Medicine and Health Sciences Commons^™

Management Of Self Poisoning, Alison L. Jones, Glyn Volans

Graduate School of Medicine - Papers (Archive)

Around 15%­20% of the workload of medical units and 10% of the workload of accident and emergency departments in the United Kingdom are due to self poisoning.1 2 Episodes of self poisoning in the United Kingdom continue to rise, particularly in young men, and alcohol is often taken with the overdose.2 In general the severity of poisoning has diminished over the past 10 years with the introduction of safer drugs, such as newer serotonin reuptake inhibitors, but the total number of deaths from poisoning in the United Kingdom remains steady at 4000 per year, and the commonest cause of death …

Systematics, Biostratigraphy And Evolution Of The Late Ludlow And Pridoli (Late Silurian) Graptolites Of The Yass District, New South Wales, Australia, R B. Rickards, Anthony J. Wright

Faculty of Science, Medicine and Health - Papers: part A

Graptolites from the Yass district of New South Wales include important material from: low in the Black Bog Shale; from the Yarwood Siltstone Member; 2 levels high in the Black Bog Shale; 2 levels low in the Rosebank Shale; low in the Cowridge Siltstone; and in the lower part of the Elmside Formation. The faunas from the lower 4 levels are late Ludlow (early Late Silurian), and the higher 4 levels are Prídolí (late Late Silurian). Twenty-seven graptolite taxa, a considerable increase on previous records from Yass, have been identified in the late Ludlow and Prídolí of the district. These …

Nutrition And Ageing In Africa, Karen E. Charlton

Faculty of Science, Medicine and Health - Papers: part A

Although the proportion of elderly people in African populations is much smaller than that in developed countries, the absolute numbers of older Africans are rapidly increasing. The huge majority of Africans live in poor economic circumstances and few countries are able to offer social assistance programs. The health and wellbeing of older persons largely depend on the integral existence of informal services, social support networks and kin support. African gerontologists have urged social welfare policy makers to take cognizance of self-organized intergenerational help systems already present on the continent, and to make public-sector finance available to support these systems. Nutrition …

Validation Of A Food Frequency Questionnaire In Older South Africans, Karen E. Charlton, Estelle V. Lambert

Faculty of Science, Medicine and Health - Papers: part A

Objectives: To assess the validity of 213-item semi-qualified food frequency questionnaire (FFQ) in estimating habitual energy and protein intake in a sample of older South Africans. Repeatability of the FFQ was assessed by comparison of reported intakes after a 6-month period. Design: Cross-sectional analytic study Methods: Twenty-one subjects were selected from a baseline sample of 200 non-institutional subjects aged 65 years and over in Cape Town, who had previously been randomly selected for a nurtition and health survey using a two-stage cluster design. Reported dietary energy and protein intakes, estimated by means of the FFQ method, were compared with 24-hour …

Stimulus Eccentricity And Spatial Frequency Interact To Determine Circular Vection, Stephen A. Palmisano, Barbara Gillam

Faculty of Health and Behavioural Sciences - Papers (Archive)

While early research suggested that peripheral vision dominates the perception of selfmotion, subsequent studies found little or no effect of stimulus eccentricity. In contradiction to these broad notions of 'peripheral dominance' and 'eccentricity independence', the present experiments showed that the spatial frequency of optic flow interacts with its eccentricity to determine circular vection magnitude—central stimulation producing the most compelling vection for high-spatial-frequency stimuli and peripheral stimulation producing the most compelling vection for lower-spatial-frequency stimuli. This interaction appeared to be due, in part at least, to the effect that the higher-spatial-frequency moving pattern had on subjects' ability to organise optic flow …

Comparison Of Assays For Measuring Plasma Paracetamol. Possibility Of Calibration Error Needs Evaluation, Alison L. Jones, D R. Jarvie, D Simpson, L F. Prescott

Graduate School of Medicine - Papers (Archive)

Egleston et al report a significant difference in plasma paracetamol concen­ trations assayed with the AcetaSite bench assay and a standard laboratory assay. Rapid and accurate determinations of plasma paracetamol concentrations are crucial in the expeditious and appropriate administration of antidotal treatment, which prevents severe liver damage if given sufficiently early in the course of poisoning.

