Comparison of primers for NLV diagnosis.
Explore the source record for details and available documents.
Caliciviridae Infections↗
Biomedical subjects
John Miller
Publications and source records attributed to John Miller.
Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years.
OBJECTIVES: To investigate the strengths and weaknesses of the indicators 'proportion of households possessing mosquito net(s)' and 'proportion of children under 5 years of age who slept under a net the preceding night' for monitoring malaria control. METHODS: Review of data from household surveys including demographic and health surveys in sub-Saharan African countries. RESULTS: Net possession ranged among 14 surveyed regions from 0.1% to 28.5% for insecticide-treated nets (ITNs) and among 69 regions from 3.6% to 79.7% for any net. Reported use during the preceding night by children under 5 years of age was between 0% and 16% for ITNs and between 0.7% and 74.5% for any net. On average, in households owning ITN(s), 55% of children slept under it (R2 = 0.97, P < 0.001). For any net, use was -4.2% + 0.875 x possession (R2 = 0.89, P < 0.001); the use of nets, however, also varied somewhat among the surveyed countries (P = 0.003). In-depth surveys suggested that use was lower than possession because: (i). nets were scarce (mean 1.8 per possessing household); (ii). nets were not always used for children and (iii). use was lower during hot, dry months than during cool rainy months, and many surveys had been conducted in the dry season. CONCLUSIONS: Not all mosquito nets owned by African households are being used for young children. Household education on the consistent use of nets for this vulnerable group is called for in malaria control programmes. Regular, district-level rapid assessments of household possession of nets should complement ongoing in-depth surveys. Data on 'use during the preceding night' must be interpreted taking the survey season into account.
Adult↗
A call to legal arms: bringing embryonic stem cell therapies to market.
Explore the source record for details and available documents.
Disclosure↗
Beyond biotechnology: FDA regulation of nanomedicine.
Nanotechnology, which involves investigating and manipulating matter at the atomic and molecular levels, may radically transform industry and society. Because nanotechnology could introduce whole new classes of materials and products, it could present an array of novel challenges to regulatory agencies. In this note, John Miller explores the regulatory challenges facing the Food and Drug Administration in regulating nanomedical products. First, the FDA will have trouble fitting the products into the agency's classification scheme. Second, it will be difficult for the FDA to maintain adequate scientific expertise in the field. He concludes that the FDA should consider implementing several reforms now to ensure that it is adequately prepared to regulate nanomedicine.
Drug Delivery Systems↗
A randomized, double-blind study of gemfibrozil for the treatment of protease inhibitor-associated hypertriglyceridaemia.
BACKGROUND: Hypertriglyceridaemia is common in patients with HIV, especially those taking protease inhibitors or with lipodystrophy, frequently observed at levels associated with accelerated cardiac disease. This study aimed to explore the efficacy and safety of gemfibrozil for hypertriglyceridemia in patients with HIV infection. METHODS: A 16-week, randomized, double-blind, comparative study of low saturated fat diet versus low saturated fat diet with gemfibrozil 600 mg twice daily in patients with triglycerides > or = 3mmol/l receiving protease inhibitor therapy. Following a 4-week period of dietary intervention alone, patients were randomized to gemfibrozil or matching placebo. The primary outcome was the difference in mean change in fasting triglycerides at week 16 between the two groups. RESULTS: 37 men were randomized (17 gemfibrozil, 20 placebo) with median fasting triglycerides 5.6 mmol/l. Mean changes in triglycerides from week 4 to week 16 were -1.22 mmol/l and +0.35 mmol/l for the gemfibrozil and placebo groups respectively (between-group mean difference of 1.57 mmol/l; 95% confidence interval, -6.7 to 3.5; = 0.08). Only one patient treated had triglycerides return to a desirable range (< or = 2.00 mmol/l). No significant changes in the other metabolic parameters were observed. Gemfibrozil was well tolerated, did not appear to induce additional protease inhibitor toxicity, and did not induce changes in CD4 lymphocyte counts or HIV RNA load. CONCLUSIONS: Gemfibrozil is safe and demonstrated at most, modest efficacy for hypertriglyceridemia in HIV-infected patients receiving protease inhibitors. Given the level of response, however, it is unclear whether these reductions will confer clinical benefit, at least in the presence of continued protease inhibitor use.
Diet↗
Synthesis and evaluation of analogues of 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine as inhibitors of tumor cell growth, trypanosomal growth, and HIV-1 infectivity.
