Showing papers by "University of Salford published in 1988"

The Correlation Between the Roentgenographic Appearance and Operative Findings at the Bone-Cement Junction of the Socket in Charnley Low Friction Arthroplasties

Abstract: In a series of 200 Charnley low friction arthroplasties revised for various reasons, the preoperative anteroposterior roentgenograms were categorized in terms of demarcation at the bone-cement interface of the socket and compared with the operative findings of movement at the bone-cement junction. All sockets showing no demarcation were found to be fixed soundly. Seven percent of the sockets showing demarcation of the outer one-third only were loose, and when two-thirds of the sockets were demarcated, 71% were loose. Ninety-four percent of the sockets with complete demarcation and all sockets that had migrated were found to be loose at revision. There is a definite correlation between roentgenographic demarcation and socket loosening. The more extensive the demarcation, the more likely it is that the socket is loose. Radiographic demarcation of the cemented socket is a prognostic sign for eventual failure.

The community management of schizophrenia. A controlled trial of a behavioural intervention with families to reduce relapse.

Abstract: Schizophrenic patients were recruited into a trial of a prophylactic behavioural intervention with families. Families with at least one high Expressed Emotion (EE) relative were randomly allocated to one of four intervention groups: Behavioural Intervention Enactive; Behavioural Intervention Symbolic; Education Only; Routine Treatment. Patients from low-EE families were randomly allocated to two groups: Education Only or Routine Treatment. Relapse rates over nine months after discharge were significantly lower for patients in the two Behavioural Intervention, compared with Education Only and Routine Treatment groups. There was little difference between the two low-EE groups. Patients returning to high-EE relatives showed significantly higher relapse rates than those returning to low-EE relatives, in groups not receiving active intervention. Changes from high to low EE occurred in the Behavioural Intervention groups, and similar although less extensive changes occurred in the Education Only and Routine Treatment groups. Changes in criticism and marked emotional over-involvement (EOI) occurred generally in high-EE groups but were larger in magnitude in the Enactive and Symbolic groups. Reduction of hostility only occurred in the Behavioural Intervention groups. These results give partial support for the causal role of EE in relapse. There were no significant differences between the groups with respect to contact with the psychiatric services or medication.

Retrospective study of 1000 deaths from injury in England and Wales

Abstract: One thousand consecutive deaths from injury in 11 coroner9s districts in England and Wales were reviewed by four independent assessors, who studied necropsy reports to identify deaths in hospital that might have been preventable. Of 514 patients admitted to hospital alive, 102 deaths (20%) were judged by all four assessors to have been potentially preventable. When those cases in which three out of four assessors considered that the death was preventable were added the total rose to 170 (33%). Nearly two thirds of all non-central nervous system deaths were judged to have been preventable. The median age of the 170 patients whose deaths were preventable was 41, and the mean Injury Severity Score was 29. Further analysis suggested that the preventable deaths were principally the result of failure to stop bleeding and prevent hypoxia and the absence of, or delay in, surgical treatment. The results closely parallel those from similar studies from the United States and suggest that there are serious deficiencies in the services for managing severe injury in England and Wales. Debate is needed now on how to correct these deficiencies. In particular, the place of trauma centres must be considered.

Intubation under induction doses of propofol.

Abstract: Summary Twenty patients, ASA grades 1 and 2, aged 18–65 years were admitted to an open study to investigate the ease of tracheal intubation after induction of anaesthesia with propofol without the use of muscle relaxants after the chance observation that propofol 2.5 mg/kg allowed easy laryngoscopy and tracheal intubation. Satisfactory intubation conditions were achieved in 19 patients.

Sclerosis of lytic bone metastases after disodium aminohydroxypropylidene bisphosphonate (APD) in patients with breast carcinoma.

Abstract: 1 Kurtz JB, Mortimer PP, Morgan-Capner P, Shafi MS, White GBB. Rubella antibody measured by radial haemolysis. Characterisation and performance of a simple screening method for use in diagnostic laboratories. Journal of Hygiene 1980;84:213-2. 2 Mortimer PP. Mumps prophylaxis in the light of a new test for antibody. BrMedJ 1978;ii: 15234. 3 Gershon AA, Krugman S. Measles virus: In: Lennette EH, Schmidt NJ, eds. Diagnostic procedures for viral, rickettsial and chlamydial infections. 5th ed. Washington: American Public Health Association, 1979:665-93. 4 Department of Health and Social Security. Statistics and research. London: DHSS, 1987. (SR2B.) 5 Office of Population Censuses and Surveys. Communicable disease statistics. London: OPCS, 1987. (MB2.) 6 Centers for Disease Control. Measles in United States, first 26 weeks 1987. MMWR 1988;37:53-7. 7 Rabo E, Taranger J. Scandinavian model for eliminating measles, mumps, and rubella. BrMedJ 1988;289:1402-4. 8 Nokes DJ, Anderson RM, Anderson MJ. Rubella epidemiology in south east England. ournal ofHygiene 1986;96:291-304.

