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Malot J, Combe C, Savary P, Moss A, Ligeon-Ligeonnet P, Hida H. [Direct cost of cataract surgery in public hospital]. ANNALES PHARMACEUTIQUES FRANÇAISES 2010; 68:380-7. [PMID: 21073996 DOI: 10.1016/j.pharma.2010.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 07/09/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION With more than 500,000 operations per year, cataract surgery is the most performed act nowadays in France. Several techniques can be used but the phacoemulsification after micro-incision is the most common and the purpose is to put an intraocular lens into the eye. AIM To approach the direct cost of the cataract surgery and to compare it to the amounts of reimbursements, and to get some epidemiological and statistical data about this surgery. MATERIAL AND METHODS This study is prospective; many operations were followed up in the operating room and every following data were recorded: age of the patient, type of anaesthesia, type of intraocular lens, adverse events, name of surgeon, duration of the intervention, single use material and medications used during operation and their quantity for each operation. RESULTS One hundred and twenty-five cataract surgeries were followed. Patients mean age was 74,1 years and the anaesthesia was topical in 87,2% of cases; only two patients had general anaesthesia. The mean duration was 42 minutes. The mean direct cost was 366 € but reached 630 € in case of capsular tear. The cost greatly varied depending on the surgeon. Two references of lens (foldable monofocal, that cost between 100 and 150 €) represented 80% of the implanted lenses. CONCLUSION This type of study may lead to a standardisation of surgical techniques and evaluate the proportion of supply and medications in that type of surgery.
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Chakkera H, Devarapalli Y, Reddy K, Mulligan D, Mazur M, Hamawi K, Moss A, Mekeel K, Swanson C, Heilman R. ASSOCIATION OF A COMPOSITE SET OF PREDICTORS PRE TRANSPLANTATION AND NEW ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION. Transplantation 2010. [DOI: 10.1097/00007890-201007272-01820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reddy K, Devarapalli Y, Mazur M, Hamawi K, Chakkera H, Moss A, Mekeel K, Post D, Heilman R, Mulligan D. Alemtuzumab with Rapid Steroid Taper in Simultaneous Kidney and Pancreas Transplantation: Comparison to Induction with Antithymocyte Globulin. Transplant Proc 2010; 42:2006-8. [DOI: 10.1016/j.transproceed.2010.05.090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Swan MP, Bourke MJ, Hopper AD, Moss A, Walker SL. Endoscopic treatment of a transversely impacted perforating fish bone in the esophagus with pneumomediastinum. Endoscopy 2010; 42 Suppl 2:E75-6. [PMID: 20195973 DOI: 10.1055/s-0029-1215415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Thapaliya P, Kundranda MN, Curtis KK, Callister MD, Ashman JB, Collins J, Moss A, Mekeel KL, Silva AC, Borad MJ. Gemcitabine and nab-paclitaxel in patients with unresectable/borderline resectable pancreatic cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Moss A, Bourke MJ, Tran K, Godfrey C, McKay G, Chandra AP, Sharma S. Lesion isolation by circumferential submucosal incision prior to endoscopic mucosal resection (CSI-EMR) substantially improves en bloc resection rates for 40-mm colonic lesions. Endoscopy 2010; 42:400-4. [PMID: 20213591 DOI: 10.1055/s-0029-1243990] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS En bloc resection is preferred for colonic laterally spreading tumors, but is limited to 20 mm with endoscopic mucosal resection (EMR) using normal saline submucosal injection. Our aims were to compare the efficacy and safety of circumferential submucosal incision prior to EMR (CSI-EMR) versus conventional EMR for en bloc resection of artificial lesions 40 x 40 mm in size using submucosal injection of succinylated gelatin in a porcine colon model. SUBJECTS AND METHODS Two areas of normal rectosigmoid mucosa measuring 40 x 40 mm were marked with soft coagulation for en bloc resection in each of 10 pigs. By alternate allocation, one was removed with conventional snare-based EMR following submucosal injection of succinylated gelatin. The other was circumferentially incised using an insulated-tip knife, followed by submucosal succinylated gelatin injection followed by EMR of the isolated area. All procedures were performed by a single endoscopist with significant experience of EMR but none of endoscopic submucosal dissection (ESD). Euthanasia and colectomy were performed on day 10. Specimens and ex vivo colon resection sites were examined by a specialist gastrointestinal histopathologist blinded to the technique used. RESULTS En bloc excision rates were 70 % for CSI-EMR vs. 0 % for conventional EMR ( P = 0.016). The median number of resections was 1 (interquartile range, IQR: 1-2) for CSI-EMR vs. 4 (3 - 6) for EMR ( P < 0.001). Mean specimen dimensions were 50 x 43 mm for CSI-EMR vs. 37 x 32 mm for EMR ( P = 0.001). Overall procedure duration (mean +/- SD) was 30.3 +/- 19.8 minutes for CSI-EMR vs. 12.4 +/- 6.8 minutes ( P = 0.003) for EMR. The mean duration of the final 5 CSI-EMRs was 17 minutes, with a statistically significant learning effect R = -0.7, P = 0.025. No perforations or bleeding occurred. All animals were euthanased on day 10. Histologically, CSI-EMR resulted in larger specimens and deeper submucosal resections. CONCLUSIONS CSI-EMR with submucosal injection of succinylated gelatin is safe and superior to conventional EMR, consistently resulting in en bloc resections larger than 50 x 40 mm. With experience, total procedure duration is comparable.
