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Biomedical subjects

L Robinson

Publications and source records attributed to L Robinson.

At least 19 recordsLinked to original sources
PubMed2007

Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review.

BACKGROUND: Wandering occurs in 15-60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. OBJECTIVE: To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. DESIGN: A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. RESULTS: (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. CONCLUSIONS: In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.

Aged↗
PubMed2006

Submandibular sialogram performed through a Wharton's duct fistula: technical adaptation of conventional technique.

We report a case of submandibular duct fistula in which a sialogram was performed through the fistulous opening after attempt of sialography through the Wharton's duct had failed. To our knowledge, this technical modification in obtaining a sialogram has not been described previously in scientific literature. Blunt-tipped needles and polythene catheters are commonly used for cannulation of the submandibular duct orifice for obtaining a sialogram. However, in this case, a larger gauge metallic cannula was employed to opacify the ductal system through the fistula.

Catheterization↗
PubMed2006

A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use.

OBJECTIVES: To determine the effectiveness and cost-effectiveness of non-pharmacological interventions (excluding subjective barriers) in the prevention of wandering in people with dementia, in comparison with usual care, and to evaluate through the review and a qualitative study the acceptability to stakeholders of such interventions and identify ethical issues associated with their use. DATA SOURCES: Major electronic databases were searched up until 31 March 2005. Specialists in the field. REVIEW METHODS: Selected studies were assessed and analysed. The results of two of the efficacy studies that used similar interventions, designs and outcome measures were pooled in a meta-analysis; results for other studies which reported standard deviations were presented in a forest plot. Owing to a lack of cost-effectiveness data, a modelling exercise could not be performed. Four focus groups were carried out with relevant stakeholders (n = 19) including people with dementia and formal and lay carers to explore ethical and acceptability issues in greater depth. Transcripts were coded independently by two reviewers to develop a coding frame. Analysis was via a thematic framework approach. RESULTS: Ten studies met the inclusion criteria (multi-sensory environment, three; music therapy, one; exercise, one; special care units, two; aromatherapy, two; behavioural intervention, one). There was no robust evidence to recommend any non-pharmacological intervention to reduce wandering in dementia. There was some evidence, albeit of poor quality, for the effectiveness of exercise and multi-sensory environment. There were no relevant studies to determine the cost-effectiveness of the interventions. Findings from the narrative review and focus groups on acceptability and ethical issues were comparable. Exercise and distraction therapies were the most acceptable interventions and raised no ethical concerns. All other interventions were considered acceptable except for physical restraints, which were considered unacceptable. Considerable ethical concerns exist with the use of electronic tagging and tracking devices and physical barriers. Existing literature ignores the perspectives of people with dementia. The small number of participants with dementia expressed caution regarding the use of unfamiliar technology. Balancing risk and risk assessment was an important theme for all carers in the management of wandering. CONCLUSIONS: There is no robust evidence so far to recommend the use of any non-pharmacological intervention to reduce or prevent wandering in people with dementia. High-quality studies, preferably randomised controlled trials, are needed to determine the clinical and cost-effectiveness of non-pharmacological interventions that allow safe wandering and are considered practically and ethically acceptable by carers and people with dementia. Large-scale, long-term cohort studies are needed to evaluate the morbidity and mortality associated with wandering in dementia for people both in the community and in residential care. Such data would inform future long-term cost-effectiveness studies.

Confusion↗
PubMed2005

Vibrotactile frequency discrimination in human hairy skin.

