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Biomedical subjects

K Evans

Publications and source records attributed to K Evans.

At least 19 recordsLinked to original sources
PubMed2006

Giving up or finding a solution? The experience of attempted suicide in later life.

Older people constitute one of the highest risk groups for suicide. Existing research in this area has been largely dominated by a risk factor approach. This is of limited usefulness since only a minority of those at risk go on to make an attempt. Therefore, prediction, prevention and the management of risk remain challenging. The present study aimed to capture the subjective experience of older people who had recently made a suicide attempt through exploring their understanding of the pathway to and from this attempt, within the context of ageing. Fifteen participants were interviewed. Transcripts were analysed using Interpretative Phenomenological Analysis. Three broad themes emerged--Struggle (experiencing life as a struggle before and after the attempt, and in relation to growing older), Control (trying to maintain control over life before the attempt, and following it either failing or succeeding to regain control) and Visibility (feeling invisible or disconnected from others and trying to fight against this before the attempt and either becoming more or less connected afterwards). Risk factors identified in the literature were often absent or construed by participants as not relevant to their attempt. Individual accounts highlight the diversity and complexity of experience of older people who attempt suicide.

Aged↗
PubMed2005

Analysis of an adult Duchenne muscular dystrophy population.

BACKGROUND: Advances in management have led to increasing numbers of patients with Duchenne muscular dystrophy (DMD) reaching adulthood. Older patients with DMD are necessarily severely disabled, and their management presents particular practical issues. AIM: To review the management of a late adolescent and adult DMD population, and to identify areas in which the present service provisions may be inadequate to their needs. DESIGN: Retrospective review. METHODS: We studied 25 patients with DMD referred to an adult neuromuscular clinic over a 7-year period. Clinical details were obtained retrospectively, from case notes or direct observations. RESULTS: There were 24 males and one symptomatic female carrier. Nine patients died during the observation period. There was no significant correlation between age of wheelchair confinement and age of death. Sixteen patients received non-invasive positive pressure support. Twelve attended mainstream schools and 12, residential special schools. All the patients lived at home for some or all of the time, when their main carers were either one or both of the parents. The most striking difficulties were with the provision of practical aids, including appropriate hoists and belts, feeding and toileting aids, and the conversion of accommodation. Patients rarely wished to discuss the later stages of their disease, and death was often more precipitate than expected. Death usually occurred outside hospital and the final cause was often difficult to establish. DISCUSSION: Adult patients with DMD develop progressive impairment, due to respiratory, orthopaedic and general medical factors. However, the particular areas of difficulty in this study often reflected inadequate and poorly directed social and medical support, illustrating the need for improvements in the structure, co-ordination and breadth of rehabilitation services for adult patients with DMD.

Adolescent↗
PubMed2005

Periodic variability in cetacean strandings: links to large-scale climate events.

Cetacean strandings elicit much community and scientific interest, but few quantitative analyses have successfully identified environmental correlates to these phenomena. Data spanning 1920-2002, involving a total of 639 stranding events and 39 taxa groups from southeast Australia, were found to demonstrate a clear 11-13- year periodicity in the number of events through time. These data positively correlated with the regional persistence of both zonal (westerly) and meridional (southerly) winds, reflecting general long-term and large-scale shifts in sea-level pressure gradients. Periods of persistent zonal and meridional winds result in colder and presumably nutrient-rich waters being driven closer to southern Australia, resulting in increased biological activity in the water column during the spring months. These observations suggest that large-scale climatic events provide a powerful distal influence on the propensity for whales to strand in this region. These patterns provide a powerful quantitative framework for testing hypotheses regarding environmental links to strandings and provide managers with a potential predictive tool to prepare for years of peak stranding activity.

Animals↗
PubMed2005

Survival in high-grade glioma: a study of survival in patients unfit for or declining radiotherapy.

