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Moss SM, Campbell C, Melia J, Coleman D, Smith S, Parker R, Ramsell P, Patnick J, Weller DP. Performance measures in three rounds of the English bowel cancer screening pilot. Gut 2012; 61:101-7. [PMID: 21561880 PMCID: PMC3230830 DOI: 10.1136/gut.2010.236430] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare performance measures across all three rounds of the English bowel cancer screening faecal occult blood test pilot and their relation to social deprivation and ethnicity. METHODS In each round in three primary care trusts, data for a restricted population of over 48,500 aged 60-69 years were analysed. Individual-based data included postcode linked to area-based data on the Index of Multiple Deprivation (IMD) 2004, and ethnicity. Outcomes were the rates of screening and colonoscopy uptake, positivity and detection of neoplasia (adenomas or bowel cancer) and bowel cancer, and the positive predictive values (PPVs) of a positive test for neoplasia and bowel cancer. Sensitivity was calculated by the proportional incidence method using data on interval cancers identified from cancer registrations. RESULTS The overall uptake rate was 61.8%, 57.0% and 58.7% in the first, second and third rounds, respectively. Although the PPV for cancer decreased over the course of the three rounds (10.9% in the 1st round, 6.5% in 3rd round), the PPV for all neoplasia remained relatively constant (42.6% in 1st round, 36.9% in 3rd round). Deprivation and non-white ethnic background (principally Indian subcontinent in the pilot region) were associated with low screening and colonoscopy uptake rates, and this changed little over the three screening rounds. Uptake was lower in men, although differences in uptake between men and women decreased over time. Non-participation in previous rounds was a strong predictor of low uptake. CONCLUSIONS Performance measures are commensurate with expectations in a screening programme reaching its third round of screening, but a substantial ongoing effort is needed, particularly to address the effects of deprivation and ethnicity in relation to uptake.
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Parker R, Gul R, Bucknall V, Bowley D, Karandikar S. Double jeopardy: pyogenic liver abscess and massive secondary rectal haemorrhage after rubber band ligation of haemorrhoids. Colorectal Dis 2011; 13:e184. [PMID: 20718833 DOI: 10.1111/j.1463-1318.2010.02387.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Perez-Moral N, Adnet C, Noel T, Parker R. The aggregative stability of β-lactoglobulin in glassy mixtures with sucrose, trehalose and dextran. Eur J Pharm Biopharm 2011; 78:264-70. [DOI: 10.1016/j.ejpb.2011.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 02/01/2011] [Accepted: 02/04/2011] [Indexed: 11/26/2022]
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Ulatowski L, Parker R, Davidson C, Yanjanin N, Kelley TJ, Corey D, Atkinson J, Porter F, Arai H, Walkley SU, Manor D. Altered vitamin E status in Niemann-Pick type C disease. J Lipid Res 2011; 52:1400-10. [PMID: 21550990 DOI: 10.1194/jlr.m015560] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vitamin E (α-tocopherol) is the major lipid-soluble antioxidant in many species. Niemann-Pick type C (NPC) disease is a lysosomal storage disorder caused by mutations in the NPC1 or NPC2 gene, which regulates lipid transport through the endocytic pathway. NPC disease is characterized by massive intracellular accumulation of unesterified cholesterol and other lipids in lysosomal vesicles. We examined the roles that NPC1/2 proteins play in the intracellular trafficking of tocopherol. Reduction of NPC1 or NPC2 expression or function in cultured cells caused a marked lysosomal accumulation of vitamin E in cultured cells. In vivo, tocopherol significantly accumulated in murine Npc1-null and Npc2-null livers, Npc2-null cerebella, and Npc1-null cerebral cortices. Plasma tocopherol levels were within the normal range in Npc1-null and Npc2-null mice, and in plasma samples from human NPC patients. The binding affinity of tocopherol to the purified sterol-binding domain of NPC1 and to purified NPC2 was significantly weaker than that of cholesterol (measurements kindly performed by R. Infante, University of Texas Southwestern Medical Center, Dallas, TX). Taken together, our observations indicate that functionality of NPC1/2 proteins is necessary for proper bioavailability of vitamin E and that the NPC pathology might involve tissue-specific perturbations of vitamin E status.
