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McCabe FJ, McQuail PM, Turley L, Hurley R, Flavin RA. Anatomical reconstruction of first ray instability hallux valgus with a medial anatomical TMTJ1 plate. Foot Ankle Surg 2021; 27:869-873. [PMID: 33353832 DOI: 10.1016/j.fas.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND First tarsometatarsal joint (TMTJ1) arthrodesis is a powerful tool for hallux valgus correction. Past criticism of the TMTJ1 arthrodesis has focused on high non-union rates, and consequent need for delayed weightbearing as prevention. In this study we present a selection and treatment protocol to minimise non-union while allowing early weightbearing. METHODS All TMTJ1 arthrodesis procedures for hallux valgus performed by the senior surgeon over the period June, 2016 to July, 2019 were included. An anatomically-designed, medial TMTJ1 plate and screw compression was utilised for TMTJ1 arthrodesis. The construct was augmented with synthetic intermetatarsal stabilisation. All patients were kept non-weightbearing for 2 weeks, followed by progressive weightbearing as tolerated for 4 weeks. Minimum follow-up was 1 year. RESULTS 300 modified Lapidus procedures were performed for hallux valgus with mean IMA 17° (Range: 14-29). Mean age was 58 years, with 93% female. 284 (94%) had an Akin osteotomy, while 222 cases (74%) were associated with another forefoot procedure. Patients began progressive weight bearing as tolerated from 2 weeks. All were fully weight bearing by 8 weeks post-operatively. There was a 100% union rate in this group. Mean AOFAS Hallux MTP-IP scores rose from 59 pre-operatively to 97 post-operatively. One plate was removed due to tibialis anterior impingement. There were no recurrences at final follow-up. CONCLUSIONS We describe a selection and treatment protocol for TMTJ1 arthrodesis for hallux valgus. This yields high union rates while allowing early weight bearing. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- F J McCabe
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland.
| | - P M McQuail
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - L Turley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R Hurley
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
| | - R A Flavin
- Department of Trauma & Orthopaedics, St. Vincent's University Hospital, Elm Park, Dublin, D04 T6F4, Ireland
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Hurley R, de Louvois J. Serious Infections in Obstetric and Neonatal Practice. J R Soc Med 2018; 73:770-5. [PMID: 7241434 PMCID: PMC1437955 DOI: 10.1177/014107688007301104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Candilio L, Malik A, Ariti C, Barnard M, Wright S, Smith A, Giannaris S, Ashley E, Martin B, Hamilton-Davies C, Cordery R, Hurley R, Bertoja E, Burt C, Di Salvo C, Lawrence D, Hayward M, Yap J, Roberts N, McGregor C, Sheikh A, Kolvekar S, Hausenloy DJ, Yellon DM. 123 THE EFFECTS OF MULTI-LIMB REMOTE ISCHAEMIC PRECONDITIONING IN PATIENTS UNDERGOING CARDIAC BYPASS SURGERY. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shim H, Hurley R, Rogalski E, Mesulam M. Spelling Errors in Primary Progressive Aphasia (S44.007). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s44.007] [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: 11/15/2022] Open
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Shim H, Hurley R, Rogalski E, Mesulam M. Spelling Errors in Primary Progressive Aphasia (IN4-1.003). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in4-1.003] [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: 11/15/2022] Open
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Hurley R. All About My Mother. West J Med 2010. [DOI: 10.1136/bmj.c6055] [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: 11/04/2022]
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Hurley R. Elegies for Angels, Punks, and Raging Queens. West J Med 2010. [DOI: 10.1136/bmj.c4630] [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: 11/03/2022]
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Hurley R. Activists storm stage at AIDS conference to demand that funders meet their pledges. West J Med 2010. [DOI: 10.1136/bmj.c3950] [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: 11/04/2022]
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Affiliation(s)
- R Hurley
- Department of Microbiology, Royal Postgraduate Medical School's Institute of Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital, London W6 0XG
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Hurley R. Proposed bill to reform UK libel law includes defence of public interest. West J Med 2010. [DOI: 10.1136/bmj.c2881] [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: 11/04/2022]
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Demel KC, Jahagirdar BN, Anderson DM, Anderson C, Schneider DJ, Jaffe JP, Cruse S, Tarchand G, Christensen-Johnston D, Hurley R. Psychological and spiritual well-being of breast cancer survivors in a community-based cancer survivorship clinic. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e19673] [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: 11/20/2022] Open
