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Sutherland J, Bowen L. Ingestion of foreign bodies and caustic substances in children. BJA Educ 2023; 23:2-7. [PMID: 36601025 PMCID: PMC9805929 DOI: 10.1016/j.bjae.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
| | - L. Bowen
- Children's Hospital for Wales, Cardiff, Wales, UK
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2
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Affiliation(s)
- L Bowen
- Department of Anaesthesia, Children's Hospital for Wales, Heath Park, Cardiff, UK
| | - M T Burtonwood
- Department of Anaesthesia, University Hospital of Wales, Heath Park, Cardiff, UK
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3
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Billioux B, Mith B, Bowen L, Schindler M, Azodi S, Ohayon J, Tarfeh-Burnette H, Dorbor J, Reilly C, Sneller M, Fallah M, Nath A. Longitudinal cohort study of neurological sequelae in ebola virus disease survivors in liberia. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.304] [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: 11/28/2022]
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4
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Chandler JE, Stypula-Cyrus Y, Almassalha L, Bauer G, Bowen L, Subramanian H, Szleifer I, Backman V. Colocalization of cellular nanostructure using confocal fluorescence and partial wave spectroscopy. J Biophotonics 2017; 10:377-384. [PMID: 27111884 PMCID: PMC5112146 DOI: 10.1002/jbio.201500298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/24/2016] [Accepted: 03/24/2016] [Indexed: 06/05/2023]
Abstract
A new multimodal confocal microscope has been developed, which includes a parallel Partial Wave Spectroscopic (PWS) microscopy path. This combination of modalities allows molecular-specific sensing of nanoscale intracellular structure using fluorescent labels. Combining molecular specificity and sensitivity to nanoscale structure allows localization of nanostructural intracellular changes, which is critical for understanding the mechanisms of diseases such as cancer. To demonstrate the capabilities of this multimodal instrument, we imaged HeLa cells treated with valinomycin, a potassium ionophore that uncouples oxidative phosphorylation. Colocalization of fluorescence images of the nuclei (Hoechst 33342) and mitochondria (anti-mitochondria conjugated to Alexa Fluor 488) with PWS measurements allowed us to detect a significant decrease in nuclear nanoscale heterogeneity (Σ), while no significant change in Σ was observed at mitochondrial sites. In addition, application of the new multimodal imaging approach was demonstrated on human buccal samples prepared using a cancer screening protocol. These images demonstrate that nanoscale intracellular structure can be studied in healthy and diseased cells at molecular-specific sites.
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Affiliation(s)
| | | | | | | | | | | | | | - Vadim Backman
- Corresponding author: , Phone: 8474913536, Fax: 8474914928
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5
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Bowen L, Zyambo M, Snell D, Kinnear J, Bould MD. Evaluation of the accuracy of common weight estimation formulae in a Zambian paediatric surgical population. Anaesthesia 2016; 72:470-478. [PMID: 28026862 DOI: 10.1111/anae.13780] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Abstract
Limited resources and access to healthcare in sub-Saharan Africa are associated with high rates of malnourished children, although many countries globally are demonstrating increasing childhood obesity. This study evaluated how well current age- or height-based formulae estimate the weight of children undergoing surgery in Zambia. All children under 14 years of age presenting for elective surgery at the University Teaching Hospital, Lusaka, had both height and weight measured. Their actual weight was compared against estimated weight from various formulae. The Broselow tape outperformed all the age-based formulae, demonstrating the lowest median percentage error of -5.8%, with 46.0% of estimates falling within 10% of the actual measured weight (p < 0.001). Of the 1111 children who were eligible for World Health Organization growth standard appraisal, 88 (8%) met the weight criteria for severe acute malnutrition. Our results are consistent with other studies in finding that the Broselow tape is the best estimator of weight in a lower middle-income country, followed by the original Advanced Paediatric Life Support formula if the Broselow tape is unavailable.
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Affiliation(s)
- L Bowen
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | - M Zyambo
- Department of Anaesthesia, University Teaching Hospital, Lusaka, Zambia
| | - D Snell
- Department of Anaesthesia and Critical Care Medicine, Northumbria Healthcare NHS Foundation Trust, Wansbeck, UK
| | - J Kinnear
- Department of Anaesthesia and Critical Care Medicine, Southend University Hospital, Southend, UK.,Postgraduate Medical Institute, Anglia Ruskin University, Chelmsford, UK
| | - M D Bould
- Department of Anesthesiology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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6
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Major JD, Al Turkestani M, Bowen L, Brossard M, Li C, Lagoudakis P, Pennycook SJ, Phillips LJ, Treharne RE, Durose K. In-depth analysis of chloride treatments for thin-film CdTe solar cells. Nat Commun 2016; 7:13231. [PMID: 27775037 PMCID: PMC5078995 DOI: 10.1038/ncomms13231] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022] Open
Abstract
CdTe thin-film solar cells are now the main industrially established alternative to silicon-based photovoltaics. These cells remain reliant on the so-called chloride activation step in order to achieve high conversion efficiencies. Here, by comparison of effective and ineffective chloride treatments, we show the main role of the chloride process to be the modification of grain boundaries through chlorine accumulation, which leads an increase in the carrier lifetime. It is also demonstrated that while improvements in fill factor and short circuit current may be achieved through use of the ineffective chlorides, or indeed simple air annealing, voltage improvement is linked directly to chlorine incorporation at the grain boundaries. This suggests that focus on improved or more controlled grain boundary treatments may provide a route to achieving higher cell voltages and thus efficiencies.
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Affiliation(s)
- J D Major
- Stephenson Institute for Renewable Energy and Department of Physics, University of Liverpool, Liverpool L69 7ZF, UK
| | - M Al Turkestani
- Department of Physics, Umm Al-Qura University, KSA, Mecca Al Taif Road, Mecca 24382, Saudi Arabia
| | - L Bowen
- Department of Physics, G.J. Russell Microscopy Facility, Durham University, South Road, Durham DH1 3LE, UK
| | - M Brossard
- University of Southampton, School of Physics &Astronomy, Southampton, Hants SO17 1BJ, UK.,Centre for Photonics and Quantum Materials, Skolkovo Institute of Science and Technology, Moscow 143026, Russia
| | - C Li
- Materials Science and Technology Division, Oak Ridge National Laboratory, 1 Bethel Valley Rd, Oak Ridge, Tennessee 37831, USA
| | - P Lagoudakis
- University of Southampton, School of Physics &Astronomy, Southampton, Hants SO17 1BJ, UK.,Centre for Photonics and Quantum Materials, Skolkovo Institute of Science and Technology, Moscow 143026, Russia
| | - S J Pennycook
- Department of Materials Science and Engineering, National University of Singapore, Singapore 117576, Singapore
| | - L J Phillips
- Stephenson Institute for Renewable Energy and Department of Physics, University of Liverpool, Liverpool L69 7ZF, UK
| | - R E Treharne
- Stephenson Institute for Renewable Energy and Department of Physics, University of Liverpool, Liverpool L69 7ZF, UK
| | - K Durose
- Stephenson Institute for Renewable Energy and Department of Physics, University of Liverpool, Liverpool L69 7ZF, UK
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7
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Rostami N, Shields RC, Yassin SA, Hawkins AR, Bowen L, Luo TL, Rickard AH, Holliday R, Preshaw PM, Jakubovics NS. A Critical Role for Extracellular DNA in Dental Plaque Formation. J Dent Res 2016; 96:208-216. [PMID: 27770039 DOI: 10.1177/0022034516675849] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Extracellular DNA (eDNA) has been identified in the matrix of many different monospecies biofilms in vitro, including some of those produced by oral bacteria. In many cases, eDNA stabilizes the structure of monospecies biofilms. Here, the authors aimed to determine whether eDNA is an important component of natural, mixed-species oral biofilms, such as plaque on natural teeth or dental implants. To visualize eDNA in oral biofilms, approaches for fluorescently stained eDNA with either anti-DNA antibodies or an ultrasensitive cell-impermeant dye, YOYO-1, were first developed using Enterococcus faecalis, an organism that has previously been shown to produce extensive eDNA structures within biofilms. Oral biofilms were modelled as in vitro "microcosms" on glass coverslips inoculated with the natural microbial population of human saliva and cultured statically in artificial saliva medium. Using antibodies and YOYO-1, eDNA was found to be distributed throughout microcosm biofilms, and was particularly abundant in the immediate vicinity of cells. Similar arrangements of eDNA were detected in biofilms on crowns and overdenture abutments of dental implants that had been recovered from patients during the restorative phase of treatment, and in subgingival dental plaque of periodontitis patients, indicating that eDNA is a common component of natural oral biofilms. In model oral biofilms, treatment with a DNA-degrading enzyme, NucB from Bacillus licheniformis, strongly inhibited the accumulation of biofilms. The bacterial species diversity was significantly reduced by treatment with NucB and particularly strong reductions were observed in the abundance of anaerobic, proteolytic bacteria such as Peptostreptococcus, Porphyromonas and Prevotella. Preformed biofilms were not significantly reduced by NucB treatment, indicating that eDNA is more important or more exposed during the early stages of biofilm formation. Overall, these data demonstrate that dental plaque eDNA is potentially an important target for oral biofilm control.
