Biomedical subjects

R Cook

Publications and source records attributed to R Cook.

At least 19 recordsLinked to original sources

PubMed2006

A new preference-based analysis for randomized trials can estimate treatment acceptability and effect in compliant patients.

BACKGROUND AND OBJECTIVES: Development of a new method of analysis to evaluate the acceptability of (or preferences for) the treatments in a randomized trial, and the benefit of treatment among compliers. MATERIALS AND METHODS: We characterize trial participants through the groups who would: accept either treatment if offered (compliers); refuse one treatment but accept the other if it is offered to them (two groups of preferers); or prefer one treatment and insist on it if it is not offered to them initially (two groups of insisters). RESULTS: We show that in our framework, one can always estimate the proportions of patients in these five preference groups. However, constraints are required to estimate the corresponding outcome rates, and thus estimate the treatment effect in the compliers. We propose two possible sets of constraints and illustrate them by numerical examples. CONCLUSIONS: The traditional intention-to-treat analysis avoids biases associated with the alternative per-protocol or as-treated approaches, but it provides imperfect information about the expected treatment effect among patients who are committed to taking the treatment. Many physicians and patients want to know the expected benefit if they adhere to the therapy. Our preference-based analysis provides an estimate of treatment benefit among such patients.

Carotid Stenosis↗

PubMed2006

The effects of birdsfoot trefoil (Lotus corniculatus) and chicory (Cichorium intybus) when compared with perennial ryegrass (Lolium perenne) on ovine gastrointestinal parasite development, survival and migration.

Two experiments were conducted to investigate the effects of birdsfoot trefoil and chicory on parasitic nematode development, survival and migration when compared with perennial ryegrass. In experiment one, sheep faeces, containing 10,385 Cooperia curticei eggs were added to 25 cm diameter pots containing birdsfoot trefoil, chicory or ryegrass, and the pots maintained under optimal conditions for nematode parasite development. Replicate pots of each forage type were destructively sampled on day 8, 16, 20, 28 and 37 to collect the nematode larvae. When forages were compared on a dry matter basis, by day 16 there were 31% and 19% fewer larvae on birdsfoot trefoil and chicory than on ryegrass, respectively (P<0.01). In the second experiment, replicate 1m(2) field plots of birdsfoot trefoil, chicory and ryegrass were sub-sampled on day 14, 21, 35 and 49 for larval counts following the application of sheep faeces containing 585,000 Teladorsagia circumcincta eggs to each plot on day 0. Results showed there were a minimum of 58% and 63% fewer infective stage parasitic larvae on birdsfoot trefoil and chicory, respectively, compared with ryegrass on day 14 and 35 when forages were compared on a forage dry matter, plot area sampled and leaf area basis (P<0.01). Overall, these results indicate that the number of infective stage larvae on birdsfoot trefoil and chicory pasture was reduced by the effect of their sward structure on the development/survival/migration of ovine parasitic nematodes. These effects may be one of the ways in which these forages may affect parasitic infections in grazing livestock.

Analysis of Variance↗

PubMed2006

Bovine respiratory syncytial virus lacking the virokinin or with a mutation in furin cleavage site RA(R/K)R109 induces less pulmonary inflammation without impeding the induction of protective immunity in calves.

The BRSV fusion (F) protein is cleaved at two furin consensus sequence sites, resulting in the generation of disulphide-linked F1 and F2 subunits and the release of an intervening peptide of 27 amino acids (pep27), which is converted into a biologically active tachykinin (virokinin). The role of the virokinin and the importance of one of the furin cleavage sites, FCS-2 [RA(R/K)R109], in the pathogenesis of BRSV infection and in the subsequent development of immunity was studied in gnotobiotic calves infected with a recombinant BRSV (rBRSV) lacking pep27 (rBRSVdelta p27) or with rBRSV108/109, which contains two amino acid substitutions in FCS-2 (RANN109). Although replication of the mutant viruses and the parental wild-type (WT) rBRSV in the lungs was similar, the extent of gross and microscopic lesions induced by the mutant viruses was less than that induced by WT rBRSV. Furthermore, the numbers of eosinophils in the lungs of calves infected with the mutant viruses were significantly less than that in calves infected with WT virus. These observations suggest a role for the virokinin in the pathogenesis of BRSV infection. Following mucosal immunization with rBRSVdelta p27, the levels of BRSV-specific serum antibodies were similar to those induced by WT virus. In contrast, the level of neutralizing antibodies induced by rBRSV108/109 was 10-fold lower than that induced by WT virus. Nevertheless, resistance to BRSV challenge induced by the mutant and WT viruses was similar, suggesting that neither pep27 nor FCS-2 plays a major role in the induction of protective immunity.

