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Patil N, Ma N, Mair M, Nazareth J, Sim A, Reynolds C, Freeman N, Chauhan M, Howells L, Peel D, Ahmad S, Sridhar T, Walter HS. Oral Cavity Cancers: Ethnic Differences in Radiotherapy Outcomes in a Majority South Asian Leicester Community. Clin Oncol (R Coll Radiol) 2024; 36:300-306. [PMID: 38388251 DOI: 10.1016/j.clon.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/15/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
AIMS Squamous cell carcinoma oral cavity cancers (SCCOCCs) have a higher reported incidence in South Asian countries. We sought to compare presenting stage and outcome by ethnicity in patients with SCCOCC treated with radical radiotherapy in a single centre in the UK. MATERIALS AND METHODS All patients with SCCOCC treated with radical radiotherapy at an oncology department in Leicester (UK) between 2011 and 2017 were identified. Baseline demographic, clinical data and 2-year treatment outcomes were reported. RESULTS Of the 109 patients included, 40 were South Asian and 59 were non-South Asian. South Asians had significantly poorer 2-year disease-free survival compared with non-South Asians (54.6% versus 73%, P = 0.01). CONCLUSION Our analysis suggests that South Asians with SCCOCC have poorer outcomes despite a younger age and similar disease characteristics. Environmental, social factors and differing biology of disease may be responsible and further research is required to inform targeted interventions.
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Affiliation(s)
- N Patil
- University Hospitals of Leicester, Leicester, UK.
| | - N Ma
- University Hospitals of Leicester, Leicester, UK
| | - M Mair
- University Hospitals of Leicester, Leicester, UK
| | - J Nazareth
- University Hospitals of Leicester, Leicester, UK
| | - A Sim
- University Hospitals of Leicester, Leicester, UK
| | - C Reynolds
- University Hospitals of Leicester, Leicester, UK
| | - N Freeman
- University Hospitals of Leicester, Leicester, UK
| | - M Chauhan
- University Hospitals of Leicester, Leicester, UK
| | - L Howells
- Institute for Precision Health, University of Leicester, Leicester, UK
| | - D Peel
- Department of Radiation Oncology, Regional Cancer Treatment Services, Midcentral District Health Board, Palmerston North, New Zealand
| | - S Ahmad
- University Hospitals of Leicester, Leicester, UK
| | - T Sridhar
- University Hospitals of Leicester, Leicester, UK
| | - H S Walter
- University Hospitals of Leicester, Leicester, UK; Leicester Cancer Research Centre, University of Leicester, Leicester, UK
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Ma N, Reynolds C, Freeman N, Chauhan M, Brown A, Ahmad S, Peel D, Walter H, Sridhar T. Outcomes from a Cancer Centre of Intensity-modulated Radiotherapy in Patients with Squamous Cell Carcinoma of the Head and Neck. Clin Oncol (R Coll Radiol) 2021; 33:e462. [PMID: 34275715 DOI: 10.1016/j.clon.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- N Ma
- University Hospitals of Leicester, Leicester, UK
| | - C Reynolds
- University Hospitals of Leicester, Leicester, UK
| | - N Freeman
- University Hospitals of Leicester, Leicester, UK
| | - M Chauhan
- University Hospitals of Leicester, Leicester, UK
| | - A Brown
- University Hospitals of Derby and Burton, Derby, UK
| | - S Ahmad
- University Hospitals of Leicester, Leicester, UK
| | - D Peel
- Palmerston North Hospital, Roslyn, Palmerston North, New Zealand
| | - H Walter
- University Hospitals of Leicester, Leicester, UK
| | - T Sridhar
- University Hospitals of Leicester, Leicester, UK
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Bradley BD, Light JD, Ebonyi AO, N'Jai PC, Ideh RC, Ebruke BE, Nyassi E, Peel D, Howie SRC. Implementation and 8-year follow-up of an uninterrupted oxygen supply system in a hospital in The Gambia. Int J Tuberc Lung Dis 2018; 20:1130-4. [PMID: 27393551 PMCID: PMC4937752 DOI: 10.5588/ijtld.15.0889] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
SETTING: A 42-bed hospital operated by the Medical Research Council (MRC) Unit in The Gambia. OBJECTIVE: To devise, test and evaluate a cost-efficient uninterrupted oxygen system in the MRC Hospital. DESIGN: Oxygen cylinders were replaced with oxygen concentrators as the primary source of oxygen. An uninterruptable power supply (UPS) ensured continuity of power. Hospital staff were trained on the use of the new system. Eight years post-installation, an analysis of concentrator maintenance needs and costs was conducted and user feedback obtained to assess the success of the system. RESULTS: The new system saved at least 51% of oxygen supply costs compared to cylinders, with savings likely to have been far greater due to cylinder leakages. Users indicated that the system is easier to use and more reliable, although technical support and staff training are still needed. CONCLUSION: Oxygen concentrators offer long-term cost savings and an improved user experience compared to cylinders; however, some technical support and maintenance are needed to upkeep the system. A UPS dedicated to oxygen concentrators is an appropriate solution for settings where power interruptions are frequent but short in duration. This approach can be a model for health systems in settings with similar infrastructure.