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Affiliation(s)
- N Rostami
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - R C Shields
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - S A Yassin
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - A R Hawkins
- 2 Institute for Cell and Molecular Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - L Bowen
- 3 Department of Physics, Durham University, Durham, UK
| | - T L Luo
- 4 Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - A H Rickard
- 4 Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - R Holliday
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - P M Preshaw
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - N S Jakubovics
- 1 School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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8
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Vohra RS, Pasquali S, Kirkham AJ, Marriott P, Johnstone M, Spreadborough P, Alderson D, Griffiths EA, Fenwick S, Elmasry M, Nunes Q, Kennedy D, Basit Khan R, Khan MAS, Magee CJ, Jones SM, Mason D, Parappally CP, Mathur P, Saunders M, Jamel S, Ul Haque S, Zafar S, Shiwani MH, Samuel N, Dar F, Jackson A, Lovett B, Dindyal S, Winter H, Fletcher T, Rahman S, Wheatley K, Nieto T, Ayaani S, Youssef H, Nijjar RS, Watkin H, Naumann D, Emeshi S, Sarmah PB, Lee K, Joji N, Heath J, Teasdale RL, Weerasinghe C, Needham PJ, Welbourn H, Forster L, Finch D, Blazeby JM, Robb W, McNair AGK, Hrycaiczuk A, Charalabopoulos A, Kadirkamanathan S, Tang CB, Jayanthi NVG, Noor N, Dobbins B, Cockbain AJ, Nilsen-Nunn A, Siqueira J, Pellen M, Cowley JB, Ho WM, Miu V, White TJ, Hodgkins KA, Kinghorn A, Tutton MG, Al-Abed YA, Menzies D, Ahmad A, Reed J, Khan S, Monk D, Vitone LJ, Murtaza G, Joel A, Brennan S, Shier D, Zhang C, Yoganathan T, Robinson SJ, McCallum IJD, Jones MJ, Elsayed M, Tuck L, Wayman J, Carney K, Aroori S, Hosie KB, Kimble A, Bunting DM, Fawole AS, Basheer M, Dave RV, Sarveswaran J, Jones E, Kendal C, Tilston MP, Gough M, Wallace T, Singh S, Downing J, Mockford KA, Issa E, Shah N, Chauhan N, Wilson TR, Forouzanfar A, Wild JRL, Nofal E, Bunnell C, Madbak K, Rao STV, Devoto L, Siddiqi N, Khawaja Z, Hewes JC, Gould L, Chambers A, Urriza Rodriguez D, Sen G, Robinson S, Carney K, Bartlett F, Rae DM, Stevenson TEJ, Sarvananthan K, Dwerryhouse SJ, Higgs SM, Old OJ, Hardy TJ, Shah R, Hornby ST, Keogh K, Frank L, Al-Akash M, Upchurch EA, Frame RJ, Hughes M, Jelley C, Weaver S, Roy S, Sillo TO, Galanopoulos G, Cuming T, Cunha P, Tayeh S, Kaptanis S, Heshaishi M, Eisawi A, Abayomi M, Ngu WS, Fleming K, Singh Bajwa D, Chitre V, Aryal K, Ferris P, Silva M, Lammy S, Mohamed S, Khawaja A, Hussain A, Ghazanfar MA, Bellini MI, Ebdewi H, Elshaer M, Gravante G, Drake B, Ogedegbe A, Mukherjee D, Arhi C, Giwa Nusrat Iqbal L, Watson NF, Kumar Aggarwal S, Orchard P, Villatoro E, Willson PD, Wa K, Mok J, Woodman T, Deguara J, Garcea G, Babu BI, Dennison AR, Malde D, Lloyd D, Satheesan S, Al-Taan O, Boddy A, Slavin JP, Jones RP, Ballance L, Gerakopoulos S, Jambulingam P, Mansour S, Sakai N, Acharya V, Sadat MM, Karim L, Larkin D, Amin K, Khan A, Law J, Jamdar S, Smith SR, Sampat K, M O'shea K, Manu M, Asprou FM, Malik NS, Chang J, Johnstone M, Lewis M, Roberts GP, Karavadra B, Photi E, Hewes J, Gould L, Chambers A, Rodriguez D, O'Reilly DA, Rate AJ, Sekhar H, Henderson LT, Starmer BZ, Coe PO, Tolofari S, Barrie J, Bashir G, Sloane J, Madanipour S, Halkias C, Trevatt AEJ, Borowski DW, Hornsby J, Courtney MJ, Virupaksha S, Seymour K, Robinson S, Hawkins H, Bawa S, Gallagher PV, Reid A, Wood P, Finch JG, Parmar J, Stirland E, Gardner-Thorpe J, Al-Muhktar A, Peterson M, Majeed A, Bajwa FM, Martin J, Choy A, Tsang A, Pore N, Andrew DR, Al-Khyatt W, Taylor C, Bhandari S, Chambers A, Subramanium D, Toh SKC, Carter NC, Mercer SJ, Knight B, Tate S, Pearce B, Wainwright D, Vijay V, Alagaratnam S, Sinha S, Khan S, El-Hasani SS, Hussain AA, Bhattacharya V, Kansal N, Fasih T, Jackson C, Siddiqui MN, Chishti IA, Fordham IJ, Siddiqui Z, Bausbacher H, Geogloma I, Gurung K, Tsavellas G, Basynat P, Kiran Shrestha A, Basu S, Chhabra Mohan Harilingam A, Rabie M, Akhtar M, Kumar P, Jafferbhoy SF, Hussain N, Raza S, Haque M, Alam I, Aseem R, Patel S, Asad M, Booth MI, Ball WR, Wood CPJ, Pinho-Gomes AC, Kausar A, Rami Obeidallah M, Varghase J, Lodhia J, Bradley D, Rengifo C, Lindsay D, Gopalswamy S, Finlay I, Wardle S, Bullen N, Iftikhar SY, Awan A, Ahmed J, Leeder P, Fusai G, Bond-Smith G, Psica A, Puri Y, Hou D, Noble F, Szentpali K, Broadhurst J, Date R, Hossack MR, Li Goh Y, Turner P, Shetty V, Riera M, Macano CAW, Sukha A, Preston SR, Hoban JR, Puntis DJ, Williams SV, Krysztopik R, Kynaston J, Batt J, Doe M, Goscimski A, Jones GH, Smith SR, Hall C, Carty N, Ahmed J, Panteleimonitis S, Gunasekera RT, Sheel ARG, Lennon H, Hindley C, Reddy M, Kenny R, Elkheir N, McGlone ER, Rajaganeshan R, Hancorn K, Hargreaves A, Prasad R, Longbotham DA, Vijayanand D, Wijetunga I, Ziprin P, Nicolay CR, Yeldham G, Read E, Gossage JA, Rolph RC, Ebied H, Phull M, Khan MA, Popplewell M, Kyriakidis D, Hussain A, Henley N, Packer JR, Derbyshire L, Porter J, Appleton S, Farouk M, Basra M, Jennings NA, Ali S, Kanakala V, Ali H, Lane R, Dickson-Lowe R, Zarsadias P, Mirza D, Puig S, Al Amari K, Vijayan D, Sutcliffe R, Marudanayagam R, Hamady Z, Prasad AR, Patel A, Durkin D, Kaur P, Bowen L, Byrne JP, Pearson KL, Delisle TG, Davies J, Tomlinson MA, Johnpulle MA, Slawinski C, Macdonald A, Nicholson J, Newton K, Mbuvi J, Farooq A, Sidhartha Mothe B, Zafrani Z, Brett D, Francombe J, Spreadborough P, Barnes J, Cheung M, Al-Bahrani AZ, Preziosi G, Urbonas T, Alberts J, Mallik M, Patel K, Segaran A, Doulias T, Sufi PA, Yao C, Pollock S, Manzelli A, Wajed S, Kourkulos M, Pezzuto R, Wadley M, Hamilton E, Jaunoo S, Padwick R, Sayegh M, Newton RC, Hebbar M, Farag SF, Spearman J, Hamdan MF, D'Costa C, Blane C, Giles M, Peter MB, Hirst NA, Hossain T, Pannu A, El-Dhuwaib Y, Morrison TEM, Taylor GW, Thompson RLE, McCune K, Loughlin P, Lawther R, Byrnes CK, Simpson DJ, Mawhinney A, Warren C, McKay D, McIlmunn C, Martin S, MacArtney M, Diamond T, Davey P, Jones C, Clements JM, Digney R, Chan WM, McCain S, Gull S, Janeczko A, Dorrian E, Harris A, Dawson S, Johnston D, McAree B, Ghareeb E, Thomas G, Connelly M, McKenzie S, Cieplucha K, Spence G, Campbell W, Hooks G, Bradley N, Hill ADK, Cassidy JT, Boland M, Burke P, Nally DM, Hill ADK, Khogali E, Shabo W, Iskandar E, McEntee GP, O'Neill MA, Peirce C, Lyons EM, O'Sullivan AW, Thakkar R, Carroll P, Ivanovski I, Balfe P, Lee M, Winter DC, Kelly ME, Hoti E, Maguire D, Karunakaran P, Geoghegan JG, Martin ST, McDermott F, Cross KS, Cooke F, Zeeshan S, Murphy JO, Mealy K, Mohan HM, Nedujchelyn Y, Fahad Ullah M, Ahmed I, Giovinazzo F, Milburn J, Prince S, Brooke E, Buchan J, Khalil AM, Vaughan EM, Ramage MI, Aldridge RC, Gibson S, Nicholson GA, Vass DG, Grant AJ, Holroyd DJ, Jones MA, Sutton CMLR, O'Dwyer P, Nilsson F, Weber B, Williamson TK, Lalla K, Bryant A, Carter CR, Forrest CR, Hunter DI, Nassar AH, Orizu MN, Knight K, Qandeel H, Suttie S, Belding R, McClarey A, Boyd AT, Guthrie GJK, Lim PJ, Luhmann A, Watson AJM, Richards CH, Nicol L, Madurska M, Harrison E, Boyce KM, Roebuck A, Ferguson G, Pati P, Wilson MSJ, Dalgaty F, Fothergill L, Driscoll PJ, Mozolowski KL, Banwell V, Bennett SP, Rogers PN, Skelly BL, Rutherford CL, Mirza AK, Lazim T, Lim HCC, Duke D, Ahmed T, Beasley WD, Wilkinson MD, Maharaj G, Malcolm C, Brown TH, Shingler GM, Mowbray N, Radwan R, Morcous P, Wood S, Kadhim A, Stewart DJ, Baker AL, Tanner N, Shenoy H, Hafiz S, Marchi JA, Singh-Ranger D, Hisham E, Ainley P, O'Neill S, Terrace J, Napetti S, Hopwood B, Rhys T, Downing J, Kanavati O, Coats M, Aleksandrov D, Kallaway C, Yahya S, Weber B, Templeton A, Trotter M, Lo C, Dhillon A, Heywood N, Aawsaj Y, Hamdan A, Reece-Bolton O, McGuigan A, Shahin Y, Ali A, Luther A, Nicholson JA, Rajendran I, Boal M, Ritchie J. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103:1716-1726. [PMID: 27748962 DOI: 10.1002/bjs.10288] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/21/2016] [Accepted: 07/06/2016] [Indexed: 01/05/2023]
Abstract
Abstract
Background
The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.
Methods
Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).
Results
Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.
Conclusion
Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.
