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PubMed2005

Brief report: if you build it, they will come: methods for recruiting Latinos into cancer research.

BACKGROUND: Latinos have low representation in cancer prevention trials and intervention studies. Culturally appropriate recruitment strategies are needed to address this issue. OBJECTIVE: To describe and summarize the effectiveness of recruitment strategies used by the Latin American Cancer Research Coalition (LACRC). DESIGN: Descriptive report of recruitment methods. PARTICIPANTS: Uninsured Latino immigrants (N=1,170; 77% female, 23% male) from Central and South America recruited to 7 cancer control studies. APPROACH: The LACRC recruitment model involved inclusion of Latino researchers and providers, and use of culturally acceptable materials released through culturally appropriate outlets such as Latino radio stations. RESULTS: The overall participation rate was high-96% of patients identified as eligible agreed to participate. Women were excellent referrals for recruiting men to research studies. Additionally, a local Latino radio program was used to efficiently recruit eligible study participants. CONCLUSIONS: Latinos are interested and willing to participate in cancer control studies when culturally relevant approaches are used. Research teams that partner with Latino researchers and with Latino service providers are important in educating Latinos about cancer control and encouraging participation in research.

Culture↗

PubMedDate not supplied

Older women and exercise: explanatory concepts.

BACKGROUND: Older women remain predominantly sedentary despite potential health benefits and reduced risks of cardiovascular disease associated with regular exercise. Primary care interventions to increase exercise need to focus on constructs amenable to intervention that predict exercise behavior. PURPOSE: The study tested an explanatory model of older women's exercise behavior using concepts from social cognitive theory, the transtheoretical model, and the theory of planned behavior (self-efficacy, outcome expectancy, perceived exercise barriers, processes of change, perceived health, and age). METHODS: Data were collected by interviews with 203 older community-dwelling women physically capable of some exercise. Ordinary least squares regression results were used to determine the direct and indirect effects in a path model. FINDINGS: All concepts and 13 hypothesized paths were retained in the trimmed model. The constructs accounted for 46% of the variance in exercise behavior. Outcome expectancy had the largest total effect. Processes of change had the largest direct effect on exercise behavior. Exercise self-efficacy and perceived exercise barriers accounted for similar amounts of variance in exercise behavior, whereas age and health had only modest effects. CONCLUSION: Important constructs for future exercise model testing and intervention research should include outcome expectancy, processes of change, exercise self-efficacy, and perceived barriers to exercise. Primary care interventions designed to increase older women's exercise should focus on these same constructs.

Aged↗

PubMed2000

The unreliability of clinical measures of muscle tone: implications for stroke therapy.

BACKGROUND: the central tenet of the neurofacilitatory approach to stroke therapy is that muscle tone needs to be normal before normal movement can occur. A reliable clinical measure of the full spectrum of muscle tone is needed to test: (i) the purported relationship between muscle tone, other motor impairments and disability, and (ii) the effectiveness of stroke therapy to restore movement. AIM: the purpose of the study was to test the inter-rater reliability of clinical categorization of muscle tone (spastic/normal/flaccid) and also a visual analogue scale with anchor points of 'lowest tone possible' (score 0) and 'highest tone possible' (score 100). METHODS: four independent raters assessed tone of elbow flexors and knee extensors of 14 stroke rehabilitation inpatients using the categorical scale. Six independent raters assessed tone of elbow flexors and knee extensors of 25 chronic stroke patients and two healthy volunteers using the visual analogue scale. All assessment orders were randomized. RESULTS: both scales were unreliable, with K coefficients for the categorical scale ranging from -0.046 to 0.56 for the categorical scale, and intra-class correlation coefficients for the visual analogue scale of 0.595 for elbow flexors and 0.451 for knee extensors. Assessment order effects for the visual analogue scale were non-significant for elbow flexors (P= 0.545) and knee extensors (P= 0.911). CONCLUSIONS: these results, and those of earlier studies, suggest that clinical measures of muscle tone are consistently unreliable. Systematic investigation of the therapy rationale for planning and evaluating treatment is required before relevant clinical measures can be developed.