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Hurley R, Jirik CL, Christensen-Johnson DL, Watry MM. ASCO Quality Oncology Practice Initiative: Harnessing the electronic medical record to provide decision support and to improve and measure quality oncology care. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16557] [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: 11/20/2022] Open
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Hurley R. A far from fairytale romance. West J Med 2010. [DOI: 10.1136/bmj.c2570] [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: 11/04/2022]
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Couture SM, Penn DL, Losh M, Adolphs R, Hurley R, Piven J. Comparison of social cognitive functioning in schizophrenia and high functioning autism: more convergence than divergence. Psychol Med 2010; 40:569-579. [PMID: 19671209 PMCID: PMC2827676 DOI: 10.1017/s003329170999078x] [Citation(s) in RCA: 159] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Individuals with schizophrenia and individuals with high-functioning autism (HFA) seem to share some social, behavioral and biological features. Although marked impairments in social cognition have been documented in both groups, little empirical work has compared the social cognitive functioning of these two clinical groups. METHOD Forty-four individuals with schizophrenia, 36 with HFA and 41 non-clinical controls completed a battery of social cognitive measures that have been linked previously to specific brain regions. RESULTS The results indicate that the individuals with schizophrenia and HFA were both impaired on a variety of social cognitive tasks relative to the non-clinical controls, but did not differ from one another. When individuals with schizophrenia were divided into negative symptom and paranoid subgroups, exploratory analyses revealed that individuals with HFA may be more similar, in terms of the pattern of social cognition impairments, to the negative symptom group than to the paranoia group. CONCLUSIONS Our findings provide further support for similarities in social cognition deficits between HFA and schizophrenia, which have a variety of implications for future work on gene-brain-behavior relationships.
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Affiliation(s)
- S M Couture
- University of North Carolina-Chapel Hill Department of Psychology, NC, USA.
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Hurley R. Every Good Boy Deserves Favour. West J Med 2010. [DOI: 10.1136/bmj.c860] [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: 11/03/2022]
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Hurley R. The Diary of a Teenage Health Freak. West J Med 2009. [DOI: 10.1136/bmj.b3355] [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: 11/04/2022]
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O'Gorman T, MacDonald N, Mould T, Cutner A, Hurley R, Olaitan A. Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications. EUR J GYNAECOL ONCOL 2009; 30:171-173. [PMID: 19480247] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). STUDY DESIGN Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. RESULTS One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. CONCLUSION TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.
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Affiliation(s)
- T O'Gorman
- Department of Womens Health, Elizabeth Garrett Anderson & Obstetric Hospital, Huntley street, London, UK.
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Hurley R, Trezona P, Peczalska E, Jirik C, Anderson E, Heinrich R. A randomized trial of self-hypnosis to contol nausea in women receiving moderately emetogenic chemotherapy. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.8182] [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: 11/20/2022] Open
Affiliation(s)
- R. Hurley
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
| | - P. Trezona
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
| | - E. Peczalska
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
| | - C. Jirik
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
| | - E. Anderson
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
| | - R. Heinrich
- HealthPartners and Regions Cancer Care Ctr, St Paul, MN
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De Souza S, Lirenman D, Carter J, Hurley R, White C, Gill I, Potts J. 509 DOES SIROLIMUS CONTRIBUTE TO ANEMIA IN PEDIATRIC KIDNEY TRANSPLANT PATIENTS? J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-509] [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: 11/03/2022]
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Abstract
We describe a new technique for removing anterior vocal fold lesions, which cannot be visualized with conventional suspension laryngoscopy. These situations are rare and the only alternative surgeons have had previously is an open laryngeal procedure. The technique we describe involves the use of a laryngeal mask airway (LMA), a flexible bronchoscope with biopsy channel, a 400 microm laser fibre and KTP/532 nm laser. This method was used to treat two patients in whom conventional suspension laryngoscopy had previously been attempted and abandoned.