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Affiliation(s)
| | - R S Vohra
- Trent Oesophago-Gastric Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Pasquali
- Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - A J Kirkham
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - P Marriott
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - M Johnstone
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - P Spreadborough
- West Midlands Research Collaborative, Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - D Alderson
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - E A Griffiths
- Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Fenwick
- Aintree University Hospital NHS Foundation Trust
| | - M Elmasry
- Aintree University Hospital NHS Foundation Trust
| | - Q Nunes
- Aintree University Hospital NHS Foundation Trust
| | - D Kennedy
- Aintree University Hospital NHS Foundation Trust
| | | | | | | | | | - D Mason
- Wirral University Teaching Hospital
| | | | | | | | - S Jamel
- Barnet and Chase Farm Hospital
| | | | - S Zafar
- Barnet and Chase Farm Hospital
| | | | - N Samuel
- Barnsley District General Hospital
| | - F Dar
- Barnsley District General Hospital
| | | | | | | | | | | | | | - K Wheatley
- Sandwell and West Birmingham Hospitals NHS Trust
| | - T Nieto
- Sandwell and West Birmingham Hospitals NHS Trust
| | - S Ayaani
- Sandwell and West Birmingham Hospitals NHS Trust
| | - H Youssef
- Heart of England Foundation NHS Trust
| | | | - H Watkin
- Heart of England Foundation NHS Trust
| | - D Naumann
- Heart of England Foundation NHS Trust
| | - S Emeshi
- Heart of England Foundation NHS Trust
| | | | - K Lee
- Heart of England Foundation NHS Trust
| | - N Joji
- Heart of England Foundation NHS Trust
| | - J Heath
- Blackpool Teaching Hospitals NHS Foundation Trust
| | - R L Teasdale
- Blackpool Teaching Hospitals NHS Foundation Trust
| | | | - P J Needham
- Bradford Teaching Hospitals NHS Foundation Trust
| | - H Welbourn
- Bradford Teaching Hospitals NHS Foundation Trust
| | - L Forster
- Bradford Teaching Hospitals NHS Foundation Trust
| | - D Finch
- Bradford Teaching Hospitals NHS Foundation Trust
| | | | - W Robb
- University Hospitals Bristol NHS Trust
| | | | | | | | | | | | | | | | - B Dobbins
- Calderdale and Huddersfield NHS Trust
| | | | | | | | - M Pellen
- Hull and East Yorkshire NHS Trust
| | | | - W-M Ho
- Hull and East Yorkshire NHS Trust
| | - V Miu
- Hull and East Yorkshire NHS Trust
| | - T J White
- Chesterfield Royal Hospital NHS Foundation Trust
| | - K A Hodgkins
- Chesterfield Royal Hospital NHS Foundation Trust
| | - A Kinghorn
- Chesterfield Royal Hospital NHS Foundation Trust
| | - M G Tutton
- Colchester Hospital University NHS Foundation Trust
| | - Y A Al-Abed
- Colchester Hospital University NHS Foundation Trust
| | - D Menzies
- Colchester Hospital University NHS Foundation Trust
| | - A Ahmad
- Colchester Hospital University NHS Foundation Trust
| | - J Reed
- Colchester Hospital University NHS Foundation Trust
| | - S Khan
- Colchester Hospital University NHS Foundation Trust
| | - D Monk
- Countess of Chester NHS Foundation Trust
| | - L J Vitone
- Countess of Chester NHS Foundation Trust
| | - G Murtaza
- Countess of Chester NHS Foundation Trust
| | - A Joel
- Countess of Chester NHS Foundation Trust
| | | | - D Shier
- Croydon Health Services NHS Trust
| | - C Zhang
- Croydon Health Services NHS Trust
| | | | | | | | - M J Jones
- North Cumbria University Hospitals Trust
| | - M Elsayed
- North Cumbria University Hospitals Trust
| | - L Tuck
- North Cumbria University Hospitals Trust
| | - J Wayman
- North Cumbria University Hospitals Trust
| | - K Carney
- North Cumbria University Hospitals Trust
| | | | | | | | | | | | | | | | | | | | | | - M P Tilston
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - M Gough
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T Wallace
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - S Singh
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - J Downing
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - K A Mockford
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - E Issa
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Shah
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - N Chauhan
- Northern Lincolnshire and Goole NHS Foundation Trust
| | - T R Wilson
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - A Forouzanfar
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - J R L Wild
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - E Nofal
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - C Bunnell
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - K Madbak
- Doncaster and Bassetlaw Hospitals NHS Foundation Trust
| | - S T V Rao
- Dorset County Hospital NHS Foundation Trust
| | - L Devoto
- Dorset County Hospital NHS Foundation Trust
| | - N Siddiqi
- Dorset County Hospital NHS Foundation Trust
| | - Z Khawaja
- Dorset County Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - D M Rae
- Frimley Park Hospital NHS Trust
| | | | | | | | | | - O J Old
- Gloucestershire Hospitals NHS Trust
| | | | - R Shah
- Gloucestershire Hospitals NHS Trust
| | | | - K Keogh
- Gloucestershire Hospitals NHS Trust
| | - L Frank
- Gloucestershire Hospitals NHS Trust
| | - M Al-Akash
- Great Western Hospitals NHS Foundation Trust
| | | | - R J Frame
- Harrogate and District NHS Foundation Trust
| | - M Hughes
- Harrogate and District NHS Foundation Trust
| | - C Jelley
- Harrogate and District NHS Foundation Trust
| | | | | | | | | | - T Cuming
- Homerton University Hospital NHS Trust
| | - P Cunha
- Homerton University Hospital NHS Trust
| | - S Tayeh
- Homerton University Hospital NHS Trust
| | | | | | - A Eisawi
- Tees Hospitals NHS Foundation Trust
| | | | - W S Ngu
- Tees Hospitals NHS Foundation Trust
| | | | | | - V Chitre
- Paget University Hospitals NHS Foundation Trust
| | - K Aryal
- Paget University Hospitals NHS Foundation Trust
| | - P Ferris
- Paget University Hospitals NHS Foundation Trust
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- Kettering General Hospital NHS Foundation Trust
| | - M Elshaer
- Kettering General Hospital NHS Foundation Trust
| | - G Gravante
- Kettering General Hospital NHS Foundation Trust
| | - B Drake
- Kettering General Hospital NHS Foundation Trust
| | - A Ogedegbe
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - D Mukherjee
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | - C Arhi
- Barking, Havering and Redbridge University Hospitals NHS Trust
| | | | | | | | | | | | | | - K Wa
- Kingston Hospital NHS Foundation Trust
| | - J Mok
- Kingston Hospital NHS Foundation Trust
| | - T Woodman
- Kingston Hospital NHS Foundation Trust
| | - J Deguara
- Kingston Hospital NHS Foundation Trust
| | - G Garcea
- University Hospitals of Leicester NHS Trust
| | - B I Babu
- University Hospitals of Leicester NHS Trust
| | | | - D Malde
- University Hospitals of Leicester NHS Trust
| | - D Lloyd
- University Hospitals of Leicester NHS Trust
| | | | - O Al-Taan
- University Hospitals of Leicester NHS Trust
| | - A Boddy
- University Hospitals of Leicester NHS Trust
| | - J P Slavin
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - R P Jones
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - L Ballance
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - S Gerakopoulos
- Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust
| | - P Jambulingam
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - S Mansour
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - N Sakai
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - V Acharya
- Luton and Dunstable University Hospital NHS Foundation Trust
| | - M M Sadat
- Macclesfield District General Hospital
| | - L Karim
- Macclesfield District General Hospital
| | - D Larkin
- Macclesfield District General Hospital
| | - K Amin
- Macclesfield District General Hospital
| | - A Khan
- Central Manchester NHS Foundation Trust
| | - J Law
- Central Manchester NHS Foundation Trust
| | - S Jamdar
- Central Manchester NHS Foundation Trust
| | - S R Smith
- Central Manchester NHS Foundation Trust
| | - K Sampat
- Central Manchester NHS Foundation Trust
| | | | - M Manu
- Royal Wolverhampton Hospitals NHS Trust
| | | | - N S Malik
- Royal Wolverhampton Hospitals NHS Trust
| | - J Chang
- Royal Wolverhampton Hospitals NHS Trust
| | | | - M Lewis
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - G P Roberts
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - B Karavadra
- Norfolk and Norwich University Hospitals NHS Foundation Trust
| | - E Photi
- Norfolk and Norwich University Hospitals NHS Foundation Trust
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- North Tees and Hartlepool NHS Foundation Trust
| | | | | | - K Seymour
- Northumbria Healthcare NHS Foundation Trust
| | - S Robinson
- Northumbria Healthcare NHS Foundation Trust
| | - H Hawkins
- Northumbria Healthcare NHS Foundation Trust
| | - S Bawa
- Northumbria Healthcare NHS Foundation Trust
| | | | - A Reid
- Northumbria Healthcare NHS Foundation Trust
| | - P Wood
- Northumbria Healthcare NHS Foundation Trust
| | - J G Finch
- Northampton General Hospital NHS Trust
| | - J Parmar
- Northampton General Hospital NHS Trust
| | | | | | - A Al-Muhktar
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - M Peterson
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - A Majeed
- Sheffield Teaching Hospitals NHS Foundation Trust
| | | | | | - A Choy
- Peterborough City Hospital
| | | | - N Pore
- United Lincolnshire Hospitals NHS Trust
| | | | | | - C Taylor
- United Lincolnshire Hospitals NHS Trust
| | | | | | | | | | | | | | | | - S Tate
- Portsmouth Hospitals NHS Trust
| | | | | | - V Vijay
- The Princess Alexandra Hospital NHS Trust
| | | | - S Sinha
- The Princess Alexandra Hospital NHS Trust
| | - S Khan
- The Princess Alexandra Hospital NHS Trust
| | | | - A A Hussain
- King's College Hospital NHS Foundation Trust
| | | | - N Kansal
- Gateshead Health NHS Foundation Trust
| | - T Fasih
- Gateshead Health NHS Foundation Trust
| | - C Jackson
- Gateshead Health NHS Foundation Trust
| | | | | | | | | | | | | | - K Gurung
- Queen Elizabeth Hospital NHS Trust
| | - G Tsavellas
- East Kent Hospitals University NHS Foundation Trust
| | - P Basynat
- East Kent Hospitals University NHS Foundation Trust
| | | | - S Basu
- East Kent Hospitals University NHS Foundation Trust
| | | | - M Rabie
- East Kent Hospitals University NHS Foundation Trust
| | - M Akhtar
- East Kent Hospitals University NHS Foundation Trust
| | - P Kumar