Humans↗

PubMed2004

Combining gene expression profiles and clinical parameters for risk stratification in medulloblastomas.

PURPOSE: Stratification of risk in patients with medulloblastoma remains a challenge. As clinical parameters have been proven insufficient for accurately defining disease risk, molecular markers have become the focus of interest. Outcome predictions on the basis of microarray gene expression profiles have been the most accurate to date. We ask in a multivariate model whether clinical parameters enhance survival predictions of gene expression profiles. PATIENTS AND METHODS: In a cohort of 55 young patients (whose medulloblastoma samples have been analyzed previously for gene expression profile), associations between clinical and gene expression variables and survival were assessed using Cox proportional hazards models. Available clinical variables included age, stage (ie, the presence of disseminated disease at diagnosis), sex, histologic subtype, treatment, and status. RESULTS: Univariate analysis demonstrated expression profiles to be the only significant clinical prognostic factor (P=.03). In multivariate analysis, gene expression profiles predicted outcome independent of other criteria. Clinical criteria did not significantly contribute additional information for outcome predictions, although an exploratory analysis noted a trend for decreased survival of patients with metastases at diagnosis but favorable gene expression profile. CONCLUSION: Gene expression profiling predicts medulloblastoma outcome independent of clinical variables. These results need to be validated in a larger prospective study.

Adolescent↗

PubMed2000

The feasibility of a kinematic measure of lip closure during meaningful speech.

PURPOSE: Assessment of dysarthria has traditionally been based on perceptual methods. The purpose of this study was to examine the feasibility of using 2D kinematic analysis to measure lip closure during normal speech. METHOD: Retroflective markers (4 mm diameter) were placed on the midline of each lip of three healthy male, caucasian volunteers aged 69 years who repeated the sentence 'My mother made me an apple and blackberry pie' six times. Videorecordings were analysed using the Ariel Performance Analysis System to calculate the distance between the lips before, during and after the sentence. RESULTS: The graphs produced from the data objectively measured the distance between the lips and identified the eight bilabial sounds. However, in spite of stringent study criteria to minimize differences linked to age, gender and race, differences were found between participants. CONCLUSION: Kinematic 2D analysis may have potential for the objective measurement of lip closure in dysarthria in the context of meaningful speech. These results justify further pilot work to explore: the possible variability within defined populations; and the usefulness of 2D kinematic analysis in the measurement of disordered lip closure in dysarthria.

Aged↗

PubMed1978

Assay of delta-aminolevulinic acid synthetase in homogenates of mouse, rat, and human liver: species differences in requirement for an exogenous succinyl-CoA-generating system.

Conditions required for optimal assay of low levels of activity of hepatic delta-aminolevulinic acid synthetase have been studied, comparing dilute homogenates of mouse, rat, and human livers. The assay method used was a modification of that described by Ebert et al. (Biochim, Biophys, Acta (1970) 208, 236-250), and livers were studied from both untreated animal and human subjects and subjects pretreated with porphyrinogenic compounds. In homogenates of mouse and human but not rat liver, maximal rates of delta-aminolevulinic acid formation required addition to the incubation mixture of an exogenous system for succinyl-CoA generation. The requirement for this generating system was increased if livers from pretreated subjects were frozen and stored prior to assay, suggesting that the endogenous capacity for succinyl-CoA generation was more labile than delta-aminolevulinic acid synthetase under these conditions. Of the metabolic inhibitors tested (F-, malonate, and arsenite), only F- (100 mM final concentration) enhanced activity. Increasing the permeability of mitochondria by quick freeze-thawing of fresh homogenates just before assay did not increase the rate of delta-aminolevulinic acid formation.

