Biomedical subjects
J Mason
Publications and source records attributed to J Mason.
Descent into the depths.
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Selective serotonin reuptake inhibitors: meta-analysis of efficacy and acceptability.
OBJECTIVE: To examine the evidence for using selective serotonin reuptake inhibitors instead of tricyclic antidepressants in the first line treatment of depression. DESIGN: Meta-analysis of 63 randomised controlled trials comparing the efficacy and acceptability of selective serotonin reuptake inhibitors with those of tricyclic and related antidepressants. MAIN OUTCOME MEASURES: Improvement in mean scores on Hamilton depression rating scale for 53 randomised controlled trials. Pooled drop out rates from the 58 trials which reported drop out by treatment group. RESULTS: Among the 20 studies reporting standard deviation for the Hamilton score no difference was found in efficacy between serotonin reuptake inhibitors and tricyclic and related antidepressants (standardised mean difference 0.004, 95% confidence interval -0.096 to 0.105). The difference remained insignificant when the remaining 33 studies that used the 17 item and 21 item Hamilton score were included by ascribing weighted standard deviations. The odds ratio for drop out rate in patients receiving serotonin reuptake inhibitors compared with those receiving tricyclic antidepressants was 0.95 (0.86 to 1.07). Similar proportions in both groups cited lack of efficacy as the reason for dropping out but slightly more patients in the tricyclic group cited side effects (18.8% v 15.4% in serotonin reuptake group). CONCLUSIONS: Routine use of selective serotonin reuptake inhibitors as the first line treatment of depressive illness may greatly increase cost with only questionable benefit.
Some guidelines on the use of cost effectiveness league tables.
Decisions to allocate resources in health care are increasingly influenced by relative cost effectiveness. To warn decision makers of some of the pitfalls currently found in cost effectiveness league tables and to suggest how meaningful comparisons may be made between health care technologies a published league table was scrutinised by examining its sources. This showed some of the methodological problems surrounding such tables and how such difficulties could be reduced in future. The source studies in the table featured different years of origin, discount rates, health state evaluations, settings, and types of comparison programmes; all of these differences may raise problems for meaningful comparison. Decision makers need to assess the relative value for money of competing health care interventions. In the absence of systematic comparisons such assessments are likely to take place informally. This will probably have a worse risk-benefit trade off than the formalized use of league tables.
Yeast artificial chromosome cloning in the glycerol kinase and adrenal hypoplasia congenita region of Xp21.
The adrenal hypoplasia congenita (AHC) and glycerol kinase (GK) loci are telomeric to the Duchenne muscular dystrophy locus in Xp21. We developed a pair of yeast artificial chromosome (YAC) contigs spanning at least 1.2 Mb and encompassing the region from the telomeric end of the Duchenne muscular dystrophy (DMD) locus to beyond YHX39 (DXS727), including the genes for AHC and GK. The centromeric contig consists of 13 YACs reaching more than 600 kb from DMD through GK. The telomeric contig group consists of 8 YACs containing more than 600 kb including the markers YHX39 (DXS727) and QST-59 (DXS319). Patient deletion breakpoints in the region of the two YAC contigs define at least eight intervals, and seven deletion breakpoints are contained within these contigs. In addition to the probes developed from YAC ends, we have mapped eight Alu-PCR probes amplified from a radiation-reduced somatic cell hybrid, two anonymous DNA probes, and one Alu-PCR product amplified from a cosmid end, for a total of 26 new markers within this region of 2 Mb or less. One YAC in the centromeric contig contains an insert encompassing the minimum interval for GK deficiency defined by patient deletion breakpoints, and this clone includes all or part of the GK gene.
Cost-effectiveness league tables: more harm than good?
In recent years it has become fashionable to make comparisons (in 'league tables' or rankings) between health care interventions in terms of their relative cost-effectiveness, in cost per life-year or cost per quality-adjusted life-year gained. However, concerns have been raised about the unthinking use of league tables and some authors have questioned the theoretical basis of their construction. In this paper a recently-reported league table is scrutinized and the important methodological features of the source studies identified. These include the choice of discount rate, the method of estimating utility values for health states, the range of costs and consequences considered and the choice of comparison programme. Several recommendations are made for improvements, both in the methodology of economic evaluation studies and in the construction and use of league tables. It is concluded that, for league tables to be useful, decision makers should be able to assess the relevance and reliability of the evidence in their own setting. Fuller reporting of methods and results by the authors of economic evaluation studies would greatly assist in the appropriate construction and use of league tables.
Bovine serum amine oxidase: some differences between chromatographically defined forms including sensitivity to inhibition by dithiomolybdate.
