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David Lamb

Publications and source records attributed to David Lamb.

18 recordsLinked to original sources
PubMed2006

Evaluating the impact of a child injury prevention project.

This article describes an evaluation study which assessed the effectiveness of a child injury prevention project in deprived localities. The initiative took place across the Bumley, Pendle and Rossendale Primary Care Trust locality in East Lancashire. Families with children under five years of age living within this locality participated in the study. The intervention consisted of a home safety consultation and the provision and fitting of low-cost safety equipment to 1234 families and their homes within Sure Start programme areas that chose to access the Home Safety Equipment Scheme. In addition to this targeted work in these programme areas, a population-wide education and information campaign was provided across the whole locality. Rates of attendance at an accident and emergency (A&E) department by children aged less than five years of age following an injury were used to assess the outcome of the intervention. Results showed that over two years the proportion of children attending an A&E department reduced at a faster rate in the intervention than in the non-intervention wards, thereby reducing the health inequalities gap. It was therefore concluded that targeted work with parents of young children living in disadvantaged areas, together with the provision and fitting of low-cost safety equipment, can improve health and reduce inequalities among the local under-five population.

Accident Prevention↗
PubMed2005

Restoration of degraded tropical forest landscapes.

The current scale of deforestation in tropical regions and the large areas of degraded lands now present underscore the urgent need for interventions to restore biodiversity, ecological functioning, and the supply of goods and ecological services previously used by poor rural communities. Traditional timber plantations have supplied some goods but have made only minor contributions to fulfilling most of these other objectives. New approaches to reforestation are now emerging, with potential for both overcoming forest degradation and addressing rural poverty.

Agriculture↗
PubMed2005

Delayed rectal and urinary symptomatology in patients treated for prostate cancer by radiotherapy with or without short term neo-adjuvant androgen deprivation.

BACKGROUND AND PURPOSE: To identify contributing factors to delayed rectal and urinary symptoms in a randomised trial comparing different durations of maximal androgen deprivation (MAD), given prior to radiotherapy, for locally advanced prostate cancer. PATIENTS AND METHODS: Between 1996 and 2000, 818 patients with stages T2b,c, 3 and 4 prostate cancer were entered into a trial comparing 0, 3 and 6 months of MAD prior to and during radiotherapy. Their delayed normal tissue effects were recorded by their treating doctors using standardised scales and by the patients using a self-assessment questionnaire regularly. Time to occurrence and prevalence data were analysed. RESULTS: Rectal and urinary symptom levels were observed to vary markedly over time in at least 80% of patients, with some indicating lasting resolution of symptoms. Prevalence rates were found to be substantially lower than actuarial probability rates. Baseline symptom levels and greatest acute symptom levels were both very powerful predictors. Obstructive lower urinary tract symptoms were noted to improve during the first 4 years after radiotherapy in approximately 60% of cases in each treatment arm. However, the treatment arm itself was not shown to influence these improvements in other univariate or multivariate analyses. MAD was shown to reduce both time to occurrence and prevalence of delayed proctopathic symptoms, but this effect was confirmed statistically in the 3 month treatment arm only. Multivariate models indicated that higher levels of haemoglobin prior to any treatment may in some way protect against delayed proctopathic symptoms. CONCLUSIONS: Prevalence data provide more clinically meaningful estimates of risk of delayed effects in normal tissues where assessment relies substantially on reported symptom levels. In these tissues consideration of the impact of baseline symptom levels and pathologies, and greatest acute symptom levels in analyses of delayed effects appears mandatory. Obstructive lower urinary symptoms improve over several years in the majority of patients treated for locally advanced prostate cancer by radiotherapy. Future research could address whether rectal toxicity is affected by initial haemoglobin levels and declines in it due to MAD.

Age Factors↗
PubMed2005

Tirapazamine, Cisplatin, and Radiation versus Fluorouracil, Cisplatin, and Radiation in patients with locally advanced head and neck cancer: a randomized phase II trial of the Trans-Tasman Radiation Oncology Group (TROG 98.02).

