Barts and The London

London, United Kingdom

Barts and The London

London, United Kingdom
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Background: Primary care databases provide a unique resource for healthcare research, but most researchers currently use only the Read codes for their studies, ignoring information in the free text, which is much harder to access. Objectives: To investigate how much information on ovarian cancer diagnosis is 'hidden' in the free text and the time lag between a diagnosis being described in the text or in a hospital letter and the patient being given a Read code for that diagnosis. Design: Anonymised free text records from the General Practice Research Database of 344 women with a Read code indicating ovarian cancer between 01 June 2002 and 31 May 2008 were used to compare the date at which the diagnosis was first coded with the date at which the diagnosis was recorded in the free text. Free text relating to a diagnosis was identified (a) from the date of coded diagnosis and (b) by searching for words relating to the ovary. Results: 90% of cases had information relating to their ovary in the free text. 45% had text indicating a definite diagnosis of ovarian cancer. 22% had text confirming a diagnosis before the coded date; 10% over 4 weeks previously. Four patients did not have ovarian cancer and 10% had only ambiguous or suspected diagnoses associated with the ovarian cancer code. Conclusions: There was a vast amount of extra information relating to diagnoses in the free text. Although in most cases text confirmed the coded diagnosis, it also showed that in some cases GPs do not code a definite diagnosis on the date that it is confirmed. For diseases which rely on hospital consultants for diagnosis, free text (particularly letters) is invaluable for accurate dating of diagnosis and referrals and also for identifying misclassified cases.


Milburn H.,The London Clinic | Ashman N.,Barts and the London Renal Center | Davies P.,Liverpool NHS Trust | Doffman S.,Brighton General Hospital | And 5 more authors.
Thorax | Year: 2010

Guidelines have been compiled by the Joint Tuberculosis Committee of the British Thoracic Society for the prevention and management of Mycobacterium tuberculosis infection and disease in patients with all grades of renal impairment.


Lotfibakhshaiesh N.,Imperial College London | Brauer D.S.,Barts and the London | Hill R.G.,Barts and the London
Journal of Non-Crystalline Solids | Year: 2010

Bioactive glass coatings with thermal expansion coefficients matched to Ti6Al4V alloys have been designed, and glasses based on the multi-component system 49.96 SiO2-7.25 MgO-3.30 Na2O-3.30 K 2O-3.00 ZnO-1.07 P2O5-32.62 CaO (mol%) with 0, 10, 25, 50, 75 and 100% of calcium oxide replaced by strontium oxide have been produced by a melt-quench route. Sintering behaviour has been characterised by differential scanning calorimetry, X-ray diffraction and scanning electron microscopy. Glass transition and crystallisation temperatures and their respective activation energies were determined; extrapolated onset values for these parameters have been determined in order to optimise the sintering temperature for producing amorphous coatings. Amorphous coatings have been produced by enamelling and showed good adhesion to the alloy with the exception of the 100% Sr substituted coating. Substituting strontium for calcium reduced the glass transition temperature and lowered the activation energy for crystallisation whilst increasing the onset temperature of crystallisation. The mixed calcium/strontium glasses exhibit a larger processing window, which favours sintering without crystallisation occurring and obtaining amorphous well sintered coatings. However, complete substitution favours crystallisation and reduces the processing window. © 2010 Elsevier B.V. All rights reserved.


Brauer D.S.,Imperial College London | Karpukhina N.,Barts and the London | Law R.V.,Imperial College London | Hill R.G.,Barts and the London
Journal of Non-Crystalline Solids | Year: 2010

Phosphate invert glasses in the system P2O5-CaO-MgO- Na2O are completely soluble and exhibit a neutral pH in aqueous media, and they are therefore of interest for use as degradable implant materials. Their structure consists of small phosphate units such as pyrophosphate (P2O7 4-), and hence they are prone to crystallisation. Addition of TiO2 is known to improve processing of the melt and also to control glass solubility. The glass structure of phosphate glasses with 37 and 35 mol% P2O5 and addition of 1 to 10 mol% TiO2 was analysed using 31P MAS NMR, and the influence of structural changes on solubility, thermal properties, processing window and crystallisation behaviour was investigated. Glasses showed an increase in activation energy for crystallisation with increasing TiO2 content, resulting in an increased processing window, thereby allowing for fibre drawing and sintering of porous scaffolds. Deconvolution of 31P MAS NMR and calculation of network connectivity and average chain lengths suggest that Ti is acting as a network modifier with Ti4+ units acting as ionic crosslinks between phosphate units thereby impeding crystallisation as well as chain hydration and subsequent chain dissolution. © 2010 Elsevier B.V. All rights reserved.


