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Biomedical subjects

Peter Mills

Publications and source records attributed to Peter Mills.

9 recordsLinked to original sources
PubMed2006

Temporal and spatial dispersal of cladobotryum conidia in the controlled environment of a mushroom growing room.

Cladobotryum spp. are responsible for cobweb disease of mushrooms. In two commercial and one experimental mushroom-growing room, Cladobotryum conidia were released into the air in direct response to physical disturbance of disease colonies during either crop watering or treatment by covering with salt to 10 mm. Conidia were detected using a Burkard spore trap or agar-based trap plates. A maximum concentration of approximately 25,000 conidia m(-3) was recorded in a small (75-m(3)) experimental growing room in the hour following the salting of 16 cobweb patches (0.55 m(2)). Concentrations of 100 and 40 conidia m(-3) were recorded in the two larger commercial growing rooms in the hour following the salting of 18 and 11 patches of cobweb (diameter, approximately 50 to 200 mm), respectively. In controlled experiments, disturbed conidia were dispersed rapidly throughout a small growing room, with 91 to 97% of conidia settling out within 15 min. Eighty-five percent of conidia settled out within a 0.5-m radius when air-conditioning fans were switched off, consistent with airborne spore dispersal. Alternative methods for treating diseased areas to minimize conidial release and distribution were investigated and included covering disease colonies with damp paper tissue prior to salt application (tissue salting) and holding a dust extractor above disease colonies during salt application. Both methods resulted in no detectable airborne conidia, but the tissue paper salting technique was more convenient. Prevention of airborne conidial release and distribution is essential to avoid mushroom spotting symptoms, secondary colonies, and early crop termination.

Agaricus↗
PubMed2006

Differences in multiple segment tremor dynamics between young and elderly persons.

BACKGROUND: Physiological tremor is an intrinsic and highly variable motor output that is sensitive to alteration in both neuromuscular function and/or changing task demands. Given that any tremor increase can severely influence fine motor performance, there is a requirement to clarify what factors lead to increased tremor. Identification of those factors that alter tremor may be particularly pertinent for elderly persons, who often exhibit a decline in postural control and amplified tremor. The aim of this study was to examine the effect of whole body posture (seated vs standing) on multiple segment tremor and forearm electromyogram (EMG) activity of younger and older individuals. METHODS: Fourteen older and 12 young participants performed a bilateral pointing task. Tremor data were collected using accelerometers attached to the forearm, hand, and finger segments of each arm. Surface EMG data were also collected from the extensor digitorum muscle of each arm. RESULTS: Although the pattern of tremor was similar between age groups, older participants exhibited increased hand and finger tremor amplitude and increased EMG activity across all postural conditions. For older individuals, tremor increases were greatest when the participant performed the task in a standing position. All age-related increases in hand and/or finger tremor were confined to increases in peak power between 8 Hz and 12 Hz. CONCLUSIONS: From a clinical perspective, these findings illustrate that using multiple segment tremor analyses can provide additional insight into potential age-related tremor differences. Additionally, the fact that postural position had a pronounced effect on tremor in older individuals suggests that body posture should be considered as a potential confounding factor when assessing tremor differences between population groups.

Adult↗
PubMed2005

Success of a multidisciplinary heart failure clinic for initiation and up-titration of key therapeutic agents.

BACKGROUND: Heart failure has a poor prognosis, yet drugs known to improve outcomes are either not prescribed, or prescribed at sub-therapeutic doses. The National Service Framework (NSF) for coronary heart disease recommended specialist heart failure clinics to address this problem but their efficacy has not been evaluated. OBJECTIVES: To determine the effectiveness of a protocol-driven heart failure clinic staffed by nurse and pharmacist specialists for improving symptoms and optimising treatment with key therapeutic agents, without adversely affecting renal function. RESULTS: Of the 234 patients with at least one follow-up visit, 127 (57%) were receiving none or only one key therapeutic agent when first seen, this was reduced to 25 patients (11%) at most recent follow-up. The improvement in prescription rates was accompanied by significant up-titration of dose, the proportion of patients on "medium" or "high" doses rising from 43 (18%) to 134 (57%) for beta-blockers, and from 129 (55%) to 201 (86%) for ACE-inhibitors/angiotensin receptor blockers. Clinical improvement was reflected in reductions in patients with NYHA functional classes III and IV (93 (40%) to 53 (23%)), and in patients with moderate or severe symptoms. Significant reductions in alcohol consumption and cigarette smoking were recorded. Up-titration of treatment was associated with reductions in heart rate and systolic blood pressure; increases in serum potassium and creatinine concentrations were small. CONCLUSION: In a heart failure clinic staffed by nurse and pharmacist specialists, it is possible to achieve target doses of key therapeutic agents and improve symptoms without adversely affecting electrolytes or renal function.

