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Biomedical subjects

S Palmer

Publications and source records attributed to S Palmer.

At least 55 records · Page 3Linked to original sources
PubMed2001

The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines. Americans Associations for Neurologic Surgeons.

BACKGROUND: Traumatic brain injury poses a serious public health challenge. Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Management of Severe Head Injury. Implementation of the AANS guidelines positively affects patient outcomes and can be successfully introduced in a community hospital setting. METHODS: Data were collected both retrospectively and prospectively from the records of all trauma patients between 1994 and 1999. A cohort of 93 patients was selected. Thirty-seven patients were treated before the implementation of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. RESULTS: Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a group managed before the practice change. A Glasgow Coma Scale (GCS) admission score > 8 was associated with a 6.58 times higher odds ratio of a good outcome compared with a GCS admission score < or = 8. Odds ratio of a good outcome decreased by a factor of 0.92 for each year increase in age of patients starting at age 9. A dedicated neurotrauma team and comprehensive treatment algorithms are critical elements to this success. Hospital charges increased by more than $97,000 per patient, but are justifiable in the face of significantly improved outcomes. CONCLUSION: Implementation of a traumatic brain injury protocol in a community hospital setting is practical and efficacious. Appropriate invasive monitoring of systemic and cerebral parameters guides care decisions. The protocol results in an increase in resource usage, but it also results in statistically improved outcomes justifying the increase in expenditures.

Adolescent↗
PubMed2001

A short pseudoautosomal region in laboratory mice.

The pseudoautosomal region (PAR) of mammalian sex chromosomes is a small region of sequence identity that is the site of an obligatory pairing and recombination event between the X and Y chromosomes during male meiosis. During female meiosis, X chromosomes can pair and recombine along their entire length; recombination in the PAR is therefore approximately 10x greater in male meiosis compared with female meiosis. A consequence of the presence of the PAR in two copies in males and females is that genes in the region escape the process of X-inactivation. Although the structure and gene content of the human PAR at Xq/Yq is well understood, the mouse PAR, which appears to be of independent evolutionary origin, is poorly characterized. Here we describe a yeast artificial chromosome (YAC) contig covering the distal part of the mouse X chromosome, which we have used to define the pseudoautosomal boundary, that is, the point of divergence of X-specific and X-Y-identical sequences. In addition, we have investigated the size of the mouse PAR by integrating a unique restriction endonuclease recognition site just proximal to the pseudoautosomal boundary by homologous recombination. Restriction digestion of this modified DNA and pulsed field gel electrophoresis reveal that the PAR in these cells is approximately 700 kb. Thus, the mouse PAR, although small in size, has retained essential sex chromosome pairing functions despite its rapid rate of evolution.

Animals↗
PubMed2001

Prokaryote multidrug efflux proteins of the major facilitator superfamily: amplified expression, purification and characterisation.

In bacterial genomes 3-12% of open reading frames are predicted to encode membrane transport proteins. These proteins can be vital for antibiotic efflux, protein/ toxin secretion, cell nutrition, environmental sensing, ATP synthesis, and other functions. Some, such as the multidrug efflux proteins, are potential targets for the development of new antibacterials and also for applications in biotechnology. In general membrane transport proteins are poorly understood, because of the technical difficulties involved in isolating sufficient protein for elucidation of their structure-activity relationships. We describe a general strategy for the amplified expression, purification and characterisation of prokaryotic multidrug efflux proteins of the 'Major facilitator superfamily' of transport proteins, using the Bacillus subtilis multidrug resistance protein, 'Bmr', as example.

Amino Acid Sequence↗
PubMed2001

[Description and classification of extra-oral implants].

There is no universal extra-oral implant (EOI) that provides an answer to all clinical situations. We present briefly the two main categories of extra-oral implants currently available, endo-osseous implants and juxta-osseous implants, comparing the advantages and disadvantages of each. We also discuss the new developments currently under experimentation in extra-oral implantology.

Bone Plates↗
PubMed2001

[The complex facial prosthesis. The value of bone-anchored maxillofacial prostheses in the treatment of extensive loss of facial tissue].

Maxillofacial surgeons are more and more confronted with wide defects of the face, particularly after resection of facial cancer. Complex wounds of the face, whatever the etiology may be, poses the difficult problem of their rehabilitation. The surgical reconstruction offers usually the most interesting solutions on the conceptual and morphological stages. There remain some particular cases where the therapeutic choice tends towards the rehabilitation by epitheses. The improvement of texture and color of epitheses and the improvement of the possibilities of their osseous anchorage by implants (endo-osseous or juxta-osseous) permit to reconstruct that kind of complex facial wounds with restoration of oral function and with a good morphologic result.

