ICU represent a severe phenotype with identifiable premorbid clinical features. The study was case-control in design. One hundred and forty-one children were studied. Seventy children admitted to the ICU and 71 children admitted to the general medical ward served as cases and controls, respectively. Children were aged between 1-16 years. They underwent skin prick allergy testing, and had a nasopharyngeal aspirate and serology performed to screen for respiratory pathogens. Their parents completed an asthma and allergy symptom questionnaire and the Newcastle Asthma Knowledge Questionnaire (NAKQ). On univariate analysis, an admission to the ICU was more likely in children with 1) "frequent episodic" or "persistent" background asthma; 2) three or more previous admissions for asthma; 3) one or more asthma admissions in the previous 12 months; 4) three or more presentations to the Emergency Department (ED) in the preceding 12 months; 5) three or more positive responses on skin prick allergy testing; 6) an elevated IgE level; 7) oxygen saturation on presentation < or =91%; 8) longer duration of asthma; 9) lower level of maternal education; 10) an admission during autumn; 11) three or more siblings; and 12) being prescribed antibiotics. Risk factors that remained significant on multivariate analysis were three or more presentations to the ED in the preceding 12 months (P=0.003), an elevated IgE level (P=0.01), oxygen saturation on presentation < or =91% (P=0.003), and longer asthma duration (P=0.02). ICU patients took longer to see a doctor and to commence oral steroids. No differences were found between cases and controls in the proportion taking preventer therapy (58% vs. 52%), provided with a written asthma action plan (32% vs. 25%), or in whom spirometry or peak flow was measured (28% vs. 42%). However, rates were low in both groups. Parental asthma knowledge was generally poor. This study identified risk factors for an ICU admission in children with asthma. A potentially preventable risk factor is a history of multiple ED presentations in the past year. Specialist referral of children with multiple ED presentations may improve asthma control and reduce the risk of an ICU admission. Background asthma management remains suboptimal in children needing hospitalization.

Adolescent↗

Congruence in the performance of model nitrifying activated sludge plants located in Germany, Scotland and Spain.

A laboratory model nitrifying activated sludge plant treating OECD synthetic sewage was designed and constructed by each of three laboratories in Germany, Scotland and Spain in order to produce a sludge inoculum for 5 rapid toxicity bioassays. The plants were run for 3 years and produced sludge for the microbially based bioassays Vibrio fischeri bioluminescence, ATP luminescence and respiration, and, nitrification and enzyme inhibition. Although the initial sludge inoculum for the plants differed, as did some of the running conditions such as temperature regime, the sludge produced within the different countries had similar characteristics with respect to sludge age, total suspended solids and volatile suspended solids. Nitrification was generally maintained over the 3-year period although there were occasions when the process was inconsistent. Nitrification recovery was afforded by reseeding with a nitrifying sludge from a local wastewater treatment works (WWTW) or imposition of starvation conditions for a period of time. The sludge produced was used to carry out toxicity testing and results compared well with those using sludge from a WWTW. Overall, the use of sludge generated in the laboratory could be used for toxicity testing negating the need to resort to the use of natural WWTW sludge, which may contain a range of toxic substances due to uncontrolled industrial and domestic inputs and an unbalanced microbial consortium.

Adenosine Triphosphate↗

Expression of human PKR protein kinase in transgenic mice.

There is a large amount of evidence describing the expression, interaction, and mode of activation of the human interferon (IFN)-mediated double-stranded RNA-activated protein kinase (PKR) gene. Studies from Pkr-null mice have defined the kinase as a transducer of dsRNA signals that converge on transcription, translation, and apoptotic programs involved in the innate resistance to viral infection. In vitro studies also suggest that PKR may possess important cell growth regulatory and tumor suppressor properties. However, the study of Pkr-null mice has not fully elucidated the role that the kinase plays in these processes, in part because of apparent redundancies in PKR-dependent and PKR-independent regulatory pathways. To overcome such limitations and to begin to examine the role of PKR in a complex biologic system, we have generated transgenic mice overexpressing wild-type human (Hu) PKR. HuPKR was expressed and active in various tissues and associated with a small body phenotype. Spleen cells from transgenic mice were resistant to apoptosis when treated with the genotoxic agent actinomycin D and showed a decrease in proliferation in response to concanavalin A (ConA) compared with spleen cells from wild-type control mice. The initial characterization of this transgenic mouse line suggests it may be useful as a model for investigating biology and diseases relative to a number of scientific disciplines.

Animals↗

Destocking as a drought-mitigation strategy: clarifying rationales and answering critiques.

The idea of externally assisted emergency destocking of pastoralists has gained currency in recent years: increasing the incentives for pastoralists to sell animals, or removing the constraints to selling animals in the early stages of drought. We identify two separate rationales put forward by proponents of destocking: environmental benefits and purchasing power/welfare benefits. We consider whether specific recent critiques of 'new range ecology' and specifically of 'tracking policies' do in fact provide arguments against emergency destocking in pastoralist areas. We illustrate some of these themes with a case study of a successful destocking exercise in northern Kenya where a very specific form of support was requested and received by pastoralists themselves. The sorts of destocking that work are likely to have significant effects on pastoralist purchasing power at key points of the drought cycle, but minimal effects on the environment. Clarifying these points will make it easier to promote destocking as a drought-mitigation policy.

Agriculture↗

Isolation of a unique benzothiophene-desulphurizing bacterium, Gordona sp. strain 213E (NCIMB 40816), and characterization of the desulphurization pathway.

Gordona sp. strain 213E (NCIMB 40816) grew in pure culture in a mineral salts medium containing fructose as a source of carbon and energy, and benzothiophene (BTH) as the sole source of sulphur. During growth a phenolic compound accumulated, as indicated by the production of a blue colour on addition of Gibb's reagent. Therefore this pathway is analogous to the dibenzothiophene (DBT) desulphurization pathway of Rhodococcus sp. strain IGTS8, in which 2-hydroxybiphenyl accumulates during growth with DBT as the sole sulphur source. Ethyl acetate extraction of the culture medium yielded the metabolites benzothiophene s-oxide (BTHO), benzothiophene s,s-dioxide (BTHO2), benzo[c][1,2]oxathiin 6-oxide (BcOTO), 2-(2'-hydroxyphenyl) ethan 1-al (HPEal) and benzofuran (BFU). The deduced pathway for BTH desulphurization is BTH-->BTHO-->BTHO2-->HPESi(-)-->HPEal. HPESi- is (Z)-2-(2'-hydroxyphenyl)ethen 1-sulphinate, the stable aqueous-solution form of BcOTO. It was concluded that HPEal was the Gibb's-reagent-reactive phenolic compound which accumulated in the culture medium of strain 213E during growth, and that the presence of BFU was due to partial condensation of HPEal during the ethyl acetate extraction procedure. Gordona sp. strain 213E was unable to grow in a mineral salts medium containing fructose as a source of carbon and energy and DBT as the sole sulphur source. BTH-desulphurization-active cells (grown using BTH as sole sulphur source) were unable to desulphurize DBT. Likewise Rhodococcus sp. strain IGTS8 was unable to grow using BTH as the sole sulphur source, and DBT-desulphurization-active cells of strain IGTS8 (grown using DBT as sole sulphur source) were unable to desulphurize BTH. This absence of cross-reactivity is discussed in terms of fundamental differences in the chemistry of the DBT- and BTH-desulphurization reactions.

Actinomycetales↗