Amino Acid Sequence↗

PubMed2005

Getting to the point: developing IT for the sharp end of healthcare.

Healthcare demonstrates the same properties of risk, complexity, uncertainty, dynamic change, and time-pressure as other high hazard sectors including aviation, nuclear power generation, the military, and transportation. Unlike those sectors, healthcare has particular traits that make it unique such as wide variability, ad hoc configuration, evanescence, resource constraints, and governmental and professional regulation. While healthcare's blunt (management) end is more easily understood, the sharp (operator) end is more difficult to research the closer one gets to the sharp end's point. Understanding sharp end practice and cognitive work can improve computer-based systems resilience, which is the ability to perform despite change and challenges. Research into actual practice at the sharp end of healthcare will provide the basis to understand how IT can support clinical practice. That understanding can be used to develop computer-based systems that will act as team players, able to support both individual and distributed cognitive work at healthcare's sharp end.

Artificial Intelligence↗

PubMed2005

The isthmuses of the mesial root of mandibular molars: a micro-computed tomographic study.

AIM: To investigate the prevalence of root canal isthmuses in the apical 5 mm of the mesial root of mandibular molars by means of micro-computed tomography (MCT) and to describe the morphology of the isthmuses. METHODOLOGY: Twenty extracted mandibular first molars that had fully formed roots were selected. The mesial roots were sectioned from the distal roots and subjected to MCT. The number of sections showing isthmuses in each of the apical 5 mm of the root canals was recorded. In each one of the apical 5 mm of the 20 roots examined, 40 sections were observed, giving a total of 800 sections observed in each group. Data were analysed as a contingency table using the chi-square statistic to test the null hypothesis that location of the sections in each of the apical 5 mm and presence of the isthmus were independent. RESULTS: Isthmuses were found to be present at all levels with prevalence figures between 17.25 and 50.25%. The chi-square test indicated a significant difference in the distribution of isthmuses with section (P = 0.001). It was found that sections in the first millimetre from the apex had fewer isthmuses than expected and that sections in the third millimetre from the apex had more isthmuses than expected under the null hypothesis. Calcifications were found to be present in most isthmuses, occasionally lateral canals originated from the central part of the isthmuses. CONCLUSIONS: Isthmuses were present in the vast majority of roots observed. The third millimetre from the apex showed more isthmuses than expected. The results of clinical and surgical endodontic procedures performed in the mesial root of mandibular molars may be affected by this aspect of the root canal anatomy.

Dental Pulp Cavity↗

PubMed2005

"Going solid": a model of system dynamics and consequences for patient safety.

Rather than being a static property of hospitals and other healthcare facilities, safety is dynamic and often on short time scales. In the past most healthcare delivery systems were loosely coupled-that is, activities and conditions in one part of the system had only limited effect on those elsewhere. Loose coupling allowed the system to buffer many conditions such as short term surges in demand. Modern management techniques and information systems have allowed facilities to reduce inefficiencies in operation. One side effect is the loss of buffers that previously accommodated demand surges. As a result, situations occur in which activities in one area of the hospital become critically dependent on seemingly insignificant events in seemingly distant areas. This tight coupling condition is called "going solid". Rasmussen's dynamic model of risk and safety can be used to formulate a model of patient safety dynamics that includes "going solid" and its consequences. Because the model addresses the dynamic aspects of safety, it is particularly suited to understanding current conditions in modern healthcare delivery and the way these conditions may lead to accidents.

Efficiency, Organizational↗

PubMed2004

Associations with Vitamin D deficiency in "at risk" Australians.

In a study of 185 elderly living in assisted care and 192 frail aged living in the community in the Sydney metropolitan area, nursing home residents were found to be at a 3-fold and hostel dwellers at a 2-fold risk of Vitamin D [25(OH)D] deficiency (<25 nmol/L) compared to self care residents. Middle Eastern people were found to be at 4-fold risk and Vietnamese a 3-fold risk of deficiency compared to their Australian counterparts. In recently arrived Chinese immigrants, Vitamin D deficiency, was found in 28%, and marginal levels (<37 nmol/L) in 60%, compared to the 34 and 76% found in our nursing home population, and 25 and 57% in hostel care residents. Of the Middle Eastern elderly, 58% were deficient and 83% marginal; although only 18% of Vietnamese were deficient, 68% had marginal Vitamin D status. Other factors associated with Vitamin D deficiency were mobility and sun exposure in assisted care, and low dietary Vitamin D and calcium intake, reduced exercise levels and high % body fat levels in the immigrant groups.

