Efficacy of haloperidol in the treatment of nausea and vomiting in the palliative patient: a systematic review.
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Biomedical subjects
Publications and source records attributed to D Marshall.
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The objective of this study was to evaluate the potential clinical and economic implications of an annual lung cancer screening programme based on helical computed tomography (CT). A decision analysis model was created using combined data from the Surveillance, Epidemiology and End Results (SEER) registry public-use database and published results from the Early Lung Cancer Action Project (ELCAP). We found that under optimal conditions in a high risk cohort of patients between 60 and 74 years of age, annual lung cancer screening over a period of 5 years appears to be cost effective at approximately $19000 per life year saved. A sensitivity analysis of the model to account for a 1-year decrease in survival benefit and changes in assumptions for incidence rate and costs generated cost effectiveness estimates ranging from approximately $10800 to $62000 per life year saved. Based on the assumptions embedded in this model, annual screening of high risk elderly patients for lung cancer may be cost effective under optimal conditions, but longer term data are needed to confirm if this will be borne out in practice.
This study investigated how knee flexion angle affects the appearance of the rupture surface of the anterior cruciate ligament (ACL) using rabbit knees. Specimens were failed at flexion angles of 45 degrees and 90 degrees at displacement rates of 10 and 500 mm/min. Video recordings and scanning electron microscopy (SEM) studied the appearance of the rupture surfaces. At the displacement rate of 10 mm/min, the major mode of failure was fibre pullout for all flexion angles. At displacement rate of 500 mm/min, which more closely approximated loading conditions during trauma, we found that all modes of failure were exhibited. At 45 degrees flexion, the majority of specimens tested failed by avulsion. The reverse was true for specimens tested at 90 degrees where the majority of failures were fibre pullouts. At 45 degrees, there were more pulled-out fibres on rupture surfaces of specimens tested at 10 mm/min than at 500 mm/min. At 90 degrees, little difference was seen in the appearance of ruptures from both rates. SEM revealed that the waviness of collagen fibres was more pronounced at 10 mm/min. Therefore, the appearance of rupture surfaces of ACLs are affected by both flexion angle and displacement rate.
Microscopes offer a limited depth of focus which precludes the observation of a complete image of a three-dimensional (3D) object in a single view. Investigations, by a variety of researchers, have led to the development of extended depth of focus algorithms for serial optical slices of microscopic 3D objects in recent years. However, to date, no quantitative comparison of the different algorithms has been performed, generally leaving the evaluation to the subjective qualitative appreciation of the observer. In this paper we use three different tests for extended depth of focus algorithm evaluation and test 10 different algorithms, some of them have been adapted (by us) for a series of optical slices. However, the main contribution of the paper is a new improved algorithm for computing the extended depth of focus.
OBJECTIVE: Inflammation in MRL/lpr mice may involve dysfunctional leucocyte-endothelial cell (EC) interactions. Previously, we have shown that intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1) increase with age in a tumour necrosis factor alpha (TNF alpha)- and interleukin-1 (IL-1)-dependent manner. The object of this study was to determine the expression of E- and P-selectin. METHODS: Selectin expression was quantified in MRL/lpr mice and BALB/c controls by intravenous injection of differentially radio-labelled antibodies. RESULTS: E-selectin, but not P-selectin, was up-regulated in the kidneys of older mice. Neither was up-regulated elsewhere. There was no defect in selectin inducibility, as a further inflammatory stimulus (intraperitoneal lipopolysaccharide) resulted in up-regulation. Serum from older MRL/lpr did not induce selectin expression by EC in vitro. CONCLUSION: The increase in E-selectin in the kidney may contribute to the development of glomerulonephritis. However, the lack of systemic E- and P-selectin expression may represent a protective mechanism which limits the interaction between leucocytes and the endothelium in the chronic inflammatory context.
The purpose of the study was to test the psychometric properties of a culturally sensitive and theory-based instrument: the Breast Health Behavior Questionnaire. This instrument was translated into Spanish and back-translated at a third- to fourth-grade reading level. The pilot group consisted of 70 Hispanic women who attended a class at a local church. Subsequent to pilot testing, another 40 Hispanic women who attended a class at the local health department comprised the study sample. The participants responded to the 15-item questionnaire, which is formatted as a Likert scale. Content validity of the Breast Health Behavior Questionnaire was determined by a panel of experts. A factor analysis of this instrument showed five separate dimensions accounting for 71.82% of the instrument's variance. The three major components of self-regulation theory (schema, coping, and appraisal criteria) were found clustered within the first three dimensions after three items were discarded. The Breast Health Behavior Questionnaire demonstrated an internal consistency reliability coefficient of .7172. The psychometric properties of the Spanish version of this questionnaire warrant further research. The instrument may support a better understanding of the Hispanic woman's practice of breast health behavior. Eventually, the Breast Health Behavior Questionnaire may assist nurses in the formulation of culturally grounded interventions.
