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Chen Z, Deng J, Carlson D, Roberts K, Decker R, Rockwell S, Nath R. A Serial-imaging Based 4D Dose Computation System for Prostate Implant Dosimetry. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Williams N, Robertson J, McGorm K, Roberts K, Elton R. What factors affect medication-storage practice among patients on methadone maintenance treatment? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2009; 17:231-235. [PMID: 20217947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Medication storage in patients' homes is an important safety issue. Safe storage of methadone oral solution is of particular concern. Previous studies have suggested that only about half of patients store methadone appropriately. The aims of this study were to describe medication-storage practice in a sample of patients receiving methadone maintenance treatment (MMT), and to identify factors associated with safe storage. METHODS The setting was a primary health care centre in Edinburgh, Scotland. One hundred and four consecutive patients on MMT completed a self-administered questionnaire covering medication-storage practice, together with clinical and demographic variables. Storage of medication was classified as 'acceptable' if medication was out of sight and out of reach of children, and 'optimal' if it was also kept in a secure container. KEY FINDINGS Percentages (95% confidence intervals) for acceptable and optimal storage were as follows: methadone 80% (71-86%) and 33% (24-42%); other prescribed medication 69% (59-78%) and 27% (19-37%); purchased medication 64% (50-76%) and 28% (17-42%). Safe storage of methadone was more common in patients taking higher doses of methadone (P = 0.004 for acceptable storage, and P = 0.012 for optimal storage), and in those with children in the house (P = 0.007 and 0.061). Safe storage of prescribed and purchased medication was strongly associated with safe storage of methadone (P < 0.01 in both cases). CONCLUSIONS Medication-storage practice was better than in previous surveys of patients on MMT. This may reflect the high profile given to safety issues for children of drug-using parents in Scotland, as well as local initiatives. Some aspects of prescribing and dispensing practice could be improved further.
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Mackie CA, Marie Healy A, Roberts K, Ryder S. A comparison of community pharmacy methadone services between Dublin and Glasgow: (1) Extent of service provision in 1997/1998 and views of pharmacists on existing provision and future service developments. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890410001711724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roberts K, Murray HM, Gilmour R. What's the problem? Why do some pharmacists provide services to drug users and others won't? JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890600774789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Coleman MT, Roberts K, Wulff D, van Zyl R, Newton K. Interprofessional ambulatory primary care practice-based educational program. J Interprof Care 2009; 22:69-84. [DOI: 10.1080/13561820701714763] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Watson JB, Hatami A, David H, Masliah E, Roberts K, Evans CE, Levine MS. Alterations in corticostriatal synaptic plasticity in mice overexpressing human alpha-synuclein. Neuroscience 2009; 159:501-13. [PMID: 19361478 DOI: 10.1016/j.neuroscience.2009.01.021] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 01/10/2009] [Accepted: 01/13/2009] [Indexed: 11/28/2022]
Abstract
Most forms of Parkinson's disease (PD) are sporadic in nature, but some have genetic causes as first described for the alpha-synuclein gene. The alpha-synuclein protein also accumulates as insoluble aggregates in Lewy bodies in sporadic PD as well as in most inherited forms of PD. The focus of the present study is the modulation of synaptic plasticity in the corticostriatal pathway of transgenic (Tg) mice that overexpress the human alpha-synuclein protein throughout the brain (ASOTg). Paired-pulse facilitation was detected in vitro by activation of corticostriatal afferents in ASOTg mice, consistent with a presynaptic effect of elevated human alpha-synuclein. However basal synaptic transmission was unchanged in ASOTg, suggesting that human alpha-synuclein could impact paired-pulse facilitation via a presynaptic mechanism not directly related to the probability of neurotransmitter release. Mice lacking alpha-synuclein or those expressing normal and A53T human alpha-synuclein in tyrosine hydroxylase-containing neurons showed, instead, paired-pulse depression. High-frequency stimulation induced a presynaptic form of long-term depression solely in ASOTg striatum. A presynaptic, N-methyl-d-aspartate receptor-independent form of chemical long-term potentiation induced by forskolin (FSK) was enhanced in ASOTg striatum, while FSK-induced cAMP levels were reduced in ASOTg synaptoneurosome fractions. Overall the results suggest that elevated human alpha-synuclein alters presynaptic plasticity in the corticostriatal pathway, possibly reflecting a reduction in glutamate at corticostriatal synapses by modulation of adenylyl cyclase signaling pathways. ASOTg mice may recapitulate an early stage in PD during which overexpressed alpha-synuclein dampens corticostriatal synaptic transmission and reduces movement.