5-Aminolevulinate Synthetase↗

PubMed1990

Seizures and other neurologic sequelae of bacterial meningitis in children.

BACKGROUND: Although the mortality rate among children with bacterial meningitis has decreased dramatically in recent decades, some patients are left with neurologic sequelae. It has not been clearly established which features of the acute illness predict the chronic neurologic sequelae, including late seizures or epilepsy. METHODS: We followed 185 infants and children prospectively during and after acute bacterial meningitis. The mean duration of follow-up was 8.9 years (range, 0.1 to 15.5). During the first six years standard neurologic examinations were performed; telephone interviews were conducted thereafter. RESULTS: One month after meningitis, 69 children (37 percent) had neurologic abnormalities. Many of these signs resolved within a year, leaving only 26 children (14 percent) with persistent deficits: 18 (10 percent) had only sensorineural hearing loss, and 8 (4 percent) had multiple neurologic deficits. Thirteen children (7 percent) had one or more late seizures not associated with fever. The presence of persistent neurologic deficits indicative of cerebral injury was the only independent predictor of late afebrile seizures (P less than 0.001). CONCLUSIONS: After bacterial meningitis only children with permanent neurologic deficits are at high risk for epilepsy. Those with normal examinations after the acute illness have an excellent change of escaping serious neurologic sequelae, including epilepsy.

Acute Disease↗

PubMed2000

The effect of body position on arterial oxygen saturation in acute stroke.

BACKGROUND: Evidence suggests that respiratory function is impaired poststroke. Body position is known to influence respiratory function in normal subjects and those with respiratory pathologies. Its effect on respiratory function after stroke has received little attention. However, one study suggests that some positions used in clinical practice may adversely influence respiratory function. This study therefore aimed to identify resting positions that maintain arterial oxygen saturation (SaO2) at optimal levels, changes in SaO2 during time spent in the test position, and differences in SaO2 among the positions investigated. METHOD: A within-subject, two-center clinical study was made. Patients in the first 72 hours following mild to moderately severe stroke were allocated a randomized sequence of four positions. One hour was spent in each position. SaO2 was recorded each minute by pulse oximetry with a finger probe. Mean values for the hour were calculated. RESULTS: Mean arterial oxygen saturation values for all patients were >90% for the hour spent in each test position for all patients. There were no changes in arterial oxygen saturation across the hour spent in the test positions (repeated-measures analysis of variance). No differences in arterial oxygen saturation were identified among positions (analysis of covariance). DISCUSSION: The saturation levels recorded corresponded to those observed in studies of normal elderly persons. The positions tested may be recommended for use in clinical practice to maintain arterial oxygen saturation in patients in the first 72 hours following mild to moderately severe stroke.

Female↗

PubMed2001

The effectiveness of very short scales for depression screening in elderly medical patients.

OBJECTIVE: To compare very short scales for screening for depression with longer, widely used scales. METHODS: Eighty-seven patients over the age of 60 who were admitted to rehabilitation wards or were attending a day rehabilitation facility at a British teaching hospital were screened for depression using the 1-item mental health inventory, and the 4-item, 15-item and 30-item geriatric depression scales. The sensitivity, specificity, and areas under receiver operating characteristic curves were compared, with the diagnostic criteria for research of ICD-10 providing the criterion diagnosis of depressive episode. RESULTS: All the scales had comparable sensitivity (82.4-100%), specificity (60.0-71.4%), and positive predictive values (33.3-42.9%). Comparison of receiver operating characteristic curves for each scale showed no statistically significant difference between them (range 0.80-0.88). CONCLUSIONS: The very short scales performed just as well as the widely used longer screening scales in this population. They are worthy of further examination in elderly populations at risk of depression, and may be particularly suitable for older adults due to their brevity and ease of use.

Aged↗

PubMed2001

Post-prandial remnant lipids impair arterial compliance.

