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Biomedical subjects

E Moss

Publications and source records attributed to E Moss.

At least 19 recordsLinked to original sources
PubMed2004

Brainstem death testing in the UK--time for reappraisal?

BACKGROUND: A diagnosis of brainstem death in the UK is based on clinical assessment rather than technical investigations, but is considered rigorous enough to be legally synonymous with death. METHODS: A questionnaire in five sections concerning clinician details, initiation of support, criteria for testing, conduct of the tests, and the process of organ donation, was sent to all members of the Neuroanaesthesia Society. RESULTS: The survey reveals evidence of failure to apply existing guidelines accurately and a wide variation in practice where the recommendations are not specific. CONCLUSIONS: In an era of scrutiny of medical process, it is timely to consider whether the current guidelines should be revisited. Clarification of the approach to biochemical derangement, and the role of confirmatory tests when the residual effect of sedative agents cannot be excluded, are two areas worthy of debate.

Brain Death↗
PubMed2004

Handover of responsibility for the anaesthetised patient - opinion and practice.

Anaesthesia is a critical and complex process that extends from the pre-operative assessment through to the postoperative management of patients. Handover of responsibility for logistical as opposed to patient-orientated reasons may compromise that process of care. If such handover becomes inevitable with shift-based patterns of working, the implications need to be considered and procedures developed in order to minimise adverse consequences. This survey of national practice reveals little formalisation of procedure and a spectrum of opinion on the relevance of the key considerations. There is, however, a majority view amongst respondents that national guidelines would be of value and that professional defensibility would be aided by standardisation and documentation of any handover.

Anesthesiology↗
PubMed2001

The neurocognitive phenotype of the 22q11.2 deletion syndrome: selective deficit in visual-spatial memory.

The 22q11.2 deletion syndrome (velocardiofacial/DiGeorge syndrome) is associated with a high frequency of learning disabilities. Although previous work has demonstrated that verbal skills are typically better preserved than non-verbal skills on both IQ and academic achievement testing in children with this syndrome, such measures are not sufficiently specific to determine a selective cognitive deficit. As part of an ongoing prospective study of patients with this syndrome, 29 children aged 5-17 with confirmed 22q11.2 deletions were assessed with a comprehensive neuropsychological test battery, including matched tasks of verbal and visuospatial memory. Results indicate that 22q patients displayed a selective deficit in visual-spatial memory, which was mirrored by deficits in arithmetic and general visual-spatial cognition. Further, a dissociation between visual-spatial and object memory was observed, indicating further selectivity of this pattern of deficit, and providing evidence for the dissociability of these components of visual cognition. These results indicate that children with 22q11.2 deletions display a specific neurocognitive phenotype, and suggest that this region of Chromosome 22q11 may harbor a gene or genes relevant to the etiology of nonverbal learning deficits.

Adolescent↗
PubMed2001

Multiple choice questions: their value as an assessment tool.

Multiple choice questions are a well-established, reliable method of assessing knowledge and are used widely in postgraduate examinations in anaesthesiology. Like other methods of assessment they have their strengths and weaknesses. With the drive for revalidation and changes in undergraduate medical education much work has been done on devising valid, reliable and feasible methods of assessment of clinical practice including the need for the use of several different methods. Different multiple choice question formats have been devised and the importance of well-written multiple choice questions with clear assessment objectives recognized. There is controversy about the use of number-right as opposed to negative marking but, provided that the candidates know which marking system is being used, either method is satisfactory. The pass standard should be determined using criterion-based rather than norm-based referencing. Multiple choice questions could be used to validate continuing education and professional development from reading, possibly using web-based technology. For as long as there is a need to test knowledge in the assessment of doctors and medical undergraduates multiple choice questions will have a part to play, but only as one component of the assessment of clinical competence.

Journal Article↗
PubMed2001

A generic approach to risk assessment for the Ionising Radiations Regulations 1999.

