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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Maitre P, Haris M, Portner R, Hoskin P, Hudson A, Wylie J, Logue J, Conroy R, Tran A, Serra M, Croxford W, Song Y, Oates J, Ramani V, Clarke N, Choudhury A. Outcomes in Locally Advanced Non-Metastatic Prostate Cancer Presenting with Low PSA at Diagnosis. Int J Radiat Oncol Biol Phys 2023; 117:e413-e414. [PMID: 37785368 DOI: 10.1016/j.ijrobp.2023.06.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Men with low serum prostate-specific antigen (PSA) and high Gleason grade group (GGG) are thought to have poor outcomes compared to high PSA secretors. However, there is limited outcome data to support this. We report clinical outcomes from a single-institutional cohort of men presenting with locally advanced prostate cancer but low serum PSA. MATERIALS/METHODS Data from electronic database of a UK tertiary cancer center was acquired for men with histological diagnosis of prostate adenocarcinoma, GGG 4 or 5, stage ≥cT3a, and PSA <10ug/L at diagnosis. Men with metastatic disease, or prior androgen deprivation therapy (ADT) were excluded. Biochemical progression was defined as per Phoenix criteria (PSA > nadir+2) for primary radiotherapy, or PSA >0.2 ug/L after primary prostatectomy (and post-operative radiotherapy, if received). Overall survival (OS, from date of diagnosis to death), metastasis-free survival (MFS, from diagnosis to first recorded metastasis or death), and biochemical progression free survival (bPFS, from diagnosis to biochemical progression or death) were estimated by Kaplan Meier method, and multivariable analysis performed using Cox proportional hazards method. RESULTS Medical records of 7,200 men presenting with non-metastatic prostate cancer from 2013 to 2021 were screened, of which 270 men satisfying the eligibility criteria were included for this study. Initial analysis of 123 men shows median PSA at presentation 7.1 ug/L (IQR 5.6-8.5), and median age 70 years (IQR 65-75). Histology was GGG 4 in 47.6% and 5 in 52.4%. Tumor stage was cT3a in 56.6%, cT3b in 36.9%, and T4 in 6.6%. Pelvic nodes were involved in 5% patients. Majority (83.7%) were treated with radical radiotherapy (external beam alone 64.2%, brachytherapy boost 19.5%), with 24 months ADT; 11.4% underwent radical prostatectomy, and 4.9% received ADT alone. Three men (2.4%) received docetaxel, and one received abiraterone. At a median follow up of 66 months (IQR 27-77), 36 (29.3%) patients had biochemical failure. Total 23 (18.6%) patients had metastases at recurrence, which were visceral in 4%, bone-only in 10%, and nodal-only in 4%. Total 38 (30.6%) patients had died, 23% with prostate cancer and 11% due to other causes. Five-year bPFS was 65.9%, MFS 69.0%, and OS was 77.4%. GGG 5 (versus 4) was associated with significantly worse 5-year bPFS (59.4% vs 73.9%, HR 1.8, 95% CI 1.0-3.2, p = 0.05) and MFS (59.2% vs 81.6%, HR 2.2, 1.2-4.2, p = 0.02). On multivariable analysis including age and PSA at diagnosis, only GGG 5 was associated with worse bPFS (HR 1.8, 1.0-3.3, p = 0.05) and MFS (HR 2.42, 1.25-4.67, p = 0.009). CONCLUSION Men with low secreting but high Gleason grade group prostate cancer are a relatively rare group with poor clinical outcomes despite being non-metastatic. Ongoing work (expected completion June 2023) will analyze remaining cases, and compare outcomes within an expanded multicentric cohort with matched controls having elevated PSA at presentation.
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Affiliation(s)
- P Maitre
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Haris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Portner
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Logue
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Conroy
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Serra
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - W Croxford
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Y Song
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Oates
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - V Ramani
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - N Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Swinton M, Dubec M, McHugh D, Biglin E, Sanchez DF, Oliveira P, Price G, McWilliam A, van Herk M, Hoskin P, Buckley DL, Hudson A, Bristow RG, Choudhury A. Validation of Hypoxia Detection Sequences on the MR Linac. Int J Radiat Oncol Biol Phys 2023; 117:e723-e724. [PMID: 37786109 DOI: 10.1016/j.ijrobp.2023.06.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic resonance linear accelerator (MRL) systems permit acquisition of novel imaging at the time of radiotherapy. A validated MR hypoxia imaging biomarker could select patients for adaptive radiotherapy with hypoxia modification or dose escalation. The aims of this study were (1) to develop a protocol for quantitative hypoxia sensitive MRI (2) to validate these in prostate cancer (PCa) against pimonidazole-stained prostatectomy sections. MATERIALS/METHODS Blood oxygen level dependent (BOLD), intravoxel incoherent motion (IVIM), oxygen-enhanced (OE) and dynamic contrast enhanced (DCE) MRI were used. Sequences were developed on a diagnostic 1.5 T MR (MRD) and MRL with healthy volunteers and PCa patients. The Hyprogen trial includes men with localized PCa scheduled for prostatectomy. Imaging is acquired twice prior to surgery and oral pimonidazole is taken 8-16 hours before surgery. Whole prostate (WP) and dominant prostatic lesion (DIL) were outlined on T2-weighted (T2W) images and a 'normal prostate' (NP) volume created by subtracting DIL from WP. Contours were applied to parametric maps from the quantitative MRI, with median and IQR extracted. Patient-specific 3D-printed prostate molds were created from WP volumes and used to guide prostate whole organ dissection. RESULTS Three of 20 patients recruited to date. MRI data were acquired successfully. A personalized prostate mold was produced for each patient and facilitated dissection of the prostatectomy specimen in a matching plane to MRI to validate hypoxia detection of the MR protocol. Correlation with pimonidazole staining is underway. Imaging parameter median values for NP and DIL acquired on MRD and MRL for the first patient are shown (Table 1). The expected differences between NP and DIL for T1 and D are seen and median values for T2* are consistent with reported values in the literature. CONCLUSION The MR hypoxia protocol can be acquired safely and is well-tolerated on the MRL. Once validated against pimonidazole staining adaptive radiotherapy protocols will be developed to use this information.
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Affiliation(s)
- M Swinton
- Christie Hospital, Manchester, United Kingdom
| | - M Dubec
- University of Manchester, Manchester, United Kingdom
| | - D McHugh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - E Biglin
- University of Manchester, Manchester, United Kingdom
| | - D F Sanchez
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - P Oliveira
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - G Price
- The University of Manchester, Manchester, United Kingdom
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - D L Buckley
- Biomedical Imaging, University of Leeds, Leeds, United Kingdom
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Freir D, Kelly S, Hudson A, Richard G, Mullins G, Chalissery A, Lefter S. Acute and Chronic Demyelinating Polyneuropathy post AstraZeneca Covid-19 Vaccine. Ir Med J 2023; 116:842. [PMID: 37791845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Hudson A, Murnane JG, O'Dwyer T, Pawlett M, Courtney R. Influence of sediment quality and microbial community on the functioning capacity of a constructed wetland treating alkaline leachate after 5.5 years in operation. Sci Total Environ 2023; 867:161259. [PMID: 36638981 DOI: 10.1016/j.scitotenv.2022.161259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/22/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Constructed wetlands (CWs) have been demonstrated as a cost-effective alternative to chemical treatment systems for mine waters, with the microbial communities attributed to promoting carbonation and aiding pH neutralization. However, few data are available for the long-term use of CWs treating alkaline leachates nor the activity of microbes within them. To investigate the feasibility of CW to buffer alkaline pH, a pilot-scale wetland was implemented in 2015 to treat alkaline bauxite residue leachate. After 5.5 years, samples of supernatant water and sediment were taken at 0.5 m increments along the 11 m long wetland. Waters were analysed for pH, EC and metal(loid) content, while sediment was subjected to physico-chemical assessment and element fractionation. Microbial biomass and community were assessed by phospholipid fatty acid analysis (PLFA) and functionality by the Rapid Automated Bacterial Impedance Technique (RABIT). Evidence presented demonstrates that the CW operating for 66 months effectively treats bauxite residue leachate, with reduced influent pH from 11.5 to 7.8. Trace element analysis revealed effective reduction in Al (94.9 %), As (86.7 %) and V (57.6 %) with substrate analysis revealing a frontloading of elevated pH and trace element content in the first 5 m of the wetland. Sediment Al, As and V were present mostly (>94 % of total) in recalcitrant forms. Sediment Na was mostly soluble (48-62 %), but soils were not sodic (ESP < 15 %). Investigations into the microbial community revealed greatest biomass was in the first 5 m of the wetland, where pH, EC and metal contents were greatest. Microbial respiration using endemic Phragmites australis as a substrate demonstrates an ability to cycle recalcitrant carbon sources within a CW system. These novel microbial findings highlight the need for further investigation into the microbial communities in alkaline CWs.
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Affiliation(s)
- A Hudson
- Department of Biological Sciences and Bernal Institute, University of Limerick, Ireland
| | - J G Murnane
- School of Engineering, University of Limerick, Ireland
| | - T O'Dwyer
- Department of Chemical Sciences and Bernal Institute, University of Limerick, Ireland
| | - M Pawlett
- School of Water Energy and Environment, Cranfield University, United Kingdom
| | - R Courtney
- Department of Biological Sciences and Bernal Institute, University of Limerick, Ireland.
