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Clairoux A, Moore A, Caron-Goudreault M, Soucy-Proulx M, Thibault M, Brulotte V, Bélanger ME, Raft J, Godin N, Idrissi M, Desroches J, Ruel M, Fortier A, Richebé P. Erector spinae plane block did not improve postoperative pain-related outcomes and recovery after video-assisted thoracoscopic surgery : a randomised controlled double-blinded multi-center trial. BMC Anesthesiol 2024; 24:156. [PMID: 38654164 DOI: 10.1186/s12871-024-02544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION There is a sizable niche for a minimally invasive analgesic technique that could facilitate ambulatory video-assisted thoracoscopic surgery (VATS). Our study aimed to determine the analgesic potential of a single-shot erector spinae plane (ESP) block for VATS. The primary objective was the total hydromorphone consumption with patient-controlled analgesia (PCA) 24 h after surgery. METHODS We conducted a randomized, controlled, double-blind study with patients scheduled for VATS in two major university-affiliated hospital centres. We randomized 52 patients into two groups: a single-shot ESP block using bupivacaine or an ESP block with normal saline (control). We administered a preoperative and postoperative (24 h) quality of recovery (QoR-15) questionnaire and assessed postoperative pain using a verbal numerical rating scale (VNRS) score. We evaluated the total standardized intraoperative fentanyl administration, total postoperative hydromorphone consumption (PCA; primary endpoint), and the incidence of adverse effects. RESULTS There was no difference in the primary objective, hydromorphone consumption at 24 h (7.6 (4.4) mg for the Bupivacaine group versus 8.1 (4.2) mg for the Control group). Secondary objectives and incidence of adverse events were not different between the two groups at any time during the first 24 h following surgery. CONCLUSION Our multi-centre randomized, controlled, double-blinded study found no advantage of an ESP block over placebo for VATS for opioid consumption, pain, or QoR-15 scores. Further studies are ongoing to establish the benefits of using a denser block (single-shot paravertebral with a continuous ESP block), which may provide a better quality of analgesia.
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Affiliation(s)
- A Clairoux
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - A Moore
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada.
| | - M Caron-Goudreault
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M Soucy-Proulx
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M Thibault
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - V Brulotte
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - M E Bélanger
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
| | - J Raft
- Institut de Cancérologie de Lorraine, Nancy, France
| | - N Godin
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - M Idrissi
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
| | - J Desroches
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - M Ruel
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - A Fortier
- Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada
| | - P Richebé
- Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Faculté de médecine de l'Université de Montréal, Montréal, Québec, Canada
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Bromberg GK, Bravard MA, Kobayashi KJ, Moore A. A Novel Role to Manage Capacity and Flow in Hospital Medicine. J Patient Saf 2024; 20:e3-e5. [PMID: 38147059 DOI: 10.1097/pts.0000000000001195] [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: 12/27/2023]
Affiliation(s)
| | | | - Kimiyoshi J Kobayashi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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Luqmani B, Brookes A, Moore A, Vale P, Pidou M, McAdam EJ. Transitioning through the vapour-liquid equilibrium for low energy thermal stripping of ammonia from wastewater: Enabling transformation of NH 3 into a zero-carbon fuel. Water Res 2024; 248:120856. [PMID: 37979564 DOI: 10.1016/j.watres.2023.120856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
Vacuum thermal stripping permits the recovery of ammonia from wastewater in a concentrated form, which is key to its exploitation in the circular economy, but the latent heat demand for thermal separation remains a critical barrier to exploitation. In this study, we investigate the vapor-liquid equilibrium (VLE) for ammonia-water as a mechanism to enhance recovered ammonia quality and minimise the thermal energy required for ammonia separation. Below the dew point (65 °C at 0.25 bar) a two-phase region of the VLE exists where 48 %wt gas-phase ammonia could be produced (61 °C) compared to only 2 %wt within the stripping region adopted widely in the literature. This was complemented by a 98 % reduction in thermal separation energy, since limited water vaporization can occur when the feed is maintained below the activation energy threshold for bulk evaporation. Operation within this practically unexplored region of the ammonia-water VLE fosters a gas-phase product suitable for energy generation in gas turbines or solid oxide fuel cells. Comparable product quality was achieved using concentrated wastewater, which validated the VLE for design in the presence of a broad range of dissolved gases and volatile inorganic compounds. Rapid desorption of CO2 occurred during vacuum stripping, subsequently increasing pH >9 without the requirement for alkali addition to shift the ammonia-ammonium equilibrium in favor of gaseous ammonia. Consequently, the two-phase region of the VLE defined for vacuum thermal stripping provides a synergistic strategy to mitigate chemical demand, minimise separation energy and recover gas-phase ammonia for zero carbon energy generation, constituting a significant advancement toward the net zero ambitions of the water sector.
