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McGoran J, Wilson A, McErlain S, Kennedy N, Masterson C, Collins C, Morrison G. Initiation of subcutaneous infliximab (Remsima) therapy for the treatment of inflammatory bowel disease during the COVID-19 pandemic. Frontline Gastroenterol 2021; 13:89-90. [PMID: 34966537 PMCID: PMC8666859 DOI: 10.1136/flgastro-2020-101760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/08/2021] [Accepted: 04/18/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- John McGoran
- Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
| | - Alan Wilson
- Pharmacy, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Noreen Kennedy
- Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Caroline Collins
- Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
| | - Graham Morrison
- Gastroenterology, Belfast Health and Social Care Trust, Belfast, UK
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Feeney S, Turner G, Murphy S, Tham T, Jacob G, Morrison G, Watson P, Kelly P, Patterson L, Coyle PV. A retrospective regional audit of Cytomegalovirus (CMV) laboratory diagnostics in Crohn’s/Colitis patients in Northern Ireland – ‘towards a diagnostic algorithm’. Access Microbiol 2019. [DOI: 10.1099/acmi.ac2019.po0236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Susan Feeney
- 1Regional Virus Laboratory, Royal Victoria Hospital, BHSCT, Belfast, United Kingdom
| | | | - Seamus Murphy
- 3Southern Health Socal Care Trust (SHSCT), Newry, United Kingdom
| | - Tony Tham
- 4South Eastern Health and Social Care Trust (SEHSCT), Belfast, United Kingdom
| | - George Jacob
- 5Northern Health and Social Care Trust (NHSCT), Antrim, United Kingdom
| | - Graham Morrison
- 6Western Health and Social Care Trust (WHSCT), Derry, United Kingdom
| | | | - Paul Kelly
- 2Royal Victoria Hospital, BHSCT, Belfast
| | | | - Peter V Coyle
- 1Regional Virus Laboratory, Royal Victoria Hospital, BHSCT, Belfast, United Kingdom
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Bekö G, Morrison G, Weschler CJ, Koch HM, Pälmke C, Salthammer T, Schripp T, Eftekhari A, Toftum J, Clausen G. Dermal uptake of nicotine from air and clothing: Experimental verification. Indoor Air 2018; 28:247-257. [PMID: 29095533 DOI: 10.1111/ina.12437] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/26/2017] [Indexed: 05/25/2023]
Abstract
This study aims to elucidate in greater detail the dermal uptake of nicotine from air or from nicotine-exposed clothes, which was demonstrated recently in a preliminary study. Six non-smoking participants were exposed to gaseous nicotine (between 236 and 304 μg/m3 ) over 5 hours while breathing clean air through a hood. Four of the participants wore only shorts and 2 wore a set of clean clothes. One week later, 2 of the bare-skinned participants were again exposed in the chamber, but they showered immediately after exposure instead of the following morning. The 2 participants who wore clean clothes on week 1 were now exposed wearing a set of clothes that had been exposed to nicotine. All urine was collected for 84 hours after exposure and analyzed for nicotine and its metabolites, cotinine and 3OH-cotinine. All participants except those wearing fresh clothes excreted substantial amounts of biomarkers, comparable to levels expected from inhalation intake. Uptake for 1 participant wearing exposed clothes exceeded estimated intake via inhalation by >50%. Biomarker excretion continued during the entire urine collection period, indicating that nicotine accumulates in the skin and is released over several days. Absorbed nicotine was significantly lower after showering in 1 subject but not the other. Differences in the normalized uptakes and in the excretion patterns were observed among the participants. The observed cotinine half-lives suggest that non-smokers exposed to airborne nicotine may receive a substantial fraction through the dermal pathway. Washing skin and clothes exposed to nicotine may meaningfully decrease exposure.
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Affiliation(s)
- G Bekö
- Technical University of Denmark, Lyngby, Denmark
| | - G Morrison
- Missouri University of Science and Technology, Rolla, MO, USA
| | - C J Weschler
- Technical University of Denmark, Lyngby, Denmark
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | - C Pälmke
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-Universität Bochum (IPA), Bochum, Germany
| | | | - T Schripp
- Fraunhofer WKI, Braunschweig, Germany
| | - A Eftekhari
- Missouri University of Science and Technology, Rolla, MO, USA
| | - J Toftum
- Technical University of Denmark, Lyngby, Denmark
| | - G Clausen
- Technical University of Denmark, Lyngby, Denmark
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Rajan PE, Krishnamurthy A, Morrison G, Rezaei F. Advanced buffer materials for indoor air CO 2 control in commercial buildings. Indoor Air 2017; 27:1213-1223. [PMID: 28378907 DOI: 10.1111/ina.12386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 03/31/2017] [Indexed: 06/07/2023]
Abstract
In this study, we evaluated solid sorbents for their ability to passively control indoor CO2 concentration in buildings or rooms with cyclic occupancy (eg, offices, bedrooms). Silica supported amines were identified as suitable candidates and systematically evaluated in the removal of CO2 from indoor air by equilibrium and dynamic techniques. In particular, sorbents with various amine loadings were synthesized using tetraethylenepentamine (TEPA), poly(ethyleneimine) (PEI) and a silane coupling agent 3-aminopropyltriethoxysilane (APS). TGA analysis indicates that TEPA impregnated silica not only displays a relatively high adsorption capacity when exposed to ppm level CO2 concentrations, but also is capable of desorbing the majority of CO2 by air flow (eg, by concentration gradient). In 10 L flow-through chamber experiments, TEPA-based sorbents reduced outlet CO2 by up to 5% at 50% RH and up to 93% of CO2 adsorbed over 8 hours was desorbed within 16 hours. In 8 m3 flow-through chamber experiments, 18 g of the sorbent powder spread over a 2 m2 area removed approximately 8% of CO2 injected. By extrapolating these results to real buildings, we estimate that meaningful reductions in the CO2 can be achieved, which may help reduce energy requirements for ventilation and/or improve air quality.
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Affiliation(s)
- P E Rajan
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, USA
- Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - A Krishnamurthy
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - G Morrison
- Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - F Rezaei
- Department of Chemical & Biochemical Engineering, Missouri University of Science and Technology, Rolla, MO, USA
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Bekö G, Morrison G, Weschler CJ, Koch HM, Pälmke C, Salthammer T, Schripp T, Toftum J, Clausen G. Measurements of dermal uptake of nicotine directly from air and clothing. Indoor Air 2017; 27:427-433. [PMID: 27555532 DOI: 10.1111/ina.12327] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/20/2016] [Indexed: 05/25/2023]
Abstract
In this preliminary study, we have investigated whether dermal uptake of nicotine directly from air or indirectly from clothing can be a meaningful exposure pathway. Two participants wearing only shorts and a third participant wearing clean cotton clothes were exposed to environmental tobacco smoke (ETS), generated by mechanically "smoking" cigarettes, for three hours in a chamber while breathing clean air from head-enveloping hoods. The average nicotine concentration (420 μg/m3 ) was comparable to the highest levels reported for smoking sections of pubs. Urine samples were collected immediately before exposure and 60 hour post-exposure for bare-skinned participants. For the clothed participant, post-exposure urine samples were collected for 24 hour. This participant then entered the chamber for another three-hour exposure wearing a hood and clothes, including a shirt that had been exposed for five days to elevated nicotine levels. The urine samples were analyzed for nicotine and two metabolites-cotinine and 3OH-cotinine. Peak urinary cotinine and 3OH-cotinine concentrations for the bare-skinned participants were comparable to levels measured among non-smokers in hospitality environments before smoking bans. The amount of dermally absorbed nicotine for each bare-skinned participant was conservatively estimated at 570 μg, but may have been larger. For the participant wearing clean clothes, uptake was ~20 μg, and while wearing a shirt previously exposed to nicotine, uptake was ~80 μg. This study demonstrates meaningful dermal uptake of nicotine directly from air or from nicotine-exposed clothes. The findings are especially relevant for children in homes with smoking or vaping.
