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Midgley N, Mortimer R, Carter M, Casey P, Coffman L, Edbrooke-Childs J, Edridge C, Fonagy P, Gomes M, Kapoor A, Marks S, Martin P, Moltrecht B, Morris E, Pokorna N, McFarquhar T. Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties. PLoS One 2023; 18:e0289503. [PMID: 37590277 PMCID: PMC10434917 DOI: 10.1371/journal.pone.0289503] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION Clinical trial registration: ISRCTN 11620914.
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Affiliation(s)
- Nick Midgley
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Rose Mortimer
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Mark Carter
- Barnet, Enfield and Haringey NHS Trust, United Kingdom
| | - Polly Casey
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Chloe Edridge
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Peter Fonagy
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | - Anoushka Kapoor
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Bettina Moltrecht
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Emma Morris
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Nikola Pokorna
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Tara McFarquhar
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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MacKean M, Lecchi T, Mortimer R, Midgley N. ‘I’ve started my journey to coping better’: exploring adolescents’ journeys through an internet-based psychodynamic therapy (I-PDT) for depression. Journal of Child Psychotherapy 2023. [DOI: 10.1080/0075417x.2023.2173271] [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: 03/06/2023]
Affiliation(s)
- Molly MacKean
- The Anna Freud Centre for Children and Families, London, UK
| | - Tanya Lecchi
- The Anna Freud Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rose Mortimer
- The Anna Freud Centre for Children and Families, London, UK
| | - Nick Midgley
- The Anna Freud Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Leibovich L, Mechler J, Lindqvist K, Mortimer R, Edbrooke-Childs J, Midgley N. Unpacking the active ingredients of internet-based psychodynamic therapy for adolescents. Psychother Res 2023; 33:108-117. [PMID: 35297746 DOI: 10.1080/10503307.2022.2050829] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Internet-based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective for treating depression, but not much is known about its active ingredients. OBJECTIVE To explore the techniques used in chat sessions in an iPDT program for depressed adolescents, and to investigate whether they predicted improvement in depression symptoms. METHOD The study uses data collected from a pilot study. The iPDT consisted of 8 modules delivered over 10 weeks that included text, video, exercises, and a weekly text-based chat session with a therapeutic support worker (TSW). The participants were 23 adolescents meeting criteria for depression. The TSWs were 9 psychology master's students. A depression inventory QIDS-A17-SR was filled weekly by the participants, and a self-rated techniques inventory (MULTI-30) was filled by the TSWs after each chat session. RESULTS Common factor techniques were the most widely used techniques in the chat sessions. Both common factors and psychodynamic techniques predicted improvement in depression, with psychodynamic techniques predicting improvement at the following week. CBT techniques were also used but did not predict improvement in depression. CONCLUSION iPDT seem to work in line with theory, where the mechanisms thought to be important for change in treatment were predictive of outcome.
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Affiliation(s)
- Liat Leibovich
- The Clinical Psychology Program, Ruppin Academic Center, Emek-Hefer, Israel
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Rose Mortimer
- The Anna Freud National Centre for Children and Families, London, UK
| | | | - Nick Midgley
- The Anna Freud National Centre for Children and Families, London, UK
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Mortimer R, Somerville MP, Mechler J, Lindqvist K, Leibovich L, Guerrero-Tates B, Edbrooke-Childs J, Martin P, Midgley N. Connecting over the internet: Establishing the therapeutic alliance in an internet-based treatment for depressed adolescents. Clin Child Psychol Psychiatry 2022; 27:549-568. [PMID: 35333646 DOI: 10.1177/13591045221081193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 11/16/2022]
Abstract
Internet-based treatments have been developed for youth mental health difficulties, with promising results. However, little is known about the features of therapeutic alliance, and how it is established and maintained, in text-based interactions between adolescents and therapists in internet-based treatments. This study uses data collected during a pilot evaluation of a psychodynamic internet-based therapy for depressed adolescents. The adolescents had instant-messaging chats with their therapists once a week, over 10 weeks. The adolescents also rated the therapeutic alliance each week, using the Session Alliance Inventory. The present study uses qualitative methods to analyse transcripts of text-based communication between the young people and their therapists. The aim is to identify and describe the key features of therapeutic alliance, and reflect upon the implications for theory and clinical practice. Analysis identified three 'values' that may underpin a strong therapeutic alliance: togetherness, agency and hope. A number of therapist techniques were also found, which seemed to create a sense of these values during text-chat sessions. These findings are discussed, alongside implications for future research.
