Biomedical subjects

N J Cooper

Publications and source records attributed to N J Cooper.

At least 19 recordsLinked to original sources

PubMed2006

The impact of diabetes on current revascularisation practice and clinical outcome in patients with critical lower limb ischaemia.

OBJECTIVE: To compare current revascularisation practice and outcome in diabetic and non-diabetic patients presenting with critical limb ischaemia (CLI) to a single vascular surgeon. METHODS: Data for 113 patients presenting with CLI were collected prospectively over a 3-year period. Forty-four (39%) were diabetic. Treatment was classified as percutaneous angioplasty, arterial reconstruction, primary major amputation, and conservative therapy. Main outcome measures were 30-day mortality, major amputation, survival, and amputation-free survival. RESULTS: Diabetic patients were more likely to present with gangrene, give a history of angina, be treated with nitrates and statins, and have lower cholesterol levels. No significant differences were found in the initial treatment options between diabetics and non-diabetics: angioplasty 39 vs 26%, surgical revascularisation 34 vs 33%, primary major amputation 9% vs 17%, and conservative treatment 11 vs 19% (p = ns in all). There were eight deaths (7%) within 30-days. At follow-up (1-44 months, median 14 months), rates of major amputation and death for the entire population were 23 and 8%, respectively. The 12-month cumulative survival and amputation-free survival rates were 90 and 72%, respectively. When comparing diabetic to non-diabetic patients, there were no significant differences in the 30-day mortality (6.8 vs 7.2%, p = 0.4), cumulative survival (93 vs 89% at 12 months, log-rank test: 0.00, p = 0.9), amputation-free survival (71 vs 73% at 12 months, log-rank test: 0.00, p = 0.99), and major amputation rates (22.7 vs 23.1% at 12 months, p = 0.96). Similarly, there were no differences in limb salvage rates between diabetic and non-diabetic patients undergoing revascularisation procedures (78 vs 90% at 12 months, log-rank test: 2.04, p = 0.15). CONCLUSIONS: In current practice, an aggressive multidisciplinary approach in diabetic patients presenting with CLI leads to similar limb salvage, amputation-free survival, mortality, and major amputation rates to those seen in non-diabetic patients. The presence of diabetes should not deter clinicians from attempting revascularisation by means of angioplasty or surgical reconstruction.

Adult↗

PubMed2005

The cost-effectiveness of influenza vaccination of healthy adults 50-64 years of age.

Influenza can cause significant morbidity and mortality. Influenza vaccination is an effective and safe strategy in the prevention of influenza. Currently the National Health Service (NHS) vaccinates 'at-risk' individuals only. This definition includes everyone over 65 years of age but excludes individuals 50-64 years of age unless they have an additional risk factor, such as underlying heart disease or lung disease. In order to examine the cost-effectiveness of an extension of the vaccination policy to include this age group we constructed an economic model to estimate the costs and benefits of vaccination from both a health service and a societal perspective. Data to populate the model was obtained from the literature and the outcome measure used was the quality adjusted life year (QALY). Influenza vaccination prevented an estimated 4508 cases (95% CI: 2431-7606) per 100,000 vaccinees per influenza season for a net cost to the NHS of pound653,221 (95% CI: 354,575-1,072,257). The net cost increased to pound1,139,069 (95% CI 27,052-2,030,473) when non-NHS costs were included and the estimated cost-per-QALY were pound6174 and pound10,766 for NHS and all costs respectively. Extension of the current immunisation policy has the potential to generate a significant health benefit at a comparatively low cost.

Cost-Benefit Analysis↗

PubMed2004

The post-operative mortality of ruptured abdominal aortic aneurysm repair.

