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D Fowler

Publications and source records attributed to D Fowler.

At least 55 records · Page 3Linked to original sources
PubMed1998

London-east Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. III: Follow-up and economic evaluation at 18 months.

BACKGROUND: A randomised controlled trial of cognitive-behavioural therapy (CBT) for people with medication-resistant psychosis showed improvements in overall symptomatology after nine months of treatment; good outcome was strongly predicted by a measure of cognitive flexibility concerning delusions. The present paper presents a follow-up evaluation 18 months after baseline. METHOD: Forty-seven (78% of original n = 60) participants were available for follow-up at 18 months, and were reassessed on all the original outcome measures (see Part I). An economic evaluation was also completed. RESULTS: Those in the CBT treatment group showed a significant and continuing improvement in Brief Psychiatric Rating Scale scores, whereas the control group did not change from baseline. Delusional distress and the frequency of hallucinations were also significantly reduced in the CBT group. The costs of CBT appear to have been offset by reductions in service utilisation and associated costs during follow-up. CONCLUSIONS: Improvement in overall symptoms was maintained in the CBT group 18 months after baseline and nine months after intensive therapy was completed. CBT may be a specific and cost-effective intervention in medication-resistant psychosis.

Adult↗
PubMed1997

London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: effects of the treatment phase.

BACKGROUND: A series of small, mainly uncontrolled, studies have suggested that techniques adapted from cognitive-behavioural therapy (CBT) for depression can improve outcome in psychosis, but no large randomised controlled trial of intensive treatment for medication-resistant symptoms of psychosis has previously been published. METHOD: Sixty participants who each had at least one positive and distressing symptom of psychosis that was medication-resistant were randomly allocated between a CBT and standard care condition (n = 28) and a standard care only control condition (n = 32). Therapy was individualised, and lasted for nine months. Multiple assessments of outcome were used. RESULTS: Over nine months, improvement was significant only in the treatment group, who showed a 25% reduction on the BPRS. No other clinical, symptomatic or functioning measure changed significantly. Participants had a low drop-out rate from therapy (11%), and expressed high levels of satisfaction with treatment (80%). Fifty per cent of the CBT group were treatment responders (one person became worse), compared with 31% of the control group (three people became worse and another committed suicide). CONCLUSIONS: CBT for psychosis can improve overall symptomatology. The findings provide evidence that even a refractory group of clients with a long history of psychosis can engage in talking about psychotic symptoms and their meaning, and this can improve outcome.

Adaptation, Psychological↗
PubMed1997

London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. II: Predictors of outcome.

BACKGROUND: Despite growing evidence of the effectiveness of cognitive-behavioural therapy (CBT) for psychosis, typically only about 50% of patients show a positive response to treatment. This paper reports the first comprehensive investigation of factors which predict treatment outcome. METHOD: In a randomised controlled trial of CBT for medication-resistant psychosis (see Part I) measures were taken at baseline of demographic, clinical and cognitive variables. Changes over time were assessed on the Brief Psychiatric Rating Scale and the relationship between potential predictor variables and outcome was investigated using analysis of variance and covariance. RESULTS: A number of baseline variables were identified as predictors of good outcome in the CBT group. Key predictors were a response indicating cognitive flexibility concerning delusions (P = 0.005) and the number of recent admissions (P = 0.002). Outcome was less predictable in the control group and was not predicted by any cognitive variable. CONCLUSIONS: Good outcome is strongly predicted in patients with persistent delusions by a cognitive measure, while this was not the case in controls. Thus we argue that positive outcome in CBT is due in part to specific effects on delusional thinking.

Adult↗
PubMed1997

Uses and limitations of routine hospital admission/separation records for perinatal surveillance.

This study examined the quality of data for delivering mothers and their newborns (April 1, 1984 to March 31, 1995) recorded by the Canadian Institute for Health Information (CIHI). The number of illogical and out-of-range values in the CIHI data were quite few; the occurrence of maternal and infant diseases estimated from CIHI data was quite similar to that in the literature; and major medical/obstetric complications recorded in CIHI were, in general, good predictors of adverse pregnancy outcomes. The authors conclude that CIHI data contain some of the information pertinent to perinatal surveillance that may be used to monitor maternal and infant health and to assess intrapartum care and hospital resource utilization. To adequately monitor and analyze patterns of health determinants and outcomes in all pregnant women and their infants in Canada, additional data collection mechanisms are needed to cover all recognized pregnancies and to collect antenatal and postpartum information and more detailed information on intrapartum care.

