1
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Milucky J, Patel K, Patton ME, Kirley PD, Austin E, Meek J, Anderson EJ, Brooks A, Brown C, Mumm E, Salazar-Sanchez Y, Barney G, Popham K, Sutton M, Talbot HK, Crossland MT, Havers FP. Characteristics and Outcomes of Pregnant Women Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2024; 11:ofae042. [PMID: 38524226 PMCID: PMC10960599 DOI: 10.1093/ofid/ofae042] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/25/2024] [Indexed: 03/26/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) can cause severe disease among infants and older adults. Less is known about RSV among pregnant women. Methods To analyze hospitalizations with laboratory-confirmed RSV among women aged 18 to 49 years, we used data from the RSV Hospitalization Surveillance Network (RSV-NET), a multistate population-based surveillance system. Specifically, we compared characteristics and outcomes among (1) pregnant and nonpregnant women during the pre-COVID-19 pandemic period (2014-2018), (2) pregnant women with respiratory symptoms during the prepandemic and pandemic periods (2021-2023), and (3) pregnant women with and without respiratory symptoms in the pandemic period. Using multivariable logistic regression, we examined whether pregnancy was a risk factor for severe outcomes (intensive care unit admission or in-hospital death) among women aged 18 to 49 years who were hospitalized with RSV prepandemic. Results Prepandemic, 387 women aged 18 to 49 years were hospitalized with RSV. Of those, 350 (90.4%) had respiratory symptoms, among whom 33 (9.4%) were pregnant. Five (15.2%) pregnant women and 74 (23.3%) nonpregnant women were admitted to the intensive care unit; no pregnant women and 5 (1.6%) nonpregnant women died. Among 279 hospitalized pregnant women, 41 were identified prepandemic and 238 during the pandemic: 80.5% and 35.3% had respiratory symptoms, respectively (P < .001). Pregnant women were more likely to deliver during their RSV-associated hospitalization during the pandemic vs the prepandemic period (73.1% vs 43.9%, P < .001). Conclusions Few pregnant women had severe RSV disease, and pregnancy was not a risk factor for a severe outcome. More asymptomatic pregnant women were identified during the pandemic, likely due to changes in testing practices for RSV.
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Affiliation(s)
- Jennifer Milucky
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kadam Patel
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica E Patton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pam Daily Kirley
- California Emerging Infections Program, Oakland, California, USA
| | - Elizabeth Austin
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - James Meek
- Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA
| | - Evan J Anderson
- Departments of Medicine and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Georgia Department of Public Health, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Alicia Brooks
- Maryland Department of Health, Baltimore, Maryland, USA
| | - Chloe Brown
- Michigan Department of Health and Human Services, Lansing, Michigan, USA
| | - Erica Mumm
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Grant Barney
- New York State Department of Health, Albany, New York, USA
| | - Kevin Popham
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Melissa Sutton
- Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - H Keipp Talbot
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Fiona P Havers
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Parsons K, Snell G, Brooks A, Westall G, Cristiano Y, Levvey B, Sullivan L, Stankovic S. Donor-Derived Lymphocyte Chimerism is Associated with Protection from Chronic Lung Allograft Dysfunction. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.051] [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: 04/05/2023] Open
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3
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Akhtar A, Brooks A, O'Connor R. EGS P01 The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.066] [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: 12/13/2022]
Abstract
Abstract
Background
There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter.
Methods
Data was retrieved for patients between 10–25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2015–2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time and mortality were analysed according to the hours of daylight, darkness and season.
Results
The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500–1630 correlating to school pick up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124) with moderate injuries (ISS 9–14) occurring most commonly during the day (72.7%) and more severe injuries (ISS>15) occurred during the night (55.8%).
Conclusions
We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role . This could be addressed through a targeted public health approach to implement change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.
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Affiliation(s)
- Amina Akhtar
- Major trauma centre, Nottingham University Hospitals , Nottingham , United Kingdom
| | - A Brooks
- Major trauma centre, Nottingham University Hospitals , Nottingham , United Kingdom
| | - R O'Connor
- Major trauma centre, Nottingham University Hospitals , Nottingham , United Kingdom
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4
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Saxenian H, Alkenbrack S, Freitas Attaran M, Barcarolo J, Brenzel L, Brooks A, Ekeman E, Griffiths UK, Rozario S, Vande Maele N, Ranson MK. Sustainable financing for Immunization Agenda 2030. Vaccine 2022:S0264-410X(22)01450-5. [PMID: 36464542 DOI: 10.1016/j.vaccine.2022.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/02/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022]
Abstract
Sustainable financing for immunization refers to the sufficient and predictable allocation and use of resources to support the achievement of immunization goals within the framework of overall health financing. The Immunization Agenda 2030 (IA2030) agenda spells out four important focus areas needed for sustainable financing: (1) ensuring sufficient and predictable resources, (2) making optimal use of resources, (3) aligning partnerships, and (4) supporting sustainable transitions from external assistance. This paper summarizes the evidence and proposes interventions under each area. While immunization is one of the best investments and justifies public financing, the COVID-19 pandemic has led to the worst economic recession since the Great Depression and threatens countries' ability to mobilize funding to ensure continuity and access to essential services, including immunization. Strategies for ensuring adequate resources differ by income group but include raising more revenues, reprioritizing the budget towards health, and ensuring that health resources favor Primary Health Care (PHC) and immunization. In low- and lower-middle income countries, support from Gavi, the Vaccine Alliance, which channels the largest amount of external financing, will remain important, but some lower-middle income countries will need to prepare for transition. Countries benefitting from the Global Polio Eradication Initiative (GPEI) are also experiencing a transition from GPEI financing to domestic and other external financing. This paper outlines ways in which countries can improve the use of domestic and external resources to better incentivize high-quality PHC and immunization services and align immunization programs with health sector reforms. While governments must lead, collective action from development partners, the private sector, and civil society is needed to promote health system financing systems that ensure that the world is better prepared for future outbreaks and pandemics, while reinforcing the IA2030 vision and making progress towards universal health coverage and the Sustainable Development Goals.
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Affiliation(s)
| | - S Alkenbrack
- World Bank Group, Health, Nutrition and Population Global Practice, Washington, D.C., United States
| | | | - J Barcarolo
- Gavi, The Vaccine Alliance, Geneva, Switzerland(1)
| | - L Brenzel
- Bill & Melinda Gates Foundation, Seattle, WA, United States
| | - A Brooks
- Bridges to Development, Geneva, Switzerland
| | - E Ekeman
- World Health Organization, Geneva, Switzerland
| | - U K Griffiths
- UNICEF Programme Division, New York City, NY, United States
| | - S Rozario
- UNICEF Programme Division, New York City, NY, United States
| | | | - M K Ranson
- World Bank Group, Health, Nutrition and Population Global Practice, Geneva, Switzerland
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5
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Goodday SM, Karlin E, Brooks A, Chapman C, Karlin DR, Foschini L, Kipping E, Wildman M, Francis M, Greenman H, Li L, Schadt E, Ghassemi M, Goldenberg A, Cormack F, Taptiklis N, Centen C, Smith S, Friend S. Better Understanding of the Metamorphosis of Pregnancy (BUMP): protocol for a digital feasibility study in women from preconception to postpartum. NPJ Digit Med 2022; 5:40. [PMID: 35354895 PMCID: PMC8967890 DOI: 10.1038/s41746-022-00579-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The Better Understanding the Metamorphosis of Pregnancy (BUMP) study is a longitudinal feasibility study aimed to gain a deeper understanding of the pre-pregnancy and pregnancy symptom experience using digital tools. The present paper describes the protocol for the BUMP study. Over 1000 participants are being recruited through a patient provider-platform and through other channels in the United States (US). Participants in a preconception cohort (BUMP-C) are followed for 6 months, or until conception, while participants in a pregnancy cohort (BUMP) are followed into their fourth trimester. Participants are provided with a smart ring, a smartwatch (BUMP only), and a smart scale (BUMP only) alongside cohort-specific study apps. Participant centric engagement strategies are used that aim to co-design the digital approach with participants while providing knowledge and support. The BUMP study is intended to lay the foundational work for a larger study to determine whether participant co-designed digital tools can be used to detect, track and return multimodal symptoms during the perinatal window to inform individual level symptom trajectories.
