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1.
Bone Marrow Transplant ; 57(6): 889-895, 2022 06.
Article in English | MEDLINE | ID: mdl-35352036

ABSTRACT

Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (TA-TMA) and diffuse alveolar hemorrhage (DAH) are well recognized post-transplant complications that carry a high risk of mortality; however, the risk of DAH complicating the course of transplant patients with TA-TMA is not well understood. We conducted a ten-year retrospective study at our institution to determine the incidence of DAH in a cohort of pediatric patients with TA-TMA and described their presentation and outcomes. Additionally, autopsy slides, when available, were reviewed to assess for histological evidence of microvascular injury and alveolar hemorrhages. A total of 58 pediatric patients with TA-TMA were identified. Of these, 14 (24%) had DAH. Majority of DAH cases occurred within a week of TA-TMA diagnosis (n = 8, 57%, range 0-698 days). Mortality was 100% for patients with DAH and TA-TMA. Infections were found to be a significant risk factor for DAH in TA-TMA. Autopsy was performed in 11 of the 14 patients, and pulmonary slides were available for review in ten cases. 70% cases had pathological evidence of microvascular injury, concerning for pulmonary TA-TMA. We conclude that DAH is a potentially fatal complication in patients with TA-TMA and may be a result of pulmonary microangiopathy.


Subject(s)
Hematopoietic Stem Cell Transplantation , Thrombotic Microangiopathies , Child , Cohort Studies , Hematopoietic Stem Cell Transplantation/adverse effects , Hemorrhage/etiology , Humans , Retrospective Studies , Thrombotic Microangiopathies/diagnosis
2.
Anim Genet ; 50(4): 347-357, 2019 Aug.
Article in English | MEDLINE | ID: mdl-31257665

ABSTRACT

Durability traits in Thoroughbred horses are heritable, economically valuable and may affect horse welfare. The aims of this study were to test the hypotheses that (i) durability traits are heritable and (ii) genetic data may be used to predict a horse's potential to have a racecourse start. Heritability for the phenotype 'number of 2- and 3-year-old starts' was estimated to be h m 2  = 0.11 ± 0.02 (n = 4499). A genome-wide association study identified SNP contributions to the trait. The neurotrimin (NTM), opioid-binding protein/cell adhesion molecule like (OPCML) and prolylcarboxypeptidase (PRCP) genes were identified as candidate genes associated with the trait. NTM functions in brain development and has been shown to have been selected during the domestication of the horse. PRCP is an established expression quantitative trait locus involved in the interaction between voluntary exercise and body composition in mice. We hypothesise that variation at these loci contributes to the motivation of the horse to exercise, which may influence its response to the demands of the training and racing environment. A random forest with mixed effects (RFME) model identified a set of SNPs that contributed to 24.7% of the heritable variation in the trait. In an independent validation set (n = 528 horses), the cohort with high genetic potential for a racecourse start had significantly fewer unraced horses (16% unraced) than did low (27% unraced) potential horses and had more favourable race outcomes among those that raced. Therefore, the information from SNPs included in the model may be used to predict horses with a greater chance of a racecourse start.


Subject(s)
Horses/genetics , Horses/physiology , Animals , Genome-Wide Association Study , Models, Biological , Phenotype , Physical Conditioning, Animal , Polymorphism, Single Nucleotide
3.
J Dairy Sci ; 102(5): 4249-4263, 2019 May.
Article in English | MEDLINE | ID: mdl-30852025

