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Search Results: 1 - 10 of 249239 matches for " Peter C Hayes "
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Human thrombin for the treatment of gastric and ectopic varices
Norma C McAvoy,John N Plevris,Peter C Hayes
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i41.5912
Abstract: AIM: To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic varices. METHODS: Retrospective observational study in a Tertiary Referral Centre. Between January 1999-October 2005, we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic varices. Patient details including age, gender and aetiology of liver disease/segmental portal hypertension were documented. The thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection needle. All patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was recorded. Initial haemostasis rates, rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin therapy. The duration of follow up was also listed. The study was conducted according to the United Kingdom research ethics guidelines. RESULTS: Thirty-seven patients were included. 33 patients (89%) had thrombin (250 U/mL) for gastric varices, 2 (5.4%) for duodenal varices, 1 for rectal varices and 1 for gastric and rectal varices. (1) Gastric varices, an average of 15.2 mL of thrombin was used per patient. Re-bleeding occurred in 4 patients (10.8%), managed in 2 by a transjugular intrahepatic portosystemic shunt (TIPSS) (one unsuccessfully who died) and in other 2 by a distal splenorenal shunt; (2) Duodenal varices (or type 2 isolated gastric varices), an average of 12.5 mL was used per patient over 2-3 endoscopy sessions. Re-bleeding occurred in one patient, which was treated by TIPSS; and (3) Rectal varices, an average of 18.3 mL was used per patient over 3 endoscopy sessions. No re-bleeding occurred in this group. CONCLUSION: Human thrombin is a safe, easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.
Newly Qualified Doctors’ Views of Medical School Training and Its Adequacy in Making Them “Fit for Purpose” as First Year Doctors  [PDF]
Peter Hayes
Open Access Library Journal (OALib Journal) , 2016, DOI: 10.4236/oalib.1102799
Abstract:
Aim: To assess whether the medical graduates from one medical school felt “fit for purpose” to work as intern doctors in the Health Service in Ireland. In the early nineties documents like “Tomorrow’s Doctors” emphasised the direction and change that undergraduate medical training had to take. It stated that “students must be properly prepared for their first day as Pre-Registration House Officer”. There are current arguments that junior doctors are not fully prepared for working life when they finish university. This study aims to analyse this perceived truth. Methods: I employed use of semi-structured interviews with a purposive sample of medical school’s qualified interns. A grounded theory thematic analysis approach was used. Results: The interviews confirmed the participants’ sense of being ill-prepared for the complexities of being a doctor. Issues such as managing professional relationships, navigating hospital politics, building support networks, knowing when to seek help and dealing with ethically challenging situations were all highlighted. Conclusions: The study has established that the medical school in which the study was situated is teaching its graduates to an acceptable standard with regard to their medical knowledge base, communication skill abilities and the basic tenets of history taking and examination, but it needs to prepare graduates in a more concrete way for working in complex multi-professional clinical environments and for participating effectively in the context of acute medical emergencies. It is arguable that all medical schools should follow up their graduates to assess how well the medical school curriculum has prepared their graduates for practice.
Update of endoscopy in liver disease: More than just treating varices
Christoforos Krystallis,Gail S Masterton,Peter C Hayes,John N Plevris
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i5.401
Abstract: The management of complications in liver disease is often complex and challenging. Endoscopy has undergone a period of rapid expansion with numerous novel and specialized endoscopic modalities that are of increasing value in the investigation and management of the patient with liver disease. In this review, relevant literature search and expert opinions have been used to provide a brief overview and update of the current endoscopic management of patients with liver disease and portal hypertension. The main areas covered are safety of endoscopy in patients with liver disease, the use of standard endoscopy for the treatment of varices and the role of new endoscopic modalities such as endoscopic ultrasound, esophageal capsule, argon plasma coagulation, spyglass and endomicroscopy in the investigation and treatment of liver-related gastrointestinal and biliary pathology. It is clear that the role of the endoscopy in liver disease is well beyond that of just treating varices. As the technology in endoscopy expands, so does the role of the endoscopist in liver disease.
Metagenomic Predictions: From Microbiome to Complex Health and Environmental Phenotypes in Humans and Cattle
Elizabeth M. Ross, Peter J. Moate, Leah C. Marett, Ben G. Cocks, Ben J. Hayes
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073056
Abstract: Mammals have a large cohort of endo- and ecto- symbiotic microorganisms (the microbiome) that potentially influence host phenotypes. There have been numerous exploratory studies of these symbiotic organisms in humans and other animals, often with the aim of relating the microbiome to a complex phenotype such as body mass index (BMI) or disease state. Here, we describe an efficient methodology for predicting complex traits from quantitative microbiome profiles. The method was demonstrated by predicting inflammatory bowel disease (IBD) status and BMI from human microbiome data, and enteric greenhouse gas production from dairy cattle rumen microbiome profiles. The method uses unassembled massively parallel sequencing (MPS) data to form metagenomic relationship matrices (analogous to genomic relationship matrices used in genomic predictions) to predict IBD, BMI and methane production phenotypes with useful accuracies (r = 0.423, 0.422 and 0.466 respectively). Our results show that microbiome profiles derived from MPS can be used to predict complex phenotypes of the host. Although the number of biological replicates used here limits the accuracy that can be achieved, preliminary results suggest this approach may surpass current prediction accuracies that are based on the host genome. This is especially likely for traits that are largely influenced by the gut microbiota, for example digestive tract disorders or metabolic functions such as enteric methane production in cattle.