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Ingle C, Parker R, James H, Scrase C. 1554 poster EVALUATION OF A COMMERCIAL AUTO-SEGMENTATION TOOL IN THE OUTLINING OF LYMPH NODES & ORGANS AT RISK IN HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71676-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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di Mambro AJ, Parker R, McCune A, Gordon F, Dayan CM, Collins P. In vitro steroid resistance correlates with outcome in severe alcoholic hepatitis. Hepatology 2011; 53:1316-22. [PMID: 21400552 DOI: 10.1002/hep.24159] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/21/2010] [Indexed: 12/20/2022]
Abstract
UNLABELLED Steroids improve the outcome in alcoholic hepatitis (AH), but up to 40% of patients fail to respond adequately. Interleukin-2 (IL-2) exacerbates steroid resistance in vitro. We performed a prospective study to determine if intrinsic steroid sensitivity correlates with response to steroids in individuals with severe AH and if IL-2 receptor blockade can reverse this. Peripheral blood mononuclear cells (PBMCs) were isolated from 20 patients with AH and a Maddrey's score >32. Patients were treated with oral prednisolone plus full supportive measures. Clinical resistance to oral steroid treatment was defined as a drop in serum bilirubin of <25% within 7 days or death within 6 months. In vitro steroid resistance was measured in PBMC using the dexamethasone suppression of lymphocyte proliferation assay and repeated after the addition of the anti-IL-2 receptor (anti-CD25) monoclonal antibody, basiliximab. Suppression of lymphocyte proliferation <60% was considered to indicate steroid resistance. In all, 82% (9/11) of in vitro steroid-resistant patients were dead at 6 months as compared to 21% (2/9) of steroid-sensitive patients (P = 0.03). Similarly, 91% (10/11) of in vitro steroid-resistant patients failed to show a significant fall in bilirubin at day 7 as compared to 44% (4/9) of steroid-sensitive patients (P < 0.05). Basiliximab improved the maximal proliferation count in 91% (10/11) of in vitro steroid-resistant patients (P = 0.003). CONCLUSION Clinical outcome of steroid therapy in this patient cohort correlated with in vitro steroid resistance. IL-2 blockade improved in vitro steroid sensitivity. This suggests that intrinsic lack of steroid sensitivity may contribute to poor clinical response to steroids in severe AH. IL-2 receptor blockade represents a possible mechanism to overcome this.
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Parker R. A Case of Focal Epilepsy: Trephining: Electrical Stimulation and Excision of Focus: Primary Healing: Improvement. BRITISH MEDICAL JOURNAL 2011; 1:1101-3. [PMID: 20754236 DOI: 10.1136/bmj.1.1691.1101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Parker R. Operations for Gastric Ulcer, Acute and Chronic1. BRITISH MEDICAL JOURNAL 2011; 2:1702-4. [PMID: 20760553 DOI: 10.1136/bmj.2.2187.1702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parker R. INGUINAL HERNIA OF UTERUS: HERNIOTOMY WITH RADICAL CURE: UNUSUAL COMPLICATIONS: RECOVERY. BRITISH MEDICAL JOURNAL 2011; 1:947-8. [PMID: 20764415 DOI: 10.1136/bmj.1.2520.947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Saran KA, Parker G, Parker R, Dickman CR. Rehabilitation as a conservation tool: a case studyusing the common wombat. ACTA ACUST UNITED AC 2011. [DOI: 10.1071/pc110310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Wildlife rehabilitation seeks to return healthy animals back to their natural habitat with good survival prospects,and hence contribute to the persistence of their populations. However, the effectiveness of rehabilitation remains largelyundocumented, and its utility as a conservation tool is unclear. In this paper, we document the rehabilitation successof a large, herbivorous marsupial, the common wombat (Vombatus ursinus), and use the findings as a case study toevaluate the contribution that rehabilitation can make to wildlife conservation. Using a database of 54 orphaned wombatsmonitored for up to eight years, we found that 81.5% of young survived to release and, of those, 77.3% were alivein the wild by the end of the study. Survival during rehabilitation was greater for larger, older animals, but influencedalso by problems during care, reaction to human contact following weaning and, in particular, the responses ofindividuals to treatment. No factors associated with rescue condition, rehabilitation or release affected survival of animalsonce returned to the wild, suggesting that wombats were not disadvantaged by their progression through rehabilitation.We provide brief recommendations to improve rehabilitation success for wombats. We conclude that rehabilitation isan under-recognized but potentially valuable conservation tool, and suggest that it is timely to consider its contributionto wildlife management more generally.
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Shiraiwa S, Baek S, Dominguez A, Marmar E, Parker R, Kramer GJ. Direct detection of lower hybrid wave using a reflectometer on Alcator C-Mod. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2010; 81:10D936. [PMID: 21033964 DOI: 10.1063/1.3492370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The possibility of directly detecting a density perturbation produced by lower hybrid (LH) waves using a reflectometer is presented. We investigate the microwave scattering of reflectometer probe beams by a model density fluctuation produced by short wavelength LH waves in an Alcator C-Mod experimental condition. In the O-mode case, the maximum response of phase measurement is found to occur when the density perturbation is approximately centimeters in front of the antenna, where Bragg scattering condition is satisfied. In the X-mode case, the phase measurement is predicted to be more sensitive to the density fluctuation close to the cut-off layer. A feasibility test was carried out using a 50 GHz O-mode reflectometer on the Alcator C-Mod tokamak, and positive results including the detection of 4.6 GHz pump wave and parametric decay instabilities were obtained.
