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Biomedical subjects

P Smith

Publications and source records attributed to P Smith.

At least 19 recordsLinked to original sources
PubMed2006

Development of a new measure of health-related quality of life for people with dementia: DEMQOL.

BACKGROUND: We identified the need to develop a scientifically rigorous measure of health-related quality of life (HRQL) in dementia that would be appropriate for use at all stages of dementia severity and would be available in both self- and proxy-report versions. METHOD: We used standard psychometric methods to eliminate items with poor psychometric properties (item-reduction field test) and to assess the acceptability, reliability and validity of the item-reduced instruments (psychometric evaluation field test). We developed and validated two versions of DEMQOL: a 28-item interviewer-administered questionnaire that is self-reported by the person with dementia (DEMQOL) and a 31-item interviewer-administered questionnaire that is proxy-reported by a caregiver (DEMQOL-Proxy). RESULTS: DEMQOL shows high reliability (internal consistency and test-retest) and moderate validity in people with mild/moderate dementia. DEMQOL-Proxy shows good acceptability and internal consistency and moderate evidence of validity in people with mild/moderate and severe dementia. Test-retest reliability and performance in people with severe dementia need further testing. CONCLUSIONS: DEMQOL and DEMQOL-Proxy show psychometric properties that are comparable with the best available dementia-specific measures of HRQL. We recommend that DEMQOL and DEMQOL-Proxy are used together. Reliability and validity need to be confirmed in independent samples and responsiveness needs to be evaluated.

Adult↗
PubMed2006

New roles to support practice learning - can they facilitate expansion of placement capacity?

The National Health Service (NHS) Plan [Department of Health, 2000. The NHS Plan: A Plan for Investment, a Plan for Reform, The Stationery Office, London] set out an ambitious programme of growth for the number of students undertaking health professional education programmes. To meet this demand there is a growing and widely acknowledged need to increase the number of clinical placements needed by these students. This paper outlines the findings from a regional project that aimed to map the current pattern and availability of clinical placements for healthcare students by the collection of quantitative placement data (such as location, specialty, and number of mentors) as well as in-depth interviews with Clinical Placement Managers (CPMs). This article will focus on the findings from interviews with CPMs and their views and experiences of what role they can play in increasing placement capacity. The study revealed that the introduction of this role had facilitated the development and expansion of placement capacity, as the CPMs filled a gap in the form of up-to-date local knowledge about the clinical areas. The CPMs provided a much needed 'bridge' between the Higher Education Institution (HEI), the student and the clinical area. Recommendations are made in relation to future introduction of similar roles that aim to support student learning in practice. Furthermore, useful insights for ongoing policy implementation and development are highlighted.

Attitude of Health Personnel↗
PubMed2006

Statin use is associated with reduced mortality in COPD.

Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of ischaemic heart disease (IHD). Statins reduce mortality and morbidity in IHD. It has been hypothesised that statin treatment is associated with reduced long-term mortality in patients with COPD. Using a retrospective cohort design, 854 consecutive patients (mean age 70.8 yrs; 51.5% female) with a diagnosis of COPD exacerbation were included in the study at discharge from a Norwegian teaching hospital. Median follow-up was 1.9 yrs, during which 333 patients died. The crude mortality rate per 1,000 person-yrs was 110 in patients treated with statins, and 191 in patients not treated with statins. After adjustment for sex, age, smoking, pulmonary function and comorbidities, the hazard ratio (HR) for statin users versus statin nonusers was 0.57 (95% confidence interval 0.38-0.87). When subdividing statin users and statin nonusers into groups according to concomitant treatment with inhaled corticosteroids (ICS) the following HRs were found: 0.75 (0.58-0.98) for ICS only; 0.69 (0.36-1.3) for statins only; and 0.39 (0.22-0.67) for the combined treatment with statin and ICS compared with no such treatment. Treatment with statins was associated with improved survival after chronic obstructive pulmonary disease exacerbation, while inhaled corticosteroids appeared to increase the survival benefit associated with statin use.

Aged↗
PubMed2006

Detailed images of asteroid 25143 Itokawa from Hayabusa.