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Affiliation(s)
- B D Bradley
- Centre for Global Engineering and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada
| | - J D Light
- Engineering Science, University of Toronto, Toronto, Ontario, Canada
| | - A O Ebonyi
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - P C N'Jai
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - R C Ideh
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - B E Ebruke
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - E Nyassi
- Medical Research Council Unit The Gambia, Fajara, The Gambia
| | - D Peel
- Ashdown Consultants, Hartfield, UK
| | - S R C Howie
- Centre for Global Engineering and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Canada; Medical Research Council Unit The Gambia, Fajara, The Gambia, Department of Paediatrics, University of Auckland, Auckland, Centre for International Health, University of Otago, Dunedin, New Zealand
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Graham HR, Ayede AI, Bakare AA, Oyewole OB, Peel D, Falade AG, Duke T. Oxygen for children and newborns in non-tertiary hospitals in South-west Nigeria: A needs assessment. Afr J Med Med Sci 2016; 45:31-49. [PMID: 28686826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Oxygen is important for the treatment of hypoxaemia associated with pneumonia, malaria, and other medical, obstetric, and surgical conditions. Access to oxygen therapy is limited in many of the high mortality settings where it would be of most benefit. METHODS A needs assessment of 12 non-tertiary hospitals in south-west Nigeria, assessing structural, technical and clinical barriers to the provision of safe and effective oxygen therapy. RESULTS Oxygen supply was reported to be a major challenge by hospital directors. All hospitals had some access to oxygen cylinders, which were expensive and frequently ran out. Nine (75%) hospitals used oxygen concentrators, which were limited by inadequate power supply and lack of maintenance capacity. Appropriate oxygen delivery and monitoring devices (nasal prongs, catheters, pulse oximeters) were poorly available, and no hospitals had clinical guidelines pertaining to the use of -oxygen for children. Oxygen was expensive to patients (median US$20/day) and to hospitals. Estimated oxygen demand is reported using both a constant mean-based estimate and adjustment for seasonal and other variability. CONCLUSIONS Making oxygen available to sick children and neonates in Nigerian hospitals will require: improving detection of hypoxaemia through routine use of pulse oximetry; improving access to oxygen through equipment, training, and maintenance structures; and commitment to building hospital and state structures that can sustain and expand oxygen initiatives.
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Miller BS, Barlow J, Calderan S, Collins K, Leaper R, Olson P, Ensor P, Peel D, Donnelly D, Andrews-Goff V, Olavarria C, Owen K, Rekdahl M, Schmitt N, Wadley V, Gedamke J, Gales N, Double MC. Validating the reliability of passive acoustic localisation: a novel method for encountering rare and remote Antarctic blue whales. ENDANGER SPECIES RES 2015. [DOI: 10.3354/esr00642] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Avery CME, Gandhi N, Peel D, Neal CP. Indications and outcomes for 100 patients managed with a pectoralis major flap within a UK maxillofacial unit. Int J Oral Maxillofac Surg 2013; 43:546-54. [PMID: 24220666 DOI: 10.1016/j.ijom.2013.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/04/2013] [Accepted: 10/09/2013] [Indexed: 11/26/2022]
Abstract
There are few studies reporting the role of the pedicled pectoralis major (PPM) flap in modern maxillofacial practice. The outcomes of 100 patients (102 flaps) managed between 1996 and 2012 in a UK maxillofacial unit that preferentially practices free tissue reconstruction are reported. The majority (88.2%) of PPM flaps were for oral squamous cell carcinoma (SCC), stage IV (75.6%) disease, and there was substantial co-morbidity (47.0% American Society of Anesthesiologists 3 or 4). The PPM flap was the preferred reconstruction on 80.4% of occasions; 19.6% followed free flap failure. Over half of the patients (57%) had previously undergone major surgery and/or chemoradiotherapy. Ischaemic heart disease (P=0.028), diabetes mellitus (P=0.040), and methicillin-resistant Staphylococcus aureus (MRSA) infection (P=0.013) were independently associated with flap loss (any degree). Free flap failure was independently associated with total (2.0%) and major (6.9%) partial flap loss (P=0.044). Cancer-specific 5-year survival for stage IV primary SCC and salvage surgery improved in the second half (2005-2012) of the study period (22.2% vs. 79.8%, P=0.002, and 0% vs. 55.7%, P=0.064, respectively). There were also declines in recurrent disease (P=0.008), MRSA (P<0.001), and duration of admission (P=0.014). The PPM flap retains a valuable role in the management of advanced disease combined with substantial co-morbidity, and following free flap failure.
