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Biomedical subjects

L Hay

Publications and source records attributed to L Hay.

At least 19 recordsLinked to original sources
PubMed2005

Systematic review of multidisciplinary interventions in heart failure.

OBJECTIVE: To determine the impact of multidisciplinary interventions on hospital admission and mortality in heart failure. DESIGN: Systematic review. Thirteen databases were searched and reference lists from included trials and related reviews were checked. Trial authors were contacted if further information was required. SETTING: Randomised controlled trials conducted in both hospital and community settings. PATIENTS: Trials were included if all, or a defined subgroup of patients, had a diagnosis of heart failure. INTERVENTIONS: Multidisciplinary interventions were defined as those in which heart failure management was the responsibility of a multidisciplinary team including medical input plus one or more of the following: specialist nurse, pharmacist, dietician, or social worker. Interventions were separated into four mutually exclusive groups: provision of home visits; home physiological monitoring or televideo link; telephone follow up but no home visits; and hospital or clinic interventions alone. Pharmaceutical and exercise based interventions were excluded. MAIN OUTCOME MEASURES: All cause hospital admission, all cause mortality, and heart failure hospital admission. RESULTS: 74 trials were identified, of which 30 contained relevant data for inclusion in meta-analyses. Multidisciplinary interventions reduced all cause admission (relative risk (RR) 0.87, 95% confidence interval (CI) 0.79 to 0.95, p = 0.002), although significant heterogeneity was found (p = 0.002). All cause mortality was also reduced (RR 0.79, 95% CI 0.69 to 0.92, p = 0.002) as was heart failure admission (RR 0.70, 95% CI 0.61 to 0.81, p < 0.001). These results varied little with sensitivity analyses. CONCLUSION: Multidisciplinary interventions for heart failure reduce both hospital admission and all cause mortality. The most effective interventions were delivered at least partly in the home.

Cardiac Output, Low↗
PubMed2001

Development of postural adaptation to arm raising.

We studied the development of the coordination between posture and movement by analyzing the shifts of the center of pressure (CoP) associated with arm raising. Three groups of children aged 3-5 years, 6-8 years, and 9-10 years and an adult group were tested. The subjects were required to raise their arms to the horizontal position while standing still, with their hands free or loaded (5% of the body weight). The arm movements were recorded by a TV-image processor, and the changes in position of the CoP were measured by a force platform and analyzed before, during, and after the arm movement. The data show that the CoP moved forward during arm raising, that additional load induced a greater shift in all age groups, and that the relative amplitude of the shift decreased with age. The greatest changes occurred between ages 3-5 years and 6-8 years. The pre- and postmovement CoP shift suggests qualitative changes in the postural adaptation to movement between these two age groups: the anticipatory postural adjustments moved from a supporting function to a compensatory function, yielding an increasing functional convergence between the feedforward and the feedback modes of postural control, and an increasing rapidness in recovering postural stability after arm movement. The postural behavior shown by the 9- to 10-year-old children and by the adults in the arms-free condition suggests an increased tolerance to unbalance when postural oscillations do not jeopardize static equilibrium.

Adaptation, Physiological↗
PubMed2000

The role of cromakalim and a nitric oxide synthase blocker in cardiac arrhythmia in the intact baboon model.

The arrhythmogenic effect of adenosine triphosphate (ATP)-sensitive potassium channel openers is controversial and may be dependent on the type of animal model used. Information on the effect of these drugs in the normal primate model is limited. The purpose of this study was first to determine the arrhythmogenic properties of cromakalim in the baboon and second to determine whether N-omega-nitro-L-arginine methyl ester (L-NAME) has any effect on the induced arrhythmia. Adult (2-4 years old) baboons (Papio ursinus) were anesthetized with a continuous i.v. infusion of ketamine (100 mg/ ml), diazepam (5 mg/ml), and saline (ratio 2:2:50) at a rate of 40-60 ml/h. Sympathetic responses were inhibited by administration of propranolol (1 mg/kg) before the start of the experiments. Cromakalim (30 microg/kg) was administered before and after L-NAME (7.5 mg/kg), and the parameters were monitored for 15 min after each intervention. A Millar double-tipped microcatheter was used to record left ventricular and aortic pressures. Lead II of the ECG was monitored. During a 15-min period after administration of cromakalim, 22.3 +/- 6.0 abnormal ventricular complexes were recorded. L-NAME administration significantly reduced these abnormal complexes to 4.5 +/- 2 (paired t test, p < or = 0.05). We therefore conclude that cromakalim has arrhythmogenic properties in the baboon and that these can be attenuated by L-NAME.

