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Li K, Hüsing A, Fortner RT, Tjønneland A, Hansen L, Dossus L, Chang-Claude J, Bergmann M, Steffen A, Bamia C, Trichopoulos D, Trichopoulou A, Palli D, Mattiello A, Agnoli C, Tumino R, Onland-Moret NC, Peeters PH, Bueno-de-Mesquita HB, Gram IT, Weiderpass E, Sánchez-Cantalejo E, Chirlaque MD, Duell EJ, Ardanaz E, Idahl A, Lundin E, Khaw KT, Travis RC, Merritt MA, Gunter MJ, Riboli E, Ferrari P, Terry K, Cramer D, Kaaks R. An epidemiologic risk prediction model for ovarian cancer in Europe: the EPIC study. Br J Cancer 2015; 112:1257-65. [PMID: 25742479 PMCID: PMC4385951 DOI: 10.1038/bjc.2015.22] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/22/2014] [Accepted: 12/29/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ovarian cancer has a high case-fatality ratio, largely due to late diagnosis. Epidemiologic risk prediction models could help identify women at increased risk who may benefit from targeted prevention measures, such as screening or chemopreventive agents. METHODS We built an ovarian cancer risk prediction model with epidemiologic risk factors from 202,206 women in the European Prospective Investigation into Cancer and Nutrition study. RESULTS Older age at menopause, longer duration of hormone replacement therapy, and higher body mass index were included as increasing ovarian cancer risk, whereas unilateral ovariectomy, longer duration of oral contraceptive use, and higher number of full-term pregnancies were decreasing risk. The discriminatory power (overall concordance index) of this model, as examined with five-fold cross-validation, was 0.64 (95% confidence interval (CI): 0.57, 0.70). The ratio of the expected to observed number of ovarian cancer cases occurring in the first 5 years of follow-up was 0.90 (293 out of 324, 95% CI: 0.81-1.01), in general there was no evidence for miscalibration. CONCLUSION Our ovarian cancer risk model containing only epidemiological data showed modest discriminatory power for a Western European population. Future studies should consider adding informative biomarkers to possibly improve the predictive ability of the model.
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Affiliation(s)
- K Li
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hüsing
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - R T Fortner
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Tjønneland
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Hansen
- The Danish Cancer Society Research Center, Copenhagen, Denmark
| | - L Dossus
- Inserm, Centre for research in Epidemiology and Population Health (CESP), U1018, Nutrition, Hormones and Women's Health team, F-94805 Villejuif, France
- University Paris Sud, UMRS 1018, F-94805 Villejuif, France
| | - J Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Bergmann
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - A Steffen
- German Institute of Human Nutrition in Potsdam-Rehbruecke, Potsdam, Germany
| | - C Bamia
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - D Trichopoulos
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - A Trichopoulou
- Bureau of Epidemiologic Research, Academy of Athens, Athens, Greece
- Hellenic Health Foundation, Athens, Greece
| | - D Palli
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute—ISPO, Florence, Italy
| | - A Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, University of Naples Federico II, Naples, Italy
| | - C Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - R Tumino
- Cancer Registry and Histopathology Unit, ‘Civic—M.P. Arezzo' Hospital, Ragusa, Italy
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Peeters
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - H B(as) Bueno-de-Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - I T Gram
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - E Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Sánchez-Cantalejo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria de Granada (Granada.ibs), Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - M-D Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain
| | - E J Duell
- Unit of Nutrition, Environment and Cancer Epidemiology Research Program, Bellvitge Biomedical Research Institute (IDIBELL), Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - E Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarre Public Health Institute, Pamplona, Spain
| | - A Idahl
- Department of Clinical Sciences, Obstetrics and Gynecology and Department of Public Health and Clinical Medicine, Nutritional Research Umeå University, Umeå, Sweden
| | - E Lundin
- Department of Medical Biosciences, Pathology Umeå University, Umeå, Sweden
| | - K-T Khaw
- University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - R C Travis
- Cancer Epidemiology Unit, Nuffield Department of Population Health University of Oxford, Oxford, UK
| | - M A Merritt
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - M J Gunter
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - E Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, UK
| | - P Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - K Terry
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - D Cramer
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - R Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Bossley CJ, Cramer D, Mason B, Hayward A, Smyth J, McKee A, Biddulph R, Ogundipe E, Jaffé A, Balfour-Lynn IM. Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2012; 97:F199-203. [PMID: 21785127 DOI: 10.1136/adc.2011.212001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO(2)) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown. METHODS Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO(2) of 0.15 for 20 min. A 'failed' test was defined as oxygen saturation (SpO(2)) <90% for at least 2 min. RESULTS 41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO(2) (median -6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO(2) dropped further during feeding (median -4% in term and -2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002). CONCLUSIONS Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.
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Zappala CJ, Desai SR, Copley SJ, Spagnolo R, Cramer D, Sen D, Alam SM, du Bois RM, Hansell DM, Wells AU. Optimal scoring of serial change on chest radiography in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2011; 28:130-138. [PMID: 22117504] [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: 05/31/2023]
Abstract
BACKGROUND The optimal means of quantifying change on chest radiography in sarcoidosis is uncertain. In current guidelines, the role of serial measurement of carbon-monoxide diffusing capacity (DLco) remains undefined and the prevalence of discordance between serial chest radiographic change and pulmonary function tends is unknown. OBJECTIVE To identify and explore key uncertainties in the monitoring of sarcoidosis by serial pulmonary function tests and chest radiography. DESIGN 354 patients with sarcoidosis and concurrent tests (chest radiography and PFTs within three months at baseline, two years and/or four years) were studied. Chest radiographs were assessed by two radiologists for changes in stage and disease extent. Radiographic change and pulmonary function trends were quantified and compared. RESULTS Change in radiographic extent of lung disease was always more frequent than change in stage (p < 0.0001) and there was poor agreement between change in stage and change in radiographic extent (Kw = 0.21 at two years; Kw = 0.23 at four years). Change in disease extent on chest radiography was linked to PFT trends on analysis of variance (p < 0.0005 for FEV1, FVC, DLco), whereas change in radiographic stage was not. Changes in gas transfer were often isolated or discordant with other serial data. Discordance between pulmonary function data and chest radiographic data was observed in 50% of cases. CONCLUSIONS Change in radiographic extent is more applicable to routine monitoring in sarcoidosis than change in radiographic stage. In future guidelines, the role of serial gas transfer estimation and reconciliation of divergent chest radiographic and functional trends might usefully be addressed.