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Hudson A, Isaac D, Novak K, Ma H, Kuc A, Carroll M, Wine E, Huynh H. A14 TRANSABDOMINAL BOWEL ULTRASOUND AND CLINICAL OUTCOMES OVER ONE YEAR IN CHILDREN WITH NEWLY DIAGNOSED CROHN’S DISEASE. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991303 DOI: 10.1093/jcag/gwac036.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Abstract
Background
Transabdominal bowel ultrasound (TABUS) is an emerging non-invasive tool for monitoring inflammatory bowel disease (IBD). Its use is particularly increasing in pediatric IBD, given the need for anesthesia during endoscopy. The assessment of TABUS in pediatric IBD has been limited to small numbers of patients with no long-term follow-up.
Purpose
To describe TABUS findings and its relationship with clinical, biochemical, and endoscopic assessments in pediatric patients with Crohn’s disease up to one year post-diagnosis.
Method
Patients (0-18 years) with suspected IBD were prospectively enrolled through the Edmonton Pediatric IBD Clinic. Those with Crohn’s disease were included. Patients underwent repeated TABUS, clinical assessments, blood work, fecal calprotectin (FCP) (baseline, 1-, 3-, 6-, 12-months), and endoscopy (baseline and 6-12 months). The weighted Pediatric Crohn’s Disease Activity Index (wPCDAI), Simple Endoscopic Score for Crohn’s Disease (SES-CD; rectum excluded), and Simple Ultrasound Activity Score for Crohn’s Disease (SUS-CD; rectum excluded) were used. Remission was defined as FCP<250mg/kg, CRP<4mg/L, wPCDAI<12, no upcoming surgery, and SES-CD score ≤2 for any bowel segment.
Result(s)
Fifty-six patients (68% male), median age 12.5 years (range 6-17), were followed for 6 months. Forty (71%) were followed up to 12 months. Median TABUS bowel wall thickness (BWT) and SUS-CD total scores improved in all bowel segments over time. SUS-CD total scores significantly correlated with SES-CD (baseline, 6-, 12-months), wPCDAI (baseline, 1-, 6-, 12-months), CRP (baseline, 1-, 3-, 6-months), ESR (baseline, 1-, 3-, 6-, 12-months), and FCP (baseline, 1-, 6-, 12-months) (rho ranged 0.302-0.732, p<0.05). Patients in remission had sustained significantly thinner BWT of their most affected bowel segment (Figure 1) starting at 1-month (median 3.1mm (IQR 2.7-3.7) vs. 4.1mm (IQR 2.9-5.6; p<0.05), and sustained significantly lower SUS-CD total scores starting at 6 months (median 0 (IQR 0-1) vs. median 2 (IQR 1-3); p<0.05). Seven patients had surgery (n=7/7 ileocecal, n=2/7 jejunal resection). All 7 patients had complex TI disease (n=6 strictures, n=1 long-segment disease >25cm) and proximal small bowel disease (n=2/2) on TABUS. Those with baseline ultrasound findings of a stricture with upstream bowel dilatation (n=7/56) had increased odds (OR=288, p<0.01) and relative risk (RR=42, p<0.01) of needing surgery (n=6/7 with baseline obstructive findings, n=1/49 without) within the first year.
Image
Conclusion(s)
TABUS had significant correlations with clinical, biochemical, and endoscopic markers of Crohn’s disease activity in pediatric patients over one year. Bowel wall thickness of the most affected bowel segment is a helpful measurement, becoming significantly thinner as soon as 1-month post-diagnosis in those who obtain remission. Baseline findings of bowel narrowing and upstream dilation increase the odds and relative risk of needing surgery in the first year.
Please acknowledge all funding agencies by checking the applicable boxes below
None
Disclosure of Interest
None Declared
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Affiliation(s)
- A Hudson
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - D Isaac
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - K Novak
- Gastroenterology, University of Calgary , Calgary , Canada
| | - H Ma
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - A Kuc
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - M Carroll
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - E Wine
- Pediatric Gastroenterology, University of Alberta , Edmonton
| | - H Huynh
- Pediatric Gastroenterology, University of Alberta , Edmonton
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Churchill J, Sachdeva A, Jones C, Issa A, Fankhauser C, Hudson A, Tran A, Oliveira P, Johnson H, Lau M, Parnham A, Sangar V. P16 status is an independent predictor of overall survival in metastatic penile cancer in a large contemporary cohort. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00680-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Portner R, Ticknell G, Song Y, Hudson A, Choudhury A. The Use of Frailty Scores to Predict Tolerance to Chemotherapy in Patients with Metastatic Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Elumalai T, Barker C, Elliott T, Malik J, Tran A, Hudson A, Song YP, Patel K, Lyons J, Hoskin P, Choudhury A, Mistry H. Translation of Prognostic and Pharmacodynamic Biomarkers from Trial to Non-trial Patients with Metastatic Castration-resistant Prostate Cancer Treated with Docetaxel. Clin Oncol (R Coll Radiol) 2022; 34:e291-e297. [PMID: 35314092 DOI: 10.1016/j.clon.2022.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
AIMS We conducted a pooled analysis of four randomised controlled trials and a non-trial retrospective dataset to study the changes in serum prostate-specific antigen (PSA) concentrations during treatment and its impact on survival in men treated with docetaxel for metastatic castration-resistant prostate cancer. We also compared the outcomes and pre-treatment prognostic factors between trial and non-trial patients. MATERIALS AND METHODS Data were obtained from four randomised controlled trials and a non-trial cohort from a tertiary cancer centre. The PSA kinetics covariates chosen were absolute value (PSAT), best percentage change (BPCH) and tumour growth rate (K). The association between the covariates collected and overall survival was assessed within a Cox proportional hazards model. How well a covariate captured the difference between trial and non-trial patients was assessed by reporting on models with or without trial status as a covariate. RESULTS We reviewed individual datasets of 2282 patients. The median overall survival for trial patients was 20.4 (95% confidence interval 19.6-22.2) months and for the non-trial cohort was 12.4 (10.7-14.7) months (P < 0.001). Of the pre-treatment factors, we found that only lactate dehydrogenase fully captured the difference in prognosis between the trial and non-trial cohorts. All PSA kinetic metrics appeared to be prognostic in both the trial and non-trial patients. However, the effect size was reduced in non-trial versus trial patients (interaction P < 0.001). Of the time-dependent covariates, we found that BPCH best captured the difference between trial and non-trial patient prognosis. CONCLUSIONS The analysis presented here highlights how data from open-source trial databases can be combined with emerging clinical practice databases to assess differences between trial versus non-trial patients for particular treatments. These results highlight the importance of developing prognostic models using both pre-treatment and time-dependent biomarkers of new treatments.
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Affiliation(s)
- T Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Barker
- The Christie NHS Foundation Trust, Manchester, UK
| | - T Elliott
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - J Malik
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, UK
| | - Y P Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Lyons
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK.
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Elumalai T, Portner R, Mariam N, Young T, Hughes S, Wickramasinghe K, Bhana R, Jayaprakash K, Sabar M, Hudson A, Hoskin P, Mistry H, Choudhury A. MO-0555 Radiotherapy for node-positive prostate cancer correlates with improved survival. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Background Since the availability of biologics and biosimilars, inflammatory bowel disease (IBD) therapy has been a rapidly expanding field. Dual biologic therapy has become a new area of interest. This is important given that clinical remission rates from biologic monotherapy are only 40% at one year, and that in Canadian children with IBD, up to 33% will need surgery within ten years. It also holds potential in those who are not likely to respond as well to traditional therapy, such as patients with genetic disorders. Mono-/poly-genic IBD and the role of genetics in IBD is an evolving field. Niemann-Pick disease type C (NPC), a neurodegenerative lysosomal storage disorder, is one such genetic disorder, and its’ associated predisposition to IBD is thought to be related to impaired destruction of intracellular bacteria within macrophages (impaired autophagy). The persistence of bacteria in the gut wall leads to an increased cytokine response. Aims We present a case of a teenage patient with NPC and crohn colitis, who sustained clinical remission only after escalating to dual biologic therapy (anti-TNF (infliximab) and anti-IL12/IL23 (ustekinumab)). Methods A literature review of dual biologic therapy in Pediatric IBD (all types of patients included) was also completed. Results The patient presented with one month of abdominal pain, weight loss, and bloody diarrhea, 9 months after her diagnosis of NPC. Endoscopy revealed mild inflammation in the rectosigmoid junction and rectum, with pathology showing granulomatous pancolitis. Induction therapy was rectal 5-ASA. Subsequent flares resulted in the addition of azathioprine, and then infliximab. She was switched to ustekinumab after a flare 21 months later, which did not lead to adequate improvement, so infliximab was added back on as a dual biologic. With this combination therapy she maintained clinical, biochemical, and endoscopic remission, ongoing two years later. A literature review revealed eight studies (case series/reports only). One Pediatric patient case combined ustekinumab with infliximab, while the remaining combined vedolizumab (gut-specific anti- α 4β 7 integrin) with infliximab. Conclusions In Pediatric patients with genetic disorders and IBD who are not responding adequately to biologic therapy, adding a second biologic medication with a different mechanism of action may be efficacious. Targeting both TNFa (which induces pro-inflammatory cytokines, among many other roles), and the proinflammatory cytokines themselves (IL12/23), may be important in genetic disorders with impaired macrophage function and increased cytokine response. This is a potential option even several years into treatment. To date, only case studies are available, with the majority combining vedolizumab with infliximab. Our case adds to the sparse literature on the utility of combining ustekinumab and infliximab. Funding Agencies None
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Affiliation(s)
- A Hudson
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - P Almeida
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - H Q Huynh
- Pediatrics, University of Alberta, Edmonton, AB, Canada
