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1.  Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis 
BMJ Open  2016;6(5):e010933.
The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS).
CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community.
Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries.
CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems.
Primary and secondary outcomes
Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources.
22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions.
Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission.
PMCID: PMC4874181  PMID: 27165648
systematic review; meta-analysis; case management; hospital admission
2.  The influence of neighbourhood-level socioeconomic deprivation on cardiovascular disease mortality in older age: longitudinal multilevel analyses from a cohort of older British men 
Evidence from longitudinal studies on the influence of neighbourhood socioeconomic factors in older age on cardiovascular disease (CVD) mortality is limited. We aimed to investigate the prospective association of neighbourhood-level deprivation in later life with CVD mortality, and assess the underlying role of established cardiovascular risk factors.
A socially representative cohort of 3924 men, aged 60–79 years in 1998–2000, from 24 British towns, was followed up until 2012 for CVD mortality. Quintiles of the national Index of Multiple Deprivation (IMD), a composite score of neighbourhood-level factors (including income, employment, education, housing and living environment) were used. Multilevel logistic regression with discrete-time models (stratifying follow-up time into months) were used.
Over 12 years, 1545 deaths occurred, including 580 from CVD. The risk of CVD mortality showed a graded increase from IMD quintile 1 (least deprived) to 5 (most deprived). Compared to quintile 1, the age-adjusted odds of CVD mortality in quintile 5 were 1.71 (95% CI 1.32 to 2.21), and 1.62 (95% CI 1.23 to 2.13) on further adjustment for individual social class, which was attenuated slightly to 1.44 (95% CI 1.09 to 1.89), but remained statistically significant after adjustment for smoking, body mass index, physical activity and use of alcohol. Further adjustment for blood pressure, high-density lipoprotein cholesterol and prevalent diabetes made little difference.
Neighbourhood-level deprivation was associated with an increased risk of CVD mortality in older people independent of individual-level social class and cardiovascular risk factors. The role of other specific neighbourhood-level factors merits further research.
PMCID: PMC4680118  PMID: 26285580
4.  The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years 
Eye  2011;25(6):740-745.
The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom.
Observational prospective study.
A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ⩾6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14–35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15–19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0–1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81–20.24).
There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.
PMCID: PMC3178125  PMID: 21423140
leprosy; ocular complications; prevalence; risk factors
5.  Lack of cortico-limbic coupling in bipolar disorder and schizophrenia during emotion regulation 
Translational Psychiatry  2012;2(3):e90-.
Bipolar disorder (BD) and schizophrenia (Sz) share dysfunction in prefrontal inhibitory brain systems, yet exhibit distinct forms of affective disturbance. We aimed to distinguish these disorders on the basis of differential activation in cortico-limbic pathways during voluntary emotion regulation. Patients with DSM-IV diagnosed Sz (12) or BD-I (13) and 15 healthy control (HC) participants performed a well-established emotion regulation task while undergoing functional magnetic resonance imaging. The task required participants to voluntarily upregulate or downregulate their subjective affect while viewing emotionally negative images or maintain their affective response as a comparison condition. In BD, abnormal overactivity (hyperactivation) occurred in the right ventrolateral prefrontal cortex (VLPFC) during up- and downregulation of negative affect, relative to HC. Among Sz, prefrontal hypoactivation of the right VLPFC occurred during downregulation (opposite to BD), whereas upregulation elicited hyperactivity in the right VLPFC similar to BD. Amygdala activity was significantly related to subjective negative affect in HC and BD, but not Sz. Furthermore, amygdala activity was inversely coupled with the activity in the left PFC during downregulation in HC (r=−0.76), while such coupling did not occur in BD or Sz. These preliminary results indicate that differential cortico-limbic activation can distinguish the clinical groups in line with affective disturbance: BD is characterized by ineffective cortical control over limbic regions during emotion regulation, while Sz is characterized by an apparent failure to engage cortical (hypofrontality) and limbic regions during downregulation.