Evidence Of Multiple Mechanisms Of Avermectin Resistance In Haemonchus Contortus--Comparison Of Selection Protocols, Jennifer H. Gill, Caroline A. Kerr, Wesley L. Shoop, Ernest Lacey

Graduate School of Medicine - Papers (Archive)

Three isolates of Haemonchus contortus selected for avermectin resistance in sheep were compared in three in vitro pharmacological tests previously shown to discriminate between field isolates of H. contortus resistant and susceptible to the avermectins. Two isolates, F7-A and IVC, were selected for avermectin resistance in the laboratory from a reference susceptible isolate using suboptimal doses of ivermectin (LD95) for 7 and 16 generations, respectively. In these isolates avermectin resistance was not associated with a decreased sensitivity to avermectin inhibition of larval development or L3 motility but was associated with an increased sensitivity to paraherquamide. The third isolate, Warren, was …

A Giant New Trimerellide Brachiopod From The Wenlock (Early Silurian) Of New South Wales, Australia, Des L. Strusz, Ian G. Percival, Anthony J. Wright, J W. Pickett, A Byrnes

Faculty of Science, Medicine and Health - Papers: part A

Keteiodoros bellense n.gen. and n.sp. is a remarkably large trimerellide brachiopod from the Wenlock Dripstone Formation, southeast of Wellington, central New South Wales. The probable articulatory mechanism is unusual for trimerellides. It apparently involved both flattened sections of the lateral commissures which acted as pivots for opening and closing the shell, and a large and strongly modified articulating plate (which partly envelopes a robust dorsal umbo) articulating with the pseudointerarea at the posterior end of the ventral platform. The heavy dorsal umbo probably acted as a counterbalance to the anterior part of the valve; the diductor muscles were apparently attached …

Micronutrient Status Of Older Coloured South Africans, K E. Charlton, Petro Wolmarans, Marita Kruger, Demetre L. Labadarios, Ingrid Aronson, Carl J. Lombard

Faculty of Science, Medicine and Health - Papers: part A

Objective. To investigate the dietary intake and nutritional status of older coloured South Africans in the Cape Peninsula with regard to their micronutrient status. Design. Cross-sectional analytical study. Methods. A random sample of 200 non-institutionalised subjects in Cape Town aged ^ 65 years was drawn using a two-stage cluster design. Trained fieldworkers interviewed subjects to obtain demographic, dietary and lifestyle data, to draw fasting blood samples for biochemical, haematological, iron status and vitamin D (serum 25-hydroxyvitamin D (25(OH)D)), serum vitamin B12 and red blood cell folate analyses. Nutrient intake was assessed with a validated quantified food frequency questionnaire. Results. The …

Southern Africa Is Good Place To Research Role Of Fetal Malnutrition In Chronic Diseases, A Rp Walker, K E. Charlton

Faculty of Science, Medicine and Health - Papers: part A

Editor — We are interested in Scrimshaw's allusion to populations in Latin America in his editorial on the relation between fetal malnutrition and chronic disease in later life. There, in the 1960s, despite a high prevalence of low birth weight, the preva­ lence of atherosclerosis and of myocardial infarction was low.

Paracetamol (Acetaminophen) Poisoning: No Need To Change Current Guidelines To Accident Departments, P Routledge, J Allister Vale, D Nicholas Bateman, G. Denis Johnston, Alison L. Jones, Alan Judd, Simon Thomas, Glyn Volans, L F. Prescott, A T. Proudfoot

Graduate School of Medicine - Papers (Archive)

Paracetamol is an effective, simple analgesic that is well tolerated by adults and children at thera­peutic doses. In many countries it is available without prescription. Unfortunately, its ready availabil­ity is associated with episodes of poisoning that prompt 3.3% of inquiries to US regional poisons centres, 10% of inquiries to the UK National Poisons Information Service, and up to 43% of all admissions to hospital with self poisoning in the United Kingdom.3 In the United States paracetamol alone accounted for 4.1% of deaths from poisoning reported to American poisons centres in 1997. Most deaths are associated with deliberate self poisoning, but …

Practising Nursing Therapeutically Through Acting As A Skilled Companion On The Illness Journey, Alan Pearson, Sally Borbasi, Ken Walsh

Faculty of Health and Behavioural Sciences - Papers (Archive)

This article explores nursing's heritage as a healing, therapeutic activity. It examines the central characteristics of nursing as skilled companionship and links them with the foundational core of nursing-a therapeutic relationship based on an understanding of the illness experience. In addition, it discusses the role of literature and performance in developing knowledge to advance nursing as a therapeutic activity.

