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Biomedical subjects

D King

Publications and source records attributed to D King.

At least 19 recordsLinked to original sources
PubMed2006

Diffusion weighted magnetic resonance imaging for acute stroke: practical and popular.

AIM: To evaluate the feasibility and impact of diffusion weighted magnetic resonance imaging (DW MRI) as the first line neuroimaging of stroke at a district general hospital. METHODS: Prospective audit of all in-patients admitted with clinically suspected acute stroke and referred for imaging over a consecutive 17 week period. The data collected included scan type, time from cerebral event to imaging request, and time from formal radiological request to neuroimaging. Clinicians' (general physicians, neurologists, and radiologists) perceptions were assessed by a questionnaire. RESULTS: 148 patients had neuroimaging for clinically suspected stroke during this period. Eighty one per cent of patients (120 of 148) had DW MRI as first line. Ninety two per cent of these patients had DW MRI within 24 hours of the formal radiological request. Twenty eight patients did not undergo DW MRI because lack of MRI safety, clinical state, unavailability because of maintenance service or lack of trained staff. Clinicians found the introduction of the DW MRI based service a significant improvement on computed tomography, especially for equivocal cases. CONCLUSION: DW based MRI service is both feasible and sustainable in the setting of a district general hospital and most clinicians feel that this is a significant improvement to stroke services.

Acute Disease↗
PubMed2006

Decline in ICU adverse events, nosocomial infections and cost through a quality improvement initiative focusing on teamwork and culture change.

BACKGROUND: Nosocomial infections occur in approximately 10% of patients in intensive care units (ICUs). Several studies have shown that a quality improvement initiative can reduce nosocomial infections, mortality, and cost. CONTEXT: Our hospital is located in Northern Mississippi and has a 28 bed Medical-Surgical ICU unit with 95% occupancy. We joined the ICU collaborative with the IMPACT initiative of the Institute of Healthcare Improvement (IHI) in October 2002. A preliminary prospective before (fiscal year (FY) 2001-2) and after (FY 2003) hypothesis generating study was conducted of outcomes resulting from small tests of change in the management of ICU patients. KEY MEASURES FOR IMPROVEMENT: Nosocomial infection rates, adverse events per ICU day, average length of stay, and average cost per ICU episode. STRATEGY FOR CHANGE: Four changes were implemented: (1) physician led multidisciplinary rounds; (2) daily "flow" meeting to assess bed availability; (3) "bundles" (sets of evidence based best practices); and (4) culture changes with a focus on the team decision making process. EFFECTS OF CHANGE: Between baseline and re-measurement periods, nosocomial infection rates declined for ventilator associated pneumonia (from 7.5 to 3.2 per 1000 ventilator days, p = 0.04) and bloodstream infections (from 5.9 to 3.1 per 1000 line days, p = 0.03), with a downward trend in the rate of urinary tract infections (from 3.8 to 2.4 per 1000 catheter days, p = 0.17). There was a strong downward trend in the rates of adverse events in the ICU as well as the average length of stay per episode. From FY 2002 to FY 2003 the cost per ICU episode fell from $3406 to $2973. LESSONS LEARNED: A systematic approach through collaboration with IHI's IMPACT initiative may have contributed to significant improvements in care in the ICU setting. Multidisciplinary teams appeared to improve communication, and bundles provided consistency of evidence based practices. The flow meetings allowed for rapid prioritization of activity and a new decision making culture empowered team members. The impact of these changes needs to be assessed more widely using rigorous study designs.

Cooperative Behavior↗
PubMed2006

Swine and circovirus.

In the 1990s Post-weaning, multi-systemic wasting syndrome (PMWS) emerged in N. America and Europe as a major disease problem with significant welfare and economic consequences for pig producers. The disease, characterised by wasting, respiratory, enteric and lymphoid system problems in pigs of 4-16 weeks of age, has since spread so that today it has a global distribution. PCV-2 is consistently associated with PMWS, is more abundant in association with PMWS and is considered by many to be the causative agent of the syndrome. However, several lines of evidence indicate that PCV-2 is necessary but not sufficient to cause the full range of clinical signs associated with PMWS, suggesting the involvement of an as yet unidentified factor or factors. The process of identifying unknown agents and their respective roles in the pathogenesis of complex syndromes now has an ever broadening spectrum of analytical techniques available. Immune phenotyping, cytokine responses, micro-array profiling, and proteomics are just some of the techniques available. This paper describes the philosophy and the application of these and classical techniques in an integrated, holistic manner to the problem of PMWS and circoviruses, by examination of samples collected from a prospective, clinical case-control study, and discusses some of the preliminary findings in relation to the efforts to understand the aetiopathogenesis of PMWS.