Adolescent↗
PubMed1996

Electroporation of synthetic oligodeoxynucleotides: a novel technique for ex vivo bone marrow purging.

Recent data suggest that tumor cells contaminating reinfused bone marrow may contribute to relapse in patients undergoing autologous bone marrow transplantation. Purging strategies that are able to remove these contaminating tumor cells need to be developed. This study describes how electroporation (EP) can be used to improve intracellular delivery of synthetic antisense oligodeoxynucleotides (ODNs), thereby enhancing their ability to suppress a target protein. Antisense ODNs that were introduced into cells by EP led to immediate suppression of targeted c-myc protein; this was associated with rapid cell death in the diffuse histiocytic lymphoma, U937; Burkitt's lymphoma, ST486; breast carcinoma, MCF-7; and Ewing's sarcoma, CHP-100, cell lines. Electroporation was found to have little or no detrimental effect on cells responsible for murine hematopoietic long-term reconstitution as determined from in vivo competitive repopulation studies. Using human c-myc-directed antisense ODNs as a model for the application of this approach to bone marrow purging, selective killing of human lymphoma U937 cells relative to normal human bone marrow cells was shown in cell mixing studies. In vivo studies were performed in which a survival advantage was shown for athymic mice that were inoculated with antisense-treated U937 cells as opposed to control cells. These studies suggest that EP of bone marrow may be of use in enhancing intracellular delivery of a variety of molecular/pharmaceutical agents. Taken together, these data suggest that the use of electroporation to enhance delivery of antisense ODNs is a promising new approach towards ex vivo bone marrow purging.

Adenocarcinoma↗
PubMed1995

An investigation of the impact of afforestation on stream-water chemistry in the Loch Dee catchment, SW Scotland.

The impact of conifer afforestation on stream-water chemistry was investigated in the acidified catchment of Loch Dee, SW Scotland. Long-term trends in stream-water chemistry were evaluated during a period of forest growth from age 6 to 17 years. A significant increase was observed for pH (0.2 units) and a significant decline for aluminium (0.05 mg litre(-1)), sulphate (1.2 mg litre(-1)) and nitrate (0.02 mg litre(-1)) concentrations. The long-term decrease in stream-water acidity was ascribed to the marked reductions in sulphur depositions during the 1970s and early 1980s. There was no evidence that this response had been attenuated by afforestation, the improvements in stream-water chemistry being of a similar magnitude to those recorded in nearby moorland lochs and exceeding that in an adjacent moorland-catchment stream. The lack of a clear forest acidification effect is consistent with deposition-model estimates which show the increased scavenging of occult and dry deposition by the growing forest to be small at this site (</=10%). Critical load calculations suggest that planned emission reductions will be sufficient to protect the catchment stream from further acidification by 2003. The additional deposition capture by the continued growth of the forest is predicted to delay this response by approximately 2 years.

Journal Article↗
PubMed1995

Deposition of fixed atmospheric nitrogen and foliar nitrogen content of bryophytes and Calluna vulgaris (L.) Hull.

Atmospheric deposition of fixed nitrogen as nitrate and ammonium in rain and by dry deposition of nitrogen dioxide, nitric acid and ammonia has increased throughout Europe during the last two decades, from 2-6 kg N ha(-1) year(-1) to 15-60 kg N ha(-1) year(-1). The nitrogen contents of bryophytes and the ericaceous shrub Calluna vulgaris have been measured at a range of sites, with the objective of showing the degree to which nitrogen deposition is reflected in foliar plant nitrogen. Tissue nitrogen concentrations of herbarium bryophyte samples and current samples of the same species collected from the same sites were compared. No significant change in tissue nitrogen was recorded at a remote site in north-west Scotland where nitrogen inputs are small (< 6 kg N ha(-1) year(-1)). Significant increases in tissue N occurred at four sites ranging from 38% in central Scotland to 63% in Cumbria where nitrogen inputs range from 15 to 30 kg N ha(-1) year(-1). The relationships found between the estimated input of atmospheric nitrogen and the tissue nitrogen content of the selected bryophytes and Calluna at the sites investigated were found to be generally linear and fitted the form N(tissue) = 0.62 + 0.022 N(dep) for bryophytes and N(tissue) = 0.83 + 0.045 N(dep) for Calluna. There was thus an increase in total tissue nitrogen of 0.02 mg g(-1) dry weight for bryophytes and 0.045 mg g(-1) dry weight for Calluna for an increase in atmospheric nitrogen deposition of 1 kg ha(-1) year(-1). The lowest concentrations were found in north-west Scotland and the highest in Cumbria and the Breckland heaths of East Anglia, both areas of high atmospheric nitrogen deposition (30-40 kg N ha(-1) year(-1)). The implications of increased tissue nitrogen content in terms of vegetation change are discussed. Changes in atmospheric nitrogen deposition with time were also examined using measured values and values inferred from tissue nitrogen content of mosses. The rate of increase in nitrogen deposition is not linear over the 90-year period, and the increases were negligible over the period 1880-1915. However, during the period 1950 to 1990 the data suggest an increase in nitrogen deposition of 2 kg N ha(-1) every 10 years.