ABSTRACT

Infection of cattle with bovine paratuberculosis (i.e., Johne's disease) is caused by Mycobacterium avium ssp. paratuberculosis (MAP) and results in a chronic incurable gastroenteritis. This disease, which has economic ramifications for the cattle industry, is increasing in detected prevalence globally; subclinically infected animals can silently shed the bacterium into the environment for years, exposing contemporaries and hampering disease-control programs. The objective of the present study was to first quantify the genetic parameters for humoral response to MAP in dairy cattle. This was followed by a genome-based association analysis and subsequent downstream bioinformatic analyses from imputed whole genome sequence SNP data. After edits, ELISA test records were available on 136,767 cows; analyses were also undertaken on a subset of 33,818 of these animals from herds with at least 5 MAP ELISA-positive cows, with at least 1 of those positive cows being homebred. Variance components were estimated using univariate animal and sire linear mixed models. The heritability calculated from the animal model for humoral response to MAP using alternative phenotype definitions varied from 0.02 (standard error = 0.003) to 0.05 (standard error = 0.008). The genome-based associations were undertaken within a mixed model framework using weighted deregressed estimated breeding values as a dependent variable on 1,883 phenotyped animals that were ≥87.5% Holstein-Friesian. Putative susceptibility quantitative trait loci (QTL) were identified on Bos taurus autosome 1, 3, 5, 6, 8, 9, 10, 11, 13, 14, 18, 21, 23, 25, 26, 27, and 29; mapping the most significant SNP to genes within and overlapping these QTL revealed that the most significant associations were with the 10 functional candidate genes KALRN, ZBTB20, LPP, SLA2, FI3A1, LRCH3, DNAJC6, ZDHHC14, SNX1, and HAS2. Pathway analysis failed to reveal significantly enriched biological pathways, when both bovine-specific pathway data and human ortholog data were taken into account. The existence of genetic variation for MAP susceptibility in a large data set of dairy cows signifies the potential of breeding programs for reducing MAP susceptibility. Furthermore, the identification of susceptible QTL facilitates greater biological understanding of bovine paratuberculosis and potential therapeutic targets for future investigation. The novel molecular similarities identified between bovine paratuberculosis and human inflammatory bowel disease suggest potential for human therapeutic interventions to be translated to veterinary medicine and vice versa.


Subject(s)
Cattle Diseases/immunology , Gastrointestinal Diseases/immunology , Immunity, Humoral/genetics , Mycobacterium avium subsp. paratuberculosis/immunology , Paratuberculosis/immunology , Animals , Breeding , Cattle , Cattle Diseases/epidemiology , Cattle Diseases/genetics , Disease Susceptibility , Enzyme-Linked Immunosorbent Assay/veterinary , Female , Gastrointestinal Diseases/genetics , Genome-Wide Association Study , Humans , Linear Models , Male , Paratuberculosis/genetics , Paratuberculosis/microbiology , Phenotype , Quantitative Trait Loci
4.
Phys Chem Chem Phys ; 13(8): 3303-10, 2011 Feb 28.
Article in English | MEDLINE | ID: mdl-21206949

ABSTRACT

The properties of two forms of polyaniline (PAni) synthesised under acidic and basic conditions have been investigated both individually and as combined complexes. The PAni polymerised within alkaline media was redox inactive and non-conducting while the PAni emeraldine salt (ES) was electroactive and conducting. Raman, electron spin resonance, UV-Vis and fluorescence spectroscopies were used to monitor the changes in electronic properties of these conducting polymer composites. Solution cast films of alkaline synthesised (A-PAni) with the PAni ES resulted in an increase in the high spin polaron population suggesting that it acts as a pseudodopant. The ability of the A-PAni to increase and maintain the population of the polaron charge carrier was confirmed by UV-vis and Raman spectroscopy. Significantly, the presence of the A-PAni in PAni ES helped to sustain higher electrical conductivities at loading levels that were well below the percolation threshold of an insulating polystyrene sulfonate polymeric oligomer model. Fluorescence studies indicated that the A-PAni was fluorescent. However, mixtures of A-PAni with the PAni ES resulted in quenching of the A-PAni emission. The quenching process was observed to involve both static and dynamic processes, with the static quenching being dominant. These results suggest that the two polymers are strongly associated with each other when in the solid state. In stark contrast, the alkaline synthesized PAni did not influence the electrochemical properties of the emeraldine salt. These results deviate significantly from the expected outcome of the addition of an insulating A-PAni additive and highlight the unusual interactions occurring between PAni and its alkaline analogue.


Subject(s)
Aniline Compounds/chemistry , Electrons , Electric Conductivity , Electron Spin Resonance Spectroscopy , Hydrogen-Ion Concentration , Spectrophotometry, Ultraviolet , Spectrum Analysis, Raman
5.
Med Sci Law ; 49(3): 179-84, 2009 Jul.
Article in English | MEDLINE | ID: mdl-19787989

