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Biomedical subjects

P West

Publications and source records attributed to P West.

At least 19 recordsLinked to original sources
PubMed2006

Characterization of extended-spectrum beta-lactamase (ESBL)-producing Kuwait and UK strains identified by the Vitek system, and subsequent comparison of the Vitek system with other commercial ESBL-testing systems using these strains.

Two hundred and fifty-one unique patient isolates of Klebsiella pneumoniae (123), Escherichia coli (114), Klebsiella oxytoca (7), Enterobacter cloacae (5) and Citrobacter freundii (2), flagged as extended-spectrum beta-lactamase (ESBL) positive by the Vitek system (GNS-526 card), were collected. These strains were isolated from a variety of clinical specimens submitted to the clinical bacteriology laboratories of the Royal Infirmary of Edinburgh (RIE), Edinburgh, UK (and associated GP practices), Hairmyers Hospital, Glasgow, UK, and the Amiri and Farwania Hospitals, Kuwait. Of the 101 RIE strains tested, 15 E. coli strains were found to be ESBL negative by Etest ESBL strips. On retesting the 15 E. coli strains with the Vitek GNS-532 card, 14 were found to be ESBL negative, despite being originally flagged as ESBL positive. The remaining 236 ESBL-producing strains were also subjected to the double disc-diffusion (DDD) technique for the detection of ESBLs. Of these, two were false negatives by Etest ESBL test strips (using both cefotaxime and ceftazidime strips), and 38 were false negatives by the DDD method. The Etest false-negative ESBL-producing strains of K. pneumoniae were positive by DDD. Technically, the Vitek method was the least demanding method to perform, as it was an integral part of the routine susceptibility test card. Etest strips were reliable, but were the most expensive of all the techniques used. The DDD test, while relatively inexpensive, was technically subjective, and in our hands, seven of the ESBL-positive strains that were confirmed by the other two techniques were not detected. Despite the false-positive ESBL-producing E. coli strains, the Vitek susceptibility card with its integral ESBL test offers the clinical laboratory a valuable and quick option to screen for ESBL-producing Klebsiella spp. and E. coli as part of the routine laboratory methodology.

Anti-Bacterial Agents↗
PubMed2005

Assessment of quality of life in the supportive care setting of the big lung trial in non-small-cell lung cancer.

PURPOSE: The Big Lung Trial (BLT) was a large, pragmatic trial to evaluate the addition of chemotherapy to primary treatment (ie, surgery, radical radiotherapy, or supportive care) in non-small-cell lung cancer (NSCLC). In the supportive care group, there was a small but significant survival benefit in patients treated with chemotherapy compared with supportive care alone (no chemotherapy). A substudy was undertaken to evaluate the quality of life (QoL) implications of the treatment options. QoL was assessed using European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires C30 (QLQ-C30) and LC17, and daily diary cards. PATIENTS AND METHODS: EORTC QLQ-C30 and LC17 were collected at 0, 6 to 8, 12, 18, and 24 weeks. Diary cards were completed during the first 12 weeks of the study. The primary end point was global QoL at 12 weeks. RESULTS: A total of 273 patients were randomly assigned: 138 to no chemotherapy and 135 to chemotherapy. There was no evidence of a large detrimental effect on QoL of chemotherapy. No statistically significant differences in global QoL or physical/emotional functioning, fatigue and dyspnea, and pain were detected at 12 weeks. Higher rates of palliative radiotherapy in the no chemotherapy arm may have lessened differences in QoL. Global QoL, role functioning, fatigue, appetite loss, and constipation were prognostic indicators of survival at 12 weeks. CONCLUSION: There were no important adverse effects of chemotherapy on QoL.

Aged↗
PubMed2005

Dietary habits and children's family lives.

PURPOSE: To investigate associations between 'less healthy eating' and 'unhealthy snacking' at age 11, and family life (family structure, meals and maternal employment status) together with potential socio-economic confounders and gender. METHODS: Children participated in a school-based survey, questionnaires also being completed by parents. Analyses were based on those with complete data, weighted to account for bias in return of parental questionnaires (N = 2146). Data from a dietary inventory, questions on food choice and snacks were used to classify 'less healthy eating' and 'unhealthy snacking'. RESULTS: Less healthy eating' (57%) and 'unhealthy snacking' (32%) were associated with greater deprivation, fewer maternal qualifications and being male. Compared with children of full-time homemakers, the likelihood of 'less healthy eating' was reduced among those whose mothers worked part-time (this effect remaining after socio-economic adjustment), full-time (effect removed after adjustment), or were unemployed, sick or disabled (effect emerging after adjustment). 'Unhealthy snacking' was not related to maternal employment, and neither measure was associated with family structure or daily meals. CONCLUSIONS: There was no evidence that family structure or meals were associated with children's diets, although maternal employment had a positive association. Contrasting with the size of these effects, relationships between diet and socio-economic status were strong.