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Affiliation(s)
- C J Zappala
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
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Skipworth JRA, Puthucheary Z, Raptis DA, Rawal J, Shrikrishna D, Windsor J, Cramer D, Polkey MI, Montgomery HE, Hopkinson NS. Effect of acute hypoxia on QTc interval in respiratory patients undergoing fitness to fly tests. Thorax 2010; 66:726-7. [DOI: 10.1136/thx.2010.151712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Corte TJ, Wells AU, Gatzoulis MA, Cramer D, Ward S, Macdonald PS, Dimopoulos K, Wort SJ. Non-invasive assessment of pulmonary blood flow using an inert gas rebreathing device in fibrotic lung disease. Thorax 2010; 65:341-5. [DOI: 10.1136/thx.2009.121129] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pryor JA, Tannenbaum E, Scott SF, Burgess J, Cramer D, Gyi K, Hodson ME. Beyond postural drainage and percussion: Airway clearance in people with cystic fibrosis. J Cyst Fibros 2010; 9:187-92. [PMID: 20153269 DOI: 10.1016/j.jcf.2010.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 12/29/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Evidence indicates that there are no statistically significant differences in effectiveness among the airway clearance techniques (ACTs) of active cycle of breathing, autogenic drainage, positive expiratory pressure (PEP) or oscillating PEP in the short-term, but are there differences in the long-term (one year)? The objective of the study was to demonstrate non-inferiority in the long-term. METHODS Seventy-five people with cystic fibrosis entered the prospective, randomised controlled trial of these five different ACTs. The primary outcome measure was forced expiratory volume in one second (FEV(1)). Secondary outcome measures included exercise capacity and health related quality of life. RESULTS Using intention to treat, data were available on 65 subjects at the end of the study period. There were no statistically significant differences among the regimens in the primary outcome measurement of FEV(1) (p=0.35). CONCLUSION In different countries either one or several airway clearance regimens are used. This study provides evidence in support of current practices.
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Affiliation(s)
- J A Pryor
- Department of Cystic Fibrosis, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, UK
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Zappala CJ, Latsi PI, Nicholson AG, Colby TV, Cramer D, Renzoni EA, Hansell DM, du Bois RM, Wells AU. Marginal decline in forced vital capacity is associated with a poor outcome in idiopathic pulmonary fibrosis. Eur Respir J 2009; 35:830-6. [PMID: 19840957 DOI: 10.1183/09031936.00155108] [Citation(s) in RCA: 236] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In therapeutic studies in idiopathic pulmonary fibrosis (IPF), the low prevalence of significant change in pulmonary functional tests (PFTs) has been a major constraint. The prognostic value of "marginal" changes in PFTs in IPF and fibrotic non-specific interstitial pneumonia (NSIP) was evaluated. In patients with biopsy-proven IPF (n = 84) and NSIP (n = 72), forced vital capacity (FVC) and diffusing capacity of the lung for carbon monoxide (D( L,CO)) trends at 6 months were categorised as "significant" (FVC >10%; D(L,CO) >15%) or "marginal" (FVC 5-10%; D(L,CO) 7.5-15%). Proportional hazards analysis and time-dependent receiver operating characteristic methodology were used to examine PFT trends against mortality. In IPF, reductions in FVC were significant in 22 cases (26%) and marginal in 19 cases (23%). Mortality was higher in patients with a significant decline in FVC (hazard ratio (HR) 2.80, 95% CI 1.54-5.06; p<0.001) and those with a marginal decline in FVC (HR 2.31, 95% CI 1.19-4.50; p = 0.01) than in those with stable disease. Progression-free survival was lower when the decline in FVC was marginal than in stable disease (HR 2.34, 95% CI 1.19-4.60; p = 0.01). Marginal changes in D(L,CO) in IPF and marginal changes in FVC and D (L,CO) in fibrotic NSIP did not provide useful prognostic information. Marginal change in FVC in IPF denotes a poor outcome. These findings are applicable to clinical practice and to the selection of patients with more progressive disease for therapeutic studies.
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Affiliation(s)
- C J Zappala
- Royal Brompton Hospital and National Heart and Lung Institute, London, UK
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Boyce EA, Costaggini I, Vitonis A, Feltmate C, Muto M, Berkowitz R, Cramer D, Horowitz NS. The epidemiology of ovarian granulosa cell tumors: a case-control study. Gynecol Oncol 2009; 115:221-5. [PMID: 19664811 DOI: 10.1016/j.ygyno.2009.06.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/24/2009] [Accepted: 06/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study identified risk factors for ovarian granulosa cell tumors (GCT) through a case-control study comparing women with GCT to women with epithelial ovarian cancers (OC) and general population (GP) controls. METHODS Women with GCT and OC were identified from our hospital tumor board and the Massachusetts and New Hampshire Statewide Cancer Registries between January, 1988 and November, 2008. Age, gender and county matched GP controls were identified through town books in Massachusetts and drivers' license lists in New Hampshire. Epidemiologic factors including age, race, obesity, pregnancy history, smoking, and family history were evaluated. Odds ratio (OR) was calculated and adjusted for race and age. RESULTS Seventy-two women with GCT, 1578 GP controls, and 1511 OC controls were identified. Patients with GCT were significantly more likely to be non-white (OR 8.49; 4.07, 17.7), obese with a BMI >30 (OR 5.80; 3.01, 11.2), and have a family history of breast (OR 2.13; 1.19, 3.80) or ovarian cancer (OR 2.89; 1.08, 7.72) than GP controls. The risk of developing GCT was significantly decreased in women who smoked (OR 0.46; 0.27, 0.78), used oral contraceptive pills (OR 0.32; 0.17, 0.63) or were parous with 1-2 (OR 0.30; 0.16-0.56) or greater than 2 births (OR 0.50; 0.27, 0.94) when compared to GP controls. CONCLUSION These findings suggest an independent association between non-white race and obesity as a hyperestrogenic state in the development of GCT while parity and OCP use may be protective. An unknown familial predisposition for GCT may exist.
