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Biomedical subjects

K Lowe

Publications and source records attributed to K Lowe.

At least 19 recordsLinked to original sources
PubMed2006

Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States.

Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet psychosocial needs and their relationship with health-care outcomes among individuals receiving HIV care in the southeastern US (n=526). We used multivariate logistic regression to examine the association of seven categories of unmet needs with HIV medication use and adherence. Most participants (84.5%) reported at least one service need in the past year. Nearly half (47%) of participants with service needs reported that at least one need was not met. Participants with one or more unmet needs were less likely to be taking any HIV medications (p = 0.007) and reported poorer medication adherence (p=0.013). The specific unmet needs for benefits (including Social Security, health insurance and prescription coverage) (p = 0.006) and a support group (p=0.040) were associated with being less likely to be taking any HIV medications. Unmet need for mental health-related counseling was associated with poorer medication adherence (p=0.003). Study findings regarding the high level of unmet need and the association of unmet need with poorer outcomes illustrate the importance of interventions to address these needs.

Adult↗
PubMed2005

Treatment and management of challenging behaviours in congregate and noncongregate community-based supported accommodation.

OBJECTIVES: To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour. SETTING: Community-based supported accommodation for people with ID and challenging behaviour. DESIGN: Longitudinal matched groups design. MAIN OUTCOME MEASURES: The nature and prevalence of use of procedures employed to treat and manage challenging behaviours. Observed and reported severity of challenging behaviours. RESULTS: Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than 15% of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (56%) and congregate (80%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff. DISCUSSION: Changes in reported and observed challenging behaviour over a 10-month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.

Adult↗
PubMed2002

Characterisation of the expression of a novel constitutive maize promoter in transgenic wheat and maize.

A novel constitutive promoter from the maize histone H2Bgene was recently identified. In this study, we characterised H2B promoter activity in both wheat and maize tissues using the gusA reporter gene and two synthetic versions of the pat (phosphinothricin acetyl transferase) selectable marker gene, namely mopat and popat. Analyses of transgenic plants showed that the H2B promoter is able to drive the expression of gusA to strong, constitutive levels in wheat and maize tissues. Using an H2B:mopat construct and phosphinothricin selection, we recovered transgenic wheat plants at efficiencies ranging from 0.3% to 7.4% (mean 1.6%), and the efficiency of selection ranged from 40% to 100% (mean 77.7%). In another application, H2B was combined with the maize Ubi-1 or the maize Adh-1 intron to drive the expression of mopat and popat. Transformation efficiencies with the Ubi-1 intron were between 1.4- to 16-fold greater than with the Adh-1 intron. However, the use of either of the introns was necessary for the recovery of transgenic plants. Mopat gave higher transformation efficiencies and induced higher levels of PAT protein in maize tissues than popat.

Acetyltransferases↗
PubMed2002

Responsiveness to staff support: evaluating the impact of individual characteristics on the effectiveness of active support training using a conditional probability approach.

BACKGROUND: Active support training was fully conducted in 38 community houses accommodating 106 adults with intellectual disabilities (ID; group 1), but not in a further 36 accommodating 82 adults with ID (group 2). The aims of the present study were to analyse whether staff became more effective in supporting resident activity after the implementation of active support, and whether there was evidence of differential responsiveness by people with differing status in relation to adaptive behaviour, psychiatric diagnosis, challenging behaviour or autism. METHODS: Observations of staff:resident interaction and resident engagement in activity were taken before and after active support training. Changes in Yule's Q statistics, indicating the likelihood that resident engagement in activity followed staff giving residents verbal instruction or non-verbal assistance, were compared for the two groups. In addition, changes in similar statistics were compared for residents within group 1: (1) with Adaptive Behaviour Scale (ABS) scores above and below 180; and (2) with and without severe challenging behaviour, the triad of social impairments and mental illness. RESULTS: Yule's Q for engagement given non-verbal assistance significantly increased post-training among group 1, but not among group 2. Similar significant increases were found among group 1 residents with ABS scores below 180 without challenging behaviour, with and without the triad of social impairments, and without mental illness, but not with an ABS score above 180, with challenging behaviour and with mental illness. CONCLUSION: The present analysis reinforces previous studies on the effectiveness of active support training for adults with more severe ID (i.e. with ABS scores below 180). Active support was as effective for people with the triad of social impairments as for those without it. However, the effectiveness of support offered to people with challenging behaviour or mental illness did not significantly increase.