An In Vitro Model of the Glomerular Capillary Wall Using Electrospun Collagen Nanofibres in a Bioartificial Composite Basement Membrane
Sadie C. Slater, Vince Beachley, Thomas Hayes, Daming Zhang, Gavin I. Welsh, Moin A. Saleem, Peter W. Mathieson, Xuejun Wen, Bo Su, Simon C. Satchell
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0020802
Abstract: The filtering unit of the kidney, the glomerulus, contains capillaries whose walls function as a biological sieve, the glomerular filtration barrier. This comprises layers of two specialised cells, glomerular endothelial cells (GEnC) and podocytes, separated by a basement membrane. Glomerular filtration barrier function, and dysfunction in disease, remains incompletely understood, partly due to difficulties in studying the relevant cell types in vitro. We have addressed this by generation of unique conditionally immortalised human GEnC and podocytes. However, because the glomerular filtration barrier functions as a whole, it is necessary to develop three dimensional co-culture models to maximise the benefit of the availability of these cells. Here we have developed the first two tri-layer models of the glomerular capillary wall. The first is based on tissue culture inserts and provides evidence of cell-cell interaction via soluble mediators. In the second model the synthetic support of the tissue culture insert is replaced with a novel composite bioartificial membrane. This consists of a nanofibre membrane containing collagen I, electrospun directly onto a micro-photoelectroformed fine nickel supporting mesh. GEnC and podocytes grew in monolayers on either side of the insert support or the novel membrane to form a tri-layer model recapitulating the human glomerular capillary in vitro. These models will advance the study of both the physiology of normal glomerular filtration and of its disruption in glomerular disease.
Impaired gluconeogenesis in a porcine model of paracetamol induced acute liver failure
Konstantinos J Dabos, Henry R Whalen, Philip N Newsome, John A Parkinson, Neil C Henderson, Ian H Sadler, Peter C Hayes, John N Plevris
World Journal of Gastroenterology , 2011,
Abstract: AIM: To investigate glucose homeostasis and in particular gluconeogenesis in a large animal model of acute liver failure (ALF).METHODS: Six pigs with paracetamol induced ALF under general anaesthesia were studied over 25 h. Plasma samples were withdrawn every five hours from a central vein. Three animals were used as controls and were maintained under anaesthesia only. Using 1H NMR spectroscopy we identified most gluconeogenic amino acids along with lactate and pyruvate in the animal plasma samples.RESULTS: No significant changes were observed in the concentrations of the amino acids studied in the animals maintained under anaesthesia only. If we look at the ALF animals, we observed a statistically significant rise of lactate (P < 0.003) and pyruvate (P < 0.018) at the end of the experiments. We also observed statistically significant rises in the concentrations of alanine (P < 0.002), glycine (P < 0.005), threonine (P < 0.048), tyrosine (P < 0.000), phenylalanine (P < 0.000) and isoleucine (P < 0.01). Valine levels decreased significantly (P < 0.05).CONCLUSION: Our pig model of ALF is characterized by an altered gluconeogenetic capacity, an impaired tricarboxylic acid (TCA) cycle and a glycolytic state.
Climate, Deer and Hogs: Drivers of Rapid Change in a Hickory-Dominated Maritime Forest on St. Catherines Island  [PDF]
C. Ken Smith, Elise Landreaux, Hali Steinmann, Royce Hayes, Alastair Keith-Lucas, Christa Hayes
Natural Resources (NR) , 2015, DOI: 10.4236/nr.2015.61002
Abstract: Maritime forests in the southeastern United States are very susceptible to climate change and have experienced dramatic reductions in extent following anthropogenic disturbances over the past two hundred years. St. Catherines Island, Georgia, an undeveloped barrier island, is home to an unusual pignut hickory (Carya glabra) maritime forest that is experiencing rapid rates of change, including a reduction in basal area from 23 m2·ha-1 in 1996 to 15 m2·ha-1 in 2014. Nine permanent forest plots and associated animal exclosures were installed across this 37 ha stand in 2012 to track forest change and seedling recruitment. From 2012 to 2014, declines in total basal area were caused by mortality of pignut hickory in the overstory and redbay (Persea borbonia) in the midstory. Pignut hickory continues to be ranked first in relative frequency, density and dominance, while Sabal palm (Sabal palmetto) is slightly increasing in relative density. In 2012, there were no woody species regenerating in any of the plots and following one year of animal exclosures, we found 478 pignut hickory seedlings ha-1; thus, deer browse and feral hog predation of nuts may be important drivers of change in this stand. The interplay among deer browse, exotic animal pressures, exotic insects and a drier climate has resulted in a very open forest with the regeneration of few woody plants. Without management of the feral hog and deer population, this unusual maritime forest, with trees as old as 250 years, may continue to decline.
