Biomedical subjects

L Ball

Publications and source records attributed to L Ball.

At least 19 recordsLinked to original sources

PubMed2006

Zidovudine use but not weight-based ribavirin dosing impacts anaemia during HCV treatment in HIV-infected persons.

Anaemia during peginterferon (PEG-IFN) and ribavirin (RBV) therapy is common in human immunodeficiency virus/hepatitis C virus (HIV/HCV)-coinfected patients despite the use of lower doses of RBV than are recommended for HIV-seronegative persons. In addition, concurrent zidovudine (ZDV) may exacerbate the anaemia caused by PEG-IFN and RBV. We retrospectively analysed the incidence of anaemia, RBV dose reduction and epoetin-alpha (EPO) use among coinfected patients treated with PEG-IFN and weight-based RBV (800-1400 mg/day) who enrolled in two clinical trials and had haemoglobin (Hb) levels assessed at baseline and after 4 and/or 12 weeks of HCV treatment. Overall, 217 patients were included; pre-treatment Hb levels (mean 14.7 g/dL) were similar in all patients, including ZDV users (29% of patients). After 4 weeks of therapy, the mean Hb decline was greater among ZDV recipients (3.13 g/dL) compared with those on other anti-retroviral treatment (ART) (2.13 g/dL) or on no ART (1.47 g/dL) (P < 0.0001). RBV dose reduction and EPO use were more common in patients taking ZDV compared with those not taking ZDV (P < 0.0001). RBV dose was not associated with Hb reduction, RBV dose reduction or EPO use. Virologic response after 12 weeks of therapy and the treatment discontinuation rate did not differ by ZDV use. The use of ZDV but not weight-based RBV dosing was associated with an increased risk of anaemia, RBV dose reduction or EPO use in coinfected patients treated with PEG-IFN/RBV. However, ZDV use was not associated with higher rates of treatment discontinuation or lower early virologic response rates. HIV and hepatitis C care providers should be cognizant of these data.

Adult↗

PubMed2005

Setting the scene for the paramedic in primary care: a review of the literature.

Recognition of the paramedic "profession" began in 2003, with the introduction of statutory registration and the promotion of graduate entry. This paper explores the published evidence which surrounds paramedic practice in an attempt to identify the skills, training, and professional capacity which paramedics of the future will require. A systematic analysis was carried out of key reviews and commentaries published between January 1995 and April 2004, and informal discussions with experts and researchers in the field were undertaken. There remains little high quality published evidence with which to validate many aspects of current paramedic practice. To keep pace with service developments, paramedic training must embrace the complexities of autonomous practice. Undoubtedly in the short term, paramedics must be taught to appropriately identify and manage a far wider range of commonly occurring conditions, minor illnesses, and trauma. However, in the longer term, and more importantly, paramedics must learn to work together to take ownership of the basic philosophies of their practice, which must have their foundation in valid and reliable research.

Clinical Competence↗

PubMed2004

Changes in haemoglobin during interferon alpha-2b plus ribavirin combination therapy for chronic hepatitis C virus infection.

Interferon alpha and ribavirin (RBV) combination therapy is associated with decreases in haemoglobin (Hb) concentrations and anaemia. The aim of this analysis was to better characterize the magnitude and frequency of Hb changes and risk factors. This retrospective analysis evaluated treatment-related changes in Hb in 677 patients who participated in either of two interferon alpha-2b plus RBV studies for chronic hepatitis C virus (HCV) infection. Study 1 included 192 interferon alpha-naïve patients randomized to receive RBV 1000-1200 mg/day plus interferon alpha-2b 3 million IU daily or three times weekly for 48 weeks. Study 2 included 485 interferon alpha-experienced patients randomized to receive RBV 1000-1200 mg daily plus interferon alpha-2b 3 million IU daily or three times weekly for 4 weeks, followed by three times weekly dosing for 44 weeks. More than 50% of all patients experienced a decrease in Hb > or =30 g/L. Women were 4.4 times as likely as men to experience a Hb level of <100 g/L; however, men were at a 40% higher risk to experience a Hb decline of >30 g/L from baseline. Daily use of interferon alpha-2b did not impact the magnitude of Hb decrease. In this pooled analysis, RBV dose reduction resulted in increases in Hb concentration of approximately 10 g/L. Lower baseline creatinine clearance, higher baseline Hb levels and increased age were independently associated with increased risk of Hb decreases of >27.7%. Lower baseline weight was not associated with increased risk of Hb decrease. Substantial Hb decreases occur frequently with interferon alpha/RBV combination therapy. Sex, the magnitude of the Hb decline and renal function are potentially important factors to consider in patients receiving RBV. Further research is needed to determine the impact on virological response and to develop strategies to manage the medical consequences.

