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Noyes RD, Baker R, Mai B. Mendelian segregation for two-factor apomixis in Erigeron annuus (Asteraceae). Heredity (Edinb) 2006; 98:92-8. [PMID: 17021613 DOI: 10.1038/sj.hdy.6800907] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The inheritance of asexual seed development (apomixis) in Erigeron annuus (Asteraceae) was evaluated in a triploid (2n=3x=27) population resulting from a cross between an apomictic tetraploid (2n=4x=36) pollen parent and a sexual diploid (2n=2x=18) seed parent. Diplospory (unreduced female gametophyte formation) and autonomous development (embryo and endosperm together) segregated independently in the population yielding four distinct phenotype classes: (1) apomictic plants combining diplospory and autonomous development, (2) diplosporous plants lacking autonomous development, (3) meiotic plants with autonomous (though abortive) development and (4) meiotic plants lacking autonomous development. Each class was represented by approximately one-quarter of the population (n=117), thus corresponding to a two-factor genetic model with no linkage (chi(2)=2.59, P=0.11). Observations demonstrate that autonomous embryo and endosperm development (jointly) may occur in either reduced or unreduced egg cells. The cosegregation of the traits is attributed to tight linkage or pleiotropy. The data are consistent with the hypothesis that autonomous development in E. annuus is regulated by a single fertilization factor, F, which initiates development of both the embryo and the endosperm in the absence of fertilization.
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152
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Staton JM, Sayer MS, Hankey GJ, Attia J, Thakkinstian A, Yi Q, Cole VJ, Baker R, Eikelboom JW. Association between phosphodiesterase 4D gene and ischaemic stroke. J Neurol Neurosurg Psychiatry 2006; 77:1067-9. [PMID: 16914755 PMCID: PMC2077747 DOI: 10.1136/jnnp.2006.092106] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND An association between the phosphodiesterase 4D (PDE4D) gene and risk of ischaemic stroke in an Icelandic population has been suggested by the deCODE group. METHODS A case-control study of 151 hospitalised patients with first-ever ischaemic stroke and 164 randomly selected age-matched and sex-matched community controls was conducted. PDE4D genotypes for the six single-nucleotide polymorphisms (SNPs) previously reported to be independently associated with stroke were determined, common haplotypes were inferred using the expectation-maximisation algorithm, and SNP and haplotype associations with stroke were examined. A meta-analysis of published studies examining the association between PDE4D and stroke was also carried out. RESULTS Our study of Australian patients with stroke showed an independent association between ischaemic stroke and PDE4D SNP 89 (CC: odds ratio (OR) 5.55, 95% confidence interval (CI) 1.02 to 30.19; CA: OR 1.68, 95% CI 0.96 to 2.96; AA: OR 1 (reference)), SNP 87 (CC: OR 2.13, 95% CI 1.08 to 4.20; TC: OR 1.64, 95% CI 0.89 to 3.00; TT: OR 1 (reference)) and SNP 83 (TT: OR 2.16, 95% CI 1.08 to 4.32; TC: OR 1.37, 95% CI 0.77 to 2.43; CC: OR 1 (reference)), and between ischaemic stroke and PDE4D haplotypes at SNP 89-87-83 (A-C-C: OR 2.13, 95% CI 1.15 to 3.96; C-C-T: OR 2.25, 95% CI 1.29 to 3.92), but no association between ischaemic stroke and PDE4D SNP 56, SNP 45 or SNP 41, or with PDE4D haplotypes at SNP 56-45-41. A meta-analysis of nine case-control studies (including our current results) of 3808 stroke cases and 4377 controls confirmed a significant association between stroke and PDE SNP 87 (pooled p = 0.002), SNP 83 (0.003) and SNP 41 (0.003). However, there was statistical heterogeneity (p < 0.1) among the studies in the direction of association for each of the individual SNPs tested. CONCLUSIONS Our results and the pooled analyses from all the studies indicate a strong association between PDE4D and ischaemic stroke. This strengthens the evidence that PDE4D plays a key part in the pathogenesis of ischaemic stroke. Heterogeneity among the studies in the direction of association between individual SNPs and stroke suggests that the SNPs tested are in linkage disequilibrium with the causal allele(s).
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Schwartz MH, Koop SE, Bourke JL, Baker R. A nondimensional normalization scheme for oxygen utilization data. Gait Posture 2006; 24:14-22. [PMID: 16112865 DOI: 10.1016/j.gaitpost.2005.06.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Accepted: 06/05/2005] [Indexed: 02/02/2023]
Abstract
The total oxygen required for gait (gross utilization) is a widely used indicator of locomotor efficiency. The standard scheme of mass normalization (dividing gross utilization by mass) is intended to eliminate confounding effects that arise from variations in age and size. Despite its prevalence, mass normalization has been shown to be inadequate, as the normalized quantity retains a marked dependence on clinically relevant factors. The current study proposes a new scheme for normalizing oxygen utilization data. The new scheme, called net-nondimensional normalization, is based on the use of net oxygen utilization (gross-rest) and nondimensional gait variables. Measures of statistical significance are employed to demonstrate that net nondimensional normalization is superior to mass normalization. Net nondimensional oxygen utilization is shown to be largely independent of the relevant physiological and anatomical factors, and is therefore well suited for studies where an independent measure of gait efficiency is needed.