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Kamousi B, Lin B, Al-Ahmad A, Hsia H, Zei P, Natale A, Moss A, Daubert J, Zareba W, Wang P. A covariance-based algorithm: a novel technique for rhythm discrimination in ICDs. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2009; 2008:5478-81. [PMID: 19163957 DOI: 10.1109/iembs.2008.4650454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inappropriate shocks due to misclassification of supraventricular and ventricular arrhythmias remain a major problem in the care of patients with Implantable Cardioverter defibrillators (ICDs). In this study we have investigated the ability of a new covariance-based algorithm, to distinguish Ventricular Tachycardia from other rhythms such as Supraventricular Tachycardia. The proposed algorithm has a low computational demand and with a small adjustment is applicable on both single-chamber and dual-chamber ICDs. The results are promising and suggest that the new covariance-based algorithm may be an effective method for ICD rhythm classification and may decrease inappropriate shocks.
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Heilman R, Chakkera H, Mazur M, Petrides S, Moss A, Mekeel K, Mulligan D, Reddy K. Outcomes of Simultaneous Kidney–Pancreas Transplantation With Positive Cross-Match. Transplant Proc 2009; 41:303-6. [DOI: 10.1016/j.transproceed.2008.08.154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 08/10/2008] [Indexed: 10/21/2022]
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Moss A, Parrish FJ, Irving PM, Haines ML, Gibson PR. Quality, clinical influence and tolerance of computed tomography enteroclysis in patients with suspected small bowel disease. Intern Med J 2008; 39:733-43. [PMID: 19220539 DOI: 10.1111/j.1445-5994.2008.01843.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Computed tomography enteroclysis (CTE) may be superior to other small bowel imaging techniques, detecting subtle mucosal lesions and extraluminal pathology. This study aimed to define the technical success, clinical influence and tolerance of CTE in patients with suspected small bowel disease. METHODS CTE scans of 42 consecutive patients (aged 21-78 years, 12 men) were reviewed by a single radiologist for technical adequacy and diagnosis. A panel of gastroenterologists reviewed clinical information. At a telephone interview, tolerance of CTE was graded numerically from 1 (unbearable) to 10 (excellent) and descriptively as unbearable, fair, good or excellent. RESULTS Good or optimal distension of small bowel was achieved in 98%. The entire small bowel was imaged in 88%. Eighteen patients had a normal small bowel, whereas 12 (29%) had active small bowel Crohn disease, 4 intussusception, 3 small bowel diverticula and 7 having other diagnoses. Mesenteric lymphadenopathy was evident in 11 and fat stranding in 5. CTE resulted in a new or altered diagnosis in 13 (31%) patients and identified more extensive Crohn disease in a further 8 (19%). A change in management plan was instituted in 18 (43%) patients, with subsequent clinically significant improvement in 12. 33 (85%) described the procedure as 'fair' or 'unbearable' rather than 'good' or 'excellent'. The median tolerance score was 3 out of 10. CONCLUSION CTE provided high-quality images in nearly all patients and had an effect on diagnosis, management or outcome in most, but was not well tolerated.
