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Alty J, Lawler K, Salmon K, McDonald S, Stuart K, Cleary A, Ma J, Rudd K, Wang X, Chiranakorn-Costa S, Collins J, Merl H, Lin X, Vickers JC. A new one-stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry. Int J Geriatr Psychiatry 2023; 38:e5988. [PMID: 37592719 DOI: 10.1002/gps.5988] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVES Unequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. 'One-stop' cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one-stop State-wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas. METHODS A novel single-visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross-sectional evaluation was undertaken using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry. RESULTS Over the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. EFFECTIVENESS 98.5% (128/130) received a same-day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients. IMPLEMENTATION Nearly all 'ideal' diagnostic clinical practices were met and >90% of surveyed patients reported 'good/very good' clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days). CONCLUSIONS This 'one-stop' model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.
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Affiliation(s)
- Jane Alty
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
- School of Medicine, University of Tasmania, Hobart, Australia
| | - Katherine Lawler
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Katharine Salmon
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Scott McDonald
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Kimberley Stuart
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Alison Cleary
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- Royal Hobart Hospital, Hobart, Australia
| | - Jak Ma
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
- I-Med Radiology Network Hobart, Hobart, Australia
| | - Kaylee Rudd
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xinyi Wang
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | | | - Jessica Collins
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Helga Merl
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
| | - Xiaoping Lin
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - James C Vickers
- Wicking Dementia Research and Education Centre, University of Tasmania, Tasmania, Australia
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Mannion J, Hennessey A, Cleary A, Subramaniyan A, Sheahan C, Sheahan R. Left bundle branch area pacing as a first line pacing strategy, which patients should we consider? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.488] [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: 11/13/2022] Open
Abstract
Abstract
Background
A higher right ventricular (RV) pacing burden in those with permanent pacemakers results in accelerated pacing induced cardiomyopathy, in addition to increased incidence of heart failure and mortality [1–3]. This process may necessitate upgrade to a biventricular system in time, as the cardiomyopathy progresses. Physiological conduction system pacing targets such as His-bundle pacing (HBP) or Left Bundle Branch Area Pacing (LBBAP) have been shown to generate comparatively narrower QRS complexes and thus mitigate this cardiomyopathy development [4,5].
The 2021 ESC guidelines have a class 2b indication for consideration of HBP as an alternative to RV pacing in those with AV block and left ventricular ejection fraction >40%, who are anticipated to have >20% ventricular pacing burden [6].
Purpose
To retrospectively identify ECG, echocardiographic, permanent pacemaker (PPM) setting and patient factors associated with high RV pacing burden that may aid selection of those who may benefit from conduction system pacing (CSP).
Methods
We retrospectively identified 300 consecutive patients who underwent cardiac implantable electronic device insertion in our Electrophysiology Lab from the years 2017–2018. We excluded patients who underwent generator replacements, in addition to those who had biventricular devices or implantable cardioverter defibrillators inserted. We collated ECG, echo, past medical history and pacing data for each patient over a three-year follow up period.
Data were analysed using SPSS v.26.
Results
160 patients met inclusion criteria. Those with an RV pacing burden >20% were categorised group one (n=85) and those with <20% in group two (n=75). Baseline characteristics of these two groups are compared in Table 1 and Table 2.
Our analysis showed that significant differences between these groups included a lower mean HR (Table 1) (55.1±17.8 vs 57.63±17.4) with a more prolonged PR interval (225.7ms ± 8.34 vs. 188.6ms ± 6.62) or atrial fibrillation/flutter (AF/AFL) on admission ECG. There were more males with a greater mean age (High Ventricular Paced (VP) = 76.6 years ± 8.4 vs Low VP = 71.23 years ± 12.3) in the higher VP group, and they demonstrated more incidence of dilated RA/RV on echo (Enlarged RA = 30.5%; Enlarged RV = 23.6% vs 10% and 8.4% respectively).
There were significant differences in PPM indications and setting between groups (Table 2), with the higher VP groups having PPM inserted for persistent high-grade AV block (CHB = 31.5% vs 4.9% and Mobitz 2 = 9.6% vs 0%) and had less MVP mode activated (Mode switch algorithm = 13.3% vs 71%).
