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Biomedical subjects

James Raftery

Publications and source records attributed to James Raftery.

At least 19 recordsLinked to original sources

Studies of an Fe9 tridiminished icosahedron.

The synthesis and structural characterization of a nonanuclear FeIII cage complex is reported. The nine iron centers in [Fe9(mu3-O)4(O3PPh)3(O2CCMe3)13] lie on the vertices of an incomplete icosahedron, with the P atoms of triphenylphosphonate at the other three vertices. The paramagnetic core therefore describes a tridiminished icosahedron. Magnetic studies suggest an S=1/2 ground state for the molecule. Analysis of exchange paths and the susceptibility data point to the interpretation that the cluster can be divided into two nearly decoupled sections: an {Fe6O3} section, with an S=0 ground state, in which three oxo-centered triangles bound a central triangle that is not oxo-centered; and an {Fe3O} triangle with S=1/2. The analysis of the susceptibility data leads to a Heisenberg model based on three significant antiferromagnetic exchange interactions, with values of 173.7 cm-1 in the {Fe3O} triangle, and 30.9 and 19.1 cm-1 within the {Fe6O3} section, while the exchange between them is <1 cm-1. With these assignments, the theoretical low-temperature differential susceptibility is also in very good agreement with measurements up to 50 T. Magnetic measurements in the milli-kelvin range reveal striking hysteresis loops and magnetization reversals associated with a Landau-Zener-Stückelberg (LZS) transition as enhanced by the occurrence of a phonon bottleneck.

Journal Article↗

Patient self-management of anticoagulation therapy: a trial-based cost-effectiveness analysis.

Demand for anticoagulation management is increasing due to an expansion of clinical indications for therapy. One possible model of care to meet demand is patient self-management (PSM), beneficial to patients who need control over their condition. This study aimed to determine the cost and cost-effectiveness of PSM of anticoagulation compared with routine clinic-based care for patients receiving long-term anticoagulation. A cost-utility analysis was conducted alongside a randomised controlled trial; 617 patients were recruited and followed up for 12 months. There was no significant difference in mean quality-adjusted life years (QALYs) between groups - after adjusting for baseline, the mean difference in QALYs was 0.009 (95% CI, -0.012 to 0.030). Overall mean healthcare costs in the PSM arm were significantly higher at pounds sterling 417 (CI pounds sterling 394- pounds sterling 442) compared with pounds sterling 122 (CI pounds sterling 103- pounds sterling 144) in the control arm. Therefore, using a formal cost-effectiveness analysis, PSM of anticoagulation does not appear to be cost-effective. However, PSM may have other benefits in relieving pressure on traditional clinic-based care, and the cost-effectiveness of this model of care for some subgroups of anticoagulation patients needs to be explored further.

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Can health technologies be assessed using routine data?

OBJECTIVES: The potential of routine data for health technology assessment (HTA) in the United Kingdom was assessed. METHODS: Compiled were a comprehensive list of routine databases, their classification according to data characteristics, literature review on their current use, and their comparison with key topics identified as priorities for HTA. RESULTS: Two hundred seventy health-care databases for England or the English regions were identified. Twenty-four included data on both health technology and patient health state. Eleven found some published use in effectiveness evaluation. Of 140 prioritized health technologies, only 22 could be identified in routine databases. CONCLUSIONS: Routine data are plentiful but of limited use in HTA. The data sets usually do not include the effect of treatments. Coding is inadequate, and confidentiality regulations will make matters worse. Both need urgent attention.

Humans↗

Predicting the impact of new health technologies on average length of stay: development of a prediction framework.

OBJECTIVES: The aim of this study was to develop a framework to predict the impact of new health technologies on average length of hospital stay. METHODS: A literature search of EMBASE, MEDLINE, Web of Science, and the Health Management Information Consortium databases was conducted to identify papers that discuss the impact of new technology on length of stay or report the impact with a proposed mechanism of impact of specific technologies on length of stay. The mechanisms of impact were categorized into those relating to patients, the technology, or the organization of health care and clinical practice. RESULTS: New health technologies have a variable impact on length of stay. Technologies that lead to an increase in the proportion of sicker patients or increase the average age of patients remaining in the hospital lead to an increase in individual and average length of stay. Technologies that do not affect or improve the inpatient case mix, or reduce adverse effects and complications, or speed up the diagnostic or treatment process should lead to a reduction in individual length of stay and, if applied to all patients with the condition, will reduce average length of stay. CONCLUSIONS: The prediction framework we have developed will ensure that the characteristics of a new technology that may influence length of stay can be consistently taken into consideration by assessment agencies. It is recognized that the influence of technology on length of stay will change as a technology diffuses and that length of stay is highly sensitive to changes in admission policies and organization of care.