- Burton Hospitals NHS Foundation Trust
| | | | - N Hussain
- Burton Hospitals NHS Foundation Trust
| | - S Raza
- Burton Hospitals NHS Foundation Trust
| | - M Haque
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - I Alam
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - R Aseem
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - S Patel
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M Asad
- Royal Albert Edward Infirmary, Wigan Wrightington and Leigh NHS Trust
| | - M I Booth
- Royal Berkshire NHS Foundation Trust
| | - W R Ball
- Royal Berkshire NHS Foundation Trust
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- Royal Bolton Hospital NHS Foundation Trust
| | - J Lodhia
- Royal Bolton Hospital NHS Foundation Trust
| | - D Bradley
- Royal Bolton Hospital NHS Foundation Trust
| | - C Rengifo
- Royal Bolton Hospital NHS Foundation Trust
| | - D Lindsay
- Royal Bolton Hospital NHS Foundation Trust
| | | | | | | | | | | | - A Awan
- Royal Derby NHS Foundation Trust
| | - J Ahmed
- Royal Derby NHS Foundation Trust
| | - P Leeder
- Royal Derby NHS Foundation Trust
| | | | | | | | | | - D Hou
- Hampshire Hospital NHS Foundation Trust
| | - F Noble
- Hampshire Hospital NHS Foundation Trust
| | | | | | - R Date
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - M R Hossack
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - Y Li Goh
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - P Turner
- Lancashire Teaching Hospitals NHS Foundation Trust
| | - V Shetty
- Lancashire Teaching Hospitals NHS Foundation Trust
| | | | | | | | - S R Preston
- Royal Surrey County Hospital NHS Foundation Trust
| | - J R Hoban
- Royal Surrey County Hospital NHS Foundation Trust
| | - D J Puntis
- Royal Surrey County Hospital NHS Foundation Trust
| | - S V Williams
- Royal Surrey County Hospital NHS Foundation Trust
| | | | | | - J Batt
- Royal United Hospital Bath NHS Trust
| | - M Doe
- Royal United Hospital Bath NHS Trust
| | | | | | | | - C Hall
- Salford Royal NHS Foundation Trust
| | - N Carty
- Salisbury Hospital Foundation Trust
| | - J Ahmed
- Salisbury Hospital Foundation Trust
| | | | | | | | - H Lennon
- Southport and Ormskirk Hospital NHS Trust
| | - C Hindley
- Southport and Ormskirk Hospital NHS Trust
| | - M Reddy
- St George's Healthcare NHS Trust
| | - R Kenny
- St George's Healthcare NHS Trust
| | | | | | | | - K Hancorn
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | - A Hargreaves
- St Helens and Knowsley Teaching Hospitals NHS Trust
| | | | | | | | | | - P Ziprin
- Imperial College Healthcare NHS Trust
| | | | - G Yeldham
- Imperial College Healthcare NHS Trust
| | - E Read
- Imperial College Healthcare NHS Trust
| | | | | | | | | | - M A Khan
- Mid Staffordshire NHS Foundation Trust
| | | | | | - A Hussain
- Mid Staffordshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | - S Ali
- City Hospitals Sunderland NHS Foundation Trust
| | - V Kanakala
- City Hospitals Sunderland NHS Foundation Trust
| | - H Ali
- Tunbridge Wells and Maidstone NHS Trust
| | - R Lane
- Tunbridge Wells and Maidstone NHS Trust
| | | | | | - D Mirza
- University Hospital Birmingham NHS Foundation Trust
| | - S Puig
- University Hospital Birmingham NHS Foundation Trust
| | - K Al Amari
- University Hospital Birmingham NHS Foundation Trust
| | - D Vijayan
- University Hospital Birmingham NHS Foundation Trust
| | - R Sutcliffe
- University Hospital Birmingham NHS Foundation Trust
| | | | - Z Hamady
- University Hospital Coventry and Warwickshire NHS Trust
| | - A R Prasad
- University Hospital Coventry and Warwickshire NHS Trust
| | - A Patel
- University Hospital Coventry and Warwickshire NHS Trust
| | - D Durkin
- University Hospital of North Staffordshire NHS Trust
| | - P Kaur
- University Hospital of North Staffordshire NHS Trust
| | - L Bowen
- University Hospital of North Staffordshire NHS Trust
| | - J P Byrne
- University Hospital Southampton NHS Foundation Trust
| | - K L Pearson
- University Hospital Southampton NHS Foundation Trust
| | - T G Delisle
- University Hospital Southampton NHS Foundation Trust
| | - J Davies
- University Hospital Southampton NHS Foundation Trust
| | | | | | | | - A Macdonald
- University Hospital South Manchester NHS Foundation Trust
| | - J Nicholson
- University Hospital South Manchester NHS Foundation Trust
| | - K Newton
- University Hospital South Manchester NHS Foundation Trust
| | - J Mbuvi
- University Hospital South Manchester NHS Foundation Trust
| | - A Farooq
- Warrington and Halton Hospitals NHS Trust
| | | | - Z Zafrani
- Warrington and Halton Hospitals NHS Trust
| | - D Brett
- Warrington and Halton Hospitals NHS Trust
| | | | | | - J Barnes
- South Warwickshire NHS Foundation Trust
| | - M Cheung
- South Warwickshire NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - M Wadley
- Worcestershire Acute Hospitals NHS Trust
| | - E Hamilton
- Worcestershire Acute Hospitals NHS Trust
| | - S Jaunoo
- Worcestershire Acute Hospitals NHS Trust
| | - R Padwick
- Worcestershire Acute Hospitals NHS Trust
| | - M Sayegh
- Western Sussex Hospitals NHS Foundation Trust
| | - R C Newton
- Western Sussex Hospitals NHS Foundation Trust
| | - M Hebbar
- Western Sussex Hospitals NHS Foundation Trust
| | - S F Farag
- Western Sussex Hospitals NHS Foundation Trust
| | | | | | | | - C Blane
- Yeovil District Hospital NHS Trust
| | - M Giles
- York Teaching Hospital NHS Foundation Trust
| | - M B Peter
- York Teaching Hospital NHS Foundation Trust
| | - N A Hirst
- York Teaching Hospital NHS Foundation Trust
| | - T Hossain
- York Teaching Hospital NHS Foundation Trust
| | - A Pannu
- York Teaching Hospital NHS Foundation Trust
| | | | | | - G W Taylor
- York Teaching Hospital NHS Foundation Trust
| | | | | | | | | | | | | | | | | | | | | | | | | | - T Diamond
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - P Davey
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - C Jones
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - J M Clements
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - R Digney
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - W M Chan
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S McCain
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Gull
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Janeczko
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - E Dorrian
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - A Harris
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - S Dawson
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - D Johnston
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | - B McAree
- Belfast City Hospital, Mater Infirmorum Hospital Belfast and Royal Victoria Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | - P Burke
- University Hospital Limerick
| | | | - A D K Hill
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Khogali
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - W Shabo
- Louth County Hospital and Our Lady of Lourdes Hospital
| | - E Iskandar
- Louth County Hospital and Our Lady of Lourdes Hospital
| | | | | | | | | | | | | | | | | | - P Balfe
- St Luke's General Hospital Kilkenny
| | - M Lee
- St Luke's General Hospital Kilkenny
| | - D C Winter
- St Vincent's University and Private Hospitals, Dublin
| | - M E Kelly
- St Vincent's University and Private Hospitals, Dublin
| | - E Hoti
- St Vincent's University and Private Hospitals, Dublin
| | - D Maguire
- St Vincent's University and Private Hospitals, Dublin
| | - P Karunakaran
- St Vincent's University and Private Hospitals, Dublin
| | - J G Geoghegan
- St Vincent's University and Private Hospitals, Dublin
| | - S T Martin
- St Vincent's University and Private Hospitals, Dublin
| | - F McDermott
- St Vincent's University and Private Hospitals, Dublin
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - S Gibson
- Crosshouse Hospital, Ayrshire and Arran
| | | | - D G Vass
- Crosshouse Hospital, Ayrshire and Arran
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - H C C Lim
- Glangwili General and Prince Philip Hospital
| | - D Duke
- Glangwili General and Prince Philip Hospital
| | - T Ahmed
- Glangwili General and Prince Philip Hospital
| | - W D Beasley
- Glangwili General and Prince Philip Hospital
| | | | - G Maharaj
- Glangwili General and Prince Philip Hospital
| | - C Malcolm
- Glangwili General and Prince Philip Hospital
| | | | | | | | - R Radwan
- Morriston and Singleton Hospitals
| | | | - S Wood
- Princess of Wales Hospital
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9
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Bowen L, Shaw A, Lyttle MD, Purdy S. The transition to clinical expert: enhanced decision making for children aged less than 5 years attending the paediatric ED with acute respiratory conditions. Emerg Med J 2016; 34:76-81. [PMID: 27496899 PMCID: PMC5384604 DOI: 10.1136/emermed-2015-205211] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Rates of unplanned paediatric admissions are persistently high. Many admissions are short-stay events, lasting less than 48 hours. OBJECTIVE This qualitative research explores factors that influence clinical decision making in the paediatric ED (PED) for children under 5 attending with acute respiratory conditions, focusing on how management decisions adapt with increasing experience. METHOD Semi-structured interviews were conducted with 15 PED clinicians (doctors, emergency nurse practitioners and registered nurses) with varying levels of experience in paediatric emergency medicine (PEM), emergency medicine or paediatrics. Audio-recorded interviews were transcribed and analysed thematically. RESULTS There were clear differences in decision-making approaches between experienced clinicians and junior staff. The latter were more risk adverse, relying heavily on guidelines, set admission criteria, clinical theory and second opinions. This was particularly true for doctors. 'Informal' learning was apparent in accounts from less-experienced doctors and nurses, whereby tacit knowledge and risk management played an increasing role in the development of clinical intuition that permitted rapid assessment and treatment of young patients. CONCLUSIONS The emergence of intuition entwined with approaches to risk management and the role of these skills in clinical decision making, carry implications for the development of training programmes for clinicians working in PEM. Enhanced training for such groups to permit development of the supplementary skills described in this study could have the ability to improve care delivery and even reduce paediatric admissions.