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Affiliation(s)
- J Kanagalingam
- Royal National Throat Nose and Ear Hospital, Gray's Inn Road, London, UK.
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Ames D, Camm J, Cook P, Falkai P, Gury C, Hurley R, Johnson G, Piepho R, Vieweg V. [Minimizing the risks associated with QTc prolongation in people with schizophrenia. A consensus statement by the Cardiac Safety in Schizophrenia Group]. Encephale 2002; 28:552-62. [PMID: 12506268] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Schizophrenia is one of the most debilitating mental illnesses, complicated by an increased incidence of suicide amongst patients compared with the general population. A recent report has also demonstrated a 33% increase in -relative risk of death associated with circulatory disease, indicating that the latter may be a more critical factor than either suicide or accidental death in this population. Indeed, the average life expectancy of a person with schizophrenia is currently approximately a decade less than that of the general population. Additionally, it has been shown that in over 50% of people with schizophrenia, there is a reduction in their chance of reaching psychosocial goals. Since the arrival of the first antipsychotic drugs in the middle of the last century, the outlook for patients with schizophrenia has improved markedly. In particular, the introduction of the new generation (atypical) class of antipsychotic agents in the 1980s and 90s has resulted in a significant reduction in the incidence of violent and aggressive episodes in treated patients. A better side-effect profile of these drugs, especially reduced extra pyramidal symptoms (EPS), has resulted in improved patient outcomes and the possibility of good long-term control of the disorder. However, while the introduction of antipsychotic agents has undoubtedly revolutionised the prognosis for patients with schizophrenia, these medications are not without their own problems. One of the concerns to emerge over the last fifteen years is unpredictable, sudden and unexplained death in patients taking antipsychotic drugs. The cause of sudden death in this population is controversial and the role of drugs is not clear. People with schizophrenia also appear to be at higher risk of cardiovascular disease compared with the general population. Many factors may play a role in this including a higher prevalence of smoking, poorer diet, more sedentary lifestyle and a greater likelihood of alcoholism and substance abuse. However, it is possible that the impact of adverse effects on the cardiovascular system related to certain antipsychotic drug use may well increase the prevalence of mortality and morbidity due to cardiovascular events and may also play a significant role in the reduced life expectancy of the patient with schizophrenia. The range of mechanisms whereby antipsychotic drugs can influence cardiovascular function is very broad and includes: receptor blockade; conduction disturbance (eg bundle branch block); delayed ventricular repolarisation (prolonged QTc interval); left ventricular dysfunction; sinus node abnormalities; myocarditis; postural hypotension; polydipsia-hyponatremia syndrome; weight gain; glucose intolerance. Of these, QTc interval prolongation, with the risk of progression to the potentially fatal ventricular tachyarrhythmia Torsades de Pointes (TdP), is of particular concern as this arrhythmia is unpredictable and difficult to manage. Coupled with these clinical concerns are regulatory issues regarding several compounds that have received warnings or been withdrawn from the market. Recently, there has been no clear guidance for psychiatrists regarding QTc interval prolongation and TdP. This document seeks: 1) to explore drug-induced ventricular arrhythmias with particular emphasis on QTc interval prolongation as a warning of increased vulnerability, 2) to provide guidelines on the therapeutic management of the patient with schizophrenia to minimize the risk of iatrogenic cardiotoxicity. Several guidance documents have previously been published in this area including the report published by the UK Working Group of the Royal College of Psychiatrists' Psychopharmacology Sub-Group in 1997, and the policy document on the potential for QTc prolongation and proarrhythmia by non-antiarrhythmic drugs published in June 1999 under the auspices of the European Society of Cardiology. This document seeks to supplement currently published guidelines.
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Affiliation(s)
- D Ames
- Université de Melbourne, Melbourne, Australie
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Hurley R, Rawlings RB. Who lost cost containment? A roster for recrimination. Manag Care Q 2002; 9:23-32. [PMID: 11813454] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The battle to contain medical costs certainly has not been won. It has returned as the most significant health care issue facing the nation. The rising premium costs over the last decade suggest that cost containment via managed care has largely failed. Obviously new methods need to be identified and tested, but before launching any new innovations, it seems prudent to review the factors that have contributed to the failure in order to give constructive criticism.
