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Biomedical subjects

H Davies

Publications and source records attributed to H Davies.

At least 37 records · Page 2Linked to original sources
PubMed2001

Public release of information on quality of care: how are health services and the public expected to respond?

Public disclosure of the comparative performance of health care providers has been proposed as one mechanism of improving the quality of care. Performance data have been made public in the USA for over a decade and the provision of comparative information about quality of care is a central feature of current UK government health policy. The balance between the advantages and risks of pursuing such a policy in publicly funded health service is largely unknown. Advocates of public disclosure cite the role that comparative data can play in ensuring accountability, shifting the ownership of information (and therefore power) from professionals to service users and encouraging improvements in the processes and outcomes of care. However, these expectations are not necessarily realistic. There is some evidence that the public make little use of comparative data and there is a risk that public release may result in a loss of confidence in the health system and demoralisation of health service staff. In addition, there is a legitimate doubt that any early impact of disclosure will not be sustained and that the outcomes will not justify the necessary expenditure. In conclusion, we suggest that the theoretical benefits of promoting public disclosure as voiced by advocates of the policy may not be realised in practice.

Health Services Research↗
PubMed2001

Training the ideal hospital doctor: the specialist registrars' perspective.

BACKGROUND: When training for junior doctors is being planned, little discussion is focused on what outcomes hospitals are trying to achieve with regard to education/training, i.e. on what makes the ideal hospital doctor. Instead, the primary focus is on the requirements of the syllabi of the Royal Colleges (credentialing) and the requirements of service delivery (job description). Current literature has no qualitative studies of any longitude in which middle-grade doctors are asked about their vision of the ideal hospital doctor, what they feel can be done to help realize this vision, and how they feel about their own training. METHODS: This study examined data principally collected through a series of semistructured interviews conducted with eight specialist registrars (SpRs), four each from the North Trent and South Thames rotations over a period of 18 months. Additional information was taken from focus groups, interviews with programme directors, and questionnaires. FINDINGS: A model was created of the SpRs' perceptions of the key attributes of an ideal hospital doctor and of how these may be achieved in training. Eight broad areas were identified: clinical knowledge and skills; key clinically related generic/non-clinical skills; self-directed learning and medical education; implementing change management; applying strategic and organizational skills in career planning; consultation skills; research; and key personal attributes. CONCLUSIONS: SpRs are articulate in expressing their own expectations of their training and have considerable insight into the components of good training. Further improvement could be made and will require significant commitment from both trainees and trainers.

Clinical Competence↗
PubMed2000

A comparison of fetal and adult porcine islets with regard to Gal alpha (1,3)Gal expression and the role of human immunoglobulins and complement in islet cell cytotoxicity.

BACKGROUND: It is still debated whether fetal or adult porcine islets should be the preferred choice for future clinical islet xenotransplantation. Each type of islet preparation has advantages and disadvantages compared with the other. Here we present a direct comparison between fetal and adult porcine islets with regard to Gal alpha(1,3)Gal expression, immunoglobulin and complement binding, and cytotoxicity after exposure to fresh human serum. METHOD: Islet single cell suspensions were prepared from adult and fetal islets by trypsin digestion. Fluorescein isothiocyanate-conjugated Bandeiraea simplicifolia isolectin B4 (BS-IB4) and affinity-purified chicken anti-Gal alpha(1,3)Gal antibody was used to detect Gal alpha(1,3)Gal expression. Immunoglobulin and complement binding to the islet cells and cytotoxicity for islet cells was compared after incubation with fresh and heat-inactivated human sera and with an immune serum from a diabetic patient who received a fetal porcine islet transplant. Furthermore, two pools of human AB sera were depleted of porcine endothelial cell cytotoxic human anti-Gal alpha(1,3)Gal antibodies by absorption and were used to analyze the effect of Gal alpha(1,3)Gal antibody removal on islet cell cytotoxicity. RESULTS: Fetal islet cells readily bound both BS-IB4 and the chicken anti-Gal alpha(1,3)Gal antibody. None of 10 adult porcine islet preparations were stained by BS-IB4. In comparison, IgY anti-Gal Ab binding was detected in two of eight adult islet isolations, whereas the other six preparations showed marginal/no binding. After incubation of fetal islet cells with fresh human serum, C3c binding was strongly positive and IgM binding variable, with occasional binding of IgG and no detectable binding of IgA. Adult islet cells were also strongly positive for C3c but did not bind detectable amounts of IgM, IgG, or IgA. Immune sera from a patient who had received fetal porcine islets showed the presence of induced antibodies that bound to fetal islet cells and to porcine peripheral blood lymphocytes, whereas binding to adult islet cells was barely detectable. Fresh human sera showed a high and similar level of complement-mediated lytic activity for both adult islet cells (78+/-22%) and fetal islet cells (75+/-16%). Cytotoxicity for fetal islet cells and peripheral blood lymphocytes was significantly reduced when the corresponding sera were depleted of anti-Gal antibodies before use (P=0.002 and P=0.003, respectively). In contrast, no difference in cytotoxicity for adult islet cells was detected when anti-Gal-depleted human sera were used. CONCLUSION: Gal alpha(1,3)Gal expression is occasionally detectable on adult porcine islet cells, but not as readily and at a lower level, compared with fetal islet cells. Thus, as porcine fetal islets mature to adult islets, the expression of the Gal alpha(1,3)Gal epitope gradually diminishes. Consequently, cytotoxic anti-Gal alpha(1,3)Gal antibodies in human serum play an important role in the lysis of fetal but not adult porcine islet cells.