Anemia, Hemolytic↗

PubMed2004

Disseminated infection with Balamuthia mandrillaris in a dog.

Bilateral chronic granulomatous nephritis and meningoencephalitis were diagnosed on necropsy of a 2-year-old male Great Dane dog. The causative agent was identified as Balamuthia mandrillaris, based on morphologic features, immunohistochemical staining, and deoxyribonucleic acid detection using the polymerase chain reaction with newly designed primer pairs. Trophozoite and cystic forms of the amoeba were evident within the kidneys and brain parenchyma. This is the first report on a B. mandrillaris infection in a dog.

Animals↗

PubMed2002

Will an orange a day keep the doctor away?

An 80 year old man, who relied on a home based meals-on-wheels service was admitted to hospital with non-specific symptoms, but had clinical and biochemical evidence of scurvy. Subsequently, all new admissions (n=37) to the department over a three week period were assessed for evidence of undernutrition. It was found that 73% had hypovitaminosis C, with 30% having concentrations suggestive of scurvy. There were no significant associations between level of vitamin C and type of accommodation, food provision, or age. The commonest symptom associated with vitamin C deficiency was anorexia, but overall, there was a paucity of clinical signs associated with vitamin C deficiency. The possible associations of vitamin C deficiency in the elderly are discussed.

Aged↗

PubMed2001

Prelicensure evaluation of combination vaccines.

There is considerable public health interest in licensing safe and effective combination vaccines. Because combination vaccines may progress rapidly from phase 1 to a pivotal phase 2 immunogenicity trial, a rigorous approach to address product issues early in development is warranted. Clinical studies to evaluate the safety, immunogenicity, and (when necessary) clinical end point efficacy of combination vaccines should be randomized and well controlled in most cases. A large phase 3 safety study (i.e., a study that enrolls thousands of vaccinees) should be included in the development plan if a phase 3 (clinical end point) efficacy trial will not be conducted. Often, the new combination vaccine under development contains immunogens that have all been previously licensed, have demonstrated efficacy in earlier clinical trials, or both. For such products, comparative immunogenicity data may be sufficient to support efficacy. When applicable, clinical data to support simultaneous administration with other relevant vaccines should be obtained. Given the complexity of combination vaccine development, early consultation with United States Food and Drug Administration can be invaluable.

Clinical Trials as Topic↗

PubMed2000

Are diverse signalling pathways integrated in the regulation of arabidopsis antioxidant defence gene expression in response to excess excitation energy?

When low-light-grown Arabidopsis rosettes are partially exposed to excess light (EL), the unexposed leaves become acclimated to excess excitation energy (EEE) and consequent photo-oxidative stress. This phenomenon, termed systemic acquired acclimation (SAA), is associated with redox changes in the proximity of photosystem II, changes in foliar H2O2 content and induction of antioxidant defences. The induction of extra-plastidial antioxidant systems is important in the protection of the chloroplast under EL conditions. A larger range of transcripts encoding different antioxidant defence enzymes may be induced in the systemically acclimated leaves and these include those encoded by the glutathione peroxidase (GPX2) and glutathione-S-transferase (GST) genes, which are also highly induced in the hypersensitive response and associated systemic acquired resistance (SAR) in incompatible plant-pathogen interactions. Furthermore, the expression of the SAR-inducible pathogenesis-related protein gene, PR2, is enhanced in SAA leaves. Wounded leaf tissue also shows enhanced systemic induction of a cytosolic ascorbate peroxidase gene (APX2) under EL conditions. These and other considerations, suggest H2O2 and other reactive oxygen species (ROS) could be the common factor in signalling pathways for diverse environmental stresses. These effects may be mediated by changes in the level and redox state of the cellular glutathione pool. Mutants with constitutive expression of a normally EL-inducible APX2 gene have much reduced levels of foliar glutathione. The expression of APX1 and APX3, encoding cytosolic and peroxisome-associated isoforms, respectively, are also under phytochrome-A-mediated control. The expression of these genes is tightly linked to the greening of plastids in etiolated seedlings. These data suggest that part of the developmental processes that bring about the acclimation of leaves to high light includes the configuration of antioxidant defences. Therefore, the linkage between immediate responses of leaves to EL, acclimation of chloroplasts to EEE and the subsequent changes to leaf form and function in high light could be mediated by the activity of foliar antioxidant defences and changes in the concentration of ROS.

