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Melson E, Fazil M, Lwin H, Thomas A, Yeo TF, Thottungal K, Tun H, Aftab F, Davitadze M, Gallagher A, Seidu S, Higgins K. Tertiary centre study highlights low inpatient deintensification and risks associated with adverse outcomes in frail people with diabetes. Clin Med (Lond) 2024; 24:100029. [PMID: 38387535 DOI: 10.1016/j.clinme.2024.100029] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
INTRODUCTION The community deintensification rates in older people with diabetes are low and hospital admission presents an opportunity for medication review. We audited the inpatient assessment and deintensification rate in people with diabetes and frailty. We also identified factors associated with adverse inpatient outcomes. METHODS A retrospective review of electronic charts was conducted in all people with diabetes and clinical frailty score ≥6 who were discharged from the medical unit in 2022. Data on demographics, comorbidities and background glucose-lowering medications were collected. RESULTS Six-hundred-and-sixty-five people with diabetes and moderate/severe frailty were included in our analysis. For people with no HbA1c in the last six months preceding admission, only 9.0% had it assessed during inpatient. Deintensification rates were 19.1%. Factors that were associated with adverse inpatient outcomes included inpatient hypoglycaemia, non-White ethnicity, and being overtreated (HbA1c <7.0% [53 mmol/mol] with any glucose-lowering medication). CONCLUSION The assessment and deintensification rate in secondary care for people with diabetes and frailty is low. Inpatient hypoglycaemia, non-White ethnicity, and overtreatment are important factors in determining inpatient outcomes highlighting the importance of deintensification and the need for an evidence-based risk stratification tool.
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Affiliation(s)
- Eka Melson
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom; Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom.
| | - Mohamed Fazil
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Hnin Lwin
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Anu Thomas
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Ting Fong Yeo
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Kevin Thottungal
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - HayMar Tun
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Faseeha Aftab
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Foundation Trust, LE1 5WW, United Kingdom
| | - Meri Davitadze
- Clinic NeoLab, Tbilisi, Georgia; Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Alison Gallagher
- Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
| | - Samuel Seidu
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom
| | - Kath Higgins
- Leicester Diabetes Centre, University of Leicester, LE5 4PW, United Kingdom; Leicester General Hospital, University Hospitals of Leicester NHS Foundation Trust, LE5 4PW, United Kingdom
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Melson E, Fazil M, Davitadze M, Lwin H, Higgins K, Gallagher A. Characteristics of patients admitted to the hospital with diabetes and clinical frailty: preliminary data of an audit in a UK tertiary centre. Clin Med (Lond) 2023; 23:30. [PMID: 38182179 PMCID: PMC11046614 DOI: 10.7861/clinmed.23-6-s30] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Affiliation(s)
- Eka Melson
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Mohamed Fazil
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Hnin Lwin
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Kath Higgins
- University Hospitals of Leicester NHS Trust, Leicester, UK
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O'Riordan MM, Reidy D, Nash M, Gallagher A, Lynch N, O'Reilly MK. Improving lens irradiation in CT brain scans - a multi-CT scanner audit. Ir Med J 2023; 116:762. [PMID: 37555572] [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: 08/10/2023]
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Paciotti M, Diana P, Gaglioli A, De Groote R, Farinha R, Ficarra V, Gaston R, Gontero P, Hurle R, Martínez-Piñeiro L, Minervini A, Pansadoro V, Van Cleynenbreugel B, Wiklund P, Casale P, Lughezzani G, Mancon S, Uleri A, Mottrie A, Palou J, Gallagher A, Breda A, Buffi N. International experts consensus on performance metrics for a transurethral resection of bladder (TURB). Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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5
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Liefaard M, Bhaskaran R, Bijl Y, Israeli D, Jong-Raadsen S, van Montfort E, Bao S, Mee S, Cavness T, Gallagher A, Falk J, Piel T, Witteveen A, van der Voort A, Vonk S, Lips E, Sonke G, Kleijn M, Glas A, Mittempergher L. 161P MammaPrint and BluePrint diagnostic tests can be robustly assessed on Whole-Transcriptome NGS platform. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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6
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O'Kane M, Murphy MH, Carlin A, Gallagher A. S06 Engaging peers, parents and pupils to increase physical activity among adolescents. Eur J Public Health 2022. [PMCID: PMC9421902 DOI: 10.1093/eurpub/ckac093.027] [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: 11/29/2022] Open
Abstract
Background Regular physical activity is associated with physiological and mental health benefits for adolescents including improved fitness and cardiometabolic health, increased muscle and bone strength and reduced risk of obesity. Despite this, globally, many adolescents (81%) fail to meet physical activity guidelines. Physical activity levels decline as children move into adolescence and through to adulthood and may affect the likelihood of developing chronic health conditions. It is recognised that parental support and friendship networks play an important role in attenuating declines in physical activity during adolescence and it is vital that we develop effective interventions to help adolescents stay active. Aim This symposium will engage policymakers, professionals, scientists and stakeholders to discuss research projects on Engaging peers, parents and pupils to increase physical activity among adolescents. The goals of this symposium are to highlight the challenges and ongoing work to address sub-optimal levels of physical activity in this population and disseminate the results of novel physical activity interventions to develop knowledge and understanding. This symposium will share experiences, learning and best practice in Patient and Public Involvement (PPI), transitioning from formative research to feasibility testing and upscaling interventions and it will also allow for debate and to identify gaps and priority areas for physical activity among adolescents. Symposia presentations 1. Putting young people at the heart of physical activity research design: The Walking In ScHools (WISH) Study (Professor Marie Murphy, Ulster University) This presentation will outline the importance of youth PPI and demonstrate how PPI can be embedded within research design using the WISH Study Youth Advisory Group as a case study. 2. The Girls Active Project (GAP): Co-design and feasibility of an after school-based physical activity intervention (Sara McQuinn, Dublin City University) This presentation will discuss the factors influencing physical activity behaviour in adolescents, outline how using public and patient involvement (PPI) and the behaviour change wheel provided a framework for developing the Girls Active Project, and the results from our feasiblity trial. 3. Supporting our lifelong engagement: mothers and teens exercising (SOLE MATES); from formative research to feasibility testing (Dr Elaine Murtagh, University of Limerick). Dr Murtagh will discuss the value of formative research in developing interventions and present findings from a novel mother-daughter multi-component physical activity programme. 4. Co-production of the Move Well, Feel Good movement behaviours intervention (Stuart Fairclougt, Edge Hill University) This presentation will describe phase 1 of the Move Well, Feel Good study, which aimed to co-produce and evaluate the feasibility of a primary school physical activity intervention to improve children’s motor competence and mental health. 5. The Walking In ScHools (WISH) Study: Development and evaluation of a peer-led school-based walking intervention in adolescent girls from pilot to fully-powered trial (Professor Marie Murphy, Ulster University) Professor Murphy will describe how the WISH pilot study guided the development of a full trial to evaluate the effects of a peer-led walking intervention at increasing physical activity in adolescent girls.