PMCID: PMC3309531  PMID: 22832855
amygdala; bipolar disorder; fMRI; negative affect regulation; schizophrenia
6.  Disambiguating ventral striatum fMRI-related bold signal during reward prediction in schizophrenia 
Molecular Psychiatry  2011;17(3):280-289.
Reward detection, surprise detection and prediction-error signaling have all been proposed as roles for the ventral striatum (vStr). Previous neuroimaging studies of striatal function in schizophrenia have found attenuated neural responses to reward-related prediction errors; however, as prediction errors represent a discrepancy in mesolimbic neural activity between expected and actual events, it is critical to examine responses to both expected and unexpected rewards (URs) in conjunction with expected and UR omissions in order to clarify the nature of ventral striatal dysfunction in schizophrenia. In the present study, healthy adults and people with schizophrenia were tested with a reward-related prediction-error task during functional magnetic resonance imaging to determine whether schizophrenia is associated with altered neural responses in the vStr to rewards, surprise prediction errors or all three factors. In healthy adults, we found neural responses in the vStr were correlated more specifically with prediction errors than to surprising events or reward stimuli alone. People with schizophrenia did not display the normal differential activation between expected and URs, which was partially due to exaggerated ventral striatal responses to expected rewards (right vStr) but also included blunted responses to unexpected outcomes (left vStr). This finding shows that neural responses, which typically are elicited by surprise, can also occur to well-predicted events in schizophrenia and identifies aberrant activity in the vStr as a key node of dysfunction in the neural circuitry used to differentiate expected and unexpected feedback in schizophrenia.
PMCID: PMC3284694  PMID: 21709684
associative learning; prediction error; reward; schizophrenia; ventral striatum
7.  Parents' attitudes to measles immunization 
A study of a cohort of children in Maidstone Health Authority examined the reasons for the failure to achieve targets for the uptake of measles immunization. Parents were interviewed before they were notified about measles immunization to determine their attitudes, beliefs and intentions regarding measles immunization and a further review was held with those whose child had no record of the immunization by the age of 20 months. The initial interview showed that most parents have a favourable attitude to measles immunization. However, many lacked knowledge, especially about valid contraindications, and claimed not to have received advice from a doctor or health visitor. The most common reasons for non-uptake of measles immunization were: the child had already had measles, concern about contraindications and delay owing to illness. This points to the importance of increasing doctors' and health visitors' knowledge of Department of Health and Social Security guidelines regarding valid contraindications and to the role of health visitors in promoting uptake. However there is also evidence that the gap between actual and target levels of uptake may be less than official figures suggest.
PMCID: PMC1710608  PMID: 3668921
8.  Inflammatory Gene Polymorphisms and Risk of Postoperative Myocardial Infarction After Cardiac Surgery 
Circulation  2006;114(1 Suppl):I275-I281.
The inflammatory response triggered by cardiac surgery with cardiopulmonary bypass (CPB) is a primary mechanism in the pathogenesis of postoperative myocardial infarction (PMI), a multifactorial disorder with significant inter-patient variability poorly predicted by clinical and procedural factors. We tested the hypothesis that candidate gene polymorphisms in inflammatory pathways contribute to risk of PMI after cardiac surgery.
Methods and Results
We genotyped 48 polymorphisms from 23 candidate genes in a prospective cohort of 434 patients undergoing elective cardiac surgery with CPB. PMI was defined as creatine kinase-MB isoenzyme level ≥10 × upper limit of normal at 24 hours postoperatively. A 2-step analysis strategy was used: marker selection, followed by model building. To minimize false-positive associations, we adjusted for multiple testing by permutation analysis, Bonferroni correction, and controlling the false discovery rate; 52 patients (12%) experienced PMI. After adjusting for multiple comparisons and clinical risk factors, 3 polymorphisms were found to be independent predictors of PMI (adjusted P < 0.05; false discovery rate < 10%). These gene variants encode the proinflammatory cytokine interleukin 6 (IL6 −572G > C; odds ratio [OR], 2.47), and 2 adhesion molecules: intercellular adhesion molecule-1 (ICAM1 Lys469Glu; OR, 1.88), and E-selectin (SELE 98G > T; OR, 0.16). The inclusion of genotypic information from these polymorphisms improved prediction models for PMI based on traditional risk factors alone (C-statistic 0.764 versus 0.703).