INTRODUCTION: Late peri-operative death after ruptured abdominal aortic aneurysm (RAAA) repair is usually due to multiple-organ failure. The aim of this study was to identify any factors that are associated with mortality in this group of patients. METHODS: A retrospective case-note review of a single decade's operative experience of RAAA repair in a single centre. Only those patients with confirmed rupture at laparotomy were included. Sixty-three pre- intra- and post-operative variables were recorded where possible for each patient who survived surgery and the initial 24-hours post-operatively. Multi-variate analysis was performed using stepwise logistic regression. The P-POSSUM, RAAA-POSSUM, RAAA-POSSUM (physiology only), V-POSSUM, and V-POSSUM (physiology only) models were all compared to determine how each performed in these patients. RESULTS: Two hundred and twenty-three cases of confirmed RAAA were identified, of whom 139 survived the operation and initial 24-hours post-operatively. In-hospital mortality in this group of patients was 32.4%. Variables significantly associated with mortality after multi-variate analysis, were low intra-operative systolic blood pressure, the presence of a consultant anaesthetist at the initial operation and the development of cardiac, renal or gastro-intestinal complications. All POSSUM models except the V-POSSUM and P-POSSUM (physiology only) models demonstrated no significant lack of fit in this dataset. DISCUSSION: Factors associated with delayed peri-operative death after RAAA are not the same as those previously found to be associated with overall peri-operative mortality after RAAA repair.

Aged↗

PubMed2004

The cost of clinically significant urinary storage symptoms for community dwelling adults in the UK.

OBJECTIVES: To estimate the cost of clinically significant urinary storage symptoms (CSUSS), including costs borne by the National Health Service (NHS) and individuals, in terms of the use of goods and services in community-dwelling adults. SUBJECTS AND METHODS: The subjects were community-dwelling adults aged >/= 40 years and living in Leicestershire. The prevalence of CSUSS was estimated using a postal questionnaire with a randomly selected sample of 23 182 respondents. The costs associated with CSUSS were estimated using home interviews with 613 cases with and 523 subjects without CSUSS. Cases were defined on the basis of urinary symptoms of leakage, urgency, frequency and nocturia. Willingness-to-pay was used to measure intangible costs as an indicator of the value of alleviating symptoms. RESULTS: The estimated total annual cost to the NHS for treating CSUSS cases in community-dwelling adults was pound 536 million at 1999/2000 prices ( pound 303 million and pound 233 million for men and women, respectively). The total value of costs borne by individuals was estimated to be pound 207 million ( pound 29 million and pound 178 million for men and women, respectively). This gives total annual costs related to the use of services of pound 743 million. There were large intangible costs borne by individuals estimated to be pound 669 million ( pound 301 and pound 368 million for men and women) for the UK in terms of willingness-to-pay. CONCLUSIONS: The costs of CSUSS in the community amounted to approximately 1.1% of overall NHS spending for 1999/2000. Personally borne and intangible costs are also large and important components of the costs of CSUSS. There are large gender differences in the proportion of costs borne by the NHS, i.e. 91% of male and 57% of female costs.

Adult↗

PubMed2003

Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair.

BACKGROUND: The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair. METHODS: A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January 1990 and the end of October 2000. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, time to discharge from hospital, return to normal activity and return to work, postoperative complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences. RESULTS: Twenty-nine trials were considered suitable for meta-analysis. Some 3017 hernias were repaired laparoscopically and 2972 hernias were repaired using an open method in 5588 patients. For four of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 38 per cent in the relative odds of postoperative complications (odds ratio 0.62 (95 per cent confidence interval (c.i.) 0.46 to 0.84); P = 0.002), 4.73 (95 per cent c.i. 3.51 to 5.96) days in time to return to normal activity (P < 0.001), 6.96 (95 per cent c.i. 5.34 to 8.58) days in time to return to work (P < 0.001) and 3.43 (95 per cent c.i. 0.35 to 6.50) h in time to discharge from hospital (P = 0.029). There was a significant increase of 15.20 (95 per cent c.i. 7.78 to 22.63) min in the mean operating time for LIHR (P < 0.001). The relative odds of short-term recurrence were increased by 50 per cent for LIHR compared with OIHR, although this result was not statistically significant (odds ratio 1.51 (95 per cent c.i. 0.81 to 2.79); P = 0.194). CONCLUSION: LIHR was associated with earlier discharge from hospital, quicker return to normal activity and work, and significantly fewer postoperative complications than OIHR. However, the operating time was significantly longer and there was a trend towards an increase in the relative odds of recurrence after laparoscopic repair.

Hernia, Inguinal↗

PubMed2002

Bull selection and use in northern Australia. 5. Social behaviour and management.