OBJECTIVES: We sought to examine the effects of plasma lipids, especially in remnants after a fat meal, on systemic arterial compliance (SAC), a newly recognized cardiovascular risk factor. BACKGROUND: Post-prandial remnants correlate with coronary heart disease events through mechanisms that may include vascular dysfunction, although the effect on SAC has not been studied. METHODS: Systemic arterial compliance was measured non-invasively over 6 h after a fat meal in 16 subjects with varying plasma triglyceride levels. Changes were related to rises in plasma lipids and remnant lipids. Systemic arterial compliance was measured in 20 subjects after a control low-fat meal. RESULTS: The fat meal induced increments in plasma triglyceride and remnant cholesterol and triglyceride (respectively +54%, 50% and 290% at 3 h, analysis of variance <0.001). Systemic arterial compliance fell at 3 h and 6 h by 25% and 27% (analysis of variance <0.001). Baseline SAC correlated significantly with all lipid concentrations at 0, 3 h and 6 h, but only with triglyceride on stepwise regression analysis. The SAC response to the low-fat meal was very small and not significant. CONCLUSIONS: This is the first demonstration of SAC becoming impaired after a fat meal. Remnant lipids and plasma total triglyceride appeared to contribute to the fall in SAC.

Arteries↗

PubMed1977

[Hysterosalpingographic finding tubal sterilization: their importance for the pathologic hysterosalpingogram(author's transl)].

110 tubal sterilizations by Pomeroy's technique were performed in the years 1973--75. 78 cases were examined by hysterosalpingography. In 14 cases the ligature was located close to the intersitial portion of the tube (proximal type), in 52 cases in the isthmic ampullary junction or close to the ampulla (distal type) and in 12 cases on one side proximal type and on the other distal type. In 2 cases of the latter group failure of the ligature was confirmed by contrast medium in the pelvic cavity. The occluded portion of the tube was on the average longer after coeliotomy in comparison with laparotomy. Occluded tubes with smooth distribution of contrast-medium showed good peristaltic activity. Hydrosalpinx never developped, although often reported in the literature. A spill over of contrast-medium into the surrounding tissue was observed only in two cases. This low incidence indicates that the phenomenon is not caused by application of to high pressure.

Female↗

PubMed2002

Frequency domain characteristics of ground reaction forces during walking of young and elderly females.

OBJECTIVE: To examine the frequency domain characteristics of the ground reaction forces of young and elderly females during free walking. DESIGN: Independent t-tests were used to examine the frequency content of all three components of the ground reaction force. BACKGROUND: Frequency domain analysis has the potential to assist in identifying changes in gait that may be masked in the time domain. No research has been done to identify changes in gait due to age-related impairments in the frequency domain. METHODS: Ten young and ten elderly females walked at a prescribed speed while ground reaction forces were collected via a force platform. The highest frequency required to reconstruct the 99% of the signal's power in each direction was calculated from the ground reaction forces. RESULTS: The frequency content significantly decreased in the anterior-posterior direction for the young group. No significant differences were found for the other two directions (vertical and mediolateral) between the two groups. The elderly had a significantly higher frequency content compared with the young in the anterior-posterior direction. CONCLUSIONS: Ageing differences were detected using the frequency domain analysis for the anterior-posterior direction. It is possible that these differences were the result of the decrease in walking speed associated with the elderly group. RELEVANCE: Frequency domain analysis of the ground reaction forces is a useful addition to the gait analyst's armamentarium especially when such changes are not obvious in the time domain.

Adult↗

PubMed2004

Conserved mechanisms across development and tumorigenesis revealed by a mouse development perspective of human cancers.

