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An assessment of medical students’ awareness of radiation exposures associated with diagnostic imaging investigations
Jennifer O’Sullivan,Owen J. O’Connor,Kevin O’Regan,Bronagh Clarke,Louise N. Burgoyne,Max F. Ryan,Michael M. Maher
Insights into Imaging , 2010, DOI: 10.1007/s13244-010-0009-8
Abstract: Assessment of students’ awareness of radiation exposures in diagnostic imaging demonstrates improved performance with increasing years in medical school and/or increasing exposure to CICR. Findings support the Euroatom 97 directive position, advocating implementation of radiation protection instruction into the undergraduate medical curriculum.
Features and outcomes of unplanned hospital admissions of older people due to ill-defined (R-coded) conditions: Retrospective analysis of hospital admissions data in England
Bronagh Walsh, Helen C Roberts, Peter G Nicholls
BMC Geriatrics , 2011, DOI: 10.1186/1471-2318-11-62
Abstract: Retrospective analysis of unplanned hospital admissions to general internal and geriatric medicine wards in one hospital over 12 months (2002) with follow-up for 36 months. The study was carried out in an acute teaching hospital in England. The participants were all people aged 65 and over with unplanned hospital admissions to general internal and geriatric medicine. Independent variables included time of admission, residence at admission, route of admission to hospital, age, gender, comorbidity measured by count of diagnoses. Main outcome measures were primary diagnosis (ill-defined versus other diagnostic code), death during the hospital stay, deaths to 36 months, readmissions within 36 months, discharge destination and length of hospital stay.Incidence of R-codes at discharge was 21.6%, but was higher in general internal than geriatric medicine (25.6% v 14.1% respectively). Age, gender and co-morbidity were not significant predictors of R-code diagnoses. Admission via the emergency department (ED), out of normal general practitioner (GP) hours, under the care of general medicine and from non-residential care settings increased the risk of receiving R-codes. R-coded patients had a significantly shorter length of stay (5.91 days difference, 95% CI 4.47, 7.35), were less likely to die (hazard ratio 0.71, 95%CI 0.59, 0.85) at any point, but were as likely to be readmitted as other patients (hazard ratio 0.96 (95% CI 0.88, 1.05).R-coded diagnoses accounted for 1/5 of emergency admission episodes, higher than anticipated from total English hospital admissions, but comparable with rates reported in similar settings in other countries. Unexpectedly, age did not predict R-coded diagnosis at discharge. Lower mortality and length of stay support the view that these are avoidable admissions, but readmission rates particularly for further R-coded admissions indicate on-going health care needs. Patient characteristics did not predict R-coding, but organisational features, part
The Internet of Things and Next-generation Public Health Information Systems  [PDF]
Robert Steele, Andrew Clarke
Communications and Network (CN) , 2013, DOI: 10.4236/cn.2013.53B1002
Abstract: The Internet of things has particularly novel implications in the area of public health. This is due to (1) The rapid and widespread adoption of powerful contemporary Smartphone’s; (2) The increasing availability and use of health and fitness sensors, wearable sensor patches, smart watches, wireless-enabled digital tattoos and ambient sensors; and (3) The nature of public health to implicitly involve connectivity with and the acquisition of data in relation to large numbers of individuals up to population scale. Of particular relevance in relation to the Internet of Things (IoT) and public health is the need for privacy and anonymity of users. It should be noted that IoT capabilities are not inconsistent with maintaining privacy, due to the focus of public health on aggregate data not individual data and broad public health interventions. In addition, public health information systems utilizing IoT capabilities can be constructed to specifically ensure privacy, security and anonymity, as has been developed and evaluated in this work. In this paper we describe the particular characteristics of the IoT that can play a role in enabling emerging public health capabilities; we describe a privacy-preserving IoT-based public health information system architecture; and provide a privacy evaluation.
Prediction in several conventional contexts
Bertrand Clarke,Jennifer Clarke
Statistics Surveys , 2012,
Abstract: We review predictive techniques from several traditional branches of statistics. Starting with prediction based on the normal model and on the empirical distribution function, we proceed to techniques for various forms of regression and classification. Then, we turn to time series, longitudinal data, and survival analysis. Our focus throughout is on the mechanics of prediction more than on the properties of predictors.
