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Baker J, Pryjmachuk S. Will safe staffing in Mental Health Nursing become a reality? J Psychiatr Ment Health Nurs 2016; 23:75-6. [PMID: 26914864 DOI: 10.1111/jpm.12282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Schapschröer M, Baker J, Schorer J. Exploring the interaction of physical exercise load and pattern recall performance in female handball players. Exp Brain Res 2016; 234:1713-23. [PMID: 26873349 DOI: 10.1007/s00221-016-4584-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/30/2016] [Indexed: 10/22/2022]
Abstract
Studies examining experts' superiority within domain-specific structured pattern recall tasks have typically had athletes perform them at rest, which is far different from how they are executed in their sport. The aim of this study was to investigate whether performing these tasks under different physical exercise intensities influenced pattern recall results of experts, advanced and novices. In two experiments, 68 participants (experiment 1: n = 33; experiment 2: n = 35) were tested using a handball-specific pattern recall task both at rest and during physical exercise. Physical exercises of 60 % heart rate reserve (constant workload: experiment 1) and of 86.5-90 % HRmax (handball-specific interval load: experiment 2) were induced. Results of both experiments revealed significant group differences with experts recalling patterns more accurately than novices but no significant within-subject differences for the two conditions and no interaction between both factors. Our findings replicate prior research concerning perceptual-cognitive expertise in structured specific pattern recall tasks. However, the lack of intergroup differences between the two conditions or interactions was surprising, suggesting sport-specific pattern recall skill is robust to changes in exercise stimuli. Future work is needed to further examine the impact of "physiological specificity" on perceptual-cognitive expertise.
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Jemielita TO, Leonard MB, Baker J, Sayed S, Zemel BS, Shults J, Herskovitz R, Denburg MR. Association of 25-hydroxyvitamin D with areal and volumetric measures of bone mineral density and parathyroid hormone: impact of vitamin D-binding protein and its assays. Osteoporos Int 2016; 27:617-26. [PMID: 26359185 PMCID: PMC4924926 DOI: 10.1007/s00198-015-3296-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/14/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED A comparison of the association of different forms of 25-hydroxyvitamin D [25(OH)D] with parathyroid hormone (PTH) and with areal and volumetric bone mineral density (BMD) demonstrated that bioavailable and free 25(OH)D do not provide a better index of vitamin D status in terms of bone health compared to total 25(OH)D. INTRODUCTION This study aims to compare measures of vitamin D-binding protein (DBP) using a monoclonal versus polyclonal ELISA and assess correlations of total versus estimated free and bioavailable 25(OH)D with BMD and PTH concentrations. METHODS DXA and peripheral quantitative CT (pQCT) scans were obtained in 304 adults (158 black, 146 white), ages 21-80 years. Free and bioavailable 25(OH)D were calculated from total 25(OH)D, DBP, and albumin concentrations. Multivariable linear regression with standardized beta coefficients was used to evaluate associations of bone measures and PTH with total, free, and bioavailable 25(OH)D. RESULTS Measures of DBP obtained using a monoclonal versus polyclonal ELISA were not correlated (r s = 0.02, p = 0.76). Free and bioavailable 25(OH)D based on the polyclonal assay were lower in black versus white participants (p < 0.0001); this race difference was not evident using the monoclonal assay. Adjusted for age, sex, calcium intake, and race, all forms of 25(OH)D were negatively associated with PTH, but the absolute coefficient was greatest for total 25(OH)D (-0.34, p < 0.001) versus free/bioavailable 25(OH)D (-0.18/-0.24 depending on DBP assay, p ≤ 0.003). In analyses stratified on race, none of the measures of 25(OH)D were associated with BMD across DXA and pQCT sites. CONCLUSIONS The monoclonal versus polyclonal ELISA yielded highly discrepant measures of DBP, particularly among black individuals, likely related to established race differences in DBP polymorphisms. Contrary to prior studies, our findings indicate that using DBP to estimate bioavailable and free 25(OH)D does not provide a better index of vitamin D status in terms of bone health.