Identification of common mechanisms underlying organ development and primary tumor formation should yield new insights into tumor biology and facilitate the generation of relevant cancer models. We have developed a novel method to project the gene expression profiles of medulloblastomas (MBs)--human cerebellar tumors--onto a mouse cerebellar development sequence: postnatal days 1-60 (P1-P60). Genomically, human medulloblastomas were closest to mouse P1-P10 cerebella, and normal human cerebella were closest to mouse P30-P60 cerebella. Furthermore, metastatic MBs were highly associated with mouse P5 cerebella, suggesting that a clinically distinct subset of tumors is identifiable by molecular similarity to a precise developmental stage. Genewise, down- and up-regulated MB genes segregate to late and early stages of development, respectively. Comparable results for human lung cancer vis-a-vis the developing mouse lung suggest the generalizability of this multiscalar developmental perspective on tumor biology. Our findings indicate both a recapitulation of tissue-specific developmental programs in diverse solid tumors and the utility of tumor characterization on the developmental time axis for identifying novel aspects of clinical and biological behavior.

Animals↗

PubMed1982

A comparison of the properties of ATPase associated with wheat and cauliflower plasma membranes.

Plasma membrane-associated ATPase obtained from cauliflower (Brassica oleraceae L.) florets isolated and assayed by several different procedures was stimulated 150 to 400% by K(+). In contrast, winter wheat (Triticum aestivum L. cv. Kharkov 22 MC) shoot and root ATPase obtained by the same methods exhibited only 10 to 25% stimulation by K(+). The level of K(+)-stimulation of the wheat enzyme was not significantly increased by purifying the crude microsomal membrane fraction using sucrose density gradients. ATPase associated with density gradient-purified cauliflower membranes was inhibited by Ca(2+), high ATP concentration in the presence of low Mg(2+), and by several metabolic inhibitors. In contrast, the wheat enzyme was largely unaffected by all of these treatments. The plasma membranes of intact wheat and cauliflower cells gave a positive reaction with the plasma membrane-specific, phosphotungstic acid-chromic acid stain (PACP). A high proportion of the cauliflower membrane vesicles in the putative plasma membrane-enriched fraction stained with PACP, whereas only a small proportion of the wheat membrane vesicles reacted positively with PACP. These results indicate that a plasma membrane-enriched fraction has been isolated successfully from cauliflower floret tissue, but that none of the procedures used effectively separate plasma membranes from homogenates of wheat shoots and roots.

Journal Article↗

PubMed2002

Measurement of sitting balance using the Manchester Active Position Seat (MAPS): a feasibility study.

BACKGROUND: Evaluation of the effectiveness of therapy to improve sitting balance has been hampered by the limited number of sensitive objective clinical measures. We developed the Manchester Active Position Seat (MAPS) to provide a portable system to track change in the position of centre of force over time. OBJECTIVES: (1) To investigate whether there is correspondence between the measurement of position change by a forceplate and by MAPS. (2) To explore whether and how MAPS measures changes in position when seated healthy adults change posture. DESIGN: A feasibility study. METHODS: (1) An adult subject sat on MAPS placed on top of a forceplate. The x and y coordinates of the centre of pressure recorded from the forceplate and centre of force from MAPS during movement were compared graphically. (2) Four adults sat on MAPS using a standardized starting position and moving into six sets of six standardized target postures in a predetermined randomized order. The absolute shift in centre of force from the starting position was calculated. RESULTS: (1) The pattern of change of position over time was similar for the forceplate and for MAPS although there was a measurement difference, which increased with distance from the centre. (2) The direction of change of position corresponded to the direction of movement to the target postures but the amount of change varied between subjects. CONCLUSIONS: MAPS shows promise as an objective clinical measure of sitting balance, but peripheral accuracy of measurement needs to be improved.

Adult↗

PubMed2005

Development of a schedule of current physiotherapy treatment used to improve movement control and functional use of the lower limb after stroke: a precursor to a clinical trial.

