38 results on '"Duncan JC"'
Search Results
2. O-106 Populationpharmacokinetic Model Of The Antimicrobial Excipient Methyl Paraben Administered In Routine Clinical Practice To Neonates: Abstract O-106 Table 1
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Mulla, H, primary, Yakkundi, S, additional, McElnay, J, additional, Varendi, H, additional, Metsvaht, T, additional, Nellis, G, additional, Windrow, J, additional, Graham, S, additional, Tapscott, S, additional, Caldwell, NA, additional, Pandya, H, additional, Duncan, JC, additional, Lutsar, I, additional, Nunn, AJ, additional, and Turner, MA, additional
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- 2014
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3. PO-0926 Are Group Assessments Superior To Individual Avoidability Assessments? A Test Of The Liverpool Adverse Drug Reaction Avoidability Assessment Tool
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Bracken, LE, primary, Duncan, JC, additional, Peak, M, additional, Arnott, J, additional, Kirkham, JJ, additional, Nunn, AJ, additional, Pirmohamed, M, additional, and Turner, MA, additional
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- 2014
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4. Medication Compliance in Patients with Chronic Schizophrenia: Implications for the Community Management of Mentally Disordered Offenders
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Duncan, JC and Rogers, R
- Abstract
The safe and effective management of mentally disordered offenders is a paramount concern in decisions for community placement. Treatment effectiveness is often vitiated by medication noncompliance. In the current study, clinical and sociodemographic correlates of treatment compliance were examined in outpatients with schizophrenia. Level of medication compliance, assessed independently by treatment staff at two outpatient settings, resulted in 40 compliant, 38 noncompliant, and 12 partially compliant patients. Key symptoms associated with medication noncompliance were anger, delusions, and hallucinations. As an initial investigation, a stepwise discriminant analysis was moderately successful at predicting medication noncompliance. The implications of these findings to mentally disordered offenders are explored.
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- 1998
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5. Examining predictors of relationship dissolution among unmarried parents: Applying the vulnerability-stress-adaptation framework.
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Duncan JC, Zhang X, Futris TG, and Sims KM
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- Humans, Female, Male, Adult, Child, Parents psychology, Divorce psychology, Divorce statistics & numerical data, Parenting psychology, Infant, Child, Preschool, Interpersonal Relations, Illegitimacy psychology, Illegitimacy statistics & numerical data, Mothers psychology, Mothers statistics & numerical data, Stress, Psychological psychology, Depression psychology, Adaptation, Psychological physiology
- Abstract
Prior research has established that parents who are in a relationship, yet unmarried at the time of their child's birth, are at an increased risk of relationship instability. However, the processes that may lead to the dissolution of these unmarried parents' couple relationships are less clear. Guided by the vulnerability-stress-adaptation model, the present study examined data from a sample of 1,575 mother and father dyads who participated in the Future of Families and Child Wellbeing Study over a 9-year period. A mixed effects Cox regression model was used to investigate how unmarried parents' reports of enduring vulnerability (depressive symptoms) over time influenced the onset of relationship dissolution between the time their focal child was 1- and 9-years old. Further, the potential mediating effect of mothers' and fathers' reports of stressful events (parenting stress) and adaptive processes (couple relationship interactions and coparenting behaviors) on the association between depressive symptoms and relationship dissolution by the 9-year follow-up were also examined. Results indicated that mothers' and fathers' reports of experiencing depressive symptoms over time were associated with relationship dissolution. Further, perceptions of couple interactions emerged as a significant mediator at the 3- (mothers) and 5- (mothers and fathers) year follow-up. Coparenting behaviors were a significant mediator for mothers and fathers at the 3- and 5-year follow-up. These results highlight how experiencing depressive symptoms over time, as well as perceptions of couple interactions and coparenting behaviors throughout the early years of parenting, are salient factors in the instability of unmarried parents' relationships. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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- 2024
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6. Association between body mass and hypotension in dogs under general anaesthesia.
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Miller L, Duncan JC, Handel IG, Shaw DJ, McKenzie HE, and Greenhalgh SN
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- Dogs, Animals, Retrospective Studies, Anesthesia, General adverse effects, Anesthesia, General veterinary, Hypotension veterinary, Anesthetics, Dog Diseases surgery
- Abstract
Objectives: To investigate the association between body mass and hypotension during general anaesthesia in dogs undergoing surgical and diagnostic procedures within a referral hospital., Materials and Methods: Retrospective evaluation of the anaesthetic records of 1789 dogs was performed. Data on signalment, anaesthetic protocol and physiological variables, including mean arterial pressure, were collected. A multivariable generalised linear model was used to identify associations between explanatory variables, including body mass, and hypotension., Results: In the population studied, increasing body mass (per 10 kg) was significantly associated with decreasing odds of hypotension (odds ratio 0.68; 95% confidence interval: 0.60 to 0.77). Additional variables associated with a decreased odds of hypotension were pre-anaesthetic medication with alpha-2 agonists (odds ratio 0.63; 95% confidence interval 0.48 to 0.82) and increased body temperature (per 1°C) during general anaesthesia (odds ratio 0.77; 95% confidence interval 0.67 to 0.88). Brachycephaly (odds ratio 1.72; 95% confidence interval 1.25 to 2.38), ASA physical status classification >3 (odds ratio 2.03; 95% confidence interval 1.16 to 3.56), undergoing a surgical procedure (versus diagnostic) (odds ratio 1.57; 95% confidence interval 1.10 to 2.23) and bradycardia (odds ratio 1.37; 95% confidence interval 1.05 to 1.80) were independently associated with increased odds of hypotension., Clinical Significance: Dogs of lower body mass and brachycephalic breeds may be at higher risk of hypotension during general anaesthesia or alternatively represent subpopulations in which accurate blood pressure measurement presents a greater challenge. Monitoring blood pressure accurately in these groups requires particular attention and provisions for treating hypotension should be readily accessible., (© 2023 The Authors. Journal of Small Animal Practice published by John Wiley & Sons Ltd on behalf of British Small Animal Veterinary Association.)
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- 2023
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7. The use of Special-Order products in England between 2012 and 2020: An insight into the need for Point-of-Care manufacturing.
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O'Donovan A, Duncan JC, Li KY, Del-Nevo L, Gill A, Peak M, and Alhnan MA
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- Humans, England, Cholecalciferol, Point-of-Care Systems, Drug Industry
- Abstract
Point-of-care manufacturing such as 3D printing has recently received significant attention from regulatory bodies and the pharmaceutical industry. However, little information is available on the quantity of the most prescribed patient-specific items, their dosage form, and why they were required to be dispensed. In England, 'Specials' are unlicensed medicines formulated to meet the requirements of a specific prescription, prescribed if no suitable licensed alternative exists. This work aims to quantify and examine trends in the prescribing of 'Specials' in England during 2012-2020, using the NHS Business Services Authority (NHSBSA) database. Quarterly prescription data from NHSBSA for the top 500 'Specials' by quantity from 2012 to 2020 were compiled yearly. The changes in net ingredient cost, the number of items, British National Formulary (BNF) drug category, dosage form, and a potential reason for requiring a 'Special' were identified. In addition, the cost-per-unit was calculated for each category. The total spending on 'Specials' decreased by 62 % from £109.2 M in 2012 to £41.4 M in 2020, primarily due to a 55.1 % reduction in the number of 'Specials' items issued. The most frequently prescribed dosage form type of 'Special' was oral dosage forms (59.6 % of all items in 2020) particularly oral liquids. The most common reason for prescribing a 'Special' was an inappropriate dosage form (74 % of all 'Specials' in 2020). The total number of items dropped over the 8 years as commonly prescribed 'Specials' such as melatonin and cholecalciferol became licensed. In conclusion, the total spending on 'Specials' dropped from 2012 to 2020 primarily due to a reduction in the number of 'Specials' items issued and pricing changes in the Drug tariff. Based on the current demand for 'special order' products, these findings are instrumental for formulation scientists to identify 'Special' formulations to design the next generation of extemporaneous medicine to be produced at the point of care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)
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- 2023
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8. Transversus abdominis plane block in rats: Preliminary cadaveric studies.