Conclusion
Our data suggests that those with persistent high grade AV block such as Mobitz 2 or CHB should be considered for CSP. Other considerations include older age, male sex, dilated RV/RA, prolonged PR, lower intrinsic HR or AF/AFL on admission ECG. PPM mode switching settings to reduce RV pacing burden should be utilised where possible.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Mannion
- Beaumont Hospital , Dublin , Ireland
| | | | - A Cleary
- Beaumont Hospital , Dublin , Ireland
| | | | - C Sheahan
- Royal College of Surgeons in Ireland, School of Medicine , Dublin , Ireland
| | - R Sheahan
- Beaumont Hospital , Dublin , Ireland
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Cleary A, Norrish G, Field E, Cervi E, Kaski JP. Clinical characteristics and natural history of pre-adolescent non-syndromic hypertrophic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1772] [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: 11/13/2022] Open
Abstract
Abstract
Background
The clinical presentation and natural history of pre-adolescent sarcomeric hypertrophic cardiomyopathy (HCM) has not been systematically characterised. The aim of this study was to describe the clinical characteristics and outcomes of a large, international, multicentre cohort of children diagnosed with non-syndromic HCM below the age of 12.
Methods
Data from the International Paediatric Hypertrophic Cardiomyopathy Consortium on 639 children meeting diagnostic criteria for HCM below 12 years of age (pre-adolescent) were collected and compared with 568 diagnosed aged 12–16 years. Patients with syndromic and metabolic HCM were excluded.
Results
Of 639 (male n=417, 65.3%) children with pre-adolescent HCM, 339 (53.1%) had a family history of HCM and 57 (8.9%) a family history of sudden cardiac death (SCD). At the time of baseline assessment; 132 (20.7%) had heart failure symptoms and 39 (6.1%) reported unexplained syncope. Median maximal left ventricular wall thickness on echocardiogram was 13.6mm (IQR 10–19) with a corresponding median z-score of 8.7 (5.3–14.4). 145 (22.7%) had left ventricular outflow tract obstruction (LVOTO) (maximal LVOT gradient≥30mmHg) and 35 (5.5%) had severe LVOTO (gradient≥90mmHg). Over a median follow up 5.6 years (IQR 2.3–10), 10.5% underwent a myectomy and 23.2% implantable cardiac defibrillator (ICD) implantation for primary (81.8%) or secondary (14.2%) prevention. 42 (6.7%) patients died [SCD 4.9%, heart failure death 0.8%, other 1%] and 21 (3.3%) underwent cardiac transplantation. 69 (10.8%) patients had an arrhythmic event (SCD n=31, resuscitated cardiac arrest n=17, appropriate ICD therapy n=14, sustained VT with haemodynamic compromise n=7). Compared to those presenting after 12 years, those under 12 were less likely to have a family history of SCD (8.9% vs 13%, p:0.047) or report unexplained syncope (6.1% vs 12.3%, p<0.00). The degree of hypertrophy did not differ but a higher proportion of pre-adolescent patients had LVOTO (22.7% vs 14.4%, p<0.00). A higher proportion of pre-adolescent underwent a myectomy (10.5% vs 7.2%, p:0.045) but a lower proportion received a primary prevention ICD (18.9% vs 30.1%, p:0.041). The overall proportion of patients reaching the mortality or arrhythmic end-points did not differ, but SCD and resuscitated cardiac arrest events were more frequent in pre-adolescent patients (4.9% vs 3.9% and 2.7 vs 1.6% respectively).
Conclusion
Pre-adolescent HCM is associated with a high symptom burden and variable cardiac phenotype, comparable to those presenting later in childhood. Despite baseline similarities and equal overall survival, younger patients were less likely to receive a primary prevention ICD despite being more likely to experience a SCD or resuscitated cardiac arrest. This study suggests that younger patients should not be considered a distinct entity for risk stratification and that similar management strategies to older HCM patients should be employed.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BHF (British Heart Foudnation) MRC (Medical Research Council)
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Affiliation(s)
- A Cleary
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - G Norrish
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - E Field
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - E Cervi
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - J P Kaski
- Great Ormond Street Hospital for Children, London, United Kingdom
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Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, McAuliffe C, Perry IJ, Griffin E, Cassidy EM, Bradley C, Kapur N, Kinahan J, Cleary A, Foster T, Gallagher J, Malone K, Ramos Costa AP, Greiner BA. Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19:275. [PMID: 31492119 PMCID: PMC6728991 DOI: 10.1186/s12888-019-2249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
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Affiliation(s)
- E. Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. Larkin
- 0000 0001 0742 0364grid.168645.8Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, 01655 USA
| | | | - S. Leitao
- 0000 0004 0617 6269grid.411916.aSchool of Public Health, College of Medicine and Health and National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Hospital Maternity Hospital, Wilton, Cork, Ireland
| | - P. Corcoran
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Williamson
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. McAuliffe
- St. Patrick’s Mental Health Services, Cork, Ireland
| | - I. J. Perry
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Griffin
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. M. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - C. Bradley
- 0000000123318773grid.7872.aDepartment of General Practice, University College Cork, Western Gateway Building, Cork, Ireland
| | - N. Kapur
- 0000 0004 0430 6955grid.450837.dCentre for Mental Health and Safety, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Kinahan