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Dobson F, Morris ME, Baker R, Wolfe R, Graham H. Clinician agreement on gait pattern ratings in children with spastic hemiplegia. Dev Med Child Neurol 2006; 48:429-35. [PMID: 16700932 DOI: 10.1017/s0012162206000946] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2005] [Indexed: 11/06/2022]
Abstract
The level of agreement between clinicians' ratings of gait patterns in children with spastic hemiplegia was investigated using the Winters, Gage, and Hicks (WGH) classification scale. Sixteen clinicians (nine physiotherapists, seven orthopaedic surgeons) from six gait laboratories in five different countries rated gait patterns in 34 children with spastic hemiplegia (22 males, 12 females; mean age 10y [SD 3y], range 6-18y). Archived three-dimensional gait reports (kinematic and video data) and videos (video clips only) were rated for each child. Agreement between clinicians was substantial for reports (weighted kappa [wkappa] 0.77, range 0.62-0.89). Agreement was lower for videos (wkappa 0.63, range 0.39-0.97) and for clinicians' agreement between reports and corresponding videos (wkappa 0.62, range 0.47-0.76). Exact agreement was unacceptable for some gait patterns using reports (mean 65%, range 32-74%) and videos (mean 53%, range 35-94%). Not all gait patterns could be rated using the original WGH categories. It was concluded that: (1) agreement is acceptable using the WGH tool; (2) kinematic data from 3D instrumented gait analysis and video should be used together when using the WGH scale; and (3) further refinement of this classification is required.
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Teichtahl AJ, Morris ME, Wluka AE, Baker R, Wolfe R, Davis SR, Cicuttini FM. Foot rotation—A potential target to modify the knee adduction moment. J Sci Med Sport 2006; 9:67-71. [PMID: 16621703 DOI: 10.1016/j.jsams.2006.03.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Isolating the particular joints/limb segments associated with knee adductor moment variability may provide clinically important data that could help to identify strategies to reduce medial tibiofemoral joint load. The aim of this study was to examine whether or not foot and thigh rotation during human locomotion are significant determinants of knee adductor moment variability. Three-dimensional gait analyses were performed on 32 healthy adult women (mean age 54+/-12 years, mean BMI 25+/-4 kg m(-2)) with radiologically normal knees. The relationships between foot rotation, thigh rotation and the external knee adduction moment were examined during early and late-stance phases of the gait cycle. The degree of foot rotation correlated significantly with the magnitude of the peak knee adduction moment during late stance (r=0.40, p=0.024). No significant associations were apparent between thigh rotation and the peak knee adduction moment. The association between foot rotation and the knee adduction moment in this study suggests that women who walk with external rotation at the foot reduce their knee adduction moment during late stance. This result implies that changes in foot kinematics can modify the medial tibiofemoral load during gait, which may be important in the prevention and management of knee osteoarthritis.
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Baker R. Drug management. Br Dent J 2006; 200:473-4. [PMID: 16703056 DOI: 10.1038/sj.bdj.4813571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Teichtahl AJ, Jackson BD, Morris ME, Wluka AE, Baker R, Davis SR, Cicuttini FM. Sagittal plane movement at the tibiofemoral joint influences patellofemoral joint structure in healthy adult women. Osteoarthritis Cartilage 2006; 14:331-6. [PMID: 16427326 DOI: 10.1016/j.joca.2005.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Accepted: 11/19/2005] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The influence exerted on cartilage and bone volumes by locomotor patterns is poorly understood, particularly at the patellofemoral joint. The aim of this study was to investigate the relationship between sagittal plane movement at the tibiofemoral joint and patella cartilage and bone volumes during the locomotion of healthy adult females. METHODS Three-dimensional Vicon gait analyses and magnetic resonance imaging were performed on 20 healthy adult women. The relationships between the degree of tibiofemoral flexion and extension at varying stages of the gait cycle and the concomitant medial, lateral and total patella cartilage and total bone volumes were examined. RESULTS For every degree the knee flexed during mid-stance, there was a 62.8 microL (95% confidence interval 3.7-122.0) increase in the medial patella facet cartilage volume after adjustment for age and the body mass index (BMI) (P = 0.04). A similar relationship that approached significance was observed for the lateral patella facet cartilage volume after adjustment for age and the BMI (P = 0.08). No association was observed between the sagittal plane tibiofemoral movements and the patella bone volume. CONCLUSIONS The association between patella cartilage volume and tibiofemoral knee movement suggests that for every degree increase in knee flexion during mid-stance, there is an associated increase in patella cartilage volume. This may be the result of the geometry of the femoral condyle influencing patella tracking and or the retropatellar load exerted on the patella during walking. These results may have important implications for people who hyperextend their knee during gait and the pathogenesis of patellofemoral osteoarthritis.