Fredholm Y.C.,Imperial College London | Karpukhina N.,Imperial College London | Law R.V.,Imperial College London | Hill R.G.,Barts and the London
Journal of Non-Crystalline Solids | Year: 2010

The influence of substituting strontium for calcium in the following glass series 49.46 SiO2-1.07 P2O5-(23.08-X) CaO-X SrO-26.38 Na2O was studied on the physical properties. Solid state nuclear magnetic resonance and vibrational spectroscopy showed that the glasses were predominantly composed of Q2 silicate chains. Addition of strontium did not result in any structural alteration of the glass network due to the similar role of SrO compared with that of CaO. The density increased with strontium content whilst the oxygen density decreased indicating a more expanded glass network. The glass transition temperature reduced with strontium substitution in a linear fashion and there was no evidence of a mixed alkaline earth effect with a lower than expected glass transition temperature. Dilatometric softening points also reduced with increasing strontium content, whilst the thermal expansion coefficients increased. The results are consistent with a weaker network as a result of the lower charge to size ratio of Sr 2+ compared to Ca2+. © 2010 Elsevier B.V. All rights reserved.


Youziel J.,University College London | Akhbar A.R.,University College London | Aziz Q.,Barts and the London | Smith M.E.B.,University College London | And 3 more authors.
Organic and Biomolecular Chemistry | Year: 2014

Bromo- and thiomaleimides are shown to serve as highly effective quenchers of a covalently attached fluorophore. Reactions with thiols that lead to removal of the maleimide conjugation, or detachment of the fluorophore from the maleimide, result in 'turn-on' of the fluorescence. These reagents thus offer opportunities in thiol sensing and intracellular reporting. This journal is © The Royal Society of Chemistry.


Kelly P.,Barts and the London
Medicine (United Kingdom) | Year: 2013

Human intestinal protozoal infections are found worldwide. Protozoa produce diarrhoeal disease by infecting the small or large intestine, or both. Amoebiasis is an important cause of dysentery and liver abscess worldwide. Giardiasis and cryptosporidiosis are important causes of diarrhoea in children; the latter is particularly associated with growth failure and malnutrition. They also cause water-borne and food-borne outbreaks. Food-borne outbreaks may also be caused by Cyclospora cayetanensis. The importance of intestinal protozoa has increased with the HIV/AIDS pandemic, which led to the recognition of new protozoal pathogens. Recently, the frequency of severe opportunistic intestinal protozoal infection has decreased because of large programmes of anti-retroviral therapy. Intestinal protozoa are difficult to identify but molecular and antigen-based tests are beginning to be adopted. Many protozoa respond readily to well-established antibiotics but some (particularly cryptosporidiosis) can be difficult to treat, especially in immunocompromised patients. Recently, molecular biological work has helped to clarify the classification of these parasites and, more importantly, is beginning to unlock features of their biology that may help in prevention. © 2013 Elsevier Ltd. All rights reserved.


Brauer D.S.,Imperial College London | Karpukhina N.,Imperial College London | O'Donnell M.D.,BioCeramic Therapeutics | Law R.V.,Imperial College London | Hill R.G.,Barts and The London
Acta Biomaterialia | Year: 2010

Bioactive glasses are able to bond to bone through formation of carbonated hydroxyapatite in body fluids, and fluoride-releasing bioactive glasses are of interest for both orthopaedic and, in particular, dental applications for caries inhibition. Melt-derived glasses in the system SiO 2-P 2O 5-CaO-Na 2O with increasing amounts of CaF 2were prepared by keeping network connectivity and the ratio of all other components constant. pH change, ion release and apatite formation during immersion of glass powder in simulated body fluid at 37 °C over up to 2 weeks were investigated. Crystal phases formed in SBF were characterized using infrared spectroscopy, X-ray diffraction with Rietveld analysis and solid-state nuclear magnetic resonance spectroscopy ( 19F and 31P MAS-NMR). Results show that incorporation of fluoride resulted in a reduced pH rise in aqueous solutions compared to fluoride-free glasses and in formation of fluorapatite (FAp), which is more chemically stable than hydroxyapatite or carbonated hydroxyapatite and therefore is of interest for dental applications. However, for increasing fluoride content in the glass, fluorite (CaF 2) was formed at the expense of FAp. Apatite formation could be favoured by increasing the phosphate content in the glass, as the release of additional phosphate into the SBF would affect supersaturation in the solution and possibly favour formation of apatite. © 2010 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.


Ahmad Z.,Barts and the London | Nouraei R.,Barts and the London | Holmes S.,Barts and the London
British Journal of Oral and Maxillofacial Surgery | Year: 2012

The complexity of facial fractures has changed considerably in recent years together with more commonly observed high velocity trauma. Traditional classification systems describe fractures in an isolated manner but fail to recognise those that affect more than one region. We applied four conceptual scoring systems for craniofacial trauma to a cohort of patients in east London. We exposed the limitations of the systems and developed a new scoring system that encompasses elements of all of the models and is capable of overcoming previous limitations. © 2011 The British Association of Oral and Maxillofacial Surgeons.


Wang Y.,Barts and the London
Journal of Medical Ethics | Year: 2016

The discourse on the failings of the National Health System often cites lack of compassion as an important factor. This has resulted in proposals to enact rules which aimed at enforcing compassion in healthcare workers so as to improve the quality of healthcare and avoid future scandals. This paper argues that compassion cannot be enforced by any rule. Moreover, the contractual nature of the current doctor-patient relationship does not foster it. Experience from other service industries shows that attempts to enforce compassion in workers are futile. Rather than improving service, these attempts result in a culture of perfunctoriness and cynicism.

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