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Biomedical subjects

K Daniels

Publications and source records attributed to K Daniels.

At least 55 records · Page 3Linked to original sources
PubMed1995

The Swedish insemination act and the availability of donors.

Sweden was in 1985 the first country in the world to enact legislation concerned with the practice of donor insemination (DI). Included in this legislation was the requirement that information about the identity of the donors be kept and be made available to the resultant offspring upon 'maturity', should they seek this. This provision has attracted much interest, debate and criticism, and claims have been made that this has led to a decline in the numbers of men coming forward to donate semen in Sweden. This paper presents data covering the pre- and post-legislation period from one clinic, along with the only available data on all the Swedish clinics providing DI, which covers a more limited post-legislation period. This data shows that there has been an increase in number of donors being recruited, suggesting that the possibility of future contact by genetic offspring has not had the negative impact on the availability of donors predicted.

Confidentiality↗
PubMed1995

Options for screening for colorectal cancer in the Royal Air Force: a cost-effectiveness evaluation.

Colorectal cancer (CRC) is the second most common form of malignancy, causing death after late presentation in two-thirds of cases. Early detection makes curative treatment likely. Faecal occult blood tests (FOBTs) detect some pre-symptomatic CRCs and their precursor lesions, adenomatous polyps. A trial showed reduced mortality in USA volunteers aged 50-80 with regular FOBTs; both this and the Nottingham population-based trial detected earlier-stage CRCs. Current US guidelines recommend annual digital rectal examination and FOBTs from age 40. FOBTs have been included in the USAF examination of aircrew for several years. Day-case colonoscopy, with appropriate biopsy-excision, is the first-choice follow-up investigation. This study aims to investigate the design of any programme to introduce FOBTs as part of the RAF's existing schedule of Periodic Medical Examinations (PMEs) and Screenings, and the age groups to be included, rather than the decision as to whether or not it should be commenced. The analysis therefore examines the cost per cancer detected. The information required to evaluate subsequent outcomes, such as cost per life-year saved, is not available for the RAF population so speculative extrapolation from other data is not attempted. Over a third of RAF personnel are under the age of 25, nearly three-quarters under 35 and over four-fifths under 40. Over a quarter of the 4 RAF CRC cases pa occur under age 40 and two-thirds under 50. The most cost-effective age at which to introduce FOBTs in the RAF is 40, regardless of the following parameters. Assuming FOBT sensitivity of 55% and positivity 5%, FOBT costing 23p and colonoscopy 175 pounds, starting FOBTs RAF-wide at age 40 would cost annually 35,968 pounds and 15,881 pounds per CRC case detected. The FOBT contribution to the costs is extremely small and the importance of maximising sensitivity and specificity very great. Hence dietary modification, and using a test or combination of tests with higher sensitivity and/or lower false-positivity, even if much more expensive, would be highly cost-effective, reducing the above costs substantially. Counting as "cases" persons with adenomas reduces the cost per "case" detected by about 75%. A pilot study is proposed concerning the introduction on selected stations of FOBTs with RAF PMEs/Screenings, from age 40, to determine: sensitivity and false-positivity rates for single and serial FOBTs, and the predictive value of positive tests, in RAF screenees; the annual cost; the costs per CRC case, and per CRC-plus-adenoma case, detected; possibly, an estimate of the cost per life-year saved; and, hence, whether the programme should be extended to all RAF personnel. FOB screening from age 40 would miss the quarter of RAF CRC cases which occur in personnel under 40. Identification is therefore recommended now of personnel at high risk for CRC, because of personal or family history, at all PMEs/Screenings, regardless of age, with the subsequent offer of serial FOBTs annually and regular colonoscopy. 2 1/2 yearly [corrected] FOBTs, done with PMEs/Screenings and half-way through the 5 year interval, would detect almost as many CRCs as annual testing, missing only half as many as 5-yearly testing. This analysis provides information on the costs and consequences of various FOB screening strategies for the RAF and other Services. Similar principles can be applied to develop informed strategies for other screening.

Adenomatous Polyps↗
PubMed1994

The Swedish Insemination Act and its impact.

In the debate surrounding secrecy in donor insemination (DI), the semen donor is often cited as a person needing the protection of anonymity. Sweden's unique legislation, the 1985 Insemination Law which, among other things, gives mature DI offspring the right of access to donor identity, has attracted much comment. Prior to the legislation's enactment, there were fears that the law would result in a rapid and irreversible decline in DI as a treatment in Sweden. It was also predicted that it would be almost impossible to recruit donors under the legislation. This paper describes the provisions of the legislation and examines what its impact has been in terms of the reactions of the medical profession, DI treatment provision, and the availability and recruitment of donors.

Attitude of Health Personnel↗
PubMed1994

Elastin exhibits a distinctive temporal and spatial pattern of distribution in the developing chick limb in association with the establishment of the cartilaginous skeleton.

