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Biomedical subjects

S Reilly

Publications and source records attributed to S Reilly.

At least 37 records · Page 2Linked to original sources
PubMed2000

Secondary prevention in a cardiology group practice and hospital setting after a heart-care initiative.

The American Heart Association (AHA) Consensus Panel Statement for Preventing Heart Attack and Death in Patients with Coronary Disease provides recommendations for the secondary prevention of heart disease in at-risk patients. Blackstone Cardiology Associates of Pawtucket, Rhode Island, undertook an initiative in their practice implementing secondary-prevention guidelines in patients with coronary artery disease. This retrospective study evaluates practice patterns for the management of hyperlipidemia for a cardiology group in an ambulatory and hospital setting after the institution of a physician-supervised, nurse-based disease management program. Practice patterns in patients with established coronary heart disease treated in a lipid center compared with non-lipid-center settings were evaluated. Parameters evaluated included documenting low-density lipoprotein (LDL) cholesterol, presence of lipid-lowering therapy, and achieving the National Cholesterol Education Program II (NCEP II) goal of LDL-cholesterol levels < or =100 mg/dL in patients with preexisting coronary artery disease. A total of 352 patients met inclusion criteria in the lipid-center setting and were compared with 289 non-lipid-center consecutively chosen patients. Age and gender differences were also evaluated. Inpatient medical records from a 254-bed Brown University-affiliated teaching hospital were also evaluated for lipid profile, achievement of NCEP II goal, and use of lipid-lowering medication on admission and discharge. The most recent LDL-cholesterol values of patients followed in the lipid-center and in the non-lipid-center setting of the Blackstone Cardiology Associates were compared. Blackstone Cardiology Associates consists of 4 cardiologists and 4 advanced-practice nurses. Achievement of LDL-cholesterol goal was higher in both the lipid-center and non-lipid-center settings compared with baseline. A smaller percentage of patients at goal in the lipid setting is likely due to referral bias resulting in patients with more difficult-to-manage mixed dyslipidemias and behavior-management issues ending up in the lipid center. There were no apparent sex differences at goal, and more elderly (age > or =65 years) achieved goal in the lipid clinic center. In the non-lipid-center setting, more males were at goal and had a lower mean LDL-cholesterol level.

Aged↗
PubMed2000

Lateral parabrachial nucleus lesions in the rat: long-and short-duration gustatory preference tests.

The present study reports two experiments that evaluated the influence of bilateral ibotenic acid lesions of the viscerosensory neurons in the lateral parabrachial nucleus (LPBN) on intake of four prototypical taste stimuli (sucrose, sodium chloride, citric acid, and quinine hydrochloride). In the 24-h, two-bottle tests of Experiment 1, rats with lesions of the LPBN were severely impaired in their concentration-dependent consumption of sucrose, displayed a mild disturbance of sodium chloride intake, and drank normal amounts of citric acid and quinine hydrochloride. These lesion-induced deficits were less pronounced when assessed with the 15-min, 1-bottle tests of Experiment 2. The results suggest that destruction of the viscerosensory neurons within the LPBN disrupt the processing of gastrointestinal feedback.

Animals↗
PubMed2000

Matching resources to care: the acceptability, validity and inter-rater reliability of a new instrument to assess severe mental illness (MARC-1).

BACKGROUND: Most definitions of severe mental illness (SMI) are categorical and assign the patient to either SMI or not-SMI status. While this is useful for some purposes, it is a rather limited approach. The purpose of the present study is to develop a new method of addressing the issue of 'severity', and to develop a dimensional rather than a categorical approach. The paper reports on the acceptability, reliability and validity of a method developed to collect a standard set of data covering the majority of items specified in the academic and policy literature as characterising SMI. METHOD: A single page form, Matching Resources to Care (MARC-1), containing most of the items used in definitions of SMI was used to collect data from community mental health staff about their current open caseload, in four co-terminous health and social services settings during a census week (n = 2139). In addition to the data from the four pilot sites, we conducted a substudy (n = 91), in which two raters rated the same cases during the same week. RESULTS: The MARC-1 scores were able to distinguish between patients in receipt, and those not in receipt, of specific types of community care (level of care, eligibility for care and statutory aftercare) (P < 0.001). The MARC-1 score was modestly but significantly correlated (r = 0.28) with the Global Assessment Scale (P < 0.001). The mean percentage inter-rater agreement for the MARC-1 score items was 87%. CONCLUSION: It is possible to use a simple census form in both health and social services agencies. The completion rates were good in both services. The levels of reliability were good, and concurrent validity was established with specific types of care in the community.

Adolescent↗
PubMed2000

Worster-Drought syndrome, a mild tetraplegic perisylvian cerebral palsy. Review of 47 cases.