AIMS: To determine the survival of patients with high-grade glioma (HGG) and a poor prognosis in terms of age or performance status managed with best supportive care alone. METHODS: An analysis of survival was carried out on 123 patients with HGG declining or judged unfit to receive radiotherapy, on the basis of age or performance status, between February 1998 and October 2003. Karnofsky performance status (KPS), biopsy or resection or no surgery, attendance at clinic and reason for not receiving radiotherapy were prospectively recorded. RESULTS: Of the 123 patients, three were excluded from the analysis, as no outcome data were available. Median age was 66 years (range 29-91 years), and median KPS was 50 (range 30-100). All 120 patients included had died at the time of analysis. Overall median survival was 68 days (95% CI 56-85), range 2-294 days and interquartile range 35-123 days. Median survival of 22 patients declining radiotherapy was 75 days (95% CI 53-123), of 98 patients unfit for radiotherapy 67 days (95% CI 48-88); non-significant difference P = 0.36. Median survival of 26 patients undergoing biopsy was 95 days (95% CI 66-123), of 56 undergoing surgical resection 74 days (95% CI 47-93), and of 38 receiving no surgical intervention 59 days (95% CI 47-70); non-significant difference P = 0.16. CONCLUSION: For patients with HGG and a poor prognosis, in terms of age or performance status managed with best supportive care, survival is short. Survival may be too short to benefit from radiotherapy and possibly surgery.

Adult↗
PubMed2005

Making sense of dementia and adjusting to loss: psychological reactions to a diagnosis of dementia in couples.

The current emphasis on early detection and disclosure of a diagnosis of dementia highlights the need to examine couples' shared constructions of, and responses to, the diagnosis, and to explore the appraisals that couples make about the illness at an early stage. While the experiences of carers and of people with dementia have mostly been considered separately, further investigation of the shared experience of couples where one partner is developing dementia is required. This study adopted a family systems perspective to investigate psychological reactions to a diagnosis of dementia in nine couples where one partner had received a diagnosis of either Alzheimer's disease or vascular dementia, with particular emphasis on the possible relevance of psychological responses to loss. Interpretative phenomenological analysis was used to explore participants' experiences of receiving a diagnosis of dementia, which were compared and contrasted across couples. Ten themes were subsumed under two higher-order themes, 'Not quite the same person, tell me what actually is wrong' and 'Everything's changed, we have to go from there', and linked through the overarching theme of 'Making sense and adjusting to loss'. A model is presented that encapsulates the oscillating processes couples appeared to go through in making sense of the experience of early-stage dementia and adjusting to the losses and difficulties evoked by the illness, which appeared to be similar to the process of adjustment outlined in dual-process models of grief. The findings suggest that couples who receive a diagnosis of dementia may be supported by helping them to create a joint construction that enables them to make sense of their situation, find ways of adjusting to the changes experienced in their roles and identity, and manage the losses they face in the early stages of dementia.

Adaptation, Psychological↗
PubMed2004

ICEE/AHMRC NSW Aboriginal Eye and Visioncare Program, Australia.

CONTEXT: An astounding 50% of blindness and 70% of vision impairment in Australia is caused by conditions that are said to be preventable or treatable. Aboriginal people suffer 10 times the rate of blindness and attend eyecare practitioners in far lower numbers than other members of the Australian population. ISSUE: In order to combat this problem in New South Wales (NSW), Australia, the International Centre for Eyecare Education (ICEE), with the Aboriginal Health and Medical Research Council (AHMRC) and the Office of Aboriginal and Torres Strait Islander Health (OATSIH), and local Aboriginal communities, have set up eyecare clinics in Aboriginal Medical Services (AMS) around the State. These eye clinics provide eyecare and vision correction, including the provision of spectacles and other optical aids, as well as educational programs to increase health awareness among the Aboriginal population and Aboriginal eye health workers. The first eyecare clinic was opened in AMS Redfern (Sydney) in July 2000 and ICEE now has a presence in over 60 locations throughout NSW. There have already been over 8000 consultations and 6000 pairs of spectacles provided to Aboriginal communities during this time. The program has also demonstrated that an effective Aboriginal eyecare program can be self-sustainable. LESSONS: The key to the success of this program has been collaboration and cooperation. This has involved working through, and with, Aboriginal community-controlled health services, which has ensured that programs are developed in accordance with community needs and cultural sensitivities. It has also involved the harnessing of the contributions of a number of State, Federal, community and professional organisations and individuals. This has provided efficiencies in service and resource provision, which are essential to the sustainability of the program.

Journal Article↗
PubMed2003

Searching for schizophrenia in ancient Greek and Roman literature: a systematic review.