Adrenergic beta-Antagonists↗
PubMed1999

Feedforward versus feedback control in children and adults subjected to a postural disturbance.

Any action performed by standing subjects is generally accompanied by compensatory postural activities, which reduce or abolish the postural disturbance generated by the movements and keep the subjects' center of gravity within the supporting base. These postural activities are triggered by either anticipatory and/or feedback-based control processes, depending on the information available and on the behavioral context. To investigate the respective involvement of these two components in postural control during development, we studied the extent to which the postural equilibrium of children (3-to 10-year-olds) and adults was disturbed by the same physical event, an unloading, depending on whether it was initiated by the subject or externally imposed. The subjects were standing on a force platform with their eyes closed, holding a load (5% of their own body weight) in their hands, with arms vertical and forearms horizontal. Two conditions were applied: (1) the subjects voluntarily released the load and (2) the load was unpredictably removed. The unloading resulted in a backward movement of the center of pressure, which was smaller with self-initiated than imposed disturbances in all age groups. This difference varied depending mainly on the age-related changes in the relative amplitude of the self-initiated disturbance, which decreased between 3- to 5-, and 6- to 8-year-olds (who showed no marked postural instability after self-initiated unloading), and increased again in the two older groups (9- to 10-year-olds and adults), in which it also became more consistent It was concluded that feedforward control. becomes more efficient as children grow up, but that its relative contribution to postural control does not show a monotonic pattern of development.

Adult↗
PubMed1998

Stability of cardiodynamic and some blood parameters in the baboon following intravenous anaesthesia with ketamine and diazepam.

The stability of cardiodynamic and some blood parameters during a slow, continuous infusion of a combination of ketamine and diazepam is reported. Contractility (dP/dt), myocardial relaxation (Tln), left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), arterial blood pressure and certain blood parameters were assessed in 3 male and 3 female juvenile baboons (Papio ursinus). Anaesthesia was induced with 15 mg/kg ketamine i.m. and maintained with a continuous i.v. infusion (40-60 ml/h) of ketamine and diazepam. The mixture consisted of 2 ml ketamine (100 mg/ml), 2 ml diazepam (5 mg/ml) and 50 ml saline. A period of 75 +/- 10 min was allowed for preparation of the animals, after which lead II of the ECG, femoral artery blood pressure and left ventricular pressure were recorded at 15-min intervals for a period of 2 h: the total duration of anaesthesia was 195 min. Arterial blood samples were analysed at 30-min intervals for blood gases, electrolytes, glucose and insulin. Left ventricular parameters were derived from the left ventricular pressure curve. Tln, LVSP and LVEDP showed small fluctuations. Contractility decreased (p < 0.037) at the 195-min interval. No arrhythmias or ECG changes were seen, while blood pressure decreased gradually. Serum calcium concentration decreased and blood glucose levels increased gradually over time. Anaesthesia and analgesia were sufficient and no other drugs were necessary. The animals appeared sedated and dazed 60-80 min after the procedure. A continuous infusion of a combination of ketamine and diazepam for a duration of 150 min can provide stable anaesthesia for cardiodynamic measurements.

Anesthetics, Dissociative↗
PubMed1996

Availability of visual and proprioceptive afferent messages and postural control in elderly adults.