- 0000 0004 0575 9497grid.411785.eNorth Lee Psychiatric Services, Mercy University Hospital, Cork, Ireland
| | - A. Cleary
- 0000 0001 0768 2743grid.7886.1Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - T. Foster
- Consultant Psychiatrist, Omagh and Fermanagh, Northern Ireland
| | - J. Gallagher
- 0000000123318773grid.7872.aSchool of Public Health, University College Cork, Cork, Ireland
| | - K. Malone
- 0000 0001 0768 2743grid.7886.1School of Medicine, University College Dublin, Dublin, Ireland
| | - A. P. Ramos Costa
- 0000000123318773grid.7872.aSchool of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - B. A. Greiner
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
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5
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Hunter RF, Cleland C, Cleary A, Droomers M, Wheeler BW, Sinnett D, Nieuwenhuijsen MJ, Braubach M. Environmental, health, wellbeing, social and equity effects of urban green space interventions: A meta-narrative evidence synthesis. Environ Int 2019; 130:104923. [PMID: 31228780 DOI: 10.1016/j.envint.2019.104923] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND As populations become increasingly urbanised, the preservation of urban green space (UGS) becomes paramount. UGS is not just dedicated recreational space such as public parks, but other types of informal green space are important, for example, street trees and roof gardens. Despite the potential from cross-sectional evidence, we know little about how to design new, or improve or promote existing UGS for health, wellbeing, social and environmental benefits, or known influencing factors such as physical activity. OBJECTIVES To perform a meta-narrative review of the evidence regarding the health, wellbeing, social, environmental and equity effects, or known influencing factors of these outcomes, of UGS interventions. DATA SOURCES Eight electronic databases were searched ((Medline, PsycINFO, Web of Science (Science and Social Science Citation Indices), PADDI (Planning Architecture Design Database Ireland), Zetoc, Scopus, Greenfiles, SIGLE (System for Information on Grey Literature in Europe)), and reference lists of included studies and relevant reviews were hand searched for further relevant studies. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS Eligibility criteria included: (i) evaluation of an UGS intervention; and (ii) health, wellbeing, social or environmental outcome(s), or known influencing factors of these outcomes, measured. Interventions involving any age group were included. Interventions must have involved: (a) physical change to green space in an urban-context including improvements to existing UGS or development of new UGS, or (b) combination of physical change to UGS supplemented by a specific UGS awareness, marketing or promotion programme to encourage use of UGS. STUDY APPRAISAL AND SYNTHESIS METHODS Following a meta-narrative approach, evidence was synthesised by main intervention approach, including: (i) park-based; (ii) greenways/trails; (iii) urban greening; (iv) large green built projects for environmental purposes. Outcomes such as economic (e.g. cost effectiveness and cost-benefit analyses), adverse effects and unintended consequences were also extracted. Evidence was synthesised following the RAMESES guidelines and publication standards, the PROGRESS-plus tool was used to explore equity impact, and risk of bias/study quality was assessed. The findings from the evidence review were presented at an expert panel representing various disciplines in a workshop and these discussions framed the findings of the review and provide recommendations that are relevant to policy, practice and research. RESULTS Of the 6997 studies identified, 38 were included. There was strong evidence to support park-based (7/7 studies) and greenway/trail (3/3 studies) interventions employing a dual-approach (i.e. a physical change to the UGS and promotion/marketing programmes) particularly for park use and physical activity; strong evidence for the greening of vacant lots (4/4 studies) for health, wellbeing (e.g. reduction in stress) and social (e.g. reduction in crime, increased perceptions of safety) outcomes; strong evidence for the provision of urban street trees (3/4 studies) and green built interventions for storm water management (6/7 studies) for environmental outcomes (e.g. increased biodiversity, reduction in illegal dumping). Park-based or greenway/trail interventions that did not employ a dual-approach were largely ineffective (7/12 studies showed no significant intervention effect). Overall, the included studies have inherent biases owing to the largely non-randomized study designs employed. There was too little evidence to draw firm conclusions regarding the impact of UGS interventions on a range of equity indicators. LIMITATIONS; CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: UGS has an important role to play in creating a culture of health and wellbeing. Results from this study provide supportive evidence regarding the use of certain UGS interventions for health, social and environmental benefits. These findings should be interpreted in light of the heterogeneous nature of the evidence base, including diverging methods, target populations, settings and outcomes. We could draw little conclusions regarding the equity impact of UGS interventions. However, the true potential of UGS has not been realised as studies have typically under-evaluated UGS interventions by not taking account of the multifunctional nature of UGS. The findings have implications for policymakers, practitioners and researchers. For example, for policymakers the trajectory of evidence is generally towards a positive association between UGS and health, wellbeing, social and environmental outcomes, but any intervention must ensure that negative consequences of gentrification and unequal access are minimised.