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159
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Huxham F, Gong J, Baker R, Morris M, Iansek R. Defining spatial parameters for non-linear walking. Gait Posture 2006; 23:159-63. [PMID: 16399511 DOI: 10.1016/j.gaitpost.2005.01.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2004] [Revised: 11/17/2004] [Accepted: 01/16/2005] [Indexed: 02/02/2023]
Abstract
Current definitions of the spatial and temporal parameters of gait have been based on the premise that walking occurs in a straight line. When the direction of progression (DoP) is not consistent and walking is non-linear, these definitions do not provide meaningful information. An alternative method based on the changing direction of each stride is presented. This method is easy to understand and use, and requires no expensive technology. A comparison of the spatial parameters of the footstep pattern during linear trials and trials incorporating a 60 degrees turn was performed, using output derived from the old and the new definitions. The two methods produced very different results. Spatial output from the old definitions was merely dictated by the change of direction. Output calculated relative to the changing stride direction however, provided useful information about the footstep adjustments made for turning and how these would act to improve stability. This method of establishing spatial parameters during non-linear walking should form a useful tool for further investigation of functional locomotion.
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Baker R, Ohameje N, Vasagar K, Gober L, Chen S, Vonakis B, Saini S. Basophil Histamine Release (HR) Activity and Disease Severity in Chronic Idiopathic Urticaria (CIU). J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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161
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Abstract
BACKGROUND The unpredictable, variable nature of Multiple Sclerosis (MS), and the possibility of increasing disability, means that a diagnosis can have substantial psychological consequences. OBJECTIVES To assess the effectiveness of psychological interventions for people with MS. SEARCH STRATEGY We searched 19 databases up to December 2004; Cochrane MS Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsychINFO, CINAHL and 14 others. We searched reference lists of articles, wrote to corresponding authors of the 13 papers identified by June 2004, and searched for trials in progress using 3 research registers. SELECTION CRITERIA Randomised controlled trials of interventions described as wholly or mostly based on psychological theory and practice, in people with MS. Primary outcome measures were disease specific and general quality of life, psychiatric symptoms, psychological functioning, disability, and cognitive outcomes. Secondary outcome measures were number of relapses, pain, fatigue, health care utilisation, changes in medication, and adherence to other therapies. DATA COLLECTION AND ANALYSIS Pertinent studies were identified from abstracts by one author. Full papers were independently compared to selection criteria by four authors. Key details were extracted from relevant papers using a standard format, and studies scored on three dimensions of quality. The review is organised into four mini-reviews (MR) dependent on the intervention's target population; people with cognitive impairments (MR1), people with moderate to severe disability (MR2), people with MS (no other criteria) (MR3), and people with depression (MR4). MAIN RESULTS Overall 16 studies were identified and included. MR1: three trials (n=145). Some evidence of effectiveness of cognitive rehabilitation on cognitive outcomes, although this was difficult to interpret because of the large number of outcome measures used. MR2: three trials (n=80). One small trial suggesting psychotherapy may help with depression. MR3: seven studies (n=688). Some evidence that cognitive behavioural therapy may help people adjust to, and cope with, having MS (three trials). The other trials were diverse in nature and some difficult to interpret because of multiple outcome measures. MR4: three trials (n=93). Two small studies of cognitive behavioural therapy showed significant improvements in depression. AUTHORS' CONCLUSIONS The diversity of psychological interventions identified indicates the many ways in which they can potentially help people with MS. No definite conclusions can be made from this review. However there is reasonable evidence that cognitive behavioural approaches are beneficial in the treatment of depression, and in helping people adjust to, and cope with, having MS.
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Baker R. Sutureless circumcision. Br J Surg 2005. [DOI: 10.1002/bjs.1800801249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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163
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Chappuis P, Portafaix C, Thomas E, Bertrand B, Walton R, Riccardo V, Baker R, Barlow I, Kaye A, Lorenz A, Durodier F. Design of a limiter for the JET EP ICRH antenna. FUSION ENGINEERING AND DESIGN 2005. [DOI: 10.1016/j.fusengdes.2005.06.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shaw B, Cheater F, Baker R, Gillies C, Hearnshaw H, Flottorp S, Robertson N. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2005:CD005470. [PMID: 16034980 DOI: 10.1002/14651858.cd005470] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Strategies to implement change in health professional performance have variable impact. A potential explanation is that the barriers to implementation are different in different settings and at different times. Change may be more likely if the strategies were specifically chosen to address the identified barriers. OBJECTIVES To assess the effectiveness of strategies tailored to address specific, identified barriers to change in professional performance. SEARCH STRATEGY We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC) specialised register and pending files until end of December 2002. English language articles only were included. SELECTION CRITERIA Randomised controlled trials (RCTs) that reported objectively measured professional practice or health care outcomes in which at least one group received an intervention designed (or tailored) to address prospectively identified barriers to change. DATA COLLECTION AND ANALYSIS Two reviewers independently extracted data and assessed quality. We also contacted study authors to obtain any missing information. Quantitative and qualitative analyses were undertaken. MAIN RESULTS We included 15 studies. For Comparison 1 (an intervention tailored to address identified barriers to change compared to no intervention or an intervention(s) not tailored to the barriers), there was no consistency in the results and the effect sizes varied both across and within studies.A meta-regression of a subset of the included studies, using a classical approach estimated a combined OR of 2.18 (95% CI: 1.09, 4.34), p = 0.026 in favour of tailored interventions. However, when a Bayesian approach was taken, meta-regression gave a combined OR of 2.27 (95% Credible Interval: 0.92, 4.75), which was not statistically significant. AUTHORS' CONCLUSIONS Interventions tailored to prospectively identify barriers may improve care and patient outcomes. However, from the studies included in this review, we were unable to determine whether the barriers were valid, which were the most important barriers, whether all barriers were identified and if they had been addressed by the intervention chosen. Based on the evidence presented in this review, the effectiveness of tailored interventions remains uncertain and more rigorous trials (including process evaluations) are needed. Further research needs to address explicitly the questions of identifying and addressing barriers.