OBJECTIVE: The aim of this study was to systematically examine ancient Roman and Greek texts to identify descriptions of schizophrenia and related disorders. METHOD: Material from Greek and Roman literature dating from the 5th Century BC to the beginning of the 2nd Century AD was systematically reviewed for symptoms of mental illness. DSM IV criteria were applied in order to identify material related to schizophrenia and related disorders. RESULTS: The general public had an awareness of psychotic disorders, because the symptoms were described in works of fiction and in historical accounts of malingering. There were isolated instances of text related to psychotic symptoms in the residents of ancient Rome and Greece, but no written material describing a condition that would meet modern diagnostic criteria for schizophrenia. CONCLUSION: In contrast to many other psychiatric disorders that are represented in ancient Greek and Roman literature, there were no descriptions of individuals with schizophrenia in the material assessed in this review.

Bipolar Disorder↗
PubMed2002

Increased post-tonsillectomy secondary haemorrhage with disposable instruments: an audit cycle.

The objective of the audit was to examine the increased morbidity associated with elective tonsillectomy with single-use instruments in a district general hospital in England. Retrospective audit of consecutive case notes of 145 patients who underwent tonsillectomy in a 6-week period after the introduction of single-use instruments was carried out. The main outcome measure was incidence of secondary haemorrhage. In total, 9.5% of patients required re-admission indicated by secondary haemorrhage, 4% required emergency surgery and 43% of the total group had haemostasis achieved with ties. None of these was re-admitted. Out of the total group, 57% had haemostasis achieved with single-use bipolar forceps; 16.8% of these patients were re-admitted, with 7% of this group requiring emergency surgery to control the haemorrhage. Animal tissue experiments and design analysis of the single-use bipolar diathermy highlighted the deficiencies of the initial single-use bipolar diathermy. This was replaced by a new design of single-use diathermy forceps. A second audit was performed which revealed a significant reduction in postoperative morbidity. Complications associated with the introduction of new instruments can be identified by repeated audit cycles.

Animals↗
PubMed2001

The effect of a hospitalist service with nurse discharge planner on patient care in an academic teaching hospital.

PURPOSE: To evaluate the impact of implementing a hospitalist service with a nurse discharge planner in an academic teaching hospital. SUBJECTS AND METHODS: Inpatient medicine service was provided by hospitalists, general internists, and specialists. Service personnel were identical except that the hospitalist service also had a nurse discharge planner. Hospitalists attended 4 months per year (compared with the 1 month by most other attending physicians) and had no outpatient responsibilities during the ward months. Patients were admitted alternately based on resident call schedule. Major outcomes included average costs of hospitalization, length of stay, and resource utilization. Quality measures included inpatient mortality, 30-day readmission rates, and satisfaction of patients, residents and students. RESULTS: Hospitalist-attended services had lower mean (+/- SD) inpatient costs per patient ($4289 +/- $6512) compared with specialist-staffed services ($6066 +/- $7550, P < 0.0001), with a trend toward lower costs when compared with generalist-attended services ($4850 +/- $7027, P = 0.11). Hospitalist services had shorter mean lengths of stay (4.4 +/- 4.0 days), compared with generalists (5.2 +/- 5.2 days) and specialists (6.0 +/- 5.5 days, P < 0.0001 for hospitalists vs. both groups). Readmission rates were similar in all groups. Mortality rates were higher in the specialist group [5.0% (44 of 874)] compared with hospitalists [2.2% (18 of 829)] and generalists [2.6% (20 of 761), P = 0.002 for specialists vs. both groups, P = 0.09 for generalists vs hospitalists]. Satisfaction results were uniformly high in all groups, with no significant differences. CONCLUSION: Hospitalist services with a nurse discharge planner were associated with lower average cost and shorter average length of hospital stay, without any apparent compromise in clinical outcomes or patient satisfaction.

Adult↗
PubMed2001

An insight into the epidemiology of dolphin morbillivirus worldwide.