Biomedical Technology↗

Comparing processes of stroke care in high- and low-mortality hospitals in the West Midlands, UK.

OBJECTIVE: There are wide variations in hospital-specific mortality for stroke. The aim of this study was to investigate whether there were differences in quality of care when a group of hospitals with high standardized mortality ratios (SMRs) in nationally published league tables were compared with a group with low SMRs. DESIGN: Retrospective case note review of a random sample of patients from hospitals with high and low mortality according to published league tables. SETTING: Eight hospitals in the West Midlands, UK. PARTICIPANTS: 702 patients admitted to hospital with acute stroke during the year 2000-2001. MAIN OUTCOME MEASURES: Process measures derived from the Intercollegiate Stroke Audit Package. RESULTS: Crude 30 day mortality was 25% (99/402) in 'top' ranking hospitals and 38% (113/300) in 'bottom' ranking hospitals (P < 0.001). Bottom hospitals performed significantly (P < 0.001) less well on four out of seven indicators of process of care relating to the patients' first 24 hours in hospital-assessment of eye movements and visual fields, screening for swallowing disorders and sensory testing. However, analysis at the individual hospital level showed that this was largely due to poor performance in one hospital with high mortality. If this outlier was omitted, there was little relationship between process of care and SMR. No significant differences were found in care provided after 24 hours. Nevertheless even in 'top' ranking hospitals only 47% of stroke patients had at least 50% of their hospital stay in a stroke/rehabilitation unit and only 40% were on aspirin within 48 hours. CONCLUSIONS: Our results show that there is scope for improving the quality of stroke care irrespective of where a hospital ranks in terms of mortality. The lack of association between SMR and quality of care as assessed by process measures casts some doubt over the value of ranking hospitals in terms of stroke SMR.

Guideline Adherence↗

A randomised controlled trial and cost effectiveness study of systematic screening (targeted and total population screening) versus routine practice for the detection of atrial fibrillation in the over 65s: (SAFE) [ISRCTN19633732].

BACKGROUND: Atrial fibrillation (AF) has been recognised as an important independent risk factor for thromboembolic disease, particularly stroke for which it provides a five-fold increase in risk. This study aimed to determine the baseline prevalence and the incidence of AF based on a variety of screening strategies and in doing so to evaluate the incremental cost-effectiveness of different screening strategies, including targeted or whole population screening, compared with routine clinical practice, for detection of AF in people aged 65 and over. The value of clinical assessment and echocardiography as additional methods of risk stratification for thromboembolic disease in patients with AF were also evaluated. METHODS: The study design was a multi-centre randomised controlled trial with a study population of patients aged 65 and over from 50 General Practices in the West Midlands. These purposefully selected general practices were randomly allocated to 25 intervention practices and 25 control practices. GPs and practice nurses within the intervention practices received education on the importance of AF detection and ECG interpretation. Patients in the intervention practices were randomly allocated to systematic (n = 5000) or opportunistic screening (n = 5000). Prospective identification of pre-existing risk factors for AF within the screened population enabled comparison between high risk targeted screening and total population screening. AF detection rates in systematically screened and opportunistically screened populations in the intervention practices were compared to AF detection rate in 5,000 patients in the control practices.

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Synthesis and studies of a trinuclear Mn(II) carboxylate complex.

We report a carboxylate triangle consisting of three manganese(II) centres which is made from manganese(II) carbonate and pivalic acid. The magnetic exchange within the triangle is extremely weak, and antiferromagnetic. Several models have been used to fit the magnetic data, and the best fit uses two weak antiferromagnetic coupling constants of J(1)=-0.588 cm(-1) and J(2)=-0.855 cm(-1). Exchange interactions between the metal centres has been calculated using DFT adopting all the three possible Heisenberg models for a trinuclear system and the results are compared with experimental values. Spin density distribution is used to analyse the nature of the coupling between the metal centres. EPR spectroscopy has been used to explore the nature of the ground state. Recrystallisation of the trinuclear compound from MeCN gives a polymer, while oxidation in air leads to a known compound--an edge-sharing bitetrahedral (MnIII2MnII4) cage.

Journal Article↗

Synthesis, structure, and magnetic properties of a [Mn22] wheel-like single-molecule magnet.

