bluuebunny/crossref_metadata_2025_split huggingface dataset:
The measurement of process and the role of information technology
Authors: Ryan M. P. , Dodd W. 
Published: June 2019

SynopsisProcess of care is the most immediate, relevant and susceptible to improvement of Donabedian's three elements of quality assurance. To place the study of process in context, the history of quality assurance in English-speaking countries is reviewed, with particular emphasis on the U.S.A. A range of methods are examined in detail and examples are provided to illustrate their strengths and weaknesses. Particular attention is paid to the use of explicit and implicit criteria. The importance of information technology in monitoring the process of care cannot be over-stated. Limited audit is possible with manual records but all substantial projects require computer support. The value of capturing data from operational systems rather than from dedicated projects is emphasised. Attention is drawn to the key importance of structured records and minimum data sets; these allow information to be pooled and process studies to be generalised. Examples are given of quality assurance projects which have used information technology. Finally potential future developments are reviewed with particular reference to clinical guidelines and computer-based clinical decision support systems.
Quality assurance from the perspective of health economics
Authors: Williams Alan 
Published: June 2019

SynopsisThere are two distinct views about the purpose of quality assurance by means of medical audit. The first is that it is a job requirement, to be backed by sanctions where necessary. The second is that it is a desirable attribute of professional practice, backed only by exhortation and opportunities for further training. This difference of view lies at the heart of much of the dispute as to how medical audit should be pursued in the UK at present. It explains why the medical profession insists that such audit should be conducted by peers, for peers, and accountable only to peers, whereas managers want some say in what is audited, how it is audited, and also want the reports of such audit made available to them, so that they can act upon the findings in their role as employers (e.g. in organising workloads, contracts, etc.). In this chapter the ‘job requirement’ view is supported, and its implications explored. It is argued that unless this route is chosen, it is unlikely that medical audit will deliver improvements in the health of the population that are commensurate with its costs.
The control and standardisation of biological medicines
Authors: Jeffcoate S. L. , Corbel M. J. , Minor P. D. , Gaines-Das R. , Schild G. C. 
Published: June 2019

SynopsisAssuring the quality, safety and efficacy of the complex medicinal drugs known as ‘biologicals’ has many facets of importance to public health. This survey covers the historical basis of this area of medical science through current issues and practices to the anticipation of future challenges. The key role of the World Health Organization in promoting international biological standardisation and of biostatistics in the design and analysis of biological assays is emphasised. Examples of the importance of quality control and standardisation are drawn especially from the fields of bacterial and viral vaccines. Assurance of the quality of these is essential for the successful implementation of childhood vaccination programmes aimed at the reduction and eradication of communicable diseases worldwide.
North Sea oil and the environment: a national perspective
Authors: Monro Hector 
Published: June 2019

The following is the text of a speech given by Sir Hector Monro to open the Conference held at the Royal Society of Edinburgh on Tuesday 21 September 1993.This conference marks a dramatic and lasting achievement at Sullom Voe. I intend in these remarks to make clear the Government's appreciation of it. Yet all of us in this room must be aware, as we approach today's business, that as little as nine months ago Shetland, and Scotland, were in the midst of a major oil spill accident.
Effects of oil-industry operations on the macrobenthos of Sullom Voe
Authors: May S. J. , Pearson T. H. 
Published: June 2019

SynopsisThe aims, methods and techniques of the macrobenthic monitoring programme in Sullom Voe and Orka Voe are described together with an analysis of the data obtained from surveys that began in 1978 and continue to the present. The distribution of the benthic macrofauna is discussed in relation to the sedimentological and hydrocarbon data obtained and compared with data from other Shetland waters. The macrofauna is considered to be typical of five of the six Facies used to describe the communities of the voes around Shetland. The possible effects of the terminal operations on the macrofauna are assessed and it is concluded that the disturbance noted to the macrofauna in Garths Voe, close to the diffuser at Calback Ness and in Orka Voe, essentially follows the same pattern seen in modifications to Shetland macrofauna that occurs where naturally occurring organic carbon enrichment exists.
Shellfish tainting – a means of monitoring petroleum-contaminated effluents
Authors: Whittle Kevin J. , Mackie Peter R. , Davis Harry K. 
Published: June 2019