Standardising Outcomes in Paediatric Clinical Trials
Mike Clarke
PLOS Medicine , 2008, DOI: 10.1371/journal.pmed.0050102
Doing New Research? Don't Forget the Old
Mike Clarke
PLOS Medicine , 2004, DOI: 10.1371/journal.pmed.0010035
Musings on genome medicine: the value of family history
Angus Clarke
Genome Medicine , 2009, DOI: 10.1186/gm75
Abstract: Family history information has been used for decades in the process of genetic risk assessment [1] and is used extensively to identify those at risk of inherited conditions and those at increased risk of common diseases, such as colorectal cancer, breast cancer and coronary artery disease [2]. Those at risk may then benefit from targeted genetic testing to distinguish between those who are actually at high risk of disease and those who are in fact not. Once genomic sequence information has become readily available, on patients and on healthy individuals, will this completely obviate the need for family history information, so that the taking of family histories becomes obsolete? In short, can everything important be written with just the four letters A, C, G and T?Undergraduate medical students are taught to take a family history for all their patients and this is also recommended in many clinical specialty training programs, including those for primary care practitioners. It not only helps to identify those at increased risk of an inherited disorder or of a single-gene (Mendelian) subset of a common disorder, but also provides useful social information about the patient and his or her family. Even if this family information were to add no further precision to estimates of disease risk, the clinician would still wish to continue collecting family histories for the additional insights they provide. One gathers not only the structure of the family and some knowledge of the diseases that have affected the various individuals but also a rich understanding of social context, occupation, family relationships (who talks to whom), and perhaps lifestyles and habits too. The process of collecting this information allows a relationship to develop between professional and patient, which is useful to the practitioner and valued by the patient [3]. Through this, one can often sense the real concerns of the patient or client: what do they fear? Do they feel destined to follow the
Cannibalism, cell survival, and endocrine resistance in breast cancer
Robert Clarke
Breast Cancer Research , 2011, DOI: 10.1186/bcr2870
Abstract: Approximately 70% of newly diagnosed breast cancers express detectable levels of estrogen receptor alpha (ERα). Patients with these tumors generally receive an endocrine-based intervention, usually in the form of an aromatase inhibitor or antiestrogen. While these interventions are associated with a significant increase in overall survival [1], many ERα-positive breast cancers recur.Breast cancer cells often respond to endocrine therapies by altering the expression of a subset of estrogen-responsive and nonresponsive genes and inducing autophagy [2-7]. Autophagy is a lysosomal self-digestion pathway, where selected subcellular components are first segregated into double membrane-bound structures called autophagosomes [8]. Subsequent fusion with lysosomes forms autolysosomes, which enables the materials sequestered therein to be digested by lysosomal hydrolases. Three primary forms of autophagy have been described: macroautophagy, microautophagy, and chaperone-mediated autophagy. The comments in this viewpoint relate primarily to macroautophagy.Autophagy can be prodeath or prosurvival and reflects an attempt by stressed cells to eliminate damaged or other organelles and recover the energy stored in their macromolecules to restore metabolic homeostasis. Autophagy can result from activation of the unfolded protein response (UPR) [9] in response to the metabolic stress of endocrine therapies [4]. In endocrine manipulated cells, prosurvival autophagy signaling is driven at least partly by UPR activation of the unconventional splicing of the estrogen-responsive XBP1 mRNA [3,10] and, downstream, increased expression of BCL2 family members including BCL2 and BCLW (BCL2L2) [11]. Prodeath signaling can involve induction of a caspasedependent apoptotic cell death (programmed cell death 1) [12] when there is adequate energy, and an autophagy-associated necrotic cell death that is probably energy independent [11]. An autophagic cell death, often referred to as programmed cell de
Regulation of human breast stem cells
RB Clarke
Breast Cancer Research , 2006, DOI: 10.1186/bcr1550
Abstract: We employed several complementary approaches to identify putative stem cell markers, to characterise an isolated stem cell population and to relate these to cells expressing ERα. ERα-positive cells were found to coexpress the putative stem cell markers p21CIP1 and Msi-1. Human breast epithelial cells with Hoechst dye-effluxing 'side population' (SP) properties characteristic of mammary stem cells in mice were demonstrated to be undifferentiated cells by lack of expression of myoepithelial and luminal epithelial membrane markers. These SP cells were sixfold enriched for ERα-positive cells and expressed several-fold higher levels of the ERα, p21CIP1 and Msi1 genes than non-SP cells. In contrast to non-SP cells, SP cells formed branching structures in matrigel which included cells of both luminal and myoepithelial lineages. The data suggest a model where scattered ERα-positive cells are stem cells that self-renew through asymmetric cell division and generate patches of transit amplifying and differentiated cells.In recent studies we have been investigating breast cancers for the presence of a stem cell population. Using a nonadherent culture method analogous to neurosphere culture that enriches for neural stem cells, we have demonstrated that breast cancer cell lines and primary tumours contain a self-renewing population that is highly regulated by the Notch receptor signaling pathway. Inhibitors of this pathway could represent a new therapeutic modality in breast cancer, perhaps through combination with current treatments.In order to discover novel pathways that regulate stem cell self-renewal, we have applied functional genomics using an RNAi library targeting ~8,000 genes involved in cancer. This has revealed the importance of several pathways not previously associated with stem cell self-renewal. These pathways may represent novel targets for breast cancer therapy aimed at the breast cancer stem cells that survive conventional therapies.
Can you believe what you read in the papers?
Mike Clarke
Trials , 2009, DOI: 10.1186/1745-6215-10-55
Abstract: There are ever increasing numbers of papers available in healthcare journals, and even more articles appearing in newer media such as the Internet. At first sight, the depth and breadth of this material might mean that people making decisions about their own care or that of others have never had it so good. Surely, they will be able to find research in the relevant topic area. They will. But the problem is: some of this research might not be reliable and the decision maker might not be able to find a sufficiently unbiased collection of the research to help her to make the right decision.For decisions about the effects of health care, randomised trials should boost the chances that comparisons are not confounded by factors other than the interventions being compared. They are, therefore, a more reliable guide for estimates of the differences between the actual interventions [1]. However, the problem of publication bias means that trials which have findings that do not favour the experimental intervention are less likely to be published quickly or at all [2,3], making the available literature a potentially biased and unreliable source of knowledge.It is possible that the recent growth in the number of trial reports being published is a sign that publication bias is being overcome. During this first decade of the twenty-first century, at least 25,000 reports of randomised or controlled trials have been published each year [4]. However, we will not know if this is a fair reflection of the volume of research being done until recent initiatives on widespread trial registration provide a means of tracking large cohorts of trials over time, and there may still be some way to go before all trials are registered prospectively. For example, the World Health Organisation's International Clinical Trials Registry Platform shows that nearly 20,000 trials were registered in the constituent registers in 2008, an increase of more than 4000 compared to 2007 [4]. However, it will only
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