Adult↗
PubMed2000

Nonsteroidal progesterone receptor ligands with unprecedented receptor selectivity.

We have characterized a series of nonsteroidal progesterone receptor ligands, the tetrahydropyridazines. Compounds in this series, exemplified by RWJ 26819, demonstrate high affinity and unprecedented specificity for the progesterone receptor relative to other steroid hormone receptors. Like steroidal progestins, RWJ 26819 induces binding of the receptor to a progesterone response element in vitro, and stimulates gene expression in and proliferation of T47D human breast cancer cells. When administered to rabbits orally or subcutaneously, the compound induces histological changes in the uterine lining comparable to those induced by levonorgestrel. It also inhibits ovulation in monkeys. Though less potent in cells and in animal models than would be predicted from binding affinity alone, their enhanced selectivity suggests that they could be effectively used in a clinical setting. Most of the tetrahydropyridazines synthesized are progestin agonists or mixed agonists and antagonists in vitro; however, one compound with antagonist activity in the rabbit uterine transformation assay has been identified.

Alkaline Phosphatase↗
PubMed2000

Chamber formation and morphogenesis in the developing mammalian heart.

In this study we challenge the generally accepted view that cardiac chambers form from an array of segmental primordia arranged along the anteroposterior axis of the linear and looping heart tube. We traced the spatial pattern of expression of genes encoding atrial natriuretic factor, sarcoplasmic reticulum calcium ATPase, Chisel, Irx5, Irx4, myosin light chain 2v, and beta-myosin heavy chain and related these to morphogenesis. Based on the patterns we propose a two-step model for chamber formation in the embryonic heart. First, a linear heart forms, which is composed of "primary" myocardium that nonetheless shows polarity in phenotype and gene expression along its anteroposterior and dorsoventral axes. Second, specialized ventricular chamber myocardium is specified at the ventral surface of the linear heart tube, while distinct left and right atrial myocardium forms more caudally on laterodorsal surfaces. The process of looping aligns these primordial chambers such that they face the outer curvature. Myocardium of the inner curvature, as well as that of inflow tract, atrioventricular canal, and outflow tract, retains the molecular signature originally found in linear heart tube myocardium. Evidence for distinct transcriptional programs which govern compartmentalization in the forming heart is seen in the patterns of expression of Hand1 for the dorsoventral axis, Irx4 and Tbx5 for the anteroposterior axis, and Irx5 for the distinction between primary and chamber myocardium.

Animals↗
PubMed2000

Community care and criminal offending in schizophrenia.

BACKGROUND: The introduction of community care in psychiatry is widely thought to have resulted in more offending among the seriously mentally ill. This view affects public policy towards and public perceptions of such people. We investigated the association between the introduction of community care and the pattern of offending in patients with schizophrenia in Victoria, Australia. METHODS: We established patterns of offending from criminal records in two groups of patients with schizophrenia over their lifetime to date and in the 10 years after their first hospital admission. One group was first admitted in 1975 before major deinstitutionalisation in Victoria, the second group in 1985 when community care was becoming the norm. Each patient was matched to a control, by age, sex, and place of residence to allow for changing patterns of offending over time in the wider community. FINDINGS: Compared with controls, significantly more of those with schizophrenia were convicted at least once for all categories of criminal offending except sexual offences (relative risk of offending in 1975=3.5 [95% CI 2.0-5.5), p=0.001, in 1985=3.0 [1.9-4.9], p=0.001). Among men, more offences were committed in the 1985 group than the 1975 group, but this was matched by a similar increase in convictions among the community controls. Those with schizophrenia who had also received treatment for substance abuse accounted for a disproportionate amount of offending. Analysis of admission data for the patients and the total population of admissions with schizophrenia showed that although there had been an increase of 74 days per annum spent in the community for each of the study population as a whole, first admissions spent only 1 more day in the community in 1985 compared with 1975. INTERPRETATION: Increased rates in criminal conviction for those with schizophrenia over the last 20 years are consistent with change in the pattern of offending in the general community. Deinstitutionalisation does not adequately explain such change. Mental-health services should aim to reduce the raised rates of criminal offending associated with schizophrenia, but turning the clock back on community care is unlikely to contribute towards any positive outcome.