The assessment of psychophysiological reactivity to the expressed emotion of relatives of schizophrenic patients.

Abstract: The measure of expressed emotion (EE) of the relative has been found to be an important predictor of schizophrenic relapse. Electrodermal measures were recorded when the schizophrenic patient was talking to an experimenter, and when the patient was talking to a relative. Although there were no differences during the relative-absent period, patients with a high-EE relative present exhibited significantly higher frequencies of non-specific skin-conductance responses (NS-SCRs) than patients with a low-EE relative present. Patients show a significant decrease in NS-SCRs on the entry of low-EE, but not high-EE relatives. Patients with high-EE relatives show overall higher levels of skin-conductance levels (SCLs) than patients with low-EE relatives. Although patients with high-EE relatives rate themselves significantly more tense and anxious on self-rating scales, there are no significant correlations between self-ratings and electrodermal measures. The use of electrodermal reactivity as an assessment measure of relapse risk is discussed.

Trypanosoma congolense: the distribution of enzymic variants in east and west Africa.

Abstract: A total of 114 stocks of Trypanosoma congolense originating from Kenya, Uganda, Tanzania, Zambia and Sudan, but including, for comparison, stocks from The Gambia, Liberia, Ivory Coast, Nigeria and Cameroun, were compared by isoenzyme electrophoresis for 6 enzymes. The zymodemes were grouped, both from a dendrogram and using a cladistic method, after calculating the dissimilarity, or distance, between profiles. Previous observations are broadly confirmed, the zymodemes clustering separately according to geographical origin and ecological zone. Thus, one group was composed almost entirely of East African stocks, and another of stocks from both East and West Africa, although each group was of savanna origin. A third group was composed of stocks from the humid, rain-forest zones of West Africa, and was particularly characterized by isoenzyme variants of superoxide dismutase and glucose-phosphate isomerase. Two stocks from the Kenyan coast formed a markedly separate group, which may be taxonomically distinct.

Comparison of atracurium-induced neuromuscular blockade in neonates, infants and children

Abstract: The potency of atracurium was determined in neonates, infants and children during thiopentone-fentanyl-nitrous oxide in oxygen anaesthesia using single dose-response curves. The effective doses producing 50% depression of the first twitch of the train-of-four were significantly lower in neonates and infants than in children (82 and 112 v. 135 micrograms kg-1). Following a standard dose of atracurium 0.5 mg kg-1, 95% depression of the first twitch occurred more rapidly in neonates than in children (0.9 v. 1.4 min), while recovery to 10% of the control twitch height occurred more rapidly in neonates than in the other two groups (22.7 v. 29.7 and 28.6 min). It is concluded that neonates and infants require less atracurium to produce a given degree of neuromuscular blockade compared with older children. However, prompt recovery can be expected in all healthy paediatric patients following a standard intubating dose of atracurium 0.5 mg kg-1.

Hydroxyethylvaline adduct formation in haemoglobin as a biological monitor of cigarette smoke intake

Abstract: The ethylene oxide adduct formed on the N-terminal valine in haemoglobin was investigated as a biological monitor of tobacco smoke intake. The modified method developed for the determination of the hydroxyethylvaline adduct (HOEtVal) involved reaction of globin with pentafluorophenyl isothiocyanate, extraction of the HOEtVal thiohydantoin product, derivatization of this by trimethylsilylation and quantitation by capillary gas chromatography with selective ion monitoring mass spectrometry using a tetradeuterated internal standard. The method was applied to globin samples from 26 habitual cigarette smokers and 24 non-smokers. There was a significant correlation between cigarette smoke intake as measured by the average number of cigarettes smoked per day and HOEtVal levels (r=0.537, p<0.01). Background levels were found in non-smokers (mean 49.9 pmol/g Hb, range 22–106 pmol/g Hb). Smoking increased these levels by 71 pmol/g Hb/ 10 cigarettes per day.

Single dose versus daily intravenous aminohydroxypropylidene biphosphonate (APD) for the hypercalcaemia of malignancy.