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Affiliation(s)
- Maria O'Kane
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University , Derry, United Kingdom
| | - Marie H Murphy
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University , Derry, United Kingdom
| | - Angela Carlin
- Centre for Exercise Medicine, Physical Activity and Health, Sports and Exercise Sciences Research Institute, Ulster University , Derry, United Kingdom
| | - Alison Gallagher
- Nutrition Innovation Centre for Food and Health (NICHE), Ulster University , Coleraine, United Kingdom
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Puliatti S, Amato M, Mazzone E, Rosiello G, De Groote R, Berquin C, Piazza P, Farinha R, Boret L, Van Respaille E, Wittouck L, Micali S, Mottrie A, Gallagher A. Development and validation of the metric-based assessment of a robotic dissection task on an avian model. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00113-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Langhendries L, Lassel M, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Van Hove K, Meganck S, Maertens L, Boret L, Migliorini F, Forte S, Rocco B, Kiely P, Micali S, Mottrie A, Gallagher A. A prospective, randomized, multi-centre trial on the efficiency and effectiveness of proficiency based progression robotic surgical skills training. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Gallagher A, Hooley K, Costello S, Felsenstein S, Mullane D, Dempsey E, Ní Chróinín M. Impact of Gestational Age on Sweat Testing. Ir Med J 2022; 115:530. [PMID: 35279064] [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: 06/14/2023]
Affiliation(s)
- A Gallagher
- Paediatrics Department, Cork University Hospital, Wilton, Cork, Ireland
| | - K Hooley
- Department of Clinical Biochemistry, Cork University Hospital, Wilton, Cork
| | - S Costello
- Department of Clinical Biochemistry, Cork University Hospital, Wilton, Cork
| | - S Felsenstein
- Paediatrics Department, Cork University Hospital, Wilton, Cork, Ireland
| | - D Mullane
- Paediatrics Department, Cork University Hospital, Wilton, Cork, Ireland
| | - E Dempsey
- Neonatology Department, Corm University Maternity Department, Wilton, Cork
| | - M Ní Chróinín
- Paediatrics Department, Cork University Hospital, Wilton, Cork, Ireland
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Merce MS, Candela-Juan C, Dabin J, Faj D, Gallagher A, de las Heras Gala H, Knežević Ž, Malchair F, De Monte F, Simantirakis G, Theodorakou C. Review of guidelines and legislative documents regarding the use of patient contact out-of-field shielding. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00061-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Dabin J, Blidéanu V, Bjelac OC, Deleu M, De Monte F, Feghali J, Gallagher A, Knežević Ž, Maccia C, Malchair F, Merce MS, Simantirakis G. Comparison of 10 skin dose mapping software products in interventional cardiology following a common protocol: results of the VERIDIC project. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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De Groote R, Puliatti S, Amato M, Mazzone E, Rossiello G, Farihna R, Paludo A, Uvin P, Decoene J, Tuyten T, D’Hondt M, Hubert N, Chatzopoulos C, De Troyer B, Desender L, Van Cleynenbreugel B, Mottrie A, Gallagher A. Proficiency based progression training versus the Halsted’s model for learning to perform a robotic vesico-urethral anastomosis on an avian tissue model: A prospective, randomized, multicenter, cross-specialty and blinded clinical trial. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01344-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Gallagher A, De Groote R, Puliatti S, Mazzone E, Amato M, Rosiello G, Paludo A, Mottrie A. The reliability, sensitivity, and specificity of Global Evaluative Assessment of Robotic Skills (GEARS) and binary scoring metrics of robotic suturing and knot tying skills in a Vesico Urethral Anastomosis (VUA) task. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Puliatti S, Amato M, Farinha R, Paludo A, Rosiello G, De Groote R, Mari A, Bianchi L, Piazza P, Van Cleynenbreugel B, Mazzone E, Migliorini F, Forte S, Bravi C, Rocco B, Kiely P, Mottrie A, Gallagher A. Does quality assured eLearning provide adequate preparation for robotic surgical skills; A prospective, randomized and multi-center study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01354-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Gallagher A, Evans-Reeves KA, Gilmore AB, Joshi A. Analysis of submissions to the EU’s public consultation on tobacco traceability and security features. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.676] [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] Open
Abstract
Abstract
Background
The Illicit Trade Protocol (ITP) requires all Parties to establish a tobacco track and trace (T&T) system. In 2016, the European Commission held a public consultation on T&T implementation in which interested parties were asked to respond online to 22 multiple-choice questions and were given additional opportunities to leave comments if desired. In May 2019, the EU's T&T system became operational. This paper explores tobacco industry influence over and policy positions within the consultation process.
Methods
The Illicit Trade Protocol (ITP) requires all Parties to establish a tobacco track and trace (T&T) system. In 2016, the European Commission held a public consultation on T&T implementation in which interested parties were asked to respond online to 22 multiple-choice questions and were given additional opportunities to leave comments if desired. In May 2019, the EU's T&T system became operational. This paper explores tobacco industry influence over and policy positions within the consultation process.
Results
Of the 197 consultation responses analysed, 131 (66.4%) had financial links to the tobacco industry. 89 respondents were trade associations, 74 of which were financially linked (33 had TTC members). 29 (22.1%) of the financially-linked respondents were not transparent about their links. There was a clear divide in the policy preferences of respondents with and without a financial link. Collectively, respondents with a financial link supported an industry-operated solution.
Conclusions
There was an extensive lobbying effort by the tobacco industry over the EU's T&T system, with TTCs' interests being represented repeatedly through multiple trade associations. The transparency requirements regarding consultation respondents' affiliations with relevant stakeholders (such as tobacco manufacturers) should be improved for future tobacco-related consultations.
Key messages
There was an extensive lobbying effort on the part of the tobacco industry Several respondents with financial links to the tobacco industry did not disclose these. Collectively, respondents with a financial link to the tobacco industry supported an industry-operated solution which would not have met the requirements of the ITP.
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Affiliation(s)
- A Gallagher
- Department for Health, University of Bath, Bath, UK
| | | | - A B Gilmore
- Department for Health, University of Bath, Bath, UK
| | - A Joshi
- Department for Health, University of Bath, Bath, UK
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Gallagher A, Evans-Reeves KA, Hatchard JL, Gilmore AB. Tobacco industry data on illicit tobacco trade: a systematic review of existing assessments. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1225] [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] Open
Abstract
Abstract
Background
The tobacco industry portrays itself as key to solving Illicit Tobacco Trade (ITT) and presents its funding of research on ITT as its attempt to address the problem. In recent years, transnational tobacco companies (TTCs) have been a major funding source of data on ITT which is heavily publicised, especially when a tobacco control policy is being debated.