Journal Article↗
PubMed1995

Ocular and orbital porcupine quills in the dog: a review and case series.

A retrospective evaluation of 5 cases of orbital or intraocular porcupine quills in the dog and a literature review from MEDLINE (1983-1995) is presented. This paper reviews the diagnosis, therapy, and visual prognosis of ocular and orbital quills in the dog. Distinguishing penetration and perforation of the eye and intraocular structures is paramount in establishing a visual prognosis and appropriate therapy. Perforation of the cornea or sclera, lens, or the uvea and retina necessitates prompt specialized surgical therapy to save vision. The diagnosis of orbital quills can be readily confirmed with ultrasonography. The characteristic sonographic appearance of a double-banded, linear, hyperechoic object allows accurate localization of the quill, which aids surgical removal.

Animals↗
PubMed1994

Cognitive behavioural therapy for drug-resistant psychosis.

A small controlled trial of cognitive behaviour therapy for drug-resistant psychosis is reported. The study was designed as a pilot study for a future larger and longer randomized controlled trial. The therapy was offered to patients with a diagnosis of schizophrenia or schizo-affective psychosis who presented unremitting positive symptoms. An average of 16 sessions were delivered over a six-month period. The results of this pilot study are promising. Rates of engagement in therapy were high. The treatment group also improved significantly on a number of key symptom measures when compared with the controls. These were reductions in delusional conviction, general symptomatology and depression scores. Future studies should offer therapy over a longer period, targeting social as well as symptom change, and considering factors which will enhance maintenance of improvement.

Activities of Daily Living↗
PubMed1993

Inhibition of Candida albicans translocation from the gastrointestinal tract of mice by oral administration of Saccharomyces boulardii.

Microbial translocation is defined as the passage of viable microbes from the gastrointestinal (GI) tract to extraintestinal sites, such as the mesenteric lymph node (MLN), spleen, liver, kidneys, and blood. The ability of orally administered viable Saccharomyces boulardii to inhibit Candida albicans translocation from the GI tract was tested in antibiotic-decontaminated, specific pathogen-free (SPF) mice, which were orally challenged with C. albicans to promote intestinal overgrowth and subsequent translocation of this organism. Oral S. boulardii treatment reduced the incidence of MLN cultures positive for C. albicans but did not decrease the numbers of C. albicans per gram of MLN in these immunocompetent mice. Prednisolone immunosuppression increased translocation of C. albicans to the MLN and allowed translocating C. albicans to spread systemically to the spleen, liver, and kidneys. In these immunosuppressed mice, orally administered S. boulardii decreased both the incidence of C. albicans translocation to the MLN, liver, and kidneys and the number of translocating C. albicans per gram of MLN, spleen, and kidneys.

Animals↗
PubMed1993

Malignant thymoma associated with T-cell lymphocytosis. A case report with immunophenotypic and gene rearrangement analysis.