Adult↗
PubMed2000

Melatonin fails to protect against long-term MPTP-induced dopamine depletion in mouse striatum.

Several laboratories recently have reported that melatonin may possess neuroprotective properties. The present paper presents the results of our studies on the long term in vivo neuroprotective effects of melatonin in a well-defined neurotoxicity model using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) in the C57BL/6 mouse. MPTP is bioactivated by brain monoamine oxidase B (MAO-B) to its neurotoxic pyridinium metabolite 1-methyl-4-phenylpyridinium (MPP(+)) which destroys dopaminergic nerve terminals leading to the depletion of neostriatal dopamine (DA) and 3,4-dihydroxyphenylacetic acid (DOPAC). Our initial study compared striatal DA and DOPAC levels in MPTP-only-treated animals and animals treated with melatonin 30 min prior to and 3 times hourly post-MPTP. DA/DOPAC levels measured 7 days after MPTP were similar in both groups. A second study was designed to address the possibility that melatonin cleared from the brain prior to MPP(+). Animals, that had been administered the same regimen of melatonin as in the first study plus a fourth post-MPTP melatonin dose, were maintained on melatonin in drinking water until 5 days post-MPTP. Striatal DA/DOPAC levels of these melatonin-plus-MPTP treated animals also were the same as the MPTP-only-treated animals. In vitro studies confirmed that melatonin is not an inhibitor of MAO-B. These data demonstrate that melatonin does not have any significant protective effects against the long-term striatal DA and DOPAC depletion induced by MPTP in the C57BL/6 mouse.

Journal Article↗
PubMed2000

Incorporating option values into the economic evaluation of health care technologies.

Despite uncertainty being intrinsic to economic evaluation of health care, existing techniques for handling uncertainty remain underdeveloped compared to the formal techniques commonly applied in the business sector. This paper develops an alternative approach to handling uncertainty in economic evaluation based on 'option-pricing' techniques. The presence of uncertainty and the degree of irreversibility of a decision make it clear that some flexibility in the timing of a decision is often a desirable characteristic with an economic value. We demonstrate how option-pricing techniques can be applied to the decision rules for economic evaluation in health care. The key determinants of an option value are the presence and type of uncertainty; the ability to defer a decision; and the irreversibility of the decision. The relative significance of each of these for a particular economic evaluation will depend on the particular characteristics of the technology under consideration.

Cost-Benefit Analysis↗
PubMed2000

The role of outbreaks in developing food safety policy: population based surveillance of salmonella outbreaks in Wales 1986-98.

In developing public policy on food safety, systematic identification and thorough investigation of all general outbreaks is necessary in order to avoid bias towards highly publicised outbreaks. In Wales, from 1986 to 1998, 87 general foodborne outbreaks of salmonellosis were identified. Most outbreaks occurred at functions or were associated with small catering outlets such as bakeries and sandwich bars. In 50 outbreaks, a vehicle of infection was confirmed microbiologically and/or epidemiologically. The most common food vehicles were those containing shell eggs. Salmonella enteritidis outbreaks were significantly more likely than outbreaks of other serotypes to be associated with vehicles containing shell eggs, suggesting that eggs were also the source of infection in many outbreaks. The routine use of analytical epidemiological studies to identify vehicles in outbreaks is recommended.

Disease Outbreaks↗
PubMed2000

Working memory: a developmental study of phonological recoding.

A cross-sectional study using children aged 3 to 7 years and a cross-sequential study using children aged between 5 and 8 years showed that the development of phonological recoding in working memory was more complex than the simple dichotomous picture portrayed in the current literature. It appears that initially children use no strategy in recall, which is proposed to represent the level of automatic activation of representations in long-term memory and the storage capacity of the central executive. This is followed by a period in which a visual strategy prevails, followed by a period of dual visual-verbal coding before the adult-like strategy of verbal coding finally emerges. The results are discussed in terms of three working memory models (Baddeley, 1990; Engle, 1996; Logie, 1996) where strategy use is seen as the development of attentional processes and phonological recoding as the development of inhibitory mechanisms in the central executive to suppress the habitual response set of visual coding.

Child↗
PubMed2000

Construction of a high-resolution 2.5-Mb transcript map of the human 6p21.2-6p21.3 region immediately centromeric of the major histocompatibility complex.