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Mulligan D, Moss A, Reddy S, Mekeel K, Byrne T, Carey E, Harrison ME, Vargas H, Douglas D, Rakela J. HEPATIC ARTERY THROMBOSIS AFTER ADULT LIVING DONOR LIVER TRANSPLANTATION: RISK FACTORS AND MANAGEMENT FOR SUCCESSFUL OUTCOMES. Transplantation 2008. [DOI: 10.1097/01.tp.0000332676.37855.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leyden J, Murray D, Moss A, Arumuguma M, Doyle E, McEntee G, O'Keane C, Doran P, MacMathuna P. Net1 and Myeov: computationally identified mediators of gastric cancer. Br J Cancer 2006; 94:1204-12. [PMID: 16552434 PMCID: PMC2361249 DOI: 10.1038/sj.bjc.6603054] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Gastric adenocarcinoma (GA) is a significant cause of mortality worldwide. The molecular mechanisms of GA remain poorly characterised. Our aim was to characterise the functional activity of the computationally identified genes, NET 1 and MYEOV in GA. Digital Differential Display was used to identify genes altered expression in GA-derived EST libraries. mRNA levels of a subset of genes were quantitated by qPCR in a panel of cell lines and tumour tissue. The effect of pro- and anti-inflammatory stimuli on gene expression was investigated. Cell proliferation and invasion were measured using in an in-vitro GA model following inhibition of expression using siRNA. In all, 23 genes not previously reported in association with GA were identified. Two genes, Net1 and Myeov, were selected for further analysis and increased expression was detected in GA tissue compared to paired normal tissue using quantitative PCR. siRNA-mediated downregulation of Net1 and Myeov resulted in decreased proliferation and invasion of gastric cancer cells in vitro. These functional studies highlight a putative role for NET1 and Myeov in the development and progression of gastric cancer. These genes may provide important targets for intervention in GA, evidenced by their role in promoting invasion and proliferation, key phenotypic hallmarks of cancer cells.
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Crane JT, Kawuma A, Oyugi JH, Byakika JT, Moss A, Bourgois P, Bangsberg DR. The price of adherence: qualitative findings from HIV positive individuals purchasing fixed-dose combination generic HIV antiretroviral therapy in Kampala, Uganda. AIDS Behav 2006; 10:437-42. [PMID: 16636892 PMCID: PMC2386888 DOI: 10.1007/s10461-006-9080-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Contrary to early expectations, recent studies have shown near-perfect adherence to HIV antiretrovirals in sub-Saharan Africa We conducted qualitative interviews with patients purchasing low-cost, generic antiretroviral therapy to better understand the social dynamics underlying these findings. We found that concerns for family well-being motivate adherence, yet, the financial sacrifices necessary to secure therapy may paradoxically undermine family welfare. We suggest that missed doses may be more due to a failure to access medication rather than a failure to adhere to medications, and that structural rather than behavioral interventions may be most useful to insure optimal treatment response.
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Garry EM, Delaney A, Blackburn-Munro G, Dickinson T, Moss A, Nakalembe I, Robertson DC, Rosie R, Robberecht P, Mitchell R, Fleetwood-Walker SM. Activation of p38 and p42/44 MAP kinase in neuropathic pain: Involvement of VPAC2 and NK2 receptors and mediation by spinal glia. Mol Cell Neurosci 2005; 30:523-37. [PMID: 16202621 DOI: 10.1016/j.mcn.2005.08.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 08/22/2005] [Accepted: 08/26/2005] [Indexed: 01/23/2023] Open
Abstract
Activation of intracellular signaling pathways involving p38 and p42/44 MAP kinases may contribute importantly to synaptic plasticity underlying spinal neuronal sensitization. Inhibitors of p38 or p42/44 pathways moderately attenuated responses of dorsal horn neurons evoked by mustard oil but not brush and alleviated the behavioral reflex sensitization seen following nerve injury. Activation of p38 and p42/44 MAP kinases in spinal cord ipsilateral to constriction injury was reduced by antagonists of NMDA, VPAC2 and NK2 (but not related) receptors, the glial inhibitor propentofylline and inhibitors of TNF-alpha. A VPAC2 receptor agonist enhanced p38 phosphorylation and caused behavioral reflex sensitization in naïve animals that could be blocked by co-administration of p38 inhibitor. Conversely, an NK2 receptor agonist activated p42/44 and caused behavioral sensitization that could be prevented by co-administration of p42/44 inhibitor. Thus, spinal p38 and p42/44 MAP kinases are activated in neuropathic pain states by mechanisms involving VPAC2, NK2, NMDA receptors and glial cytokine production.
