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Biomedical subjects

B Jones

Publications and source records attributed to B Jones.

At least 91 records · Page 5Linked to original sources

Abdominal wall penetration by a police "bean bag".

Police departments across the country now have at their disposal a "nonlethal" weapon known as a "bean bag" shotgun. The bean bags, which come loaded in standard shotgun shells, are missiles intended to disable dangerous suspects without having to resort to lethal force. They were specifically designed not to create penetrating injuries. Here we present a case of abdominal wall penetration by a police bean bag. To our knowledge this is the first such reported case of this type of injury.

Abdominal Muscles↗

Randomised controlled trial of tailored strategies to implement guidelines for the management of patients with depression in general practice.

BACKGROUND: Various methods are available for implementing change in the clinical behaviour of general practitioners (GPs). Although passive dissemination of information is generally ineffective, other methods can be variably effective. Few studies have investigated the impact of tailored methods. AIM: To determine whether methods tailored to overcome obstacles to change using psychological theories are more effective than dissemination alone in the implementation of guidelines for depression among GPs. DESIGN OF STUDY: Randomised controlled trial. SETTING: Sixty general practices in England; 30 GPs in the control group, 34 in the intervention group. METHOD: Practitioners identified patients presenting with depression before and after the implementation of guidelines (control group n = 192 in the first data collection, n = 181 in the second; intervention group n = 210 in the first data collection and n = 197 in the second). The main outcome measures were: record of adherence to guideline recommendations in clinical records; proportion of patients with Beck Depression Inventory (BDI) score less than 11 at 16 weeks after diagnosis. RESULTS: In comparison with the control group, in the group of GPs receiving tailored implementation, there were increases in the proportions of patients assessed for suicide risk. In the intervention group, the proportion of patients with BDI scores of less than 11 at 16 weeks increased. CONCLUSION: Obstacles to implementation can be identified and strategies tailored to address them. The findings indicate a new approach for research to understand and develop methods of implementation.

Depressive Disorder↗

Estimation of the combined response to treatment in multicenter trials.

Analyses of multicenter trials consider the estimated treatment effect differences of the individual centers and combine them into an estimate of the overall treatment effect. There has been much debate in the literature concerning the best way to combine these treatment effect differences. We emphasize that first of all one should define the combined response to treatment (CRT), the object that has to be estimated from the results of a multicenter clinical trial. It is shown that the choice of CRT determines not only the best estimator, but also the allocation of patients among the centers that minimizes the mean squared error. A new estimator of the CRT is proposed that is based on a preliminary clustering of the centers and the use of a weighted average of the Type I estimators obtained from within each cluster. The clustering aims to minimize the bias of the combined estimator. We show via a simulation study that the simple clustering procedure provides a reasonably improved estimator. The clustering can be done on blinded data, as long as the numbers of patients on each treatment arm in each center are known. The methodology is illustrated by analyzing a multicountry, multicenter trial to compare an active treatment with placebo for the treatment of a psychiatric disorder.

Algorithms↗

Estimation of optimum dose per fraction for high LET radiations: implications for proton radiotherapy.

PURPOSE: For high linear energy transfer (LET) radiations, the relative biologic effect (RBE) changes with dose per fraction. Methods for calculating the optimum dose per fraction for high LET radiations should therefore include an allowance for RBE. METHODS AND MATERIALS: The linear-quadratic (LQ) model, and the associated biologic effective dose (BED) concept, has previously been extended to incorporate the RBE effect. Differential calculus is now used to calculate the optimum dose per fraction (z), when high-LET radiation is used, which is given by the solution for z of (g - LATE(alpha/beta)(L)/TUM(alpha/beta)L . RBE(M( z(2))) - 2 . f . g . K . z - (LATE)(alpha/beta)(L) . f . K . RBE(M) = 0 where g is the normal tissue sparing factor, RBE(M) is the maximum RBE value, f the mean interfraction interval, K the daily low-LET BED equivalent dose for clonogen repopulation and (LATE)(alpha/beta)(L) and (TUM)(alpha/beta)(L) are the respective late reacting normal tissue and tumor fractionation sensitivities for low-LET radiation. RESULTS: The optimum dose per fraction for proton therapy is generally lower than that calculated for photons but there is not a simple relationship between the magnitude of the reduction and the assumed value of RBE(M.) Thus(,) generic values of RBE(M) cannot always be used in such calculations. In some cases, where tumor alpha/beta ratios are low (around 5-6 Gy) and where there is good normal tissue sparing, the optimum dose per fraction is relatively large, typically 4-8 Gy. CONCLUSION: BED equations that include the RBE parameter, together with low-LET alpha/beta ratios and repopulation dose equivalents, constitute a rational model of high-LET radiotherapy. In the case of proton beam therapy, a wide range of optimum dose per fraction is predicted.