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Affiliation(s)
- C M E Avery
- Department of Maxillofacial Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK.
| | - N Gandhi
- University of Birmingham, Birmingham, UK
| | - D Peel
- Department of Clinical Oncology, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
| | - C P Neal
- Department of Surgery, Leicester Royal Infirmary, University Hospitals of Leicester, Leicester, UK
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Peel D, Neighbour R, Eltringham R. A reply. Anaesthesia 2013; 68:1199-200. [DOI: 10.1111/anae.12482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D. Peel
- Safe Anaesthesia Worldwide; Marden UK
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Do C, Waples RS, Peel D, Macbeth GM, Tillett BJ, Ovenden JR. NeEstimatorv2: re-implementation of software for the estimation of contemporary effective population size (Ne) from genetic data. Mol Ecol Resour 2013; 14:209-14. [DOI: 10.1111/1755-0998.12157] [Citation(s) in RCA: 1229] [Impact Index Per Article: 111.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 07/25/2013] [Accepted: 07/25/2013] [Indexed: 12/01/2022]
Affiliation(s)
- C. Do
- Conservation Biology Division; Northwest Fisheries Science Center; 2725 Montlake Blvd East, Seattle WA 98112 USA
| | - R. S. Waples
- Northwest Fisheries Science Centre; NOAA Fisheries; 2725 Montlake Blvd East, Seattle WA 98112 USA
| | - D. Peel
- CSIRO Computational Informatics; Castray Esplanade Hobart Tas. 7004 Australia
| | - G. M. Macbeth
- Queensland Department of Agriculture, Fisheries and Forestry; 80 Ann St.; Brisbane Qld 4000 Australia
| | - B. J. Tillett
- Australian Institute of Marine Science; UWA Oceans Institute; 35 Stirling Highway Crawley WA 6009 Australia
| | - J. R. Ovenden
- Molecular Fisheries Laboratory; School of Biomedical Sciences; University of Queensland; Otto Hirschfeld Building (81), St Lucia Qld 4072 Australia
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Duke T, Peel D, Graham S, Howie S, Enarson PM, Jacobson R. Oxygen concentrators: a practical guide for clinicians and technicians in developing countries. ACTA ACUST UNITED AC 2013; 30:87-101. [DOI: 10.1179/146532810x12637745452356] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Peel D, Neighbour R, Eltringham RJ. Evaluation of oxygen concentrators for use in countries with limited resources. Anaesthesia 2013; 68:706-12. [PMID: 23654218 DOI: 10.1111/anae.12260] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2013] [Indexed: 11/28/2022]
Abstract
Seven different models of oxygen concentrators were purchased. The manufacturer's data were evaluated by a ranking method for operation at high temperature and high relative humidity, power consumption, warranty and cost. Measurements were then made of the oxygen concentration produced at maximum operating temperature. All the concentrators were CE marked and claimed compliance with the relevant Standard ISO 8359:1996. Only two models complied with their specification. On examination of the concentrators and the accompanying documents we found that compliance with 61 points listed in ISO 8359 ranged from 85% to 98%. Oxygen concentration was measured with the machines running simultaneously under both high temperature and high humidity. All models delivered low oxygen concentrations at 40 °C and 95% relative humidity. Only two models delivered >82% at 35 °C and 50% relative humidity. Concentrators intended for use in countries with limited resources should be evaluated before they are purchased, by independent experts, using the methods described herein.
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Affiliation(s)
- D Peel
- Ashdown Consultants, Hartfield, UK
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Peel D, Waples RS, Macbeth GM, Do C, Ovenden JR. Accounting for missing data in the estimation of contemporary genetic effective population size (N
e
). Mol Ecol Resour 2012; 13:243-53. [DOI: 10.1111/1755-0998.12049] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 10/30/2012] [Indexed: 12/01/2022]
Affiliation(s)
- D. Peel
- CSIRO Mathematics Informatics and Statistics Castray Esplanade Hobart TAS 7001 Australia
| | - R. S. Waples
- Northwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration Seattle 98112 WA USA
| | - G. M. Macbeth
- Northwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration Seattle 98112 WA USA
| | - C. Do
- Conservation Biology Division Northwest Fisheries Science Center Seattle WA USA
| | - J. R. Ovenden
- Northwest Fisheries Science Center National Marine Fisheries Service, National Oceanic and Atmospheric Administration Seattle 98112 WA USA
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La Vincente SF, Peel D, Carai S, Weber MW, Enarson P, Maganga E, Soyolgerel G, Duke T. The functioning of oxygen concentrators in resource-limited settings: a situation assessment in two countries. Int J Tuberc Lung Dis 2011; 15:693-9. [PMID: 21756524 DOI: 10.5588/ijtld.10.0544] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING The paediatric wards of hospitals in Malawi and Mongolia. OBJECTIVE To describe oxygen concentrator functioning in two countries with widespread, long-term use of concentrators as a primary source of oxygen for treating children. DESIGN A systematic assessment of concentrators in the paediatric wards of 15 hospitals in Malawi and nine hospitals in Mongolia. RESULTS Oxygen concentrators had been installed for a median of 48 months (interquartile range [IQR] 6-60) and 36 months (IQR 12-96), respectively, prior to the evaluation in Malawi and Mongolia. Concentrators were the primary source of oxygen. Three quarters of the concentrators assessed in Malawi (28/36) and half those assessed in Mongolia (13/25) were functional. Concentrators were found to remain functional with up to 30 000 h of use. However, several concentrators were functioning very poorly despite limited use. Concentrators from a number of different manufacturers were evaluated, and there was marked variation in performance between brands. Inadequate resources for maintenance were reported in both countries. CONCLUSION Years after installation of oxygen concentrators, many machines were still functioning, indicating that widespread use can be sustained in resource-limited settings. However, concentrator performance varied substantially. Procurement of high-quality and appropriate equipment is critical, and resources should be made available for ongoing maintenance.