Should Methionine Be Added To Every Paracetamol Tablet?, Alison L. Jones, P C. Hayes, A T. Proudfoot, J A. Vale, L F. Prescott

Graduate School of Medicine - Papers (Archive)

Paracetamol is commonly used for self poisoning, and the costs of treating the resulting liver failure in the few who develop it are high. The morbidity could be avoided by adding methionine to paracetamol tablets, but this would mean that the millions of people who take paracetamol responsibly would have to take methionine unnecessarily. Alison Jones and colleagues and Edward Krenzelok debate the issue.

Skeletal Muscle Triglyceride Levels Are Inversely Related To Insulin Action, D A. Pan, S Lillioja, A D. Kriketos, M R. Milner, L A. Baur, C Bogardus, A B. Jenkins, L H. Storlien

Graduate School of Medicine - Papers (Archive)

In animal studies, increased amounts of triglyceride associated with skeletal muscle (mTG) correlate with reduced skeletal muscle and whole body insulin action. The aim of this study was to test this relationship in humans. Subjects were 38 nondiabetic male Pima Indians (mean age 28 ± 1 years). Insulin sensitivity at physiological (M) and supraphysiological (MZ) insulin levels was assessed by the euglycemic clamp. Lipid and carbohydrate oxidation were determined by indirect calorimetry before and during insulin administration. mTG was determined in vastus lateralis muscles obtained by percutaneous biopsy. Percentage of body fat (mean 29 ± 1%, …

Graptolite Zonation In The Late Wenlock (Early Silurian), With A New Graptolite-Brachiopod Fauna From New South Wales, R B. Rickards, Anthony J. Wright

Faculty of Science, Medicine and Health - Papers: part A

The Panuara Formation at Cobblers Creek near Orange, New South Wales, Australia has yielded a graptolite-brachiopod fauna assigned to the sherrardae sub-Biozone (late Wenlock: Early Silurian). The sherrardae sub-Biozone as defined here is equivalent to the praedeubeli subBiozone, and is the lowest part of the ludensis Biozone. The ludensis Biozone is reappraised following restudy of the type specimens of Monograptus ludensis, which are shown to exhibit growth stages from the deubeli to the gerhardi condition. The graptolite fauna consists of Gothograptus chainos Lenz, G. marsupium Lenz, Pristiograptus jaegeri Holland, Rickards & Warren, Pristiograptus dubius (Suess), Monograptus ludensis (Murchison), Monograptus moorsi …

Physical Activity, Change In Blood Pressure And Predictors Of Mortality In Older South Africans - A 2-Year Follow-Up Study, Karen E. Charlton, Estelle V. Lambert, Judith Kreft

Faculty of Science, Medicine and Health - Papers: part A

Objective. A 2-year follow-up study of a cohort of 200 historically disadvantaged older South Africans was conducted to: (i) characterise current levels of habitual physical activity; (ii) relate physical activity to current risk factors for chronic disease; and (iii) identify risk factors associated with 2-year mortaJity. The baseline sample, drawn in 1993, was found to have a high prevalence of hypertension (71.7%). Research design. Retrospective cohort study. Methods. A baseline sample of 200 persons aged ;:;.. 65 years, resident in the Cape Peninsula, was randomly drawn by means of a two-stage cluster design. Baseline measurements included: anthropometry, waist/hip ratio, systolic …

The Prevalence Of Diabetes Mellitus And Associated Risk Factors In Elderly Coloured South Africans, Karen E. Charlton, Naomi S. Levitt, Carl J. Lombard