Dose Fractionation, Radiation↗

Radiobiological modeling and clinical trials.

PURPOSE: Standard clinical trial designs can lead to restrictive conclusions: the "best recommended treatments" based on trial results, although generally applicable to patient populations, do not necessarily apply to individual patients. In theory, radiobiological modeling, coupled with reliable predictive assays, can be used to rationalize the selection of patients for particular schedules in trials. MATERIALS AND METHODS: Linear-quadratic modeling of radiotherapy can be used to simulate a clinical trial. This is achieved by random sampling techniques where the key radiobiological parameters (alpha, beta, T(pot) and clonogen number) are selected from known or expected ranges. Clinical trial design in radiotherapy may be improved by formal radiobiological assessment designed to estimate the likely changes in tumor cure probability (TCP) and the likely normal tissue biologically effective dose (BED). Modeling may also be used to rationalize the allocation of patients to a test or standard schedule or for individual optimization of a treatment schedule. Such approaches depend on there being reliable predictive assays of the radiobiological parameters in individual patients. The influence of variations in predictive assay accuracy on the improved outcomes are assessed. RESULTS: Clinical trials, which have been preceded by modeling simulation, offer potentially substantial improvements in the results of cancer treatment by radiotherapy. These exceed the usual gains found in standard clinical trials. CONCLUSION: Future preclinical trial design should include modeling assessments that indicate how best to structure the trial.

Cell Division↗

Biological equivalent dose assessment of the consequences of hypofractionated radiotherapy.

PURPOSE: To investigate the changes in biological effective dose (BED) that occur in high-dose regions within a target volume when radiotherapy is hypofractionated. METHODS AND MATERIALS: By comparing a standard prescription of 2 Gy per fraction that is matched to give the same BED as a hypofractionated schedule at a standard intersectional prescription point, the BED increments for late-tissue effects at a higher dose region within the planning target volume (PTV) are compared. The alternative approach of BED matching between a conventional and hypofractionated schedule at the high-dose region is also considered. The results are presented as a sequence of calculations that can be understood by practicing radiation oncologists and in graphical form. RESULTS: The BED increment at the high-dose region is marginally increased by hypofractionation, although the latter effect is relatively small: up to 5% additional BED due to hypofractionation for a 20% increase in physical dose when the prescribed fraction size is 6-7 Gy. BED matching for late effects between a conventional and hypofractionated schedule at the high-dose region produces lower BED values throughout the remaining PTV, but at the expense of a reduced tumor control BED. CONCLUSION: Clinical trials that use BED isoeffect matching for late reacting tissue effects to design a hypofractioned test schedule should include comprehensive calculations of the likely BED in high-dose regions.

Algorithms↗

The 'mysterious' disease in Swedish moose. Concentrations of trace elements in liver and kidneys and clinical chemistry. Comparison with experimental molybdenosis and copper deficiency in the goat.

Moose (Alces alces L.) affected by a disease with unknown aetiology were compared with healthy moose regarding trace element concentrations in liver and kidneys, as well as certain clinical chemical parameters of blood plasma. The diseased moose showed decreased hepatic concentrations of Cu, Cd and Mg. Renal concentrations of Cd, Co, Mg and Mn were also decreased. Substantially increased concentrations in both liver and kidneys were seen for Al, Ca, Fe, Pb and Zn, while Se and Mo were increased in liver tissue. The hepatic levels of Mo in the affected moose were 36% higher and Cu was approximately 60% lower than in reference animals collected in 1982. The most important clinical chemical changes were decreased concentrations of bilirubin, thyroxine (T4) and the liver-specific enzymes GLDH and g-GT. Also, the activities of the enzymes CuZn-SOD and GSH-Px in erythrocytes were decreased. Increases were recorded for free fatty acids (NEFA), the muscle-specific enzyme CK, but especially for urea and insulin. Changes in the plasma protein pattern were also discernible after electrophoresis on agarose gel membranes, indicating chronic immunostimulation. All the observed changes in trace element concentrations and clinical chemical parameters are compatible with molybdenosis and secondary Cu deficiency in ruminants and most of the parameters are in agreement with those found in experimental copper deficiency and molybdenosis in the goat. It is, therefore, suggested that the moose disease with previously unknown aetiology is mainly caused by molybdenosis.

Animals↗

Experimental copper and chromium deficiency and additional molybdenum supplementation in goats. II. Concentrations of trace and minor elements in liver, kidneys and ribs: haematology and clinical chemistry.