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Affiliation(s)
- B Luqmani
- Cranfield Water Science Institute, Vincent Building, Cranfield University, Bedfordshire MK43 0AL, UK
| | - A Brookes
- Anglian Water, Block C-Western House, Peterborough Business Park, Peterborough PE2 6FZ, UK
| | - A Moore
- Northumbrian Water, Boldon House, Wheatlands Way, Durham DH1 5FA, UK
| | - P Vale
- Severn Trent Water, 2 St. Johns Street, Coventry CV1 2LZ, UK
| | - M Pidou
- Cranfield Water Science Institute, Vincent Building, Cranfield University, Bedfordshire MK43 0AL, UK
| | - E J McAdam
- Cranfield Water Science Institute, Vincent Building, Cranfield University, Bedfordshire MK43 0AL, UK.
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Moore A, Lima JC, Patel S, Junge-Maughan L, Dufour AB, Lipsitz L. An Interdisciplinary Videoconference to Improve Transitions of Care and Reduce Readmission, Cost, and Post-Acute Length of Stay in a Teaching and Community Hospital. J Am Med Dir Assoc 2024; 25:84.e1-84.e7. [PMID: 37832595 DOI: 10.1016/j.jamda.2023.09.001] [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] [Received: 06/20/2023] [Revised: 08/24/2023] [Accepted: 09/04/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES Coordination of care across health care settings is needed to ensure safe patient transfers. We examined the effects of the ECHO-Care Transitions program (ECHO-CT) on readmissions, skilled nursing facility (SNF) length of stay (LOS), and costs. DESIGN This is a prospective cohort study evaluating the ECHO-CT program. The intervention consisted of weekly 90-minute teleconferences between hospital and SNF-based teams to discuss the care of recently discharged patients. SETTING AND PARTICIPANTS The intervention occurred at one small community hospital and 7 affiliated SNFs and 1 large teaching hospital and 11 associated SNFs between March 23, 2019, and February 25, 2021. A total of 882 patients received the intervention. METHODS We selected 13 hospitals and 172 SNFs as controls. Specific hospital-SNF pairings within the intervention and control groups are referred to as hospital-SNF dyads. Using Medicare claims data for more than 10,000 patients with transfers between these hospital-SNF dyads, we performed multivariable regression to evaluate differences in 30-day rehospitalization rates, SNF lengths of stay, and SNF costs between patients discharged to intervention and control hospital-SNF dyads. We split the post period into pre-COVID and COVID periods and ran models separately for the small community and large teaching hospitals. RESULTS There was no significant difference-in-differences among intervention compared to control facilities during either post-acute care period for any of the outcomes. CONCLUSIONS AND IMPLICATIONS Although video-communication of care plans between hospitalists and post-acute care clinicians makes good clinical sense, our analysis was unable to detect significant reductions in rehospitalizations, SNF lengths of stay, or SNF Medicare costs. Disruption of the usual processes of care by the COVID pandemic may have played a role in the null findings.
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Affiliation(s)
- Amber Moore
- Harvard Medical School, Boston, MA, USA; Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA.