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Affiliation(s)
- Rose Mortimer
- 4785Anna Freud National Centre for Children and Families, London, UK
| | | | | | | | - Liat Leibovich
- Clinical Psychology, 54619Ruppin Institute, Emek Hefer, Israel
| | | | - Julian Edbrooke-Childs
- 4785Anna Freud National Centre for Children and Families, London, UK.,4919University College London, UK
| | | | - Nick Midgley
- 4785Anna Freud National Centre for Children and Families, London, UK.,4919University College London, UK
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Thomson G, Mortimer R, Baybutt M, Whittaker K. Evaluation of birth companions perinatal and peer support provision in two prison settings in England: a mixed-methods study. Int J Prison Health 2022; 19:125-142. [PMID: 35099853 PMCID: PMC10427972 DOI: 10.1108/ijph-09-2021-0099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/29/2021] [Revised: 10/15/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE This paper reports on insights from an evaluation of Birth Companions (BC) (a UK-based charity) perinatal support in two prison settings in England. The initiative involved the provision of group and/or one-to-one perinatal support and training women prisoners as peer supporters. DESIGN/METHODOLOGY/APPROACH A mixed-methods study was undertaken that involved observations of support groups and peer support supervision sessions (n = 9); audio recorded interviews (n = 33) with prison and health-care staff, women in prison, peer supporters and BC staff; analysis of existing routinely collected data by BC and notes undertaken during regular meetings (n = 10) with the BC Project Manager. Thematic analysis was undertaken supported by MAXQDA qualitative data analysis software. FINDINGS BC provided instrumental/practical support, emotional support, information support, signposting to services and advocating for women to the prison concerning their perinatal needs and rights. Key themes revealed that support had an impact on the lives of perinatal women by creating a safe place characterised by meaningful interactions and women-centred approaches that facilitated access to wider care and support. The service made a difference by empowering women and providing added value for peer supporters, prison, health-care and BC staff. Key enablers and strategies for the care of perinatal women and the delivery of perinatal support are also detailed. ORIGINALITY/VALUE Through longitudinal data and the involvement of a range of stakeholders, this study evidences the subtleties of support provided by BC and the potential it has to make a difference to perinatal women in prison and those volunteering or working within the prison system.
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Affiliation(s)
- Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK and Dalarna University, Falun, Sweden
| | | | - Michelle Baybutt
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
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Sales CMD, Martins F, Alves MM, Carletto S, Conejo-Cerón S, da Silva LC, Čuš A, Edridge C, Ferreira N, Hancheva C, Lima EMA, Liverpool S, Midgley N, Moltrecht B, Moreno-Peral P, Morgan N, Mortimer R, Mota CP, Pietrabissa G, Sousa S, Ulberg R, Edbrooke-Childs J. Patient and Public Involvement in Youth Mental Health Research: Protocol for a Systematic Review of Practices and Impact. Front Psychol 2021; 12:703624. [PMID: 34803797 PMCID: PMC8603822 DOI: 10.3389/fpsyg.2021.703624] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from this project will provide valuable insights and set out the key steps to adopting adequate PPI methods when involving children and young people in mental health research.
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Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto (CPUP), Porto, Portugal
| | - Filipa Martins
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Marisa M Alves
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | | | - Luis Costa da Silva
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Anja Čuš
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Chloe Edridge
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Esperanca M A Lima
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Nick Midgley
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | - Bettina Moltrecht
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | | | - Nicholas Morgan
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rose Mortimer
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | - Catarina Pinheiro Mota
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Sonia Sousa
- School of Digital Technologies, Tallinn University, Tallinn, Estonia
| | - Randi Ulberg
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry at Diakonhjemmet Hospital, Oslo, Norway
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
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Midgley N, Mortimer R, Cirasola A, Batra P, Kennedy E. The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis. Front Psychol 2021; 12:662671. [PMID: 33986713 PMCID: PMC8110733 DOI: 10.3389/fpsyg.2021.662671] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022] Open
Abstract
Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers (28 distinct studies). When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers (82 distinct studies). The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations (small sample sizes, lack of control groups etc.), and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people.