SynopsisWater from the separation plant at Sullom Voe is discharged into the sea under agreed conditions from a diffuser situated to the north of Calback Ness, close to natural scallop (Pecten maximus) beds.As part of the arrangements to monitor potential effects of the discharge, Torry Research Station was asked to assess, for petroleum taint, shellfish which would be sampled at intervals from Sullom Voe. To avoid depletion of the natural shellfish beds, queen scallops (Chlamys opercularis) or scallops, whichever were available from other areas, were set out in cages suspended (or on the bottom) 100–1250 m eastwards of the outfall for a period, and then recovered, frozen, and assessed subsequently at the laboratory by a trained taste panel, and compared with the same species unexposed.The cages were laid on 10 occasions from March 1980 to February 1987. Initially, no petroleum taint was detected. In August 1980 and May 1981, a different flavour, but not recognisable as a petroleum taint, was detected at 800–1000 m from the outfall after three days exposure. In May 1982, 33% of the queen scallops in the cage on the bottom, 100 m south east of the diffuser, were dead after six days exposure, and taint was detected at the threshold level in shellfish in the cage at 300 m. In May 1983, taint and petroleum derived hydrocarbons were detected in the sample from the cage on the bottom, 100 m south east of the diffuser, after seven days exposure. In May 1984, taint was again detected at the bottom, 200 m south east of the outfall, after 10 days exposure.Enquiries established that the diffuser was not operating with maximum efficiency. Subsequently, monitoring revealed an improvement. Taint assessment proved to be a sensitive detector of petroleum contamination.
Annual changes in selected aspects of soft-shore biology
Authors: Jones A. M. 
Published: June 2019

SynopsisAnnual variations in a number of parameters over the period 1977–84 are described: they were generally site-specific in character. Linear shell dimensions of Cerastoderma edule populations (seven sites) remained stable but trends in both shell and soft-tissue dry weights changed over this period. Population structure and growth rates of C. edule are described using growth-ring analysis: they provide evidence of sporadic recruitment and persistent dominance by one or more yearclasses, although several populations are particularly individual in character. Populations of Macoma balthica (two sites) had a stable structure. Populations of both species at one site (inner Houb of Scatsta) declined markedly following the Esso Bernicia oil spill in 1982 and had not recovered before the study was terminated. Studies of transects at two sites are described: sedimentary changes were small while infaunal community characteristics showed both persistent environmental trends for some species and random fluctuations in others. The communities at each site showed high diversity, with generally stable structures upon which are superimposed annual and site-specific fluctuations in abundance of component species.
Response to the Esso Bernicia oil spill
Authors: Foxton Peter , Heubeck Martin 
Published: June 2019

SynopsisA brief description is given of the accident to the tanker Esso Bernicia that resulted in the release of 1174 tonnes of heavy fuel oil into the harbour at Sullom Voe. The measures taken to deal with the spill and the resulting oil pollution are described and their effectiveness assessed. Aspects of the environmental effects are considered with particular reference to birds, otters and sheep. Wide-ranging inquiries were made into the cause of the incident, the adequacy of the response, and the effects of the pollution. The actions that resulted are described. Finally the significance of the event is considered in relation to the subsequent development of oil spill contingency planning at Sullom Voe, and in the wider context of Shetland.
A structural analysis of rain forest at Korup and Douala–Edea, Cameroon
Authors: Newbery D. McC. , Gartlan J. S. 
Published: June 2019