A well-defined series of 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine analogues was designed and synthesized in order to further ascertain the optimal structural requirements for S-adenosylmethionine decarboxylase inhibition and potentially to augment and perhaps separate their antiproliferative and antitrypanosomal activities. Most structural modifications had a deleterious affect on both the antitrypanosomal and antineoplastic activity of 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine. However, di-O-acetylation of the parent compound produced a potential prodrug that caused markedly pronounced inhibition of trypanosomal and neoplastic cell growth and viability. Moreover, the acetylated derivative of 5'-([(Z)-4-amino-2-butenyl]methylamino)-5'-deoxyadenosine did inhibit HIV-1 growth and infectivity, whereas the parent compound did not.
Adenosylmethionine Decarboxylase↗
The role of the paternal health history in cord blood banking.
BACKGROUND: Umbilical cord blood (UCB) transplantation is becoming more widely used, yet ethical and policy issues regarding consent and health history persist. Whereas most UCB banks do not require paternal consent or paternal health history (PHH), both are obtained at this institution whenever possible. This study assessed the value of PHH in making UCB safer. STUDY DESIGN AND METHODS: A retrospective review was performed of all cord blood units (CBUs) collected by this bank between November 1999 and October 2000. All discarded CBUs were studied to identify those deferred based exclusively on PHH provided by the father in the PHH questionnaire. RESULTS: PHH was obtained for 301 of 655 (46%) CBUs collected. Of the 339 CBUs banked, 269 (79%) had PHH available. Three of the 301 CBUs in which PHH was available were discarded based solely on PHH, since maternal medical history and infectious disease testing were negative. Paternal high-risk factors in those three cases were: gave money or drugs for sex; traveled to an HIV high-risk area; and did not answer high-risk questions. CONCLUSION: Considerable time and effort is expended in the process and follow-up of obtaining PHH with an overall indistinct and unconvincing role in minimizing infectious disease transmission risk in UCB banking.
Adult↗
Health physics technician injury reduction.
As part of a safety summit sponsored by Fluor Hanford Occupational Health and Safety, it was noted that Health Physics Technicians (HPTs) have one of the highest injury rates at Hanford. A multi-disciplined team made up of HPTs, health physics professionals, health physics management, indostrial hygienists, and medical personnel was established to determine causes and corrective actions. Committee activities included reviewing and characterizing occupational injuries and illnesses, assessing areas affecting the health of HPTs, soliciting field input, performing field evaluations of tasks, and making recommendations for improvements to senior management. Five areas showed a need for immediate improvement: manmachine interface (human factors and ergonomics), work environment, procedures, people, and communications. A key area of risk identified is the lack of ergonomic design considerations of the survey instruments currently used. There are several cases of cumulative trauma disorder requiring surgery. These cases are directly related to use of health physics instrumentation and/or survey techniques. The committee has made ergonomics and instrument redesign/modification its key initiative for 2001. The committee is encouraging vendor support and is seeking feedback from other health physics organizations regarding their experience and any recommendations they would like to make. Some success has already been achieved through an ergonomics-training program aimed at all HPTs and their supervisors. In addition, there have been several changes made to the way surveys are conducted, survey frequencies have been reduced, and the way modifications have been made to existing instrumentation. This is a long-term initiative with broad support within the Hanford HPT community. This document reports the progress made thus far on the initiative.
Health Physics↗
The place of bowel resection in initial debulking surgery for advanced ovarian cancer.
OBJECTIVE: To evaluate the efficacy and morbidity associated with bowel resection at the initial debulking procedure for patients with advanced ovarian cancer. DESIGN: Retrospective medical record and computerised database review. SETTING: John Hunter Hospital, Newcastle, New South Wales. SAMPLE: All women with FIGO stage III or IV epithelial ovarian cancer and with adequate case note documentation who underwent bowel resection as part of their primary debulking surgery at the John Hunter Hospital from 1991 to July 2000. MAIN OUTCOME MEASURES: Cumulative overall and disease free survival, optimal (residual disease < 1 cm) versus suboptimal cytoreduction and short (< 6 weeks) and long-term postoperative morbidity. RESULTS: For the optimally debulked patients the two and five-year overall and disease free survival rates were 49%, 30%, 19% and 8.9% respectively. The two-year overall survival rate for the suboptimally debulked patients was 20%. The major short-term morbidity rate was 17.6%. Long-term morbidity occurred in 10 of 51 patients; however, not all morbidity was surgery related. CONCLUSIONS: Cytoreductive surgery, including bowel resection, appears indicated in the treatment of patients with advanced ovarian cancer. The surgical morbidity rate from these procedures appears acceptable.
Adult↗
State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society's evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.
Canada↗