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Affiliation(s)
- Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rose Mortimer
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Antonella Cirasola
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Prisha Batra
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Eilis Kennedy
- Research and Development Unit, Tavistock and Portman NHS Trust, London, United Kingdom
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Núñez L, Midgley N, Capella C, Alamo N, Mortimer R, Krause M. The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists. Psychother Res 2021; 31:988-1000. [PMID: 33509052 DOI: 10.1080/10503307.2021.1876946] [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] [Indexed: 10/22/2022] Open
Abstract
This study addresses the therapeutic relationship in child psychotherapy, through an exploration of the experience of the main actors engaged in child psychotherapy. To describe and analyse the therapeutic relationship integrating the views of children, parents and therapists. This study employs a qualitative methodology, assuming a discovery-oriented approach which draws from grounded theory. Twelve psychotherapy triads participated, composed of children aged 6-10, their parents and psychotherapists. Semi-structured follow-up interviews were conducted (N=36), including a drawing in the case of the children. A positive therapeutic relationship with children and parents was viewed as a gradually constructed process, based on a positive emotional encounter between participants. It was facilitated primarily by the therapist's commitment and playful stance, the child and therapist mutual involvement, and the parent's collaboration. These aspects entailed a trustful, validating and caring relationship, that shaped children and parents' motivations towards therapy and facilitated change. From a multiple-perspective approach, therapy was conceived as a relational experience. The development of positive relationships required different and evolving dispositions from therapy main actors. Therapists' genuine feelings and engagement in therapeutic activity seem central, underlining the importance of addressing relational aspects in child therapy research and training.
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Affiliation(s)
- Lucía Núñez
- Psychology Department, Pontifical Catholic University of Chile, Santiago, Chile.,Psychology Department, University of Chile, Santiago, Chile
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London (UCL), UK
| | | | - Nicolle Alamo
- Social Work School, Pontifical Catholic University of Chile, Santiago, Chile
| | - Rose Mortimer
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
| | - Mariane Krause
- Psychology Department, Pontifical Catholic University of Chile, Santiago, Chile
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Abstract
This paper discusses the findings of qualitative research that examined the accounts of five "mostly recovered" ex-patients who had experienced transition between two or more eating disorder diagnoses. This study found that, in the minds of participants, the different diagnostic labels were associated with various good or bad character traits. This contributed to the belief in a diagnostic hierarchy, whereby individuals diagnosed with anorexia nervosa were viewed as morally better than those diagnosed with bulimia nervosa or binge eating disorder. Consequently, diagnostic crossover from a "better" to a "worse" eating disorder was often experienced as shameful moral failing, and a new diagnosis impacted the individual's sense of self-identity. These findings are of significance for both ethicists and clinicians; the paper concludes by outlining the relevance and possible clinical implications of shame in diagnostic crossover and suggesting avenues for future research.
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Affiliation(s)
- Rose Mortimer
- Department of Psychiatry, Warneford Hospital, University of Oxford, Warneford Lane, Oxford, OX3 7JX, England.
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Mortimer R, McKeown A, Singh I. Philosophical Bioethics in the Policy Arena: A Response to Open Peer Commentaries on "Just Policy? An Ethical Analysis of Early Intervention Policy Guidance". Am J Bioeth 2019; 19:W14-W18. [PMID: 30676901 PMCID: PMC6352370 DOI: 10.1080/15265161.2018.1549291] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
Early intervention (EI) aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of "life chances," so that all children are given fair opportunity to realize their potential and lead a good life; EI policy design, therefore, invokes ethical questions about the balance of responsibilities between the state, society, and individuals in addressing inequalities. We analyze a corpus of EI policy guidance to investigate explicit and implicit ethical arguments about who should be held morally responsible for safeguarding child health and well-being. We examine the implications of these claims and explore what it would mean to put the proposed policies into practice. We conclude with some remarks about the useful role that philosophical analysis can play in EI policy development.
