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Weisberg DB, Leuer J, McClenaghan J, Yu JH, Wehner W, McLaughlin K, Abrams T, Barr J, Grierson B, Lyons B, MacDonald JR, Meneghini O, Petty CC, Pinsker RI, Sinclair G, Solomon WM, Taylor T, Thackston K, Thomas D, van Compernolle B, VanZeeland M, Zeller K. An Integrated Design Study for an Advanced Tokamak to Close Physics Gaps in Energy Confinement and Power Exhaust. Fusion Science and Technology 2023. [DOI: 10.1080/15361055.2022.2149210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- D. B. Weisberg
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - J. Leuer
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - J. McClenaghan
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - J. H. Yu
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - W. Wehner
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - K. McLaughlin
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - T. Abrams
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - J. Barr
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - B. Grierson
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - B. Lyons
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - J. R. MacDonald
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - O. Meneghini
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - C. C. Petty
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - R. I. Pinsker
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - G. Sinclair
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - W. M. Solomon
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - T. Taylor
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - K. Thackston
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - D. Thomas
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | | | - M. VanZeeland
- General Atomics, PO Box 85608, San Diego, California 92186-5608
| | - K. Zeller
- General Atomics, PO Box 85608, San Diego, California 92186-5608
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Espejo C, Lyons B, Woods GM, Wilson R. Early Cancer Biomarker Discovery Using DIA-MS Proteomic Analysis of EVs from Peripheral Blood. Methods Mol Biol 2023; 2628:127-152. [PMID: 36781783 DOI: 10.1007/978-1-0716-2978-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
One of the cornerstones of effective cancer treatment is early diagnosis. In this context, the identification of proteins that can serve as cancer biomarkers in bodily fluids ("liquid biopsies") has gained attention over the last decade. Plasma and serum fractions of blood are the most commonly investigated sources of potential cancer liquid biopsy biomarkers. However, the high complexity and dynamic range typical of these fluids hinders the sensitivity of protein detection by the most commonly used mass spectrometry technology (data-dependent acquisition mass spectrometry (DDA-MS)). Recently, data-independent acquisition mass spectrometry (DIA-MS) techniques have overcome the limitations of DDA-MS, increasing sensitivity and proteome coverage. In addition to DIA-MS, isolating extracellular vesicles (EVs) can help to increase the depth of serum/plasma proteome coverage by improving the identification of low-abundance proteins which are a potential treasure trove of diagnostic molecules. EVs, the nano-sized membrane-enclosed vesicles present in most bodily fluids, contain proteins which may serve as potential biomarkers for various cancers. Here, we describe a detailed protocol that combines DIA-MS and EV methodologies for discovering and validating early cancer biomarkers using blood serum. The pipeline includes size exclusion chromatography methods to isolate serum-derived extracellular vesicles and subsequent EV sample preparation for liquid chromatography and mass spectrometry analysis. Procedures for spectral library generation by DDA-MS incorporate methods for off-line peptide separation by microflow HPLC with automated fraction concatenation. Analysis of the samples by DIA-MS includes recommended protocols for data processing and statistical methods. This pipeline will provide a guide to discovering and validating EV-associated proteins that can serve as sensitive and specific biomarkers for early cancer detection and other diseases.
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Affiliation(s)
- Camila Espejo
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Bruce Lyons
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory M Woods
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Richard Wilson
- Central Science Laboratory, University of Tasmania, Hobart, TAS, Australia.
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James S, Jennings G, Kwon YM, Stammnitz M, Fraik A, Storfer A, Comte S, Pemberton D, Fox S, Brown B, Pye R, Woods G, Lyons B, Hohenlohe PA, McCallum H, Siddle H, Thomas F, Ujvari B, Murchison EP, Jones M, Hamede R. Tracing the rise of malignant cell lines: Distribution, epidemiology and evolutionary interactions of two transmissible cancers in Tasmanian devils. Evol Appl 2019; 12:1772-1780. [PMID: 31548856 PMCID: PMC6752152 DOI: 10.1111/eva.12831] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 01/04/2023] Open
Abstract
Emerging infectious diseases are rising globally and understanding host-pathogen interactions during the initial stages of disease emergence is essential for assessing potential evolutionary dynamics and designing novel management strategies. Tasmanian devils (Sarcophilus harrisii) are endangered due to a transmissible cancer-devil facial tumour disease (DFTD)-that since its emergence in the 1990s, has affected most populations throughout Tasmania. Recent studies suggest that devils are adapting to the DFTD epidemic and that disease-induced extinction is unlikely. However, in 2014, a second and independently evolved transmissible cancer-devil facial tumour 2 (DFT2)-was discovered at the d'Entrecasteaux peninsula, in south-east Tasmania, suggesting that the species is prone to transmissible cancers. To date, there is little information about the distribution, epidemiology and effects of DFT2 and its interaction with DFTD. Here, we use data from monitoring surveys and roadkills found within and adjacent to the d'Entrecasteaux peninsula to determine the distribution of both cancers and to compare their epidemiological patterns. Since 2012, a total of 51 DFTD tumours have been confirmed among 26 individuals inside the peninsula and its surroundings, while 40 DFT2 tumours have been confirmed among 23 individuals, and two individuals co-infected with both tumours. All devils with DFT2 were found within the d'Entrecasteaux peninsula, suggesting that this new transmissible cancer is geographically confined to this area. We found significant differences in tumour bodily location in DFTD and DFT2, with non-facial tumours more commonly found in DFT2. There was a significant sex bias in DFT2, with most cases reported in males, suggesting that since DFT2 originated from a male host, females might be less susceptible to this cancer. We discuss the implications of our results for understanding the epidemiological and evolutionary interactions of these two contemporary transmissible cancers and evaluating the effectiveness of potential management strategies.
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Affiliation(s)
- Samantha James
- School of Natural SciencesUniversity of TasmaniaHobartTasmaniaAustralia
| | - Geordie Jennings
- School of Natural SciencesUniversity of TasmaniaHobartTasmaniaAustralia
| | - Young Mi Kwon
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | | | - Alexandra Fraik
- School of Biological SciencesWashington State UniversityPullmanWashingtonUSA
| | - Andrew Storfer
- School of Biological SciencesWashington State UniversityPullmanWashingtonUSA
| | - Sebastien Comte
- School of Natural SciencesUniversity of TasmaniaHobartTasmaniaAustralia
| | - David Pemberton
- Department of Primary Industries, Parks, Water and the Environment (DPIPWE)HobartTasmaniaAustralia
| | - Samantha Fox
- Department of Primary Industries, Parks, Water and the Environment (DPIPWE)HobartTasmaniaAustralia
| | - Bill Brown
- Department of Primary Industries, Parks, Water and the Environment (DPIPWE)HobartTasmaniaAustralia
| | - Ruth Pye
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Gregory Woods
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Bruce Lyons
- Menzies Institute for Medical ResearchUniversity of TasmaniaHobartTasmaniaAustralia
| | - Paul A. Hohenlohe
- Department of Biological Sciences, Institute for Bioinformatics and Evolutionary StudiesUniversity of IdahoMoscowIdahoUSA
| | - Hamish McCallum
- School of Environment and ScienceGriffith UniversityNathanQueenslandAustralia
| | - Hannah Siddle
- Centre for Biological SciencesUniversity of SouthamptonSouthamptonUK
| | - Frédéric Thomas
- Centre for Ecological and Evolutionary Research on CancerMontpellierFrance
| | - Beata Ujvari
- Centre for Integrative Ecology, School of Life and Environmental SciencesDeakin UniversityDeakinVictoriaAustralia
| | | | - Menna Jones
- School of Natural SciencesUniversity of TasmaniaHobartTasmaniaAustralia
| | - Rodrigo Hamede
- School of Natural SciencesUniversity of TasmaniaHobartTasmaniaAustralia
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Cafferkey A, Lyons B. Cross-sectional Analysis of the Standards of Consent Applied to Anaesthesia in Ireland: Are Anaesthetists Aware of their Legal and Ethical Obligations? Ir Med J 2018; 111:668. [PMID: 29869849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Consent to a medical intervention has legally and ethically evolved to a process prioritising autonomy and patient-led decision-making. This cross-sectional analysis investigated Irish anaesthetists' practices of taking consent. Following ethical approval, trainees and fellows of the College of Anaesthetists of Ireland were invited to participate in a 33 question online survey. One hundred and sixty responses (11.8%) were received, an equal number coming from consultants and trainees. The majority (93.7%) worked in a teaching hospital. Fifteen percent said their department had guidelines on obtaining consent for anaesthesia, but only 4.5% said their department used a separate consent form. Most (63.8%) do not usually document consent. A significant number rarely (21.8%) or never (27.8%) explained risks to patients. Lack of time was identified as the most frequent barrier (77.6%), with just under half first meeting the patient in the theatre holding-bay or the anaesthetic room. Forty-one percent felt the ultimate decision regarding which anaesthetic technique is employed should usually lie with the anaesthetist alone. These results suggest a wide variation in the practice of obtaining consent for anaesthesia. Less than half deemed their practice to be adequate in this regard, while 50% were concerned about litigation stemming from inadequate consent.
