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Wysham C, Bergenstal R, Malloy J, Yan P, Walsh B, Malone J, Taylor K. DURATION-2: efficacy and safety of switching from maximum daily sitagliptin or pioglitazone to once-weekly exenatide. Diabet Med 2011; 28:705-14. [PMID: 21434995 PMCID: PMC3123706 DOI: 10.1111/j.1464-5491.2011.03301.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS In the initial 26-week, double-blind, double-dummy assessment period of the DURATION-2 trial in patients with Type 2 diabetes on metformin, the once-weekly glucagon-like peptide 1 (GLP-1) receptor agonist exenatide once-weekly resulted in greater HbA(1c) improvement and weight reduction compared with maximum approved daily doses of sitagliptin or pioglitazone. This subsequent, 26-week, open-label, uncontrolled assessment period evaluated the safety and efficacy of (i) continued exenatide once-weekly treatment and (ii) switching from sitagliptin or pioglitazone to exenatide once-weekly. METHODS Randomised oral medications were discontinued and all patients received exenatide once-weekly. Of the 364 patients [original baseline HbA(1c) 8.5 ± 1.1% (70 mmol/mol), fasting plasma glucose 9.0 ± 2.5 mmol/l, weight 88 ± 20 kg) who continued into the open-label period, 319 patients (88%) completed 52 weeks. RESULTS Evaluable patients who received only exenatide once-weekly demonstrated significant 52-week improvements (least square mean ± se) in HbA(1c) (-1.6 ± 0.1%), fasting plasma glucose (-1.8 ± 0.3 mmol/l) and weight (-1.8 ± 0.5 kg). Evaluable patients who switched from sitagliptin to exenatide once-weekly demonstrated significant incremental improvements in HbA(1c) (-0.3 ± 0.1%), fasting plasma glucose (-0.7 ± 0.2 mmol/l) and weight (-1.1 ± 0.3 kg). Patients who switched from pioglitazone to exenatide once-weekly maintained HbA(1c) and fasting plasma glucose improvements (week 52: -1.6 ± 0.1%, -1.7 ± 0.3 mmol/l), with significant weight reduction (-3.0 ± 0.3 kg). Exenatide once-weekly was generally well tolerated and adverse events were predominantly mild or moderate in intensity. Nausea was the most frequent adverse event in this assessment period (intent-to-treat: exenatide once-weekly-only 5%; sitagliptin→exenatide once-weekly 11%; pioglitazone→exenatide once-weekly 10%). No major hypoglycaemia was observed. CONCLUSIONS Patients who switched to once-weekly exenatide from daily sitagliptin or pioglitazone had improved or sustained glycaemic control, with weight loss.
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Ambler DR, Diamond MP, Malone J. Haemophilus influenzae abscess: inclusion in the differential diagnosis of a large pelvic mass? J Minim Invasive Gynecol 2010; 17:104-6. [PMID: 20129341 DOI: 10.1016/j.jmig.2009.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Revised: 09/04/2009] [Accepted: 09/14/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND This report describes an unusual first case in which an abscess containing Haemophilus influenzae incorporates the entire uterine cavity without overt signs of infection. CASE A 39-year-old woman presented with right lower quadrant abdominal pain and a large abdominal pelvic mass. Evaluation with computed tomography and ultrasonography showed a 20- x 14- x 10-cm cystic mass arising from the uterus. Tumor markers were negative. The patient underwent a total abdominal hysterectomy. Intraoperative findings included a 20-cm intramyometrial uterine abscess, completely replacing the uterine cavity. The abscess was densely adhered to the sigmoid colon. The mass was ruptured during the surgical procedure when mobilizing it off the colon, and cultures were obtained. Microbiologic culture illustrated H. influenzae. Pathologic diagnosis confirmed an intramyometrial abscess, originating from the wall of the uterus occupying the entire uterine cavity, lined with granulation tissue, foamy macrophages, and chronic inflammation. CONCLUSION Intramyometrial abscesses can masquerade as degenerating fibroids and, even with microorganisms, can exist without overt signs or symptoms of an active infection.