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Affiliation(s)
- R F Hunter
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - C Cleland
- UKCRC Centre of Excellence for Public Health/Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
| | - A Cleary
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
| | - M Droomers
- University of Amsterdam, Amsterdam, the Netherlands.
| | - B W Wheeler
- European Centre for Environment and Human Health, University of Exeter Medical School, Exeter, England, United Kingdom.
| | - D Sinnett
- University of the West of England, Bristol, England, United Kingdom.
| | - M J Nieuwenhuijsen
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Braubach
- WHO Regional Office for Europe, European Centre for Environment and Health, Bonn, Germany.
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Agimelen OS, Svoboda V, Ahmed B, Cardona J, Dziewierz J, Brown CJ, McGlone T, Cleary A, Tachtatzis C, Michie C, Florence AJ, Andonovic I, Mulholland AJ, Sefcik J. Multi-sensor inline measurements of crystal size and shape distributions during high shear wet milling of crystal slurries. ADV POWDER TECHNOL 2018. [DOI: 10.1016/j.apt.2018.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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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Cardona J, Ferreira C, McGinty J, Hamilton A, Agimelen OS, Cleary A, Atkinson R, Michie C, Marshall S, Chen YC, Sefcik J, Andonovic I, Tachtatzis C. Image analysis framework with focus evaluation for in situ characterisation of particle size and shape attributes. Chem Eng Sci 2018. [DOI: 10.1016/j.ces.2018.06.067] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Neugebauer P, Cardona J, Besenhard MO, Peter A, Gruber-Woelfler H, Tachtatzis C, Cleary A, Andonovic I, Sefcik J, Khinast JG. Crystal Shape Modification via Cycles of Growth and Dissolution in a Tubular Crystallizer. Cryst Growth Des 2018; 18:4403-4415. [PMID: 30918477 PMCID: PMC6430499 DOI: 10.1021/acs.cgd.8b00371] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/25/2018] [Indexed: 05/31/2023]
Abstract
Besides size and polymorphic form, crystal shape takes a central role in engineering advanced solid materials for the pharmaceutical and chemical industries. This work demonstrates how multiple cycles of growth and dissolution can manipulate the habit of an acetylsalicylic acid crystal population. Considerable changes of the crystal habit could be achieved within minutes due to rapid cycling, i.e., up to 25 cycles within <10 min. The required fast heating and cooling rates were facilitated using a tubular reactor design allowing for superior temperature control. The face-specific interactions between solvent and the crystals' surface result in face-specific growth and dissolution rates and hence alterations of the final shape of the crystals in solution. Accurate quantification of the crystal shapes was essential for this work, but is everything except simple. A commercial size and shape analyzer had to be adapted to achieve the required accuracy. Online size, and most important shape, analysis was achieved using an automated microscope equipped with a flow-through cell, in combination with a dedicated image analysis routine for particle tracking and shape analysis. Due to the implementation of this analyzer, capable of obtaining statistics on the crystals' shape while still in solution (no sampling and manipulation required), the dynamic behavior of the size shape distribution could be studied. This enabled a detailed analysis of the solvent's effect on the change in crystal habit.
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Affiliation(s)
- Peter Neugebauer
- Graz
University of Technology, Institute of Process
and Particle Engineering, Inffeldgasse 13, 8010 Graz, Austria
| | - Javier Cardona
- Centre
for Intelligent Dynamic Communications, Department of Electronic and
Electrical Engineering, University of Strathclyde, Royal College Building, 204 George
Street, Glasgow, G1 1XW, U.K.
| | - Maximilian O. Besenhard
- Department
of Chemical Engineering, University College
London, Torrington Place, London, WC1E 7JE, U.K.