Aged↗

PubMed2003

The effect of dietary forage on the development and survival of helminth parasites in ovine faeces.

Studies in New Zealand and the UK have shown that lambs grazing birdsfoot trefoil (Lotus corniculatus) or chicory (Cichorium intybus) have reduced parasite intensities compared to lambs grazing ryegrass swards. However, data in the literature on the influence of forages on helminth parasites is equivocal and the underlying mechanisms by which different forage diets may affect these parasites have not been fully determined. The aim of the experiments reported here was to investigate the hypothesis that the consumption of these forages does not affect the hatching and development of helminth eggs in the faeces subsequently produced by the host animal. Lambs grazed monoculture swards of birdsfoot trefoil, chicory, Italian ryegrass (Lolium multiflorum)/red clover (Trifolium pratense) or perennial ryegrass (Lolium perenne)/white clover (Trifolium repens) for 5 weeks and faecal samples collected on days 14, 21, 28 and 35 directly from the rectum of each lamb were used to prepare replicate cultures for each forage type on each occasion. The experiment was repeated over two consecutive years but ryegrass/red clover was not included in Year 2. The dry matter of all faeces was made constant and the faeces were cultured at 27 degrees C for 7 days, before larvae were extracted, counted and identified according to genus or, where possible, species. Overall, the results showed that forage diet had no effect on egg hatchability but significantly affected the development/survival of infective helminth larvae in the faeces of the host animal. Furthermore, feeding birdsfoot trefoil to lambs was found to increase the percentage of helminth parasites that reached the infective stage in the subsequent faeces compared to other forages. Further work is needed to assess whether this would increase the number of larvae on birdsfoot trefoil swards overall under field conditions and to understand the implications of these findings in an applied farming system.

Animal Husbandry↗

PubMed2003

The effect of birdsfoot trefoil (Lotus corniculatus) and chicory (Cichorium intybus) on parasite intensities and performance of lambs naturally infected with helminth parasites.

Conventionally, farmers rely upon the routine use of anthelmintics to control helminth parasites and their use has proved highly cost-effective. However, several factors, including the emergence of helminths resistant to pharmaceutical anthelmintics, are forcing farmers to seek alternative approaches to parasite control. Studies in New Zealand have shown that some alternative forages may reduce parasitic infestation in sheep. In the current study, it was found that under UK environmental conditions lambs with naturally acquired helminth infections grazing chicory (Cichorium intybus) and birdsfoot trefoil (Lotus corniculatus) had fewer helminth parasites than sheep grazing ryegrass/white clover (Lolium perenne/Trifolium repens). Twelve pure-bred Lleyn male lambs grazed replicated 0.5ha plots of birdsfoot trefoil, chicory or ryegrass/white clover for 5 weeks. Liveweight and faecal egg counts (FECs) were determined weekly and eight lambs per forage were slaughtered at the end of the trial to determine total helminth intensities. Lambs grazing birdsfoot trefoil had a lower FEC on day 7 (P<0.05) and fewer total adult helminths than those grazing the other forages on day 35 (P<0.01). Lambs grazing chicory did not have significantly lower FEC than lambs grazing other forages but these lambs were found to have fewer total adult abomasal helminths than lambs grazing ryegrass/white clover (P<0.001). As the performance of grazing lambs is inversely correlated with the intensity of helminth parasites, these alternative forages could be used to improve the liveweight gain of lambs produced in the UK. Overall, the results support the contention that alternative forages could have a positive role in the control of helminth parasites in sheep, subject to successful agronomic development and integration of these forages into whole farm systems.

Abomasum↗

PubMed2003

Aberrant monocyte prostaglandin synthase 2 (PGS2) expression in type 1 diabetes before and after disease onset.

METHODS: We examined monocyte prostaglandin synthase 2 (PGS2/COX2) expression in individuals at risk for or with type 1 diabetes including: (i) 58 established type 1 and 2 diabetic patients; (ii) 34 autoantibody positive (AA+) children and adults; (iii) 164 infants and young children with insulin-dependent diabetes mellitus (IDDM) susceptibility human leukocyte antigen (HLA) alleles; and (iv) 37 healthy control individuals, over a 5-yr period. RESULTS: Established type 1 diabetic patients (1 month to 30+ yr post-disease onset) had significantly higher PGS2 expression than healthy controls; by contrast, insulin-treated type 2 diabetic patients had significantly lower PGS2 expression than healthy controls. Longitudinal studies of AA+ subjects at risk for type 1 diabetes indicated that 73% (11/15) of individuals who developed this disease during the study period expressed high levels of PGS2 prior to or after onset. We also found high level PGS2 expression in genetically at-risk infants and young children that correlated with having a first-degree relative with type 1 diabetes, but not with age, gender, or HLA genotype. In this population, high level PGS2 expression coincided with or preceded autoantibody detection in 30% (3/10) of subjects. CONCLUSIONS: These findings suggest that high level monocyte PGS2 expression, although subject to fluctuation, is present in at-risk subjects at an early age and is maintained during progression to and after type 1 diabetes onset.