Functional genetic variants in cytokine and leukocyte–endothelial interaction pathways are independently associated with severity of myonecrosis after cardiac surgery. This may aid in preoperative identification of high-risk cardiac surgical patients and development of novel cardioprotective strategies.
PMCID: PMC1945056  PMID: 16820586
cardiopulmonary bypass; genetics; inflammation; myocardial infarction; single nucleotide polymorphisms
9.  SeqEM: an adaptive genotype-calling approach for next-generation sequencing studies 
Bioinformatics  2010;26(22):2803-2810.
Motivation: Next-generation sequencing presents several statistical challenges, with one of the most fundamental being determining an individual's genotype from multiple aligned short read sequences at a position. Some simple approaches for genotype calling apply fixed filters, such as calling a heterozygote if more than a specified percentage of the reads have variant nucleotide calls. Other genotype-calling methods, such as MAQ and SOAPsnp, are implementations of Bayes classifiers in that they classify genotypes using posterior genotype probabilities.
Results: Here, we propose a novel genotype-calling algorithm that, in contrast to the other methods, estimates parameters underlying the posterior probabilities in an adaptive way rather than arbitrarily specifying them a priori. The algorithm, which we call SeqEM, applies the well-known Expectation-Maximization algorithm to an appropriate likelihood for a sample of unrelated individuals with next-generation sequence data, leveraging information from the sample to estimate genotype probabilities and the nucleotide-read error rate. We demonstrate using analytic calculations and simulations that SeqEM results in genotype-call error rates as small as or smaller than filtering approaches and MAQ. We also apply SeqEM to exome sequence data in eight related individuals and compare the results to genotypes from an Illumina SNP array, showing that SeqEM behaves well in real data that deviates from idealized assumptions.
Conclusion: SeqEM offers an improved, robust and flexible genotype-calling approach that can be widely applied in the next-generation sequencing studies.
Availability and implementation: Software for SeqEM is freely available from our website: under Software Download.
Supplementary information: Supplementary data are available at Bioinformatics online.
PMCID: PMC2971572  PMID: 20861027
10.  Phlegm production and lung function among cigarette smokers changing tar groups during the 1970s. 
In 1971-3 data on smoking habits, cigarette brand smoked, morning phlegm production, and lung function were recorded for factory workers as part of the Heart Disease Prevention Project. These men were reassessed in 1984 and those who had always smoked cigarettes from the same tar group were compared with those who had dropped one tar group (mean decreases of 6.6 mg tar, 0.1 mg nicotine) and two tar groups (mean decreases of 11.9 mg tar, 0.5 mg nicotine). Over the 13 years, men who had dropped one tar group were significantly more likely (p less than 0.05) to stop producing phlegm, but the effect was less marked for those who had dropped two tar groups. The mean fall in FEV1 was similar in all three groups, but 95% confidence limits showed that although dropping one tar group could be associated with at most a saving of 84 ml over the follow up period, there could be little extra benefit from dropping two tar groups. In 1984, all three groups of smokers excreted similar amounts of nicotine metabolites in the urine, suggesting that men who had dropped two tar groups compensated for the reduced nicotine yield of their cigarettes. This could account for the lack of a dose response relationship between reduction in the tar yield of cigarettes and cessation of phlegm and fall in FEV1.
PMCID: PMC1052503  PMID: 3746171
11.  Does teaching audit improve standards, and affect MCQ results in undergraduate trauma and orthopaedic tuition? 
Over the study period from 1981 to 1987 inclusive, student critiques were scored to indicate the undergraduates' perception of the quality of teaching they received on each 2-month attachment to the trauma and orthopaedic surgical departments of two teaching hospitals. The medical staff and the environment in the two teaching hospitals were different. It was found that while the mean MCQ results did not change significantly throughout the study period, an improvement was noticed in the perceived quality of undergraduate tuition, especially at one hospital.