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Current vaccines designed to promote humoral immunity to respiratory virus infections also induce potent CD4+ T cell memory. However, little is known about the impact of primed CD4+ T cells on the immune response to heterologous viruses that are serologically distinct, but that share CD4+ T cell epitopes. In addition, the protective capacity of primed CD4+ T cells has not been fully evaluated. In the present study, we addressed these two issues using a murine Sendai virus model. Mice were primed with an HN421-436 peptide that represents the dominant CD4+ T cell epitope on the hemagglutinin-neuraminidase (HN) of Sendai virus. This vaccination strategy induced strong CD4+ T cell memory to the peptide, but did not induce Abs specific for the Sendai virus virion. Subsequent Sendai virus infection of primed mice resulted in 1) a substantially accelerated virus-specific CD4+ T cell response in the pneumonic lung; 2) enhanced primary antiviral Ab-forming cell response in the mediastinal lymph nodes; and 3) accelerated viral clearance. Interestingly, the virus-specific CD8+ T cell response in the lung and the development of long-term memory CD8+ T cells in the spleen were significantly reduced. Taken together, our data demonstrate that primed CD4+ T cells, in the absence of pre-existing Ab, can have a significant effect on the subsequent immune responses to a respiratory virus infection.
The UK Crop Plant Bioinformatics Network (UK CropNet) was established in 1996 in order to harness the extensive work in genome mapping in crop plants in the UK. Since this date we have published five databases from our central UK CropNet WWW site (http://synteny.nott.ac.uk/) with a further three to follow shortly. Our resource facilitates the identification and manipulation of agronomically important genes by laying a foundation for comparative analysis among crop plants and model species. In addition, we have developed a number of software tools that facilitate the visualisation and analysis of our data. Many of our tools are made freely available for use with both crop plant data and with data from other species.
OBJECTIVE: We have hypothesized that the process of monocyte to macrophage differentiation may alter the inflammatory response of mononuclear phagocytes to the uptake of monosodium urate monohydrate (MSU) crystals. METHODS: Eight mouse monocyte/macrophage cell lines were arranged in increasing order of differentiation, as judged by expression of the macrophage markers F4/80 and BM 8 and by phagocytic capacity. Secretion of tumor necrosis factor alpha (TNFalpha) in response to MSU was measured by enzyme-linked immunosorbent assay. RESULTS: The panel of monocyte/macrophage cell lines revealed a close linkage between the state of differentiation and the capacity of the cells to ingest MSU crystals. TNFalpha production, however, was not linked to phagocytic ability. Peak TNFalpha levels were synthesized by cells at an intermediate state of differentiation (3.2-14.1 ng/ml), whereas mature macrophages, which efficiently phagocytosed crystals, did not secrete TNFalpha. Mature cell lines produced TNFalpha when stimulated with zymosan (5.9-6.2 ng/ml), but this was abolished by coincubation with MSU crystals. Suppression of the zymosan response was not due to apoptosis or steric hindrance by MSU crystals. Culture supernatants from mature macrophages did not stimulate endothelial cell activation, in contrast to MSU-treated cells at an earlier stage of differentiation, which stimulated intercellular adhesion molecule 1 expression on sEND endothelioma cells through the release of TNFalpha (inhibited 80.6% by anti-TNFa). CONCLUSION: We demonstrated that phagocytosis and TNFalpha production are distinct events in the response of mononuclear phagocytes to urate crystals, and these events can be distinguished at the level of macrophage differentiation. The noninflammatory removal of urate crystals by mature macrophages defines a new pathway that may be important in controlling the development of acute gout in patients with hyperuricemia.
PROBLEM: Increased calls to "do something" about child protective services (CPS) have resulted in proposals or new "paradigms" for services to at-risk or abusive families. These new paradigms call for the reform or revamping of CPS through the development of a community-based alternative response to some reports of child abuse and/or neglect. METHOD: This article reports on outcomes for 1,263 "low" risk CPS referrals diverted to a community-based alternative response system. Data on child, family, and case characteristics and services provided are presented as well as outcomes associated with re-referral and placement post service provision. RESULTS: The risk level and severity of some of the referrals to alternative response systems seems inappropriately high. The rates of re-referral were similar for families who did or did not engage in assessment services, and were highest for families where domestic violence was present. CONCLUSIONS: Criteria for diversion to community alternatives to CPS must be clearly articulated and applied. Both CPS and alternative response system workers must have the skills required to address a family's recognition of the problem and degree of motivation to engage in problem resolution, and to understand their relationship to continued risk of CA/N.