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Affiliation(s)
- Leah Bowen
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Alison Shaw
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
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10
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Karthigan R, Reid K, Wali U, Mouralidarane A, Bowen L, Saltan S, Flindall I, Swift R. Extended venous thromboprophylaxis following colorectal cancer surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11
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Roy HK, Brendler CB, Subramanian H, Zhang D, Maneval C, Chandler J, Bowen L, Kaul KL, Helfand BT, Wang CH, Quinn M, Petkewicz J, Paterakos M, Backman V. Nanocytological field carcinogenesis detection to mitigate overdiagnosis of prostate cancer: a proof of concept study. PLoS One 2015; 10:e0115999. [PMID: 25706755 PMCID: PMC4338151 DOI: 10.1371/journal.pone.0115999] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/21/2014] [Indexed: 01/14/2023] Open
Abstract
Purpose To determine whether nano-architectural interrogation of prostate field carcinogenesis can be used to predict prognosis in patients with early stage (Gleason 6) prostate cancer (PCa), which is mostly indolent but frequently unnecessarily treated. Materials and Methods We previously developed partial wave spectroscopic microscopy (PWS) that enables quantification of the nanoscale intracellular architecture (20–200nm length scale) with remarkable accuracy. We adapted this technique to assess prostate needle core biopsies in a case control study from men with Gleason 6 disease who either progressed (n = 20) or remained indolent (n = 18) over a ~3 year follow up. We measured the parameter disorder strength (Ld) characterizing the spatial heterogeneity of the nanoscale cellular structure and nuclear morphology from the microscopically normal mucosa ~150 histologically normal epithelial cells. Results There was a profound increase in nano-architectural disorder between progressors and non-progressors. Indeed, the Ld from future progressors was dramatically increased when compared to future non-progressors (1±0.065 versus 1.30±0.0614, respectively p = 0.002). The area under the receiver operator characteristic curve (AUC) was 0.79, yielding a sensitivity of 88% and specificity of 72% for discriminating between progressors and non-progressors. This was not confounded by demographic factors (age, smoking status, race, obesity), thus supporting the robustness of the approach. Conclusions We demonstrate, for the first time, that nano-architectural alterations occur in prostate cancer field carcinogenesis and can be exploited to predict prognosis of early stage PCa. This approach has promise in addressing the clinically vexing dilemma of management of Gleason 6 PCa and may provide a paradigm for dealing with the larger issue of cancer overdiagnosis.
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Affiliation(s)
- Hemant K. Roy
- Department of Medicine, Boston University Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Charles B. Brendler
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Hariharan Subramanian
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
| | - Di Zhang
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
| | - Charles Maneval
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
| | - John Chandler
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
| | - Leah Bowen
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
| | - Karen L. Kaul
- Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Brian T. Helfand
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Chi-Hsiung Wang
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Margo Quinn
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Jacqueline Petkewicz
- Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Michael Paterakos
- Department of Pathology, NorthShore University HealthSystem, Evanston, Illinois, United States of America
| | - Vadim Backman
- Biomedical Engineering Department, Northwestern University, Evanston, Illinois, United States of America
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Kouroukla E, Bailiff I, Terry I, Bowen L. Luminescence characterisation of alumina substrates using cathodoluminescence microscopy and spectroscopy. RADIAT MEAS 2014. [DOI: 10.1016/j.radmeas.2014.03.018] [Citation(s) in RCA: 6] [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: 12/01/2022]
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13
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Warren S, Findlater R, Bowen L, Penner B. VALVE REPLACEMENT AND POST-OPERATIVE PAIN MANAGEMENT IN THE OPIOID ADDICTED PATIENT. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.662] [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: 10/24/2022] Open
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14
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Bowen L, Purdy S, Lyttle MD, Heawood A. THE TRANSITION TO EXPERT: A QUALITATIVE STUDY EXPLORING CLINICAL DECISION MAKING FOR CHILDREN UNDER FIVE ATTENDING THE EMERGENCY DEPARTMENT WITH MINOR RESPIRATORY CONDITIONS. Arch Emerg Med 2014. [DOI: 10.1136/emermed-2014-204221.31] [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: 11/04/2022]
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15
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Procter S, Stewart K, Reeves D, Bowen L, Purdy S, Ridd M, Salisbury C. Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations. BMC Fam Pract 2014; 15:105. [PMID: 24885298 PMCID: PMC4046503 DOI: 10.1186/1471-2296-15-105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Accepted: 05/19/2014] [Indexed: 11/10/2022]
Abstract
Background There is an increasing recognition that many consultations in general practice involve several problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the number and type of problems discussed in primary care consultations. Methods Thirteen consultations between general practitioners and patients were initially videoed and reviewed to identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and repeated cycles of testing and development was used to develop a measurement proforma and coding manual for assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations. Results The problems requiring action were usually readily identified. However the different dimensions of the problem and how they were addressed required the identification and definition of ‘issues’. A coding proforma was developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has subsequently been used to analyse 229 consultations. Conclusion The iterative approach to development of the tool reflected the complexity of doctor-patient interactions. A reliable tool has been developed that can be used to analyse the number and range of problems managed in primary care consultations.
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Affiliation(s)
- Sunita Procter
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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Stone R, Rosamond M, Coleman K, Petty M, Kolosov O, Bowen L, Dubrovskii V, Zeze D. Tungstate sharpening: a versatile method for extending the profile of ultra sharp tungsten probes. Rev Sci Instrum 2013; 84:035107. [PMID: 23556852 DOI: 10.1063/1.4797483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The benefits of a new electrochemical etching method for the controlled sharpening of sub-micron tungsten probes are demonstrated. The proposed technique only utilizes the insulating effect of the WO₄(2-) by-product which offers more practical ways of controlling the process parameters. The electrosharpening method was fully automated through the analysis of the process current, bulk coulometry, shadowgraphs, and time lapse microscopy. Tip radii smaller than 15 nm were maintained over a wide range of controlled lengths up to 4.5 mm with conic angles of less than 1°.
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Affiliation(s)
- R Stone
- School of Engineering, Durham University, Durham DH1 3LE, United Kingdom
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Trotter CL, Yaro S, Njanpop-Lafourcade BM, Drabo A, Kroman SS, Idohou RS, Sanou O, Bowen L, Findlow H, Diagbouga S, Gessner BD, Borrow R, Mueller JE. Seroprevalence of bactericidal, specific IgG antibodies and incidence of meningitis due to group A Neisseria meningitidis by age in Burkina Faso 2008. PLoS One 2013; 8:e55486. [PMID: 23457471 PMCID: PMC3573051 DOI: 10.1371/journal.pone.0055486] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/27/2012] [Indexed: 01/17/2023] Open
Abstract
Background We investigated serological correlates of protection against Neisseria meningitidis serogroup A (NmA) in Burkina Faso before the introduction of NmA conjugate vaccine. Methodology/Principal Findings We collected blood from a representative sample (N = 1022) of Bobo-Dioulasso residents. Sera were evaluated for serum bactericidal antibody (SBA) activity against NmA strains of immunotype L11 (F8238) and L10 (3125) and NmA-specific IgG. Seroprevalence was compared to the age-specific NmA meningitis incidence in Bobo-Dioulasso during March 2007–February 2008. Meningococcal carriage was evaluated in a subset (N = 538). Geometric mean titres (GMT)/concentrations (GMC) of SBA and NmA-specific IgG increased with age, peaking around age 20 years. Overall, 70% of our sample had NmA-specific IgG ≥2 ug/mL. Meningitis incidence was highest in those aged <6 months and 5–19 years. No NmA carriers were found. Compared to the reference strain SBA, GMTs were higher against a locally isolated strain and around 40-fold lower against Dutch strain 3125. Conclusions/Significance This study provides estimates of natural immunity to NmA, according to a variety of antibody measures, which will be helpful in ascertaining antibody persistence after MenAfriVac™ introduction. Age-specific seroprevalence of reference strain SBA titres most likely reflects exposure to meningococci and consecutive reactive immunity. We could not define any serological correlate of protection.
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Affiliation(s)
- Caroline L Trotter
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.
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Gupta V, Vinay DG, Rafiq S, Kranthikumar MV, Janipalli CS, Giambartolomei C, Evans DM, Mani KR, Sandeep MN, Taylor AE, Kinra S, Sullivan RM, Bowen L, Timpson NJ, Smith GD, Dudbridge F, Prabhakaran D, Ben-Shlomo Y, Reddy KS, Ebrahim S, Chandak GR. Association analysis of 31 common polymorphisms with type 2 diabetes and its related traits in Indian sib pairs. Diabetologia 2012; 55:349-57. [PMID: 22052079 PMCID: PMC3245821 DOI: 10.1007/s00125-011-2355-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 09/30/2011] [Indexed: 12/04/2022]
Abstract
AIMS/HYPOTHESIS Evaluation of the association of 31 common single nucleotide polymorphisms (SNPs) with fasting glucose, fasting insulin, HOMA-beta cell function (HOMA-β), HOMA-insulin resistance (HOMA-IR) and type 2 diabetes in the Indian population. METHODS We genotyped 3,089 sib pairs recruited in the Indian Migration Study from four cities in India (Lucknow, Nagpur, Hyderabad and Bangalore) for 31 SNPs in 24 genes previously associated with type 2 diabetes in European populations. We conducted within-sib-pair analysis for type 2 diabetes and its related quantitative traits. RESULTS The risk-allele frequencies of all the SNPs were comparable with those reported in western populations. We demonstrated significant associations of CXCR4 (rs932206), CDKAL1 (rs7756992) and TCF7L2 (rs7903146, rs12255372) with fasting glucose, with β values of 0.007 (p = 0.05), 0.01 (p = 0.01), 0.007 (p = 0.05), 0.01 (p = 0.003) and 0.08 (p = 0.01), respectively. Variants in NOTCH2 (rs10923931), TCF-2 (also known as HNF1B) (rs757210), ADAM30 (rs2641348) and CDKN2A/B (rs10811661) significantly predicted fasting insulin, with β values of -0.06 (p = 0.04), 0.05 (p = 0.05), -0.08 (p = 0.01) and -0.08 (p = 0.02), respectively. For HOMA-IR, we detected associations with TCF-2, ADAM30 and CDKN2A/B, with β values of 0.05 (p = 0.04), -0.07 (p = 0.03) and -0.08 (p = 0.02), respectively. We also found significant associations of ADAM30 (β = -0.05; p = 0.01) and CDKN2A/B (β = -0.05; p = 0.03) with HOMA-β. THADA variant (rs7578597) was associated with type 2 diabetes (OR 1.5; 95% CI 1.04, 2.22; p = 0.03). CONCLUSIONS/INTERPRETATION We validated the association of seven established loci with intermediate traits related to type 2 diabetes in an Indian population using a design resistant to population stratification.