Calf output of bulls was derived using DNA typing for paternity following multiple-sire mating at two sites in northern Australia. At Swan's Lagoon Beef Cattle Research Station, 12, mixed-age, Brahman cross bulls were continuously mated with an average of 325 females in a 22km2 open-savannah paddock. Water was available in two troughs. Behaviour of the bulls and location of cows were monitored. At Kamilaroi Station, 2- to 2.5-year-old Brahman bulls were introduced to the study. Twenty-four bulls (HIGH%) were mated in an 84km2 paddock for 3.5 months to 411 heifers in 1995/1995 and for 4.5 months to 350 heifers and 320 first-lactation cows in 1995/1996. A second group of 10 bulls (LOW%) selected on reproductive soundness was mated concurrently in a neighbouring 60km2 paddock to 411 heifers in 1995/1995 and to 350 heifers and 298 first-lactation cows in 1995/1996. In each paddock in both years, 300-350 females were expected to cycle during mating. Both paddocks were flat and semi-forested and water was available only at troughs. At both sites, detailed physical and reproductive examinations of all bulls were conducted prior to and post-mating.Calf output of individual bulls was highly variable but repeatable (r=0.6-0.7) between years. Up to 90% of the 270-380 calves resulting from each mating were sired by between 6 and 8 bulls. Reducing from 3.7 to 2.8% bulls:females at Swan's Lagoon did not delay conceptions. At Kamilaroi, reproductively sound bulls achieved an estimated 5-6 conceptions per week over the peak mating period when sufficient cycling females were available. Differences in pregnancy rates between paddocks appeared due to differences in nutrition and it appeared that conceptions were not delayed with LOW% vs. HIGH% bulls. Variance between bulls in calf output was substantially lower when fewer bulls were used. Bull attrition occurred each year in the HIGH% paddock but not in the LOW% paddock. Calf output was unrelated to body condition of bulls. Seven of the 12 bulls in one 2-year period at Swan's Lagoon appeared to restrict their movement range to 250-750ha for 90-100% of the time. These ranges expanded when the bull:female ratio was reduced. Only one of the nine bulls remained within a 500ha home range for at least 85% of the time during peak mating in 1998 at 2.8% bulls:females. In previous years with 3.7% bulls:females, up to eight of the 12 bulls had remained within a 500ha home range for 85% of the time. Bull behaviour related to high calf output included restricted movement range, grazing with females at a majority of observations, stable social behaviour, and social dominance. These observations demonstrate that multiple-sire mating of reproductively sound Brahman and Brahman-derived bulls at 2.5% of cycling females will not jeopardise herd fertility under extensive management in northern Australia.

Animals↗

PubMed2002

Total costs and predictors of costs in individuals with early inflammatory polyarthritis: a community-based prospective study.

OBJECTIVE: To estimate the health service, non-health service and total costs and predictors of costs in individuals with early inflammatory polyarthritis (IP). METHODS: We conducted a prospective longitudinal study over a 6-month period. The participants were a random sample of 133 individuals who had enrolled with the community-based Norfolk Arthritis Register (NOAR) database between 1994 and 1999. The main outcome measures were the mean (per person) 6-month health service cost, non-health-service cost and total cost associated with IP. RESULTS: One hundred and fifteen of the 133 individuals who were recruited into the study completed 6 months of follow-up. The mean 6-month total cost was estimated to be 2800 pounds sterling per person, of which 14% was health service costs and the remainder non-health-service costs. Higher total costs were associated with lower health status and rheumatoid factor positivity. CONCLUSIONS: Early IP has a considerable impact on both the health-care system and, more importantly, society. Non-health-service costs (i.e. costs incurred by the individual with the disease, their family and friends) account for a substantial proportion (86%) of the total costs associated with early IP.

Adolescent↗

PubMed2002

Decision analytical economic modelling within a Bayesian framework: application to prophylactic antibiotics use for caesarean section.