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Affiliation(s)
- S F La Vincente
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Henson CC, Andreyev HJ, Symonds RP, Peel D, Swindell R, Davidson SE. Late-onset bowel dysfunction after pelvic radiotherapy: a national survey of current practice and opinions of clinical oncologists. Clin Oncol (R Coll Radiol) 2011; 23:552-7. [PMID: 21550216 DOI: 10.1016/j.clon.2011.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 02/21/2011] [Accepted: 02/22/2011] [Indexed: 12/23/2022]
Abstract
AIMS Seventeen thousand patients receive treatment with radical pelvic radiotherapy annually in the UK. It is common for patients to develop gastrointestinal symptoms after treatment. The aim of this study was to determine the current practice of clinical oncologists in the UK with respect to late-onset bowel dysfunction after pelvic radiotherapy, and to discuss the wider issues surrounding current and future service provision for this patient group. MATERIALS AND METHODS A questionnaire was developed to establish current practice. This was sent to the 314 clinical oncologists in the UK who treat pelvic malignancies up to a maximum of three times. RESULTS One hundred and ninety (61%) responses were received. Most oncologists (76%) screen for gastrointestinal dysfunction after pelvic radiotherapy, usually through history taking rather than formal tools. Clinical oncologists view toxicity as a significant problem, with most estimating that up to 24% of patients at 1 year have bowel symptoms. Most oncologists refer less than 50% of their symptomatic patients, with most referring less than 10%. These referrals are 31% to a gastroenterologist, 23% to a gastrointestinal surgeon and 33% to both. Most (58%) do not have access to a gastroenterologist or a gastrointestinal surgeon with a specialist interest in their area. Sixty-five per cent of oncologists think a service is required specifically for patients with bowel dysfunction after pelvic radiotherapy, but half (52%) think that the current service in their area is inadequate. CONCLUSIONS Clinical oncologists recognise late-onset bowel dysfunction after pelvic radiotherapy as a significant problem, but one that is linked to poor recognition of symptoms and an inadequate patchy service.
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Affiliation(s)
- C C Henson
- The Christie NHS Foundation Trust, Manchester, UK.
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Duke T, Graham SM, Cherian MN, Ginsburg AS, English M, Howie S, Peel D, Enarson PM, Wilson IH, Were W. Oxygen is an essential medicine: a call for international action. Int J Tuberc Lung Dis 2010; 14:1362-8. [PMID: 20937173 PMCID: PMC2975100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Hypoxaemia is commonly associated with mortality in developing countries, yet feasible and cost-effective ways to address hypoxaemia receive little or no attention in current global health strategies. Oxygen treatment has been used in medicine for almost 100 years, but in developing countries most seriously ill newborns, children and adults do not have access to oxygen or the simple test that can detect hypoxaemia. Improving access to oxygen and pulse oximetry has demonstrated a reduction in mortality from childhood pneumonia by up to 35% in high-burden child pneumonia settings. The cost-effectiveness of an oxygen systems strategy compares favourably with other higher profile child survival interventions, such as new vaccines. In addition to its use in treating acute respiratory illness, oxygen treatment is required for the optimal management of many other conditions in adults and children, and is essential for safe surgery, anaesthesia and obstetric care. Oxygen concentrators provide the most consistent and least expensive source of oxygen in health facilities where power supplies are reliable. Oxygen concentrators are sustainable in developing country settings if a systematic approach involving nurses, doctors, technicians and administrators is adopted. Improving oxygen systems is an entry point for improving the quality of care. For these broad reasons, and for its vital importance in reducing deaths due to lung disease in 2010: Year of the Lung, oxygen deserves a higher priority on the global health agenda.