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Affiliation(s)
- A Cafferkey
- Department of Anaesthesia, The Royal Victoria Eye and Ear Hospital, Dublin 2
| | - B Lyons
- Department of Anaesthesia, Our Lady's Children's Hospital, Crumlin, Dublin 12
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Patchett AL, Pinfold TL, Tovar C, Lyons B, Woods GM. Abstract B040: Imiquimod initiates tumor specific overload of the ER stress response in Tasmanian devil facial cancer cells. Cancer Immunol Res 2016. [DOI: 10.1158/2326-6066.imm2016-b040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The potent immune modifier imiquimod (R-837) induces apoptosis of various tumor cell lines by mechanisms that are not fully understood. As a topical immunotherapy, imiquimod successfully activates tumor-specific cytotoxic responses via stimulation of TLR7 signaling pathways and antagonism of adenosine receptor mediated regulatory pathways. A role for imiquimod-induced tumor apoptosis in augmenting this response has not been defined, however it remains plausible that molecular changes may render the cells more susceptible to an anti-tumor response. An improved understanding of the pathways regulated by imiquimod in tumor cells will reveal whether this is likely the case. Devil facial tumor disease (DFTD) is a clonal transmissible cancer threatening the world's largest marsupial carnivore, the Tasmanian devil. DFTD evades both non-self and anti-cancer immune defenses to survive in new hosts, providing an ideal model for studying immunotherapeutic mechanisms. As we have previously shown that DFTD cells are sensitive to treatment with imiquimod, investigation of these effects could reveal new therapeutic strategies for DFTD, and will improve our understanding of this drug in cancer immunotherapy.
Methods: To investigate the mechanisms of imiquimod action in tumor cells, DFTD cell lines and control fibroblast cell lines were treated in culture with imiquimod. Changes to cell viability were monitored by proliferation and cell death assays. Molecular changes to DFTD cells were assessed through RNA sequencing and proteomic mass spectrometry, and bioinfomatic techniques were employed to identify biological processes regulated by imiquimod. Major findings were confirmed by quantitative PCR.
Results: Imiquimod treatment induces complete apoptosis of DFTD cells, but not fibroblasts, over a period of days. Transcriptomic and proteomic analysis revealed high constitutive expression of ER stress genes in DFTD cell lines, which were further augmented in response to imiquimod treatment. Up-regulation of genes required for ER-stress mediated apoptosis was also detected, suggesting that imiquimod induces apoptosis through exhaustion of the ER stress response. Molecular pathways associated with tumor growth and survival were modulated in the dying cells, and damage-associated alarmins were highly expressed.
Conclusions: Our study provides the first whole transcriptome and proteome analysis of any imiquimod treated tumor cell line. By using DFTD cells as a tumor model, we have shown that imiquimod directly increases the apoptotic potential of tumor cells through augmentation of ER stress, while producing molecular changes consistent with reduced tumorigenicity. These effects were not replicated in fibroblasts, suggesting that constitutive activation of stress responses in tumor cells may impact their ability to cope with additional stressors. Our findings suggest that ER stress pathways are ideal targets for therapy against DFTD in our endangered Tasmanian devil. These data can also be applied for more rational use of imiquimod as an immunotherapeutic agent in human cancer.
Citation Format: Amanda L. Patchett, Terry L. Pinfold, Cesar Tovar, Bruce Lyons, Gregory M. Woods. Imiquimod initiates tumor specific overload of the ER stress response in Tasmanian devil facial cancer cells [abstract]. In: Proceedings of the Second CRI-CIMT-EATI-AACR International Cancer Immunotherapy Conference: Translating Science into Survival; 2016 Sept 25-28; New York, NY. Philadelphia (PA): AACR; Cancer Immunol Res 2016;4(11 Suppl):Abstract nr B040.
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Affiliation(s)
- Amanda L. Patchett
- 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Terry L. Pinfold
- 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Cesar Tovar
- 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Bruce Lyons
- 2School of Medicine, University of Tasmania, Hobart, Australia
| | - Gregory M. Woods
- 1Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Hu S, Marshall C, Darby J, Korner H, Lyons B. TNF deficiency leads to splenomegaly during Cutaneous Leishmaniasis. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.131.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Cutaneous leishmaniasis in resistant C57BL/6 (B6.WT) mice is resolved spontaneously by Th-1 mediated production of TNF-α and IFN-γ, with consequent induction of inducible nitric oxide synthase. Intriguingly, C57BL/6 mice with a TNF gene knockout (B6.TNF−/−) show uncontrolled fatal infection involving the liver and spleen, which are the two main targets in visceral leishmaniasis. The exact role of TNF or specific mechanism, which is responsible for the fatal outcome of Leishmania infection in this gene-deficient mouse strain, is not yet understood.
B6.TNF−/− mice spleen significantly enlarged from Day 28 post-infection, and they were more than 2-fold larger than B6.WT mice on Day 35 and Day 42. To confirm Leishmania infection in the spleen, limiting dilution assay was recruited and showed Leishmania existed since Day 21 in B6.TNF−/− mice, but there was none evident in B6.WT mice. Diff Quik stain results confirmed that architecture of spleen in B6.TNF−/− was disorganized and white and red pulps were no longer clearly separated. Cells infected with Leishmania were dispersed throughout the spleen and lymph cells infiltrated. A gradually increasing population CD45+CD11b+CD11chighCCR2+Ly6C+F4/80high was emerged in B6.TNF−/− mice, which had both dendritic cell and macrophages like phenotype. In vitro, at steady state, macrophages from B6.TNF−/− mice showed no difference comparing to B6.WT. After exposure with Leishmania promastigotes, they showed potential M2-like phenotype and more easily succumbed to infection
We are currently sorting this population from B6.TNF−/− mice and examining the characteristics and potential mechanisms that may affect the spleen immunity against Leishmania major infection in the absence of TNF.
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Affiliation(s)
- Shanshan Hu
- 1Univ. of Tasmania, Australia
- 2Anhui Med. Univ., China
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Young RJ, Urban D, Angel C, Corry J, Lyons B, Vallance N, Kleid S, Iseli TA, Solomon B, Rischin D. Frequency and prognostic significance of p16(INK4A) protein overexpression and transcriptionally active human papillomavirus infection in laryngeal squamous cell carcinoma. Br J Cancer 2015; 112:1098-104. [PMID: 25688737 PMCID: PMC4366899 DOI: 10.1038/bjc.2015.59] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/18/2014] [Accepted: 01/19/2015] [Indexed: 12/30/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is a powerful prognostic biomarker in a subset of head and neck squamous cell carcinomas, specifically oropharyngeal cancers. However, the role of HPV in non-oropharyngeal sites, such as the larynx, remains unconfirmed. Methods: We evaluated a cohort of 324 laryngeal squamous cell carcinoma (LSCC) patients for the expression of p16INK4A (p16) protein by immunohistochemistry (IHC) and for high-risk HPV E6 and E7 mRNA transcripts by RNA in situ hybridisation (ISH). p16 expression and HPV status were correlated with clinicopathological features and outcomes. Results: Of 307 patients assessable for p16 IHC, 20 (6.5%) were p16 positive. Females and node-positive patients were more likely to be p16 positive (P<0.05). There were no other significant clinical or demographic differences between p16-positive and -negative cases. There was no difference in overall survival (OS) between p16-positive and -negative patients with 2-year survival of 79% in each group (HR=0.83, 95% CI 0.36–1.89, P=0.65). There was no statistically significant difference in failure-free survival (FFS) with 2-year FFS of 79% and 66% for p16-positive and -negative patients, respectively (HR=0.60, 95% CI 0.26–1.36, P=0.22). Only seven cases were found to be HPV RNA ISH positive, all of which were p16 IHC positive. There was no statistically significant difference in OS between patients with HPV RNA ISH-positive tumours compared with -negative tumours with 2-year survival of 86% and 71%, respectively (HR=0.76, 95% CI 0.23–2.5, P=0.65). The 2-year FFS was 86% and 59%, respectively (HR=0.62, 95% CI 0.19–2.03, P=0.43). Conclusions: p16 overexpression is infrequent in LSCC and the proportion of cases with high-risk HPV transcripts is even lower. There are no statistically significant correlations between p16 IHC or HPV RNA ISH status and OS or disease outcomes.