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Steingröver C, Wattie N, Baker J, Schorer J. Does Relative Age Affect Career Length in North American Professional Sports? SPORTS MEDICINE-OPEN 2016; 2:18. [PMID: 26807348 PMCID: PMC4713707 DOI: 10.1186/s40798-016-0042-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/10/2022]
Abstract
Background Relative age effects (RAEs) typically favour older members within a cohort; however, research suggests that younger players may experience some long-term advantages, such as longer career length. The purposes of this study were to replicate previous findings on RAEs among National Hockey League (NHL) ice hockey players, National Basketball Association (NBA) basketball players and National Football League (NFL) football players and to investigate the influence of relative age on career length in all three sports. Methods Using official archives, birthdates and number of games played were collected for players drafted into the NBA (N = 407), NFL (N = 2380) and NHL (N = 1028) from 1980 to 1989. We investigated the possibility that younger players might be able to maximize their career length by operationalizing career length as players’ number of games played throughout their careers. Results There was a clear RAE for the NHL, but effects were not significant for the NBA or NFL. Moreover, there was a significant difference in matches played between birth quartiles in the NHL favouring relatively younger players. There were no significant quartiles by career length effects in the NBA or NFL. Conclusions The significant relationship between relative age and career length provides further support for relative age as an important constraint on expertise development in ice hockey but not basketball or football. Currently, the reason why relatively younger players have longer careers is not known. However, it may be worth exploring the influence of injury risk or the development of better playing skills.
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McMenamin D, Baker J, Middleton M. The Medical Reception Station: a new primary care capability for 3 Commando Brigade. JOURNAL OF THE ROYAL NAVAL MEDICAL SERVICE 2016; 102:4-7. [PMID: 29984970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
3 Commando Brigade’s delivery of pre-hospital (Role 1) care has until now largely been based around junior doctors delivering trauma-based resuscitation and limited primary care from small self-contained Regimental Aid Posts (RAPs). With the drawdown of large scale operations in Iraq and Afghanistan, and the diversity of potential future military operations, the deficiency of General Practitioner(GP)-led care in the deployed setting has become more evident, and this has driven the requirement for a deployable primary care facility in the form of a Medical Reception Station (MRS). This paper describes the evolution of this project, the realities of deploying a new medical capability for the first time, some of the issues faced, and the potential utility of such a medical facility in future.
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Baker J. Functional voice disorders: Clinical presentations and differential diagnosis. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:389-405. [PMID: 27719859 DOI: 10.1016/b978-0-12-801772-2.00034-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In this chapter, an overview of the heterogeneous group of functional voice disorders is given, including the psychogenic voice disorder (PVD) and hyperfunctional or muscle tension voice disorder (MTVD) subgroups. Reference is made to prevalence and demographic data, with empiric evidence for psychosocial factors commonly associated with the onset and maintenance of these disorders. Clinical features that distinguish between the different presentations of PVD and MTVD are described. While there are some shared characteristics, key differences between these two subgroups indicate that PVD more closely resembles the psychogenic movement disorders and a range of other functional neurologic disorders. Assessment procedures and auditory-perceptual features of the voice that distinguish these disorders from the neurologically based voice disorders are discussed, with case examples highlighting ambiguous features that may influence differential diagnosis. The clinical profiles of PVD and MTVD affirm approaches to clinical management by speech-language pathologists that integrate symptomatic behavioral voice therapy with "top-down" models of counseling or psychotherapy. They also support the proposition that PVD may be construed as a subtype of functional neurologic disorders.