ABSTRACT

In the U.K., cases of sudden unexpected death in infancy are under the jurisdiction of the Coroner and consent for a post-mortem is not required. Prior to the Human Tissue Act 2006 (HTA) there was also no requirement to request retention of tissue (blocks and slides). The HTA stipulates that parental/ guardian consent is mandatory to retain or dispose of all tissues after the Coroners' purposes have been fulfilled. In 2007, in order to avoid confusion with the consent needed for hospital post-mortems, a new form was introduced by Sheffield Children's Hospital NHS Foundation Trust (SCH) called Record of parents'/guardians'wishes regarding samples taken at a Coroner's post mortem. This version specifically asks if blocks and slides may be retained as part of the medical record, or are to be disposed of, and for parental agreement (or not) for the frozen tissue, blocks and slides to be used for education, audit, quality control and medical research. One hundred and nineteen Coroners' postmortems covering the years 2006-2007 were reviewed. All parents/guardians (P/G) were contacted and the outcomes of P/G wishes recorded by SCH staff, Coroners' Officers (CO) and Police Family Liaison Officers (PFLO) were analysed and compared (44% from CO were outstanding at the time of audit). Any delay in recording P/G wishes by these three groups was also compared. In 2006, parental agreement to the use of blocks and slides for education, audit, quality control and medical research was 94%, 77% and 75% for SCH, CO and PFLO, respectively. In 2007 it was 84%, 37% and 100% for the same groups. Permission for the retention of frozen tissue given to SCH, CO and PFLO was 90%, 62% and 100% in 2006 and 90%, 44% and 100% in 2007, respectively. Cases where parents did not wish for the retention or use of tissue (including blocks and slides) were 3%, 15% and 0% in 2006 for SCH, CO and PFLO respectively, and 0% for all groups in 2007. Training of staff in all aspects of post-mortem and bereavement care is essential for ascertaining parental wishes. Families should be provided with the knowledge that allows them to make informed choices. The analysis of the results of the audit supports this view.


Subject(s)
Autopsy/legislation & jurisprudence , Legal Guardians , Parents , Sudden Infant Death , Tissue and Organ Procurement/legislation & jurisprudence , Attitude to Health , Humans , Infant , Informed Consent/legislation & jurisprudence , Medical Audit , Retrospective Studies , United Kingdom
6.
Eye (Lond) ; 23(4): 933-9, 2009 Apr.
Article in English | MEDLINE | ID: mdl-18425069

ABSTRACT

PURPOSE: To determine risk factors for early angle-closure disease (AD) in a Burmese population. METHODS: A cross-sectional, population-based survey of the inhabitants, 40 years of age and over, from villages in the Meiktila District was performed; 2481 eligible participants were identified, 2076 participated in the study, and 2050 could be categorized as having early AD (defined by the presence of so-called occludable angles (<90 degrees of posterior trabecular meshwork visible on gonioscopy), but without glaucomatous optic neuropathy). The ophthalmic examination included Snellen visual acuity, slit-lamp examination, tonometry, gonioscopy, biometry, and dilated stereoscopic fundus examination. RESULTS: The mean axial length (AL) and anterior chamber depth (ACD) in those with occludable angles were 21.9 and 2.60 mm, respectively; in those with non-occludable angles, the corresponding lengths were 22.74 and 2.84 mm, respectively (P<0.001 for both comparisons). In the univariate analyses, age, female gender, nuclear and cortical cataract, steeper corneal curvature, more anterior lens position, and myopia were also significantly associated with occludability. In the multivariate analysis, age, AL, ACD, and nuclear cataract were significantly associated with occludability. CONCLUSION: In this Burmese population, those with occludable angles had significantly shorter ALs, ACDs, and thicker lenses than those without occludable angles. In multivariate analysis, increasing age, decreasing AL, decreasing ACD, and nuclear cataract were significant predictors of early AD. The presence of nuclear cataract per se should raise clinical suspicion of the possibility of AD in this population.


Subject(s)
Glaucoma, Angle-Closure/epidemiology , Age Factors , Aged , Anterior Chamber/pathology , Cornea/pathology , Cross-Sectional Studies , Female , Glaucoma, Angle-Closure/pathology , Humans , Lens, Crystalline/pathology , Male , Middle Aged , Myanmar , Myopia/epidemiology , Optic Disk/pathology , Retina/pathology , Risk Factors , Rural Population/statistics & numerical data , Sex Factors , Visual Acuity
7.
Br J Ophthalmol ; 92(10): 1325-8, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18662915

