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Bray TJP, Eddison J, Hamilton J, Webb D, Bennett A, Machado PM, Gaffney K, Sengupta R, Hall-Craggs MA, Marzo-Ortega H. Evaluation of the current use of MRI to aid the diagnosis of axial spondyloarthritis in the UK: results from a freedom of information request. Clin Radiol 2024; 79:107-116. [PMID: 37968226 DOI: 10.1016/j.crad.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023]
Abstract
AIM To evaluate the impact of recommendations from the 2019 consensus exercise conducted by radiologists and rheumatologists on the use of magnetic resonance imaging (MRI) to investigate axial spondyloarthritis (axSpA) in clinical practice. MATERIALS AND METHODS A freedom of information (FOI) request was used to assess the use of MRI in the diagnosis of axSpA and radiologists' awareness of the 2019 guidance across all NHS Trusts and Health Boards in the UK, including England, Scotland, Northern Ireland, and Wales. RESULTS The FOI request was sent to 150 Trusts/Health Boards, and 93 full responses were received. Of the 93 respondents (97%), 90 reported familiarity with the term axSpA and 70/93 (75%) reported familiarity with the 2019 recommendations. Awareness of recommendations regarding specific MRI features supportive of the diagnosis of axSpA was 74/93 (80%) for the sacroiliac joints (SIJs) and 66/93 (71%) for the spine. The median wait for MRI acquisition was 2-3 months. Fifty-two of the 93 (56%) reported at least some outsourcing of axSpA MRI (33%/29% for specialist/non-specialist outsourcing respectively); 32/93 (34%) reported some scans being reported in-house by non-musculoskeletal radiologists. CONCLUSION There have been several positive developments in the understanding and use of MRI for the diagnosis of axSpA in the UK since the 2017 survey, although substantial scope for further improvement remains. Several new challenges have also emerged, including the increase in waiting times, reliance on outsourcing, and the reporting of MRI by non-musculoskeletal radiologists.
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Affiliation(s)
- T J P Bray
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK.
| | - J Eddison
- National Axial Spondyloarthritis Society, London, UK
| | - J Hamilton
- National Axial Spondyloarthritis Society, London, UK
| | - D Webb
- National Axial Spondyloarthritis Society, London, UK
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Unit, Loughborough, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - P M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
| | - K Gaffney
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - R Sengupta
- Royal National Hospital for Rheumatic Diseases and University of Bath, Bath, UK
| | - M A Hall-Craggs
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK
| | - H Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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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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P, Pesce F, Pessolano G, Petchey W, Petr EJ, Pfab T, Phelan P, Phillips R, Phillips T, Phipps M, Piccinni G, Pickett T, Pickworth S, Piemontese M, Pinto D, Piper J, Plummer-Morgan J, Poehler D, Polese L, Poma V, Pontremoli R, Postal A, Pötz C, Power A, Pradhan N, Pradhan R, Preiss D, Preiss E, Preston K, Prib N, Price L, Provenzano C, Pugay C, Pulido R, Putz F, Qiao Y, Quartagno R, Quashie-Akponeware M, Rabara R, Rabasa-Lhoret R, Radhakrishnan D, Radley M, Raff R, Raguwaran S, Rahbari-Oskoui F, Rahman M, Rahmat K, Ramadoss S, Ramanaidu S, Ramasamy S, Ramli R, Ramli S, Ramsey T, Rankin A, Rashidi A, Raymond L, Razali WAFA, Read K, Reiner H, Reisler A, Reith C, Renner J, Rettenmaier B, Richmond L, Rijos D, Rivera R, Rivers V, Robinson H, Rocco M, Rodriguez-Bachiller I, Rodriquez R, Roesch C, Roesch J, Rogers J, Rohnstock M, Rolfsmeier S, Roman M, Romo A, Rosati A, Rosenberg S, Ross T, Rossello X, Roura M, Roussel M, Rovner S, Roy S, Rucker S, Rump L, Ruocco M, Ruse S, Russo F, Russo M, Ryder M, Sabarai A, Saccà C, Sachson R, Sadler E, Safiee NS, Sahani M, Saillant A, Saini J, Saito C, Saito S, Sakaguchi K, Sakai M, Salim H, Salviani C, Sammons E, Sampson A, Samson F, Sandercock P, Sanguila S, Santorelli G, Santoro D, Sarabu N, Saram T, Sardell R, Sasajima H, Sasaki T, Satko S, Sato A, Sato D, Sato H, Sato H, Sato J, Sato T, Sato Y, Satoh M, Sawada K, Schanz M, Scheidemantel F, Schemmelmann M, Schettler E, Schettler V, Schlieper GR, Schmidt C, Schmidt G, Schmidt U, Schmidt-Gurtler H, Schmude M, Schneider A, Schneider I, Schneider-Danwitz C, Schomig M, Schramm T, Schreiber A, Schricker S, Schroppel B, Schulte-Kemna L, Schulz E, Schumacher B, Schuster A, Schwab A, Scolari F, Scott A, Seeger W, Seeger W, Segal M, Seifert L, Seifert M, Sekiya M, Sellars R, Seman MR, Shah S, Shah S, Shainberg L, Shanmuganathan M, Shao F, Sharma K, Sharpe C, Sheikh-Ali M, Sheldon J, Shenton C, Shepherd A, Shepperd M, Sheridan R, Sheriff Z, Shibata Y, Shigehara T, Shikata K, Shimamura K, Shimano H, Shimizu Y, Shimoda H, Shin K, Shivashankar G, Shojima N, Silva R, Sim CSB, Simmons K, Sinha S, Sitter T, Sivanandam S, Skipper M, Sloan K, Sloan L, Smith R, Smyth J, Sobande T, Sobata M, Somalanka S, Song X, Sonntag F, Sood B, Sor SY, Soufer J, Sparks H, Spatoliatore G, Spinola T, Squyres S, Srivastava A, Stanfield J, Staplin N, Staylor K, Steele A, Steen O, Steffl D, Stegbauer J, Stellbrink C, Stellbrink E, Stevens W, Stevenson A, Stewart-Ray V, Stickley J, Stoffler D, Stratmann B, Streitenberger S, Strutz F, Stubbs J, Stumpf J, Suazo N, Suchinda P, Suckling R, Sudin A, Sugamori K, Sugawara H, Sugawara K, Sugimoto D, Sugiyama H, Sugiyama H, Sugiyama T, Sullivan M, Sumi M, Suresh N, Sutton D, Suzuki H, Suzuki R, Suzuki Y, Suzuki Y, Suzuki Y, Swanson E, Swift P, Syed S, Szerlip H, Taal M, Taddeo M, Tailor C, Tajima K, Takagi M, Takahashi K, Takahashi K, Takahashi M, Takahashi T, Takahira E, Takai T, Takaoka M, Takeoka J, Takesada A, Takezawa M, Talbot M, Taliercio J, Talsania 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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Roberts NJ, Bennett A, Cheema SS. Photon spectra in NPL standard monoenergetic neutron fields. Radiat Prot Dosimetry 2023; 199:1685-1688. [PMID: 37819355 DOI: 10.1093/rpd/ncad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 10/13/2023]
Abstract
A High Purity Germanium (HPGe) detector has been used to measure the photon spectra in the majority of monoenergetic neutron fields produced at NPL (0.144, 0.250, 0.565, 2.0, 5.0 and 16.5 MeV). The HPGe was characterised and then modelled to produce a response matrix. The measured pulse height spectra were then unfolded to produce photon fluence spectra. The new spectra were used to improve the photon to neutron dose equivalent ratios from some earlier work at NPL with Geiger-Muller tubes and electronic personal dosemeters.
