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Velidedeoglu E, Desai NM, Campos L, Olthoff KM, Shaked A, Nunes F, Zeldin G, Stewart C, Blumberg E, Abrams J, Markmann JF. Effect of donor hepatitis C on liver graft survival. Transplant Proc 2001; 33:3795-6. [PMID: 11750616 DOI: 10.1016/s0041-1345(01)02606-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rehor PR, Dunnagan T, Stewart C, Cooley D. Alteration of mood state after a single bout of noncompetitive and competitive exercise programs. Percept Mot Skills 2001; 93:249-56. [PMID: 11693692 DOI: 10.2466/pms.2001.93.1.249] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study evaluated the effects of three popular physical activities on the psychological well-being of university students. 44 students in three physical activity classes enrolled in the Fitness for Life Program at Montana State University which included circuit training, weight training, and racquetball were administered the Profile of Mood States scale 5 min. before and 5 min. after one bout of physical activity. Two of the three activities appeared to be associated positively with scores on certain subscales. The results supported positive psychological well-being of students after physical activity. Implications for research are presented.
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Moseley M, Fielder A, Stewart C. Compliance with amblyopia therapy. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2001; 119:1226. [PMID: 11483109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Elfenbein JL, Fisher RA, Wei S, Morell RJ, Stewart C, Friedman TB, Friderici K. Audiologic aspects of the search for DFNA20: a gene causing late-onset, progressive, sensorineural hearing loss. Ear Hear 2001; 22:279-88. [PMID: 11527035 DOI: 10.1097/00003446-200108000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this research was to identify the gene responsible for a novel form of nonsyndromic, late-onset, bilateral, progressive, sensorineural hearing loss in a Michigan family of English descent. This report describes the audiologic aspects of the search. DESIGN Fifty-eight members of the family served as subjects for the study. Family pedigree information was gathered from family interviews, family records, birth and death registration records and census data. Audiologic evaluation was used to describe the hearing loss (phenotype) and classify family members as affected or unaffected based on hearing status. These data then were used in a linkage analysis, a process in which the inheritance of a trait is compared with the inheritance of genetic markers and statistically significant associations are sought. RESULTS The team mapped the hearing loss to the long arm of chromosome 17 at band 17q25. The pattern of inheritance is autosomal dominant. The search for the gene is continuing using a candidate gene approach. CONCLUSIONS The hearing loss demonstrated by this mid-Michigan family is a novel form of nonsyndromic, genetic, late-onset, bilateral, progressive, sensorineural hearing loss. The locus of the gene, the 20th for autosomal dominant hearing loss, is at band 17q25 of chromosome 17.
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Stewart C. A hungry baby fails to thrive. Postgrad Med J 2001; 77:410, 420-1. [PMID: 11375466 PMCID: PMC1742056 DOI: 10.1136/pmj.77.908.410a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Doctors have a duty to ensure that patients in their care who refuse medical treatment are competent to do so. Doctors who comply with an incompetent patient's refusal of treatment risk harm to the patient and are breaching their duty of care. On the other hand, doctors who treat a competent patient against the patient's will violate his or her autonomy and commit a battery. The test of competence is a legal one, with the courts being the final arbiters in cases of doubt. Assessment of competence involves a three-step process of determining whether the patient (a) can comprehend and retain relevant information, (b) believes the information, and (c) can weigh the information in the balance and arrive at a choice. Asking patients a few simple questions can help doctors assess their competence.
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Johnson MK, Flanigan U, Fuld J, Irwin A, Stewart C, Stevenson RD. Hospital at home services for acute exacerbation of chronic obstructive pulmonary disease: a survey of British practice. HEALTH BULLETIN 2001; 59:163-70. [PMID: 12664756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To identify the prevalence of and attitudes towards hospital at home services for acute exacerbation of chronic obstructive pulmonary disease (COPD) in Great Britain. To identify the models of service in existence, in particular staff numbers and the workload experienced. DESIGN A postal survey was used to locate existing schemes. Telephone interviews were conducted with each of the hospital at home services identified. SUBJECTS & SETTING A questionnaire was sent to one consultant in each of 223 respiratory departments in Great Britain. Thirty six departments were subsequently contacted by telephone. OUTCOME MEASURES Awareness and prevalence of hospital at home services. Perceived problems with starting a service. Details of organisation of existing services. RESULTS We received 186 replies to the postal questionnaire. Of these respiratory departments, 179 (96%) were aware of hospital at home services for acute exacerbation of COPD and, in November 1999, 30 (16%) were running such a service. Difficulty in obtaining funding was the main reason for not setting up a service rather than lack of evidence of benefit or unsuitability of local circumstances. Median staffing level was two nurses (range one to six) looking after a median number of new patients of five per week (range 0.5 to 12). There was wide variation in the organisation of services. CONCLUSIONS Despite lack of objective evidence of effectiveness, there was a high level of awareness of and interest in starting hospital at home services for acute exacerbation of COPD in British respiratory departments when assessed in November 1999.