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Affiliation(s)
- R J Young
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - D Urban
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C Angel
- 1] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [2] Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Corry
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - B Lyons
- Department of Surgery, St Vincent's Hospital, Melbourne, Australia
| | - N Vallance
- Department of Otorhinolaryngology, Monash Medical Centre, Melbourne, Australia
| | - S Kleid
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T A Iseli
- Department of Surgery, Melbourne University, Royal Melbourne Hospital, Melbourne, Australia
| | - B Solomon
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [3] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - D Rischin
- 1] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [2] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Smith AD, Olson C, Lyons B, Tran D, Blackburn DF. Adherence to abiraterone among the first 86 recipients after release in Saskatchewan. ACTA ACUST UNITED AC 2015; 22:64-7. [PMID: 25684990 DOI: 10.3747/co.22.2219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Metastatic castration-resistant prostate cancer is now commonly treated with abiraterone, an orally administered chronic medication. Although abiraterone has certain advantages over docetaxel-based therapy, patients are now responsible for ensuring optimal adherence to their medication. To our knowledge, adherence to abiraterone in a real-world setting has never been described. The objective of the present study was to measure adherence to abiraterone among the first patients to receive the drug in Saskatchewan. Electronic pharmacy claims were obtained from the Saskatchewan Cancer Agency after removal of patient names and identifiers. All patients with at least 1 dispensation for abiraterone between August 2011 and October 2013 were eligible. The primary endpoint was the percentage of patients achieving optimal adherence at 6 months, defined as a medication possession ratio (mpr) of 80% or better. During the study period, 141 patients received abiraterone, among whom 86 could be followed for at least 6 months. Optimal adherence was achieved in 82.6% of patients (71 of 86) at 6 months, with 79.1% achieving a mpr of at least 90%. Of patients with available follow-up to 1 year, 81.6% (31 of 38) maintained optimal adherence during the entire period.
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Affiliation(s)
- A D Smith
- The Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
| | - C Olson
- Saskatoon Cancer Centre, Saskatoon, SK
| | - B Lyons
- Saskatoon Cancer Centre, Saskatoon, SK
| | - D Tran
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
| | - D F Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK
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Lyons B. Medical manslaughter. Ir Med J 2013; 106:26-27. [PMID: 23472376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
On November 29, 2011 Dr Conrad Murray was sentenced to four years in prison after being convicted of the involuntary manslaughter of Michael Jackson. Expert witness statements indicated that Murray's actions were an "extreme departure from the standard of care", particularly with regard to (1) inappropriately treating insomnia with a surgical anaesthetic (propofol); (2) failing to acquire sufficiently informed consent; (3) administering propofol without the necessary monitoring equipment; (4) delaying contacting the emergency services; and (5) making ineffective resuscitation efforts. Further medical evidence argued that Murray's care of Jackson contained "17 egregious violations", defined as acts that posed a foreseeable danger to the patient's life. These deficiencies, it was stated, constituted gross negligence. Such events might seem remote from daily medical practice in Ireland. However, medical errors resulting in patient death are reported to be unfortunately frequent, even if such fatalities are rarely as dramatic, or as public, as that of Michael Jackson. Medical care is not necessarily straightforward, and any treatment outcome is dependent on clinician skill, the nature of the intervention, and on the pathological condition of the patient. Regardless of these latter two factors, a poor outcome still may occur through physician omissions or the commission of errors or violations. Merry and McCall Smith distinguish between errors and violations on the following basis: (1) errors are not deliberate, and result in unintentional actions and consequences; (2) violations, on the other hand, entail a deliberate deviation from accepted rules or norms. It was alleged that much of Dr Murray's professional conduct in this case fell into the latter category.
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Sankaye P, Chhatani S, Doyle S, Steel J, Paisley K, Lyons B, Watkins R, Porter G. Preoperative sonographic axillary staging in breast cancer: correlation with sentinel node sampling. Breast Cancer Res 2011. [PMCID: PMC3238270 DOI: 10.1186/bcr2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lyons B, Arshad I, Senaratne J. Comment on "Is there a benefit of frequent CT follow-up after EVAR"? Eur J Vasc Endovasc Surg 2009; 38:650; author reply 650-1. [PMID: 19751981 DOI: 10.1016/j.ejvs.2009.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 06/13/2009] [Indexed: 11/26/2022]
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Pearson T, Shultz LD, Miller D, King M, Laning J, Fodor W, Cuthbert A, Burzenski L, Gott B, Lyons B, Foreman O, Rossini AA, Greiner DL. Non-obese diabetic-recombination activating gene-1 (NOD-Rag1 null) interleukin (IL)-2 receptor common gamma chain (IL2r gamma null) null mice: a radioresistant model for human lymphohaematopoietic engraftment. Clin Exp Immunol 2008; 154:270-84. [PMID: 18785974 DOI: 10.1111/j.1365-2249.2008.03753.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Immunodeficient hosts engrafted with human lymphohaematopoietic cells hold great promise as a preclinical bridge for understanding human haematopoiesis and immunity. We now describe a new immunodeficient radioresistant non-obese diabetic mice (NOD) stock based on targeted mutations in the recombination activating gene-1 (Rag1(null)) and interleukin (IL)-2 receptor common gamma chain (IL2rgamma(null)), and compare its ability to support lymphohaematopoietic cell engraftment with that achieved in radiosensitive NOD.CB17-Prkdc(scid) (NOD-Prkdc(scid)) IL2rgamma(null) mice. We observed that immunodeficient NOD-Rag1(null) IL2rgamma(null) mice tolerated much higher levels of irradiation conditioning than did NOD-Prkdc(scid) IL2rgamma(null) mice. High levels of human cord blood stem cell engraftment were observed in both stocks of irradiation-conditioned adult mice, leading to multi-lineage haematopoietic cell populations and a complete repertoire of human immune cells, including human T cells. Human peripheral blood mononuclear cells also engrafted at high levels in unconditioned adult mice of each stock. These data document that Rag1(null) and scid stocks of immunodeficient NOD mice harbouring the IL2rgamma(null) mutation support similar levels of human lymphohaematopoietic cell engraftment. NOD-Rag1(null) IL2rgamma(null) mice will be an important new model for human lymphohaematopoietic cell engraftment studies that require radioresistant hosts.
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Affiliation(s)
- T Pearson
- Diabetes Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Cendales LC, Kanitakis J, Schneeberger S, Burns C, Ruiz P, Landin L, Remmelink M, Hewitt CW, Landgren T, Lyons B, Drachenberg CB, Solez K, Kirk AD, Kleiner DE, Racusen L. The Banff 2007 working classification of skin-containing composite tissue allograft pathology. Am J Transplant 2008; 8:1396-400. [PMID: 18444912 DOI: 10.1111/j.1600-6143.2008.02243.x] [Citation(s) in RCA: 319] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Composite tissue allotransplantation (CTA) is a recently introduced option for limb replacement and reconstruction of tissue defects. As with other allografts, CTA can undergo immune-mediated rejection; therefore standardized criteria are required for characterizing and reporting severity and types of rejection. This article documents the conclusions of a symposium on CTA rejection held at the Ninth Banff Conference on Allograft Pathology in La-Coruna, Spain, on 26 June 2007, and proposes a working classification, the Banff CTA-07, for the categorization of CTA rejection. This classification was derived from a consensus discussion session attended by the first authors of three published classification systems, pathologists and researchers from international centers where clinical CTA has been performed. It was open to all attendees to the Banff conference. To the extent possible, the format followed the established National Institutes of Health (NIH) guidelines on Consensus Development Programs. By consensus, the defining features to diagnose acute skin rejection include inflammatory cell infiltration with involvement of epidermis and/or adnexal structures, epithelial apoptosis, dyskeratosis and necrosis. Five grades of severity of rejection are defined. This classification refines proposed schemas, represents international consensus on this topic, and establishes a working collective classification system for CTA reporting of rejection in skin-containing CTAs.
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Affiliation(s)
- L C Cendales
- Emory Transplant Center, Emory University, Atlanta, GA, USA.
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16
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17
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Gounaris I, Rahamim J, Shivasankar S, Earl S, Lyons B, Yiannakis D. Marked response to a cisplatin/docetaxel/temozolomide combination in a heavily pretreated patient with metastatic large cell neuroendocrine lung carcinoma. Anticancer Drugs 2007; 18:1227-30. [PMID: 17893525 DOI: 10.1097/cad.0b013e32827bc61b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
At present, there is no clear consensus on the most appropriate treatment approach for large cell neuroendocrine carcinoma of the lung. Large cell neuroendocrine carcinoma lesions differ from other nonsmall cell lung carcinomas in that they have a particularly aggressive clinical behaviour and extremely poor prognosis. We report a 52-year-old woman large cell neuroendocrine carcinoma patient with progressive stage IV disease in the chest, liver, adrenal glands and, particularly, the brain, who achieved a marked response to a fourth-line combination of docetaxel, cisplatin and temozolomide. This regimen significantly improved her quality of life and survival. The good response obtained in this heavily pretreated patient adds to the evidence regarding the use of temozolomide in patients with lung cancer with brain metastases.