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Affiliation(s)
- R Hurley
- Department of Health Administration, Virginia Commonwealth University, Richmond, VA, USA
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Lake T, Gold M, Hurley R. HMO provider networks in Medicare+Choice: comparing Medicare and commercial lines of business. Manag Care Q 2002; 9:16-22. [PMID: 11813453] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The Medicare+Choice (M+C) program was intended to expand choice of managed care plans for Medicare beneficiaries. In the past few years, the opposite has occurred as many participating HMOs reduced Medicare service areas or withdrew from the program. This paper presents findings from a study of the provider networks of 85 HMOs that were participating in M+C in 1999. The study shows that provider networks serving Medicare enrollees are usually similar to those developed for HMOs' commercial line of business, but when they are different, Medicare provider networks are smaller. Most HMOs also had at least some problems maintaining their Medicare provider networks. These findings have implications for the future of the Medicare+Choice program and Medicare enrollees' access to health care.
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Affiliation(s)
- T Lake
- Mathematica Policy Research, Inc., 50 Church St., Cambridge, MA 02138, USA.
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Fenner M, Cresswell J, Hurley R, Baldwin T. Relationship between capitulum size and pre-dispersal seed predation by insect larvae in common Asteraceae. Oecologia 2002; 130:72-77. [PMID: 28547027 DOI: 10.1007/s004420100773] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [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: 12/12/2000] [Accepted: 07/03/2001] [Indexed: 11/29/2022]
Abstract
The evolution of a showy floral display as an advertisement to pollinators could simultaneously advertise the availability of resources to pre-dispersal seed-predators. The hypotheses tested here are that the incidence of seed predation by bud-infesting insect larvae in capitula of Asteraceae is positively related to (1) capitulum size among species, (2) capitulum size within species, (3) capitulum lifespan, and (4) the degree of flowering asynchrony on individual plants. Three populations of each of 20 common herbaceous species of Asteraceae from disturbed ground and grassland habitats were monitored for the presence of pre-dispersal, seed-eating insect larvae. Mean capitulum size (receptacle width) of each species was measured. In a sub-set of eight species, individual capitula were tagged to determine their flowering phenology and lifespan (from anthesis to seed shedding). From these data an index of flowering synchrony on individual plants was derived. Among species, the incidence of larval infestation increased with capitulum size. Small-flowered species such as Achillea millefolium were largely free of bud-infesting larvae, whilst large-flowered species such as Arctium minus were heavily infested. In three cases investigated in greater detail, bud infestation was found to increase with capitulum size within species, suggesting a potential for natural selection to favour smaller capitula. No relationship was found between infestation levels and either capitulum lifespan or degree of flowering synchrony, and there was no evidence that the relationship between capitulum size and infestation was confounded by correlations with these other features. The results support hypotheses 1 and 2, but not 3 and 4. It is suggested that the characteristic capitulum size of each species may represent a trade-off between the opposing selection pressures of pollinators and pre-dispersal seed predators.
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Affiliation(s)
- M Fenner
- School of Biological Sciences, University of Southampton, Bassett Crescent East, SO16 7PX, Southampton, UK
| | - J Cresswell
- School of Biological Sciences, University of Exeter, Hatherly Laboratories, Prince of Wales Road, EX4 4PS, Exeter, UK
| | - R Hurley
- Centre for Environmental Sciences, University of Southampton, SO17 1BJ, Southampton, UK
| | - T Baldwin
- Centre for Environmental Sciences, University of Southampton, SO17 1BJ, Southampton, UK
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Abstract
OBJECTIVE To describe important sequelae occurring among a cohort of children aged 5 years who had had meningitis during the first year of life and who had been identified by a prospective national study of meningitis in infancy in England and Wales between 1985 and 1987. DESIGN Follow up questionnaires asking about the children's health and development were sent to general practitioners and parents of the children and to parents of matched controls. The organism that caused the infection and age at infection were also recorded. SETTING England and Wales. PARTICIPANTS General practitioners and parents of children who had had meningitis before the age of 1 year and of matched controls. MAIN OUTCOME MEASURES The prevalence of health and developmental problems and overall disability among children who had had meningitis compared with controls. RESULTS Altogether, 1584 of 1717 (92.2%) children who had had meningitis and 1391 of 1485 (93.6%) controls were successfully followed up. Among children who survived to age 5 years 247 of 1584 (15.6%) had a disability; there was a 10-fold increase in the risk of severe or moderate disability at 5 years of age among children who had had meningitis (relative risk 10.3, 95% confidence interval 6.7 to 16.0, P<0.001). There was considerable variation in the rates of severe or moderate disability in children infected with different organisms. CONCLUSION The long term consequences of having meningitis during the first year of life are significant: 32 of 1717 (1.8%) children died within five years. Not only did almost a fifth of children with meningitis have a permanent, severe or moderately severe disability, but subtle deficits were also more prevalent.