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Abstract
Disseminated intravascular coagulation (DIC) is a condition that is seen in critical care areas in association with a number of precipitating conditions. DIC is often described as a paradoxical disease process of concurrent haemorrhage and thrombus formation, resulting in a range of clinical manifestations related to end organ ischaemia. This article will discuss the coagulation cascade as a basis for understanding the aetiology and pathophysiology of DIC. The discourse surrounding medical treatment will be highlighted to enable bedside nurses to understand the divergent orders they may receive from physicians for different patients. Management of the patient experiencing DIC will be approached from a multidisciplinary focus, as well as highlighting the specific nursing considerations and alternatives from an independent focus.
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Abstract
RATIONALE Nicotine is known to facilitate attentional processing, but its role in processing spatial and non-spatial cues is not well established in rodents. OBJECTIVE These experiments tested the hypothesis that nicotine facilitates the orienting of attention in space but has no effect on non-spatial cues and that the benefits are blocked by the nicotinic antagonist mecamylamine. METHODS Eight male rats were trained to insert their noses in an opening, which triggered the presentation of cue and target lights in a modified covert orienting task. Four types of trials were presented: valid cues (cue and target lights on the same side of the nose hole), invalid cues (cue and targets on opposite sides), double cues (both cue lights illuminated, target on either side), and no cue (cue lights omitted, targets on either side). The reaction time required to withdraw the nose from the fixation hole (RT) and the time for the rat to move to the feeder (MT) were measured. RESULTS Nicotine decreased all RTs in a dose-dependent manner but significantly lowered the invalid cue RTs and the validity effect (invalid-valid cue RT). Mecamylamine slowed RTs in a dose-dependent fashion and reduced the validity effect by significantly slowing the valid cue RTs. With mixtures of a fixed strength of nicotine and an increasing dose of mecamylamine, RTs showed nicotine-like effects at low doses and mecamylamine-like effects at high doses. Neither of these drugs had a major effect on non-orienting trials (double and no cue RTs), and the alerting effect (no cue RTs-double cue RTs). CONCLUSIONS Taken together with recent work in humans and non-human primates, these results suggest that the nicotinic cholinergic modulation of visual covert orienting is conserved across species despite different ecological niches.
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Kleinegger CL, Stewart C, McGinnis JP. Oral complications associated with the use of immunosuppressive agents in a renal transplant patient. MISSISSIPPI DENTAL ASSOCIATION JOURNAL 2001; 52:20-2. [PMID: 9571915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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186
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Ratnasinghe D, Tangrea JA, Stewart C, Bhat NK, Virtamo J, Albanes D, Taylor PR. Influence of antioxidants and the CYP1A1 isoleucine to valine polymorphism on the smoking--lung cancer association. Anticancer Res 2001; 21:1295-9. [PMID: 11396202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
To evaluate the association between CYP1A1 genotype and lung cancer risk and to assess the effect of CYP1A1 genotype and antioxidant supplementation on the smoking--lung cancer relationship we conducted a case-control study nested within a large cancer prevention trial cohort. Controls (n = 324) were matched to cases (n = 282) on age (+/- 5 years), intervention group and study clinic in a 1:1 ratio, using incidence density sampling. Genotype was determined by a PCR-based method and logistic regression was used to calculate relative risk estimates. Overall, we found no association between CYP1A1 genotype and lung cancer risk. CYP1A1 genotype did not modify the effect of smoking on lung cancer risk. However, in an examination of subgroups defined by randomized intervention assignment our findings suggest that alpha-tocopherol supplementation may reduce the risk of lung cancer associated with cumulative smoking exposure regardless of CYP1A1 genotype with the greatest effect seen among those with the variant CYP1A1 allele.