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Burrows CS, Duncan JC, and Martinez-Taboada F
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- Humans, Female, Animals, Rats, Infant, Rats, Sprague-Dawley, Pain, Cadaver, Abdominal Muscles, Ultrasonography, Interventional methods, Pain, Postoperative, Methylene Blue, Abdominal Wall diagnostic imaging
- Abstract
The transversus abdominis plane (TAP) block is an ultrasound guided regional anaesthetic technique used to provide analgesia to the abdominal wall. Research in humans and cats has demonstrated that TAP blocks reduce pain and post-operative opioid requirements after abdominal surgery. To date TAP blocks have not been described in rats. The optimal technique to employ when performing TAP blocks is controversial with single point injection techniques failing to reliably provide adequate coverage of the cranial abdominal wall. It has been suggested that performing a two point injection may provide more reliable coverage of the cranial abdominal wall.The objective of this study was to determine the feasibility of performing ultrasound guided TAP blocks in rat cadavers and to evaluate whether performing a two point technique provides greater spread of injectate than a one point technique when administering the same total volume of methylene blue solution.Twenty-three, four-month-old, female Sprague Dawley rat cadavers weighing 506 ± 78 g were used. TAP blocks were performed using a total of 1 ml/kg of methylene blue solution.Overall success rates for injections were 21.7% (13.6-32.8%). Single point injection area of spread was 87.8 ± 32 mm
2 compared with 102.4 ± 17 mm2 for the two point injection technique.Due to the low success rate the use of TAP blocks using the current technique cannot be recommended. Two point injection technique appears to provide greater spread; however, additional data is required to draw meaningful conclusions.- Published
- 2023
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9. Development and evaluation of an assessment of the age-appropriateness/inappropriateness of formulations used in children.
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Duncan JC, Bracken LE, Nunn AJ, Peak M, and Turner MA
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- Adult, Infant, Newborn, Humans, Child, Reproducibility of Results, Consensus, Data Collection, Excipients, Hospitals, Pediatric
- Abstract
Background: Medicines designed for adults may be inappropriate for use in children in terms of strength, dosage form and/or excipient content. There is currently no standardised method of assessing the age-appropriateness of a medicine for paediatric use., Aim: To develop and test a tool to assess whether a dosage form (formulation) is appropriate for children and estimate the proportion of formulations considered 'inappropriate' in a cohort of hospitalised paediatric patients with a chronic illness., Method: A multi-phase study: patient data collection, tool development, case assessments and tool validation. Inpatients aged 0-17 years at two UK paediatric/neonatal hospitals during data collection periods between January 2015 and March 2016. Written informed consent/assent was obtained. Medicines assessed were new or regularly prescribed to inpatients as part of their routine clinical care. All medicine administration episodes recorded were assessed using the Age-appropriate Formulation tool. The tool was developed by a consensus approach, as a one-page flowchart. Independent case assessments were evaluated in 2019., Results: In 427 eligible children; 2,199 medicine administration episodes were recorded. Two assessors reviewed 220 episodes in parallel: percentage exact agreement was found to be 91.7% (99/108) and 93.1% (95/102). In total, 259/2,199 (11.8%) medicine administration episodes involved a dosage form categorised as 'age-inappropriate'., Conclusion: A novel tool has been developed and internally validated. The tool can identify which medicines would benefit from development of an improved paediatric formulation. It has shown high inter-rater reliability between users. External validation is needed to further assess the tool's utility in different settings., (© 2022. The Author(s).)
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- 2022
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10. Exploring Acceptability Drivers of Oral Antibiotics in Children: Findings from an International Observational Study.
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Vallet T, Bensouda Y, Saito J, Mathiesen L, Pokharkar V, Klingmann V, Peak M, Elhamdaoui O, Yamatani A, Ivanovic I, Sajith M, Münch J, Bracken L, Duncan JC, Salunke S, Wang S, and Ruiz F
- Abstract
Antibiotics are among the most commonly prescribed drugs in children. Adherence to the treatment with these drugs is of the utmost importance to prevent the emergence of resistant bacteria, a global health threat. In children, medicine acceptability is likely to have a significant impact on compliance. Herein we used a multivariate approach, considering simultaneously the many aspects of acceptability to explore the drivers of oral antibiotic acceptability in children under twelve, especially in toddlers and in preschoolers. Based on 628 real-life observer reports of the intake of 133 distinct medicines, the acceptability reference framework highlighted the influence of many factors such as age and sex of patients, previous exposure to treatment, place of administration, administration device, flavor agent in excipients and active pharmaceutical ingredient. These findings from an international observational study emphasize the multidimensional nature of acceptability. Therefore, it is crucial to consider all these different aspects for assessing this multi-faceted concept and designing or prescribing a medicine in order to reach adequate acceptability in the target population.
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- 2021
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11. Controlled Environment Neutron Radiography of Moisture Sorption/Desorption in Nanocellulose-Treated Cotton Painting Canvases.
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Bridarolli A, Odlyha M, Burca G, Duncan JC, Akeroyd FA, Church A, and Bozec L
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Nanocellulose-based materials have recently been used to consolidate degraded cotton painting canvases. Canvas-supported paintings consist of materials that are sensitive to moisture and especially susceptible to environmental fluctuations in temperature and relative humidity (RH). These environmental fluctuations occur in uncontrolled environments found in historic houses and palaces and can lead to hydrolytic degradation and mechanical damage to canvases. To simulate this situation in an experimental setting, canvas samples were mounted in a custom-made closed-cell and subjected to programmed cycles of RH at a controlled temperature while exposed to the neutron beam. Results are presented for both untreated samples and those treated with a polar consolidant, cellulose nanofibrils (CNF(aq)) in water, and an apolar consolidant, a composite of persilylated methyl cellulose with surface silylated cellulose nanocrystals (MC+CNC(h)) in heptane. They were then compared with changes in ionic conductivities as measured by dielectric analysis (DEA) with the same cyclic RH program and temperature. Although the samples were exposed to the same experimental conditions, they presented treatment-specific responses. CNF-treated canvas showed higher hygroscopicity than the untreated sample and facilitated moisture diffusion across the sample to areas not exposed to the environment. A sample treated with MC+CNC(h) retarded moisture diffusion during the increase in RH and could, therefore, afford protection to moisture absorption in uncontrolled environments. Thus, the experimental setup and resulting data provide a pilot study demonstrating the potential of neutron radiography in following and comparing real-time moisture diffusion dynamics in untreated and nanocellulose-consolidated cotton canvases and assisting in validating the overall benefit of the treatment., Competing Interests: The authors declare no competing financial interest., (© 2021 The Authors. Published by American Chemical Society.)
- Published
- 2021
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12. A citizen science model for implementing statewide educational DNA barcoding.