| | - Julie C Lima
- Center for Gerontology and Health Care Research and Department of Health Services, Policy & Practice within the Brown University School of Public Health, Providence, RI, USA
| | - Sweta Patel
- Center for Gerontology and Health Care Research and Department of Health Services, Policy & Practice within the Brown University School of Public Health, Providence, RI, USA
| | | | - Alyssa B Dufour
- Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lewis Lipsitz
- Harvard Medical School, Boston, MA, USA; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Stevens A, Hendrie N, Bacon M, Parrott S, Monaghan M, Williams E, Lewer D, Moore A, Berlin J, Cunliffe J, Quinton P. Correction: Evaluating police drug diversion in England: protocol for a realist evaluation. Health Justice 2023; 11:52. [PMID: 38112934 PMCID: PMC10729508 DOI: 10.1186/s40352-023-00255-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
| | | | | | | | | | | | - Dan Lewer
- Bradford Institute for Health Research, Bradford, UK
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O'Mahony S, Collins NA, Doyle G, Gibney ER, Moore A. Supermarket availability and socio-economic deprivation in urban Ireland - CORRIGENDUM. Proc Nutr Soc 2023; 82:488. [PMID: 36305493 DOI: 10.1017/s0029665122002737] [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: 06/16/2023]
Affiliation(s)
- S O'Mahony
- Food Safety Authority of Ireland, The Exchange, Georges Dock, Dublin 1, Ireland
- University College Dublin, Belfield, Dublin 4, Ireland
| | - N A Collins
- Food Safety Authority of Ireland, The Exchange, Georges Dock, Dublin 1, Ireland
| | - G Doyle
- University College Dublin, Belfield, Dublin 4, Ireland
| | - E R Gibney
- University College Dublin, Belfield, Dublin 4, Ireland
| | - A Moore
- University of Ulster, Coleraine, Northern Ireland, BT52 1SA, UK
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Stevens A, Hendrie N, Bacon M, Parrott S, Monaghan M, Williams E, Lewer D, Moore A, Berlin J, Cunliffe J, Quinton P. Evaluating police drug diversion in England: protocol for a realist evaluation. Health Justice 2023; 11:46. [PMID: 37968494 PMCID: PMC10652635 DOI: 10.1186/s40352-023-00249-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023]
Abstract
There is increasing international interest in the use of police drug diversion schemes that offer people suspected of minor drug-related offences an educative or therapeutic intervention as an alternative to criminalisation. While there have been randomised trials of some such schemes for their effects on reducing offending, with generally positive results, less is known about the health outcomes, and what works, for whom, in what circumstances and why. This protocol reports on a realist evaluation of police drug diversion in England that has been coproduced by a team of academic, policing, health, and service user partners. The overall study design combines a qualitative assessment of the implementation, contexts, mechanisms, moderators and outcomes of schemes in Durham, Thames Valley and the West Midlands with a quantitative, quasi-experimental analysis of administrative data on the effects of being exposed to the presence of police drug diversion on reoffending and health outcomes. These will be supplemented with analysis of the cost-consequences of the evaluated schemes, an analysis of the equity of their implementation and effects, and a realist synthesis of the various findings from these different methods.
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Affiliation(s)
| | | | | | | | | | | | - Dan Lewer
- Bradford Institute for Health Research, Bradford, UK
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Whitehead T, Moore A, Agarwal A, Appleby J. Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use. BMJ Case Rep 2023; 16:e250098. [PMID: 37914175 PMCID: PMC10626919 DOI: 10.1136/bcr-2022-250098] [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: 11/03/2023] Open
Abstract
We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, and Enterococcus faecalis on blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.
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Affiliation(s)
| | - Amber Moore
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Casey D, MacGowan B, Hurricane O, Landen O, Nora R, Haan S, Kritcher A, Zylstra A, Ralph J, Dewald E, Hohenberger M, Pak A, Springer P, Weber C, Milovich J, Divol L, Hartouni E, Bionta R, Hahn K, Schlossberg D, Moore A, Gatu Johnson M. Diagnosing the origin and impact of low-mode asymmetries in ignition experiments at the National Ignition Facility. Phys Rev E 2023; 108:L053203. [PMID: 38115512 DOI: 10.1103/physreve.108.l053203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023]
Abstract
Inertial confinement fusion ignition requires high inflight shell velocity, good energy coupling between the hotspot and shell, and high areal density at peak compression. Three-dimensional asymmetries caused by imperfections in the drive symmetry or target can grow and damage the coupling and confinement. Recent high-yield experiments have shown that low-mode asymmetries are a key degradation mechanism and contribute to variability. We show the experimental signatures and impacts of asymmetry change with increasing implosion yield given the same initial cause. This letter has implications for improving robustness to a key degradation in ignition experiments.