Rendezvous of the Japanese spacecraft Hayabusa with the near-Earth asteroid 25143 Itokawa took place during the interval September through November 2005. The onboard camera imaged the solid surface of this tiny asteroid (535 meters by 294 meters by 209 meters) with a spatial resolution of 70 centimeters per pixel, revealing diverse surface morphologies. Unlike previously explored asteroids, the surface of Itokawa reveals both rough and smooth terrains. Craters generally show unclear morphologies. Numerous boulders on Itokawa's surface suggest a rubble-pile structure.

Journal Article↗
PubMed2006

A phase III trial comparing CHOP to PMitCEBO with or without G-CSF in patients aged 60 plus with aggressive non-Hodgkin's lymphoma.

The management of older patients with aggressive non-Hodgkin's lymphoma presents a challenge to the physician. Age is a poor prognostic indicator, due to reduced ability to tolerate and maintain dose-intensive chemotherapy. Generally, older patients demonstrate a lower response rate, reduced survival and increased toxicity, although the majority of large randomised trials exclude older patients. This randomised trial was conducted in patients 60 years or over to compare CHOP (cyclophosphamide 750 mg m(-2), doxorubicin 50 mg m(-2), vincristine 1.4 mg m(-2), prednisolone 100 mg) with PMitCEBO (mitoxantrone 7 mg m(-2), cyclophosphamide 300 mg m(-2), etoposide 150 mg m(-2), vincristine 1.4 mg m(-2), bleomycin 10 mg m(-2) and prednisolone 50 mg). Due to the myelosuppressive nature of these regimens, patients were also randomised to the addition of G-CSF. The formal results of this trial with long-term follow-up are now reported. Data were analysed to assess efficacy and toxicity. Overall response rate was 84% in the CHOP arm and 83% in the PMitCEBO arm, with overall response rates of 83% for the use of G-CSF and 84% for no G-CSF. At median 44 months follow-up, there was no significant difference in failure-free, progression-free or overall survival between the CHOP and PMitCEBO arms. At 3 years, the actuarial failure-free survival was 44% in CHOP recipients and 42% in PMitCEBO recipients and the 3-year actuarial overall survival was 46% and 45% respectively. There was no significant difference in the failure-free, progression-free or overall survival with the addition of G-CSF.

Age Factors↗
PubMed2006

Regulation of placental efficiency for nutrient transport by imprinted genes.

Intrauterine growth and development can impact upon the long-term health of an individual. The fetus is dependent upon the placenta for its supply of nutrients and oxygen from the mother. In turn, the functional capacity of the placenta to supply that demand is under the control of the fetal and maternal genomes. Recent evidence suggests that imprinted genes, a class of genes found in placental mammals whose expression depends on their parental origin, have multiple roles in the placenta. The imprinted genes regulate the growth and transport capacity of the placenta, thereby controlling the supply of nutrients. They may also regulate the growth rate of fetal tissues directly, thereby controlling nutrient demand by the fetus. Recent studies using mice with deletions or disruption of imprinted genes with an altered balance between placental and fetal growth and changes in placental efficiency are indicative of feto-placental signalling of fetal nutrient demand. We propose that signalling mechanisms involving growth demand signals and nutrient transporters are likely to occur and are important for fine tuning normal fetal growth.

Animals↗
PubMed2006

Variation in occlusal dental wear of two Chalcolithic populations in the southern Levant.

Occlusal wear rate and wear plane in two Chalcolithic ( approximately 6500-5500 BP) samples from the southern Levant were compared, using paired first and second mandibular molars. Though food staples in both societies were derived from agro-pastoralism, they were located in distinct environmental regions: Wadi (W.) Makkukh in the Judean desert, and Peqi'in in the Upper Galilee. Accordingly, it was predicted that variation in wear should occur due to their location in distinct environments. Jaw size and tooth size were measured to estimate the possible impact of these variables on wear scores. Molar occlusal surfaces were divided into four quadrants, and wear scores were recorded for each quadrant. Principal axis analysis was then performed between total wear scores of paired, adjacent first and second molars to assess wear rates. Principal axis analysis was also used to analyze the change in occlusal wear plane in each sample by comparing between-buccal-cusps wear scores of the first molar with lingual wear scores of the second molar. The results indicate that the occlusal wear plane was similar in both samples but that wear tended to be more rapid in W. Makkukh. Since both samples were similar in jaw/tooth size, it is argued that the results reflect less refined food-processing methods as well as the unintentional ingestion of sand by individuals interred in the Judean desert.