- Research
Center for Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria
| | - Anna Peter
- Research
Center for Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria
| | - Heidrun Gruber-Woelfler
- Graz
University of Technology, Institute of Process
and Particle Engineering, Inffeldgasse 13, 8010 Graz, Austria
- Research
Center for Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria
| | - Christos Tachtatzis
- Centre
for Intelligent Dynamic Communications, Department of Electronic and
Electrical Engineering, University of Strathclyde, Royal College Building, 204 George
Street, Glasgow, G1 1XW, U.K.
| | - Alison Cleary
- Centre
for Intelligent Dynamic Communications, Department of Electronic and
Electrical Engineering, University of Strathclyde, Royal College Building, 204 George
Street, Glasgow, G1 1XW, U.K.
| | - Ivan Andonovic
- Centre
for Intelligent Dynamic Communications, Department of Electronic and
Electrical Engineering, University of Strathclyde, Royal College Building, 204 George
Street, Glasgow, G1 1XW, U.K.
| | - Jan Sefcik
- Department
of Chemical and Process Engineering, University
of Strathclyde, 75 Montrose Street, Glasgow, G1 1XJ, U.K.
| | - Johannes G. Khinast
- Graz
University of Technology, Institute of Process
and Particle Engineering, Inffeldgasse 13, 8010 Graz, Austria
- Research
Center for Pharmaceutical Engineering (RCPE) GmbH, Inffeldgasse 13, 8010 Graz, Austria
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Ryan G, Cleary A, Keady D, Allen NM, Moylett E. 2015-2016 Influenza Season in an Irish Regional Paediatric Unit: Importance of Influenza Vaccination Highlighted. Ir Med J 2017; 110:609. [PMID: 29341521] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- G Ryan
- Academic Department of Paediatrics, National University of Ireland, Galway
| | - A Cleary
- Academic Department of Paediatrics, National University of Ireland, Galway
| | - D Keady
- Department of Microbiology, University Hospital Galway, Galway
| | - N M Allen
- Academic Department of Paediatrics, National University of Ireland, Galway
| | - E Moylett
- Academic Department of Paediatrics, National University of Ireland, Galway
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Raats MM, Malcolm RN, Lähteenmäki L, Pravst I, Gage H, Cleary A, Klopčič M. Understanding the impact of European Regulation on the substantiation and use of claims on food and drinks: Design of the REDICLAIM project and initial results. NUTR BULL 2015. [DOI: 10.1111/nbu.12179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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)
| | | | | | - I. Pravst
- Nutrition Institute; Ljubljana Slovenia
| | - H. Gage
- University of Surrey; Guildford UK
| | | | - M. Klopčič
- University of Ljubljana; Ljubljana Slovenia
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11
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Tachtatzis C, Sheridan R, Michie C, Atkinson RC, Cleary A, Dziewierz J, Andonovic I, Briggs NE, Florence AJ, Sefcik J. Image-based monitoring for early detection of fouling in crystallisation processes. Chem Eng Sci 2015. [DOI: 10.1016/j.ces.2015.01.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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Veres IA, Cleary A, Thursby G, McKee C, Armstrong I, Pierce G, Culshaw B. Golay code modulation in low-power laser-ultrasound. Ultrasonics 2013; 53:122-129. [PMID: 22591755 DOI: 10.1016/j.ultras.2012.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Revised: 03/31/2012] [Accepted: 04/15/2012] [Indexed: 05/31/2023]
Abstract
The current work presents a correlation-based detection technique with application in modulated laser-ultrasonics. In standard use of coded sequences the impulse response of a system is recovered in the time domain with improved signal to noise ratio (SNR). The presented method is an extension of this technique, where the response to a chirped waveform is restored with improved SNR; hence, the response is in a well-defined frequency range. To achieve this goal the chirped waveforms are modulated by Golay codes. It will be shown that the response to this bandlimited carrier waveform can be recovered in the time domain with improved signal to noise ratio using a cross-correlation technique. Improvement in the SNR is discussed analytically and it is shown that this improvement is proportional to the square root of the length of the applied sequences. Experimental applications in laser-ultrasound are shown using modulated laser diodes as excitation sources with an output power of ∼1W. In the experiments a plate with a thickness of 50μm is investigated using Lamb waves in the MHz range to confirm the predicted improvement in the SNR. Golay codes with three different lengths were used with 7, 9 and 11 bits resulting in 2(7)=128, 2(9)=512, and 2(11)=2048 repetitions in an individual signal, respectively. The predicted improvements of 2 in the SNR between the 7 and 9 bits, and between the 9 and 11 bits waveforms, respectively, were well approximated by the experimentally obtained values of 1.83 and 2.17. As Lamb wave dispersion curves can be used for the characterization of plates or layered samples by inverse problems, it is also shown that by using multiple measurement points the recovered waveforms can be utilized in the evaluation of the dispersion relation.
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Affiliation(s)
- István A Veres
- Research Center for Non-Destructive Testing GmbH, Altenberger Straße 69, 4040 Linz, Austria.
