PubMed Health⌕ Search

Biomedical subjects

Richard Stephenson

Publications and source records attributed to Richard Stephenson.

11 recordsLinked to original sources
PubMed2006

Building an interprofessional curriculum framework for health: a paradigm for health function.

There is an increasing call for curricula in health care to facilitate interprofessional client-centred evidence-based decision making through a reflective and reflexive framework. This discussion paper proposes that adoption of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) as a framework for curricula of health professionals promotes the necessary paradigm shift needed to legitimise a broad evidence base as the foundation of interprofessional dialogue. Client function is seen as the product of an open system incorporating the individual, social and environmental influences on behaviour, with the role of the professional being to acknowledge the context of individual behaviour through an understanding of individual's functioning in their environment. It is concluded that client focused practice and an iterative process of clinical reasoning based on a broad evidence base that conceptualises health care as the maintenance and promotion of health across the lifespan requires a re-conceptualising of health. The emerging concept shifts the primary emphasis of health care away from post-diagnosis tertiary care towards clients who maintain a life-long independence in the community.

Curriculum↗
PubMed2006

The effect of time of day on apnoea index in the sleeping rat.

This study tested the hypothesis that apnoea index would be greater during daytime sleep than nighttime sleep in the rat. Electroencephalogram and electromyogram were monitored via biotelemetry implant and respiration was measured using whole body plethysmography in six male rats in two separate 34h recording sessions per animal. Apnoeas were classified as "spontaneous" or "post-sigh". Daily average spontaneous apnoea index was 35 times greater (p<0.0001) during rapid eye movement (REM) sleep than in non-REM (NREM) sleep. In contrast, daily average post-sigh apnoea index was not significantly greater in REM sleep than in non-REM (NREM) sleep (p=0.39). There was a greater post-sigh apnoea index during daytime REM than during nighttime REM (p=0.043) but REM-related spontaneous apnoea index was unaffected by time of day. There was no day to night difference in spontaneous apnoea index or post-sigh apnoea index during NREM sleep. Respiratory variability (coefficient of variation for breath duration and tidal volume) was not affected by time of day in REM or NREM sleep. We conclude that the circadian timing system has no effect on apnoea index during NREM sleep in the rat, but it may influence the propensity for post-sigh apnoea during REM sleep.

Animals↗
PubMed2006

The 20-item Toronto Alexithymia Scale: validation of factor solutions using confirmatory factor analysis on physiotherapy out-patients.

OBJECTIVE: Whilst the 20-item Toronto Alexithymia Scale (TAS-20) was developed to measure three intercorrelated dimensions, there is some debate as to whether the scale is best served by a two- or three-factor construct. In particular, there is some doubt as to whether clinical data exhibit the third factor. This study uses data from a sample of physiotherapy (physical therapy) out-patients in the UK to validate the factorial structure of a set of models postulated in the literature, including the three-factor model hypothesized by Bagby et al. (1994). METHOD: Data were collected from a sample of physiotherapy out-patients (N=242). Specialist factor analysis software (LISREL 8.54) was used to perform confirmatory factor analyses on a range of models proposed in the literature. RESULTS: The analysis supports the three-factor model assumed by Bagby et al. (1994), as well as most of the two-factor models suggested in the literature. CONCLUSIONS: This new set of clinical data supports most of the two- and three-factor models postulated in the recent literature, including the three-factor model advocated by Bagby et al. (1994).

Affective Symptoms↗
PubMed2005

A visual aid for computer-based analysis of sleep-wake state in rats.

Computer-based sleep scoring systems are often calibrated by reference to a conventional visual analysis of electroencephalographic (EEG) and electromyographic (EMG) traces. However, these types of data place high demands on digital storage capacity which may limit the duration or feasibility of some studies. The present paper describes an approach to visual analysis that involves reconstruction of a waveform (termed a "pseudopolygram" (PPG)) from conditioned data derived from the EEG and EMG. The PPG is the sum of three sine waves, each of which has a distinct frequency (non-REM sleep (NREM), 3 Hz; rapid eye movement sleep (REM), 7 Hz and wakefulness (WAKE), 60 Hz) and amplitude proportional to the value of a state-specific scoring variable. Thus, in NREM sleep the wave depicting the NREM quantifier has high amplitude and produces a PPG with dominant 3 Hz frequency. In REM sleep, the wave depicting the REM quantifier has high amplitude and produces a PPG with a dominant 7 Hz frequency, and in WAKE the PPG is dominated by 60 Hz. Thus, the PPG provides a means for visual discrimination of the three behavioural states. Validation studies found an overall reliability of 94% compared with conventional visual analysis of EEG and EMG. The PPG was also found to remain accurate in rats after 24 h of sleep deprivation.