In this work we have analyzed the presence of elastic components in the extracellular matrices of the developing chick leg bud. The distributions of elastin and fibrillin were studied immunohistochemically in whole-mount preparations using confocal laser microscopy. The association of these constituents of the elastic matrix with other components of the extracellular matrix was also studied, using several additional antibodies. Our results reveal the transient presence of an elastin-rich scaffold of extracellular matrix fibrillar material in association with the establishment of the cartilaginous skeleton of the leg bud. The scaffold consisted of elastin-positive fibers extending from the ectodermal surface of the limb to the central cartilage-forming regions and between adjacent cartilages. Fibrillin immunolabeling was negative in this fibrillar scaffold while other components of the extracellular matrix including: tenascin, laminin and collagens type I, type III and type VI; appeared codistributed with elastin in some regions of the scaffold. Progressive changes in the spatial pattern of distribution of the elastin-positive scaffold were detected in explant cultures in which one expects a modification in the mechanical stresses of the tissues related to growth. A scaffold of elastin comparable to that found in vivo was also observed in high-density micromass cultures of isolated limb mesodermal cells. In this case the elastic fibers are observed filling the spaces located between the cartilaginous nodules. The fibers become reoriented and attach to the ectodermal basal surface when an ectodermal fragment is located at the top of the growing micromass. Our results suggest that the formation of the cartilaginous skeleton of the limb involves the segregation of the undifferentiated limb mesenchyme into chondrogenic and elastogenic cell lineages. Further, a role for the elastic fiber scaffold in coordinating the size and the spatial location of the cartilaginous skeletal elements within the limb bud is also suggested from our observations.

Animals↗
PubMed1994

Rapid assay of lactoferrin in keratoconjunctivitis sicca.

We compared measurement of lactoferrin concentration by the LactoCard solid phase ELISA assay with the LactoPlate radial immunodiffusion assay in tears of normal patients and those with keratoconjunctivitis sicca. The LactoCard, a new lactoferrin assay, allows rapid determination of tear lactoferrin concentration in 10-15 min, a notable improvement over the 3 days required of the LactoPlate. There was no statistically significant difference between the accuracy of the two assays in normal patients nor in those patients with a diagnosis of keratoconjunctivitis sicca. Both assays showed a significant decrease in tear lactoferrin concentration in patients with severe keratoconjunctivitis sicca when compared to normal patients. The LactoCard is a rapid and reliable means of measuring tear lactoferrin concentration in a clinical setting.

Adult↗
PubMed1993

Determinants of induction of ventricular tachycardia in nonsustained ventricular tachycardia after myocardial infarction and the usefulness of the signal-averaged electrocardiogram.

Assessment of the implications of clinical and noninvasive variables, including the results of signal-averaged electrocardiography, was performed > or = 3 weeks after myocardial infarction in 57 patients with nonsustained ventricular tachycardia (VT) who underwent programmed ventricular stimulation to guide antiarrhythmic therapy. The clinical and noninvasive parameters assessed included ages, left ventricular ejection fractions, sites of infarction, presence of akinetic or dyskinetic left ventricular segments, history of syncope, history of coronary artery bypass surgery, and presence or absence of late potentials from signal-averaged electrocardiography. Other than the presence of late potentials, no clinical or noninvasive parameters identified such persons with a significantly higher likelihood of inducible VT. When assessed as positive if 1 or more variables were abnormal, 16 of 16 (100%) patients with versus 17 of 41 without inducible VT had late potentials (p < 0.002). With more stringent criteria required (defined as prolongation of the QRS vector complex duration and low root-mean-square voltage of the terminal 40 ms of the vector complex) 8 of 16 patients (50%) with and 4 of 41 (10%) without inducible VT had late potentials recorded (p < 0.002). Thus, the signal-averaged electrocardiogram may enable identification of persons with nonsustained VT after myocardial infarction who are most likely to have VT induced at programmed ventricular stimulation.

Aged↗
PubMed1993

Recruitment of participants in the Lung Health Study, II: Assessment of recruiting strategies.

The Lung Health Study (LHS), a multicenter randomized clinical trial of treatment to prevent chronic obstructive pulmonary disease (COPD), recruited, over a 28-month period, 5887 smokers aged 35-60 who had evidence of mild airflow obstruction on pulmonary function testing. The LHS participants were identified from a pool of over 73,000 age-eligible smokers who underwent the initial pulmonary function screening tests. Methods of recruitment in the 10 centers are here classified into five general strategies: worksites, public sites, mail/phone, media, and other. This paper deals with the results of each of these general methods and their effectiveness in producing participants eligible for the study. The most effective strategies proved to be mail/phone and media. Ongoing monitoring and a flexible approach to recruitment characterized the most successful clinics. Over the recruitment period, LHS clinics shifted their emphasis away from worksite and public site strategies and tended to focus on variations of the mail/phone strategy. Female screenees who passed first-screen eligibility criteria were more likely than males to refuse further participation.