ABSTRACT

AIMS: The aim of this study was to report on the prevalence and correlates of pseudoexfoliation syndrome (PXF) in a rural Burmese population. METHODS: The study was a cross-sectional, population-based survey of the inhabitants > or =40 years in the Meiktila District. Ophthalmic examination included Snellen visual acuity, slit lamp examination, tonometry, gonioscopy, dilated fundus examination and frequency doubling perimetry. RESULTS: In a population of 2076 subjects (4016 eyes) the prevalence of PXF was 3.4% (95% CI 2.14 to 4.67%; 78 eyes). Twelve eyes with PXF were blind. In the univariate analysis, PXF was associated with: increasing age, blindness (odds ratio (OR) 4, 95% CI 1.84 to 8.68; p<0.0004), increasing intraocular pressure (IOP) (OR 1.08, 95% CI 1.04 to 1.11; p<0.00001), nuclear cataract (OR 6.92, 95% CI 2.89 to 16.59; p<0.00001), cortical cataract (OR 4.78, 95% CI 2.37 to 9.65; p<0.00001) and the presence of an occludable angle (OR 3.05, 95% CI 1.52 to 6.13; p<0.002). In the multivariate analysis, only increasing age and IOP remained significantly associated with PXF. CONCLUSIONS: The prevalence of PXF in the Burmese population is greater than previously reported in other East Asian populations. Increasing age and IOP are the strongest predictors of PXF, and it is associated with cataract, occludable angles and blindness.


Subject(s)
Exfoliation Syndrome/epidemiology , Adult , Age Distribution , Aged , Blindness/complications , Cataract/complications , Cross-Sectional Studies , Exfoliation Syndrome/ethnology , Exfoliation Syndrome/physiopathology , Female , Glaucoma/complications , Humans , Intraocular Pressure/physiology , Male , Middle Aged , Myanmar/epidemiology , Predictive Value of Tests , Risk Factors , Rural Health , Tonometry, Ocular/methods
8.
Br J Ophthalmol ; 91(7): 856-9, 2007 Jul.
Article in English | MEDLINE | ID: mdl-17576708

ABSTRACT

AIM: To determine the prevalence of preglaucomatous angle-closure disease in central Myanmar. METHODS: A population-based survey of inhabitants >or=40 years in the Meiktila District was carried out; 2481 subjects were identified, 2076 participated and 2060 underwent gonioscopy of at least one eye. Eyes with angles traditionally described as "occludable" were recorded as primary angle-closure suspects (PACS); eyes with PACS and peripheral anterior synechiae (PAS), or an increased intraocular pressure but without primary angle-closure glaucoma, were recorded as primary angle closure (PAC). RESULTS: The prevalence of PACS in at least one eye was 5.7% (95% CI 4.72 to 6.62); prevalence increased with age and was more common in women (p<0.001). The prevalence of PAC in at least one eye was 1.50% (95% CI 1.47 to 1.53). All participants with PAS had at least 90 degrees of closure (range 90-360 degrees). CONCLUSION: The prevalence of preglaucomatous angle-closure disease (PACS and PAC) in this population was 5.7% and 1.5%, respectively. PACS was more common in women, and its prevalence increased with age.


Subject(s)
Glaucoma, Angle-Closure/epidemiology , Gonioscopy , Adult , Age Distribution , Aged , Epidemiologic Methods , Female , Glaucoma, Angle-Closure/diagnosis , Humans , Male , Middle Aged , Myanmar/epidemiology , Rural Health/statistics & numerical data , Severity of Illness Index , Sex Distribution
9.
Br J Ophthalmol ; 91(6): 710-4, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17510475

ABSTRACT

AIM: To determine the prevalence of glaucoma in the Meiktila district of central, rural Myanmar. METHODS: A cross-sectional, population-based survey of inhabitants > or =40 years of age from villages in Meiktila district, Myanmar, was performed; 2481 eligible participants were identified and 2076 participated in the study. The ophthalmic examination included Snellen visual acuity, slit-lamp examination, tonometry, gonioscopy, dilated stereoscopic fundus examination and full-threshold perimetry. Glaucoma was classified into clinical subtypes and categorised into three levels according to diagnostic evidence. RESULTS: Glaucoma was diagnosed in 1997 (80.5%) participants. The prevalence of glaucoma of any category in at least one eye was 4.9% (95% CI 4.1 to 5.7; n = 101). The overall prevalence of primary angle-closure glaucoma (PACG) was 2.5% (95% CI 1.5 to 3.5) and of primary open-angle glaucoma (POAG) was 2.0% (95% CI 0.9 to 3.1). PACG accounted for 84% of all blindness due to glaucoma, with the majority due to acute angle-closure glaucoma (AACG). CONCLUSION: The prevalence of glaucoma in the population aged > or =40 years in rural, central Myanmar was 4.9%. The ratio of PACG to POAG was approximately 1.25:1. PACG has a high visual morbidity and AACG is visually devastating in this community. Screening programmes should be directed at PACG, and further study of the underlying mechanisms of PACG is needed in this population.