Animals↗
PubMed2005

Enhancing spatial estimates of metal pollutants in raw wastewater irrigated fields using a topsoil organic carbon map predicted from aerial photography.

Various approaches have been used to estimate metal pollutant element (TE) contents at unsampled locations in a 15-ha contaminated site located in the plain of Pierrelaye-Bessancourt (about 24 km Northwest of Paris). 87 samples of soil plough layer were randomly sampled at each mesh of a regular square grid over the whole study area and the total contents of Cd, Cr, Cu, Ni, Pb, and Zn were measured. A first set of 50 measurements, randomly selected from the 87 samples, was used for the prediction and another set of 37 measurements was kept for the validation. Topsoil organic carbon contents (SOC) were measured at 75 sites with 50 measurements sharing the same locations as TE. An aerial photography of the study area showing bare soils was selected for relating brightness intensities and SOC. Mapping procedures used were ordinary kriging (OK), cokriging (COK), collocated cokriging (CC), and kriging with external drift (KED). SOC maps used as exhaustively sampled information in KED and CC of TE were obtained by KED and CC procedures, respectively, accounting for 75 SOC measurements and the brightness intensities of numerical counts provided by the visible bands of the aerial photograph bare soils. Consequently, for each TE, four maps were generated: two maps resulting from KED and CC procedures (KED-SOC75P, CC-SOC75P), another one provided by standard cokriging (COK-TE50SOC75) accounting for TE prediction set plus 75 SOC measurements, and the last one corresponding to that estimated by ordinary kriging from only prediction set measurements (OK50). Three indices: (1) the mean prediction error (ME) and the mean absolute prediction error (|ME|); (2) the root mean square error (RMSE); and (3) the relative improvement (RI) of accuracy, as well as residuals analysis, were computed from the validation set (observed data) and predicted values. On the 37 test data, the results showed that the more accurate predictions were systematically those obtained by kriging accounting for SOC map predicted by KED from 75 SOC measurements and brightness values of the aerial photo (KED-SOC75P) followed closely by CC-SOC75P procedure, except for Cu and Zn where CC-SOC75P appeared to be slightly more accurate than KED-SOC75P. In regard to the RI of accuracy between prediction methods, the results confirmed once for all the benefit of accounting for SOC data set plus the exhaustively sampled information provided by the aerial photography regardless of the considered TE. Nevertheless, for Cd, Pb, and Zn, the RI of accuracy was less than 20% between the two most accurate methods (KED-SOC75P and CC-SOC75P) and standard cokriging in which the information provided by the aerial photography is ignored when mapping. The sensitivity of KED-SOC75P and CC-SOC75P approaches to the sampling density of the target variables (TE) was assessed using 10 random subsets of different sizes (25 and 33 observations) drawn from a prediction set that includes 50 data. Results have shown that the TE estimates by KED-SOC75P and CC-SOC75P approaches using only 25 TE samples were much more accurate than the estimates performed by OK50 and COK-TE50SOC75 approaches that use the whole samples of the prediction set. Moreover, the RI of accuracy was reduced by less than 15% if the original sampling density was reduced by a third.

Agriculture↗
PubMed2004

Time-dependent changes in the formation of titania-based films at the air-water interface.

The growth of surfactant-assisted titanium dioxide-based films at the air-water interface previously reported (Henderson et al. Aust. J. Chem. 2003, 56, 933) has been monitored with a time resolution of minutes over the whole growth period by X-ray energy-dispersive reflectometry. Two new phenomena are described: (a) short-term shifts in the Bragg spacing of the layer structure and (b) the periodic disappearance of the diffraction from the film. We associate these with changes in the chemistry of the reacting mixture, with changes in the packing of the templated titanium species, and with macroscopic and (possibly) microscopic rippling of the solid film during growth.

Journal Article↗
PubMed2004

Isolated rupture of the popliteus tendon in a professional soccer player.

We report an unusual case of an isolated intra-substance rupture of the popliteus tendon in a professional soccer player. The injury, sustained in a soccer tackle, was diagnosed on magnetic resonance imaging and subsequently confirmed on arthroscopic examination of the knee. The impinging proximal stump was debrided and the patient returned to playing competitive soccer within 6 weeks of surgery.

