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Biomedical subjects

E Ferguson

Publications and source records attributed to E Ferguson.

At least 19 recordsLinked to original sources

From comparative risk assessment to multi-criteria decision analysis and adaptive management: recent developments and applications.

Environmental risk assessment and decision-making strategies over the last several decades have become increasingly more sophisticated, information-intensive, and complex, including such approaches as expert judgment, cost-benefit analysis, and toxicological risk assessment. One tool that has been used to support environmental decision-making is comparative risk assessment (CRA), but CRA lacks a structured method for arriving at an optimal project alternative. Multi-criteria decision analysis (MCDA) provides better-supported techniques for the comparison of project alternatives based on decision matrices, and it also provides structured methods for the incorporation of project stakeholders' opinions in the ranking of alternatives. We argue that the inherent uncertainty in our ability to predict ecosystem evolution and response to different management policies requires shifting from optimization-based management to an adaptive management paradigm. This paper brings together a multidisciplinary review of existing decision-making approaches at regulatory agencies in the United States and Europe and synthesizes state-of-the-art research in CRA, MCDA, and adaptive management methods applicable to environmental remediation and restoration projects. We propose a basic decision analytic framework that couples MCDA with adaptive management and its public participation and stakeholder value elicitation methods, and we demonstrate application of the framework to a realistic case study based on contaminated sediment management issues in the New York/New Jersey Harbor.

Community Participation↗

Percutaneous removal of two self-expanding stent grafts following failed deployment.

Insertion of self-expanding stent grafts was attempted in two patients with venous obstruction following unsuccessful venoplasty. One patient with end-stage renal disease had stenosis at the caudal end of the previously placed stent in the right external iliac vein. The second patient was treated for occlusion of multiple stents in the left iliac vein. Two of the stent grafts failed deployment and were subsequently removed percutaneously. New stent grafts were inserted in the intended positions. Despite additional venous access sites with large caliber sheaths, required for retrieval of the failed stent grafts, there were no major complications.

Adult↗

Identification of nutritionally adequate mixtures of vegetable oils by linear programming.

OBJECTIVE: To determine the types and proportions of vegetable oils to recommend for a healthy diet. METHODS: Optimal vegetable oil combinations were designed, using linear programming and, as decision variables, nine single oils and 29 basic food items. 'Oil models' were run to determine whether reasonable amounts of individuals oils or oil mixtures satisfied a set of constraints on essential fatty acids and vitamin E. 'Meal models' were run to test whether selected mixtures could be used as the sole source of added fat in a meal that met micronutrient and macronutrient recommendations. RESULTS: The cheapest mixture (0.97 euro L(-1)) that solved the oil models contained 81% rapeseed and 19% sunflower oils. About 10-15 g of this mixture, alone or with olive, soya bean, wheat germ or walnut oils, also solved the meal models. Mixtures that contained a high proportion (>or=50%) of the tasty olive and walnut oils also solved the models but were more expensive (4.9 euro L(-1) and 8.5 euro L(-1), respectively). CONCLUSIONS: The consumption of a mixture composed of rapeseed and sunflower oils in a 4 : 1 proportion is an inexpensive and simple way to meet current dietary recommendations for essential fatty acids and vitamin E, favouring overall dietary nutrient adequacy.

Cost-Benefit Analysis↗

Unhappiness and dissatisfaction in doctors cannot be predicted by selectors from medical school application forms: a prospective, longitudinal study.

BACKGROUND: Personal statements and referees' reports are widely used on medical school application forms, particularly in the UK, to assess the suitability of candidates for a career in medicine. However there are few studies which assess the validity of such information for predicting unhappiness or dissatisfaction with a career in medicine. Here we combine data from a long-term prospective study of medical student selection and training, with an experimental approach in which a large number of assessors used a paired comparison technique to predict outcome. METHODS: Data from a large-scale prospective study of students applying to UK medical schools in 1990 were used to identify 40 pairs of doctors, matched by sex, for whom personal statements and referees' reports were available, and who in a 2002/3 follow-up study, one pair member was very satisfied and the other very dissatisfied with medicine as a career. In 2005, 96 assessors, who were experienced medical school selectors, doctors, medical students or psychology students, used information from the doctors' original applications to judge which member of each pair of doctors was the happier, more satisfied doctor. RESULTS: None of the groups of assessors were significantly different from chance expectations in using applicants' personal statements and the referees' reports to predict actual future satisfaction or dissatisfaction, the distribution being similar to binomial expectations. However judgements of pairs of application forms from pairs of doctors showed a non-binomial distribution, indicating consensus among assessors as to which doctor would be the happy doctor (although the consensus was wrong in half the cases). Assessors taking longer to do the task concurred more. Consensus judgements seem mainly to be based on referees' predictions of academic achievement (even though academic achievement is not actually a valid predictor of happiness or satisfaction). CONCLUSION: Although widely used in medical student selection to assess motivation, interest and commitment to a medical career, the personal statement and the referee's report cannot validly be used by assessors, including experienced medical school selectors, to identify doctors who will subsequently be dissatisfied with a medical career.