Animals↗
PubMed2005

A theoretical analysis of diving performance in the Weddell seal (Leptonychotes weddelli).

Marine mammals are constrained in their foraging behaviour because, as obligate air breathers, they must undertake regular trips to the water surface to satisfy the need for respiratory gas exchange. Maximum underwater endurance time is determined by O2 supply and demand, but this does not necessarily imply that O2 is the main factor regulating individual dive and surface times. This study presents a theoretical analysis of diving performance that emphasizes a key role for CO2 in the proximate control of diving behaviour. Computer simulations, based on a mathematical model of the mammalian cardiorespiratory control system, are used to investigate the influence of swimming to depth and other energetic stresses (feeding, thermogenesis, sleep) on predicted diving behaviour in an average adult Weddell seal. The plausibility of the proposed model is supported by the study, which replicated published observations of natural diving behaviour in this species. It is suggested that diving behaviour is tuned to oscillations in respiratory drive and that behavioural and physiological factors can alter the dynamic characteristics of the system to achieve a highly adaptable reciprocal interaction that blurs the boundary between physiology and behaviour.

Animals↗
PubMed2005

Physiological control of diving behaviour in the Weddell seal Leptonychotes weddelli: a model based on cardiorespiratory control theory.

Despite being obligate air breathers, many species of marine mammal are capable of spending most of their lives submerged in water. How they do this has been a subject of intense interest to physiologists for over a century, yet we still do not have a detailed understanding of the physiological mechanisms underlying this behaviour. What are the proximate mechanisms that trigger the 'decisions' to submerge and return to the surface? The present study proposes a model intended to address this question, based on fundamental concepts of cardiorespiratory control. Two basic hypotheses are examined by computer simulation, using a mathematical model of the mammalian cardiorespiratory control system with parameter values for an adult Weddell seal: (1) that the control of diving can be considered to be a respiratory control problem, and (2) that dives are initiated and maintained by disfacilitation of respiratory drive, not inhibition. Computer simulations confirmed the plausibility of these hypotheses. Simulated diving behaviour and physiological responses (ventilation, cardiac output, blood and tissue gas tensions) were consistent with published data from freely diving Weddell seals. Dives up to the estimated aerobic dive limit (ADL, 18-25 min) could be simulated without the need for active inhibition of breathing in this model. This theoretical analysis suggests that the most important physiological adjustments occur during the surface interval phase of the dive cycle and include hyperventilation accompanied by high cardiac output, appropriate regulation of cerebral blood flow and central chemoreceptor threshold shifts. During dives, cardiac output, distribution of peripheral blood flow, splenic contraction and peripheral chemoreflex drives were found to modulate physiological and behavioural responses, but were not essential for simulated dives to occur. The main conclusion from this study is that the central chemoreceptor may be an important mechanism involved in the regulation of diving behaviour, implying that CO2, not O2, is the key regulatory variable in this model. This model includes and extends the ADL concept and suggests an explicit mechanism by which the respiratory control system may play a central role in the regulation of diving behaviour. It is likely that respiratory mechanisms are an important component of a hierarchical behavioural control system and further studies are required to test the qualitative and quantitative validity of the model.

Animals↗
PubMed2004

A theoretical study of the effect of circadian rhythms on sleep-induced periodic breathing and apnoea.

This study employed a mathematical model of the respiratory control system to test the plausibility of the hypothesis that circadian rhythms in respiratory control can significantly influence respiratory stability at sleep onset. Computer simulations utilized a standardized "normal" sleep onset effect, superimposed upon systematic changes in chemoreflex parameters that mimicked the peaks and troughs of normal and high amplitude circadian rhythms. The analysis predicted that circadian influences may augment sleep-induced periodic breathing in nocturnal sleep compared with daytime naps. Furthermore, increased circadian amplitude of chemoreflex threshold, or absence of a circadian rhythm in peripheral chemosensitivity, each acted to stabilize respiration during daytime sleep onset and promote periodic breathing during nocturnal sleep onset. High amplitude circadian rhythms in respiratory control were predicted to cause an increasing number and duration of obstructive apnoeas from early to late night. It is suggested that the circadian timing system creates a nocturnal window of respiratory vulnerability and that abnormal circadian rhythms could potentially induce nocturnal sleep apnoea, even in individuals with normal sleep mechanisms.