Adult↗

PubMed2003

Papaverine angioplasty to treat cerebral vasospasm following traumatic subarachnoid haemorrhage.

The management of vasospasm associated with traumatic subarachnoid haemorrhage presents many challenges. We present a 20-year-old male admitted after sustaining a closed head injury complicated by a Fisher grade III traumatic subarachnoid haemorrhage. Despite treatment with intravenous nimodipine he developed a delayed ischaemic neurological deficit due to cerebral arterial vasospasm. The vasospasm was successfully managed with serial papaverine angioplasty.

Adult↗

PubMed2002

Impacts of soil faunal community composition on model grassland ecosystems.

Human impacts, including global change, may alter the composition of soil faunal communities, but consequences for ecosystem functioning are poorly understood. We constructed model grassland systems in the Ecotron controlled environment facility and manipulated soil community composition through assemblages of different animal body sizes. Plant community composition, microbial and root biomass, decomposition rate, and mycorrhizal colonization were all markedly affected. However, two key ecosystem processes, aboveground net primary productivity and net ecosystem productivity, were surprisingly resistant to these changes. We hypothesize that positive and negative faunal-mediated effects in soil communities cancel each other out, causing no net ecosystem effects.

Animals↗

PubMed2002

The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

BACKGROUND AND OBJECTIVES: The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. MATERIALS AND METHODS: Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. RESULTS: The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. CONCLUSIONS: The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

Blood Banks↗

PubMed2002

Iron deficiency in autism and Asperger syndrome.

This research considers the prevalence of iron deficiency in children with autism and Asperger syndrome and examines whether this will influence guidelines and treatment. Retrospective analysis of the full blood count and, as far as available, serum ferritin measurements of 96 children (52 with autism and 44 with Asperger syndrome) was undertaken. Six of the autistic group were shown to have iron deficiency anaemia and, of the 23 autistic children who had serum ferritin measured, 12 were iron deficient. Only two of the Asperger group had iron deficiency anaemia and, of the 22 children who had their serum ferritin measured, only three were iron deficient. Iron deficiency, with or without anaemia, can impair cognition and affect and is associated with developmental slowing in infants and mood changes and poor concentration in children. This study showed a very high prevalence of iron deficiency in children with autism, which could potentially compromise further their communication and behavioural impairments.

Adolescent↗

PubMed2001

Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study.

BACKGROUND: Resuscitation directives should be a sign of patient's preference. Our objective was to ascertain prevalence, predictors, and procurement pattern of cardiopulmonary resuscitation directives within 24 h of admission to the intensive-care unit (ICU). METHODS: We enrolled 2916 patients aged 18 years and older from 15 ICUs in four countries, and recorded whether, when, and by whom their cardiopulmonary resuscitation directives were established. By polychotomous logistic regression we identified factors associated with a resuscitate or do-not-resuscitate directive. FINDINGS: Of 2916 patients, 318 (11%; 95% CI 9.8-12.1) had an explicit resuscitation directive. In 159 (50%; 44.4-55.6) patients, the directive was do-not-resuscitate. Directives were established by residents for 145 (46%; 40.0-51.3) patients. Age strongly predicted do-not-resuscitate directives: for 50-64, 65-74, and 75 years and older, odds ratios were 3.4 (95% CI 1.6-7.3), 4.4 (2.2-9.2), and 8.8 (4.4-17.8), respectively. APACHE II scores greater than 20 predicted resuscitate and do-not-resuscitate directives in a similar way. An explicit directive was likely for patients admitted at night (odds ratio 1.4 [1.0-1.9] and 1.6 [1.2-2.3] for resuscitate and do-not-resuscitate, respectively) and during weekends (1.9 [1.3-2.7] and 2.2 [1.5-3.2], respectively). Inability to make a decision raised the likelihood of a do-not-resuscitate (3.7 [2.6-5.4]) than a resuscitate (1.7 [1.2-2.3]) directive (p=0.0005). Within Canada and the USA, cities differed strikingly, as did centres within cities. INTERPRETATION: Cardiopulmonary resuscitation directives established within 24 h of admission to ICU are uncommon. As well as clinical factors, timing and location of admission might determine rate and nature of resuscitation directives.