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MESH Headings
- Animals
- Disease Models, Animal
- Enzyme Activation/drug effects
- Enzyme Activation/physiology
- Enzyme Inhibitors/pharmacology
- Inflammation Mediators/pharmacology
- MAP Kinase Signaling System/drug effects
- MAP Kinase Signaling System/physiology
- Male
- Mitogen-Activated Protein Kinase 1/drug effects
- Mitogen-Activated Protein Kinase 1/metabolism
- Neuralgia/metabolism
- Neuralgia/physiopathology
- Neuroglia/drug effects
- Neuroglia/metabolism
- Neuroprotective Agents/pharmacology
- Peripheral Nerve Injuries
- Peripheral Nerves/metabolism
- Peripheral Nerves/physiopathology
- Peripheral Nervous System Diseases/metabolism
- Peripheral Nervous System Diseases/physiopathology
- Phosphorylation/drug effects
- Physical Stimulation
- Posterior Horn Cells/drug effects
- Posterior Horn Cells/metabolism
- Rats
- Rats, Wistar
- Receptors, N-Methyl-D-Aspartate/drug effects
- Receptors, N-Methyl-D-Aspartate/metabolism
- Receptors, Neurokinin-2/drug effects
- Receptors, Neurokinin-2/metabolism
- Receptors, Vasoactive Intestinal Peptide, Type II/drug effects
- Receptors, Vasoactive Intestinal Peptide, Type II/metabolism
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Tumor Necrosis Factor-alpha/metabolism
- Xanthines/pharmacology
- p38 Mitogen-Activated Protein Kinases/drug effects
- p38 Mitogen-Activated Protein Kinases/metabolism
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Paisey JR, Yue AM, White A, Moss A, Morgan JM, Roberts PR. Radiation peak skin dose to risk stratify electrophysiological procedures for deterministic skin damage. Int J Cardiovasc Imaging 2005; 20:285-8. [PMID: 15529910 DOI: 10.1023/b:caim.0000041943.73199.d3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
UNLABELLED Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures. METHODS All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors. RESULTS 67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002). CONCLUSION FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.
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Moss A, Aladin F, Marshal E, Blake N, Coulson J. P-091 Targeting small cell lung cancer with virus-specific CD8+cytotoxic t lymphocytes. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80585-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heilman RL, Mazur MJ, Reddy KS, Moss A, Post D, Mulligan D. Steroid Avoidance Immunosuppression in Low-Risk Kidney Transplant Recipients. Transplant Proc 2005; 37:1785-8. [PMID: 15919466 DOI: 10.1016/j.transproceed.2005.02.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent clinical trials have documented the short-term safety of steroid avoidance (SA) in kidney transplant recipients. Since July 2003, we have used a SA immunosuppression protocol for low-risk kidney transplant recipients. Eligibility criteria are age > or = 18, primary transplant (living or deceased donor), and tacrolimus started by postoperative day 3. Recipients were excluded if peak/current PRA was >50%/20%, or if they had a positive flow crossmatch, or if they had the recent use of corticosteroids (<6 months). All recipients received induction with rabbit anti-thymocyte globulin, total dose 6 mg/kg, or basiliximab. Recipients received 5 daily doses of corticosteroid and mycophenolate mofetil 1 gm twice daily starting on the day of transplantation. Tacrolimus was started when the serum creatinine level decreased by 20%, or by postoperative day 3. The goal for trough tacrolimus levels was 10-15 ng/mL for the first month, 8-12 ng/mL for months 2-3, and 5-10 ng/mL after month 3. Protocol biopsies (bx) were performed at reperfusion, 1 month, 4 months, and 12 months. Ninety-four kidney transplantations were performed during the study period. Sixty-seven recipients (71%) were eligible and enrolled in SA. Characteristics of the 67 SA recipients: mean age, 53 years (range, 26-70); 41% female; 67% Caucasian; 24% Hispanic; 15% African American; and 5% Native American. Also, 77% received a living donor kidney. The mean follow-up was 180 days (range, 10-360). At last follow-up, 91% remained steroid-free. Biopsy-proven acute rejection (BPAR) occurred in 5 recipients (7.5%). Three recipients (4.5%) had clinical BPAR and 2 had subclinical. One recipient died with pneumonia 4 months following transplantation. Posttransplantation diabetes mellitus (PTDM) occurred in 2 (5%) of 38 recipients. In the initial 41 recipients, 27 had protocol bx at 1 month and 13 at 4 months available for analysis. Chronic allograft nephropathy (CAN) was present on protocol bx in 48% at 1 month and 69% at 4 month. Actuarial (Kaplan-Meier method) patient and graft survival rates at 351 days were 97.8% and 96.8%, respectively. SA with anti-thymocyte globulin induction in low-immunologic risk kidney transplant recipients is safe and is associated with a low risk of BPAR. The incidence of PTDM appears to be lower.