Antioxidants↗

PubMed2000

Light-mediated antifungal activity of Echinacea extracts.

This study demonstrated that plant extracts containing acetylenic isobutylamides and polyacetylenes, previously reported as occurring in Echinacea, have phototoxic antimicrobial activity against fungi, including clinically relevant pathogenic fungi. Results show that hexane extracts of Echinacea variably inhibit growth of yeast strains of Saccharomyces cerevisiae, Candida shehata, C. kefyr, C. albicans, C. steatulytica and C. tropicalis under near UV irradiation (phototoxicity) and to a lower extent without irradiation (conventional antifungal activity). The presence of polyacetylenes and alkylamides in extracts of different organs was confirmed in Echinacea purpurea by HPLC in agreement with previously reported data in the literature, and was related to phototoxic activity. Two representative pure compounds, undeca-2E,4Z-diene-8,10-diynoic acid isobutylamide and dodeca-2E,4E,8Z,10E/Z-tetraenoic acid isobutylamide, were isolated from Echinacea purpurea root extracts, and compared in a disk assay (5 micrograms/disk) with the highly conjugated trideca-1-ene-3,5,7,9,10-pentayne (previously isolated in our laboratory and found here in E. purpurea). Significant phototoxicity was demonstrated by pure trideca-1-ene-3,5,7,9,10-pentayne, while only minor phototoxicity was induced by the other two acetylenic compounds. Phototoxic activity of Echinacea spp. is primarily attributed to the ketoalkenes and ketoalkynes abundantly present in the roots.

Antifungal Agents↗

PubMed1999

Solution structure of the receptor tyrosine kinase EphB2 SAM domain and identification of two distinct homotypic interaction sites.

The sterile alpha motif (SAM) is a protein interaction domain of around 70 amino acids present predominantly in the N- and C-termini of more than 60 diverse proteins that participate in signal transduction and transcriptional repression. SAM domains have been shown to homo- and hetero-oligomerize and to mediate specific protein-protein interactions. A highly conserved subclass of SAM domains is present at the intracellular C-terminus of more than 40 Eph receptor tyrosine kinases that are involved in the control of axonal pathfinding upon ephrin-induced oligomerization and activation in the event of cell-cell contacts. These SAM domains appear to participate in downstream signaling events via interactions with cytosolic proteins. We determined the solution structure of the EphB2 receptor SAM domain and studied its association behavior. The structure consists of five helices forming a compact structure without binding pockets or exposed conserved aromatic residues. Concentration-dependent chemical shift changes of NMR signals reveal two distinct well-separated areas on the domains' surface sensitive to the formation of homotypic oligomers in solution. These findings are supported by analytical ultracentrifugation studies. The conserved Tyr932, which was reported to be essential for the interaction with SH2 domains after phosphorylation, is buried in the hydrophobic core of the structure. The weak capability of the isolated EphB2 receptor SAM domain to form oligomers is supposed to be relevant in vivo when the driving force of ligand binding induces receptor oligomerization. A formation of SAM tetramers is thought to provide an appropriate contact area for the binding of a low-molecular-weight phosphotyrosine phosphatase and to initiate further downstream responses.

Amino Acid Motifs↗

PubMed1996

Overconfidence and personal evaluations of social rank.

Research on confidence judgements suggests that people are often overconfident. However, some studies have found that depressed mood reduces this positive bias. To date this has been explained as a mood phenomenon. In this study we explore an alternative theory which suggests that confidence is related to internal judgements of social rank and status. This theory suggests that the lower one perceives oneself to be in status and rank the less one can afford to be overconfident. Data from a student population suggests that confidence judgements are associated with internal judgements of status.

