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Biomedical subjects

S Austin

Publications and source records attributed to S Austin.

At least 19 recordsLinked to original sources
PubMed2006

An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department.

BACKGROUND AND OBJECTIVES: Corneal abrasions are a common presentation to accident and emergency (A&E) departments. Patients can be treated and discharged by A&E staff without the need for an ophthalmologist's attention; complicated cases, however, should be recognised and referred. Inexperience and limited training in ophthalmology may lead to suboptimal patient care and inappropriate use of ophthalmology outpatient clinics. Issues of poor documentation may also arise. The purpose of this audit was to assess the effect of guidelines on the management of corneal abrasion by A&E staff. METHODS: A retrospective case note audit was performed to assess current management of corneal abrasions. Guidelines for management of corneal abrasions were formulated following a literature search and collaboration between A&E and ophthalmology staff. A prospective case note audit was undertaken to assess management after introduction of the guidelines. RESULTS: A total of 51 cases were audited before the introduction of the guidelines and 57 cases after. Following the introduction of the guidelines documentation of visual acuity increased to 93% and specific enquiry into contact lens wear rose from 35.3% to 71.9%. A&E staff stopped giving out local anaesthetic eye drops. The follow up profile also improved; appropriate patient discharges increased by 40% whereas inappropriate referrals to eye clinic dropped by 75%. More patients were given abrasion advice (a 101% increase). CONCLUSIONS: A&E staff members are capable of managing corneal abrasions if they are given guidance and some training. This audit identified shortcomings in current management and showed that guidelines can significantly improve clinical practice.

Anesthetics↗
PubMed2004

Longitudinal study of Pelvicol pubovaginal slings using magnetic resonance imaging.

The mechanism of urinary continence is complicated and is poorly understood. One current opinion is that there is an absence or weakness of the endopelvic fascial supports of the urethra. Pubovaginal slings are rapidly becoming the surgical procedure of choice in the management of urodynamic stress incontinence but their method of action is unclear. This study using magnetic resonance imaging shows how a pubovaginal sling can restore the normal anatomy and continence and adds to the global understanding of this condition.

Female↗
PubMed2004

Pharmacokinetics of levobupivacaine 0.25% following caudal administration in children under 2 years of age.

BACKGROUND: Levobupivacaine, the S(-)enantiomer of racemic bupivacaine is less cardiotoxic than racemic bupivacaine and the R(+)enantiomer dexbupivacaine, while retaining similar local anaesthetic properties and potency to racemic bupivacaine. The pharmacokinetic profiles of the two bupivacaine enantiomers differs and that of racemic bupivacaine may be age dependent. We examined the pharmacokinetics of levobupivacaine after its single shot caudal epidural administration in children. METHODS: An open-label phase 2 study was undertaken to examine the pharmacokinetics of levobupivacaine 0.25% 2 mg kg(-1) in 49 children aged less than 2 yr, after single shot caudal epidural administration. Plasma concentrations were determined at intervals up to 60 min after caudal injection. RESULTS: Time to peak plasma concentration (T(max)) ranged between 5 and 60 min (median 30 min) and was reached later in children aged less than 3 months (P<0.005). Peak plasma concentration (C(max)) ranged between 0.41 and 2.12 micro g ml(-1) (median 0.80, mean (SD) 0.91 (0.40) micro g ml(-1)). CONCLUSION: After the caudal epidural administration of levobupivacaine 2 mg kg(-1) in children less than 2 yr of age, C(max) was within the accepted safe range for racemic bupivacaine. T(max) varied and occurred later in some children, particularly those aged less than 3 months. Sampling in future pharmacokinetic studies in this age group should extend beyond 60 min.

Age Factors↗
PubMed2003

Efficacy and safety of caudal injection of levobupivacaine, 0.25%, in children under 2 years of age undergoing inguinal hernia repair, circumcision or orchidopexy.