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Affiliation(s)
- G Bekö
- Technical University of Denmark, Lyngby, Denmark
| | - G Morrison
- Missouri University of Science and Technology, Rolla, MO, USA
| | - C J Weschler
- Technical University of Denmark, Lyngby, Denmark
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, NJ, USA
| | - H M Koch
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany
| | - C Pälmke
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Bochum, Germany
| | | | - T Schripp
- Fraunhofer WKI, Braunschweig, Germany
| | - J Toftum
- Technical University of Denmark, Lyngby, Denmark
| | - G Clausen
- Technical University of Denmark, Lyngby, Denmark
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Adiotomre E, Summers L, Allison A, Walters SJ, Digby M, Broadley P, Lang I, Morrison G, Bishop N, Arundel P, Offiah AC. Diagnostic accuracy of DXA compared to conventional spine radiographs for the detection of vertebral fractures in children. Eur Radiol 2016; 27:2188-2199. [PMID: 27655305 PMCID: PMC5374187 DOI: 10.1007/s00330-016-4556-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/05/2016] [Accepted: 08/09/2016] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In children, radiography is performed to diagnose vertebral fractures and dual energy x-ray absorptiometry (DXA) to assess bone density. In adults, DXA assesses both. We aimed to establish whether DXA can replace spine radiographs in assessment of paediatric vertebral fractures. METHODS Prospectively, lateral spine radiographs and lateral spine DXA of 250 children performed on the same day were independently scored by three radiologists using the simplified algorithm-based qualitative technique and blinded to results of the other modality. Consensus radiograph read and second read of 100 random images were performed. Diagnostic accuracy, inter/intraobserver and intermodality agreements, patient/carer experience and radiation dose were assessed. RESULTS Average sensitivity and specificity (95 % confidence interval) in diagnosing one or more vertebral fractures requiring treatment was 70 % (58-82 %) and 97 % (94-100 %) respectively for DXA and 74 % (55-93 %) and 96 % (95-98 %) for radiographs. Fleiss' kappa for interobserver and average kappa for intraobserver reliability were 0.371 and 0.631 respectively for DXA and 0.418 and 0.621 for radiographs. Average effective dose was 41.9 μSv for DXA and 232.7 μSv for radiographs. Image quality was similar. CONCLUSION Given comparable image quality and non-inferior diagnostic accuracy, lateral spine DXA should replace conventional radiographs for assessment of vertebral fractures in children. KEY POINTS • Vertebral fracture diagnostic accuracy of lateral spine DXA is non-inferior to radiographs. • The rate of unreadable vertebrae for DXA is lower than for radiographs. • Effective dose of DXA is significantly lower than radiographs. • Children prefer DXA to radiographs. • Given the above, DXA should replace radiographs for paediatric vertebral fracture assessment.
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Affiliation(s)
- E Adiotomre
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK.,Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - L Summers
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - A Allison
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - S J Walters
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, South Yorkshire, S1 4DA, UK
| | - M Digby
- Sheffield Medical School, University of Sheffield, Beech Hill Rd, Sheffield, South Yorkshire, S10 2RX, UK
| | - P Broadley
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - I Lang
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - G Morrison
- Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, Sheffield, South Yorkshire, S10 2JF, UK
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - P Arundel
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK
| | - A C Offiah
- Radiology Department, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK. .,Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, South Yorkshire, S10 2TH, UK.
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Pourgiezis N, Reddy SP, Nankivell M, Morrison G, VanEssen J. Alignment and component position after patient-matched instrumentation versus conventional total knee arthroplasty. J Orthop Surg (Hong Kong) 2016; 24:170-4. [PMID: 27574257 DOI: 10.1177/1602400210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare patient-matched instrumentation (PMI) with conventional total knee arthroplasty (TKA) in terms of limb alignment and component position. METHODS Nine men and 36 women (mean age, 69.5 years) who underwent PMI TKA were compared with 20 men and 25 women (mean age, 69.3 years) who underwent conventional TKA by the same team of surgeons with the same prosthesis and protocols in terms of limb alignment and component position using the Perth protocol computed tomography, as well as bone resection measurements, operating time, and the number of trays used. RESULTS The PMI and conventional TKA groups were comparable in terms of age, body mass index, tourniquet time, operating time, and the number of trays used. For limb alignment and component position, the 2 groups differed significantly in sagittal femoral component position (2.4º vs. 0.9º, p=0.0008) and the percentage of knees with femoral component internally rotated ≥1° with respect to the transepicondylar axis (20% vs. 55%, p=0.001). The difference was not significant in terms of limb alignment, coronal and rotational femoral component position, or coronal and sagittal tibial component position. Intra-operatively, all patient-matched cutting blocks demonstrated acceptable fit and stability. No instrument-related adverse events or complications were encountered. One (2.2%) femur and 6 (13.3%) tibiae were recut 2 mm for optimal ligament balancing. Two femoral components were upsized to the next size, and 2 tibial components were upsized and 2 downsized to the next size. CONCLUSION PMI was as accurate as conventional instrumentation in TKA. There was no significant difference in limb alignment or femoral and tibial component position in the coronal and sagittal planes between PMI and conventional TKA. PMI had a higher tendency to achieve correct femoral component rotation.
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Affiliation(s)
- N Pourgiezis
- Department of Orthopaedics, The Queen Elizabeth Hospital, Adelaide, SA, Australia
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Parker K, Morrison G. Methamphetamine absorption by skin lipids: accumulated mass, partition coefficients, and the influence of fatty acids. Indoor Air 2016; 26:634-641. [PMID: 26126994 DOI: 10.1111/ina.12229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 06/25/2015] [Indexed: 06/04/2023]
Abstract
Occupants of former methamphetamine laboratories, often residences, may experience increased exposure through the accumulation of the methamphetamine in the organic films that coat skin and indoor surfaces. The objectives of this study were to determine equilibrium partition coefficients of vapor-phase methamphetamine with artificial sebum (AS-1), artificial sebum without fatty acids (AS-2), and real skin surface films, herein called skin oils. Sebum and skin oil-coated filters were exposed to vapor-phase methamphetamine at concentrations ranging from 8 to 159 ppb, and samples were analyzed for exposure time periods from 2 h to 60 days. For a low vapor-phase methamphetamine concentration range of ~8-22 ppb, the equilibrium partition coefficient for AS-1 was 1500 ± 195 μg/g/ppb. For a high concentration range of 98-112 ppb, the partition coefficient was lower, 459 ± 80 μg/g/ppb, suggesting saturation of the available absorption capacity. The low partition coefficient for AS-2 (33 ± 6 μg/g/ppb) suggests that the fatty acids in AS-1 and skin oil are responsible for much high partition coefficients. We predict that the methamphetamine concentration in skin lipids coating indoor surfaces can exceed recommended surface remediation standards even for air concentrations well below 1 ppb.