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Grinblatt D, Narang M, Malone J, Sweet D, Dunne T, Sullivan K. P121 Patients with hematologic disorders receiving azacitidine who are enrolled in AVIDA, a longitudinal patient registry, achieve transfusion independence. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70202-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Al-wahab Z, Malone J, Bryant C, Shah J, Vay A, Ali R, Solomon L, Morris R. Papillary Serous Carcinoma of the Cervix: Case Report. J Minim Invasive Gynecol 2008. [DOI: 10.1016/j.jmig.2008.09.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wright SE, Baudouin SV, Kaudeer N, Shrestha S, Malone J, Burn L, Kanagasundaram NS. Patient flow from critical care to renal services: a year-long survey in a critical care network. QJM 2008; 101:643-8. [PMID: 18577544 DOI: 10.1093/qjmed/hcn071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The NSF for Renal Services stresses the importance of collaboration between renal services and critical care networks in managing patients with acute renal failure in the most clinically appropriate setting. Anecdotal evidence in our region suggested that some patients were remaining on critical care inappropriately because of a lack of capacity for step-down care in local renal units. AIM To determine the number of extra days patients spend on critical care receiving single-organ renal support before transfer to a renal unit. DESIGN Prospective, multi-centre, service evaluation. METHODS Prospective data were collected over a one-year period by either daily telephone calls or bedside review. Follow-up data were retrieved from electronic and patient records. RESULTS Five hundred and forty-two patients received renal replacement therapy (RRT) in critical care. With 68 (12.5%) patients already receiving RRT for end-stage renal failure, this gave an incidence of new RRT on critical care of 234 per million population per year. The median duration of RRT on critical care was 4 days (range 1-30). One hundred and twenty-seven patients (23%) were discharged from critical care still requiring RRT. A period of single-organ renal support (median 2 days, range 1-8) was provided to 74 of these patients (58%) using 113 critical care bed days. DISCUSSION Over half of patients receiving RRT on discharge from critical care in our network received a short period of single-organ renal support before step-down. This may represent either delayed discharge from critical care or a potential opportunity for care in an alternative high-dependency facility.
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Bahrami S, Malone J, Webb K, Callen J. Tissue Eosinophilia as an Indicator of Drug-Induced Leukocytoclastic Vasculitis: A Clinicopathologic Investigation. J Cutan Pathol 2008. [DOI: 10.1111/j.0303-6987.2005.0320o.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Faulkner K, Malone J, Vano E, Padovani R, Busch HP, Zoetelief JH, Bosmans H. The SENTINEL project. RADIATION PROTECTION DOSIMETRY 2008; 129:3-5. [PMID: 18310611 DOI: 10.1093/rpd/ncn019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Health-care expenditure on radiological equipment in Europe is a growing fraction of the gross domestic product for all member states. This increase in expenditure has been driven by technical developments in equipment design, matched by the introduction of novel clinical practices, examinations and procedures. The radiation protection implications of these developments have to be assessed. The SENTINEL co-ordination action covered radiation protection, safety and related issues that arise from these technical and clinical developments. SENTINEL covered 90% of patient examinations in European Radiology, 60% of the collective dose from medical sources and approximately 50% of the collective dose to European citizens from man-made sources. The SENTINEL co-ordination actions 'main' objective was to address the safety and efficacy issues which are common to all digital diagnostic imaging systems, including nuclear medicine. High-dose procedures and sensitive groups (such as children) were covered by the project. Specifically, the co-ordination action aimed: (1) to establish both physical and clinical image quality criteria and link the two, (2) to undertake a series of dosimetry studies to establish the reference levels for new procedures and (3) to develop good practice guidelines for radiation protection in digital imaging and produce training material.
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Padovani R, Trianni A, Bokou C, Bosmans H, Jankowski J, Kottou S, Kepler K, Malone J, Tsapaki V, Salat D, Vano E, Vassileva J. Survey on performance assessment of cardiac angiography systems. RADIATION PROTECTION DOSIMETRY 2008; 129:108-111. [PMID: 18310097 DOI: 10.1093/rpd/ncn046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Advances in imaging technology have facilitated the development of increasingly complex interventional cardiac equipment. Consequently, there is a need for definitive equipment requirements. The aim of the study is to assess the performances of different cardiac angiographic systems. A questionnaire was sent to centres participating in SENTINEL Project to collect dosimetry data (typical entrance dose rate in fluoroscopy and imaging mode), image quality evaluations (low and high contrast resolutions) and KAP calibration factors. Results from this survey could contribute to the explanation of patient dose variability in angiographic cardiac procedures and to derive reference levels for cardiac angiographic equipment performance parameters.