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Affiliation(s)
- D Casey
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - B MacGowan
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - O Hurricane
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - O Landen
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - R Nora
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - S Haan
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A Kritcher
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A Zylstra
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - J Ralph
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - E Dewald
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - M Hohenberger
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A Pak
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - P Springer
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - C Weber
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - J Milovich
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - E Hartouni
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - R Bionta
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - K Hahn
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - D Schlossberg
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - A Moore
- Lawrence Livermore National Laboratory, Livermore, CA 94550, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology (MIT), Cambridge, 02139 Massachusetts, USA
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Moore A, Paudyal R, Elder G, Lakhman Y, White C, Zhang Z, Broach VA, Liu Y, Damanto A, Cohen GN, Nunez DA, Dreyfuss A, Alektiar KM, Dave A, Kollmeier MA. Pre-Brachytherapy Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Response as Predictor of Local Control in the Definitive Treatment of Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e534. [PMID: 37785655 DOI: 10.1016/j.ijrobp.2023.06.1820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Chemoradiation consisting of external beam radiotherapy (EBRT) followed by brachytherapy (BT) is the standard of care for Stage IB2-IVA cervical cancer (CC). Multi-parametric MRI (mpMRI) is a valuable tool for initial staging, treatment planning and response assessment. In this study, we aim to explore the potential of mpMRI, in particular DW-MRI, to predict overall tumor control following chemoradiation in CC. MATERIALS/METHODS We identified 78 consecutive patients treated with chemoradiation for FIGO IB2-IVA CC between 2012-2020, who had an MRI at baseline (MRb) and post-EBRT prior to brachytherapy boost (MRpb) that included DW-MRI (b-value = 0 and 800 s/mm2). Median age was 53 years, most patients had squamous cell carcinoma (76.9%) and advanced-stage disease (56.4% stage IIIA-IVA). Median time from completion of EBRT to MRpb was 3 days. Regions of interest (ROI) in primary tumor were delineated on DW image (b = 0 s/mm2) using ITK-SNAP software. DW-MRI data were fitted to a monoexponential model to calculate apparent diffusion coefficient (ADC) values using in-house software platform (MRI-QAMPER). MRpb mean ADC values (n = 78) and relative changes (%) in mean ADC values between MRb and MRpb (n = 64) were correlated with outcomes, including local failure (LF), regional or distant failure (RDF), and failure at any site (FAS), with death without failure as a competing risk. Median follow-up time was 45 months (95% CI 38, 53). RESULTS At first post treatment assessment, 72 patients (92.3%) had a complete response (CR) in the cervix and 68 patients (87.2%) had CR in all disease sites. Of patients who had CR in the cervix (n = 72), only 1 patient had local recurrence. Of patients who had CR in all disease sites, 10 later recurred (1 LF only, 1 LF&RDF, 8 RDF only). Overall, 7 patients (9%) had LF, and 19 patients (24.4%) had FAS. A higher mean ADC value in MRpb was associated with LF (HR 4.3, 95% CI 1.32, 14.6; P = 0.016), but not with RDF (P = 0.4) or FAS (P = 0.5). A higher relative change in the mean ADC value between MRb and MRpb was associated with a lower risk of LF (HR 0.94, 95% CI 0.90, 0.98; P = 0.002), but not with RDF (P = 0.8) or FAS (P = 0.4). CONCLUSION Treatment response as measured on prebrachytherapy DW-MRI is a significant predictor of local control in patients undergoing chemoradiation for stage IB2-IVA CC. ADC values, a quantitative imaging biomarker on MRpb may be instrumental in dose intensification/de-escalation efforts in CC.