Serum samples from 288 cetaceans representing 25 species and originating from 11 different countries were collected between 1995 and 1999 and examined for the presence of dolphin morbillivirus (DMV)-specific antibodies by an indirect ELISA (iELISA) (N = 267) or a plaque reduction assay (N = 21). A total of 35 odontocetes were seropositive: three harbour porpoises (Phocoena phocoena) and a common dolphin (Delphinus delphis) from the Northeastern (NE) Atlantic, a bottlenose dolphin (Tursiops truncatus) from Kent (England), three striped dolphins (Stenella coeruleoalba), two Risso's dolphins (Grampus griseus) and a bottlenose dolphin from the Mediterranean Sea, one common dolphin from the Southwest (SW) Indian Ocean, three Fraser's dolphins (Lagenodelphis hosei) from the SW Atlantic, 18 long-finned pilot whales (Globicephala melas) and a bottlenose dolphin from the SW Pacific as well as a captive bottlenose dolphin (Tursiops aduncus) originally from Taiwan. The presence of morbillivirus antibodies in 17 of these animals was further examined in other iELISAs and virus neutralization tests. Our results indicate that DMV infects cetaceans worldwide. This is the first report of DMV-seropositive animals from the SW Indian, SW Atlantic and West Pacific Oceans. Prevalence of DMV-seropositives was 85.7% in 21 pilot whales from the SW Pacific and both sexually mature and immature individuals were infected. This indicates that DMV is endemic in these animals. The same situation may occur among Fraser's dolphins from the SW Atlantic. The prevalence of DMV-seropositives was 5.26% and 5.36% in 19 common dolphins and 56 harbour porpoise from the NE Atlantic, respectively, and 18.75% in 16 striped dolphins from the Mediterranean. Prevalence varied significantly with sexual maturity in harbour porpoises and striped dolphins; all DMV-seropositives being mature animals. The prevalence of seropositive harbour porpoise and striped dolphins appeared to have decreased since previous studies. These data suggest that DMV is not endemic within these populations, that they are losing their humoral immunity against the virus and that they may be vulnerable to new epidemics.

Animal Diseases↗
PubMed2001

EEG power, frequency, asymmetry and coherence in male depression.

Quantitative electroencephalographic (EEG) power topography has served as a useful tool for investigating brain regional mechanisms underlying affective disorders. In an attempt to examine the role of gender and widen the scope of the measurement probes used in these investigations, the traditional power and inter-hemispheric power ratio indices were supplemented with intra-hemispheric power ratios, mean frequency and both inter and intra-hemispheric coherence indices, in the comparison of depressed male patients and healthy controls. Resting (eyes closed), vigilance controlled EEG recordings from 21 scalp sites were collected from 70 male, unmedicated, unipolar major depressive disorder outpatients and 23 normal control male subjects. Absolute and relative power, frequency, asymmetry and coherence measures derived from spectrally analyzed EEGs were subjected to univariate analyses for group comparisons as well as to discriminant function analysis to examine their utility as classification indices. Compared with controls, patients evidenced greater overall relative beta power and, at bilateral anterior regions, greater absolute beta power and faster mean total spectrum frequency. Inter-hemispheric alpha power asymmetry index differences were noted, with controls exhibiting relatively reduced left hemisphere activation, and widespread reduced delta, theta, alpha and beta coherence indices. Whereas intra-hemispheric theta power asymmetry reduction was exhibited in patients bilaterally at all regions, group differences with intra-hemispheric beta power asymmetry were unilateral, being restricted to the right hemisphere. Discriminant analysis correctly classified 91.3% of the patients and controls. Quantitative EEG measurements in male depression appear to describe a pattern of aberrant inter-hemispheric synchrony/asymmetry and a profile of frontal activation.

Adult↗
PubMed2001

Evaluation of PCR, IEF and ELISA techniques for the detection and identification of potato cyst nematodes from field soil samples in England and Wales.

Effective management of potato cyst nematodes (PCNs) requires simple, rapid and accurate identification and quantification of field populations. Soil samples from a survey of 484 fields in potato rotations in England and Wales were used to compare the identification and quantification of PCNs using IEF, PCR, ELISA and bait plant tests. The cyst counts and bait plant test revealed that 64.3% of field samples contained PCNs. Bait plant tests increased the detection rate of PCNs in field samples by 4-6.4%. This means that some infestations are cryptic and would not normally be detected by standard counts. IEF, PCR and ELISA methods distinguished between Globodera rostochiensis and G pallida and were able to register mixed populations; however they were not in full agreement. All methods suggested that G pallida is the dominant species in the field samples tested. The PCR results indicated that 66% of field samples contained pure G pallida, 8% contained pure G rostochiensis and 26% contained mixtures of the two species. Estimates of the relative process times taken per sample in the PCR, IEF and ELISA techniques are given.