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Affiliation(s)
- T Duke
- Centre for International Child Health, Department of Paediatrics, University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
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Peel D, Sundar S. Metronomic Cyclophosphamide and Dexamethasone is Active in Docetaxel, Castration Refractory, Prostate Cancer. Clin Oncol (R Coll Radiol) 2009. [DOI: 10.1016/j.clon.2009.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hill SE, Njie O, Sanneh M, Jallow M, Peel D, Njie M, Weber M, Hill PC, Adegbola RA, Howie SRC. Oxygen for treatment of severe pneumonia in The Gambia, West Africa: a situational analysis. Int J Tuberc Lung Dis 2009; 13:587-593. [PMID: 19383191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
SETTING Health facilities in The Gambia, West Africa. OBJECTIVES Oxygen treatment is vital in pneumonia, the leading cause of death in children globally. There are shortages of oxygen in developing countries, but little information is available on the extent of the problem. We assessed national oxygen availability and use in The Gambia, a sub-Saharan African country. METHODS A government-led team visited 12 health facilities in The Gambia. A modified World Health Organization assessment tool was used to determine oxygen requirements, current provision and capacity to support effective oxygen use. RESULTS Eleven of the 12 facilities managed severe pneumonia. Oxygen was reliable in three facilities. Requirement and supply were often mismatched. Both oxygen concentrators and oxygen cylinders were used. Suboptimal electricity and maintenance made using concentrators difficult, while logistical problems and cost hampered cylinder use. Children were usually triaged by trained nurses who reported lack of training in oxygen use. Oxygen was given typically by nasal prongs; pulse oximetry was available in two facilities. CONCLUSIONS National data showed that oxygen availability did not meet needs in most Gambian health facilities. Remedial options must be carefully assessed for real costs, reliability and site-by-site usability. Training is needed to support oxygen use and equipment maintenance.
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Affiliation(s)
- S E Hill
- Department of Public Health, University of Otago, Wellington, New Zealand
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Abstract
It is unclear whether hypertension and antihypertensive medication use are associated with breast cancer. In order to examine these associations, we conducted a case-control study among women aged 50-75 years. Breast cancer cases were ascertained via a population-based cancer registry (n=523) and controls were ascertained via random-digit-dialing (n=131). Participants completed a self-administered questionnaire which queried history of hypertension, antihypertensive medication use and risk factors. Unconditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence intervals (CI), adjusted for age, body mass index (BMI), diabetes, smoking, alcohol use, menopausal status, family history of breast or ovarian cancer, age at first full-term pregnancy and education. History of treated hypertension was associated with significant increased risk of breast cancer (OR, 1.77; 95% CI, 1.04-3.03) and this association appeared only in women with BMI > or =25 kg/m(2) (OR, 2.30; 95% CI, 1.12-4.71). Diuretic use was also associated with elevated breast cancer risk (OR, 1.79; 95% CI, 1.07-3.01). The risk associated with diuretic use increased with duration of use (P for trend, <0.01). Use of other blood pressure medications was not found to be associated with breast cancer risk. These results support a positive association between treated hypertension, diuretic use and breast cancer risk among women aged 50-75 years.
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Affiliation(s)
- J A Largent
- Department of Medicine, Epidemiology Division, University of California, Irvine, Irvine, CA 92697-7555, USA.
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Large PJ, Peel D, Quayle JR. Microbial growth on C(1) compounds. 4. Carboxylation of phosphoenolpyruvate in methanol-grown Pseudomonas AM1. Biochem J 2006; 85:243-50. [PMID: 16748968 PMCID: PMC1243936 DOI: 10.1042/bj0850243] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P J Large
- Medical Research Council Cell Metabolism Research Unit, Department of Biochemistry, University of Oxford
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Large PJ, Peel D, Quayle JR. Microbial growth on C(1) compounds. 3. Distribution of radioactivity in metabolites of methanol-grown Pseudomonas AM1 after incubation with [C]methanol and [C]bicarbonate. Biochem J 2006; 82:483-8. [PMID: 16748943 PMCID: PMC1243485 DOI: 10.1042/bj0820483] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P J Large
- Medical Research Council Cell Metabolism Research Unit, Department of Biochemistry, University of Oxford
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Hoggatt KJ, Bernstein L, Reynolds P, Anton-Culver H, Deapen D, Peel D, Pinder R, Ross RK, West DW, Wright W, Ziogas A, Horn-Ross PL. Correlates of vitamin supplement use in the United States: data from the California Teachers Study cohort. Cancer Causes Control 2002; 13:735-40. [PMID: 12420952 DOI: 10.1023/a:1020282927074] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe factors associated with vitamin supplement use in a large cohort of adult women. METHODS California teachers and administrators (n = 133,479) completed a questionnaire on lifestyle factors and medical history. Specific supplement users regularly used at least one specific vitamin supplement in the past year; multivitamin users regularly used a multivitamin; and multivitamin and specific supplement users took a multivitamin and one or more specific supplements. Associations between supplement use and other variables were quantified using means, cross-tabulations, and age-adjusted prevalence odds ratios. RESULTS Multivitamin and specific supplement users tended to be older and Caucasian. Compared to non-users, they were also leaner (odds ratio [OR] for BMI > or = 30 kg/m2 = 0.6 for specific supplement users with or without multivitamins, and OR = 0.7 for multivitamin only users), and were less likely to be current smokers (OR for current smoking = 0.8 for multivitamin plus specific supplement users, OR = 0.9 for specific supplement only users, and OR = 0.7 for multivitamin only users). Specific supplement users (with or without multivitamins) were more likely to use cancer screening tests, eat fruits and vegetables, and exercise than were multivitamin only users or non-users. CONCLUSIONS A variety of demographic, dietary, and health-related factors were associated with different categories of supplement use.