Subject(s)
Glaucoma/epidemiology , Adult , Age Distribution , Aged , Cross-Sectional Studies , Female , Glaucoma/diagnosis , Glaucoma, Angle-Closure/diagnosis , Glaucoma, Angle-Closure/epidemiology , Glaucoma, Open-Angle/diagnosis , Glaucoma, Open-Angle/epidemiology , Humans , Intraocular Pressure , Male , Middle Aged , Myanmar/epidemiology , Prevalence , Rural Health/statistics & numerical data , Sex Distribution
10.
Ophthalmology ; 114(12): 2302-8, 2007 Dec.
Article in English | MEDLINE | ID: mdl-17448538

ABSTRACT

OBJECTIVE: To determine the prevalence and causes of visual impairment in the Meiktila district of central, rural Myanmar. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Random, stratified, cluster sampling of the inhabitants 40 years of age and older from villages in the Meiktila district was performed; 2481 eligible participants were identified and 2076 participated in the study. METHODS: The ophthalmic examination included presenting and pinhole Snellen visual acuity with an illiterate E chart, slit-lamp examination of the anterior segment, and dilated stereoscopic fundus examination. The principal cause of visual impairment was recorded. MAIN OUTCOME MEASURES: Visual impairment and blindness were defined by both presenting and corrected visual acuity according to World Health Organization criteria: better eye < 6/18 and < 3/60, respectively. RESULTS: Comprehensive examinations, including Snellen visual acuity, were performed on 2073 participants (83.6%) The prevalence estimate of presenting visual impairment was 40.4% (95% confidence interval [CI], 36.1-44.7) and of presenting blindness was 8.1% (95% CI, 6.5-9.9). After pinhole correction, the corresponding prevalences were 26.8% (95% CI, 23.5-30.1) and 5.3% (95% CI, 4.0-6.6). Cataract, uncorrected refractive error, and glaucoma were the most common causes of visual impairment. CONCLUSIONS: Visual impairment and blindness remain major public health problems in rural Myanmar. Specific programs directed toward reducing the cataract burden need to be implemented.


Subject(s)
Blindness/epidemiology , Blindness/etiology , Rural Population/statistics & numerical data , Visually Impaired Persons/statistics & numerical data , Adult , Aged , Cataract/complications , Cross-Sectional Studies , Female , Glaucoma/complications , Humans , Male , Middle Aged , Myanmar/epidemiology , Prevalence , Refractive Errors/complications , Visual Acuity/physiology
11.
Proc Natl Acad Sci U S A ; 103(7): 2368-73, 2006 Feb 14.
Article in English | MEDLINE | ID: mdl-16461910

ABSTRACT

The regulation of initiation of DNA replication is crucial to ensure that the genome is replicated only once per cell cycle. In the Gram-positive bacterium Bacillus subtilis, the function of the YabA protein in initiation control was assigned based on its interaction with the DnaA initiator and the DnaN sliding clamp in the yeast two-hybrid and on the overinitiation phenotype observed in a yabA null strain. However, YabA is unrelated to known regulators of initiation and interacts with several additional proteins that could also be involved directly or not in initiation control. Here, we investigated the specific role of YabA interactions with DnaA and DnaN in initiation control by identifying single amino acid changes in YabA that disrupted solely the interaction with DnaA or DnaN. These disruptive mutations delineated specific interacting surfaces involving a Zn2+-cluster structure in YabA. In B. subtilis, these YabA interaction mutations abolished both initiation control and the formation of YabA foci at the replication factory. Upon coexpression of deficient YabA mutants, mixed oligomers formed foci at the replisome and restored initiation control, indicating that YabA acts within a heterocomplex with DnaA and DnaN. In agreement, purified YabA oligomerized and formed complexes with DnaA and DnaN. These findings underscore the functional association of YabA with the replication machinery, indicating that YabA regulates initiation through coupling with the elongation of replication.