OBJECTIVE: To develop a treatment schedule of physical therapy techniques used to improve movement control and functional use of the paretic lower limb after stroke in U.K. clinical centers to be involved in a subsequent clinical trial of experimental interventions given in addition to routine clinical practice. METHODS: Ten physiotherapists experienced in stroke rehabilitation who worked in or near the clinical centers to be involved in a subsequent clinical trial completed an individual semi-structured interview. The verbatim transcripts were condensed independently by 2 researchers into a draft list of interventions. The researchers then resolved disagreement through discussion and produced a preliminary list of interventions. At a focus group meeting, the participating physiotherapists discussed the preliminary list, refined it to produce a final list, and then transformed it into a draft treatment schedule. The draft treatment schedule was piloted in clinical practice. Refinements were made, and the final treatment schedule was produced. RESULTS: The treatment schedule consists of an A4 recording form with instructions and glossary of terms printed on the back. Each treatment record provides information including duration of treatment, treatment aims, and the 45 specific physical therapy interventions provided in the 11 sections (e.g., "splinting techniques" and "function - in sitting towards standing"). CONCLUSION: A treatment schedule was produced, which can now be used in a subsequent phase II evaluative trial.

Adult↗

PubMed1999

Transmission rates of hepatitis C virus by different batches of a contaminated anti-D immunoglobulin preparation.

BACKGROUND AND OBJECTIVES: The aim of this study was to determine the hepatitis C virus (HCV) infection rate of recipients of different batches of anti-D immunoglobulin associated with an outbreak of HCV infection which occurred in 1977 and its relationship to the polymerase chain reaction (PCR) status of the implicated batches. This study was undertaken to determine the predictive value of HCV genome detection and quantification for subsequent infection in recipients of an HCV-contaminated anti-D immunoglobulin product for intravenous use. MATERIALS AND METHODS: Sera from recipients of anti-D were tested by HCV enzyme immunoassay and if found positive were subsequently tested by recombinant immunoblot assay and HCV PCR in a national HCV anti-D screening programme set up in 1994. The HCV status of 1,342 known recipients of infectious or potentially infectious batches has been compared to the amount of HCV RNA in the anti-D batch they received so as to determine the value of PCR in the prediction of infectivity in immunoglobulin preparations. RESULTS: It has been demonstrated that HCV-infected plasma derived from batches of anti-D showing levels of viral genome in excess of 10(4) genomes per millilitre led to infection of up to 60% of recipients. In contrast, batches with undetectable levels of HCV genome very rarely transmitted infection. CONCLUSIONS: The presence of HCV RNA in intravenous immunoglobulin preparations which have not undergone a specific viral inactivation step is a predictor of HCV infection in recipients.

Disease Outbreaks↗

PubMed1999

Mobility and dementia: is physiotherapy treatment during respite care effective?

BACKGROUND: Mobility problems experienced by elderly people with a dementia are associated with falls, fractures and admission to long-term care. A hospital respite care admission is therefore often seen as an opportunity to provide physiotherapy treatment. AIM: To find whether elderly people with a dementia and a mobility problem show a greater improvement in mobility skills if given physiotherapy treatment than if given non-physical activities intervention during a hospital respite admission. METHOD: A controlled randomized multicentre trial with independent blinded assessment. The Southampton Mobility Assessment (mobility score) and Two Minute Walking Test (distance walked) were undertaken at the beginning and end of the study admission and beginning of the next respite admission. Following the first assessment, participants were randomized to either physiotherapy or activities. RESULTS: Eighty-one participants, from 12 clinical centres, with a mean age of 81.9 years and CAPE I/O score of 2. During the study admission there was a non-significant trend for a lower reduction in mobility score of the physiotherapy group (Mann-Whitney; p = 0.614) and a non-significant trend for greater decrease in distance walked in the activities group (t-test; p = 0.325). DISCUSSION: The results of this trial do not support the positive changes demonstrated elsewhere. However, changes in respite care during the early stages of this trial may have produced differences between the sample for this trial and that for the pilot study. This trial was therefore underpowered. CONCLUSION: This trial suggests that future research needs to change the focus from clinical settings to presentations.

Aged↗