Methods
Papers and reports assessing tobacco industry-funded data on ITT were obtained via systematic searching of academic and grey literature through databases and Google/website searches respectively. Characteristics of assessed industry funded data and criticisms/praise of them as detailed in the assessments were coded using a framework based on existing literature on methods for measuring ITT and for assessing the quality of estimates on tobacco tax avoidance and evasion.
Results
Of the 35 assessments reviewed, 31 argued that tobacco industry estimates were higher than independent estimates. Criticisms identified problems with data collection (29), analytical methods (22) and presentation of results (21), which resulted in inflated ITT estimates or data on ITT that were presented in a misleading manner. Lack of transparency from data collection right through to presentation of findings was a key issue with insufficient information to allow replication of the findings frequently cited.
Conclusions
Our findings demonstrate that the contribution of tobacco industry-funded data on ITT thus far in aiding understanding of ITT is extremely limited, if not counterproductive, as tobacco industry funded data on ITT is unreliable and primarily serves as a platform for the industry to lobby against tobacco control policies, including tax increases.
Key messages
TTC-funded data routinely exaggerate/overestimate levels of illicit when compared with independent sources and fail to meet the standards of peer-reviewed publications. A potential means for providing high-quality and transparent ITT research would be a tax on tobacco companies, with funds going towards independent development of established methodologies.
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Affiliation(s)
- A Gallagher
- Department for Health, University of Bath, Bath, UK
| | | | - J L Hatchard
- Department for Health, University of Bath, Bath, UK
| | - A B Gilmore
- Department for Health, University of Bath, Bath, UK
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Crawford R, Gallagher A, Devine C, Mijares Zamuner M. Quinolone-induced Biceps Tendon Rupture. Ir Med J 2020; 113:130. [PMID: 35575630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Presentation A 76-year-old man presented with acute left upper limb pain and subsequent large ecchymosis. Diagnosis An ultrasound study was performed which showed partial left biceps tendon rupture. Treatment He was managed conservatively with Orthopaedic input. The patient was given analgesia and reassured. Discussion Tendon rupture is an unusual but serious complication of quinolone exposure. This case highlights that this should be included in the differential for acute limb pain in patients who have been prescribed these drugs.
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Affiliation(s)
- R Crawford
- Department of Medicine, Bon Secours Hospital, Glasnevin
| | - A Gallagher
- Department of Medicine, Bon Secours Hospital, Glasnevin
| | - C Devine
- Pharmacy Department, Bon Secours Hospital, Glasnevin
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TALBOT B, Franca Gois P, Healy H, Gallagher A, Sen S, Chadban S, Gallagher M, Knight J, Barraclough K. SUN-058 Variations in Environmentally Sustainable Practice within Australian Dialysis Units: Time for a Nationwide Approach? Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.454] [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] Open
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19
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Gallagher A, Hooley K, Mullane D, Costello S, Ni Chroinin M. P036 Newborn Screening Cork University Hospital 2011–2019 - impact of gestational age on sweat testing. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Siiskonen T, Ciraj-Bjelac O, Dabin J, Diklic A, Domienik-Andrzejewska J, Farah J, Fernandez J, Gallagher A, Hourdakis C, Jurkovic S, Järvinen H, Järvinen J, Knežević Ž, Koukorava C, Maccia C, Majer M, Malchair F, Riccardi L, Rizk C, Sanchez R, Sandborg M, Merce MS, Segota D, Sierpowska J, Simantirakis G, Sukupova L, Thrapsanioti Z, Vano E. Establishing the European diagnostic reference levels for interventional cardiology. Phys Med 2018; 54:42-48. [DOI: 10.1016/j.ejmp.2018.09.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/29/2022] Open
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21
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Gray P, Murphy M, Gallagher A, Simpson EEA. A qualitative investigation of physical activity compensation among older adults. Br J Health Psychol 2017; 23:208-224. [PMID: 29171704 DOI: 10.1111/bjhp.12282] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 10/11/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study explored the mechanisms of physical activity (PA) compensation among older adults who recently reduced their non-exercise physical activity (NEPA) in response to a structured PA intervention. DESIGN A post-trial, retrospective qualitative process evaluation using interviews was employed. METHODS Levels of PA compensation were determined by comparing NEPA prior to and during the final week of a 4-week structured PA intervention. Those who reduced their NEPA by 10% or greater were considered as compensators. Interviews were conducted with older adult compensators (mean age = 58.56 ± 3.88 years; n = 9), employing thematic analysis to identify potential mechanisms of PA compensation. RESULTS The findings suggest that the majority of participants were unaware that they had compensated in their PA, suggesting that this may be a non-volitional process. Most participants perceived PA compensation to hold negative implications for health and well-being. Physiological processes of fatigue and delayed onset of muscle soreness were cited as the principal cause of PA compensation, whereas psychological processes including a drive to be inactive, fear of overexertion, deficient motivation, and perceived time constraints were cited to a lesser extent. CONCLUSION A range of physiological and psychological compensatory barriers were identified. Implications of and methods to overcome these compensatory barriers are discussed. Statement of contribution What is already known on this subject? Physical activity compensation holds negative implications for physical activity promotion and health. Older adults are an age group more likely to compensate in their physical activity levels. What does this study add? Physical activity compensation may be a result of a range of physiological and psychological processes including fatigue and delayed onset of muscle soreness, compensatory health beliefs, fear of overexertion, deficient motivation, and perceived time constraints. Most older adult compensators may be unaware they are compensating and, however, agree that physical activity compensation has negative implications for health and well-being.
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Affiliation(s)
- Phillip Gray
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - Marie Murphy
- Sport and Exercise Sciences Research Institute, Ulster University, Jordanstown, Northern Ireland
| | - Alison Gallagher
- Northern Ireland Centre for Food and Health, Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland
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22
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Eysenck WJT, Veasey RA, El-Nayir MH, Gallagher A, Jouhra F, Patel NR, Furniss SS, Sulke AN. 73Analysing mortality variances between right ventricular high septal pacing vs. right ventricular apical pacing following av node ablation: 10 years follow up. Europace 2017. [DOI: 10.1093/europace/eux283.068] [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: 11/12/2022] Open
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23
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Gallagher A, Chen KW, Cary SK, Kametani F, Graf D, Albrecht-Schmitt TE, Shekhter A, Baumbach RE. Thermodynamic and electrical transport investigation of URu 2Si 2-x P x. J Phys Condens Matter 2017; 29:024004. [PMID: 27861169 DOI: 10.1088/0953-8984/29/2/024004] [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: 06/06/2023]
Abstract
Magnetic susceptibility, electrical resistivity, and heat capacity results are reported for the chemical substitution series URu2Si2-x P x for [Formula: see text]. This study expands in detail on work recently reported in Gallagher et al (2016 Nat. Commun. 10712), which focused on the small x region of this substitution series. Measurements presented here reveal persistent hybridization between the f- and conduction electrons and strong variation of the low temperature behavior with increasing x. Hidden order and superconductivity are rapidly destroyed for [Formula: see text] and are replaced for [Formula: see text] by a region with Kondo coherence but no ordered state. Antiferromagnetism abruptly appears for [Formula: see text]. This phase diagram differs significantly from those produced by most other tuning strategies in URu2Si2, including applied pressure, high magnetic fields, and isoelectronic chemical substitution (i.e. Ru → Fe and Os), where hidden order and magnetism share a common phase boundary. Besides revealing an intriguing evolution of the low temperature states, this series provides a setting in which to investigate the influence of electronic tuning, where probes that are sensitive to the Fermi surface and the symmetry of the ordered states will be useful to unravel the anomalous behavior of URu2Si2.