The human capacity for vibrotactile frequency discrimination has been compared directly for glabrous and hairy skin regions by means of a two-alternative, forced-choice psychophysical procedure in five subjects. Sinusoidal vibratory stimuli, delivered by means of a 4-mm-diam probe, were first used to obtain detection threshold values for the two skin sites, the finger tip and the dorsal forearm, at four standard frequencies, 20, 50, 100, and 200 Hz. Values confirmed previous results showing detection thresholds were markedly higher on hairy skin than on glabrous skin. For the discrimination task, each standard frequency, at an amplitude four times detection threshold, was paired with a series of comparison frequencies, and discrimination capacity then was quantified by deriving from psychometric function curves, measures of the discriminable frequency increment (Deltaf) and the Weber Fraction (Deltaf/f), which, when plotted as a function of the four standard frequencies, revealed similar capacities for frequency discrimination at the two skin sites at the standard frequencies of 20, 100, and 200 Hz but an equivocal difference at 50 Hz. Cutaneous local anesthesia produced a marked impairment in vibrotactile detection and discrimination at the low standard frequencies of 20 and 50 Hz but little effect at higher frequencies. In summary, the results reveal, first, a striking similarity in vibrotactile discriminative performance in hairy and glabrous skin despite marked differences in detection thresholds for the two sites, and, second, the results confirm that vibrotactile detection and discrimination in hairy skin depend on superficial receptors at low frequencies but depend on deep, probably Pacinian corpuscle, receptors for high frequencies.

Discrimination Learning↗
PubMed2005

Vibrotactile coding capacities of spinocervical tract neurons in the cat.

The response characteristics and tactile coding capacities of individual dorsal horn neurons, in particular, those of the spinocervical tract (SCT), have been examined in the anesthetized cat. Twenty one of 38 neurons studied were confirmed SCT neurons based on antidromic activation procedures. All had tactile receptive fields on the hairy skin of the hindlimb. Most (29/38) could also be activated transynaptically by electrical stimulation of the cervical dorsal columns, suggesting that a common set of tactile primary afferent fibers may provide the input for both the dorsal column-lemniscal pathway and for parallel ascending pathways, such as the SCT. All but 3 of the 38 neurons studied displayed a pure dynamic sensitivity to controlled tactile stimuli but were unable to sustain their responsiveness throughout 1s trains of vibration at vibration frequencies exceeding 5-10 Hz. Stimulus-response relations revealed a very limited capacity of individual SCT neurons to signal, in a graded way, the intensity parameter of the vibrotactile stimulus. Furthermore, because of their inability to respond on a cycle-by-cycle pattern at vibration frequencies >5-10 Hz, these neurons were unable to provide any useful signal of vibration frequency beyond the very narrow bandwidth of approximately 5-10 Hz. Similar limitations were observed in the responsiveness of these neurons to repetitive forms of antidromic and transynaptic inputs generated by electrical stimulation of the spinal cord. In summary, the observed limitations on the vibrotactile bandwidth of SCT neurons and on the precision and fidelity of their temporal signaling, suggest that SCT neurons could serve as little more than coarse event detectors in tactile sensibility, in contrast to DCN neurons the bandwidth of vibrotactile responsiveness of which may extend beyond 400 Hz and is therefore broader by approximately 40-50 times than that of SCT neurons.

Action Potentials↗
PubMed2005

Processing of vibrotactile inputs from hairy skin by neurons of the dorsal column nuclei in the cat.

The capacity of single neurons of the dorsal column nuclei (DCN) for coding vibrotactile information from the hairy skin has been investigated in anesthetized cats to permit quantitative comparison first with the capacities of DCN neurons responding to glabrous skin vibrotactile inputs and second with those of spinocervical tract neurons responding to vibrotactile inputs from hairy skin. Dynamically sensitive tactile neurons of the DCN the input of which came from hairy skin could be divided into two classes, one associated with hair follicle afferent (HFA) input, the other with Pacinian corpuscle (PC) input. The HFA-related class was most sensitive to low-frequency (<50 Hz) vibration and had a graded response output as a function of vibrotactile intensity changes. PC-related neurons had a broader vibrotactile sensitivity, extending to > or =300 Hz and appeared to derive their input from the margins of hairy skin, near the footpads, or from deeper PC sources such as the interosseous membranes or joints. HFA-related neurons had phaselocked responses to vibration frequencies up to approximately 75 Hz, whereas PC neurons retained this capacity up to frequencies of approximately 300 Hz with tightest phaselocking between 50 and 200 Hz. Quantitative measures of phaselocking revealed that the HFA-related neurons provide the better signal of vibrotactile frequency up to approximately 50 Hz with a switch-over to the PC-related neurons above that value. In conclusion, the functional capacities of these two classes of cuneate neuron appear to account for behavioral vibrotactile frequency discriminative performance in hairy skin, in contrast to the limited capacities of vibrotactile-sensitive neurons within the spinocervical tract system.