PURPOSE: To select one of two chemoradiotherapy regimens for locally advanced squamous cell carcinoma (SCC) of the head and neck as the experimental arm for the next Trans-Tasman Radiation Oncology Group phase III trial. PATIENTS AND METHODS: One hundred twenty-two previously untreated patients with stage III/IV SCC of the head and neck were randomized to receive definitive radiotherapy (70 Gy in 7 weeks) concurrently with either cisplatin (75 mg/m(2)) plus tirapazamine (290 mg/m(2)/d) on day 2 of weeks 1, 4, and 7, and tirapazamine alone (160 mg/m(2)/d) on days 1, 3, and 5 of weeks 2 and 3 (TPZ/CIS), or cisplatin (50 mg/m(2)) on day 1 and infusional fluorouracil (360 mg/m(2)/d) on days 1 through 5 of weeks 6 and 7 (chemoboost). RESULTS: Three-year failure-free survival rates were 55% with TPZ/CIS (95% CI, 39% to 70%) and 44% with chemoboost (95% CI, 30% to 60%; log-rank P = .16). Three-year locoregional failure-free rates were 84% in the TPZ/CIS arm (95% CI, 71% to 92%) and 66% in the chemoboost arm (95% CI, 51% to 79%; P = .069). More febrile neutropenia and grade 3 or 4 late mucous membrane toxicity were observed with TPZ/CIS, while acute skin radiation reaction was more severe and prolonged with chemoboost. Compliance with protocol treatment was satisfactory on both arms. CONCLUSION: Both regimens are feasible and are associated with significant but acceptable toxicity profiles in the cooperative group setting. Based on the promising efficacy seen in this trial, TPZ/CIS is being evaluated in a large phase III trial.

Adult↗
PubMed2005

Analysis of respiratory viral coinfection and cytomegalovirus coisolation in pediatric inpatients.

OBJECTIVE: To determine (1) the rates of single infection and coinfection with 7 respiratory viruses in pediatric inpatients undergoing respiratory viral cultures, (2) the rate of cytomegalovirus (CMV) coisolation in these patients and (3) the relationship between these and length of hospital stay. METHODS: A retrospective analysis of all respiratory viral cultures undertaken at the Royal Children's Hospital, Melbourne, Australia during a 4-year period. RESULTS: A total of 6706 respiratory virus cultures were identified, of which 3955 were the first nasopharyngeal or nasal specimen taken within 48 hours of admission from inpatients younger than 18 years of age. A virus was isolated in 1444 (36.5%) specimens. Coinfection was found in only 13 (0.9%) of these culture-positive specimens (0.3% of all 3955 specimens). After adjustment for age and seasonal variation in virus isolation, rates of coinfection were lower than would have been predicted for most respiratory viruses, particularly for respiratory syncytial virus (RSV) with influenza A, and RSV with any other virus. CMV was isolated in 174 (4.4%) specimens. Rates of CMV coisolation with respiratory viruses were lower than predicted from independent infection rates, with clearest evidence for the most common virus, RSV. The length of hospital stay varied between different viruses, but there was no evidence of increased length of stay in patients with coinfection (median, 1.9 days) compared with single infection (median, 2.5 days). The length of stay was longer in patients with CMV, especially when coisolated with a respiratory virus (a median of 3.9 days for coisolation compared with a median of 2.5 days for CMV isolation alone). CONCLUSION: Coinfection with respiratory viruses is rare and in our study occurred less commonly than predicted from the independent virus isolation rates. Coisolation of CMV occurs less commonly than predicted with RSV. CMV coisolation, in contrast to respiratory virus coinfection, is associated with a longer length of stay.

Adolescent↗
PubMed2005

A comparison of a rapid test for influenza with laboratory-based diagnosis in a paediatric population.

The rapid and accurate detection of influenza A and B in a hospital setting is useful to confirm infection, exclude other diseases and assist in the management of patient illness including the possible use of specific antiviral therapy. We evaluated the use of the Directigen Flu A+B in a paediatric hospital laboratory in comparison with the established diagnostic tests direct immunofluorescence, viral culture and reverse transcriptase-polymerase chain reaction. A total of 193 respiratory specimens were examined and the Directigen test detected positive samples with an 80.8 per cent sensitivity and a specificity of 100 per cent. This study confirms other paediatric studies which have found the Directigen Flu A+B to be less sensitive than traditional laboratory tests but nevertheless to have a potential role in patient management especially when a positive result is obtained.