Faculty of Science, Medicine and Health - Papers: part A

Objective. To determine the prevalence of diabetes and its associated risk factors in elderly coloured South Africans. Research design. Cross-sectional analytical study. Methods. A random sample of 200 non-institutionalised coloured (mixed ancestry) subjects aged 65 years of age, resident in urban Cape Town, was drawn by means of a two-stage cluster design. The survey procedure included an oral glucose tolerance test, anthropometric measurements, and physical activity and alcohol intake assessments. Results. The prevalence of diabetes was 28.7% (95% Cl 21.7 - 35.7%), 25.7% in men and 30.3% in women. The prevalence of impaired glucose tolerance was 15% (95% Cl 9.2 …

Heterogeneity Of Nicotinic Receptor Class And Subunit Mrna Expression Among Individual Parasympathetic Neurons From Rat Intracardiac Ganglia, Kevin Poth, Thomas J. Nutter, Javier Cuevas, Michael J. Parker, David J. Adams, Charles W. Luetje

Illawarra Health and Medical Research Institute

Neurons have the potential to form thousands of distinct neuronal nicotinic receptors from the eight α and three β subunits that currently are known. In an effort to determine how much of this potential complexity is realized among individual neurons, we examined the nicotinic pharmacological and biophysical properties and receptor subunit mRNA expression patterns in individual neurons cultured from rat epicardial ganglia. Analysis of the whole-cell pharmacology of these neurons showed a diversity of responses to the agonists acetylcholine, nicotine, cytisine, and 1,1-dimethyl-4- phenylpiperazinium, suggesting that a heterogeneous population of nicotinic receptor classes, or subtypes, is expressed by individual neurons. …

Vitamin D Status Of Older South Africans, K E. Charlton, D Labadarios, C J. Lombard, M E. J Louw

Faculty of Science, Medicine and Health - Papers: part A

Objective. To determine the vitamin D status of older 'coloured' South Africans who had not sustained a fracture. Design. Cross-sectional analytic study.

Methods. A random sample of 200 non-institutionalised subjects in Cape Town aged 65 years was drawn using a two-stage cluster design. Trained fieldworkers interviewed subjects to obtain demographic, dietary and lifestyle data, to draw fasting blood samples for the analysis of serum 25-hydroxyvilamin 0 (25(OH)O) and other biochemical parameters. and to take anthropometric measurements.

Results. Seventeen per cent of the subjects (95% Cl: 11.4 - 22.6%) had serum 25(OH)D levels in the deficient range for the elderly « …

A Redefinition Of Somatosensory Areas In The Lateral Sulcus Of Macaque Monkeys, Leah Krubitzer, Janine Clarey, Rowan Tweedale, Guy Elston, Mike Calford

Illawarra Health and Medical Research Institute

The present investigation was designed to determine the organization of somatosensory fields in the lateral sulcus of macaque monkeys using standard microelectrode recording techniques. Our results provide evidence for two complete representations of the body surface. We term these fields the second somatosensory area (SII) and the parietal ventral area (PV) because of their similarities in position, internal organization, and relationship to anterior parietal fields, as described for SII and PV in other mammals. Areas SII and PV are mirror- symmetrical representations of the body surface, sharing a common boundary at the representations of the digits of the hand and …

Skeletal Muscle Membrane Lipid Composition Is Related To Adiposity And Insulin Action, David A. Pan, Stephen Lillioja, Michael R. Milner, Adamandia D. Kriketos, Louise A. Baur, Clifton Bogardus, Leonard H. Storlien

Graduate School of Medicine - Papers (Archive)

The cellular basis of insulin resistance is still unknown, however, relationships have been demonstrated between insulin action in muscle and the fatty acid profile of the major membrane structural lipid (phospholipid). The present study aimed to further investigate the hypothesis that insulin action and adiposity are associated with changes in the structural lipid composition of the cell. In 52 adult male Pima Indians, insulin action (euglycemic clamp), percentage body fat (pFAT; underwater weighing), and muscle phospholipid fatty acid composition (percutaneous biopsy of vastus lateralis) were determined. Insulin action (high-dose clamp; MZ) correlated with composite measures of membrane unsaturation (% C20-22 …