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Khorana A, Bunn P, McLaughlin P, Vose J, Stewart C, Czuczman MS. A phase II multicenter study of CAMPATH-1H antibody in previously treated patients with nonbulky non-Hodgkin's lymphoma. Leuk Lymphoma 2001; 41:77-87. [PMID: 11342359 DOI: 10.3109/10428190109057956] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CAMPATH-1H is a humanized antilymphocyte monoclonal antibody (mAb) directed against the CD52 antigen expressed on normal and malignant lymphocytes. We report the results of a multicenter phase II trial using intravenous CAMPATH-1H in previously treated patients with nonbulky non-Hodgkin's lymphoma (NHL) or minimal residual NHL. Sixteen previously treated patients with nonbulky NHL and two patients with minimal residual NHL, were treated with CAMPATH-1H. Changes in peripheral blood lymphocyte subsets were analyzed by multiparameter flow cytometric techniques in eleven patients. The 18 patients enrolled in the studies received CAMPATH-1H for a median duration of 6 weeks (range, 3 to 14 weeks), and a median cumulative dose of 470 mg (range, 180 to 1185 mg). Two of the sixteen patients with nonbulky NHL achieved a complete response (CR) and one patient achieved a partial response (PR). One of the two patients with minimal residual NHL achieved a molecular CR. Infusional complications were seen with the majority of patients but were more common with initial infusions. Significant hematologic toxicity was also observed with grade (3/4) thrombocytopenia (n=10), grade (3/4) neutropenia (n=4) and grade 3 anemia (n=3). Due to excessive infectious complications observed with the patients enrolled, the trials were terminated early. Anti-tumor activity was demonstrated in a small subset of previously treated low-grade lymphoma patients with nonbulky or minimal residual disease. Future studies evaluating the effect of different drug schedules, modes of mAb administration, and concurrent use of prophylactic antibiotics/antiviral/antifungal agents to optimize anti-tumor activity and limit infectious toxicities are planned.
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MESH Headings
- Adult
- Aged
- Alemtuzumab
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/toxicity
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/toxicity
- Antigens, CD/analysis
- Antigens, CD/drug effects
- Antigens, Neoplasm
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/pharmacology
- Antineoplastic Agents/toxicity
- Bacterial Infections/etiology
- CD52 Antigen
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Follow-Up Studies
- Glycoproteins/analysis
- Glycoproteins/drug effects
- Humans
- Immunization, Passive
- Immunophenotyping
- Lymphoma, Non-Hodgkin/complications
- Lymphoma, Non-Hodgkin/drug therapy
- Middle Aged
- Neoplasm, Residual/complications
- Neoplasm, Residual/drug therapy
- Treatment Outcome
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O'Connor HJ, Stewart C, Walsh R, McGee CN, Flynn B. Six-year follow-up after Helicobacter pylori eradication in peptic ulcer disease. Ir J Med Sci 2001; 170:24-7. [PMID: 11440407 DOI: 10.1007/bf03167715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The longterm outlook after Helicobacter pylori (H. pylori) eradication in peptic ulcer disease is unclear. AIM This study documents H. pylori recurrence, dyspeptic symptoms and anti-secretory therapy in peptic ulcer patients six years or more after H. pylori eradication. METHODS Peptic ulcer patients with H. pylori eradication between 1990 and 1992 were included. Infection recurrence was diagnosed by 13-carbon urea breath test (UBT). Dyspeptic symptoms and anti-secretory therapy use were assessed by questionnaire. RESULTS Sixty-one patients completed the study protocol. Mean follow-up after eradication was 6.1 years (range 4.8-8.3). Four patients had a positive UBT. H. pylori recurrence rate was 6.6% or 0.02% per patient per year. Forty-two patients (69%) had dyspeptic symptoms. Heartburn and belching were more common than pain (p<0.001). All four patients with H. pylori recurrence had symptoms compared with 38 of 57 H. pylori-negative patients (p>0.05). Ten of 61 patients (16.4%) were taking anti-secretory therapy and their dyspepsia scores were higher. CONCLUSIONS Despite a low H. pylori recurrence rate, longterm dyspeptic symptoms were common in peptic ulcer patients after H. pylori eradication. The symptoms are mainly reflux in type and require anti-secretory therapy in only a minority of patients.