The synthesis and magnetic properties of the compound [Mn(22)O(6)(OMe)(14)(O(2)CMe)(16)(tmp)(8)(HIm)(2)] 1 are reported. Complex 1 was prepared by treatment of [Mn(3)O(MeCO(2))(6)(HIm)(3)](MeCO(2)) (HIm = imidazole) with 1,1,1-tris(hydroxymethyl)propane (H(3)tmp) in MeOH. Complex 1.2MeOH crystallizes in the orthorhombic space group Pbca. The molecule consists of a metallic core of 2 Mn(IV), 18 Mn(III), and 2 Mn(II) ions linked by a combination of 6 micro(3)-bridging O(2)(-) ions, 14 micro(3)- and micro(2)-bridging MeO(-) ions, 16 micro-MeCO(2)(-) ligands, and 8 tmp(3)(-) ligands, which use their alkoxide arms to bridge in a variety of ways. The metal-oxygen core is best described as a wheel made from [Mn(3)O(4)] partial cubes and [Mn(3)O] triangles. Variable-temperature direct current (dc) magnetic susceptibility data were collected for complex 1 in the 1.8-300 K temperature range in a 1 T applied field. The chi(M)T value steadily decreases from 56 cm(3) K mol(-)(1) at 300 K to 48.3 cm(3) K mol(-)(1) at 30 K and then increases slightly to reach a maximum value of 48.6 cm(3) K mol(-)(1) at 15 K before dropping rapidly to 40.3 cm(3) K mol(-)(1) at 5 K. The ground-state spin of complex 1 was established by magnetization measurements in the 0.1-2.0 T and 1.80-4.00 K ranges. Fitting of the data by a matrix-diagonalization method to a model that assumes only the ground state is populated and incorporating only axial zero-field splitting (DS(z)()(2)), gave a best fit of S = 10, g = 1.96 and D = -0.10 cm(-)(1). The ac magnetization measurements performed on complex 1 in the 1.8-8 K range in a 3.5 G ac field oscillating at 50-1000 Hz showed frequency-dependent ac susceptibility signals below 3 K. Single-crystal hysteresis loop and relaxation measurements indicate loops whose coercivities are strongly temperature and time dependent, increasing with decreasing temperature and increasing field sweep rate, as expected for the superparamagnetic-like behavior of a single-molecule magnet, with a blocking temperature (T(B)) of approximately 1.3 K.

Journal Article↗

Distorted equatorial coordination environments and weakening of U=O bonds in uranyl complexes containing NCN and NPN ligands.

Treatment of [UO(2)Cl(2)(thf)(3)] in thf with 2 equiv of Na[PhC(NSiMe(3))(2)] (Na[NCN]) or Na[Ph(2)P(NSiMe(3))(2)] (Na[NPN]) gives uranyl complex [UO(2)(NCN)(2)(thf)] (1) or [UO(2)(NPN)(2)] (3), respectively. Each complex is a rare example of out-of-plane equatorial nitrogen ligand coordination; the latter contains a significantly bent O=U=O unit and represents the first example of a uranyl ion within a quadrilateral-faced monocapped trigonal prismatic geometry. Removal of the thf in 1 gives [UO(2)(NCN)(2)] (2) with in-plane N donor ligands. Addition of 3 equiv of Na[NCN] gives the tris complex [Na(thf)(2)PhCN][[UO(2)(NCN)(3)] (4.PhCN) with elongation and weakening of one U=O bond through coordination to Na(+). Hydrolysis of 4 provides the oxo-bridged dimer [Na(thf)UO(2)(NCN)(2)](2)(micro(2)-O) (6), a complex with the lowest reported O=U=O symmetrical stretching frequency (nu(1) = 757 cm(-)(1)) for a dinuclear uranyl complex. The anion in complex 4 is unstable in solution but can be stabilized by the introduction of 18-crown-6 to give [Na(18-crown-6)][UO(2)(NCN)(3)] (5). The structures of 1-4 and 6 have been determined by crystallography, and all except 2 show significant deviations of the N ligand atoms from the equatorial plane, driven by the steric bulk of the NCN and NPN ligands. Despite the unusual geometries, these distortions in structure do not appear to have any direct effect on the bonding and electronic structure of the uranyl ion. The main influences toward lowering the U=O bond stretching frequency (nu(1)) are the donating ability of the equatorial ligands, overall charge of the complex, and U=O.Na-type interactions. The intense orange/red colors of these compounds are because of low-energy ligand-to-metal charge-transfer electronic transitions.

Journal Article↗

The structure and refinement of apocrustacyanin C2 to 1.3 A resolution and the search for differences between this protein and the homologous apoproteins A1 and C1.