Adolescent↗
PubMed2005

Estimation of the additional costs of chemotherapy for patients with advanced non-small cell lung cancer.

BACKGROUND: A large multicentre randomised trial, the Big Lung Trial, which in part compared supportive care with or without cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer, provided an opportunity to evaluate the impact on the UK National Health Service of the costs incurred with the use of chemotherapy. METHODS: This costing study was based on the retrospective collection of resource use data from hospital records. Case notes from 194 patients (98 chemotherapy + supportive care (C), 96 supportive care alone (NoC)) were inspected in eight centres recruiting the largest numbers of patients into the Big Lung Trial. Quantities were multiplied by fixed unit costs to calculate a total cost for each patient. The main outcome measure was the total cost incurred by the use of secondary care resources (including investigations, chemotherapy, radiotherapy, surgical procedures, inpatient days, outpatient attendances, and hospice inpatient care) in the two groups. RESULTS: Patients randomised to receive cisplatin-based chemotherapy had an average of 3.4 more inpatient bed days than the mean of 11.9 days for patients randomised to supportive care alone, and more outpatient attendances. NoC patients were more likely to have received palliative radiotherapy. The mean total cost for C patients was 5355 sterling pound compared with 3595 sterling pound for the NoC group, difference 760 sterling pound (95% CI 781 sterling pound to 2742 sterling pound ). When split, the cost in the C group associated with the administration of chemotherapy was 1233 sterling pound and non-chemotherapy costs were 4122 sterling pound . CONCLUSION: The additional cost of chemotherapy was not offset by a reduction in subsequent costs (as the non-chemotherapy costs were similar), so the survival benefit of about 10 weeks observed in the C group was achieved with the cost of chemotherapy administration.

Adult↗
PubMed2004

Chemotherapy versus supportive care in advanced non-small cell lung cancer: improved survival without detriment to quality of life.

BACKGROUND: In 1995 a meta-analysis of randomised trials investigating the value of adding chemotherapy to primary treatment for non-small cell lung cancer (NSCLC) suggested a small survival benefit for cisplatin-based chemotherapy in each of the primary treatment settings. However, the meta-analysis included many small trials and trials with differing eligibility criteria and chemotherapy regimens. METHODS: The aim of the Big Lung Trial was to confirm the survival benefits seen in the meta-analysis and to assess quality of life and cost in the supportive care setting. A total of 725 patients were randomised to receive supportive care alone (n = 361) or supportive care plus cisplatin-based chemotherapy (n = 364). RESULTS: 65% of patients allocated chemotherapy (C) received all three cycles of treatment and a further 27% received one or two cycles. 74% of patients allocated no chemotherapy (NoC) received thoracic radiotherapy compared with 47% of the C group. Patients allocated C had a significantly better survival than those allocated NoC: HR 0.77 (95% CI 0.66 to 0.89, p = 0.0006), median survival 8.0 months for the C group v 5.7 months for the NoC group, a difference of 9 weeks. There were 19 (5%) treatment related deaths in the C group. There was no evidence that any subgroup benefited more or less from chemotherapy. No significant differences were observed between the two groups in terms of the pre-defined primary and secondary quality of life end points, although large negative effects of chemotherapy were ruled out. The regimens used proved to be cost effective, the extra cost of chemotherapy being offset by longer survival. CONCLUSIONS: The survival benefit seen in this trial was entirely consistent with the NSCLC meta-analysis and subsequent similarly designed large trials. The information on quality of life and cost should enable patients and their clinicians to make more informed treatment choices.

Adult↗
PubMed2001

Delta-conotoxin structure/function through a cladistic analysis.

Delta-conotoxins are Conus peptides that inhibit inactivation of voltage-gated sodium channels. The suggestion that delta-conotoxins might be an essential component of the venoms of fish-hunting cone snails which rapidly immobilize their prey [Terlau, H., Shon, K., Grilley, M., Stocker, M., Stühmer, W., and Olivera, B. M. (1996) Nature 381, 148-151] has not been tested. On the basis of cDNA cloning, all of the fish-hunting Conus analyzed yielded at least one delta-conotoxin sequence. In addition, one delta-conotoxin isolated from the venom of Conus striatus had an amino acid sequence identical to that predicted from cDNA cloning. This new peptide exhibited properties of delta-conotoxins: it targeted sodium channels and potentiated action potentials by slowing channel inactivation. Homologous sequences of delta-conotoxins from two groups (clades) of related fish-hunting Conus species share consensus features but differ significantly from the two known delta-conotoxins from mollusc-hunting Conus venoms. Three large hydrophobic amino acids were conserved; analogues of the previously described delta-conotoxin PVIA with alanine substituted for the conserved amino acids F9 and I12 lost substantial biological activity. In contrast, both the T8A and K13A delta-conotoxin PVIA analogues, where substitutions were at nonconserved loci, proved to be biologically active. Taken together, our results indicate that a cladistic approach can identify amino acids critical for the activity of conotoxins and provide extensive information as to which amino acid substitutions can be made without significant functional consequences.