SynopsisDiameter frequency distributions (dfds) of 197 tree species in Korup National Park and 118 tree species in Douala–Edea Forest Reserve (based onc.41 000 and 25 000 trees ≥ 30 cm gbh in 135 and 104 plots along four transects at each site, respectively) were individually classified into four groups of species according to their maximum diameters (≥99% trees <50, <70 and <90cm dbh, and > 1% ≥90cm dbh), and separated into two abundance classes (n≥50 andn= 20–49 (or 15–49). A fifth group, from those species in 3 and 4, was defined by a relative lack of small stems and given detailed attention. Dfds were evaluated for all species together on a transect and site basis, and compared for individual species across transects, and between sites for those group 5 species in common.Analysis focussed on three large ectomycorrhizal species in groups 3 and 4,Microberlinia bisulcata, Tetraberlinia bifoliolataandT. moreliana(Caesalpiniaceae), which were restricted to, and dominated, the forest on the nutrient-poor soils of transect P at Korup.M. bisulcata, the most abundant, was markedly group 5 in character, with very few small trees, whilst theTetraberliniaspecies had strong replacement potential. Although there were 27 species (42% of groups 3 & 4) at Korup and 19 (48%) at Douala–Edea in group 5,M. bisulcatawas unique in its combination of large size, dfd, mycorrhizal habit, spatial distribution and soil association. The potential replacement of this species was contrasted also with a non-ectomycorrhizal caesalp with similar dfd that occurred on nutrient-richer soils,Erythrophleum ivorense.Knowledge of the Caesalpiniaceae-richla forêt biafriéeneof Letouzey (which includes Korup and Douala–Edea) is reviewed, and the distribution, ecology and regeneration of the caesalps discussed. Structure and inferred dynamics of the forest at Korup are discussed with special regard to the ectomycorrhizal species.
Forest indigenous peoples: concept, critique and cases
Authors: Richards Paul 
Published: June 2019

SynopsisThis chapter has two linked objectives. The first is to sketch the process of human occupance of the lowland rain forest zone in West Africa, and illustrate (by means of a case study) the current circumstances of human settlement at the forest margins. The second is to bring the category ‘indigenous peoples’ under review, and to point out some of the pitfalls associated with the use of this term in the context of the West African forest frontier. All parts of the forest zone in West Africa have a long and complex history of occupation and use. In consequence, I shall argue that it is rarely, if ever, realistic to think of forest country as a residuum of empty land not yet passed into human ownership and use, but that it is equally distorting to treat the local groups currently found in possession of the forest edge as sole custodians. Forest resources have over time become part of the fabric of wider community life in West Africa, up to and beyond the national level, and narrow definitions of the category ‘indigenous peoples’ are to be avoided. Rather than search for putative forest indigenes, living in greater harmony with nature than incoming settlers (a usage reflecting Amazonian experience) it would be better, I suggest, to consider the term ‘indigenous peoples’ as covering all groups in West Africa with effective local knowledge of the forest. An eventual aim should be to understand how the experience of forest occupance has passed into the make-up of the institutions and values of civil society throughout the forest zone in West Africa today, regardless of whether or not these groups have a current direct connection to surviving areas of high forest. This is a much broader sociological agenda than conservationists have been prepared to tackle so far, but the threatened forests of West Africa are also complex human landscapes of considerable historical depth, and this human complexity is, in my judgement, no less worthy of understanding and conservation than the envelope of non-human biodiversity from which is has emerged. In fact, the two sets of issues are inextricably intertwined.
Clinical evidence for the involvement of oestrogen in the development and progression of breast cancer
Authors: Howell Anthony 
Published: June 2019

SynopsisOestrogens may be involved in breast cancer development by at least three mechanisms, all of which involve stimulation of growth. Firstly, they may stimulate proliferation of the normal gland and possibly expand the pool of cells susceptible to carcinogens; secondly, they may expand the population of cells initiated by carcinogens by a promoting action to produce clinically detectable tumours; and thirdly, they may stimulate the growth and progression of infiltrating tumours. All of these effects are probably produced by interactions with the oestrogen receptor. There is suggestive evidence from immunocytochemical studies that promotion to the phase of carcinoma in situ in volves expansion of a receptor-positive clone of cells. After progression, there is a gradual loss of endocrine responsiveness either because of loss of the receptor protein or of receptor function. The high proportion of receptor-positive cells in early malignant lesions holds great hope for preventive strategies using anti-oestrogens for suppression of ovarian oestrogen production.
A new approach to the prevention of breast cancer
Authors: Bradlow H. Leon , Michnovicz Jon J. 
Published: June 2019