Since the mid-1980s a previously undescribed disease has affected moose in south-western Sweden. Investigations made to reveal evidence of a viral aetiology have proved unsuccessful. Trace element studies in apparently healthy moose shot during regular hunting suggested a trace element imbalance, with excessive molybdenum uptake causing secondary copper deficiency. The results also indicated a possible chromium deficiency. To verify this hypothesis, an experimental study was performed in male goats fed a semi-synthetic diet for 1.5 years. The animals were kept and treated in four groups: Controls, Cu-deficient group (group 1), Cr-deficient group (group 2), and combined Cu- and Cr-deficient group with additional supplementation of tetrathiomolybdate for 10 weeks at the end of the study (group 3). The present paper presents tissue contents of trace and minor elements, haematology and clinical chemical parameters. Feed consumption and weight development, as well as pathological and histopathological investigations, were also performed in this study, but these results are presented elsewhere. Changes in trace element concentrations were determined by comparing groups 1, 2 and 3 with the control group. Increased concentrations were observed for Al, Ca, Co, Fe, Mo, Pb, Se in the liver; for Al, Cd, Co, Cr, Mo in the kidneys; and for Mn and Mo in the ribs. Considerable accumulation of Mn in ribs seems to be a useful way to determine oxidative stress. Decreases in Mg and P in all organs and blood serum is characteristic of Cu deficiency and molybdenosis. Also the ratio of Ca/Mg was increased as the result of tissue lesions causing an intracellular increase in Ca and decrease in Mg. The trace element changes observed in group 1 were enhanced by the Mo supplementation in group 3, resulting in characteristic patterns, 'spectra' of changes. The alterations were not as remarkable in group 2 as in the two other groups. However, Cr deficiency considerably influenced Al, Co, V and to a smaller extent also Mn in ribs. In groups 1 and 2, only a few minor changes were detected in the haematological parameters, probably caused by increased adrenal activity after transportation of the animals. In group 3, severe anaemia was present but also a leukopenia. For the different clinical chemical parameters measured, all three groups showed changes, explained mainly by the altered activity of enzymes induced by trace element deficiencies and imbalance. Impaired carbohydrate and lipid metabolism was seen in groups 1 and 3, with increased concentrations of glucose, lactate and triglycerides in serum. Increased concentrations of total bilirubin were measured in all three groups (bile stasis was also seen post mortem). A considerably increased concentration of serum urea was found in group 3, although there were no indications of renal insufficiency or dehydration. Regarding hormones, a substantial decrease was seen in thyroxine (T4) in group 3 as a result of the molybdenosis, but a minor decrease was also seen in group 1. Insulin on the other hand showed increased levels in group 3--and especially in group 2 due to the Cr deficiency but also affected by the molybdenosis. As could be expected, Cu deficiency (groups 1 and 3) caused low levels of caeruloplasmin, secondarily affecting the Fe metabolism in these animals. Protein abnormalities, detected as altered electrophoretic patterns of serum proteins, were also seen mainly in group 3. The findings were also confirmed by multivariate data analysis, where PCA revealed the overall impact of the deficiencies, and PLS regression coefficients indicated the influence on the various analytes.

Animals↗

An evaluation of an oral health training programme for carers of the elderly in residential homes.

OBJECTIVE: The objectives of this study were: to evaluate carers' knowledge of oral health; to provide a high quality, consistent, oral health training programme for carers in residential homes; to evaluate the quality of this programme by examining both carers' changes in knowledge and any changes in carers' behaviour as reported by residents and to assess any changes in the oral health of the elderly residents after one year. DESIGN: A cross-sectional, multi-centre study using a carer training programme, evaluated by both a questionnaire conducted with carers and residents and oral examination of residents. SETTING: In August 1996, 20 (20%) of the residential/nursing homes, in West Hertfordshire were chosen at random and all managers contacted and offered an oral examination for all their residents. Ten (10%) of the homes were also offered an oral health training programme for their carers. Eighteen homes accepted the oral examination for all consenting residents and 7 of the 10 homes offered accepted the carer training. SUBJECTS: Thirty-nine carers from 7 of the residential homes attended an oral health training course and 213 elderly residents in the 18 homes were examined both at baseline and after 12 months. RESULTS: Carers' baseline knowledge about oral health was poor; the oral health training programme was enjoyed and their knowledge gain after one week was high. However, the elderly residents perceived no change in the oral care given by carers either after one week or after one year and there was no measurable improvement in the oral health of residents after carer training, except for an increase in filled coronal surfaces. Few of the carers originally trained were still working in the same residential homes after one year. CONCLUSION: Although the carer training programme was well received, no changes in oral health practice resulted. Barriers to practice of oral care by carers remained and training, even when including practical skills, evaluation by peers and a high knowledge gain, failed to reduce these barriers.