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Sinnott JD, Mortimer R, Smith J, Skelton E, Drinkwater K, Lipscomb D, Howlett DC. The effect of routine radiological reporting of thyroid incidentalomas on rates of thyroid needle biopsy, thyroid surgery and detection of thyroid malignancy. Clin Endocrinol (Oxf) 2017; 87:825-831. [PMID: 28718944 DOI: 10.1111/cen.13424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study looked at the effect of a changing radiology reporting policy to routinely review the thyroid gland where visible and report on any thyroid lesion, recommending further investigation as appropriate. CONTEXT Incidentaloma is a term used to describe a lesion found on imaging unrelated to the clinical issue under investigation. There is variability in the radiological reporting of thyroid incidentalomas and conflicting recommendations as to how these lesions should be managed. DESIGN Data were collected retrospectively during a two-year period, including 12 months before and 12 months after the change in reporting policy and categorized according to whether the lesion under investigation was a thyroid incidentaloma or a symptomatic thyroid lesion. PATIENTS All patients undergoing ultrasound-guided fine-needle aspiration cytology or core biopsy were included. MEASUREMENTS The effects of the change in policy were analysed including rates of needle biopsy, rates of malignancy and subsequent surgical intervention. RESULTS There was a 122% increase in thyroid incidentalomas undergoing needle biopsy, the majority of these were detected on computed tomography. The number of malignancies increased from 1 to 4 from year 1 to year 2. All patients were >35 years old. One patient had a positron emission tomography (PET)-detected cancer, two of four of the non-PET-detected malignancies were <1.5 cm. CONCLUSION This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.
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Affiliation(s)
- J D Sinnott
- Department of ENT, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - R Mortimer
- Department of Accident and Emergency, Eastbourne District General Hospital, Eastbourne, UK
| | - J Smith
- Department of Oral and Maxillofacial Surgery, Eastbourne District General Hospital, Eastbourne, UK
| | - E Skelton
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK
| | - K Drinkwater
- Audit Officer, Royal College of Radiologists, London, UK
| | - D Lipscomb
- Department of Endocrinology, Eastbourne District General Hospital, Eastbourne, UK
| | - D C Howlett
- Department of Radiology, Eastbourne District General Hospital, Eastbourne, UK
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Howlett DC, Mortimer R. Fatal Haemorrhage following Fna. J R Coll Physicians Edinb 2016. [DOI: 10.1177/147827151604600404] [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: 11/16/2022] Open
Affiliation(s)
- DC Howlett
- FY2 ENT, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD
| | - R Mortimer
- FY2 ENT, Eastbourne District General Hospital, Eastbourne, East Sussex BN21 2UD
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Beevers C, Pearce G, Foster L, Mortimer R. Positive control dose response curves in the in vivo comet assay. Toxicol Lett 2015. [DOI: 10.1016/j.toxlet.2015.08.327] [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: 10/23/2022]
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Kethineni N, Mortimer R, Flamang S, Lanford J, Paul S. 475 TRANSFERRING CARE IS A MARKER FOR POOR PATIENT ADHERENCE WITH HIV TREATMENT GUIDELINES. J Investig Med 2004. [DOI: 10.1136/jim-52-suppl1-474] [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 Mortimer
- Department of Endocrinology, Royal Brisbane Hospital, Queensland, Australia.
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Abstract
This article reviews current methods of evaluating reproductive performance in the sheep industry. The reproductive technologies of breeding soundness examination, reproductive ultrasonography, estrus manipulation, artificial insemination, and embryo transfer are also extensively discussed. The veterinarian's current and future role in the application of these technologies is discussed.