Action Potentials↗
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

Association analysis of two candidate phospholipase genes that map to the chromosome 15q15.1-15.3 region associated with reading disability.

Molecular genetic studies have suggested a reading disability (RD, dyslexia) susceptibility locus on chromosome 15q. We have previously mapped this locus by association to the region surrounding D15S994. Very little is known about the neurobiological processes involved in RD, and therefore selecting positional candidate genes for analysis based upon function is difficult. Nevertheless we were able to identify two functional candidates based upon existing hypotheses. Both were phospholipase genes, phospholipase C beta 2 (PLCB2) and phospholipase A2, group IVB (cytosolic; PLA2G4B). D15S944 is located within PLCB2 and is 1.6 Mb from PLA2G4B. We examined each gene for association using a mixed direct and indirect association approach, a case (n = 164)/control (n = 174) sample, and a partially overlapping sample of 178 RD parent-proband trios from South Wales and England. Mutation analysis revealed 14 sequence variants in PLCB2 and 33 variants in PLA2G4B. All non-synonymous SNPs were genotyped as were SNPs across each gene with maximum distance between SNPs of 6 kb. Case-control analyses revealed modest evidence (0.01 < P < 0.05) for association between a single variant in PLCB2 and two variants in PLA2G4B. However, association was not confirmed in the family based sample. As the latter sample has previously generated replicated significant evidence for association between RD and markers/haplotypes surrounding D15S944, it should have sufficient power to detect association to variants in susceptibility gene itself. We conclude that neither gene accounts for the association signal we previously observed. As these are the only clear cut functional candidate genes in the region, identification of the putative susceptibility locus for RD on 15q will require more methodical non-hypothesis driven positional cloning approaches.

Alleles↗
PubMed2003

Linkage disequilibrium mapping provides further evidence of a gene for reading disability on chromosome 6p21.3-22.

Linkage disequilibrium (LD) mapping was used to follow up reports of linkage between reading disability (RD) and an 18 cM region of chromosome 6p21.3-22. Using a two-stage approach, we tested for association between RD and 22 microsatellite markers in two independent samples of 101 (Stage 1) and 77 (Stage 2) parent/proband trios in which RD was rigorously defined. The most significant replicated associations were observed between combinations of markers D6S109/422/1665 (Stage 1, P=0.002 (adjusted for multiple testing); Stage 2, P=0.0001) and D6S506/1029/1660 (Stage 1, P=0.02 (adjusted), Stage 2, P=0.0001). The only two-marker association observed in both samples was with D6S422/1665 (P=0.01, 0.04). No single marker showed replicated association but D6S506 produced values of P=0.01 and 0.08 which were significant when combined (P=0.02). We observed weaker and less consistent evidence of association in a region of confirmed linkage to RD in previous studies. The most consistently significant haplotypic association D6S109/422/1665, showed association with single-word reading, spelling, phonological awareness, phonological decoding, orthographic accuracy and random automised naming, but not with vocabulary or Attention Deficit Hyperactivity Disorder. Our findings strongly support the presence of a gene contributing to RD in a region of chromosome 6 between markers D6S109 and D6S1260, but do not rule out the presence of a gene between D6S1556 and MOG.

Adolescent↗
PubMed2003

Reliability of a combined 3-min constant load and performance cycling test.