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Lunj S, Song Y, Hudson A, Patel K, Nightingale H, Smith T, Hoskin P, Bristow R, West C, Choudhury A. PO-1933 Can baseline or Ra-223-induced changes in the plasma predict progressive disease mCRPC patients? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08384-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Connors K, Vickers A, Conroy R, Coyle C, Hudson A, Logue J, Serra M, Tran A, Mistry H, Wylie J, Choudhury A, Song Y. PO-1338 Does frailty influence treatment intent in men with non-metastatic prostate cancer? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07789-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Haslett K, Koh P, Hudson A, Ryder W, Falk S, Mullan D, Taylor B, Califano R, Blackhall F, Faivre-Finn C. Phase I trial of the MEK inhibitor selumetinib in combination with thoracic radiotherapy in non-small cell lung cancer. Clin Transl Radiat Oncol 2021; 28:24-31. [PMID: 33748440 PMCID: PMC7970011 DOI: 10.1016/j.ctro.2021.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background The RAS/RAF/MEK/ERK signalling pathway has a pivotal role in cancer proliferation and modulating treatment response. Selumetinib inhibits MEK and enhances effects of radiotherapy in preclinical studies. Patients and methods Single-arm, single-centre, open-label phase I trial. Patients with stage III NSCLC unsuitable for concurrent chemo-radiotherapy, or stage IV with dominant thoracic symptoms, were recruited to a dose-finding stage (Fibonacci 3 + 3 design; maximum number = 18) then an expanded cohort (n = 15). Oral selumetinib was administered twice daily (starting dose 50 mg) commencing 7 days prior to thoracic radiotherapy, then with radiotherapy (6-6.5 weeks; 60-66 Gy/30-33 fractions). The primary objective was to determine the recommended phase II dose (RP2D) of selumetinib in combination with thoracic radiotherapy. Results 21 patients were enrolled (06/2010-02/2015). Median age: 62y (range 50-73). M:F ratio 12(57%):9(43%). ECOG PS 0:1, 7(33%):14(67%). Stage III 16(76%); IV 5(24%). Median GTV 64 cm3 (range 1-224 cm3). 15 patients comprised the expanded cohort at starting dose. All 21 patients completed thoracic radiotherapy as planned and received induction chemotherapy. 13 (62%) patients received the full dose of selumetinib.In the starting cohort no enhanced radiotherapy-related toxicity was seen. Two patients had dose-limiting toxicity (1x grade 3 diarrhoea/fatigue and 1x pulmonary embolism). Commonest grade 3-4 adverse events: lymphopaenia (19/21 patients) and hypertension (7/21 patients). One patient developed grade 3 oesophagitis. No patients developed grade ≥3 radiation pneumonitis. Two patients were alive at the time of analysis (24 and 26 months follow-up, respectively). Main cause of first disease progression: distant metastases ± locoregional progression (12/21 [57.1%] patients). Six patients had confirmed/suspected pneumocystis jiroveci pneumonia. Conclusion We report poor outcome and severe lymphopenia in most patients treated with thoracic radiotherapy and selumetinib at RP2D in combination, contributing to confirmed/clinically suspected pneumocystis jiroveci pneumonia. These results suggest that this combination should not be pursued in a phase II trial.ClinicalTrials.gov reference: NCT01146756.
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Affiliation(s)
- K. Haslett
- The Christie NHS Foundation Trust, United Kingdom
| | - P. Koh
- University of Manchester, United Kingdom
- New Cross Hospital, United Kingdom
| | - A. Hudson
- The Christie NHS Foundation Trust, United Kingdom
| | - W.D. Ryder
- University of Manchester, United Kingdom
| | - S. Falk
- The Christie NHS Foundation Trust, United Kingdom
| | - D. Mullan
- The Christie NHS Foundation Trust, United Kingdom
| | - B. Taylor
- The Christie NHS Foundation Trust, United Kingdom
| | - R. Califano
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
| | - F. Blackhall
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
| | - C. Faivre-Finn
- The Christie NHS Foundation Trust, United Kingdom
- University of Manchester, United Kingdom
- Corresponding author at: The Christie NHS Foundation Trust, United Kingdom.
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16
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Sitati A, Joe E, Pentz B, Grayson C, Jaime C, Gilmore E, Galappaththi E, Hudson A, Alverio GN, Mach KJ, van Aalst M, Simpson N, Schwerdtle PN, Templeman S, Zommers Z, Ajibade I, Chalkasra LSS, Umunay P, Togola I, Khouzam A, Scarpa G, de Perez EC. Climate change adaptation in conflict-affected countries: A systematic assessment of evidence. Discov Sustain 2021; 2:42. [PMID: 35425913 PMCID: PMC8475313 DOI: 10.1007/s43621-021-00052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/25/2021] [Indexed: 05/22/2023]
Abstract
People affected by conflict are particularly vulnerable to climate shocks and climate change, yet little is known about climate change adaptation in fragile contexts. While climate events are one of the many contributing drivers of conflict, feedback from conflict increases vulnerability, thereby creating conditions for a vicious cycle of conflict. In this study, we carry out a systematic review of peer-reviewed literature, taking from the Global Adaptation Mapping Initiative (GAMI) dataset to documenting climate change adaptation occurring in 15 conflict-affected countries and compare the findings with records of climate adaptation finance flows and climate-related disasters in each country. Academic literature is sparse for most conflict-affected countries, and available studies tend to have a narrow focus, particularly on agriculture-related adaptation in rural contexts and adaptation by low-income actors. In contrast, multilateral and bilateral funding for climate change adaptation addresses a greater diversity of adaptation needs, including water systems, humanitarian programming, and urban areas. Even among the conflict-affected countries selected, we find disparity, with several countries being the focus of substantial research and funding, and others seeing little to none. Results indicate that people in conflict-affected contexts are adapting to climate change, but there is a pressing need for diverse scholarship across various sectors that documents a broader range of adaptation types and their results.
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Affiliation(s)
- A. Sitati
- United Nations Office for Disaster Risk Reduction (UNDRR), Geneva, Switzerland
| | - E. Joe
- World Resources Institute, Washington, USA
| | - B. Pentz
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Scarborough, Canada
| | - C. Grayson
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | - C. Jaime
- Faculty of Geo-Information Science and Earth Observation, University of Twente, 7514 AE Enschede, The Netherlands
- Red Cross Red Crescent Climate Centre, The Hague, The Netherlands
| | - E. Gilmore
- Department of International Development, Community and Environment, Clark University, Worcester, MA 01610 USA
| | | | - A. Hudson
- Yale Law School, Yale University, 127 Wall St, New Haven, CT 06511 USA
- Oxford University Centre for the Environment, S Parks Rd, Oxford, OX1 3QY UK
| | - G. Nagle Alverio
- Nicholas School of the Environment at Duke University, Sanford School of Public Policy at Duke University, Duke University School of Law, 9 Circuit Dr, Durham, NC 27701 USA
| | - K. J. Mach
- Department of Environmental Science and Policy, Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL USA
- Leonard and Jayne Abess Center for Ecosystem Science and Policy, University of Miami, Coral Gables, FL USA
| | - M. van Aalst
- Faculty of Geo-Information Science and Earth Observation, University of Twente, 7514 AE Enschede, The Netherlands
- Red Cross Red Crescent Climate Centre, The Hague, The Netherlands
- International Research Institute for Climate and Society, Columbia University, New York, USA
| | - N. Simpson
- African Climate and Development Initiative, University of Cape Town, Cape Town, South Africa
| | - P. Nayna Schwerdtle
- Faculty of Medicine and University Hospital, Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
- Monash Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences. Monash University, Clayton, Australia
| | | | - Z. Zommers
- United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), New York, USA
| | - I. Ajibade
- Department of Geography, Portland State University, 1721 SW Broadway, Portland, OR 97201 USA
| | - L. S. Safaee Chalkasra
- Department of Geography, Environment and Geomatics, University of Ottawa, Simard Hall, Rm 047, Ottawa, ON K1N 6N5 Canada
- International Development Research Centre, 150 Kent St., Ottawa, ON K1P 0B2 Canada
| | - P. Umunay
- Nature for Climate Branch, Ecosystems Division, UNEP, Nairobi, Kenya
- Yale School of Environment, 360 Prospect Street, New Haven, CT 06511 USA
| | | | - A. Khouzam
- International Committee of the Red Cross (ICRC), Geneva, Switzerland
| | | | | | - E. Coughlan de Perez
- Faculty of Geo-Information Science and Earth Observation, University of Twente, 7514 AE Enschede, The Netherlands
- Friedman School of Nutrition Science and Policy, Tufts University, Medford, USA
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17
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Betlem K, Canfarotta F, Raumbault R, Banks CE, Eersels K, van Grinsven B, Cleij TJ, Crapnell R, Hudson A, Peeters M. Thermistors coated with molecularly imprinted nanoparticles for the electrical detection of peptides and proteins. Analyst 2020; 145:5419-5424. [PMID: 32589168 DOI: 10.1039/d0an01046d] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this communication, molecularly imprinted nanoparticles (nanoMIPs) that are produced by solid-phase synthesis are functionalised onto thermistors via dip-coating. These thermistors are soldered onto a printed-circuit board to facilitate electrical detection. Subsequently, these are inserted into a home-made thermal device that can measure the selective binding of biomolecules to the nanoMIP layer via monitoring the thermal resistance (Rth) at the solid-liquid interface. This thermal analysis technique, referred to as the Heat-Transfer Method, has previously been used for detection of proteins with MIP-based binders. While offering the advantages of low-cost and label free analysis, this method is limited by the high noise on the feedback loop and not being commercially available. These disadvantages can be overcome by the use of thermistors, which offer superior temperature sensitivity compared to thermocouples, and its electrical read-out can be easily integrated into portable devices. To our knowledge, this is the first report where MIPs are directly integrated onto thermistors for detection purposes. Measurements were conducted with an epitope of epidermal growth factor receptor (EGFR) and trypsin, where the electrical resistance was correlated to the biomolecule concentration. For both EGFR and trypsin, an enhanced signal to noise ratio for the electrical measurements was observed compared to previous analysis that was based on thermal resistance. The sensitivity of the sensors in buffered solution was in the nanomolar range, which is compatible with physiologically relevant concentrations. Upon exposure of the nanoMIP for EGFR towards pepsin no significant change in the resistance was yielded, establishing the selectivity of the developed sensor platform. Besides the enhanced sensitivity, the use of thermistors will enable miniaturisation of the device and has potential for in vivo measurements since specified electrochemical measurements are compatible with human use. To highlight the versatility of the nanoMIPs, this work should be extended to a set of biomolecules with various structures, with the possibility of extending this to an array format.
