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Hill C.M.,University of Southampton | Dimitriou D.,University of London | Baya A.,Private University of Santa Cruz de la Sierra | Webster R.,University of Western Australia | And 4 more authors.
Neuropsychology | Year: 2014

Objectives: To assess cognition in populations born and living at high altitude (HA; 3,700 m) and low altitude (LA; 500 m) in Bolivia, who were similar for both socioeconomic status and genetic ancestry. To determine whether HA hypoxia influences cognitive decline across the life span. Method: In total, 191 healthy participants aged 4 to 85 years were assessed at HA (N = 94; 33; 35% male) and LA (N = 97; 46, 47% male) on a battery of cognitive tasks: fluid intelligence, attention, short- and long-term memory, and psychomotor speed. Saliva samples were obtained for evaluation of genetic ancestry. Results: HA participants were significantly slower on measures of processing speed and speed of attention than individuals born and living at LA. HA participants had slightly higher percentage of native Andean ancestry than LA participants, but this was not associated with cognitive performance. Conclusions: This is the first study of HA residence and neurocognition across the life span. Given the physiological challenges of HA living, the impact on cognition appears to be subtle and related only to the speed of more complex cognitive operations, rather than to their accuracy. Moreover, the impact on cognition does not appear to differ with increasing age or for different degrees of genetic admixture. Further studies recruiting HA participants with a broader range of native Andean ancestry will help to address the issue of to what extent Amerindian ancestry provides neuroprotection to chronic hypoxia in those living at HA. © 2014 American Psychological Association. Source


Puppa G.,Hopitaux Universitaires Of Geneva | Poston G.,University of Liverpool | Jess P.,Copenhagen University | Nash G.F.,Poole General Hospital | And 2 more authors.
World Journal of Gastroenterology | Year: 2013

One of the main changes of the current TNM-7 is the elimination of the category MX, since it has been a source of ambiguity and misinterpretation, especially by pathologists. Therefore the ultimate staging would be better performed by the patient's clinician who can classify the disease M0 (no distant metastasis) or M1 (presence of distant metastasis), having access to the completeness of data resulting from clinical examination, imaging workup and pathology report. However this important change doesn't take into account the diagnostic value and the challenge of small indeterminate visceral lesions encountered, in particular, during radiological staging of patients with colorectal cancer. In this article the diagnosis of these lesions with multiple imaging modalities, their frequency, significance and relevance to staging and disease management are described in a multidisciplinary way. In particular the interplay between clinical, radiological and pathological staging, which are usually conducted independently, is discussed. The integrated approach shows that there are both advantages and disadvantages to abandoning the MX category. To avoid ambiguity arising both by applying and interpreting MX category for stage assigning, its abandoning seems reasonable. The recognition of the importance of small lesion characterization raises the need for applying a separate category; therefore a proposal for their categorization is put forward. By using the proposed categorization the lack of consideration for indeterminate visceral lesions with the current staging system will be overcome, also optimizing tailored follow-up. © 2013 Baishideng. All rights reserved. Source


Heilman J.M.,University of Saskatchewan | Kemmann E.,University of New Brunswick | Bonert M.,University of Toronto | Chatterjee A.,Poole General Hospital | And 17 more authors.
Journal of Medical Internet Research | Year: 2011

The Internet has become an important health information resource for patients and the general public. Wikipedia, a collaboratively written Web-based encyclopedia, has become the dominant online reference work. It is usually among the top results of search engine queries, including when medical information is sought. Since April 2004, editors have formed a group called WikiProject Medicine to coordinate and discuss the English-language Wikipedia's medical content. This paper, written by members of the WikiProject Medicine, discusses the intricacies, strengths, and weaknesses of Wikipedia as a source of health information and compares it with other medical wikis. Medical professionals, their societies, patient groups, and institutions can help improve Wikipedia's health-related entries. Several examples of partnerships already show that there is enthusiasm to strengthen Wikipedia's biomedical content. Given its unique global reach, we believe its possibilities for use as a tool for worldwide health promotion are underestimated. We invite the medical community to join in editing Wikipedia, with the goal of providing people with free access to reliable, understandable, and up-to-date health information. Source