The ability of young and elderly adults to keep a stable upright posture while facing changes in the availability of visual and/or propriomuscular information was investigated. The two sensory sources of information were alternatively available and withdrawn, jointly and separately, during 10-s alternating sequences. Vision was modified by means of liquid-crystal goggles, and proprioception was altered by means of tendon vibration of both antagonistic ankle muscles. Elderly adults were less stable than young adults when vision was withdrawn. Both groups were greatly affected when propriomuscular inputs were altered by vibration. Under constant visual conditions and following a propriomuscular perturbation (i.e., vibration), elderly adults were unable to take advantage of the reinsertion of propriomuscular inputs. They showed a transient, decreased stability and were unable to fully recover during a 10-s period, whereas young adults were able to rapidly integrate the information to stabilize their posture. When both propriomuscular and visual inputs were withdrawn and concurrently reinserted, the elderly adults did not show a transitory increase in the velocity of the center of foot pressure. The present results extend findings on the inability of elderly adults to reconfigure rapidly the postural set following reinsertion of sensory inputs. The results also suggest that elderly adults have difficulties in taking advantage of sensory redundancy in postural control.

Adult↗
PubMed1996

Some adverse cardiodynamic effects of prostaglandin E2 in congestive heart failure.

The cardiodynamic effects of prostaglandin E(2) (PGE(2)) were studied in both healthy sheep and in animals with congestive heart failure (CHF). Merino ewes were equipped surgically with high fidelity micromanometers and left ventricular pressures measured. Heart rate, left ventricular systolic and end-diastolic pressures, +dP/dt and T(ln) were calculated on a computer from the recorded pressure curves. The paired t-test was used to determine the statistical significance of the differences. PGE(2) (25 mu g/kg) significantly improved the cardiac contractility and relaxation rate of healthy sheep and significantly reduced the heart rate, while the loading conditions under which the heart operates were not significantly affected. In contrast to healthy sheep, PGE(2) significantly reduced the contractility and relaxation rate of sheep with congestive heart failure and significantly increased the preload while heart rate and afterload were significantly reduced. The study suggests that despite the promising vasodilatory, positive inotropic and relaxation rate actions of PGE(2) in normal hearts, PGE(2) might not be a suitable therapeutic agent for CHF, because of the worsening effect it has on the cardiodynamics and loading conditions of the failing heart.

Animals↗
PubMed1996

Patient, nurse and physician views of dyspnea.

Dyspnea, the subjective sensation of laboured or difficult breathing, is a frequent complaint of patients with terminal disease. Among terminally ill cancer patients, for example, the incidence has been reported to be as high as 74 per cent. Dyspnea is multidimensional, having both physiological and psychological aspects, and, for most people, it worsens as the disease progresses. It is an extremely distressing symptom for both the patient and the family; virtually all dyspneic patients report anxiety or fear of suffocation, a fear that, in turn, exacerbates the dyspnea.

Aged↗
PubMed1995

Age effects on reflex and postural responses to propriomuscular inputs generated by tendon vibration.

The effects of aging on two sensorimotor levels of propriomuscular function were investigated in a young (20- to 44-year-old) and an elderly (60- to 86-year-old) population by eliciting segmental reflex and postural responses via the same muscle spindle inflow generated by applying the same pattern of tendon vibration. The latency and amplitude of the reflex responses to vibration (tonic vibration reflex) of the biceps and triceps brachii did not depend on the subjects' age. No major age-related changes were observed in the deep reflexes of the lower limbs. The postural responses to the same vibratory stimulation applied to both the soleus or the tibialis anterior muscles (vibration-induced falling) did not show any changes in latency depending on either age or the visual conditions, whereas the intensity of these responses decreased both with age and when the use of vision was possible. Our results suggest that the two levels at which the same propriomuscular messages were processed are differentially affected by aging. The lower reflex level does not undergo any noticeable impairment, whereas the higher postural control level deteriorates in the elderly, which might be partly responsible for the balance problems which tend to occur more frequently with advancing age.