The blue carotenoprotein alpha-crustacyanin of Homarus gammarus lobster carapace is comprised chemically of five 20 kDa subunits. Only two genes for the proteins have been isolated (J. B. C. Findlay, personal communication) and the five apoproteins fall into two sets of homologous proteins based on their chemical properties (CRTC, consisting of apoproteins C(1), C(2) and A(1), and CRTA, consisting of apoproteins A(2) and A(3)). The diffraction quality of apo C(2) has been improved from 2.2 to 1.3 A and its structure solved. The structure is compared with the A(1) and C(1) proteins determined at 1.4 A [Cianci et al. (2001), Acta Cryst. D57, 1219-1229] and 1.15 A, respectively [Gordon et al. (2001), Acta Cryst. D57, 1230-1237] and found to be very similar. Normalized B-factor difference plots per residue of different types were used to try to find chemically modified residues; none were found at these resolutions. It remains possible that the differences between the CRTC proteins result from differences in amidation. By comparison of a crystal grown with glycerol (studied at 1.6 A) and one grown without glycerol (studied at 1.3 A) it was seen that glycerol bound at the astaxanthin site.

Animals↗

Diffusion of thrombolysis for acute myocardial infarction from 1981 to 2000 in England: trend analysis and comparison with need.

OBJECTIVES: To describe the adoption and take up of thrombolytic agents for acute myocardial infarction since 1980 in England and compare use with the estimated ceiling of need. METHODS: Data on national sales and use of thrombolysis since 1980 (supplied by IMS Health) was used to draw an adoption and diffusion curve. The epidemiological ceiling of acute myocardial infarction, from hospital activity statistics, was modified to an estimated clinical need by accounting for diagnostic difficulty and contraindications using information from published surveys of thrombolysis use in the United Kingdom. RESULTS: There was a rapid uptake of thrombolytic agents in the first 2 years after availability in 1987, then a plateau, followed by a rise to a peak use in 1995. The shortfall in doses resulting from the difference between estimated ceiling of clinical need and doses purchased and provided in the 14 years since availability is estimated as 167,800 (95 percent confidence range 94,000 to 241,700). CONCLUSIONS: Although there was a rapid initial uptake of thrombolysis in England, usage took 8 years to reach the ceiling of clinical need of 65 percent of patients with acute myocardial infarction, with many patients missing the opportunity to benefit. Monitoring of uptake of innovations known to be cost-effective is required to identify those developments that need additional stimulus for change to ensure that patients do not miss out on the opportunity to benefit.

Diffusion of Innovation↗

Counting in-hospital deaths in England: a comparison of hospital computer systems and mortuary registers.

OBJECTIVES: In-hospital death counts derived from hospital computer systems have been used in England by an independent company, 'Dr Foster', to rank the quality of care of hospitals, but the validity of the underlying data remains unclear. This study compares counts of in-hospital deaths using two different sources - the hospital computer system and the mortuary register - to determine: whether the counts of in-hospital deaths from these two sources differed; qualitative explanations for possible sources of discrepancy; the direction and magnitude of any differences; and the possible impact of any differences on the Dr Foster rankings. METHODS: The four highest and the four lowest National Health Service (NHS) hospitals in the West Midlands, as ranked by Dr Foster, participated. Each hospital was asked to compare the monthly counts of in-hospital deaths from the hospital computer system and the hospital mortuary register for the fiscal year 1999/2000. RESULTS: One hospital, with a computerised mortuary register, had identical counts of in-hospital deaths. Two hospitals reported 4-5% more deaths and four hospitals reported fewer deaths (0.4-7%) from their hospital computer system than from their mortuary register. These differences were not large enough to change their Dr Foster rankings. Wide discrepancies were noted on a monthly basis (range: -13.9% to +15.9%). DISCUSSION: The differences between the two sources of in-hospital death counts were not large enough to influence the Dr Foster ranks but were sufficient to raise concern about the validity and completeness of mortality data in the NHS.

Attitude of Health Personnel↗

Solvothermal syntheses of high-nuclearity vanadium(III) clusters.

Superheating alcohol solutions of simple trimetallic vanadium(III) precursors gives the octa- and decametallic vanadium(III) clusters [V(8)(OEt)(8)(OH)(4)(O(2)CPh)(12)] (1) and [V(10)(OMe)(20)(O(2)CMe)(10)] (2). Cluster 2 is the largest vanadium(III) cluster synthesised to date. Thus solvothermal synthetic techniques are an excellent route to high-nuclearity vanadium(III) clusters. Both 1 and 2 consist of a planar or near-planar array of V(III) ions. The metal ions in 1 are bridged by either a micro(2)-hydroxide and two micro(2)-benzoate groups or two micro(2)-ethoxides and a micro(2)-benzoate groups, the two bridging arrangements alternating around the ring. In 2 each pair of neighbouring metal ions is bridged by two micro(2)-methoxides and a micro(2)-acetate, and this molecule is the V(III) analogue of Lippard's famous "ferric wheel". Preliminary magnetic susceptibility studies show the exchange coupling in both complexes to be antiferromagnetic in nature, with the coupling stronger in 1 than in 2.