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Affiliation(s)
- K Parker
- Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - G Morrison
- Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
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Aldred JR, Darling E, Morrison G, Siegel J, Corsi RL. Benefit-cost analysis of commercially available activated carbon filters for indoor ozone removal in single-family homes. Indoor Air 2016; 26:501-512. [PMID: 25952610 DOI: 10.1111/ina.12220] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 05/02/2015] [Indexed: 06/04/2023]
Abstract
This study involved the development of a model for evaluating the potential costs and benefits of ozone control by activated carbon filtration in single-family homes. The modeling effort included the prediction of indoor ozone with and without activated carbon filtration in the HVAC system. As one application, the model was used to predict benefit-to-cost ratios for single-family homes in 12 American cities in five different climate zones. Health benefits were evaluated using disability-adjusted life-years and included city-specific age demographics for each simulation. Costs of commercially available activated carbon filters included capital cost differences when compared to conventional HVAC filters of similar particle removal efficiency, energy penalties due to additional pressure drop, and regional utility rates. The average indoor ozone removal effectiveness ranged from 4 to 20% across the 12 target cities and was largely limited by HVAC system operation time. For the parameters selected in this study, the mean predicted benefit-to-cost ratios for 1-inch filters were >1.0 in 10 of the 12 cities. The benefits of residential activated carbon filters were greatest in cities with high seasonal ozone and HVAC usage, suggesting the importance of targeting such conditions for activated carbon filter applications.
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Affiliation(s)
- J R Aldred
- Department of Civil, Architectural, and Environmental Engineering, University of Texas, Austin, TX, USA
| | - E Darling
- Department of Civil, Architectural, and Environmental Engineering, University of Texas, Austin, TX, USA
| | - G Morrison
- Department of Civil, Architectural, and Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - J Siegel
- Department of Civil Engineering, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - R L Corsi
- Department of Civil, Architectural, and Environmental Engineering, University of Texas, Austin, TX, USA
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Ghatak A, Paul P, Hawcutt DB, White HD, Furlong NJ, Saunders S, Morrison G, Langridge P, Weston PJ. UK service level audit of insulin pump therapy in paediatrics. Diabet Med 2015; 32:1652-7. [PMID: 25884635 DOI: 10.1111/dme.12782] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 12/01/2022]
Abstract
AIM To conduct an audit of insulin pump therapy in the UK after the issue of guidelines for the use of continuous subcutaneous insulin infusion by NICE in 2008 (Technology Appraisal 151). METHODS All centres in the UK, providing pump services to children and young people were invited to participate in an online audit. Audit metrics were aligned to NICE Technology Appraisal 151 and an electronic data collection tool was used. RESULTS Of the 176 UK centres identified as providing pump services, 166 (94.3%) participated in the study. A total of 5094 children and young people were identified as using continuous subcutaneous insulin infusion (19% of all paediatric patients with Type 1 diabetes), with a median (range) of 16.9 (0.67-69.4)% per centre. Units had a median of 0.58 consultant sessions, 0.43 full-time equivalent diabetic specialist nurses, and 0.1 full-time equivalent dieticians delivering the pump service. The majority of this time was not formally funded. Families could access 24-h clinical and technical support (83% units), although the delivery varied between consultant, diabetic specialist nurse and company representatives. Only 53% of units ran, or accessed, structured education programmes for continuous subcutaneous insulin infusion use. Most units (86%) allowed continuous subcutaneous insulin infusion use for paediatric inpatients, but only 56% had written guidelines for this scenario. Nine percent of units had encountered funding refusal for a patient fulfilling NICE (Technology Appraisal 151) criteria. CONCLUSION The number of children and young people on continuous subcutaneous insulin infusion therapy is consistent with numbers estimated by NICE. There is a worrying lack of funded healthcare professional time. The audit also identified gaps in the provision of structured education and absence of written inpatient guidelines.
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Affiliation(s)
- A Ghatak
- Alder Hey Children's Hospital, Liverpool, UK
| | - P Paul
- Alder Hey Children's Hospital, Liverpool, UK
| | - D B Hawcutt
- Alder Hey Children's Hospital, Liverpool, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - H D White
- Aintree University Hospital NHS Trust, Liverpool, UK
| | - N J Furlong
- St Helens and Knowsley NHS Trust, St Helens, UK
| | - S Saunders
- Warrington and Halton Hospitals NHS Trust, Warrington, UK
| | - G Morrison
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - P J Weston
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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Hancock Friesen C, Lockhart A, Moulton D, Morrison G, O'Blenes S, Warren A. OUTCOME ABILITY: ENSURING OUTCOMES IN A SMALL VOLUME PEDIATRIC CARDIAC SURGERY PROGRAM. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.631] [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: 11/26/2022] Open
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Murphy B, Morrison G, Podmore P. Successful use of adalimumab to treat pyoderma gangrenosum, acne and suppurative hidradenitis (PASH syndrome) following colectomy in ulcerative colitis. Int J Colorectal Dis 2015; 30:1139-40. [PMID: 25564349 DOI: 10.1007/s00384-014-2110-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 02/04/2023]
Affiliation(s)
- Bryan Murphy
- Altnagelvin Area Hospital, Glenshane Road, Londonderry, BT47 6SB, Northern Ireland,
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13
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Morrison G, Shakila NV, Parker K. Accumulation of gas-phase methamphetamine on clothing, toy fabrics, and skin oil. Indoor Air 2015; 25:405-414. [PMID: 25244432 DOI: 10.1111/ina.12159] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/15/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED To better understand methamphetamine exposure and risk for occupants of former residential clandestine methamphetamine laboratories, we measured the dynamic accumulation of methamphetamine in skin oil, cotton and polyester (PE) clothing, upholstery, and toy fabric (substrates) exposed to 15-30 ppb (91-183 μg/m(3)) neutral methamphetamine in air for up to 60 days. The average equilibrium partition coefficients at 30% RH, in units of μg of methamphetamine per gram of substrate per ppb, are 3.0 ± 0.2 for a PE baby blanket, 5.6 ± 3.5 for a PE fabric toy, 3.7 ± 0.2 for a PE shirt, 18.3 ± 8.0 for a PE/cotton upholstery fabric, and 1200 ± 570 in skin oil. The partition coefficients at 60% RH are 4.5 ± 0.4, 5.2 ± 2.1, 4.5 ± 0.6, 36.1 ± 3.6, and 1600 ± 1100 μg/(g ppb), respectively. There was no difference in the partition coefficient for a clean and skin-oil-soiled cotton shirt [15.3 ± 2.1 μg/(g ppb) @ 42 days]. Partition coefficients for skin oil may be sensitive to composition. 'Mouthing' of cloth is predicted to be the dominant exposure pathway [60 μg/(kg body weight*ppb)] for a toddler in former meth lab, and indoor air concentrations would have to be very low (0.001 ppb) to meet the recommended reference dose for children. PRACTICAL IMPLICATIONS Gas-phase methamphetamine transfers to and accumulates on clothing, toys and other fabrics significantly increases risk of ingestion of methamphetamine. Current remediation methods should consider measurement of postremediation gas-phase air concentrations of methamphetamine in addition to surface wipe samples.