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Affiliation(s)
- K J Hoggatt
- Northern California Cancer Center, Union City 94587, USA.
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Abstract
MOTIVATION This paper introduces the software EMMIX-GENE that has been developed for the specific purpose of a model-based approach to the clustering of microarray expression data, in particular, of tissue samples on a very large number of genes. The latter is a nonstandard problem in parametric cluster analysis because the dimension of the feature space (the number of genes) is typically much greater than the number of tissues. A feasible approach is provided by first selecting a subset of the genes relevant for the clustering of the tissue samples by fitting mixtures of t distributions to rank the genes in order of increasing size of the likelihood ratio statistic for the test of one versus two components in the mixture model. The imposition of a threshold on the likelihood ratio statistic used in conjunction with a threshold on the size of a cluster allows the selection of a relevant set of genes. However, even this reduced set of genes will usually be too large for a normal mixture model to be fitted directly to the tissues, and so the use of mixtures of factor analyzers is exploited to reduce effectively the dimension of the feature space of genes. RESULTS The usefulness of the EMMIX-GENE approach for the clustering of tissue samples is demonstrated on two well-known data sets on colon and leukaemia tissues. For both data sets, relevant subsets of the genes are able to be selected that reveal interesting clusterings of the tissues that are either consistent with the external classification of the tissues or with background and biological knowledge of these sets. AVAILABILITY EMMIX-GENE is available at http://www.maths.uq.edu.au/~gjm/emmix-gene/
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Affiliation(s)
- G J McLachlan
- Department of Mathematics, University of Queensland, Brisbane, Queensland 4072, Australia
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Rose SE, Chalk JB, Griffin MP, Janke AL, Chen F, McLachan GJ, Peel D, Zelaya FO, Markus HS, Jones DK, Simmons A, O'Sullivan M, Jarosz JM, Strugnell W, Doddrell DM, Semple J. MRI based diffusion and perfusion predictive model to estimate stroke evolution. Magn Reson Imaging 2001; 19:1043-53. [PMID: 11711228 DOI: 10.1016/s0730-725x(01)00435-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study we present a novel automated strategy for predicting infarct evolution, based on MR diffusion and perfusion images acquired in the acute stage of stroke. The validity of this methodology was tested on novel patient data including data acquired from an independent stroke clinic. Regions-of-interest (ROIs) defining the initial diffusion lesion and tissue with abnormal hemodynamic function as defined by the mean transit time (MTT) abnormality were automatically extracted from DWI/PI maps. Quantitative measures of cerebral blood flow (CBF) and volume (CBV) along with ratio measures defined relative to the contralateral hemisphere (r(a)CBF and r(a)CBV) were calculated for the MTT ROIs. A parametric normal classifier algorithm incorporating these measures was used to predict infarct growth. The mean r(a)CBF and r(a)CBV values for eventually infarcted MTT tissue were 0.70 +/- 0.19 and 1.20 +/- 0.36. For recovered tissue the mean values were 0.99 +/- 0.25 and 1.87 +/- 0.71, respectively. There was a significant difference between these two regions for both measures (p < 0.003 and p < 0.001, respectively). Mean absolute measures of CBF (ml/100g/min) and CBV (ml/100g) for the total infarcted territory were 33.9 +/- 9.7 and 4.2 +/- 1.9. For recovered MTT tissue, the mean values were 41.5 +/- 7.2 and 5.3 +/- 1.2, respectively. A significant difference was also found for these regions (p < 0.009 and p < 0.036, respectively). The mean measures of sensitivity, specificity, positive and negative predictive values for modeling infarct evolution for the validation patient data were 0.72 +/- 0.05, 0.97 +/- 0.02, 0.68 +/- 0.07 and 0.97 +/- 0.02. We propose that this automated strategy may allow possible guided therapeutic intervention to stroke patients and evaluation of efficacy of novel stroke compounds in clinical drug trials.