APACHE↗

PubMed2001

Nitrate relationships between stream baseflow, well water, and land use in the Tomorrow-Waupaca Watershed.

We examined the use of stream baseflow water quality as a representative measure of mean ground water quality in the Tomorrow-Waupaca Watershed in central Wisconsin and the relationship between agricultural land use and watershed water quality. From 1997 to 1999, 38 stream sites were sampled for nitrate during winter and summer baseflow conditions. Some sites have been sampled during winter baseflow conditions since 1994. The land area contributing ground water to each stream sampling site was delineated, resulting in 38 sub-basins. In addition, over 3500 test results from private wells in the watershed were compiled and mapped using a Geographic Information System (GIS). Nitrate concentrations in stream baseflow and well waters were found to have strong positive correlation in the sub-basins of second order or higher. This indicates that stream baseflow may be valid for monitoring mean ground water quality in watersheds predominantly fed by ground water, where much of the stream nitrate is believed to originate from ground water. Analysis of seasonal variation in the stream data showed that winter nitrate concentrations were higher than summer concentrations, implying that winter stream monitoring may be more critical for the assessment of overall ground water quality in the watershed. We also found that, as the amount of agricultural land increased in each sub-basin, average nitrate concentrations in the well and stream waters also increased, suggesting a connection between agricultural land use and nitrate contamination of water resources in the watershed.

Agriculture↗

PubMed2001

Equity of access to a memory clinic in Melbourne? Non-English speaking background attenders are more severely demented and have increased rates of psychiatric disorders.

OBJECTIVES: The aim of this study was to compare demographic and clinical features of patients from Non-English Speaking Background (NESB) with those from English Speaking Background (ESB) who attended a memory clinic in Melbourne, Australia. METHODS: Data on 556 consecutive patients attending the memory clinic were analysed retrospectively. All patients were assessed by a geriatrician (Italian speaking) or psychogeriatrician with the aid of Cambridge Examination for Mental Disorders in the Elderly (CAMDEX) interview schedule. Patients were classified into the categories of dementia, functional psychiatric disorder (including depression), cognitive impairment other than dementia and normal, using ICD 10 criteria. Severity of dementia was determined using the Clinical Dementia Rating scale. Demographic information and use of community services were also documented. RESULTS: Of those seen, 148 (28.8%) were of NESB, the majority Italian (69, 12.4%). Patients of NESB were younger (p = 0.001), less educated (p = 0.001) and less likely to live alone (p = 0.009) compared to persons of ESB. Those of NESB were more likely present with a functional psychiatric disorder (particularly depression) or normal cognition (p = 0.001). Patients of NESB with dementia presented at a later stage of their disease as determined by CDR (p = 0.003). Those of NESB scored significantly lower (more impaired) on CAMCOG in all patients seen (including normal and psychiatric groups) (p = 0.02). CONCLUSIONS: The clinical and demographic features of people of NESB referred to a memory clinic in Melbourne, Australia, differ from their ESB counterparts, with specific groups being under represented. This has implications for equity of assessment, service provision and utilisation for those of ethnically diverse backgrounds.

Aged↗

PubMed2001

Degradation of [(14)C]carfentrazone-ethyl under aerobic aquatic conditions.

Carfentrazone-ethyl (CF-E) is an aryl triazolinone reduced-risk herbicide for use on corn, wheat, and soybean. As part of the assessment of its metabolic fate, the aerobic aquatic metabolism of [(14)C]CF-E at a concentration of 0.22 microg/g was investigated. Two separate aquatic sediments (silty clay loam and clay loam soils, flooded with water) were used in the study. At each of eight samplings throughout the 30-day study, the distribution of radioactivity between surface water, sediment, and volatile fractions was assessed. At zero time, the majority of the applied radioactivity was contained in the water layer (83-90%), declining to 70-80% after 30 days. This was coupled with an increase in the percent radioactivity in the soil layer from 4-6% at day 0 to 13-19% after 30 days. Nonextractable soil residues and volatile degradation products were formed in negligible amounts. Analysis of the incubation extracts from either aquatic sediment indicated a rapid conversion (<2 days) of the parent CF-E ester to carfentrazone-chloropropionic acid. Over time, increasing amounts of a cascade of acidic degradation products comprising >90% of the applied radioactivity were formed. Identification of these degradation products was initially achieved through chromatographic comparison with reference synthetic standards and subsequently confirmed using LC-MS analysis. A degradation pathway for CF-E under aerobic aquatic conditions is proposed.

Carbon Radioisotopes↗