Abstract: Thirty patients with hypercalcaemia and known malignant disease were randomly allocated to receive 60 mg 3-amino-1-hydroxypropylidene-1,1-bisphosphonate (APD) intravenously as a single dose or as consecutive daily doses of 30 mg (two days) or 15 mg (four days). The rate of infusion was the same for each regimen (7.5 mg/hour). Calcium concentrations fell in all patients and returned to normal in all but two. Relapse of hypercalcaemia occurred after a mean of 21 days in each group. Urinary calcium excretion fell in all groups and symptoms were greatly improved. After relapse patients were retreated with APD (30 mg as a single infusion) and normocalcaemia maintained by regular infusions at two to three week intervals. APD given as a single 60 mg infusion over eight hours together with rehydration is recommended as the initial management of the hypercalcaemia of malignancy, followed by 30 mg APD roughly every two to three weeks to maintain normal or near normal serum calcium concentrations.

The practice of community psychiatric nursing and mental health social work in Salford. Some implications for community care.

Abstract: The context and content of work undertaken with individual clients by community psychiatric nurses (CPNs) and mental health social workers (MHSWs) in Salford were found to be significantly different. Although there were some areas of overlap, the ways in which the two professions worked were quite distinct. MHSWs discussed a wide range of topics and were as concerned with clients' interactions with family and community networks as they were with symptoms. Their interviews with schizophrenic clients followed a similar pattern to those with other groups, and they worked closely with psychiatrists and other mental health staff. CPNs, on the other hand, focused mainly on psychiatric symptoms, treatment arrangements, and medications, and spent significantly less time with individual psychotic clients than they did with patients suffering from neuroses. They were as likely to be in contact with general practitioners as they were with psychiatrists, and had fewer contacts with other mental health staff than the MHSWs. There was evidence that the long-term care of chronic psychiatric patients living outside hospital required more co-ordinated long-term multidisciplinary input.

A model of tsetse-transmitted animal trypanosomiasis.

Abstract: The data needed to develop analytical models of trypanosomiasis transmission have become available only recently. By making some simplifying assumptions, models of the dynamics of the disease in vector, cattle and wild mammal populations can be constructed in order to determine criteria for successful disease control by mass and targetted chemotherapy, and by vector control. The heterogeneity in transmission due to tsetse fly feeding preferences and the variability of immunological characteristics among the vertebrate hosts account for differences in prevalence of Trypanosoma vivax and T. congolense, and also lead to an increase in the basic reproductive rates of the parasites and a corresponding decrease in the vector population density threshold for disease eradication or persistence. The long life-span of the vectors relative to the duration of the parasites' developmental period lead to high infection rates in the vector and high values of R0. The efficacy of chemotherapeutic regimes depends on the relationship between treatment rate and the duration of prophylaxis conferred by the drugs used. The model's predictions of the effects of vector control are shown to be in broad agreement with published field data for Mkwaja Ranch, Tanzania. Vector control programmes are frequently blighted by reinvasion, and the implications of this are discussed in terms of a model for fly immigration. With immigration of vectors, the disease is always endemic, though the infection rate in the fly population is modified by the effect of differential mortalities inside and outside the controlled area on cohorts of incubating flies. Sensitivity analysis of the model, using Monte-Carlo methods, enables an assessment of the relative importance of the parameters to be made. The results emphasize the need for studies of the wild animal reservoir to be carried out alongside entomological surveys. The relative accuracy with which field measurements need to be made in order to minimize the uncertainty in predictions of trypanosomiasis prevalence is discussed.

Adrenocorticotrophin (acth) deficiency undetected by standard dynamic tests of the hypothalamic‐pituitary‐adrenal axis

Abstract: SUMMARY Six patients (four females, two males; aged 18–65 years), previously treated by external pituitary irradiation (2000–4000 cGY in 8–15 fractions over 10–20 days) for pituitary tumours, presented with the symptoms of excessive and inappropriate tiredness suggestive of ACTH deficiency, despite a normal peak cortisol response to an insulin tolerance test (four cases) or to a glucagon stimulation test (two cases). These six patients were found to have significantly lower mean 24 h urinary free cortisol levels (100 ± 40 nmol; mean ± SD) compared with the mean value of 31 normal controls (210 ± 70.8 nmol; P<0.01). In addition serum cortisol profiles based on a series of four timed samples between 0900–2300 h were subnormal (mean 130 nmol/l) in comparison with profiles obtained from 12 normal controls (mean 270 nmol/l) (P <0.001). Glucocorticoid replacement therapy promptly abolished their symptoms. These results suggest that a discordance between ACTH secretion under basal circumstances and ACTH response to pharmacological tests may exist in patients with ACTH deficiency. We speculate that defective endogenous corticotrophin-releasing hormone (CRF) secretion, due to radiation-induced damage at hypothalamic level, is one cause of this phenomenon.