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Cheater F, Baker R, Hearnshaw H, Robertson N, Hicks N, Oxman A, Flottorp S. Tailored interventions to overcome identified barriers to change: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2005. [DOI: 10.1002/14651858.cd001483.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Foy R, Eccles MP, Jamtvedt G, Young J, Grimshaw JM, Baker R. What do we know about how to do audit and feedback? Pitfalls in applying evidence from a systematic review. BMC Health Serv Res 2005; 5:50. [PMID: 16011811 PMCID: PMC1183206 DOI: 10.1186/1472-6963-5-50] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 07/13/2005] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Improving the quality of health care requires a range of evidence-based activities. Audit and feedback is commonly used as a quality improvement tool in the UK National Health Service [NHS]. We set out to assess whether current guidance and systematic review evidence can sufficiently inform practical decisions about how to use audit and feedback to improve quality of care. METHODS We selected an important chronic disease encountered in primary care: diabetes mellitus. We identified recommendations from National Institute for Clinical Excellence (NICE) guidance on conducting audit and generated questions which would be relevant to any attempt to operationalise audit and feedback in a healthcare service setting. We explored the extent to which a systematic review of audit and feedback could provide practical guidance about whether audit and feedback should be used to improve quality of diabetes care and, if so, how audit and feedback could be optimised. RESULTS National guidance suggests the importance of securing the right organisational conditions and processes. Review evidence suggests that audit and feedback can be effective in changing healthcare professional practice. However, the available evidence says relatively little about the detail of how to use audit and feedback most efficiently. CONCLUSION Audit and feedback will continue to be an unreliable approach to quality improvement until we learn how and when it works best. Conceptualising audit and feedback within a theoretical framework offers a way forward.
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Merrill R, Brown J, Byrd A, Alder S, Baker R, White G, Lyon J. 482: Risk of Anxiety and Depressive Disorders in Children and the Parents of Children Undergoing Cancer Workup or Treatment. Am J Epidemiol 2005. [DOI: 10.1093/aje/161.supplement_1.s121a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Graham HK, Baker R, Dobson F, Morris ME. Multilevel orthopaedic surgery in group IV spastic hemiplegia. ACTA ACUST UNITED AC 2005; 87:548-55. [PMID: 15795209 DOI: 10.1302/0301-620x.87b4.15525] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Most children with spastic hemiplegia have high levels of function and independence but fixed deformities and gait abnormalities are common. The classification proposed by Winters et al is widely used to interpret hemiplegic gait patterns and plan intervention. However, this classification is based on sagittal kinematics and fails to consider important abnormalities in the transverse plane. Using three-dimensional gait analysis, we studied the incidence of transverse-plane deformity and gait abnormality in 17 children with group IV hemiplegia according to Winters et al before and after multilevel orthopaedic surgery. We found that internal rotation of the hip and pelvic retraction were consistent abnormalities of gait in group-IV hemiplegia. A programme of multilevel surgery resulted in predictable improvement in gait and posture, including pelvic retraction. In group IV hemiplegia pelvic retraction appeared in part to be a compensating mechanism to control foot progression in the presence of medial femoral torsion. Correction of this torsion can improve gait symmetry and function.
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Grimshaw G, Baker R, Thompson J, Wilson A, Clay D. Interventions for improving coverage of screening schemes for diabetic retinopathy. Hippokratia 2005. [DOI: 10.1002/14651858.cd002756.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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170
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Dusitanond P, Eikelboom JW, Hankey GJ, Thom J, Gilmore G, Loh K, Yi Q, Klijn CJM, Langton P, van Bockxmeer FM, Baker R, Jamrozik K. Homocysteine-Lowering Treatment With Folic Acid, Cobalamin, and Pyridoxine Does Not Reduce Blood Markers of Inflammation, Endothelial Dysfunction, or Hypercoagulability in Patients With Previous Transient Ischemic Attack or Stroke. Stroke 2005; 36:144-6. [PMID: 15569860 DOI: 10.1161/01.str.0000150494.91762.70] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Epidemiological and laboratory studies suggest that increasing concentrations of plasma homocysteine (total homocysteine [tHcy]) accelerate cardiovascular disease by promoting vascular inflammation, endothelial dysfunction, and hypercoagulability.
Methods—
We conducted a randomized controlled trial in 285 patients with recent transient ischemic attack or stroke to examine the effect of lowering tHcy with folic acid 2 mg, vitamin B
12
0.5 mg, and vitamin B
6
25 mg compared with placebo on laboratory markers of vascular inflammation, endothelial dysfunction, and hypercoagulability.