Adolescent↗

PubMed1993

Development and testing of a bovine trichomoniasis vaccine.

Eighteen culled dairy cows were randomly allocated into 1 of 5 treatment groups. Six cows were vaccinated twice (2V), 21 days apart, 3 with whole cell (2WC) and 3 with fragmented cell membrane (2FC) containing 1 x 10(9)Trichomonas fetus organisms or protein equivalent in a commercial mineral oil adjuvant vaccine. Six more cows were vaccinated once (1V), 3 with whole cell (1WC) and 3 with fragmented cell vaccine (1FC), using the same vaccine, while 6 cows were used as the unvaccinated controls. All cows were challenged with 1 x 10(5) organisms 4 weeks after the second or the only vaccination. After challenge, cervico-vaginal mucus (CVM) samples were cultured for T . fetus weekly for 9 weeks. Whole cell vaccines were superior to fragmented cell vaccines, and both performed better than no vaccination for apparent elimination of trichomonad infections in dairy cows. In addition, 2V was superior to 1V, which, in turn, was superior to no vaccination. Furthermore, clearance time was reduced most by 2V and whole cell vaccination compared with 1V and fragmented cell vaccination. Clearance time was decreased significantly in all vaccinated cows compared with that in unvaccinated cows.

Journal Article↗

PubMed1993

Testing of trichomoniasis vaccine in heifers mated to infected bulls.

This study was conducted to evaluate the effectiveness of a Trichomonas fetus vaccine to protect heifers from infection when bred to infected bulls. The vaccine consisted of a whole cell vaccine of T. fetus organisms stabilized in formaldehyde and adjuvanted in a mineral oil base. In the trial, fewer vaccinated heifers became infected than unvaccinated controls (69.4 vs 93.0%, respectively; P<0.08). The vaccinated heifers tended to clear the infections sooner than the controls (48.9 vs 68.5 days, respectively; P<0.10). The average number of days open was shorter in the vaccinated heifers than in the controls (33.2 vs 56.9 days, respectively; P<0.07). The first service conception rate was higher in the vaccinated heifers than in the controls (66.7 vs 33.3%, respectively; P<0.05). The number of services per conception in conceiving heifers was lower in vaccinated than in control heifers (1.44 vs 1.73, respectively; P<0.16). Cervicovaginal mucus (CVM) samples were collected every 14 days following first challenge (first service). On average, more CVM samples were positive for T. fetus for a longer period of time in the control than in the vaccinated heifers (3.9 vs 1.85 sampling periods, respectively; P<0.08). We concluded that, under the conditions of this trial, some protection to T. fetus was afforded by double vaccination with a whole cell vaccine. However, vaccination does not completely prevent heifers from developing infection.

Journal Article↗

PubMed1993

Blood use in spinal operations in children.

This paper reports a retrospective analysis of blood use in 27 children undergoing major spinal surgery in Liverpool in 1990. Overall 133 units of blood were cross-matched, but only 60 units (45%) were used. The results of the analysis show a significant difference between the operative techniques used in elective spinal surgery. This hospital has now introduced new guidelines for the cross-matching of blood.

Adolescent↗

PubMed1993

Successful second unrelated donor BMT in a child with juvenile chronic myeloid leukaemia: documentation of chimaerism using the polymerase chain reaction.

A 3-year old child with juvenile chronic myeloid leukaemia received a T cell-depleted BMT from a male unrelated donor. There was early graft failure associated with increasing splenomegaly and hypersplenism. Splenectomy was performed 53 days post-transplant and was followed by autologous marrow recovery with return of leukaemia. A second unrelated donor BMT was performed 9 months later using T cell-replete marrow from a similarly matched female donor. Grade 2 GVHD involving the skin and gut responded to treatment with steroids. Chimaerism was assessed using Y-specific polymerase chain reaction (PCR) and microsatellites. Samples taken at the time of splenectomy showed no donor marrow engraftment but there was significant engraftment in the spleen. Following the second transplant, donor-type haematopoiesis was documented using a panel of microsatellite probes. The patient remains well 6 months after transplant. Splenectomy should be considered prior to transplant in patients with significant splenomegaly and hypersplenism. Partial chimaerism in the spleen, but not bone marrow, post-BMT, has not previously been documented. PCR technology is a useful and highly sensitive way to assess chimaerism post-BMT and is informative in sex-matched cases, whilst the small amount of material required is advantageous in paediatric patients.