BACKGROUND: Levobupivacaine is the S(-)-enantiomer of racemic bupivacaine. Evidence suggests that it is less cardiotoxic than racemic bupivacaine and the R(+)-enantiomer, dexbupivacaine, while retaining similar local anaesthetic properties and potency to racemic bupivacaine. METHODS: This was an open study designed to assess the efficacy and safety of 0.25% levobupivacaine administered as a caudal injection at a dose of 2 mg.kg(-1) to 49 paediatric patients aged less than 2 years old undergoing circumcision (group 1), or hernia repair or orchidopexy (group 2). RESULTS: Adequate analgesia (an increase of <20% in pulse or respiratory rate compared with baseline and an absence of gross movement on application of surgical stimulus) was achieved in 43/48 patients evaluable for efficacy (89.6%). All 22 patients in the circumcision group had adequate analgesia, and two of these patients did not require additional analgesia. The mean time to the use of additional analgesia was 7.3 h. Only one event (a mild rash) was considered possibly related to study medication. CONCLUSIONS: Levobupivacaine is a promising new local anaesthetic agent for pain management in paediatric patients and appears to offer similar anaesthetic efficacy to racemic bupivacaine with a potentially improved tolerability profile.

Anesthesia, Caudal↗
PubMed2001

Cell toxicity caused by products of the p(L) operon of bacteriophage lambda.

Induction of a lambda prophage causes the death of the host cell even in the absence of phage replication and lytic functions due to expression of functions from the lambda p(L) operon. We genetically modified the lambda prophage to determine which lambda p(L) operon functions were involved in cell killing. Viability assays and flow cytometry were used to monitor cell death and filamentation. The kil gene was shown to cause cell death and filamentation as described previously. Another killing activity was mapped within the p(L) operon to the gam gene. Inspection of the DNA sequence showed that there are two possible translation start points for both kil and gam. In both cases, the shorter of the two possible products could cause cell killing. The shorter products were also sufficient for the known filamentation and recombination activities of the respective Kil and Gam functions. The expression level of the p(L) operon is down-regulated by Cro repressor. In the absence of Cro, higher p(L) expression levels allow either Kil or Gam to be lethal or growth inhibitory, whereas at lowered expression in Cro-repressed conditions, only Kil is lethal. The filamentation function of Kil and recombination activity of Gam are unaffected at Cro-repressed levels of expression.

Bacterial Proteins↗
PubMed2001

An analysis of the factory model for chromosome replication and segregation in bacteria.

Recent advances in microscopy have given us important clues as to the nature of chromosome segregation in bacteria. Most current observations favour the view that the process is co-replicational: DNA replication forks are anchored at the cell centre, and the newly replicated DNA is moved towards the cell poles. This scheme can account for orderly segregation even at high growth rates where multiple replication cycles overlap. We argue that there are five distinct activities directly involved in co-replicational segregation dynamics. These we refer to as Push, Direct, Condense, Hold and Clear. We attempt to assign one of these roles to each protein implicated in chromosome segregation. The proposed process is very different from mitosis in eukaryotic cells and perhaps more closely resembles the formation of separate sister chromatids during DNA replication.

Bacteria↗
PubMed2001

Policies and procedures: friend or foe? Part 1.

Policy and procedure wording can make or break caregiving accountability. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com.

Humans↗
PubMed2001

Policies and procedures: friend or foe? Part 3.

Review a case where policy and procedure violation resulted in patient death and hospital liability. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com.

Heart Arrest↗
PubMed2001

Proper equipment use makes or breaks care.

Review the following case that addresses proper staff education regarding equipment usage and standards. Test your knowledge with the following questions, then check your answers at http://www.nursingmanagement.com.

Burns↗
PubMed2001

Protein-protein interactions in the complex between the enhancer binding protein NIFA and the sensor NIFL from Azotobacter vinelandii.