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Affiliation(s)
- A Gallagher
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, FL, USA
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Dashora U, Gallagher A, Dhatariya K, Winocour P, Gregory R. Association of British Clinical Diabetologists (ABCD) position statement on the risk of diabetic ketoacidosis associated with the use of sodium-glucose cotransporter-2 inhibitors. Br J Diabetes 2016. [DOI: 10.15277/bjd.2016.112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
In this article we consider some of the implications of the UK Human Rights Act 1998 for nurses in practice. The Act has implications for all aspects of social life in Britain, particularly for health care. We provide an introduction to the discourse of rights in health care and discuss some aspects of four articles from the Act. The reciprocal relationship between rights and obligations prompted us to consider also the relationship between guidelines in the United Kingdom Central Council’s Code of professional conduct and the requirements of the Human Rights Act 1998. We conclude with the recommendation that the new legislation should be welcomed for its potential to support good practice and to urge critical and reflective practice rather than as yet another burdensome bureaucratic imposition.
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Affiliation(s)
- J McHale
- University of Leicester, University Road, Leicester LE1 7RH, UK
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Gallagher A, Winocour PH. Don't dismiss pioglitazone on basis of uncertain risk. BMJ 2016; 354:i3667. [PMID: 27384907 DOI: 10.1136/bmj.i3667] [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] [Indexed: 11/03/2022]
Affiliation(s)
- Alison Gallagher
- Association of British Clinical Diabetologists, ABCD Secretariat, PO Box 2927, Malmesbury SN16 0WZ, UK
| | - Peter H Winocour
- Association of British Clinical Diabetologists, ABCD Secretariat, PO Box 2927, Malmesbury SN16 0WZ, UK
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Kennedy E, Gallagher A, Hourihane J, Fallon P, Murray D, Segre J, Kong H, Irvine A. 476 Skin microbiome alterations in infants before clinical atopic dermatitis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brady D, Lavelle LP, McEvoy SH, Murphy DJ, Gallagher A, Gibney B, Butler MW, Shortt F, McMullan M, Fabre A, Lynch DA, Abbara S, Donnelly SC, Dodd JD. Assessing fibrosis in pulmonary sarcoidosis: late-enhanced MRI compared to anatomic HRCT imaging. QJM 2016; 109:257-64. [PMID: 26537956 DOI: 10.1093/qjmed/hcv200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Received: 03/25/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- D Brady
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - L P Lavelle
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S H McEvoy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D J Murphy
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Gallagher
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - B Gibney
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - M W Butler
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - F Shortt
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - M McMullan
- Department of Radiology, St Vincent's Private Hospital, Elm Park, Dublin 4, Ireland
| | - A Fabre
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - S Abbara
- Department of Radiology, UT Southwestern, Dallas, TX, USA
| | - S C Donnelly
- Department of Respiratory Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J D Dodd
- From the Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
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Ahmed O, O'Donnell B, Shorten G, Gallagher A. Regional anaesthesia competency assessment. Anaesthesia 2016; 71:472-3. [PMID: 26994540 DOI: 10.1111/anae.13393] [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: 11/26/2022]
Affiliation(s)
- O Ahmed
- Cork University Hospital, Cork, Ireland
| | | | - G Shorten
- Cork University Hospital, Cork, Ireland
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Walsh SM, Gallagher A, Gallagher R, Barnes E, Doherty GA, Dodd JD, Butler MW. First do no harm: nasogastric tube placement and confirmation. QJM 2016; 109:219. [PMID: 26319701 DOI: 10.1093/qjmed/hcv160] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- S M Walsh
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - A Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - R Gallagher
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - E Barnes
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - G A Doherty
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and
| | - J D Dodd
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - M W Butler
- From the St Vincents University Hospital, Elm Park, Dublin, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
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Gallagher A, Chen KW, Moir CM, Cary SK, Kametani F, Kikugawa N, Graf D, Albrecht-Schmitt TE, Riggs SC, Shekhter A, Baumbach RE. Unfolding the physics of URu2Si2 through silicon to phosphorus substitution. Nat Commun 2016; 7:10712. [PMID: 26891903 PMCID: PMC4762885 DOI: 10.1038/ncomms10712] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 06/30/2015] [Accepted: 01/12/2016] [Indexed: 11/15/2022] Open
Abstract
The heavy fermion intermetallic compound URu2Si2 exhibits a hidden-order phase below the temperature of 17.5 K, which supports both anomalous metallic behavior and unconventional superconductivity. While these individual phenomena have been investigated in detail, it remains unclear how they are related to each other and to what extent uranium f-electron valence fluctuations influence each one. Here we use ligand site substituted URu2Si2-xPx to establish their evolution under electronic tuning. We find that while hidden order is monotonically suppressed and destroyed for x≤0.035, the superconducting strength evolves non-monotonically with a maximum near x≈0.01 and that superconductivity is destroyed near x≈0.028. This behavior reveals that hidden order depends strongly on tuning outside of the U f-electron shells. It also suggests that while hidden order provides an environment for superconductivity and anomalous metallic behavior, it's fluctuations may not be solely responsible for their progression. The heavy fermion compound URu2Si2 displays a hidden order phase and superconductivity at low temperatures. Here, the authors perform substitution studies—partially replacing silicon with phosphorus—and study the effects on hidden order and superconductivity.
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Affiliation(s)
- A Gallagher
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - K-W Chen
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - C M Moir
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - S K Cary
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306, USA
| | - F Kametani
- Applied Superconductivity Center, Florida State University, Tallahassee, Florida 32310, USA
| | - N Kikugawa
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA.,National Institute for Materials Science 3-13 Sakura, Tsukuba 305-0003, Japan
| | - D Graf
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - T E Albrecht-Schmitt
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, Florida 32306, USA
| | - S C Riggs
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - A Shekhter
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
| | - R E Baumbach
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310, USA
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Ramirez D, Gallagher A, Baumbach R, Siegrist T. Synthesis and characterization of the divalent samarium Zintl-phases SmMg2Bi2 and SmMg2Sb2. J SOLID STATE CHEM 2015. [DOI: 10.1016/j.jssc.2015.08.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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O'Connor U, Walsh C, Gallagher A, Dowling A, Guiney M, Ryan JM, McEniff N, O'Reilly G. Occupational radiation dose to eyes from interventional radiology procedures in light of the new eye lens dose limit from the International Commission on Radiological Protection. Br J Radiol 2015; 88:20140627. [PMID: 25761211 PMCID: PMC4628470 DOI: 10.1259/bjr.20140627] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 02/27/2015] [Accepted: 03/10/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators. METHODS Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3). RESULTS Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis. CONCLUSION Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit. ADVANCES IN KNOWLEDGE We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.
