Platelet transfusion in neonatal alloimmune thrombocytopenia.
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Adult↗
Biomedical subjects
David Allen
Publications and source records attributed to David Allen.
Cataract and surgery for cataract.
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Cataract↗
Do variations in the theatre team have an impact on the incidence of complications?
BACKGROUND: To examine whether variations in non-medical personnel influence the incidence of complications in a cataract theatre. METHODS: A retrospective Case-Control study was undertaken in a single-site, designated cataract theatre. Staffing variations within theatre were examined and the incidence of cataract complications was assessed. RESULTS: 100 complicated lists and 200 uncomplicated control lists were chosen. At least 7 nurses were present for every list. Mean experience of the nurses was 6.4 years for case lists and 6.5 years for control lists. Average scrub nurse experience in years was 7.6 years for complicated lists and 8.0 years for controls. 26% of complicated case lists were affected by unplanned leave and 17% in control lists. Odds ratio 1.7 (1.0 to 3.1) 95% CI. CONCLUSION: Unplanned leave can have a detrimental effect on the operating list. The impact of this may be modifiable with careful planning.
Absenteeism↗
European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens.
OBJECTIVE: To report the safety and effectiveness of the AcrySof ReSTOR apodized diffractive intraocular lens (IOL), model MA60D3, when implanted into the capsular bag. DESIGN: Multicenter European study including university clinics, eye hospitals, and private ophthalmic surgical centers. PARTICIPANTS: One hundred twenty-seven subjects implanted in cataractous eyes in an open multicenter study. INTERVENTION: After phacoemulsification, the foldable 3-piece hydrophobic acrylic apodized diffractive IOL was implanted in the capsular bag using a Monarch injector with an A-cartridge. The mean preoperative patient age was 68.4+/-12 years. Intraocular lens implant power ranged from 18.0 to 25.0 diopters (D) in 0.5-D increments. MAIN OUTCOME MEASURES: Distance visual acuity (VA), near VA, spectacle dependence, unwanted visual symptoms, and patient satisfaction. RESULTS: At the 6-month postoperative visit, binocular (both eyes simultaneously) mean uncorrected distance and near logarithm of the minimum angle of resolution VAs for the MA60D3 were 0.04+/-0.14 and 0.09+/-0.12 (n = 118), respectively. In addition, 88.0% and 84.6% of ReSTOR subjects achieved spectacle independence for distance and near vision, respectively. Glare and halos were reported as severe by only 8.5% and 4.2% of patients, respectively. Ninety-two percent of patients stated that they would choose to have the same lens implanted again after the first implant, and 95.7% answered likewise after the second implant. CONCLUSIONS: The AcrySof ReSTOR MA60D3 IOL demonstrated excellent near VA without compromising distance vision. Spectacle independence and patient satisfaction were high, whereas unwanted photic phenomena were clinically acceptable.
Acrylic Resins↗
Recovery of visual and functional disability following cataract surgery in older people: Sunderland Cataract Study.
PURPOSE: To examine changes in visual, psychological, and functional disability in older people waiting for cataract extraction and 6 months after surgery. SETTING: Community-based study in Northeast England. METHODS: Participants were 92 patients (mean age 78.1 years +/- 6.5 [SD], 79% female) with age-related cataract. Questionnaires were administered at time of listing for cataract extraction, 2 weeks preoperatively, and 2 and 6 months after surgery to assess visual symptoms and function, anxiety and depression, perceived health status, cognition, and activities of daily living. RESULTS: Mean waiting time was 265 +/- 64.4 days. Forty-six patients had first-eye surgery, 39 had second-eye surgery, and 7 had sequential-eye surgery (both eyes operated on during follow-up). During the waiting period, there were no significant changes in visual symptoms, cognition, or functional abilities. However, perceived health status, anxiety, and depression improved significantly during this time. For first- and second-eye patients, surgery resulted in significant improvements in all questionnaire scores, except activities of daily living. CONCLUSIONS: Despite waiting 9 months for cataract surgery, patients did not decline in visual symptoms, social functioning, or cognition. In first- and second-eye patients, successful cataract extraction resulted in significant gains in visual function, cognition, and emotional and general well-being. The benefits of cataract surgery in older people extended beyond simple measures of visual acuity.
Activities of Daily Living↗
Cataract surgery management in patients taking tamsulosin staged approach.