Adult↗

Fatty acid metabolism in human preimplantation embryos.

BACKGROUND: Little is known of fatty acid metabolism in human embryos. This information would be useful in developing metabolic tests of embryo quality and improving embryo culture media. METHODS: The fatty acid composition of human embryos and their ability to accumulate 13C labelled fatty acids was assessed in relation to the stage of development using gas-chromatography and combustion-isotope-ratio-mass spectrometry. RESULTS: Compared with embryos which did not develop beyond the 4-cell stage, those that did had significantly higher concentrations of the unsaturates, linoleic (12% versus 3%; P=0.02) and oleic (14% versus 7%; P=0.02), and a lower concentration of total saturates (62% versus 77%; P=0.04). There was uptake of both 13C linoleic and palmitic, but the developmental pattern was different for each fatty acid. The net accumulation in pmol/embryo/24h for palmitic was 1 at the 2-cell to <8-cell stage, 4 at the 8-cell-morula stage and negligible at the blastocyst stage. For linoleic, there was little net accumulation at the 2-cell to <8-cell stage, 8 (8-cell-morula stage) and 17 pmol/embryo/24 h (blastocyst stage). CONCLUSION: Preimplantation human embryos actively take up individual fatty acids at different rates at different stages of development. The high unsaturated concentration at the later stages of development may be explained by preferential uptake of linoleic acid.

Biological Transport↗

Pilot study in the development of an interactive multimedia learning environment for sexual health interventions: a focus group approach.

In the UK there are high rates of sexually transmitted infections and unintended pregnancies amongst young people. There is limited and contradictory evidence that current sexual health education interventions are effective or that they improve access to appropriate sexual health services. This paper describes the outcome of focus group work with young people that was undertaken to inform the design of an Interactive Multimedia Learning Environment that incorporates message framing, intended for use in sexual health promotion. The focus group work addressed sexual attitudes, behaviour, risk perception, and knowledge of sexual health and sexual health services in Nottingham. The results provided new insights into young peoples' sexual behaviour, and their diversity of knowledge and beliefs. Common themes expressed regarding sexual health services included concerns about confidentiality, lack of confidence to access services and fear of the unknown. The results showed that while the adolescents are reasonably knowledgeable about infection, they do not know as much about the relevant services to treat it. This work emphasizes the need for user involvement throughout the design and development of a sexual health intervention, and will form the basis of the next part of the project.

Focus Groups↗

Agreement of aspiration tests using barium videofluoroscopy, salivagram, and milk scan in children with cerebral palsy.

To study the agreement between three tests for aspiration, barium videofluoroscopy, salivagram, and milk scan we studied 63 children with severe non-ambulant spastic quadriplegic cerebral palsy (CP) aged 14 months to 16 years (32 males, 31 females). The salivagram was most frequently positive (56%, 95% confidence interval 43 to 68%); the next most frequently positive was barium videofluoroscopy when aspiration was defined as the presence of either laryngeal penetration of material or frank aspiration (39%, 95% confidence interval 26 to 53%). The milk scan was rarely positive (6%, 95% confidence interval 2 to 16%). Agreement between the tests of aspiration was poor. The maximum agreement (kappa=0.20) was between aspiration as diagnosed with the salivagram and by barium videofluoroscopy. Positive tests for aspiration are frequent in children with severe CP. Frequency varies widely depending on the investigation used. There is poor agreement between tests used for the diagnosis of aspiration. This information is of importance in assessing the significance of test results.