Depletion Of Glutathione And Enhanced Lipid Peroxidation In The Csf Of Acute Psychotics Following Haloperidol Administration., B. Nagesh Pai, N. Janakiramaih, B. N. Gangadhar, Vijayalakshmi Ravindranath

Graduate School of Medicine - Papers (Archive)

Haloperidol administration for 2 weeks results in significant reduction in the concentration of GSH in the CSF. Concomitantly, the levels of lipid peroxidation products increased as evidenced by increased malondialdehyde levels. The malondialdehyde levels in the CSF prior to haloparidol administration were not significantly higher than that seen in CSF from normal controls (data not shown) suggesting that increased oxidative stress did not exist in these patients prior to haloperidol administration. All the patients included in the present study were drug naive and hence the changes observed in the glutathione and malon6ialdehyde levels in the CSF were indeed mediated by …

Interstitial Insulin Concentrations Determine Glucose Uptake Rates But Not Insulin Resistance In Lean And Obese Men, Charles Castillo, Clitton Bogardus, Richard Bergman, Pam Thuillez, Stephen Lillioja

Graduate School of Medicine - Papers (Archive)

Insulin action and obesity are both correlated with the density of muscle capillary supply in humans. Since the altered muscle anatomy in the obese might affect interstitial insulin concentrations and reduce insulin action, we have cannulated peripheral lymphatic vessels in lean and obese males, and compared peripheral lymph insulin concentrations with whole body glucose uptake during a euglycemic, hyperinsulinemic clamp. Lymph insulin concentrations in the lower limb averaged only 34% of arterial insulin concentrations during 150 min of insulin infusion. Obese subjects had the highest arterial (P < 0.0001) and lymph insulin (P < 0.005) concentrations, but the lowest glucose uptake rates (P < 0.002). In contrast to the initial steep rise then plateau of arterial insulins, both lymph insulin and whole body glucose uptake rates rose slowly and did not consistently reach a plateau. In each individual, the glucose uptake closely correlated with peripheral lymphatic insulin concentrations (mean r2 - 0.95). The coupling between glucose uptake and lymph insulin (glucose uptake/pmol insulin) was much steeper in lean subjects than in the obese (P < 0.0001). These results indicate that even if insulin diffusion into tissues is rate limiting for insulin action, a tissue defect rather than an insulin diffusion defect causes insulin resistance in obese subjects.

Audit On Myocardial Infarction In A District General Hospital: Is There Room For Improvement In Diagnostic Accuracy?, Wilson Wong, Adam Jones, Timothy J. Goodwin

Graduate School of Medicine - Papers (Archive)

The proportion of patients with an acute myocardial infarction (MI) whose diagnosis was missed on admission was accessed. The admitting consultants were then tested to see if they could diagnose the patients correctly when they were shown the admission histories and electrocardiograms (ECGs). Twenty-six per cent of patients with a final diagnosis of MI were not correctly diagnosed on admission. Fifty-one per cent of all patients did not receive thrombolytic therapy (TT) mainly because the diagnosis was not made on admission. A smaller proportion of these patients were admitted to the coronary care unit (CCU). The consultants only correctly diagnosed …

Insulin Resistance And Insulin Secretory Dysfunction As Precursors Of Non- Insulin-Dependent Diabetes Mellitus: Prospective Studies Of Pima Indians, Stephen Lillioja, David M. Mott, Maximilian Spraul, Robert Ferraro, James E. Foley, Eric Ravussin, William C. Knowler, Peter H. Bennett, Clifton Bogardus

Graduate School of Medicine - Papers (Archive)

Background. The relative roles of obesity, insulin resistance, insulin secretory dysfunction, and excess hepatic glucose production in the development of non-insulin-dependent diabetes mellitus (NIDDM) are controversial. We conducted a prospective study to determine which of these factors predicted the development of the disease in a group of Pima Indians.

Methods. A body-composition assessment, oral and intravenous glucose- tolerance tests, and a hyperinsulinemic-euglycemic clamp study were performed in 200 non-diabetic Pima Indians (87 women and 113 men; mean [+-SD] age, 26+-6 years). The subjects were followed yearly thereafter for an average of 5.3 years.