Inadequacy of Scaling Arguments for Neutrino Cross Sections
A. C. Hayes
Physics , 2003, DOI: 10.1103/PhysRevC.68.067302
Abstract: The problem with the use of scaling arguments for simultaneous studies of different weak interaction processes is discussed. When different neutrino scattering cross sections involving quite different momentum transfers are being compared it difficult to define a meaningful single scaling factor to renormalize calculated cross sections. It has been suggested that the use of such scaling can be used to estimate high energy neutrino cross sections from low energy neutrino cross sections. This argument has lead to questions on the consistency of the magnitude of the LSND muon neutrino cross sections on $^{12}$C relative to other lower energy weak processes. The issue is revisited here and from inspection of the structure of the form factors involved it is seen that the problem arises from a poor description of the transition form factors at high momentum transfer. When wave functions that reproduce the transverse magnetic inelastic (e,e') scattering form factor for the 15.11 MeV state in $^{12}$C are used there is no longer a need for scaling the axial current, and the different weak interactions rates involving the T=1 1$^+$ triplet in mass 12 are consistent with one another.
Markedly Increased High-Mobility Group Box 1 Protein in a Patient with Small-for-Size Syndrome
Darren G. Craig,Patricia Lee,E. Anne Pryde,Ernest Hidalgo,Peter C. Hayes,Stephen J. Wigmore,Stuart J. Forbes,Kenneth J. Simpson
Case Reports in Transplantation , 2014, DOI: 10.1155/2014/272498
Abstract: Background. Small-for-size syndrome (SFSS) occurs in the presence of insufficient liver mass to maintain normal function after liver transplantation. Murine mortality following 85% hepatectomy can be reduced by the use of soluble receptor for advanced glycation end products (sRAGE) to scavenge damage-associated molecular patterns and prevent their engagement with membrane-bound RAGE. Aims. To explore serum levels of sRAGE, high-mobility group box-1 (HMGB1) protein, and other soluble inflammatory mediators in a fatal case of SFSS. Methods. Serum levels of HMGB1, sRAGE, IL-18, and other inflammatory mediators were measured by ELISA in a case of SFSS, and the results were compared with 8 patients with paracetamol-induced acute liver failure (ALF) and 6 healthy controls (HC). Results. HMGB1 levels were markedly higher in the SFSS patient (92.1?ng/mL) compared with the ALF patients (median (IQR) 11.4 (3.7–14.8)?ng/mL) and HC (1.42 (1.38–1.56)?ng/mL). In contrast, sRAGE levels were lower in the SFSS patient (1.88?ng/mL) compared with the ALF patients (3.53 (2.66–12.37)?ng/mL) and were similar to HC levels (1.40 (1.23–1.89)?ng/mL). Conclusion. These results suggest an imbalance between pro- and anti-inflammatory innate immune pathways in SFSS. Modulation of the HMGB1-RAGE axis may represent a future therapeutic avenue in this condition. 1. Introduction The capacity for liver regeneration is finite, placing a restriction upon the minimum mass of liver tissue required to maintain hepatic function following split liver transplantation (LT) or liver resection. Small-for-size syndrome (SFSS) occurs in the presence of insufficient liver mass to maintain normal function and is characterised by severe graft dysfunction and increased ascites output [1]. The pathophysiology of SFSS is multifactorial, involving insufficient graft volume, poor graft quality, and excessive portal inflow [2]. Amplification of proinflammatory mediators in the remnant tissue is also recognised to play an important role in limiting liver regeneration [3]. Recent murine studies have suggested that a key pathway in this process involves the receptor for advanced glycation end products (RAGE), a cell-surface multiligand pattern recognition receptor linked with amplification of the innate inflammatory response to cell death. Engagement of membrane-bound RAGE with ligands such as high-mobility group box 1 (HMGB1) protein sustains inflammatory responses and promotes apoptosis in the hepatic remnant following massive hepatectomy [4]. Soluble RAGE (sRAGE), the truncated extracellular domain of RAGE,
Online Instructional Effort Measured through the Lens of Teaching Presence in the Community of Inquiry Framework: A Re-Examination of Measures and Approach
Peter Shea,Jason Vickers,Suzanne Hayes
International Review of Research in Open and Distance Learning , 2010,
Abstract: With more than 4 million students enrolled in online courses in the US alone (Allen & Seaman, 2010), it is now time to inquire into the nature of instructional effort in online environments. Reflecting the community of inquiry (CoI) framework (Garrison, Anderson, & Archer, 2000) this paper addresses the following questions: How has instructor teaching presence (Anderson, Rourke, Garrison, & Archer, 2001) traditionally been viewed by researchers? What does productive instructor effort look like in an entire course, not just the main threaded discussion? Results suggest that conventional research approaches, based on quantitative content analysis, fail to account for the majority of teaching presence behaviors and thus may significantly under represent productive online instructional effort.
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