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Affiliation(s)
- S M Goodday
- 4YouandMe, Seattle, WA, USA. .,Department of Psychiatry, University of Oxford, Oxford, UK.
| | | | | | | | - D R Karlin
- 4YouandMe, Seattle, WA, USA.,MindMed, Inc., New York, NY, USA.,Tufts University School of Medicine, Boston, MA, USA
| | - L Foschini
- Evidation Health Inc., Santa Mateo, CA, USA
| | - E Kipping
- Evidation Health Inc., Santa Mateo, CA, USA
| | - M Wildman
- Evidation Health Inc., Santa Mateo, CA, USA
| | | | | | | | | | - M Ghassemi
- Institute for Medical Engineering and Science, MIT, Cambridge, MA, USA.,Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA, USA.,Vector Institute, CIFAR AI Chair, Toronto, Canada
| | - A Goldenberg
- Vector Institute, CIFAR AI Chair, Toronto, Canada.,SickKids Research Institute, Department of Computer Science, University of Toronto, Toronto, Canada
| | - F Cormack
- Cambridge Cognition, Cambridge, GB, USA.,Department of Psychiatry, University of Cambridge, Cambridge, GB, USA
| | | | - C Centen
- Bodyport Inc., San Francisco, CA, USA
| | - S Smith
- Bodyport Inc., San Francisco, CA, USA
| | - S Friend
- 4YouandMe, Seattle, WA, USA.,Department of Psychiatry, University of Oxford, Oxford, UK
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6
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Smith M, Hennessey J, Willard T, Bishop D, Simmonds F, Kunsch I, Sturges J, Brooks A, Titus P, Zhang H, Wang W, Luttrell C, Cook J, Basinger J. Design and Analyses of the NSTX-U PF1A Poloidal Field Coil Support. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1897730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Smith
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - J. Hennessey
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - T. Willard
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - D. Bishop
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - F. Simmonds
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - I. Kunsch
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - J. Sturges
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - A. Brooks
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - P. Titus
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - H. Zhang
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - W. Wang
- Princeton Plasma Physics Laboratory, C34-101, MS-42, P.O. Box 451, Princeton, New Jersey 08543-0451
| | - C. Luttrell
- Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - J. Cook
- Oak Ridge National Laboratory, Oak Ridge, Tennessee
| | - J. Basinger
- Oak Ridge National Laboratory, Oak Ridge, Tennessee
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7
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Rana C, Brown T, Titus P, Zhai Y, Brooks A, Menard JE. Concept Design and Analysis of the Magnet System of the Sustained High Power Density Tokamak Facility. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1940645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C. Rana
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - T. Brown
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - P. Titus
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - Y. Zhai
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - A. Brooks
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - J. E. Menard
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
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8
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Titus P, Brooks A, Zhang H. Modeling Delamination in NSTX-U Inner Leg Using “EKILL”. Fusion Science and Technology 2021. [DOI: 10.1080/15361055.2021.1912568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peter Titus
- Princeton Plasma Physics Laboratory, Princeton, New Jersey
| | - A. Brooks
- Princeton Plasma Physics Laboratory, Princeton, New Jersey
| | - H. Zhang
- Princeton Plasma Physics Laboratory, Princeton, New Jersey
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9
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Merchán A, Beaulieu A, Côté N, Linden A, Koenig J, Brooks A. Use of computed tomography angiography for the evaluation of a cutaneous haemangioma in a Standardbred horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Merchán
- Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - A. Beaulieu
- Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - N. Côté
- Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - A. Linden
- Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - J. Koenig
- Department of Clinical Studies Ontario Veterinary College University of Guelph Guelph Ontario Canada
| | - A. Brooks
- Animal Health Laboratory University of Guelph Guelph Ontario Canada
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10
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Gysling S, Maresca G, Brooks A, Patel A, Caruana EJ. Impact of enhanced personal protective equipment on surgeon workload and intraoperative patient outcomes. Br J Surg 2021; 108:e135-e136. [PMID: 33793712 DOI: 10.1093/bjs/znaa172] [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] [Received: 11/29/2020] [Accepted: 12/13/2020] [Indexed: 11/12/2022]
Abstract
This work shows the need for targeted improvement to mitigate communication challenges associated with use of enhanced personal protective equipment. The data provide reassurance to surgeons and patients that there is no negative impact on surgeon workload or patient outcomes from use of enhanced personal protective equipment in the operating theatre.
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Affiliation(s)
- S Gysling
- Academic Foundation Programme, University Hospitals of Derby and Burton NHS Trust, Derby, UK
| | - G Maresca
- Urological Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - A Brooks
- Trauma Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - E J Caruana
- Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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11
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Vondracek P, Panek R, Hron M, Havlicek J, Weinzettl V, Todd T, Tskhakaya D, Cunningham G, Hacek P, Hromadka J, Junek P, Krbec J, Patel N, Sestak D, Varju J, Adamek J, Balazsova M, Balner V, Barton P, Bielecki J, Bilkova P, Błocki J, Bocian D, Bogar K, Bogar O, Boocz P, Borodkina I, Brooks A, Bohm P, Burant J, Casolari A, Cavalier J, Chappuis P, Dejarnac R, Dimitrova M, Dudak M, Duran I, Ellis R, Entler S, Fang J, Farnik M, Ficker O, Fridrich D, Fukova S, Gerardin J, Hanak I, Havranek A, Herrmann A, Horacek J, Hronova O, Imrisek M, Isernia N, Jaulmes F, Jerab M, Kindl V, Komm M, Kovarik K, Kral M, Kripner L, Macusova E, Majer T, Markovic T, Matveeva E, Mikszuta-Michalik K, Mohelnik M, Mysiura I, Naydenkova D, Nemec I, Ortwein R, Patocka K, Peterka M, Podolnik A, Prochazka F, Prevratil J, Reboun J, Scalera V, Scholz M, Svoboda J, Swierblewski J, Sos M, Tadros M, Titus P, Tomes M, Torres A, Tracz G, Turjanica P, Varavin M, Veselovsky V, Villone F, Wąchal P, Yanovskiy V, Zadvitskiy G, Zajac J, Zak A, Zaloga D, Zelda J, Zhang H. Preliminary design of the COMPASS upgrade tokamak. Fusion Engineering and Design 2021. [DOI: 10.1016/j.fusengdes.2021.112490] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Seehra JK, Lewis-Lloyd C, Gida G, Adiamah A, Brooks A. O35 The impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the east Midlands major trauma centre: an icon trauma study. Br J Surg 2021. [DOI: 10.1093/bjs/znab282.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
During the COVID-19 pandemic, Major Trauma services were subject to significant challenges including reduced access to Computed Tomography (CT) scanning and restrictions on operative intervention due to limited intensive care beds. This study evaluated the pandemic’s impact on access and timeliness of imaging and surgical intervention.
