Biomedical subjects
E Draper
Publications and source records attributed to E Draper.
Presentation of the European project models of organising access to intensive care for very preterm births in Europe (MOSAIC) using European diversity to explore models for the care of very preterm babies.
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Numerical simulations of subsurface probing in diffusely scattering media using spatially offset Raman spectroscopy.
We present the first elementary model predicting how Raman intensities vary for a range of experimental variables for spatially offset Raman spectroscopy (SORS), a recently proposed technique for the effective retrieval of Raman spectra of subsurface layers in diffusely scattering media. The model was able to reproduce the key observations made from the first SORS experiments, namely the dependence of Raman signal intensities on the spatial offset between the illumination and collection points and the relative contributions to the overall spectrum from the top layer and sub-layer. The application of the SORS concept to a three-layer system is also discussed. The model also clearly indicates that an annular geometry, rather than a point-collection geometry, which was used in the earlier experiments, would yield much improved data.
Biochemical analysis of yeast G(alpha) mutants that enhance adaptation to pheromone.
The mating-specific heterotrimeric G(alpha) protein of Saccharomyces cerevisiae, Gpa1, negatively regulates activation of the pheromone response pathway both by sequestering G(beta)gamma and by triggering an adaptive response through an as yet unknown mechanism. Previous genetic studies identified mutant alleles of GPA1 that downregulate the pheromone response independently of the pheromone receptor (GPA1E364K), or through a receptor-dependent mechanism (GPA1N388D). To further our understanding of the mechanism of action of these mutant alleles, their corresponding proteins were purified and subjected to biochemical analysis. The receptor-dependent activity of Gpa1N388D was further analyzed using yeast strains expressing constitutively active receptor (Ste2) mutants, and C-terminal truncation mutant forms of Gpa1. A combination of G(alpha) affinity chromatography, GTP binding/hydrolysis studies, and genetic analysis allowed us to assign a distinct mechanism of action to each of these mutant proteins.
Stage of change is associated with assessment of the health risks of maternal smoking among pregnant women.
This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.
Initial development of a system-wide maternal-fetal outcomes assessment program.
OBJECTIVE: This study was undertaken to develop a comprehensive risk-assessment approach capable of evaluating maternal and fetal outcomes. STUDY DESIGN: Data from 10,984 women and 11,066 infants delivered at 79 military treatment facilities in the United States from 1995 to 1997 were used to develop two individual but complementary risk-adjustment models for maternal and, separately, fetal outcomes. A range of maternal and delivery-related risk variables and clinically important outcomes were identified by expert opinion and selected and weighted with ordinal logistic regression analysis. Receiver operating characteristic curves for the maternal and fetal models were determined. Variation across the facilities in risk-adjusted performance was also evaluated. RESULTS: Risk factors and poor outcomes were rare for both mothers and infants, with 96.9% of infants and 97.7% of mothers having good or excellent outcomes (0.7% mortality and 0.01% mortality, respectively). Despite the low frequency of poor outcomes both models performed well, with receiver operating characteristic curves of 0.75 for maternal outcomes and 0.78 for infant outcomes. When the models were applied to the military treatment facilities, there were significant differences among facilities in risk-adjusted outcomes. Twenty-four of the facilities in the study (30%) had outcomes odds ratios that were significantly >1 or significantly <1 (P <.05). There did not appear to be any relationship between the performance of a military treatment facility for maternal outcome and that for infant outcome. CONCLUSION: Complementary risk models for maternal and infant outcomes were developed that had satisfactory discriminatory power across a variety of facilities within a large health system. With further development and refinement this approach holds promise of being able to detect variations in risk-adjusted performance that could be used to identify best practices. The results might also be used to help coordinate and improve the quality of care for the entire conception-to-delivery process.
Evaluation of pressure beneath a split above elbow plaster cast.
It has previously been shown that splitting a plaster cast after manipulation of, or surgery on, a limb leads to a decrease in pressure beneath the cast by accommodating the swelling that may occur. However, it is not known whether the axis along which the cast is split influences the amount of swelling that can occur before a critical pressure is reached. We investigated this with reference to above elbow plaster casts.
Preventive law by corporate professional team players: liability and responsibility in the work of company doctors.
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Are outcome data regarding the survivors of neonatal care available from routine sources?