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Affiliation(s)
- A Moore
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - R Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G Elder
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, NEW YORK, NY
| | - Y Lakhman
- Department of Imaging, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C White
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer center, New York, NY
| | - Z Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - V A Broach
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Y Liu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Damanto
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - G N Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A Dreyfuss
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K M Alektiar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - A Dave
- Department of Medical Physics, Department of Imaging, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Wong B, Shiely F, Creechan P, Moore A, Dyer B, Radhakrishna A, Russell V, McDermott A, Maher J, McDonald K, Ledwidge M. The COVID-19 pandemic has negatively affected health behaviours in those with pre- heart failure. Ir Med J 2023; 116:837. [PMID: 37791717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Nasir B, Ferraro P, Liberman M, Overbeek C, Moore A. Randomized Trial Evaluating Routine Versus On-Demand Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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13
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Reichelt B, Kabadi N, Pearcy J, Gatu Johnson M, Dannhoff S, Lahmann B, Frenje J, Li CK, Sutcliffe G, Kunimune J, Petrasso R, Sio H, Moore A, Mariscal E, Hartouni E. Determining spectral response of the National Ignition Facility particle time of flight diagnostic to x rays. Rev Sci Instrum 2023; 94:033510. [PMID: 37012781 DOI: 10.1063/5.0101725] [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] [Received: 06/03/2022] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
The Particle Time of Flight (PTOF) diagnostic is a chemical vapor deposition diamond detector used for measuring multiple nuclear bang times at the National Ignition Facility. Due to the non-trivial, polycrystalline structure of these detectors, individual characterization and measurement are required to interrogate the sensitivity and behavior of charge carriers. In this paper, a process is developed for determining the x-ray sensitivity of PTOF detectors and relating it to the intrinsic properties of the detector. We demonstrate that the diamond sample measured has a significant non-homogeneity in its properties, with the charge collection well described by a linear model ax + b, where a = 0.63 ± 0.16 V-1 mm-1 and b = 0.00 ± 0.04 V-1. We also use this method to confirm an electron to hole mobility ratio of 1.5 ± 1.0 and an effective bandgap of 1.8 eV rather than the theoretical 5.5 eV, leading to a large sensitivity increase.
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Affiliation(s)
- B Reichelt
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Kabadi
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Pearcy
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - M Gatu Johnson
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - S Dannhoff
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Lahmann
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Frenje
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - C K Li
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - G Sutcliffe
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - J Kunimune
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - R Petrasso
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - H Sio
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Mariscal
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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Safavi KC, Copenhaver MS, Moore A, Bravard MA, Britton O, Dunn P. Impact of a hospital policy to redistribute admission flow across clinical services for capacity relief during COVID-19 surges. J Hosp Med 2023. [PMID: 36788630 DOI: 10.1002/jhm.13058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/05/2022] [Revised: 11/30/2022] [Accepted: 01/08/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Increased hospital admissions due to COVID-19 place a disproportionate strain on inpatient general medicine service (GMS) capacity compared to other services. OBJECTIVE To study the impact on capacity and safety of a hospital-wide policy to redistribute admissions from GMS to non-GMS based on admitting diagnosis during surge periods. DESIGN, SETTING, AND PARTICIPANTS Retrospective case-controlled study at a large teaching hospital. The intervention included adult patients admitted to general care wards during two surge periods (January-February 2021 and 2022) whose admission diagnosis was impacted by the policy. The control cohort included admissions during a matched number of days preceding the intervention. MAIN OUTCOMES AND MEASURES Capacity measures included average daily admissions and hospital census occupied on GMS. Safety measures included length of stay (LOS) and adverse outcomes (death, rapid response, floor-to-intensive care unit transfer, and 30-day readmission). RESULTS In the control cohort, there were 365 encounters with 299 (81.9%) GMS admissions and 66 (18.1%) non-GMS versus the intervention with 384 encounters, including 94 (24.5%) GMS admissions and 290 (75.5%) non-GMS (p < .001). The average GMS census decreased from 17.9 and 21.5 during control periods to 5.5 and 8.5 during intervention periods. An interrupted time series analysis confirmed a decrease in GMS daily admissions (p < .001) and average daily hospital census (p = .014; p < .001). There were no significant differences in LOS (5.9 vs. 5.9 days, p = .059) or adverse outcomes (53, 14.5% vs. 63, 16.4%; p = .482). CONCLUSION Admission redistribution based on diagnosis is a safe lever to reduce capacity strain on GMS during COVID-19 surges.