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Affiliation(s)
- N J Roberts
- National Physical Laboratory, Nuclear Metrology Group, Hampton Road, Teddington, Middx. TW11 0LW, United Kingdom
| | - A Bennett
- National Physical Laboratory, Nuclear Metrology Group, Hampton Road, Teddington, Middx. TW11 0LW, United Kingdom
| | - S S Cheema
- National Physical Laboratory, Nuclear Metrology Group, Hampton Road, Teddington, Middx. TW11 0LW, United Kingdom
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Ables S, Bennett A, Vanner S, Lomax A, Reed D. A272 EVIDENCE OF SEX DIFFERENCES IMPACTING PAIN SIGNALING BY LUMINAL MEDIATORS IN IRRITABLE BOWEL SYNDROME. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991243 DOI: 10.1093/jcag/gwac036.272] [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
Background Irritable bowel syndrome (IBS) is more than twice as common in women and female patients report more severe abdominal pain. This suggests that sex-specific mechanisms may contribute to the pathophysiology of IBS. Many IBS patients have altered gut microbiota and luminal meditators, implicating the gut microbiota in abdominal pain. These luminal mediators can alter excitability of visceral nociceptors, thus potentially contributing to abdominal pain in IBS. Furthermore, in a subset of IBS patients a low FODMAP diet (LFD) reduces the effect of luminal mediators on pain sensing neurons. The LFD may improve abdominal pain at greater rates in women, and numerous putative mechanisms contributing to abdominal pain in IBS are susceptible to sex-specific mediators. However, it is unknown whether luminal mediators have similar effects on visceral pain signaling in both males and females. We hypothesize that luminal mediators will cause greater differences in neuronal excitability and pain signaling in female mice due to sex-specific factors. Purpose To determine whether FS from IBS patients (IBS FS) affects nociceptors from female mice more than nociceptors from male mice. Method Neurons from dorsal root ganglia from male and female mice were incubated overnight in media containing fecal supernatant (FS) from IBS patients (N=2 females) before and after the LFD, or healthy controls (HC, N=1 female and 1 male). Ratiometric Ca2+ imaging with FURA-2-AM was employed to quantify TRPV1 channel sensitization following application of capsaicin (100nM for 1 minute) as a measure of neuronal excitability. Data was analyzed using chi-squared test as well as two-way and mixed-effects model ANOVA as appropriate, followed by Sidak’s multiple comparisons test. Result(s) IBS FS caused a 177% larger Ca2+ influx in response to capsaicin compared to HC FS in female mice (p=0.0148, N=6-7 mice, neurons=43-49). In male mice, IBS FS increased Ca2+ influx by only 13% compared to HC FS (p=0.79, N=5 mice, neurons=28-35). In female mice, 117% more neurons responded to capsaicin after incubation with IBS FS versus HC FS (p=0.0004), while in male mice, only 17% more neurons responded following incubation with IBS FS (p=0.46). Finally, FS from the same IBS patients following a LFD reduced neuronal Ca2+ influx by 39% compared to IBS FS in female mice (p=0.0434, N=4-6 mice, neurons=18-49). In male mice, LFD FS reduced Ca2+ influx by 11% versus IBS FS (p=0.98, N=5 mice, neurons=28-35). Conclusion(s) Nociceptive neurons from female mice are more sensitive to the pro-nociceptive effects of FS from IBS patients, as well as a reduction of these excitatory effects following the LFD. This suggests a potential role of sex hormones in pain signaling in IBS. Disclosure of Interest None Declared
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Affiliation(s)
- S Ables
- Queen's University, Kingston, Canada
| | - A Bennett
- Queen's University, Kingston, Canada
| | - S Vanner
- Queen's University, Kingston, Canada
| | - A Lomax
- Queen's University, Kingston, Canada
| | - D Reed
- Queen's University, Kingston, Canada
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Bennett A, Baker C, Guzman-Rodriguez M, Jimenez-Vargas N, Vanner S, Reed D, Lomax A. A278 SEX DIFFERENCES IN THE EFFECT OF THE MICROBIOTA FROM IRRITABLE BOWEL SYNDROME PATIENTS ON ABDOMINAL PAIN. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991273 DOI: 10.1093/jcag/gwac036.278] [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
Background Irritable bowel syndrome (IBS) is a chronic abdominal pain disorder that affects women twice as often as men. The gut microbiota has been implicated as a key player in the modulation of abdominal pain in IBS. Given this, we hypothesised that the production of pro-nociceptive mediators within the gut lumen are increased in females, and this contributes to the female predominance of IBS. Purpose Compare the effects of FS from male and female IBS patients on abdominal pain pathways and identify the impact of female mouse estrous cycle on abdominal pain. Method Fecal supernatants (FS) were perfused through murine colonic preparations while performing extracellular colonic afferent nerve recordings to measure changes in action potential frequency in response to colonic distension. Phase of estrous cycle in female mice was determined through vaginal swabs. FS from male and female IBS patients reporting low, moderate, and high levels of abdominal pain were used. Result(s) FS from female IBS patients (N=6) increased afferent nerve discharge (p < 0.05) whereas FS from male IBS patients has no effect (N=4). However, single unit analysis of nociceptive axons revealed that male IBS FS increased nociceptor activity in female mice taken during the proestrus/estrus stage (p < 0.05), but not female mice taken during the metestrus/diestrus stage or male mice. Further investigation found that IBS FS from female patients with high abdominal pain (N=6), but not patients with moderate (N=5) or low pain (N=3), increased visceral afferent nerve discharge by 70%. Single unit analysis of nociceptive axons showed that their activation was increased by almost 50% following FS perfusion from high abdominal pain patients only (p < 0.05). Histamine concentrations and proteolytic activity are increased in FS from female IBS patients with high abdominal pain compared to male IBS patients. Conclusion(s) This work suggests that luminal mediators that impact abdominal pain are increased in female IBS patients compared to male IBS patients, and females appear to be more sensitive to their pro-nociceptive effects. Together, these sex differences may contribute to the female predominance of IBS. Disclosure of Interest None Declared
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Affiliation(s)
- A Bennett
- Department of Biomedical and Molecular Sciences
| | - C Baker
- Department of Biomedical and Molecular Sciences
| | | | | | - S Vanner
- Department of Medicine, Queen's University, Kingston, Canada
| | - D Reed
- Department of Medicine, Queen's University, Kingston, Canada
| | - A Lomax
- Department of Biomedical and Molecular Sciences
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McPhail S, Steed D, Holdsworth D, Nicol E, Bennett A, Phillips S. Development, design and experience of the UK Military's return to diving pathway following SARS-CoV-2 infection. BMJ Mil Health 2022:e002327. [PMID: 36581498 DOI: 10.1136/military-2022-002327] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
After the emergence of the SARS-CoV-2 virus in early 2020, it quickly became clear that symptomatic or asymptomatic infection had the potential to negatively impact on an individual's fitness to dive through effects on the respiratory, cardiovascular or neurological systems. The significance of these effects in the military diving environment was initially unclear due to an absence of data concerning incidence, chronology or severity. In order to safely return divers to the water and maintain operational capability, the UK Military developed a pathway for SARS-CoV-2 positive divers that stratified risk of sequelae and extent of required clinical investigation, while minimising reliance on viral testing and hospital-based investigations. We present this process, provide rationale and support for its design and detail the number of SARS-CoV-2 positive divers who have been returned to full diving fitness following infection of varying degrees of severity.
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Affiliation(s)
- Stuart McPhail
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
- Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
| | - D Steed
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
| | - D Holdsworth
- Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Nicol
- Royal Brompton Hospital, London, UK
- King's College London School of Biomedical Engineering and Imaging Sciences, London, UK
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - S Phillips
- Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
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Bennett A, Rice E, Muhonda P, Kaunda E, Katengeza S, Liverpool-Tasie LSO, Belton B, Infante DM, Ross J, Virdin J, Gondwe E. Spatial analysis of aquatic food access can inform nutrition-sensitive policy. Nat Food 2022; 3:1010-1013. [PMID: 37118314 DOI: 10.1038/s43016-022-00642-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/20/2022] [Indexed: 12/23/2022]
Abstract
AbstractAquatic foods are critical for food and nutrition security in Malawi, but it is unclear which populations benefit from different aquatic foods and what factors shape food access. Spatial analysis of food flows across value chains from Lake Malawi to domestic consumers shows that usipa (Engraulicypris sardella) reaches more consumers than chambo (Oreochromis karongae) across all Malawi districts, particularly rural populations. Higher number of markets, nutrient content, and overall supply coupled with lower retail prices and volumes make usipa more accessible to consumers than chambo. Spatial analysis of food flows can guide policymakers towards supporting fisheries that reach vulnerable populations and designing interventions that enhance physical and economic access to fish.