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Foti C, Padovani R, Trianni A, Bokou C, Christofides S, Corbett RH, Kepler K, Korenová Z, Kosunen A, Malone J, Torbica P, Tsapaki V, Vano E, Vassileva J, Zdesar U. Staff dosimetry in interventional cardiology: survey on methods and level of exposure. RADIATION PROTECTION DOSIMETRY 2008; 129:100-103. [PMID: 18287188 DOI: 10.1093/rpd/ncn038] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
In interventional cardiac procedures, staff operates near the patient in a non-uniformly scattered radiation field. Consequently, workers may receive, over a period, relatively high radiation doses. The measurement of individual doses to personnel becomes critical due to the use of protective devices and, as a consequence of the large number of methods proposed to assess the effective dose, great variability in monitoring programmes is expected among European countries. SENTINEL consortium has conducted a survey on staff dosimetry methods and on the level of staff exposure in 12 European cardiac centres demonstrating the urgent need to harmonise dosimetry methods. From the dosimetry survey, constraint annual effective dose of 1.4 mSv and Hp(0.07) over the protective apron of 14 mSv are proposed for the optimisation the exposure the most-exposed operator.
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Vano E, Järvinen H, Kosunen A, Bly R, Malone J, Dowling A, Larkin A, Padovani R, Bosmans H, Dragusin O, Jaschke W, Torbica P, Back C, Schreiner A, Bokou C, Kottou S, Tsapaki V, Jankowski J, Papierz S, Domienik J, Werduch A, Nikodemova D, Salat D, Kepler K, Bor MD, Vassileva J, Borisova R, Pellet S, Corbett RH. Patient dose in interventional radiology: a European survey. RADIATION PROTECTION DOSIMETRY 2008; 129:39-45. [PMID: 18287189 DOI: 10.1093/rpd/ncn024] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.
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Dowling A, Gallagher A, O'Connor U, Larkin A, Gorman D, Gray L, Malone J. Acceptance testing and QA of interventional cardiology systems. RADIATION PROTECTION DOSIMETRY 2008; 129:291-294. [PMID: 18283061 DOI: 10.1093/rpd/ncn042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Interventional cardiology (IC) is a rapidly growing field of medical specialisation. Such procedures are complex and may subject patients and operators to higher levels of risk than those encountered in general radiology. Acceptance testing and quality assurance (QA) of radiological equipment, including IC equipment, is a requirement of the EU Medical Exposures Directive (MED) (97/43/EURATOM). In addition, the MED identifies interventional radiology as an area of special concern. This study presents the results of a survey of 17 IC systems (including several flat panel detector systems) in Irish hospitals. The results of the survey indicate large differences in patient doses between manufacturers for equivalent levels of measured image quality. In addition, all systems were found to have failed one or more acceptance tests, with 60% of systems demonstrating significant problems at acceptance testing. The results of the survey demonstrate the importance of acceptance testing and QA in IC. The results also provide baseline data, which may be used in the development of future QA guidelines.
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O'Connor U, Dowling A, Gallagher A, Gorman D, Walsh C, Larkin A, Gray L, Devine M, Malone J. Acceptance testing of fluoroscopy systems used for interventional purposes. RADIATION PROTECTION DOSIMETRY 2008; 129:56-58. [PMID: 18285319 DOI: 10.1093/rpd/ncn041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study presents the results of acceptance testing on 18 interventional fluoroscopy systems in Ireland. Acceptance testing and routine quality assurance (QA) of X-ray systems are the requirements of the EU Medical Exposures Directive (MED) and these requirements were subsequently implemented into Irish legislation. The MED states that special consideration should be given to the QA and dose assessment of high dose procedures such as interventional fluoroscopy. Owing to the advances in fluoroscopy technology, it has been found that comprehensive testing of interventional systems proves challenging in a busy hospital environment. A number of recurrent problems have been identified and are presented.