PURPOSE: To demonstrate a progressive approach to the problems of intraoperative floppy-iris syndrome (IFIS) in cataract surgery caused by tamsulosin. SETTING: Cataract Treatment Center, Sunderland Eye Infirmary, Sunderland, United Kingdom. METHODS: Thirty-two eyes of 20 patients who were using tamsulosin had cataract surgery by the same surgeon using the same technique. Patients received standard preoperative eyedrops consisting of topical cyclopentolate, phenylephrine, and diclofenac. When necessary, intracameral phenylephrine, iris hooks, or both were used. All cases were videotaped and analyzed for surgical complications. RESULTS: The degree of IFIS manifested varied widely in the patients: Seventeen of 32 eyes (53%) had good mydriasis preoperatively (type 1 and type 2 pupils); however, in 7 of the 17 eyes (43%), the pupils constricted later during surgery (type 2 pupils). Twelve eyes (38%) had a mid-dilated pupil that sometimes constricted later (type 3 pupils), and 3 eyes (9%) had poor dilation at the beginning of surgery (type 4 pupils). There were no surgical complications attributed to IFIS. Full IFIS manifestation varied between eyes of the same patient. Some eyes required no intervention. Intraoperative pupil constriction was reversed with intracameral phenylephrine, which also prevented iris prolapse and billowing and further pupil constriction in patients who had medium to small pupils preoperatively. CONCLUSION: A staged approach in managing pupils in IFIS and using phenylephrine intracamerally when necessary effectively prevented serious intraoperative complications.
Adrenergic alpha-1 Receptor Antagonists↗
Intraoperative floppy-iris syndrome associated with tamsulosin.
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Adrenergic alpha-1 Receptor Antagonists↗
Pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy.
The acute lesions of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) consist of endoneurial foci of chemokine and chemokine receptor expression and T cell and macrophage activation. The myelin protein antigens, P2, P0, and PMP22, each induce experimental autoimmune neuritis in rodent models and might be autoantigens in CIDP. The strongest evidence incriminates P0, to which antibodies have been found in 20% of cases. Failure of regulatory T-cell mechanism is thought to underlie persistent or recurrent disease, differentiating CIDP from the acute inflammatory demyelinating polyradiculoneuropathy form of Guillain-Barré syndrome. Corticosteroids, intravenous immunoglobulin and plasma exchange each provide short term benefit but the possible long-term benefits of immunosuppressive drugs have yet to be confirmed in randomised, controlled trials.
Animals↗
Posterior capsule opacification: back to basics.
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Animals↗
A wide range of protein isoforms in serum and plasma uncovered by a quantitative intact protein analysis system.
We have implemented an orthogonal 3-D intact protein analysis system (IPAS) to quantitatively profile protein differences between human serum and plasma. Reference specimens consisting of pooled Caucasian-American serum, citrate-anticoagulated plasma, and EDTA-anticoagulated plasma were each depleted of six highly abundant proteins, concentrated, and labeled with a different Cy dye (Cy5, Cy3, or Cy2). A mixture consisting of each of the labeled samples was subjected to three dimensions of separation based on charge, hydrophobicity, and molecular mass. Differences in the abundance of proteins between each of the three samples were determined. More than 5000 bands were found to have greater than two-fold difference in intensity between any pair of labeled specimens by quantitative imaging. As expected, some of the differences in band intensities between serum and plasma were attributable to proteins related to coagulation. Interestingly, many proteins were identified in multiple fractions, each exhibiting different pI, hydrophobicity, or molecular mass. This is likely reflective of the expression of different protein isoforms or specific protein cleavage products, as illustrated by complement component 3 precursor and clusterin. IPAS provides a high resolution, high sensitivity, and quantitative approach for the analysis of serum and plasma proteins, and allows assessment of PTMs as a potential source of biomarkers.
Anticoagulants↗
The effect of reducing the fine-particle mass of salmeterol from metered-dose inhalers on bronchodilatation and bronchoprotection against methacholine challenge: a randomized, placebo-controlled, double-blind, crossover study.