Adult↗
PubMed2001

Evaluation of the dissemination of active support training in staffed community residences.

Our aim was to replicate Active Support, a staff training intervention designed to increase the assistance given to adults with severe mental retardation living in community residences in order to increase their participation in activities. Training was conducted in 38 residences, involving 303 staff members and 106 persons with mental retardation. Active Support resulted in significant increases in assistance and engagement in activity. Significant correlations between participant abilities, receipt of assistance, and levels of engagement were found. Active Support was found to be of greater benefit to people with lower adaptive behavior and to have a diminishing value for people with higher adaptive behavior, implying that its implementation should be matched to the support needs of residents.

Adult↗
PubMed2000

Attitudinal effects of degrading themes and sexual explicitness in video materials.

This study examined the independent and interactive effects of sexual explicitness and degrading themes toward women on mens' attitudes following exposure to video presentations of male-female interactions. Subjects were 83 male college students who viewed video vignettes under one of four stimulus conditions: (a) sexually explicit/degrading, (b) sexually explicit/nondegrading, (c) nonexplicit/degrading, and (d) nonexplicit/nondegrading. Results revealed that men exposed to degrading material, regardless of explicitness, were significantly more likely to express attitudes supportive of rape, while explicitness had no significant main or interactive effect on these attitudes. Further, the interaction of explicitness with degradation was found to impact scores on a measure of sexual callousness. Theoretical and clinical implications of these findings are discussed.

Adult↗
PubMed1999

Effect of fly control on trachoma and diarrhoea.

BACKGROUND: Domestic flies are accepted vectors of diarrhoea, but their role in trachoma transmission has never been quantified and no study has shown that fly control decreases the prevalence of trachoma. We assessed the effect of fly control on public health in a pilot study in Gambian villages. METHODS: We studied two pairs of villages--one pair in the 1997 wet season, and one pair in the 1998 dry season. For each pair, deltamethrin was sprayed for 3 months to control flies in one village whilst the other was used as a control. Fly populations were monitored with traps. We surveyed trachoma at baseline and at 3 months, and collected daily data on diarrhoea in children aged between 3 months and 5 years. FINDINGS: Fly control decreased numbers of muscid flies by around 75% in the intervention villages compared with controls. Trachoma prevalence was similar at baseline (wet season, prevalence in intervention village 8.8% vs control 12.2%; dry season, 18.0% vs 16.0%), but after 3 months of fly control there were 75% fewer new cases of trachoma in the intervention villages (wet season 3.7% vs 13.7%; dry season 10.0% vs 18.9%; rate ratio and relative risk of pooled data 0.25 [adjusted 95% CI 0.09-0.64], p=0.003). There was 22% less childhood diarrhoea in the wet season (14% vs 19%, period prevalence ratio 0.78 [0.64-0.95], p=0.01), and 26% less diarrhoea in the dry season (6% vs 8%; 0.74 [0.34-1.59], p=0.60) compared with controls. INTERPRETATION: Muscid flies are important vectors of trachoma and childhood diarrhoea in The Gambia. Deltamethrin spray is effective for fly control and may be useful for reducing trachoma and diarrhoea in some situations, but further research on sustainable fly-control methods is needed.

Animals↗
PubMed1999

Opportunity and the promotion of activity among adults with severe intellectual disability living in community residences: the impact of training staff in active support.

Active support, a package of procedures which includes activity planning, support planning and training on providing effective assistance, was introduced in five community residences serving 19 adults with severe intellectual disability following a multiple baseline design. The residents were directly observed to ascertain the level of assistance they received from staff and their engagement in activity. The introduction of active support increased the levels of assistance residents received, their engagement in domestic activities and their total engagement in activity. The intervention did not affect the level of social engagement. Across individuals, increases in assistance and engagement in activity were significantly and positively correlated. Both were significantly inversely related to resident adaptive behaviour. At baseline, staff gave more attention and assistance to people who were behaviourally more able. After the introduction of active support, receipt of attention was unrelated to adaptive behaviour and the behaviourally less able received more assistance. The disparity in activity between the more and less able was reduced. Gains were maintained in the majority of houses.