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Affiliation(s)
- U O'Connor
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - C Walsh
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - A Gallagher
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - A Dowling
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
| | - M Guiney
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - J M Ryan
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - N McEniff
- Department of Radiology, St James's Hospital, Dublin, Ireland
| | - G O'Reilly
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland
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Weeks AD, Watt P, Yoxall CW, Gallagher A, Burleigh A, Bewley S, Heuchan AM, Duley L. Innovation in immediate neonatal care: development of the Bedside Assessment, Stabilisation and Initial Cardiorespiratory Support (BASICS) trolley. ACTA ACUST UNITED AC 2015; 1:53-58. [PMID: 26191414 PMCID: PMC4467574 DOI: 10.1136/bmjinnov-2014-000017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 02/13/2015] [Accepted: 03/13/2015] [Indexed: 12/04/2022]
Abstract
Objective Babies receive oxygen through their umbilical cord while in the uterus and for a few minutes after birth. Currently, if the baby is not breathing well at birth, the cord is cut so as to transfer the newborn to a resuscitation unit. We sought to develop a mobile resuscitation trolley on which newly born babies can be resuscitated while still receiving oxygenated blood and the ‘placental transfusion’ through the umbilical cord. This would also prevent separation of the mother and baby in the first minutes after birth. Design Multidisciplinary iterative product development. Setting Clinical Engineering Department of a University Teaching Hospital. Methods Following an initial design meeting, a series of prototypes were developed. At each stage, the prototype was reviewed by a team of experts in the laboratory and in the hospital delivery suite to determine ease of use and fitness for purpose. A commercial company was identified to collaborate on the trolley's development and secure marking with the Conformité Européenne mark, allowing the trolley to be introduced into clinical practice. Results The trolley is a small mobile resuscitation unit based on the concept of an overbed hospital table. It can be manoeuvred to within 50 cm of the mother's pelvis so that the umbilical cord can remain intact during resuscitation, irrespective of whether the baby is born naturally, by instrumental delivery or by caesarean section. Warmth for the newborn comes from a heated mattress and the trolley has the facility to provide suction, oxygen and air. Conclusions This is the first mobile resuscitation device designed specifically to facilitate newborn resuscitation at the bedside and with an intact cord. The next step is to assess its safety, its acceptability to clinicians and parents, and to determine whether it allows resuscitation with an intact cord.
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Affiliation(s)
- A D Weeks
- Department of Women's and Children's Health , University of Liverpool , Liverpool , UK
| | - P Watt
- Department of Clinical Engineering , University of Liverpool , Liverpool , UK
| | - C W Yoxall
- Liverpool Women's NHS Foundation Trust , Liverpool , UK
| | - A Gallagher
- Worcestershire Royal Hospital , Worcester , UK
| | | | - S Bewley
- Division of Women's Health, Kings College London, London, UK
| | - A M Heuchan
- Royal Hospital for Sick Children and Southern General Maternity Hospital , Glasgow , UK
| | - L Duley
- Nottingham Clinical Trials Unit , University of Nottingham , Nottingham , UK
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Logue C, Peters S, Gallagher A, Verhagen H. Perspectives on Low Calorie Intense Sweeteners with a Focus on Aspartame and Stevia. ACTA ACUST UNITED AC 2015. [DOI: 10.9734/ejnfs/2015/14815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Piela N, Sacchetti A, Abrams A, Gallagher A. 310 Outcome of Emergency Department Placement of Transvenous Pacemakers. Ann Emerg Med 2014. [DOI: 10.1016/j.annemergmed.2014.07.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Ennis A, Gallagher A, Hoblyn J. L34 Caregiver Supports For Families Of Those With Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hoblyn J, Higgins A, McCaffrey S, Gallagher A, O'Neill S, Ennis A. L12 Developing A Psychiatric Service For Individuals With Huntington's Disease. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cozen W, Timofeeva MN, Li D, Diepstra A, Hazelett D, Delahaye-Sourdeix M, Edlund CK, Franke L, Rostgaard K, Van Den Berg DJ, Cortessis VK, Smedby KE, Glaser SL, Westra HJ, Robison LL, Mack TM, Ghesquieres H, Hwang AE, Nieters A, de Sanjose S, Lightfoot T, Becker N, Maynadie M, Foretova L, Roman E, Benavente Y, Rand KA, Nathwani BN, Glimelius B, Staines A, Boffetta P, Link BK, Kiemeney L, Ansell SM, Bhatia S, Strong LC, Galan P, Vatten L, Habermann TM, Duell EJ, Lake A, Veenstra RN, Visser L, Liu Y, Urayama KY, Montgomery D, Gaborieau V, Weiss LM, Byrnes G, Lathrop M, Cocco P, Best T, Skol AD, Adami HO, Melbye M, Cerhan JR, Gallagher A, Taylor GM, Slager SL, Brennan P, Coetzee GA, Conti DV, Onel K, Jarrett RF, Hjalgrim H, van den Berg A, McKay JD. A meta-analysis of Hodgkin lymphoma reveals 19p13.3 TCF3 as a novel susceptibility locus. Nat Commun 2014; 5:3856. [PMID: 24920014 PMCID: PMC4055950 DOI: 10.1038/ncomms4856] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 04/11/2014] [Indexed: 12/20/2022] Open
Abstract
Recent genome-wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio (OR)=0.81, 95% confidence interval (95% CI) = 0.76-0.86, P(combined) = 3.5 × 10(-10)), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16, 5q31, 6p31, 8q24 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk.