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Affiliation(s)
- G Morrison
- Civil, Architectural & Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - N V Shakila
- Civil, Architectural & Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
| | - K Parker
- Civil, Architectural & Environmental Engineering, Missouri University of Science and Technology, Rolla, MO, USA
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Papovich C, Labbé I, Quadri R, Tilvi V, Behroozi P, Bell EF, Glazebrook K, Spitler L, Straatman CMS, Tran KV, Cowley M, Davé R, Dekel A, Dickinson M, Ferguson HC, Finkelstein SL, Gawiser E, Inami H, Faber SM, Kacprzak GG, Kawinwanichakij L, Kocevski D, Koekemoer A, Koo DC, Kurczynski P, Lotz JM, Lu Y, Lucas RA, McIntosh D, Mehrtens N, Mobasher B, Monson A, Morrison G, Nanayakkara T, Persson SE, Salmon B, Simons R, Tomczak A, van Dokkum P, Weiner B, Willner SP. ZFOURGE/CANDELS: ON THE EVOLUTION OFM* GALAXY PROGENITORS FROMz= 3 TO 0.5. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/803/1/26] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Affiliation(s)
- CL Morrison
- Pendyffryn Medical Group; Ffordd Pendyffryn, Prestatyn; Denbighshire UK
| | - P Morar
- Royal Blackburn Hospital; East Lancashire Hospitals NHS Trust; Blackburn Lancashire UK
| | - G Morrison
- Diabetes Centre; Royal Liverpool University Hospital; Liverpool UK
| | - TS Purewal
- Diabetes Centre; Royal Liverpool University Hospital; Liverpool UK
| | - PJ Weston
- Diabetes Centre; Royal Liverpool University Hospital; Liverpool UK
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Thomson AJ, Morrison G, Thomson E, Beattie C, Nimmo AF, Glen JB. Induction of general anaesthesia by effect-site target-controlled infusion of propofol: influence of pharmacokinetic model and ke0value. Anaesthesia 2014; 69:429-35. [DOI: 10.1111/anae.12597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2014] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - E. Thomson
- Royal Infirmary of Edinburgh; Edinburgh UK
| | - C. Beattie
- Royal Infirmary of Edinburgh; Edinburgh UK
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White HD, Goenka N, Furlong NJ, Saunders S, Morrison G, Langridge P, Paul P, Ghatak A, Weston PJ. The U.K. service level audit of insulin pump therapy in adults. Diabet Med 2014; 31:412-8. [PMID: 24117515 DOI: 10.1111/dme.12325] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 06/27/2013] [Revised: 08/27/2013] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
Abstract
AIMS The National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of continuous subcutaneous insulin infusion in 2008 (technology appraisal 151). The first U.K.-wide insulin pump audit took place in 2012 with the aim of determining adherence to the guidance issued in NICE technology appraisal 151. The results of the adult service level audit are reported here. METHODS All centres providing continuous subcutaneous insulin infusion services to adults with diabetes in the U.K. were invited to participate. Audit metrics were aligned to technology appraisal 151. Data entry took place online using a DiabetesE formatted data collection tool. RESULTS One hundred and eighty-three centres were identified as delivering adult continuous subcutaneous insulin infusion services in the U.K., of which 178 (97.3%) participated in the audit. At the time of the audit, 13 428 adults were using insulin pump therapy, giving an estimated prevalence of use of 6%. Ninety-three per cent of centres did not report any barriers in obtaining funding for patients who fulfilled NICE criteria. The mean number of consultant programmed activities dedicated to continuous subcutaneous insulin infusion services was 0.96 (range 0-8), mean whole-time equivalent diabetes specialist nurses was 0.62 (range 0-3) and mean whole-time equivalent dietitian services was 0.3 (range 0-2), of which 39, 61 and 60%, respectively, were not formally funded. CONCLUSIONS The prevalence of continuous subcutaneous insulin infusion use in the U.K. falls well below the expectation of NICE (15-20%) and that of other European countries (> 15%) and the U.S.A. (40%). This may be attributable, in part, to lack of healthcare professional time needed for identification and training of new pump therapy users.
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Affiliation(s)
- H D White
- Aintree University Hospital NHS Trust, Liverpool, UK
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Abstract
BACKGROUND Narcotic bowel syndrome (NBS) describes disabling chronic severe abdominal pain that worsens despite continuing or escalating doses of opiates. Therapy is very limited. AIM To examine effects of blocking peripheral µ-opioid receptors on the symptomatology of patients with NBS and its safety. METHODS An open-label observational study was performed in four women with NBS. After a 2-week run-in period, patients were treated for 12 weeks with 8-12 mg methylnaltrexone bromide subcutaneously every other day, increasing to daily if there was poor response. Patient and physician assessment was documented, and patients completed an eight-symptom visual analogue scale weekly and the Functional Assessment of Chronic Illnesses Therapy-Fatigue questionnaire for fatigue. Patients were observed for 4 weeks following withdrawal of the drug. RESULTS One patient was unable to tolerate the study medication because of worsening pain after injection, and withdrew. Two showed clear benefit with reduction of symptoms overall, pain, bloating, distension, nausea and tiredness, with improved satisfaction and consistency of bowel actions and fatigue scores. Both reduced analgesic usage. The third had improved ileostomy output and had no episodes of severe bloating, but pain scores remained high. All three worsened after drug withdrawal and requested retreatment. Three experienced abdominal pains of moderate severity for 30-60 min consistently within 5 min of each injection. No other adverse events were experienced. CONCLUSIONS Methylnaltrexone has a positive impact on symptoms in women with NBS, although treatment does induce transient pain following its administration. Larger studies are required to examine its efficacy and longer term safety in this patient group.
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Affiliation(s)
- P R Gibson
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.
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Abstract
Low rates of statin prescribing have been noted in several major studies of patients with schizophrenia and the aim of this study was to investigate clinicians' attitudes to prescribing statins to different patient groups. The general practitioners (GPs) in Dumfries and Galloway were randomized into two groups. They received an email invitation to a web-based survey. The survey asked for treatment recommendation for three patient vignettes, each with a 10-year cardiovascular risk of 20%. In one group descriptions of the patient included type 1 diabetes, epilepsy and unemployed and in the other group these were replaced by type 2 diabetes, schizophrenia and retired. The questionnaires had no other differences. After three email invites, 53 questionnaires were completed (40% of a potential 133 participants). Statin therapy was recommended by 88% and 85% of respondents for patients with type 1 and type 2 diabetes, respectively; by 37% of respondents for patients with schizophrenia and 31% for patients with epilepsy; by 33% of respondents for retired patients and 23% of respondents for patients who are unemployed. This study demonstrates under-prescribing of statins. This was not worse for patients with schizophrenia as compared with patients with epilepsy. This suggests that the low rates of treatment of metabolic risk factors in patients with schizophrenia are not the result of clinician bias when compared with patients with epilepsy. Clinician bias, however, may reduce the chances of an unemployed patient receiving statin treatment.
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Affiliation(s)
- J Macklin
- Crichton Royal Hospital, Dumfries, UK.
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20
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Ding X, Morrison G, Dean B, Hop CECA, Tobler L, Percey S, Meng M, Reuschel S, West DA, Holden S, Ware JA. A solid phase extraction-liquid chromatographic-tandem mass spectrometry method for determination of concentrations of GDC-0941, a small molecule class I phosphatidylinositide 3-kinase inhibitor, to support clinical development. J Pharm Biomed Anal 2011; 61:1-7. [PMID: 22169467 DOI: 10.1016/j.jpba.2011.11.005] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 11/30/2022]
Abstract
A solid phase extraction (SPE) liquid chromatographic-tandem mass spectrometry (LC-MS/MS) method for the determination of GDC-0941 concentrations in human plasma has been developed and validated to support clinical development. An Oasis MCX 10mg 96-well SPE plate was used to extract plasma samples (50 μL) and the resulting extracts were analyzed using reverse-phase chromatography and mass spectrometer coupled with a turbo-ionspray interface. The method was validated over the calibration curve range 0.500-500 ng/mL with linear regression and 1/x(2) weighting. Within-run relative standard deviation (%RSD) ranged from 1.5 to 11.5%, while the between-run %RSD varied from 0.0 to 4.4%. The accuracy ranged from 96.0% to 110.0% of nominal for within-run and 98.0% to 108.0% of nominal for between-run at all concentrations including the LLOQ quality control at 0.500 ng/mL. Extraction recovery of GDC-0941 was between 79.0% and 86.2%. Stability of GDC-0941 was established in human plasma for 602 days at -70 °C and 598 days at -20°C, respectively, and established in reconstituted sample extracts for 167 h when stored at room temperature. Internal standard normalized matrix factor was 1.1, demonstrating that the use of the stable-labeled internal standard GDC-0941-d(8) effectively compensated observed matrix effect and resulting in no adverse impact on the quality of the data produced. This assay was used for the determination of GDC-0941 human plasma concentrations over a sufficient time period to determine pharmacokinetic parameters at relevant clinical doses.