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Stewart C. The influence of spirituality on substance use of college students. JOURNAL OF DRUG EDUCATION 2001; 31:343-351. [PMID: 11957390 DOI: 10.2190/hepq-cr08-mgyf-yylw] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES The issue of substance use and the problems resulting from that use has become a major concern in the United States. The past decade has seen several new trends in substance use by college students and an increase in the effort to try and determine factors that may ameliorate the problem. Spirituality is one possible factor that may have some role in the phenomenon. Some research has been conducted on the relationship of spirituality to substance use but the results are mostly descriptive and concerned with religiosity rather than spirituality. The purpose of this study was to explore the relationship between a student's spiritual and religious beliefs and the impact of those beliefs on the decision to use substances. METHOD A sample of 337 university students was surveyed using the CORE Alcohol and Drug Survey and several supplemental questions. RESULTS In general, spirituality had a moderate buffering effect upon the decision to use alcohol and marijuana. This general protective effect exists for both alcohol use and binge drinking but dissipated as the students reached upper-class levels. CONCLUSION Spirituality may play a significant role in the decision of college students to use substances. Further research should focus on this important factor. Also, implementation of spiritual aspects into university prevention and treatment programs may help boost efficacy rates.
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Magner WJ, Kazim AL, Stewart C, Romano MA, Catalano G, Grande C, Keiser N, Santaniello F, Tomasi TB. Activation of MHC class I, II, and CD40 gene expression by histone deacetylase inhibitors. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2000; 165:7017-24. [PMID: 11120829 DOI: 10.4049/jimmunol.165.12.7017] [Citation(s) in RCA: 227] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epigenetic mechanisms are involved in regulating chromatin structure and gene expression through repression. In this study, we show that histone deacetylase inhibitors (DAIs) that alter the acetylation of histones in chromatin enhance the expression of several genes on tumor cells including: MHC class I, II, and the costimulatory molecule CD40. Enhanced transcription results in a significant increase in protein expression on the tumor cell surface, and expression can be elicited on some tumors that are unresponsive to IFN-gamma. The magnitude of induction of these genes cannot be explained by the effect of DAIs on the cell cycle or enhanced apoptosis. Induction of class II genes by DAIs was accompanied by activation of a repressed class II transactivator gene in a plasma cell tumor but, in several other tumor cell lines, class II was induced in the apparent absence of class II transactivator transcripts. These findings also suggest that the abnormalities observed in some tumors in the expression of genes critical to tumor immunity may result from epigenetic alterations in chromatin and gene regulation in addition to well-established mutational mechanisms.
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Norman RG, Pal I, Stewart C, Walsleben JA, Rapoport DM. Interobserver agreement among sleep scorers from different centers in a large dataset. Sleep 2000; 23:901-8. [PMID: 11083599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
STUDY OBJECTIVES To evaluate epoch by epoch agreement in sleep stage assignment between scorers from different laboratories. DESIGN N/A. METHODS 62 NPSGs were selected for analysis from 3 sleep centers (38 diagnostic studies for sleep disordered breathing [SDB], 10 studies during CPAP titration, and 14 studies in subjects with no sleep related complaints or sleep pathology). The sleep recording montage consisted of at least 2 EEG leads, left and right EOG and a submental EMG. Scoring was performed manually by 5 experienced sleep technologists. No scorer had knowledge of any other scorers' results. Agreement was tabulated both for sleep stage distribution and on an epoch by epoch basis for the entire data set and the normal and SDB subsets. MEASUREMENTS AND RESULTS The mean epoch by epoch agreement between scorers for all records was 73% (range 67-82%). Agreements were higher in the normal subset (mean 76%, range 65-85%) than in the SDB subset (mean 71%, range 65-78%). There was significant variability in agreement between records and between pairs of scorers. Overall, 75% of epochs had at least 4 of the 5 scorers in agreement on the sleep stage and 96% of epochs had agreement of at least 3 of the 5 scorers. CONCLUSIONS The level of agreement in sleep stage assignment varies between scorers, by diagnosis, and by record. The level of agreement between laboratories is lower than what can be maintained between scorers within the same laboratory. This warrants caution when comparing data scored in separate laboratories. The lower agreement in SDB patients supports the generally held view that sleep fragmentation makes application of the R&K rules less reliable.