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Affiliation(s)
- K Betlem
- Université Libre de Bruxelles, Experimental Soft Matter and Thermal Physics group, Physics division, Campus de Plaine, Boulevard du Triomphe, B-1050, Brussels, Belgium
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18
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Tyminski N, Hudson A, Turner J, Silverman J. A134 RATES OF PARENTERAL NUTRITION-ASSOCIATED CHOLESTASIS/LIVER DISEASE AND GROWTH PRE- AND POST-SMOFLIPID INTRODUCTION IN NEONATES AND INFANTS WITH INTESTINAL FAILURE. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Parenteral nutrition (PN) is essential for survival in infants with intestinal failure (IF). PN-associated cholestasis (PNAC) and liver disease (PNALD) are life-threatening complications of long-term PN use. SMOFlipid (soybean oil, medium-chain triglycerides, olive oil, and fish oil) has recently been approved as an off-label alternative to the conventional soy-based lipid emulsion (Intralipid). It is thought to have anti-cholestatic properties due to its more diverse lipid composition. Due to its’ recent approval in Canada (2013) and the USA (2016), data remains sparse.
Aims
We aim to determine if infants with IF receiving SMOFlipid had significantly lower rates of PNAC and improved growth compared to those receiving Intralipid.
Methods
All patients (≤1 year old at start of PN therapy) who received PN of any duration at two tertiary pediatric hospitals in Edmonton (2010–2018) were identified from the shared pharmacy database. Those with IF who received one type of PN continuously for ≥6 weeks total were included. Individuals with an initial serum conjugated bilirubin >50 µmol/L and/or who had PN interruptions >5 days were excluded. Data on liver parameters, growth, and complications were collected. Non-parametric tests (Mann-Whitney U test for continuous variables and χ2 test for categorical variables) were used to compare PNAC/PNALD (serum conjugated bilirubin >34umol/L during PN) and growth (weight/length/head circumference z-scores) between SMOFlipid and Intralipid.
Results
1777 patients were reviewed; 40 infants (55% male), median age 4 weeks (range 0–48 weeks) at the time of PN initiation, met the inclusion criteria. Reasons for exclusion (n=1737) were receiving PN <6 weeks total (n=1485), duplicate patients (n=154), receiving multiple types of PN with each less than 6 weeks total (n=62), an initial serum conjugated bilirubin >50umol/L (n=21), more than 5 consecutive days off of PN (n=12), and older than 1 year old at time of PN initiation (n=3). Twenty-one patients (53%) received SMOFlipid, 15 (38%) Intralipid, and 4 (10%) Omegaven for ≥6 weeks. The majority (92%) were in an intensive care unit (neonatal or pediatric). No patients were septic when starting PN. Individuals received PN over a median of 7.9 weeks (range 6–27 weeks).
Conclusions
As expected, neonatal onset intestinal failure is rare in Edmonton. In our tertiary pediatric institutions, 2010–2018, SMOFLipid was the predominant lipid choice for infants with intestinal failure, followed by Intralipid. Omegaven was used rarely. This dataset will now allow us to compare the rates of PNAC at six weeks post-PN initiation and differences in growth between infants with IF receiving SMOFlipid versus the traditional Intralipid in our Canadian setting. Analysis is currently underway.
Funding Agencies
Women and Children’s Health Research Institute (WCHRI) at the University of Alberta
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Affiliation(s)
- N Tyminski
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - A Hudson
- Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - J Turner
- Stollery Children’s Hospital, Edmonton, AB, Canada
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Coote J, Tang C, Salem A, Bayman N, Chan C, Cobben D, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Sheikh H, Woolf D. Outcomes of curative-intent radiotherapy in patients with severe COPD or lung fibrosis. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Itchins M, Hayes S, Hudson A, Howell V, Tan S, Clarke S, Solomon B, Pavlakis N. P2.01-11 ALKternate: A Proof of Concept Study in ALK-Rearranged NSCLC Alternating Lorlatinib with Crizotinib After Disease Progression. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Itchins M, Hudson A, Hayes S, Harvie R, Wei G, Buckland M, Clarke S, Howell V, Pavlakis N. P1.01-129 Preclinical Genetic Evaluation of Alternating ALK TKI Therapy Versus Continuous Dosing in ALK NSCLC to Inform the ALKternate Clinical Trial. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Hudson A, Brown S, Chalmers A, Dive C, Franks K, Hanna G, Hannaway N, Harrow S, Haswell T, Hiley C, Hinsley S, Krebs M, Murden G, Reed S, Ryan A, Sebag-Montefiore D, Shaw P, Smith A, Walls G, Young R, Faivre-Finn C, Greystoke A. P2.01-08 Clinical Trial in Progress: CONCORDE - A Phase 1B Study of Novel Agents in Combination with Conventional Radiotherapy in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Itchins M, Hudson A, Harvie R, Zaw T, Mckay M, Clarke S, Howell V, Pavlakis N, Hayes S. P1.01-24 Preclinical Proteomic Evaluation of Alternating ALK TKI Therapy Versus Continuous Dosing in ALK NSCLC to Inform the ALKternate Clinical Trial. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Behrouzi R, Bayman N, Harris M, Salem A, Hudson A, Chan C, Faivre-Finn C, Cobben D, Sheikh H, Coote J, Pemberton L, Woolf D. P2.17-02 Survival in Performance Status 3 Non-Small Cell Lung Cancer Patients Receiving Radical Radiotherapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Okala S, Doughty J, Watt RG, Santella AJ, Conway DI, Crenna-Jennings W, Mbewe R, Morton J, Lut I, Thorley L, Benton L, Hibbert M, Jefferies JMC, Kunda C, Morris S, Osborne K, Patterson H, Sharp L, Valiotis G, Hudson A, Delpech V. The People Living with HIV STIGMASurvey UK 2015: Stigmatising experiences and dental care. Br Dent J 2019; 225:143-150. [PMID: 30050184 DOI: 10.1038/sj.bdj.2018.530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 12/27/2022]
Affiliation(s)
- S Okala
- Family Planning Association, London, UK.,Public Health England, London, UK
| | - J Doughty
- Research Department of Epidemiology & Public Health, University College London
| | - R G Watt
- Research Department of Epidemiology & Public Health, University College London
| | | | - D I Conway
- School of Medicine, Dentistry, and Nursing, University of Glasgow
| | | | - R Mbewe
- The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK
| | - J Morton
- The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK.,European AIDS Treatment Group (EATG)
| | - I Lut
- Family Planning Association, London, UK
| | - L Thorley
- Family Planning Association, London, UK.,The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK
| | - L Benton
- Family Planning Association, London, UK
| | | | | | - C Kunda
- The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK
| | - S Morris
- European AIDS Treatment Group (EATG)
| | - K Osborne
- The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK.,The International AIDS Society (IAS)
| | - H Patterson
- School of Medicine, Dentistry, and Nursing, University of Glasgow
| | - L Sharp
- Family Planning Association, London, UK.,School of Medicine, Dentistry, and Nursing, University of Glasgow
| | | | - A Hudson
- Family Planning Association, London, UK.,The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK
| | - V Delpech
- Public Health England, London, UK.,The People Living with HIV Stigma Index UK 2015 Advisory Group, London, UK
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Ogunsanya M, Cho S, Hudson A, Chong B. CLEQoL 的验证和可靠性. Br J Dermatol 2019. [DOI: 10.1111/bjd.17967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Ogunsanya M, Cho S, Hudson A, Chong B. Validation and reliability of CLEQoL. Br J Dermatol 2019. [DOI: 10.1111/bjd.17950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ogunsanya ME, Cho SK, Hudson A, Chong BF. Validation and reliability of a disease-specific quality-of-life measure in patients with cutaneous lupus erythematosus. Br J Dermatol 2019; 180:1430-1437. [PMID: 30637718 DOI: 10.1111/bjd.17636] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cutaneous lupus erythematosus (CLE) is a potentially disfiguring, chronic autoimmune disease with variable skin manifestations, negatively affecting patients' quality of life (QoL). Patient-reported outcome (PRO) measures assessing QoL in patients with CLE have been generic or developed without input from patients. OBJECTIVES To demonstrate the reliability and validity of a disease-specific QoL measure for CLE - the cutaneous lupus erythematosus quality of life (CLEQoL). METHODS One hundred and one patients with CLE were recruited, and each patient was asked to complete the CLEQoL. Internal consistency was used as a measure of reliability. Validity was measured in two ways - structural validity via exploratory factor analysis and convergent validity via Spearman correlations between CLEQoL and the Short Form 36 (SF-36), visual analogue scales and clinical variables. Patient demographic and disease characteristics were collected. RESULTS The mean ± SD age of patients with CLE was 48 ± 13 years, with discoid lupus (n = 72; 71.3%) being the most predominant CLE subtype. Patients were mostly female (n = 88; 87·1%) and African American/Black (n = 59; 58·4%). Internal consistency ranged from 0·67 to 0·97. Five domains (functioning, emotions, symptoms, body image/cosmetic effects and photosensitivity) were extracted with a total explained variance of 71·1%. CLEQoL-related domains correlated with SF-36 domains (r range -0·39 to -0·65). CONCLUSIONS The CLEQoL was found to be a valid and reliable PRO measure for assessing QoL in patients with CLE. Demonstrating that the CLEQoL has strong psychometric properties is an important step towards the development of a disease-specific PRO measure that future clinical trials can use.