Adolescent↗

Perceived safety of donor blood and blood substitutes for transfusion: the role of informational frame, patient groups and stress appraisals.

Patients express concerns about the safety of donated blood. Do they have similar concerns about potential 'blood substitutes' and does the way information is presented on these options alter patients' perceptions? A two (informational frame: gain or loss) by four (transfusion type: human donor blood, human haemoglobin, bovine haemoglobin or perfluorocarbon emulsion substitutes) by three (patient group: adult haemophiliac/leukaemia patients, relatives/friends of haemophiliac/leukaemia patients and controls) between-subjects design was used. There were 82 patients, 118 relatives/friends and 263 controls from the UK. Blood substitutes were perceived as being significantly less safe than donor blood. Perceptions of safety were greater when transfusion information (regardless of transfusion type or patient group) was presented as gains rather than losses. Different demographic and psychological factors predicted perceived safety (e.g. sex) and perceived risk (e.g. age and experience).

Adult↗

Trustworthiness of information about blood donation and transfusion in relation to knowledge and perceptions of risk: an analysis of UK stakeholder groups.

There is evidence that the public perceive blood transfusion as risky, and there is a growing literature exploring factors associated with perceived transfusion risk. One contributory factor might be the types of information different key stakeholders (e.g. general practitioners, anaesthetists, health/life style journalists and blood donors) rely on for information. This article addresses four unanswered questions about transfusion/donation risk, namely (1) do different stakeholder groups perceive different sources of information as more or less trustworthy, (2) to what extent is the perceived trustworthiness related to levels of knowledge and perceived risk, (3) is optimistic bias observed across the stakeholder groups, and (4) is knowledge related to levels of perceived risk across the stakeholder groups? A questionnaire survey was used to assess the trustworthiness of sources of information, perceived risk and knowledge. Four stakeholder groups were examined, namely (1) blood donors (n = 250), (2) general practitioners (n = 88), (3) anaesthetists (n = 143) and (4) medical journalists (n = 20). The results showed that (1) judgements of trustworthiness vary as a function of stakeholder groups, and (2) it is what people think they know rather than what they actually know that is related to judgements of trustworthiness and perceptions of risk. Judgements of trustworthiness are generally unrelated to perceptions of risk, and all stakeholder groups show optimistic bias. The implications of these findings for risk communication, specifically relating to transfusion medicine, are discussed.

Attitude to Health↗

Benefit and risk perceptions in transfusion medicine: blood and blood substitutes.

Blood transfusion is a remarkably safe, routine procedure in clinical medicine. However, little attention has focused on the perceptions of risk associated with the receipt of blood, blood products or 'blood substitutes'. It is pertinent to ask (i) what key stakeholder groups know about transfusion, (ii) how safe they perceive blood/blood products to be, (iii) how the latter information might influence their own and others' perceptions of risk linked to transfusion, and (iv) the extent to which approved blood substitutes might be preferred over autologous or donor blood. An appreciation of what stakeholders perceive to be the benefits and risks of the receipt of blood and blood substitutes will inform future transfusion strategies. To obtain such information, a programme of research has been initiated at Nottingham. Surveys have targeted key stakeholder groups, namely, UK adult blood donors and nondonors, anaesthetists, general practitioners and health care journalists. Experimental studies examining message framing and cueing have also been conducted with undergraduate students. Such research will improve misunderstandings about current issues associated with blood donation and transfusion against the backdrop of changing public trust of health care professionals and attitudes and expectations on blood safety and benefits of blood substitutes.

Attitude↗

Complementary food supplements to achieve micronutrient adequacy for infants and young children.

Many children in developing countries survive on a nutritionally inadequate diet. Dietary inadequacies during the complementary feeding period can be prevented by using complementary food supplements (CFSs) such as water dispersible or crushable micronutrient tablets, micronutrient sprinkles added to food just before feeding, or fortified spreads added to food just before feeding or fed as a snacks. A meeting was convened to discuss technical and operational issues related to the development of these new approaches and to identify knowledge gaps. The technical issues covered: what micronutrients to include, tolerable upper intake limits, bioavailability, micronutrient and macronutrient stability, package systems and amounts, encapsulation technologies, methods to limit or eliminate allergens, bacterial and chemical contamination, interactions between CFSs and complementary foods, and flavoring agents. Operational issues included: identifying the market positioning of CFSs, cost positioning of CFSs, regulatory requirements, CFS production and technology transfer, quality assurance, and public-private sector partnership and coordination. Intervention trials are needed to determine the efficacy of CFSs in preventing micronutrient deficiencies. Other important knowledge gaps relate to technical and operational issues. Sprinkles and tablets are produced using well-known technologies, but further research is needed to modify them for use as CFSs. Spread development is not as advanced as sprinkle and tablet development, and further research is needed to improve the technology. Although none of the products is ready for widespread use, enough information is available to set research priorities and accelerate product development and implementation.