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Cotton MM, Bucknall CE, Dagg KD, Johnson MK, MacGregor G, Stewart C, Stevenson RD. Early discharge for patients with exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial. Thorax 2000; 55:902-6. [PMID: 11050257 PMCID: PMC1745631 DOI: 10.1136/thorax.55.11.902] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We have previously reported the use of a hospital based respiratory nurse service (Acute Respiratory Assessment Service, ARAS) to support home treatment of patients with exacerbations of chronic obstructive pulmonary disease (COPD). A controlled trial was undertaken to compare early discharge with home treatment supported by respiratory nurses with conventional hospital management of patients admitted with exacerbations of COPD. METHODS Patients with COPD admitted as emergencies were identified the next working day. They were eligible for inclusion in the study if the differential diagnosis included an exacerbation of COPD, but were excluded if other medical conditions or acidotic respiratory failure required inpatient investigation or management. Of 360 patients reviewed, 209 were being assessed for other active medical problems and were excluded, 33 potential participants were already involved in research studies and so were ineligible, and 37 did not wish to participate in the study. Eighty one patients were randomised to receive conventional inpatient care (n=40) or to planned early discharge the next working day (n=41). Those discharged early continued treatment at home under the supervision of specialist respiratory nurses. Outcome measures were readmission, additional hospital days, and deaths within 60 days of initial admission. Process measures included number of visits, duration of follow up by the respiratory nurse, and additional treatment provided to support early discharge. RESULTS On an intention to treat basis, a policy of early discharge reduced inpatient stay from a mean of 6.1 (range 1-13) days with conventional management to 3.2 (1-16) days with an early discharge policy. Twelve patients (30% conventional management, 29.3% early discharge) were readmitted in each group giving a mean difference in readmission of 0.7% (95% CI of the difference -19.2 to 20.6). In the conventional management group readmitted patients spent a mean of 8.75 additional days in hospital compared with 7.83 days in the early discharge group, giving a mean difference of 0.92 days (95% CI of the difference -6.5 to 8.3). There were two deaths (5%) in the conventional management group and one (2.4%) in the early discharge group, a mean difference of 2.6% (95% CI of the difference -5.7 to 10.8). CONCLUSIONS Patients with acute exacerbations of COPD uncomplicated by acidotic respiratory failure or other medical problems can be discharged home earlier than is current practice with support by visiting respiratory nurses. No difference was found in the subsequent need for readmission.
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Lyons BP, Stewart C, Kirby MF. 32P-postlabelling analysis of DNA adducts and EROD induction as biomarkers of genotoxin exposure in dab (Limanda limanda) from British coastal waters. MARINE ENVIRONMENTAL RESEARCH 2000; 50:575-579. [PMID: 11460752 DOI: 10.1016/s0141-1136(00)00111-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Dab (Limanda limanda) were sampled from a number of polluted and unpolluted areas in British coastal waters. The 32P-postlabelling assay was used to analyse the level of aromatic/hydrophobic DNA adducts in pooled samples of liver tissue. The mean levels of DNA adducts detected from areas known to receive anthropogenic pollutants ranged from 4.0 to 26.8 adducts per 10(8) nucleotides, with all sites containing samples displaying DNA adduct profiles consisting of diagonal radioactive zones. In contrast no DNA adducts were detectable in samples from an unpolluted reference site. The ranking of polluted sites based on DNA adduct levels did not correspond with the ranking of sites based on sediment associated polycyclic aromatic hydrocarbon levels, highlighting the problem of linking the presence of contamination with detectable biological responses. No correlation could be found in this study between EROD activity and the level of DNA adducts.
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Abstract
We examine the ethical principles underpinning advance directives (ADs) and the legal duties of doctors in determining their validity. A physician attending an incompetent patient with an acute life-threatening illness, and an AD refusing treatment, should ensure that the AD is legally valid before making the treatment decision. Treatment against a patient's wishes, as expressed in a valid AD, compromises patient autonomy and may constitute battery. Conversely, withholding treatment in accordance with an AD that is not legally valid risks substantial harm to the patient and may constitute breach of the duty of care and negligence. Legally valid directives should be respected. If an AD is not legally valid, the patient should be treated in his or her best interests. If uncertain, the physician should treat according to the patient's best interests while seeking legal advice.