Ilioinguinal nerve blockade for analgesia after caesarean section

Abstract: Bilateral ilioinguinal nerve blockade was performed, using 0.5% plain bupivacaine 10ml to each side, in 13 patients having elective Caesarean section under general anaesthesia. Pain scores and requirement for postoperative analgesia were compared with 13 patients in a control group. Pain scores were less in the block patients at all times during the first day after operation, with the exception of 12 h. There was an increased time from the patient's recovery from anaesthesia to the first injection of opioid in the block group. In the control group, patients required more analgesia in the first 24 h after surgery compared with patients having ilioinguinal nerve blockade. There were no observed adverse effects following nerve blocks.

‘Unhealthy areas’: Town planning, eugenics and the slums, 1890–1945

Abstract: The value of planning in remedying slum problems in Britain was widely recognized by the outbreak of the Second World War. Indeed, the identification of planning with social progress underpinned the post‐war consensus. This broad agreement, however, was achieved in the face of apparently distinct and opposing views. From 1890 onwards, the sufficiency of environmental reform in ‘Unhealthy Areas’ was challenged by radical socialists on the one hand, and by the ‘eugenists’ of the social hygiene movement on the other. No one view, however, succeeded in eliminating the others before 1945. The issue at stake was whether differences in housing and health were the direct product of economic and environmental inequalities, or whether these differences resulted from a process of selective social mobility sorting out the ‘fit’ from the ‘unfit’. Much of the debate centred on overcrowding and its causes. Radical formulations of the slum problem, however, whether from the left or the right, offered no politically plaus...

Trypanosoma (Megatrypanum) incertum from Pipistrellus pipistrellus: development and transmission by cimicid bugs.

Abstract: Trypanosoma (Megatrypanum) incertum Pittaluga 1905 was found in 33 out of 206 Pipistrellus pipistrellus caught at various sites in Britain. The trypanosome is described from blood smears. Development took place in laboratory-reared Cimex pipistrelli and Cimex lectularius. Epimastigote forms initially multiplied rapidly in the ventriculus and midgut of Cimex. Metacyclic trypanosomes were found in the rectum of both species of Cimex after 8 days when bugs were maintained at 20 degrees C and as early as 3 days at 30 degrees C. Electron microscopy of infected bugs revealed that there was no attachment to epithelial cells of the ventriculus or midgut, but within the rectum epimastigotes were attached by their flagella to the cuticle of the rectum by hemidesmosomes. Transmission was achieved by feeding experimentally infected bugs to bats kept in the laboratory. These bats were negative as judged by xenodiagnosis using laboratory-reared Cimex. Bats which had been caught in the wild demonstrated low-grade or sub-patent parasitaemias (positive in xenodiagnosis) for up to 400 days after the day of capture. Despite an extensive search of impression smears of tissues immediately after trypanosomes first appeared in the blood of experimentally infected bats no multiplicative stages were found.

The ultrastructure of Leishmania major in the foregut and proboscis of Phlebotomus papatasi

Abstract: The relationship between Leishmania parasites and their sandfly vectors has been the subject of several studies over the past decade (see Killick-Kendrick 1979, 1986; Molyneux and Killick-Kendrick 1987; Molyneux et al. 1986). Transmission and scanning electron microscopy of infected flies (Killick-Kendrick et al. 1974; Molyneux etal. 1975; Warburg et al. 1986; Walters et al. 1987; Lawyer et al. 1987) have been complemented by biochemical and physiological studies (Sacks et al. 1985; Schlein 1986) and, as a result, we have a much better, yet incomplete, picture of parasite morphogenesis of the development of infectivity to the vertebrate host and of transmission. Confirmation of the existence of metacyclic promastigotes in stationary phase cultures and midgut populations in sandflies (Sacks and Perkins 1984, 1985; Sacks et al. 1985; Franke et al. 1985; Howard et al. 1987) has led to the importance of the investigation of foregut infections, particularly of attached parasites. Phlebotomus papatasi forcefed L. major could later egest promastigotes, although apparently no parasites were attached to the sandfly foregut (Warburg and Schlein 1986). Walters et al. (1987) have recently suggested that foregut infections are ephemeral and of little significance, since in the foreguts of Lutzomyia abonnenci, which they infected with L. mexicana mexicana (of which the former is not the natural vector), they only found a few parasites that appeared to be degenerating. This has prompted us to publish electron micrographs from one of very few natural vector/parasite combinations studied in detail (Table 1), which demonstrate intense foregut infections with few degenerating parasites, and which are, as far as we are aware, the first published

Eigenstructure assignment by output feedback in descriptor systems

Abstract: Some necessary and sufficient conditions for closed-loop eigenstructure assignment by output feedback inlinear time-invariant descriptor systems are presented. These generalise in a natural way the known corresponding results for state-space systems. However, our arguments extend somewhat existing work on eigenstructure assignment by state feedback in descriptor systems. The main issue throughout the paper is closed-loop regularity, i.e. uniqueness of solutions of the initial value problem, which cannot be taken for granted.