Patients with malignant thymoma rarely may also have a peripheral T-cell lymphocytosis. "Lymphocyte spillover" from the thymus into the peripheral blood as well as a second, associated neoplasm (ie, T-cell chronic lymphocytic leukemia) are two hypotheses that have been proposed to explain this clinical phenomenon. We describe another patient with a lymphocyte-rich malignant thymoma associated with peripheral T-cell lymphocytosis. At the time of initial diagnosis, the patient's complete blood cell count was unremarkable. However, subsequent to the development of pulmonary metastases, the patient developed persistent lymphocytosis. The total leukocyte count ranged from 20 to 30 x 10(9)/L, 80% of these cells being lymphocytes. Immunophenotypic analysis of peripheral blood specimens from this patient proved that the circulating cells were mature, polyclonal T cells. The cells expressed the alpha/beta T-cell receptor and the pan-T-cell antigens CD2, CD3, CD5, and CD7, and were negative for both terminal deoxynucleotidyl transferase (TdT) and the CD1 antigen. A mixture of T-helper (CD4+) and T-suppressor (CD8+) cells were present in a ratio of 1:1.6. Gene rearrangement studies revealed that the T-cell receptor beta chain and the immunoglobulin heavy-chain genes were in the germline configuration. Serum samples from this patient were also analyzed for thymic hormones; the level of thymosin alpha 1 was markedly elevated, while that of thymosin beta 4 was decreased. These results effectively exclude the hypothesis that the lymphocytosis represents a second, associated neoplasm. The lymphocyte spillover hypothesis also seems unlikely (although not excluded), since the lymphocytes in lymphocyte-rich thymomas usually have an immature thymic cortical immunophenotype. Furthermore, one might expect nonspecific elevation of all thymic hormone levels with lymphocyte spillover. Thus, we suggest that the lymphocytosis results from a poorly defined immunoregulatory disorder, related to the presence of thymoma, and perhaps secondary thymic hormone imbalance.

Aged↗
PubMed1992

Orographic enhancement of snowfall.

Field studies have been conducted at a hill site in Scotland to measure the variation with altitude of wet deposition by snowfall. The results showed that, due to wind drift effects, snowflakes were captured very inefficiently by snow collectors. It was therefore not possible to measure an increase in precipitation with altitude. The average concentrations of principal ions dissolved in the snow water were calculated over a two-month period. The results showed that the concentrations increased by factors of between 1.4 and 1.9 with an altitude rise of 400 m. A model of the orographic enhancement of snowfall by the seeder-feeder effect showed that the orographic enhancements of precipitation and pollutant deposition were significantly greater for snowfall than for rainfall. The wind drift of snow crystals and the evaporation of precipitation in dry valley air were important in determining the patterns of deposition.

Journal Article↗
PubMed1992

Contribution of canopy leaching to sulphate deposition in a Scots pine forest.

Radioactive sulphate (35SO4) was applied to the soil below a Scots pine forest on 23 June 1989, and its movement into the canopy and into throughfall and stemflow was measured over 4 months. The specific activity, Bq (mg S)(-1), of the canopy increased monotonically; uptake by current-year (1989) expanding needles was initially twice as fast as by older needles or live twigs. By 10 October the canopy average specific activity was 62 Bq (mg S)(-1). The specific activity of net throughfall (throughfall + stemflow - rain), deduced from measurements from six throughfall collectors, six stemflow collectors and two rain collectors, fell rapidly from 12.6 Bq (mg S)(-1) in late July to <1 Bq (mg S)(-1) in mid-August. The results suggest (assuming rapid equilibration of 35S with sulphate in soil) that root-derived sulphate contributed c. 3% of sulphate in net throughfall and that dry deposition of SO2 and sulphate particles contributed c. 97% of the 0.56 g S m(-2) measured in net throughfall over the period. Simultaneous measurements of SO2 at canopy height and of NH3 above and within the canopy gave mean concentrations of 5.9 and 0.86 microg m(-3), respectively, sufficient to account for the sulphate measured in net throughfall only if codeposition of NH3 and SO2 occurred to canopy surfaces. The large values of specific activity observed in July, however, indicate that throughfall composition may be closely related to recent soil input of sulphate, and that equilibrium cannot be safely assumed. The possibility of a significant contribution of soil-derived sulphate to sulphate deposition in net throughfall cannot be ruled out on the basis of this experiment.

Journal Article↗
PubMed1992

Deposition of atmospheric ammonia to moorlands.