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Affiliation(s)
- V. Gupta
- South Asia Network for Chronic Disease, Public Health Foundation of India, C-1/52, Safdarjung Development Area, New Delhi, 110016 India
- Public Health Foundation of India, New Delhi, India
| | - D. G. Vinay
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
| | - S. Rafiq
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - M. V. Kranthikumar
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
| | - C. S. Janipalli
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
| | - C. Giambartolomei
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - D. M. Evans
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK
| | - K. R. Mani
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
| | - M. N. Sandeep
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
| | - A. E. Taylor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK
| | - S. Kinra
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R. M. Sullivan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - L. Bowen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - N. J. Timpson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK
| | - G. D. Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol, UK
| | - F. Dudbridge
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London, UK
| | | | - Y. Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - K. S. Reddy
- South Asia Network for Chronic Disease, Public Health Foundation of India, C-1/52, Safdarjung Development Area, New Delhi, 110016 India
- Public Health Foundation of India, New Delhi, India
| | - S. Ebrahim
- South Asia Network for Chronic Disease, Public Health Foundation of India, C-1/52, Safdarjung Development Area, New Delhi, 110016 India
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London, UK
| | - G. R. Chandak
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Habshiguda, Uppal Road, Hyderabad, 500007 India
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Satija A, Taylor FC, Khurana S, Tripathy V, Khandpur N, Bowen L, Prabhakaran D, Kinra S, Reddy KS, Ebrahim S. Differences in consumption of food items between obese and normal-weight people in India. Natl Med J India 2012; 25:10-13. [PMID: 22680313] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a rising prevalence of obesity in India, and diet may be a major determinant of this. We aimed to assess differences in types and quantities of food items consumed by obese and normal-weight people in India. METHODS Cross-sectional data of 7067 factory workers and their families were used from the Indian Migration Study, conducted in four cities across northern, central and southern India. Food frequency questionnaire data were used to compare the quantities of consumption of 184 food items between 287 obese (body mass index>30 kg/m2) and 1871 normalweight (body mass index 18.50-22.99 kg/m2) individuals, using t tests and ANCOVAs. Individuals with diabetes,hypertension and cardio-vascular disease were excluded. SPSS 16.0 was used for analysis. RESULTS After adjusting for age, sex, location and socioeconomic status, obese individuals were found to eat significantly larger quantities of 11 food items compared with normalweight individuals. These included phulkas, chapatis/parathas/naan, plain dosa, mutton/chicken pulao/biryani, chicken fried/grilled, rasam, mixed vegetable sagu, vegetable raitha, honey,beetroot and bottlegourd (p< 0.01). Consumption of plain milk was higher among normal-weight than among obese individuals (p< 0.05). Consumption of some of these food items was also found to increase by socioeconomic status, decrease by age, and be higher among men relative to women. CONCLUSION Obese individuals were found to consume larger quantities of certain food items compared with normal weight individuals. Interventions should aim at limiting overall food consumption among obese individuals.
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Affiliation(s)
- A Satija
- South Asia Network for Chronic Disease, C 1/52, First Floor, Safdarjung Development Area, New Delhi 110016, India.
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Bowen L, Kiernan JD, Eder K, Werner I, Leutenegger CM, Adkison MA, Hedrick RP, Johnson ML. Euthanization methods influence cytokine mRNA expression levels in age 0 year Oncorhynchus mykiss. J Fish Biol 2011; 79:539-545. [PMID: 21781109 DOI: 10.1111/j.1095-8649.2011.03034.x] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Significant differences in cytokine transcription were found between Oncorhynchus mykiss euthanized using the pharmacological agents MS-222 v. benzocaine and also when contrasting death induced by carbon dioxide asphyxiation v. physical methods (cervical dislocation). This study highlights the need to consider the potentially confounding effect of euthanization method on gene expression data.
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Affiliation(s)
- L Bowen
- Center for Watershed Sciences, One Shields Avenue, University of California, Davis, CA 95616, USA.
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Puig CJ, Greiner R, Huchery C, Perkins I, Bowen L, Collier N, Garnett ST. Beyond cattle: potential futures of the pastoral industry in the Northern Territory. Rangel J 2011. [DOI: 10.1071/rj10043] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The pastoral industry of the Northern Territory faces a suite of environmental and economic challenges associated with, inter alia, export markets, costs of production, climate change, change in government policies, and potential cattle diseases. A participatory planning process was adopted by the industry’s principal representative body, the Northern Territory Cattlemen’s Association to explore the complexity and extent of possible impacts on the industry, and to initiate conversations about anticipating potential futures. The process was facilitated by a system dynamics model, named the Pastoral Properties Future Simulator (PPFS). The PPFS combined a systems modelling approach of the pastoral industry with scenario explorations to gauge the likely impacts on, and possible industry adaptations to, beef price variation, productivity improvements, diversification of land use, climate change, climate policy and employment. The PPFS was used as an interactive tool during stakeholder workshops and results underpinned discussions about impacts and adaptation strategies. Land use and enterprise diversification emerged as key strategies for building enterprise and industry resilience, but with regionally diverging emphasis. The research illustrates the benefits of applied systems dynamic modelling for participatory strategic planning in the face of an uncertain future. The PPFS helped industry members and stakeholders understand the complexity of drivers affecting the industry’s future, risk profiles, possible adaptation strategies and trade-offs.
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Taylor AE, Sandeep MN, Janipalli CS, Giambartolomei C, Evans DM, Kranthi Kumar MV, Vinay DG, Smitha P, Gupta V, Aruna M, Kinra S, Sullivan RM, Bowen L, Timpson NJ, Davey Smith G, Dudbridge F, Prabhakaran D, Ben-Shlomo Y, Reddy KS, Ebrahim S, Chandak GR. Associations of FTO and MC4R Variants with Obesity Traits in Indians and the Role of Rural/Urban Environment as a Possible Effect Modifier. J Obes 2011; 2011:307542. [PMID: 21785715 PMCID: PMC3139181 DOI: 10.1155/2011/307542] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 03/04/2011] [Indexed: 11/22/2022] Open
Abstract
Few studies have investigated the association between genetic variation and obesity traits in Indian populations or the role of environmental factors as modifiers of these relationships. In the context of rapid urbanisation, resulting in significant lifestyle changes, understanding the aetiology of obesity is important. We investigated associations of FTO and MC4R variants with obesity traits in 3390 sibling pairs from four Indian cities, most of whom were discordant for current dwelling (rural or urban). The FTO variant rs9939609 predicted increased weight (0.09 Z-scores, 95% CI: 0.03, 0.15) and BMI (0.08 Z-scores, 95% CI: 0.02, 0.14). The MC4R variant rs17782313 was weakly associated with weight and hip circumference (P < .05). There was some indication that the association between FTO and weight was stronger in urban than that in rural dwellers (P for interaction = .03), but no evidence for effect modification by diet or physical activity. Further studies are needed to investigate ways in which urban environment may modify genetic risk of obesity.
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Affiliation(s)
- A. E. Taylor
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol BS8 2BN, UK
- *A. E. Taylor: and
| | - M. N. Sandeep
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - C. S. Janipalli
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - C. Giambartolomei
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London WC1E 6BT, UK
| | - D. M. Evans
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol BS8 2BN, UK
| | - M. V. Kranthi Kumar
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - D. G. Vinay
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - P. Smitha
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - V. Gupta
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi 110 016, India
| | - M. Aruna
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
| | - S. Kinra
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London WC1E 6BT, UK
| | - R. M. Sullivan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - L. Bowen
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - N. J. Timpson
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol BS8 2BN, UK
| | - G. Davey Smith
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
- MRC Centre for Causal Analyses in Translational Epidemiology, University of Bristol, Bristol BS8 2BN, UK
| | - F. Dudbridge
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London WC1E 6BT, UK
| | - D. Prabhakaran
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi 110 016, India
- Centre for Chronic Disease Control, New Delhi 110 016, India
- Public Health Foundation of India, New Delhi 110 016, India
| | - Y. Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - K. S. Reddy
- Public Health Foundation of India, New Delhi 110 016, India
| | - S. Ebrahim
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Bloomsbury Centre for Genetic Epidemiology and Statistics, London WC1E 6BT, UK
- South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi 110 016, India
| | - G. R. Chandak
- Centre for Cellular and Molecular Biology (CCMB), Council of Scientific and Industrial Research (CSIR), Hyderabad, India
- *G. R. Chandak:
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Christensen H, May M, Bowen L, Hickman M, Trotter CL. Meningococcal carriage by age: a systematic review and meta-analysis. The Lancet Infectious Diseases 2010; 10:853-61. [PMID: 21075057 DOI: 10.1016/s1473-3099(10)70251-6] [Citation(s) in RCA: 432] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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DeCarlo C, Alderson J, Bowen L, Rutllant J, Aldridge B. Characterization of the immunomodulatory effect of a commercial extender on semen-induced inflammatory response in equine uterine lumenal immune cells. J Reprod Immunol 2006. [DOI: 10.1016/j.jri.2006.08.042] [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 major histocompatibility complex (MHC) is central to maintaining the immunologic vigor of individuals and populations. Classical MHC class II genes were targeted for partial sequencing in sea otters (Enhydra lutris) from populations in California, Washington, and Alaska. Sequences derived from sea otter peripheral blood leukocyte mRNAs were similar to those classified as DQA, DQB, DRA, and DRB in other species. Comparisons of the derived amino acid compositions supported the classification of these as functional molecules from at least one DQA, DQB, and DRA locus and at least two DRB loci. While limited in scope, phylogenetic analysis of the DRB peptide-binding region suggested the possible existence of distinct clades demarcated by geographic region. These preliminary findings support the need for additional MHC gene sequencing and expansion to a comprehensive study targeting additional otters.