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Chiovitti A, Thorpe F, Gorman C, Cuxson JL, Robevska G, Szwed C, Duncan JC, Vanyai HK, Cross J, Siemering KR, and Sumner J
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- Animals, Australia, Base Sequence, Feedback, Genetic Variation, Mitochondria genetics, Phylogeny, Reptiles classification, Reptiles genetics, Species Specificity, Students, DNA Barcoding, Taxonomic, Models, Educational, Science
- Abstract
Our aim was to develop a widely available educational program in which students conducted authentic research that met the expectations of both the scientific and educational communities. This paper describes the development and implementation of a citizen science project based on DNA barcoding of reptile specimens obtained from the Museums Victoria frozen tissue collection. The student program was run by the Gene Technology Access Centre (GTAC) and was delivered as a "one day plus one lesson" format incorporating a one-day wet laboratory workshop followed by a single lesson at school utilising online bioinformatics tools. The project leveraged the complementary resources and expertise of the research and educational partners to generate robust scientific data that could be analysed with confidence, meet the requirements of the Victorian state education curriculum, and provide participating students with an enhanced learning experience. During two 1-week stints in 2013 and 2014, 406 students mentored by 44 postgraduate university students participated in the project. Students worked mainly in pairs to process ~200 tissue samples cut from 53 curated reptile specimens representing 17 species. A total of 27 novel Cytochrome Oxidase subunit 1 (CO1) sequences were ultimately generated for 8 south-east Australian reptile species of the families Scincidae and Agamidae., Competing Interests: The commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials.
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- 2019
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13. Drawing the line in clinical treatment of companion animals: recommendations from an ethics working party.
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Grimm H, Bergadano A, Musk GC, Otto K, Taylor PM, and Duncan JC
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- Advisory Committees, Animals, Europe, Humans, Societies, Pets, Therapeutics ethics, Therapeutics veterinary, Veterinary Medicine ethics
- Abstract
Modern veterinary medicine offers numerous options for treatment and clinicians must decide on the best one to use. Interventions causing short-term harm but ultimately benefitting the animal are often justified as being in the animal's best interest. Highly invasive clinical veterinary procedures with high morbidity and low success rates may not be in the animal's best interest. A working party was set up by the European College of Veterinary Anaesthesia and Analgesia to discuss the ethics of clinical veterinary practice and improve the approach to ethically challenging clinical cases. Relevant literature was reviewed. The 'best interest principle' was translated into norms immanent to the clinic by means of the 'open question argument'. Clinical interventions with potential to cause harm need ethical justification, and suggest a comparable structure of ethical reflection to that used in the context of in vivo research should be applied to the clinical setting. To structure the ethical debate, pertinent questions for ethical decision-making were identified. These were incorporated into a prototype ethical tool developed to facilitate clinical ethical decision-making. The ethical question 'Where should the line on treatment be drawn' should be replaced by 'How should the line be drawn?', Competing Interests: Competing interests: PMT is also a member of the Veterinary Record editorial board., (© British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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14. Promoting Science in Secondary School Education.
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Chiovitti A, Duncan JC, and Jabbar A
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- Science standards, Parasitology education, Schools standards, Science education, Science trends
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Engaging secondary school students with science education is crucial for a society that demands a high level of scientific literacy in order to deal with the economic and social challenges of the 21st century. Here we present how parasitology could be used to engage and promote science in secondary school students under the auspice of a 'Specialist Centre' model for science education., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
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- 2017
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15. Genome Sequences of Cluster G Mycobacteriophages Cambiare, FlagStaff, and MOOREtheMARYer.
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Pope WH, Augustine DA, Carroll DC, Duncan JC, Harwi KM, Howry R, Jagessar B, Lum BA, Meinert JW, Migliozzi JS, Milliken KA, Mitchell CJ, Nalatwad AS, Orlandini KC, Rhein MJ, Saravanan V, Seese BA, Schiebel JG, Thomas KB, Adkins NL, Cohen KL, Iyengar VB, Kim H, Kramer ZJ, Montgomery MT, Schafer CE, Wilkes KE, Grubb SR, Warner MH, Bowman CA, Russell DA, and Hatfull GF
- Abstract
Mycobacteriophages Cambiare, FlagStaff, and MOOREtheMARYer are newly isolated phages of Mycobacterium smegmatis mc(2) 155 recovered from soil samples in Pittsburgh, PA. All three genomes are closely related to cluster G mycobacteriophages but differ sufficiently in nucleotide sequence and gene content to warrant division of cluster G into several subclusters., (Copyright © 2015 Pope et al.)
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- 2015
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16. Comparison of anaesthesia 'Day 1 skills' expectations between veterinary anaesthetists and general practitioners.
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Duncan JC, Ross M, Rhind S, Clutton E, and Shaw DJ
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- Anesthesiology education, Animals, Education, Veterinary standards, Humans, Societies, Medical, Surveys and Questionnaires, United Kingdom, Anesthesia veterinary, Attitude of Health Personnel, Clinical Competence, Veterinarians psychology
- Abstract
Day One Skills (DOS) were introduced by the Royal College of Veterinary Surgeons (RCVS) in 2006 as a guideline for minimum skills required by a veterinary graduate. However, the RCVS anaesthesia DOS are broad and do not specify differences in skills required for different species. The aims of this study were: (1) to determine which anaesthesia skills were considered essential for day one practice by UK-based veterinary practitioners (GPs) and anaesthetists; and (2) to explore current opinions on veterinary undergraduate anaesthesia training. Questionnaires for veterinary GPs (QGPs) and veterinary anaesthetists (QVAs) were developed which asked general information on expectations of anaesthesia skills as well as specific expectations for the common veterinary species. Fifty-five UK-based members of the Association of Veterinary Anaesthetists responded, with a random sample of veterinary practices stratified by UK county generating 234 responses and a convenience sample targeted at more specialist veterinary specialities in the UK generating 161 responses. There was close overall agreement between the two groups of GPs and anaesthetists on essential anaesthesia DOS. However, expectations varied with species-greatest in cats and dogs, lowest in exotics. Many respondents commented that new veterinary graduates lack practical skills and should not be expected to be omnicompetent across all species. In conclusion, anaesthesia undergraduate training should prioritise essential practical DOS., (British Veterinary Association.)
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- 2015
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17. Modeling the effect of a prosthetic limb on 4-km pursuit performance.
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Childers WL, Gallagher TP, Duncan JC, and Taylor DK
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- Humans, Monte Carlo Method, Artificial Limbs, Athletic Performance physiology, Bicycling physiology, Models, Statistical, Prosthesis Design
- Abstract
The individual pursuit is a 4-km cycling time trial performed on a velodrome. Parathletes with transtibial amputation (TTA) have lost physiological systems, but this may be offset by the reduced aerodynamic drag of the prosthesis. This research was performed to understand the effect of a unilateral TTA on Olympic 4-km pursuit performance. A forward-integration model of pursuit performance explored the interplay between power loss and aerodynamic gains in parathletes with TTA. The model is calibrated to a 4-km pursuit time of 4:10.5 (baseline), then adjusted to account for a TTA. Conditions simulated were based on typical pedal asymmetry in TTA (AMP), if foot stiffness were decreased (FLEX), if pedaling asymmetries were minimized (ASYM), if the prosthesis were aerodynamically optimized (AERO), if the prosthesis had a cosmetic cover (CC), and if all variables were optimized (OPT). A random Monte Carlo analysis was performed to understand model precision. Four-kilometer pursuit performances predicted by the model were 4:10.5, 4:20.4, 4:27.7, 4:09.2, 4:19.4, 4:27.9, and 4:08.2 for the baseline, AMP, FLEX, ASYM, AERO, CC, and OPT models, respectively. Model precision was ±3.7 s. While the modeled time decreased for ASYM and OPT modeled conditions, the time reduction fell within model precision and therefore was not significant. Practical application of these results suggests that parathletes with a TTA could improve performance by minimizing pedaling asymmetry and/or optimizing aerodynamic design, but, at best, they will have performance similar to that of intact cyclists. In conclusion, parathletes with TTA do not have a net advantage in the individual pursuit.
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- 2015
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18. Risk assessment of neonatal excipient exposure: lessons from food safety and other areas.