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Affiliation(s)
- S Sharkey
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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Abstract
UNLABELLED Anorexia nervosa (AN) can lead to osteoporosis and fractures. OBJECTIVE This study evaluated adolescent females with AN diagnosed within the previous 12 months to determine whether there is bone mass reduction and to investigate relationships between nutritional indices (weight, body mass index [BMI], lean mass, fat mass, and percentage fat) and total body (TB) and lumbar spine (LS) bone mineral densities (BMD) and content (BMC). METHOD TB and LS BMD and BMC and body composition were measured in 24 adolescent females with AN. RESULTS There was no significant reduction in TB or LS BMD. Regression analysis shows significant correlation (p < 0.001) between lean mass and TB BMD (r = +0.83), TB BMC (r = +0.92), LS BMD (r = +0.81), and LS BMC (r = +0.92). There was also a significant relationship between weight percentile and LS BMD z score (p < 0.005; r = +0.60). DISCUSSION Adolescent females with early AN do not appear to have reduced bone mass. Lean mass is correlated to BMD and BMC.
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Affiliation(s)
- J C Wong
- Department of Nuclear Medicine and Bone Mineral Densitometry, Royal Brisbane Hospital, Brisbane, Australia.
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19
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Abstract
The aim of this retrospective study was to establish the impact of myomectomy on pregnancy outcome with particular reference to its effect on the incidence of pregnancy loss. Myomectomy was performed using microsurgical procedures upon 51 women who had intramural or subserosal fibroids and wished to conceive. Overall, the conception rate following myomectomy was 57%. Multiple regression analysis showed that age was the only factor which influenced conception rate: </=35 years, 74% (23/31); >/=36 years, 30% (6/20; P < 0.005). The pregnancy loss rate prior to myomectomy was 60% (24/40), which was reduced to 24% (8/33) after myomectomy (P < 0.001). There was no instance of premature labour or scar rupture among 25 live births. This retrospective study suggests that myomectomy for intramural and subserosal fibroids may significantly improve the reproductive performance of women presenting with infertility or pregnancy loss.
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Affiliation(s)
- T C Li
- Jessop Hospital for Women, Leavygreave Road, Sheffield S3 7RE, UK
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20
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Mortimer R. FPA, MedPartners, and claims-made malpractice insurance. Cost Qual Q J 1999; 5:25-7. [PMID: 10539008] [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: 02/14/2023]
Affiliation(s)
- R Mortimer
- HealthCare Professionals' Insurance Services of Brea, CAP6USA
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21
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Abstract
There is still a lack of agreement concerning the relative contribution of wine yeast that may originate in the vineyard compared to that which may originate in the cellar. Part of this controversy is due to the extreme difficulty of finding Saccharomyces cerevisiae on the grapes. We estimate that only about one in one-thousand grape berries carries wine yeast. However, we have found that grape berries that are damaged (i.e. the skin is broken) are very rich depositories of microorganisms including S. cerevisiae, and that one in four such berries is S. cerevisiae-positive. These positive berries have between 100,000 and 1,000,000 wine yeast cells on them, and there is evidence that these yeasts are clonal. We believe that the yeasts are brought to the berries by insects such as bees, wasps, and Drosophila and that they multiply in the rich medium of the grape interior. Even though there are many cells of S. cerevisiae on the damaged berries, they are in a definite minority. All the other organisms that are found in wine fermentations are also present on these berries, and their total numbers are in the range of 10 million to 100 million cells per berry.
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Affiliation(s)
- R Mortimer
- Department of Molecular and Cell Biology, University of California, Berkeley 94720, USA
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22
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Mortimer R. What's happening to the cost and quality of medical malpractice insurance? Cost Qual Q J 1998; 4:39-40. [PMID: 10178958] [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: 02/11/2023]
Affiliation(s)
- R Mortimer
- HealthCare Professionals' Insurance Services, Santa Ana, CA, USA
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23
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Abstract
On the basis of the levels of secondary product formation four different phenotypes were represented among the 28 strains of Saccharomyces cerevisiae isolated during the spontaneous fermentation of grape juice. The genetic analysis indicated that four different strains, representing each phenotypic class, were derived, one from the other, by mutation. The spontaneous fermentation of a Malvasia must was dominated by different strains of Saccharomyces cerevisiae at different stages of fermentation.