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Affiliation(s)
- W Cozen
- 1] USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA [2]
| | - M N Timofeeva
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2] Institute of Genetics and Molecular Medicine, University of Edinburgh, EH4 2XU Edinburgh, UK [3]
| | | | - A Diepstra
- 1] University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands [2]
| | - D Hazelett
- 1] USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA [2]
| | - M Delahaye-Sourdeix
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2]
| | - C K Edlund
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - L Franke
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - K Rostgaard
- Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - D J Van Den Berg
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - V K Cortessis
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - K E Smedby
- Karolinska Institutet and Karolinska University Hospital, S-221 00 Stockholm, Sweden
| | - S L Glaser
- Cancer Prevention Institute of California, Fremont, California 94538, USA
| | - H-J Westra
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - L L Robison
- St Jude Children's Hospital, Cordova, Tennessee 38105, USA
| | - T M Mack
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - H Ghesquieres
- Centre Léon Bérard, UMR CNRS 5239-Université Lyon 1, 69008 Lyon, France
| | - A E Hwang
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - A Nieters
- University Medical Centre Freiburg, D-79085 Freiburg, Germany
| | - S de Sanjose
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | | | - N Becker
- German Cancer Research Centre, D-69120 Heidelberg, Germany
| | - M Maynadie
- CHU de Dijon, EA 4184, University of Burgundy, 21070 Dijon, France
| | - L Foretova
- Masaryk Memorial Cancer Institute, 656 53 Brno, Czech Republic
| | - E Roman
- University of York, YO10 5DD York, UK
| | - Y Benavente
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | - K A Rand
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - B N Nathwani
- City of Hope National Medical Center, Duarte, California 91010, USA
| | | | - A Staines
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - P Boffetta
- Icahn School of Medicine at Mount Sinai, New York City, New York 10029-6574, USA
| | - B K Link
- University of Iowa College of Medicine, Iowa City, Iowa 52242, USA
| | - L Kiemeney
- Radboud University Nijmegen Medical Centre, 6500HB Nijmegen, The Netherlands
| | - S M Ansell
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - S Bhatia
- City of Hope National Medical Center, Duarte, California 91010, USA
| | - L C Strong
- MD Anderson Cancer Center, University of Texas, Houston, Texas 77030, USA
| | - P Galan
- INSERM U557 (UMR Inserm; INRA; CNAM, Université Paris 13), 93017 Paris, France
| | - L Vatten
- Norwegian University of Science and Technology, NO-7491 Trondheim, Norway
| | | | - E J Duell
- IDIBELL Institut Català d'Oncologia, 8907 Barcelona, Spain
| | - A Lake
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - R N Veenstra
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - L Visser
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - Y Liu
- University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands
| | - K Y Urayama
- Department of Human Genetics and Disease Diversity, Tokyo Medical and Dental University, Tokyo 104-0044, Japan
| | - D Montgomery
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - V Gaborieau
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - L M Weiss
- Clarient Pathology Services, Aliso Viejo, California 92656, USA
| | - G Byrnes
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - M Lathrop
- Genome Quebec, Montreal, Canada H3A 0G1
| | - P Cocco
- Institute of Occupational Health, University of Cagliari, Monserrato, 09042 Cagliari, Italy
| | - T Best
- The University of Chicago, Chicago, Illinois 60637-5415, USA
| | - A D Skol
- The University of Chicago, Chicago, Illinois 60637-5415, USA
| | - H-O Adami
- 1] Karolinska Institutet and Karolinska University Hospital, S-221 00 Stockholm, Sweden [2] Harvard University School of Public Health, Boston, Massachusetts 02115, USA
| | - M Melbye
- Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - J R Cerhan
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - A Gallagher
- MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
| | - G M Taylor
- School of Cancer Sciences, University of Manchester, St Mary's Hospital, M13 0JH Manchester, UK
| | - S L Slager
- Mayo Clinic, Rochester, Minnesota 55905, USA
| | - P Brennan
- International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - G A Coetzee
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - D V Conti
- USC Keck School of Medicine, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California 90089-9175, USA
| | - K Onel
- 1] The University of Chicago, Chicago, Illinois 60637-5415, USA [2]
| | - R F Jarrett
- 1] MRC University of Glasgow Centre for Virus Research, Garscube Estate, University of Glasgow, G12 8QQ Glasgow, Scotland, UK [2]
| | - H Hjalgrim
- 1] Statens Serum Institut, DK-2300 Copenhagen, Denmark [2]
| | - A van den Berg
- 1] University of Groningen, University Medical Centre Groningen, 9700 RB Groningen, The Netherlands [2]
| | - J D McKay
- 1] International Agency for Research on Cancer (IARC), 69372 Lyon, France [2]
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Mähler Convenor M, Berard M, Feinstein R, Gallagher A, Illgen-Wilcke B, Pritchett-Corning K, Raspa M. FELASA recommendations for the health monitoring of mouse, rat, hamster, guinea pig and rabbit colonies in breeding and experimental units. Lab Anim 2014; 48:178-192. [PMID: 24496575 DOI: 10.1177/0023677213516312] [Citation(s) in RCA: 376] [Impact Index Per Article: 37.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The microbiological quality of experimental animals can critically influence animal welfare and the validity and reproducibility of research data. It is therefore important for breeding and experimental facilities to establish a laboratory animal health monitoring (HM) programme as an integrated part of any quality assurance system. FELASA has published recommendations for the HM of rodent and rabbit colonies in breeding and experimental units (Nicklas et al. Laboratory Animals, 2002), with the intention of harmonizing HM programmes. As stated in the preamble, these recommendations need to be adapted periodically to meet current developments in laboratory animal medicine. Accordingly, previous recommendations have been revised and shall be replaced by the present recommendations. These recommendations are aimed at all breeders and users of laboratory mice, rats, Syrian hamsters, guinea pigs and rabbits as well as diagnostic laboratories. They describe essential aspects of HM, such as the choice of agents, selection of animals and tissues for testing, frequency of sampling, commonly used test methods, interpretation of results and HM reporting. Compared with previous recommendations, more emphasis is put on the role of a person with sufficient understanding of the principles of HM, opportunistic agents, the use of sentinel animals (particularly under conditions of cage-level containment) and the interpretation and reporting of HM results. Relevant agents, testing frequencies and literature references are updated. Supplementary information on specific agents and the number of animals to be monitored and an example of a HM programme description is provided in the appendices.
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Affiliation(s)
| | - M Mähler Convenor
- GV-SOLAS, Gesellschaft für Versuchstierkunde BioDoc, Hannover, Germany
| | - M Berard
- AFSTAL, Association Française des Sciences et Techniques de l'Animal de Laboratoire Animalerie Centrale, Institut Pasteur, Paris, France
| | - R Feinstein
- Scand-LAS, Scandinavian Society for Laboratory Animal Science Department of Pathology and Wildlife Diseases, National Veterinary Institute, Uppsala, Sweden
| | - A Gallagher
- LASA, Laboratory Animal Science Association MRC National Institute for Medical Research, London, UK
| | - B Illgen-Wilcke
- SGV, Schweizerische Gesellschaft für Versuchstierkunde MicroBioS GmbH, Reinach, Switzerland
| | - K Pritchett-Corning
- AALAS, American Association for Laboratory Animal Science Charles River Laboratories, Wilmington, MA, USA University of Washington, Seattle, WA, USA
| | - M Raspa
- AISAL, Associazione Italiana per le Scienze degli Animali da Laboratorio Consiglio Nazionale delle Ricerche, European Mouse Mutant Archive, Institute of Cell Biology and Neurobiology, Monterotondo Scalo, Italy
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O'Connor U, Gallagher A, O'Reilly G, Dowling A, Malone JF. Practical application of suspension criteria scenarios in general radiography, computed radiography,digital radiography and fluoroscopy. Radiat Prot Dosimetry 2013; 153:236-240. [PMID: 23169811 DOI: 10.1093/rpd/ncs299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Radiological equipment must be assessed against criteria for acceptability to ensure that it meets the minimum standards for patient safety. This assessment is typically led by a medical physicist with input from radiology staff and the equipment supplier. Equipment that does not meet the criteria requires action and may be suspended from clinical use. European Commission report RP 91 will be revised and replaced as RP 162. It has been drawn up to aid medical physicists with the assessment process and provide guidance on suspension levels. This paper details several cases where the criteria in the proposed RP 162 were applied in general radiography, computed radiography, digital radiography and fluoroscopy. The factors considered by the medical physicist and the outcome of each case are presented. The proposed RP 162 report improves on its predecessor and provides a robust set of criteria for ensuring that patient safety within the EU medical exposures framework is optimised.