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Affiliation(s)
- S E Rose
- Centre For Magnetic Resonance, University of Queensland, Brisbane, Queensland 4072, Australia.
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Peel D. Infanticide happens when no real mental health care exists. Tex Med 2001; 97:15-7. [PMID: 11561316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Abstract
The majority of renal cell carcinomas (RCCs) are sporadic, and increasing incidence rates suggest that such environmental risk factors as smoking play a role in the etiology of the disease. Cases with RCC were selected from the population-based cancer registry of Orange County, California, between 1994 and 1997; controls were recruited by telephone using random digit dialing. A total of 115 case and 259 control subjects were genotyped for N-acetyltransferase 2 (NAT2), which codes for a polymorphic enzyme involved in tobacco-carcinogen metabolism. Subjects with slow acetylator genotypes were found to be at twofold increased risk (odds ratio (OR) = 1.8; 95 percent confidence interval (CI): 1.1, 2.9) of RCC. Although cancer risk doubled among smokers (OR = 2.2; 95 percent CI: 1.3, 3.7), stratified analysis revealed gene-environment interaction among slow acetylators that smoked (OR = 3.2; 95 percent CI: 1.7, 6.1) compared with rapid acetylators that smoked (OR = 1.4; 95 percent CI: 0.7, 2.9). A dose response was found for pack-years among slow acetylators (p < 0.01) but not among rapid acetylators (p = 0.06). Although smoking is a well-established risk factor of RCC, our data suggest that the risk is pronounced among slow rather than rapid acetylators.
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Affiliation(s)
- J C Semenza
- School of Community Health, College of Urban and Public Affairs, Portland State University, Portland, OR 97207-0751, USA.
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31
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Abstract
This paper is offered as an addition to the small existing body of research on the history of old age in Australia. It considers the experiences of a cohort of early settlers in a Victorian country district as they grew old in their community. It finds that while the experience and even the definition of old age varied with class, gender and circumstance, most ageing people in the Colac area remained more engaged with both the community and family than more general studies have suggested.
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Kolodner RD, Tytell JD, Schmeits JL, Kane MF, Gupta RD, Weger J, Wahlberg S, Fox EA, Peel D, Ziogas A, Garber JE, Syngal S, Anton-Culver H, Li FP. Germ-line msh6 mutations in colorectal cancer families. Cancer Res 1999; 59:5068-74. [PMID: 10537275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Hereditary nonpolyposis colorectal carcinoma (HNPCC) is due primarily to inherited mutations in two mismatch repair genes, MSH2 and MLH1, whereas germ-line mutations in other mismatch repair genes are rare. We examined the frequency of germ-line msh6 mutations in a population-based series of 140 colorectal cancer patients, including 45 sporadic cases, 91 familial non-HNPCC cases, and 4 HNPCC cases. Among the 91 population-based familial non-HNPCC cases, germ-line msh6 mutations were found in 6 patients (7.1% of probands analyzed; median age at diagnosis, 61 years). These mutations included a splice site mutation, a frameshift mutation, two missense mutations that were demonstrated to be loss of function mutations, and two missense mutations for which functional studies were not possible. In contrast, germ-line msh6 mutations were not found in any of the 45 sporadic cases and the 4 HNPCC cases in the population-based series or in the second series of 58 clinic-based, primarily HNPCC families. Our data suggest that germ-line msh6 mutations predispose individuals to primarily late-onset, familial colorectal carcinomas that do not fulfill classic criteria for HNPCC.
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Affiliation(s)
- R D Kolodner
- Ludwig Institute for Cancer Research, Department of Medicine and Cancer Center, University of California San Diego Medical School, La Jolla 92093-0660, USA.
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Kawamura K, Shibata T, Saget O, Peel D, Bryant PJ. A new family of growth factors produced by the fat body and active on Drosophila imaginal disc cells. Development 1999; 126:211-9. [PMID: 9847235 DOI: 10.1242/dev.126.2.211] [Citation(s) in RCA: 197] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
By fractionating conditioned medium (CM) from Drosophila imaginal disc cell cultures, we have identified a family of Imaginal Disc Growth Factors (IDGFs), which are the first polypeptide growth factors to be reported from invertebrates. The active fraction from CM, as well as recombinant IDGFs, cooperate with insulin to stimulate the proliferation, polarization and motility of imaginal disc cells. The IDGF family in Drosophila includes at least five members, three of which are encoded by three genes in a tight cluster. The proteins are structurally related to chitinases, but they show an amino acid substitution that is known to abrogate catalytic activity. It therefore seems likely that they have evolved from chitinases but acquired a new growth-promoting function. The IDGF genes are expressed most strongly in the embryonic yolk cells and in the fat body of the embryo and larva. The predicted molecular structure, expression patterns, and mitogenic activity of these proteins suggest that they are secreted and transported to target tissues via the hemolymph. However, the genes are also expressed in embryonic epithelia in association with invagination movements, so the proteins may have local as well as systemic functions. Similar proteins are found in mammals and may constitute a novel class of growth factors.