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Sullivan L, Boyce JM, Brown A, Baker J. Quaternary ammonium compounds (QAC) issues encountered in an environmental services (EVS) department. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474684 DOI: 10.1186/2047-2994-4-s1-p42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Roggenbuck J, Temme R, Pond D, Baker J, Jarvis K, Liu M, Dugan S, Mendelsohn NJ. Erratum to: The Long and Short of Genetic Counseling Letters: A Case-control Study. J Genet Couns 2015; 25:211. [PMID: 26531311 DOI: 10.1007/s10897-015-9904-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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84
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Baker J, Parsons R, Sellahewa C, Wirithamulla H. MRSA screening in day case surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Matsumoto S, Tan P, Baker J, Durbin K, Tomiya M, Azuma K, Doi M, Elliott RB. Clinical porcine islet xenotransplantation under comprehensive regulation. Transplant Proc 2015; 46:1992-5. [PMID: 25131091 DOI: 10.1016/j.transproceed.2014.06.008] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Xenotransplantation with porcine islets is a promising approach to overcome the shortage of human donors. This is the first report of phase 1/2a xenotransplantation study of encapsulated neonatal porcine islets under the current framework of regulations for xenotransplantation in New Zealand. METHODS Newborn piglets were anesthetized and bled, and the pancreata were removed with the use of sterile technique and processed. Encapsulated neonatal porcine islets were implanted with the use of laparoscopy into the peritoneal cavity of 14 patients with unstable type 1 diabetes without any immunosuppressive drugs. The patients received encapsulated islets of 5,000 (n = 4; group 1), 10,000 (n = 4; group 2), 15,000 (n = 4; group 3), or 20,000 (n = 2; group 4) islet equivalents per kg body weight. Outcome was determined from adverse event reports, HbA1c, total daily insulin dose, and frequency of unaware hypoglycemic events. To assess graft function, transplant estimated function (TEF) scores were calculated. Sufficient or marginal numbers of encapsulated neonatal porcine islets were transplanted into streptozotocin-induced diabetic B6 mice as an in vivo functional assay. RESULTS There were 4 serious adverse events, of which 3 were considered to be possibly related to the procedure. Tests for porcine endogenous retrovirus DNA and RNA were all negative. The numbers of unaware hypoglycemia events were reduced after transplantation in all groups. Four of 14 patients attained HbA1c <7% compared with 1 at baseline. The average TEF scores were 0.17, 0.02, -0.01, and 0.08 in groups 1, 2, 3, and 4 respectively. The in vivo study demonstrated that a sufficient number of the transplanted group reversed diabetes with positive porcine C-peptide. CONCLUSIONS Transplantation of encapsulated neonatal porcine islets was safe and was followed by a reduction in unaware hypoglycemia events in unstable type 1 diabetic patients. The mouse in vivo assessment data demonstrated certain graft function.
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Baker J. SP0193 Lessons Learnt from Recent MRI Trials in RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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87
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Baker J. SP0223 Lessons Learnt from Recent MRI Trials in RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Holm JC, Gamborg M, Trier C, Mollerup P, Nielsen T, Fonvig C, Baker J. Childhood obesity chronic care treatment. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baker J. MO-B-BRD-03: Principles, Pitfalls and Techniques of 3D Printing for Bolus and Compensators. Med Phys 2015. [DOI: 10.1118/1.4925295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lemez S, Wattie N, Baker J. Early death in active professional athletes: Trends and causes. Scand J Med Sci Sports 2015; 26:544-9. [PMID: 25996659 DOI: 10.1111/sms.12480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2015] [Indexed: 11/29/2022]
Abstract
The objective of the study was to examine mortality trends and causes of death among professional athletes from the four major sports in North America who died during their playing careers. 205 deceased athletes who were registered as active when they died from the National Basketball Association (NBA), National Football League (NFL), National Hockey League (NHL), and Major League Baseball (MLB) were examined. Results were compared with the Canadian and U.S. general population. The leading causes of death in players reflected the leading causes of death in the Canadian and U.S. general population (i.e., car accidents). Descriptively, NFL and NBA players had a higher likelihood of dying in a car accident (OR 1.75, 95% CI: 0.91-3.36) compared with NHL and MLB players. In addition, NFL and NBA players had a significantly higher likelihood of dying from a cardiac-related illness (OR 4.44, 95% CI: 1.59-12.43). Mortality trends were disproportionate to team size. Overall, death in active athletes is low. Out of 53 400 athletes who have historically played in the four leagues, only 205 died while active (0.38%). Future examinations into the trends and causes of mortality in elite athlete populations will create a better understanding of health-related risks in elite sport.