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Montalvo S, Bennett A, All S, Lue B, Kakadiaris E, Westover K, Iyengar P, Lu W, Gu X, Munshi N, Zaha V, Dianels J, Link M, Alluri P. Association between Thoracic Radiation and Heart Rhythm Disorders: Toward a Model for Describing Long-Term Cardiac Risk from Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.430] [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: 11/17/2022]
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Tigchelaar M, Leape J, Micheli F, Allison EH, Basurto X, Bennett A, Bush SR, Cao L, Cheung WW, Crona B, DeClerck F, Fanzo J, Gelcich S, Gephart JA, Golden CD, Halpern BS, Hicks CC, Jonell M, Kishore A, Koehn JZ, Little DC, Naylor RL, Phillips MJ, Selig ER, Short RE, Sumaila UR, Thilsted SH, Troell M, Wabnitz CC. The vital roles of blue foods in the global food system. Global Food Security 2022. [DOI: 10.1016/j.gfs.2022.100637] [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: 10/18/2022]
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Noblet T, Jadhakhanb F, Bennett A, McCrum C, O'Shea S, Crook AH, Barratt P, Regan P, Ronan L, Baker D, Rushton A. A multi-site prospective, observational study of physiotherapist independent prescribing activity in musculoskeletal clinics across seven healthcare locations in England. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.270] [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: 11/27/2022]
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Gore ML, Bennett A. Importance of deepening integration of crime and conservation sciences. Conserv Biol 2022; 36:e13710. [PMID: 33600003 PMCID: PMC9291754 DOI: 10.1111/cobi.13710] [Citation(s) in RCA: 4] [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] [Received: 05/18/2020] [Revised: 09/21/2020] [Accepted: 10/30/2020] [Indexed: 05/22/2023]
Abstract
Conservation crime is a globally distributed societal problem. Conservation crime science, an emerging interdisciplinary field, has the potential to help address this problem. However, its utility depends on serious reflection on the transposition of crime science approaches to conservation contexts, which may differ in meaningful ways from traditional crime contexts. We considered the breadth of crime science approaches being used in conservation as well as the depth of crime science integration in conservation. We used the case of sea cucumber (Holothuria floridana, Isostichopus badionotus) trafficking in Mexico as an example of why the interdisciplinarity of crime and conservation sciences should be deepened and how integration can help ideate new solutions. We first conducted a review of literature to capture the range of interdisciplinarity applications. We identified 6 crime science approaches being applied to the conservation contexts of illegal, unreported, and unregulated fishing; wildlife and plant crime; and illegal logging. We then compared this knowledge base to the case of illegal sea cucumber fishing in Mexico. We identified 5 challenges in the application of these approaches to conservation contexts: the relative diffusion of harms and victims in conservation crimes; scalar mismatches in crime, authority, and the conservation issue itself; interactions between legal and illegal networks; communities and their authority to define and control crime; and the role of natural science in the rule of law. Considering these 5 factors may enhance the depth of interdisciplinarity between crime and conservation sciences. Nurturing interdisciplinary crime and conservation science will expand innovation and help accelerate successful risk management programs and other policy agendas.
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Affiliation(s)
- Meredith L. Gore
- Department of Geographical SciencesUniversity of MarylandCollege ParkMD20742U.S.A.
| | - Abigail Bennett
- Department of Fisheries and WildlifeMichigan State UniversityEast LansingMI48824U.S.A.
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Tigchelaar M, Cheung WWL, Mohammed EY, Phillips MJ, Payne HJ, Selig ER, Wabnitz CCC, Oyinlola MA, Frölicher TL, Gephart JA, Golden CD, Allison EH, Bennett A, Cao L, Fanzo J, Halpern BS, Lam VWY, Micheli F, Naylor RL, Sumaila UR, Tagliabue A, Troell M. Compound climate risks threaten aquatic food system benefits. Nat Food 2021; 2:673-682. [PMID: 37117477 DOI: 10.1038/s43016-021-00368-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 08/17/2021] [Indexed: 04/30/2023]
Abstract
Aquatic foods from marine and freshwater systems are critical to the nutrition, health, livelihoods, economies and cultures of billions of people worldwide, but climate-related hazards may compromise their ability to provide these benefits. Here, we estimate national-level aquatic food system climate risk using an integrative food systems approach that connects climate hazards impacting marine and freshwater capture fisheries and aquaculture to their contributions to sustainable food system outcomes. We show that without mitigation, climate hazards pose high risks to nutritional, social, economic and environmental outcomes worldwide-especially for wild-capture fisheries in Africa, South and Southeast Asia, and Small Island Developing States. For countries projected to experience compound climate risks, reducing societal vulnerabilities can lower climate risk by margins similar to meeting Paris Agreement mitigation targets. System-level interventions addressing dimensions such as governance, gender equity and poverty are needed to enhance aquatic and terrestrial food system resilience and provide investments with large co-benefits towards meeting the Sustainable Development Goals.
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Affiliation(s)
| | - William W L Cheung
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Hanna J Payne
- Center for Ocean Solutions, Stanford University, Stanford, CA, USA
| | | | - Colette C C Wabnitz
- Center for Ocean Solutions, Stanford University, Stanford, CA, USA
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammed A Oyinlola
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas L Frölicher
- Climate and Environmental Physics, University of Bern, Bern, Switzerland
- Oeschger Centre for Climate Change Research, University of Bern, Bern, Switzerland
| | - Jessica A Gephart
- Department of Environmental Science, American University, Washington DC, USA
| | - Christopher D Golden
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Abigail Bennett
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA
| | - Ling Cao
- School of Oceanography, Shanghai Jiao Tong University, Shanghai, China
| | - Jessica Fanzo
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Nitze School of Advanced International Studies, Johns Hopkins University, Washington DC, USA
| | - Benjamin S Halpern
- National Center for Ecological Analysis and Synthesis, University of California, Santa Barbara, CA, USA
- Bren School of Environmental Science and Management, University of California, Santa Barbara, CA, USA
| | - Vicky W Y Lam
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fiorenza Micheli
- Center for Ocean Solutions, Stanford University, Stanford, CA, USA
- Hopkins Marine Station, Stanford University, Pacific Grove, CA, USA
| | - Rosamond L Naylor
- Department of Earth System Science, Stanford University, Stanford, CA, USA
| | - U Rashid Sumaila
- Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- School of Public Policy and Global Affairs, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Max Troell
- Beijer Institute of Ecological Economics, The Royal Swedish Academy of Sciences, Stockholm, Sweden
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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14
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Bennett A, Basurto X, Virdin J, Lin X, Betances SJ, Smith MD, Allison EH, Best BA, Brownell KD, Campbell LM, Golden CD, Havice E, Hicks CC, Jacques PJ, Kleisner K, Lindquist N, Lobo R, Murray GD, Nowlin M, Patil PG, Rader DN, Roady SE, Thilsted SH, Zoubek S. Recognize fish as food in policy discourse and development funding. Ambio 2021; 50:981-989. [PMID: 33454882 PMCID: PMC7811336 DOI: 10.1007/s13280-020-01451-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 03/16/2020] [Revised: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 05/27/2023]
Abstract
The international development community is off-track from meeting targets for alleviating global malnutrition. Meanwhile, there is growing consensus across scientific disciplines that fish plays a crucial role in food and nutrition security. However, this 'fish as food' perspective has yet to translate into policy and development funding priorities. We argue that the traditional framing of fish as a natural resource emphasizes economic development and biodiversity conservation objectives, whereas situating fish within a food systems perspective can lead to innovative policies and investments that promote nutrition-sensitive and socially equitable capture fisheries and aquaculture. This paper highlights four pillars of research needs and policy directions toward this end. Ultimately, recognizing and working to enhance the role of fish in alleviating hunger and malnutrition can provide an additional long-term development incentive, beyond revenue generation and biodiversity conservation, for governments, international development organizations, and society more broadly to invest in the sustainability of capture fisheries and aquaculture.