Most fitness assessments either use a constant load to exhaustion (exercise capacity test) or an "all-out" effort (performance test). The purpose of this study was to determine the reliability of a high-intensity assessment that combined a constant load element with a performance test. Ten moderately trained male cyclists completed a ramp test to voluntary exhaustion in order to measure maximum minute power output (mean +/- s, 349.3 w +/- 55.0 w). On two other occasions subjects cycled at a constant load at maximum minute power output for 2-min immediately followed by a 1-min performance test. All tests were conducted on the subjects' own bicycles using a Kingcycle trade mark test rig. Power output was measured each second using SRM trade mark Power Cranks. The data were analysed by measuring the reliability of each 30 s of the 3-min test together with the peak power and the peak cadence achieved in the performance element of the test. There was no systematic bias in the data from trial 1 to trial 2 for any of the 6, 30 s blocks of the test, the peak power (mean, 95 % CI, 413.8 w, 357.8 - 469.7 w and 403.8 w, 339.9 - 467.6 w, trial 1 and trial 2, respectively) or peak cadence (95.0 rev x min(-1), 89.5 - 100.5 rev x min(-1) and 95.1 rev x min(-1), 90.0 - 100.1 rev x min(-1), trial 1 and trial 2, respectively). Mean (+/- s) total distance over the 3-min was 2.23 +/- 0.23 km and 2.26 +/- 0.26 km for trial 1 and trial 2 respectively (p > 0.05). The coefficients of variation ranged from 0.9 - 5.4 % and the intraclass correlation coefficients ranged from 0.96 - 0.99. It is concluded that in moderately trained subjects, the 3-min combination test provides reliable data and could therefore be used for short-term, high-intensity cycling intervention studies.

Analysis of Variance↗
PubMed2001

Visual discrimination learning in the water maze: a novel test for visual acuity.

Learning about space, the environment and specific objects comprising three-dimensional arrangements requires processing of visual information. As learning and memory experiments in mammals rely heavily on normal processing of visual cues, drug-induced disruption of acquisition learning or memory formation necessitates the important control for visual acuity. A popular task used frequently for rats is the Morris water maze. However, previously used visual tasks in the water maze only control for gross visual disturbances. Here we describe a new training procedure enabling visual acuity to be tested in the water maze. Animals were trained to discriminate between two cue cards containing a pattern of vertical black and white stripes. Cards were presented in two adjacent quadrants separated by a barrier with the escape platform located in front of the smaller stripes (1 cm wide). Once 80% correct responses were attained, the wider cue card (normally 5 cm wide stripes) was randomly changed to gratings of 1,2,3,4,5, and 10 cm width. Animals learned the discrimination with acuity of 1.5 c/deg. A detailed analysis of the swim patterns further suggests that, independent of the grating used, animals make a choice immediately after release and swim along the walls towards the cue. In a further acuity test taken a few weeks later when animals were given saline infusions, performance was better than in the first test suggesting an effect of learning. This novel test may prove useful in determining subtle drug-induced deficits in visual acuity that may contribute to disruption of spatial performance in the water maze.

Animals↗
PubMed2001

Program directors' opinions in regard to Didactic Program in Dietetics graduates' failure to secure placement in Supervised Practice Programs.

This study investigated program directors' perspectives on Didactic Program in Dietetics graduates' inability to secure positions in Supervised Practice Programs. The sample included all 229 program directors listed in the Directory of Dietetics Programs 1997-98. Directors contacted by electronic mail or fax completed a 4-part survey instrument including 3 Likert scale sections exploring the effects of the situation and strategies suggested to lessen them. The fourth part reported current practices. Response rate was 56%. Graduates' failure to secure Supervised Practice Program positions was found to be a significant or somewhat significant problem regardless of program size or affiliation. Strategies to increase the likelihood of Supervised Practice Program acceptance included work experience, application coaching, graduate coursework, and reapplication. We found that program directors have a high level of concern about their graduates' futures and are frustrated by their limited ability to improve the situation. Helping graduates who do not secure Supervised Practice Program assignments identify career options is essential.

Career Choice↗
PubMed2001

Evaluation of diets for the development and reproduction of Franklinothrips orizabensis (Thysanoptera: Aeolothripidae).