Bone Marrow Transplantation↗

PubMed1992

Evidence for gene-environmental interactions in Utah families with hypertension, dyslipidaemia and early coronary heart disease.

1. Among 45,258 Utah families surveyed, about 4% have a strong aggregation of early coronary disease. In detailed clinical evaluation, about 21% of such high risk coronary families were found to have familial dyslipidaemic hypertension (FDH) and about 3% were found to have heterozygous familial hypercholesterolaemia (hFH). 2. Common and potentially modifiable environmental factors seem to play an important role in these high risk families. Non-genetic obesity promotes the expression of FDH. A high fat diet promotes the expression of FH. Cigarette smoking promotes earlier death in all coronary prone families. 3. Practical approaches are suggested for helping coronary prone pedigrees by applying our understanding of genetic and environmental factors that promote earlier coronary disease onset.

Adult↗

PubMed1991

Development of a new controlled-release formulation of chlorpheniramine maleate using in vitro/in vivo correlations.

Development of a controlled-released formulation of chlorpheniramine maleate is described, using in vitro/in vivo correlates, according to a process that has been termed "biorelevant dissolution". The process begins with simulations using several possible input rates combined with known disposition parameters of chlorpheniramine maleate. Based on desired plasma concentrations, an input rate is selected for further development which consists of a combination of clinical bioequivalence studies and further in vitro testing and simulations. The method is designed to reduce the requirements for trial and error clinical bioequivalence testing of a new controlled-release formulation.

Administration, Oral↗

PubMed1990

Relativism and stations of epistemic doubt.

This sequence of studies examined the role that relativistic thinking plays in the cognitive and social-emotional lives of adolescents. Study 1 introduces an assessment strategy and associated descriptive model employed in evaluating how 70 concrete and formal operational adolescents differently interpret and resolve problems involving competing knowledge claims. A second study explored the relations between the epistemic orientations evidenced by 61 of these subjects and their current level of identity development. Study 3 compared the epistemic assumptions of a group of 29 psychiatrically hospitalized adolescents with those of a matched group of normal controls. Results from these studies indicate that relativistic approaches to problems of belief entitlement are: a) routinely characteristic of most normal adolescents; b) available to formal operational, but not concrete operational individuals; c) associated with more mature ego-identity statuses; and d) typically absent in groups of psychiatrically hospitalized youth.

Adolescent↗

PubMed1989

Breeding soundness, libido and performance of beef bulls mated to estrus synchronized females.

Ninety-three beef bulls and 2316 females were used to determine the relationships between breeding assessments of bulls and subsequent mating performance. Each bull was given a breeding soundness examination (BSE) and two 10-min libido/serving capacity (L/SC) tests. Breeding potential of each bull was classified as satisfactory (BSE score = 60 to 100) or questionable (BSE score = 30 to 59); libido was classified as either high (mean score = 9.0 to 10) or medium (mean score = 6.0 to 8.5). Bulls were then joined, single-sire, with groups of females which had received one of two treatments to synchronize estrus. Bull-to-female ratios ranged from 1:7 to 1:51. Continuous observations were conducted on the mating activity of each group. One bull was removed from the experiment due to a severe breeding problem. Bulls of satisfactory breeding potential (n = 80) did not differ (P > 0.10) from bulls of questionable breeding potential (n = 12) in measurements of mating activity. However, by the end of the synchronized breeding period, bulls classified as satisfactory breeders achieved approximately a 9% higher (P < 0.10) pregnancy rate than did bulls of questionable breeding status (45.6 +/- 2.1% vx 36.5 +/- 5.3%). Bulls with a high libido (n = 69) serviced more (P < 0.01) estrous females (81.3 +/- 3.1% vs 63.5 +/- 4.2%) than bulls with a medium libido (n = 23). However, pregnancy rates achieved by bulls of either libido classification did not differ significantly. Individual components of the BSE as well as mean libido score were poorly correlated with pregnancy rates (r = -0.22 to 0.18). It was concluded that classification of bulls by mean libido score can aid in identifying groups of bulls that service more estrus synchronized females, whereas classification by BSE score aids in identifying groups of bulls that impregnate more females.

Journal Article↗