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Affiliation(s)
- H Bedford
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH.
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Jones M, Wilson R, Norbeck JM, Han W, Hurley R, Schuetzle D. A systems evaluation on the effectiveness of a catalyst retrofit program in China. Environ Sci Technol 2001; 35:3416-3421. [PMID: 11563641 DOI: 10.1021/es0016699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A low-cost, rare-earth oxide (REO) catalyst has been recommended as part of China's retrofit program for Chinese carbureted vehicles. This study evaluated: (1) the emission reduction efficiency of the REO catalyst during chassis dynamometer testing on the FTP cycle; (2) the effect that fuel properties had on tailpipe emissions and catalyst efficiency; (3) the importance of vehicle premaintenance as part of a retrofit protocol; and (4) the emission reductions obtained following implementation of the program. Results also show that current in-use Chinese noncatalyst, carbureted vehicles operate excessively rich, resulting in extremely high emissions of CO, gaseous toxic compounds, and other non-methane hydrocarbon species (NMHC). Preretrofit maintenance alone has the potential to reduce these emissions by approximately 50%. Dynamometer emission tests showed emissions reductions of >95% for hydrocarbons, CO, and gaseous toxics after retrofit of the REO catalyst. In particular, the relative unit health risk associated with the decrease in emissions of airborne toxic compounds using unleaded Chinese fuel was reduced from 6.33 to 0.30. (Use of low-sulfur California Phase II gasoline rather than current in-use Chinese fuel reduced emissions further.) Following implementation of the program, a follow-up study showed that in-use emissions benefits were considerably less than anticipated, primarily because of poor quality control at the retrofit service centers, a less aggressive preretrofit maintenance procedure, and unauthorized modification to the recommended retrofit control system. Overall results indicate that a carefully controlled retrofit program using REO catalyst technology can reduce emissions significantly. However, well-defined implementation guidelines, and strict adherence to these guidelines are needed to achieve maximum benefits.
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Affiliation(s)
- M Jones
- Bourns College of Engineering-Center for Environmental Research and Technology, University of California, Riverside 92521-0425, USA
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Abstract
Provider organizations have evolved to function as intermediaries between managed care plans and individual providers. These organizations assume much financial risk and care management responsibilities. We profile the characteristics of these organizations in markets across the country. The data, taken from a 1999 telephone survey of sixty-four entities in twenty markets and from interviews conducted during site visits to four markets, highlight the youth of many of these organizations, the large financial risk and functional responsibilities they bear, and the mixed views they hold about the health plans they contract with in terms of their willingness to delegate the authority, support, and collaboration that accompany risk. Policymakers need to evaluate what this means for oversight of managed care.
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Affiliation(s)
- M R Gold
- Mathematica Policy Research (MPR), Washington, D.C., USA
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Affiliation(s)
- S A Somers
- Center for Health Care Strategies, Princeton, NJ 08540, USA
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Abstract
Venous thromboembolism is a common disease that causes significant morbidity and mortality. In recent years, the ability to diagnose inherited genetic defects and common acquired conditions predisposing to thrombosis has greatly increased. Venous thromboembolism is now understood to be a complex interaction of genetic and environmental factors leading to thrombosis. Integrating the various factors to individually assess thrombotic risk still poses a challenging clinical problem that will likely become easier as more data accumulate. As the ability to accurately assess risk increases, the data can then be translated into tailored treatment regimens. Until then, only general guidelines regarding evaluation and management are available. In the future, it is likely that other prothrombotic conditions will be elucidated, adding to the pool of data.