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Day J, Baker J, Schofield H, Mathews F, Gaston KJ. Part-night lighting: implications for bat conservation. Anim Conserv 2015. [DOI: 10.1111/acv.12200] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Koran M, Lipnik A, Meranze S, Bream P, Baron C, Baker J, Omary R, Brown D. Procedural impact of a dedicated interventional oncology service line in an NCI comprehensive cancer center. J Vasc Interv Radiol 2015. [DOI: 10.1016/j.jvir.2014.12.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Hopwood MJ, Farrow D, MacMahon C, Baker J. Sibling dynamics and sport expertise. Scand J Med Sci Sports 2015; 25:724-33. [PMID: 25640295 DOI: 10.1111/sms.12387] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
Family members are known to be highly influential in the development of sport expertise. To date, much of the research in this area has focused on parents, with less known about sibling influences on expertise. This investigation explored associations between sport expertise, sibling characteristics, and sibling participation in sport and physical activity. Athletes representing three skill levels provided details of sibling characteristics and participation in sport and physical activity via the Developmental History of Athletes Questionnaire. Elite athletes were more likely to be later-born children, while pre-elite and non-elite athletes were more likely to be first-born. Compared with siblings of non-elite athletes, siblings of elite athletes were more likely to have participated in regular physical activity and were more likely to have participated in sport at the pre-elite and elite levels. These results suggest siblings may play a key role in sport expertise development.
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Rienhoff R, Fischer L, Strauss B, Baker J, Schorer J. Focus of attention influences quiet-eye behavior: An exploratory investigation of different skill levels in female basketball players. ACTA ACUST UNITED AC 2015. [DOI: 10.1037/spy0000031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Keenan CM, Baker J, Bradley A, Goodman DG, Harada T, Herbert R, Kaufmann W, Kellner R, Mahler B, Meseck E, Nolte T, Rittinghausen S, Vahle J, Yoshizawa K. International Harmonization of Nomenclature and Diagnostic Criteria (INHAND): Progress to Date and Future Plans. Toxicol Pathol 2014; 43:730-2. [PMID: 25530274 DOI: 10.1177/0192623314560031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The International Harmonization of Nomenclature and Diagnostic Criteria for Lesions in Rats and Mice proposal (INHAND) has been operational since 2005. A Global Editorial Steering Committee manages the overall objectives of the project, and the development of harmonized terminology for each organ system is the responsibility of the Organ Working Groups, drawing upon experts from North America, Europe, and Japan. Great progress has been made with 9 systems published to date--respiratory, hepatobiliary, urinary, central/peripheral nervous systems, male reproductive and mammary, zymbals, clitoral, and preputial glands in Toxicologic Pathology and the integument and soft tissue and female reproductive in the Journal of Toxicologic Pathology as supplements and on a Web site--www.goReni.org. INHAND nomenclature guides offer diagnostic criteria and guidelines for recording lesions observed in rodent toxicity and carcinogenicity studies. The guides provide representative photomicrographs of morphologic changes, information regarding pathogenesis, and key references. The purpose of this brief communication is to provide an update on the progress of INHAND.
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Roggenbuck J, Temme R, Pond D, Baker J, Jarvis K, Liu M, Dugan S, Mendelsohn NJ. The Long and Short of Genetic Counseling Summary Letters: A Case–control Study. J Genet Couns 2014; 24:645-53. [DOI: 10.1007/s10897-014-9792-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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Niu X, Poon JL, Riske B, Zhou ZY, Ullman M, Lou M, Baker J, Koerper M, Curtis R, Nichol MB. Physical activity and health outcomes in persons with haemophilia B. Haemophilia 2014; 20:814-21. [PMID: 25156277 DOI: 10.1111/hae.12485] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
Regular participation in physical activity helps to prevent damage and maintain joint health in persons with haemophilia. This study describes self-reported physical activity participation among a sample of people with haemophilia B in the US and measures its association with health-related quality of life (HRQoL). Data on 135 participants aged 5-64 years were abstracted from Hemophilia Utilization Group Study Part Vb. The International Physical Activity Questionnaire assessed physical activity among participants aged 15-64 years, and the Children's Physical Activity Questionnaire abstracted from the Canadian Community Health Survey was used for participants aged 5-14 years. SF-12 was used to measure HRQoL and the EuroQol (EQ-5D-3L) was used to measure health status for participants older than 18 years of age. PedsQL was used to measure HRQoL in children aged 5-18 years. Sixty-two percent of participants in the 15-64 year-old age cohort reported a high level of physical activity, 29% reported moderate activity and 9% reported low activity. For children aged 5-14 years, 79% reported participating in physical activity for at least 4 days over a typical week. Based on the 2008 Physical Activity Guidelines for Americans, 79% of adults achieved the recommended physical activity level. Multivariable regression models indicated that adults who engaged in a high level of physical activity reported EQ-5D Visual Analogue Scale (VAS) scores that were 11.7 (P = 0.0726) points greater than those who engaged in moderate/low activity, indicating better health outcomes. Among children, no statistically significant differences in health outcomes were found between high and moderate or low activity groups.
