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    ABSTRACT: Currently, there are no formal screening programmes for coronary artery disease (CAD). Computed tomographic coronary angiography (CTCA) has been suggested as a non-invasive and reliable method of atherosclerotic plaque assessment, with the potential for use in screening programmes. In this article, we briefly present the current understanding of atherosclerotic plaque formation, explain key technological aspects of CTCA and critique this method in the light of World Health Organisation (WHO) criteria for devising a screening programme. Current evolving and future insights are also considered. Overall, in our view, there is currently insufficient evidence to support the formal use of CTCA in a screening programme for CAD, although this viewpoint will undoubtedly evolve.
    Clinical medicine (London, England) 10/2013; 13(5):465-471.
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    Clinical medicine (London, England) 08/2013; 13(4):418-419.
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    British journal of hospital medicine (London, England: 2005) 07/2013; 74(7):C98-101.
  • Practical Neurology 04/2013;
  • BMJ (online) 09/2012; 345:e4611.
  • The Lancet 06/2012; 379(9833):2235-6.
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    BMJ (online) 06/2012; 344:e3974.
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    ABSTRACT: BACKGROUND: The aim of this study was to review patients conveyed by the Great Western Air Ambulance to its main receiving hospital. METHODS: Retrospective data were collected for all patients transferred to Frenchay Hospital by the Great Western Air Ambulance between 1 June 2008 and 1 March 2010. RESULTS: 115 patients were included in the review. Patients were conveyed up to 85 km, 79% bypassing the closest emergency department (ED). 51% of these patients had major trauma and 35% were intubated at the scene. On arrival, the mean time to CT scan was 78 min, reduced to 63 min for those with a head injury. 16% of patients were discharged from the ED. CONCLUSIONS: This review provides an overview of the characteristics of patients transferred to a major receiving hospital by a prehospital critical care team.
    Emergency Medicine Journal 05/2012;
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    ABSTRACT: Autoantibodies to islet cell proteins currently provide the only reliable indication that the process leading to type 1 diabetes has started. The period from the first detection of islet autoantibodies to clinical onset of diabetes can last months or years. Longitudinal birth cohort family studies give crucial information concerning the natural history of islet autoimmunity and have already shown that islet autoantibodies, which precede diabetes development, often appear in early infancy. In this issue of Diabetologia, Ziegler et al (DOI: 10.1007/s00125-012-2472-x ) and Parikka et al (DOI: 10.1007/s00125-012-2523-3 ) report findings from their birth cohort studies after numerous children have entered adolescence, allowing a more complete picture of islet autoimmunity in childhood to be revealed. Both groups are in accord that, between 6 months and 3 years of age, there is an explosion of islet autoimmunity in susceptible children and that the great majority (approximately 80%) of genetically at-risk children who present with diabetes before adolescence develop islet autoimmunity at this young age. These findings emphasise the importance of early life events in disease pathogenesis and have major implications for efforts aimed at preventing type 1 diabetes.
    Diabetologia 05/2012; 55(7):1873-6.
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    ABSTRACT: The hypothesis that a virus might in some way be involved in the causation of type 1 diabetes has a long history, but decades of research have failed to resolve the issue beyond reasonable doubt. Viruses could potentially play a primary role in the pathogenesis of type 1 diabetes by initiating autoimmunity, a secondary role by promoting established immune responses, or a tertiary role by precipitating the onset of hyperglycaemia. There is currently little evidence to suggest that viruses play a primary role in the causation of type 1 diabetes, let alone a necessary or sufficient role. Secondary or tertiary roles remain possible, but have yet to be confirmed in prospective studies.
    Clinical & Experimental Immunology 04/2012; 168(1):1-4.
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