Animals↗
PubMed2001

Postprandial lipid metabolism and insulin sensitivity in young Northern Europeans, South Asians and Latin Americans in the UK.

The aim of this study was to determine whether the higher susceptibility to coronary heart disease and diabetes in South Asian immigrants to the United Kingdom compared with the Caucasian population may reflect insulin resistance and altered postprandial lipid metabolism. We also wished to study Latin Americans, an ethnic group that has not been previously studied in the United Kingdom. The intention was to carry out a detailed study in a relatively small number of subjects to provide essential baseline information for larger epidemiological studies. Postprandial lipaemia was measured in 25 subjects (eight South Asians, eight Latin Americans and nine Northern Europeans) who resided in the United Kingdom. Results from the postprandial studies were correlated to insulin sensitivity measured by the insulin tolerance test, food intake, anthropometry and adipose tissue fatty acid composition. In South Asians, postprandial glucose and insulin concentrations were greater than in the other groups (P<0.01 and <0.05, respectively), although there were no differences in postprandial triacylglycerol concentrations or in insulin sensitivity assessed with the insulin tolerance test. The decreased glucose tolerance in this group could not be explained by differences in percentage body fat, body mass index, or by dietary intake measured by food records or adipose tissue fatty acid composition. We conclude that postprandial lipaemia is not affected in young South Asians compared to Northern Europeans although glucose intolerance is detectable. The results from the present study should help in the design of further postprandial lipid studies in different ethnic groups.

Adipose Tissue↗
PubMed2001

The relationships between neonatal encephalopathy and cerebral palsy: a cohort study.

There is a high risk of cerebral palsy (CP) following neonatal encephalopathy (NE) with fits, often attributed to intrapartum asphyxia. The evidence for the association is inconclusive and antepartum factors offer an alternative explanation. A cohort study was carried out to assess the evidence for and against hypoxic ischaemic injury as the cause of NE-associated CP in term infants. A total of 57 159 consecutive births were enrolled. There were 150 cases with NE, of whom 92 had at least one fit and 58 had no fits. The incidence of all NE was 2.62 per 1000 births and of NE with fits was 1.61 per 1000 births. Infants with NE were followed-up to identify those with cerebral palsy. There were 13 cases of four-limb cerebral palsy and three with hemiplegia among the survivors. In 12 of the 13 cases of four-limb CP, a combination of low Apgar scores, an early onset acute evolving encephalopathy, acidosis, renal dysfunction and the absence of antepartum factors suggested an acute intrapartum event as the immediate cause of the NE. An obstetric event likely to cause acute hypoxic injury was identified in four of the 12 cases. The clinical picture was similar in the four with and the eight without a specific obstetric event. The pathway leading to NE-associated CP remains unexplained, but intrapartum events appear to play a major role in most cases.

Journal Article↗
PubMed2001

MexR repressor of the mexAB-oprM multidrug efflux operon of Pseudomonas aeruginosa: identification of MexR binding sites in the mexA-mexR intergenic region.

The MexR repressor of the mexAB-oprM multidrug efflux operon of Pseudomonas aeruginosa was purified as a C-terminal histidine-tagged protein by metal chelate affinity chromatography. The purified protein was shown to bind ca. 200 bp upstream of mexA, at two sites, each of which contains a repeat of the nucleotide sequence GTTGA in inverse orientation. DNA sequence analysis identified mexA and mexR promoters within the MexR binding regions, consistent with the previously observed negative regulation of mexR and mexAB-oprM expression by MexR. Transcription of mexA from the promoter originating within the MexR binding site II was confirmed and shown to be markedly enhanced in a nalB (i.e., mexR) mutant of P. aeruginosa. A second mexA promoter was also identified, ca. 70 bp upstream of mexAB-oprM, and transcription from this promoter appeared to occur in both the wild type and a nalB mutant. Production of MexAB-OprM in wild-type cells may be due to expression from a constitutively expressed proximal promoter, while MexAB-OprM hyperexpression in nalB mutants is due to the additional expression from a MexR-regulated distal promoter.

Bacterial Outer Membrane Proteins↗