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Affiliation(s)
- E A Boyce
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, USA
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Ye B, Jiang W, Mok SC, Cramer D. Gingkolide B is a potential therapeutic agent in ovarian cancer through PAF-PAFR signaling pathways. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.16538] [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: 11/20/2022] Open
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Chesney J, Rasku M, Clem A, Telang S, Taft B, Gettings K, Gragg H, Cramer D, Lear S, McMasters KM, Miller DM. Transient T-cell depletion causes regression of melanoma metastases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
3060 Background: Bevacizumab (B-Mab) is a murine-derived monoclonal antibody with human IgG1 framework against vascular endothelial growth factor (VEGF). Soluble PGG β -glucan functions with complement activation product iC3b to activate complement receptor 3 (CR3) and recruit neutrophils and macrophages leading to CR3 (iC3b-receptor)-dependent cytotoxicity of tumors coated with iC3b. In mouse xenograft models, PGG β-glucan has a synergistic effect with human anti-tumor antibodies. Consequently, we hypothesized that the IgG1 antibody B-Mab is capable of binding surface VEGF (sVEGF) on tumor cells thereby activating complement, and synergizing with PGG β-glucan to elicit CR3-dependent cytotoxicity. Methods: SCID mouse xenografts with SKOV-3 human ovarian carcinoma cells were established in groups treated intravenously as follows: PBS treated as control (C), PGG β-glucan alone (B), B-Mab alone (A) and combination PGG β-glucan + B-Mab (B+A), twice weekly for 4 weeks. After implantation, tumors were allowed to grow until they were 300 mm3 before treatment. Results: SKOV-3 tumors in SCID mice showed sVEGF expression and had a complement deposition after B-Mab treatment. In vitro CR3-dependent cytotoxicity assay of B-Mab alone and B-Mab plus active moiety of β-glucan resulted in 0.2% and 19% cytotoxicity respectively. Tumor-bearing SCID mice treated with combination (A+B) showed significant difference in tumor growth inhibition and long-term survival as compared to the other treated groups. Moreover, neutrophil infiltration was markedly increased in the combination (A+B) group compared to the other groups. Conclusions: We have shown that combination treatment with bevacizumab and β -glucan imparts synergistic tumor cytotoxicity that achieves growth inhibition of VEGF-expressing tumor in vivo. Combination therapy should be considered as a potential therapeutic approach in patients with sVEGF positive tumors. (Supported by NIH grant RO1 CA86412 and gift research fund from Biothera, Inc.) No significant financial relationships to disclose.
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Affiliation(s)
- C. Salvador
- J.G. Brown Cancer Center, Univeristy of Louisville, Louisville, KY
| | - B. Li
- J.G. Brown Cancer Center, Univeristy of Louisville, Louisville, KY
| | - R. Hansen
- J.G. Brown Cancer Center, Univeristy of Louisville, Louisville, KY
| | - D. Cramer
- J.G. Brown Cancer Center, Univeristy of Louisville, Louisville, KY
| | - J. Yan
- J.G. Brown Cancer Center, Univeristy of Louisville, Louisville, KY
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Cramer D. The Commitment of Geneva's Youth for International Relations and Humanitarian Action. Refugee Survey Quarterly 2007. [DOI: 10.1093/rsq/hdi0292] [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: 11/13/2022]
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Pryor J, Tannenbaum E, Cramer D, Scott S, Burgess J, Gyi K, Hodson M. 347 A comparison of five airway clearance techniques in the treatment of people with Cystic Fibrosis. J Cyst Fibros 2006. [DOI: 10.1016/s1569-1993(06)80294-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Unstead M, Stearn MD, Cramer D, Chadwick MV, Wilson R. An audit into the efficacy of single use bacterial/viral filters for the prevention of equipment contamination during lung function assessment. Respir Med 2005; 100:946-50. [PMID: 16242312 DOI: 10.1016/j.rmed.2005.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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] [Received: 07/21/2005] [Revised: 09/05/2005] [Accepted: 09/09/2005] [Indexed: 11/15/2022]
Abstract
Lung function testing has been suggested to provide a potential risk regarding cross-infection between patients. About 155 patients (86 infectious, 69 non-infectious) used a single use bacterial/viral filter when performing routine lung function tests. Swabs from the patient side of the filter (Proximal) and the equipment side (Distal), and two sections of the filter itself were cultured. About 33/155 samples showed bacterial growth on the Proximal compared with 2/155 on the Distal side (P<0.01). Growth was obtained from the filter in 125/155 (80.6%) of cases. Pathogenic micro-organisms such as Pseudomonas aeruginosa (4 cases) and Staphylococcus aureus (5 cases) were isolated. Appropriate infection control measures should be used when performing lung function tests.
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Affiliation(s)
- M Unstead
- Lung Function Department, Royal Brompton Hospital, Fulham Road, London SW3 6HP, UK.
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Paredi P, Caramori G, Cramer D, Ward S, Ciaccia A, Papi A, Kharitonov SA, Barnes PJ. Slower rise of exhaled breath temperature in chronic obstructive pulmonary disease. Eur Respir J 2003; 21:439-43. [PMID: 12661998 DOI: 10.1183/09031936.03.00061902] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [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: 11/05/2022]
Abstract
In chronic obstructive pulmonary disease (COPD) there is decreased vascularity of the bronchi and inflammation of the airways that may have opposite effects on the regulation of heat loss. Exhaled air temperature increase (delta(e) T) was measured in 23 patients with moderate COPD (18 male, mean age +/- SEM 70 +/- 1 yrs; forced expiratory volume in one second (FEV1) 45 +/- 3%, FEV1/forced vital capacity 54 +/- 4%) and 16 normal volunteers (64 +/- 4 yr) and compared to exhaled nitric oxide (eNO) and inflammatory cells in induced sputum as a marker of airway inflammation. Delta(e) T was measured during a flow- and pressure-controlled single exhalation with a fast-response thermometer. delta(e) T was reduced in patients with COPD (1.86 +/- 0.15 delta C x s(-1)) compared to normal subjects (4.00 +/- 0.26 delta C x s(-1)). There was no difference in delta(e) T between patients treated with inhaled steroids and those who were steroid naïve. Delta(e) T was correlated with eNO (r=0.60) but not with sputum neutrophilia. In COPD patients, delta(e) T was increased (2.26 +/- 0.16 delta C x s(-1)) after the inhalation of 200 microg of albuterol, which is a known vasodilator, indicating that delta(e) T and bronchial blood flow may be correlated. Exhaled temperature increase is reduced in chronic obstructive pulmonary disease patients and is increased by the inhalation of vasodilators and therefore may be related to changes of bronchial blood flow and tissue remodelling.