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Affiliation(s)
- M E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73117, U.S.A
| | - S K Cho
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
| | - A Hudson
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
| | - B F Chong
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, U.S.A
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Gadallah B, Hudson A, Egan J, Nolke L, Redmond K. Sequential Single Lung Transplant (SLT) with or without Ex-Vivo Lung Perfusion Maximizes on Donor to Transplant Conversion Rates. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lewis T, Kennedy J, Price G, Mee T, Kirkby K, Kirkby N, Woolf D, Bayman N, Chan C, Coote J, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Salem A, Sheikh H, Mistry H, Cobben D. PO-0775 Palliative lung radiotherapy: audit of prescribing practice and survival analysis. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31195-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lewis T, Kennedy J, Price G, Mee T, Woolf D, Bayman N, Chan C, Coote J, Faivre-Finn C, Harris M, Hudson A, Pemberton L, Salem A, Sheikh H, Mistry H, Cobben D. Palliative lung radiotherapy at the Christie: audit of prescribing practice and survival analysis. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McKelvey K, Hudson A, Wheeler H, Diakos C, Howell V. P04.18 Unravelling the tumour microenvironment of glioma. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K McKelvey
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Mark Hughes Foundation, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - A Hudson
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
| | - H Wheeler
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - C Diakos
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - V Howell
- Bill Walsh Translational Cancer Laboratory, The University of Sydney Northern Clinical School, Faculty of Health and Medicine; Northern Sydney Local Heath District Research (Kolling Institute); Sydney Vital Translational Research Centre, St Leonards, Australia
- The Brain Cancer Group, North Shore Private Hospital, St Leonards, Australia
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Hibbert M, Crenna-Jennings W, Kirwan P, Benton L, Lut I, Okala S, Asboe D, Jeffries J, Kunda C, Mbewe R, Morris S, Morton J, Nelson M, Thorley L, Paterson H, Ross M, Reeves I, Sharp L, Sseruma W, Valiotis G, Wolton A, Jamal Z, Hudson A, Delpech V. The people living with HIV stigma survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay and heterosexual men. AIDS Care 2018; 30:1189-1196. [PMID: 29806466 DOI: 10.1080/09540121.2018.1479027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
We aim to understand the difference in stigma and discrimination, in particular sexual rejection, experienced between gay and heterosexual men living with HIV in the UK. The People Living with HIV StigmaSurvey UK 2015 recruited a convenience sample of persons with HIV through over 120 cross sector community organisations and 46 HIV clinics to complete an online survey. 1162 men completed the survey, 969 (83%) gay men and 193 (17%) heterosexual men, 92% were on antiretroviral therapy. Compared to heterosexual men, gay men were significantly more likely to report worrying about workplace treatment in relation to their HIV (21% vs. 11%), worrying about HIV-related sexual rejection (42% vs 21%), avoiding sex because of their HIV status (37% vs. 23%), and experiencing HIV-related sexual rejection (27% vs. 9%) in the past 12 months. In a multivariate logistic regression controlling for other sociodemographic factors, being gay was a predictor of reporting HIV-related sexual rejection in the past 12 months (aOR 2.17, CI 1.16, 4.02). Both gay and heterosexual men living with HIV experienced stigma and discrimination in the past 12 months, and this was higher for gay men in terms of HIV-related sexual rejection. Due to the high proportion of men reporting sexual rejection, greater awareness and education of the low risk of transmission of HIV among people on effective treatment is needed to reduce stigma and sexual prejudice towards people living with HIV.
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Affiliation(s)
- M Hibbert
- a HIV & STI Department, Public Health England , London , UK
| | | | - P Kirwan
- a HIV & STI Department, Public Health England , London , UK
| | | | - I Lut
- b StigmaIndexUK , London , UK
| | - S Okala
- a HIV & STI Department, Public Health England , London , UK.,b StigmaIndexUK , London , UK
| | - D Asboe
- c British HIV Association , London , UK.,d Positively UK , London , UK
| | - J Jeffries
- a HIV & STI Department, Public Health England , London , UK
| | - C Kunda
- b StigmaIndexUK , London , UK
| | - R Mbewe
- b StigmaIndexUK , London , UK.,d Positively UK , London , UK
| | | | - J Morton
- b StigmaIndexUK , London , UK.,e Terrence Higgins Trust , London , UK
| | - M Nelson
- f Chelsea & Westminster Hospital , London , UK
| | | | | | - M Ross
- c British HIV Association , London , UK.,h CliniQ , London , UK
| | - I Reeves
- i Homerton University Hospital , London , UK
| | - L Sharp
- g University of Glasgow , Glasgow , UK
| | - W Sseruma
- b StigmaIndexUK , London , UK.,j NAZ, London , London , UK
| | - G Valiotis
- b StigmaIndexUK , London , UK.,k HIV Scotland , Edinburgh , UK
| | - A Wolton
- b StigmaIndexUK , London , UK.,f Chelsea & Westminster Hospital , London , UK.,h CliniQ , London , UK
| | | | | | - V Delpech
- a HIV & STI Department, Public Health England , London , UK
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Le Pen L, Watson G, Hudson A, Powrie W. Behaviour of under sleeper pads at switches and crossings - Field measurements. Proc Inst Mech Eng F J Rail Rapid Transit 2018; 232:1049-1063. [PMID: 30662165 PMCID: PMC6319517 DOI: 10.1177/0954409717707400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 03/26/2017] [Indexed: 06/09/2023]
Abstract
Major growth in rail traffic in many parts of the world in recent years has brought railway networks close to capacity and restricted the time available for track access to carry out maintenance work without costly temporary route closures. There are, therefore, significant benefits in designing or modifying ballasted track systems to reduce maintenance and associated access requirements. Under sleeper pads (USPs) offer the potential to extend ballasted track system life and to extend the intervals between routine maintenance. This paper presents and evaluates field measurements, made using geophones and high speed filming with digital image correlation (DIC), of the performance of a renewed section of track incorporating two switches and crossings (S&C) over a period of two years. One S&C was fitted with two types of USP (categorised as medium and soft), while the other had no USPs and acted as a control. Measurements demonstrate that the bearers with USPs fitted showed less variability in movement than bearers without USPs fitted. The provision of soft USPs caused large increases (>40%) in vertical bearer movements relative to bearers without USPs, although the medium USPs showed little difference. Increased movements of elongated bearers supporting both tracks fitted with soft USPs led to increased bearer rotations towards the loaded track. This effect was aided by the rigid steel collar fixing in the middle of the bearer used in this design of S&C, and raises questions concerning the desirability of this feature. DIC measurements showed that the at rest position of the elongated bearers rotated towards the track on which a train had most recently passed.
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Affiliation(s)
- Louis Le Pen
- Louis Le Pen, University of Southampton, University Road, Highfield, Southampton SO17 1BJ, UK.
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Hudson A. SP-0114: Circulating tumour cell (CTC) analysis in radiotherapy patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hibbert M, Wolton A, Crenna-Jennings W, Benton L, Kirwan P, Lut I, Okala S, Ross M, Furegato M, Nambiar K, Douglas N, Roche J, Jeffries J, Reeves I, Nelson M, Weerawardhana C, Jamal Z, Hudson A, Delpech V. Experiences of stigma and discrimination in social and healthcare settings among trans people living with HIV in the UK. AIDS Care 2018; 30:836-843. [PMID: 29409344 DOI: 10.1080/09540121.2018.1436687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The People Living with HIV StigmaSurvey UK 2015 was a community led national survey investigating experiences of people living with HIV in the UK in the past 12 months. Participants aged 18 and over were recruited through over 120 cross-sector community organisations and 46 HIV clinics to complete an anonymous online survey. Trans is an umbrella term which refers to individuals whose current gender identity is different to the gender they were assigned at birth. Trans participants self-identified via gender identity and gender at birth questions. Descriptive analyses of reported experiences in social and health care settings were conducted and multivariate logistic regression analyses were used to identify sociodemographic predictors of reporting being treated differently to non-HIV patients, and being delayed or refused healthcare treatment in the past 12 months. 31 out of 1576 participants (2%) identified as trans (19 trans women, 5 trans men, 2 gender queer/non-binary, 5 other). High levels of social stigma were reported for all participants, with trans participants significantly more likely to report worrying about verbal harassment (39% vs. 23%), and exclusion from family gatherings (23% vs. 9%) in the last 12 months, compared to cisgender participants. Furthermore, 10% of trans participants reported physical assault in the last 12 months, compared to 4% of cisgender participants. Identifying as trans was a predictor of reporting being treated differently to non-HIV patients (48% vs. 30%; aOR 2.61, CI 1.06, 6.42) and being delayed or refused healthcare (41% vs. 16%; aOR 4.58, CI 1.83, 11.44). Trans people living with HIV in the UK experience high levels of stigma and discrimination, including within healthcare settings, which is likely to impact upon health outcomes. Trans-specific education and awareness within healthcare settings could help to improve service provision for this demographic.