Stratified, terminally differentiated epithelia, such as epidermis and oral epithelia, provide protective barriers against the environment. We recently developed wholemount assays that demonstrate epidermal barrier function during late gestation and showed that epidermal barrier forms at specific sites (epidermal initiation sites), and then spreads around the body as apparent moving fronts. We now ask if this is a fundamental and widespread mode of epithelial developmental change. If so, then the pattern should be apparent when assaying for developmental change other than barrier institution (e.g., gene induction) and similar types of patterned change should be apparent in other types of epithelia. In this study we demonstrate patterned barrier function in a range of additional stratified epithelia from the oral cavity and show that the gene induction pattern of a stratum corneum precursor small proline-rich region protein 1 (SPRR1) precedes barrier function and occurs in the barrier pattern, i.e., gene induction occurs first at initiation sites and propagates across epithelia as apparent moving fronts. These results demonstrate that late gestational developmental change in multiple terminally differentiating epithelia occurs via initiation sites and moving fronts. The pattern precedes barrier formation and results in a developmental gradient that influences gene induction.
The type and frequency of simple sequence repeats (SSRs) in plant genomes was investigated using the expanding quantity of DNA sequence data deposited in public databases. In Arabidopsis, 306 genomic DNA sequences longer than 10 kb and 36,199 EST sequences were searched for all possible mono- to pentanucleotide repeats. The average frequency of SSRs was one every 6.04 kb in genomic DNA, decreasing to one every 14 kb in ESTs. SSR frequency and type differed between coding, intronic, and intergenic DNA. Similar frequencies were found in other plant species. On the basis of these findings, an approach is proposed and demonstrated for the targeted isolation of single or multiple, physically clustered SSRs linked to any gene that has been mapped using low-copy DNA-based markers. The approach involves sample sequencing a small number of subclones of selected randomly sheared large insert DNA clones (e.g., BACs). It is shown to be both feasible and practicable, given the probability of fortuitously sequencing through an SSR. The approach is demonstrated in barley where sample sequencing 34 subclones of a single BAC selected by hybridization to the Big1 gene revealed three SSRs. These allowed Big1 to be located at the top of barley linkage group 6HS.
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Telemedicine links were established between two nurse-led minor injuries units (MIUs) located in community hospitals and an accident and emergency department in a district general hospital. Telemedicine consultations were logged. During the first year of operation, telemedicine use was surprisingly constant, there being an average of 36 calls a month from one MIU and 16 from the other. Possible reasons for this include the clinical protocols under which nurses could refer patients to hospital. The average duration of teleconsultations was 3.5 min. Although the MIUs dealt with roughly similar numbers of patients, approximately 600-700 per month, the proportion for whom telemedicine was used was very different, at 5.2% and 2.3%.
In a study combining tissue mechanics and fracture morphology for the first time, we examined the ruptured surfaces of anterior cruciate ligaments of rabbits and related their appearance to the initial loading conditions. Sixteen specimens were stretched to failure at rates of displacement of 10 and 500 mm/min. We used video images to study the changes which occurred during the fracture process and SEM to examine the appearance of the ruptured surfaces. The surfaces of ligaments tested at 10 mm/min had more pulled-out collagen fibres and the fibres had more pronounced waviness compared with those tested at 500 mm/min. We have shown that the macroscopic appearance of ruptured ligaments can be related to their microscopic appearance and that it is possible to deduce whether failure was by gradual tearing of the fibres or catastrophic failure.
The selectins are adhesion molecules that mediate the tethering and rolling of leukocytes on vascular endothelium. Although E-selectin and P-selectin are known to be expressed by endothelial cells (EC) in response to proinflammatory stimuli, their pattern and mechanisms of expression in immune-mediated inflammation remain poorly understood. By quantifying luminal endothelial selectin expression via i.v. administration of radiolabeled mAb, we detected constitutive expression of P-selectin, but not E-selectin, in mouse skin. Both selectins were transiently up-regulated after intradermal TNF-alpha, IL-1alpha, or IL-1beta. In contrast, during a contact sensitivity response to oxazolone, expression of both selectins was prolonged, with distinct peaks at 6 and 48 h. Experiments with P-selectin gene-targeted mice showed that the P-selectin measured was exclusively expressed by EC rather than platelets. The early and late phases of selectin expression in contact sensitivity were differentiated in terms of their requirement for prior sensitization, and the action of IL-1. Whereas the early phase was a nonspecific 'irritant' response to oxazolone, the late phase was Ag specific and was partially IL-1 dependent. Therefore, persistence of both E- and P-selectin expression in vivo can occur as a result of sequential and distinct EC activation processes that appear to be at least partially different from those previously reported as stimulating ICAM-1 and VCAM-1 expression. The further elucidation of mechanisms of EC activation in this model may help determine the relative roles of selectins and ligands for leukocyte integrins in the sequential recruitment of T cells and other leukocyte subsets during ongoing immune-mediated inflammatory responses.