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Affiliation(s)
- Abigail Bennett
- Michigan State University, 1405 S. Harrison Road, Room 115, East Lansing, MI 48823 USA
| | - Xavier Basurto
- Nicholas School of the Environment, Duke University, 135 Duke Marine Lab Rd., Beaufort, NC 28516 USA
| | - John Virdin
- Duke University’s Nicholas Institute for Environmental Policy Solutions, P.O. Box 90335, Durham, NC 27708 USA
| | - Xinyan Lin
- Duke University Marine Lab, 135 Duke Marine Lab Rd, Beaufort, NC 28516 USA
| | - Samantha J. Betances
- Michigan State University, 1405 S. Harrison Road, Room 318, East Lansing, MI 48823 USA
| | - Martin D. Smith
- Nicholas School of the Environment, Duke University, Box 90328, Durham, NC 27708 USA
| | - Edward H. Allison
- WorldFish, Jalan Batu Maung, Batu Maung, Bayan Lepas, Penang 11960 Malaysia
| | - Barbara A. Best
- U.S. Agency for International Development, 907 Westwood Drive, NE, Vienna, VA 22180 USA
| | - Kelly D. Brownell
- Sanford School of Public Policy, Duke University, 201 Science Drive, Campus, Box 90245, Durham, NC 27708 USA
| | - Lisa M. Campbell
- Nicholas School of the Environment, Duke University, 135 Duke Marine Lab Rd., Beaufort, NC 28516 USA
| | - Christopher D. Golden
- Harvard T.H. Chan School of Public Health, 665 Huntington Ave. Bldg. 2, Boston, MA 02115 USA
| | - Elizabeth Havice
- Department of Geography CB#3220, University of North Carolina, Chapel Hill, 220 Carolina Hall, Chapel Hill, NC 27599-3220 USA
| | - Christina C. Hicks
- Lancaster Environment Centre, Lancaster University, Lancaster, LA1 4YQ UK
| | - Peter J. Jacques
- University of Central Florida, 4297 Andromeda Loop N. Howard Phillips Hall, Rm. 302, Orlando, FL 32816-1356 USA
| | - Kristin Kleisner
- Environmental Defense Fund, 18 Tremont Street, Ste. 850, Boston, MA 02108 USA
| | - Niels Lindquist
- UNC Institute of Marine Sciences, 3431 Arendell Street, Morehead City, NC 28557 USA
| | - Rafaella Lobo
- Duke University Marine Lab, 135 Duke Marine Lab Rd, Beaufort, NC 28516 USA
| | - Grant D. Murray
- Nicholas School of the Environment, Duke University, 135 Duke Marine Lab Rd., Beaufort, NC 28516 USA
| | | | - Pawan G. Patil
- The World Bank Group, 1818 H Street N.W., Washington, DC 20433 USA
| | - Douglas N. Rader
- Environmental Defense Fund, 4000 Westchase Blvd., Suite 510, Raleigh, NC 27607 USA
| | - Stephen E. Roady
- Duke Nicholas School of the Environment, Duke University, 1201 Pennsylvania Ave NW, Washington, DC 20004 USA
| | | | - Sarah Zoubek
- World Food Policy Center, Duke University, 1201 Pennsylvania Avenue NW, Suite 500, Washington, DC 20004 USA
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15
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Nguyen A, Chung B, Besser S, Bennett A, Rodgers D, Kim G, Pinney S, Uriel N, Aronsohn A. Providers and Patients Differ in Their Opinions on Travel for Organ Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.652] [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: 10/21/2022] Open
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16
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Dela Cruz M, Littmann E, Nayak R, Lehmann C, Keskey R, Baker T, Lin H, Bennett A, Kim G, Pinney S, Pamer E, Nguyen A. The Gut Microbiome in Heart Transplantation: A Prospective Pilot Study. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1797] [Citation(s) in RCA: 1] [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: 10/21/2022] Open
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17
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Moore G, Rickard H, Stevenson D, Aranega-Bou P, Pitman J, Crook A, Davies K, Spencer A, Burton C, Easterbrook L, Love HE, Summers S, Welch SR, Wand N, Thompson KA, Pottage T, Richards KS, Dunning J, Bennett A. Detection of SARS-CoV-2 within the healthcare environment: a multi-centre study conducted during the first wave of the COVID-19 outbreak in England. J Hosp Infect 2021; 108:189-196. [PMID: 33259882 PMCID: PMC7831847 DOI: 10.1016/j.jhin.2020.11.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/25/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Understanding how severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is spread within the hospital setting is essential in order to protect staff, implement effective infection control measures, and prevent nosocomial transmission. METHODS The presence of SARS-CoV-2 in the air and on environmental surfaces around hospitalized patients, with and without respiratory symptoms, was investigated. Environmental sampling was undertaken within eight hospitals in England during the first wave of the coronavirus disease 2019 outbreak. Samples were analysed using reverse transcription polymerase chain reaction (PCR) and virus isolation assays. FINDINGS SARS-CoV-2 RNA was detected on 30 (8.9%) of 336 environmental surfaces. Cycle threshold values ranged from 28.8 to 39.1, equating to 2.2 x 105 to 59 genomic copies/swab. Concomitant bacterial counts were low, suggesting that the cleaning performed by nursing and domestic staff across all eight hospitals was effective. SARS-CoV-2 RNA was detected in four of 55 air samples taken <1 m from four different patients. In all cases, the concentration of viral RNA was low and ranged from <10 to 460 genomic copies/m3 air. Infectious virus was not recovered from any of the PCR-positive samples analysed. CONCLUSIONS Effective cleaning can reduce the risk of fomite (contact) transmission, but some surface types may facilitate the survival, persistence and/or dispersal of SARS-CoV-2. The presence of low or undetectable concentrations of viral RNA in the air supports current guidance on the use of specific personal protective equipment for aerosol-generating and non-aerosol-generating procedures.
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Affiliation(s)
- G Moore
- National Infection Service, Public Health England, Porton Down, Salisbury, UK.
| | - H Rickard
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - D Stevenson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - P Aranega-Bou
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Pitman
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Crook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K Davies
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - A Spencer
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - C Burton
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - L Easterbrook
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - H E Love
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S Summers
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - S R Welch
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - N Wand
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K-A Thompson
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - T Pottage
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - K S Richards
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - J Dunning
- Emerging Infections and Zoonoses Unit, National Infection Service, Public Health England, Colindale, London, UK; NIHR Health Protection Research Unit in Emerging Infections and Zoonoses, Liverpool, UK
| | - A Bennett
- National Infection Service, Public Health England, Porton Down, Salisbury, UK
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18
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Upadhyay U, McCook A, Bennett A, Cartwright A, Roberts S. P16 State abortion policies and ability to obtain an abortion. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.035] [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: 11/24/2022]
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19
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Wilkins S, Oliva K, Chowdhury E, Ruggiero B, Bennett A, Andrews EJ, Dent O, Chapuis P, Platell C, Reid CM, McMurrick PJ. Australasian ACPGBI risk prediction model for 30-day mortality after colorectal cancer surgery. BJS Open 2020; 4:1208-1216. [PMID: 32985127 PMCID: PMC7709373 DOI: 10.1002/bjs5.50356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/08/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postoperative mortality after colorectal cancer surgery varies across hospitals and countries. The aim of this study was to test the Association of Coloproctologists of Great Britain and Ireland (ACPGBI) models as predictors of 30-day mortality in an Australian cohort. METHODS Data from patients who underwent surgery in six hospitals between 1996 and 2015 (CRC data set) were reviewed to test ACPGBI models, and patients from 79 hospitals in the Bi-National Colorectal Cancer Audit between 2007 and 2016 (BCCA data set) were analysed to validate model performance. Recalibrated models based on ACPGBI risk models were developed, tested and validated on a data set of Australasian patients. RESULTS Of 18 752 patients observed during the study, 6727 (CRC data set) and 3814 (BCCA data set) were analysed. The 30-day mortality rate was 1·1 and 3·5 per cent in the CRC and BCCA data sets respectively. Both the original and revised ACPGBI models overestimated 30-day mortality for the CRC data set (observed to expected (O/E) ratio 0·17 and 0·21 respectively). Their ability to correctly predict mortality risk was poor (P < 0·001, Hosmer-Lemeshow test); however, the area under the curve for both models was 0·88 (95 per cent c.i. 0·85 to 0·92) showing good discriminatory power to classify 30-day mortality. The recalibrated original model performed well for calibration and discrimination, whereas the recalibrated revised model performed well for discrimination but not for calibration. Risk prediction was good for both recalibrated models. On external validation using the BCCA data set, the recalibrated models underestimated mortality risk (O/E ratio 3·06 and 2·98 respectively), whereas both original and revised ACPGBI models overestimated the risk (O/E ratio 0·48 and 0·69). All models showed similar good discrimination. CONCLUSION The original and revised ACPGBI models overpredicted risk of 30-day mortality. The new Australasian calibrated ACPGBI model needs to be tested further in clinical practice.
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Affiliation(s)
- S. Wilkins
- Cabrini Monash University Department of SurgeryMalvernVictoria
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoria
| | - K. Oliva
- Cabrini Monash University Department of SurgeryMalvernVictoria
| | - E. Chowdhury
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoria
- School of Public HealthCurtin UniversityPerthWestern Australia
| | - B. Ruggiero
- Cabrini Monash University Department of SurgeryMalvernVictoria
| | - A. Bennett
- Department of AnaesthesiaCabrini HospitalMalvernVictoria
| | - E. J. Andrews
- Department of SurgeryCork University HospitalCorkIreland
| | - O. Dent
- Department of Colorectal SurgeryConcord HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - P. Chapuis
- Department of Colorectal SurgeryConcord HospitalSydneyNew South WalesAustralia
- Discipline of Surgery, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
- Bi‐National Colorectal Cancer AuditCorkIreland
| | - C. Platell
- Colorectal Surgical UnitSt John of God Subiaco Hospital, University of Western AustraliaPerthWestern Australia
- Bi‐National Colorectal Cancer AuditCorkIreland
| | - C. M. Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoria
- School of Public HealthCurtin UniversityPerthWestern Australia
- Bi‐National Colorectal Cancer AuditCorkIreland
| | - P. J. McMurrick
- Cabrini Monash University Department of SurgeryMalvernVictoria
- Bi‐National Colorectal Cancer AuditCorkIreland
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20
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Hannaway N, Jiang X, Aspray T, Burns A, Ferguson J, Pedley I, Frew J, Azzabi A, Pearson R, Chandler R, Hughes A, Showler H, Bennett A, McMenemin R. 673P Assessing bone health and osteoporotic risk in patients requiring anti androgen therapy for prostate cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.932] [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: 10/23/2022] Open
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21
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Bennett A, Barrera E, Namballa H, Harding W, Ranaldi R. (-)-Stepholidine blocks expression, but not development, of cocaine conditioned place preference in rats. Neurosci Lett 2020; 734:135151. [PMID: 32531529 DOI: 10.1016/j.neulet.2020.135151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to investigate the effects of (-)-stepholidine (SPD), a compound with dopamine D1 partial agonist and D2/D3 antagonist properties, on the development and expression of cocaine conditioned place preference (CPP). Subjects (N = 65; male Long Evans rats) were tested using a CPP procedure consisting of 3 phases: (1) a 15-min pre-exposure session where animals could explore each compartment freely, (2) eight 30-min conditioning sessions where animals were restricted to one side or the other with cocaine (10 mg/kg) or saline, respectively, on alternating days and (3) a 15-minute preference test session where animals could explore each compartment freely. To test the effects of SPD on expression of cocaine CPP, rats were administered vehicle (distilled water with 20 % DMSO), 10, 15 or 20 mg/kg SPD (intraperitoneally) 30 min prior to the test session. We found that 20 mg/kg of SPD significantly blocked the expression of cocaine CPP. To test the effects of SPD on the development of CPP, 0 (vehicle), 10, 15 or 20mg/kg SPD were administered 30 min prior to each cocaine conditioning session and vehicle before each saline conditioning session; no treatment was given prior to the test session. A preference test showed that each SPD group maintained a CPP similar to the vehicle group. These data indicate that SPD can block the expression of a cocaine CPP but has no effect on its development, suggesting that it inhibits the effects of cocaine cues on cocaine incentive motivated behavior. These results suggest that SPD may be a potential treatment for cue-driven aspects of cocaine use disorder.