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Affiliation(s)
- L Bowen
- U. S. Geological Survey, Western Ecological Research Center, Davis Field Station, Davis, CA, USA.
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Bowen L, Aldridge BM, Delong R, Melin S, Godinez C, Zavala A, Gulland F, Lowenstine L, Stott JL, Johnson ML. MHC gene configuration variation in geographically disparate populations of California sea lions (Zalophus californianus). Mol Ecol 2005; 15:529-33. [PMID: 16448418 DOI: 10.1111/j.1365-294x.2005.02612.x] [Citation(s) in RCA: 20] [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: 12/01/2022]
Abstract
Major histocompatibility complex (MHC) class II DRB genotypes were examined in two geographically isolated populations of California sea lions (Zalophus californianus) (Gulf of California and California coastal Pacific Ocean). Genomic DNA from 227 California sea lions was examined using eight sequence-specific primer (SSP) pairs flanking the putative peptide-binding site. A total of 40 different Zaca-DRB genotype configurations were identified among the 227 individuals. Using SSP-PCR, significant differences were found between coastal California and Gulf of California Zalophus populations in numbers of DRB sequences per individual and configuration of sequences within individuals. Additionally, unique local patterns of MHC diversity were identified among the Midriff Island animals. These population differences are consistent with either ecologically distinct patterns of selection pressures and/or geographical isolation. The consequences of these partitioned MHC configurations at the population level are as yet unknown; however, the worldwide increase in emerging marine diseases lends urgency to their examination.
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Affiliation(s)
- L Bowen
- Laboratory for Marine Mammal Immunology, School of Veterinary Medicine, Department of Pathology, Microbiology and Immunology, University of California, Davis, CA, 95616, USA.
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Bowen L. Forests of hope: Costa Rica. Restoring hope in the clouds. People Planet 2002; 5:22-3. [PMID: 12322449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Abstract
The ectoparasite fauna for island foxes (Urocyon littoralis) on Santa Cruz Island (California, USA) in April (wet season) and September (dry season) 1998 was evaluated. Three taxa of ectoparasites were identified. These were fleas (Pulex irritans), lice (Neotrichodectes mephitidis), and ticks (Ixodes pacificus). Ectoparasite abundances varied seasonally. Typical of insular endemic species, island foxes may be especially vulnerable to the introduction of novel disease organisms and their vectors.
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Affiliation(s)
- K R Crooks
- Department of Biology, University of California, Santa Cruz 95064, USA.
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Abstract
Serum and hematologic biochemistry values for island foxes (Urocyon littoralis) on Santa Cruz Island (California, USA) in April (wet season) and September (dry season) 1998 were evaluated. Serum chemistry of island foxes generally varied seasonally; 10 (40%) of the 25 serum characteristics were higher in the wet season, and three (12%) of the 25 serum characteristics were higher in the dry season. No hematologic parameters varied between seasons, although some measures varied between sexes. Blood analytes also varied with age; fox pups had higher values than adults for one hematologic and four serum parameters, whereas adult foxes had higher values for five hematologic characteristics. The information on blood chemistry provides baseline data useful in the monitoring of this threatened insular endemic carnivore.
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Affiliation(s)
- K R Crooks
- Department of Biology, University of California, Santa Cruz 95064, USA.
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Affiliation(s)
- J Weinzweig
- Department of Plastic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence 02905, USA.
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Abstract
Periodontal ligament (PDL) cells maintain the attachment of the tooth to alveolar bone. These cells reside at a site in which they are challenged frequently by bacterial products and proinflammatory cytokines, such as interleukin-1beta (IL-1beta), during infections. In our initial studies we observed that IL-1beta down-regulates the osteoblast-like characteristics of PDL cells in vitro. Therefore, we examined the functional significance of the loss of the PDL cell's osteoblast-like characteristics during inflammation. In this report we show that, during inflammation, IL-1beta can modulate the phenotypic characteristics of PDL cells to a more functionally significant lipopolysaccharide (LPS)-responsive phenotype. In a healthy periodontium PDL cells exhibit an osteoblast-like phenotype and are unresponsive to gram-negative bacterial LPS. Treatment of PDL cells with IL-1beta inhibits the expression of their osteoblast-like characteristics, as assessed by the failure to express transforming growth factor beta1 (TGF-beta1) and proteins associated with mineralization, such as alkaline phosphatase and osteocalcin. As a consequence of this IL-1beta-induced phenotypic change, PDL cells become responsive to LPS and synthesize proinflammatory cytokines. The IL-1beta-induced phenotypic changes in PDL cells were transient, as removal of IL-1beta from PDL cell cultures resulted in reacquisition of their osteoblast-like characteristics and lack of LPS responsiveness. The IL-1beta-induced phenotypic changes occurred at concentrations that are frequently observed in tissue exudates during periodontal inflammation (0.05 to 5 ng/ml). The results suggest that, during inflammation in vivo, IL-1beta may modulate PDL cell functions, allowing PDL cells to participate directly in the disease process by assuming LPS responsiveness at the expense of their normal structural properties and functions.
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Affiliation(s)
- S Agarwal
- Division of Oral Biology, University of Pittsburgh, Pennsylvania 15261, USA. sagar+@pitt.edu
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Quintero JC, Piesco NP, Langkamp HH, Bowen L, Agarwal S. LPS responsiveness in periodontal ligament cells is regulated by tumor necrosis factor-alpha. J Dent Res 1995; 74:1802-11. [PMID: 8530744 DOI: 10.1177/00220345950740111401] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Gingival fibroblasts function as accessory immune cells and are capable of synthesizing cytokines in response to lipopolysaccharides (LPS) from Gram-negative microbes. Recently, we have isolated, cloned, and characterized two cell lines which exhibit characteristics of periodontal ligament (PDL) cells. In this report, we demonstrate that PDL cells showing osteoblast-like phenotype are not LPS-responsive cells. However, treatment of PDL cells with tumor necrosis factor-alpha (TNF-alpha) inhibits the expression of their osteoblast-like characteristics. As a consequence of this TNF-alpha-induced phenotypic change, PDL cells become LPS-responsive, i.e., synthesize several pro-inflammatory cytokines in response to LPS. These phenotypic changes occur at concentrations of TNF-alpha that are frequently observed in tissue exudates during periodontal inflammation, suggesting a physiological significance for these in vitro observations. It is of interest that TNF-alpha-induced phenotypic changes in PDL cells are transient, since removal of rhTNF-alpha from the supernatants of PDL cell cultures results in re-acquisition of the osteoblast-like characteristics and lack of LPS responsiveness of PDL cells. These results suggest that TNF-alpha, by regulating the PDL cell functions, may allow these cells to participate in the disease process as accessory immune cells at the expense of their structural properties.
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Affiliation(s)
- J C Quintero
- Division of Oral Biology, University of Pittsburgh, PA 15261, USA
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Liberman RP, Van Putten T, Marshall BD, Mintz J, Bowen L, Kuehnel TG, Aravagiri M, Marder SR. Optimal drug and behavior therapy for treatment-refractory schizophrenic patients. Am J Psychiatry 1994; 151:756-9. [PMID: 8166320 DOI: 10.1176/ajp.151.5.756] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Thirteen treatment-refractory schizophrenic patients (10 men and three women) who were receiving more than 50 mg/day of haloperidol and who had been hospitalized for more than 1 year successfully tolerated a mean dose reduction of 63% with consequent improvement in psychopathology and side effects. The addition of intensive behavior therapy to the optimal dose of haloperidol yielded further improvements in functional behavior, such as self-care and social interaction.
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Affiliation(s)
- R P Liberman
- Camarillo-UCLA Research Center, Camarillo State Hospital, CA 93011-6022
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Bowen L, Wallace CJ, Glynn SM, Nuechterlein KH, Lutzker JR, Kuehnel TG. Schizophrenic individuals' cognitive functioning and performance in interpersonal interactions and skills training procedures. J Psychiatr Res 1994; 28:289-301. [PMID: 7932288 DOI: 10.1016/0022-3956(94)90012-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.5] [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
The purpose of this research was to determine the relationship between schizophrenic individuals' cognitive functioning and their performance in interpersonal interactions and skills training procedures. Thirty schizophrenic individuals and 15 non-mentally ill individuals were administered two versions of the Continuous Performance Test, the Span of Apprehension Test, the Digit Span Distractibility Test, the Assessment of Interpersonal Problem Solving Skills, and three elemental skills training tasks. Vigilance level as measured by the Continuous Performance Test was substantially correlated with performance in both roleplayed interactions and skills training tasks, while recall memory as measured by the Digit Span Distractibility Test was correlated with performance in the skills training tasks independently of vigilance level. Thus, the results indicated that the cognitive dysfunctions of schizophrenia are associated with poorer social functioning and with reduced performance in the elemental procedures that constitute efforts to improve that functioning.
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Affiliation(s)
- L Bowen
- UCLA Clinical Research Center for Schizophrenia and Psychiatric Rehabilitation
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Green MF, Mintz J, Bowen L, Marshall BD, Kuehnel TG, Hayden JL, Liberman RP. Prediction of response to haloperidol dose reduction by Span of Apprehension measures for treatment-refractory schizophrenic patients. Am J Psychiatry 1993; 150:1415-6. [PMID: 8352355 DOI: 10.1176/ajp.150.9.1415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Thirteen treatment-refractory schizophrenic patients participated in a haloperidol reduction study. Two of the subjects were unable to tolerate medication reduction. These subjects were comparable to the other patients in terms of initial clinical variables but were outliers on baseline accuracy and reaction time measures from the Span of Apprehension. The results suggest that aspects of basic visual processing and motor response speed may identify patients who require higher neuroleptic doses.
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Affiliation(s)
- M F Green
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine
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Van Putten T, Marshall BD, Liberman R, Mintz J, Kuehnel TG, Bowen L, Aravagiri M, Marder SR. Systematic dosage reduction in treatment-resistant schizophrenic patients. Psychopharmacol Bull 1993; 29:315-320. [PMID: 7904763] [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: 05/22/2023]
Abstract
Thirteen treatment-resistant, chronically institutionalized schizophrenic patients on high-dose neuroleptic (the equivalent of at least 50 mg of haloperidol (HPL) daily) were transferred to a special research ward for a trial of systematic dosage reduction. In these 13 patients, it was possible to reduce the dose of HPL from 63.1 mg/day (SD +/- 12.5, range = 50-80 mg/day) to 23.1 mg/day (SD +/- 16.3, range = 0-65 mg/day) over a mean period of 32 weeks (SD +/- 9.6, range = 15-46 weeks). Their total Brief Psychiatric Rating Scale (BPRS) scores were improved (p = .04), they definitely experienced fewer extrapyramidal side effects (p = .01), and 6 of the patients showed global improvement. On several behavioral rating scales there was, if anything, an improvement in negativistic behavior. The substantial dosage reduction was paralleled by a comparable drop in plasma levels. HPL plasma levels at baseline were 38.8 ng/mL (SD +/- 17.8, range = 21.5-69.5 ng/mL) and at the lowest effective dose were 12.4 ng/mL (SD +/- 10.3, range = 0-43.4 ng/mL).
