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Biomedical subjects

P Welch

Publications and source records attributed to P Welch.

At least 19 recordsLinked to original sources
PubMed2006

An outbreak of Cryptosporidium hominis infection at an Illinois recreational waterpark.

Cryptosporidium has become increasingly recognized as a pathogen responsible for outbreaks of diarrhoeal illness in both immunocompetent and immunocompromised persons. In August 2001, an Illinois hospital reported a cryptosporidiosis cluster potentially linked to a local waterpark. There were 358 case-patients identified. We conducted community-based and waterpark-based case-control studies to examine potential sources of the outbreak. We collected stool specimens from ill persons and pool water samples for microscopy and molecular analysis. Laboratory-confirmed case-patients (n=77) were more likely to have attended the waterpark [odds ratio (OR) 16.0, 95% confidence interval (CI) 3.8-66.8], had pool water in the mouth (OR 6.0, 95% CI 1.3-26.8), and swallowed pool water (OR 4.5, 95% CI 1.5-13.3) than age-matched controls. Cryptosporidium was found in stool specimens and pool water samples. The chlorine resistance of oocysts, frequent swimming exposures, high bather densities, heavy usage by diaper-aged children, and increased recognition and reporting of outbreaks are likely to have contributed to the increasing trend in number of swimming pool-associated outbreaks of cryptosporidiosis. Recommendations for disease prevention include alteration of pool design to separate toddler pool filtration systems from other pools. Implementation of education programmes could reduce the risk of faecal contamination and disease transmission.

Adolescent↗
PubMed2001

Molecular mechanisms of polymer crystallization from solution.

Our simulations of polymer crystallization from solutions show that (1) entropic barriers control the selection of the initial lamellar thickness, (2) growth at the crystalline interface is chain adsorption followed by crystallographic registry, and (3) lamellar thickening is a highly cooperative process requiring the mobility of all chains in the crystal. These results, especially the latter, challenge the conventional Lauritzen-Hoffman theory and its generalizations.

Journal Article↗
PubMed2001

Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite.

BACKGROUND: It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease. METHODS: In an area of New York where Lyme disease is hyperendemic we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Entomologists confirmed the species of the ticks and classified them according to sex, stage, and degree of engorgement. RESULTS: Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P<0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02) and particularly after bites from nymphal ticks that were at least partially engorged with blood (8 of 81 bites [9.9 percent], as compared with 0 of 59 bites from unfed, or flat, nymphal ticks [0 percent]; P=0.02). CONCLUSIONS: A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.

Adolescent↗
PubMed2000

Microbial quality of water in rural communities of Trinidad.

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0%), fecal coliforms in 102 (61.1%), and E. coli in 111 (66.5%). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6%) were mucoid, 9 (3.6%) were hemolytic, and 37 (14.6%) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5%) were verocytotoxigenic. Twenty-eight (14.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1%) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3%), while 48 households (28.7%) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coliform contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2% of samples) than was water stored in tanks (53.3% of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9% versus 88.8%, P < 0.001) and fecal coliforms (41.2% versus 69.8%, P < 0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage.

Humans↗
PubMed1997

Risk reversals in predictive testing for Huntington disease.

The first predictive testing for Huntington disease (HD) was based on analysis of linked polymorphic DNA markers to estimate the likelihood of inheriting the mutation for HD. Limits to accuracy included recombination between the DNA markers and the mutation, pedigree structure, and whether DNA samples were available from family members. With direct tests for the HD mutation, we have assessed the accuracy of results obtained by linkage approaches when requested to do so by the test individuals. For six such individuals, there was significant disparity between the tests. Three went from a decreased risk to an increased risk, while in another three the risk was decreased. Knowledge of the potential reasons for these changes in results and impact of these risk reversals on both patients and the counseling team can assist in the development of strategies for the prevention and, where necessary, management of a risk reversal in any predictive testing program.

Adult↗
PubMed1995

Performance-based public health in Texas.

Responding to a 1987 state audit report, the Texas Department of Health began a performance-based objectives project to tie contract funds to local health departments (LHDs) to performance measures. The overall goal of the project is to improve public health practice in Texas. A major focus has been on having regional and LHD program staff develop realistic and measurable outcome and process objectives. Training on the planning and monitoring phases of the health program management cycle has been conducted, with future training planned on the evaluation phase. There are increasing reports on the value of the performance-based objectives process.

Humans↗
PubMed1991

Intravenous buprenorphine reduces pupil size and the light reflex in humans.

The pupillary effects of intravenous buprenorphine were studied in eight nondependent male subjects who reported previous opiate use. Buprenorphine (0.3, 0.6, and 1.2 mg) decreased pupil size, the amplitude of the light reflex, and the velocities of constriction and dilation. Significant pupillary effects occurred within 15 min of the injection and persisted for 24 hr. At 48 hr most measures returned to baseline levels. Generally the magnitude of the effect was not dose related although recovery occurred sooner after the lower dose. The time course of the pupillary effects of buprenorphine exceeds duration of its analgesic and subjective effects. Previous studies have reported that pupillary measures are especially sensitive to the acute effects of full opiate agonists. The results of the present study indicate that buprenorphine, a partial opiate agonist, causes profound and persistent effects on pupillary size and dynamic measures.

Adult↗
PubMed1989

Diabetics in long-term care. Effect of sweetness on dietary intake.

This study reported on the dietary intake of the institutionalized diabetics consuming low-kilocalorie sweeteners or fructose. The dietary intake was comparable to that for nondiabetics and consistent with the data from NHANES II. Nutrient intakes for diabetics met 100% of the RDA when either sweetener was used. Because of the increase in carbohydrates from fructose, the percentage of calories from fat approximated more closely the 30% recommended for diabetic adults. When fructose diets were used, there was a decrease in sucrose intake, which may help keep serum glucose and insulin responses within a normal range. The additional energy from fructose probably had little negative effect on the institutionalized diabetic population (which was not obese) and may have provided energy for weight maintenance. The use of calorie-dense sweeteners with the general population of diabetics who tend to be overweight requires further study.

Aged↗
PubMed1989

Opiate-induced pupillary effects in humans.

The pupillary effects of several opiates were assessed in human volunteers (N = 6) by means of a newly developed hand-held pupilometer, Pupilscan. Static (diameter) and dynamic (light reflex) responses after morphine, heroin, codeine, oxycodone, oxymorphone and hydrocodone were recorded. The opiates caused dose-related decreases in pupillary size and in the velocity of constriction to a light stimulus. The velocity of redilation after a light stimulus was also decreased. These data indicate that opiates cause systematic changes in dynamic pupillary responses in humans and that measures of these changes may be useful in the quantitative estimation of drug-induced impairment.

Adult↗
PubMed1988

Clonidine partially blocks the physiologic effects but not the subjective effects produced by smoking marijuana in male human subjects.

Clonidine, an alpha 2-agonist, was studied in three male human subjects in a multi-dose pilot study in combination with smoking marijuana cigarettes. Marijuana alone caused increases in responses on subjective effect questionnaires and increased heart rate. Pretreatment with single oral doses of clonidine three hours prior to marijuana induced no changes in subjective effects prior to smoking marijuana and did not diminish the subjective effects produced by marijuana. Clonidine did substantially reduce but did not abolish the marijuana-induced rise in heart rate. Based on these preliminary data from three subjects, it is concluded that clonidine does not have therapeutic value in the clinical management of active marijuana abuse.

Adrenocorticotropic Hormone↗