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Affiliation(s)
- P Paredi
- Dept of Thoracic Medicine, Imperial College School of Medicine at the National Heart and Lung Institute and Lung Function Unit, Royal Brompton Hospital, London, UK
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Hart N, Cramer D, Ward SP, Nickol AH, Moxham J, Polkey MI, Pride NB. Effect of pattern and severity of respiratory muscle weakness on carbon monoxide gas transfer and lung volumes. Eur Respir J 2002; 20:996-1002. [PMID: 12412695 DOI: 10.1183/09031936.00.00286702] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [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: 11/05/2022]
Abstract
In clinical practice, an elevated carbon monoxide (CO) transfer coefficient (KCO) and restrictive ventilatory defect are taken as features of respiratory muscle weakness (RMW). However, the authors hypothesised that both pattern and severity of RMW effect gas transfer and lung volumes. Measurements of CO transfer and lung volumes were performed in patients with isolated diaphragm weakness (n=10), inspiratory muscle weakness (n=12), combined inspiratory and expiratory muscle weakness (n=5) and healthy controls (n=6). Patients with diaphragm weakness and inspiratory muscle weakness had reduced total lung capacity (TLC) (83.6% predicted and 68.9% pred, respectively), functional residual capacity (FRC) (83.9% pred and 83.6% pred) and transfer factor of the lung for CO (TL,CO) (86.2% pred and 66.2% pred) with increased KCO (114.1% pred and 130.2% pred). Patients with combined inspiratory and expiratory muscle weakness had reduced TLC (80.9% pred) but increased FRC (109.9% pred) and RV (157.4% pred) with decreased TL,CO (58.0% pred) and KCO (85.5% pred). In patients with diaphragm weakness, the increase in carbon monoxide transfer coefficient was similar to that of normal subjects when alveolar volume was reduced. However, the increase in carbon monoxide transfer coefficient in inspiratory muscle weakness was often less than expected, while in combined inspiratory and expiratory muscle weakness, the carbon monoxide transfer coefficient was normal/reduced despite further reductions in alveolar volume, which may indicate subtle abnormalities of the lung parenchyma or pulmonary vasculature. Thus, this study demonstrates the limitations of using carbon monoxide transfer coefficient in the diagnosis of respiratory muscle weakness, particularly if no account is taken of the alveolar volume at which the carbon monoxide transfer coefficient is made.
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Cramer D. The clinical utility of arterialized earlobe capillary blood in the assessment of patients for long-term oxygen therapy (Respir Med 2001; 95: 655-660). Respir Med 2002; 96:204; author reply 204. [PMID: 11905554 DOI: 10.1053/rmed.2001.1244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
BACKGROUND We have previously suggested that it is possible to predict oxygen desaturation during flight in children with cystic fibrosis and chronic lung disease by non-invasive measurement of oxygen saturation following inhalation of 15% oxygen--the pre-flight hypoxic challenge. This study reports on the results of measurements over 5 years. METHODS The study comprised a pre-flight hypoxic challenge measuring oxygen saturation by finger tip pulse oximetry (SpO(2)) during tidal breathing of 15% oxygen in nitrogen and spirometric testing 1 month before the flight followed by SpO(2) measurements during intercontinental flights to and from holidays abroad with children in wake and sleep states. RESULTS Pre-flight tests were completed on 87 children with cystic fibrosis. Desaturation of <90% occurred in 10 children at some stage during the flight, three of whom received supplementary oxygen. Using a cut off SpO(2) of 90%, the pre-flight hypoxic challenge correctly predicted desaturation in only two of these children. The sensitivity and specificity of the pre-flight hypoxic challenge were 20% and 99%, respectively, compared with 70% and 96% for spirometric tests (using a cut off for forced expiratory volume in 1 second (FEV(1)) of <50% predicted). Overall, pre-flight spirometric tests were a better predictor of desaturation during flight with the area under the Receiver Operating Characteristic (ROC) curve of 0.89 compared with 0.73 for the hypoxic challenge test. CONCLUSIONS In this group of subjects pre-flight spirometric testing was a better predictor of desaturation during flight than the pre-flight hypoxic challenge.
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Affiliation(s)
- R M Buchdahl
- Royal Brompton & Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
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20
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Abstract
The Powerbreathe is an inspiratory muscle trainer promoted as improving inspiratory muscle strength (and consequently exercise performance) in athletes and patients with respiratory disease. No published evidence supports its efficacy. We performed a prospective randomized controlled study in which 12 normal subjects received either Powerbreathe training or sham training for a 6-week period. The primary outcome measure was diaphragm strength evaluated as twitch transdiaphragmatic pressure (Tw Pdi) but secondary outcome measures were provided by full respiratory muscle assessment and cardiopulmonary exercise testing. An advantage to training was observed when outcome was assessed by maximal static inspiratory mouth pressure (mean advantage 14.5 cm H2O, 95% CI 2.2-26.9 cm H2O, P=0.025). However. no significant difference was observed between the groups in any other parameter. In particular the deltaTw Pdi was not different between groups (mean 'advantage' 0.7 cmH2O, 95% CI- 7.0+/-5.5 cmH2O, P=0.8). The continued sale and use of the Powerbreathe device is not justified by our data. A sample size calculation showed that 234 subjects would need to be randomized to definitively refute the hypothesis that Powerbreathe improves Tw Pdi and we argue that such a study is required.
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Affiliation(s)
- N Hart
- Respiratory Muscle Laboratories, Royal Brompton and Kings College Hospitals, London, UK
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21
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Abstract
In this cross-sectional study of 92 romantic relationships, both the S. S. Hendrick (1988) Relationship Assessment Scale and a 16-item negative conflict scale were independently associated with the consensus items of the Short Marital Adjustment Test (H. J. Locke & K. M. Wallace, 1959), but not with change from initial to present consensus. However, consensus change was significantly correlated with relationship satisfaction and negative conflict in those reporting decreased consensus or no change but not increased consensus. Furthermore, relationship satisfaction was accounted for solely by negative conflict in the increased consensus group and by present consensus in the decreased consensus group. These results suggest that the association of relationship satisfaction with consensus and negative conflict may differ according to perceived consensus change.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, Leicestershire, England.