The suitability of ten diets for the development and reproduction of Franklinothrips orizabensis Johansen, the key natural enemy of Scirtothrips perseae Nakahara, a pest of California grown avocados, was determined in the laboratory. The experimental diets evaluated were: (i) irradiated Ephestia kuehniella Zeller eggs; (ii) irradiated E. kuehniella eggs and avocado pollen; (iii) Tetranychus pacificus McGregor eggs; (iv) T. pacificus eggs and avocado pollen; (v) irradiated E. kuehniella eggs and T. pacificus eggs; (vi) irradiated E. kuehniella eggs, T. pacificus eggs and avocado pollen; (vii) Scirtothrips perseae; (viii) Heliothrips haemorrhoidalis (Bouchè); (ix) avocado pollen; and (x) a young avocado leaf. Franklinothrips orizabensis larvae were unable to develop to adulthood on diets 9 and 10. The remaining eight diets supported complete development of F. orizabensis, but only diets 1, 2, 5, 6, 7 and 8 produced fecund females. On diet 5, F. orizabensis exhibited high larval to adult survivorship (90%), mated females exhibited highest daily and lifetime fecundity, and the progeny of mated females were female biased (53%). Analysis of jackknife estimates of net reproduction (Ro), intrinsic rate of increase (rm), and finite rate of increase (lambda) were all significantly greater for F. orizabensis reared on irradiated E. kuehniella eggs and T. pacificus eggs (i.e. diet 5) than corresponding values for other diets on which female F. orizabensis were able to complete development and reproduce. Incorporation of avocado pollen into diets had an adverse effect on demographic statistics for F. orizabensis, and low quality diets resulted in male biased sex ratios for this predator.

Animal Feed↗
PubMed2001

Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function.

BACKGROUND: Compartmental syndrome (CS) is difficult to diagnose in intensive care unit patients. Compartment perfusion pressure (CPP) is an invasive, indirect measure of ischemia. Near-infrared spectroscopy is noninvasive, and directly measures ischemia by transmitting light through tissues at wavelengths that react with hemoglobin to provide percent tissue oxygen saturation (Sto(2)). Animal studies demonstrate that Sto(2) is superior to CPP for detecting CS. However, there are no studies in humans comparing Sto(2) with CPP. We hypothesized that Sto(2) can reliably detect CS, and is superior to CPP. METHODS: CS was induced in 15 human volunteers using a standard calf compression model. At 30-minute intervals, compression was increased to reduce Sto(2) from baseline (86% +/- 4%) to 60%, 40%, 20%, and < 10%, with simultaneous recording of CPP. Outcome variables included deep peroneal nerve conduction assessed by electromyography, cutaneous peroneal nerve sensitivity using Semmes-Weinstein monofilaments, and pain (visual analog scale). RESULTS: Both Sto(2) and CPP significantly correlated with all ischemia outcome variables (p < 0.001). Receiver operating characteristic curves of deep peroneal nerve conduction demonstrated that Sto(2) had higher sensitivity than CPP for detecting > 50% block. For example, when specificity was 83% for Sto(2) and 84% for CPP, sensitivity was 85% versus 56%, respectively (p = 0.02). When specificity for both was 72%, sensitivity was 94% for Sto(2) versus 76% for CPP (p = 0.04). CONCLUSION: In intensive care unit patients who cannot alert physicians to symptoms, near-infrared spectroscopy may help clinicians to avoid delayed or unnecessary prophylactic fasciotomy, and provides the benefits of a continuous, noninvasive monitoring technique.

Adolescent↗
PubMed2001

The management of constipation in people with advanced cancer.

Constipation represents a significant problem for people with advanced cancer. It ranks in the top three most uncomfortable symptoms experienced, causing pain and anorexia that ultimately result in misery. The negative impact upon the quality of life of the patient and their carers is significant. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the management of constipation. Theoretical knowledge enables appropriate preventative interventions to be planned in collaboration with other members of the multidisciplinary team. When preventative measures are not applied or are unsuccessful, informed assessment and care planning enables appropriate interventions to be applied in order to resolve constipation. This article will discuss the causes and management of constipation. The discussion focuses on assessment, setting goals with the patient and their carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes.

Cathartics↗
PubMed2000

A specialist toxicity database (TRACE) is more effective than its larger, commercially available counterparts.

The retrieval precision and recall of a specialist bibliographic toxicity database (TRACE) and a range of widely available bibliographic databases used to identify toxicity papers were compared. The analysis indicated that the larger size and resources of the major bibliographic databases did not, for a series of test queries, assure superior retrieval of relevant papers. The specialist database, in which document selection and indexing is undertaken by the same expert toxicologists who use the database in their day-to-day work, achieved markedly better retrieval, using simpler search strategies, than the other databases. Specialist databases may offer a valuable alternative to the existing major bibliographic databases. The concept of relevance, as used to determine the effectiveness of bibliographic databases, is discussed.

Data Collection↗