SynopsisWhile the role of oestrogens in breast cancer has been recognised for over a century, until recently our understanding of the mechanism by which they act has been limited, despite zealous efforts on the part of many investigators to seek for differences in oestrogen levels or metabolism in cancer patients. Since the initiation of breast cancer occurs many years before the detection of overt disease, it seems reasonable to suggest that these earlier studies may have been carried out at the wrong stage of the disease. Using a time invariant radiometric procedure, we have established that of the three principal sites of oestrogen metabolism at C-2, C-16α, and C-17, only C-16α hydroxylation is elevated in women with breast cancer. Further studies in women at high risk for breast cancer for familial reasons showed that they have an elevated rate of 16α-hydroxylation. Parallel studies in mice with high and low rates of spontaneous mammary tumour formation show a close parallelism between the extent of 16α-hydroxylation and tumour incidence. Studies of 16α-hydroxyoestrone, the product of 16α-hydroxylation, have demonstrated that it is a unique oestrogen, capable of binding irreversibly to the oestrogen receptor and permanently activating it. Studies on the effects of diet and drugs on the extent of C-2 and C-16α hydroxylation have shown that while the former reaction is easily increased or decreased, the latter is refractory to treatment and behaves like a constitutive enzyme. Thus, treatment with cimetidine, obesity, or high fat diets decrease the extent of C-2 hydroxylation, while high protein diets, hyperthyroidism, smoking, or dioxins increase C-2 hydroxylation. In contrast, 16α-hydroxylation is essentially unchanged in any of these conditions.A link between increased C-2 hydroxylation and decreased levels of breast and endometrial cancer is suggested by epidemiological studies in smokers. Conversely, decreases in this reaction as in obesity are associated with increased risk for these tumours. The aim of these studies is to develop a safe prophylactic regimen which will increase C-2 hydroxylation, resulting in a decrease in active oestrogen and a lower tumour incidence.
Oestrogen-induced pro-cathepsin D in breast cancer: from biology to clinical applications
Authors: Rochefort Henri , Augereau Patrick , Briozzo Pierre , Capony François , Cavailles Vincent , Freiss Gilles , Garcia Marcel , Maudelonde Thierry , Morisset Muriel , Touitou Isabelle , Vignon Françoise 
Published: June 2019

SynopsisIn addition to secreted growth factors, acting as autocrine or paracrine mitogens, breast cancer cells secrete other proteins whose function and significance in mammary carcinogenesis may be important. Among them, proteases are particularly interesting since it has been suggested that they play a role in metastatic process, and since at least two of them, the tissue type plasminogen activator and pro-cathepsin D, the precursor of a lysosomal protease, are induced by oestrogens and secreted in excess in some mammary cancer cells.In oestrogen-receptor-positive human breast cancer cell lines (MCF7, ZR75–1), oestrogens stimulate cell proliferation and specifically increase the secretion into the culture medium of a 52,000-dalton (52-kDa) glycoprotein identified as the secreted precursor of a cathepsin D bearing mannose-6-phosphate signals, which is routed to lysosomesviamannose-6-phosphate-IGF-II receptors. We have determined the structure of this procathepsin D by sequencing its complete cDNA sequence, its chromosomal localisation and its transcriptional regulation by oestrogens and other mitogens. In breast cancer cells, pro-cathepsin D production and secretion is much higher and its processing is altered compared to normal mammary epithelial cells in culture.In vitro, pro-cathepsin D acts as an autocrine mitogen on breast cancer cells and can be activated at acidic pH to degrade extracellular matrix, suggesting a role in mediating the effect of oestrogens on tumour growth and invasion. Retrospective clinical studies indicate a significant correlation between high 52-kDa cathepsin D concentrations in the cytosol of primary breast cancer and poor prognosis (Danish Breast Cancer Group, S. Thorpe, Copenhagen). We propose that among the proteases secreted by cancer cells, 52-kDa cathepsin D is important both as a tissue marker in breast cancer and as a potential factor involved in carcinogenesis.
Oestrogen-receptors: an overview of recent advances in their structure and function
Authors: King R. J. B. 
Published: June 2019