Adolescent↗
PubMed2004

Retrospective characterization of Newcastle Disease Virus Antrim '73 in relation to other epidemics, past and present.

In November 1973 Newcastle disease suddenly appeared in Northern Ireland, where the viscerotropic disease had not been seen in 3 1/2 years and the two Irelands had been regarded as largely disease free for 30 years. It was successfully controlled with only 36 confirmed affected layer flocks, plus 10 more slaughtered as 'dangerous contacts'. Contemporary investigations failed to reveal the source of the Irish epidemic. Using archival virus samples from most of the affected flocks, RT PCR was conducted with primers selected for all six NDV genes. Phylogenetic analyses of three genes, HN, M and F, confirmed vaccine as the cause of one of the outbreaks. The other six samples were identical and closely related to previous outbreaks in the United States and western Europe initiated by infected imported Latin American parrots. The probable cause of the epidemic followed from the importation from The Netherlands of bulk feed grains contaminated with infected pigeon faeces.

HN Protein↗
PubMed2004

Infection of stationary human brain aggregates with HIV-1 SF162 and IIIB results in transient neuronal damage and neurotoxicity.

The cellular basis of HIV associated dementia has been correlated with microglial activation and neuronal dysfunction in symptomatic HIV-1 disease. As a cellular model of HIV-1 infection of brain tissue in vitro, we established a stationary human brain aggregate (SHBA) system to compare infection of HIV-1 SF162 (R5 virus) to that of IIIB (X4 virus). Aggregates were analysed by immunohistochemistry, morphometry, flow cytometry and p24 ELISA. SHBAs had a 1 mm(3) size with a mixed cellular composition of 36% neurones, 27% astrocytes, 2% macrophages/microglia and 14% oligodendrocytes. Infection of SHBA's with the R5 HIV-1 SF162 virus led to the expression of HIV-1 p24 antigen in 6% of cells. Infection with this R5 using virus culminated in transient neuronal damage and a decrease in mitotically active progenitor cells within aggregates. Infection with X4 using HIV-1 IIIB was associated with astrocytosis and neurotoxicity. We propose that: (1) the pattern of cellular damage elicited by HIV-1 infection of brain tissue in vitro depends on virus subtype as determined by its preferential use of R5 or X4 chemokine receptors for entry into cells; (2) SHBAs are a reliable and readily established model of the cellular complexity of human brain tissue in vitro.

Brain↗
PubMed2004

Transperitoneal or extraperitoneal laparoscopic radical prostatectomy: does the approach matter?

PURPOSE: : The greater accuracy of apical dissection and reconstruction in our first 100 patients undergoing transperitoneal laparoscopic radical prostatectomy (TLRP) was not matched by a proportionate increase in the rate of return to normal continence compared with our prior open prostatectomy experience. We postulated that greater bladder dysfunction due to the almost total bladder dissection mandated by TLRP might be responsible and this might be rectified by the adoption of laparoscopic radical prostatectomy using an extraperitoneal approach (ELRP). MATERIALS AND METHODS: : A total of 100 patients undergoing TLRP were compared with 100 undergoing ELRP. The groups were subdivided into halves to investigate the influence of any learning curve effect. All patients had clinical stage T3aN0M0 or less prostate cancer and they were operated on by a single surgeon. RESULTS: : Mean operative time (238.9 vs 190.6 minutes), blood loss (310.5 vs 201.5 ml), postoperative hospitalization (3.8 vs 2.6 nights) and catheterization duration (11.3 vs 10.1 days) were significantly greater in the TLRP group. After the first 50 cases were excluded in each group statistical significance persisted only for operative time (218.3 vs 184.2 minutes) and hospitalization (3.5 vs 2.5 nights). The pad-free rate was significantly lower 3 months following ELRP (80% vs 56%, p = 0.02). The overall 12-month pad-free rate for TLRP and ELRP was 90% and 96%, respectively. The overall 12-month erection rate for TLRP and ELRP was 61% and 82%, respectively. CONCLUSIONS: : ELRP is superior to TLRP with respect to operative time, hospitalization and early continence.

Adenocarcinoma↗
PubMed2003

Does the dental profession know how to care for the primary dentition?