Subject(s)
Bacillus subtilis/genetics , Bacterial Proteins/metabolism , DNA Replication , DNA-Binding Proteins/metabolism , DNA-Directed DNA Polymerase/metabolism , Bacillus subtilis/chemistry , Bacterial Proteins/analysis , Bacterial Proteins/genetics , Genetic Complementation Test , Green Fluorescent Proteins/analysis , Green Fluorescent Proteins/genetics , Point Mutation , Protein Interaction Mapping , Recombinant Fusion Proteins/analysis , Recombinant Fusion Proteins/genetics
12.
Emerg Med J ; 22(12): 867-8, 2005 Dec.
Article in English | MEDLINE | ID: mdl-16299195

ABSTRACT

OBJECTIVES: To evaluate the relationship between Trendelenburg tilt and internal jugular vein (IJV) diameter, and to examine any cumulative effects of tilt on the IJV diameter. METHODS: Using a tilt table, healthy volunteers were randomised to Trendelenburg tilts of 10 degrees, 15 degrees, 20 degrees, 25 degrees, and 30 degrees. Ultrasound was used to measure and record the lateral diameter of the right IJV at the level of the cricoid cartilage. Following each reading the table was returned to the supine position. Balanced randomisation was used to assess cumulative tilt effects. RESULTS: A total of 20 healthy volunteers were recruited (10 men, 10 women). Mean supine IJV diameter was 13.5 mm (95% CI 12.8 to 14.1) and was significantly greater at 10 degrees (15.5 mm, 95% CI 14.9 to 16.1). There was no significant difference between 10 degrees and greater angles of tilt. The effect of the previous angle of tilt did not prove to be statistically significant. CONCLUSION: Increasing the degree of Trendelenburg tilt increases the lateral diameter of the IJV. Even a 10 degrees tilt is effective. The cumulative effect of tilt (that is, the effect of the previous angle) is not significant. Ultrasound guided cannulation is ideal, but in its absence Trendelenburg tilt will increase IJV diameter and improve the chance of successful cannulation. While 25 degrees achieved optimum distension, this may not be practical and may be detrimental (for example, risk of raised intracranial pressure).


Subject(s)
Catheterization, Central Venous/methods , Head-Down Tilt/physiology , Jugular Veins/physiology , Adult , Analysis of Variance , Female , Humans , Jugular Veins/anatomy & histology , Jugular Veins/diagnostic imaging , Male , Middle Aged , Ultrasonography
13.
Emerg Med J ; 22(11): 788-9, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16244336

ABSTRACT

BACKGROUND: Invasive practical procedures require identification of surface anatomical landmarks to reduce risk of damage to other structures. Needle thoracocentesis has specific complications, which have been previously documented. An observational study was performed among emergency physicians to name the landmark for needle thoracocentesis and identify this point on a human volunteer as per Advanced Trauma and Life Support (ATLS) guidelines. RESULTS: A cohort of 25 emergency physicians was studied, 21 (84%) of which were ATLS certified. The correct landmark was named by 22 (88%). Only 15 (60%) correctly identified the second intercostal space on the human volunteer, all placing the needle medial to the midclavicular line, with a range of 3 cm. Two (8%) named and identified the site of needle pericardiocentesis; one (4%) named and identified the fifth intercostal space in the anterior axillary line. DISCUSSION: These results demonstrate a low accuracy among emergency physicians in identifying correct landmarks for needle thoracocentesis under elective conditions. Should greater emphasis be placed on competency based training in ATLS?


Subject(s)
Clinical Competence/standards , Medical Staff, Hospital/standards , Paracentesis/methods , Pneumothorax/therapy , Chi-Square Distribution , Cohort Studies , Emergency Treatment/standards , Humans , Needles , Thorax
14.
Emerg Med J ; 22(8): 553-5, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16046754