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Affiliation(s)
- Kyan C Safavi
- Healthcare Systems Engineering, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martin S Copenhaver
- Healthcare Systems Engineering, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amber Moore
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marjory A Bravard
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - O'Neil Britton
- Mass General Brigham, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Dunn
- Healthcare Systems Engineering, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Greer PB, Standen T, David R, Miri N, Bobrowski K, Lehmann J, Zwan B, Moore A. Remote EPID-based dosimetric auditing using DVH patient dose analysis. Phys Med Biol 2023; 68. [PMID: 36595255 DOI: 10.1088/1361-6560/aca953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022]
Abstract
Objective.The aim of this work was to develop and validate a method for remote dosimetric auditing that enables dose-volume histogram parameter comparisons of measured and planned dose in the patient CT volume.Approach. The method is derived by adapting and combining a remote electronic portal imaging (EPID) based auditing method (Virtual Epid based Standard Phantom Audit-VESPA) and a method to estimate 3D in-patient dose distributions from planar dosimetric measurements. The method was tested with a series of error-induced plans including monitor unit and multileaf collimator (MLC) positioning errors. A pilot audit study was conducted with eleven radiotherapy centres. IMRT plans from two clinical trials, a post-prostatectomy (RAVES trial) plan and a head and neck (HPV trial) plan were utilized. Clinically relevant DVH parameters for the planned dose and estimated measured dose were compared.Main results. The method was found to reproduce the induced dose errors within 0.5% and was sensitive to MLC positioning errors as small as 0.5 mm. For the RAVES plan audit all DVH results except one were within 3% and for the HPV plan audit all DVH results were within 3% except three with a maximum difference of 3.2%.Significance. The results from the audit method produce clinically meaningful DVH metrics for the audited plan and could enable an improved understanding of a centre's radiotherapy quality.
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Affiliation(s)
- P B Greer
- Calvary Mater Newcastle Hospital, Newcastle, Australia.,University of Newcastle, Newcastle, Australia
| | - T Standen
- University of Sydney, Sydney, Australia
| | - R David
- University of Newcastle, Newcastle, Australia.,Central Coast Cancer Centre, Gosford, Australia
| | - N Miri
- University of Newcastle, Newcastle, Australia
| | - K Bobrowski
- University of Wollongong, Wollongong, Australia
| | - J Lehmann
- Calvary Mater Newcastle Hospital, Newcastle, Australia.,University of Newcastle, Newcastle, Australia.,University of Sydney, Sydney, Australia
| | - B Zwan
- Central Coast Cancer Centre, Gosford, Australia
| | - A Moore
- University of Newcastle, Newcastle, Australia.,TROG Cancer Research, Newcastle, Australia
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16
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Moore A, Glogowska M, Lasserson D, Hayward G. 1367 RECOGNITION AND MANAGEMENT OF ACUTE FUNCTIONAL DECLINE: A QUALITATIVE INTERVIEW STUDY WITH UK CARE HOME STAFF. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.051] [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: 01/18/2023] Open
Abstract
Abstract
Introduction
Older people living in care homes sometimes experience episodes of acute functional decline. These represent a diagnostic challenge to healthcare professionals and can result in antibiotic prescriptions or hospital admissions, though this may not always the most appropriate management strategy. We aimed to understand how episodes of acute functional decline are recognised, managed and escalated by care home staff in the UK.
Method
This was a qualitative interview study with UK care home staff, including managers, nurses and carers. Participants were recruited through advertisements circulated via email, social media and word of mouth. Semi-structured interviews were conducted over the phone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software.
Results
25 care home staff were interviewed. Participants described feeling confident in recognising when residents were less well than usual, especially if they knew them well. However, they sometimes felt it was difficult to differentiate between an ‘off day’ and something more significant. Most participants talked about clear early communication amongst the team to flag a resident of concern. Initial management steps in the care home included checking clinical observations and doing a urine dipstick. Many participants talked about considering the underlying cause for deterioration. Some participants felt comfortable monitoring residents for a few days themselves or trying a simple intervention. Others preferred escalating directly to outside clinical support. Triggers for escalation included perceived severity of illness, gut feeling or failure to respond to initial supportive management.
Conclusions
These results highlight the skill base of care home staff. However, it has also helped to identify areas for additional support and training including the use and interpretation of the urine dipstick. The findings of this study are being used to inform the design of a feasibility prospective cohort study of UK care home residents.