PMCID: PMC2498007  PMID: 8285545
12.  Analysis of cell proliferation data. 
Environmental Health Perspectives  1993;101(Suppl 5):73-77.
When estimating the labeling index is of interest, the design of experiments raises a number of methodological questions: How many cells should be scored? How big a difference in labeling index is likely to be detectable? What is the potential effect of low growth fraction on detecting a treatment effect? What are appropriate ways of expressing treatment effects on labeling index? Data from two labeling index experiments are used to shed light on these questions. The answers to all questions depend on the level of labeling index under consideration: a low frequency of labeling makes it important to count more cells, but this should not be done at the expense of using fewer animals. Detecting differences between treated and control groups when labeling index is low or when growth fraction is low is difficult, and caution must be used when expressing treatment effect as fold increase when labeling index is small.
PMCID: PMC1519430  PMID: 8013427
13.  Negative selection of patients for dialysis and transplantation in the United Kingdom. 
In order to understand why the United Kingdom ranks low in the treatment of end stage renal failure a questionnaire investigating knowledge of current acceptance practice for dialysis and transplantation was sent to various groups of doctors throughout the country. The questionnaire comprised 16 case histories of patients with established end stage renal failure and associated social and medical problems. In each case the responding doctor was asked to indicate whether the patient would be suitable for treatment by dialysis or transplantation or both. The questionnaire was sent to a randomly selected sample of general practitioners and non-renal consultant physicians and their responses compared with those of all the nephrologists identified in the United Kingdom. The mean number of cases rejected by both general practitioners and non-renal consultant physicians was significantly higher than the number rejected by nephrologists. The findings suggest that underreferral of patients to dialysis and transplant units contributes to the current low acceptance rate of new patients into treatment programmes in the United Kingdom.
PMCID: PMC1441425  PMID: 6424755
14.  Confirming the diagnosis of mild hypertension. 
Patients with newly found raised blood pressure are known to have lower pressures at subsequent measurements even when not treated. A study was undertaken to determine the extent to which (a) the number of follow-up measurements and (b) the duration of the intervals between them contributed to this fall in pressure. In 42 general practices 110 patients were identified as having for the first time a diastolic pressure (phase V) greater than 90 and less than 110 mm Hg. Both diastolic and systolic pressures were appreciably lower when measured at return visits when compared with the first measurement. The systolic pressure dropped appreciably in the intervals between the first and the second visits and again between the second and third visits. The diastolic pressure fell appreciably only between the first and second visits. The duration of the interval between visits was not associated with a fall in either systolic or diastolic pressure, but the number of measurements was. This pattern of fall in pressure was not affected by the patient's age or sex. From these results we conclude that patients with newly identified blood pressures that are mildly raised should be seen at two further visits before a decision about treatment is made. The timing of these follow-up visits is not crucial.
PMCID: PMC1546485  PMID: 6402075
15.  Inequalities in coronary revascularisation during the 1990s: evidence from the British regional heart study 
Heart  2005;91(5):635-640.
Objective: To investigate the influence of age and social circumstances on probability of revascularisation among British men.
Design: Prospective population based study
Setting: 24 medium sized British towns, none of which contained a hospital undertaking coronary artery bypass surgery.
Subjects: 5814 surviving participants of the BRHS (British regional heart study), aged 52–73 years, with no history of revascularisation when responding to a questionnaire in November 1992.
Main outcomes: Incident coronary revascularisations, as documented in general practitioner records, over the following 7.1 years and coronary angiography investigations reported by men in a further questionnaire in November 1996.