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13
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Cleary A, Walsh F, Connolly H, Hays V, Oluwole B, Macken E, Dowling M. Monitoring and documentation of side effects from depot antipsychotic medication: an interdisciplinary audit of practice in a regional mental health service. J Psychiatr Ment Health Nurs 2012; 19:395-401. [PMID: 22070791 DOI: 10.1111/j.1365-2850.2011.01807.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 11/30/2022]
Abstract
This audit reviewed current practice within a rural mental health service area on the monitoring and documentation of side effects of antipsychotic depot medication. A sample of 60 case files, care plans and prescriptions were audited, which is 31% of the total number of service users receiving depot injections in the mental health service region (n= 181). The sample audited had a range of diagnoses, including: schizophrenia, schizoaffective disorder, bipolar affective disorder, depression, alcoholic hallucinosis and autism. The audit results revealed that most service users had an annual documented medical review and a documented prescription. However, only five (8%) case notes examined had documentation recorded describing the condition of the injection site, and alternation of the injection site was recorded in only 28 (47%) case notes. No case notes examined had written consent to commence treatment recorded. In 57 (95%) of case notes, no documentation of recorded information on the depot and on side effects was given. The failure to monitor and record some blood tests was partly attributed to a lack of clarity regarding whose responsibility it was. A standardized checklist has been developed as a result of the audit and this will be introduced by all teams across the service.
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Affiliation(s)
- A Cleary
- East Galway Catchment Galway Mental Health Services, St Brigids Hospital, Ballinasloe, Co. Galway, Ireland.
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14
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Abstract
This teaching machine has been designed and used to train reading and other visual discrimination skills with normal and retarded children. On each frame the subject responds by touching one of three response panels on which are projected the multiple-choice alternatives. The response panels are coated with a transparent conducting film which allows electronic detection of this simple and direct response. Correct responses are reinforced by the machine naming the stimulus, while auditory reinforcement is absent for an incorrect response. The subject's performance level is continuously computed as an exponentially weighted moving average. The measure is weighted so that it rapidly follows recent changes in performance.
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Affiliation(s)
- A Cleary
- University of Newcastle Upon Tyne
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15
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Cleary A, Dowling M. Knowledge and attitudes of mental health professionals in Ireland to the concept of recovery in mental health: a questionnaire survey. J Psychiatr Ment Health Nurs 2009; 16:539-45. [PMID: 19594676 DOI: 10.1111/j.1365-2850.2009.01411.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [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: 11/29/2022]
Abstract
Recovery is the model of care presently advocated for mental health services internationally. The aim of this study was to examine the knowledge and attitudes of mental health professionals to the concept of recovery in mental health. A descriptive survey approach was adopted, and 153 health care professionals (nurses, doctors, social workers, occupational therapists and psychologists) completed an adapted version of the Recovery Knowledge Inventory. The respondents indicated their positive approach to the adoption of recovery as an approach to care in the delivery of mental health services. However, respondents were less comfortable in encouraging healthy risk taking with service users. This finding is important because therapeutic risk taking and hope are essential aspects in the creation of a care environment that promotes recovery. Respondents were also less familiar with the non-linearity of the recovery process and placed greater emphasis on symptom management and compliance with treatment. Multidisciplinary mental health care teams need to examine their attitudes and approach to a recovery model of care. The challenge for the present and into the future is to strive to equip professionals with the necessary skills in the form of information and training.
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Affiliation(s)
- A Cleary
- Mental Health, East Galway Mental Health Services, Loughrea Day Hospital, Barrick Street, Loughrea, Co Galway, Ireland
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16
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Affiliation(s)
- H Wang
- Department of Biochemistry, University of Saskatchewan, Saskatoon SK, Canada S7N 5E5
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17
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Ruano JM, Glidle A, Cleary A, Walmsley A, Aitchison JS, Cooper JM. Design and fabrication of a silica on silicon integrated optical biochip as a fluorescence microarray platform. Biosens Bioelectron 2003; 18:175-84. [PMID: 12485763 DOI: 10.1016/s0956-5663(02)00170-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Previous research into the use of Flame Hydrolysis Deposition (FHD) of glasses in integrated optics has focused on the successful commercial exploitation of low cost optical devices within the field of telecommunications and optoelectronics. Recently we have sought to apply these fabrication technologies to the development of optical biochips, utilising their ability to be integrated with microfluidics as a 'Lab-on-a-chip' platform. In this paper, we carry this development forward by seeking to create a microarray of integrated optical sensing elements, addressed using a glass-polymer hybrid technology in which poly(dimethylsiloxane), PDMS, is used as an elastomeric packaging over-layer. In particular, we describe the wide range of modelling and microfabrication processes required for the successful manufacture, integration and packaging of such arrays. The integration of both optical and fluidic circuits in this device avoids precise alignment requirements and results in a compact, robust and reliable device. Finally, in this paper, we describe the implementation of a pumping system for delivering small amounts of fluid across the array together with an optical signal treatment.
