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Biomedical subjects

S Bowles

Publications and source records attributed to S Bowles.

13 recordsLinked to original sources

Genetic relatedness predicts South African migrant workers' remittances to their families.

Inclusive fitness models predict many commonly observed behaviours: among humans, studies of within-household violence, the allocation of food and child care find that people favour those to whom they are more closely related. In some cases however, kin-altruism effects appear to be modest. Do individuals favour kin to the extent that kin-altruism models predict? Data on remittances sent by South African migrant workers to their rural households of origin allow an explicit test, to our knowledge the first of its kind for humans. Using estimates of the fitness benefits and costs associated with the remittance, the genetic relatedness of the migrant to the beneficiaries of the transfer, and their age- and sex-specific reproductive values, we estimate the level of remittance that maximizes the migrant worker's inclusive fitness. This is a much better predictor of observed remittances than is average relatedness, even when we take account (by means of a multiple regression) of covarying influences on the level of remittance. But the effect is modest: less than a third of the observed level of remittances can be explained by our kin-altruism model.

Age Factors↗

Costly signaling and cooperation.

We propose an explanation of cooperation among unrelated members of a social group in which cooperation evolves because it constitutes an honest signal of the member's quality as a mate, coalition partner or competitor, and therefore results in advantageous alliances for those signaling in this manner. Our model is framed as a multi-player public goods game that involves no repeated or assortative interactions, so that non-cooperation would be a dominant strategy if there were no signaling benefits. We show that honest signaling of underlying quality by providing a public good to group members can be evolutionarily stable, and can proliferate in a population in which it is initially rare, provided that certain plausible conditions hold, including a link between group-beneficial signaling and underlying qualities of the signaler that would be of benefit to a potential mate or alliance partner. Our model applies to a range of cooperative interactions, including unconditionally sharing individually consumable resources, participating in group raiding or defense, and punishing free-riding or other violations of social norms.

Animals↗

The effect of an acute pain service on nurses' knowledge and beliefs about post-operative pain.

The management of post-operative pain has been an area of concern for many years, with many studies focusing on the knowledge and beliefs of nurses working in this area. Following the report of the Royal College of Surgeons & College of Anaesthetists (1990) in the UK, there has been a rapid expansion in the development of Acute Pain Services (APS) in an attempt to counter these concerns. This descriptive study considers the possible impact the introduction of an APS had on the knowledge and beliefs of nurses working in the surgical area. A closed-answer questionnaire was used to replicate an earlier study (Mackintosh, 1994) which took place before the introduction of the APS. Findings demonstrate a consistent but mainly statistically non-significant trend in all areas towards an improved knowledge base and more appropriate beliefs about pain.

Attitude of Health Personnel↗

Factors influencing function of temporary dialysis catheters.

AIM: To determine risk factors for failure of temporary dialysis catheters, we prospectively studied the outcome of 178 non-tunneled dual lumen catheters placed in 126 consecutive patients requiring treatment of acute renal failure (ARF) or end-stage renal disease (ESRD). METHODS: Internal jugular (IJ) or subclavian (SC) catheters were used in 122 instances and femoral catheters were employed in 56. RESULTS: IJ or SC catheters with tips in the right atrium or superior vena cava (n = 112) failed (defined as a blood flow < 250 ml/min) 17% of the time, compared with a 40% failure rate for catheters with more peripherally located tips (n = 10), p < 0.05, chi2 testing. In a multivariate analysis, use in ESRD and location peripheral to the SVC were risk factors for catheter failure. Use of one of three catheter brands was associated with a lower failure rate. Although mean venous pressures at 200 ml/min blood flow were higher in IJ or SC catheters that failed, the presence of a high venous pressure, number of catheter uses, IJ vs. SC placement, inpatient vs. outpatient status, and fresh venipuncture vs. placement over a guidewire passed through a previous catheter did not predict catheter malfunction. With femoral catheters, the only risk factor for failure was use in ESRD. CONCLUSION: Of the factors that can be influenced by placement technique, catheter tip location is most important. Whether one catheter brand is superior awaits further confirmation.

Catheterization↗

Aircrew perceived stress: examining crew performance, crew position and captains personality.

This study was conducted at NASA Ames Research Center as a part of a larger research project assessing the impact of captain's personality on crew performance and perceived stress in 24 air transport crews (5). Three different personality types for captains were classified based on a previous cluster analysis (3). Crews were comprised of three crewmembers: captain, first officer, and second officer/flight engineer. A total of 72 pilots completed a 1.5-d full-mission simulation of airline operations including emergency situations in the Ames Manned Vehicle System Research Facility B-727 simulator. Crewmembers were tested for perceived stress on four dimensions of the NASA Task Load Index after each of five flight legs. Crews were divided into three groups based on rankings from combined error and rating scores. High performance crews (who committed the least errors in flight) reported experiencing less stress in simulated flight than either low or medium crews. When comparing crew positions for perceived stress over all the simulated flights no significant differences were found. However, the crews led by the "Right Stuff" (e.g., active, warm, confident, competitive, and preferring excellence and challenges) personality type captains typically reported less stress than crewmembers led by other personality types.

Adult↗

The use of non-prescription sleep products in the elderly.