Journal Article↗

Unravelling the structural chemistry of the colouration mechanism in lobster shell.

Biochemistry, biological crystallography, spectroscopy, solution X-ray scattering and microscopy have been applied to study the molecular basis of the colouration in lobster shell. This article presents a review of progress concentrating on recent results but set in the context of more than 50 years of work. The blue colouration of the carapace of the lobster Homarus gammarus is provided by a multimolecular carotenoprotein, alpha-crustacyanin. The complex is a 16-mer of five different subunits each binding the carotenoid, astaxanthin (AXT). A breakthrough in the structural studies came from the determination of the structure of beta-crustacyanin (protein subunits A1 with A3 with two shared bound astaxanthins). This was solved by molecular replacement using apocrustacyanin A1 as the search motif. A molecular movie has now been calculated by linear interpolation based on these two 'end-point' protein structures, i.e. apocrustacyanin A1 and A1 associated with the two astaxanthins in beta-crustacyanin, and is presented with this paper. This movie highlights the structural changes forced upon the carotenoid on complexation. In contrast, the protein-binding site remains relatively unchanged in the binding region, but there is a large conformational change occurring in a more remote surface-loop region. It is suggested here that this loop could be important in complexation of AXT and contributes to the spectral properties. Also presented here is the first observation of single-crystal diffraction of the full 'alpha-crustacyanin' complex comprising 16 protein subunits and 16 bound AXT molecules (i.e eight beta-crustacyanins) at 5 A resolution. Optimization of crystallization conditions is still necessary as these patterns show multiple crystallite character, however, 10 A resolution single-crystal diffraction has now been achieved. Provision of the new SRS MPW 10 and SRS MPW 14 beamline robotic systems will greatly assist in the surveying of the many alpha-crustacyanin crystallization trials that are being made. New solution X-ray scattering (SXS) measurements of beta- and alpha-crustacyanin are also presented. The beta-crustacyanin SXS data serve to show how the holo complex fits the SXS curve, whereas the apocrustacyanin A1 homodimer from the crystal data naturally does not. Reconstructions of alpha-crustacyanin were accomplished from its scattering-profile shape. The most plausible ultrastructure, based on a fourfold symmetry constraint, was found to be a stool with four legs. The latter is compared with published electron micrographs. A detailed crystal structure of alpha-crustacyanin is now sought in order to relate the full 150 nm bathochromic shift of AXT to that complete molecular structure, compared with the 100 nm achieved by the beta-crustacyanin protein dimer alone. Rare lobster colourations have been brought to attention as a result of this work and are discussed in an appendix.

Animals↗

Protocol for Birmingham Atrial Fibrillation Treatment of the Aged study (BAFTA): a randomised controlled trial of warfarin versus aspirin for stroke prevention in the management of atrial fibrillation in an elderly primary care population [ISRCTN89345269].

BACKGROUND: Atrial fibrillation (AF) is an important independent risk factor for stroke. Randomised controlled trials have shown that this risk can be reduced substantially by treatment with warfarin or more modestly by treatment with aspirin. Existing trial data for the effectiveness of warfarin are drawn largely from studies in selected secondary care populations that under-represent the elderly. The Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study will provide evidence of the risks and benefits of warfarin versus aspirin for the prevention of stroke for older people with AF in a primary care setting. STUDY DESIGN: A randomised controlled trial where older patients with AF are randomised to receive adjusted dose warfarin or aspirin. Patients will be followed up at three months post-randomisation, then at six monthly intervals there after for an average of three years by their general practitioner. Patients will also receive an annual health questionnaire.1240 patients will be recruited from over 200 practices in England. Patients must be aged 75 years or over and have AF. Patients will be excluded if they have a history of any of the following conditions: rheumatic heart disease; major non-traumatic haemorrhage; intra-cranial haemorrhage; oesophageal varices; active endoscopically proven peptic ulcer disease; allergic hypersensitivity to warfarin or aspirin; or terminal illness. Patients will also be excluded if the GP considers that there are clinical reasons to treat a patient with warfarin in preference to aspirin (or vice versa). The primary end-point is fatal or non-fatal disabling stroke (ischaemic or haemorrhagic) or significant arterial embolism. Secondary outcomes include major extra-cranial haemorrhage, death (all cause, vascular), hospital admissions (all cause, vascular), cognition, quality of life, disability and compliance with study medication.

Aged↗