AIM: To determine whether existing information and surveillance systems can be used to provide follow up data on groups of infants at increased risk of disability--for example, the survivors of neonatal intensive care. METHODS: A survey was made of maternity, neonatal, and community child health information systems and surveillance programmes in the Trent Regional Health Authority. Children known to have received neonatal intensive care in Trent between 1 August 1992 and 31 July 1993, and a random sample of normal children in two health districts (data quality check) were included. A data linkage study was made to determine whether follow up information about a random sample of infants, known to be at increased risk of poor outcome, could be identified on community child health databases. Two widely accepted datasets (birth and 2 years) were used as standards for this exercise. The quality of data was audited. RESULTS: All clinical items of the birth minimum dataset were routinely recorded by at least one agency in each health district in Trent. Of the descriptive items, only the mother's age on leaving full time education was not collected. At 2 years, all clinical items were collected as part of the routine surveillance programme, but data were recorded using a system which severely limited interpretation. Data quality, in terms of the number of errors introduced at data entry, was very good with only 1.1% of the check items (4/368) incorrectly recorded. Only two districts had organised electronic transfer of data between maternity, neonatal, and community child health systems. The mother's NHS number, although available, was not routinely recorded by any system. The NHS number of the infant was routinely collected by six out of 12 community paediatric services. Data linkage was attempted in six districts with appropriate community child health databases. Just over 70% of the intensive care sample was successfully linked with follow up information on child health systems. CONCLUSIONS: The existing programmes for routine child surveillance could provide outcome data for high risk groups of infants, such as the survivors of neonatal intensive care. However, the present coding system used for data entry is inadequate. Furthermore, rates of identification, without the use of a unique identifier (NHS number) for each subject, are currently insufficient for monitoring health status in later life.
Neonatal intensive care cots: estimating the population based requirement in Trent, UK.
STUDY OBJECTIVES: To estimate the population based requirement for neonatal intensive care (NIC) cots by investigating NIC utilisation in a large population based study. DESIGN AND SETTING: This was a two year, non-randomised, prospective cohort study of neonates receiving NIC in hospitals in the Trent Regional Health Authority (RHA). PARTICIPANTS: The main study considered the 2979 neonates born to Trent RHA residents who had begun high dependency care in Trent RHA or neighbouring health authorities between 1 April 1990 and 31 March 1992 and met any of the following criteria: (i) birth weight < 1500 g; (ii) gestation < 32 weeks; (iii) need for active respiratory support other than initial resuscitation; (iv) need for in utero or neonatal transfer to receive high dependency care; (v) severe asphyxial brain insult after delivery : and (vi) death. The analysis here is restricted to the 1730 neonates who received total parenteral nutrition or assisted ventilation, or both; that is, those who received NIC level 1 (ICL1) on at least one day. MEASUREMENT AND ANALYSIS: The treatment history of each neonate was converted into a time-line detailing the dates of beginning and stopping NIC, the dates of any transfers between units, and any gaps in NIC treatment. The duration of ICL1 was observed directly and that of intensive care level 2 (ICL20 was imputed from a model based upon round trip transfers. These were also recorded on the timeline. The time-lines were first used to derived the observed distribution of the utilisation of NIC cots in Trent RHA during the study. An extensive series of Monte Carlo simulations was then carried out in order; (i) to estimate cot requirements in smaller populations; (ii) to determine whether Trent RHA utilised its NIC cots in a manner that was clinically appropriate at the population based level; (iii) to perform a series of sensitivity analyses; and (iv) to compare results with an equivalent study carried out in the Northern RHA. MAIN RESULTS AND CONCLUSIONS: Trent RHA is reasonably representative of the greater population of England and Wales in terms of both the distribution of birth weight and of birth weight-specific neonatal mortality. Trent RHA did not seen to be underprovided for NIC cots or to be overusing these cots inappropriately. It therefore seems reasonable, if the assumptions of the analysis are borne carefully in mind, to treat these utilisation data as a rough guide to true population based need. NIC cot requirements depend critically upon the size of the served population - small populations are subject to greater random variability and require relatively more cots to ensure cot availability on an equivalent proportion of days. A neonatal unit should not therefore serve a population generating fewer than 5000 and 25 000 births per annum, the estimated population based provision which would ensure free cots on 29 out of 30 days falls gradually from 1.20 to 0.88 NIC cots per 1000 births per annum. A cooperative network of NICUs offers the opportunity to provide fewer cots per head of population while maintaining good access for most neonates referred to the service.
A weight on children's minds: body shape dissatisfactions at 9-years old.
Although adolescent dieting is common, comparatively little is known about its developmental course. The present study investigated the self-perception and body shape satisfaction of 9-year old girls and boys in different weight categories. Two hundred and thirteen girls and 166 boys from three schools completed assessments of body-esteem, self-esteem, body shape preference and dietary restraint. The children's body weight and height were also measured. The heaviest children expressed the most discontent, having a low body-esteem, a desire for thinness and higher levels of dietary restraint. However, this desire for thinness and associated dieting motivation was apparent in some children in all weight categories. Furthermore, this pattern was more characteristic of girls than boys. By the age of nine, girls and boys already differ in their body shape satisfaction and differ in their body shape aspirations. Initiatives to reduce obesity should acknowledge these early and strongly-held gender differences or risk promoting the unwarranted pursuit of thinness by girls.
IBEES Prize Lecture: the future of biomedical engineering.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Development of APACHE.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Introduction.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Study design--data collection.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Development of APACHE III.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Analysis: quality of care.
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APACHE III study design: analytic plan for evaluation of severity and outcome in intensive care unit patients. Efficiency and nurse staff.
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