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Affiliation(s)
- X Ding
- Genentech, Drug Metabolism and Pharmacokinetics, MS 412A, 1 DNA Way, South San Francisco, CA 94080, United States.
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Sharma D, Morrison G, Joseph F, Purewal TS, Weston PJ. The role of continuous subcutaneous insulin infusion therapy in patients with diabetic gastroparesis. Diabetologia 2011; 54:2768-70. [PMID: 21842427 DOI: 10.1007/s00125-011-2282-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [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: 04/10/2011] [Accepted: 07/14/2011] [Indexed: 12/27/2022]
Abstract
AIMS/OBJECTIVE To describe the effectiveness of continuous subcutaneous insulin infusion (CSII) in patients with symptomatic diabetic gastroparesis and unstable glycaemic control. METHODS Data from 26 patients with symptomatic diabetic gastroparesis and unstable glycaemic control using multiple-dose insulin (MDI) regimens, and subsequently managed with CSII, were analysed. RESULTS Following initiation of CSII, the median length of inpatient bed days associated with hospital admissions related to gastroparesis and glycaemic instability was reduced from 8.5 (range 0-144) days patient( -1) year( -1) prior to CSII to 0 (range 0-15) days patient( -1) year( -1). The median HbA(1c) reduction with CSII was 1.8% (22 mmol/mol; p < 0.05). The median capillary blood glucose (CBG) with CSII was significantly lower than with MDI: 7.7 mmol/l (range 3.8-15.4 mmol/l) vs 9.8 mmol/l (range 2.3-27 mmol/l), respectively, p < 0.001. Glycaemic variability with CSII was significantly reduced compared with MDI: CBG CV 0.37 vs CV 0.53, respectively, p < 0.001. CONCLUSIONS/INTERPRETATION CSII therapy in patients with diabetic gastroparesis results in significant improvement in glycaemic control and reductions in glycaemic variability and number of hospital inpatient bed days.
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Affiliation(s)
- D Sharma
- The Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK.
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van Langenberg DR, Morrison G, Foley A, Buttigieg RJ, Gibson PR. Cytomegalovirus disease, haemophagocytic syndrome, immunosuppression in patients with IBD: 'a cocktail best avoided, not stirred'. J Crohns Colitis 2011; 5:469-72. [PMID: 21939923 DOI: 10.1016/j.crohns.2011.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [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] [Received: 02/28/2011] [Revised: 04/14/2011] [Accepted: 04/14/2011] [Indexed: 02/08/2023]
Abstract
We report two cases of cytomegalovirus (CMV) viraemia resulting in severe pneumonitis and associated haemophagocytic syndrome manifesting in patients with inflammatory bowel disease, on stable doses of azathioprine in clinical remission. In both cases, azathioprine was withdrawn at time of hospital presentation and after delays in diagnosis; intravenous ganciclovir was then administered, with resultant rapid improvement of haematological and clinical parameters. Following recovery, immunomodulators were not recommenced given patient aversion and the theoretical risk of CMV reactivation, albeit the evidence for this approach is limited. CMV-related haemophagocytic syndrome and organ dysfunction, in the context of immunomodulator therapy in IBD are rare but life-threatening, and thus requires further investigation and discussion.
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Affiliation(s)
- Daniel R van Langenberg
- Monash University Department of Gastroenterology & Hepatology, Medicine, Box Hill Hospital, Victoria, Australia.
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Garg M, Morrison G, Friedman A, Lau A, Lau D, Gibson PR. A rapid infusion protocol is safe for total dose iron polymaltose: time for change. Intern Med J 2011; 41:548-54. [DOI: 10.1111/j.1445-5994.2010.02356.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
UNLABELLED Field experiments were conducted in five homes during three seasons (summer 2005, summer 2006 and winter 2007) to quantify ozone-initiated secondary aldehyde yields, surface reaction probabilities, and trends any temporal over a 1.5-year interval. Surfaces examined include living room carpets, bedroom carpets, kitchen floors, kitchen counters, and living room walls. Reaction probabilities for all surfaces for all seasons ranged from 9.4 x 10(-8) to 1.0 x 10(-4). There were no significant temporal trends in reaction probabilities for any surfaces from summer 2005 to summer 2006, nor over the entire 1.5-year period, indicating that it may take significantly longer than this period for surfaces to exhibit any 'ozone aging' or lowering of ozone-surface reactivity. However, all surfaces in three houses exhibited a significant decrease in reaction probabilities from summer 2006 to winter 2007. The total yield of aldehydes for the summer of 2005 were nearly identical to that for summer of 2006, but were significantly higher than for winter 2007. We also observed that older carpets were consistently less reactive than in newer carpets, but that countertops remained consistently reactive, probably because of occupant activities such as cooking and cleaning. PRACTICAL IMPLICATIONS Ozone reactions taking place at indoor surfaces significantly influence personal exposure to ozone and volatile reaction products. These field studies show that indoor surfaces only slowly lose their ability to react with ozone over several year time frames, and that this is probably because of a combination of large reservoirs of reactive coatings and periodic additions of reactive coatings in the form of cooking, cleaning, and skin-oil residues. When considering exposure to ozone and its reaction products and in the absence of dramatic changes in occupancy, activities or furnishings, indoor surface reactivity is expected to change very slowly.
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Affiliation(s)
- H Wang
- Civil, Architectural and Environmental Engineering, Missouri University of Science & Technology, Rolla, MO 65409, USA
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Morrison G, Headon B, Gibson P. Update in inflammatory bowel disease. Aust Fam Physician 2009; 38:956-961. [PMID: 20369146] [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: 05/29/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a common disease in Australia and frequently encountered in primary care. Major developments in investigation and management have taken place. OBJECTIVE This article aims to review some recent breakthroughs in IBD investigation and management. DISCUSSION Diagnosis involves a changing combination of enhanced traditional techniques with new diagnostic tools, typically blood and stool testing with improved endoscopy and new radiological tests. Management has seen the introduction of new powerful biologic therapies, greater understanding in the way we use older therapies, and a focus on preventing complications such as malignancy or infection. Treatment philosophy now attempts to alter the natural history of the disease and prevent long term complications. The importance of associated, previously overlooked factors is being increasingly recognised. Only by taking a long term, patient centred multidisciplinary approach will an optimal outlook for the majority of patients with IBD be achieved.
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Affiliation(s)
- Graham Morrison
- Department of Gastroenterology, Box Hill Hospital, Melbourne, Victoria.