Diet↗
PubMed2006

Psychiatric inpatient units for children and adolescents with intellectual disability.

BACKGROUND: Inpatient beds for the psychiatric assessment and treatment of young people (under the age of 18 years) with intellectual disability have become scarce although there is pressure to redevelop them. In the UK, 63% of the NHS beds are at Prudhoe Hospital. This study examines their rôle and utility in relation to community services, both local and national. METHOD: A case note study of the 96 young people admitted over three years was supplemented by a standardised interview canvassing the opinion of the staff involved, both within the units and in the community. RESULTS: Two groups emerged: those with more severe disability who were admitted for neuropsychiatric management (63%) and those, predominantly adolescent, whose problems were closer to mainstream psychiatry but whose intellectual disability prevented their needs being met adequately by mainstream services (37%). Admissions were equally divided between those from the immediate vicinity and nationally. For 43% the primary aim was to disentangle the extent of the environmental effect on the individual: the remainder were admitted for various reasons including, for example, the need to protect the individual from harming themselves or others, unusually complex or hazardous treatment or the carers inability to cope with the treatment plan. All admissions were thought appropriate but, had the community resources been better, 18% were avoidable. CONCLUSIONS: Admission is necessary for a small number of young people who are not readily managed within mainstream units. While the number may be reduced by better community provision, this is likely to partially offset by better case finding. Inpatient facilities should be closely linked with community services; a point reinforced by the prolongation of admissions because a shortfall in community resources.

Adolescent↗
PubMed2006

Inhibitory autoantibodies against ADAMTS-13 in patients with thrombotic thrombocytopenic purpura bind ADAMTS-13 protease and may accelerate its clearance in vivo.

BACKGROUND: Many patients with acquired thrombotic thrombocytopenic purpura (TTP) harbor autoantibodies that may bind and/or inhibit ADAMTS-13 proteolytic activity and accelerate its clearance in vivo. METHODS: To test this hypothesis, we determined ADAMTS-13 activity and antigen levels in parallel plasma samples from patients clinically diagnosed with TTP. Collagen binding, GST-VWF73 and FRETS-VWF73 assays were used to determine ADAMTS-13 activity and to detect inhibitory autoantibodies. Enzyme-linked immunosorbent assay (ELISA) and immunoprecipitation plus Western blotting (IP/WB) were used to detect total anti-ADAMTS-13 IgG (inhibitory and non-inhibitory). RESULTS: Among 40 patients with TTP (21 idiopathic and 19 non-idiopathic), inhibitory autoantibodies were detected (by FRETS-VWF73) in 52% of idiopathic and 0% of non-idiopathic TTP patients. In contrast, non-inhibitory IgG autoantibodies were detected in 29% of idiopathic and 50% of non-idiopathic TTP patients. The concentration of inhibitory IgG autoantibody in idiopathic TTP patients was significantly higher than that of non-inhibitory IgG in either idiopathic or non-idiopathic TTP patients. Idiopathic TTP patients demonstrated significantly reduced ADAMTS-13 activity compared with non-idiopathic patients, but only slightly lower ADAMTS-13 antigen levels. Interestingly, patients with inhibitory autoantibodies exhibited significantly lower ADAMTS-13 antigen levels than those with only non-inhibitory IgG autoantibodies or no autoantibody. Serial plasma exchanges increased levels of ADAMTS-13 activity and antigen concurrently in patients with inhibitory autoantibodies. CONCLUSION: The identification of severe ADAMTS-13 deficiency and autoantibodies or inhibitors appears to be assay-dependent; the inhibitory IgG autoantibodies, in addition to binding and inhibiting ADAMTS-13 proteolytic activity, may accelerate ADAMTS-13 clearance in vivo.

ADAM Proteins↗
PubMed2006

Rapid, field-adapted indirect enzyme-linked immunosorbent assay for detection of antibodies in bovine whole blood and serum to Brucella abortus.