A retrospective case-note analysis was undertaken of 47 children with a congenital upper motor neurone bulbar palsy (excluding pure speech dyspraxia) to clarify the phenotype of Worster-Drought syndrome (WDS) and to record its associated features and complications. The results revealed that the study children had significant bulbar problems (with 80% still needing a modified diet and a similar number using augmentative communication methods at last review). There were also high rates of predictable bulbar complications (86% had dribbling, 60% had glue ear, gastro-oesophageal reflux in 40%, history of poor nutrition in 40% and aspiration in 40%). Most of the children had additional complex impairments (91% had mild pyramidal tetraplegia, 81% learning difficulties, 60% congenital defects, 41% neuropsychiatric problems and 28% epilepsy). Over half of the children had significant medical problems in the first year, but mean age at diagnosis was 6 years. There were no obvious causes in pregnancy or birth. Six children had a family history of WDS and 32% (12/37) had abnormal neuroimaging including five with bilateral perisylvian polymicrogyria. In our experience, WDS is not uncommon, is relatively easily diagnosed and is crucial not to miss as the management of these children's multiple impairments is complex and requires a careful team approach. WDS falls clearly within the cerebral palsies as a syndrome that includes motor impairment arising from static damage to the brain in early life. The common presence of cognitive, behavioural and seizure impairments strongly supports the cerebral cortical (presumably perisylvian) localization. Its core elements are a suprabulbar paresis, a mild spastic tetraplegia and a significant excess of cognitive and behavioural impairments and epilepsy. The complete overlap in phenotype between WDS and the bilateral perisylvian syndrome leads us to propose that they are the same condition. WDS is startlingly absent from epidemiological studies of the cerebral palsies and rarely diagnosed, presumably because of lack of clinical awareness of the condition and lack of major gross motor impairments.

Adolescent↗
PubMed1999

Reinforcement value of gustatory stimuli determined by progressive ratio performance.

The progressive ratio schedule provides a means to determine reinforcement value that is independent of response rate. This is achieved by increasing the number of lever presses for each successive reinforcement until, eventually, the subject fails to respond within a designated time limit. The number of responses in the final completed ratio defines the break point. When tested with appetitive gustatory stimuli (sucrose and saccharin), rats showed a concentration-dependent increase in break point when food deprived (Experiment 1A and, for sucrose only, Experiments 1B and IC) but not when water deprived (Experiment 1A). For aversive gustatory stimuli (sodium chloride, citric acid, and quinine) break point declined as concentration increased (Experiment 1A). In Experiment 1C, reinforcement duration had a significant, although relatively small, influence on break point for each of three concentrations of sucrose. Experiment 2 found a dose-dependent effect of the neuroleptic drug haloperidol (0.025, 0.05, and 0.1 mg/kg) on break point for sucrose reinforcement. The present study demonstrates that the progressive ratio schedule provides a valuable method to assess the influence of manipulations that might affect the perceived reinforcement value of gustatory stimuli.

Animals↗
PubMed1999

The parabrachial nucleus and conditioned taste aversion.

The parabrachial nucleus (PBN) surrounds the brachium conjunctivum in the dorsolateral pons. Although composed of numerous subnuclei, the PBN is typically organized into medial and lateral subdivisions according to their location relative to the brachium. In rodents, the medial PBN is part of the central gustatory system, whereas the lateral PBN is a component of the visceral sensory system. Lesions of the PBN disrupt conditioned taste aversion, a critically important learning mechanism that prevents the repeated ingestion of toxic food. Relevant neurobehavioral literature is reviewed to elucidate the role of the PBN in taste aversion learning.

Animals↗
PubMed1999

Progressive ratio performance in rats with gustatory thalamus lesions.

To determine whether damage of the gustatory thalamus (the parvicellular region of the ventroposteromedial nucleus) disrupts the perceived value of reinforcing stimuli, the performance of rats with bilateral, electrophysiologically guided, electrolytic lesions of the area was examined in Experiment 1 with a progressive-ratio schedule of reinforcement. Lesioned rats showed normal concentration-dependent changes in break point (an index of the amount of effort a subject will expend to obtain reinforcement) and in consummatory responding (licking) for the sucrose reward. In the reward comparison procedure of Experiment 2, however, the same lesioned rats failed to show morphine-induced suppression of alanine consumption. The results provide no support for the view that the thalamic taste area is involved in the perception of the absolute reinforcing value of gustatory stimuli.

Alanine↗
PubMed1999

A model for the assessment and management of children with multiple disabilities.

Children with multiple disabilities present complex management problems, both for their families and for the professionals involved in their care. For any one child, the list of functional and medical problems that need to be addressed is frequently reflected in an even longer list of involved professionals, leading to conflicting advice and problems in co-ordination of care. A hierarchical model for assessment and management is proposed, which highlights the interdependency of apparently different areas of functioning. The model aims to assist both parents and professionals in determining priorities, to improve interdisciplinary working, and to underpin staff training. Illustrative case studies indicate the importance of resolving issues in areas such as visual functioning, positioning and nutrition before integrated functions such as communication skills can be addressed successfully.