Results: 160 men underwent at least one revascularisation during this period (4.2/1000 person-years). In multifactorial analysis, which included adjustment for incidence of major coronary heart disease or angina, a lower incidence of revascularisation was found among men aged over 65 years in November 1992 (hazard ratio 0.62, 95% confidence interval (CI) 0.44 to 0.87), among men with manual occupations (0.73, 95% CI 0.53 to 1.02), among men living in households possessing no car (0.44, 95% CI 0.24 to 0.80) or one car (0.60, 95% CI 0.42 to 0.87) compared with two or more cars, among council tenants (0.49, 95% CI 0.25 to 0.97), and among men living outside southern England (0.71, 95% CI 0.51 to 0.99). Only car ownership was related to the incidence of diagnostic angiography: the odds ratio for angiography for those owning fewer than two cars was 0.62 (95% CI 0.42 to 0.89).
Conclusion: During the 1990s, there were major inequalities in the probability of undergoing coronary revascularisation between British men according to socioeconomic status, age, and geographic location.
PMCID: PMC1768900  PMID: 15831650
age group; coronary revascularisation; epidemiology; social inequality
16.  Power calculations for likelihood ratio tests for offspring genotype risks, maternal effects and parent-of-origin (POO) effects in the presence of missing parental genotypes when unaffected siblings are available 
Genetic epidemiology  2007;31(1):18-30.
Genotype-based likelihood ratio tests (LRT) of association that examine maternal and parent-of-origin effects have been previously developed in the framework of log-linear and conditional logistic regression models. In the situation where parental genotypes are missing, the expectation maximization (EM) algorithm has been incorporated in the log-linear approach to allow incomplete triads to contribute to the likelihood ratio test. We present an extension to this model which we call the Combined_LRT that incorporates additional information from the genotypes of unaffected siblings to improve assignment of incompletely typed families to mating type categories, thereby improving inference of missing parental data. Using simulations involving a realistic array of family structures, we demonstrate the validity of the Combined_LRT under the null hypothesis of no association and provide power comparisons under varying levels of missing data and using sibling genotype data. We demonstrate the improved power of the Combined_LRT compared with the family-based association test (FBAT), another widely used association test. Lastly, we apply the Combined_LRT to a candidate gene analysis in Autism families, some of which have missing parental genotypes. We conclude that the proposed log-linear model will be an important tool for future candidate gene studies, for many complex diseases where unaffected siblings can often be ascertained and where epigenetic factors such as imprinting may play a role in disease etiology.
PMCID: PMC2118060  PMID: 17096358
family-based association; candidate gene tests; imprinting; parent-of-origin; maternal effects
17.  Cigarette smoking in British men and selection for coronary artery bypass surgery. 
Heart  1996;75(6):557-562.
OBJECTIVE: To examine the relation between smoking status, clinical need, and likelihood of coronary artery bypass grafting in middle aged men. DESIGN: A prospective study of cardiovascular disease in British men aged 40 to 59 years, screened in 1978-80 and followed until December 1991. SUBJECTS AND SETTING: 7735 men drawn from one general practice in each of 24 British towns. MAIN OUTCOME MEASURE: Coronary artery bypass graft surgery. RESULTS: Of the 3185 current smokers, 38 (1.03/1000/year) underwent coronary artery bypass surgery compared with 47 of 2715 (1.45/1000/year) ex-smokers, and 19 of 1817 (0.85/1000/year) never-smokers. Ex-smokers had a lower incidence of major ischaemic heart disease during follow up than current smokers. After adjustment for incidence of ischaemic heart disease during follow up, the hazard ratio of coronary artery bypass surgery for ex-smokers compared with smokers was 1.52 (95% confidence interval 0.99 to 2.34). Ex-smokers were more likely at screening to recall a doctor diagnosis of ischaemic heart disease than smokers (7.1% v 5.3%), but among those who recalled a doctor diagnosis, smokers were less likely to undergo coronary artery bypass surgery than ex-smokers (9.4% v 3.5%, P = 0.026). By 1992, men defined as smokers at screening were no less likely than ex-smokers to have been referred to a cardiologist (18.5% v 18.8%), nor to report having undergone coronary angiography less frequently than ex-smokers (12.7% v 11.4%). CONCLUSION: Even allowing for the strong relation between coronary artery bypass surgery and clinical need, continuing smokers were less likely to undergo coronary artery bypass surgery than ex-smokers. A complex interplay exists between the men's experience of heart disease, the decision to stop smoking, and the willingness of doctors to consider coronary artery bypass surgery.