Neutron diffraction measurements of residual stress and plastic deformation in an aluminium alloy weld

Abstract: The neutron diffraction technique for measuring residual stresses non-destructively in an aluminium alloy weld has been examined. Calibration experiments have been performed to determine th...

The ubiquitous positive streamer

Abstract: It is argued that the positive streamer mechanism in liquid insulators can be considered as a natural progression from the streamer process occurring in high-pressure gases. The streamer tip propagates under the influence of the applied Laplacian field and the Coulomb field of the tip charge and its image. The streamer will only propagate if the initial discharge at the anode is of sufficient magnitude. An increase in tip charge with streamer growth is required to account for branching. This increase is occasioned by charge movement within the conducting filament. The model suggests a limiting tip charge of approximately 5 pC, and photographs show that rate at which branches form. Taken together with the derived values of tip velocity, minimum filament currents of approximately 200 mu A can be deduced. It is suggested that the streamer model proposed is consistent with most of the experimental evidence available relating to the positive discharge. >

Polychromophilus murinus: a malarial parasite of bats: life-history and ultrastructural studies.

Abstract: Polychromophilus murinus, a malaria parasite of Chiroptera is reported from Myotis daubentoni in England. The vector was suspected to be the ectoparasitic Nycteribiid fly, Nycteribia kolenatii. N. kolenatii collected from wild-caught M. daubentoni were found to have oocysts on the midgut and sporozoites in the salivary glands. Wild-caught N. kolenatii were maintained on two wild-caught M. daubentoni harbouring heavy (patent) infections of P. murinus; both oocysts and sporozoites were found in these flies. The mature oocysts measured 52-71 micron in diameter. Sporozoites were straight or slightly crescentic and had a mean length of 7.4 micron. Electron microscopy of immature and mature oocysts revealed a morphology similar to that of malaria parasites. Sporozoites were also similar in structure to Plasmodium sporozoites and were found in the epithelial cells of the salivary gland and within the lumen; a cytostome was present and transverse sections revealed 21 microtubules arranged evenly around the periphery. Sporozoites were observed within the basement membrane of the salivary gland of N. kolenatii; such sporozoites appeared to be penetrating the gland, a process hitherto not described in malaria parasites. Rickettsia-like bodies were found within the cytoplasm of the epithelial cells of the salivary gland. Exflagellation of microgametocytes was achieved. An ultrastructural study of the gametocytes revealed a structure similar to that described in other Haemoproteidae. A common feature of infected erythrocytes was a projecting erythrocyte membrane. Attempts to find schizogony in impression smears and sections of tissues of two infected M. daubentoni were not successful.

Schizotrypanum in British bats.

Abstract: Two species of Schizotrypanum, T. (S.) dionisii and T. (S.) vespertilionis, were identified from British bats. Laboratory studies on stocks of isolated trypanosomes from 5 species of bat (Pipistrellus pipistrellus, Nyctalus leisleri, N. noctula, Eptesicus serotinus and Myotis brandti) indicated that the predominant species was T. d. dionisii. Collections and dissection of the bat bug Cimex pipistrelli from bat roosts revealed flagellate infection in a total of 12 out of 20 bugs; 7 of these bugs had metacyclic trypanosomes present. C. pipistrelli and the human bed bug, C. lectularius were reared in the laboratory and allowed to feed on wild-caught bats known to be infected with T. d. dionisii. Development occurred in both species of Cimex. Cimex spp. could be used to detect subpatent Schizotrypanum infections by xenodiagnosis. This technique was used to test the parasitological status of bats collected in the wild or reared in captivity. On a single occasion an apparent transmission of T. d. dionisii to an uninfected (by xenodiagnosis) laboratory reared bat was achieved. A stock of Schizotrypanum isolated from a wild-caught C. pipistrelli collected in a N. leisteri roost was identified by DNA buoyant density centrifugation as T. (S.) vespertilionis. A P. pipistrellus known to be infected with T. d. dionisii was found to have cyst-like structures in thoracic skeletal muscle containing amastigotes. The study provided the strongest evidence yet that C. pipistrelli is the vector of Schizotrypanum in British bats.