UNLABELLED: While sleep disorders are common in the elderly, the use of non-prescription products for sleep in this population has not been fully evaluated. The objectives of this project were to assess the use, perceived effectiveness and toxicity of non-prescription sleep products in an ambulatory elderly population. METHODS: A self-administered 20-question survey was distributed to seniors, aged 60 years or more, during hospital or pharmacy visits. RESULTS: Of the total respondents (N=176, mean age 74+/-7 years, 59% female), 84 (48%) indicated that they had used one or more therapies for sleep within the past year. These included non-prescription products (50% of therapies), prescription products (17%) and non-drug activities such as walking or drinking milk (34%). For those individuals who had used a non-prescription product in the past year (N=47, 27% of total respondents), the most frequently used products were: dimenhydrinate (21%), acetaminophen (19%), diphenhydramine (15%), alcohol (13%) and herbal products (11%). Most took them at least 1 day per week (79%) and 32% took them daily. These products subjectively improved sleep latency (mean 32 vs 61 minutes, p<0.001), number of nocturnal awakenings (mean 2 vs 3 awakenings, p<0.001) and total hours of sleep (mean 6.6 vs 5.4 hours, p<0.001). Mild side-effects were reported by 35 respondents (75%), the most common being dry mouth (N=22) and daytime drowsiness (N=13). Respondents were taking an average of four (SD+/-3, range 0-10) other medications currently. CONCLUSIONS: Non-prescription products are widely used by this population of ambulatory elderly for sleep disturbances. Most of the products were not marketed for sleep; however, they were perceived to be efficacious with low toxicity. The potential for drug interaction is high. Further research is warranted to evaluate the safety and effectiveness of non-prescription sleep products in the elderly.

Aged↗

Serology of collagen types I and III in normal healing of tibial shaft fractures.

OBJECTIVES: To establish that serological indicators of synthesis of collagens I and III in humans with normally healing tibial shaft fractures will display a temporal pattern consistent with the sequence of expression of these collagens observed histologically in animal models of fracture healing. DESIGN: Prospective. SETTING: Four district general hospitals in the United Kingdom supported by an academic unit. PARTICIPANTS: Twenty consecutive patients with isolated tibial shaft fractures were studied. On clinical and radiological grounds, seventeen of the cases united within twenty weeks; these seventeen cases formed the material for this review. INTERVENTIONS: Nineteen patients were treated conservatively, and a functional brace was applied at five weeks. One patient treated with an external fixator had a functional brace applied at twelve weeks. MAIN OUTCOME MEASURES: Assays of collagen I carboxy-terminal propeptide (PICP), collagen III amino-terminal propeptide (PIIINP), and collagen I carboxy-terminal telopeptide (ICTP) were made in serum samples taken at standard intervals from twenty-four hours to twenty weeks after fracture. RESULTS: PICP showed a significant, transient early drop, whereas ICTP rose, indicating early breakdown with uncoupling of collagen I formation and degradation. PIIINP levels rose significantly from day eight to week five, in keeping with early expression of collagen III in experimental fracture callus. PICP levels showed a gradual rise, consistent with later expression of collagen I. CONCLUSIONS: The changes observed are in keeping with previous histological work on animal fracture models, suggesting that serological measures may reflect events occurring at the fracture site and thus offer a means for noninvasive and dynamic observation of collagen synthesis after fracture. Final proof that such measurements reflect bony healing per se, as opposed to events in other tissues, would require comparison with similar data from a soft tissue injury model.

Adolescent↗

Evaluation of a nurse-led acute pain service. Can clinical nurse specialists make a difference?

This paper attempts to identify the impact of a nurse-led in-patient acute pain service (APS) on three areas of concern; pre-operative information, patients self-reported levels of pain, and analgesics prescribed. It considers the results of a baseline survey carried out in 1992 and its replication in 1995, in an attempt to assess the impact this service may have had. Results appear to indicate some changes in all areas of concern, with significant reductions in reported levels of pain and patterns of analgesic prescribing between the two surveys. It therefore appears within the constraints of this type of study, that the work of the nurse-led APS has had a significant impact on changing outcomes and improving quality of patient care.

Adolescent↗

The Tripler Army Medical Center LEAN Program: a healthy lifestyle model for the treatment of obesity.

This paper provides an overview of the Tripler Army Medical Center LEAN Program for the treatment of obesity, hypercholesterolemia, and essential hypertension. The LEAN Program, a multi-disciplinary prevention program, emphasizes healthy Lifestyles, Exercise and Emotions, Attitudes, and Nutrition for active duty service members. The treatment model offers a medically healthy, emotionally safe, and reasonable, low-intensity exercise program to facilitate weight loss. We will discuss the philosophy behind the LEAN Program and the major components. Thereafter, we will briefly discuss the preliminary results.

Counseling↗

Reading from color displays: a psychophysical model.

We have investigated the effects of chromatic and luminance contrast on reading colored text on multicolor displays. Stimuli were defined in a color space with three cardinal axes. Two of these axes are chromatic and maximally modulate the opponent mechanisms of color vision; the third is an achromatic axis. We measured detection and discrimination of words and nonwords. The results show that near-perfect reading at equiluminance is possible and that in terms of machine units, luminance differences are more salient than purely chromatic differences, but these differences disappear when the discrimination data are scaled for detection threshold.

Adult↗

A model for forecasting intermittent skilled home nursing needs.

The problem of forecasting the need and the cost for post-discharge skilled home nursing services is addressed by a simple statistical model. The model, assumptions, and simple calculations are described. Use of the model is illustrated with 7598 cancer patients and 2337 myocardial infarction patients. Simulation of the impact of changes in the health care delivery system toward greater and lesser severity of hospitalized patients is carried out. Two key projections illustrating the model's output are the number of patients with these diseases who will need care and the cost of that care.

Costs and Cost Analysis↗

Audit of postoperative pain following day case surgery.

Day case surgery is an expanding area within the NHS. However, pain following day case procedures remains a constant concern for healthcare professionals. An audit of postoperative pain following a range of day case procedures over a 2-year period at a general hospital in the north of England found that 17-20% of patients experienced unacceptable levels of pain. However, very few of these patients were worried about the pain they experienced and none contacted their GP. This implies that healthcare professionals overestimate the significance of postoperative pain for the patients concerned.

Ambulatory Surgical Procedures↗