Adolescent↗
PubMed2003

Rapid enhanced tissue culture immunofluorescence: a new, rapid method for detection of viruses.

The detection of a large variety of viruses requires a number of different susceptible cell lines in a shell vial method--currently considered to be the most enhanced method of viral detection. However, this method is unsuitable in its standard form for handling a large volume of specimens. We have developed a time and cost saving new method, named rapid enhanced tissue culture immunofluorescence (RETCIF) and incorporates the attributes of the current methods. It is specific, uses the most sensitive cell lines and monoclonal antibodies and does not require the use of cover slips. The RETCIF method, in our hands, is a time saving procedure, with higher isolation ratio than the shell vial method. We recommend the RETCIF method for busy diagnostic virology laboratories.

Antibodies, Monoclonal↗
PubMed2002

Comparative influence of forest management and habitat structural factors on the abundances of hollow-nesting bird species in subtropical Australian eucalypt forest.

We examined the impact of single-tree selective logging and fuel reduction burns on the abundance of hollow-nesting bird species at a regional scale in southeastem Queensland, Australia. Data were collected on species abundance and habitat structure of dry sclerophyll production forest at 36 sites with known logging and fire histories. Sixteen bird species were recorded with most being resident, territorial, obligate hollow nesters that used hollows that were either small (< 10 cm diameter) or very large (>18 cm diameter). Species densities were typically low, but combinations of two forest management and three habitat structural variables influenced the abundances of eight bird species in different and sometimes conflicting ways. The results suggest that habitat tree management for biodiversity in production forests cannot depend upon habitat structural characteristics alone. Management histories appear to have independent influence (on some bird species) that are distinguishable from their impacts on habitat structure per se. Rather than managing to maximize species abundances to maintain biodiversity, we may be better off managing to avoid extinctions of populations by identifying thresholds of acceptable fluctuations in populations of not only hollow-nesting birds but other forest dependent wildlife relative to scientifically valid forest management and habitat structural surrogates.

Animals↗
PubMed1999

Molecular aspects of azole antifungal action and resistance.

During the past three decades azole compounds have been developed as medical and agricultural agents to combat fungal diseases. During the 1980s they were introduced as orally active compounds in medicine and the number of such azole drugs is likely to expand in the near future. They represent a successful strategy for antifungal development, but as the incidence of fungal infection has increased coupled to prolonged use of the drugs, the (almost) inevitable emergence of resistance has occurred. This was after resistance had already been encountered as a serious problem in the field, where a larger number of azole fungicides had been employed commercially. In this review the molecular basis of how azoles work is discussed together with how fungi overcome the inhibitory effect of these compounds: through alterations in the primary target molecule (cytochrome P45051; Erg11p; sterol 14alpha-demethylase); through drug efflux mechanisms and through a suppressor mechanism allowing growth on 14-methylated sterols. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1990

Danish ethics council rejects brain death as the criterion of death -- commentary 1: wanting it both ways.

In this commentary on the recommendations of the Danish Council of Ethics (DCE) concerning criteria for death it is argued that whilst the DCE is correct in stressing the cultural aspects of death, its adoption of cardiac-oriented criteria raises several problems. There are problems with its notion of a 'death process', which purportedly begins with brain death and ends with cessation of cardiac function, and there are serious problems regarding its commitment to a cardiac-oriented definition whilst permitting transplantation when the heart is still beating.

Advisory Committees↗
PubMed1989

Priorities in health care: reply to Lewis and Charny.

This paper is a reply to proposals to base priority health-care decisions on public opinion surveys. Whilst it is recognised that current practice is less than satisfactory, it is argued here that basing health-care priorities on societal attitudes in this way is not a solution and does not provide a satisfactory basis for bringing democracy to the health service.

Age Factors↗
PubMed1978

Diagnosing death.

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Brain Death↗