ABSTRACT

INTRODUCTION: Emergency department ultrasound (EDU) is widely practised in the USA, Australia, parts of Europe, and Asia. EDU has been used in the UK since the late 1990s but as yet, few areas have established a practice. OBJECTIVES: To assess the current climate of opinion with respect to the practice, constraints, and establishment of EDU among emergency department (ED) consultants on the island of Ireland. METHODS: A postal questionnaire was formulated, piloted, and assessed for ambiguity by a sample of ED consultants and an independent non-ED consultant, prior to being mailed to all ED consultants in Ireland. RESULTS: Of the 58 consultants canvassed 46 (79%) responded. Of the respondents, 40 (87%) strongly agreed/agreed that EDU is appropriate and should be performed in the ED. Of these, 3 (7%) are currently performing EDU; 37 (80%) have not had formal training in EDU, however 42 (91%) support the establishment of national guidelines for training in focused ultrasound in the ED. Problems instituting EDU were often multifactorial. Commonly highlighted difficulties included financial issues (24 respondents, 52%) and radiology department support (16 respondents, 34%). Other cited problems include varying interdepartmental practices (15 respondents, 33%) and (for some EDs) low numbers of patients requiring EDU, with projected difficulties in skills maintenance. CONCLUSION: Despite the vast majority of ED consultants being in favour of EDU, very few actually perform it on a regular basis or have had any formal training. Highlighted difficulties in EDU implementation included financial constraints, lack of support from radiology departments, and lack of formal training.


Subject(s)
Attitude of Health Personnel , Emergency Service, Hospital/organization & administration , Ultrasonography/statistics & numerical data , Consultants , Education, Medical, Continuing/standards , Emergency Medicine/education , Health Services Research , Humans , Ireland , Northern Ireland , Point-of-Care Systems/statistics & numerical data , Practice Guidelines as Topic , Radiology/education , Surveys and Questionnaires , Ultrasonography/psychology
15.
Emerg Med J ; 22(5): 333-5, 2005 May.
Article in English | MEDLINE | ID: mdl-15843699

ABSTRACT

BACKGROUND: Emergency department ultrasound (EDU) is a physician performed ultrasound service aimed at improving patient flow and diagnosis in the emergency department. METHODS: This paper describes the initial phase of the introduction of EDU with three illustrative case reports and a discussion on the pitfalls and benefits of EDU. RESULTS AND DISCUSSION: In three cases discussed here, the use of EDU facilitated treatment and reduced the need for formal radiological scanning. While there are drawbacks to EDU, we believe these are far outweighed by the advantages, and in a recent survey of emergency medicine consultants throughout Ireland, the vast majority were in favour of its introduction. CONCLUSION: EDU has become a routine part of our clinical practice, and although we are still on a learning curve with regard to its use, we have experienced significant benefits in patient care. With technological advances (such as improved image resolution and teleradiology) the potential for EDU will continue to expand, but training, practice, accreditation, and audit are essential.


Subject(s)
Emergency Service, Hospital/organization & administration , Ultrasonography , Aged , Aortic Aneurysm, Abdominal/diagnostic imaging , Child, Preschool , Exudates and Transudates/diagnostic imaging , Fingers/diagnostic imaging , Foreign Bodies/diagnostic imaging , Hip Joint/diagnostic imaging , Humans , Male , Northern Ireland , Ultrasonography/standards
16.
Emerg Med J ; 21(2): 185-8, 2004 Mar.
Article in English | MEDLINE | ID: mdl-14988344

ABSTRACT

OBJECTIVE: To discover if there is a significant difference in the pattern and severity of injury sustained during falls in patients who have consumed alcohol and those who have not. To determine how pattern and severity of injury correlates with blood alcohol concentration. METHOD: A prospective quasi-randomised controlled study between November 2001 and July 2002. All healthy adults between 16 and 60 years who had fallen from standing height were included. A systematic history and examination permitted calculation of injury severity scores as per abbreviated injury scale update 1998. Blood alcohol concentrations were obtained from intoxicated patients with consent. RESULTS: 351 healthy adult patients were included in the study, there were 238 in the no alcohol group, 113 had consumed alcohol and blood alcohol intake were obtained for 47. The alcohol group had a higher incidence of head injuries (46 (48%) versus 22 (9%)) with a lower incidence of limb injuries (39 (39%) versus 183 (76%)) than the no alcohol group. There was a significant difference in the pattern of injury between the alcohol and no alcohol groups (chi(2), p<0.001) and there was a significant difference in the injury severity scores (p<0.001, Z = -2.5). In the alcohol group severity and pattern correlated with alcohol concentration at the time of injury. Patients with an alcohol concentration<2 g/l had mostly soft tissue limb injuries (58%), 2-2.5 mostly significant limb fractures (55%), and >2.5 mostly significant head injuries (90%). CONCLUSIONS: Alcohol related falls are more often associated with severe craniofacial injury. The severity of both limb and head injury is greater and correlates directly with blood alcohol concentration.