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18
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de Crécy E, Metzgar D, Allen C, Pénicaud M, Lyons B, Hansen CJ, de Crécy-Lagard V. Development of a novel continuous culture device for experimental evolution of bacterial populations. Appl Microbiol Biotechnol 2007; 77:489-96. [PMID: 17896105 DOI: 10.1007/s00253-007-1168-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2007] [Revised: 08/15/2007] [Accepted: 08/15/2007] [Indexed: 10/22/2022]
Abstract
The availability of a robust and reliable continuous culture apparatus that eliminates wall growth problems would lead to many applications in the microbial field, including allowing genetically engineered strains to recover high fitness, improving biodegradation strains, and predicting likely antibiotic resistance mechanisms. We describe the design and implementation of a novel automated continuous culture machine that can be used both in time-dependent mode (similar to a chemostat) and turbidostat modes, in which wall growth is circumvented through the use of a long, variably divisible tube of growth medium. This tube can be restricted with clamps to create a mobile growth chamber region in which static portions of the tube and the associated medium are replaced together at equal rates. To functionally test the device as a tool for re-adaptation of engineered strains, we evolved a strain carrying a highly deleterious deletion of Elongation Factor P, a gene involved in translation. In 200 generations over 2 weeks of dilution cycles, the evolved strain improved in generation time by a factor of three, with no contaminations and easy manipulation.
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Affiliation(s)
- E de Crécy
- Evolugate 5745 SW 75th St #188, Gainesville, FL 32608, USA
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19
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Ramies DA, Sandler A, Gray R, Giantonio B, Brahmer J, Lyons B, Schiller J. Bevacizumab: Analysis of clinical benefit in females across trials in colorectal cancer and non-small cell lung cancer. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7634 Background: Bevacizumab (Bv) has demonstrated significant improvement in overall survival (OS) in randomized trials in first- and second-line (FL and SL) metastatic CRC (mCRC), FL NSCLC, and progression-free survival (PFS) in metastatic breast cancer (mBC). However, in FL metastatic non-squamous NSCLC, OS benefit was less robust in females treated with Bv + chemotherapy (CTx). In order to examine whether there is a gender effect upon efficacy in other trials, an analysis of results from randomized ph II and open-label ph III trials with Bv in mCRC (and a randomized ph II trial in SL NSCLC) was conducted for females. Methods: RR, PFS and OS are summarized for females in the following trials (primary endpoint): 1] ph II FL mCRC (PFS); 2] ph III: FL mCRC (OS); 3] ph III SL mCRC (OS); 4] ph II SL NSCLC (PFS); 5] ph III FL NSCLC (OS). Results: Table 1 presents results of Studies 1 - 5. RR is presented as the difference in RR between Bv and respective control arms. Conclusions: Clinical benefit with Bv + CTx compared to CTx-alone was observed in OS for females in studies which included Bv in treatment of mCRC. OS observed in females in Study 5 (FL NSCLC) is inconsistent with findings in mCRC, mBC and SL NSCLC, and the improvement for PFS and RR for females in Study 5. As such, there is no compelling evidence to suggest lack of benefit with Bv in females. [Table: see text] [Table: see text]
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Affiliation(s)
- D. A. Ramies
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - A. Sandler
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - R. Gray
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - B. Giantonio
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - J. Brahmer
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - B. Lyons
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
| | - J. Schiller
- Genentech, Inc., South San Francisco, CA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Harvard School of Public Health, Boston, MA; University of Pennsylvania, Philadelphia, PA; Johns Hopkins University, Baltimore, MD; UT Southwestern, Dallas, TX
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20
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Tabet N, Rafi H, Weaving G, Lyons B, Iversen SA. Behavioural and psychological symptoms of Alzheimer type dementia are not correlated with plasma homocysteine concentration. Dement Geriatr Cogn Disord 2007; 22:432-8. [PMID: 16983185 DOI: 10.1159/000095802] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Vitamin B12 and folate deficiencies have been associated with cognitive impairment and various psychiatric symptoms but not specifically with behavioural and psychological symptoms of dementia (BPSD). A limitation of previous studies in dementia was lack of concurrent homocysteine measurement especially as it may provide a better indicator of tissue activities of these vitamins. This study was designed to clarify whether a relationship exists between plasma homocysteine concentration and BPSD. METHODS Plasma homocysteine, serum vitamin B12 and folate were measured in 23 Alzheimer's disease (AD) patients with BPSD and 27 AD patients without BPSD as determined through the use of the Neuropsychiatric Inventory (NPI). Blood levels of measured substances were also correlated with individual NPI scores and with cumulative NPI scores for different cluster of symptoms. RESULTS There was no significant difference (p = 0.956) in the mean plasma homocysteine levels between AD patients with BPSD (17.48 micromol/l) and AD patients without BPSD (17.34 micromol/l). Similarly, there was no significant difference between the two groups in the mean serum B12 (382.61 and 391.60 pg/ml, respectively) and folate (7.95 and 10.02 ng/ml, respectively). Mean levels for both vitamins were well within the laboratory reference range. Neither individual nor cluster NPI scores correlated significantly with plasma homocysteine. CONCLUSION This study shows for the first time that BPSD are not associated with hyperhomocysteinaemia in Alzheimer dementia. Although previous studies have identified homocysteine as an independent risk factor in AD, the results reported here do not lend weight to an aetiological role for homocysteine specifically in BPSD.
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Affiliation(s)
- N Tabet
- Postgraduate Medical School, Faculty of Health, University of Brighton, Brighton, UK.
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21
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Kirby MF, Smith AJ, Barry J, Katsiadaki I, Lyons B, Scott AP. Differential sensitivity of flounder (Platichthys flesus) in response to oestrogenic chemical exposure: an issue for design and interpretation of monitoring and research programmes. Mar Environ Res 2006; 62:315-25. [PMID: 16769108 DOI: 10.1016/j.marenvres.2006.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 04/27/2006] [Accepted: 04/28/2006] [Indexed: 05/10/2023]
Abstract
This study was conducted as an initial investigation of 'differential response' in one of the main sentinel organisms used for monitoring programmes in United Kingdom estuaries, the flounder Platichthys flesus. It has been hypothesised that monitoring using species with a wide geographical spread and limited migration, such as flounder, might result in the comparison of different genetic stocks and certainly of populations with differing early life stage contaminant exposure histories. Furthermore, it is probable that these pre-exposure and genetic differences could manifest themselves in an ability to respond differently to contaminant exposure, so-called 'differential response'. It is important that the extent and nature of this response is understood, if we want to be able to fully interpret the monitoring data from such programmes. During this study, flounder were collected from four separate sources; wild caught fish from the estuaries of the Rivers Alde, Mersey and Tyne, and farmed flounder from Port Erin Farm, Isle of Man. Under controlled laboratory conditions, groups of fish from each source were exposed to water-borne concentrations of the synthetic oestrogen ethynylestradiol (EE2) at a nominal concentration of 50 ng/l. Plasma was taken from each male fish after 6 and 10 days exposure and analysed for the presence of vitellogenin (VTG) using an ELISA technique. Significant levels of VTG induction were evident in fish from all sources after both 6 and 10 days exposure. Flounder from the Mersey were the only fish with significantly elevated initial background levels of VTG (day 0) and this appeared to be reflected in that these specimens showed the highest induction response after day 6. However, after day 10, fish from all other sites had a slightly higher mean VTG than those from the Mersey which showed significantly (p < 0.05) lower mean plasma VTG. It is suggested that other differential responses may have been masked by the use of a high dose of EE2 which produced maximum induction in nearly all fish. The findings of the study are discussed in terms of implications for further research into the differential response issue and how the initial plasma VTG figures contribute to a time-series from the Mersey, Tyne and Alde estuaries.
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Affiliation(s)
- M F Kirby
- CEFAS, Burnham Laboratory, Remembrance Avenue, Burnham-on-Crouch, Essex, UK.
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22
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Roberts D, Taylor S, Bodell W, Gostick G, Silkstone J, Smith L, Phippen A, Lyons B, Denny D, Norris A, McDonald H. Development of a holistic admission assessment: an integrated care pathway for the hospice setting. Int J Palliat Nurs 2005; 11:322-23, 326-8, 330-2. [PMID: 16116388 DOI: 10.12968/ijpn.2005.11.7.18484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes the development of a holistic admission assessment for all inpatients admitted to a 66-bedded hospice, structured in the form of an integrated care pathway (ICP). The need for an improved assessment process was identified by clinical staff, who recognized that the existing assessment was not truly holistic and was dependent on the skills of the assessors. The assessment also lacked appropriate goals and actions. The recently published National Institute for Clinical Excellence (NICE) guidance on Improving Supportive and Palliative Care for Adults with Cancer, has also highlighted key areas for the improvement of patient assessment in specialist palliative care (NICE, 2004). Implementation of the ICP has resulted in a systematic and timely holistic assessment process for patients. The ICP addresses effectively the NICE recommendations for the assessment of specialist palliative care patients.