Aging↗
PubMed2000

The use of seldi proteinchip arrays to monitor production of Alzheimer's betaamyloid in transfected cells.

beta-Amyloid (Abeta), a 39-43 residue peptide, is the principal component of senile plaques found in the brains of patients with Alzheimer's disease (AD). There are two main lines of evidence that its deposition is the cause of neurodegeneration. First, mutations found in three genes in familial Alzheimer's cases give rise to increased production of the longest, most toxic, form, Abeta 1-42. Second. aggregated Abeta is toxic to neuronal cells in culture. Inhibitors of the proteases involved in its release from the amyloid precursor protein are, therefore, of major therapeutic interest. The best candidates for the releasing proteases are both aspartyl proteases, which are integrated into the membranes of the endoplasmic reticulum and Golgi network. A sensitive assay using Ciphergen's Seldi system has been developed to measure all the variants of Abeta in culture supernatants, which will be of great value in screening inhibitors of these proteases. With this assay, it has been shown that increasing intracellular cholesterol increases the activities of both beta-secretase, and gamma-secretase 42. Moreover, changing the intracellular targeting of amyloid precursor glycoprotein (APP) yields increased alpha-secretase cleavage, and increases in the amounts of oxidized/nitrated forms of Abeta.

Alzheimer Disease↗
PubMed2000

Methotrexate as a steroid sparing agent for asthma in adults.

BACKGROUND: Sustained oral corticosteroid use can lead to complications, so there is interest in identifying agents that can reduce oral steroid use in people with asthma. Methotrexate has attracted attention as a possible steroid sparing agent in patients with chronic oral steroid dependent asthma. OBJECTIVES: The objective of this review was to assess the effects of adding methotrexate to oral corticosteroids in adults with stable asthma who are dependent on oral corticosteroids. SEARCH STRATEGY: The Cochrane Airways Group trials register and reference lists of identified articles were searched. SELECTION CRITERIA: Randomised trials of the addition of methotrexate compared with placebo in adult steroid dependent asthmatics. Duration of therapy needed to be at least 12 weeks. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extraction was carried out by two reviewers independently. Study authors were contacted for missing information. MAIN RESULTS: Ten trials involving a total of 185 people were included. Study design and quality, corticosteroid dosages and outcomes varied widely. There was a reduction in oral corticosteroid dose favouring methotrexate in parallel trials (weighted mean difference -4.1 mg per day, 95% confidence interval -6.8 to -1.3) and also in cross-over trials (weighted mean difference -2.9 mg per day, 95% confidence interval -5.9 to -0.2). There was no difference between methotrexate and placebo for forced expiratory volume in one minute (weighted mean difference 0.12 litre, 95% confidence interval -0.21 to 0.45). Hepatotoxicity was a common adverse effect with methotrexate compared to placebo (odds ratio 6.9, 95% confidence interval 3.1 to 15.5). REVIEWER'S CONCLUSIONS: Methotrexate may have a small steroid sparing effect in adults with asthma who are dependent on oral corticosteroids. However, the overall reduction in daily steroid use is probably not large enough to reduce steroid-induced adverse effects. This small potential to reduce the impact of steroid side-effects is probably insufficient to offset the adverse effects of methotrexate.