Airway Obstruction↗
PubMed2004

Design and validation of a computer-based sleep-scoring algorithm.

A computer-based sleep scoring algorithm was devised for the real time scoring of sleep-wake state in Wistar rats. Electroencephalogram (EEG) amplitude (microV(rms)) was measured in the following frequency bands: delta (delta; 1.5-6 Hz), theta (Theta; 6-10 Hz), alpha (alpha; 10.5-15 Hz), beta (beta; 22-30 Hz), and gamma (gamma; 35-45 Hz). Electromyographic (EMG) signals (microV(rms)) were recorded from the levator auris longus (neck) muscle, as this yielded a significantly higher algorithm accuracy than the spinodeltoid (shoulder) or temporalis (head) muscle EMGs (ANOVA; P=0.009). Data were obtained using either tethers (n=10) or telemetry (n=4). We developed a simple three-step algorithm that categorizes behavioural state as wake, non-rapid eye movement (NREM) sleep, rapid eye movement (REM) sleep, based on thresholds set during a manually-scored 90-min preliminary recording. Behavioural state was assigned in 5-s epochs. EMG amplitude and ratios of EEG frequency band amplitudes were measured, and compared with empirical thresholds in each animal.STEP 1: EMG amplitude greater than threshold? Yes: "active" wake, no: sleep or "quiet" wake. STEP 2: EEG amplitude ratio (delta x alpha)/(beta x gamma) greater than threshold? Yes: NREM, no: REM or "quiet" wake. STEP 3: EEG amplitude ratio Theta(2)/(delta x alpha) greater than threshold? Yes: REM, no: "quiet" wake. The algorithm was validated with one, two and three steps. The overall accuracy in discriminating wake and sleep (NREM and REM combined) using step one alone was found to be 90.1%. Overall accuracy using the first two steps was found to be 87.5% in scoring wake, NREM and REM sleep. When all three steps were used, overall accuracy in scoring wake, NREM and REM sleep was determined to be 87.9%. All accuracies were derived from comparisons with unequivocally-scored epochs from four 90-min recordings as defined by an experienced human rater. The algorithms were as reliable as the agreement between three human scorers (88%).

Algorithms↗
PubMed2003

Do circadian rhythms in respiratory control contribute to sleep-related breathing disorders?

Sleep-related respiratory dysfunction compromises the health and quality of life of millions of people worldwide, underscoring the need for a full understanding of the mechanisms by which the respiratory control system is altered at night. This paper suggests the hypothesis that the circadian timing system may play a role in the pathogenesis of some types of sleep-related breathing disorders. Recent studies have provided evidence that the circadian timing system has an influence on respiration and respiratory control, even in the absence of sleep. These new data are reviewed and potential mechanisms underlying the circadian modulation of breathing are outlined, identifying important gaps in our knowledge. It is proposed that circadian rhythms in respiratory control may increase the propensity for nocturnal respiratory instability and recurrent apnea. Importantly, circadian and sleep mechanisms appear to have additive effects on breathing, suggesting that the circadian timing system can potentially amplify or suppress sleep-related breathing abnormalities, depending upon the characteristics of the circadian output and the time of day at which sleep occurs.

Body Temperature↗
PubMed2002

Theoretical and practical considerations in the application of whole body plethysmography to sleep research.

The sleep-wake state has a profound influence on many, perhaps most, aspects of normal physiology and is strongly implicated in the mediation (or remediation) of impaired health and performance. Many sleep disorders stem from abnormal respiratory anatomy or sleep-induced changes in respiratory control, underscoring the need for research into the effects of the sleep-wake state on respiratory control processes. Whole body plethysmography is being increasingly used to study respiration in freely behaving animals, and is especially well suited to studies of sleeping animals and human subjects. The method is simple in principle, but care is required in its application to ensure reliable results, and there are circumstances in which it is an inappropriate technique. This review describes the main advantages, pitfalls, and limitations inherent in the use of whole body plethysmography for non-invasive measurement of lung ventilation and metabolic rate in sleeping animals. Sources of potential error, and ways of avoiding such errors, are discussed, with reference to studies involving animal models of sleep-related breathing disorders.

Animals↗