The Ionising Radiations Regulations 1999 (IRR99) require that an explicit risk assessment be carried out to control properly the risks associated with the use of ionising radiation. Prior to IRR99, risk was controlled implicitly via mechanisms such as Local Rules and staff monitoring, which were initiated by the Radiation Protection Adviser using professional judgement. To enable a consistent approach across our Trust's radiation users, a generic model of risk assessment was employed. This had been developed previously by the Trust in response to a national initiative within the NHS to manage risk. The methodology involves the generation, by a multidisciplinary staff brain-storming session, of a complete list of all possible risks. This is followed by a risk stratification process based upon severity of consequence and frequency of risk. Auditable controls are then applied and quantifiable outcome measures are monitored for continued compliance. Template risk assessments are presented to aid others in this process. It is estimated that even in a large teaching hospital with a full complement of medical radiation applications, the time resource necessary for this approach is of the order of a few days.

Environmental Exposure↗
PubMed2001

Attachment at school age and academic performance.

The association between attachment and school-related cognitive functioning was longitudinally examined for a French Canadian sample of 108 school-age children. The affective quality of mother-child interaction patterns, child cognitive engagement, and quality of child attachment to mother were evaluated during a laboratory visit that included a separation-reunion procedure occurring when the children were approximately 6 years of age. Children's mastery motivation and academic performance were assessed 2 years later (at age 8). Analyses indicated that secure children had higher scores than their insecure peers on communication, cognitive engagement, and mastery motivation. Controlling children were at greatest risk for school underachievement, with the poorest performance on all measures except mastery motivation. Avoidant and ambivalent children were lowest on mastery motivation. Results of mediational analyses support the salience of mother-child interactional processes and child cognitive engagement at school age in explaining relations between attachment and cognitive functioning in school.

Child↗
PubMed1999

Cognitive and behavior profile of preschool children with chromosome 22q11.2 deletion.

A microscopic deletion of chromosome 22q11.2 has been identified in most patients with the DiGeorge, velocardiofacial syndrome, conotruncal anomaly face syndrome, and in some patients with isolated conotruncal cardiac anomalies. This study presents the neurodevelopmental outcome, including cognitive development, language development, speech, neuromuscular development, and behavioral characteristics of 40 preschool children (ages 13 to 63 months) who have been diagnosed with the 22q11.2 deletion. The impact of cardiac disease, cardiac surgery, and the palatal anomalies on this population was also studied. In the preschool years, children with a 22q11.2 deletion are most commonly found to be developmentally delayed, have mild hypotonia, and language and speech delays. The more significantly delayed children are at high risk to be subsequently diagnosed with mild or moderate mental retardation. The global delays and the variations in intelligence found are directly associated with the 22q11.2 deletion and are not explained by physical anomalies such as palatal defects or cardiac defects, or therapeutic interventions such as cardiac surgery. Our findings demonstrate that there is a pattern of significant speech disorders within this population. All of the children had late onset of verbal speech. Behavioral outcomes included both inhibition and attention disorders. Early intervention services are strongly recommended beginning in infancy to address the delays in gross motor skills, speech and language, and global developmental delays.

Behavioral Symptoms↗
PubMed1999

Analgesia after intracranial surgery: a double-blind, prospective comparison of codeine and tramadol.

We have compared codeine and tramadol in a prospective, double-blind study of postoperative analgesia in 75 patients after elective intracranial surgery. Twenty-five patients received codeine 60 mg, tramadol 50 mg or tramadol 75 mg i.m. Patients receiving codeine had significantly lower pain scores over the first 48 h after operation (P < 0.0001). Although there was no difference in visual analogue scale (VAS) scores between the three groups at 24 h, the codeine group had significantly lower scores at 48 h (P < 0.0001). The tramadol 75 mg group had significantly higher scores for both sedation and nausea and vomiting (P < 0.0001 for both scores). We conclude that codeine 60 mg i.m. provided better postoperative analgesia than tramadol after craniotomy and that tramadol 75 mg should be avoided because of its side effects of increased sedation and nausea and vomiting.

Adolescent↗
PubMed1999

The Philadelphia story: the 22q11.2 deletion: report on 250 patients.

A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge, velocardiofacial, and conotruncal anomaly face syndromes, and in some patients with the Opitz G/BBB and Cayler cardiofacial syndromes. We have been involved in the analysis of DiGeorge syndrome and related diagnoses since 1982 and have evaluated a large number of patients with the deletion. We describe our cohort of 250 patients whose clinical findings help to define the extremely variable phenotype associated with the 22q11.2 deletion and may assist clinicians in providing genetic counseling and guidelines for clinical management based on these findings.