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Affiliation(s)
- T Van Putten
- Department of Veterans Affairs, Brentwood, West Los Angeles, CA 90073
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Abstract
Institutionalized persons with a deteriorating form of schizophrenia that was refractory to neuroleptic medication were titrated downward in their haloperidol dose. Based on ratings of their clinical status, an optimal dose was reached that was an average 66 percent reduction from their initial levels. Patients then participated in a personalized, intensive behavior therapy program to remediate their extreme, persisting deficits and disturbances in behavior.
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Abstract
The effect of a new drug (CP 68,722, Pfizer) on parameters of insulin sensitivity in an established insulin-resistant animal model was examined. Rates of hepatic glucose production (HGP) and peripheral glucose uptake in obese Zucker (fa/fa) rats treated with a 10-day course of the medication using a two-step (2 and 10 mU/kg/min) euglycemic hyperinsulinemic clamp technique were measured. In addition, changes in substrate concentrations after drug treatment were examined. Basal HGP rates were similar in the lean versus the obese animals (37 +/- 3 v 39 +/- 3 mumol/kg/min); however, the obese animals had impaired insulin-induced suppression of HGP at both 2 mU/kg/min (36 +/- 3 v 23 +/- 4 mumol/kg/min) and 10 mU/kg/min (18 +/- 5 v 2 +/- 1 mumol/kg/min). Insulin stimulation of glucose disposal was also defective in the obese animals (37 +/- 2 v 88 +/- 7 mumol/kg/min at 2 mU/kg/min and 98 +/- 9 v 219 +/- 18 mumol/kg/min at 10 mU/kg/min). In addition, obese animals had elevated free fatty acid (FFA) and ketone levels, both of which were resistant to insulin-induced suppression. After drug treatment, few alterations in glucose or lipid metabolism were found in the lean animals. In the obese animals, insulin suppression of HGP was normalized during the higher insulin infusion rate (0 v 18 +/- 5 mumol/kg/min at 10 mU/kg/min), and peripheral glucose disposal was enhanced at both steps of the insulin clamp (54 +/- 4 v 37 +/- 2 mumol/kg/min at 2 mU/kg/min and 134 +/- 12 v 98 +/- 9 mumol/kg/min at 10 mU/kg/min).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Bowen
- Section of Endocrinology and Metabolism, Yale University School of Medicine, New Haven, CT
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Jacob RJ, Sherwin RS, Bowen L, Fryburg D, Fagin KD, Tamborlane WV, Shulman GI. Metabolic effects of IGF-I and insulin in spontaneously diabetic BB/w rats. Am J Physiol 1991; 260:E262-8. [PMID: 1996629 DOI: 10.1152/ajpendo.1991.260.2.e262] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To examine the influence of insulin-dependent diabetes on the metabolic response to insulin-like growth factor I (IGF-I), awake chronically catheterized diabetic and nondiabetic BB/w rats received IGF-I (5 micrograms.kg-1.min-1) or insulin (2 mU.kg-1.min-1) for 2 h while maintaining euglycemia. In nondiabetic rats, IGF-I and insulin produced similar twofold increases in glucose uptake, but insulin was more effective in reducing hepatic glucose production (90 +/- 15 vs. 5 +/- 11%; P less than 0.001) and beta-hydroxybutyrate levels (94 +/- 1 vs. 19 +/- 6%; P less than 0.001). In diabetic rats, insulin-stimulated glucose uptake was impaired (8.5 +/- 0.9 vs. 11.5 +/- 0.9 mg.kg-1.min-1 in nondiabetics; P less than 0.05). In contrast, IGF-I-stimulated glucose uptake was identical in diabetic and nondiabetic rats. Furthermore, IGF-I suppressed glucose production by 73% (P less than 0.01) and caused a greater lowering of beta-hydroxybutyrate levels (from 2.9 +/- 0.8 to 0.8 +/- 0.3 mumol/l) in diabetic rats. We conclude that 1) the capacity of IGF-I infusion to stimulate glucose uptake is maintained in spontaneously diabetic BB rats that are insulin resistant, and 2) IGF-I infusion suppresses elevated glucose production rates and plasma ketone concentrations in diabetic rats but is relatively ineffective in nondiabetic rats. Thus the metabolic responses to infused IGF-I do not appear to be diminished in diabetic rats with impaired responses to insulin.
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Affiliation(s)
- R J Jacob
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut 06510
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Abstract
Behavioral treatment of a 35 year old female with chronic schizophrenia and water intoxication with seizures was conducted on an inpatient psychiatric unit. Treatment included frequent daily weights, restricted fluid intake, positive reinforcement for program compliance, and time-out from reinforcement following significant weight gain or other specified program violations. The final 6 months of the 30 month treatment program were a maintenance phase during which most contingencies were faded and all fluid restrictions were removed. There was no reported recurrence of polydipsia after 18 months of community placement.
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Affiliation(s)
- L Bowen
- UCLA Neuropsychiatric Institute/Camarillo State Hospital 93011
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Bowen L. The first postgraduate job. Vet Rec 1990; 126:46. [PMID: 2301122] [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: 12/31/2022]
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Bowen L. Understanding and utilizing Medicare ancillary services. Provider 1990; 16:18-20. [PMID: 10106302] [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] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- L Bowen
- Hillhaven Corporation, Tacoma, WA
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Smith S, Teitelbaum P, Bowen L, Tomlinson R, Berry P, Yani A, Parnes H, Chaplin M. Metabolic fate of the new anti-ulcer drug enprostil in animals. 1st communication: absorption, distribution and excretion in the mouse, rat and rabbit. Arzneimittelforschung 1989; 39:335-41. [PMID: 2502986] [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: 01/01/2023]
Abstract
Absorption, distribution and excretion of [3H]-enprostil ((+-)-11a,15a-dihydroxy-9-oxo-16-phenoxy-17,18,19,20-tetranorpr osta -4,5,13(t)-trienoic acid methyl ester, TA-84135), a new anti-ulcer prostaglandin, were studied in mice, rats and rabbits. Radioactivity associated with enprostil was rapidly absorbed from the gastrointestinal tract with Tmax values of 15 or 30 min. Absorption was also efficient inasmuch as approximately 80% of an oral dose was recovered in bile and urine in 24 h in bile duct-cannulated rats. Experiments in pylorus-ligated, bile duct-cannulated rats demonstrated that enprostil was mainly absorbed from the intestine, rather than from the stomach. In mice given oral doses of 2, 8 and 32 micrograms/kg, Cmax and AUC values of enprostil radioequivalents increased proportionately to the increase in dose, indicating linear kinetics over this dose range. Distribution of enprostil-associated radioactivity was investigated in rats by quantitating tritium in various tissues after the oral administration of [3H]-enprostil. Radioactivity in tissues was highest at 15 or 30 min after dosing. Highest levels of radioactivity were found in the stomach and intestines, the organs which came into direct contact with the dose, and the liver and kidney, the organs involved in excretion of enprostil. The rate of elimination of enprostil-associated radioactivity from all tissues and from plasma was similar. Enprostil-associated radioactivity did not accumulate in any tissue. Radioactivity was found in fetuses following oral administration of [3H]-enprostil to rats on the 12th or 19th day of gestation.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Smith
- Department of Drug Metabolism, Bioanalytical and Metabolic Research, Syntex Research, Palo Alto, CA
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Bowen L. 'Backs to health' remedies financial, worker strains. Provider 1989; 15:36. [PMID: 10318166] [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: 02/12/2023]
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Wong SE, Terranova MD, Bowen L, Zarate R, Massel HK, Liberman RP. Providing independent recreational activities to reduce stereotypic vocalizations in chronic schizophrenics. J Appl Behav Anal 1987; 20:77-81. [PMID: 3583965 PMCID: PMC1285953 DOI: 10.1901/jaba.1987.20-77] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
We evaluated the effects of minimally supervised, independent recreational activities on stereotypic vocal behavior in two chronic schizophrenic patients. In baseline sessions, subjects were observed during unstructured free time in the psychiatric ward. In treatment sessions, therapists presented preferred recreational materials (magazines, models, and art projects), verbally prompted on-task behavior every 20 min, and, in one condition, administered contingent tokens. Independent recreational activities reduced medium-rate self-talk in one subject and high-rate mumbling in a second subject by 60%-70%. Results were the same with or without contingent tokens. Apparent self-maintaining characteristics of these vocal responses are discussed.
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Tomlinson RV, Runkel R, Chaplin MD, Bowen L, Kanagy J, Chu N. In vitro studies on the binding of cloprednol to human plasma proteins. J Steroid Biochem 1982; 16:75-80. [PMID: 7062742 DOI: 10.1016/0022-4731(82)90146-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
In a retirement community group of 73 relatively fit elderly white persons, a cross-sectional study of 53 different blood tests was conducted. The five test categories for blood values were hematology, chemistry, thyroid function, protein electrophoresis, and immunology. Fifteen percent of the blood findings were outside the range accepted as normal by the examining laboratories. Most of the subjects showed between 5 and 10 "abnormal" values within the five test categories. Since the findings were fairly predictable in view of the patho-anatomic changes that accompany aging, and since the manifestations of disease were at most subclinical, only minor alterations in individual management were needed. Subsequent appropriate clinical re-evaluation of these subjects during a six-month follow-up revealed no striking changes. It would appear that the ranges of "normal" reference values may need to be expanded. Although cross-sectional laboratory studies are useful, longitudinal studies seem essential if clinicians are to attain a more valid perspective.
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Bowen L. How to gain community fluoridation. Dent J 1974; 40:666. [PMID: 4529550] [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: 01/11/2023]
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