Results—
At 6 months after randomization, there was no significant difference in blood concentrations of markers of vascular inflammation (high-sensitivity C-reactive protein [
P
=0.32]; soluble CD40L [
P
=0.33]; IL-6 [
P
=0.77]), endothelial dysfunction (vascular cell adhesion molecule-1 [
P
=0.27]; intercellular adhesion molecule-1 [
P
=0.08]; von Willebrand factor [
P
=0.92]), and hypercoagulability (P-selectin [
P
=0.33]; prothrombin fragment 1 and 2 [
P
=0.81]; D-dimer [
P
=0.88]) among patients assigned vitamin therapy compared with placebo despite a 3.7-μmol/L (95% CI, 2.7 to 4.7) reduction in total homocysteine (tHcy).
Conclusions—
Lowering tHcy by 3.7 μmol/L with folic acid-based multivitamin therapy does not significantly reduce blood concentrations of the biomarkers of inflammation, endothelial dysfunction, or hypercoagulability measured in our study. The possible explanations for our findings are: (1) these biomarkers are not sensitive to the effects of lowering tHcy (eg, multiple risk factor interventions may be required); (2) elevated tHcy causes cardiovascular disease by mechanisms other than the biomarkers measured; or (3) elevated tHcy is a noncausal marker of increased vascular risk.
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Baurin N, Baker R, Richardson C, Chen I, Foloppe N, Potter A, Jordan A, Roughley S, Parratt M, Greaney P, Morley D, Hubbard RE. Drug-like annotation and duplicate analysis of a 23-supplier chemical database totalling 2.7 million compounds. ACTA ACUST UNITED AC 2004; 44:643-51. [PMID: 15032546 DOI: 10.1021/ci034260m] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We have implemented five drug-like filters, based on 1D and 2D molecular descriptors, and applied them to characterize the drug-like properties of commercially available chemical compounds. In addition to previously published filters (Lipinski and Veber), we implemented a filter for medicinal chemistry tractability based on lists of chemical features drawn up by a panel of medicinal chemists. A filter based on the modeling of aqueous solubility (>1 microM) was derived in-house, as well as another based on the modeling of Caco-2 passive membrane permeability (>10 nm/s). A library of 2.7 million compounds was collated from the 23 compound suppliers and analyzed with these filters, highlighting a tendency toward highly lipophilic compounds. The library contains 1.6 M unique structures, of which 37% (607,223) passed all five drug-like filters. None of the 23 suppliers provides all the members of the drug-like subset, emphasizing the benefit of considering compounds from various compound suppliers as a source of diversity for drug discovery.
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Abstract
Harold Shipman was an English general practitioner who murdered at least 215 of his patients between 1974 and 1998. A public inquiry is underway, but general practitioners and all doctors also need to consider the implications for their profession. The aim of this paper is to stimulate debate. Issues identified as important to consider include: trust between doctors; attitudes towards failing systems such as cremation certification; acceptance of the duty of accountability; ensuring patients can have reasonable confidence in their doctors; commitment to preventing such a case occurring again; and relationships with patients. It is argued that restricting debate to methods to detect doctors who murder would limit the opportunity to improve medical practice and would constitute a failure to fulfil the duty owed by doctors to Shipman's victims and their families.
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Shaheen M, Nelson A, Todoroff C, Baker R, Wang R. Vaccination coverage for African American children in Los Angeles. Ann Epidemiol 2004. [DOI: 10.1016/j.annepidem.2004.07.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hankey GJ, Eikelboom JW, Loh K, Yi Q, Pizzi J, Tang M, Hickling S, Le M, Klijn CJM, Dusitanond P, van Bockxmeer F, Gelavis A, Baker R, Jamrozik K. Is There Really a Power Shortage in Clinical Trials Testing the “Homocysteine Hypothesis?”. Arterioscler Thromb Vasc Biol 2004; 24:e147. [PMID: 15297291 DOI: 10.1161/01.atv.0000136385.50973.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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176
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Young J, Baker R, Swartz C. Input saturation effects in optimizing control—inclusion within a simultaneous optimization framework. Comput Chem Eng 2004. [DOI: 10.1016/j.compchemeng.2003.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Baker R. Patient-centred care after Shipman. J R Soc Med 2004. [DOI: 10.1258/jrsm.97.4.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Baker R, Moss P, Upton D, Pankhania J. Investigation of systems to prevent diversion of opiate drugs in general practice in the UK. Qual Saf Health Care 2004; 13:21-5. [PMID: 14757795 PMCID: PMC1758056 DOI: 10.1136/qshc.2002.002485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Statutory regulations govern the procedures that must be followed by general practitioners (GPs) in the UK to minimise the risk of diversion of prescribed opiate drugs for illicit use. However, evidence presented at the trial of Harold Shipman, a GP convicted of murdering patients with diamorphine, suggests that the regulations and monitoring of GPs' prescribing are failing. AIM To assess the policies followed by general practices in Leicestershire and Rutland with regard to the controlled drugs regulations. METHODS A semi-structured interview was administered to a purposeful sample of lead GPs to explore how their practices applied the regulations. The controlled drugs registers and drug storage facilities in these practices were inspected. A questionnaire was sent to all the remaining practices to seek information about their application of the regulations, any concerns they had about the regulations, and any suggestions for improving them. RESULTS Of the 142 general practices in Leicestershire, the lead GP in 14 took part in the interviews. Respondents expressed dissatisfaction with current policies including the design of controlled drug registers, and generally supported the reintroduction of an inspection scheme. Ninety (70.9%) of the 127 practices to whom the questionnaire was sent responded and, of these, 31 (34.4%) no longer held a supply of controlled drugs. Those that did hold controlled drugs indicated concern about the regulations, confusion about some aspects including the return and disposal of unused drugs, and a desire for advice and support in the implementation of the regulations. Forty two of the 59 respondents who held a supply of controlled drugs (71.2%) would welcome regular inspection. CONCLUSION GPs are confused about the controlled drugs regulations and have little support in implementing them. The suspension of inspection schemes has reduced the amount of advice and support available to them and, in consequence, the regulations are interpreted differently in different practices. These findings are cause for concern about the risk of diversion of controlled drugs, and illustrate how patient safety systems can decay when they are not maintained.