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Turner MA, Duncan JC, Shah U, Metsvaht T, Varendi H, Nellis G, Lutsar I, Yakkundi S, McElnay JC, Pandya H, Mulla H, Vaconsin P, Storme T, Rieutord A, and Nunn AJ
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- Animals, Food Safety, Humans, Infant, Newborn, Risk Assessment, Excipients adverse effects
- Abstract
Newborn babies can require significant amounts of medication containing excipients intended to improve the drug formulation. Most medicines given to neonates have been developed for adults or older children and contain excipients thought to be safe in these age groups. Many excipients have been used widely in neonates without obvious adverse effects. Some excipients may be toxic in high amounts in which case they need careful risk assessment. Alternatively, it is conceivable that ill-founded fears about excipients mean that potentially useful medicines are not made available to newborn babies. Choices about excipient exposure can occur at several stages throughout the lifecycle of a medicine, from product development through to clinical use. Making these choices requires a scalable approach to analysing the overall risk. In this contribution we examine these issues., (Copyright © 2013 Elsevier B.V. All rights reserved.)
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- 2014
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19. Adverse drug reactions and off-label and unlicensed medicines in children: a nested case-control study of inpatients in a pediatric hospital.
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Bellis JR, Kirkham JJ, Thiesen S, Conroy EJ, Bracken LE, Mannix HL, Bird KA, Duncan JC, Peak M, Turner MA, Smyth RL, Nunn AJ, and Pirmohamed M
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- Adolescent, Case-Control Studies, Child, Child, Preschool, Drug-Related Side Effects and Adverse Reactions etiology, England epidemiology, Female, Hospitals, Pediatric, Humans, Infant, Inpatients statistics & numerical data, Male, Proportional Hazards Models, Risk Factors, Drug-Related Side Effects and Adverse Reactions epidemiology, Off-Label Use statistics & numerical data
- Abstract
Background: Off-label and unlicensed (OLUL) prescribing has been prevalent in pediatric practice. Using data from a prospective cohort study of adverse drug reactions (ADRs) among pediatric inpatients, we aimed to test the hypothesis that OLUL status is a risk factor for ADRs., Methods: A nested case?control study was conducted within a prospective cohort study. Details of all medicines administered were recorded, including information about OLUL status. The odds ratio for OLUL medicines being implicated in a probable or definite ADR was calculated. A multivariate Cox proportional hazards regression model was fitted to the data to assess the influence that OLUL medicine use had on the hazard of an ADR occurring., Results: A total of 10,699 medicine courses were administered to 1,388 patients. The odds ratio (OR) of an OLUL medicine being implicated in an ADR compared with an authorized medicine was 2.25 (95% confidence interval (CI) 1.95 to 2.59). Medicines licensed in children but given to a child below the minimum age or weight had the greatest odds of being implicated in an ADR (19% of courses in this category were implicated, OR 3.54 (95% CI 2.82 to 4.44). Each additional OLUL medicine given significantly increased the hazard of an ADR (hazard ratio (HR) 1.3 95% CI 1.2 to 1.3, P <0.001). Each additional authorized medicine given also significantly increased the hazard (HR 1.2 95% CI 1.2 to 1.3, P <0.001)., Conclusions: OLUL medicines are more likely to be implicated in an ADR than authorized medicines. The number of medicines administered is a risk factor for ADRs highlighting the need to use the lowest number of medicines, at the lowest dose for the shortest period, with continual vigilance by prescribers, in order to reduce the risk of ADRs.
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- 2013
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20. Incidence, characteristics and risk factors of adverse drug reactions in hospitalized children - a prospective observational cohort study of 6,601 admissions.
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Thiesen S, Conroy EJ, Bellis JR, Bracken LE, Mannix HL, Bird KA, Duncan JC, Cresswell L, Kirkham JJ, Peak M, Williamson PR, Nunn AJ, Turner MA, Pirmohamed M, and Smyth RL
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- Adolescent, Analysis of Variance, Child, Child, Preschool, Cohort Studies, Humans, Incidence, Infant, Infant, Newborn, Kaplan-Meier Estimate, Prospective Studies, Risk Factors, United Kingdom epidemiology, Drug-Related Side Effects and Adverse Reactions epidemiology, Hospitalization statistics & numerical data
- Abstract
Background: Adverse drug reactions (ADRs) are an important cause of harm in children. Current data are incomplete due to methodological differences between studies: only half of all studies provide drug data, incidence rates vary (0.6% to 16.8%) and very few studies provide data on causality, severity and risk factors of pediatric ADRs. We aimed to determine the incidence of ADRs in hospitalized children, to characterize these ADRs in terms of type, drug etiology, causality and severity and to identify risk factors., Methods: We undertook a year-long, prospective observational cohort study of admissions to a single UK pediatric medical and surgical secondary and tertiary referral center (Alder Hey, Liverpool, UK). Children between 0 and 16 years 11 months old and admitted for more than 48 hours were included. Observed outcomes were occurrence of ADR and time to first ADR for the risk factor analysis., Results: A total of 5,118 children (6,601 admissions) were included, 17.7% of whom experienced at least one ADR. Opiate analgesics and drugs used in general anesthesia (GA) accounted for more than 50% of all drugs implicated in ADRs. Of these ADRs, 0.9% caused permanent harm or required admission to a higher level of care. Children who underwent GA were at more than six times the risk of developing an ADR than children without a GA (hazard ratio (HR) 6.40; 95% confidence interval (CI) 5.30 to 7.70). Other factors increasing the risk of an ADR were increasing age (HR 1.06 for each year; 95% CI 1.04 to 1.07), increasing number of drugs (HR 1.25 for each additional drug; 95% CI 1.22 to 1.28) and oncological treatment (HR 1.90; 95% CI 1.40 to 2.60)., Conclusions: ADRs are common in hospitalized children and children who had undergone a GA had more than six times the risk of developing an ADR. GA agents and opiate analgesics are a significant cause of ADRs and have been underrepresented in previous studies. This is a concern in view of the increasing number of pediatric short-stay surgeries.
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- 2013
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21. Clinical assessments of increased sensory sensitivity in dogs with cranial cruciate ligament rupture.
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Brydges NM, Argyle DJ, Mosley JR, Duncan JC, Fleetwood-Walker S, and Clements DN
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- Animals, Anterior Cruciate Ligament physiology, Biomechanical Phenomena, Chronic Pain complications, Chronic Pain physiopathology, Dog Diseases etiology, Dogs, Female, Gait, Hindlimb physiology, Hyperalgesia etiology, Hyperalgesia physiopathology, Male, Pain Measurement veterinary, Rupture physiopathology, Rupture veterinary, Thermosensing, Weight-Bearing, Anterior Cruciate Ligament physiopathology, Chronic Pain veterinary, Dog Diseases physiopathology, Hindlimb physiopathology, Hyperalgesia veterinary, Pain Measurement methods
- Abstract
Dogs with chronic pain have a compromised quality of life. Repeatable and accurate sensory assessments form a means by which the hypersensitivity likely to reflect chronic pain may be quantified. These assessments can be applied to individuals to identify those that may benefit from improved analgesic relief. In this study four sensory assessments were evaluated in dogs presenting with a naturally occurring chronic painful condition (cranial cruciate ligament rupture, CCLR) and were compared with healthy control animals of similar age and weight. Inter-digital von Frey filament and thermal sensitivity tests revealed that the affected hind limb of dogs with CCLR was significantly more sensitive than the opposing limb. Static weight bearing and gait parameter scores were also reduced in the affected hind limb compared to the opposing hind limb of dogs with CCLR; no such differences were found between the hind limbs of healthy (control) dogs. The quantitative sensory tests permitted the differentiation of limbs affected by CCLR from healthy limbs. Dogs presenting with CCLR demonstrate objectively quantitative sensory sensitivities, which may require additional consideration in case management., (Copyright © 2012 Elsevier Ltd. All rights reserved.)
- Published
- 2012
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22. Correlates of spontaneous viral control among long-term survivors of perinatal HIV-1 infection expressing human leukocyte antigen-B57.