Adult↗
PubMed1993

Formulating selection policies for assisted reproduction.

This paper addresses one of the most important problems in the area of assisted reproduction, namely the selection policies used by the providers of the services. Some of the difficulties involved in formulating policies in this area are outlined. The paper concludes that public involvement in decision making in this area is vital, and that to facilitate this the issues must be opened up to public scrutiny and debate. Such a debate would be a significant first step towards the implementation of policies which reflect the opinion of the entire community rather than just the professionals who provide the service, or sectional groups who manage to influence the professionals.

Advisory Committees↗
PubMed1992

Type X collagen is transcriptionally activated and specifically localized during sternal cartilage maturation.

Type X collagen is an extracellular matrix protein which is synthesized by chondrocytes when they undergo hypertrophy. We present evidence here that the expression of type X collagen in the developing chick sternum is controlled primarily by transcriptional mechanisms. Using chondrocyte nuclei isolated from 15-, 16-, 17- and 18-day chick embryonic sterna, nuclear run-off assays demonstrate that type X collagen gene transcription begins at day 16 in chondrocytes isolated from the cephalic portion. This occurs two days prior to mineralization of this tissue as observed by alizarin red staining. The rate of type X transcription increases dramatically through days 17 and 18. Western blot analyses of extracts of freshly isolated sternal chondrocytes from the same stages show that intracellular levels of the type X protein follow the same time course. Immunostaining with a monoclonal antibody specific for type X collagen demonstrates that the initial appearances of hypertrophic cells and pericellular type X collagen occur at embryonic day 16 in the cephalic portion of sterna. Observation of immunostained cephalic sternal sections from day 18 embryos by confocal microscopy reveals that type X collagen is localized in a capsule-like configuration around each hypertrophic chondrocyte.

Animals↗
PubMed1992

Length of training, hostility and the martial arts: a comparison with other sporting groups.

Previous research has indicated that training in the martial arts leads to a reduction in levels of hostility. However, such research has only compared hostility within martial arts groups. The present research compares two martial arts groups and two other sporting groups on levels of assaultive, verbal and indirect hostility. Moderated multiple regression analyses revealed a significant interaction between length of training in the respondent's stated sport and whether that sport was a martial art in predicting assaultive and verbal hostility. The form of the interaction suggests that participation in the martial arts is associated, over time, with decreased feelings of assaultive and verbal hostility.

Adult↗
PubMed1990

An analysis of the relationship between hostility and training in the martial arts.

Contrasting views and data are available on the issue of whether combative sports facilitate or reduce aggression. In the present study levels of hostility were assessed in two groups of martial arts students using the Buss-Durkee Inventory. Levels of hostility on a variety of the sub-scales were compared with scores from similar samples of participants in a body contact, aggressive but non-combative sport (rugby football) and a competitive sport with no body contact or direct aggression (badminton). When the effects of age and length of training were controlled by use of partial correlation there was no evidence to support group differences in either the combined score from the varied sub-scales of the inventory or the more specific assaultive sub-scale. However, there was evidence to suggest a significant effect of length of training on hostility levels in martial artists. Beginners attracted to the martial arts were more hostile but the hostility declined with the duration of training. No difference was apparent in this respect for students participating in either jui jitsu or karate. It is suggested that such differential effects with respect to length of training may lead to the overall absence of the between-sport differences. The results provide tentative support for the notion that the discipline of the martial arts may reduce assaultive hostility rather than serve as a model for such behaviour, yet support the need for prospective longitudinal studies on intra-individual hostility.

Adult↗
PubMed1986

Planning for quality in the home care system.

The cycle of quality planning includes five steps needed to establish a home care quality program. These include commitment, development, communication, implementation, and evaluation of a workable quality of care strategy. Tools available as control mechanisms when implementing the system are patient rights, home evaluation, documentation of care, and performance evaluation. Upon patient discharge, an entire case is reviewed and summarized for future reference and audit. In approaching the challenge of quality care, home care management must be aware that quality permeates every aspect of operations and is not confined to the functional domain of a committee or to the administrative bounds of a specific program. Quality is an overall measure of performance and should be respected as such at all levels of the organization. A summary list of guidelines for enforcing quality in home health care operations is presented in Figure 3, page 251. This figure, as with other suggestions presented in this article, reinforces the same general message: articulate, communicate, and evaluate. Cost-effective, high-quality home health care is becoming significantly more desirable as the number of home health agencies rises and the potential for prospective payment by the federal and state programs and the health maintenance organization concept expand. In addition, the prospect of the Joint Commission on Accreditation of Hospitals' developing an accreditation program for all home health care agencies offers the opportunity to have baseline data for building and measuring QA.

California↗