The enhancer binding protein NIFA and the sensor protein NIFL from Azotobacter vinelandii comprise an atypical two-component regulatory system in which signal transduction occurs via complex formation between the two proteins rather than by the phosphotransfer mechanism, which is characteristic of orthodox systems. The inhibitory activity of NIFL towards NIFA is stimulated by ADP binding to the C-terminal domain of NIFL, which bears significant homology to the histidine protein kinase transmitter domains. Adenosine nucleotides, particularly MgADP, also stimulate complex formation between NIFL and NIFA in vitro, allowing isolation of the complex by cochromatography. Using limited proteolysis of the purified proteins, we show here that changes in protease sensitivity of the Q linker regions of both NIFA and NIFL occurred when the complex was formed in the presence of MgADP. The N-terminal domain of NIFA adjacent to the Q linker was also protected by NIFL. Experiments with truncated versions of NIFA demonstrate that the central domain of NIFA is sufficient to cause protection of the Q linker of NIFL, although in this case, stable protein complexes are not detectable by cochromatography.

Adenosine Triphosphate↗
PubMed2001

Activation of the murine EP3 receptor for PGE2 inhibits cAMP production and promotes platelet aggregation.

The importance of arachidonic acid metabolites (termed eicosanoids), particularly those derived from the COX-1 and COX-2 pathways (termed prostanoids), in platelet homeostasis has long been recognized. Thromboxane is a potent agonist, whereas prostacyclin is an inhibitor of platelet aggregation. In contrast, the effect of prostaglandin E2 (PGE2) on platelet aggregation varies significantly depending on its concentration. Low concentrations of PGE2 enhance platelet aggregation, whereas high PGE2 levels inhibit aggregation. The mechanism for this dual action of PGE2 is not clear. This study shows that among the four PGE2 receptors (EP1-EP4), activation of EP3 is sufficient to mediate the proaggregatory actions of low PGE2 concentration. In contrast, the prostacyclin receptor (IP) mediates the inhibitory effect of higher PGE2 concentrations. Furthermore, the relative activation of these two receptors, EP3 and IP, regulates the intracellular level of cAMP and in this way conditions the response of the platelet to aggregating agents. Consistent with these findings, loss of the EP3 receptor in a model of venous inflammation protects against formation of intravascular clots. Our results suggest that local production of PGE2 during an inflammatory process can modulate ensuing platelet responses.

Animals↗
PubMed2000

A case for sliding SeqA tracts at anchored replication forks during Escherichia coli chromosome replication and segregation.

SeqA is an Escherichia coli DNA-binding protein that acts at replication origins and controls DNA replication. However, binding is not exclusive to origins. Many fragments containing two or more hemi-methylated GATC sequences bind efficiently. Binding was optimal when two such sequences were closely apposed or up to 31 bases apart on the same face of the DNA helix. Binding studies suggest that neighboring bound proteins contact each other to form a complex with the intervening DNA looped out. There are many potential binding sites distributed around the E.coli chromosome. As replication produces a transient wave of hemi-methylation, tracts of SeqA binding are likely to associate with each fork as replication progresses. The number and positions of green fluorescent protein-SeqA foci seen in living cells suggest that they correspond to these tracts, and that the forks are tethered to planes of cell division. SeqA may help to tether the forks or to organize newly replicated DNA into a structure that aids DNA to segregate away from the replication machinery.

Bacterial Outer Membrane Proteins↗
PubMed2000

Screening for learning disabilities in preadolescents using psychosocial disability markers-a pilot study.