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Affiliation(s)
- A P Barger
- University of Minnesota Medical School-Minneapolis, USA.
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Harnett MJ, Hurley R. Anesthesia for fetal intervention. Anesth Analg 2000; 91:500. [PMID: 10910885 DOI: 10.1097/00000539-200008000-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hurley R, Mythen MG. The Haldane effect--an explanation for increasing gastric mucosal PCO2 gradients? Br J Anaesth 2000; 85:167-9. [PMID: 10928005] [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: 02/17/2023] Open
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Abstract
Infection with the tick-borne protozoa Babesia is becoming more common. Babesiosis is usually successfully treated with antibiotics but, in some cases, apheresis may also be indicated. We report two patients with babesiosis and hemolysis treated by apheresis and antibiotics. One case had traditional indications for red blood cell (RBC) exchange, and a second patient was treated with RBC exchange, and plasmapheresis for hemolysis, probably secondary to Babesia parasitemia. Case 1 involved a 44-year-old man with chronic relapsing pancreatitis who had become infected with Babesia from a unit of RBCs transfused during surgery. At 5 weeks after surgery, fever and severe hemolysis developed, along with a hemoglobin of 69 g/L; 30% of his RBCs were found to be infected with Babesia. This patient had several postoperative complications; the babesiosis was treated with clindamycin, quinine, and three RBC exchanges. Parasitemia fell to less then 1% of RBCs, but the patient died of pancreatitis. Case 2 was a 47-year-old man with a renal transplant who had been receiving immunosuppressive therapy for 8 years. He had a history of tick bites, fever, and hemolytic anemia. Analysis of a peripheral blood smear detected Babesia. He was initially treated with antibiotic therapy and two RBC exchanges. Hemolysis improved transiently but worsening parasitemia developed later, as well as an IgG RBC autoantibody. He was then treated by plasmapheresis and RBC exchange. Although his condition improved, he had a third hemolytic episode, which was treated with plasmapheresis and RBC exchange before the parasitemia and autoimmune hemolytic anemia disappeared. In conclusion, immunosuppressed or severely ill people who become infected with Babesia may benefit from RBC exchange or plasmapheresis, or both.
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Affiliation(s)
- D A Evenson
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, USA
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Hurley R, Grocott M, Mythen M. In vitro validation of the Tonocap ® and a modified Paratrend 7 ® sensor. Br J Anaesth 2000. [DOI: 10.1093/bja/84.5.687-a] [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: 11/13/2022] Open
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Walton J, Doll R, Asscher W, Hurley R, Langman M, Gillon R, Strachan D, Wald N, Fletcher P. Consequences for research if use of anonymised patient data breaches confidentiality. BMJ 1999; 319:1366. [PMID: 10567154 PMCID: PMC1117094 DOI: 10.1136/bmj.319.7221.1366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Haffty BG, Hurley R, Peters LJ. Radiation therapy with hyperbaric oxygen at 4 atmospheres pressure in the management of squamous cell carcinoma of the head and neck: results of a randomized clinical trial. Cancer J Sci Am 1999; 5:341-7. [PMID: 10606475] [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] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
PURPOSE The purpose of this study was to present the results of a randomized trial evaluating HBO-4 in combination with hypofractionated radiation therapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS AND MATERIALS Between April 1974 and December 1975, 48 patients with locally advanced unresected SCCHN, referred for primary radiation therapy, were randomized to radiation delivered in air in two fractions of 12.65 Gy over 21 days to a total of 25.30 Gy (air, n = 25); or radiation under HBO-4 in two fractions of 11.50 Gy over 21 days to at total of 23.00 Gy (HBO-4, n = 23). The HBO-4 was administered under general anesthesia to minimize patient discomfort and potential problems with seizures associated with rapid compression to 4 atmospheres. Patients were monitored regularly by the radiation oncologists for toxicity, response, local control, and survival. The original hospital records, radiation records, and hyperbaric treatment logs were recently reviewed, and all data were entered onto a computerized database for the current analysis. The results of this trial have not previously been published. RESULTS The air and HBO-4 arms were evenly matched with respect to