Child↗
PubMed1999

Gustatory thalamus lesions eliminate successive negative contrast in rats.

Neurologically intact rats expecting to receive a high-value reward (1.0 M sucrose), licked less for an unexpected low-value reward (0.15% saccharin) than did control subjects that only received the saccharin solution. This reward comparison effect, termed successive negative contrast, was eliminated after bilateral electrolytic lesions of the gustatory thalamus. The results are discussed in terms of disrupted memory processes that may have rendered the lesioned rats incapable of computing the relative reward value of the available solution (0.15% saccharin) with respect to the memory of the preferred solution (1.0 M sucrose).

Animals↗
PubMed1998

Expression of FAC1 in activated microglia during Alzheimer's disease.

The presence of reactive microglia and astrocytes is a common observation in Alzheimer's disease brain. Microglia are present within the numerous beta-amyloid containing neuritic plaques, whereas reactive astrocytes usually surround the plaque perimeter. These glial cells express and secrete numerous neurotrophic and neurotoxic factors that contribute to the etiology of the disease. The molecular mechanisms that dictate glial cell activation and subsequent alternative gene expression are currently unknown. In the present study we determine that activated microglia in AD brain express the FAC1 protein, a developmentally regulated gene product, while astrocytes fail to express significant levels of FAC1 protein. Since FAC1 is a putative DNA binding protein, expression in microglia during AD suggests that FAC1 participates in the regulation of alternative gene expression.

Aged↗
PubMed1998

The role of the gustatory thalamus in taste-guided behavior.

Gustatory thalamus is the functional name for the parvicellular region of the ventroposteromedial nucleus of the thalamus. It is the penultimate nucleus in the thalamocortical pathway of the central gustatory system. Early research encouraged the view that the gustatory thalamus was important for taste detection and recognition. Consistent with this analysis, lesions of the area were found to induce profound deficits of innate taste preferences and aversions, salt appetite, and conditioned taste aversions (CTAs). More recent research using discrete lesions placed with electrophysiological guidance has, however, demonstrated that these deficits were due to damage to structures outside of, rather than within, the boundaries of the gustatory thalamus. In fact, the new data show that the gustatory thalamus is not essential for taste detection, sodium appetite, or CTA learning, but is critical for the preparatory (i.e. food-seeking) rather than the consummatory (i.e. food-eating) aspects of taste-guided behavior.

Animals↗
PubMed1998

Self-care actions to manage fatigue among myasthenia gravis patients.

Fatigue is the most frequently reported symptom by myasthenia gravis (MG)patients. Despite the prevalence of fatigue, treatment protocols are lacking, thus patients are left to self-manage. The purpose of this study was to describe self-care actions used to manage fatigue among patients with MG. A national sample (N = 250) of MG patients responded to two structured instruments. The Fatigue Survey (FS), modified with permission of authors Hubsky and Sears; and the Myasthenia Gravis Fatigue Scale (MGFS). Both instruments were based on the concept of fatigue. Participants identified three major categories of self-managed actions: mental interventions (76%), physical interventions (78%) and rest/sleep (80%). A subset of the respondents (N = 36) reported using aerobic exercise to attempt to relieve fatigue which is usually contradicted with MG. No significant difference in fatigue scores was found between those reporting aerobic exercise to be helpful and those not finding exercise helpful. However, those utilizing aerobic exercise reported the highest functional status categories. A question arises as to whether aerobic exercise is performed by the least ill MG patients, or aerobic exercise improves functional status. When demographic and functional status variables were associated with fatigue scores and selfcare actions, only gender and functional status were significantly correlated with fatigue score. Effective self-care actions include stress reduction techniques, pacing all activities and increased rest and sleep. Further investigation into the role of aerobic exercise is indicated as a self-care action for MG fatigue.

Activities of Daily Living↗
PubMed1998

Ibotenic acid lesions of the parabrachial nucleus and conditioned taste aversion: further evidence for an associative deficit in rats.

Rats with extensive ibotenic acid lesions centered in the gustatory zone of the pontine parabrachial nucleus (PBN) failed to acquire a conditioned taste aversion (CTA) induced by lithium chloride (LiCl) toxicosis (Experiments 1 and 4). This deficit cannot be explained as an inability to either perceive or process gustatory information because lesioned rats that failed to acquire a CTA readily acquired a conditioned flavor preference (Experiment 2). Similarly, the CTA deficit cannot be attributed to an inability to experience or process visceral input because PBN-lesioned rats that failed to acquire a CTA successfully learned an aversion to a trigeminal stimulus, capsaicin, when paired with LiCl-induced illness (Experiment 3). This pattern of results supports the view that cell bodies within the PBN are essential for the associative processes that govern CTA learning.