- Author
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Tang Y, Huang S, Dunkley-Thompson J, Steel-Duncan JC, Ryland EG, St John MA, Hazra R, Christie CD, and Feeney ME
- Subjects
- Adolescent, Child, Epitopes, T-Lymphocyte genetics, Epitopes, T-Lymphocyte immunology, Female, HIV Infections genetics, HIV Infections virology, HIV Long-Term Survivors, HLA-B Antigens metabolism, Humans, Immune Tolerance, Interferon-gamma immunology, Interferon-gamma metabolism, Male, Viremia, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, HIV Infections immunology, HIV-1 genetics, HIV-1 immunology, HLA-B Antigens immunology
- Abstract
Objective: We sought to identify immunologic and virologic correlates of spontaneous viral control among long-term survivors of perinatal HIV infection expressing the protective human leukocyte antigen (HLA)-B57 allele., Design: The frequency, epitope specificity, and functional attributes of HIV-specific T cells and sequence variation within B57-restricted epitopes were compared between 'spontaneous controllers' who maintained normal CD4 percentages and viral loads less than 3000 copies/ml without antiretroviral therapy, and 'treated progressors' who had initiated HAART., Methods: Recognition of HIV optimal epitopes was assessed by interferon gamma (IFNgamma) enzyme-linked immunosorbent spot. Functional characterization of CD8 cells targeting B57 epitopes was performed by staining for cytokine production (intracellular IFNgamma, interleukin-2, tumor necrosis factor alpha) and degranulation. Sequencing of autologous RNA was performed to determine the prevalence of viral escape mutations within B57-restricted epitopes and associated compensatory mutations., Results: HLA-B57 remained immunodominant during chronic infection in both controllers and progressors, but controllers recognized fewer epitopes and targeted epitopes within Gag and reverse transcriptase only, whereas progressors demonstrated a broader response targeting additional proteins. No individual epitope was targeted more frequently by spontaneous controllers. CD8 cytokine production patterns were heterogeneous among individuals and even among different epitopes in the same individual and did not correlate with spontaneous viral control. Extensive sequence variation within B57 epitopes was observed in both groups, but only progressors displayed additional capsid mutations that are known to offset the viral fitness cost of B57-driven immune escape., Conclusion: Among HLA-B57-positive long-term survivors, spontaneous control of viremia is not associated with a qualitatively or quantitatively superior T-cell response, but with uncompensated fitness-attenuating mutations in the viral capsid.
- Published
- 2010
- Full Text
- View/download PDF
23. The bispectral index during recovery from halothane and sevoflurane anaesthesia in horses.
- Author
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Belda E, Blissitt KJ, Duncan JC, Laredo FG, Escobar Gil de Montes M, and Clutton RE
- Subjects
- Animals, Female, Intraoperative Care veterinary, Male, Preanesthetic Medication veterinary, Sevoflurane, Anesthesia Recovery Period, Anesthesia, Inhalation veterinary, Anesthetics, Inhalation, Consciousness Monitors veterinary, Halothane, Horses physiology, Methyl Ethers
- Abstract
Objective: To record the bispectral index (BIS) when horses moved during either halothane or sevoflurane anaesthesia and when they made volitional movements during recovery from these anaesthetics., Study Design: Randomized prospective clinical study., Animals: Twenty-five client-owned horses undergoing surgery aged 8.8 (+/- 5.3; 1-19) years (mean +/- SD; range)., Methods: Baseline BIS values were recorded before pre-anaesthetic medication (BIS(B)) and during anaesthesia (BIS(A)) maintained with halothane (group H; n = 12) or sevoflurane (group S; n =13) at approximately 0.8-0.9 x minimum alveolar concentrations (MAC). Bispectral indices were recorded during the surgery when unexpected movement occurred (BIS(MA)), during recovery when the first movement convincingly associated with consciousness was observed (BIS(M1)) and once sternal recumbency was achieved (BIS(ST))., Results: No significant difference in BIS(M1) was found between halothane- (85 +/- 7; 75-93) and sevoflurane- (87 +/- 10; 70-98) anaesthetized horses although BIS(A) was significantly (p = 0.0002) lower in group S (62 +/- 7; 53-72) than group H (74 +/- 7; 60-84). Differences between BIS(M1) and BIS(A) were significant in sevoflurane (p = 0.00001) and halothane recipients (p = 0.002) but were greater in group S (25 +/- 9; 4-38) compared with group H (12 +/- 10; -9-25). In six of eight horses, BIS(MA) values ranged between those recorded during anaesthesia and at first movement., Conclusions and Clinical Relevance: Bispectral indices appear to approximate levels of unconsciousness, suggesting that monitoring the BIS may assist equine anaesthesia. However, it does not predict intra-operative movement.
- Published
- 2010
- Full Text
- View/download PDF
24. Maternal transmission of human immunodeficiency virus escape mutations subverts HLA-B57 immunodominance but facilitates viral control in the haploidentical infant.
- Author
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Schneidewind A, Tang Y, Brockman MA, Ryland EG, Dunkley-Thompson J, Steel-Duncan JC, St John MA, Conrad JA, Kalams SA, Noel F, Allen TM, Christie CD, and Feeney ME
- Subjects
- Amino Acid Sequence, Animals, Child, Preschool, Disease Progression, Female, HIV genetics, HIV Core Protein p24 genetics, HIV Infections transmission, HIV Infections virology, Humans, Infant, Male, Molecular Sequence Data, Sequence Analysis, DNA, HIV growth & development, HIV immunology, HIV Core Protein p24 immunology, HIV Infections immunology, HLA-B Antigens immunology, Infectious Disease Transmission, Vertical, Mutation, Missense immunology
- Abstract
Expression of HLA-B57 is associated with restricted replication of human immunodeficiency virus (HIV), but the mechanism for its protective effect remains unknown. If this advantage depends upon CD8 T-cell recognition of B57-restricted epitopes, mother-to-child transmission of escape mutations within these epitopes could nullify its protective effect. However, if the B57 advantage is largely mediated by selection for fitness-attenuating viral mutations within B57-restricted epitopes, such as T242N in TW10-Gag, then the transmission of such mutations could facilitate viral control in the haploidentical infant. We assessed the consequences of B57-associated mutations on replication capacity, viral control, and clinical outcome after vertical transmission in 13 mother-child pairs. We found that expression of HLA-B57 was associated with exceptional control of HIV during infancy, even when mutations within TW10 and most other B57-restricted epitopes were transmitted, subverting the natural immunodominance of HLA-B57. In contrast, most B57-negative infants born to B57-positive mothers progressed rapidly to AIDS. The presence of T242N led to a reproducible reduction in viral fitness, as demonstrated by in vitro assays using NL4-3 constructs encoding p24 sequences from individual mothers and infants. Associated compensatory mutations within p24-Gag were observed to reverse this impairment and to influence the propensity of T242N to revert after transmission to B57-negative hosts. Moreover, primary failure to control viremia was observed in one infant to whom multiple compensatory mutations were transmitted along with T242N. These parallel in vivo and in vitro data suggest that HLA-B57 confers its advantage primarily by driving and maintaining a fitness-attenuating mutation in p24-Gag.
- Published
- 2009
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- View/download PDF
25. Self Organising Maps for distinguishing polymer groups using thermal response curves obtained by dynamic mechanical analysis.
- Author
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Lloyd GR, Brereton RG, and Duncan JC
- Abstract
Self Organising Maps are described including the U-Matrix, component planes, hit histograms, quality indicators as mean quantisation error and topological error. Software was written in Matlab and several new approaches for visualising multiclass maps are employed. The method is applied to a dataset consisting of the Dynamic Mechanical Analysis of 293 polymers, involving heating the polymers over a temperature range of -51 degrees C to 270 degrees C. These can be characterised in three different ways (a) amorphous or semi-crystalline (b) as 9 groups (c) as 30 grades.