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Robin F, Engmann J, Tomasi D, Breton O, Parker R, Schuchmann HP, Palzer S. Adjustable Twin-Slit Rheometer for Shear Viscosity Measurement of Extruded Complex Starchy Melts. Chem Eng Technol 2010. [DOI: 10.1002/ceat.201000151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gilliland I, Nadeau J, Williams S, Munoz L, Parker R, Cook J, McNeill J, Mahon M, Rauschhuber M, Gunter M, McDonnell H, Richardson C, Jones ME. Remembering Wartime Experiences: The Role of Spirituality Among Retired Military Nurses. JOURNAL OF SPIRITUALITY IN MENTAL HEALTH 2010. [DOI: 10.1080/19349631003730084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Parker R. MO-E-203-01: Department of Transportation Hazmat Employee Training for Shippers of Radioactive Materials - Part II. Med Phys 2010. [DOI: 10.1118/1.3469103] [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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Parker R, Dixit A, Fraser A, Creed TJ, Probert CS. Clinical experience of methotrexate in Crohn's disease: response, safety and monitoring of treatment. Postgrad Med J 2010; 86:208-11. [DOI: 10.1136/pgmj.2009.085787] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tinker A, Parker R, Lord D, Grear K. Advancing newborn health: The Saving Newborn Lives initiative. Glob Public Health 2010; 5:28-47. [PMID: 19851911 PMCID: PMC2790805 DOI: 10.1080/17441690903286572] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Until recently, newborn health was virtually absent from the global health agenda. Now, assistance agencies, national governments and non-governmental organisations are increasingly addressing this previously neglected issue of close to four million newborns dying every year. The experience of the Saving Newborn Lives initiative documents some of the progress that has been made and the challenges and opportunities that lie ahead. Since the start of the initiative in 2000, targeted research, focused on overcoming the key barriers to improved newborn survival, has demonstrated low-cost, community-based interventions and strategies that can significantly reduce newborn mortality. Building on what has been learned from this and other efforts to date, the challenge now is to reach the millions of newborns still at risk.
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McKay D, Ostring G, Broderick C, Parker R, Chaitow J, Singh-Grewal D. A pilot study of the effect of intra-articular steroid injection on isokinetic muscle strength in children with juvenile idiopathic arthritis. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.216] [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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Al-Haj A, Lobriguito A, Parker R. SU-FF-I-78: Effective Doses in Whole Body and Brain PET/CT Procedures of Adult Patients. Med Phys 2009. [DOI: 10.1118/1.3181198] [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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Parker R, Eley K, Bond S, Watt-Smith S. Is the ratio of functional fibrinogen to platelets as measured by thromboelastography a predictive parameter for thrombotic complications in free tissue transfer surgery? Int J Oral Maxillofac Surg 2009. [DOI: 10.1016/j.ijom.2009.03.656] [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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Bhaumik S, Watson JM, Devapriam J, Raju LB, Tin NN, Kiani R, Talbott L, Parker R, Moore L, Majumdar SK, Ganghadaran SK, Dixon K, Das Gupta A, Barrett M, Tyrer F. Brief report: Aggressive challenging behaviour in adults with intellectual disability following community resettlement. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:298-302. [PMID: 19250390 DOI: 10.1111/j.1365-2788.2008.01111.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Aggressive challenging behaviour is common in adults with intellectual disability (ID) in long-term care facilities. The government's commitment to the closure of all facilities in England has led to concerns over how to manage this behaviour in the community. The aim of this study was to assess changes in aggressive challenging behaviour and psychotropic drug use in adults with ID following resettlement using a person-centred approach. METHOD The Modified Overt Aggression Scale was administered to carers of 49 adults with ID prior to discharge from a long-stay hospital and 6 months and 1 year after community resettlement. RESULTS All areas of aggressive challenging behaviour reduced significantly between baseline and 6 months following resettlement (P < 0.001). This reduction remained (but did not decrease further) at 1-year follow-up. CONCLUSIONS Further work is needed to evaluate the role of environmental setting on aggressive challenging behaviour in adults with ID.