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Affiliation(s)
- M Polsinelli
- Dipartimento di Biologia Animale e Genetica, Università di Firenze, Italy
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24
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Romano P, Suzzi G, Mortimer R, Polsinelli M. Production of high levels of acetoin in Saccharomyces cerevisiae wine yeasts is a recessive trait. J Appl Bacteriol 1995; 78:169-74. [PMID: 7698951 DOI: 10.1111/j.1365-2672.1995.tb02838.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A genetic study of acetoin production was performed on wild wine yeast strains of Saccharomyces cerevisiae producing different amounts of the compound. By using differences found in these strains as source of genetic variability, it was found that crosses between high and low acetoin producing strains yielded the low level in the hybrids, indicating the low production as a dominant trait. Tetrad analysis showed that high vs low acetoin production is segregated as a single gene.
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Affiliation(s)
- P Romano
- Dipartimento di Biologia, Difesa e Biotecnologie Agroforestali, Università della Basilicata, Potenza, Italy
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25
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Rinchuse DJ, Abraham J, Medwid L, Mortimer R. TMJ sounds: are they a common finding or are they indicative of pathosis/dysfunction? Am J Orthod Dentofacial Orthop 1990; 98:512-5. [PMID: 2248229 DOI: 10.1016/s0889-5406(08)80058-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- D J Rinchuse
- School of Dental Medicine, University of Pittsburgh, Pa
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26
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Abstract
Two patients who presented with steatohepatitis had acquired partial lipodystrophy. This association has not previously been well documented. A common pathophysiological mechanism in lipodystrophy, obesity-associated nonalcoholic steatohepatitis, and alcoholic liver disease is possible.
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Affiliation(s)
- E E Powell
- Department of Medicine, University of Queensland, Brisbane, Australia
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27
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Abstract
Cytological examination of the aspirate of fine-needle biopsy is becoming more widely accepted as a screening test for malignancy in thyroid nodules. However, it tends to be used in addition to, rather than instead of, more traditional methods. In this five-year prospective evaluation we performed fine-needle biopsy in 618 euthyroid patients with nodular thyroid enlargement, 86% of whom also underwent radionuclide scans and 55% of whom underwent ultrasound scans. In 19% of patients fine-needle biopsy yielded insufficient material for diagnosis, and in 14% of patients normal follicular cells were found (which indicated that the clinical lesion was not sampled). To date, a histological diagnosis has been obtained in 258 (42%) patients, 44 of whom had malignancies. The results of the radionuclide and ultrasound scans did not alter the odds in favour of the detection of malignancy. The cytological diagnosis of malignancy was falsely-positive in two patients and falsely-negative in four patients (three cases of which probably were sampling errors). If, in addition to overtly-malignant cells, atypical Hürthle cells and follicular neoplasms were considered to be potentially malignant, fine-needle biopsy alone had a sensitivity of 87% and a specificity of 72%. This good accuracy would be reduced by sampling failures, but a policy of operating on all patients with potentially-malignant cells, or on those in whom satisfactory aspirates could not be obtained, would yield high rates of the diagnosis of malignancy and would reduce the number of operations. Our data indicate that the most-appropriate method of screening thyroid nodules for malignancy is fine-needle biopsy without pertechnetate scanning or ultrasound examinations.
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Affiliation(s)
- F Khafagi
- Royal Brisbane Hospital, Herston, QLD
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28
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Abstract
Thyroid function and serum thyroglobulin levels were studied in 66 subjects whose Hodgkin's disease had been previously treated by cervical, mediastinal and axillary lymph node (mantle) irradiation. Three patients were already undergoing treatment for thyroid disorders (one for primary hypothyroidism, two for Graves' disease) and a fourth was found to have euthyroid Graves' disease. 36 (Group I) of the remaining 62 patients had normal free thyroxine indices, normal basal thyrotrophin (TSH) levels and normal TSH response to thyrotrophin releasing factor (TRH). In 20 patients (Group II) free thyroxine indices were normal but either basal TSH levels were raised or normal basal TSH levels were associated with an exaggerated response to TRH. In 6 patients (Group III) free thyroxine indices were subnormal. Although results of thyroid function tests in group I lay within the normal range, the mean free thyroxine index was significantly lower and mean basal and peak TSH levels were significantly higher than those of a group of 35 normal subjects, indicating mild thyroid hypofunction. Elevated thyroglobulin levels were demonstrated in 11 irradiated subjects (18%). Mean thyroglobulin levels were significantly raised in each of the three groups of irradiated subjects. Significant positive correlations were found between log serum thyroglobulin and log basal TSH (r = 0.453, P less than 0.001) and log peak TSH (r = 0.515, P less than 0.001) levels. Mild thyroid hypofunction is common after mantle irradiation for Hodgkin's disease and raised serum thyroglobulin levels are a sensitive indicator of TSH stimulation of the damaged thyroid gland.