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Affiliation(s)
- Dai Roberts
- St Ann's Hospice, St Ann's Road, Heald Green, Cheadle, Cheshire, UK.
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23
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McCombe D, Lyons B, Winkler R, Morrison W. Speech and swallowing following radial forearm flap reconstruction of major soft palate defects. ACTA ACUST UNITED AC 2005; 58:306-11. [PMID: 15780224 DOI: 10.1016/j.bjps.2004.09.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2003] [Accepted: 09/15/2004] [Indexed: 11/30/2022]
Abstract
Velopharyngeal function is often compromised by the resection and reconstruction of oropharyngeal and palatal tumours. While free tissue transfer has improved the outcomes of head and neck reconstruction. In general, palatal reconstruction remains a challenge. Velopharyngeal function was analysed in eight patients following microsurgical reconstruction of defects of between 50 and 100% of the soft palate. The radial forearm fasciocutaneous free flap was used in all cases. The outcome of reconstruction was analysed by patient questionnaire and with standardised tests of speech and swallowing function. Velopharyngeal function post-operatively ranged from poor to near normal. Poor function appeared due to the loss of active elevation and contracture of the reconstructed palate producing failure of velopharyngeal closure during swallowing and speech. The results emphasise the limitations of reconstruction of a dynamic structure such as the soft palate with the static fold of skin and soft tissue produced by a fasciocutaneous flap. The relatively poor results obtained suggest that an anatomical approach to soft palate reconstruction is inadequate and reduction of the calibre of the velopharyngeal aperture is required to compensate for the lack of mobility in the reconstructed palate.
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Affiliation(s)
- D McCombe
- Plastic and Reconstructive Surgery Unit and Department of Surgery, St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, Vic. 3065, Australia.
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24
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Crowe S, Mannion D, Healy M, O'Hare B, Lyons B. Paediatric near-drowning: mortality and outcome in a temperate climate. Ir Med J 2003; 96:274-6. [PMID: 14753583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
The decision whether to continue to resuscitate the paediatric victim of near-drowning is influenced by potential poor neurological outcome. A low core body temperature at presentation is frequently cited as a reason to continue resuscitation. We report the case of an 11 month old infant admitted to the intensive care unit following near-drowning and a prolonged resuscitation. The infant's core body temperature was 29 degrees C. Cardiac output was restored, but the child remains in a persistent vegetative state. We present the results of a ten year review of near-drowning in a tertiary referral institution, to evaluate the mortality and outcome in a temperate climate. Thirteen patients were identified in the review. The mortality was 23%. The incidence of a persistent vegetative state was 15%. Asystole, immersion time greater than 15 minutes, resuscitation time longer than 30 minutes, the administration of epinephrine, and a low core body temperature were associated with a poor outcome.
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Affiliation(s)
- S Crowe
- Department of Anaesthesia and Intensive Care Medicine, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland.
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25
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Schell DJ, Farmer J, Hamilton J, Lyons B, McMillan JD, Sáez JC, Tholudur A. Influence of operating conditions and vessel size on oxygen transfer during cellulase production. Appl Biochem Biotechnol 2002; 91-93:627-42. [PMID: 11963891 DOI: 10.1385/abab:91-93:1-9:627] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The production of low-cost cellulase enzyme is a key step in the development of an enzymatic-based process for conversion of lignocellulosic biomass to ethanol. Although abundant information is available on cellulase production, little of this work has examined oxygen transfer. We investigated oxygen transfer during the growth of Trichoderma reesei, a cellulase-producing microorganism, on soluble and insoluble substrates in vessel sizes from 7 to 9000 L. Oxygen uptake rates and volumetric mass transfer coefficients (kLa) were determined using mass spectroscopy to measure off gas composition. Experimentally measured kLa values were found to compare favorably with a kLa correlation available in the literature for a non-Newtonian fermentation broth during the period of heavy cell growth.
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Affiliation(s)
- D J Schell
- National Renewable Energy Laboratory, Golden, CO 80401, USA.
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26
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Moinpour CM, Lyons B, Grevstad PK, Lovato LC, Crowley J, Czaplicki K, Buckner ZM, Ganz PA, Kelly K, Gandara DR. Quality of life in advanced non-small-cell lung cancer: results of a Southwest Oncology Group randomized trial. Qual Life Res 2002; 11:115-26. [PMID: 12018735 DOI: 10.1023/a:1015048908822] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The main purpose of this paper is to present the results of a randomized trial comparing the effects of two chemotherapy regimens on the Quality of life (QOL) of patients with advanced non-small-cell lung cancer (NSCLC). Trials in advanced stage disease represent an important treatment context for QOL assessment. A second purpose of this paper is to examine methods for handling the level of missing data commonly observed in the advanced stage disease context. METHODS Patients were randomized to receive cisplatin plus vinorelbine or carboplatin plus paclitaxel. The QOL of 222 patients was assessed with the Functional Assessment of Cancer Therapy-Lung (FACT-L) prior to randomization; follow-up assessments occurred at 13 and 25 weeks. Three methods were used to analyze the QOL data: (1) cross-sectional analysis of four patient categories (improved, stable, missing, and declined) based on changes in the FACT-L score, (2) a mixed linear model, and (3) a pattern mixture model. The longitudinal analyses addressed two potential data biases. RESULTS Questionnaire submission rates were 91% at baseline, 68% at 13 weeks, and 47% at 25 weeks. The cross-sectional and mixed linear model analyses did not show significant differences by treatment arm in patient-reported QOL. The pattern mixture model analysis, more appropriate given non-ignorable missing data, also found no statistically significant effect of treatment on patient QOL. CONCLUSION We present a sensitivity analysis approach with multiple methods for analyzing treatment effects on patient QOL in the presence of substantial, non-ignorable missing data in an advanced stage disease clinical trial. We conclude that the two treatment arms did not differ statistically in their effects on patient QOL over a 25-week treatment period.
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Affiliation(s)
- C M Moinpour
- Southwest Oncology Group Statistical Center, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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27
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Abstract
BACKGROUND AND OBJECTIVE Epidermolysis bullosa is a rare, genetically determined disorder characterized by excessive susceptibility of the skin and mucosa to separate from the underlying tissues after mechanical trauma. Patients suffering from this disease may have multiple medical problems, but the risk of anaesthesia is attributed mainly to oropharyngeal involvement; airway management may be hazardous and preservation of mucosa and skin integrity problematical. There is a paucity of data in the literature concerning the perioperative management of children with epidermolysis bullosa. We present our experience of managing 54 general anaesthetics (and two local anaesthetics) over the past 20 years. METHODS The case notes of 16 children with epidermolysis bullosa were reviewed. The children underwent surgical procedures under local or general anaesthesia over a 20-year period. RESULTS Fifty-four general and two local anaesthetics were administered for 58 procedures in 10 children (mean age 12.6 years). Surgical procedures included oesophageal dilatation (24), insertion/revision of gastrostomy (16), dental procedures (10), hand surgery (2), skin biopsy (2) and others (4). Anaesthesia was induced by inhalation in 73.4% of patients and the airway was maintained with an endotracheal tube in 64.8%. Monitoring of anaesthesia was performed with pulse oximetry (89%), whereas electrocardiography and non-invasive blood pressure monitoring were used in 16.6% of cases each. The mean duration of anaesthesia was 64 min. Tracheal intubation was difficult in two of the five children who were intubated. Mucocutaneous blistering occurred in three children, otherwise there was no attributable morbidity. CONCLUSION With maximal skin and mucous membrane protection, anaesthesia in children with epidermolysis bullosa may be undertaken with few sequelae.
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Affiliation(s)
- G Iohom
- Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland
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28
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Abstract
The United States continues to stand almost alone among developed nations in its lack of universal health care coverage. In this essay, we argue that even though the debate over whether the federal government or states should lead the effort to expand health care coverage under the federal system is relevant in strategizing how to cover the uninsured; the more critical issues stem from the challenge of the mixed and fragmented mode of public-private financing of our pluralistic health care system. We base this argument on (1) an in-depth review of Oregon's and Tennessee's five years of experience with broad coverage reform in the context of the United States health care system and on (2) a more abbreviated review of other state experiences in providing health care coverage. We conclude from our review that when the will exists, states can substantially expand coverage. However, as one moves up the income scale, political support and resources are harder to come by. Further, concerns grow about the interface of public and private coverage, with issues of "crowd out" and other distributional questions dominating the discussion of coverage expansion as policy makers focus less on how to cover people than on how to make sure one kind of coverage doesn't preempt another. Concern for crowd out can then lead to policies that keep out some of the very people policy makers may want to cover. In this context the question whether states or the federal government is more likely to succeed in expanding coverage is eclipsed by the more fundamental challenges raised by pluralism. Neither federal nor state government is likely to be fully successful without first identifying ways of better coordinating public and private activities and resources to provide continuous and affordable coverage.