Adrenergic beta-Antagonists↗
PubMed2004

Learning on the Web. Case 5: infective endocarditis.

A 70 year old man presented with microscopic haematuria and proteinuria and a fever five months after having a transurethral resection of the prostate (TURP). Initially urological review was arranged as the family doctor thought that a urinary infection was the most likely diagnosis. The patient was concerned that he was not getting better and he self-referred to a physician. He had continuing fever, weight loss, and malaise. The physician detected a mitral pan-systolic murmur that had not been heard before. On the basis of this finding infective endocarditis was suspected and investigations begun. His subsequent course and its management are discussed in an interactive case presentation.

Aged↗
PubMed2003

Investigating the source of hepatitis C virus infection among individuals whose route of infection is undefined: a study of ten cases.

Hepatitis C virus (HCV) transmission is predominantly parenteral via infected blood products or shared injecting equipment. Many infected individuals, however, deny these risk factors. This study set out to determine whether an in-depth interview would determine the likely source of infection for those whose route of infection was undefined. Between May 1999 and July 1999, risk factor information was sought, through in-depth interview, from 10 patients whose source of hepatitis C infection was undefined. The clinical notes of the patients were scrutinized to complement the information provided through the questionnaire. Despite undertaking an in-depth interview, it was not possible to establish the likely route of infection for 9 of the 10 individuals studied as they reported several risk events. There is little benefit to interviewing routinely those HCV-infected people who have no history of injecting drugs or having received a contaminated blood/blood product transfusion, to ascertain their likely source or time of infection; at best, such effort might only increase one's confidence that infection was acquired through means other than these 2 routes.

Adult↗
PubMed2002

Brief intervention during hospital admission to help patients to give up smoking after myocardial infarction and bypass surgery: randomised controlled trial.

OBJECTIVE: To evaluate a smoking cessation intervention that can be routinely delivered to smokers admitted with cardiac problems. DESIGN: Randomised controlled trial of usual care compared with intervention delivered on hospital wards by cardiac rehabilitation nurses. SETTING: Inpatient wards in 17 hospitals in England. PARTICIPANTS: 540 smokers admitted to hospital after myocardial infarction or for cardiac bypass surgery who expressed interest in stopping smoking. INTERVENTION: Brief verbal advice and standard booklet (usual care). Intervention lasting 20-30 minutes including carbon monoxide reading, special booklet, quiz, contact with other people giving up, declaration of commitment to give up, sticker in patient's notes (intervention group). MAIN OUTCOME MEASURES: Continuous abstinence at six weeks and 12 months determined by self report and by biochemical validation at these end points. Feasibility of the intervention and delivery of its components. RESULTS: After six weeks 151 (59%) and 159 (60%) patients remained abstinent in the control and intervention group, respectively (P=0.84). After 12 months the figures were 102 (41%) and 94 (37%) (P=0.40). Recruitment was slow, and delivery of the intervention was inconsistent, raising concerns about the feasibility of the intervention within routine care. Patients who received the declaration of commitment component were almost twice as likely to remain abstinent than those who did not receive it (P<0.01). Low dependence on tobacco and high motivation to give up were the main independent predictors of positive outcome. Patients who had had bypass surgery were over twice as likely to return to smoking as patients who had had a myocardial infarction. CONCLUSIONS: Single session interventions delivered within routine care may have insufficient power to influence highly dependent smokers.

Adult↗
PubMedDate not supplied

Assessing the performance of specialist registrars.

Assessing the performance of doctors while they are engaged in clinical work is a challenging concept. The introduction of objective-based curricula provides the stimulus and opportunity for the Royal Colleges of Physicians to develop relevant and reliable methods of in-service assessment. We propose to pilot a study investigating the validity, reliability and feasibility of three assessment methods--direct observation of the clinical encounter using an adapted mini-CEX, direct observation of the performance of practical procedures (DOPS), and the doctor's ability to perform effectively as part of a team using 360 degree assessment. The methods will be studied in the setting of routine clinical care. Whilst demanding of time from both trainees and trainers, they will represent a significant advance on the current system which is characterised by a lack of evidence in the assessment process.

Clinical Competence↗