We have constructed a 2.5-Mb physical and transcription map that spans the human 6p21.2-6p21.3 region and includes the centromeric end of the MHC, using a combination of techniques. In total 88 transcription units including exons, cDNAs, and cDNA contigs were characterized and 60 were confidently positioned on the physical map. These include a number of genes encoding nuclear and splicing factors (Ndr kinase, HSU09564, HSRP20); cell cycle, DNA packaging, and apoptosis related [p21, HMGI(Y), BAK]; immune response (CSBP, SAPK4); transcription activators and zinc finger-containing genes (TEF-5, ZNF76); embryogenesis related (Csa-19); cell signaling (DIPP); structural (HSET), and other genes (TULP1, HSPRARD, DEF-6, EO6811, cyclophilin), as well as a number of RP genes and pseudogenes (RPS10, RPS12-like, RPL12-like, RPL35-like). Furthermore, several novel genes (a Br140-like, a G2S-like, a FBN2-like, a ZNF-like, and B1/KIAA0229) have been identified, as well as cDNAs and cDNA contigs. The detailed map of the gene content of this chromosomal segment provides a number of candidate genes, which may be involved in several biological processes that have been associated with this region, such as spermatogenesis, development, embryogenesis, and neoplasia. The data provide useful tools for synteny studies between mice and humans, for genome structure analysis, gene density comparisons, and studies of nucleotide composition, of different isochores and Giemsa light and Giemsa dark bands.

Amino Acid Sequence↗
PubMed2000

A randomised trial of an intervention to develop health promoting schools in Australia: the south western Sydney study.

OBJECTIVE: This paper describes the evaluation of a health promoting schools intervention carried out in the south western region of Sydney, Australia. The evaluation sought to assess the project's impact on structures to support the health promoting school concept and changes in health-related policies and practices within 22 local schools. METHODS: A randomised controlled study was employed. Intervention schools were offered seminars and training in the health promoting schools concept, encouraged to use a resource kit to help them establish their school as health promoting and invited to participate in a support network. Pre- and post measures of awareness, school structures and policies and practices to support the development of a health promoting school were taken and intervention and control schools compared. RESULTS: There was an increased level of awareness of the health promoting school concept among intervention schools. However, there were no significant changes in health-related policies and practices at the school level, among both intervention and control schools. CONCLUSIONS: A longer time frame and more structured support are required to influence school structures to support the development of a health promoting school. IMPLICATIONS: To facilitate organisational change in schools, health promoting school interventions need to provide structured support for schools and recognise that change takes time. A committee to initiate action, a plan to guide work and school support are likely to facilitate the adoption of the health promoting schools approach. Further work to refine the measurement of school-based action and its outcome and the development of indicators for a health promoting school is needed.

Health Policy↗
PubMed2000

Use of mark-recapture techniques to estimate the size of hard-to-reach populations.

OBJECTIVES: To review the main problems associated with mark-recapture methods of population estimation, and to indicate some practical strategies for addressing these problems, with illustrations from a study of drug-use prevalence across Wales. METHODS: Unnamed identifier data were collected in 1994 on 2610 drug users who were in contact with various agencies across Wales: the police, drug treatment agencies, needle exchanges, probation services, and agencies reporting to the Welsh Drugs Misuse Database. RESULTS: Based on the dependency relationships between different agencies' datasets, different estimates of the 'hidden' populations (not in contact with agencies) were modelled for each county, for males and females, for injecting drug users and serious drug users, and for those under 25 and those over 25 years of age. Different models were also constructed for the same subpopulations, using different agency datasets and different criteria of overlap between them, yielding a total of 230 different models. CONCLUSIONS: The issues of sample heterogeneity and population definition are particularly intractable in mark-recapture studies. Sample heterogeneity may be partly addressed by separately modelling different subpopulations to check whether they show the same dependency relationships as the main population. Population definition may be partly addressed by restricting modelling to datasets thought to share roughly congruent population definitions.

Adult↗
PubMed2000

Keeping the brain in the zone. Applying the severe head injury guidelines to practice.

Providing care to the TBI patient population with severe injuries requires an integrated multidisciplinary approach. The team in clinical practice must be willing to examine its own practice, seek out the latest information on TBI, and critically analyze the information. Members must be open to changing their own practice when the data presented support change. Interventions based on scientific evidence provide a strong foundation for delivering care. The standardization of these interventions into protocols facilitates team communication and coordination. Measuring outcomes is imperative for evaluating the effectiveness of current treatment algorithms. Changes in treatment practice should be based on the measured outcomes and advances in the scientific literature.

Adult↗