Method
This observational study compared 2 cohorts of patients admitted in a 10-week period during the COVID-19 pandemic and a similar time period in 2019. Variables included demographics, time to CT scan and to surgery and operative characteristics. Statistical comparisons were undertaken using Mann Whitney U, Fisher’s exact and Chi-squared tests.
Result
Of 642 patients, 405 were admitted in 2019 and 237 in 2020 representing a 41.5% absolute reduction in trauma admissions during the pandemic. There were no statistical differences (P = 0.2585) between arrival to the Emergency Department and time to CT scan across both years (median 42 minutes) or between operative approach (P = 0.728) and level of post-operative care (P = 0.788). However, there were statistical differences in time to surgery (P = 0.0193) and operative length (P = 0.0141) with a 2-fold increase in overnight operating, 31.2% increase in patients operated on < 24 hours from admission, and 42.9% reduction in surgery lasting >120 minutes during the COVID-19 pandemic.
Conclusion
Early robust restructuring of trauma services during the COVID-19 pandemic ensured timely access to appropriate imaging and surgery for major trauma injured patients. The higher rates of overnight surgery and shorter duration of procedure were likely explained by the increased onsite availability of suitably trained trauma surgical teams.
Take-home Message
COVID-19 had the potential to significantly impact Major Trauma services, however excellence in patient care was maintained by quick restructuring to staff, space and services Improvements to the Major Trauma pathway have become ingrained into daily practice and optimised for future outbreaks.
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Affiliation(s)
- J K Seehra
- Queens Medical Centre, Nottingham University Hospitals
| | - C Lewis-Lloyd
- Queens Medical Centre, Nottingham University Hospitals
| | - G Gida
- Queens Medical Centre, Nottingham University Hospitals
| | - A Adiamah
- Queens Medical Centre, Nottingham University Hospitals
| | - A Brooks
- Queens Medical Centre, Nottingham University Hospitals
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13
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Peer S, Brooks A, McGuire J. "How I do it": Novel non-occlusive balloon dilation in paediatric airway stenosis: A paradigm shift (with video). Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 1:21-22. [PMID: 34175253 DOI: 10.1016/j.anorl.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/25/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Peer
- Division of Otorhinolaryngology, University of Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
| | - A Brooks
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Division of Cardiothoracic Surgery, University of Cape Town, South Africa
| | - J McGuire
- Division of Otorhinolaryngology, University of Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
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14
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Hall M, La Valle A, Freij R, Brooks A. Uncommon traumatic anterior aortic dissection in the context of a blunt trauma. BMJ Case Rep 2021; 14:14/6/e242387. [PMID: 34155022 DOI: 10.1136/bcr-2021-242387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Michael Hall
- General Surgery, Queen's Medical Centre, Nottingham, UK
| | | | - Ramzi Freij
- Accident and Emergency, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Brooks
- Surgery, Queen's Medical Centre, Nottingham, UK
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15
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Seehra JK, Lewis-Lloyd C, Gida G, Adiamah A, Brooks A. Impact of COVID-19 on access and availability of radiological imaging and surgical intervention at the East Midlands Major Trauma Centre: An ICON Trauma Study. Br J Surg 2021; 108:e170-e172. [PMID: 33723581 PMCID: PMC7989566 DOI: 10.1093/bjs/znab014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/07/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | - A Adiamah
- Correspondence to: East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK (e-mail: )
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16
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Gysling S, Maresca G, Brooks A, Patel A, Caruana E. 617 Does Wearing Enhanced Personal Protective Equipment (PPE) In Theatre Increase Surgeon Workload and Patient Morbidity? Br J Surg 2021. [PMCID: PMC8135824 DOI: 10.1093/bjs/znab134.072] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Delivery of surgical services during the Covid-19 pandemic has required the use of enhanced PPE in the operating theatre. We sought to evaluate the impact of this change on surgeon workload and intraoperative patient outcomes. Method Surgeons performing as primary operator completed an online procedure-specific questionnaire on workload ratings for each operative case, using an extension of the validated Surgeon Task Load Index (SURG-TLX) tool (reported on a 20-point scale), together with operative details. Local approval was obtained at individual sites. Data was analysed in Stata SE v16. Results 118 responses (17 surgeons, 7 specialties) were collected from June to September 2020. 77.1% used enhanced PPE. There was no association between enhanced PPE use and overall workload (p = 0.151) as measured with SURG-TLX, although surgeons wearing enhanced PPE commonly reported finding individual procedures harder than expected (37% vs 0%, p < 0.001). Communication was rated worse when using enhanced PPE use (MD -4.38, 95%CI -6.74 to 02.03; p < 0.001). There was no association between enhanced PPE use and intraoperative complications (p = 0.745). Conclusions The use of enhanced PPE is not associated with complications or increased surgeon workload assessed by SURG-TLX. It is, however, associated with difficulty in communicating, and subjectively experiencing more procedural challenge than anticipated.
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Affiliation(s)
- S Gysling
- Foundation Programme, University Hospitals of Derby and Burton NHS Trust, Derby, United Kingdom
| | - G Maresca
- Urological Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - A Brooks
- Trauma Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - A Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
| | - E Caruana
- Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
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17
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Adiamah A, Thompson AI, Lewis-Lloyd C, Dickson E, Blackburn L, Moody N, Gida S, La Valle A, Reilly JJ, Saunders J, Brooks A. 664 The ICON Trauma Study: The Impact of the COVID-19 Lockdown on Major Trauma Workload in the UK. Br J Surg 2021. [PMCID: PMC8135784 DOI: 10.1093/bjs/znab134.074] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction Anecdotal evidence suggest a direct impact of the SARS-COV-2-pandemic on presentation and severity of major trauma. Method This observational study from a UK Major Trauma Centre matched a cohort of patients admitted during a 10-week period of the SARS-CoV-2-pandemic (09/03/2020 to 18/05/2020) to a historical cohort admitted during a similar time period in 2019 (11/03/2019 to 20/05/2019). Demographic differences, injury method and severity were compared using Fisher’s and Chi-squared tests. Multivariable logistic regression examined the associated factors predicting 30-day mortality. Results Of 642 patients, 405 and 237 were in the 2019 and 2020 cohorts respectively. 1.69%(4/237) of the 2020 cohort tested SARS-CoV-2 positive. There was a 41.5% decrease in trauma admissions in 2020. The 2020 cohort was older (median 46 vs.40 years), more comorbid and frailer (p < 0.0015). There was a significant difference in injury method with a decrease in vehicle related trauma, but an increase in falls. There was a 2-fold increased risk of mortality in the 2020 cohort that in adjusted models, was explained by higher injury severity and frailty. Positive SARS-CoV-2 status was not associated with increased mortality on multivariable analysis. Conclusions Patients admitted during the SARS-CoV-2-pandemic were older, frailer, more co-morbid and had an increased risk of mortality.