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Robertson J, McGorm K, Roberts K, Elton R, Williams N. What factors affect medication-storage practice among patients on methadone maintenance treatment? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2009. [DOI: 10.1211/ijpp/17.03.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Williams N, Robertson J, McGorm K, Roberts K, Elton R. What factors affect medication-storage practice among patients on methadone maintenance treatment? INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2009; 17:165-169. [PMID: 20218248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Medication storage in patients' homes is an important safety issue. Safe storage of methadone oral solution is of particular concern. Previous studies have suggested that only about half of patients store methadone appropriately. The aims of this study were to describe medication-storage practice in a sample of patients receiving methadone maintenance treatment (MMT), and to identify factors associated with safe storage. METHODS The setting was a primary health care centre in Edinburgh, Scotland. One hundred and four consecutive patients on MMT completed a self-administered questionnaire covering medication-storage practice, together with clinical and demographic variables. Storage of medication was classified as 'acceptable' if medication was out of sight and out of reach of children, and 'optimal' if it was also kept in a secure container. KEY FINDINGS Percentages (95% confidence intervals) for acceptable and optimal storage were as follows: methadone 80% (71-86%) and 33% (24-42%); other prescribed medication 69% (59-78%) and 27% (19-37%); purchased medication 64% (50-76%) and 28% (17-42%). Safe storage of methadone was more common in patients taking higher doses of methadone (P = 0.004 for acceptable storage, and P = 0.012 for optimal storage), and in those with children in the house (P = 0.007 and 0.061). Safe storage of prescribed and purchased medication was strongly associated with safe storage of methadone (P < 0.01 in both cases). CONCLUSIONS Medication-storage practice was better than in previous surveys of patients on MMT. This may reflect the high profile given to safety issues for children of drug-using parents in Scotland, as well as local initiatives. Some aspects of prescribing and dispensing practice could be improved further.
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Roberts K, Blethyn K, Foreman M, Bleetman A. Influence of air ambulance doctors on on-scene times, clinical interventions, decision-making and independent paramedic practice. Emerg Med J 2009; 26:128-34. [DOI: 10.1136/emj.2008.059899] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chen Z, Deng J, Decker R, Roberts K, Wilson L, Nath R. Impact of using Different Tissue Heterogeneity Correction Algorithms on the Successful Implementation of Stereotactic Body Radiotherapy Programs for Lung Tumors. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1849] [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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111
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Westwood K, Griffin M, Roberts K, Williams M, Yoong K, Digger T. Incentive spirometry decreases respiratory complications following major abdominal surgery. Surgeon 2008; 5:339-42. [PMID: 18080608 DOI: 10.1016/s1479-666x(07)80086-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary complications are the leading cause of morbidity and mortality following major abdominal surgery. Chest physiotherapy aims to decrease the likelihood of these complications and hasten recovery. Exercises aimed at maximising inspiratory effort are the most beneficial for the patients. The incentive spirometer is a handheld device that patients use to achieve effective inspiration. In a nonrandomised pilot study of 263 patients we have found that the addition of the incentive spirometer, as part of an intensive post-operative physiotherapy programme, decreased the occurrence of pulmonary complications (6 vs 17%, p = 0.01) and length of stay on the surgical high dependency unit (3.1 vs 4 days p = 0.03). The two groups were comparable when age, sex, smoking history, the need for emergency surgery and post-operative analgesia were compared.