age, sex, performance status, hemoglobin level, primary site, and stage of disease. Acute toxicities were acceptable with no significant differences between the two treatment arms. A trend toward excess severe late complications were noted in the hyperbaric arm (12 vs 7). There was a highly significant difference in complete clinical responses between the two arms, with 21/25 in complete dinical responses in the HBO-4 arm compared with 13/25 in complete clinical responses in the air arm, and a statistically insignificant trend toward improved 5-year local control in the HBO-4 arm (29% vs 16%). There were no significant differences between the two arms with respect to 5-year survival, distant metastasis, or second primary tumors. CONCLUSIONS Long-term outcome from this historical randomized trial demonstrate substantial improvements in response rate with the use of HBO-4. The hypofractionation scheme used in the trial resulted in relatively low local control and high complication rates in this group of patients with very advanced SCCHN. However, these results support the theory that radioresistant hypoxic cells limit the radiocurability of SCCHN. Further investigations addressing the hypoxic cell problem with hypoxic cytotoxins or hypoxic cell sensitizers in combination with radiation therapy using more conventional fractionation schemes are warranted.
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Affiliation(s)
- B G Haffty
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520-8040, USA
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Abstract
We studied cervical spine movement in 10 patients scheduled for elective surgery under general anaesthesia. Each patient was fitted with a rigid cervical collar before undergoing direct laryngoscopy for orotracheal intubation. Laryngoscopy was performed using the McCoy laryngoscope in the activated position and the standard Macintosh blade. Displacement of the cervical spine at laryngeal exposure was measured using lateral cervical spine X-rays. Flexion and extension movements of the cervical spine during the use of the two laryngoscope blades were compared. For each blade, the greatest degree of extension occurred at the joint between the first and second cervical vertebrae. There was no significant difference in cervical spine movement when the two blades were compared.
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Affiliation(s)
- P A MacIntyre
- Royal National Throat, Nose and Ear Hospital, London, UK
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Hurley R. From trickle down to paying up: making money talk. Front Health Serv Manage 1998; 15:29-32; discussion 40-4. [PMID: 10187238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R Hurley
- Medical College of Virginia, Virginia Commonwealth University, Richmond, USA
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Benson SH, Hurley R. Improving pain management practices curriculum changes in a baccalaureate program. A report from the Nursing Research & Education Council. Prairie Rose 1998; 67:15. [PMID: 12025585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Holt DE, Ryder TA, Fairbairn A, Hurley R, Harvey D. The myelotoxicity of chloramphenicol: in vitro and in vivo studies: I. In vitro effects on cells in culture. Hum Exp Toxicol 1997; 16:570-6. [PMID: 9363474 DOI: 10.1177/096032719701601004] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
1 Chloramphenicol is used extensively in non-industrialized countries for the treatment of life-threatening infections because it is cheap and effective, despite its known hemotoxicity and linkage to fatal aplastic anaemia. It is important to define the mechanism of toxicity so that means can be devised to ameliorate the toxic effects in order to produce safer usage. 2 Chloramphenicol, at concentrations from 5 mM to 2 mM initiated apoptosis in dividing cells from a monkey kidney-derived cell line and in haematopoietic progenitor cells from human neonatal cord blood. 3 Growth of progenitor cells was suppressed at concentrations of chloramphenicol which would be considered less than therapeutic during patient treatment. 4 These effects could be ameliorated in progenitor cells by co-culture with the antioxidant mercaptoethylamine and in monkey kidney cells by co-culture with vitamin C. 5 This is the first report of apoptosis in chloramphenicol toxicity and suggests a possible link between a metabolic event i.e. the production of free radicals; a morphological effect, apoptosis; and a clinical effect, bone marrow suppression and aplastic anaemia.
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Affiliation(s)
- D E Holt
- Karin Centre for Meningitis Research, Queen Charlotte's & Chelsea Hospital, London, UK
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