A simple, rapid, field-adapted indirect enzyme-linked immunoassay (FldELISA) for the detection of antibodies to Brucella abortus in whole blood and serum has been developed. This assay detects antibodies to B. abortus in approximately 15 min or less. Over a 3-month period, this assay has consistently identified immunized and nonimmunized animals, while the percent coefficient of variation for each immunized animal has been less than 20%. As with any indirect enzyme-linked immunoassay, quality control can be established and maintained. Using defined positive and negative sera, the sensitivity and specificity of the FldELISA was 100% and 94.2%, respectively. As a model, this test can be readily extended to other disease applications that use lipopolysaccharide or other stable antigens for the detection of antibodies, such as those to Salmonella spp., Escherichia coli, or Yersinia spp.

Animals↗
PubMed2006

Young people and work injuries: an examination of jurisdictional variation within Canada.

OBJECTIVE: The purpose of this study was to identify risk factors of work injuries among Canadian adolescents and young adults and to examine provincial differences in work injury rates. METHODS: Information on work and injuries were obtained from a representative sample of 14 541 Canadians aged 15-24 years. Respondents reported medically attended, work related injuries in the past 12 months, work hours, and type of occupation. A multivariate logistic regression on likelihood of work injury included demographic and work variables, as well as province of residence. RESULTS: Even when factors expected to vary by province such as occupation were statistically controlled, Saskatchewan youth were about twice as likely to be injured at work compared to Ontario youth. Type of job was a major correlate of injury risk, with all jobs showing higher risk than administrative clerical jobs. Even with type of job controlled, visible minorities, students, and 15-17 year olds had a reduced likelihood of work injury than their counterparts. CONCLUSIONS: Many young Canadians sustain work injuries that have clear medical costs and potential long term health consequences. Individual level explanations for youth's increased risk for workplace injuries (for example, inexperience or developmental factors) need to be supplemented with a better understanding of the broader social, economic, and political factors across jurisdictions.

Accidents, Occupational↗
PubMed2006

Quality of life in dementia: more than just cognition. An analysis of associations with quality of life in dementia.

OBJECTIVES: To explore the extent to which commonly used measures of specific outcomes in dementia are an appropriate proxy for quality of life in dementia. METHODS: This was a cross sectional study set in communities in London and Nottingham, comprising 101 people with dementia and their 99 main family caregivers. The main outcome measures were health related quality of life in dementia (measured by the DEMQOL-Proxy), cognition (Mini Mental State Examination), functional impairment (Barthel Index), behavioural and psychological symptoms in dementia (Neuropsychiatric Inventory; NPI), and carer mental health (General Health Questionnaire). RESULTS: On univariate analysis, decreased quality of life was statistically significantly correlated with higher levels of behavioural and psychological disturbance (NPI total score and its agitation, depression, anxiety, disinhibition, and irritability subscales); younger age of the person with dementia; and poorer mental health of the carer. Quality of life was not statistically significantly associated with cognition or carer age. In a multivariate model, psychological and behavioural disturbance and patient age remained statistically significantly associated with quality of life. Carer mental health was no longer statistically significantly associated, and cognition and functional limitation remained statistically insignificant. CONCLUSIONS: These data suggest that quality of life in dementia is complex, and that simple proxy substitutions of discrete measures such as cognition or function are likely to miss important factors.

Activities of Daily Living↗
PubMed2006

Trial by fire: a multivariate examination of the relation between job tenure and work injuries.

AIMS: This study examined the relation between months on the job and lost-time claim rates, with a particular focus on age related differences. METHODS: Workers' compensation records and labour force survey data were used to compute claim rates per 1000 full time equivalents. To adjust for potential confounding, multivariate analyses included age, sex, occupation, and industry, as well job tenure as predictors of claim rates. RESULTS: At any age, the claim rates decline as time on the job increases. For example, workers in the first month on the job were over four times more likely to have a lost-time claim than workers with over one year in their current job. The job tenure injury associations were stronger among males, the goods industry, manual occupations, and older adult workers. CONCLUSIONS: The present results suggest that all worker subgroups examined show increased risk when new on the job. Recommendations for improving this situation include earlier training, starting workers in low hazard conditions, reducing job turnover rates in firms, and improved monitoring of hazard exposures that new workers encounter.