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Affiliation(s)
- U O'Connor
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin, Ireland.
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Malone J, Baldelli P, Balter S, Bischof N, Bosmans H, Dowling A, Edyvean S, Gallagher A, Faulkner K, Horner K, Malone L, Mclean ID, O'Connor U, Schreiner A, Vassileva J, Vano E, Zoetelief J. Criteria and suspension levels in diagnostic radiology. Radiat Prot Dosimetry 2013; 153:185-189. [PMID: 23173220 DOI: 10.1093/rpd/ncs295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The EC (European Council) Directive on radiation protection of patients requires that criteria for acceptability of equipment in diagnostic radiology, nuclear medicine and radiotherapy be established throughout the member states. This study reviews the background to this requirement and to its implementation in practice. It notes and considers parallel requirements in the EC medical devices directive and International Electrotechnical Commission standards that it is also important to consider and that both sets of requirements should ideally be harmonised due to the global nature of the equipment industry. The study further reviews the types of criteria that can be well applied for the above purposes, and defines qualitative criteria and suspension levels suitable for application. Both are defined and relationships with other acceptance processes are considered (including acceptance testing at the time of purchase, commissioning and the issue of second-hand equipment). Suspension levels are divided into four types, A, B, C and D, depending on the quality of evidence and consensus they are based on. Exceptional situations involving, for example, new or rapidly evolving technology are also considered. The publication and paper focuses on the role of the holder of the equipment and related staff, particularly the medical physics expert and the practitioner. Advice on how the criteria should be created and implemented is provided for these groups and how this might be coordinated with the supplier. Additional advice on the role of the regulator is provided.
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Affiliation(s)
- J Malone
- Trinity College Centre for Health Sciences, Dublin 8, Ireland.
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Bowden L, Faulkner R, Gallagher A, O'Connor U, Walsh C, Dowling A, O'Reilly G. Doses measured using AEC on direct digital radiographic (DDR) X-rays systems: updated results with an RP 162 perspective. Radiat Prot Dosimetry 2013; 153:251-254. [PMID: 23175645 DOI: 10.1093/rpd/ncs282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As digital technology in diagnostic radiology systems becomes more prevalent, there is a need to provide comparative dose information for these new systems. This is needed in particular for testing the automatic exposure control (AEC) devices on direct digital radiography (DDR) systems as there is no consensus on the receptor dose level in the current guidelines. The new European Commission RP 162 document sets the suspension level for the 'verification of kerma at receptor entrance in computed radiography and DDR systems under AEC' as ≥10 µGy. This document also notes that alternate methodologies are acceptable, and may require adjustment in the suspension level if used. This study provides a range of typical doses under AEC for DDR systems, for a variety measurement methodologies, including that described in RP 162.
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Affiliation(s)
- L Bowden
- Department of Medical Physics and Bioengineering, St James's Hospital, Dublin 8, Ireland.
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O'Connor U, Gallagher A, Malone L, O'Reilly G. Occupational radiation dose to eyes from endoscopic retrograde cholangiopancreatography procedures in light of the revised eye lens dose limit from the International Commission on Radiological Protection. Br J Radiol 2013; 86:20120289. [PMID: 23385992 PMCID: PMC3608047 DOI: 10.1259/bjr.20120289] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 10/19/2012] [Accepted: 11/12/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure that combines the use of X-ray fluoroscopy and endoscopy for examination of the bile duct. Published data on ERCP doses are limited, including staff eye dose from ERCP. Occupational eye doses are of particular interest now as the International Commission on Radiological Protection (ICRP) has recommended a reduction in the dose limit to the lens of the eye. The aim of this study was to measure occupational eye doses obtained from ERCP procedures. METHODS A new eye lens dosemeter (EYE-D(™), Radcard, Krakow, Poland) was used to measure the ERCP eye dose, H(p)(3), at two endoscopy departments in Ireland. A review of radiation protection practice at the two facilities was also carried out. RESULTS The mean equivalent dose to the lens of the eye of a gastroenterologist is 0.01 mSv per ERCP procedure with an undercouch X-ray tube and 0.09 mSv per ERCP procedure with an overcouch X-ray tube. Staff eye dose normalised to patient kerma area product is also presented. CONCLUSION Staff eye doses in ERCP have the potential to exceed the revised ICRP limit of 20 mSv per annum when an overcouch X-ray tube is used. The EYE-D dosemeter was found to be a convenient method for measuring lens dose. Eye doses in areas outside of radiology departments should be kept under review, particularly in light of the new ICRP eye dose limit. ADVANCES IN KNOWLEDGE Occupational eye lens doses from ERCP procedures have been established using a new commercially available dedicated H(p)(3) dosemeter.
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Affiliation(s)
- U O'Connor
- Department of Medical Physics and Bioengineering, St. James's Hospital, Dublin 8, Ireland.
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Gatti-Mays M, Kallakury BVS, Makariou E, Venzon D, Permaul E, Isaacs C, Cohen P, Warren R, Gallagher A, Eng-Wong J. Abstract P1-09-04: Down-regulation of trefoil protein 1(TFF1) in normal breast tissue of postmenopausal women at increased risk for breast cancer on exemestane. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-09-04] [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: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors (AI) are effective for breast cancer risk reduction in postmenopausal women. TFF1, also known as pS2, is an estrogen response gene present in normal mammary tissue with increased expression in estrogen receptor positive breast cancer. Previous studies have demonstrated down-regulation of TFF1 and Ki-67, a marker of proliferation, in postmenopausal women with locally advanced breast cancer who receive neoadjuvant AIs. TFF1 and proliferating cell nuclear antigen (PCNA) may serve as biomarkers of effect of AIs in women at increased risk for breast cancer.
Methods: We conducted a single-arm phase II trial of exemestane in women at increased risk for breast cancer and examined the impact on TFF1 and PCNA. Postmenopausal women at increased risk for invasive breast cancer by clinical or histological criteria received 25mg of exemestane daily for 2 years. Subjects were required to have stopped any hormonal medication ≥ 3 months prior to enrollment. Image guided breast biopsies targeting dense breast tissue were performed at baseline and at 12 months. Core specimens were obtained under local anesthesia at each time point from the same area of the breast. One core biopsy sample was formalin-fixed, paraffin-embedded and examined for pathologic abnormalities, as well as TFF1 and PCNA. TFF1 was assessed by intensity of stain (0 to 3+) and percent of cells with any staining; PCNA was assessed by percent of cells staining within the tissue section. The pathologist (B.K.) was blinded to the time of biopsy. Change in intensity and % positive cells were evaluated by paired t-test.