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Affiliation(s)
- M Hibbert
- a HIV & STI Department , Public Health England , London , UK
| | - A Wolton
- b StigmaIndexUK, FPA , London , UK.,c CliniQ , London , UK.,d Chelsea & Westminster Hospital , London , UK
| | | | | | - P Kirwan
- a HIV & STI Department , Public Health England , London , UK
| | | | - S Okala
- a HIV & STI Department , Public Health England , London , UK
| | - M Ross
- b StigmaIndexUK, FPA , London , UK.,c CliniQ , London , UK
| | - M Furegato
- a HIV & STI Department , Public Health England , London , UK
| | - K Nambiar
- f Brighton and Sussex University NHS Trust , Brighton , UK
| | - N Douglas
- g Policy Innovation Research Unit , London School of Hygiene and Tropical Medicine , London , UK
| | | | | | - I Reeves
- h Homerton University Hospital , London , UK
| | - M Nelson
- d Chelsea & Westminster Hospital , London , UK
| | | | | | - A Hudson
- b StigmaIndexUK, FPA , London , UK.,e FPA , London , UK
| | - V Delpech
- a HIV & STI Department , Public Health England , London , UK
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Hudson A, Bryce H, Molokhia A, Reece-Anthony R, Law T. Improved physiotherapy outcome measures by the use of cycle ergometry in critical care. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Gupta A, Ayub M, Miller C, Rothwell D, Wallace A, Jordan A, Cook N, Thistlethwaite F, Carter L, O’Brien C, Aruketty S, Dean E, Hudson A, Frese K, Dransfield J, Hughes A, Marais R, Dive C, Brady G, Krebs M. Development of the Manchester Cancer Research Centre Molecular Tumour Board for matching patients to clinical trials based on tumour and ctDNA genetic profiling. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hudson A, Gough K, Yi S, Stiles M, Davis MacNevin P, Stewart SH. Examining the effects of gambling-relevant cues on gambling outcome expectancies. International Gambling Studies 2017. [DOI: 10.1080/14459795.2017.1324893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A. Hudson
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - K. Gough
- Department of Marketing & Consumer Studies, University of Guelph, Guelph, Canada
| | - S. Yi
- Department of Marketing & Consumer Studies, University of Guelph, Guelph, Canada
| | - M. Stiles
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - P. Davis MacNevin
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
| | - S. H. Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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Hudson A, Stratton K, Hatchette J, Blake K. DEVELOPMENT OF A NEW FEEDING SCALE FOR USE IN CHARGE SYNDROME AND IMPLICATIONS FOR ITS USE IN AUTISM AND OTHER GENETIC CONDITIONS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rob D, Špunda R, Lindner J, Šmalcová J, Šmíd O, Kovárník T, Linhart A, Bìlohlávek J, Marinoni MM, Cianchi G, Trapani S, Migliaccio ML, Gucci L, Bonizzoli M, Cramaro A, Cozzolino M, Valente S, Peris A, Grins E, Kort E, Weiland M, Shresta NM, Davidson P, Algotsson L, Fitch S, Marco G, Sturgill J, Lee S, Dickinson M, Boeve T, Khaghani A, Wilton P, Jovinge S, Ahmad AN, Loveridge R, Vlachos S, Patel S, Gelandt E, Morgan L, Butt S, Whitehorne M, Kakar V, Park C, Hayes M, Willars C, Hurst T, Best T, Vercueil A, Auzinger G, Adibelli B, Akovali N, Torgay A, Zeyneloglu P, Pirat A, Kayhan Z, Schmidbauer SS, Herlitz J, Karlsson T, Friberg H, Knafelj R, Radsel P, Duprez F, Bonus T, Cuvelier G, Mashayekhi S, Maka M, Ollieuz S, Reychler G, Mosaddegh R, Abbasi S, Talaee S, Zotzmann VZ, Staudacher DS, Wengenmayer TW, Dürschmied DD, Bode CB, Nelskylä A, Nurmi J, Jousi M, Schramko A, Mervaala E, Ristagno G, Skrifvars M, Ozsoy G, Kendirli T, Azapagasi E, Perk O, Gadirova U, Ozcinar E, Cakici M, Baran C, Durdu S, Uysalel A, Dogan M, Ramoglu M, Ucar T, Tutar E, Atalay S, Akar R, Kamps M, Leeuwerink G, Hofmeijer J, Hoiting O, Van der Hoeven J, Hoedemaekers C, Konkayev A, Kuklin V, Kondratyev T, Konkayeva M, Akhatov N, Sovershaev M, Tveita T, Dahl V, Wihersaari L, Skrifvars MB, Bendel S, Kaukonen KM, Vaahersalo J, Romppanen J, Pettilä V, Reinikainen M, Lybeck A, Cronberg T, Nielsen N, Friberg H, Rauber M, Steblovnik K, Jazbec A, Noc M, Kalasbail P, Garrett F, Kulstad E, Bergström DJ, Olsson HR, Schmidbauer S, Friberg H, Mandel I, Mikheev S, Podoxenov Y, Suhodolo I, Podoxenov A, Svirko J, Sementsov A, Maslov L, Shipulin V, Vammen LV, Rahbek SR, Secher NS, Povlsen JP, Jessen NJ, Løfgren BL, Granfeldt AG, Grossestreuer A, Perman S, Patel P, Ganley S, Portmann J, Cocchi M, Donnino M, Nassar Y, Fathy S, Gaber A, Mokhtar S, Chia YC, Lewis-Cuthbertson R, Mustafa K, Sabra A, Evans A, Bennett P, Eertmans W, Genbrugge C, Boer W, Dens J, De Deyne C, Jans F, Skorko A, Thomas M, Casadio M, Coppo A, Vargiolu A, Villa J, Rota M, Avalli L, Citerio G, Moon JB, Cho JH, Park CW, Ohk TG, Shin MC, Won MH, Papamichalis P, Zisopoulou V, Dardiotis E, Karagiannis S, Papadopoulos D, Zafeiridis T, Babalis D, Skoura A, Staikos I, Komnos A, Passos SS, Maeda F, Souza LS, Filho AA, Granjeia TAG, Schweller M, Franci D, De Carvalho Filho M, Santos TM, De Azevedo P, Wall R, Welters I, Tansuwannarat P, Sanguanwit P, Langer T, Carbonara M, Caccioppola A, Fusarini CF, Carlesso E, Paradiso E, Battistini M, Cattaneo E, Zadek F, Maiavacca R, Stocchetti N, Pesenti A, Ramos A, Acharta F, Toledo J, Perezlindo M, Lovesio L, Dogliotti A, Lovesio C, Schroten N, Van der Veen B, De Vries MC, Veenstra J, Abulhasan YB, Rachel S, Châtillon-Angle M, Alabdulraheem N, Schiller I, Dendukuri N, Angle M, Frenette C, Lahiri S, Schlick K, Mayer SA, Lyden P, Akatsuka M, Arakawa J, Yamakage M, Rubio J, Mateo-Sidron JAR, Sierra R, Celaya M, Benitez L, Alvarez-Ossorio S, Rubio J, Mateo-Sidron JAR, Sierra R, Fernandez A, Gonzalez O, Engquist H, Rostami E, Enblad P, Toledo J, Ramos A, Acharta F, Canullo L, Nallino J, Dogliotti A, Lovesio C, Perreault M, Talic J, Frenette AJ, Burry L, Bernard F, Williamson DR, Adukauskiene D, Cyziute J, Adukauskaite A, Malciene L, Luca L, Rogobete A, Bedreag O, Papurica M, Sarandan M, Cradigati C, Popovici S, Vernic C, Sandesc D, Avakov V, Shakhova I, Trimmel H, Majdan M, Herzer GH, Sokoloff CS, Albert M, Williamson D, Odier C, Giguère J, Charbonney E, Bernard F, Husti Z, Kaptás T, Fülep Z, Gaál Z, Tusa M, Donnelly J, Aries M, Czosnyka M, Robba C, Liu M, Ercole A, Menon D, Hutchinson P, Smielewski P, López R, Graf J, Montes JM, Kenawi M, Kandil A, Husein K, Samir A, Heijneman J, Huijben J, Abid-Ali F, Stolk M, Van Bommel J, Lingsma H, Van der Jagt M, Cihlar RC, Mancino G, Bertini P, Forfori F, Guarracino F, Pavelescu D, Grintescu I, Mirea L, Alamri S, Tharwat M, Kono N, Okamoto H, Uchino H, Ikegami T, Fukuoka T, Simoes M, Trigo E, Coutinho P, Pimentel J, Franci A, Basagni D, Boddi M, Cozzolino M, Anichini V, Cecchi A, Peris A, Markopoulou D, Venetsanou K, Papanikolaou I, Barkouri T, Chroni D, Alamanos I, Cingolani E, Bocci MG, Pisapia L, Tersali A, Cutuli SL, Fiore V, Palma A, Nardi G, Antonelli M, Coke R, Kwong A, Dwivedi DJ, Xu M, McDonald E, Marshall JC, Fox-Robichaud AE, Charbonney E, Liaw PC, Kuchynska I, Malysh IR, Zgrzheblovska LV, Mestdagh L, Verhoeven EF, Hubloue I, Ruel-laliberte J, Zarychanski R, Lauzier F, Bonaventure PL, Green R, Griesdale D, Fowler R, Kramer A, Zygun D, Walsh T, Stanworth S, Léger C, Turgeon AF, Baron DM, Baron-Stefaniak J, Leitner GC, Ullrich R, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Tarabrin O, Mazurenko A, Potapchuk