PURPOSE: Learning disabilities (LD) are among the most common developmental and psychiatric disorders encountered by pediatricians, yet many children are not adequately diagnosed or treated in elementary school when intervention is most effective. Because of the well-known co-morbidity between psychosocial problems and LD, this pilot study sought to utilize psychosocial "markers" to screen for unidentified LD among all fifth graders in three urban/suburb Connecticut elementary schools.METHODS: 115 fifth graders, representing a 71% response rate, agreed to participate in the study and were screened using standardized psychosocial questionnaires administered to parents (Child Behavior Checklist), students (Youth Self Report), and teachers (Teacher Report Form). Psychosocial symptom scores and associated t-scores were obtained for three types of problems; "internalizing," "attention" and "externalizing." 28 students with high levels (t > 60) of internalizing or attention problems, were selected along with a sample of 22 "normal" students with no evidence of psychosocial impairment. These 50 students were given an individually administered battery of ability, performance and cognitive processing tests to determine the presence of unidentified LD. Performance tests included standardized tests of reading, writing and mathematics. All test scores were normed with a mean of 100 and a SD of 15. LD was determined to be present if the student had a 1.5 SD or greater discrepancy between ability and performance in any of the three academic areas, and evidence of a cognitive processing deficit.RESULTS: The results indicated that 14 of the 50 students tested (28%) had evidence of undiagnosed LD. No significant difference was found in the proportion of undiagnosed LD among psychosocially impaired versus normal students. However regression analysis suggested that this finding was misleading. Controlling for ability, attention problems reported by the parent, were found to be significant (p < 0.05) predictors of lowered test scores, whereas internalizing problems were found to be predictive of increased test scores. Students with both internalizing and attention problems did not differ significantly from psychologically unimpaired students.CONCLUSIONS: This pilot study indicates that better screening methods are needed to identify the likely high proportion of elementary school children with undiagnosed learning difficulties and co-morbid psychosocial problems.

Journal Article↗
PubMed2000

Suppression of chromosome segregation defects of Escherichia coli muk mutants by mutations in topoisomerase I.

Escherichia coli muk mutants are temperature-sensitive and produce anucleate cells. A spontaneously occurring mutation was found in a DeltamukBkan mutant strain that suppressed the temperature-sensitive phenotype and mapped in or near topA, the gene that encodes topoisomerase I. Previously characterized topA mutations, topA10 and topA66, were found to be general suppressors of muk mutants: they suppressed temperature sensitivity and anucleate cell production of cells containing null or point mutations in mukB and null mutations in mukE or mukF. The suppression correlated with excess negative supercoiling by DNA gyrase, and the gyrase inhibitor, coumermycin, reversed it. Defects in topA allow 99% of cell division events in muk null mutants to proceed without chromosome loss or loss of cell viability. This observation imposes important limitations on models for Muk activity and is consistent with a role for MukBEF in chromosome folding and DNA condensation.

Aminocoumarins↗
PubMed2000

Sinonasal disease and olfactory impairment in HIV disease: endoscopic sinus surgery and outcome measures.

OBJECTIVES: To investigate the effects of ESS (ESS) on olfactory impairment, disease-specific symptoms, and general quality of well-being In HIV+ patients with sinonasal disease. STUDY DESIGN: Study 1: Nasal cytology, rhinomanometry, nasal examination including endoscopy, disease-specific sinonasal symptoms, olfactory threshold sensitivity, and odor identification testing were performed before and after ESS in HIV+ patients with sinonasal complaints. Study 2: Quality of well-being was assessed before and after ESS in HIV+ patients with sinonasal complaints and controls. RESULTS: Significant olfactory sensitivity loss persisted for patients with chronic sinusitis after ESS, suggesting that the impairment in these patients may be due to viral disease rather than inflammation. Significant improvement in other disease-specific symptom scores (nasal obstruction, nasal congestion, headache, sinus pain, etc.) and results of the general quality of well-being assessment showed ESS to be beneficial in the extended health management of HIV illness. CONCLUSIONS: The current study indicated both olfactory dysfunction and subjective negative symptoms in HIV+ patients with chronic sinusitis. Although olfactory dysfunction remained, ESS was successful in providing marked alleviation of symptomatology in HIV+ patients with chronic sinusitis. The results support ESS as an appropriate treatment option for HIV+ patients with chronic sinusitis.

Adult↗
PubMed2000

Staffing: know your liability.

Read this case of poor staffing judgment regarding outside agency employees and answer the questions, then check your answers at http://www.nursingmanagement.com.

Clinical Competence↗