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Parker R, Burgess S, Dubaniewicz A, Gouws L, Krone J, Madden V, Nortje C, Parsons C. Patient satisfaction with a pilot chronic pain management programme in Cape Town, South Africa. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2009. [DOI: 10.4102/sajp.v65i1.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The goals of a chronic pain management clinic includeincreasing patient knowledge about pain, developing pain management skillsand increasing patients’ confidence in their pain management abilities.A Chronic Pain Management Programme (CPMP) based on evidence basedguidelines was developed at a chronic pain management clinic to facilitatepatient discharge to a primary healthcare level. Aim: The aim of this study was to explore patient satisfaction with, acceptability of and the perceived success which could be due to the CPMP developed at the Chronic Pain Management Clinic of Groote Schuur Hospital,Cape Town.Methods: Patients (n=14) were referred to the pilot study from the Chronic Pain Management Clinic. A s a pilot, four courses were run over a period ofone year. In order to reach the research aim, an eleven-question, structuredopen-ended interview was conducted with all participants. Results: Fourteen patients enrolled in the CPMP. Responses were favourable with participants emphasising the roleof increased knowledge about pain, the role of exercise and of stress management techniques. Participants also recog-nised a positive change in behaviours and attitudes following participation in the CPMP.Conclusions: Findings suggest that participants found the format of the course acceptable as regards course content,structure and delivery. Participant responses suggest that the course was acceptable and perceived as useful. However,future courses would benefit from refresher courses or structured support groups.
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Ince-Cushman A, Rice JE, Reinke M, Greenwald M, Wallace G, Parker R, Fiore C, Hughes JW, Bonoli P, Shiraiwa S, Hubbard A, Wolfe S, Hutchinson IH, Marmar E, Bitter M, Wilson J, Hill K. Observation of self-generated flows in tokamak plasmas with lower-hybrid-driven current. PHYSICAL REVIEW LETTERS 2009; 102:035002. [PMID: 19257362 DOI: 10.1103/physrevlett.102.035002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Indexed: 05/27/2023]
Abstract
In Alcator C-Mod discharges lower hybrid waves have been shown to induce a countercurrent change in toroidal rotation of up to 60 km/s in the central region of the plasma (r/a approximately <0.4). This modification of the toroidal rotation profile develops on a time scale comparable to the current redistribution time (approximately 100 ms) but longer than the energy and momentum confinement times (approximately 20 ms). A comparison of the co- and countercurrent injected waves indicates that current drive (as opposed to heating) is responsible for the rotation profile modifications. Furthermore, the changes in central rotation velocity induced by lower hybrid current drive (LHCD) are well correlated with changes in normalized internal inductance. The application of LHCD has been shown to generate sheared rotation profiles and a negative increment in the radial electric field profile consistent with a fast electron pinch.
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Parker R, Deville S, Dupuis L, Bertrand F, Aucouturier J. Adjuvant formulation for veterinary vaccines: Montanide™ Gel safety profile. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.provac.2009.07.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Goodyear SJ, Stallard N, Gaunt A, Parker R, Williams N, Wong L. Local impact of the English arm of the UK Bowel Cancer Screening Pilot study. Br J Surg 2008; 95:1172-9. [DOI: 10.1002/bjs.6230] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Abstract
Background
The English arm of the UK Bowel Cancer Screening Pilot study recently concluded its third round. The primary aim was to assess the impact of faecal occult blood test (FOBT) screening on the detection of symptomatic (non-screen-detected) cancers within the target age group (50–69 years). The secondary aim was to assess differences between screened and non-screened cohorts in Dukes' classification at diagnosis.
Methods
This population-based study utilized retrospective analysis of existing validated colorectal cancer (CRC) data over 5 years (April 2000 to March 2005), encompassing rounds one and two of screening.
Results
There was a 23 per cent (P = 0·011) reduction in the diagnosis of over the 5 years. Presentations with symptomatic cancer reduced by 49 per cent (P = 0·049), with a proportionate (2·6-fold) rise in the detection of screened (asymptomatic) malignancy. Cancers were diagnosed at an earlier stage in the screened population, with significantly more Dukes' A tumours than in the non-screen-detected cohort (P < 0·001) and an estimated odds ratio of 0·27 (95 per cent confidence interval 0·08 to 0·91) (P = 0·035) for Dukes' ‘D’ cancers.
Conclusion
FOBT screening resulted in a significant reduction in the number of symptomatic cancers detected within the target age group. Tumours detected by screening were diagnosed at an earlier pathological stage.
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Parker R, Adams J, Ogola G, McBrayer D, Hubbard J, McCullough T, Hartman J, Cleveland T. Current Activity Guidelines for CABG Patients are too Restrictive: Comparison of the Forces Exerted on the Median Sternotomy during a Cough vs. Lifting Activities Combined with Valsalva Maneuver. Thorac Cardiovasc Surg 2008; 56:190-4. [DOI: 10.1055/s-2008-1038470] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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