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Affiliation(s)
- A Bennett
- Queens College of the City University of New York, Department of Psychology, USA
| | - E Barrera
- Queens College of the City University of New York, Department of Psychology, USA
| | - H Namballa
- Hunter College of the City University of New York, Department of Chemistry, USA; CUNY Graduate Center, 365 5thAvenue, New York, NY 10016, USA; CUNY Graduate Center, 365 5thAvenue, New York, NY 10016, USA
| | - W Harding
- Hunter College of the City University of New York, Department of Chemistry, USA; CUNY Graduate Center, 365 5thAvenue, New York, NY 10016, USA; CUNY Graduate Center, 365 5thAvenue, New York, NY 10016, USA
| | - R Ranaldi
- Queens College of the City University of New York, Department of Psychology, USA; CUNY Graduate Center, 365 5thAvenue, New York, NY 10016, USA.
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22
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Basurto X, Bennett A, Lindkvist E, Schlüter M. Governing the commons beyond harvesting: An empirical illustration from fishing. PLoS One 2020; 15:e0231575. [PMID: 32324767 PMCID: PMC7179885 DOI: 10.1371/journal.pone.0231575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Harvesting has received most theoretical, empirical, and policy attention towards understanding common-pool resource dilemmas. Yet, pre-harvesting and post-harvesting activities influence harvesting outcomes as well. Broadening the analytical focus beyond harvesting is needed to imagine new ways of theorizing and governing the commons. Fishing—which is synonymous with harvesting—is a case in point. We contribute to a beyond-harvesting research agenda by incorporating concepts from common-pool resources theory that have not received enough attention in the literature. We compare two ubiquitous self-organizing strategies (i.e., fishing cooperatives and patron-client relationships) fishers use to access means of production and analyze their effects on the distribution of benefits resulting from harvesting. We use rarely available longitudinal data of monetary loans to fishers in Mexican small-scale fisheries and find that cooperatives can deliver broader distribution of benefits than patron-client relationships. Our study highlights the importance of historically and contextually situating analyses linking the effects of pre-harvesting processes on harvesting outcomes, and the benefits of broadening the scope of inquiry beyond a narrow policy attention on harvesting to move towards a fuller understanding of commons dilemmas.
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Affiliation(s)
- Xavier Basurto
- Duke University Marine Lab, Nicholas School of the Environment, Duke University, Beaufort, NC, United States of America
- * E-mail:
| | - Abigail Bennett
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, United States of America
| | - Emilie Lindkvist
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
| | - Maja Schlüter
- Stockholm Resilience Centre, Stockholm University, Stockholm, Sweden
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23
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Bennett A, Thavorn K, Coyle D, Arendas K, Singh SS. 2935 Cost-Effectiveness of an Outpatient Uterine Assessment and Treatment Unit in Patients with Abnormal Uterine Bleeding: A Modelling Study. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.385] [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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24
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Patel MR, Pearson VK, Evans DJ, Summers DJ, Paton S, Truscott P, Pottage T, Bennett A, Gow JPD, Goodyear MD, Mason JP, Leese MR, Patel RD. The transfer of unsterilized material from Mars to Phobos: Laboratory tests, modelling and statistical evaluation. Life Sci Space Res (Amst) 2019; 23:112-134. [PMID: 31791600 DOI: 10.1016/j.lssr.2019.08.002] [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: 04/01/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Sample return missions to Phobos are the subject of future exploration plans. Given the proximity of Phobos to Mars, Mars' potential to have supported life, and the possibility of material transfer from Mars to Phobos, careful consideration of planetary protection is required. If life exists, or ever existed, on Mars, there is a possibility that material carrying organisms could be present on Phobos and be collected by a sample return mission such as the Japanese Martian Moons eXplorer (MMX). Here we describe laboratory experiments, theoretical modelling and statistical analysis undertaken to quantify whether the likelihood of a sample from Phobos material containing unsterilized material transferred from Mars is less than 10-6, the threshold to transition between restricted and unrestricted sample return classification for planetary protection. We have created heat, impact and radiation sterilization models based on the Phobos environment, and through statistical analyses investigated the level of sterilization expected for martian material transferred to Phobos. These analyses indicate that radiation is the major sterilization factor, sterilizing the Phobos surface over timescales of millions of years. The specific events of most relevance in the Phobos sample return context are the 'young' cratering events on Mars that result in Zunil-sized craters, which can emplace a large mass of martian material on Phobos, in a short period of time, thus inhibiting the effects of radiation sterilization. Major unknowns that cannot yet be constrained accurately enough are found to drive the results - the most critical being the determination of exact crater ages to statistical certainty, and the initial biological loading on Mars prior to transfer. We find that, when taking a conservative perspective and assuming the best-case scenario for organism survival, for a 100 g sample of the Phobos regolith to be below the planetary protection requirement for unrestricted sample return, the initial biological loading on Mars must be <8.2 × 103cfu kg-1. For the planned MMX mission, a ∼10 g sample to be obtained from a 25-30 mm diameter core as planned would require an initial martian biological loading to be <1.6 × 104cfu kg-1, in order to remain compliant with the planetary protection threshold.
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Affiliation(s)
- M R Patel
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK.
| | - V K Pearson
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - D J Evans
- Fluid Gravity Engineering Ltd, The Old Coach House, 1 West Street, Emsworth PO 10 7DX, UK
| | - D J Summers
- Thales Alenia Space UK Ltd., Bld 660, Bristol Business Park, Cold Harbour Lane, Bristol BS16 1EJ, UK
| | - S Paton
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - P Truscott
- Kallisto Consultancy Limited, Farnborough, Hampshire GU14 9AJ, UK
| | - T Pottage
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - A Bennett
- Public Health England, Porton Down, Salisbury SP4 0JG, UK
| | - J P D Gow
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - M D Goodyear
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - J P Mason
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - M R Leese
- School of Physical Sciences, The Open University, Milton Keynes MK7 6AA, UK
| | - R D Patel
- Indospace Ltd, Abingdon, Oxfordshire, UK
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25
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Bennett A, Bennett A, Patrick C. The value of the lung cancer nurse specialist in the development and implimentation of the local optimal lung cancer pathway. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30166-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Aranega-Bou P, George RP, Verlander NQ, Paton S, Bennett A, Moore G. Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system. J Hosp Infect 2018; 102:63-69. [PMID: 30571992 DOI: 10.1016/j.jhin.2018.12.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [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: 11/12/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Hospital sinks, waste traps and drains can harbour carbapenem-resistant Enterobacteriaceae (CRE). AIM To investigate the dispersal of CRE from sinks in which water delivered from the tap flows directly into the drain and from clinical handwash basins with the drain at the rear. The effect of fast and slow drainage rates was also assessed. METHODS Waste traps, known to be colonized with CRE, were taken from a hospital and installed within a model laboratory system. New waste traps were also installed and artificially inoculated with CRE. The potential for bacteria to be dispersed from sinks was assessed using cyclone air samplers and/or settle plates. FINDINGS When the waste traps were artificially contaminated and CRE colonization was confined to the waste trap water, significantly fewer bacteria were dispersed from sinks that drained quickly (P = 0.004) and/or from rear-draining sinks (P = 0.002). When the waste traps were naturally contaminated and CRE colonized the trap, pipework and drain, there was significant interaction between sink drainage and position of the drain (P < 0.001). When drainage was slow, dispersal from rear-draining sinks was almost 30-fold less than from sinks with the drain underneath the tap (P < 0.001). When drainage was fast, rear-draining sinks again released comparatively fewer CRE, although, in this case, the difference was not statistically significant (P = 0.7). Contaminated splashes travelled up to 1 m from the sink. CONCLUSION Slow drainage rates and sink designs with the drain directly underneath the tap increase the risk of CRE present in waste traps and drains contaminating the ward environment.