- Published
- 2008
- Full Text
- View/download PDF
26. Effectiveness of antiretroviral therapy in treating paediatric HIV/AIDS in Jamaica.
- Author
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Pierre RB, Steel-Duncan JC, Evans-Gilbert T, Rodriguez B, Moore J, Palmer P, Smikle MF, Davis D, Figueroa JP, and Christie CD
- Subjects
- Acquired Immunodeficiency Syndrome drug therapy, Acquired Immunodeficiency Syndrome epidemiology, Acquired Immunodeficiency Syndrome mortality, Adolescent, Adult, Anti-HIV Agents administration & dosage, Child, Child, Preschool, Confidence Intervals, Female, HIV Infections epidemiology, HIV Infections mortality, Humans, Infant, Jamaica epidemiology, Male, Prospective Studies, Survival Analysis, Treatment Outcome, Young Adult, Antineoplastic Combined Chemotherapy Protocols therapeutic use, HIV Infections drug therapy, Quality of Life
- Abstract
Background and Purpose: Paediatric HIV/AIDS remains a significant challenge in developing countries. We describe the effectiveness of interventions in HIV-infected children attending Paediatric Infectious Diseases Clinics in Jamaica., Methods: One hundred and ninety-seven HIV-infected children were followed prospectively in multicentre ambulatory clinics between September 1, 2002 and August 31, 2005, in the Kingston Paediatric and Perinatal HIV/AIDS Programme, Jamaica, and their outcomes described., Results: Median follow-up was 23 child-months (interquartile range [IQR] 12-31) with 12 children (6.0%) lost to follow-up and deaths (n=13) occurred at 4.64 per 100 child-years of follow-up. Median age was 5.0 years (IQR 2.2-8.1) and 32.1% had Centers for Disease Control and Prevention (CDC) category C disease at enrollment; 62% were ever on antiretroviral therapy (ART) with median duration of 15.4 months (IQR 5.5-25.5); 85% initiated ART with zidovudine/lamivudine/nevirapine. Mean weight-for-height 0.13 +/- 1.02 (mean difference -1.71 [95% Confidence interval (CI) -2.73, -0.69]; p = 0.001) and body mass index-for-age 0.05 +/- 1.11 (mean difference -1.11, [CI -1.79, -0.43]; p = 0.002); z scores increased after 24 months on ART; however, children remained stunted. Reductions in the incidence of hospitalizations (mean diff 30.95, [CI 3.12, 58.78]; p = 0.03) and in episodes of pneumonia, culture-positive sepsis and tuberculosis occurred in those on ART., Conclusions: A successfully implemented ambulatory model for paediatric HIV care in Jamaica has improved the quality of life and survival of HIV-infected children.
- Published
- 2008
27. Learning vector quantization for multiclass classification: application to characterization of plastics.
- Author
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Lloyd GR, Brereton RG, Faria R, and Duncan JC
- Abstract
Learning vector quantization (LVQ) is described, with both the LVQ1 and LVQ3 algorithms detailed. This approach involves finding boundaries between classes based on codebook vectors that are created for each class using an iterative neural network. LVQ has an advantage over traditional boundary methods such as support vector machines in the ability to model many classes simultaneously. The performance of the algorithm is tested on a data set of the thermal properties of 293 commercial polymers, grouped into nine classes: each class in turn consists of several grades. The method is compared to the Mahalanobis distance method, which can also be applied to a multiclass problem. Validation of the classification ability is via iterative splits of the data into test and training sets. For the data in this paper, LVQ is shown to perform better than the Mahalanobis distance as the latter method performs best when data are distributed in an ellipsoidal manner, while LVQ makes no such assumption and is primarily used to find boundaries. Confusion matrices are obtained of the misclassification of polymer grades and can be interpreted in terms of the chemical similarity of samples.
- Published
- 2007
- Full Text
- View/download PDF
28. Pattern recognition for the analysis of polymeric materials.
- Author
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Lukasiak BM, Faria R, Zomer S, Brereton RG, and Duncan JC
- Subjects
- Pattern Recognition, Automated methods, Polymers chemistry, Temperature, Materials Testing methods, Polymers classification
- Abstract
A new method of polymer classification is described involving dynamic mechanical analysis of polymer properties as temperature is changed. The method is based on the chemometric analysis of the damping factor (tan delta) as a function of temperature. In this study four polymer groups, namely, polypropylene, low density polyethylene, polystyrene and acrylonitrile-butadiene-styrene, each characterised by different grades, were studied. The aim is to distinguish polymer groups from each other. The polymers were studied over a temperature range of -50 degrees C until the minimum stiffness was reached, tan delta values were recorded approximately every 1.5 degrees . Principal components analysis was performed to visualise groupings and also for feature reduction prior to classification and clustering. Several clustering and classification methods were compared including k-means clustering, hierarchical cluster analysis, linear discriminant analysis, k-nearest neighbours, and class distances using both Euclidean and Mahalanobis measures. It is demonstrated that thermal analysis together with chemometrics provides excellent discrimination, representing a new approach for characterisation of polymers.
- Published
- 2006
- Full Text
- View/download PDF
29. Nursing interventions in the Kingston Paediatric and Perinatal HIV/AIDS Programme in Jamaica.
- Author
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Palmer PM, Anderson-Allen MM, Billings CC, Moore JT, McDonald-Kerr C, Steel-Duncan JC, and Christie CD
- Subjects
- Acquired Immunodeficiency Syndrome nursing, Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome transmission, Child, Child, Preschool, Female, HIV Infections prevention & control, HIV Infections transmission, Humans, Infant, Infant, Newborn, Jamaica, Pregnancy, Pregnancy Complications, Infectious prevention & control, HIV Infections nursing, Infectious Disease Transmission, Vertical prevention & control, Midwifery, Nursing Process, Pediatric Nursing, Pregnancy Complications, Infectious nursing, Program Evaluation
- Abstract
Background: Nursing care has been the "grass roots" of healthcare management even before nursing became a profession. Literature on the nursing experience with HIV is minimal and so it is challenging to comment on, or to compare experiences., Purpose: This paper highlights the nursing interventions as a key feature in the ongoing development and success of a prevention of mother-to-child HIV transmission (pMTCT) programme in a resource-limited setting., Method: In the Kingston Paediatric and Perinatal HIV/AIDS Programme, the nurses and midwives were carefully selected and then trained in the management of preventing mother-to-child transmission (pMTCT) of HIV/AIDS, voluntary counselling and testing and the identification and nursing management of paediatric and perinatal HIV/AIDS. The sites of the programme included three large maternity centres and four paediatric centres, with several feeder clinics for pregnant women. A nurse coordinator supervised the interventions at each site. A multidisciplinary team followed protocol-driven management for the care of pregnant HIV-positive women and children. There was strong collaboration with the Jamaican government and other agencies., Results: The nursing interventions served to: sensitize and encourage other healthcare workers in the care of persons living with HIV/AIDS; sensitize persons in the community about the disease; improve the comfort level of women and families with accessing healthcare; enable prospective data collection for programme assessment and research purposes and to enhance multidisciplinary collaboration to widen the scope of patient care and prevent duplication of healthcare services., Conclusion: Nursing intervention is a vital part of a pMTCT HIV programme; however, ongoing education and training of the entire healthcare team needs to be continued in order to strengthen the programme. It is hoped that much of what is done in the Kingston Paediatric and Perinatal HIV/AIDS Programme will become integrated in the nursing management of maternal and child health nationally.