Action Potentials↗
PubMed2001

FTIR microscopic imaging of collagen and proteoglycan in bovine cartilage.

Articular cartilage, a connective tissue that provides resistance to compressive forces during joint movements, has not been examined in detail by conventional Fourier transform infrared (FTIR) spectroscopy, microspectroscopy (FTIRM), or imaging (FTIRI). The current study reports FTIRM and FTIRI analyses of normal bovine cartilage and identifies the specific molecular components of cartilage that contribute to its IR spectrum. FTIRM data acquired through the superficial, middle, and deep zones of thin sections of bovine articular cartilage showed a variation in intensities of the absorbance bands that arise from the primary nonaqueous components of cartilage, collagen, and proteoglycan (primarily aggrecan) and thus reflected the differences in quantity of these specific components. The spectra of mixtures of model compounds, which had varying proportions of type II collagen and aggrecan, were analyzed to identify spectral markers that could be used to quantitatively analyze these components in cartilage. Collagen and aggrecan were then imaged by FTIRI based on markers found in the model compounds. Polarization experiments were also performed to determine the spatial distribution of the collagen orientation in the different zones of cartilage. This study provides a framework in which complex pathological changes in this heterogeneous tissue can be assessed by IR microscopic imaging.

Animals↗
PubMed2001

Social class and smoking at age 15: the effect of different definitions of smoking.

AIM: To explore whether the association between social class and smoking among teenagers varies according to the definition of smoking adopted. Design, setting and participants. A survey of 2196 15-year-olds in 43 secondary schools in the West of Scotland. MEASURES: Current smoking status and number of cigarettes smoked, and social class based on the occupation of the head of the household. FINDINGS: 'Current smoker' was the only category not significantly differentiated by class; the ratio of smokers from unskilled compared with professional backgrounds rose with increasingly stringent definitions of smoking. CONCLUSION: The extent to which teenage smoking is patterned by social class depends on the definition of smoking adopted.

Adolescent↗
PubMed2001

Clinical trials in a rural population: professional education aspects.

BACKGROUND: While the majority of cancer patients in rural New Hampshire and Vermont are treated in community hospitals, few have entered clinical trials. This report describes a rural hospital consortium as a single Cancer and Leukemia Group B (CALGB) affiliate that used local cancer teams and itinerant oncologists to develop a clinical trials program. METHOD: Grafted onto an existing oncology outreach program, educational programs were developed to help identify patients and recruit them to cooperative group clinical trials. Outcomes included the number of patients accrued to clinical trials, and a comparison of the quality of audited research records with those of affiliated institutions of the CALGB. The consequences of the program were to measure changes in patterns of care of breast, prostate, colorectal, and lung cancers during the study period. These included diagnostic, staging, and treatment changes that occurred over time. RESULTS: 3.3% of incident cases were accrued to clinical trials during the study period, more often for breast and colorectal than for lung and prostate cancers. Reasons that were identified for low accrual were lack of clinical trials for the majority of cases, including the elderly. More than 65% of the patients in the outreach population were older than 65, compared with 50% at the cancer center. Patterns of care did change for breast and prostate cancers, but were similar to national trends.

Adult↗
PubMed2001

Poor but healthy? The youngest generation of Irish catholics in west Scotland.