Abnormalities, Multiple↗
PubMed1998

Selective chemical modifications of polymyxin B.

Polymyxin B (1) monohydrochloride was converted to the tetra-BOC derivatives 1b and 1c by reaction with di-tert-butyl dicarbonate. The structures of these protected intermediates were established utilizing a degradative sequence that afforded 3 and 5. A method for the deprotection 2,4-dinitrophenylamines to the free amine, utilizing a strongly basic ion-exchange resin, was developed for use in the degradative sequence. The tetra-BOC derivatives 1b and 1c were used to prepare several Polymyxin B derivatives 6-27 at the DAB1 and DAB9-gamma-amine. The antibacterial activity of these selectively functionalized derivatives is reported here.

Anti-Bacterial Agents↗
PubMed1998

Aerosol exposure from an ultrasonically activated (Harmonic) device.

STUDY OBJECTIVE: To determine the distribution and concentration of aerosol particles caused by an ultrasonic (Harmonic) scalpel during simulated surgical use. DESIGN: Prospective experimental analysis (Canadian Task Force classification II-1). SETTING: Standard operating room. MATERIALS: Lean pork, lean beef, water, and blood, and the Harmonic scalpel with ball, curved scalpel, and cutting tips. INTERVENTIONS: Real-time sampling of airborne aerosols was performed over 6-second sampling periods. MEASUREMENTS AND MAIN RESULTS: Blood and tissue particles increased significantly during use of the Harmonic scalpel. Local exhaust evacuation methods diminished these concentrations. CONCLUSIONS: The Harmonic scalpel causes formation of bioaerosols that are composed of material of respirable size. When this device is used, a local exhaust system or smoke-evacuation method should be activated to reduce exposure to blood, blood by-products, and potentially infectious materials.

Aerosols↗
PubMed1998

Correlates of attachment at school age: maternal reported stress, mother-child interaction, and behavior problems.

The contribution of attachment, maternal reported stress, and mother-child interaction to the prediction of teacher-reported behavior problems was examined for a French-Canadian sample of 121 school-age children. Attachment classifications were assigned on the basis of reunion behavior with mother when the children were between 5 and 7 years of age. Maternal reported stress and mother-child interaction patterns were assessed concurrent to the attachment measure, whereas behavior problems were evaluated both at ages 5 to 7 and 7 to 9 years. Security of attachment significantly predicted the likelihood of school-age behavior problems: Controlling/other children were most at risk for both externalizing and internalizing problems across both age periods. Younger ambivalent children presented clinical cut-off levels of externalizing problems, and older avoidant boys had higher internalizing scores. Patterns of maternal-reported stress and mother-child interaction differed across attachment groups and contributed to prediction of school-age behavior problems, partially mediating the relation between attachment and adaptation. Results support the importance of attachment in explaining school-age adaptation and validity of attachment coding for children of this age.

Adult↗
PubMed1997

The 22q11.2 deletion: screening, diagnostic workup, and outcome of results; report on 181 patients.

A submicroscopic deletion of chromosome 22q11.2 has been identified in the majority of patients with the DiGeorge syndrome, velocardiofacial syndrome, conotruncal anomaly face syndrome, and in some patients with isolated conotruncal cardiac anomalies, Opitz G/BBB syndrome, and Cayler cardiofacial syndrome. We have evaluated 181 patients with this deletion. We describe our cohort of patients, how they presented, and what has been learned by having the same subspecialists evaluate all of the children. The results help define the extremely variable phenotype associated with this submicroscopic deletion and will assist clinicians in formulating a management plan based on these findings.

Abnormalities, Multiple↗
PubMed1997

Canadian beef quality audit.