Economic evaluation of health care interventions based on decision analytic modelling can generate valuable information for health policy decision makers. However, the usefulness of the results obtained depends on the quality of the data input into the model; that is, the accuracy of the estimates for the costs, effectiveness, and transition probabilities between the different health states of the model. The aim of this paper is to review the use of Bayesian decision models in economic evaluation and to demonstrate how the individual components required for decision analytical modelling (i.e., systematic review incorporating meta-analyses, estimation of transition probabilities, evaluation of the model, and sensitivity analysis) may be addressed simultaneously in one coherent Bayesian model evaluated using Markov Chain Monte Carlo simulation implemented in the specialist Bayesian statistics software WinBUGS. To illustrate the method described, a simple probabilistic decision model is developed to evaluate the cost implications of using prophylactic antibiotics in caesarean section to reduce the incidence of wound infection. The advantages of using the Bayesian statistical approach outlined compared to the conventional classical approaches to decision analysis include the ability to: (i) perform all necessary analyses, including all intermediate analyses (e.g., meta-analyses) required to derive model parameters, in a single coherent model; (ii) incorporate expert opinion either directly or regarding the relative credibility of different data sources; (iii) use the actual posterior distributions for parameters of interest (opposed to making distributional assumptions necessary for the classical formulation); and (iv) incorporate uncertainty for all model parameters.

Antibiotic Prophylaxis↗

PubMed2001

Contraceptive efficacy of an intra-uterine device in Brahman cattle.

The contraceptive efficacy of an intra-uterine device was evaluated using 218 heifers and 212 cows on three north Australian cattle stations. The heifers were aged approximately 2 years and weighed 250-378 kg; the cows were aged 3-16 years and weighed 256-540 kg. All cattle were non-pregnant, non-lactating Brahmans. At the end of the monsoon (wet) season (April-June 1997), the cattle were allocated by stratified randomisation to the three treatments which were untreated controls (n=59), surgical ovariectomy (n=105), or implantation with a bovine intra-uterine device (BIUD; n=266). All cattle grazed and were managed as one group within each station. They were exposed to bulls (4 per 100 females) from soon after treatment until slaughter approximately 12 months later. The BIUD could not be implanted in 25% of heifers and 8% of cows due to narrow or twisted cervices. Correct placement of the BIUDs appeared to be achieved in 57% of heifers and 72% of cows. At slaughter, the devices were incorrectly positioned in 73% of heifers and 49% of cows into which BIUDs had been inserted and that remained non-pregnant. Uterine perforations by the BIUD were observed in 35 and 45% of these heifers and cows, respectively; most perforations appeared to occur during implantation. Low-grade endometritis was observed at slaughter in most BIUD-implanted animals; 2% had pyometra.BIUD animals did not have significantly different growth to that of control or ovariectomised animals, other than when ovariectomy suppressed growth following surgery. Most animals implanted with BIUDs appeared to have normal ovarian function and animals were observed mating. All ovariectomised animals remained non-pregnant. Over 80% of controls were pregnant within 8 months of exposure to bulls, except heifers at one station where pregnancy rate was restricted to 25% as a result of severe nutritional conditions. Pregnancy was diagnosed in 21% of heifers and 33% of cows with implanted BIUDs. The device remained correctly positioned and with no pregnancy diagnosed in the year following implantation in only 2% of heifers and 14% of cows originally allocated. Because of the difficulties of implanting BIUDs, the high frequency of associated uterine injury, the high pregnancy rate in implanted animals, and that growth was unaffected by the presence of a BIUD, it was concluded that the device had poor contraception efficacy and no growth-promotant effect in Brahman cattle.

Animals↗

PubMed2001

GABA(B)R expressed on vagal afferent neurones inhibit gastric mechanosensitivity in ferret proximal stomach.

GABA(B)-receptor (GABA(B)R) agonists reduce transient lower esophageal sphincter relaxation (TLESR) and reflux episodes through an action on vagal pathways. In this study, we determined whether GABA(B)R are expressed on vagal afferent neurones and whether they modulate distension-evoked discharge of vagal afferents in the isolated stomach. Vagal mehanoreceptor activity was recorded following distensions of the isolated ferret proximal stomach before and after perfusion with the GABA(B)R-selective agonists baclofen and 3-aminopropylphosphinic acid (3-APPiA). Retrograde labeling and immunohistochemistry were used to identify GABA(B)R located on vagal afferent neurones in the nodose ganglia. Vagal afferent fibers responded to isovolumetric gastric distension with an increase in discharge. The GABA(B)-receptor agonists baclofen (5 x 10(-5) M) and 3-APPiA (10(-6) to 10(-5) M) but not muscimol (GABA(A)-selective agonist: 1.3 x 10(-5) M) significantly decreased afferent distension-response curves. The effect of baclofen (5 x 10(-5) M) was reversed by the GABA(B)-receptor antagonist CGP 62349 (10(-5) M). Over 93% of retrogradely labeled gastric vagal afferents in the nodose ganglia expressed immunoreactivity for the GABA(B)R. GABA(B)R expressed on vagal afferent fibers directly inhibit gastric mechanosensory activity. This is likely a contributing mechanism to the efficacy of GABA(B)-receptor agonists in reducing TLESR and reflux episodes in vivo.