Aged↗

Timing of prenatal androgen exposure: anatomical and endocrine effects on juvenile male and female rhesus monkeys.

Prenatal androgen shapes genital differentiation. In humans, genital anatomy determines sex of rearing and subsequent behavioral development. Rhesus monkey genital anatomy and neuroendocrine function are sexually differentiated, and behavioral development occurs in a complex social environment. We investigated prenatal hormonal influences on sexual differentiation by suppressing or increasing androgens in male and female rhesus monkeys. Pregnant multiparous female rhesus monkeys received 35-40 days of testosterone enanthate (TE) treatment, androgen antagonist (flutamide, FL) treatment, or vehicle starting on gestation day (GD) 35 or 40 (early) or GD 110 or 115 (late). Exogenous androgen increased neonatal LH secretion in females when given early and altered female genital differentiation when administered either early or late. TE treatment, early or late in gestation, had no measurable effects on male genital differentiation or neuroendocrine function. Early FL treatment, however, radically altered male genital differentiation, producing in two cases males with a urethral opening separate from the glans. In females, early FL treatment produced detectable alterations in genitalia consistent with a reduced exposure to prenatal androgen, suggesting that female rhesus monkeys are naturally exposed prenatally to meaningful levels of T. Late FL treatment reduced male penis size and increased neonatal T secretion, but had no effect in females. This is the first study to block endogenous prenatal testosterone in rhesus monkeys, thereby altering sexual differentiation. These findings illustrate the complexity of prenatal influences on anatomical and neuroendocrine development. The relationship between the anatomical changes reported here and sex differences in behavior is currently under investigation.

Animals↗

Electrochemical lesions in the rat liver support its potential for treatment of liver tumors.

BACKGROUND: An effective therapy is needed for patients with surgically unresectable liver tumors who have very limited life expectancy. One possible treatment is electrochemical tumor necrosis. This study investigated the natural history of electrochemical lesions in the normal rat liver. MATERIALS AND METHODS: A direct current generator, connected to platinum electrodes, was used to create controlled areas of liver necrosis. Animals were sacrificed 2 days, 2 weeks, 2 months, and 6 months after treatment and the macroscopic and histological appearance of the necrotic lesions was followed. RESULTS: No animal died as a result of electrolysis; postoperatively, all gained weight normally. Liver enzymes were significantly (P < 0.001) elevated after treatment, but returned to normal after a week. Two days after electrolysis, histology confirmed an ellipsoidal area of coagulative necrosis at the site of the electrode tip and commonly a segment of peripheral necrosis. After 2 weeks there was histological evidence of healing. By 6 months, very little necrotic tissue remained within a small fibrous scar. CONCLUSIONS: Electrolysis is a safe method for creating defined areas of liver necrosis that heal well with no associated mortality. This study supports the potential of electrolysis for treating patients with unresectable liver tumors.

Animals↗

Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment.

The adverse consequences of aspiration in regard to patient health and quality of life are well documented. It is generally accepted that the probability of aspiration is increased in patients with unilateral vocal fold motion impairment, however, the incidence and proposed mechanism of aspiration vary depending on the reported series. We reviewed the cine or video pharyngoesophagographic findings in patients with documented unilateral vocal fold motion impairment, identified through the Johns Hopkins Hospital Swallowing Center database, to determine the prevalence and cause of aspiration and laryngeal penetration. Aspiration and laryngeal penetration were identified in 38% and 12% of patients, respectively. Aspiration resulted from impaired airway protection, not from esophageal obstruction with laryngeal "spill-over." The number and degree of impairments directly correlated with probability of aspiration. Obstruction potentiated the likelihood of aspiration. Video pharyngoesophagography accurately identifies patients at risk for aspiration.

Adult↗

Does peer-reviewed publication change the habits of surgeons?

BACKGROUND: From April 1994 to December 1995 a prospective randomized trial was conducted at our institution comparing outcomes of laparoscopic and open appendectomy. It demonstrated no significant advantage to laparoscopic appendectomy. Our current study evaluates whether surgeon's habits at our hospital have been influenced by our previously published study. METHODS: Charts were reviewed for patients who underwent appendectomy from August 1998 to December 1998. In addition, a formal survey was conducted of all staff surgeons to ascertain their procedure of choice for appendicitis, and the reasons for their preference. RESULTS: Seventy-nine percent of the appendectomies were attempted laparoscopically. The median operative time was longer for laparoscopic appendectomy, and median hospital charges were higher. Survey results showed that most staff surgeons prefer laparoscopic appendectomy. CONCLUSION: Despite our own published paper supporting open appendectomy over laparoscopic appendectomy, laparoscopic appendectomy has become the standard of care at our institution for the treatment of appendicitis.

Appendectomy↗