Accidents, Occupational↗
PubMed2006

Expression of genes related to activity of oxaliplatin and 5-fluorouracil in endoscopic biopsies of primary esophageal cancer in patients receiving oxaliplatin, 5-flourouracil and radiation: characterization and exploratory analysis with survival.

With a goal of identifying relations between gene expression and response (mucosal or pathological) or survival in esophageal cancer patients (stages II to IV) receiving oxaliplatin, 5-fluorouracil (5FU) and radiation, we measured in endoscopic primary tumor biopsies from 38 patients, the expression of seven genes (gammaGCS, gammaGT, MRP-2, ERCC-1, XPA, TS and DPD) prior to treatment, 1 week following oxaliplatin alone and at the end of the combined radio-chemotherapy cycle using real time QRT-PCR. A higher pretreatment level of XPA was related to shorter survival with a hazard ratio of 2.43 (90% confidence interval 1.09 to 5.43) using Cox regression modeling. However, multivariate analysis with a Cox model indicated low expression of XPA or TS and combined stages II and III had a higher probability of survival (for XPA: hazard ratio 3.0 and 90% C.I. of 1.3 to 6.9, with adjustment for stage included; for TS: hazard ratio is 1.98 with 90% C.I. of 0.94 to 4.20. The expression of TS, gammaGCS, ERCC-1 and MRP-2 declined from D 1 to the end of the cycle (p<0.05, sign test). A validation and further understanding of the findings need to be carried out in a larger study with a more homogeneous population of patients.

Aged↗
PubMed2005

Rain, winds and haze during the Huygens probe's descent to Titan's surface.

The irreversible conversion of methane into higher hydrocarbons in Titan's stratosphere implies a surface or subsurface methane reservoir. Recent measurements from the cameras aboard the Cassini orbiter fail to see a global reservoir, but the methane and smog in Titan's atmosphere impedes the search for hydrocarbons on the surface. Here we report spectra and high-resolution images obtained by the Huygens Probe Descent Imager/Spectral Radiometer instrument in Titan's atmosphere. Although these images do not show liquid hydrocarbon pools on the surface, they do reveal the traces of once flowing liquid. Surprisingly like Earth, the brighter highland regions show complex systems draining into flat, dark lowlands. Images taken after landing are of a dry riverbed. The infrared reflectance spectrum measured for the surface is unlike any other in the Solar System; there is a red slope in the optical range that is consistent with an organic material such as tholins, and absorption from water ice is seen. However, a blue slope in the near-infrared suggests another, unknown constituent. The number density of haze particles increases by a factor of just a few from an altitude of 150 km to the surface, with no clear space below the tropopause. The methane relative humidity near the surface is 50 per cent.

Atmosphere↗
PubMed2005

Antiplasmodial diterpenoid from the leaves of Hyptis suaveolens.

Bioactivity-guided fractionation of the petroleum ether extract of the leaves of Hyptis suaveolens, widely used in Traditional Medicine, has led to the isolation of an abietane-type diterpenoid endoperoxide, 13 alpha-epi-dioxiabiet-8(14)-en-18-ol, displaying high antiplasmodial activity (IC(50) 0.1 microg/ml).

Animals↗
PubMed2005

Serological discrimination by indirect enzyme immunoassay between the antibody response to Brucella sp. and Yersinia enterocolitica O:9 in cattle and pigs.

A rapid, inexpensive and rugged serological test that distinguishes cattle and swine infected with Brucella sp. or Yersinia enterocolitica O:9 is described. The test protocol, which is an indirect enzyme immunoassay uses a high concentration of divalent cation chelating agents to minimize binding of Y. enterocolitica O:9 antibody to rough lipopolysaccharide antigen derived from B. abortus RB51. No false positive reactions were observed when testing 100 Canadian cattle and swine without any evidence of brucellosis. The assay detected 91.6% of cattle (n=155) and 93.5% (n=31) of swine infected with Brucella sp. Sera from 58 cattle and 38 swine exposed to Y. enterocolitica O:9 were negative while only 20 sera from 121 'false positive' reactors of unspecified origin gave low level positive reactions, eliminating 84% of the false positive reactions.

Animals↗