Across the UK many thousands of young children regularly attend the GDS for routine dental care. Once in the dental surgery the same story is repeated countless times - preventive advice is delivered, reassurance given, caries is treated and the case notes are written up by the dentist. The whole interaction is a largely unremarkable event and is accepted by patient, parent and dentist. The records of all these individual clinical episodes remain within each practice and until a patient returns for further care can expect to lay undisturbed.

Child↗
PubMed2003

The influences on preventive care provided to children who frequently attend the UK General Dental Service.

OBJECTIVES: To identify the relationship between the preventive and restorative care provided to children who frequently attend the General Dental Service in the UK after taking into account socio-economic status, gender and dental caries experience. SETTING: General dental practices in the North West of England. SUBJECTS AND MATERIALS: The study design involved a retrospective investigation of case notes of 677 children who regularly attended 50 general dental practitioners. The complete history of the dental care received by each child during the primary dentition period was recorded. Analyses took place at the patient level. Information was recorded on the total number of carious teeth and restorative and preventive care provided to the children. Preventive care was categorised as dietary advice, oral hygiene instruction, prescription of fluoride tablets and application of fluoride varnish. Socio-economic status was measured using the Townsend score of the electoral ward of residence of each subject. Logistic regression models, taking into account the clustering of the subjects within dental practices were fitted to identify whether or not socio-economic status was significantly associated with provision of each category of preventive care, after controlling for gender, the total number of teeth affected by caries and the proportion of carious teeth which were restored. RESULTS: Children from poorer backgrounds were significantly more likely to receive oral hygiene instruction than their more affluent peers. Socio-economic status did not influence dentists' decisions to prescribe fluoride tablets, but children from affluent backgrounds were significantly more likely to have fluoride varnish applied to their teeth than children from deprived backgrounds after controlling for other factors. The more teeth affected by decay significantly increased the odds of giving dietary advice, prescription of fluoride tablets and application of fluoride varnish, but had no effect on whether or not oral hygiene instruction was given. As the percentage of decayed but filled teeth decreased the odds of giving dietary advice or applying fluoride varnish increased significantly. Conclusion It would appear that dentists are providing appropriate preventive care according to the aetiological causes of dental disease. They also look to be providing preventive care in compensation for decisions not to restore carious primary teeth. However the preventive care provided seems to be reactive to disease patterns, and in this high risk group of patients does not seem to be particularly effective.

Cariostatic Agents↗
PubMed2003

Predicting outcome in ruptured abdominal aortic aneurysm: a prospective study of 100 consecutive cases.

OBJECTIVES: Case selection for surgery in patients presenting with ruptured abdominal aortic aneurysms (RAAA) is often difficult. A previous retrospective review identified five pre-operative risk factors associated with mortality [J Vasc Surg 23 (1996) 123]. In this study we aimed to identify whether these criteria could be usefully applied prospectively in patients presenting with RAAA. METHODS: All patients presenting with RAAA from October 2000 to December 2002 were included. The criteria were recorded with the time they were available and the time surgery commenced. The decision to operate was made on clinical grounds and no patient was refused surgery on the basis of these criteria. RESULTS: One hundred consecutive patients were studied, median age 75 (range 54-94). The operative mortality was 32.9% (26/79 patients). Surgical mortality increased with the number of positive criteria and was 8% (2/24), 24% (7/29), 55% (11/20) and 100% (6/6) for scores, 0, 1, 2 and > or =3, respectively. Age and conscious level were available in every patient. However, an ECG, haemoglobin and creatinine results were only available in 94, 81, and 69%, respectively. CONCLUSIONS: The scoring system accurately predicted operative mortality. The score was available in the majority of cases and may help the surgeon give informed consent to patients and relatives prior to surgical intervention.

Aged↗
PubMed2003

Epidemiological risk factors for hypersensitivity reactions to abacavir.

We investigated risk factors for hypersensitivity reactions (HSR) to abacavir in a case-control study. In a multivariate analysis, white race [odds ratio (OR), 5.16; 95% confidence interval (CI), 1.16-22.97] and a higher CD8 cell count at initiation of abacavir (>850 vs. < or =850 cells: OR, 3.74; 95% CI, 1.19-11.77) were found to be significantly associated with the development of HSR. Age, gender, stage of disease, prior antiretroviral exposure and type of concurrent antiretroviral therapy were not associated with HSR. Differences in predisposition to HSR according to ethnicity and baseline CD8 cell count may be explained by the reported MHC genetic associations with HSR.

Adult↗