Activities of Daily Living↗
PubMed1998

Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours: processes, outcomes and costs.

A survey of people with severe intellectual disability and the most severe challenging behaviour in Wales identified five adults living in family homes, 17 in new specialist community housing and 19 in traditional services. With the omission of two people from the latter group and with a restricted collection of data for people living in the family home, the present study explored service input, outcome and costs across the three setting types. Process and outcome indicators for the family home group, who received little service input, were better than those for the traditional service group, although less good than those for the community house group. The specialist community home model produced significant gains over the traditional services in virtually all areas. Across the residential data set as a whole, there was no association between staff:resident ratios and severity of disability or between costs and severity of disability. This was largely true of the service types separately. There was a relationship between costs and service quality. However, this association was underpinned by gross differences between community houses and traditional settings. Costs, processes and outcomes ceased to be related when the two residential types were considered separately. Although higher costs of new community services compared to traditional services may be set against improved outcomes, high costs within the former could not be related to benefit. Outcome indicators were generally related to each other, suggesting that high quality in one sense was matched by high quality in other senses. Outcome was significantly associated with the ability of residents. Outcome indicators also tended to be related to observed staff performance, which was independent of resident ability. Therefore, outcome may be considered as dually determined by differences in resident ability and in what staff did.

Adult↗
PubMed1998

The characteristics and residential situations of people with severe intellectual disability and the most severe challenging behaviour in Wales.

A total population study of people in Wales with severe intellectual disability and the most severe challenging behaviour was undertaken to identify their characteristics, and the nature of their residential arrangements and service support. Forty-one participants were identified: five living in family homes, 17 in community housing, 17 in hospitals and two in hostels. The family home group had slightly higher adaptive behaviour scores than residents in community housing. Both groups had significantly higher scores than the hospital and hostel residents combined. Assessments of challenging behaviour showed the groups to be similar and to have a considerable range and extent of severely problematic behaviour. Co-occurrence of several forms of frequent severe problem behaviour was the norm and there was a marked association with social impairment. The five people living in their family homes had nominated service keyworkers, but reported professional input was low. The residential situations comprised two main service types: (1) traditional services, which were characterized by large living unit and facility size, atypical architectural design, relative isolation from the community, a greater level of buildings adaptations, low staff:resident ratios, a relatively high percentage of qualified staff, and a relative absence of systematic approaches to goal planning and structured activity; and (2) new community houses, which were characterized by small size, domestic design, location within the community, a lower level of buildings adaptations, much higher staff:resident ratios, and less emphasis on qualified staff but a greater emphasis on systematic working methods. Community settings were similar in having 'specialist' resident groupings based on challenging behaviour or conditions like autism in which challenging behaviours are common. A policy to provide for people with these characteristics being resettled from traditional settings in this way seems to have been established.

Adult↗
PubMed1996

Molecular biology in nutrition research: modeling of folate metabolism.

Model CHO cells obtained by transfecting CHO mutants with the E. coli and human folylpolyglutamate synthetase genes have proven useful for assessing the role of folylpolyglutamates in one carbon metabolism and for delineating how folate intracellular stores are regulated. Cells expressing enzymes in specific subcellular compartments, expressing enzymes with different substrate specificity's, and expressing enzyme activity at different levels, all in a common background, in this case the CHO cell, has allowed the development of kinetic models for assessing the role of folypolyglutamate synthetase in folate retention and in the cytotoxicity of antifolates.

Animals↗
PubMed1996

A one-year follow-up study of depression in dementia sufferers.