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Herrmann K, Limmer J, Henry R, Ratner R, Guan X, Malone J, Kendall D. Zwei-Jahres-Daten mit Exenatide bei Patienten mit Typ-2-Diabetes: Anhaltende glykämische Kontrolle bei gleichzeitiger Gewichtsreduktion. DIABETOL STOFFWECHS 2007. [DOI: 10.1055/s-2007-982164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Malone J. Operants Were Never "Emitted," Feeling Is Doing, And Learning Takes Only One Trial: A Review Of B. F. Skinner's Recent Issues In The Analysis Of Behavior. J Exp Anal Behav 2006; 71:115-20. [PMID: 16812889 PMCID: PMC1284696 DOI: 10.1901/jeab.1999.71-115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Morris RT, Alvarez RD, Malone J, Bryant C, Andrews SJ, Kilgore L, Phibbs GD, Heilbrun L, Munkarah AR. Phase II study of weekly topotecan in patients with relapsed platinum-sensitive ovarian or peritoneal cancer. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dowling A, Gallagher A, Walsh C, Malone J. Equipment standards for interventional cardiology. RADIATION PROTECTION DOSIMETRY 2005; 117:79-86. [PMID: 16461508 DOI: 10.1093/rpd/nci732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Interventional radiology has seen rapid growth in cardiology and represents an alternative to hazardous surgery. Recently there has been a substantial growth in the number of procedures being performed and interventional cardiology (IC) procedures are the most common interventional procedures in Europe. Advances in imaging technology have facilitated the development of increasingly complex radiological IC equipment. Currently, the technology is developing at a rate ahead of supporting research, equipment standards and a regulatory framework. International standards play a key role in the design, manufacture and performance of radiological IC equipment. A survey of 12 IC systems (15 imaging chains) was conducted in Irish hospitals. The aim of the study was to assess the imbalance between rapidly advancing technology and existing standards and to propose recommendations for new IC equipment standards. The results demonstrate the need for definitive equipment requirements and standardisation in the design, manufacture, acceptance and maintenance of IC equipment.
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Walsh C, Dowling A, Meade A, Malone J. Subjective and objective measures of image quality in digital fluoroscopy. RADIATION PROTECTION DOSIMETRY 2005; 117:34-7. [PMID: 16461534 DOI: 10.1093/rpd/nci708] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
There are numerous methods for assessing image quality in diagnostic X ray. In our study we assessed how imaging quality assurance methods perform in practice. Physics assessments were based on IPEM protocols using Leeds test objects. Clinical assessment was based on a questionnaire. A total of 15 systems in three European locations were assessed, covering a range of image intensifier-TV digital fluoroscopy units. Analysis of 274 clinical questionnaires showed that clinical and physics assessments did not place systems in the same order, based on a given image quality parameter. In almost all the comparisons, low level correlation was measured for statistical comparison of rank order (rs < 0.3). However, broad agreement was observed between physics and clinical assessments for image quality associated with contrast and noise. This study emphasises the importance of maintaining links with clinical assessment, when developing quality assurance metrics, and measuring the mutual performance of clinical and physical assessments of image quality.
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Reid A, Malone J. Q fever in Ireland. A seroprevalence study of exposure to Coxiella burnettii among Department of Agriculture workers. Occup Med (Lond) 2004; 54:544-7. [PMID: 15377752 DOI: 10.1093/occmed/kqh086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To estimate the risk of exposure to Coxiella burnettii among 'at risk' workers in Ireland. METHODS A cross-sectional seroprevalence study, using the complement fixation technique (CFT), was carried out among technical and support staff of the Department of Agriculture in Ireland (n = 375). Participants were divided into low- (n = 34), moderate- (n = 158) and high-risk (n = 83) groups according to the likelihood of occupational exposure. A result of <1:8 on CFT was accepted as normal, i.e. no evidence of past exposure to the causative organism, C. burnettii. Participants with titres of 1:16 were clinically assessed for evidence of past or present infection and interviewed regarding the possibility of non-occupational exposure. RESULTS The participation rate was 75% (n = 281). Overall, 24 of the 281 participants (8.5%, 95% confidence interval = 5.6-12.4%) tested positive (titres = 1:8). No statistically significant difference existed between the three groups (low, 8.8%; moderate, 9.5%; high, 7.2%). Of those reviewed (n = 10), no evidence of either past or present clinically significant illness was detected. Possible non-occupational exposure was identified in two cases. CONCLUSION Laboratory evidence of past exposure to Q fever is common amongst readily identifiable 'at risk' occupational groups in Ireland, and appropriate preventative steps are warranted. Employees who do not have direct exposure to animals or animal products, but who work in a high risk environment appear to have a similar risk of exposure C. burnettii. Although clinical illness appears to be rare, health care workers should consider the possibility of Q fever in cases of unexplained illness arising in those working in 'high risk' environments.