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Wilson A, Baker R, Thompson J, Grimshaw G. Coverage in screening for diabetic retinopathy according to screening provision: results from a national survey in England and Wales. Diabet Med 2004; 21:271-8. [PMID: 15008839 DOI: 10.1111/j.1464-5491.2004.01131.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To assess the proportion of people with diabetes screened for retinopathy according to provision of screening services. METHODS Twenty-five health authorities in England and Wales were sampled after stratification by type of screening provision for diabetic retinopathy. Nine did not have a population-based screening scheme, six had an optometry scheme, six had a camera scheme and four had schemes with more than one method of screening ('mixed schemes'). Within each authority general practices were randomly sampled, 129 in total, and in each the records of a sample of diabetic patients examined. RESULTS Of the 9200 records examined, 5812 (63.2%) had a record of one or more retinal examinations from any source in the year before the survey. This proportion did not differ significantly according to type of screening provision. The proportion of people with one or more retinal examinations by an 'expert' (defined as ophthalmologist, diabetologist, optometrist or screening scheme) in the last year was 44.7% where there was no screening scheme and 62.2%, 59.4%, and 61.6%, respectively, where optometry, camera and mixed schemes were present. Adjusted relative odds (95% confidence interval) for a retinal examination from any source in the last year compared with areas with no screening schemes were 1.19 (0.73, 1.93), 1.26 (0.80, 1.98), and 1.19 (0.77, 1.84) for camera, optometry and mixed schemes, respectively. Equivalent figures for an expert retinal examination were 2.30 (1.51, 3.49), 1.86 (1.25, 2.78) and 2.13 (1.32, 3.45). Coverage by schemes themselves did not differ according to type of scheme. Highest coverage rates, including examinations by screening schemes, were achieved in those treated with insulin, and the lowest rates found in those treated with diet alone. CONCLUSIONS Screening schemes have had a small impact on overall retinal examinations, but a higher impact on the coverage of examinations performed by experts.
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Thomas PW, Thomas S, Hillier C, Galvin K, Baker R, Cole J. Psychological interventions for multiple sclerosis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2003. [DOI: 10.1002/14651858.cd004431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tedaldi EM, Baker R. Reply. Clin Infect Dis 2003. [DOI: 10.1086/376781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Baker R, Stevens-King A, Bhat N, Leong P. Should patients with asymmetrical noise-induced hearing loss be screened for vestibular schwannomas? CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2003; 28:346-51. [PMID: 12871250 DOI: 10.1046/j.1365-2273.2003.00721.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Peterborough ENT department receives many referrals for MoD personnel who have suffered hearing loss from occupational noise exposure. Those patients with asymmetrical sensorineural hearing loss are routinely screened for vestibular schwannomas by MRI scanning. Scan reports from the past 5 years have been reviewed and out of 152 scans, four revealed vestibular schwannomas giving a pick-up rate of 2.5%, which compares favourably with other published pick-up rates. Review of the audiograms in these cases suggests that they can be misleading in this context. The conclusion is that patients with noise-induced asymmetrical hearing loss should be screened for acoustic neuromas.
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Hallis B, Silman NJ, Noonan S, Baker R, Roberts ADG, Quinn CP, Marks T, Wiblin C, Lloyd G, Robinson A, Hudson MJ. Novel in vitro functional assays for the determination of anthrax toxin components. DEVELOPMENTS IN BIOLOGICALS 2003; 111:321-6. [PMID: 12678256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The characterisation and evaluation of the UK licensed human anthrax vaccine depends on several in vivo tests that determine its safety and potency. Assays for the determination of functionally active and/or immunoreactive toxin components and S-layer proteins have been developed and applied to the characterisation of anthrax vaccine. These technologies may support production of consistent and effective vaccines, and may ultimately reduce the requirements for in vivo testing.