Animals↗

PubMed2001

Glycoconjugates on the surface of epididymal spermatozoa in a marsupial, the brushtail possum, Trichosurus vulpecula.

Variation in localization and distribution of saccharides on the sperm surface of a marsupial, the brushtail possum, Trichosurus vulpecula, was compared between spermatozoa from the caput and cauda epididymides. Spermatozoa were subjected to the following treatments: (i) unfixed and fixed spermatozoa were stained with fluorescein-labelled lectins; (ii) unfixed spermatozoa were incubated with lectins for determination of agglutination; and (iii) spermatozoa were incubated with detergent to remove the plasmalemma, the glycoproteins were separated on SDS-PAGE and western blots were stained with biotinylated lectins. Many of the fluorescein isothiocyanate (FITC)-labelled lectins bound selectively to the sperm surface, and marked differences were found in lectin staining affinity between caput and cauda epididymal spermatozoa. Incubation of spermatozoa from the cauda epididymidis with neuraminidase reversed many of the differences in staining of the cauda epididymal spermatozoa, indicating masking of some terminal saccharides by sialic acid. Agglutination of spermatozoa from the caput epididymidis occurred after incubation with Concanavalin A (ConA) and soybean agglutinin (SBA), but agglutination was less extensive for spermatozoa from the cauda epididymidis. Western blot analysis indicated several ConA-positive bands in caput sperm extracts, but fewer positive bands in the cauda sperm extracts, whereas SBA stained four bands from caput but none from the cauda epididymal spermatozoa. These results demonstrate extensive glycosylation of the surface proteins of spermatozoa from the caput epididymidis and significant differences in spermatozoa from the cauda epididymidis. In general, the findings indicate similar glycosylation of the surface of marsupial spermatozoa to those from eutherian mammals despite marked differences in their morphology and early divergence of marsupials from eutherian mammals. It would appear that this situation differs markedly from that in sub-mammalian vertebrates.

Animals↗

PubMed2000

The use of narrative in the development of critical thinking.

This paper describes an approach to assessment aimed at developing critical skills in the production of arguments concerning contemporary issues in health. It is demonstrated that, in teaching from a constructivist position of knowledge, students can be cautious in producing assignments because of the relativist characteristic of constructivism. It is proposed that students could be more open and flexible in their approach to assessment and the use of cooperative working through the creation of narratives. It is suggested that narratives can provide an accessible and heuristic process from which academic accounts may be built. The use of narratives in taking the students from their everyday thinking to academic accounts is presented in relation to four teaching sessions. The use of this approach is in turn evaluated by students' narratives of their learning experience. Of 30 narratives obtained from students, analysis demonstrated that 21 accounts expressed aspects associated with the development of critical thinking. Nine students voiced some dissatisfaction with the assessment process, and further work to remedy these problems is outlined.

Attitude of Health Personnel↗

PubMed2000

Economic burden of rheumatoid arthritis: a systematic review.

OBJECTIVE: To summarize the state of knowledge with regard to the economic impact of rheumatoid arthritis (RA) and to highlight any weaknesses in the work conducted to date, so as to inform future RA cost-of-illness studies. METHODS: Four computerized literature databases were searched to identify all the literature relevant to this review. Seven elements indicating a quality cost-of-illness study were established and used to appraise the literature identified critically. Where possible, costs reported by the different studies were converted to 1996 US dollars using the consumer price index for medical care. RESULTS: Total average medical costs were reported to range from US$5720 (UK pound3575) to US$5822 (UK pound3638). Medication constituted between 8 and 24% of total medical costs, physician visits between 8 and 21%, and in-patient stays between 17 and 88%. The average number of days absent from work due to a person's RA was reported to range from 2.7 to 30 days/year. CONCLUSION: The economic impact of RA in terms of cost was reported to be substantial by all studies reviewed. However, methodological problems meant that discrepancies in the average (per person) annual cost of RA existed across studies.

Arthritis, Rheumatoid↗

PubMed2000

Secondary health service care and second line drug costs of early inflammatory polyarthritis in Norfolk, UK.