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Rim D, Novoselec A, Morrison G. The influence of chemical interactions at the human surface on breathing zone levels of reactants and products. Indoor Air 2009; 19:324-34. [PMID: 19382954 DOI: 10.1111/j.1600-0668.2009.00595.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
UNLABELLED Using computational fluid dynamics simulations of an occupant in a ventilated room, we find that breathing zone ozone levels can be substantially lower and ozone reaction products associated with human surfaces (ORPHS) levels considerably higher than room levels. For air exchange rates <3/h, the ratio of the breathing zone to the ozone concentration 1 m from the body (bulk air), r(ozone), ranges from 0.59 to 0.75 for floor or ceiling air supply. ORPHS are enriched in the breathing zone, with concentrations for these conditions ranging from 1.2 to 2.5 greater than bulk air concentrations. At high air exchange rates (>8/h), the breathing zone concentrations approach bulk air concentrations (r(ozone) > 0.9) with a floor supply, whereas large concentration gradients occur between breathing zone and bulk air with a ceiling supply. At these high air exchange rates, ORPHS levels are 1.6-2.0 and 2.9-6.0 times the bulk air concentrations for floor and ceiling supply, respectively. The extent of depletion of ozone or enrichment of ORPHS is large enough that reliance on micro-environmental measurements alone, to assess the intake of ozone or ORPHS, is undesirable. PRACTICAL IMPLICATIONS Chemical reactions between ozone and human and clothing surfaces are predicted to significantly reduce ozone concentrations, and increase ozone reaction products associated with human surfaces (ORPHS) concentrations, in the breathing zone, relative to those concentrations in the larger microenvironment of a room. Existing measurements may overestimate ozone exposure and intake in typical indoor environments.
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Affiliation(s)
- D Rim
- Department of Civil, Environmental and Architectural Engineering, University of Texas at Austin, Austin, TX, USA
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Hopkins C, Whetstone S, Foster T, Blaney S, Morrison G. The impact of paediatric tracheostomy on both patient and parent. Int J Pediatr Otorhinolaryngol 2009; 73:15-20. [PMID: 19019462 DOI: 10.1016/j.ijporl.2008.09.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [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] [Received: 07/02/2008] [Revised: 08/31/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We set out to assess the impact of paediatric tracheostomy, performed in a central London hospital, on patients and their families. METHODS We conducted structured interviews with caregivers of tracheostomised children using the Pediatric Tracheotomy Health Status Instrument during all in-patient admissions for airway endoscopy over a 6-month period. RESULTS Completed questionnaires were received from 26 caregivers, 7 (27%) of whose children had been successfully decannulated. Carers reported adverse effects on all aspects of their quality of life, including sleep, relationships, social life and ability to work. The families included in the study had gross household incomes below the mean for SE London. There is a shortfall in the provision of home nursing when compared with the needs of the caregivers. CONCLUSIONS Tracheostomy has wide ranging effects on the quality of life of both the patient and their caregivers. We identified the need for better pre-operative preparation where possible, and greater support for such families in the community.
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Affiliation(s)
- C Hopkins
- Evelina Children's Hosptial, London SE1 7EH, UK.
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Krsek P, Maton B, Jayakar P, Dean P, Korman B, Rey G, Dunoyer C, Pacheco-Jacome E, Morrison G, Ragheb J, Vinters HV, Resnick T, Duchowny M. Incomplete resection of focal cortical dysplasia is the main predictor of poor postsurgical outcome. Neurology 2008; 72:217-23. [PMID: 19005171 DOI: 10.1212/01.wnl.0000334365.22854.d3] [Citation(s) in RCA: 223] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Focal cortical dysplasia (FCD) is recognized as the major cause of focal intractable epilepsy in childhood. Various factors influencing postsurgical seizure outcome in pediatric patients with FCD have been reported. OBJECTIVE To analyze different variables in relation to seizure outcome in order to identify prognostic factors for selection of pediatric patients with FCD for epilepsy surgery. METHODS A cohort of 149 patients with histologically confirmed mild malformations of cortical development or FCD with at least 2 years of postoperative follow-up was retrospectively studied; 113 subjects had at least 5 years of postoperative follow-up. Twenty-eight clinical, EEG, MRI, neuropsychological, surgical, and histopathologic parameters were evaluated. RESULTS The only significant predictor of surgical success was completeness of surgical resection, defined as complete removal of the structural MRI lesion (if present) and the cortical region exhibiting prominent ictal and interictal abnormalities on intracranial EEG. Unfavorable surgical outcomes are mostly caused by overlap of dysplastic and eloquent cortical regions. There were nonsignificant trends toward better outcomes in patients with normal intelligence, after hemispherectomy and with FCD type II. Other factors such as age at seizure onset, duration of epilepsy, seizure frequency, associated pathologies including hippocampal sclerosis, extent of EEG and MRI abnormalities, as well as extent and localization of resections did not influence outcome. Twenty-five percent of patients changed Engel's class of seizure outcome after the second postoperative year. CONCLUSIONS The ability to define and fully excise the entire region of dysplastic cortex is the most powerful variable influencing outcome in pediatric patients with focal cortical dysplasia.
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Affiliation(s)
- P Krsek
- Department of Pediatric Neurology, Charles University, Second Medical School, Motol University Hospital, V Uvalu 84, CZ 15006 Prague 5, Czech Republic.
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Barsegov V, Morrison G, Thirumalai D. Role of internal chain dynamics on the rupture kinetic of adhesive contacts. Phys Rev Lett 2008; 100:248102. [PMID: 18643632 DOI: 10.1103/physrevlett.100.248102] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Indexed: 05/26/2023]
Abstract
We study the forced rupture of adhesive contacts between monomers that are not covalently linked in a Rouse chain. When the applied force (f) to the chain end is less than the critical force for rupture (f{c}), the reversible rupture process is coupled to the internal Rouse modes. If f/f{c}>1 the rupture is irreversible. In both limits, the nonexponential distribution of contact lifetimes, which depends sensitively on the location of the contact, follows the double-exponential (Gumbel) distribution. When two contacts are well separated along the chain, the rate limiting step in the sequential rupture kinetics is the disruption of the contact that is in the chain interior. If the two contacts are close to each other, they cooperate to sustain the stress, which results in an "all-or-none" transition.
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Affiliation(s)
- V Barsegov
- Department of Chemistry, University of Massachusetts, Lowell, Massachusetts 01854, USA
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Abstract
Following preliminary indications that in some individuals arm exercise enhanced rather than reduced simultaneous leg endurance, ten young men and women performed three forms of intermittent work to volitional exhaustion, under duty cycles of 45 s work, 15 s rest. The protocols were as follows: (A) knee extensions at 30% maximum voluntary contraction (MVC); (B) 30% MVC knee extensions combined with arm cranking at 130% of their own lactate threshold; (C) combined 30% MVC knee extensions and arm cranking at 20% of their own lactate threshold. Heart rate, oxygen uptake (VO(2)), and blood lactate concentration were among the variables recorded throughout. All physiological indicators of demand were substantially higher in protocol B than in protocols A or C [heart rate: (A) 154 beats . min(-1), (B) 171 beats . min(-1), (C) 150 beats . min(-1); VO(2): (A) 11.9 ml . kg(-1) . min(-1), (B) 21.7 ml . kg(-1) . min(-1), (C) 14.2 ml . kg(-1) . min(-1); blood lactate concentration: (A) 3.3 mmol . l(-1), (B) 5.1 mmol . l(-1), (C) 2.8 mmol . l(-1)], yet there were no significant differences (P > 0.05) in the endurance times between the three conditions [(A) 11.43 min, (B) 11.1 min, (C) 10.57 min] and seven participants endured longest in protocol B. Results from protocol (C) cast doubt on explanations in terms of psychological distraction. We suggest that lactic acid produced by the arms is shuttled to the legs and acts there either as a supplementary fuel source or as an antagonist to the depressing effects of increased potassium concentration.
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Affiliation(s)
- C Easton
- Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK
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Abstract
We calculate the mean end-to-end distance R of a self-avoiding polymer encapsulated in an infinitely long cylinder with radius D. A self-consistent perturbation theory is used to calculate R as a function of D for impenetrable hard walls and soft walls. In both cases, R obeys the predicted scaling behavior in the limit of large and small D. The crossover from the three-dimensional behavior (D --> infinity) to the fully stretched one-dimensional case (D --> 0) is nonmonotonic. The minimum value of R is found at D approximately 0.46R(F), where R(F) is the Flory radius of R at D --> infinity. The results for soft walls map onto the hard wall case with a larger cylinder radius.