Results: Thirty four subjects underwent both baseline & 12 month breast biopsies. Eight biopsies at baseline and 5 biopsies at 12 months did not contain any ductal or lobular tissue and were not analyzed. Twenty-two subjects had evaluable breast tissue at both time points for TFF1 analysis and 23 subjects for PCNA analysis. No high risk lesions or invasive cancers were identified. Of the baseline specimens, 95.5% were positive for TFF1: 59.1% (13 of 22) were scored as 3+(intense), 31.8% (7 of 22) were 2+(moderate) and 4.5% (1 of 22) were 1+(low). Percent of cells staining for TFF1 ranged from 0 to 20% (median = 1%). After 1 year on exemestane TFF1 intensity decreased in 17 subjects (77.3%), 4 had no change and 1 increased. Mean TFF1 change was −1.32 (95% CI −1.87 to −0.76; p < 0.001). The change in % positive cells for PCNA ranged from −15 to +30% (median = 0%).
Discussion: Assessing tissue biomarkers with repeat core needle biopsies in a phase II prevention trial in high risk women is feasible. Since prevention agents are not universally protective, determining biomarkers of effect may allow tailored therapy. TFF1 is a biologically plausible biomarker of AI activity that was down-regulated in 77% of breast tissue following exemestane therapy. This is the first study to evaluate this tissue marker in the prevention setting. Further study is needed to correlate with other biomarkers of interest, e.g. change in mammographic density, serum hormone levels and clinical outcomes.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-09-04.
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Affiliation(s)
- M Gatti-Mays
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - BVS Kallakury
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - E Makariou
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - D Venzon
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - E Permaul
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - C Isaacs
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - P Cohen
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - R Warren
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - A Gallagher
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Eng-Wong
- Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
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Cotter N, Dowling W, Gatto C, Gallagher A, Smith J, Evans R, Musanti R, Bustami R. P02.142. Efficacy of energy therapy in relieving anxiety and pain in patients undergoing lumbar spine fusion surgery. Altern Ther Health Med 2012. [PMCID: PMC3373350 DOI: 10.1186/1472-6882-12-s1-p198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Gatti M, Venzon D, Zujewski J, Korde L, Isaacs C, Cohen P, Warren R, Gallagher A, Eng-Wong J. P3-11-01: Effects of Exemestane Therapy on the Lipid Profile of Postmenopausal Women with an Elevated Risk of Developing Invasive Breast Cancer. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-11-01] [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: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors are effective for breast cancer prevention in postmenopausal women. In the recent MAP.3 study, exemestane significantly reduced invasive breast cancer in postmenopausal women with an elevated risk of developing breast cancer. At 35 months follow up there was no increase risk in cardiovascular events in this study; however, the effects of exemestane use on lipid profiles and cardiovascular health are still unclear.
Methods: We conducted a single-arm phase II trial of exemestane in women at increased risk for breast cancer and examined the impact of exemestane on lipid profiles. Postmenopausal women at high risk for invasive breast cancer (e.g., Gail Model risk ≥ 1.7, a history of lobular neoplasia, atypical ductal hyperplasia, DCIS, or stage I/II breast cancer, or BRCA 1/2 mutation) were given exemestane (25 mg orally daily) for 2 years. Fasting serum total cholesterol, HDL, LDL, triglycerides, and homocysteine were collected at baseline, 3, 12, and 24 months after initiation of exemestane therapy. Apolipoprotein A and B were collected at baseline, 3 and 12 months. Wilcoxon sign ranked test was used to analyze if changes from baseline values differed from zero. The Hochberg p-value adjustment was used to account for multiple hypothesis tests.
Results: Of the 42 women enrolled in the study, 6 dropped out prior to completing 1 year and 1 dropped out prior to completing 2 years of exemestane therapy. Thirty-one women have completed 2 years of exemestane therapy and the remaining 4 are expected to complete 2 years of therapy by January 2012. On average, participants were 58.5 years old, mostly Caucasian (n = 37; 84.1%), and had a BMI of 29.2 kg/m2. A majority (n = 19) of participants were on lipid-lowering medications (14 were taking a statin) or taking fish oil supplements (n =5) prior to starting on the trial and 1 was started on a statin approximately 10 months after starting the trial. There were no significant differences in mean lipid values for each of the 4 assessment points or in the mean change from baseline at 3, 12, and 24 months between patients who were taking lipid-lowering medications and those were not. In unadjusted analyses, change in HDL from baseline was significantly different from zero and decreased from baseline at 3, 12 and 24 months (−8.0 mg/dL, −8.5 mg/dL, and −9.9 mg/dL; All p-values ≤ .001 before and after applying the Hochberg adjustment). Total cholesterol also significantly decreased from baseline at 3 months (−13.6 mg/dL, p = .002) but was no longer significant at 12 and 24 months (−9.6 mg/dL and −11.4 mg/dL, respectively; p-values = .07). The rest of the lipid panel did not significantly change during follow-up.
Discussion: In agreement with previous studies, we found that exemestane causes a significant decrease in HDL and total cholesterol, while leaving the rest of the lipid panel unchanged. Prior studies excluded patients on lipid-lowering medication; half of our participants were taking lipid-lowering medication. It is notable that both women off and on lipid-lowering medication had decreases in HDL. Additional studies are needed to elucidate long-term cardiovascular outcomes in this high risk but otherwise healthy population.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-11-01.
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Affiliation(s)
- M Gatti
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - D Venzon
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Zujewski
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - L Korde
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - C Isaacs
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - P Cohen
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - R Warren
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - A Gallagher
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
| | - J Eng-Wong
- 1Georgetown University Hospital, Washington, DC; National Cancer Institute, National Institutes of Health, Bethesda, MD; University of Washington, Seattle, WA; Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC
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Lassonde M, Bastien D, Gallagher A, Tremblay J, Vannasing P, Lepore F. Specific functional asymmetries of the human visual cortex revealed by functional Near-Infrared Spectroscopy. J Vis 2011. [DOI: 10.1167/11.11.1068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Gallagher A, Kovach A, Stemmer-Rachamimov A, Rosenberg AE, Eskandar E, Thiele EA. Metaplastic bone in a cortical tuber of a young patient with tuberous sclerosis complex. Neurology 2011; 76:1602-4. [PMID: 21536642 DOI: 10.1212/wnl.0b013e3182190d25] [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: 11/15/2022] Open
Affiliation(s)
- A Gallagher
- Carol and James Herscot Center for Tuberous Sclerosis Complex, 175 Cambridge Street, Suite 340, Boston, MA 02114, USA
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