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Cox ME, Moss A, Smyth GK. Water quality condition and trend in North Queensland waterways. MARINE POLLUTION BULLETIN 2004; 51:89-98. [PMID: 15757711 DOI: 10.1016/j.marpolbul.2004.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The Queensland Environmental Protection Agency monitored water quality at 133 sites in North Queensland waterways between Cooktown and Bundaburg from 1992 to 2001. Condition of the waterways was rated by comparing recent data with the Queensland Water Quality Guidelines. Long-term trends were analysed using a censored regression technique that incorporates the effects of flow, temperature, seasonality and allows for long-term non-linear trends. Many sites were in good condition; those in poor condition were usually impacted by point source discharges; those in moderate condition were usually impacted by agricultural land use. There were no consistent long-term trends across the whole region. Recommendations for future programs include incorporating pressure indicators, ensuring high standards of quality assurance, including covariates such as rainfall in trend assessment and continuing programs over more than 10 years to allow detection of trends due to changes in land-use.
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Paisey J, White A, Moss A, Yue A, Butchart J, Morgan J, Roberts P. P-140 Use of maximum entry point radiation dose to risk stratify electrophysiological procedures for deterministic skin damage. Europace 2003. [DOI: 10.1016/eupace/4.supplement_2.b99-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Moss A, Clarke E, Crowe J, Lennon J, Mac Mathuna P. Management of Barrett's oesophagus in 2001 in Ireland. Ir J Med Sci 2003; 172:174-6. [PMID: 15029984 DOI: 10.1007/bf02915284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic surveillance of patients with Barrett's oesophagus is recommended to detect early carcinoma. The practice patterns of endoscopists since the publication of more recent management guidelines remain unknown. METHODS All endoscopists (n=68) in the Irish Medical Directory and their trainees were sent a postal questionnaire on Barrett's surveillance. RESULTS Fifty-five per cent (30/54) perform surveillance on all patients with Barrett's oesophagus and 38% on selected patients. In patients with no dysplasia, repeat endoscopy was more commonly practiced annually (28/54) than every two to three years (23/54). Surgeons were more likely to perform surveillance annually than gastroenterologists (75% vs 40%). Only 26% of endoscopists took four-quadrant biopsies every 2 cm. Intervention was recommended by a majority (28/54) of endoscopists in a patient with high grade dysplasia. A majority of respondents (47/54) would have surveillance if they were found to have Barrett's oesophagus. CONCLUSION Most endoscopists in Ireland do not adhere to recent guidelines in their management of Barrett's oesophagus. Surgical endoscopists perform surveillance more frequently than their medical colleagues.