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Affiliation(s)
- M R Gold
- Mathematica Policy Research, Inc., 600 Maryland Avenue S.W., Suite 550, Washington, DC 20024, USA
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29
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Colreavy MP, Baker T, Campbell M, Murphy M, Lyons B. The safety and effectiveness of the Le Fort I approach to removing central skull base lesions. Ear Nose Throat J 2001; 80:315-8, 320. [PMID: 11393911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
The difficulty of gaining access to the central skull base has led to the development of many surgical approaches to this area during the past decade. Yet we believe that the Le Fort I technique, which has been used for almost 140 years in orthognathic surgery, is still an excellent approach to treating anterior skull base lesions. This procedure, which entails the horizontal sectioning of the dentoalveolar maxillary segment, seemed to fall out of favor with otolaryngologists after a few reports of complications surfaced during the past 10 to 15 years. In this article, we report a series of seven patients whom we treated with a Le Fort I approach during a 3-year period for a variety of benign and malignant anterior skull base lesions. We have encountered no significant complications of surgery or recurrence of disease at a maximum postoperative followup of 3 years.
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Affiliation(s)
- M P Colreavy
- Department of Otolaryngology-Head and Neck Surgery, Royal Victorian Eye and Ear Hospital, Adelaide Rd., Dublin 2, Republic of Ireland.
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30
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Abstract
BACKGROUND How many physicians are needed in the United States and how they should be allocated geographically and among specialties has been the subject of intense debate, a debate that has often focused more on costs to third-party payers and government than on benefits to health. Child health is a central aspect of public health, and immunization is one of its most cost-effective and easily measured interventions. OBJECTIVE To examine the association of immunization rates and delivery characteristics with the distribution of child health physicians in the United States in 1997. DESIGN Cross-sectional ecological study, using the state as the unit of analysis, immunization rates and delivery characteristics (from the National Immunization Survey) as the main outcome measures, concentration of the principal physician specialties providing routine care to children (pediatric, family, and general physicians from the American Medical Association Masterfile) as the main risk factor, while controlling for demographic and economic factors (from the Bureau of the Census and other sources). RESULTS Of the 96 689 physicians providing routine care to children, 37% were pediatric, 49% family, and 14% general physicians. Higher rates of vaccination, private sector vaccination, and increased numbers of public and private vaccination sites were all associated with the concentration of pediatricians but not of family or general physicians. The distribution of pediatricians was strongly associated with the distribution of residency positions. CONCLUSIONS Pediatrician distribution is a strong correlate to immunization rates and delivery characteristics. Opportunities to affect pediatrician distribution may exist with allocation of residency positions.
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Affiliation(s)
- C W LeBaron
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Abstract
Studies have highlighted the tensions that can arise between Medicaid managed care organizations and safety net providers. This article seeks to identify what other states can learn from Maryland's effort to include protections for safety net providers in its Medicaid managed care program--HealthChoice. Under HealthChoice, traditional provider systems can sponsor managed care organizations, historical providers are assured of having a role, patients can self-refer and have open access to certain public health providers, and capitation rates are risk adjusted through the use of adjusted clinical groups and claims data. The article is based on a week-long site visit to Maryland in fall 1998 that was one part of a seven-state study. Maryland's experience suggests that states have much to gain in the way of "good" public policy by considering the impact of their Medicaid managed care programs on the safety net, but states should not underestimate the challenges involved in balancing the need to protect the safety net with the need to contain costs and minimize the administrative burden on providers. No amount of protection can compensate for a poorly designed or implemented program. As the health care environment continues to change, so may the need for and the types of protections change. It also may be most difficult to guarantee adequate protections to those who need it most--among relatively financially insecure providers that have a limited management infrastructure and that depend heavily on Medicaid and the state for funds to care for the uninsured.
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Affiliation(s)
- M Gold
- Mathematica Policy Research in Washington, DC 20024, USA.
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Moinpour C, Lyons B, Lovato L, Grevstad P, Kelly K, Crowley J, Gandara D. Comparison of quality of life (QLT) outcomes for two chemotherapy regimens in non-small cell lung cancer (NSCLC). Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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LeBaron CW, Massoudi M, Stevenson J, Dang H, Lyons B. The status of immunization measurement and feedback in the United States. Arch Pediatr Adolesc Med 2000; 154:832-6. [PMID: 10922282 DOI: 10.1001/archpedi.154.8.832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND A large body of scientific and programmatic data has demonstrated that provider measurement and feedback raises immunization coverage. Starting in 1995, Congress required that all states measure childhood immunization coverage in all public clinics, and federal grant guidelines encourage private practice measurements. OBJECTIVES To determine state immunization measurement rates and examine risk factors for high rates. METHODS Review of 1997 state reports, with correlation of measurement rates to birth cohort and provider numbers, public/private proportions, and vaccine distribution systems. RESULTS Of the 9505 public clinics, 48% were measured; 4 states measured all clinics; 29 measured a majority. Measurement rates were highest for Health Department clinics (67%), lower for community/migrant health centers (39%), and lowest for other clinics (22%). Rates were highly correlated among categories of clinics (r>+0.308, P<.03), and the fewer the clinics, the higher the measurement rates (r = -0.351, P =. 01), but other factors were not significant. Of the 41,378 private practices, 6% were measured; no state measured all its practices; 1 measured a majority. Private practice measurement rates were not correlated to public clinic measurement rates or other factors examined. Of the 50,883 total providers, 14% were measured; no state measured all providers; 2 measured a majority. A trend toward higher measurement rates was found in states with fewer providers (r = -0. 266, P =.06). CONCLUSIONS Three years after the congressional mandate, only a minority of public clinics and very few private practices had their immunization coverage measured. Greater efforts will be needed to assure implementation of the intervention. Arch Pediatr Adolesc Med. 2000;154:832-836
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Affiliation(s)
- C W LeBaron
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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35
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Shultz LD, Lang PA, Christianson SW, Gott B, Lyons B, Umeda S, Leiter E, Hesselton R, Wagar EJ, Leif JH, Kollet O, Lapidot T, Greiner DL. NOD/LtSz-Rag1null mice: an immunodeficient and radioresistant model for engraftment of human hematolymphoid cells, HIV infection, and adoptive transfer of NOD mouse diabetogenic T cells. J Immunol 2000; 164:2496-507. [PMID: 10679087 DOI: 10.4049/jimmunol.164.5.2496] [Citation(s) in RCA: 118] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Development of a small animal model for the in vivo study of human immunity and infectious disease remains an important goal, particularly for investigations of HIV vaccine development. NOD/Lt mice homozygous for the severe combined immunodeficiency (Prkdcscid) mutation readily support engraftment with high levels of human hematolymphoid cells. However, NOD/LtSz-scid mice are highly radiosensitive, have short life spans, and a small number develop functional lymphocytes with age. To overcome these limitations, we have backcrossed the null allele of the recombination-activating gene (Rag1) for 10 generations onto the NOD/LtSz strain background. Mice deficient in RAG1 activity are unable to initiate V(D)J recombination in Ig and TCR genes and lack functional T and B lymphocytes. NOD/LtSz-Rag1null mice have an increased mean life span compared with NOD/LtSz-scid mice due to a later onset of lymphoma development, are radioresistant, and lack serum Ig throughout life. NOD/LtSz-Rag1null mice were devoid of mature T or B cells. Cytotoxic assays demonstrated low NK cell activity. NOD/LtSz-Rag1null mice supported high levels of engraftment with human lymphoid cells and human hemopoietic stem cells. The engrafted human T cells were readily infected with HIV. Finally, NOD/LtSz-Rag1null recipients of adoptively transferred spleen cells from diabetic NOD/Lt+/+ mice rapidly developed diabetes. These data demonstrate the advantages of NOD/LtSz-Rag1null mice as a radiation and lymphoma-resistant model for long-term analyses of engrafted human hematolymphoid cells or diabetogenic NOD lymphoid cells.