Dabare D.,Poole General Hospital | Lo T.T.H.,William Harvey Hospital | McCormack D.J.,London Chest Hospital | Kung V.W.S.,Royal London Hospital
Interactive Cardiovascular and Thoracic Surgery | Year: 2012

A best-evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether screening asymptomatic individuals for an abdominal aortic aneurysm (AAA) is feasible and improves disease-free survival. Seven studies presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and limitations of the studies are tabulated. In total, four randomized population-based studies have evaluated ultrasound screening for AAA: two British studies, Multicentre Aneurysm Screening Study (MASS) and the Chichester trial, and one each in Viborg County, Denmark and Western Australia. Participants were randomized to receive an invitation to screen or not. The MASS trial randomized 67 770 men, followed participants over 10 years and concluded that screening would almost half AAA-related deaths in men aged 65-74 years. The smaller Chichester trial included only 6040 men but demonstrated a 42% reduction in AAA-related mortality at 5 years, with ongoing benefit at 15 years (11% reduction). The Viborg County trial recruited 12 639 men aged 64-73 years, showed a 66% reduction in AAA-related mortality over 14 years. Finally, the Western Australia trial evaluated 41 000 men but included an older population of 65-83 years old. No benefit was seen in this age group but subgroup analysis of men aged 65-74 showed a significant mortality benefit. Only a small or insignificant benefit in all-cause mortality was seen in any of these studies. A recent meta-analysis of these trials has shown a significant benefit in AAA-related mortality in the long term and concluded that AAA screening is superior to other established screening programmes. The cost-effectiveness of screening was assessed in the MASS and Viborg County trials and was found to be substantially below the cost threshold set by the National Institute of Clinical Excellence for acceptance of interventions. Quality of life was assessed in the MASS and in a case-control study and showed no adverse effects that outweigh the benefits. We concluded that ultrasound screening for AAAs has met all the criteria to become a screening programme and would substantially reduce disease-related death with no adverse effect on quality of life. © The Author 2012. Source


Naik S.,Bh Tec Inc. | Kerr D.,Bh Tec Inc. | Begley J.,Poole General Hospital | Morton J.,Bh Tec Inc.
Diabetes Technology and Therapeutics | Year: 2012

Aims: The aim of this study was to determine whether changes in local skin temperature over which the infusion catheters pass when using insulin pump therapy and the choice of rapid-acting insulin analog influence the risk of catheter occlusion. Subjects and Methods: Twenty healthy volunteers were assigned to wear insulin pumps primed with insulin glulisine and insulin aspart in a randomized order each for a duration of 5 days and a temperature probe (taped to the skin near the insulin catheter). To reproduce the effect of subcutaneous infusion, the insulin catheter was inserted into an absorbent sponge in a plastic bag strapped to the subject's abdomen. Basal infusion rates were programmed at 0.2IU/h, and 2-IU boluses were given three times a day with meals. Results: Average skin temperature ranged between 33.5°C and 36.68°C for insulin glulisine and 32.35°C and 35.28°C for insulin aspart, with no difference in skin temperature between treatments or between the first and second week of the study. Nine occlusions were seen in eight subjects with an overall rate of occlusion of 22.5% (95% confidence interval, 21.9-61.3%) and were more likely to occur in the second week. On an individual level the risk of occlusion was similar for insulin glulisine and insulin aspart (odds ratio, 0.87%; P=0.6). Conclusions: Overall, in this small study simulating subcutaneous insulin infusion, the rate of catheter occlusion was low and unaffected by local fluctuations in ambient skin temperature. There was no significant difference between the two rapid-acting insulin analogs tested. Where occlusions occurred, they were more likely to happen beyond the manufacturer's recommended 72-h limit for catheter use. © Mary Ann Liebert, Inc. Source

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