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Maclaren NK, Lan MS, Schatz D, Malone J, Notkins AL, Krischer J. Multiple autoantibodies as predictors of Type 1 diabetes in a general population. Diabetologia 2003; 46:873-4. [PMID: 12802500 DOI: 10.1007/s00125-003-1123-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2003] [Revised: 02/03/2003] [Indexed: 10/26/2022]
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Zhou XN, Hu XS, Yang GJ, Sun NS, Wang TP, Malone J, McCarroll J, Lin DD, Hong QB, Sun LP, Zhang ZY, Xu DZ. [Establishment of minimum medical geographic information systems database in China]. ZHONGHUA LIU XING BING XUE ZA ZHI = ZHONGHUA LIUXINGBINGXUE ZAZHI 2003; 24:253-6. [PMID: 12820938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To establish a minimum medical geographic information systems (GIS) database as a spatial decision supporting system (SDSS), and to use the database into public health practice in China. METHODS Spatial data collected from different sources were standardized as decimal degree format, including: (1) satellite images covering areas of China; (2) digital maps of China in vector files; (3) diseases database and relevant models. RESULTS Necessary satellite images for the database have been collected from NOAA AVHRR, Landsat TM, etc., including the normalized difference vegetation index (NDVI) images from AVHRR, earth surface temperature images from AVHRR, GTOPO30 DEM images from USGS and landuse images from USGS. The digital vector files for GIS analysis were collected including political (county, provinces, country) boundaries file, environmental (drainage, land cover, soil type) vector file, population data and climate data; Data on diseases mainly generated from survey or case reporting. Relevant models on transmission of Schistosoma japonicum and Plasmodium vivax, and models of Oncomelania hupensis and Anophores sinansis were developed, and the relevant environmental factors related to incidence of cancers were mapped, to test and verify those database. CONCLUSION The database unified the data from different sources for users. Minimum medical data included in the database could be used in the practice of public health. It is expected that this database be used in a wider range.
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Reid A, Malone J. A cross-sectional study of employer and employee occupational health needs and priorities within the Irish Civil Service. Occup Med (Lond) 2003; 53:41-5. [PMID: 12576564 DOI: 10.1093/occmed/kqg005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study aimed to establish how important an occupational health unit (OHU) is to its clients, and to identify the perceived needs and priorities for such a service. METHODS A cross-sectional postal survey of a stratified, randomly selected group of employees (n = 760) and all human resources (HR) managers (n = 34) was conducted in the Irish Civil Service. Each participant was requested to rate the overall importance of the OHU and to prioritize eight proposed functions for the unit: medical surveillance, general health education, pre-employment/promotion medical assessments, ill-health retirement assessments, return-to-work (after sick leave) assessments, occupational health education, research, and general medical screening. The results were analysed according to age group, gender, grade and occupation. RESULTS There was a response rate of 69% from employees and 74% from personnel managers. Significantly more HR managers than employees (92 versus 81%) thought an occupational health service was either important or very important. There were also differences in prioritization of functions by employees and HR managers. HR managers prioritized those functions concerned with assessing individuals' fitness for work, notably pre-employment/promotional health assessments, whereas employees consider group-directed 'preventative' functions to be more important, i.e. general medical screening, health education and medical surveillance. Both sets of opinions are not mutually exclusive, and considerable overlap exists, notably in the areas of occupational and general health education.