SynopsisRecent advances in our understanding of the receptor components involved in the initial events of oestradiol action are reviewed with an emphasis on aspects of clinical relevance. Two main features of the models have evolved: (1) the domain structure of the ligand-binding unit, with distinct parts of the molecule being concerned with oestrogen-binding and interaction with DNA, and other parts of the molecule having important regulatory functions; (2) the regulatory regions (oestrogen-response elements) of oestrogen-sensitive genes which specifically interact with the receptor protein.The homologies between different proteins capable of binding ligands as diverse as oestradiol, retinoic acid and thyroid hormone point to possible interactions between such ligands. Oestrogen-response elements can recognise oestradiol receptor proteins complexed with either agonists or antagonists. Interactions with DNA may play an important rôle in determining gene expression additional to those seen at the receptor level.
The relevance of local oestrogen metabolism within the breast
Authors: Miller W. R. , O'Neill J. S. 
Published: June 2019

SynopsisOvarian oestrogens appear to have a central role in the development of the breast. However, peripheral tissues including the breast and its tumours have the potential to synthesise and metabolise oestrogens. When ovarian secretion of hormones is low, for example, after the menopause, such extra-gonadal steroidogenesis may assume biological significance.While no individual steroid conversion in the breast has been shown to correlate with levels of endogenous oestrogens, certain positive associations have been observed between enzyme activities and the presence, stage and hormone dependence of breast cancer.Thus biosynthesis of oestrogen (aromatisation) in breast fat is significantly higher in patients with breast cancer as compared to that from women with benign breast disease. Within the breasts of women with cancer, oestrogen biosynthesis is enhanced in quadrants bearing tumour. In contrast, levels of 17β-hydroxysteroid dehydrogenase are not associated with the presence of malignancy, but in women with breast cancer, activity is significantly higher in breast fat of patients with large tumours and those with nodal metastasis. There is also evidence that oestrogen sulphurylation in breast cancer is associated with hormone dependence and among postmenopausal patients with oestrogen-receptor-positive tumours, response to the aromatase inhibitor, aminoglutethimide, is restricted to cancers possessing aromatase activity.
Optimisation of antioestrogen therapy: laboratory and clinical concepts
Authors: Jordan V. Craig 
Published: June 2019

SynopsisTamoxifen, a non-steroidal antioestrogen, is the first line endocrine therapy for breast cancer. Laboratory studies during the past decade have provided valuable clues to understand the mode of action of tamoxifen so that the drug can be used to its best advantage in the clinic. Animal models (carcinogen-induced rat mammary carcinoma models, spontaneous mouse mammary tumours, and athymic mice inoculated with hormone-dependent human breast cancer cell lines) all demonstrate that tamoxifen is a tumouristatic agent and long-term or indefinite therapy is required to prevent the appearance of tumours. However, when treatment is stopped, tumours appear spontaneously or can be encouraged to re-appear with oestrogen therapy. These data clearly support the view that adjuvant clinical trials with tamoxifen should employ an indefinite treatment policy or at least until the time of treatment failure. Several clinical trials organisations in Great Britain (CRC and Scottish trial) have recruited a significant number of premenopausal patients. However, unlike postmenopausal patients, long-term tamoxifen therapy of premenopausal women often causes an increase in circulating oestrogen. Since tamoxifen has been shown to be a competitive inhibitor of oestrogen action, strategies to reduce ovarian steroidogenesis (oophorectomy or Zodalex®) may provide an optimal environment to sustain the long-term effectiveness of adjuvant tamoxifen therapy.