A study was conducted in 4 Canadian processing plants in 1995-96 to determine the prevalence of quality defects in Canadian cattle. One percent of the annual number of cattle processed in Canada were evaluated on the processing floor and 0.1% were graded in the cooler. Brands were observed on 37% and multiple brands on 6% of the cattle. Forty percent of the cattle had horns, 20% of which were scurs, 33% were stubs, 10% were tipped, and 37% were full length. Tag (mud and manure on the hide) was observed on 34% of the cattle. Bruises were found on 78% of the carcasses, 81% of which were minor in severity. Fifteen percent of the bruises were located on the round, 29% on the loin, 40% on the rib, 16% on the chuck, and 0.02% on the brisket. Grubs were observed in 0.02% of the steers, and injection sites were observed in 1.3% of whole hanging carcasses. Seventy percent of the livers were passed for human food and 14% for pet food; 16% were condemned. Approximately 71% of the liver condemnations were due to liver abscesses. Four percent of the heads, 6% of the tongues, and 0.2% of whole carcasses were condemned. The pregnancy rate in female cattle was approximately 6.7%. The average hot carcass weight was 357 kg (s = 40) in steers, 325 kg (s = 41) in heifers, 305 kg (s = 53) in cows, 388 kg (s = 62) in virgin bulls and 340 kg (s = 39) in mature bulls. The average ribeye area in all cattle was 84 cm2 (s = 12); range 29 cm2 to 128 cm2. Grade fat was highly variable and averaged 9 mm (s = 4) for steers and heifers, 6 mm (s = 6) for cows, 5 mm (s = 1) for virgin bulls, and 4 mm (s = 0.5) for mature bulls. The average lean meat yield was 59.7% in cattle (s = 3.4); range 39% to 67%. One percent of the carcasses were devoid of marbling, 1% were dark cutters, and 0.05% of the steer carcasses were staggy. Six percent of the carcasses had poor conformation, 3.7% were underfinished, and 0.7% were overfinished. Yellow fat was observed in 4% of the carcasses; 10% of carcasses were aged. Based on January 1996 prices, the economic analysis showed that the Canadian beef industry lost $70.52 per head or $189.6 million annually from quality nonconformities. Methods identified to reduce these nonconformities included improvements in management, animal identification, handling, genetic selection, marketing, grading, and information transfer.

Abattoirs↗
PubMed1996

Synthesis of TNF alpha and TGF beta mRNA in the different micro-environments within atheromatous plaques.

OBJECTIVE: To examine localisation of tumour necrosis factor (TNF alpha) and transforming growth factor beta (TGF beta) mRNA synthesis in human coronary artery atheromatous plaques, to explore how synthesis of these cytokines relates to distribution of macrophages and smooth muscle cells, and to correlate this with plaque micro-environments. METHOD: In situ hybridisation with digoxigenin-labelled sense and anti-sense riboprobes was used, combined with immunohistochemistry to detect TNF alpha protein, macrophage, lymphocyte and smooth muscle cell markers. RESULTS: In the intimal plaque TNF alpha mRNA is synthesised by monocytes/macrophages as well as by smooth muscle cells. Both TNF alpha and TGF beta mRNAs were present at the margins of the lesions and in reactive areas, where there was little lipid and fibrosis. Focal aggregates of macrophages in the adventitia expressed both TNF alpha mRNA and protein and TGF beta mRNA. CONCLUSION: Synthesis of these two cytokines by macrophages as well as smooth muscle cells contributes to the pathobiology of the plaque and that this is part of the 'reaction to injury', rather than a feature of a specific cell, or a specific layer, within the vessel wall.

Coronary Disease↗
PubMed1996

Effect of antagonism of mivacurium on recovery of extraocular muscle function.

We have measured extraocular muscle function in 41 patients who received neuromuscular block with mivacurium 0.2 mg kg-1 during anaesthesia with propofol, ketorolac, fentanyl and isoflurane in nitrous oxide and oxygen, which was antagonized at the end of surgery with neostigmine 0.05 mg kg-1 and glycopyrronium 0.01 mg kg-1 in 21 of these patients. Extraocular muscle function was measured before and after surgery in each group with the Maddox Wing apparatus and compared with a control group (n = 20) who breathed spontaneously the same gaseous anaesthetic mixture via a reinforced laryngeal mask airway. In patients where the action of mivacurium was antagonized, extraocular muscle function was improved significantly 20 min after antagonism (P < 0.001) compared with those who received no antagonism. At 60 min after antagonism, there were no differences between the groups. There were no differences between patients who received no neuromuscular blockers and those who received blocker and antagonist.

Ambulatory Surgical Procedures↗