OBJECTIVE: To estimate the secondary health service care and second line drug costs (including drug monitoring costs) for a cohort of people with early inflammatory polyarthritis (IP) and the subgroup classified as having rheumatoid arthritis (RA) recruited to a population based register. METHODS: The study population consisted of 344 people with IP who had enrolled on the Norfolk Arthritis Register (NOAR) in 1990-91, an average of 24 weeks after onset of their symptoms. Utilizing resource use data from NOAR, augmented by unit cost data from other sources, the average (per person) and cumulative secondary care and second line drug costs were estimated for Years 1, 2, 3, 4, and 5 following registration with NOAR. RESULTS: The total secondary health service care and second line drug costs were 472,125 (338,704 for RA subgroup) (1990-91 prices) over the 5 year study period, with inpatient stays, outpatient visits, and second line drugs accounting for 58, 9, and 33%, respectively. Nineteen percent of the study population neither visited hospital nor were prescribed second line drugs. CONCLUSION: Overall, inpatient stay costs represented the largest proportion of secondary health service care and second line drug costs, making 21% of the total study cohort responsible for 80% of the total 5 year costs incurred.

Adolescent↗

PubMed1998

Protein synthesis and secretion by the epididymis of the brushtail possum, Trichosurus vulpecula.

In this study of brushtail possums, proteins present in epididymal fluid and not present in blood plasma and those that become associated with spermatozoa as they pass along the tract were investigated. At least 19 proteins were present in epididymal fluid in the various regions of the tract that were not detected in serum. Some of these may be present on the sperm plasmalemma. Six proteins were extracted from caput spermatozoa (M(r) 117,000, 103,000, 87,500, 85,000, 62,000 and 33,000) that did not appear in the caudal sperm extracts. Eight proteins (M(r) 50,000, 49,000, 32,000, 27,000, 26,500, 25,000, 24,500 and 18,000) were localized to caudal sperm extracts. These findings suggest that some sperm proteins are lost or modified, whereas others are added to the sperm plasma membrane during epididymal transit. In vitro incorporation of [35S]methionine by the epididymal tissue showed that the distal caput and corpus are the most active regions in the synthesis and secretion of proteins. Four caudal epididymal proteins (M(r) 72,000, 31,000, 26,500 and 21,000) were partially sequenced. Those of M(r) 31,000 and 26,500 had the same N-terminal amino acid sequence suggesting post-translational modification of the same protein; they showed homology to a retinoic acid-binding protein. The protein of M(r) 72,000 was found to be homologous to alpha-fetoprotein, whereas the protein of M(r) 21,000 showed no significant homology to any protein in the database. These results show that the lumen of the epididymis has many proteins that are not present in the blood, some of which appear to become associated with spermatozoa during epididymal transit.

Amino Acid Sequence↗

PubMed1998

Extratesticular sperm maturation in the brush-tail possum, Trichosurus vulpecula.

The changes in distribution of protein and sugar components in, and on, the plasmalemma of the spermatozoon during epididymal transit of a marsupial, the brush-tail possum, Trichosurus vulpecula, are described. Freeze-fracture studies indicate a change in organization of plasmalemma intramembranous particles of both the head and midpiece of the tail as the spermatozoa pass from the caput to cauda epididymides. Staining with fluorescein isothiocyanate (FITC)-lectins shows, that heads of caput spermatozoa stain with Con A, WGA, RCA120, LCA and JAC, whereas those from the cauda epididymides stain only with LCA and JAC, thus suggesting that N-acetyl-beta-D-glucosamine, alpha-D-glucose, or beta-D-galactose may either become lost or masked during epididymal transit. A reduction of alpha-D-mannose is also suggested. Collectively these results show that the plasmalemma of the spermatozoon of at least this marsupial species undergoes both protein and saccharide modification during transit of the epididymis. How these findings relate to sperm maturation in preparation for sperm-egg binding has yet to be determined.

Acetylglucosamine↗

PubMed1997

Neonatal screening for inborn errors of metabolism: cost, yield and outcome.