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MESH Headings
- Adoptive Transfer/methods
- Aging/genetics
- Aging/immunology
- Animals
- Diabetes Mellitus, Type 1/genetics
- Diabetes Mellitus, Type 1/immunology
- Disease Models, Animal
- Erythrocyte Count
- Female
- Fetal Blood/cytology
- Fetal Blood/immunology
- Genes, RAG-1/immunology
- HIV Infections/genetics
- HIV Infections/immunology
- Hematopoietic Stem Cell Transplantation/methods
- Humans
- Immunoglobulins/blood
- Immunologic Deficiency Syndromes/genetics
- Immunologic Deficiency Syndromes/immunology
- Immunologic Deficiency Syndromes/pathology
- Immunologic Deficiency Syndromes/physiopathology
- Immunophenotyping
- Killer Cells, Natural/immunology
- Leukocyte Count
- Leukocytes, Mononuclear/transplantation
- Longevity
- Lymphoid Tissue/pathology
- Lymphoma/genetics
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma/physiopathology
- Male
- Mice
- Mice, Inbred C57BL
- Mice, Inbred NOD
- Mice, Knockout
- Mice, SCID
- Poly I-C/pharmacology
- Radiation Tolerance/genetics
- Radiation Tolerance/immunology
- Spleen/cytology
- Spleen/immunology
- Spleen/transplantation
- T-Lymphocytes/transplantation
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Affiliation(s)
- L D Shultz
- The Jackson Laboratory, Bar Harbor, ME 04609, USA.
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Moinpour CM, Lyons B, Schmidt SP, Chansky K, Patchell RA. Substituting proxy ratings for patient ratings in cancer clinical trials: an analysis based on a Southwest Oncology Group trial in patients with brain metastases. Qual Life Res 2000; 9:219-31. [PMID: 10983485 DOI: 10.1023/a:1008978512572] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In studies of the effect of cancer treatment in the advanced disease setting, researchers have attempted to avoid missing data for quality of life (QOL) assessments by either substituting proxy for patient assessments from the outset or by interspersing proxy measures when patients are unable to respond. Although poor agreement between patient and proxy assessments has been amply demonstrated in the literature, interest in using proxy measures persists. Completion of the Spitzer QL-Index by a small sample of patients with brain metastases and family member proxies provided data for evaluating the ability to substitute proxy for patient QOL assessments. These data cannot address treatment efficacy due to the modest sample size. Rather, the analyses serve to alert researchers to the important distinction (in a clinical trial setting) between agreement and the use of the proxy as a surrogate. We present several methods for evaluating the accuracy of proxy measures and for identifying other sources of error and bias that may vary with time or with treatment arm. Lin's concordance correlation coefficient suggests that proxies are generally a poor substitute for capturing a patient's perspective of his/her QOL. A longitudinal analysis suggests that the use of proxy rather than patient responses could lead to different conclusions concerning radiation therapy's effect on QOL.
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Affiliation(s)
- C M Moinpour
- Southwest Oncology Group Statistical Center, Seattle, WA, USA.
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Corry J, Rischin D, Smith JG, D'Costa IA, Huges PG, Sexton MA, Sizeland A, Lyons B, Peters LJ. Radiation with concurrent late chemotherapy intensification ('chemoboost') for locally advanced head and neck cancer. Radiother Oncol 2000; 54:123-7. [PMID: 10699474 DOI: 10.1016/s0167-8140(99)00182-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to review our experience with a treatment regimen that combined conventionally fractionated radiation therapy (70 Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last 2 weeks of radiation therapy in patients with previously untreated advanced squamous cell cancer of the head and neck region.Twenty-eight patients, all but two having UICC stage IV disease, were treated at the Peter MacCallum Cancer Institute between November 1995 and April 1998. Planned chemotherapy consisted initially of continuous infusion at 10 mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on days 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiotherapy. After the first 14 patients, the dose of fluorouracil was reduced to 360 mg/m(2) per day because of acute toxicity.36.8 months), with an estimated 50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed confluent mucositis and 11 (39%) developed patchy mucositis. The median duration of mucositis for these 27 patients was 1.5 months. Seventeen patients (61%) required nutritional support for a median duration of 1.4 months. Fourteen patients (50%) had grade three skin reactions, and 12 (43%) had one or more other significant (Grade 3) toxicities, predominantly infective. Grade 3 late toxicity has been observed in three patients to date (three xerostomia, including one with severe depression), and one patient had chronic ulceration of the oral tongue (grade 4). This chemoradiation regimen achieved an excellent complete response rate and good locoregional control at 2 years in patients with a poor initial prognosis. Acute toxicity was significant but manageable. The regimen offers an alternative to surgery and postoperative radiation therapy in locally advanced head and neck cancer.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East, Melbourne, Australia
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38
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Koshy CE, Lyons B, Morris RJ. An unusual scalp swelling. Br J Plast Surg 2000; 53:80-1. [PMID: 10657459 DOI: 10.1054/bjps.1999.3258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Ceramide is known to have major roles in the control of cell proliferation, differentiation, and apoptosis. Recent studies also have shown that ceramide affects steroid production by JEG-3 choriocarcinoma cells, acutely dispersed rat Leydig cells, and ovarian granulosa cells, but the mechanism by which this occurs is unknown. Because ceramide induces apoptosis in many different cell types, we hypothesized that ceramide might affect steroidogenesis and/or induce apoptosis in MA-10 murine Leydig cells. To test this, MA-10 cells were incubated with either the water soluble C2-ceramide, (N-acetyl-sphingosine, 0.01-10 cm); bacterial sphingomyelinase (1-100 mU/ml); or C2-dihydroceramide (N-acetyl-sphinganine, 0.1-10 microM). The data show that N-acetyl-sphingosine significantly increased basal (0.87 +/- 0.2 vs. 0.42 +/- 0.09 ng/mg cell protein, P < 0.01) and human chorionic gonadotropin (hCG) stimulated progesterone (P) synthesis (204 +/- 12 vs. 120 +/- 5 ng/mg cell protein, P < 0.001); as did sphingomyelinase (basal P = 0.83 +/- 0.1 ng/mg cell protein, P < 0.01; hCG stimulated P = 173 +/- 7 ng/mg cell protein, P < 0.001). C2-dihydroceramide also increased basal P synthesis but was less effective than ceramide on a molar basis. Neither sphingomyelinase (100 mU/ml) nor ceramide (10 microM) had any effect on cAMP production or human chorionic gonadotropin binding; and neither induced any signs of apoptosis (FragEL DNA fragmentation assay and electron microscopy). Cells incubated with anti-Fas (300 ng/ml) demonstrated DNA fragmentation, nuclear condensation, and frequent apoptotic bodies, but had no change in P synthesis. These data show that ceramide significantly increases MA-10 Leydig cell P synthesis but does not induce apoptosis. The mechanism by which ceramide increases steroid hormone synthesis remains unknown but does not appear to be linked to the induction of apoptosis in MA-10 cells.
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Affiliation(s)
- C Kwun
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA
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Rodewald L, Maes E, Stevenson J, Lyons B, Stokley S, Szilagyi P. Immunization performance measurement in a changing immunization environment. Pediatrics 1999; 103:889-97. [PMID: 10103327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE The measurement of performance in the delivery of recommended vaccinations for children is used frequently as a marker for quality of care and as an outcome for studies of interventions to improve immunization coverage levels. The critical element of immunization performance measurement is the determination of immunization status. This methodologic review 1) discusses immunization status as a measure of quality of primary care for children, 2) describes immunization status measures used in immunization intervention studies, and 3) examines selected technical issues of immunization status measurement. METHODS AND TOPICS 1) Description of the characteristics of immunization status measurements obtained by a systematic review of studies published between 1980 and 1997 on interventions to raise immunization coverage, and 2) illustration of technical considerations for immunization status measurement using one local database and one national database of immunization histories. Technical issues for immunization status measurement include 1) the need to use documented immunization histories rather than parental recall to determine immunization status, 2) the need to link records across providers to obtain complete records, 3) the sensitivity of immunization status to missing immunization data, and 4) the potential of measures incorporating combinations of immunizations to underestimate the degree of vaccination in a population. CONCLUSIONS Immunization performance measurement has many characteristics of a robust quality of care measure, including high acceptance by primary care providers of routine vaccination, association of immunization status with the conduct of other clinical preventive services, agreed-on technical and programmatic standards of care, and legislative requirements for medical record documentation. However, it is not without challenges. Careful attention to technical issues has potential to improve immunization delivery health services research.
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Affiliation(s)
- L Rodewald
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
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41
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Lyons B. ENT malignancies. What the GP needs to know. Aust Fam Physician 1999; 28:209-15. [PMID: 10098299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
BACKGROUND The head and neck are sites that are accessible to examination, therefore early detection of cancers in these sites should be simple. OBJECTIVE This article discusses the commoner malignant tumours encountered in the various head and neck subsites. It gives an overview of the types of tumours that occur and the presenting features which allow us to distinguish them from benign disorders and facilitate much earlier diagnosis. Recent advances in diagnostic imaging and treatment are discussed. DISCUSSION Improved outcomes for patients with head and neck cancers will occur with earlier detection and community education about risk factors.