Y, Sazhyn D, Tarabrin P, Pérez AG, Silva J, Artemenko V, Bugaev A, Tokar I, Konashevskaya S, Kolesnikova IM, Roitman EV, Kiss TR, Máthé Z, Piros L, Dinya E, Tihanyi E, Smudla A, Fazakas J, Ubbink R, Boekhorst te P, Mik E, Caneva L, Ticozzelli G, Pirrelli S, Passador D, Riccardi F, Ferrari F, Roldi EM, Di Matteo M, Bianchi I, Iotti GA, Zurauskaite G, Voegeli A, Meier M, Koch D, Haubitz S, Kutz A, Bargetzi M, Mueller B, Schuetz P, Von Meijenfeldt G, Van der Laan M, Zeebregts C, Christopher KB, Vernikos P, Melissopoulou T, Kanellopoulou G, Panoutsopoulou M, Xanthis D, Kolovou K, Kypraiou T, Floros J, Broady H, Pritchett C, Marshman M, Jannaway N, Ralph C, Lehane CL, Keyl CK, Zimmer EZ, Trenk DT, Ducloy-Bouthors AS, Jonard MJ, Fourrier F, Piza F, Correa T, Marra A, Guerra J, Rodrigues R, Vilarinho A, Aranda V, Shiramizo S, Lima MR, Kallas E, Cavalcanti AB, Donoso M, Vargas P, Graf J, McCartney J, Ramsay S, McDowall K, Novitzky-Basso I, Wright C, Medic MG, Bielen L, Radonic V, Zlopasa O, Vrdoljak NG, Gasparovic V, Radonic R, Narváez G, Cabestrero D, Rey L, Aroca M, Gallego S, Higuera J, De Pablo R, González LR, Chávez GN, Lucas JH, Alonso DC, Ruiz MA, Valarezo LJ, De Pablo Sánchez R, Real AQ, Wigmore TW, Bendavid I, Cohen J, Avisar I, Serov I, Kagan I, Singer P, Hanison J, Mirza U, Conway D, Takasu A, Tanaka H, Otani N, Ohde S, Ishimatsu S, Coffey F, Dissmann P, Mirza K, Lomax M, Dissmann P, Coffey F, Mirza K, Lomax M, Miner JR, Leto R, Markota AM, Gradišek PG, Aleksejev VA, Sinkovič AS, Romagnoli S, Chelazzi C, Zagli G, Benvenuti F, Mancinelli P, Boninsegni P, Paparella L, Bos AT, Thomas O, Goslar T, Knafelj R, Perreault M, Martone A, Sandu PR, Rosu VA, Capilnean A, Murgoi P, Frenette AJ, Lecavalier A, Jayaraman D, Rico P, Bellemare P, Gelinas C, Williamson D, Nishida T, Kinoshita T, Iwata N, Yamakawa K, Fujimi S, Maggi L, Sposato F, Citterio G, Bonarrigo C, Rocco M, Zani V, De Blasi RA, Alcorn D, Barry L, Riedijk MA, Milstein DM, Caldas J, Panerai R, Camara L, Ferreira G, Bor-Seng-Shu E, Lima M, Galas F, Mian N, Nogueira R, de Oliveira GQ, Almeida J, Jardim J, Robinson TG, Gaioto F, Hajjar LA, Zabolotskikh I, Musaeva T, Saasouh W, Freeman J, Turan A, Saseedharan S, Pathrose E, Poojary S, Messika J, Martin Y, Maquigneau N, Henry-Lagarrigue M, Puechberty C, Stoclin A, Martin-Lefevre L, Blot F, Dreyfuss D, Dechanet A, Hajage D, Ricard J, Almeida E, Almeida J, Landoni G, Galas F, Fukushima J, Fominskiy E, De Brito C, Cavichio L, Almeida L, Ribeiro U, Osawa E, Boltes R, Battistella L, Hajjar L, Fontela P, Lisboa T, Junior LF, Friedman GF, Abruzzi F, Primo JAP, Filho PM, de Andrade JS, Brenner KM, boeira MS, Leães C, Rodrigues C, Vessozi A, Machado AS, Weiler M, Bryce H, Hudson A, Law T, Reece-Anthony R, Molokhia A, Abtahinezhadmoghaddam F, Cumber E, Channon L, Wong A, Groome R, Gearon D, Varley J, Wilson A, Reading J, Wong A, Zampieri FG, Bozza FA, Ferez M, Fernandes H, Japiassú A, Verdeal J, Carvalho AC, Knibel M, Salluh JI, Soares M, Gao J, Ahmadnia E, Patel B, McCartney J, MacKay A, Binning S, Wright C, Pugh RJ, Battle C, Hancock C, Harrison W, Szakmany T, Mulders F, Vandenbrande J, Dubois J, Stessel B, Siborgs K, Ramaekers D, Soares M, Silva UV, Homena WS, Fernandes GC, Moraes AP, Brauer L, Lima MF, De Marco F, Bozza FA, Salluh JI, Maric N, Mackovic M, Udiljak N, Bosso CE, Caetano RD, Cardoso AP, Souza OA, Pena R, Mescolotte MM, Souza IA, Mescolotte GM, Bangalore H, Borrows E, Barnes D, Ferreira V, Azevedo L, Alencar G, Andrade A, Bierrenbach A, Buoninsegni LT, Bonizzoli M, Cecci L, Cozzolino M, Peris A, Lindskog J, Rowland K, Sturgess P, Ankuli A, Molokhia A, Rosa R, Tonietto T, Ascoli A, Madeira L, Rutzen W, Falavigna M, Robinson C, Salluh J, Cavalcanti A, Azevedo L, Cremonese R, Da Silva D, Dornelles A, Skrobik Y, Teles J, Ribeiro T, Eugênio C, Teixeira C, Zarei M, Hashemizadeh H, Eriksson M, Strandberg G, Lipcsey M, Larsson A, Lignos M, Crissanthopoulou E, Flevari K, Dimopoulos P, Armaganidis A, Golub JG, Markota AM, Stožer AS, Sinkovič AS, Rüddel H, Ehrlich C, Burghold CM, Hohenstein C, Winning J, Sellami W, Hajjej Z, Bousselmi M, Gharsallah H, Labbene I, Ferjani M, Sattler J, Steinbrunner D, Poppert H, Schneider G, Blobner M, Kanz KG, Schaller SJ, Apap K, Xuereb G, Xuereb G, Apap K, Massa L, Xuereb G, Apap K, Massa L, Delvau N, Penaloza A, Liistro G, Thys F, Delattre IK, Hantson P, Roy PM, Gianello P, Hadîrcă L, Ghidirimschi A, Catanoi N, Scurtov N, Bagrinovschi M, Sohn YS, Cho YC, Golovin B, Creciun O, Ghidirimschi A, Bagrinovschi M, Tabbara R, Whitgift JZ, Ishimaru A, Yaguchi A, Akiduki N, Namiki M, Takeda M, Tamminen JN, Reinikainen M, Uusaro A, Taylor CG, Mills ED, Mackay AD, Ponzoni C, Rabello R, Serpa A, Assunção M, Pardini A, Shettino G, Corrêa T, Vidal-Cortés PV, Álvarez-Rocha L, Fernández-Ugidos P, Virgós-Pedreira A, Pérez-Veloso MA, Suárez-Paul IM, Del Río-Carbajo L, Fernández SP, Castro-Iglesias A, Butt A, Alghabban AA, Khurshid SK, Ali ZA, Nizami IN, Salahuddin NS, Alshahrani M, Alsubaie AW, Alshamsy AS, Alkhiliwi BA, Alshammari HK, Alshammari MB, Telmesani NK, Alshammari RB, Asonto LP, Zampieri FG, Damiani LP, Bozza F, Salluh JI, Cavalcanti AB, El Khattate A, Bizrane M, Madani N, Belayachi J, Abouqal R, Ramnarain D, Gouw-Donders B, Benstoem C, Moza A, Meybohm P, Stoppe C, Autschbach R, Devane D, Goetzenich A, Taniguchi LU, Araujo L, Salgado G, Vieira JM, Viana J, Ziviani N, Pessach I, Lipsky A, Nimrod A, O´Connor M, Matot I, Segal E, Kluzik A, Gradys A, Smuszkiewicz P, Trojanowska I, Cybulski M, De Jong A, Sebbane M, Chanques G, Jaber S, Rosa R, Robinson C, Bessel M, Cavalheiro L, Madeira L, Rutzen W, Oliveira R, Maccari J, Falavigna M, Sanchez E, Dutra F, Dietrich C, Balzano P, Rezende J, Teixeira C, Sinha S, Majhi K, Gorlicki JG, Pousset FP, Kelly J, Aron J, Gilbert AC, Urankar NP, Knafelj R, Irazabal M, Bosque M, Manciño J, Kotsopoulos A, Jansen N, Abdo W, Casey ÚM, O’Brien B, Plant R, Doyle B. 37th International Symposium on Intensive Care and Emergency Medicine (part 2 of 3). Crit Care 2017. [PMCID: PMC5374552 DOI: 10.1186/s13054-017-1630-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hudson A, Macdonald M, Friedman J, Blake K. CHARGE syndrome gastrointestinal involvement: from mouth to anus. Clin Genet 2017; 92:10-17. [DOI: 10.1111/cge.12892] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/01/2016] [Accepted: 10/02/2016] [Indexed: 11/29/2022]
Affiliation(s)
- A. Hudson
- Dalhousie Medical School; Halifax Canada
| | | | - J.N. Friedman
- Department of Pediatrics; The Hospital for Sick Children, University of Toronto; Toronto Canada
| | - K. Blake
- Division of Medical Education; Dalhousie University Faculty of Medicine; Halifax Canada
- Department of Pediatrics; IWK Health Centre; Halifax Canada
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Hudson A, Macdonald M, Cloney K, Steele S, Berman J, Blake K, Stoyek M, Croll R, Smith F. Feeding Difficulties and Gastrointestinal Tract Morphology and Innervation in ‘Charge’ Syndrome. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e72b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: CHARGE syndrome has been linked to mutations in the CHD7 gene and results in a number of physiological and structural abnormalities. The estimated incidence in the Atlantic Provinces is 1 in 8500 births. Challenges include eating problems, which have a profound impact throughout a child’s life and can lead to complications and even death.