OBJECTIVE: This study examined the clinical relevance of fine-particle mass (FPM) delivered from metered dose inhalers (MDIs) to bronchodilatation and bronchoprotection against methacholine challenge by comparing a marketed chlorofluorocarbon (CFC) formulation of salmeterol with an investigational hydrofluoroalkane (HFA)formulation. METHODS: This was a randomized, double-blind, placebo-controlled, 3-way crossover study in patients with mild to moderate asthma who had a forced expiratory volume in 1 second (FEV (1)) of > or =60% predicted and a base-line provocation dose of inhaled methacholine required to produce a 20% decrease in FEV(1) (PD (20) [methacholine]) of < or =3.2 mg. On separate occasions, patients received 2 inhalations of salmeterol 25 microg from either the CFC MDI (FPM 14 microg), the investigational HFA MDI (FPM 7 microg), or placebo via CFC MDI. Serial measurements of FEV(1) were made over 90 minutes after dosing, followed by methacholine challenge. Efficacy end points were PD(20) (methacholine) and FEV(1) AUC (inc) (incremental area under the FEV(1) curve) over 15 to 90 minutes. The study was designed to demonstrate non-inferiority of the investigational HFA formulation to the CFC formulation in terms of protection against methacholine-induced bronchial hyperresponsiveness; for PD(20) (methacholine), noninferiority was predefined as 1.0 doubling dose of methacholine. RESULTS: The study enrolled 40 patients (65% men; mean age, 36.9 years). Both active treatments were significantly better than placebo in terms of PD(20) (methacholine) (P < 0.001). In the per-protocol population, the mean (SE) difference in bronchoprotection between the CFC MDI and placebo was 2.7888 (0.3432) doubling doses of methacholine (n = 32), and the difference between the investigational HFA MDI and placebo was 1.8268 (0.3418) doubling doses(n = 33). The adjusted mean (SE) treatment difference between the CFC MDI and HFA MDI was 0.9621 (0.3454) doubling doses. The upperlimit of the 95% CI (0.2714-1.6527) was greater than the predefined limit for noninferiority. There was no significant difference in FEV(1) AUC(inc) between formulations (mean treatment difference, 1.895 L . min; 95% CI, -4.893 to 8.684); however, both active treatments were significantly different from placebo (P < 0.001). CONCLUSIONS: FPM from different MDI formulations may affect the bronchoprotective properties of salmeterol. In this study, the formulation with the smaller FPM was associated with less-effective bronchoprotection, although there was no difference in bronchodilatation. This study did not demonstrate noninferiority of the investigational HFA formulation to the CFC formulation in terms of protection against methacholine-induced bronchial hyperresponsiveness.
Adult↗
Secondary generalized dystonia without basal ganglia damage.
We report the case of a woman who developed generalized dystonia, severe cognitive deficits and dysphagia following an overdose of the hypoglycaemic drug, sulphonylurea. The MRI reveals frontal and temporal lobe atrophy, but no evidence of damage to the basal ganglia. This case adds to the small number of previously reported cases with secondary dystonia seemingly due to cortical rather than subcortical damage.
Adult↗
Quantitative determination of sterols and other alcohols in overland flow from grazing land and possible source materials.
Organic marker compounds (biomarkers) can be used to identify the sources of waterborne pollutants. This paper examines sterols and other alcohols in overland flow from pasture-based grazing systems, possible agricultural source materials and water extracts of these source materials as a preliminary step to developing chemical profiles that can be used for tracing pollutants. The biomarkers were quantified using gas chromatography and gas chromatography-mass spectrometry techniques. Analyses of plant material show that some pasture species contain unique compounds, enabling their identification. For example, Arctotheca calendula (capeweed) contains an as yet unidentified compound (Arctotheca m/z 163). Other pasture species that do not contain unique compounds do contain unique ratios of phytol, hexacosanol, octacosanol and 24-ethylcholesterol, enabling their identification. Analyses of faecal samples show that the ratios of sterols to stanols enable faeces to be distinguished from the pasture species, e.g. the ratio of 24-ethylcholesterol to 24-ethylcoprostanol was <1, generally <0.25 for faeces, while for most pasture species this ratio was >4. Using this ratio, qualitative apportioning of the sources of pollutants in overland flow to vegetation or faeces could be performed, but only in extreme cases (i.e. when the ratio <1 or >4). Decaying organic matter and surface soil appear to contain a composite of plant and faecal sterols. Sterols, being sparingly soluble in water and surface active, were not expected to be present in overland flow samples. Surprisingly, cholesterol and 24-ethylcoprostanol were found in both the particulate and filtrate fractions of most overland flow and water extracts of most source materials. Using the ratios of sterols to stanols, particulate organic material in water could be traced back to its broader source, i.e. vegetation or faeces.