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Affiliation(s)
- P Aranega-Bou
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK.
| | - R P George
- Manchester University NHS Foundation Trust, Manchester, UK
| | - N Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service, Public Health England, Colindale, UK
| | - S Paton
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
| | - A Bennett
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
| | - G Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
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Bennett A, Pollock L, Jere KC, Pitzer VE, Parashar U, Tate JE, Heyderman RS, Mwansambo C, French N, Nakagomi O, Iturriza-Gomara M, Everett D, Cunliffe NA, Bar-Zeev N. Direct and possible indirect effects of vaccination on rotavirus hospitalisations among children in Malawi four years after programmatic introduction. Vaccine 2018; 36:7142-7148. [PMID: 29887320 PMCID: PMC6238204 DOI: 10.1016/j.vaccine.2018.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/24/2017] [Accepted: 04/12/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Despite increased use of vaccine in routine immunisation, rotavirus remains a major cause of acute gastroenteritis (AGE) in low-income countries. We describe rotavirus prevalence and hospitalisation in Malawi pre and four years post vaccine introduction; provide updated vaccine effectiveness (VE) estimates; and assess rotavirus vaccine indirect effects. METHODS Children under five years of age presenting to a referral hospital in Blantyre with AGE were recruited. Stool samples were tested for rotavirus using Enzyme Immunoassay. The change in rotavirus prevalence was evaluated using Poisson regression. Time series analysis was used to further investigate trends in prevalence over time. VE against rotavirus diarrhoea of any severity was estimated using logistic regression. Indirect effects were estimated by evaluating rotavirus prevalence in unvaccinated children over time, and by comparing observed reductions in incidence of rotavirus hospitalisation to those expected based on vaccine coverage and trial efficacy estimates. RESULTS 2320 children were included. Prevalence of rotavirus in hospitalised infants (<12 months) with AGE decreased from 69/139(49.64%) prior to vaccine introduction to 197/607(32.45%) post-vaccine introduction (adjusted RR 0.67[95% CI 0.55, 0.82]). Prevalence in children aged 12-23 months demonstrated a less substantial decline: 15/37(40.54%) pre- and 122/352(34.66%) post-vaccine introduction (adjusted RR 0.85, 95% CI 0.57, 1.28). Adjusted VE was 61.89%(95% CI 28.04-79.82), but lower in children aged 12-23 months (31.69% [95% CI -139.03 to 80.48]). In hospitalised infants with rotavirus disease, the observed overall effect of the vaccine was 9% greater than expected according to vaccine coverage and efficacy estimates. Rotavirus prevalence among unvaccinated infants declined post-vaccine introduction (RR 0.70[95% CI 0.55-0.80]). CONCLUSIONS Following rotavirus vaccine introduction in Malawi, prevalence of rotavirus in hospitalised children with AGE has declined significantly, with some evidence of an indirect effect in infants. Despite this, rotavirus remains an important cause of severe diarrhoea in Malawian children, particularly in the second year of life.
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Affiliation(s)
- A Bennett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK.
| | - L Pollock
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - K C Jere
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - V E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - U Parashar
- Centers for Disease Control and Prevention, Atlanta, USA
| | - J E Tate
- Centers for Disease Control and Prevention, Atlanta, USA
| | - R S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Division of Infection and Immunity, University College London, UK
| | | | - N French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - O Nakagomi
- Department of Molecular Epidemiology, Nagasaki University, Nagasaki, Japan
| | - M Iturriza-Gomara
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | - D Everett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - N A Cunliffe
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - N Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi; Centre for Global Vaccine Research, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
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Gilligan P, Bennett A, Houlihan A, Padki A, Owen N, Morris D, Chochliouros I, Mohammed A, Mutawa A, Eswarara MA, Gannon S, Alrmawi A, Gasem JZ, Sheung PPN, Tynan C, Little R, Merriman W, Amadi-Obi A, Kenna L, Alim DA, O’Donnel C. The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine. Ir Med J 2018; 111:769. [PMID: 30518784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.
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Affiliation(s)
- P Gilligan
- Department of Emergency Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
| | - A Bennett
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - A Houlihan
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | - N Owen
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | | | | | - A Mutawa
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - M A Eswarara
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - S Gannon
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - A Alrmawi
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - J Z Gasem
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - P P N Sheung
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - C Tynan
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | - R Little
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | - A Amadi-Obi
- Department of Emergency Medicine, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
| | | | - D A Alim
- Royal College of Surgeons in Ireland (RCSI), Dublin 2, Ireland
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de Graaf H, Sukhtankar P, Arch B, Ahmad N, Lees A, Bennett A, Spowart C, Hickey H, Jeanes A, Armon K, Riordan A, Herberg J, Hackett S, Gamble C, Shingadia D, Pallett A, Clarke SC, Henman P, Emonts M, Sharland M, Finn A, Pollard AJ, Powell C, Marsh P, Ballinger C, Williamson PR, Clarke NM, Faust SN. Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health Technol Assess 2018; 21:1-164. [PMID: 28862129 DOI: 10.3310/hta21480] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is little current consensus regarding the route or duration of antibiotic treatment for acute osteomyelitis (OM) and septic arthritis (SA) in children. OBJECTIVE To assess the overall feasibility and inform the design of a future randomised controlled trial (RCT) to reduce the duration of intravenous (i.v.) antibiotic use in paediatric OM and SA. DESIGN (1) A prospective service evaluation (cohort study) to determine the current disease spectrum and UK clinical practice in paediatric OM/SA; (2) a prospective cohort substudy to assess the use of targeted polymerase chain reaction (PCR) in diagnosing paediatric OM/SA; (3) a qualitative study to explore families' views and experiences of OM/SA; and (4) the development of a core outcome set via a systematic review of literature, Delphi clinician survey and stakeholder consensus meeting. SETTING Forty-four UK secondary and tertiary UK centres (service evaluation). PARTICIPANTS Children with OM/SA. INTERVENTIONS PCR diagnostics were compared with culture as standard of care. Semistructured interviews were used in the qualitative study. RESULTS Data were obtained on 313 cases of OM/SA, of which 218 (61.2%) were defined as simple disease and 95 (26.7%) were defined as complex disease. The epidemiology of paediatric OM/SA in this study was consistent with existing European data. Children who met oral switch criteria less than 7 days from starting i.v. antibiotics were less likely to experience treatment failure (9.6%) than children who met oral switch criteria after 7 days of i.v. therapy (16.1% when switch was between 1 and 2 weeks; 18.2% when switch was > 2 weeks). In 24 out of 32 simple cases (75%) and 8 out of 12 complex cases (67%) in which the targeted PCR was used, a pathogen was detected. The qualitative study demonstrated the importance to parents and children of consideration of short- and long-term outcomes meaningful to families themselves. The consensus meeting agreed on the following outcomes: rehospitalisation or recurrence of symptoms while on oral antibiotics, recurrence of infection, disability at follow-up, symptom free at 1 year, limb shortening or deformity, chronic OM or arthritis, amputation or fasciotomy, death, need for paediatric intensive care, and line infection. Oral switch criteria were identified, including resolution of fever for ≥ 48 hours, tolerating oral food and medicines, and pain improvement. LIMITATIONS Data were collected in a 6-month period, which might not have been representative, and follow-up data for long-term complications are limited. CONCLUSIONS A future RCT would need to recruit from all tertiary and most secondary UK hospitals. Clinicians have implemented early oral switch for selected patients with simple disease without formal clinical trial evidence of safety. However, the current criteria by which decisions to make the oral switch are made are not clearly established or evidence based. FUTURE WORK A RCT in simple OM and SA comparing shorter- or longer-course i.v. therapy is feasible in children randomised after oral switch criteria are met after 7 days of i.v. therapy, excluding children meeting oral switch criteria in the first week of i.v. therapy. This study design meets clinician preferences and addresses parental concerns not to randomise prior to oral switch criteria being met. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Hans de Graaf
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Priya Sukhtankar
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Barbara Arch
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nusreen Ahmad
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Public Health England, Southampton, UK
| | - Amanda Lees
- Health and Wellbeing Research and Development Group, University of Winchester, Winchester, UK
| | - Abigail Bennett
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Catherine Spowart
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Annmarie Jeanes
- Radiology, Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Armon
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Andrew Riordan
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jethro Herberg
- Section of Paediatrics, Imperial College London, St Mary's Campus, London, UK
| | - Scott Hackett
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Carrol Gamble
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Delane Shingadia