OBJECTIVES: To investigate feeding difficulties and model the morphology and innervation of the gastrointestinal tract in CHARGE syndrome.
DESIGN/METHODS: Three research studies (two clinical, one basic science) were conducted to assess feeding difficulties in CHARGE syndrome. The first study conducted a qualitative analysis of parent interviews to understand packing and problematic feeding behaviors. The second study investigated general eating and GI motility problems by having parents complete a series of feeding questionnaires. The third study modeled CHARGE syndrome in zebrafish by using a morpholino to knock down the expression of CHD7.
RESULTS: Study 1: Twenty parents completed a phone interview, describing their child/adult’s (2-32 years) adverse feeding behaviors. Parents reported food packing most commonly with bread and pasta (33%), and reported that food was held in cheeks for hours after a meal had ended (35%). Packing was reported to prolong mealtimes for over an hour (30%). Parents were worried about choking during eating (30%).Study 2: Sixty-nine parents of children (age 1-18 years) completed the questionnaires. Those who were tube fed had significantly more gastrointestinal symptoms (stomach pain, nausea, etc.) and worse feeding difficulties than those who were orally fed. The CHARGE characteristics of choanal atre-sia/stenosis and cranial nerve IX/X dysfunction were associated with significantly more gastrointestinal symptoms. Parents identified constipation as a major challenge. Study 3: Immunohistochemistry demonstrated changes in the enteric innervation of the gastrointestinal tract in the CHARGE syndrome zebrafish models. There was decreased branching of the gastrointestinal nerve network surrounding the stomach. Use of fluorescent microbeads demonstrated reduced motility and delayed passage of the microbeads through the gastrointestinal tract.
CONCLUSION: These three studies provided a comprehensive analysis of feeding and gastrointestinal difficulties, from mouth to anus, in CHARGE syndrome. They provide a deeper understanding of adverse feeding behaviors, feeding difficulties, and the abnormal morphology of the gastrointestinal system. The information from this study can be useful for general pediatricians and feeding therapy teams who are involved in the care of these individuals starting in infancy. The team-based approach of conducting multiple research projects investigating a common issue may be useful in other genetic disorders.
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Brown D, Court L, Hudson A, Odom A, Pipman Y. SU-F-P-02: A New Framework for the Equipment Donation Program. Med Phys 2016. [DOI: 10.1118/1.4955709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Krishnan N, Higgins R, Short A, Zehnder D, Pitcher D, Hudson A, Raymond NT. Kidney Transplantation Significantly Improves Patient and Graft Survival Irrespective of BMI: A Cohort Study. Am J Transplant 2015; 15:2378-86. [PMID: 26147285 DOI: 10.1111/ajt.13363] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/18/2015] [Accepted: 03/07/2015] [Indexed: 01/25/2023]
Abstract
Obesity and end-stage renal disease (ESRD) are on the increase worldwide. Kidney transplantation is the treatment of choice for ESRD. However, obesity is considered a contraindication for transplantation. We investigated the effect of BMI on mortality in transplanted and patients remaining on the waiting list in the United Kingdom. We analyzed the UK Renal Registry (RR) and the National Health Service Blood and Transplant (NHSBT) Organ Donation and Transplantation data for patients listed from January 1, 2004 to December 31, 2010, with follow-up until December 31, 2011. Seventeen thousand six hundred eighty-one patients were listed during the study period, with BMI recorded for 13 526 (77%). One- and five-year patient survival was significantly better in all BMI bands (<18.5, 18.5-<25, 25-<30, 30-<35, 35-<40, and 40+kg/m(2) ) in the transplant group when compared to those who remained on the waiting list (p < 0.0001). The analyses were repeated excluding live donor transplants and the results were essentially the same. On analyses of patient survival with BMI as a continuous variable or using 5 kg weight bands, there was no cut-off observed in the higher BMI patients where there would be no benefit to transplantation. For transplanted patients (N = 8088), there was no difference in patient or graft survival between the defined BMI bands. Thus, irrespective of BMI, patient survival is improved if transplanted.
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Affiliation(s)
- N Krishnan
- Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - R Higgins
- Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A Short
- Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - D Zehnder
- Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - A Hudson
- Organ Donation, NHS Blood and Transplant, Bristol, UK
| | - N T Raymond
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Mason L, Powers E, Hudson A, Seabolt L, Niswender K, Silver H. Intake of Dietary Simple Sugars Contributes to Metabolic Syndrome in Division I College Football Players. J Acad Nutr Diet 2015. [DOI: 10.1016/j.jand.2015.06.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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O’Sullivan K, Byrne JS, Hudson A, Murphy AM, Sadlier D, Hurley JP. 60 Examining the impact of obesity ≥30 kg/m2 on acute kidney injury following cardiac surgery. Heart 2015. [DOI: 10.1136/heartjnl-2015-308621.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hudson A, Bradbury L, Johnson R, Fuggle SV, Shaw JAM, Casey JJ, Friend PJ, Watson CJE. The UK Pancreas Allocation Scheme for Whole Organ and Islet Transplantation. Am J Transplant 2015; 15:2443-55. [PMID: 25943412 DOI: 10.1111/ajt.13284] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/01/2015] [Accepted: 02/23/2015] [Indexed: 01/25/2023]
Abstract
In order to develop a national allocation scheme for donor pancreases, factors affecting waiting time and transplant outcomes in the United States (US) and United Kingdom (UK) were analyzed and compared. Blood group, sensitization, dialysis requirement, and whether the patient was waiting for a kidney and pancreas or pancreas alone affected waiting time in both countries; ethnicity and body mass index (BMI) also affected waiting time in the US. Ninety-day pancreas survival was similar in the UK and US, and was poorer for patients receiving a pancreas alone, with older donors, higher BMI and longer duration of ischemia in both countries. Factors affecting outcome, together with published data on factors affecting islet transplantation, informed the development of a points based allocation scheme for deceased donor pancreases in the UK providing equitable access for both whole organ and islet recipients through a single waiting list. Analysis of the allocation scheme 3 years after its introduction in December 2010 showed that the results were broadly as simulated, with a significant reduction in the number of long waiting patients and an increase in the number of islet transplants. There remains a surplus of highly sensitized patients in the waiting list, which the scheme should address in time.
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Affiliation(s)
- A Hudson
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - L Bradbury
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - R Johnson
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England
| | - S V Fuggle
- Organ Donation and Transplantation Directorate, NHS Blood and Transplant, Bristol, England.,The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England
| | - J A M Shaw
- Institute of Cellular Medicine (Diabetes), The Medical School, Newcastle-upon-Tyne, England
| | - J J Casey
- Scottish Islet Transplant Unit, The Royal Infirmary, Edinburgh, Scotland
| | - P J Friend
- The Oxford Transplant Center, Churchill Hospital, Headington, Oxford, England
| | - C J E Watson
- University Department of Surgery, Addenbrooke's Hospital, Cambridge and the NIHR Cambridge Biomedical Research Center, England
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Conroy L, Yeung R, Quirk S, Phan T, Hudson A, Smith WL. SU-E-J-62: Breath Hold for Left-Sided Breast Cancer: Visually Monitored Deep Inspiration Breath Hold Amplitude Evaluated Using Real-Time Position Management. Med Phys 2015. [DOI: 10.1118/1.4924149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Giallo R, Seymour M, Matthews J, Gavidia-Payne S, Hudson A, Cameron C. Risk factors associated with the mental health of fathers of children with an intellectual disability in Australia. J Intellect Disabil Res 2015; 59:193-207. [PMID: 24645779 DOI: 10.1111/jir.12127] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Raising a child with a disability places considerable demands and stress on parents, which can contribute to mental health difficulties. Research has primarily focused on mothers' mental health, and our understanding of the effects on fathers remains limited. The factors that place fathers at increased risk of mental health difficulties are also poorly understood. This study aimed to redress these gaps by reporting on the mental health of a large sample of fathers of children with an intellectual disability (ID) (aged 3-15 years), comparing this to published Australian norms and mothers of children with ID. The second aim of the study was to explore risk factors associated with fathers' mental health. METHOD The data for this study come from 315 Australian fathers of children (aged 3-15 years) with ID, who participated in the large-scale evaluation of the Signposts for building better behaviour programme. Fathers completed a range of self-report questionnaires at baseline including the Depression Anxiety Stress Scale (DASS). RESULTS Fathers in the present sample reported significantly more symptoms of depression and stress than the Australian normative data, with approximately 6-8% reporting symptoms in the severe to extremely severe range. The strongest predictors of fathers' mental health difficulties were children's behaviour problems, daily stress arising from fathers' own needs and children's care needs, and low parenting satisfaction. Socio-economic factors did not predict mental health difficulties. CONCLUSION This study is among one of the first to report the mental health of fathers of children with a disability in Australia. Findings highlight that some fathers of children with ID are at heightened risk of experiencing mental health difficulties, underscoring the importance of the provision of information and interventions to promote their mental health.
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Affiliation(s)
- R Giallo
- Parenting Research Centre, East Melbourne, Vic., Australia; RMIT University, Bundoora, Vic., Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic., Australia
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