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Collett BJ, Cordle C, Stewart C. Setting up a multidisciplinary clinic. Best Pract Res Clin Obstet Gynaecol 2000; 14:541-56. [PMID: 10962641 DOI: 10.1053/beog.1999.0090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic pelvic pain can be a perplexing and complex problem, frustrating to both clinicians and patients. The traditional medical and surgical model does not always relieve symptoms, and many patients suffer years of pain and undergo multiple surgical procedures without long-term benefit. The biopsychosocial model for chronic pelvic pain gives clinicians the opportunity to broaden the scope for management. A multidisciplinary team can offer simultaneous assessment and management of somatic, behavioural and psychosocial components of the pain. Key members of the team are identified and their roles explored. Practical aspects of operating a multidisciplinary clinic are discussed. A multidisciplinary approach comprises many elements. Further research is needed to identify which are the essential elements to secure optimum outcome for the individual patient.
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Stewart C, Redmond A. Neonatal diabetes mellitus. THE ULSTER MEDICAL JOURNAL 2000; 69:71-3. [PMID: 10881652 PMCID: PMC2449158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stewart C. Maxillofacial trauma. EMERGENCY MEDICAL SERVICES 2000; 29:73-4, 78-83. [PMID: 11067454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Wilson DC, Kalnins D, Stewart C, Hamilton N, Hanna AK, Durie PR, Tullis E, Pencharz PB. Challenges in the dietary treatment of cystic fibrosis related diabetes mellitus. Clin Nutr 2000; 19:87-93. [PMID: 10867725 DOI: 10.1054/clnu.1999.0081] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cystic fibrosis related diabetes mellitus is an increasingly recognized problem as survival in patients with cystic fibrosis improves. In a 5 year retrospective study of 627 children and adults attending Toronto cystic fibrosis clinics, we identified 57 (9%) patients with cystic fibrosis related diabetes mellitus; four (1.3%) of 301 children (<18 years) and 53 (16%) of 326 adults. The development of this complication of cystic fibrosis is associated with increased mortality, deteriorations in both respiratory and nutritional status, and the development of late microvascular, but not macrovascular, diabetic complications. Unfortunately, systematic review of the literature provides few well designed studies that provide sound evidence for clinical practice. Recommendations are therefore often based on anecdote, rather than physiological or outcomes research. Dietary therapy combines the principles of the dietary management of both cystic fibrosis and diabetes mellitus, but emphasizes the need for a high energy diet (> 100% of recommended daily intake) in patients with cystic fibrosis related diabetes mellitus. The importance of calories from fat is emphasized, with no restriction on total carbohydrate intake. Insulin intake mirrors carbohydrate intake. Routine dietary therapy is straightforward, but challenges occur due to both complications of cystic fibrosis and advancing disease. If a patient with cystic fibrosis related diabetes mellitus is malnourished, overnight enteral tube feeding is often used, with an adjusted insulin regimen. There is a great need for both physiological and outcomes research to provide sound scientific evidence for the dietary treatment of cystic fibrosis related diabetes mellitus.
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Hull R, Rudy D, Donovan W, Svanborg C, Wieser I, Stewart C, Darouiche R. Urinary tract infection prophylaxis using Escherichia coli 83972 in spinal cord injured patients. J Urol 2000; 163:872-7. [PMID: 10687996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
PURPOSE Escherichia coli 83972 was previously shown to establish bladder colonization in select patient groups. We evaluate the safety and feasibility of using bacterial interference with E. coli 83972 to prevent urinary tract infection in spinal cord injured patients. MATERIALS AND METHODS A total of 21 men and women with neurogenic bladder secondary to spinal cord injury underwent intravesical inoculation with E. coli 83972. Frequency of symptomatic urinary tract infection before and after colonization was compared. RESULTS Successful long-term bladder colonization was achieved in 13 study participants. Mean duration of colonization was 12.3 months (range 2 to 40). Subjects had no symptoms of urinary tract infection while colonized with E. coli 83972 (0 infection per 18.4 patient-years). Successfully colonized subjects had experienced a mean of 3.1 symptomatic urinary tract infections per year (range 2 to 7) before colonization. Symptomatic infection also occurred in 4 subjects who were not successfully colonized with E. coli 83972 and in 7 others after spontaneous loss of colonization. Colonized subjects reported subjective improvement in quality of life with respect to urinary tract infection while colonized. CONCLUSIONS E. coli 83972 may be safely used to establish long-term asymptomatic bladder colonization in spinal cord injured subjects. Preliminary findings suggest that colonization with E. coli 83972 may reduce the frequency of urinary tract infection in patients with neurogenic bladder secondary to spinal cord injury.
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