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Affiliation(s)
- K Kawamura
- Developmental Biology Center, University of California, Irvine, Irvine, CA 92717, USA.
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Jouzel J, Alley RB, Cuffey KM, Dansgaard W, Grootes P, Hoffmann G, Johnsen SJ, Koster RD, Peel D, Shuman CA, Stievenard M, Stuiver M, White J. Validity of the temperature reconstruction from water isotopes in ice cores. ACTA ACUST UNITED AC 1997. [DOI: 10.1029/97jc01283] [Citation(s) in RCA: 473] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Virus-associated hemophagocytic syndrome (VAHS) is a rare histiocytic proliferative disorder secondary to viral infection affecting children and young adults and in which there is both a poor prognosis and no specific treatment. We report a case of VAHS in a 22-year-old woman secondary to infection with Epstein Barr virus in which multiorgan failure developed with a fatal outcome 3 weeks after presentation. Clonal analysis showed EBV incorporation into the T cell genome accompanied by monoclonal rearrangement of the TCR beta gene. Treatment with cyclosporin A resulted in hematological improvement but the patient died of disseminated fungal infection. We propose that bone marrow ablation and allografting should be available for these rare cases and suggest that a protocol should be developed with designated transplant centres to aid early referral.
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Affiliation(s)
- G Bird
- Department of Medicine, Maidstone Hospital, Kent, U.K
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36
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Woods DF, Hough C, Peel D, Callaini G, Bryant PJ. Dlg protein is required for junction structure, cell polarity, and proliferation control in Drosophila epithelia. J Cell Biol 1996; 134:1469-82. [PMID: 8830775 PMCID: PMC2120992 DOI: 10.1083/jcb.134.6.1469] [Citation(s) in RCA: 352] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The Discs large (Dlg) protein of Drosophila is the prototypic member of a growing family of proteins termed membrane-associated guanylate kinase homologs (MAGUKs). The MAGUKs are composed of a series of peptide domains that include one or three DHR/PDZs, an SH3, and a region homologous to guanylate kinase (GUK). We have previously shown that the product of this gene, the Dlg protein, is localized at the septate junctions between epithelial cells, and that mutations in the gene cause neoplastic overgrowth of the imaginal discs. The dlg locus is therefore defined as a tumor suppressor gene. In this paper, we show that the Dlg protein is localized on the cytoplasmic face of the septate junction and is required for the maintenance of this structure. It is also required for proper organization of the cytoskeleton, for the differential localization of membrane proteins, and for apicobasal polarity of epithelial cells. However, these other functions can be uncoupled from Dlg's role as a tumor suppressor since mutations in two domains of the protein, the SH3 and GUK, cause loss of normal cell proliferation control without affecting the other functions of the protein. These results suggest that, besides regulating cellular proliferation, the Dlg protein is a critical component of the septate junctions and is required for maintaining apicobasal polarity in Drosophila epithelium.
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Affiliation(s)
- D F Woods
- Developmental Biology Center, University of California, Irvine 92717-2274, USA
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37
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Abstract
Technical problems in developing countries often require more than just technological solutions. Many small hospitals in rural areas are without a reliable oxygen supply; small oxygen concentrators offer a solution, but simply sending out machines is ineffective. This account details the setting up and first year's operation of a project to test oxygen concentrations in a developing country. A co-ordinated strategy has been developed to include machines, supplies, education, training, and feedback. Initial results are encouraging, and support the idea that suitably installed and maintained concentrations can have a valuable role in bringing oxygen therapy to patients and hospitals in countries which have so far been denied it.
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Affiliation(s)
- M Dobson
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
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38
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Affiliation(s)
- G Handley
- Clinical Chemistry Department, Queen Elizabeth Hospital, Gateshead, UK
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39
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Hopewell JW, Hamlet R, Peel D. The response of pig skin to single doses of irradiation from strontium-90 sources of differing surface area. Br J Radiol 1985; 58:778-80. [PMID: 3842286 DOI: 10.1259/0007-1285-58-692-778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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40
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41
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Peel D, Kay JD, Taylor F. Reminder: cresol and phenol preservatives interfere with analysis for glucose with the YSI Analyzer. Clin Chem 1983; 29:1558-9. [PMID: 6872227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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42
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Peel D. The chaplain and lay pastoral volunteers. Dimens Health Serv 1982; 59:44-45. [PMID: 7106429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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43
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Affiliation(s)
- D Peel
- Abbotsbury Laboratories, Barnet Lane, Elstree, Herts., U.K
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