Biological Availability↗

Confidence in the safety of blood for transfusion: the effect of message framing.

BACKGROUND: Blood transfusion is a universally used, life-saving medical intervention. However, there are increasing concerns among patients about blood safety. This study investigates the effect of message framing, a means of presenting information, on confidence in blood transfusion safety. STUDY DESIGN AND METHODS: The same factual information regarding the safety of blood for transfusion was presented to a sample of 254 adult students (donors and nondonors) as either a gain frame (lives saved), a loss frame (lives lost), or a combined frame (a loss frame expressed in a positive context). This provided a basic two-way, between-subjects design with 1) blood donation history (donors vs. nondonors) and 2) message frame (gain, loss, and combined) functioning as the between-groups factors. It was hypothesized that participants would consider blood safer if information was presented as a gain frame. The role of stress appraisals as potential mediators of the framing effect was also explored. RESULTS: As predicted, participants receiving the gain-frame information were significantly more confident of the safety of blood for transfusion than those receiving loss-frame information or both. This was unaffected by donation history or appraisals of stress associated with transfusion. The extent to which blood was considered safe was negatively associated, independently of framing effects, with perceptions that transfusion was threatening. CONCLUSION: Information about transfusion should be conveyed to patients in a form focusing on the positive, rather than the negative, known facts about the safety of blood.

Adult↗

RNA expression in the early characterization of hepatotoxicants in Wistar rats by high-density DNA microarrays.

High-density microarrays are useful tools to study gene expression for the purpose of characterizing functional tissue changes in response to the action of drugs and chemicals. To test whether high-density expression data can identify mechanisms of toxicity and to identify an unknown sample through its RNA expression pattern, groups of male Wistar rats were administered 6 hepatotoxicants. The compounds chosen for this study were microcystin-LR (MLR), phenobarbital (PB), lipopolysaccharide (LPS), carbon tetrachloride (CT), thioacetamide (THA), and cyproterone acetate (CPA). These hepatotoxicants are known to induce adverse liver effects through different mechanisms. Liver mRNA was isolated and used to generate biotinylated cRNA for hybridization to a custom 1,600-rat gene DNA microarray. Treatment correlation matrices analyzed hybridization data from a hepatotoxicant-blinded sample, with gene expression coefficients (GEC) evaluated by means of hierarchical cluster analysis and visual representation as dendrograms. The experimental liver toxicity from the different treatments was confirmed by means of concurrent histopathology, liver enzymes, and bilirubin assays. This toxico genomic analysis identified multiple genes and groups of genes that were affected by the hepatotoxicants on study, indicating that high-density microarray expression data are useful to identify groups of genes involved in toxicity. In addition, the mRNA expression profile of an unidentified sample can be accurately identified when compared with the expression profiles resident in the data set. This study supports the use of gene expression-profiling technology to determine or to predict toxic liver effects.

Animals↗

Sex and sexual orientation: the effect of group membership on individuals' judgments about self and others' HIV risk.

No previous study has directly compared homosexual and heterosexual men and women's perceptions of HIV risk. In fact, empirical research focusing on homosexual women's perception of HIV risk is scarce. This paper, therefore, examines whether homosexual and heterosexual women and men (N = 60) make varied self and other (peer and non-peer) HIV risk judgments. The paper also examines the roles of motivational (health anxiety) and cognitive (HIV knowledge) factors in relation to HIV risk judgments. The results show that each group held different perceptions of risk for various "other" groups. Only homosexual men showed evidence for an optimistic bias, whereas homosexual women showed evidence of realistic perceptions. Both cognitive and motivational factors were shown to be associated with risk judgments for homosexual women and heterosexual men. Methodologically the use of Multidimensional scaling as an analytic strategy is recommended.

Adult↗