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Wright P, Smith A, Roberts K, Selby P, Velikova G. Screening for social difficulties in cancer patients: clinical utility of the Social Difficulties Inventory. Br J Cancer 2007; 97:1063-70. [PMID: 17895887 PMCID: PMC2360446 DOI: 10.1038/sj.bjc.6604006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 08/23/2007] [Accepted: 08/31/2007] [Indexed: 11/12/2022] Open
Abstract
Guidelines for psychosocial support have been developed, but there are no standard approaches in routine oncology practice to identify patients experiencing social difficulties. We have designed and evaluated a Social Difficulties Inventory (SDI) to identify patients requiring further assessment and, where appropriate, referral to support services. The purpose of this study was to develop a clinically meaningful SDI scoring system with guidance for oncology staff. Out of 189 patients, 183 completed the SDI and were interviewed by a social work researcher who scored the SDI independently. Comparison of patient/interviewer assessment was good (intraclass correlation 0.61, 95% confidence interval: 0.51, 0.70). Using top 10% of interviewer social distress (SD) scores to indicate 'SD case', the best 'cut-point' was a patient score of > or =10 (sensitivity=0.80; specificity=0.76; 56 out of 183 'cases'). Out of 127 patients, 72 with SD score <10 had individual SDI item rated at a higher level. Following interview, 32 patients were referred to specialist services, 46 given information and 112 had no action taken. An interpretation algorithm developed includes SD score, individual SDI item rating, and an additional general question, illustrated using four case scenarios. In conclusion, general guidance for interpreting the SDI has been developed to enhance health-care professional/patient consultations with a view to identifying patients who may benefit from support, advice or intervention.
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George W, Roberts K. THE SUTURE OF THE APONEUROSIS OF THE INTERNAL OBLIQUE MUSCLE TO THE LIGAMENT OF POUPART. Ann Surg 2007; 81:833-8. [PMID: 17865241 PMCID: PMC1399995 DOI: 10.1097/00000658-192504000-00012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brookes MJ, Boult J, Roberts K, Cooper BT, Hotchin NA, Matthews G, Iqbal T, Tselepis C. A role for iron in Wnt signalling. Oncogene 2007; 27:966-75. [PMID: 17700530 DOI: 10.1038/sj.onc.1210711] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
There is an emerging body of evidence implicating iron in carcinogenesis and in particular colorectal cancer, but whether this involves Wnt signalling, a major oncogenic signalling pathway has not been studied. We aimed to determine the effect of iron loading on Wnt signalling using mutant APC (Caco-2 and SW480) and wild-type APC (HEK-293 and human primary fibroblasts) containing cell lines. Elevating cellular iron levels in Caco-2 and SW480 cells caused increased Wnt signalling as indicated by increased TOPFLASH reporter activity, increased mRNA expression of two known targets, c-myc and Nkd1, and increased cellular proliferation. In contrast wild-type APC and beta-catenin-containing lines, HEK 293 and human primary fibroblasts were not responsive to iron loading. This was verified in SW480 cells that no longer induced iron-mediated Wnt signalling when transfected with wild-type APC. The cell line LS174T, wild type for APC but mutant for beta-catenin, was also responsive suggesting that the role of iron is to regulate beta-catenin. Furthermore, we show that E-cadherin status has no influence on iron-mediated Wnt signalling. We thus speculate that excess iron could exacerbate tumorigenesis in the background of APC loss, a common finding in cancers.
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Roberts K, Costelloe D, Hutchinson M, Tubridy N. What difference does a neurologist make in a general hospital? Estimating the impact of neurology consultations on in-patient care. Ir J Med Sci 2007; 176:211-4. [PMID: 17593329 DOI: 10.1007/s11845-007-0051-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2006] [Accepted: 05/24/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine the impact of neurological consultations on the care of hospital in-patients and to ascertain patients' perceptions, referrals were prospectively recorded over a 6-month period. The neurology team's view and changes suggested to management were documented. All referred patients' notes were reviewed at 6 months and the impact of a neurology referral was determined. RESULTS Two hundred and fifty-four (254) referrals were seen. There was a significant change in diagnosis in 55%, and in management in nearly 70%. Neurological referral facilitated earlier discharge for 65% patients. Thirty-seven of 163 patients contacted at 6 months did not know they were seen by a neurologist. Of those who knew, 57% felt referral had aided in their diagnosis and 86% felt it had aided treatment. CONCLUSIONS Neurological consultations can make a significant difference to in-patient management. Early referral may lead to early discharge. Patient satisfaction was high but not without criticism.