1. Bovine serum amine oxidase (BSAO) forms, defined by DEAE-cellulose and hydroxyapatite chromatography, were shown to have different kinetic characteristics with p-dimethylaminobenzylamine as a substrate; there was also some variation in heat sensitivity. 2. The forms showed similar sensitivity to inhibition by aminoguanidine but there were differences with respect to dithiomolybdate. 3. The results also provided some support for the view that both subunits were active catalytically. 4. It is concluded that while the forms were interconvertible, the practice of pooling different chromatographic fractions may not be acceptable in all circumstances. 5. While inhibition by dithiomolybdate is of biochemical interest it is concluded that inhibition of BSAO by thiomolybdates is unlikely to play a role in the clinical syndromes which are common in cattle exposed to Mo in the herbage.
Conventions for the reporting of nuclear magnetic shielding (or shift) tensors suggested by participants in the NATO ARW on NMR shielding constants at the University of Maryland, College Park, July 1992.
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Cannabis in the external ear.
ENT surgeons may well be asked to remove cannabis from the external ear where it has been lodged for various reasons. We report two cases and review four other cases we found in the literature to illustrate some of the difficulties. It is important that anyone working with people who abuse drugs are aware that cannabis can be concealed in the external ear.
Genomic scanning for expressed sequences in Xp21 identifies the glycerol kinase gene.
Rapid genomic scanning methods are required to identify expressed sequences and we report an efficient, sensitive and specific approach which relies upon hybridization of an amplified, labeled cDNA library to digested cosmid DNA. We identified expressed sequences within a cosmid in the glycerol kinase (GK) "critical region" of Xp21 that had impressive similarity to prokaryotic GKs. We used this genomic sequence information to clone the human hepatic GK cDNA. Independent confirmation of the identity of this gene was obtained by functional complementation of GK deficient E. coli mutants with a construct containing the complete human X-linked GK coding sequence.
Cholesterol screening and cholesterol lowering treatment.
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Patient education: bridging the gap between inpatient and ambulatory care.
This article describes a model curriculum of perinatal education designed to bridge the gap between prenatal ambulatory care education and labor and delivery, postpartum and well child care in a high-risk population of inner city women. The curriculum, which consists of broad-based, maternal-child health information, was developed, implemented, and evaluated through an interdisciplinary approach. The initiative narrowed the preexisting gap between departments, increased clients' knowledge, and promoted positive changes in clients' behavior. The breadth of the curriculum content addresses the unquestionable need for perinatal education that will enhance compliance and empower clients toward health maintenance.
Transcultural emphasis in NT education.
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Piriformis abscess mimicking a hip pyarthrosis.
Joint sepsis and osteomyelitis often give a confusing clinical picture in children because of the prevalent use of oral antibiotics for otolaryngeal disease, resulting in partially treated musculoskeletal infections. Unusual sites of infection must be considered when the patient does not respond to standard treatment. Recent scanning techniques can be useful in resolving this dilemma.
Mizoribine as an alternative to azathioprine in triple-therapy immunosuppressant regimens in cadaveric renal transplantation.
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Food irradiation: let's move ahead.
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Two wnt genes in Caenorhabditis elegans.
wnt genes encode secretory glycoproteins that have been implicated in growth control and development in mice, frogs and insects. In this report we examine properties of two wnt genes recently identified in the nematode Caenorhabditis elegans. The first gene, Ce-wnt-1, was previously identified by a polymerase chain reaction-based screen of genomic DNA, and the second, Ce-wnt-2, was fortuitously encountered in a survey of clones in a cDNA library by the Caenorhabditis Genome Project. Full-length or nearly full-length cDNAs representing both mRNAs encode proteins that are similar in length, sequence and functional domains to other Wnt proteins. Primary products of 372 and 362 amino acids begin with a hydrophobic signal peptide, include two potential N-linked glycosylation sites and contain the 22 cysteine residues conserved throughout the wnt family. In contrast to mammalian and insect wnt genes with four or five exons and conserved intron-exon boundaries, Ce-wnt-1 has nine coding exons; only one of the eight identified introns interrupts the coding sequence at a position homologous to an intron position in other wnt genes. The major transcript derived from Ce-wnt-1 is 1.4 kb in length, and the 22 nucleotides at its 5' end are added by a trans-splicing mechanism. Ce-wnt-2 is also expressed via a single major transcript, 1.5 kb in length. Both RNAs are detectable in all larval forms and adults, but they are most abundant at the embryonic stage. Ce-wnt-1 is localized to the left arm of chromosome II and Ce-wnt-2 maps to a cluster of genes on chromosome IV.