Adult↗
PubMed1994

Resolving power of the perceptual- and sensorimotor systems in 6- to 10-year-old children.

Children aged 6 to 10 were tested on their ability to move accurately and to perceptually evaluate their motor response. Subjects performed a directional and an amplitude visuo-manual aiming task without vision of their moving limb. They were asked to correct their error, after completion of their movements, only if they felt they were not accurate. Terminal aiming errors and correction responses (adjustments) were analyzed, and threshold detection was determined relative to terminal aiming error. Action accuracy and evaluation of action accuracy are two abilities that do not develop synchronously. Moreover, the relationship between these abilities depends on whether accuracy and direction or amplitude are required. Amplitude undergoes more corrections than direction, suggesting that the spatial system of reference involved depends more upon the coding of the final position than on direction. Two spatial comparators, operating on the basis of two types of evaluation, seem to have a variably distinct contribution to movement and perception accuracy, according to age.

Journal Article↗
PubMed1994

The dose-related hyper-and-hypokalaemic effects of salbutamol and its arrhythmogenic potential.

1. The hypokalaemic effect of salbutamol after more than 30 min of administration has been well described. A hyper-and-hypokalaemic effect for adrenaline has been reported, but no such hyperkalaemic effect for salbutamol. 2. The possible hyper-and-hypokalaemic effects of salbutamol with the concomitant potential for pro-arrhythmia were assessed in the baboon (Papio ursinus). 3. Male and female baboons were anaesthetized with ketamine (15 mg kg-1) and maintained with 6% pentobarbitone as spontaneously breathing animals. Six baboons in each group received either 10, 100 or 500 micrograms kg-1 salbutamol i.v. Lead II of the ECG and femoral i.a. blood pressure were recorded continuously for 10 min. Arterial blood samples were collected at 0 min and then after 3 and 10 min of salbutamol administration. 4. All the animals developed sinus tachycardia (above 200 beats min-1) within 30 s of each dose of salbutamol administration and the high heart rate persisted throughout the experiment. All the animals were hyperkalaemic after 3 min and hypokalaemic after 10 min for each dose of salbutamol. Left ventricular conduction defects were seen in 3 animals during the hyperkalaemic phase. No arrhythmia was seen during the hypokalaemic phase. 5. Salbutamol has a transient hyperkalaemic and a more prolonged hypokalaemic effect in the baboon. The hypokalaemia could not be associated with arrhythmia although conduction defects were associated with the hyperkalaemia. 6. Since salbutamol is used as a bronchodilator in asthmatic patients and to treat acute hyperkalaemia, it is suggested that caution should be exercised when using salbutamol in high doses to treat acute asthma especially during the first few minutes of administration. The finding of hyperkalaemia with salbutamol questions its use in the treatment of hyperkalaemia.

Albuterol↗
PubMed1992

The effects of nutritional status of rabbits and sheep on their resistance to the ticks Rhipicephalus evertsi evertsi and R. appendiculatus.

Rabbits and sheep were exposed to low- and high-protein diets and subsequently infested three times with adults of Rhipicephalus appendiculatus and Rhipicephalus evertsi evertsi. The mean weight of R.e. evertsi females which dropped from rabbits maintained on a high-protein diet decreased from 515.0 +/- 24.9 mg (naive) to 381.5 +/- 25.0 (second infestation) to 340.3 +/- 23.3 mg (third infestation) while the weight of ticks fed on animals which were exposed to a low-protein diet did not change significantly (2.7%). The mean weight of engorged females of R. appendiculatus which completed their blood meal on rabbits (high protein) decreased from 520.9 +/- 31.8 (naive) to 369.3 +/- 39 mg (3rd infestation), a significant decrease of 29.1% compared to a 12.3% decrease in weight between the 1st and 3rd infestation of females fed on animals on a low-protein diet. Rhipicephalus e. evertsi fed on sheep exhibited the same phenomenon. The mean decrease in weight of 4rd-infestation ticks which dropped from sheep fed lucerne was 26.2% compared to 16.6% for ticks from sheep which were fed on grass. Hosts maintained on a low-protein diet failed to acquire resistance to ticks, lost weight and developed anaemia while those on a high-protein diet developed resistance, maintained weight and did not develop anaemia. The nutritional stress of the hosts and its application in South Africa are discussed.