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Chen Z, Deng J, Roberts K, Nath R. TH-E-M100E-07: The Impact of Procedure-Induced Edema On Cell Survival and Tumor Control Probability in Permanent Prostate Brachytherapy Using 131Cs Radioactive Source. Med Phys 2007. [DOI: 10.1118/1.2761777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Roberts K, Papadaki A, Conçalves C, Tighe M, Atherton D, Shenoy R, McRobbie D, Anand P. 226 A FEASIBILITY STUDY OF EEG AND FMRI CO-ACTIVATION WITH CHEPS (CONTACT HEAT EVOKED POTENTIAL STIMULATOR). Eur J Pain 2007. [DOI: 10.1016/j.ejpain.2007.03.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Roberts K, Duffy A, Kaufman J, Burrell M, Dziura J, Bell R. Size matters: gastric pouch size correlates with weight loss after laparoscopic Roux-en-Y gastric bypass. Surg Endosc 2007; 21:1397-402. [PMID: 17332953 DOI: 10.1007/s00464-007-9232-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 11/16/2006] [Accepted: 11/20/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Over the past 20 years, there has been an ongoing discussion about the importance of gastric pouch size as a key factor influencing weight loss after bariatric surgery. This analysis aimed to determine the relationship between initial gastric pouch size and excess weight loss (EWL) after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS Between August 2002 and March 2005, 320 LRYGB were performed at Yale New Haven Hospital. The patients' demographics were entered into a longitudinal, prospective database. Upper gastrointestinal series were routinely performed on postoperative day 1. Pouch size was measured as area (cm2) on an anteroposterior radiograph at maximum pouch distention. Linear regression analysis was performed to determine the association between pouch size and weight loss at 6 and 12 months postoperatively. Adjustments were made for age, gender, and preoperative body mass index (BMI). RESULTS The mean age of the patients was 41.2 years. Of the 320 study patients, 261 were women (81.6%) and 59 were men (18.4%). The mean preoperative BMI was 51.1 kg/m2; the mean 6-month EWL was 50.5%; the mean 12-month EWL was 62.5%; and the mean pouch size was 63.9 cm2. A statistically significant, negative correlation between pouch size and EWL was found at 6 months (beta = -0.241; p < 0.01) and at 12 months (beta = -0.302; p < 0.02). The findings show that male gender (beta = 0.147; p < 0.04) and preoperative BMI (beta = 0.190; p < 0.01) are positively correlated with pouch size. CONCLUSION The analysis demonstrates that initial gastric pouch size is not the only significant component for successful weight loss after LRYGB. Male gender and increased preoperative BMI were identified as factors predicting pouch size. Efforts to standardize small pouch size for all patients seems important to the success of surgical therapy for morbid obesity.
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Chen Z, Deng J, Roberts K, Nath R. 2866. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.1285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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121
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Deng J, Chen Z, Roberts K, Nath R. SU-FF-T-456: What Is the Optimal Source-To-Collimator Distance for An Extendible MLC Designed for Energy- and Intensity-Modulated Electron Radiation Therapy of Superficial Tumors. Med Phys 2006. [DOI: 10.1118/1.2241374] [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] Open
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Roberts K, Revell M, Youssef H, Bradbury AW, Adam DJ. Hypotensive Resuscitation in Patients with Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg 2006; 31:339-44. [PMID: 16388972 DOI: 10.1016/j.ejvs.2005.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2005] [Accepted: 11/02/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The technique of hypotensive resuscitation in haemorrhagic shock involves resuscitation to below normotensive blood pressures achieving the minimum perfusion pressure that will adequately perfuse vital organs until definitive arrest of haemorrhage. AIM To summarise the evidence for the use of hypotensive resuscitation in patients with uncontrolled haemorrhagic shock and ruptured abdominal aortic aneurysm (AAA). METHODS A MEDLINE (1966-2004) and Cochrane library search for articles relating to hypotensive resuscitation was undertaken; see text for further details. RESULTS Several animal studies exist using an abdominal aortotomy model of ruptured AAA. These have demonstrated improved tissue perfusion, decreased blood loss and improved survival associated with hypotensive resuscitation compared with aggressive resuscitation. There are several human studies advocating delayed rather than immediate resuscitation in trauma patients but careful review of the literature reveals no prospective studies of hypotensive resuscitation in patients with ruptured AAA. CONCLUSIONS Animal studies demonstrate superiority of hypotensive resuscitation over aggressive resuscitation but further research is required to assess its efficacy in patients with ruptured AAA.