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Affiliation(s)
- A Adiamah
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - A i Thompson
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - C Lewis-Lloyd
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - E Dickson
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - L Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - N Moody
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - S Gida
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - A La Valle
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - J J Reilly
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - J Saunders
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
| | - A Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS, Nottingham, United Kingdom
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18
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Akhtar A, O'Connor R, Rosen J, Brooks A. 1002 Calcium administration in Major haemorrhage Protocol. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.523] [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: 11/14/2022]
Abstract
Abstract
Introduction
Calcium gluconate is an essential part of the major haemorrhage protocol (MHP). It minimizes the exacerbation of transfusion coagulopathies due to the citrate preservative. As fifty percent of trauma patients present with hypocalcaemia prior to transfusion, the risk is pertinent. Given the importance of the issue, surprisingly current guidelines remain sparse. We analysed the percentage of patients who received calcium and their hypocalcaemia incidence.
Method
A Retrospective review of red traumas during June to August 2019. The frequency of MHP and the patient’s ionised plasma calcium levels on VBG (1.15-1.26mmol/L) were identified. Our standard stated 100% of MHP should receive calcium. A massive transfusion was defined as 10 red blood cells units in 24 hours or 4 blood products within 30mins.
Results
27 red traumas were accepted to audit, MHP was activated in 85%. Out of these 75% received calcium and on average after 6.4 units of blood products. The incidence of ionised hypocalcaemia in all MHP patients was 67%.
Conclusions
We identified a standard that supplementary calcium should be supplemented in all MHPs. Hypocalcaemia was more frequency than our research stipulated. Improvement needs to be made to meet standards. We recommend incorporation of Calcium gluconate into major haemorrhage pack and transfusion guidelines.
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Affiliation(s)
- A Akhtar
- Nottingham University Hospital, Nottingham, United Kingdom
| | - R O'Connor
- Nottingham University Hospital, Nottingham, United Kingdom
| | - J Rosen
- Nottingham University Hospials, Nottingham, United Kingdom
| | - A Brooks
- Nottingham University Hospital, Nottingham, United Kingdom
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19
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Howley C, Shellberg J, Olley J, Brooks A, Spencer J, Burford M. Sediment and nutrient sources and sinks in a wet-dry tropical catchment draining to the Great Barrier Reef. Mar Pollut Bull 2021; 165:112080. [PMID: 33740597 DOI: 10.1016/j.marpolbul.2021.112080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/29/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
Many tropical river systems have altered water quality due to human land use, impacting the biodiversity of freshwater and coastal ecosystems. Long-term, catchment-scale monitoring is needed to understand pollutant sources, controls, and trends. This 12-year study monitored baseflow and flood event nutrient and sediment concentrations, and estimated sediment loads across the Normanby Basin in northern Australia. Suspended sediment concentrations and yields were highest in upper catchment areas where cattle grazing occurred on erosion-prone sodic soils. Mid- and lower catchment rivers and floodplains were a sink for sediments and nutrients, trapping around 75% of suspended sediments during events. Clays (<4 μm) were preferentially transported to the estuary, with an estimated 46% sediment delivery ratio. In the estuary, suspended sediment concentrations were influenced by tidal resuspension processes and there were significant sources of DIN. These findings can help prioritise land management investments for the protection of Great Barrier Reef and freshwater ecosystems.
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Affiliation(s)
- C Howley
- Howley Environmental Consulting, Cooktown, Qld 4895, Australia; Australian Rivers Institute, Griffith University, Nathan, Qld 4111, Australia.
| | - J Shellberg
- Shell Hydrologic, Cooktown, Qld 4985, Australia
| | - J Olley
- Australian Rivers Institute, Griffith University, Nathan, Qld 4111, Australia
| | - A Brooks
- Centre for Coastal Management, Griffith University, Southport, Qld 4222, Australia
| | - J Spencer
- Centre for Coastal Management, Griffith University, Southport, Qld 4222, Australia
| | - M Burford
- Australian Rivers Institute, Griffith University, Nathan, Qld 4111, Australia
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20
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Abstract
Electronic cigarettes (also known as e-cigarettes or electronic nicotine delivery systems) were invented in China in 2003 then introduced to the British market in 2007. They remain popular among the public and are deemed to be effective in reducing tobacco smoking (the UK being one of the first countries to embrace them in a harm reduction policy). However, reports in the media of e-cigarettes exploding are of concern, considering the potential functional and psychological impairment that lifelong disfigurement will cause, especially given their uptake among people of any age. We present a case of this rare, but dramatic, effect of e-cigarette use as a warning to the public.
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Affiliation(s)
| | - Rory O'Connor
- Oral and Maxillofacial Surgery, Major Trauma, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
| | - A Brooks
- Surgery, Queen’s Medical Centre, Nottingham, UK
| | - Ramzi Freij
- Accident and Emergency, Queen's Medical Centre Nottingham University Hospital NHS Trust, Nottingham, UK
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21
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Veronese L, Swanevelder J, Brooks A. Anaesthesia for the child with a univentricular heart: a practical approach. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.3.2572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - J Swanevelder
- Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
| | - A Brooks
- Red Cross War Memorial Children’s Hospital, University of Cape Town,
South Africa
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22
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Baksaas-Aasen K, Gall LS, Stensballe J, Juffermans NP, Curry N, Maegele M, Brooks A, Rourke C, Gillespie S, Murphy J, Maroni R, Vulliamy P, Henriksen HH, Pedersen KH, Kolstadbraaten KM, Wirtz MR, Kleinveld DJB, Schäfer N, Chinna S, Davenport RA, Naess PA, Goslings JC, Eaglestone S, Stanworth S, Johansson PI, Gaarder C, Brohi K. Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial. Intensive Care Med 2021; 47:49-59. [PMID: 33048195 PMCID: PMC7550843 DOI: 10.1007/s00134-020-06266-1] [Citation(s) in RCA: 133] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 09/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Contemporary trauma resuscitation prioritizes control of bleeding and uses major haemorrhage protocols (MHPs) to prevent and treat coagulopathy. We aimed to determine whether augmenting MHPs with Viscoelastic Haemostatic Assays (VHA) would improve outcomes compared to Conventional Coagulation Tests (CCTs). METHODS This was a multi-centre, randomized controlled trial comparing outcomes in trauma patients who received empiric MHPs, augmented by either VHA or CCT-guided interventions. Primary outcome was the proportion of subjects who, at 24 h after injury, were alive and free of massive transfusion (10 or more red cell transfusions). Secondary outcomes included 28-day mortality. Pre-specified subgroups included patients with severe traumatic brain injury (TBI). RESULTS Of 396 patients in the intention to treat analysis, 201 were allocated to VHA and 195 to CCT-guided therapy. At 24 h, there was no difference in the proportion of patients who were alive and free of massive transfusion (VHA: 67%, CCT: 64%, OR 1.15, 95% CI 0.76-1.73). 28-day mortality was not different overall (VHA: 25%, CCT: 28%, OR 0.84, 95% CI 0.54-1.31), nor were there differences in other secondary outcomes or serious adverse events. In pre-specified subgroups, there were no differences in primary outcomes. In the pre-specified subgroup of 74 patients with TBI, 64% were alive and free of massive transfusion at 24 h compared to 46% in the CCT arm (OR 2.12, 95% CI 0.84-5.34). CONCLUSION There was no difference in overall outcomes between VHA- and CCT-augmented-major haemorrhage protocols.