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Harrington DK, Bonser M, Moss A, Heafield MTE, Riddoch MJ, Bonser RS. Neuropsychometric outcome following aortic arch surgery: a prospective randomized trial of retrograde cerebral perfusion. J Thorac Cardiovasc Surg 2003; 126:638-44. [PMID: 14502133 DOI: 10.1016/s0022-5223(03)00214-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aortic surgery requiring hypothermic circulatory arrest is associated with a high incidence of brain injury. However, knowledge of neuropsychometric outcome is limited. Retrograde cerebral perfusion has become a popular adjunctive technique to hypothermic circulatory arrest. The aim of this study was to assess neuropsychometric outcome and compare the 2 techniques. METHODS In a prospective randomized trial, 38 patients requiring elective aortic arch surgery were allocated to either hypothermic circulatory arrest plus retrograde cerebral perfusion or hypothermic circulatory arrest alone. Neuropsychometric testing was performed preoperatively, and at 6 weeks and 12 to 24 weeks postoperatively. Deficit was defined as a 20% decline in 2 tests or more. Standardized Z scores were calculated for each patient and test. Eighteen patients underwent hypothermic circulatory arrest and 20 patients underwent hypothermic circulatory arrest plus retrograde cerebral perfusion. The mean cardiopulmonary bypass, hypothermic circulatory arrest, and retrograde cerebral perfusion durations were 169, 30, and 25 minutes, respectively. RESULTS There were 2 deaths and 2 neurological deficits. At 6 weeks postoperatively, 77% of the hypothermic circulatory arrest group and 93% of the hypothermic circulatory arrest plus retrograde cerebral perfusion group had a deficit (P =.22). At 12 weeks this was reduced to 55% and 56%, respectively (P =.93). There was a worse total Z test score in the hypothermic circulatory arrest plus retrograde cerebral perfusion group at 12 weeks (P =.05). Neuropsychometric change did not correlate with hypothermic circulatory arrest duration, presence of aortic atheroma, cannulation technique, or procedure. CONCLUSIONS Hypothermic circulatory arrest plus/minus retrograde cerebral perfusion is associated with a high incidence of neuropsychometric change despite ostensibly normal clinical outcomes and apparently safe arrest duration. Retrograde cerebral perfusion did not improve outcome in this small study.
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Moss A, Morris E, Mac MP. Palliative biliary stents for obstructing pancreatic carcinoma. Hippokratia 2003. [DOI: 10.1002/14651858.cd004200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Buavirat A, Page-Shafer K, van Griensven GJP, Mandel JS, Evans J, Chuaratanaphong J, Chiamwongpat S, Sacks R, Moss A. Risk of prevalent HIV infection associated with incarceration among injecting drug users in Bangkok, Thailand: case-control study. BMJ 2003; 326:308. [PMID: 12574043 PMCID: PMC143525 DOI: 10.1136/bmj.326.7384.308] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify risks for HIV infection related to incarceration among injecting drug users in Bangkok, Thailand. DESIGN Case-control study of sexual and parenteral exposures occurring before, during, and after the most recent incarceration. SETTING Metropolitan Bangkok. PARTICIPANTS Non-prison based injecting drug users formerly incarcerated for at least six months in the previous five years, with documented HIV serostatus since their most recent release; 175 HIV positive cases and 172 HIV negative controls from methadone clinics. MAIN OUTCOME MEASURE Injection of heroin and methamphetamine, sharing of needles, sexual behaviour, and tattooing before, during, and after incarceration. RESULTS In the month before incarceration cases were more likely than controls to have injected methamphetamine and to have borrowed needles. More cases than controls reported using drugs (60% v 45%; P=0.005) and sharing needles (50% v 31%; P<0.01) in the holding cell before incarceration. Independent risk factors for prevalent HIV infection included injection of methamphetamine before detention (adjusted odds ratio 3.3, 95% confidence interval 1.01 to 10.7), sharing needles in the holding cell (1.9, 1.2 to 3.0), being tattooed while in prison (2.1, 1.3 to 3.4), and borrowing needles after release (2.5, 1.3 to 4.4). CONCLUSIONS Injecting drug users in Bangkok are at significantly increased risk of HIV infection through sharing needles with multiple partners while in holding cells before incarceration. The time spent in holding cells is an important opportunity to provide risk reduction counselling and intervention to reduce the incidence of HIV.
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73
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Zolty R, Passarino G, Taylor M, Moss A, Mestroni L, Bristow M. Molecular epidemiology of cardiac actin gene mutations in dilated cardiomyopathy. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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74
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Jones T, Harrington D, Wong C, Bonser M, Moss A, Heafield T, Riddoch J, Bonser R. Retrograde cerebral perfusion does not improve neuropsychometric outcome after aortic surgery. Ann Thorac Surg 2002. [DOI: 10.1016/s0003-4975(01)03490-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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75
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Burgess RM, Huang M, Corpstein C, Durley J, McGraw L, Moss A, Nichols A. THE EFFECT OF VISION ON A VARIETY OF BALANCE MEASURES. J Geriatr Phys Ther 2002. [DOI: 10.1519/00139143-200225030-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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