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Hauer KE, Winawer N, Gillock MR, Cramer D, Kefalides PT. Update in hospital medicine. Ann Intern Med 2000; 133:707-13. [PMID: 11074904 DOI: 10.7326/0003-4819-133-9-200011070-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- K E Hauer
- University of California, San Francisco, Box 0320, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
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Paredi P, Kharitonov SA, Leak D, Ward S, Cramer D, Barnes PJ. Exhaled ethane, a marker of lipid peroxidation, is elevated in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 162:369-73. [PMID: 10934055 DOI: 10.1164/ajrccm.162.2.9909025] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ethane is a product of lipid peroxidation and can be measured in the exhaled air as an index of oxidative stress. Oxidant/antioxidant imbalance is important in the pathogenesis of chronic obstructive pulmonary disease (COPD). Therefore, we measured exhaled ethane in 22 patients with COPD (mean age +/- SEM, 59 +/- 8 yr; 19 male) and compared it with other noninvasive markers of oxidative stress and inflammation such as carbon monoxide (CO), measured electrochemically, and nitric oxide (NO), measured by chemiluminescence. Exhaled ethane was collected during a flow and pressure-controlled exhalation into a reservoir, discarding dead space air contaminated with ambient air. A sample of the collected expired air was analyzed by chromatography. Compared with normal subjects (n = 14; eight men; age, 33 +/- 2.8 yr), patients with COPD not on steroid treatment (n = 12; FEV(1), 58 +/- 6%) had elevated levels of exhaled ethane (2.77 +/- 0.25 and 0.88 +/- 0.09 ppb, respectively, p < 0.05), CO (5.96 +/- 0.50 and 2.8 +/- 0.25 ppm, p < 0.05) and NO (11.86 +/- 0.53 and 6.77 +/- 0.50 ppb, p < 0.05) levels. Ethane was correlated to FEV(1) (r = -0.67, p < 0.05). Patients receiving steroid treatment (n = 10; FEV(1), 56 +/- 2%) had lower levels of ethane (0.48 +/- 0.05 ppb) than did steroid-treated patients, whereas CO (5.99 +/- 0.63 ppm) and NO (9.11 +/- 0.53 ppb) levels were similar in the two treatment groups. Exhaled ethane is elevated, correlates with FEV(1), and is significantly lower in patients treated with steroids, so it may be complementary to the use of NO and CO in assessing and monitoring oxidative stress in COPD.
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Affiliation(s)
- P Paredi
- Department of Thoracic Medicine, Imperial College School of Medicine at the National Heart and Lung Institute, Department of Biochemistry, Imperial College of Science, Technology and Medicine, and Lung Function Unit, Royal Brompton Hospital, London
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Abstract
The aim of this study was to determine to what extent the association between relationship satisfaction and a negative conflict style in romantic relationships may be due to the frequency of conflict or of conflict not satisfactorily resolved. The 6-item Relationship Assessment Scale (S. S. Hendrick, 1988) and an 11-item conflict scale created by the author for this study were completed by a group of young British adults (65 women and 30 men) concerning their current romantic relationships, all of which were heterosexual. The results confirmed that a negative conflict style was significantly associated with relationship satisfaction when either conflict or conflict not satisfactorily resolved was controlled. Conflict not satisfactorily resolved was also significantly correlated with relationship satisfaction when either conflict or a negative conflict style was controlled. Conflict and a negative conflict style were also significantly correlated with relationship duration.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, Leicestershire, England.
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Paredi P, Kharitonov SA, Leak D, Shah PL, Cramer D, Hodson ME, Barnes PJ. Exhaled ethane is elevated in cystic fibrosis and correlates with carbon monoxide levels and airway obstruction. Am J Respir Crit Care Med 2000; 161:1247-51. [PMID: 10764319 DOI: 10.1164/ajrccm.161.4.9906122] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [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: 11/16/2022] Open
Abstract
Ethane is produced from lipid peroxidation and can be measured in the exhaled air. Cystic fibrosis (CF) is characterized by recurrent respiratory infections, release of reactive oxygen species by inflammatory cells, and increased oxidative stress. We measured exhaled ethane in 23 CF subjects (mean age +/- SEM, 21 +/- 4 yr; 10 male, FEV(1) 62 +/- 4%) and compared it with two other noninvasive markers of oxidative stress and inflammation, carbon monoxide (CO) and nitric oxide (NO). Exhaled ethane was collected during a flow and pressure-controlled exhalation into a reservoir discarding dead space air contaminated with ambient air. A sample (2 ml) of the expired air was analyzed by chromatography. Ethane levels were elevated in patients not on steroids (n = 13, 1.99 +/- 0.20 ppb) compared with steroid-treated patients (n = 10, 0.67 +/- 0.09 ppb, p < 0.01) and with 14 nonsmoking control (8 men, age 33 +/- 2.8 yr) subjects (0.82 +/- 0.40 ppb, p < 0.05). In patients not on steroid treatment ethane was correlated to airway obstruction as assessed by the ratio of residual volume to total lung capacity (RV/ TLC) (r = 0. 66, p < 0.05) and exhaled CO (r = 0.65, p < 0.05). CO concentrations were also higher in patients not on steroid treatment (3.4 +/- 0.2 ppm) than in steroid-treated patients (2.6 +/- 0.1 ppm, p < 0.05), whereas NO concentrations were not influenced by steroid treatment (3.0 +/- 0.4 ppm and 2.9 +/- 0.2 ppm, p > 0.05) and were lower than in a control group (7.0 +/- 0.4 ppb, p < 0.05). Exhaled ethane is elevated in CF, reduced in steroid-treated patients and correlates with CO and RV/TLC; therefore, it may be a useful noninvasive marker of oxidative stress.
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Affiliation(s)
- P Paredi
- Department of Thoracic Medicine, National Heart and Lung Institute, London, UK
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Abstract
The authors investigated (a) whether increased closeness and decreased closeness of a relationship are associated with better and poorer psychological health, respectively; and (b) whether poorer psychological health is related to perceiving oneself or to perceiving the other person as primarily responsible for decreased closeness. A sample of English undergraduate students (52 female, 52 male; 16-23 years of age) completed M. Rosenberg's (1965) Self-Esteem Scale, D. P. Goldberg's (1972) 12-item General Health Questionnaire, and a 6-item scale developed for this study to measure change in closeness and to identify the initiator(s) of the change. Decreased closeness was related to poorer psychological health in male participants' platonic relationships and in female participants' romantic relationships. Poorer psychological health was associated with (a) perceiving the other person as responsible for decreased closeness in male participants' platonic relationships and (b) perceiving both parties as mutually responsible for decreased closeness in female participants' romantic relationships.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, Leicestershire, England
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Nozawa S, Wu GD, Gochi E, Wakiyama S, Sandrin M, McKenzie IF, Xing PX, Starnes V, Cramer D. ANALYSIS OF IMMUNOGLOBULIN VH GENES ENCODING GALACTOSE-α(1,3)GALACTOSE ANTIBODIES IN GAL K/O MICE. Transplantation 1999. [DOI: 10.1097/00007890-199904150-00531] [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: 11/25/2022]
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Abstract
The phenomenon of depressive realism was examined in relation to the future prediction of positive and negative life events. A group of dysphoric (n = 20) and nondepressed (n = 38) British undergraduates participated in a prospective study lasting 3 months. Partly consistent with the depressive realism hypotheses, dysphoric participants were more realistic concerning the negative life events they would experience, but they were less realistic concerning the negative life events they would not experience. Although no difference was found for predicting the occurrence of positive life events, dysphoric participants were found to be more realistic concerning positive life events that they would not experience.