Administration, Oral↗
PubMed2000

Validation of the ISAAC video questionnaire (AVQ3.0) in adolescents from a mixed ethnic background.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) has developed an international version of the asthma video questionnaire (AVQ3.0) to measure asthma prevalence. This questionnaire has not been validated in adolescents from a mixed ethnic background. OBJECTIVE: The aims of this study were to compare the video questionnaire with a written questionnaire in the detection of airway hyperresponsiveness to hypertonic saline in a population of adolescents from a mixed ethnic background, and to establish the repeatability and psychometric properties of the asthma video questionnaire. METHODS: The study was conducted in four secondary schools in Sydney, an area with a high proportion of people from a non-English speaking background. Four hundred and seventy-five students from schools 1 and 2 completed the video questionnaire and a subgroup of these students (n = 170) completed the written questionnaire and a hypertonic saline inhalation challenge. Reproducibility of the questionnaire was evaluated by administering the questionnaire to a subsample of students 2 weeks later. The psychometric properties of the video questionnaire were examined in 852 students at two other schools (schools 3 and 4). RESULTS: One hundred and sixty-nine students aged 13.5 (sd 1.3) years completed both written and video questionnaires, and the hypertonic saline challenge. The students had widely different cultural backgrounds including Asian, South Pacific, Middle Eastern, European and African countries. There was good agreement between the questionnaires for wheeze (kappa 0.42). Questions on the video questionnaire concerning wheezing had good sensitivity (90%) and specificity (68%) for airway hyperresponsiveness to hypertonic saline. The video questionnaire was reproducible (kappa 0.82), had good internal consistency (Cronbach's alpha 0.81) and each question pertained to a single construct explaining 58% of the variance in total score. CONCLUSION: This study has validated the international version of the ISAAC video questionnaire against airway hyperresponsiveness to hypertonic saline in adolescents from a mixed ethnic background, and identified that the questionnaire has good psychometric properties. The ISAAC video has proved to be a valuable tool for the assessment of asthma prevalence in populations of ethnic diversity.

Adolescent↗
PubMed2000

Tissue-specific microdissection coupled with ProteinChip array technologies: applications in cancer research.

Analysis of whole genomes to monitor specific changes in gene activation or changes in gene copy number due to perturbation has recently become possible using DNA chip technologies. It is now becoming apparent, however, that knowing the genetic sequence encoding a protein is not sufficient to predict the size or biological nature of a protein. This can be particularly important in cancer research where posttranslational modifications of a protein can specifically lead to the disease. To address this area, several proteomic tools have been developed. Currently the most widely used proteomics tool is two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), which can display protein expression patterns to a high degree of resolution. However, 2D-PAGE can be time consuming; the analysis is complicated and, compared with DNA techniques, is not very sensitive. Although some of these problems can be alleviated by using high-quality homogeneous samples, such as those generated using microdissection techniques, the quantity of sample is often limited and may take several days to generate sufficient material for a single 2D-PAGE analysis. As an alternative to 2D-PAGE, a preliminary study using a new technique was used to generate protein expression patterns from either whole tissue extracts or microdissected material. Surface-enhanced laser desorption and ionization allows the retention of proteins on a solid-phase chromatographic surface or ProteinChip Array with direct detection of retained proteins by time-of-flight mass spectrometry. Using this system, we analyzed tumor and normal tissue from head and neck cancer and microdissected melanoma to determine differentially expressed proteins. In particular, comparisons of the protein expression patterns from microdissected normal and tumor tissues indicated several differences, highlighting the importance of extremely defined tissue lysates for protein profiling.

Biosensing Techniques↗
PubMed1999

The role of cholesterol in the biosynthesis of beta-amyloid.

Addition of the beta-hydroxy-beta-methylglutaryl-CoA (HmG-CoA) reductase inhibitor lovastatin to human HEK cells transfected with the amyloid precursor protein (APP) reduces intracellular cholesterol/protein ratios by 50%, and markedly inhibits beta-secretase cleavage of newly-synthesized APP. Exogenous water-solubilized cholesterol at 200 microg/ml concentration increases newly synthesized beta-amyloidogenic products four-fold. These intracellular changes are detectable by immunoprecipitation and immunofluorescent labelling. Analyses of the fragments captured from culture medium by an N-terminal anti-beta-amyloid antibody on ProteinChip arrays and detected using surface-enhanced laser desorption/ionization (SELDI) mass spectrometry revealed that culture with cholesterol (200 microg/ml) increased secretion of beta-amyloid 1-40 by 1.8-fold, and increased secretion of beta-amyloid 1-42. Changes in APP processing by cholesterol may mediate the way in which the ApoE4 allele increases risk of developing Alzheimer's disease (AD) in western populations.

Amyloid beta-Peptides↗
PubMed1999

Edible mushroom (Agaricus bisporus) lectin, which reversibly inhibits epithelial cell proliferation, blocks nuclear localization sequence-dependent nuclear protein import.