OBJECTIVES. To systematically review the literature on inborn errors of metabolism, neonatal screening technology and screening programmes in order to analyse the costs and benefits of introducing screening based on tandem mass-spectrometry (tandem MS) for a wide range of disorders of amino acid and organic acid metabolism in the UK. To evaluate screening for cystic fibrosis, Duchenne muscular dystrophy and other disorders which are tested on an individual basis. HOW THE RESEARCH WAS CONDUCTED. Systematic searches were carried out of the literature on inborn errors of metabolism, neonatal screening programmes, tandem MS-based neonatal screening technology, economic evaluations of neonatal screening programmes and psychological aspects of neonatal screening. Background material on the biology of inherited metabolic disease, the basic philosophy, and the history and current status of the UK screening programme was also collected. Relevant papers in the grey literature and recent publications were identified by hand-searching. Each paper was graded. For each disease an aggregate grade for the state of knowledge in six key areas was awarded. Additional data were prospectively collected on activity and costs in UK neonatal screening laboratories, and expert clinical opinion on current treatment modalities and outcomes. These data were used to construct a decision-analysis model of neonatal screening technologies, comparing tandem MS with the existing phenylketonuria screening methods. This model determined the cost per additional case identified and, for each disease, the additional treatment costs per case, and the cost per life-year saved. All costs and benefits were discounted at 6% per annum. One-way sensitivity analysis was performed showing the effect of varying the discount rate, the incidence rate of each disorder, the number of neonates screened and the cost of tandem MS, on the cost per life-year gained. RESEARCH FINDINGS. The UK screening programmes for phenylketonuria and congenital hypothyroidism have largely achieved the expected objectives and are cost-effective. Current concerns are the difficulty of maintaining adequate coverage, perceived organisational weaknesses, and a lack of overview. For many of the organic acid disorders it was necessary to rely on data obtained from clinically-diagnosed cases. Many of these diseases can be treated very effectively and a sensitive screening test was available for most of the diseases. Except for cystic fibrosis, there have been no randomised controlled trials of the overall effectiveness of neonatal screening. Despite the anxiety generated by the screening process, there is strong parental support for screening. The effects of diagnosis through screening on subsequent reproductive behaviour is less clear. Conflicts exist between current concepts and the traditional principles of screening. The availability of effective treatment is not an absolute prerequisite: early diagnosis is of value to the family concerned and, to the extent that is leads to increased use of prenatal diagnosis, may help to reduce the overall burden of disease. Neonatal screening is also of value in diseases which present early but with non-specific symptoms. Indeed, almost all of the diseases considered could merit neonatal screening. The majority of economic evaluations failed to incorporate the health benefits from screening, and therefore failed to address the value of the information which the screening programmes provided to parents. The marginal cost of changing from present technology to tandem MS would be approximately 0.60 pounds per baby at a workload of 100,000 samples a year, and 0.87 pounds at 50,000 samples per year. The ability to screen for a wider range of diseases would lead to the identification of some 20 additional cases per 100,000 infants screened, giving a laboratory cost per additional diagnosis of 3000 pounds at an annual workload of 100,000 babies per year.(ABSTRACT TRUNCATED)

Cost-Benefit Analysis↗

PubMed1995

An evaluation of visual assessment for fertility in Brahman cross cows using the Bonsma technique.

A technique of visual assessment of cattle for reproductive efficiency, described by Professor Jan Bonsma of South Africa, was evaluated in two well-managed large herds of 1/2 to 3/4 Brahman cross heifers and cows located in the dry tropics of north Australia. Individual lifetime performance records were available for all animals. Experienced cattlemen carried out the assessments. Higher scores were previously claimed to indicate higher fertility. The technique had high repeatability (0.7) and was quickly learned by the assessors. Scores from visual assessment had no useful predictive value for either heifer or cow fertility or for growth rate up to 27 mo of age, although 2.5-yr-old heifers which were scored as subfertile matured into 4% smaller cows than heifers which had scored higher. Scores decreased as fatness increased (P < 0.05). Some biases in visual assessment occurred. Lactating cows scored higher than nonlactating cows (P < 0.05), independently of their reproductive record. Red and grey cows scored higher than brindle and black/brown cows (P < 0.05). Bonsma scores were not influenced by the percentage of Brahman in the genotype. Significant, but apparently random, age effects on scores also occurred. It was concluded that the visual assessment criteria described by Bonsma were of no practical value in assessing potential productivity of breeding animals in well-managed Brahman cross cattle in the dry tropics.

Journal Article↗