Alcohols↗
Trace gases and particulate matter emissions from wildfires and agricultural burning in Northeastern Mexico during the 2000 fire season.
An inventory of air pollutants emitted from forest and agricultural fires in Northeastern Mexico for the period of January to August of 2000 is presented. The emissions estimates were calculated using an emissions factor methodology. The inventory accounts for the emission of carbon monoxide (CO), methane, nonmethane hydrocarbons, ammonia, nitrogen oxides, and particulate matter (PM). Particulate matter emissions include estimates for fine PM and coarse PM. A total of 2479 wildfires were identified in the domain for the period of interest, which represented approximately 810,000 acres burned and 621,130 short tons emitted (81% being CO). The main source of information used to locate and estimate the extent of the fires came from satellite imagery. A geographic information system was used to determine the type of vegetation burned by each fire. More than 54% of the total area burned during the period of study was land on the State of Tamaulipas. However, >58% of the estimated emissions came from the State of Coahuila. This was because of the mix of vegetation types burned in each state. With respect to the temporal distribution, 76.9% of the fires occurred during the months of April and May consuming almost 78% of the total area burned during the period of study. Analysis of wind forward trajectories of air masses passing through the burned areas and 850-mb wind reanalyses indicate possible transboundary transport of the emissions from Mexico to the United States during the occurrence of the major wildfires identified.
Agriculture↗
Abnormalities of the RB1 pathway in ovarian serous papillary carcinoma as determined by overexpression of the p16(INK4A) protein.
Dysfunction of proteins involved in the G1 to S transition of the cell cycle, such as p16(INK4A) and RB1, is common in many cancer types. A screen of p16 protein expression was performed in benign, borderline, and invasive ovarian tumors, together with endometrial cancers, aligned on a tissue microarray. We observed frequent p16 overexpression in serous papillary carcinomas of ovarian and endometrial origin. An extended cohort of ovarian serous papillary carcinomas was examined to further evaluate the frequency of p16 overexpression. Strong, uniform staining in the majority of cancer cells occurred commonly in invasive serous papillary ovarian cancers, particularly in grade 3 carcinomas. RB1 protein expression abnormalities were rare. Our data indicate that abnormalities in the retinoblastoma pathway, as determined by p16 overexpression, are common in serous papillary carcinomas and are probably an early event.
Adult↗
Antibodies to peripheral nerve myelin proteins in chronic inflammatory demyelinating polyradiculoneuropathy.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired disorder of the peripheral nervous system with a probable auto-immune pathogenesis. The nature of the responsible autoantigens is unclear in most patients. We used the Western immunoblot technique to seek antibodies to peripheral nerve protein antigens. Sera from eight of 32 (25%) CIDP patients, 12 of 37 (32%) Guillain-Barré syndrome (GBS) patients, zero of 30 (0%) chronic idiopathic axonal polyneuropathy patients and two of 39 (5%) healthy control subjects contained anti-peripheral nerve protein antibodies. The frequency of such antibodies was significantly greater in both CIDP (p = 0.04) and GBS (p = 0.003) patients than in normal control subjects. For CIDP patients, there were non-significant trends for antibodies to be more common in females and in those who responded to treatment with either intravenous immunoglobulin or plasma exchange. The commonest antibodies were directed against a band at 28 kDa, resembling that labelled by a monoclonal antibody against myelin protein zero (P0). Six CIDP and seven GBS patients' sera reacted with this band. These results support the view that antibodies to myelin proteins, and especially P0, are present in the serum of some patients with CIDP and GBS.
Adult↗
The language of 'experience' in nursing research.
This paper is an analysis of how the signifier 'experience' is used in nursing research. We identify a set of issues we believe accompany the use of experience but are rarely addressed. These issues are embedded in a spectrum that includes ontological commitments, visions of the person/self and its relation to 'society', understandings of research methodology and the politics of nursing. We argue that a poststructuralist understanding of the language of experience in research opens up additional ways to analyze the relationship between the conduct of nursing research and cultural/political commitments.
Adaptation, Psychological↗