- Published
- 2004
30. Uptake of interventions, outcomes and challenges in caring for HIV-exposed infants in Kingston, Jamaica.
- Author
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Steel-Duncan JC, Pierre R, Evans-Gilbert T, Rodriquez B, Smikle MF, Palmer P, Whorms S, Hambleton I, Figueroa JP, and Christie CD
- Subjects
- Female, HIV Infections epidemiology, HIV Infections transmission, Humans, Infant, Infant, Newborn, Jamaica epidemiology, Pregnancy, Prospective Studies, Retrospective Studies, Antibiotic Prophylaxis, HIV Infections prevention & control, Infant Care, Infectious Disease Transmission, Vertical prevention & control, Nevirapine therapeutic use, Patient Acceptance of Health Care, Prenatal Care, Treatment Outcome, Zidovudine therapeutic use
- Abstract
Background: In a few Caribbean islands, prevention of mother-to-child transmission (pMTCT) of HIV with zidovudine prophylaxis has reduced transmission rates from 27 - 44% to 5.5 - 9 %., Objectives: To highlight the uptake of interventions, preliminary outcomes and challenges in caring for HIV-exposed infants in a pMTCT HIVprogramme in a resource-limited setting., Method: A cohort of HIV-infected pregnant women were identified at the leading maternity centres in Greater Kingston through HIV counselling and testing and enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme. Antiretroviralprophylaxis with zidovudine or nevirapine was given to the HIV-positive women and their newborns along with formula feeding. Some infants were enrolled retrospectively and followed irrespective of whether they had or had not received antiretroviral prophylaxis. A multidisciplinary team at the paediatric centres supervised protocol-driven management of the infants. Infants were followed for clinical progress and definitive HIV-infection status was to be confirmed at 18 months of age by ELISA or the Determine Rapid Test., Results: During September 1, 2002 through August 31, 2003, 132 HIV-exposed infants were identified. For those infants prospectively enrolled (78), 97% received antiretroviral prophylaxis and 90% were not breastfed For all HIV-exposed children, 90% received cotrimoxazole prophylaxis and 88% continued follow-up care. Ninety-two per cent of all the infants remained asymptomatic and five died; of these deaths one is possibly HIV-related (severe sepsis at 11 weeks). This infant was retrospectively identified, had received no antiretroviral prophylaxis and was breastfed The main programme challenges, which were overcome, included the impact of stigma, compliance with antiretroviral chemoprophylaxis, breast-milk substitution and follow-up care. Financial constraints and laboratory quality assurance issues limited early diagnosis of HIV infection., Conclusion: Despite the challenges, the expected outcome is to prevent 50 new cases of HIV/AIDS in children living in Greater Kingston per year (300 over six years).
- Published
- 2004
31. HIV/AIDS following sexual assault in Jamaican children and adolescents: a case for HIV post-exposure prophylaxis.
- Author
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Steel-Duncan JC, Pierre R, Evans-Gilbert T, Rodriquez B, and Christie CD
- Subjects
- Acquired Immunodeficiency Syndrome prevention & control, Acquired Immunodeficiency Syndrome transmission, Adolescent, Chemoprevention statistics & numerical data, Child, Drug Therapy, Combination, Female, HIV Infections transmission, Humans, Jamaica, Lamivudine therapeutic use, Male, Rape, Risk Factors, Zidovudine therapeutic use, Anti-HIV Agents therapeutic use, Child Abuse, Sexual, HIV Infections prevention & control
- Abstract
Reported sexual assault in Jamaica is highest among children and adolescents. The risk of HIV transmission after sexual assault, although small, may be significant in certain circumstances, and it is therefore reasonable that post-exposure prophylaxis should be offered. These HIV transmission rates are similar to those of healthcare workers after occupational exposure to known HIV-infected blood for which routine post-exposure prophylaxis is recommended. We present a case series of children/adolescents with HIV/AIDS post-sexual assault and make the case for post-exposure prophylaxis for HIV infection following sexual assault.
- Published
- 2004
32. Antiretroviral drug therapy in HIV-infected Jamaican children.
- Author
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Evans-Gilbert T, Pierre R, Steel-Duncan JC, Rodriguez B, Whorms S, Hambleton IR, Figueroa JP, and Christie CD
- Subjects
- Adolescent, Child, Child, Preschool, Female, HIV Infections classification, HIV Infections physiopathology, Humans, Infant, Jamaica, Male, Prospective Studies, Severity of Illness Index, Anti-Retroviral Agents therapeutic use, Antiretroviral Therapy, Highly Active statistics & numerical data, Child Health Services, HIV Infections drug therapy, Treatment Outcome
- Abstract
Background: The study describes a cohort of HIV-infected Jamaican children receiving antiretroviral therapy (ART) and reports the outcome., Method: An observational prospective study was conducted on HIV-infected Jamaican children receiving anti retroviral drug therapy (ART). The outcome measures, weight, height, hospital admissions and length of stay were compared at initiation and within six months of commencing ART., Results: There were 37 (33.6%) of 110 HIV-infected children receiving ART during 2001 to 2003. The median age at commencement was six years (age range 1-16 years) with 54.1% (20) males and 48% AIDS orphans. Care was home-based for 68 % of all cases with the University Hospital of the West Indies managing 27 (73%) and the Bustamante Hospital for Children 10 (27%). The distribution by Centers for Disease Control and Prevention (CDC) clinical class was C (severely symptomatic), 22 (59.5%); B (moderately symptomatic), 8 (21.6%); A (mildly symptomatic), 6 (16.2%) and N (asymptomatic), one (2.7%). Among 14 (36%) children with CD4 counts, 8 (57%) were CDC immune class 2 (moderate immunodeficiency) and 6 (43%) were class 3 (severe immunodeficiency). After commencing ART the mean difference in admissions was--1.5+/-2.55 admissions (95% CI -2.3, -0.6; p < 0.001) and in length of stay was -12.9+/-21 day (95% CI -19.9, -0.5.9; p < 0.001). Antiretroviral therapy resulted in a mean weight gain of 2.8 kg+/-4.9 kg (95% CI 1.0, 4.5; p < 0.003) and a mean gain in height of 1.7 cm+/-2.6 cm (95% CI 0.6, 2.8; p < 0.003). Five children required second line therapy., Conclusion: The introduction of antiretroviral therapy has resulted in improved outcomes and is being initiated in older children cared for mainly at home. Limitations in accessing affordable second line agents underscore the need for compliance with first line therapy.
- Published
- 2004
33. Socio-demographic characteristics of HIV-exposed and HIV-infected Jamaican children.
- Author
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Rodriquez B, Steel-Duncan JC, Pierre R, Evans-Gilbert T, Hambleton I, Palmer P, Figueroa JP, and Christie CD
- Subjects
- Child, Preschool, Cost of Illness, Disease Progression, Female, HIV Infections prevention & control, Humans, Incidence, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical prevention & control, Infectious Disease Transmission, Vertical statistics & numerical data, Jamaica epidemiology, Pregnancy, Prevalence, Prospective Studies, Retrospective Studies, Risk Factors, Socioeconomic Factors, HIV Infections epidemiology, HIV Seropositivity epidemiology, Social Class
- Abstract
Background: In the face of the continuing pandemic of HIV/AIDS, the burden of the disease is now largest in the resource-poor developing world. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has listed the adult prevalence rate for the Caribbean as second only to Sub-Saharan Africa., Objective: To document the socio-demographic characteristics of paediatric and perinatal HIV/AIDS in Kingston, Jamaica., Methods: A cohort of HIV-infected pregnant women were identified at the leading maternity centres in Kingston and St Catherine and were enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme. Infants born to mothers within the programme were prospectively enrolled. Infants and children identified after delivery, whether HIV-exposed or infected, were also enrolled (retrospective group). All were followed according to standardized protocols., Results: We report on a total of 239 children, 78 (prospective group) and 161 (retrospective group). Among the retrospective group, 68% were classified as infected. For the prospective group, the patients were recruited within twenty-four hours of birth in 98.7% of cases, whereas in the retrospective group, the median age of recruitment was 2.6 years. The median age of the mother was 27 years and that of the father was 33 years. There were seven teenage mothers. Twenty-six per cent of the children were in institutional care. Family size ranged from one to nine children--the median was two children. For those parents where occupation was reported, the majority held semi-skilled or unskilled jobs. Patients attended their regional clinics., Conclusion: HIV/AIDS represents a significant human and financial burden on a developing country such as Jamaica and this underscores the need for urgent and sustained interventions to stem the epidemic.