Animals↗
PubMed1998

The parabrachial nucleus is essential for acquisition of a conditioned odor aversion in rats.

Rats with bilateral ibotenic acid lesions of the gustatory zone of the parabrachial nuclei (PBN) failed to acquire a conditioned taste aversion (CTA) in Experiment 1. They also failed to acquire a conditioned odor aversion (COA) when the olfactory cue was presented on an odor disk in Experiment 2 or when it was presented in water in Experiment 3. The failure to acquire the COA was not due to an inability to detect or use olfactory stimuli because the lesioned rats displayed neophobia to a novel odor in Experiment 3 and used an olfactory cue to predict the availability of an aversive capsaicin solution in Experiment 4. Together, the results demonstrate that, as with CTA learning, PBN cell bodies are essential for the establishment of a specific association between an olfactory conditioned stimulus and a lithium chloride unconditioned stimulus.

Analysis of Variance↗
PubMed1997

Gustatory thalamus lesions in the rat: III. Simultaneous contrast and autoshaping.

The performance of rats with electrophysiologically guided electrolytic lesions of the gustatory thalamus (GT) was compared to that of control subjects in two experiments. In Experiment 1, the lesioned rats showed normal simultaneous contrast effects (both positive and negative) during brief, alternating access to 0.15% saccharin and 1.0 M sucrose. There was, however, a substantial lesion-induced impairment in the level of conditioned stimulus-directed maintenance responding on the autoshaping procedure of Experiment 2. These findings are discussed with respect to the anticipatory contrast deficit recently reported in GT-lesioned rats.

Animals↗
PubMed1997

Prevention of post splenectomy sepsis: a population based approach.

BACKGROUND: The aim of the study was to prevent the occurrence of serious, overwhelming infection following splenectomy, by a district based initiative. Subjects were residents of Plymouth and Torbay District Health Authority (DHA) who had undergone splenectomy in the past and general practitioners (GPs) within the District. METHODS: District guidelines on the prevention of post splenectomy sepsis were developed and disseminated among local GPs and hospital doctors. Patients who had undergone operative splenectomy were actively traced through GP and hospital information systems so that they could be offered sepsis preventive measures in accordance with the guidelines. Data capture-recapture was used as an ascertainment adjustment method to estimate the district prevalence of alive patients who have had an operative splenectomy. A postal questionnaire of district GPs was undertaken after one year to determine their awareness and use of the guidelines. RESULTS: Eight-eight alive patients who had undergone splenectomy were not previously identified be their GP as being asplenic. They were traced so that they could be offered sepsis preventive measures in line with the local guidelines. The estimated district prevalence of individuals who had had an operative splenectomy after ascertainment adjustment using data capture-recapture is p = 9.75 per 10,000 population [95 per cent confidence interval (CI) (7.87, 11.64) per 10,000]. Out of 367 district GPs, 201 used the local guidelines after one year. CONCLUSIONS: Effective prevention of overwhelming infection following splenectomy requires an active population based approach.

Community Health Planning↗
PubMed1997

Sprawling locomotion in the lizard Sceloporus clarkii: quantitative kinematics of a walking trot

Although the hindlimb is widely considered to provide the propulsive force in lizard locomotion, no study to date has investigated the kinematic patterns of the lizard hindlimb during running for more than one stride for a single individual. The quantitative kinematics of the hindlimb, pelvis and backbone are described here for two individuals of the lizard Sceloporus clarkii using a fast walking trot on a treadmill moving at a constant speed of 0.833 m s-1. Pelvic rotation, femoral retraction, knee flexion and posterior movement of the foot all begin before the foot hits the substratum and, thus, there is a terminal portion of the swing phase during which the limb is retracting. Pelvic rotation (to the opposite side), femoral protraction and knee flexion all begin before the foot leaves the substratum. The foot, however, continues to move posteriorly into the early swing phase. Thus, limb retraction and protraction movements do not directly correlate with footfall phases. Axial bending involves a rough standing wave with two nodes, one centered on each limb girdle. In Sceloporus clarkii, the foot clearly remains lateral to the knee and, thus, has a more sprawling posture than that of any other vertebrate studied to date. Therefore, the generalization that the 'lacertilian' foot passes under the knee joint is no longer supported. The kinematics of sprawling locomotion in Sceloporus clarkii are compared and contrasted with the general understanding of lizard locomotion based on qualitative work to date. Comparisons with other tetrapods reveal a fundamental functional dichotomy in hindlimb retraction mechanics in salamanders and mammals versus lizards that may be related to a key morphological difference in the saurian caudifemoralis muscle.

Journal Article↗