Subject(s)
Accidental Falls , Alcohol Drinking/blood , Trauma Severity Indices , Wounds and Injuries/etiology , Adolescent , Adult , Arm Injuries/blood , Arm Injuries/etiology , Craniocerebral Trauma/blood , Craniocerebral Trauma/etiology , Ethanol/blood , Fractures, Bone/blood , Fractures, Bone/etiology , Humans , Leg Injuries/blood , Leg Injuries/etiology , Middle Aged , Prospective Studies , Soft Tissue Injuries/blood , Soft Tissue Injuries/etiology , Wounds and Injuries/blood
17.
J Biol Chem ; 276(49): 45818-25, 2001 Dec 07.
Article in English | MEDLINE | ID: mdl-11585815

ABSTRACT

Primosomes are nucleoprotein assemblies designed for the activation of DNA replication forks. Their primary role is to recruit the replicative helicase onto single-stranded DNA. The "replication restart" primosome, defined in Escherichia coli, is involved in the reactivation of arrested replication forks. Binding of the PriA protein to forked DNA triggers its assembly. PriA is conserved in bacteria, but its primosomal partners are not. In Bacillus subtilis, genetic analysis has revealed three primosomal proteins, DnaB, DnaD, and DnaI, that have no obvious homologues in E. coli. Interestingly, they are involved in primosome function both at arrested replication forks and at the chromosomal origin. Our biochemical analysis of the DnaB and DnaD proteins unravels their role in primosome assembly. They are both multimeric and bind individually to DNA. Furthermore, DnaD stimulates DnaB binding activities. DnaD alone and the DnaD/DnaB pair interact specifically with PriA of B. subtilis on several DNA substrates. This suggests that the nucleoprotein assembly is sequential in the PriA, DnaD, DnaB order. The preferred DNA substrate mimics an arrested DNA replication fork with unreplicated lagging strand, structurally identical to a product of recombinational repair of a stalled replication fork.


Subject(s)
Bacillus subtilis/metabolism , Bacterial Proteins/metabolism , Base Sequence , Biopolymers , DNA Primers , DNA Replication , DNA, Bacterial , DNA, Single-Stranded/metabolism
18.
Mol Microbiol ; 42(1): 245-55, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11679082

ABSTRACT

Phenotypes of Bacillus subtilis priA mutants suggest that they are deficient in the restart of stalled chromosomal replication forks. The presumed activity of PriA in the restart process is to promote the assembly of a multiprotein complex, the primosome, which functions to recruit the replication fork helicase onto the DNA. We have proposed previously that three proteins involved in the initiation of replication at oriC in B. subtilis, DnaB, DnaD and DnaI, are components of the PriA primosome in this bacterium. However, the involvement of these proteins in replication restart has not yet been studied. Here, we describe dnaB mutations that suppress the phenotypes of B. subtilis priA mutants. In a representative mutant, the DnaC helicase is loaded onto single-stranded DNA in a PriA-independent, DnaD- and DnaI-dependent manner. These observations confirm that DnaB, DnaD and DnaI are primosomal proteins in B. subtilis. Moreover, their involvement in the suppression of priA phenotypes shows that they participate in replication fork restart in B. subtilis.


Subject(s)
Bacillus subtilis/metabolism , Bacterial Proteins/metabolism , DNA Helicases/metabolism , DNA Replication , Escherichia coli Proteins , Bacillus subtilis/genetics , Bacterial Proteins/genetics , DNA Helicases/genetics , DNA Primase/metabolism , DNA-Binding Proteins/genetics , DNA-Binding Proteins/metabolism , DnaB Helicases , Mutation , Replication Protein A , Suppression, Genetic
19.
Am J Orthopsychiatry ; 71(4): 416-25, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11822214

ABSTRACT

In emergencies, family court judges must often make rapid decisions, without benefit of thorough information, that have significant impact on people's lives. Action-oriented research was used to develop a model that would bring psychosocial factors to the legal system for the purpose of enhancing the judicial decision-making process in emergency and temporary child placement cases.


Subject(s)
Decision Making , Emergencies , Foster Home Care/legislation & jurisprudence , Child , Humans , Jurisprudence , Needs Assessment , Time Factors
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