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Saad A, Lo S, Han I, Tekyi-Mensah S, Keole S, Orton C, Deppe G, Malone J, Munkarah A, Morris R, Christensen C, Forman J. Radiation therapy with or without chemotherapy for cervical cancer with periaortic lymph node metastasis. Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Munkarah AR, Morris R, Baumann P, Deppe G, Malone J, Diamond MP, Saed GM. Effects of prostaglandin E(2) on proliferation and apoptosis of epithelial ovarian cancer cells. ACTA ACUST UNITED AC 2002. [PMID: 12009392 DOI: 10.1016/s1071-5576(02)00141-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE There is strong evidence indicating that prostaglandins (PG) and their synthesizing enzyme cyclooxygenase-2 (COX-2) play an important role in tumorigenesis. The purposes of the present study were to determine the pattern of expression of COX-2 and the effect of PG treatment on proliferation and apoptosis in epithelial ovarian cancer cells. METHODS Two epithelial ovarian cancer cell lines, MDAH-2774 and SKOV3, were grown in flasks to confluence. Cells were then treated with exogenous dimethyl prostaglandin E(2) (dmPGE(2)) at increasing concentrations of 0-10 microg/mL. Total RNA was extracted from cells at different treatment doses and subjected to reverse transcriptase-polymerase chain reaction for the semiquantitative analysis of COX-2, Bcl-2, and bax expression. Flow cytometry was performed to assess effect of treatment on the cell cycle. The TUNEL assay was used to assess apoptosis. RESULTS We found that COX-2 was constitutively expressed in the MDAH-2774 and SKOV3 epithelial ovarian cancer cells as determined by detection of a 304-bp amplified fragment using specific primers for the COX-2 gene. Treatment of both cell lines with dmPGE(2) resulted in dose-dependently higher expression of COX-2, Bcl-2, and bax mRNA compared with untreated cells. These changes were associated with an increase in the proliferative fraction and with a simultaneous reduction in apoptosis. CONCLUSIONS Prostaglandin E(2) stimulated proliferation and reduced apoptosis in epithelial ovarian cancer cells. These effects were associated with overexpression of COX-2 and an increase in the ratio of Bcl-2:bax mRNA.
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Moore R, Mallonee S, Sabogal RI, Zanardi L, Redd J, Malone J. From the Centers for Disease Control and Prevention. Heat-related deaths--four states, July-August 2001, and United States, 1979-1999. JAMA 2002; 288:950-1. [PMID: 12201273 DOI: 10.1001/jama.288.8.950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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White NH, Cleary PA, Dahms W, Goldstein D, Malone J, Tamborlane WV. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr 2001; 139:804-12. [PMID: 11743505 DOI: 10.1067/mpd.2001.118887] [Citation(s) in RCA: 303] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Diabetes Control and Complications Trial (DCCT) demonstrated that intensive therapy of type 1 diabetes mellitus reduces the risk of development and progression of microvascular complications. The Epidemiology of Diabetes Interventions and Complications (EDIC) study assessed whether these benefits persisted after the end of DCCT. Results for the adolescent DCCT cohort are reported here. STUDY DESIGN Of the DCCT adolescent cohort (n = 195), 175 participated in EDIC, 151 had fundus photography, and 156 had albumin excretion rate measured at year 3 or 4. The odds of progression of retinopathy and albuminuria from closeout of the DCCT until EDIC year 4 were assessed. RESULTS In contrast to the 7.4 years of the DCCT, during which mean hemoglobin A(1c) levels were significantly lower with intensive therapy than conventional therapy (8.06% vs 9.76%; P <.0001), the subsequent first 4 years of EDIC had mean hemoglobin A(1c) levels that were similar between the former intensive and the former conventional groups (8.38% vs 8.45%). However, the prevalence of worsening of 3 steps or more in retinopathy and of progression to proliferative or severe nonproliferative retinopathy were reduced by 74% (P <.001) and 78% (P <.007), respectively, in the former intensive therapy group compared with the former conventional group. CONCLUSIONS These findings provide further support for the DCCT recommendation that most adolescents with type 1 diabetes receive intensive therapy aimed at achieving glycemic control as close to normal as possible to reduce the risk of microvascular complications.
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