Results. Diabetes developed in 38 subjects during …

A New Taql Allele Detected By The Cri-R227 (D4s101) Probe In Pima Indians, M G. Choi, M Prochazka, P Thuillez, Stephen Lillioja

Graduate School of Medicine - Papers (Archive)

[No abstract available]

Lower Sedentary Metabolic Rate In Women Compared With Men, Robert Ferraro, Stephen Lillioja, Anne-Marie Fontvieille, Russell Rising, Clifton Bogardus, Eric Ravussin

Graduate School of Medicine - Papers (Archive)

Since females have a greater prevalence of obesity compared with males, the question arises whether females have lower metabolic rate than males after adjusting for differences in body weight and composition. 24-h energy expenditure (24EE), basal metabolic rate (BMR), and sleeping metabolic rate (SMR) were measured in a respiratory chamber in 235 healthy, nondiabetic Caucasian subjects (114 males, 121 females). Body composition was determined by hydrodensitometry. 24EE was 124 +/- 38 kcal/d (P less than 0.002) higher in males than females after adjusting for differences in fat-free mass, fat mass, and age. Spontaneous physical activity was not significantly different between …

A Genetic Classification Of Floodplains, G C. Nanson, J C. Croke

Faculty of Science, Medicine and Health - Papers: part A

Floodplains are formed by a complex interaction of fluvial processes but their character and evolution is essentially the product of stream power and sediment character. The relation between a stream's ability to entrain and transport sediment and the erosional resistance of floodplain alluvium that forms the channel boundary provides the basis for a genetic classification of floodplains. Three classes are recognised: (1) high-energy non-cohesive; (2) medium-energy non-cohesive; and (3) low-energy cohesive floodplains. Thirteen derivative orders and suborders, ranging from confined, coarse-grained, non-cohesive floodplains in high-energy environments to unconfined fine-grained cohesive floodplains in low-energy environments, are defined on the basis of …

Racial Differences In The Relation Between Blood Pressure And Insulin Resistance, Mohammad F. Saad, Stephen Lillioja, B Nyomba, Castillo C, R Ferraro, M De Gregorio, E Ravussin, W C. Knowler, P H. Bennett, B Howard, C Bogardus

Graduate School of Medicine - Papers (Archive)

Background. Insulin resistance and the concomitant compensatory hyperinsulinemia have been implicated in the pathogenesis of hypertension. However, reports on the relation between insulin and blood pressure are inconsistent. This study was designed to investigate the possibility of racial differences in this relation. Methods. We studied 116 Pima Indians, 53 whites, and 42 blacks who were normotensive and did not have diabetes; the groups were comparable with respect to mean age (29, 30, and 32 years, respectively) and blood pressure (113/70, 111/68, and 113/68 mm Hg, respectively). Insulin resistance was determined by the euglycemic-hyperinsulinemic clamp technique during low-dose (40 Mu per …

Insulin Resistance Associated With Lower Rates Of Weight Gain In Pima Indians, Boyd A. Swinburn, Bulangu L. Nyomba, Mohammad F. Saad, Francesco Zurlo, Itamar Raz, William C. Knowler, Stephen Lillioja, Clifton Bogardus, Eric Ravussin

Graduate School of Medicine - Papers (Archive)

Insulin resistance is commonly associated with obesity and noninsulin-dependent diabetes. Whereas it predicts the development of diabetes, its effect on body weight change is unknown. We measured glucose disposal rates at submaximally- and maximally-stimulating insulin concentrations in 192 nondiabetic Pima Indians and followed their weight change over 3.5±1.8 y (mean±SD).

Results: (a) Insulin-resistant subjects gained less weight than insulin-sensitive subjects (3.1 vs. 7.6 kg, P < 0.0001). (b) The percent weight change per year correlated with glucose disposal at submaximally- (r = 0.19, P < 0.01) and maximallystimulating (r = 0.34, P < 0.0001) insulin concentrations independent of sex, age, initial weight, and 24-h energy expenditure; the correlations were stronger for glucose oxidation than for glucose storage. (c) Weight gain was associated with an increase in insulin resistance more than four times that predicted from the cross-sectional data.

We conclude that insulin resistance is associated with a reduced risk of weight gain in nondiabetic Pima Indians.