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Roberts K, Shirsat AH. Increased extensin levels in Arabidopsis affect inflorescence stem thickening and height. JOURNAL OF EXPERIMENTAL BOTANY 2006; 57:537-45. [PMID: 16397002 DOI: 10.1093/jxb/erj036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Extensins are hydroxyproline-rich glycoproteins which are abundant in the cell walls of higher plants and whose precise function has been the subject of much speculation. In order to investigate this, transgenic A. thaliana plants were generated containing the Arabidopsis Atext1 extensin coding sequence under the transcriptional control of the strong constitutive CaMV 35S promoter. Northern analysis and RT-PCR identified transgenics with high constitutive levels of Atext1 mRNA. Hydroxyproline assays confirmed that transgenic plants which over-expressed Atext1 contained high levels of hydroxyproline-rich protein. Phenotypic analysis of the transgenics showed that there were no significant phenotypic effects on the timing of different developmental stages or on the general form of the plant. However, transgenics with high extensin levels showed an enhanced increase in stem thickness, with an indirect effect on stem height. This effect, is, however, rather small, with a reduction in height of between 5-8% depending on the transgenic line being analysed.
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Sakhalkar VS, Roberts K, Hawthorne LM, McCaskill DM, Veillon DM, Caldito GC, Cotelingam JD. Allosensitization in Patients Receiving Multiple Blood Transfusions. Ann N Y Acad Sci 2005; 1054:495-9. [PMID: 16339705 DOI: 10.1196/annals.1345.072] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Extended antigen (C, E, K) matching decreased the incidence of alloantibody (alloAB) and autoantibody (autoAB) formation, in addition to eliminating transfusion reactions in the multiply transfused sickle cell disease patients. AlloAB formation possibly transforms the immune system into a hyperactive state leading to further and earlier alloAB and autoAB formation. However, additional CEK matching results in marked overuse of Rh-negative packed red blood cell (pRBC) units, 30 minutes' extra time of a skilled technologist, and 153 dollars extra CEK reagent cost per unit to find CEK-matched pRBCs for every transfusion for these multiply transfused patients.
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Roberts K, Jewkes F, Whalley H, Hopkins D, Porter K. A review of emergency equipment carried and procedures performed by UK front line paramedics on paediatric patients. Emerg Med J 2005; 22:572-6. [PMID: 16046763 PMCID: PMC1726868 DOI: 10.1136/emj.2004.022533] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES In 1997 a review of paramedic practice upon adult patients in the UK found many inconsistencies and deficiencies in basic care. A follow up review in 2002 identified widespread improvement in provision of equipment and skills to provide basic and advanced life support.Paediatric care was not assessed in either review. The authors conducted this study to identify current standards of care in paediatric paramedic practice and areas of potential improvement. METHOD A questionnaire designed to determine what equipment and skills were available to paramedics for the management of common or serious paediatric emergencies was sent to chief executives of the 32 NHS Ambulance Trusts in England and Wales. RESULTS The trend of expanding and standardising practice among adult patients has not extended to paediatric practice despite national guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC). Furthermore there are some serious failings in the provision of care and skills. Many Trusts have not adopted JRCALC guidelines for the management of life threatening paediatric emergencies such as asthma, meningitis, and fluid replacement in hypovolaemia. CONCLUSIONS Ambulance Trusts not meeting standards set out in the JRCALC guidelines must address their areas of deficiency. Failure to do so endangers children's lives and leaves Trusts open to criticism.
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