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Affiliation(s)
| | - L S Gall
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Stensballe
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - N P Juffermans
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Curry
- Oxford University Hospital NHS Trust, Oxford, UK
| | - M Maegele
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - A Brooks
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Rourke
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Gillespie
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - J Murphy
- Queen Mary University of London, London, UK
| | - R Maroni
- Queen Mary University of London, London, UK
| | - P Vulliamy
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - H H Henriksen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K Holst Pedersen
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - M R Wirtz
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - D J B Kleinveld
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - N Schäfer
- Cologne-Merheim Medical Centre, University of Witten/Herdecke, Cologne, Germany
| | - S Chinna
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R A Davenport
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - P A Naess
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - J C Goslings
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - S Eaglestone
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK
| | - S Stanworth
- Oxford University Hospital NHS Trust, Oxford, UK.,NHS Blood and Transplant, Bristol, UK
| | - P I Johansson
- Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - C Gaarder
- Oslo University Hospital & University of Oslo, Oslo, Norway
| | - K Brohi
- Centre for Trauma Sciences, Queen Mary University of London, Blizard Institute, 4 Newark Street, London, E1 2AT, UK.
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23
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Adiamah A, Moody N, Blackburn L, Dickson E, Thompson A, Reilly JJ, Saunders J, Brooks A. ICON Trauma (Impact of COVID-19 on Major Trauma workload) Study. Br J Surg 2020; 107:e412-e413. [PMID: 32749673 PMCID: PMC7436320 DOI: 10.1002/bjs.11855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022]
Affiliation(s)
- A Adiamah
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - N Moody
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - L Blackburn
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - E Dickson
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Thompson
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - J J Reilly
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - J Saunders
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - A Brooks
- East Midlands Major Trauma Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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24
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Someili A, Alosail A, Brooks A, Irfan N, Leto D, Hadzic A, Alajmi A, Mertz D, Bader M. A100 ORAL VANCOMYCIN THERAPY FOR CLOSTRIDIOIDES DIFFICILE INFECTION AND RISK OF INFECTION WITH GRAM-NEGATIVE ORGANISMS. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vancomycin is the recommended first-line therapy for mild to severe Clostridioides difficile infection (CDI). However, oral vancomycin is associated with disruption of the indigenous microbiota, predisposing patients to overgrowth of endogenous pathogens such as vancomycin-resistant enterococci.
Aims
The primary objective of the study is to examine the effect of the treatment regimens of CDI on the risk of infection with gram-negative organisms in adult patients treated for CDI.
Methods
A retrospective cohort study of 319 adult patients treated for CDI at Hamilton Health Sciences in the year 2015. A multivariate logistic regression analysis was performed to determine if oral vancomycin-based therapy is associated with an increased risk of infection with gram-negative organisms after adjustment for other factors.
Results
Eighty-one patients were excluded because of recurrent episodes of CDI within the same year or missing information. 238 patients were included in the final analysis. 48 (20.2%) patients had positive culture for gram-negative organisms after onset of CDI. Urine was the most common source for gram-negative organisms (39/48, 81.3%) followed by blood (8/48,16.7%). The most common isolated gram-negative organisms were Escherichia coli (18/48, 37.5%) and Klebsiella pneumonia (9/48, 18.8%).
The most common CDI treatment regimens were metronidazole monotherapy (137/238, 57.6%), vancomycin monotherapy (13/238, 5.5%), and combination therapy (88/238, 37.0%). Among patients who were treated with metronidazole monotherapy, vancomycin monotherapy, and combination therapy, 30(30/137, 21.9%), 3 (3/13,23.1%), and 15 (15/88, 17.1%) had positive culture for gram-negative organisms, respectively (P= 0.6).
Ninety-seven (97/238,40.8%) patients had severe CDI, 40 (40/97, 41.2%) were treated with metronidazole monotherapy, 5(5/97, 5.2%) with vancomycin monotherapy, and 52 (52/97, 53.6%) with combination therapy. 26 (26/141,18.4%) and 22 (22/97, 22.7%) had positive culture for gram-negative organisms among patients with non-severe and severe CDI, receptively (P= 0.7). In the multivariate analysis, neither type of CDI treatment regimen (P=0.2, 95% CI 0.30–1.31) nor CDI severity (P=0.4, 95% CI 0.67–2.69) was associated an increased risk of infection with gram-negative organisms after CDI onset.
Conclusions
Contrary to the reported literature, we did not find that oral vancomycin-based CDI treatment was associated with increased risk of infection with gram-negative organisms.
Funding Agencies
None
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Affiliation(s)
- A Someili
- McMaster university, Hamilton, ON, Canada
| | - A Alosail
- McMaster university, Hamilton, ON, Canada
| | - A Brooks
- McMaster university, Hamilton, ON, Canada
| | - N Irfan
- McMaster university, Hamilton, ON, Canada
| | - D Leto
- McMaster university, Hamilton, ON, Canada
| | - A Hadzic
- McMaster university, Hamilton, ON, Canada
| | - A Alajmi
- McMaster university, Hamilton, ON, Canada
| | - D Mertz
- McMaster university, Hamilton, ON, Canada
| | - M Bader
- McMaster university, Hamilton, ON, Canada
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25
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Mavigner M, Brooks A, Mattingly C, Vanderford T, Keele B, Lifson J, Dunham R, Margolis D, Silvestri G, Chahroudi A. The latency reversal activity of the SMAC mimetic AZD5582 in ART-suppressed SIV-infected rhesus macaques is potentiated by CD8a cell depletion. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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26
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Lunsford R, Raman R, Brooks A, Ellis RA, Lay WS. Modeling of Ablatant Deposition from Electromagnetically Driven Radiative Pellets for Disruption Mitigation Studies. Fusion Science and Technology 2019. [DOI: 10.1080/15361055.2019.1629246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Roger Raman
- University of Washington, Seattle, Washington
| | - A. Brooks
- Princeton Plasma Physics Laboratory, Princeton, New Jersey
| | - R. A. Ellis
- Princeton Plasma Physics Laboratory, Princeton, New Jersey
| | - W.-S. Lay
- University of Washington, Seattle, Washington
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27
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Woolf Z, Swanson M, Park T, Brooks A, Dragunow M. P10.02 Differentiating microglia and tumour associated macrophages in high grade glioma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.142] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma multiforme (GBM) is the most common primary brain tumour that affects adults. This aggressive tumour is invariably fatal, carrying a rapid progression and a dismal median survival period of only 15 months despite multimodal treatment approaches. Central to GBM pathogenesis is the immunosuppressive profile of these tumours. The two cell types that are highly abundant in these tumours and play critical roles in the immunosuppressive niche are the brain’s resident microglia and their peripheral counterparts - tumour associated macrophages (TAMs). Despite microglia and TAMs being ontogenetically distinct, these cells have largely been grouped together in research owing to the previous lack of cell-specific markers. Recent evidence has suggested that although TAMs may hold a predominantly pro-tumoral role, microglia may adopt a more anti-tumoral phenotype. Therefore, the differentiation of these two cell types is critical in elucidating the potentially characteristic roles of these two cell types in GBM pathogenesis.