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Mortimer R, White E, Myers S, Lorentz J, Ledbetter S. As I see it... Parents', teenagers' rights clash in 'squeal' rule. Am Nurse 1983; 15:5, 19. [PMID: 6552893] [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: 04/05/2023]
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30
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Abstract
Tetrad and random spore analyses have been used to further develop the genetic map of Saccharomycopsis lipolytica. Mutations in 23 new nuclear genes have been isolated. Eight genes have been located on linkage fragment 1, 4 on fragment 2, 2 on fragment 5 and 3 on fragment 6. Linkage fragments 3 and 4 have been shown to be linked, and this fragment now contains 12 markers. A tentative map of the linkage fragments 1 and 3 is presented (Fig. 1). Markers exhibiting possible centromere linkage have been identified. Interference estimates suggest that there is little interference in S. lipolytica.
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31
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Abstract
Hybrid plasmid YRp7 (Escherichia coli plasmid pBR322 carrying a 1.4-kb yeast fragment containing the TRP1 gene) transforms two related haploid yeast strains (trp1) to Trp+ at frequencies per microgram DNA varying by two orders of magnitude. The diploid cross of these two strains is transformed at a frequency less than that of the low-frequency parent, indicating that high-frequency transformation is inherited in a recessive fashion. Segregant strains of two tetrads of this cross showed intermediate levels of transformability, suggesting the polygenic inheritance of transformation frequency. Levels of variation are changed extensively when frequencies are expressed as transformants per regenerated spheroplast colony, although the inheritance of higher frequency remains clearly recessive. Storage of spheroplast-DNA preparations at 4 degrees C increases the yield of transformants with some strains.
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32
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Harty M, Cerney M, Colson D, Coyne L, Frieswyk S, Johnson SB, Mortimer R. Correlates of change and long-term outcome. An exploratory study of intensively treated hospital patients. Bull Menninger Clin 1981; 45:209-28. [PMID: 7306729] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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33
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Mortimer R. The Prior of Butley and the lepers of West Somerton. Bull Inst Hist Res 1980; 53:99-103. [PMID: 11614301 DOI: 10.1111/j.1468-2281.1980.tb01731.x] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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34
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Fogel S, Mortimer R, Lusnak K, Tavares F. Meiotic gene conversion: a signal of the basic recombination event in yeast. Cold Spring Harb Symp Quant Biol 1979; 43 Pt 2:1325-41. [PMID: 290446 DOI: 10.1101/sqb.1979.043.01.152] [Citation(s) in RCA: 149] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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35
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Ogrydziak D, Bassel J, Contopoulou R, Mortimer R. Development of genetic techniques and the genetic map of the yeast Saccharomycopis lipolytica. ACTA ACUST UNITED AC 1978. [DOI: 10.1007/bf00271953] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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36
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Goldman J, Matz R, Mortimer R, Freeman R. High elevations of creatine phosphokinase in hypothyroidism. An isoenzyme analysis. JAMA 1977; 238:325-6. [PMID: 577537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In hypothyroidism, slight elevations of serum creatine phosphokinase (CPK) levels are common. In contrast, we describe six hypothyroid patients with extreme elevations (17- to 160-fold) of CPK levels. Enzyme analysis showed only MM isoenzyme in four cases and MM plus trace MB isoenzyme in two patients. Hypothyroidism should, therefore, be considered when elevated CPK levels, even extreme, are found. Isoenzyme analysis in such a case will show primarily an MM pattern, although trace MB fraction can also be seen. This isoenzyme pattern suggests that the sources of the CPK elevations is skeletal muscle.