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Affiliation(s)
- E G Kapçi
- Faculty of Educational Sciences, Ankara University, Turkey
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Paredi P, Loukides S, Ward S, Cramer D, Spicer M, Kharitonov SA, Barnes PJ. Exhalation flow and pressure-controlled reservoir collection of exhaled nitric oxide for remote and delayed analysis. Thorax 1998; 53:775-9. [PMID: 10319060 PMCID: PMC1745326 DOI: 10.1136/thx.53.9.775] [Citation(s) in RCA: 43] [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] [Indexed: 11/03/2022]
Abstract
BACKGROUND Expiratory flow rate, soft palate closure, and dead space air may influence exhaled levels of nitric oxide (NO). These factors have not been evaluated in the reservoir collection of NO. METHODS Exhaled NO was collected into a reservoir during a single flow and pressure controlled exhalation. RESULTS NO collected in a reservoir containing silica gel was stable for 24 hours. Nasally delivered 4.8% argon measured by mass spectrometry did not contaminate exhaled argon levels (0.1 (0.02)%) in five volunteers during exhalation against a resistance (10 (0.5) cmH2O), hence proving an effective soft palate closure. Exhaled NO in the reservoir was 11 (0.2) ppb, 8.6 (0.1) ppb, 7.1 (0.6) ppb, and 6.6 (0.4) ppb in five normal subjects and 48.3 (18) ppb, 20.3 (12) ppb, 16.9 (0.3) ppb and 10.1 (0.4) ppb in 10 asthmatic subjects at four studied expiratory flows (5-6, 7-8, 10-11, and 12-13 l/min, respectively), with NO levels equal to direct measurement (7.3 (0.5) ppb and 17.4 (0.5) ppb for normal and asthmatic subjects respectively, p < 0.05) at the flow rate 10-11 l/min. Elimination of dead space proved necessary to provide NO levels comparable to the direct measurement. Exhaled NO collected into the reservoir without dead space during flow controlled exhalation against mild resistance provided close agreement (mean (SD) difference -0.21 (0.68), coefficient of variation 4.58%) with direct measurement in 74 patients (NO range 1-69 ppb). CONCLUSIONS Flow and pressure controlled collection of exhaled NO into a reservoir with silica gel provides values identical to the direct measurement and may be used to monitor asthma at home and where analysers are not on site.
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Affiliation(s)
- P Paredi
- Department of Thoracic Medicine, Imperial College School of Medicine, National Heart and Lung Institute, London, UK
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Wells AU, Hansell DM, Rubens MB, King AD, Cramer D, Black CM, du Bois RM. Fibrosing alveolitis in systemic sclerosis. Indices of lung function in relation to extent of disease on computed tomography. ACTA ACUST UNITED AC 1997. [DOI: 10.1002/art.1780400706] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wells AU, Hansell DM, Rubens MB, King AD, Cramer D, Black CM, du Bois RM. Fibrosing alveolitis in systemic sclerosis: indices of lung function in relation to extent of disease on computed tomography. Arthritis Rheum 1997; 40:1229-36. [PMID: 9214422 DOI: 10.1002/1529-0131(199707)40:7<1229::aid-art6>3.0.co;2-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Thin-section computed tomography (CT) provides a sensitive and reproducible method of quantifying the morphologic extent of disease in the clinical management of fibrosing alveolitis associated with systemic sclerosis (FASSc). The aim of this study was to determine which indices of lung function best reflect the extent of disease on CT in FASSc, and to determine the independent influences of smoking history, extent of fibrosing alveolitis, demographic features, and concurrent treatment upon functional impairment in FASSc. METHODS Sixty-four patients with FASSc were studied using CT and static and exercise lung function testing. Statistical relationships were determined by multiple regression analyses. RESULTS Five patients with overt pulmonary hypertension were characterized by severe impairment in 3 indices of lung function: diffusing capacity for carbon monoxide (DLCO), DLCO adjusted for alveolar volume (KCO), and arterial partial pressure of oxygen. On multiple regression analysis, the major determinant of functional impairment was the extent of fibrosing alveolitis on CT. A history of smoking was independently associated with preservation of total lung capacity and depression of KCO, but did not otherwise influence functional-morphologic correlations. The percent predicted DLCO correlated better with extent of disease on CT (r = -0.70) than did oxygen desaturation on exercise (r = 0.55), the physiologic component of the clinical-radiographic-physiologic score (CRP index) (r = 0.52), or other indices of lung function. Lung volume measures correlated poorly with disease extent on CT. CONCLUSION The percent predicted DLCO best reflects the extent of fibrosing alveolitis in FASSc, and therefore should be measured in routine evaluations. Exercise testing may also have a useful role in staging the severity of pulmonary fibrosis, but the CRP index offers no additional advantage over the DLCO and exercise testing.
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Affiliation(s)
- A U Wells
- Green Lane Hospital, Auckland, New Zealand
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Wells AU, King AD, Rubens MB, Cramer D, du Bois RM, Hansell DM. Lone cryptogenic fibrosing alveolitis: a functional-morphologic correlation based on extent of disease on thin-section computed tomography. Am J Respir Crit Care Med 1997; 155:1367-75. [PMID: 9105081 DOI: 10.1164/ajrccm.155.4.9105081] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.0] [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: 02/04/2023] Open
Abstract
In most clinical series of patients with cryptogenic fibrosing alveolitis (CFA), disease severity is staged using lung function indices. However, many physiologic indices are measured in routine clinical practice; the choice of variable to evaluate functional severity is contentious. Computed tomography (CT) provides a reproducible means of quantifying the morphologic extent of disease. The aim of this study was to evaluate the functional consequences of smoking-related lung damage in CFA and to identify functional measures best reflecting the extent of fibrosing alveolitis on CT. Sixty-eight patients with CFA were studied. Fourteen patients with emphysema on CT were characterized by relative preservation of FVC and TLC (p < 0.005) and relative depression of DLCO (p < 0.05) and KCO (p < 0.00005). On multivariate analysis, the extent of fibrosing alveolitis and the presence of emphysema were independent determinants of functional impairment; there was no independent relationship between smoking history and functional abnormalities. In patients without emphysema on CT, percent predicted DLCO (r = -0.68), oxygen desaturation on exercise (r = 0.64), and the physiologic component of the clinical-radiographic-physiologic (CRP) score (r = 0.62) correlated much better with the extent of disease on CT than spirometric and plethysmographic volumes. A composite functional index was generated against the extent of disease on CT, using multivariate analysis; comparison with the CRP score suggested that the relationship between morphologic disease extent and the CRP score would be improved by the inclusion of DLCO and by the use of negative weighting for depression of FEV1. These findings indicate that in CFA, the presence of concurrent emphysema on CT has a more profound influence upon functional measures than the smoking history, and underline the importance of both the measurements of DLCO and exercise testing in the assessment of the severity of CFA.