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Affiliation(s)
- Jesus M Ruano
- Department of Electronics and Electrical Engineering, The University of Glasgow, Glasgow G12 8LT, UK
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18
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Abstract
Amplification of AML1 has been confirmed by fluorescence in situ hybridization analysis in two cases of childhood acute lymphoblastic leukemia. It remains to be elucidated whether this amplification results in up-regulation of the normal AML1 gene product or a potentially mutant AML1 transcript.
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Affiliation(s)
- P Dal Cin
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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19
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Abstract
In 1996, a nursing committee at an acute care facility organized the first pressure ulcer point prevalence survey for that hospital. In 1996, hospital-acquired pressure ulcers were 90 percent of the predicted prevalence rate; in 1997, the rate dropped to 59 percent of the predicted prevalence and in 1998, to 53 percent of the predicted prevalence. The severity index decreased markedly from 291 (1996) to 98 (1997) then to 62 (1998). These improvements are attributed to the purposeful addition of multidimensional interventions, including best practices and research-based protocols, to prevent and treat nosocomial pressure ulcers.
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Affiliation(s)
- B Hopkins
- Scott & White Memorial Hospital and Clinic, Texas A&M Health Science Center, Temple, USA
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20
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Wessel LC, Cleary A. Treatment of a patient with an enterocutaneous fistula after emergency surgery. J Wound Ostomy Continence Nurs 1997; 24:283-7. [PMID: 9376905 DOI: 10.1016/s1071-5754(97)90104-2] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- L C Wessel
- Southeast Missouri Hospital, Cape Girardeau 63701, USA
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21
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Cleary A. Can a good mom be a good doctor? Med Econ 1996; 73:100, 105-8, 114. [PMID: 10159449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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22
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Cleary A. Seeing green. The Rural Wisconsin Health Cooperative helps keep the state's rural hospitals from being put out to pasture. Here are three of their stories. Hosp Health Netw 1995; 69:73-4, 76. [PMID: 7550466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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23
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Cleary A. Profiles in service (1986-1995). The Foster G. McGaw Prize winners. Copley Hospital, Morrisville, VT and Mount Sinai Hospital, Hartford, CT. Hosp Health Netw 1995; 69:45-7. [PMID: 7697094] [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: 01/26/2023]
Abstract
For Carolyn Roberts of Copley Hospital, Morristown, VT, the 1987 Foster G. McGaw co-winning hospital, staying ahead of the curve means strengthening a commitment to community service. Meanwhile, after riding out a wave of financial troubles, Mt. Sinai Hospital, Hartford, CT, the other 1987 co-winner, affiliated with its competitor, potentially opening up even greater opportunities for reaching the community.
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Cleary A. The long view on long-term care. Hosp Health Netw 1995; 69:61-2, 64. [PMID: 7889097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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25
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Beaton S, ten Have J, Cleary A, Bradley MP. Cloning and partial characterization of the cDNA encoding the fox sperm protein FSA-Acr.1 with similarities to the SP-10 antigen. Mol Reprod Dev 1995; 40:242-52. [PMID: 7766418 DOI: 10.1002/mrd.1080400214] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We have isolated and characterized a cDNA, cFSA-Acr.1, encoding a testis-specific fox sperm antigen. The antigen is located on the inner acrosomal compartment, and is expressed during spermatogenesis on the developing acrosome of round and elongating spermatids. Database searches with the deduced amino acid sequence of cFSA-Acr.1 revealed that the clone has high homology to both human and baboon sperm protein SP-10, and the mouse sperm protein, MSA-63. The region of highest homology is within the carboxyl terminus. In the middle of the open reading frame, the fox sequence shows unique sequences absent from both the human, baboon SP-10, and mouse MSA-63 sequences. In addition to cFSA-Acr.1, two other clones were also isolated from the same fox testis cDNA library, and sequence analysis shows that they may represent alternatively spliced mRNAs coding for other FSA-Acr proteins.