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Baker R. Prophylaxis for long distance travel. J Thromb Haemost 2003. [DOI: 10.1111/j.1538-7836.2003.tb03860.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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Baker R. Human milk substitutes. An American perspective. Minerva Pediatr 2003; 55:195-207. [PMID: 12900706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Formula is a substitute for the preferred nutritional fluid for infants, human milk. Considering that human milk is uniquely suited for human infants, formula feeds have done remarkably well in promoting growth and development of bottle-fed and partially breast-fed infants. Early in the last century, the horrendously high infant mortality rate spurred the development of infant formula. A clean source of milk was thought to be necessary to overcome the mainly diarrheal deaths due to unhygienic conditions. Initially, the success of a formula was measured merely by the survival of the infant. As formulas more closely mimicked the performance of human milk, feedings were compared by the ability to support growth. Now, the additions and alterations to formulas have become more sophisticated and the outcome measures may be protection from infections, visual acuity and mental development. Studies to test these outcomes are difficult and often long term. Additionally, mere growth is recognized as an insufficient measure, rather quality of growth needs to be considered. Formula, like no other food, is potentially the sole source of an individual's nutrition for 4 to 6 months of life. In recognition of its importance, formula is the only food that is regulated by its own law in the United States, the Infant Formula Act of 1986. For the future, breast feeding will remain preferable for almost all infants and breastfeeding should be encouraged. Formulas will continue to be used and will continue to be needed. Improving and assuring the adequacy and safety of infant formulas is an increasingly difficult challenge.
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Pirpiris M, Trivett A, Baker R, Rodda J, Nattrass GR, Graham HK. Femoral derotation osteotomy in spastic diplegia. Proximal or distal? THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2003; 85:265-72. [PMID: 12678365 DOI: 10.1302/0301-620x.85b2.13342] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe the results of a prospective study of 28 children with spastic diplegia and in-toed gait, who had bilateral femoral derotation osteotomies undertaken at either the proximal intertrochanteric or the distal supracondylar level of the femur. Preoperative clinical evaluation and three-dimensional movement analysis determined any additional soft-tissue surgery. Distal osteotomy was faster with significantly lower blood loss than proximal osteotomy. The children in the distal group achieved independent walking earlier than those in the proximal group (6.9 +/- 1.3 v 10.7 +/- 1.7 weeks; p < 0.001). Transverse plane kinematics demonstrated clinically significant improvements in rotation of the hip and the foot progression angle in both groups. Correction of rotation of the hip was from 17 +/- 11 degrees internal to 3 +/- 9.5 degrees external in the proximal group and from 9 +/- 14 degrees internal to 4 +/- 12.4 degrees external in the distal group. Correction of the foot progression angle was from a mean of 10.0 +/- 17.3 degrees internal to 13.0 +/- 11.8 degrees external in the proximal group (p < 0.001) compared with a mean of 7.0 +/- 19.4 degrees internal to 10.0 +/- 12.2 degrees external in the distal group (p < 0.001). Femoral derotation osteotomy at both levels gives comparable excellent correction of rotation of the hip and foot progression angles in children with spastic diplegia.
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Brochert A, Reynolds T, Baker R. MRI in a case of muslin-induced granuloma. Neuroradiology 2003; 45:82-4. [PMID: 12592488 DOI: 10.1007/s00234-002-0896-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2002] [Accepted: 08/23/2002] [Indexed: 10/20/2022]
Abstract
When intracranial aneurysms are deemed nonclippable, an accepted alternative neurosurgical treatment is to reinforce the aneurysm wall by wrapping or coating it with various materials, including muslin (cotton gauze). Granulomatous or "foreign-body" reactions, sometimes referred to as "muslinomas" or "gauzomas," and adhesive arachnoiditis are known but rare complications. Experience with MRI in these cases is limited. We describe the clinical and MRI features of a muslinoma developing after treatment of an anterior communicating artery aneurysm.
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Krishnan B, Ganeshaguru K, Baker R, Richfield L, Mehta AB. Multidrug resistance and myelomonocytic leukaemia in gaucher's disease. Haematologica 2003; 88:ECR02. [PMID: 12604426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
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Bennett D, Orr JF, Beverland DE, Baker R. The influence of shape and sliding distance of femoral head movement loci on the wear of acetabular cups in total hip arthroplasty. Proc Inst Mech Eng H 2003; 216:393-402. [PMID: 12502003 DOI: 10.1243/095441102321032184] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Wear of the polyethylene acetabular component is the most serious threat to the long-term success of total hip replacements (THRs). Greatly reduced wear rates have been reported for unidirectional, compared to multidirectional, articulation in vitro. This study considers the multidirectional motions experienced at the hip joint as described by movement loci of points on the femoral head for individual THR patients. A three-dimensional computer program determined the movement loci of selected points on the femoral head for THR patients and normal subjects using kinematic data obtained from gait analysis. The sizes and shapes of these loci were quantified by their sliding distances and aspect ratios with substantial differences exhibited between individual THR patients. The average sliding distances ranged from 10.0 to 18.1 mm and the average aspect ratios of the loci ranged from 2.5 to 9.2 for the THR patients. Positive correlations were found between wear rate and average sliding distance, the inverse of the average aspect ratio of the loci and the product of the average sliding distance and the inverse of the average aspect ratio of the loci. Patients with a normal hip joint range of motion produce multidirectional motion loci and tend to experience more wear than patients with more unidirectional motion loci. Differing patterns of multidirectional motion at the hip joint for individual THR patients may explain widely differing wear rates in vivo.