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Affiliation(s)
- A U Wells
- Department of Radiology, Royal Brompton Hospital London, United Kingdom
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Cramer D. Post-traumatic stress counselling: benefit or indulgence? Br J Hosp Med (Lond) 1996; 56:567-8. [PMID: 8982481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Cramer D, Biondi-Sexton C. Operative procedure review with a multidisciplinary, patient-centered focus. J Nurs Care Qual 1996; 11:7-8. [PMID: 8936875 DOI: 10.1097/00001786-199610000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- D Cramer
- Kaiser Permanente Medical Center, Martinez, CA, USA
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Abstract
LISREL analyses with manifest variables were used to examine the causal relationship between mental health and adequacy of social integration and of attachment, measured at four consecutive waves each four months apart, in a representative sample of 225 adult residents in Canberra. Mental health was assessed with the 30-item General Health Questionnaire. The analyses suggest that while there is no temporal relationship between adequacy of attachment and mental health, adequacy of social integration is influenced by earlier mental health. The temporal relationship between adequacy of attachment and adequacy of social integration appears to be reciprocal.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, UK
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Rosenberg L, Bégaud B, Bergman U, Brown B, Buist AS, Cramer D, Daling J, Grimes D, Kemper F, Mills A. What are the risks of third-generation oral contraceptives? Are third-generation oral contraceptives safe? Hum Reprod 1996; 11:687-8. [PMID: 8724792 DOI: 10.1093/oxfordjournals.humrep.a019224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- L Rosenberg
- Slone Epidemiology Unit, Boston University School of Medicine, Brookline, Massachusetts, USA
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Abstract
BACKGROUND The aim of this study was to simulate an in flight environment at sea level with a fractional inspired concentration of oxygen (FiO2) of 0.15 to determine how much supplemental oxygen was needed to restore a subject's oxygen saturation (SaO2) to 90% or to the level previously attained when breathing room air (FiO2 of 0.21). METHODS Three groups were selected with normal, obstructive, and restrictive lung function. Using a sealed body plethysmograph an environment with an FiO2 of 0.15 was created and mass spectrometry was used to monitor the FiO2. Supplemental oxygen was administered to the patient by nasal cannulae. SaO2 was continuously monitored and recorded at an FiO2 of 0.21, 0.15, and 0.15 + supplemental oxygen. RESULTS When given 2 l/m of supplemental oxygen all patients in the 15% environment returned to a similar SaO2 value as that obtained using the 21% oxygen environment. One patient with airways obstruction needed 3 l/m of supplemental oxygen to raise his SaO2 above 90%. CONCLUSIONS This technique, which simulates an aircraft environment, enables an accurate assessment to be made of supplemental oxygen requirements.
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Affiliation(s)
- D Cramer
- Lung Function Unit, Royal Brompton Hospital, London, UK
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Newburn G, Edwards R, Thomas H, Collier J, Fox K, Collins C, Cramer D, Reeves J, Caracatsanis A. A comparison of the efficacy and tolerability of moclobemide given as a single daily dose or in three divided doses per day for the treatment of patients with a major depressive episode (DSM-III-R). J Clin Psychopharmacol 1995; 15:10S-15S. [PMID: 7593724 DOI: 10.1097/00004714-199508001-00003] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This was a prospective, double-blind, randomized, multicenter trial comparing moclobemide once daily (OD) with three times daily (TDS) dosing. The duration of the study was 6 weeks with the initial dose of moclobemide being 450 mg/day (either 450 mg in the morning or 150 mg three times daily). Placebo tablets were used to ensure that the study was double blind. After 2 weeks, the dose could be increased to 600 mg/day if tolerability was acceptable and efficacy was judged insufficient by the investigator. Patients were assessed at baseline and at days 3, 7, 14, 21, 28, and 42. Efficacy was primarily judged on the Hamilton Rating Scale for Depression (HAM-D) (17item). Patients had to score at least 17 to enter the study. Safety and tolerability were judged on reported adverse events, safety parameters, premature withdrawals, and a physicians' global tolerability rating. There were also three secondary efficacy parameters--the Hamilton Rating Scale for Anxiety, Visual Analogue Scales for pain and irritability, and physicians' Clinical Global Impression (CGI). A total of 130 evaluable patients were required to detect a difference of more than 20% (alpha = 0.05 and beta = 0.8) between groups. A total of 189 patients entered the study, and the standard analysis comprised 145 patients. The efficacies between the two dosing regimens as determined by the HAM-D score and from the CGI were found not to differ significantly. For the standard analysis population, there was a reduction in mean HAM-D of 73.8 and 72.9% for the OD and TDS groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G Newburn
- Rotorua Rehabilitation Centre, New Zealand
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39
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Tucker SM, Cramer D. Interdisciplinary care paths: creation to implementation. Nurs Qual Connect 1995; 5:6-7. [PMID: 7663364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Abstract
Partnering with the patient in the planning and delivery of care to achieve high-quality outcomes is a goal shared by health care providers. The achievement of a full partnership with the patient often varies based on the communication skills of individual nurses. To provide more consistency, Patient Standards of Care (SOCs) were created that are written from the patients' viewpoint in lay terms and are condition-specific. The content includes commitments of the health care team, patient care issues and concerns, what the team will do, what the patient can do, and outcome expectations. The end result is to promote the patients' engagement in their own care through the sharing of accountabilities for desired outcomes.