MATERIAL AND METHODS
Tissue sections from resected low- and high-grade glioma tumours, along with epilepsy tissue (control), were used for immunohistochemistry (IHC) staining of macrophage pan-makers (Iba1, CD45, PU.1) and microglial-specific markers (TMEM119, P2RY12). Marker co-localisation was then used to differentiate microglia from TAMs. We further investigated a wider subset of cell-specific markers using multicolour flow cytometry and immunocytochemical staining of isolated cells from patient tissue samples.
RESULTS
Immunofluorescent staining of glioma and epilepsy tissue revealed two clear populations of cells; one population displayed long processes and co-labelling for both pan- and microglial-specific markers, whilst the other population displayed an amoeboid phenotype with only pan-maker staining. Preliminary analysis comparing microglia/TAM populations in low-grade, high-grade and epilepsy tissue suggests a clear difference in the proportions of these cells.
CONCLUSION
Our work complements RNA-Seq studies, showing that TMEM119 and P2RY12, alongside other markers, can indeed identify two distinct myeloid cell populations within glioma tissue. This provides a strong basis for further study where we aim to elucidate the respective roles of microglia and TAMs within tumours. Ultimately, this may hold the potential for differential targeting of these cells using immunotherapies.
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Affiliation(s)
- Z Woolf
- The University of Auckland, Auckland, New Zealand
| | - M Swanson
- The University of Auckland, Auckland, New Zealand
| | - T Park
- The University of Auckland, Auckland, New Zealand
| | - A Brooks
- The University of Auckland, Auckland, New Zealand
| | - M Dragunow
- The University of Auckland, Auckland, New Zealand
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28
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Macapagal J, Brooks A, Schweder P, Mee E, Faull R, Park TIH, Dragunow M. P10.03 Immunological differences between patient-matched normal-derived and GBM-derived pericytes. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.143] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Glioblastoma Multiforme (GBM) is the most aggressive, fatal, yet most common form of brain malignancy in adults. Despite advances in immune-based treatments for other modes of cancer, GBM remains a challenge due to its ability to dampen immune responses via mechanisms not yet fully understood. With a median survival time of only 15 months following diagnosis, there is a strong push to find new targets for therapy. The microenvironment comprises a mixture of malignant tumour cells, stroma, blood vessels and infiltrating inflammatory cells. Despite advances in understanding the contribution of these cells in establishing an anti-inflammatory microenvironment, the contribution of pericytes, an important neurovascular mural cell that forms the blood-brain barrier, has been inadequately studied. Therefore, we investigated the differences in immune profile between patient-matched non-neoplastic brain- and GBM-derived pericytes under basal and induced conditions.
MATERIAL AND METHODS
Primary patient-matched non-neoplastic brain and GBM tumour derived pericytes were isolated from specimens excised from consenting patients undergoing GBM surgical resection at Auckland City Hospital. Pericytes were treated with inflammatory cytokines including IL-1β, IFN-γ, TNFα and TGFβ for up to 24 hours. Inflammatory profile changes were probed for using fluorescent immunocytochemistry, qRT-PCR and spectral flow cytometry. Media was also collected for secretome analysis via cytometric bead array.
RESULTS
GBM pericytes show decreased expression of CX3CL1, both basally and following IL-1β treatment, via qRT-PCR and CBA. In contrast, increased gene expression and secretion of IL-6 and IL-8 by GBM pericytes were observed. GBM pericytes also basally express CD90 and anti-inflammatory molecule PD-L1 compared to their normal counterparts. In terms of activated pathways, basal SMAD2/3 activation is increased in GBM pericytes, while also showing greater activation following treatment with IL-1β, IFN-γ but not TNFα. C/EBPδ is activated and translocated following inflammatory stimulation; however, shows localised expression within the cytoplasm only observed in GBM pericytes.
CONCLUSION
This immunological screen of GBM pericytes highlights them as key players in the establishment of the tumour microenvironment. With data suggesting the activation of pathways such as the SMAD2/3 pathway in an unconventional manner, it suggests the potential for pericytes to manipulate pathways towards a more immunosuppressive outcome. Further immune characterisation of such cells is required to fully understand how they might contribute to the immunosuppressive nature of GBM.
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Affiliation(s)
- J Macapagal
- Center for Brain Research, Auckland, New Zealand
| | - A Brooks
- Maurice Wilkins Centre, Auckland, New Zealand
- Auckland Cytometry, Faculty of Science, Auckland, New Zealand
| | - P Schweder
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - E Mee
- Department of Neurosurgery, Auckland City Hospital, Auckland, New Zealand
| | - R Faull
- Center for Brain Research, Auckland, New Zealand
| | - T I H Park
- Center for Brain Research, Auckland, New Zealand
| | - M Dragunow
- Center for Brain Research, Auckland, New Zealand
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Sullivan L, Shaw E, Snell G, Brooks A, Westall G. A Longitudinal Study of γδ T Cell Subsets Post Lung Transplant: Potential Players in CMV Immunity. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.629] [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: 11/25/2022] Open
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Brooks A, Chakera AJ. The challenge of managing Type 1 diabetes in frail older people. Diabet Med 2019; 36:453-456. [PMID: 30663119 DOI: 10.1111/dme.13904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
Affiliation(s)
- A Brooks
- Bournemouth Diabetes & Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - A J Chakera
- Royal Sussex County Hospital, Brighton and Sussex University Hospitals, Brighton, UK
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O'Shea C, Brooks A, Campbell K, Hendriks J, Lau D, Sanders P. A Retrospective Analysis of Remote Monitoring Alerts for Atrial Fibrillation: Implications for Anticoagulation. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.341] [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: 10/26/2022]
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O'Shea C, Campbell K, Hendriks J, Brooks A, Lau D, Sanders P. Remote Monitoring Alert Burden from Implantable Cardioverter Defibrillators: An Analysis of >4000 Patients. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.421] [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: 10/26/2022]
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Brooks A, Iris Leng X, Kritchevsky S. THE DIFFERENTIAL IMPACT OF PAIN OLDER BLACK AND WHITE ADULTS: A SECONDARY ANALYSIS OF THE HEALTH ABC STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Brooks
- Wake Forest School of Medicine, WInston-Salem, North Carolina,United States
| | - X Iris Leng
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - S Kritchevsky
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Moerman-Herzog A, Rahmatallah Y, Glazko G, Brooks A, Blair S, Wong H. 222 DNA methylomic profiles of TWIST1, PLS3 and GATA6 genes in Sezary Syndrome. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.227] [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: 11/25/2022]