OBJECTIVE: Catholic adults in the West of Scotland, who are mainly of Irish origin, have been shown to suffer excess morbidity and mortality compared to the general population. A major contributing factor to this inequality is socio-economic disadvantage. This paper investigates the health and socio-economic position of Catholics in the youngest generation. DESIGN: Secondary analysis of baseline data from the West of Scotland 11-16 STUDY: Teenage Health, which is a longitudinal school-based survey. SETTING: One hundred and thirty five primary schools in Glasgow and surrounding districts. SUBJECTS: Two thousand five hundred and eighty six final-year pupils (average age eleven years and three months), born in 1983/1984. RESULTS: Comparing Catholics and non-Catholics on a range of indicators of general health, recent acute symptoms, chronic conditions, mental health and physical measures, we found no evidence of any systematic health inequality. A few indicators did show statistically significant differences at the five percent level, but these were not in any consistent direction. In terms of household socio-economic position, though, we found strong evidence of disadvantage for Catholics. Catholic children were more likely to have parents of manual social class, without any formal qualifications, who were less likely to own their home or a car, more likely to express difficulty 'making ends meet', and more likely to live in a deprived area. CONCLUSIONS: We discuss the prospects for diminishing socio-economic inequality over time between Catholics and non-Catholics in this cohort, which will depend on Catholic social mobility. We consider the likelihood of enduring health equality for Catholics, which will depend on the effects of different influences on health over the life course.

Catholicism↗
PubMed2000

Impurity-induced suppression of core turbulence and transport in the DIII-D tokamak

Turbulence is significantly reduced in a tokamak plasma as a result of neon seeding of an L-mode discharge. Correspondingly, confinement is improved and cross-field ion thermal transport reduced. Fully saturated turbulence in the range 0.1</=k( perpendicular)rho(s)</=0. 6 is measured at rho = 0.7 and exhibits a factor of 5 reduction in total power after neon injection, with almost complete suppression for k( perpendicular)rho(s)>0.35. These observations are consistent with a reduction in the calculated linear growth rate for k( perpendicular)rho(s)>0.5 and an increase in the measured ExB flow shearing rate.

Journal Article↗
PubMed2000

Evaluating theories of alcohol-related aggression using observations of young adults in bars.

AIMS: The objective of the present study is to evaluate 36 explanations of alcohol-related aggression that have been proposed in the research literature in terms of their relevance to naturally-occurring incidents of aggression involving alcohol. DESIGN: The study involved content analysis of descriptions of 105 incidents of aggression. SETTING AND PARTICIPANTS: Bars frequented by young adults. MEASUREMENTS: Step-by-step descriptions of incidents of aggression reported by researcher-observers based on 93 nights of observation in bars between midnight and 3 a.m. FINDINGS: Some explanations relating to the effects of alcohol (e.g. focused on the present, reduced anxiety about sanctions or danger, heightened emotionality) and the environment (e.g. generally permissive environment, expectation by patrons that aggression will be tolerated) were found to be relevant to most incidents, while other explanations (e.g. crowding, release of pent-up anger) were directly relevant to only a few or no incidents. Incidents involving male-to-male aggression were more likely than incidents involving both males and females to be attributable to expectations, acceptance of aggression, power concerns, male honor and "macho" values. Principal components analysis identified five groupings of explanations: risk-taking effects of alcohol, cognitive impairment from alcohol, hyperemotional effects of alcohol, "macho" subculture, and permissive environment. CONCLUSIONS: The findings are consistent with a model of alcohol-related aggression that involves multiple contributing factors including alcohol effects and situational contexts. The greater relevance of certain explanations and the natural groupings of explanations point to directions for future research.

Adolescent↗
PubMed2000

Alcohol-related aggression in the general population.

OBJECTIVE: This study estimates the relationships between drinking in the event and drinking patterns and different levels of aggression severity. METHOD: A telephone survey of 1,001 adults (542 women) age 18 and over was conducted (response rate of 67%) using computer assisted telephone interviewing (CATI). Respondents were asked whether they had been personally involved in a serious argument, an incident involving threat, or physical aggression in the past year and whether anyone had been drinking alcohol in the most recent incident. Respondents also reported their typical alcohol consumption patterns. RESULTS: The proportion of respondents reporting involvement in serious arguments, threats or physical aggression was 19.8%, 11.8% and 12.0%, respectively. Someone in the incident had been drinking in 38.1% of serious arguments, 56.5% of threats and 67.9% of incidents of physical aggression. When gender, age, education, marital status and employment status were controlled for, high quantity drinking (as measured by the largest number of drinks consumed on one drinking occasion in the past year), overall estimated annual volume of alcohol consumed, and frequency of consuming five drinks per occasion were significantly greater for physical aggression, compared with arguments and no aggression. However, drinker status (abstainer/drinker) and frequency of drinking were not significantly associated with involvement in aggression. In a logistic regression analysis controlling for demographic variables, a composite measure of alcohol consumption was highly significant for physical aggression versus no aggression and for physical versus verbal aggression. Physical aggression was also associated with being younger, separated/ divorced and a student. CONCLUSIONS: The results suggest that alcohol intoxication, rather than mere alcohol consumption, is associated with aggression. Moreover, alcohol intoxication is more strongly associated with physical aggression than with verbal aggression.

Adolescent↗