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Affiliation(s)
- B Lyons
- St Vincent's Hospital, Peter MacCallum Cancer Institute, Melbourne
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42
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Hoekstra EJ, LeBaron CW, Megaloeconomou Y, Guerrero H, Byers C, Johnson-Partlow T, Lyons B, Mihalek E, Devier J, Mize J. Impact of a large-scale immunization initiative in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). JAMA 1998; 280:1143-7. [PMID: 9777813 DOI: 10.1001/jama.280.13.1143] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Inner-city immunization rates have lagged behind those in other areas of the country. OBJECTIVE To evaluate the impact of an initiative linking immunization with distribution of food vouchers in the inner city. DESIGN Retrospective analysis of immunization data gathered in 1996 and 1997. SETTING Nineteen Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) sites serving 30% of the Chicago, III, birth cohort. PARTICIPANTS A total of 16581 children 24 months old or younger. INTERVENTIONS Voucher incentives (varying frequency of food voucher issuance based on immunization status) and assessment of immunization status and referral to immunization provider. MAIN OUTCOME MEASURES Age-appropriate immunization rates and WIC enrollment rates. RESULTS During the 15-month period of evaluation, immunization rates increased from 56% to 89% at sites performing voucher incentives. The proportion of children needing voucher incentives declined from 51% to 12%. Sites performing assessment and referral, but not providing voucher incentives, showed no evidence of improvement in immunization coverage. No difference was observed in enrollment rates between sites performing voucher incentives and those that did not. CONCLUSION Applied in a large-scale, programmatic fashion, voucher incentives in WIC can rapidly increase and sustain high childhood immunization rates in an inner-city population.
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Affiliation(s)
- E J Hoekstra
- National Immunization Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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43
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Abstract
This DataWatch examines the relationship between managed care enrollment and access to care for low-income adults with Medicaid and compares their experience with that of low-income, privately insured managed care enrollees. Medicaid managed care enrollees are more likely than low-income, privately insured managed care enrollees to be poorer, have health problems, and experience access problems. Compared with low-income populations in fee-for-service care, managed care enrollees, whether in Medicaid or privately insured, are not appreciably different in having a usual source of care, having a regular provider, or emergency room use but report more problems in obtaining care and are more likely to be dissatisfied with their health plans.
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Affiliation(s)
- M Lillie-Blanton
- Johns Hopkins University School of Public Health, Baltimore, USA
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Smith OP, White B, Vaughan D, Rafferty M, Claffey L, Lyons B, Casey W. Use of protein-C concentrate, heparin, and haemodiafiltration in meningococcus-induced purpura fulminans. Lancet 1997; 350:1590-3. [PMID: 9393338 DOI: 10.1016/s0140-6736(97)06356-3] [Citation(s) in RCA: 178] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Inflammatory and coagulation processes are both affected in meningococcaemia. Severe acquired protein-C deficiency in meningococcaemia is usually associated with substantial mortality: in survivors, skin grafts, amputation, and end-organ failure are not uncommon. Protein C is a natural anticoagulant and also has important anti-inflammatory activity. We assessed the effects of early replacement therapy with protein-C concentrate together with continuous veno-venous haemodiafiltration and conventional treatment in meningococcaemia. METHODS 12 patients aged between 3 months and 27 years with meningococcaemia and severe acquired protein-C deficiency (mean 0.20 IU/mL) were studied. All patients had septic shock, widespread purpura, skin necrosis, and disseminated intravascular coagulopathy. After a test dose of protein-C concentrate, patients received a continuous infusion with the dose adjusted daily to keep the plasma concentration between 0.8 and 1.2 IU/mL. 11 patients were given unfractionated intravenous heparin (10-15 IU kg-1 h-1). Nine patients had haemodiafiltration and one had peritoneal dialysis. The Glasgow meningococcal septicaemia prognostic score and the paediatric risk of mortality score predicted a minimum mortality of 80% and 57%, respectively. FINDINGS No patient died. No adverse reactions to the treatment were seen. Two patients had lower-limb amputations, one of whom had a thrombotic cerebrovascular accident; both patients had received the protein-C concentrate and heparin later than the rest of the group (60 h [16.97] vs 12 h [3.13]). One patient developed chronic renal failure despite receiving protein-C infusion 15 h after admission. INTERPRETATION The acquired severe deficiency of protein C in meningococcaemia contributes to the pathogenesis of the thrombotic necrotic lesions in the skin and other organs and probably has an important role in the inflammatory response. Protein-C therapy is merely one approach to improve the host response in this syndrome. We suggest that a double-blind, randomised, controlled multicentre trial is needed to confirm our results.
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Affiliation(s)
- O P Smith
- Department of Paediatric Haematology, National Children's Hospital, Dublin, Ireland
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Abstract
Using survey data from 2,000 low-income adult respondents in each of five states, this DataWatch assesses how uninsured, low-income adults differ from low-income adults who have public or private insurance and how Medicaid expansions have affected insurance coverage patterns across states with different eligibility policies. Findings show that the proportion of low-income uninsured adults is two to three times higher in states that have not expanded Medicaid eligibility beyond relatively low welfare levels. Compared with persons who have either Medicaid or private insurance, uninsured persons report more difficulties getting needed care, are less likely to have a regular provider, and rate the care they do receive as lower quality.
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Affiliation(s)
- C Schoen
- Commonwealth Fund, New York City, USA
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Abstract
The extent of unmet need, or the extent to which needed assistance is unavailable for insufficient, is an important issue in public policy and financing of health and support services. This article reviews the research of literature to assess how unmet method is measured, and the extent of unmet needs among elderly people in the community. Measurement difficulties include variable definitions and measures of need across studies, the relative dearth of studies which undertake to measure unmet needs, and varying methodologies used to estimate need and unmet need. In addition, some measures of status and need, such as cognitive impairment and care giver burden are excluded from many estimates. Estimates of unmet need range from around 2 percent to about 35 percent of community dwelling elders, depending on what is included or excluded from the definition. Unmet need is associated with higher disability levels and living alone. The literature suggests that estimates of future unmet need will be mitigated by declining disability levels and increased use of assistive devices among the elder population.
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Affiliation(s)
- J Williams
- Williams Stern & Associates, Inc., Miami, FL, USA
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Abstract
This study was designed to assess the incidence, severity and possible aetiological factors of postanaesthetic shivering in children. Three hundred and seventy-six children undergoing general anaesthesia were enrolled in the study. Tympanic membrane temperatures were recorded pre-operatively and every 15 min postoperatively in the recovery room until discharge to the ward. Also recorded were all anaesthetic data including fluid administration, methods of temperature preservation used, sedation scores and shivering (using a four-point scale). The overall incidence of shivering was 14.4%. Multiple regression analysis identified three factors that were significantly related to shivering: age, the administration of atropine and peri-operative temperature changes. Children who shivered rewarmed faster in the recovery room.
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Affiliation(s)
- B Lyons
- Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin
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48
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Abstract
The aim of this study was to assess whether passive smoking affected the frequency of airway complications in children undergoing general anaesthesia. One hundred and twenty-five children undergoing general anaesthesia for elective daycase surgery were monitored for adverse respiratory events and desaturation during induction, intra-operatively and in the recovery room. Oxygen saturation was monitored throughout and a venous sample was taken for estimation of carboxyhaemoglobin levels. Parents were asked to fill in a questionnaire detailing their smoking habits. Sixty-three of the children were passive smokers with a potential daily exposure varying from 5-130 cigarettes. There was no difference in the frequency of respiratory events between passive smokers and those not exposed to cigarette smoke at induction or intra-operatively. However, in the recovery room, desaturation was significantly more common in passive smokers (p < 0.02). This was related to the cumulative number of cigarettes smoked by individuals to whom the child was exposed (p < 0.05). Neither carboxyhaemoglobin levels nor domiciliary address were predictive of desaturation. This study suggests that passive smoking contributes to postoperative arterial oxygen desaturation following general anaesthesia in children.
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Affiliation(s)
- B Lyons
- Department of Anaesthesia, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Abstract
One hundred and fifty ASA 1 and 2 patients were randomly allocated to receive pethidine 25 mg (1 ml), lignocaine 10 mg (1 ml) or 0.9% saline (1 ml) on a double-blind basis, as pretreatment to reduce pain on injection of propofol. Both active treatments were significantly better than placebo at preventing pain (p < 0.01). Lignocaine was most effective in preventing pain in men (p < 0.05) whilst pethidine was more effective in women (p < 0.05).
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Affiliation(s)
- B Lyons
- Department of Anaesthesia, Cappagh Orthopaedic Hospital, Dublin, Ireland
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Abstract
The case of an 11-year-old boy who suffered second and third degree burns to 78% of his body is reported. The large doses of morphine used as analgesia resulted in severe side effects: ventilatory dependence, impairment of gastrointestinal function and psychological disturbance. Intravenous lignocaine was added without benefit. The addition of low-dose intravenous clonidine, however, precipitated a dramatic reduction in morphine consumption with an attendant improvement in ventilatory, gastrointestinal and psychological functions.
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Affiliation(s)
- B Lyons
- Dept. of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland
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