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Affiliation(s)
- G Morrison
- Biophysics Program, Institute for Physical Science and Technology, University of Maryland, College Park, Maryland 20742, USA
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Grem JL, Wright M, Morrison G, Lin PX, Leonard G, Nguyen D, Guo XD, Szabo E. Phase I pharmacokinetic (PK) & pharmacogenetic study of sequential infusional irinotecan (IR) and fluorouracil (FU). J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.2075] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - M. Wright
- National Cancer Institute, Bethesda, MD
| | | | - P.-X. Lin
- National Cancer Institute, Bethesda, MD
| | | | - D. Nguyen
- National Cancer Institute, Bethesda, MD
| | - X.-D. Guo
- National Cancer Institute, Bethesda, MD
| | - E. Szabo
- National Cancer Institute, Bethesda, MD
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Ash S, Reeves MM, Yeo S, Morrison G, Carey D, Capra S. Effect of intensive dietetic interventions on weight and glycaemic control in overweight men with Type II diabetes: a randomised trial. Int J Obes (Lond) 2003; 27:797-802. [PMID: 12821964 DOI: 10.1038/sj.ijo.0802295] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [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: 11/08/2022]
Abstract
OBJECTIVE To investigate the effectiveness of intensive innovative methods for implementing dietary prescriptions on weight management and glycaemic control in overweight men with Type II diabetes. DESIGN A randomised clinical trial with a 12-week intervention period - three isocaloric dietary intervention groups (intermittent energy restriction, pre-portioned meals and self-selected meals) each with weekly dietitian contact - and a follow-up visit after 18 months. SUBJECTS A total of 51 men with Type II diabetes (mean age 54 y, mean body mass index (BMI) 31.7 kg/m(2)). MEASUREMENTS Weight, body composition, waist circumference, glycaemic control (HbA(1c)) and blood lipids. RESULTS For all subjects, intensive diet therapy over the 12-week intervention period resulted in a mean reduction in energy intake of 2360+/-2780 kJ/day (564+/-665 kcal/day) and significant reductions in weight (6.4+/-4.6 kg), waist circumference (8.1+/-4.6 cm), percent body fat (1.9+/-1.5%), HbA(1c) (1.0+/-1.4%) and triglyceride levels (0.3+/-0.6 mmol/l) compared to baseline levels. Intervention group did not affect clinical outcomes, with the exception of percent body fat. A total of 27 (52.9%) subjects attended the 18-month follow-up visit. At this visit, none of the improvements in clinical parameters was maintained, with all parameters returning to preintervention levels. CONCLUSIONS : A dietary prescription of 6000-7000 kJ/day (1400-1700 kcal/day) was effective in achieving a 6% weight loss and improving glycaemic control. The method of implementation made no difference to the outcomes between groups at 12 weeks or 18 months. Thus, we propose that it was the intensive weekly contact with a health professional in combination with moderate energy restriction that facilitated the successful short-term results seen.
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Affiliation(s)
- S Ash
- Princess Alexandra Hospital, Nutrition and Dietetic Services, Woolloongabba, Brisbane, Queensland, Australia.
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Kaulich B, Bacescu D, Cocco D, Susini J, Salomé M, Dhez O, David C, Weitkamp T, Di Fabrizio E, Cabrini S, Morrison G, Charalambous P, Thieme J, Wilhein T, Kovac J, Podnar M, Kiskinova M. Twinmic: A European twin microscope station combining full-field imaging and scanning microscopy. ACTA ACUST UNITED AC 2003. [DOI: 10.1051/jp4:200300039] [Citation(s) in RCA: 9] [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: 11/15/2022]
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Gómez B, Palacios MA, Gómez M, Sanchez JL, Morrison G, Rauch S, McLeod C, Ma R, Caroli S, Alimonti A, Petrucci E, Bocca B, Schramel P, Zischka M, Petterson C, Wass U. Levels and risk assessment for humans and ecosystems of platinum-group elements in the airborne particles and road dust of some European cities. Sci Total Environ 2002; 299:1-19. [PMID: 12462571 DOI: 10.1016/s0048-9697(02)00038-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Traffic is the main source of platinum-group element (PGE) contamination in populated urban areas. There is increasing concern about the hazardous effects of these new pollutants for people and for other living organisms in these areas. Airborne and road dusts, as well as tree bark and grass samples were collected at locations in the European cities of Göteborg (Sweden), Madrid (Spain), Rome (Italy), Munich (Germany), Sheffield and London (UK). Today, in spite of the large number of parameters that can influence the airborne PGE content, the results obtained so far indicate significantly higher PGE levels at traffic sites compared with the rural or non-polluted zones that have been investigated (background levels). The average Pt content in airborne particles found in downtown Madrid, Göteborg and Rome is in the range 7.3-13.1 pg m(-3). The ring roads of these cities have values in the range 4.1-17.7 pg m(-3). In Munich, a lower Pt content was found in airborne particles (4.1 pg m(-3)). The same tendency has been noted for downtown Rh, with contents in the range 2.2-2.8 pg m(-3), and in the range 0.8-3.0 and 0.3 pg m(-3) for motorway margins in Munich. The combined results obtained using a wide-range airborne classifier (WRAC) collector and a PM-10 or virtual impactor show that Pt is associated with particles for a wide range of diameters. The smaller the particle size, the lower the Pt concentration. However, in particles <PM-10, some of the highest values correspond to the fraction <0.39 microm. Considering an average Pt content in all particles of approximately 15 pg m(-3), which is representative for all countries and environmental conditions, the tracheobronchial fraction represents approximately 10% and the alveolar fraction approximately 8% of the total particles suspended in air. However, from the environmental risk point of view, an exposure to PGEs in traffic-related ambient air is at least three orders of magnitude below the levels for which adverse health effects might theoretically occur (of approx. 100 ng m(-3)). Therefore, today inhalation exposure to PGEs from automotive catalysts does not seem to pose a direct health risk to the general population. Even though the data available today indicate no obvious health effects, there are still a number of aspects related to PGEs and catalysts that justify further research. First, continual monitoring of changes in PGE levels in air and road dust is warranted, to make sure that there is no dramatic increase from today's levels. Secondly, more detailed information on the chemical composition of the PGE-containing substances or complexes leaving the catalyst surface and the size distribution of the PGE-containing particles released during driving will facilitate a more in-depth human risk assessment.