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Affiliation(s)
- S Beaton
- Cooperative Research Centre for the Biological Control for Vertebrate Pest Populations, CSIRO Division of Wildlife & Ecology, Canberra, Australia
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26
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Cleary A. Boston. The 'health care capital' faces up to market-based reform. Hosp Health Netw 1994; 68:58, 60, 62. [PMID: 8081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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27
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Cleary A. Kid-sized care. Pediatric PHOs and children's networks emerge, but will they play? Hosp Health Netw 1994; 68:101-3. [PMID: 8038816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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28
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Cleary A. A better place to be. Integrated, capitated care gives frail elderly a choice over nursing homes. Hosp Health Netw 1994; 68:58-60. [PMID: 8193653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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29
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Abstract
A monoclonal antibody was raised to a fox sperm protein (FSA-1) which was found to be localized to the inner acrosomal compartment of sperm fixed in methanol. Western blots of testicular germ cell membrane extracts probed with this antibody identified a major protein band with a molecular weight of 36,000. Immunofluorescent studies on fox testis sections showed that the antigen is expressed on round and elongating spermatids on a crescent-shaped structure, which probably represents the developing acrosome. An antibody specific for FSA-1 was used to screen a fox testis cDNA library for its cognate gene. An 875-bp cDNA clone was isolated and sequenced revealing an open reading frame. Searches of the GenBank and EMBL databases with the nucleic acid sequence revealed significant homology (86%) of FSA-1 with 406 bases of an unidentified RNA transcript from human fetal brain (EST02625). Northern blot analysis of fox testis RNA samples identified an RNA transcript of approximately 0.9 kb during the months when spermatogenesis is active. Zoo Northern blots (at high stringency) reveal an RNA transcript of a similar size present in testis RNA from dogs and mice. Zoo Southern analysis (high stringency) reveal genomic sequences present in dogs, mice, cattle and sheep. At present, the function of the FSA-1 gene product remains unknown, but it may play a role as a structural protein component of the acrosome.
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Affiliation(s)
- S Beaton
- Cooperative Research Centre for the Biological Control of Vertebrate Pest Populations, CSIRO, Division of Wildlife and Ecology, Lyneham, Australia
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Allan W, Tabi Z, Cleary A, Doherty PC. Cellular events in the lymph node and lung of mice with influenza. Consequences of depleting CD4+ T cells. The Journal of Immunology 1990. [DOI: 10.4049/jimmunol.144.10.3980] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
The cellularity of the mediastinal lymph nodes of mice infected intranasally with a high dose of an H3N2 influenza A virus increases massively within 5 days. All classes of lymphocytes are involved. A similar, but much smaller, expansion in cell numbers occurs after exposure to a comparable dilution of normal chick allantoic fluid. In the control group, this increase in lymph node size is totally prevented by the in vivo depletion of CD4+ T cells whereas there is only a 50% reduction in the virus-infected mice. The lymphocyte component of the cellular exudate in the lungs of infected mice is dominated by activated, CD8+ T cells, which are also prevalent in the mediastinal lymph nodes. Elimination of the CD4+ subset does not greatly diminish the severity of this inflammatory process. The CD4-depleted mice clear the virus from the lung, and there is little effect on the frequency of virus-specific, cytotoxic T lymphocyte precursors in either the lymph node or the lung. Substantial involvement of CD4+ T cells is not essential for the development of effective cell-mediated immunity in mice with influenza.
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Affiliation(s)
- W Allan
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105
| | - Z Tabi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105
| | - A Cleary
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105
| | - P C Doherty
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105
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Allan W, Tabi Z, Cleary A, Doherty PC. Cellular events in the lymph node and lung of mice with influenza. Consequences of depleting CD4+ T cells. J Immunol 1990; 144:3980-6. [PMID: 1692070] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The cellularity of the mediastinal lymph nodes of mice infected intranasally with a high dose of an H3N2 influenza A virus increases massively within 5 days. All classes of lymphocytes are involved. A similar, but much smaller, expansion in cell numbers occurs after exposure to a comparable dilution of normal chick allantoic fluid. In the control group, this increase in lymph node size is totally prevented by the in vivo depletion of CD4+ T cells whereas there is only a 50% reduction in the virus-infected mice. The lymphocyte component of the cellular exudate in the lungs of infected mice is dominated by activated, CD8+ T cells, which are also prevalent in the mediastinal lymph nodes. Elimination of the CD4+ subset does not greatly diminish the severity of this inflammatory process. The CD4-depleted mice clear the virus from the lung, and there is little effect on the frequency of virus-specific, cytotoxic T lymphocyte precursors in either the lymph node or the lung. Substantial involvement of CD4+ T cells is not essential for the development of effective cell-mediated immunity in mice with influenza.
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Affiliation(s)
- W Allan
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105
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32
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Cleary A, Shelley E. Smoking and health. The facts in Ireland. Ir Med J 1983; 76:1-29. [PMID: 6662659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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