- Paediatric Infectious Diseases, Great Ormond Street Hospital for Children, London, UK
| | - Ann Pallett
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart C Clarke
- Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Philip Henman
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Marieke Emonts
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Mike Sharland
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Adam Finn
- Bristol Children's Vaccine Centre, School of Clinical Sciences, University of Bristol, Bristol, UK.,Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew J Pollard
- Department of Paediatrics, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Colin Powell
- School of Medicine, University of Cardiff, Cardiff, UK.,Department of Paediatrics, University Hospital of Wales, Cardiff, UK
| | - Peter Marsh
- Public Health England, South East Public Health England Regional Laboratory, Southampton, UK
| | - Claire Ballinger
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paula R Williamson
- Medicines for Children Clinical Trials Unit, Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Nicholas Mp Clarke
- University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Paediatric Orthopaedics, University of Southampton, Southampton, UK
| | - Saul N Faust
- National Institute for Health Research Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Roscoe D, Roberts AJ, Hulse D, Shaheen A, Hughes MP, Bennett A. Barefoot plantar pressure measurement in Chronic Exertional Compartment Syndrome. Gait Posture 2018; 63:10-16. [PMID: 29702369 DOI: 10.1016/j.gaitpost.2018.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/18/2017] [Accepted: 04/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patients with Chronic Exertional Compartment Syndrome (CECS) have exercise-limiting pain that subsides at rest. Diagnosis is confirmed by intramuscular compartment pressure (IMCP) measurement. Accompanying CECS, subjective changes to gait (foot slap) are frequently reported by patients. This has not previously been investigated. The aim of this study was to investigate differences in barefoot plantar pressure (BFPP) between CECS cases and asymptomatic controls prior to the onset of painful symptoms. METHODS 40 male military volunteers, 20 with symptoms of CECS and 20 asymptomatic controls were studied. Alternative diagnoses were excluded with rigorous inclusion criteria, magnetic resonance imaging and dynamic IMCP measurement. BFPP was measured during walking and marching. Data were analysed for: Stance Time (ST); foot progression angle (FPA); centre of force; plantarflexion rate after heel strike (IFFC-time); the distribution of pressure under the heel; and, the ratio between inner and outer metatarsal loading. Correlation coefficients of each variable with speed and leg length were calculated followed by ANCOVA or t-test. Receiver operating characteristic (ROC) curves were constructed for IFFC-time. RESULTS Caseshad shorter ST and IFFC-times than controls. FPA was inversely related to walking speed (WS) in controls only. The area under the ROC curve for IFFC-time ranged from 0.746 (95%CI: 0.636-0.87) to 0.773 (95%CI: 0.671-0.875) representing 'fair predictive validity'. CONCLUSION Patients with CECS have an increased speed of ankle plantarflexion after heel strike that precedes the onset of painful symptoms likely resulting from a mechanical disadvantage of Tibialis Anterior. These findings provide further insight into the pathophysiology of CECS and support further investigation of this non-invasive diagnostic. The predictive value of IFFC-time in the diagnosis of CECS is comparable to post-exercise IMCP but falls short of dynamic IMCP measured during painful symptoms.
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Affiliation(s)
- D Roscoe
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Department of Biomedical Engineering, University of Surrey Postgraduate Medical School, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7TE, United Kingdom.
| | - A J Roberts
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Department of Sport and Health Sciences, University of Exeter, College of Life and Environmental Sciences, St. Luke's Campus, Exeter, EX1 2LU, United Kingdom
| | - D Hulse
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom
| | - A Shaheen
- Department of Life Sciences, Brunel University London, Kingston Lane, Uxbridge, Middlesex UB8 3PH, United Kingdom
| | - M P Hughes
- Department of Biomedical Engineering, University of Surrey Postgraduate Medical School, Duke of Kent Building, University of Surrey, Guildford, Surrey, GU2 7TE, United Kingdom
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey, KT18 6JW, United Kingdom; Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Leeds, LS9 7TF, United Kingdom
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Bennett A, Antonopoulos K, Sullivan N, Sadler A, Mills H, O’Doherty O, Parkinson M. Integrating a NHS community physiotherapy and musculoskeletal clinical assessment service: a service evaluation. Physiotherapy 2017. [DOI: 10.1016/j.physio.2017.11.153] [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: 12/01/2022]
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Collins S, Stevenson D, Walker J, Bennett A. Evaluation ofLegionellareal-time PCR against traditional culture for routine and public health testing of water samples. J Appl Microbiol 2017; 122:1692-1703. [DOI: 10.1111/jam.13461] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/25/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Collins
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - D. Stevenson
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - J. Walker
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
| | - A. Bennett
- Biosafety Air and Water Microbiology Group; Public Health England; Porton Down Salisbury UK
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Henning DCW, Bennett A. Role 1 Enhanced: a new paradigm in humanitarian operations. J R Nav Med Serv 2017; 103:32-34. [PMID: 30088737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Operation BUCKTAIL is the UK contribution to migrant surveillance and reconnaissance in the Aegean Sea. This paper describes two different and novel medical configurations which deployed in early 2016 to this Area of Operations (AO). Casualties in this situation would be treated under the Convention of Safety Of Life At Sea, a humanitarian role which may be less familiar to some of the Defence Medical Services. Casualty management is discussed and the composition of medical teams examined.
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Tod A, Magee L, Coates M, Bennett A, Sarkar N. 96: An evaluation of a lung cancer research training for nurses: Thoracic Oncology Research from Concept to Home Run (TORCH). Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30146-0] [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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Gupta R, Derevensky J, Tsanos A, Klein C, Bennett A, Kanevsky L. A Comparison of Adolescents' Fears from Montreal and Vancouver. Canadian Journal of School Psychology 2016. [DOI: 10.1177/082957359501100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Adolescence is a developmental period often filled with uncertainty, conflict, and major life changes. Fear, a powerful human emotion, represents a normal response to active or perceived threat experienced by all individuals at all stages of life. Adolescents were found to experience fears relevant to their stage in life. Issues of acceptance by peers, the formulation of one's identity, discovering intimate relationships, and the uncertainty of their future are all typical adolescent concerns. Substantial interindividual variability was found to exist in the manifestation, acquisition, and persistence of fears. Findings revealed that as a whole the three most commonly reported fears concern their future, issues related to the environment, and AIDS. With respect to location, adolescents in Vancouver report significantly more fears, especially fears of violence and pain and death, than do those from Montreal. Montrealers most frequently expressed fears of the future, AIDS, and political instability. Developmental trends revealed an increase in fears of the future, the environment, and political instability, and a decrease in fears of violence and peer pressure as they get older. Females in general were found to express more fears than their male counterparts in most categories. The results are discussed with respect to situational and demographic factors, developmental changes, and gender differences.
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36
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Roberts A, Roscoe D, Hulse D, Bennett A, Dixon S. BIOMECHANICAL DIFFERENCES BETWEEN CASES WITH CECS AND ASYMPTOMATIC CONTROLS DURING WALKING AND MARCHING. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096952.6] [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: 11/04/2022]
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Roscoe D, Roberts A, Hulse D, Hughes M, Shaheen A, Bennett A. BAREFOOT PLANTAR PRESSURE MEASUREMENT IN CHRONIC EXERTIONAL COMPARTMENT SYNDROME. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096952.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Roberts A, Roscoe D, Hulse D, Bennett A, Dixon S. BIOMECHANICAL DIFFERENCES BETWEEN CASES WITH CECS AND ASYMPTOMATIC CONTROLS DURING RUNNING. Br J Sports Med 2016. [DOI: 10.1136/bjsports-2016-096952.32] [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: 11/03/2022]
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39
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Rosenstein H, Bennett A, Gold M. Addressing reproductive coercion in family medicine residency programs. Contraception 2016. [DOI: 10.1016/j.contraception.2016.07.187] [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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40
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Affiliation(s)
| | - K E Eakins
- Institute of Ophthalmology, Judd Street, London WC1H 9QS
| | - A Bennett
- King's College Hospital Medical School, London SE5 8RX
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41
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Pergolotti M, Bryant AL, Bennett A, Williams GR. Senior SWAY: A Mobile Application to Predict Fall Risk in Older Adults. Am J Occup Ther 2016. [DOI: 10.5014/ajot.2016.70s1-po5122] [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: 11/17/2022] Open
Abstract
Abstract
Date Presented 4/8/2016
This study evaluated a new mobile application’s ability to predict fall risk in older adults. Senior SWAY was significantly associated with patient-reported previous falls and the Timed Up and Go. This application could potentially ease identification of older adults at risk of falling.