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37
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Bassel J, Hambright P, Mortimer R, Bearden AJ. Mutant of the yeast Saccharomycopsis lipolytica that accumulates and excretes protorphyrin IX. J Bacteriol 1975; 123:118-22. [PMID: 1141193 PMCID: PMC235697 DOI: 10.1128/jb.123.1.118-122.1975] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The red, water-insoluble pigment excreted by a mutant strain of the yeast Saccharomycopsis lipolytica is show to be protoporphyrin IX. In genetic crosses the red phenotype has the properties characteristic of a defect in a single, recessive nuclear gene. The yield and ease of harvest of protoporphyrin IX from the yeast mutant indicate that this strain or its derivatives may be a valuable source of this substance.
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38
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Abstract
The mating reaction in Saccharomycopsis lipolytica is shown to be bipolar through the analysis of whole meiotic tetrads. Genetic evidence is provided that alkane metabolism proceeds through a fatty acid or a fatty acid intermediate since several mutants unable to grow on n-tetradecane were also unable to utilize palmitic acid.
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39
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Abstract
The galactose structural genes of Saccharomyces cerevisiae were ordered by determining the genotypes of mitotic and meiotic recombinants from crosses heterozygous for the three genes. The most probable order is centromere-gal7-gal10-gal1. Nonreciprocal recombination was more frequent than reciprocal exchange, and both mitotic and meiotic co-conversions involving mutant sites in all three genes were observed.
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40
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Abstract
Nutritional requirements were introduced into wild-type, heterothallic strains of Candida lipolytica by exposing the cells to X rays. Complementing hybrids were recovered from mixtures of the auxotrophic strains, and genetic recombination was observed in individually isolated ascospores from the hybrid strains.
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41
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Powell LW, Mortimer R, Harris OD. Cirrhosis of the liver. A comparative study of the four major aetiological groups. Med J Aust 1971; 1:941-50. [PMID: 5314134] [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: 01/14/2023]
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42
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Affiliation(s)
- L. W. Powell
- University of Queensland Department of Medicine Royal Brisbane Hospital, and the Princess Alexandra HospitalBrisbane
| | - R. Mortimer
- University of Queensland Department of Medicine Royal Brisbane Hospital, and the Princess Alexandra HospitalBrisbane
| | - O. D. Harris
- University of Queensland Department of Medicine Royal Brisbane Hospital, and the Princess Alexandra HospitalBrisbane
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Shields LM, Sansoy OM, Mortimer R. Directional trends in serum uric acid and lipids in 865 Spnnish-and Anglo-American men and women, age 20-79 years. Southwest Med 1971; 52:54-57. [PMID: 5554571] [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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44
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Shields LM, Sansoy OM, Mortimer R. Directional trends in serum uric acid and lipids in 865 Spanish-and Anglo-American men and women, age 20-79 years. Southwest Med 1971; 52:54-7. [PMID: 5145070] [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: 01/14/2023]
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45
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Myers DK, Tribe TA, Mortimer R. On the Radiation-Induced Reaction of Iodoacetamide with Albumin and with the Erythrocyte Membrane. Radiat Res 1969. [DOI: 10.2307/3573011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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46
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Myers DK, Tribe TA, Mortimer R. On the radiation-induced reaction of iodoacetamide with albumin and with the erythrocyte membrane. Radiat Res 1969; 40:580-7. [PMID: 5352957] [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: 01/14/2023]
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47
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48
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50
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Harris RJ, Dougherty RM, Biggs PM, Payne LN, Goffe AP, Churchill AE, Mortimer R. Contaminant viruses in two live virus vaccines produced in chick cells. J Hyg (Lond) 1966; 64:1-7. [PMID: 4286627 PMCID: PMC2134684 DOI: 10.1017/s0022172400040286] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Samples of yellow-fever vaccine prepared from homogenized chick embryos, and of an experimental measles vaccine prepared from chick embryo cells, have each been shown to contain a contaminant virus similar in properties to an avian leukosis virus. Young adult males injected with the yellow-fever vaccine did not develop neutralizing antibodies for Rous sarcoma virus.
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