The Galbeta1-3GalNAcalpha (TF antigen)-binding lectin (ABL) from the common edible mushroom (Agaricus bisporus) has a potent anti-proliferative effect without any apparent cytotoxicity. This unusual combination of properties prompted investigation of its mechanism of action. In contrast to soluble lectin, agarose-immobilized, and hence noninternalizable ABL had no effect on proliferation of HT29 colon cancer cells. Electron microscopy of HT29 cells incubated with fluorescein- and gold-conjugated ABL showed internalization of the lectin into endocytotic vesicles and multivesicular bodies. Confocal microscopy showed perinuclear accumulation of fluorescein isothiocyanate-conjugated lectin, which also inhibits HT29 cell proliferation, raising the possibility that the lectin might interfere with nuclear pore function. Transport of heat shock protein 70 into the nucleus in response to heat shock was blocked by preincubation of HT29 cells for 6 h with 40 micrograms/ml ABL. In digitonin-permeabilized cells, nuclear uptake of bovine albumin conjugated to a nuclear localization sequence (NLS)-containing peptide was also inhibited by a 15-min preincubation with 40-100 micrograms/ml ABL. In contrast, serum-stimulated nuclear translocation of mitogen-activated protein kinase, which is NLS-independent, was not affected by pretreatment of cells with the lectin. These results suggest that the anti-proliferative effect of ABL is likely to be a consequence of the lectin trafficking to the nuclear periphery, where it blocks NLS-dependent protein uptake into the nucleus.

Adult↗
PubMed1999

Self-administration of cocaine analogs by rats.

RATIONALE: A novel scheme for the synthesis of cocaine analogs from vinylcarbenoid precursors has made available compounds that have a diverse range of affinities for the DA and 5-HT transporters. These compounds were used to explore the relationship between their biochemical properties and their reinforcing effects. OBJECTIVES: The objective was to assess the reinforcing efficacy of selected cocaine analogs and compare the results with their selectivity in binding to DA and 5-HT transporters. METHODS: Rats were prepared with chronically indwelling intravenous cannulae and trained to self-administer cocaine on a progressive ratio (PR) schedule. A range of doses of seven cocaine analogs were substituted for cocaine in separate groups of animals. RESULTS: The results demonstrate a wide range of reinforcing efficacies and potencies among the seven selected drugs. Four tropane analogs (WF-11, WF-23, WF-24, WF-55) were found to support self-administration behavior on a PR schedule while three did not (WF-31, WF-54 and WF-60). The DA/5-HT selectivity ratio was found to be a better predictor of self-administration behavior than affinity at the DA transporter alone. CONCLUSION: These data suggest that drugs with a higher affinity for the DA versus the 5-HT transporter are more likely to be self-administered.

Animals↗
PubMed1999

The psychological impact of genetic testing for Alzheimer disease.

Information regarding one's genetic risk for a particular disease might effectively inform medical, financial, and reproductive decisions and perhaps promote established risk reduction behaviors. However, genetic testing may also lead to significant levels of anxiety, depression, or other forms of distress, especially when psychological coping strategies and social reserves are not adequate to manage positive or inconclusive results. This paper focuses on the psychological impact of predisposition genetic for Alzheimer disease (AD). We present stress and coping models that capture the essence of this impact and discuss the potential role of counseling and follow-up interventions. The discussion draws primarily from the experiences of professionals working with other diseases, and seeks to expand that experience into the AD arena. In addition, we emphasize two issues we believe need additional attention in the psychological literature regarding genetic testing and counseling: (i) the psychosocial vulnerability of individuals being tested and, (ii) the sociocultural context of the AD patient and their family members.

Alzheimer Disease↗
PubMed1999

Endotoxin exposure among softwood lumber mill workers in the Canadian province of British Columbia.

An increased prevalence of respiratory problems among softwood lumber mill workers has been observed in a number of studies. These workers are potentially exposed to a variety of respiratory hazards including wood dust, abietic or other resin acids, monoterpenes, and fungi, as well as endotoxins. The objectives of this study were to determine if lumber mill workers were exposed to hazardous levels of airborne endotoxin and to identify the factors contributing to high exposures. Personal endotoxin samples (n = 216) were collected in four lumber mills in the Canadian province of British Columbia. The mean personal exposure concentration was 2.09 ng/m.(3) and 9% of the samples were above 5 ng/m.(3). Factors related to the personal endotoxin exposure were type of job, use of compressed air, the percentage of time spent in a booth or cab during a shift, and dust concentration. Log storage practices were also suspected of playing a role. The levels of exposure observed in this study were low compared to the levels reported for populations with respiratory problems attributed to endotoxins.

Air Microbiology↗
PubMed1999

Profiling of amyloid beta peptide variants using SELDI Protein Chip arrays.

The profile of amyloid beta (A beta) peptide variants secreted into the media of human cultured cells that express the amyloid precursor protein was examined by Surface Enhanced Laser Desorption/Ionization (SELDI) ProteinChip technology from Ciphergen Biosystems using biologically active ProteinChip Arrays. An anti-A beta polyclonal antibody (anti-NTA4) was used to capture and purify multiple immunoreactive A beta fragments from a single microliter of media onto the ProteinChip Array. Fragments retained on the surface of the ProteinChip Array were detected directly by mass in the ProteinChip System to provide detailed information on the identity of different A beta variants secreted from the cultured cells. We discuss existing and potential applications of this immunoassay for the detection and relative quantitation of A beta species from both cultured cell systems and clinical samples.

Alzheimer Disease↗