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Harkin DW, Barros D'Sa AAB, McCallion K, Baker R, Hoper M, Campbell FC. Ischaemic preconditioning before lower limb ischaemia–reperfusion protects against acute lung injury. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01757-12.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Background
Ischaemic preconditioning (IPC) of skeletal muscle, by exposing it to repeated brief periods of ischaemia and reperfusion (I-R) before a subsequent longer ischaemic period, protects against local damage on reperfusion. In a large animal model of hindlimb I-R it was hypothesized that hindlimb IPC would attenuate the systemic inflammatory response syndrome and prevent acute lung injury associated with limb reperfusion injury.
Methods
Anaesthetized ventilated swine (six per group) were used throughout. After midline laparotomy, animals were randomized to the following three groups: bilateral external iliac artery occlusion for 120 min, followed by reperfusion for 180 min (I-R group); IPC (three cycles of 5 min ischaemia, then 5 min reperfusion of both external iliac arteries) followed by bilateral external iliac artery occlusion for 120 min and reperfusion for 180 min (I-R + IPC group); or laparotomy alone (control group). Acute lung injury was assessed by invasive pulmonary artery pressure (PAP) measurement, arterial to alveolar (A-a) oxygen gradient, lung tissue wet: dry weight ratio, and lung myeloperoxidase (MPO) concentration.
Results
Conclusion
Lower limb I-R induces systemic inflammation and acutely impairs oxygen transport associated with lung neutrophil sequestration. IPC attenuates acute pulmonary hypertension, impairment of oxygen transport, oedema and leucosequestration in planned lower limb I-R.
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Baker R, Jasinski M, Maciag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Carr L, MacLean J, Lin JP, Lynch B, Theologis T, Wendorff J, Eunson P, Cosgrove A. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol 2002. [PMID: 12418791 DOI: 10.1111/j.1469-8749-2002-tb00268.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.
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Baker R, Jasinski M, Maciag-Tymecka I, Michalowska-Mrozek J, Bonikowski M, Carr L, MacLean J, Lin JP, Lynch B, Theologis T, Wendorff J, Eunson P, Cosgrove A. Botulinum toxin treatment of spasticity in diplegic cerebral palsy: a randomized, double-blind, placebo-controlled, dose-ranging study. Dev Med Child Neurol 2002; 44:666-75. [PMID: 12418791 DOI: 10.1017/s0012162201002730] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study evaluated the efficacy and safety of three doses of botulinum toxin A (BTX-A; Dysport) in 125 patients (mean age 5.2 years, SD 2; 54% male)with dynamic equinus spasticity during walking. Participants were randomized to receive Dysport (10, 20, or 30 units/kg) or placebo to the gastrocnemius muscle of both legs. Muscle length was calculated from electrogoniometric measurements and the change in the dynamic component of gastrocnemius shortening at four weeks was prospectively identified as the primary outcome measure. All treatment groups showed statistically significant decreases in dynamic component compared with placebo at 4 weeks. Mean improvement in dynamic component was most pronounced in the 20 units/kg group, being equivalent to an increase in dorsiflexion with the knee extended at 19 degrees, and was still present at 16 weeks. The safety profile of the toxin appears satisfactory.
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Parker SG, Peet SM, McPherson A, Cannaby AM, Abrams K, Baker R, Wilson A, Lindesay J, Parker G, Jones DR. A systematic review of discharge arrangements for older people. Health Technol Assess 2002; 6:1-183. [PMID: 12065067 DOI: 10.3310/hta6040] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
There are no easy solutions to the problem of improving the quality of care. Research has shown how difficult it can be, but has failed to provide reliable and effective ways to change services and professional performance for the better. Much depends on the perspectives of users and the attitudes and behaviours of professionals in the context of their organisations and healthcare teams. Qualitative research offers a variety of methods for identifying what really matters to patients and carers, detecting obstacles to changing performance, and explaining why improvement does or does not occur. The use of such methods in future studies could lead to a better understanding of how to improve quality.
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Grol R, Baker R, Moss F. Quality improvement research: understanding the science of change in health care. Qual Saf Health Care 2002; 11:110-1. [PMID: 12448794 PMCID: PMC1743590 DOI: 10.1136/qhc.11.2.110] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Winstein S, Bruck P, Radlick P, Baker R. Three-Center Nonclassical Cation in the Pentahomocyclopentadienyl System. J Am Chem Soc 2002. [DOI: 10.1021/ja01063a053] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Winstein S, Baker R, Smith S. Dissociated Ions and Ion Pairs in Acetolysis of threo-3-Anisyl-2-butyl p-Bromobenzenesulfonate. J Am Chem Soc 2002. [DOI: 10.1021/ja01064a036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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200
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Neidig HA, Funck DL, Uhrich R, Baker R, Kreiser W. Oxidation of Some Secondary Aliphatic-aromatic Alcohols. J Am Chem Soc 2002. [DOI: 10.1021/ja01166a078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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