Primary Author and Speaker: Mackenzi Pergolotti
Additional Author and Speaker: Ashley Bryant
Contributing Authors: A. Bennett, G. R. Williams
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Liu Q, Nassar A, Farias K, Buccini L, Mangino MJ, Baldwin W, Bennett A, O'Rourke C, Iuppa G, Soliman BG, Urcuyo-Llanes D, Okamoto T, Uso TD, Fung J, Abu-Elmagd K, Miller C, Quintini C. Comparing Normothermic Machine Perfusion Preservation With Different Perfusates on Porcine Livers From Donors After Circulatory Death. Am J Transplant 2016; 16:794-807. [PMID: 26663737 DOI: 10.1111/ajt.13546] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/08/2015] [Accepted: 09/25/2015] [Indexed: 01/25/2023]
Abstract
The utilization of normothermic machine perfusion (NMP) may be an effective strategy to resuscitate livers from donation after circulatory death (DCD). There is no consensus regarding the efficacy of different perfusates on graft and bile duct viability. The aim of this study was to compare, in an NMP porcine DCD model, the preservation potential of three different perfusates. Twenty porcine livers with 60 min of warm ischemia were separated into four preservation groups: cold storage (CS), NMP with Steen solution (Steen; XVIVO Perfusion Inc., Denver, CO), Steen plus red blood cells (RBCs), or whole blood (WB). All livers were preserved for 10 h and reperfused to simulate transplantation for 24 h. During preservation, the NMP with Steen group presented the highest hepatocellular injury. At reperfusion, the CS group had the lowest bile production and the worst hepatocellular injury compared with all other groups, followed by NMP with Steen; the Steen plus RBC and WB groups presented the best functional and hepatocellular injury outcomes, with WB livers showing lower aspartate aminotransferase release and a trend toward better results for most parameters. Based on our results, a perfusate that contains an oxygen carrier is most effective in a model of NMP porcine DCD livers compared with Steen solution. Specifically, WB-perfused livers showed a trend toward better outcomes compared with Steen plus RBCs.
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Affiliation(s)
- Q Liu
- Cleveland Clinic, Cleveland, OH
| | | | | | | | - M J Mangino
- Virginia Commonwealth University, Richmond, VA
| | | | | | | | - G Iuppa
- Cleveland Clinic, Cleveland, OH
| | | | | | | | - T D Uso
- Cleveland Clinic, Cleveland, OH
| | - J Fung
- Cleveland Clinic, Cleveland, OH
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Koval CE, Khanna A, Pallotta A, Spinner M, Taege AJ, Eghtesad B, Fujiki M, Hashimoto K, Rodriguez B, Morse G, Bennett A, Abu-Elmagd K. En Bloc Multivisceral and Kidney Transplantation in an HIV Patient: First Case Report. Am J Transplant 2016; 16:358-63. [PMID: 26437326 DOI: 10.1111/ajt.13455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/24/2014] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 01/25/2023]
Abstract
The continual improvement in outcome with highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) infection and visceral transplantation for gut failure stimulated our interest in lifting HIV infection as a contraindication for intestinal and multivisceral transplantation. This report is the first to describe visceral transplantation in a patient with HIV infection. A HAART regimen was introduced in the setting of short-gut syndrome with successful suppression of HIV viral load. The indication for en bloc multivisceral and kidney transplantation was end-stage liver failure with portomesenteric venous thrombosis and chronic renal insufficiency. The underlying hepatic pathology was alcoholic and home parenteral nutrition-associated cirrhosis. Surgery was complicated due to technical difficulties with excessive blood loss and long operative time. The complex posttransplant course included multiple exploratory laparotomies due to serious intra-abdominal and systemic infections. Heavy immunosuppression was required to treat recurrent episodes of severe allograft rejection. Posttransplant oral HAART successfully sustained undetectable viral load. Unfortunately, the patient succumbed to sepsis 3 months posttransplant. With new insights into the biology of gut immunity, mechanisms of allograft tolerance, and HIV-associated immune dysregulation, successful outcome is anticipated, particularly in patients who are in need of isolated intestinal and less-organ-contained visceral allografts.
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Affiliation(s)
- C E Koval
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
| | - A Khanna
- Department of Surgery, Cleveland Clinic, Cleveland, OH.,Transplantation Center, Cleveland Clinic, Cleveland, OH
| | - A Pallotta
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH
| | - M Spinner
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH
| | - A J Taege
- Department of Infectious Disease, Cleveland Clinic, Cleveland, OH
| | - B Eghtesad
- Department of Surgery, Cleveland Clinic, Cleveland, OH
| | - M Fujiki
- Department of Surgery, Cleveland Clinic, Cleveland, OH.,Transplantation Center, Cleveland Clinic, Cleveland, OH
| | - K Hashimoto
- Department of Surgery, Cleveland Clinic, Cleveland, OH.,Transplantation Center, Cleveland Clinic, Cleveland, OH
| | - B Rodriguez
- Division of Infectious Disease, Case Western Reserve University, Cleveland, OH
| | - G Morse
- Department of Pharmacy, University of Buffalo, Buffalo, NY
| | - A Bennett
- Department of Pathology, Cleveland Clinic, Cleveland, OH
| | - K Abu-Elmagd
- Department of Surgery, Cleveland Clinic, Cleveland, OH.,Transplantation Center, Cleveland Clinic, Cleveland, OH
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Appelbe D, Broadbent D, Mobayen-Rahni M, Eleuteri A, Bennett A, Moitt T, Wang A, García-Fiñana M, Fisher A, Harding S. Introducing personalised risk based intervals in screening for diabetic retinopathy: development, implementation and assessment of safety, cost-effectiveness and patient experience (ISDR): a case study in the use of automated systems in trials. Trials 2015. [PMCID: PMC4658818 DOI: 10.1186/1745-6215-16-s2-o59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Amico J, Bennett A, Karasz A, Gold M. Women's experiences with early elective IUD removal. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.194] [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: 10/23/2022]
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Kumar B, Bennett A, Blank A, Gold M. The future of family planning in Texas: are family physicians ready? Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.228] [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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Bennett A, Watson T, Simmonds J. The efficacy of the use of manual therapy in the management of tendinopathy: a systematic review. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1629] [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: 10/23/2022]
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Bennett A, Kerr K, Sharratt G. Improving evidence-based medicines prescription in heart failure (HF) and acute coronary syndrome (ACS) at hospital discharge. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.632] [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: 10/23/2022]
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Bennett A, Ashby J, Curtiss M, Pal N, Wambaa T, Menzies S. M37 Does The Tuberculin Skin Test Increase The Detection Of Tb Infection When Screening Hiv Positive Patients? Three Years' Experience In A District General Hospital. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.425] [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: 11/03/2022]
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Bartels EM, Christensen R, Christensen P, Henriksen M, Bennett A, Gudbergsen H, Boesen M, Bliddal H. Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2014; 22:1817-25. [PMID: 25106676 DOI: 10.1016/j.joca.2014.07.027] [Citation(s) in RCA: 23] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis (KOA) may reflect changes in tissue turnover induced by interventions. The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients. METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention (ClinicalTrials.gov: NCT00655941). Serum Cartilage Oligomeric Matrix Protein (sCOMP), Urine C-terminal telopeptide of collagen type II (uCTX-II) and type I (uCTX-I) were determined by enzyme-linked immunoassay (ELISA) at baseline and after 16 weeks. Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) Questionnaire without the sports and recreation score (KOOS-4). Change from baseline was analyzed using Analysis of CoVariance (ANCOVA) adjusting for sex, age, and body mass index (BMI). Bivariate associations were analyzed using Spearman's test of rank correlation. RESULTS 175 patients completed the treatment and lost mean 13.4 (95% CI: 12.5-14.4) kg. sCOMP concentration decreased on average 1.1 (95% CI: -1.5 to -0.8) U/L with a correlation to weight loss (r = -0.17, P = 0.028), but not to change in KOOS-4 (r = -0.13, P = 0.091). uCTX-II increased significantly, mean 69 (95% CI: 31-106) ng/mmol creatinine, with no relation to weight loss (P = 0.14). Change in uCTX-II was reversely related to change in KOOS-4 (r = -0.28, P = 0.0003). uCTX-I increased, mean 67 (95% CI: 47-87) μg/mmol creatinine, and correlated to weight loss (r = 0.22, P = 0.0007), while not to KOOS-4 (P = 0.93). CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly, while significantly associated with a reduction in sCOMP, and increases in both uCTX-II and uCTX-I.
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Affiliation(s)
- E M Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
| | - P Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - A Bennett
- Immunodiagnostic Systems Limited (IDS), UK.
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Knowledgecentre for Telemedicine, The Capital Region of Denmark, Denmark; Department of Rheumatology, Copenhagen University Hospitals, Glostrup, Frederiksberg and Bispebjerg, Denmark.
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Faculty of Health Science, University of Copenhagen, Denmark; SMI, Aalborg University, Denmark.
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