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Li Q, Baker J, Kowalczyk J, Jiang Q, Uitto J, Schachner L. Paediatric pseudoxanthoma elasticum with cardiovascular involvement. Br J Dermatol 2014; 169:1148-51. [PMID: 23746223 DOI: 10.1111/bjd.12462] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pseudoxanthoma elasticum (PXE) is characterized by aberrant mineralization of connective tissues, causing considerable morbidity and mortality. The disease is typically of late onset, the skin manifestations first being noted in the teens or later. Another aberrant mineralization disorder, generalized arterial calcification of infancy (GACI), is present at birth and can demonstrate a phenotypic overlap with PXE. OBJECTIVES A patient with PXE was noted to have skin findings as early as at 6 years of age, with cardiovascular involvement. The purpose of this study was to examine the genetic basis of this phenotypic presentation in the spectrum of PXE/GACI. METHODS The patient's genotype was studied by sequencing ABCC6 and ENPP1, genes known to be associated with PXE and/or GACI. RESULTS Screening of the ABCC6 gene revealed two pathogenetic mutations, p.R1141X and g.del23-29. Analysis of the ENPP1 gene failed to demonstrate the presence of mutations. CONCLUSIONS This study demonstrates the presence of cutaneous findings of PXE in an 8-year-old paediatric patient, with cardiovascular involvement, illustrating the phenotypic spectrum of PXE.
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Hongo D, Tang X, Baker J, Strober S. Requirement for Interactions of Natural Killer T Cells and Myeloid Derived Suppressor Cells for Transplantation Tolerance. Transplantation 2014. [DOI: 10.1097/00007890-201407151-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fitzmaurice DA, McCahon D, Baker J, Murray ET, Jowett S, Sandhar H, Holder RL, Hobbs FDR. Is screening for AF worthwhile? Stroke risk in a screened population from the SAFE study. Fam Pract 2014; 31:298-302. [PMID: 24728774 DOI: 10.1093/fampra/cmu011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is an important independent risk factor for stroke and oral anticoagulation therapy provides a highly effective treatment to reduce this risk. Active screening strategies improve detection of AF in comparison with routine care; however, whether screen-detected patients have stroke risk profiles favouring anticoagulation is unclear. Using data derived from the screening for AF in the elderly (SAFE) study, the aim of this article was to determine if patients with AF detected via active screening have stroke risk profiles that warrant prophylactic anticoagulation. METHODS Secondary analysis of data derived from 25 general practices within which cohorts of 200 patients were randomly allocated to opportunistic [pulse and electrocardiogram (ECG)] or systematic screening (postal invitation for ECG). Stroke risk assessment was undertaken using baseline data extracted from medical records and CHADS2 criteria. CHADS2 scores were compared between the screening groups. RESULTS One hundred and forty-nine new cases of AF were detected, 75 via opportunistic screening and 74 via systematic screening. CHADS2 scores were ≥1 in 83% [95% confidence interval (CI) 72.6-89.6] of patients detected via opportunistic screening and 78% (95% CI 67.7-86.2) detected via systematic screening. There were no significant differences in stroke risk profiles of patients detected via opportunistic and systematic screenings. CONCLUSION Stroke risk profiles of patients detected via opportunistic and systematic screenings were similar. Data derived from the SAFE study suggest that active screening for AF in patients aged ≥65 years in primary care is a useful screening programme with 78-83% of patients identified eligible for anticoagulation treatment according to the CHADS2 criteria.
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