PMCID: PMC484376  PMID: 8697156
18.  A Nurse in General Practice 
PMCID: PMC5068062  PMID: 5707970
19.  Audit from preschool developmental surveillance of vision, hearing, and language referrals. 
Archives of Disease in Childhood  1991;66(8):921-926.
Referrals from preschool medical examinations were followed up for two years to assess attendance rate, waiting time for appointment, appropriateness of the referral, the diagnosis and management of the condition. Altogether 184 children were referrals for ophthalmology, 285 for audiology, and 195 for speech therapy. The median waiting time for an appointment was 46 days in ophthalmology, 175 days in audiology, and 83 days in speech therapy. The poorest attendance rate was identified in speech therapy (75%). Approximately 60% of examined children had a justified referral to ophthalmology and 20% had a clear defect. Over half the children in audiology (55%) had an altered impedance or hearing impairment. Of those with a hearing problem kept under review only half improved spontaneously. In speech therapy 80% of those assessed had a language problem. Many health problems were detected for which parents were unaware or did not use the service. Parental awareness alone will not uncover the sizable level of lingual and sensorial problems in inner city areas. This audit identified specific deficiencies in the provision of services and a number of organisational changes are suggested to improve their effectiveness.
PMCID: PMC1793450  PMID: 1929488
20.  Measles immunisation: feasibility of a 90% target uptake. 
Archives of Disease in Childhood  1987;62(12):1209-1214.
A three part investigation of the factors that might influence uptake of immunisation was carried out in Maidstone Health Authority; this included studies of the computer system and attitudes of parents and professionals. Several problems with immunisation scheduling, information transfer between general practitioners and clinics and the computer centre, and validity of computer information were identified. The attitudes of parents, relatives, and friends were generally favourable, although parents reported a lack of knowledge about the disease and vaccine and lack of advice from professionals. Perceived contraindications to immunisation, particularly a history of measles, were important reasons for non-uptake. Professionals' perceptions of contraindications, however, were at variance with Department of Health and Social Security guidelines and none of the recorded contraindications was valid. Calculations of potential uptake suggest that a 90% target uptake is feasible and recommendations are made for changes in services.
PMCID: PMC1778613  PMID: 3435154
21.  Teeth and benign oesophageal stricture. 
Gut  1987;28(1):61-63.
In patients undergoing upper gastrointestinal endoscopy, benign oesophageal strictures were significantly more frequent (p less than 0.01) in those with severe tooth loss than in controls of the same age. This may be because of edentulous patients eating less solid and more liquid food, which would otherwise dilate the lower oesophagus, or poor salivary flow leading to both tooth loss and impaired neutralisation of refluxed gastric acid, or malnutrition. No association was found, however, between either oesophagitis or hiatus hernia and dentition.
PMCID: PMC1432732  PMID: 3817586
22.  Assessment of new radioimmunoassay kit for determining urinary albumin at low concentrations: comparison with radial immunodiffusion. 
Journal of Clinical Pathology  1986;39(10):1151-1154.
The assay characteristics of a new radioimmunoassay kit for determining urinary albumin at low concentrations were studied. The sensitivity for urinary albumin was 2 mg/l, the analytical range 2 to 40 mg/l, and interassay coefficient of variation less than 12%. In a method comparison study entailing diabetic urine samples covering an albumin concentration of 2 to 150 mg/l the kit compared adequately with radial immunodiffusion (mean difference between methods = 2 mg/l; residual standard deviation = 4.6 mg/l), absolute variation between methods increasing with the concentration. The kit required much less skill than radial immunodiffusion but its capital and running cost were higher.
PMCID: PMC500241  PMID: 3097081
23.  Poisoning with chlormethiazole. 
British Medical Journal  1979;2(6199):1219.
PMCID: PMC1597251  PMID: 519367
25.  B.M.A. Subscription 
British Medical Journal  1969;2(5655):516.
PMCID: PMC1983421

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