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35
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Meidinger S, Brooks A, Lehnert K, Feisst V, Locke M, Dunbar R. 1289 CD26+ FAP+ fibroblasts increase ECM expression in keloid scarring. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.1305] [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: 10/17/2022]
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36
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du Mez E, Johnson R, Kho D, Feisst V, Locke M, McIntosh J, Brooks A, Didsbury A, Graham S, Angel C. 939 Individual and cocktails of TLR ligands influence cytokine secretion by human skin explants. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tuason R, Brooks A, Krumlauf M, Li Y, Raju S, Ding Y, Wallen G. 1004 I Was Sleeping, Or So I Thought: Comparison Of Subjective And Objective Reports In Individuals With Alcohol Dependence During An Inpatient Rehabilitation Treatment Program. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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38
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Linz D, Kadhim K, Elliott A, Brooks A, Hendriks JMLH, Lau DH, Mcevoy DH, Hohl M, Baumert M, Sanders P. 1007Diagnostic accuracy of overnight oximetry for the diagnosis of sleep-disordered breathing in atrial fibrillation patients. Europace 2018. [DOI: 10.1093/europace/euy015.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Linz
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - K Kadhim
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Elliott
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - A Brooks
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - JMLH Hendriks
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Lau
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - D H Mcevoy
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - M Hohl
- Saarland University Hospital, Department of Internal Medicine III, Cardiology, Homburg, Germany
| | - M Baumert
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
| | - P Sanders
- South Australian Health and Medical Research Institute, Centre for Heart Rhythm Disorders, Adelaide, Australia
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Cox SG, Davidson A, Thomas J, Brooks A, Hewitson J, Numanoglu A, Millar AJW. Surgical management and outcomes of 12 cases of Wilms tumour with intracardiac extension from a single centre. Pediatr Surg Int 2018; 34:227-235. [PMID: 29022081 DOI: 10.1007/s00383-017-4197-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE To review demographics, effect of preoperative chemotherapy on tumour thrombus, imaging, operative strategy, and outcomes of 12 patients presenting with intracardiac extension of Wilms tumour thrombus. METHODS A retrospective audit was undertaken on patients with intracardiac extension of Wilms tumour. Patients were identified from the oncology database and information obtained on clinical presentation, stage, preoperative treatment, surgical procedures and complications, histology, and survival status. Ethics approval was obtained from the University of Cape Town Human Research Ethics Committee. RESULTS From 1984 to 2016, 337 children with Wilms tumour were treated. Twelve (3.6%) had intracardiac extension of tumour thrombus, nine into the right atrium, and three into the right ventricle. Ultrasound, computerized tomography, magnetic resonance imaging, and echocardiograms were used to assess thrombus level. Patients were staged as stage III(8) and IV(4). All patients received preoperative chemotherapy. Thrombus retracted from the heart in two cases. One patient died preoperatively. Eleven underwent laparotomy, median sternotomy, and cardiopulmonary bypass (CPB). Four underwent cavectomy. Five required cavoatrial patches. Thrombus extending into the hepatic veins was extracted in five patients. There was one intraoperative complication and one perioperative death. Thrombus histology showed viable tumour in 9 of 11 patients. Three patients died of progressive disease. Seven patients are currently disease free. CONCLUSION A combination of imaging is required to determine thrombus extent, and this facilitates surgical planning. Preoperative chemotherapy may cause thrombus regression, thus avoiding CPB. CPB offers appropriate conditions for safe tumour thrombus excision. Full management in centres with appropriately experienced staff and facilities for CPB is recommended.
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Affiliation(s)
- Sharon G Cox
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa.
| | - A Davidson
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - J Thomas
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - A Brooks
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - J Hewitson
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - A Numanoglu
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
| | - A J W Millar
- Divisions of Paediatric Surgery, Cardiothoracic Surgery, Anaesthetics and Haematology/Oncology, University of Cape Town, Red Cross War Memorial Children's Hospital, Klipfontein Road, Rondebosch, Cape Town, 7700, South Africa
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Edet U, Antai S, Brooks A, Asitok A, Enya O, Japhet F. An Overview of Cultural, Molecular and Metagenomic Techniques in Description of Microbial Diversity. ACTA ACUST UNITED AC 2017. [DOI: 10.9734/jamb/2017/37951] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kendall A, Woolcock A, Brooks A, Moore GE. Glutathione Peroxidase Activity, Plasma Total Antioxidant Capacity, and Urinary F2- Isoprostanes as Markers of Oxidative Stress in Anemic Dogs. J Vet Intern Med 2017; 31:1700-1707. [PMID: 29031029 PMCID: PMC5697175 DOI: 10.1111/jvim.14847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 08/04/2017] [Accepted: 08/28/2017] [Indexed: 11/27/2022] Open
Abstract
Background Oxidative stress plays a role in the pathophysiology of several diseases and has been documented as a contributor to disease in both the human and veterinary literature. One at‐risk cell is the erythrocyte, however, the role of oxidative stress in anemia in dogs has not been widely investigated. Hypothesis/Objective Anemic dogs will have an alteration in the activity of glutathione peroxidase (GPx), a decrease in of total antioxidant capacity (TAC), and an increased concentration of urinary 15‐F2‐isoprostanes (F2‐IsoP) when compared to healthy dogs. Animals 40 client‐owned dogs with anemia (PCV <30%) age‐matched to 40 client‐owned healthy control dogs. Methods Prospective, cross‐sectional study. Whole blood GPx activity, plasma TAC, and urinary F2‐isoprostane concentrations were evaluated in each dog and compared between groups. Results Anemic dogs had significantly lower GPx activity (43.1 × 103 +/‐ 1.6 × 103 U/L) than did dogs in the control group (75.8 × 103 +/‐ 2.0 × 103 U/L; P < 0.0001). The GPx activity in dogs with hemolysis (103 +/‐ 0.8 × 103 U/L) was not significantly different (P = 0.57) than in dogs with nonhemolytic anemia (43.5 × 103 +/‐ 1.1 × 103 U/L). The TAC concentrations (P = 0.15) and urinary F2‐isoprostanes (P = 0.73) did not significantly differ between groups. Conclusions and Clinical Importance Glutathione peroxidase activity was significantly decreased in anemic dogs indicating oxidative stress. Additional studies are warranted to determine if antioxidant supplementation would improve survival and overall outcome as part of a therapeutic regimen for anemic dogs.