BACKGROUND: Little data are available about the course or incidence of depression in dementia sufferers. METHOD: Monthly follow-up data over one year is reported regarding depression in a cohort of 124 dementia sufferers. Dementia was diagnosed according to DSM-III-R criteria. Depression was assessed with the Cornell Depression Scale and diagnosed according to RDC criteria. Cognitive functioning was assessed with the CAMCOG: RESULTS: Eighty-nine of the 124 patients completed the follow-up. The annual incidence rates of RDC major depression and RDC minor depression were 10.6% and 29.8%, respectively. Twenty per cent of patients with depression experienced these symptoms for six months or longer. Patients with vascular dementia were significantly more likely to experience three or more months of depression than patients with other dementias. RDC minor depression was highly persistent among 23.8% of sufferers. CONCLUSION: Depression is persistent in patients with vascular dementia. Some patients with minor depression have a dysthymia-like disorder.

Aged↗
PubMed1996

Challenging behaviour: the effectiveness of specialist support teams.

Two specialist community services for people with learning disabilities and challenging behaviour were evaluated over approximately 3 years. Intervention effectiveness was assessed with respect to changes in subjects' skills, challenging behaviours, mental health and quality of life, and to changes in staff morale. Subjects assessed as having challenging behaviour but not referred for specialist input were also studied. Comparison of changes in referred and non-referred samples over time showed minor differences only, indicating little intervention effect and demonstrating stability in the comparison sample. Analysis of the two services separately yielded different results. Positive client change was evident with respect to one service, whilst little change was noted with respect to the other. There was little evidence to suggest that either service had any effect on staff morale. Differences between the two services in terms of structure, staffing characteristics and operational policies are discussed as possible factors in the differential results obtained. A major issue raised by the study concerns the quality of settings from which the subjects were referred for specialist support. This is discussed as a factor which may limit the effectiveness of specialist input.

Adolescent↗
PubMed1995

Volunteer bias in sexuality research.

Biases associated with volunteering for studies in human sexuality were studied. Beginning with a sample of over 1000 introductory psychology students, subjects participated in a two-phase study in which those willing and unwilling to volunteer for a variety of sexuality studies were compared. In both phases of this study, volunteers were significantly different from nonvolunteers on some, but not all, dimensions assessed. Specifically, compared to nonvolunteers, volunteers reported a more positive attitude towards sexuality, less sexual guilt, and more sexual experience. These differences were independent of subject gender. Sobering implications of these findings for the generalizability of sexuality research results are discussed.

Adult↗
PubMed1995

People with learning disabilities and challenging behaviour: the characteristics of those referred and not referred to specialist teams.

The characteristics of two samples of people with learning disabilities and severely challenging behaviour were examined. The experimental sample comprised subjects who had been referred to two specialist challenging behaviour services in separate counties. The comparison sample comprised subjects from the same counties who were not referred or accepted for specialist intervention. No significant differences were found between the samples in terms of age, gender, social impairment, dependency characteristics, ability levels and mental health. Significant differences between them were found in the nature and severity of aberrant behaviour presented, as assessed by their carers. The implications of these findings are discussed with regard to how the term 'severely challenging behaviour' is defined in practice.

Activities of Daily Living↗
PubMed1995

How do carers assess the severity of challenging behaviour? A total population study.

The severity of management problems of 13 types of problem behaviour presented by a total population sample of people with learning disabilities, as reported by their primary carers on eight separate assessments over 5 years, was examined. Three types of residential setting were represented: hospitals, family homes and community houses. The results showed a remarkable consistency in carers' assessments of the severity of management problem posed to them. An association was found between the reported frequency of occurrence and the assessment of the severity of behaviours, with certain behaviours likely to be rated as severe regardless of the frequency with which they occurred. Differences between residential settings were found, with carers in family homes and community houses rating more behaviours as presenting severe management problems than carers in hospital. The results from this study and other studies which have examined the relative severity of different behaviour topographies are discussed.

Adult↗
PubMed1995

Providing intensive community support to people with learning disabilities and challenging behaviour: a preliminary analysis of outcomes and costs.

The impact of a specialist community service on the lives of three people with challenging behaviour was assessed using single-case studies. The outcome measures employed recorded changes in adaptive behaviours, challenging behaviours and staff satisfaction with the interventions used. Improvements on the behavioural measures were observed for each client, and positive feedback was received from each of the staff groups concerned. The costs of providing these interventions in community settings were calculated and compared to the costs of alternative service options.

Adult↗