- Published
- 2004
34. Nevirapine-associated rash in a Jamaican child with HIV/AIDS.
- Author
-
Steel-Duncan JC, Pierre R, Gabay L, and Christie CD
- Subjects
- Acquired Immunodeficiency Syndrome drug therapy, Exanthema physiopathology, Humans, Infant, Jamaica, Male, Anti-HIV Agents adverse effects, Exanthema chemically induced, HIV Infections drug therapy, Nevirapine adverse effects
- Abstract
Nevirapine is one of the first line antiretroviral agents used in the treatment of HIV/AIDS as well as for prophylaxis against mother-to-child transmission of HIV As antiretroviral medication becomes more available it is important for physicians to recognize the major clinical toxicities of these medications. We report a HIV-infected infant who developed a rash with systemic symptoms in association with nevirapine administration.
- Published
- 2004
35. CDC-defined diseases and opportunistic infections in Jamaican children with HIV/AIDS.
- Author
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Pierre R, Steel-Duncan JC, Evans-Gilbert T, Rodriguez B, Palmer P, Smikle MF, Whorms S, Hambleton I, Figueroa JP, and Christie CD
- Subjects
- Acquired Immunodeficiency Syndrome epidemiology, Acquired Immunodeficiency Syndrome pathology, Acquired Immunodeficiency Syndrome transmission, Adolescent, Centers for Disease Control and Prevention, U.S., Child, Child, Preschool, Disease Progression, Female, HIV Infections pathology, HIV Infections transmission, Humans, Infant, Infectious Disease Transmission, Vertical, Jamaica epidemiology, Male, Prevalence, Prospective Studies, Risk Factors, United States, AIDS-Related Opportunistic Infections epidemiology, HIV Infections epidemiology
- Abstract
Objective: To document the frequency of Centers for Disease Control and Prevention (CDC)-defined clinical conditions, opportunistic and co-infections among children with HIV/AIDS., Methods: This prospective, observational study reports the findings of 110 HIV-infected children followed in multicentre ambulatory clinics during September 1, 2002, to August 31, 2003, from the 239 children enrolled in the Kingston Paediatric and Perinatal HIV/AIDS Programme, Jamaica. We describe the clinico-pathologic characteristics of these children with HIV/AIDS, using the CDC criteria., Results: The client distribution by clinic site was as follows: the University Hospital of the West Indies, 71 (64.6%), Bustamante Hospital for Children, 23 (20.9%), Comprehensive Health Centre 13 (11.8/%) and Spanish Town Hospital, 3 (2.7%). The median age of the 110 children with HIV/AIDS was 6.0 years (range 0.9-17.5). Mode of transmission was primarily mother-to-child (88.0%) and only 4% maternal/infant pairs received antiretroviralprophylaxis. Grouped by CDC category: 17 (15.4%) were asymptomatic (N), 22 (20.0%) mildly symptomatic (A), 30 (27.3%) moderately symptomatic (B) and 41 (37.3%) severely symptomatic (C). The most common CDC-defining symptoms were lymphadenopathy (12, 42.8%) and asymptomatic (6, 21.4%) in category N; lymphadenopathy (30, 29.7%), dermatitis (20, 19.8%) and persistent or recurrent upper respiratory tract infections (20, 19.8%) in category A; bacterial sepsis (18, 34.6%) and recurrent diarrhoea (11, 21.2%) in category B; and wasting (28, 30.0%), encephalopathy (26, 27.9%), and serious bacterial infections (15, 16.1%) in category C; Pulmonary tuberculosis (7, 7.5%) and Pneumocystis (jiroveci) carinii pneumonia; (5, 5.4%) were the most frequent opportunistic infections. Streptococcus pneumoniae (10, 30.3%) was the most common invasive bacterial pathogen causing sepsis and Escherichia coli (14, 34.2%) was the most common bacterial pathogen causing urinary tract infections, among the cohort. Thirty-three per cent commenced antiretroviral drugs (ARVs). There were 57 hospitalizations and five deaths., Conclusions: The study is an important step toward documentation of the natural history of paediatric HIV/AIDS in a primarily ARV-naive population from a developing country. It promotes training in paediatric HIV management as we move toward affordable access to antiretroviral agents in the wider Caribbean and the implementation of clinical trials.
- Published
- 2004
36. alpha 1 Connexin (connexin43) gap junctions and activities of cAMP-dependent protein kinase and protein kinase C in developing mouse heart.
- Author
-
Duncan JC and Fletcher WH
- Subjects
- Animals, Cell Fractionation, Female, Heart growth & development, Heart physiology, Immunoblotting, Male, Mice, Phosphorylation, Pregnancy, Protein Isoforms metabolism, Connexin 43 metabolism, Cyclic AMP-Dependent Protein Kinases metabolism, Gap Junctions metabolism, Heart embryology, Myocardium metabolism, Protein Kinase C metabolism
- Abstract
alpha 1 Connexin (connexin43) is the dominant gap junction protein of the developing and mature heart where it forms channels that mediate intercellular electrical and metabolic coupling events that are critical for heart function. alpha1 connexin channels are rapidly and reversibly gated by actions of cAMP-dependent protein kinase (PKA) and protein kinase C (PKC), and disruption of consensus sites for these phosphorylations are associated with severe heart malformations. However, there have been no reports on the relative activities of PKA or PKC in early heart formation. Nor has the presence and phosphorylation state of alpha1 connexin been documented in these same developmental stages. To begin these studies, we used hearts from 8.5-18.5 dpc (days postcoitus) mouse embryos, postpartum pups, and adults. Membrane or supernatant fractions were used for immunoblots to assess the amounts and distribution of alpha1 connexin protein and each protein kinase. Phosphotransferase assays were done to document the endogenous activities of PKA and PKC. Three species of alpha1 connexin at 44, 46, and 49 kDa were evident in 8.5- and 9.5-dpc embryos and adult hearts, but the 49-kDa band was not consistently found in 10.5 dpc or embryos through 18.5 dpc, although it was robust in adult heart. The amount of PKA was minimal in 8.5-dpc hearts but rose thereafter and was maximal by 10.5 dpc and remained stable throughout development. Catalytic activity of this enzyme was minimal in 8.5-dpc hearts then rose thereafter and was maximal by 10.5 dpc of development. PKC delta was confined mainly to membrane fractions, whereas PKC epsilon had supernatant- and membrane-associated forms. Both enzyme isoforms showed large fluctuations throughout development. In 8.5- and 9.5-dpc hearts, PKC catalytic activity was maximal but, by 10.5 dpc, activity dramatically declined and remained low thereafter. The results demonstrate that alpha1 connexin is present at the heart tube stage (8.5 dpc) of development onward and provide evidence suggesting that channels formed by this protein are dynamically regulated by PKA and PKC, especially in 8.5- and 9.5-day embryonic hearts, which are crucial times for heart formation and left/right patterning in general., (Copyright 2001 Wiley-Liss, Inc.)
- Published
- 2002
- Full Text
- View/download PDF
37. Changes Observed in the Crab Nebula in Taurus.
- Author
-
Duncan JC
- Published
- 1921
- Full Text
- View/download PDF
38. Aminocaproic acid for haemophilia.
- Author
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Duncan JC
- Subjects
- Humans, Aminocaproates therapeutic use, Hemophilia A drug therapy
- Published
- 1969
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