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Affiliation(s)
- A Kendall
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - A Woolcock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - A Brooks
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - G E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Myers E, Fausnacht A, Brooks A, Hess E, Bremer M, Hedrick V. The Ability of a Beverage Intake Questionnaire (BEVQ-15) to Rapidly Assess Healthy Beverage Index (HBI) Scores among a Diverse Adult Population. J Acad Nutr Diet 2017. [DOI: 10.1016/j.jand.2017.06.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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43
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Neilson GH, Heitzenroeder PJ, Nelson BE, Reiersen WT, Brooks A, Brown TG, Chrzanowski JH, Cole MJ, Dahlgren F, Dodson T, Dudek LE, Ellis RA, Fan HM, Fogarty PJ, Freudenberg KD, Goranson PL, Harris JH, Kalish MR, Labik G, Lyon JF, Pomphrey N, Priniski CD, Raftopoulos S, Rej DJ, Sands WR, Simmons RT, Stratton BE, Strykowsky RL, Viola ME, Williamson DE, Zarnstorff MC. Engineering Accomplishments in the Construction of NCSX. Fusion Science and Technology 2017. [DOI: 10.13182/fst09-a8950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- G. H. Neilson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | | | - B. E. Nelson
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | - W. T. Reiersen
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - A. Brooks
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - T. G. Brown
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - J. H. Chrzanowski
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - M. J. Cole
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | - F. Dahlgren
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - T. Dodson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - L. E. Dudek
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - R. A. Ellis
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - H. M. Fan
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - P. J. Fogarty
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | | | - P. L. Goranson
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | - J. H. Harris
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | - M. R. Kalish
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - G. Labik
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - J. F. Lyon
- Oak Ridge National Laboratory, P.O. Box X, Oak Ridge, TN 37831
| | - N. Pomphrey
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - C. D. Priniski
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - S. Raftopoulos
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - D. J. Rej
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - W. R. Sands
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - R. T. Simmons
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - B. E. Stratton
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - R. L. Strykowsky
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | - M. E. Viola
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
| | | | - M. C. Zarnstorff
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, NJ 08543
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Reiman A, Hirshman S, Hudson S, Monticello D, Rutherford P, Boozer A, Brooks A, Hatcher R, Ku L, Lazarus EA, Neilson H, Strickler D, White R, Zarnstorff M. Equilibrium and Flux Surface Issues in the Design of the NCSX. Fusion Science and Technology 2017. [DOI: 10.13182/fst07-a1296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Reiman
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - S. Hirshman
- Oak Ridge National Laboratory, P.O. Box 2009, Oak Ridge, Tennessee 37831
| | - S. Hudson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - D. Monticello
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - P. Rutherford
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - A. Boozer
- Columbia University, New York, New York 10027
| | - A. Brooks
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - R. Hatcher
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - L. Ku
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - E. A. Lazarus
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608
| | - H. Neilson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - D. Strickler
- Oak Ridge National Laboratory, P.O. Box 2009, Oak Ridge, Tennessee 37831
| | - R. White
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - M. Zarnstorff
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
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Neumeyer C, Brooks A, Bryant L, Chrzanowski J, Feder R, Gomez M, Heitzenroeder P, Kalish M, Lipski A, Mardenfeld M, Simmons R, Titus P, Zatz I, Daly E, Martin A, Nakahira M, Pillsbury R, Feng J, Bohm T, Sawan M, Griffiths I, Schaffer M. Design of the ITER In-Vessel Coils. Fusion Science and Technology 2017. [DOI: 10.13182/fst11-a12333] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. Neumeyer
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - A. Brooks
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - L. Bryant
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - J. Chrzanowski
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - R. Feder
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - M. Gomez
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | | | - M. Kalish
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - A. Lipski
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - M. Mardenfeld
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - R. Simmons
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - P. Titus
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - I. Zatz
- Princeton University, Plasma Physics Lab, Princeton, NJ, USA
| | - E. Daly
- ITER Organization, St. Paul-lez-Durance, France
| | - A. Martin
- ITER Organization, St. Paul-lez-Durance, France
| | - M. Nakahira
- ITER Organization, St. Paul-lez-Durance, France
| | | | - J. Feng
- MIT Plasma Science and Fusion Center, Cambridge, MA, USA
| | - T. Bohm
- Fusion Technology Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - M. Sawan
- Fusion Technology Institute, University of Wisconsin-Madison, Madison, WI, USA
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Pomphrey N, Boozer A, Brooks A, Hatcher R, Hirshman SP, Hudson S, Ku LP, Lazarus EA, Mynick H, Monticello D, Redi M, Reiman A, Zarnstorff MC, Zatz I. NCSX Magnetic Configuration Flexibility and Robustness. Fusion Science and Technology 2017. [DOI: 10.13182/fst07-a1298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- N. Pomphrey
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - A. Boozer
- Columbia University, New York, New York 10027
| | - A. Brooks
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - R. Hatcher
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - S. P. Hirshman
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - S. Hudson
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - L. P. Ku
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - E. A. Lazarus
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - H. Mynick
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - D. Monticello
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - M. Redi
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - A. Reiman
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - M. C. Zarnstorff
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
| | - I. Zatz
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08540
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Daly EF, Ioki K, Loarte A, Martin A, Brooks A, Heitzenroeder P, Kalish M, Neumeyer C, Titus P, Zhai Y, Wu Y, Jin H, Long F, Song Y, Wang Z, Pillsbury R, Feng J, Bohm T, Sawan M, Preble J. Update on Design of the ITER In-Vessel Coils. Fusion Science and Technology 2017. [DOI: 10.13182/fst13-a18073] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- E. F. Daly
- ITER Organization, Route de Vinon, 13115 St Paul-lez-Durance, France
| | - K. Ioki
- ITER Organization, Route de Vinon, 13115 St Paul-lez-Durance, France
| | - A. Loarte
- ITER Organization, Route de Vinon, 13115 St Paul-lez-Durance, France
| | - A. Martin
- ITER Organization, Route de Vinon, 13115 St Paul-lez-Durance, France
| | - A. Brooks
- Princeton Plasma Physics Lab, Princeton, NJ, USA
| | | | - M. Kalish
- Princeton Plasma Physics Lab, Princeton, NJ, USA
| | - C. Neumeyer
- Princeton Plasma Physics Lab, Princeton, NJ, USA
| | - P. Titus
- Princeton Plasma Physics Lab, Princeton, NJ, USA
| | - Y. Zhai
- Princeton Plasma Physics Lab, Princeton, NJ, USA
| | - Y. Wu
- Chinese Academy of Sciences - Institute of Plasma Physics, Anhui, China
| | - H. Jin
- Chinese Academy of Sciences - Institute of Plasma Physics, Anhui, China
| | - F. Long
- Chinese Academy of Sciences - Institute of Plasma Physics, Anhui, China
| | - Y. Song
- Chinese Academy of Sciences - Institute of Plasma Physics, Anhui, China
| | - Z. Wang
- Chinese Academy of Sciences - Institute of Plasma Physics, Anhui, China
| | | | - J. Feng
- MIT Plasma Science and Fusion Center, Cambridge, MA, USA,
| | - T. Bohm
- Fusion Technology Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - M. Sawan
- Fusion Technology Institute, University of Wisconsin-Madison, Madison, WI, USA
| | - J. Preble
- Thomas Jefferson National Accelerator Facility, Newport News, VA, USA
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48
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Myers CE, Edwards MR, Berlinger B, Brooks A, Cohen SA. Passive Superconducting Flux Conservers for Rotating-Magnetic-Field-Driven Field-Reversed Configurations. Fusion Science and Technology 2017. [DOI: 10.13182/fst12-a13341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- C. E. Myers
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - M. R. Edwards
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - B. Berlinger
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - A. Brooks
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
| | - S. A. Cohen
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543
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Jaworski M, Brooks A, Kaita R, Lopes-Cardozo N, Menard J, Ono M, Rindt P, Tresemer K. Upgrades toward high-heat flux, liquid lithium plasma-facing components in the NSTX-U. Fusion Engineering and Design 2016. [DOI: 10.1016/j.fusengdes.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Pancreatic trauma is relatively uncommon and although the surgical management is in many cases comparatively simple, occasionally complex technical surgery is required. Early diagnosis is paramount, although this remains difficult. The challenge of pancreatic trauma is compounded by a high incidence of associated injuries to adjoining organs and major vascular structures that may require damage control surgery and delayed definitive repair and add to the high frequency of postoperative complications, morbidity and mortality.
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Affiliation(s)
- A Brooks
- Department of General Surgery, Queens Medical Centre, Nottingham, UK
| | - A Shukla
- Department of Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - I Beckingham
- Department of General Surgery, Queens Medical Centre, Nottingham, UK
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