Analysis of Variance↗
PubMed1991

Kinematics of aiming in direction and amplitude: a developmental study.

The patterns of aimed movements to visual targets were analyzed in children aged 6, 8 and 10. Tasks with direction and/or amplitude requirements were used. The tasks were performed both with and without vision. Peak velocity, acceleration and deceleration and their relative temporal occurrence were evaluated. Overall, the 6- and 10-year-olds exhibited higher peak velocity and acceleration when performing the pure directional task than when performing tasks with an amplitude or stopping requirement. On the contrary, 8-year-olds showed similar peak acceleration and velocity across all three tasks. Similarly, when performing the pure directional task, the 6- and 10-year-olds reached their peak velocity and acceleration relatively later in time than the 8-year-olds. Vision of movement increased the peak velocity in all experimental tasks and peak acceleration was increased only in the pure directional task. Thus, movement kinematics varied according to the task requirements and age. Eight-year-olds showed greater propensity to feedback control in all tasks, suggesting an over-inhibition in their approach patterns, whereas 10-year-olds tended to use feedforward processes, with a shortened deceleration phase.

Child↗
PubMed1991

Proprioceptive control of goal-directed movements in man, studied by means of vibratory muscle tendon stimulation.

The purpose of this study was to investigate the role of propriomuscular feedback in the control of pluriarticular pointing movements, performed without visual feedback toward visual targets. The proprioceptive inputs were distorted during movements by applying vibration to the distal tendon of the biceps muscle. Various movement and vibration durations were imposed. The results show that vibration affects the spatial outcome of the movements. The effects of vibration were movement time-independent when the durations were shorter than 450 ms and became movement time-dependent with longer durations. Moreover, the effects of vibration became more marked when a short vibration was applied at the end rather than at the beginning of a slow movement. These studies suggest that at least two types of proprioceptive control loops may be involved in correcting this kind of movement, depending on the execution time. In slow movements, the final phase might be a privileged period for on-line, propriomuscular-based corrections. Lastly, it emerged that the regulation of a goal-directed movement on the basis of proprioceptive feedback processing can take place within at most 200 ms.

Journal Article↗
PubMed1990

Timing and accuracy of visually directed movements in children: control of direction and amplitude components.

The reaction times (RTs), movement times (MTs), and final accuracy of hand movements directed towards visual goals were measured in 6-, 8-, and 10-year-old children, using tasks in which direction and amplitude components of movement were distinctly required. The tasks were performed with and without visual feedback of the limb. RTs decreased with age, and were shorter in directional than in amplitude task, in all ages. MTs were the longest at age 8 in both tasks, equally short at ages 6 and 10 in the directional task, the shortest at age 10, and intermediate at age 6, when amplitude had to be regulated. In the amplitude task, the target distance generally affected MTs under both visual conditions, but to a lower degree at age 10 than in the two younger groups. Movement accuracy, which was in all cases higher with visual feedback, showed different developmental trends among the two spatial components: directional accuracy was not different among the three groups of age, whereas amplitude accuracy showed a nonmonotonic development in the nonvisual condition, with an increase between age 6 and age 10, and the lowest level at age 8. In the visual condition, amplitude accuracy did not change with age. The specification of direction seems therefore to predominantly load the preparatory stage of the response. Amplitude specification seems to be more dependent on on-going regulations and to undergo a longer and more complex development, with a critical period around age 8 when a greater propensity for a feedback-based control appears on the two components. With increasing age, amplitude tends to be specific to a greater extent by a feedforward process.

Attention↗