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Affiliation(s)
- B Gómez
- Departamento de Química Analítica, Facultad de Químicas, Universidad Complutense de Madrid (UCM), Ciudad Universitaria s/n, Madrid 28040, Spain
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Moldovan M, Palacios MA, Gómez MM, Morrison G, Rauch S, McLeod C, Ma R, Caroli S, Alimonti A, Petrucci F, Bocca B, Schramel P, Zischka M, Pettersson C, Wass U, Luna M, Saenz JC, Santamaría J. Environmental risk of particulate and soluble platinum group elements released from gasoline and diesel engine catalytic converters. Sci Total Environ 2002; 296:199-208. [PMID: 12398337 DOI: 10.1016/s0048-9697(02)00087-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A comparison of platinum-group element (PGE) emission between gasoline and diesel engine catalytic converters is reported within this work. Whole raw exhaust fumes from four catalysts of three different types were examined during their useful lifetime, from fresh to 80,000 km. Two were gasoline engine catalysts (Pt-Pd-Rh and Pd-Rh), while the other two were diesel engine catalysts (Pt). Samples were collected following the 91441 EUDC driving cycle for light-duty vehicle testing, and the sample collection device used allowed differentiation between the particulate and soluble fractions, the latter being the most relevant from an environmental point of view. Analyses were performed by inductively coupled plasma-mass spectrometry (ICP-MS) (quadrupole and high resolution), and special attention was paid to the control of spectral interference, especially in the case of Pd and Rh. The results obtained show that, for fresh catalysts, the release of particulate PGE through car exhaust fumes does not follow any particular trend, with a wide range (one-two orders of magnitude) for the content of noble metals emitted. The samples collected from 30,000-80,000 km present a more homogeneous PGE release for all catalysts studied. A decrease of approximately one order of magnitude is observed with respect to the release from fresh catalysts, except in the case of the diesel engine catalyst, for which PGE emission continued to be higher than in the case of gasoline engines. The fraction of soluble PGE was found to represent less than 10% of the total amount released from fresh catalysts. For aged catalysts, the figures are significantly higher, especially for Pd and Rh. Particulate PGE can be considered as virtually biologically inert, while soluble PGE forms can represent an environmental risk due to their bioavailability, which leads them to accumulate in the environment.
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Affiliation(s)
- M Moldovan
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense de Madrid, Spain
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Goodwin ARH, Morrison G. Measurement of the dipole moment of gaseous 1,1,1-trichlorotrifluoroethane, 1,2-difluoroethane, 1,1,2-trichlorotrifluoroethane, and 2-(difluoromethoxy)-1,1,1-trifluoroethane. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/j100192a062] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Allardyce J, Boydell J, Van Os J, Morrison G, Castle D, Murray RM, McCreadie RG. Comparison of the incidence of schizophrenia in rural Dumfries and Galloway and urban Camberwell. Br J Psychiatry 2001; 179:335-9. [PMID: 11581114 DOI: 10.1192/bjp.179.4.335] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [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: 11/23/2022]
Abstract
BACKGROUND Being born or living in urban areas is associated with high rates of schizophrenia. However, few studies have compared the incidence in urban/rural areas using the same methodology. AIMS To compare service-based incidence rates for schizophrenia in rural Dumfries and Galloway in south-west Scotland with urban Camberwell in south-east London. METHOD Using Research Diagnostic Criteria diagnoses from the OPCRIT computer algorithm, we compared the incidence of schizophrenia over 12 years (1979-1984 and 1992-1997) using indirect standardisation techniques and Poisson regression modelling. RESULTS The incidence was 61% higher in urban Camberwell than in rural Dumfries and Galloway (standardised incidence ratio (SIR)=1.61; 95% CI=1.42-1.81). There was no difference in incidence when we compared the White population in Camberwell with Dumfries and Galloway (SIR=1.12; 95% CI=0.86-1.43). CONCLUSIONS The incidence of schizophrenia in urban Camberwell was higher than that in rural Dumfries and Galloway; the high incidence of non-Whites in Camberwell largely explains the urban/rural difference.
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Affiliation(s)
- J Allardyce
- Department of Clinical Research, Crichton Royal Hospital, Dumfries DG1 4TG, UK.
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Abstract
This paper describes a multi-parametric user interface based around the Musical Instrument Digital Interface (MIDI) Creator system developed at York which provides MIDI data in response to changing pressures on five strain gauge sensors to control the fundamental frequency, first three formants and the overall amplitude of synthesized speech. Vocal synthesis is achieved by means of a freely available time domain formant synthesis system running on a standard PC compatible machine. The result is a novel hand-controlled speech synthesizer which is not command/phoneme based, but is rather more like a continually controlled musical instrument where the speech sounds are shaped in real-time.
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Affiliation(s)
- A Hunt
- Department of Electronics, University of York, Heslington, UK.
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Abstract
As much as we hate to admit it, even the gentlest of our friendly pets can harbor harmful pathogens, and although the fact is not widely known, pet-associated infections can significantly affect the health of humans. In this article, Dr Morrison focuses on pets and their accompanying potential zoonoses, outlining how these diseases can be transmitted to humans and how the infections are treated. Special attention is paid to rabies and toxoplasmosis, which have attained particular notoriety over time.
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Affiliation(s)
- G Morrison
- Department of Family Practice, Hennepin County Medical Center, 5 W Lake St, Minneapolis, MN 55408, USA.
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Romaguera RL, Minagar A, Bruce JH, Jagid JR, Falcone S, Curless RG, Ragheb J, Morrison G. Adrenocortical carcinoma with cerebral metastasis in a child: case report and review of the literature. Clin Neurol Neurosurg 2001; 103:46-50. [PMID: 11311478 DOI: 10.1016/s0303-8467(01)00105-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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
OBJECTIVE AND IMPORTANCE Adrenocortical carcinoma (ACC) is rare in the pediatric population, and brain metastasis seldom occurs. CLINICAL PRESENTATION The authors report a case of metastatic ACC to the brain in a 9-year-old patient who had an adrenal cortex neoplasm removed at 4 years of age, and was free of symptoms for 5 years. Two weeks before admission she complained of blurred vision in both eyes. INTERVENTION Examination revealed bilateral papilledema, and a Magnetic Resonance Imaging (MRI) of the brain revealed a mass in the left lateral ventricle with extensive vasogenic edema and hydrocephalus. The tumor was removed, and histopathologic examination demonstrated metastatic ACC. CONCLUSION Although ACC is a rare neoplasm it must be considered in the differential diagnosis of cerebral lesions in patients with a history of this tumor. Periodic long-term brain imaging is suggested as part of the follow up in patients with adrenocortical neoplasms.
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Affiliation(s)
- R L Romaguera
- Department of Pathology, University of Miami, Jackson Memorial Hospital, East Tower Room # 2142, 1611 NW 12th Ave., Miami, FL 33136, USA.
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Goroll AH, Morrison G, Bass EB, Jablonover R, Blackman D, Platt R, Whelan A, Hekelman FP. Reforming the core clerkship in internal medicine: the SGIM/CDIM Project. Society of General Internal Medicine/Clerkship Directors in Internal Medicine. Ann Intern Med 2001; 134:30-7. [PMID: 11187418 DOI: 10.7326/0003-4819-134-1-200101020-00011] [Citation(s) in RCA: 31] [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: 11/22/2022] Open
Abstract
Dramatic changes in health care have stimulated reform of undergraduate medical education. In an effort to improve the teaching of generalist competencies and encourage learning in the outpatient setting, the Society of General Internal Medicine joined with the Clerkship Directors in Internal Medicine in a federally sponsored initiative to develop a new curriculum for the internal medicine core clerkship. Using a broad-based advisory committee and working closely with key stakeholders (especially clerkship directors), the project collaborators helped forge a new national consensus on the learning agenda for the clerkship (a prioritized set of basic generalist competencies) and on the proportion of time that should be devoted to outpatient care (at least one third of the clerkship). From this consensus emerged a new curricular model that served as the basis for production of a curriculum guide and faculty resource package. The guide features the prioritized set of basic generalist competencies and specifies the requisite knowledge, skills, and attitudes/values needed to master them, as well as a list of suggested training problems. It also includes recommended training experiences, schedules, and approaches to faculty development, precepting, and student evaluation. Demand for the guide has been strong and led to production of a second edition, which includes additional materials, an electronic version, and a pocket guide for students and faculty. A follow-up survey of clerkship directors administered soon after completion of the first edition revealed widespread use of the curricular guide but also important barriers to full implementation of the new curriculum. Although this collaborative effort appears to have initiated clerkship reform, long-term success will require an enhanced educational infrastructure to support teaching in the outpatient setting.
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Affiliation(s)
- A H Goroll
- Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA
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