Micrometeorological methods were applied to measure fluxes of atmospheric ammonia (NH3) to moorlands. Measurements were made in a wide variety of surface conditions and included both Calluna vulgaris (L.) Hull and Eriophorum vaginatum L. dominated sites. NH3 was found to deposit rapidly to all the sites investigated, providing large deposition velocities (Vd, typically 10-40 mm s(-1)) and usually minimal surface resistances (rc). A small number of measurements were made in frozen conditions and suggest a possible exception to this pattern with mean rc of 50-200 s m(-1). The effect of vegetation drying was also investigated and a possible increase in rc observed, though this was small (< 10 s m(-1)). The results are interpreted in terms of the processes controlling exchange; it is shown that NH3 deposition is predominantly to the leaf surfaces and that the net NH3 compensation point approaches zero. Annual estimates show that dry deposition of NH3 is a major source of atmospheric nitrogen to moorland ecosystems. For two typical UK sites subject to background air concentrations, NH3 dry deposition is of similar magnitude to equivalent NH4+ inputs in wet deposition. In the vicinity of emission sources, NH3 dry deposition is expected to dominate inputs of atmospheric nitrogen.

Journal Article↗
PubMed1992

The exchange of nitric oxide, nitrogen dioxide and ozone between pasture and the atmosphere.

Fluxes of NO, NO2 and O3 were determined over a drained marshland pasture in south-east England by using flux-gradient techniques. Nitric oxide was found to be emitted at rates of up to 40 ng m(-2) s(-1), the rate of emission being related to the magnitude of the eddy diffusivity. Nitrogen dioxide deposited at rates of up to 90 ng m(-2) s(-1) under the control of stomatal resistance, a clear diurnal cycle being observed. Minimum canopy resistance was of the order of 80 s m(-1). Ozone deposition was also controlled by stomatal resistance, the minimum canopy resistance being around 100 s m(-1) and fluxes reaching a maximum of 220 ng m(-2) s(-1). Corrections made to NO and NO2 fluxes to compensate for chemical reactions showed flux divergences of the order of 30% for NO and NO2, but these were not statistically significantly different from the measured fluxes. The pasture was found to be a net sink for nitrogen in the form of NOx.

Journal Article↗
PubMed1992

A field study of the generation of nitrate in a hill cap cloud.

A field experiment to investigate the formation of nitrate as an airstream passes through a hill cap cloud has been performed at the UMIST field station on Great Dun Fell. It has been shown that the aerosol nitrate concentration increased by about 0.5 microg m(-3) as the airstream passed through the cloud during the night. At sunrise the nitrate production disappeared. It is suggested that the most likely mechanism for this nitrate production was due to the solution of N2O5 and NO3 formed from the reaction of NO2 with O3. These higher oxides build up overnight in the absence of short wave radiation to photolyse them. Other possible mechanisms of nitrate production are also discussed.

Journal Article↗
PubMed1992

Measurements and modelling of cloudwater deposition to moorland and forests.

The objective of the study was to measure the size dependence of cloudwater deposition and associated average ionic fluxes to vegetated surfaces. Measurements were made over a forest canopy at Dunslair heights in south Scotland and a moorland site, Great Dun Fell, in northern England. Measurements were made using the gradient and eddy correlation techniques. Eddy correlation measurements were made using an ultrasonic anemometer, a Knollenberg forward scattering spectrometer probe (to measure liquid water fluxes and fluxes of droplets in 1 microm size intervals) and a GSI particulate volume monitor (to measure liquid-water fluxes). Measurements were made at Great Dun Fell of the size dependence of droplet deposition velocity, using the gradient technique with two Knollenberg probes. Simultaneous gradient and eddy correlation measurements were also made at Great Dun Fell of average cloud-water fluxes, together with chemical analysis of cloud water composition, using a continuous analysis system. At Dunslair Heights, eddy correlation measurements were made using both the Knollenberg and Gerber Scientific Instruments (GSI) probes, while simultaneous gradient measurements using two GSI probes were also attempted. Samples of cloud water were collected at Dunslair Heights, using passive string collectors for chemical analysis by ion chromatography. The major findings of the study were: 1. The droplet deposition velocities measured by the two techniques were similar. 2. The deposition velocities were a strong function of droplet size. Considerable resistance to deposition was evident for droplets of less than 5 microm radius. Deposition velocities for particles from about 6 to 8 microm exceeded those for momentum. 3. Except when the droplets were very small or the winds very light, bulk cloud-water deposition velocities were about 80% or more of the momentum deposition velocities to forests.

Journal Article↗