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Affiliation(s)
- D Cramer
- Kaiser Permanente Medical Center, Martinez, California
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Tucker SM, Cramer D. Partnering with patients for quality outcomes. Nurs Qual Connect 1995; 4:4. [PMID: 7767299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Williams NI, McArthur JW, Turnbull BA, Bullen BA, Skrinar GS, Beitins IZ, Besser GM, Rees LH, Gilbert I, Cramer D. Effects of follicular phase exercise on luteinizing hormone pulse characteristics in sedentary eumenorrhoeic women. Clin Endocrinol (Oxf) 1994; 41:787-94. [PMID: 7889615 DOI: 10.1111/j.1365-2265.1994.tb02794.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Current studies reveal little regarding the inception of exercise-induced LH changes during physical training. This study aimed to assess the susceptibility of the hypothalamic-pituitary axis to the acute physical stress of exercise in untrained, physically inactive women. The acute effects of submaximal endurance exercise upon the pulsatile LH secretion in the follicular phase were compared with those accompanying leisurely strolling for a similar time period. SUBJECTS All subjects were eumenorrhoeic, as determined by biphasic temperature patterns, detection of the urinary LH surge, and mid-luteal serum progesterone levels. Subjects were not physically active and had little history of strenuous exercise (VO2max = 38.0 +/- 1.8) (mean +/- SEM) ml/kg/min). DESIGN All women completed a 13.5-hour pulsatility test which included three consecutive 20-minute runs on a treadmill at 50, 60 and 70% of the subjects' maximum oxygen uptake (n = 16). Six of these same subjects completed a separate test on another occasion in which one hour of leisurely strolling was substituted for exercise. Blood was sampled every 10 minutes via an indwelling cannula for 4.5 hours before and 8 hours after one hour of exercise and or strolling. MEASUREMENTS A pulse algorithm (Pulsar) was used to quantify LH pulse characteristics. RESULTS Exercise produced no significant effects upon LH pulse frequency or mean serum LH concentration. However, exercise of moderate intensity caused a significant increase in LH pulse amplitude (P < 0.05). Strolling produced no significant changes in LH secretion. CONCLUSION Acute exercise of moderate intensity in the follicular phase of untrained women is an insufficient stimulus to inhibit the GnRH pulse generator in the post-exercise period, yet may produce a slight stimulatory effect on the amount of LH released per pulse.
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Affiliation(s)
- N I Williams
- Department of Endocrinology, St. Bartholomew's Hospital, London
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Abstract
The temporal relationship between psychological distress and Neuroticism, both measured at two points eight months apart, was examined in a representative sample of 225 adult residents in Canberra, using cross-lagged panel correlation and latent variable LISREL analysis. Psychological distress was assessed by the 30-item General Health Questionnaire (GHQ-30). Because the synchronous and autocorrelations differed significantly, the interpretation of the significant difference between the cross-lagged correlations was problematic. The cross-lagged path coefficients in the LISREL models were not significantly positive, suggesting that the temporal relationship between these two variables was spurious and due to error variance. The test-retest correlation was significantly higher for Neuroticism than for the GHQ-30, implying that Neuroticism is more a measure of a relatively stable personality characteristic and the GHQ-30 more one of transient psychological distress.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, Leicestershire, UK
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Hartge P, Whittemore AS, Itnyre J, McGowan L, Cramer D. Rates and risks of ovarian cancer in subgroups of white women in the United States. The Collaborative Ovarian Cancer Group. Obstet Gynecol 1994; 84:760-4. [PMID: 7936508] [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: 01/27/2023]
Abstract
OBJECTIVE To provide estimates of the age-adjusted incidence and lifetime risk of ovarian cancer in subgroups of women defined by key risk factors. METHODS We combined data from seven case-control studies (1122 cases and 5359 controls) with Surveillance, Epidemiology, and End Results incidence data to estimate the incidence rate and probability of developing ovarian cancer within subgroups of women defined according to the three major known risk factors: a history of ovarian cancer in the mother or sister, years of oral contraceptive (OC) use, and number of term pregnancies. RESULTS Among women with no family history of ovarian cancer, the risk at age 65 varied from 0.3% among those who had had three or more term pregnancies and 4 or more years of OC use, to 1.6% among nulliparous women with no OC use. Among women with a positive family history, the risk of developing ovarian cancer by age 65 was estimated as 4.4% and the lifetime risk as 9.4%. The data were too sparse to estimate the risks associated with OC use and pregnancy among women with a positive family history. CONCLUSIONS The risk of developing ovarian cancer within the total population of white women can be divided informatively into component risks within subpopulations. At birth, the estimated risk of developing ovarian cancer before age 65 for the total population is 0.8%, but the component risks vary 15-fold, from 0.3 to 4.4%.
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Affiliation(s)
- P Hartge
- Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Lau CC, Mok SC, Kelley A, Cramer D. Detection of a RsaI polymorphism within the human galactokinase gene (GK2) by PCR-SSCP. Hum Mol Genet 1994; 3:1916. [PMID: 7849734 DOI: 10.1093/hmg/3.10.1916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- C C Lau
- Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115
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Cramer D. Standardization of the measurement of transfer factor. Eur Respir J 1993. [DOI: 10.1183/09031936.93.06101577] [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: 11/16/2022]
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Cramer D. Standardization of the measurement of transfer factor. Eur Respir J 1993; 6:1577-8. [PMID: 8112455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Cramer D. Counselling: indications and results. Br J Hosp Med (Lond) 1993; 50:333-6. [PMID: 8242217] [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: 01/29/2023]
Abstract
There are a number of distinct theoretical approaches to counselling. The most influential are behavioural, cognitive-behavioural, psychodynamic and person-centered treatments. However, the factors responsible for the beneficial effects of treatment remain to be discovered.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University
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Cramer D, Kupshik G. Effect of rational and irrational statements on intensity and 'inappropriateness' of emotional distress and irrational beliefs in psychotherapy patients. Br J Clin Psychol 1993; 32:319-25. [PMID: 8251962 DOI: 10.1111/j.2044-8260.1993.tb01062.x] [Citation(s) in RCA: 12] [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: 01/29/2023]
Abstract
Ellis's rational-emotive theory postulates that since irrational statements augment emotional distress, replacing irrational with rational statements should lessen distress. This hypothesis was tested in the initial stages of psychotherapy by having 13 and 14 clinical out-patients respectively repeat for one minute either rational or irrational statements about their major presenting psychological problem. The distinction by Ellis & Harper (1975) that 'inappropriate' emotions differ qualitatively from 'appropriate' emotions was also examined. Although the experimental intervention had no effect on a post-test measure of irrational beliefs, patients repeating rational statements had significantly lower appropriate and inappropriate negative emotions at post-test, suggesting that inappropriate emotions do not differ qualitatively from appropriate emotions and that making rational statements may lower emotional distress in patients. Patients reiterating irrational statements showed no change in emotions, implying that these kinds of irrational cognitions may have already been present.
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Affiliation(s)
- D Cramer
- Department of Social Sciences, Loughborough University, UK
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