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Bachmann B, MacLaren SA, Bhandarkar S, Briggs T, Casey D, Divol L, Döppner T, Fittinghoff D, Freeman M, Haan S, Hall GN, Hammel B, Hartouni E, Izumi N, Geppert-Kleinrath V, Khan S, Kozioziemski B, Krauland C, Landen O, Mariscal D, Marley E, Masse L, Meaney K, Mellos G, Moore A, Pak A, Patel P, Ratledge M, Rice N, Rubery M, Salmonson J, Sater J, Schlossberg D, Schneider M, Smalyuk VA, Trosseille C, Volegov P, Weber C, Williams GJ, Wray A. Measurement of Dark Ice-Ablator Mix in Inertial Confinement Fusion. Phys Rev Lett 2022; 129:275001. [PMID: 36638294 DOI: 10.1103/physrevlett.129.275001] [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] [Received: 04/19/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
We present measurements of ice-ablator mix at stagnation of inertially confined, cryogenically layered capsule implosions. An ice layer thickness scan with layers significantly thinner than used in ignition experiments enables us to investigate mix near the inner ablator interface. Our experiments reveal for the first time that the majority of atomically mixed ablator material is "dark" mix. It is seeded by the ice-ablator interface instability and located in the relatively cooler, denser region of the fuel assembly surrounding the fusion hot spot. The amount of dark mix is an important quantity as it is thought to affect both fusion fuel compression and burn propagation when it turns into hot mix as the burn wave propagates through the initially colder fuel region surrounding an igniting hot spot. We demonstrate a significant reduction in ice-ablator mix in the hot-spot boundary region when we increase the initial ice layer thickness.
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Affiliation(s)
- B Bachmann
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S A MacLaren
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - S Bhandarkar
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - T Briggs
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - D Casey
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - L Divol
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - T Döppner
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - D Fittinghoff
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - M Freeman
- Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - S Haan
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - G N Hall
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B Hammel
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - E Hartouni
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - N Izumi
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | | | - S Khan
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - B Kozioziemski
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - C Krauland
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - O Landen
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - D Mariscal
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - E Marley
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - L Masse
- Commissariat à l'Energie Atomique, DAM, DIF, F-91297 Arpajon, France
| | - K Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - G Mellos
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A Moore
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A Pak
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - P Patel
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - M Ratledge
- General Atomics, San Diego, California 92121, USA
| | - N Rice
- General Atomics, San Diego, California 92121, USA
| | - M Rubery
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - J Salmonson
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - J Sater
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - D Schlossberg
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - M Schneider
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - V A Smalyuk
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - C Trosseille
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - P Volegov
- Los Alamos National Laboratory, Los Alamos, New Mexico 87544, USA
| | - C Weber
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - G J Williams
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
| | - A Wray
- Lawrence Livermore National Laboratory, Livermore, California 94551, USA
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Ferketa M, Moore A, Klein-Barton J, Stulberg D, Hasselbacher L. P020Exploring pharmacist comfort and readiness to dispense mifepristone. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.045] [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: 11/19/2022]
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19
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Zelefsky M, Kollmeier M, White C, Zhang Z, Reuter V, Ehdaie B, Moore A, Samson F, Gorovets D, Damato A, Elsayegh A, McBride S. Superior Post-Treatment Biopsy Outcomes with High Dose SBRT Compared to High-Dose Conventionally Fractionated IMRT for Clinically Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Miller E, Haworth L, Bennett M, Moore A. Hysteroscopy Assisted Wedge Resection of an Interstitial Ectopic Pregnancy. J Minim Invasive Gynecol 2022. [DOI: 10.1016/j.jmig.2022.09.217] [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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21
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Moore A, Zhang Z, Schmitt A, Higginson D, Mueller B, Zinovoy M, Gelblum D, Yerramilli D, Xu A, Brennan V, Guttmann D, Grossman C, Dover L, Shaverdian N, Pike L, Cuaron J, Lis E, Barzilai O, Bilsky M, Yamada Y. 40 Gray in 5 Fractions for Salvage Re-Irradiation of Spine Lesions Previously Treated with Stereotactic Body Radiotherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1667] [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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22
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O'Neill A, Brady A, Donnelly T, McGlynn J, Moore A, Hopper C. 53 A REVIEW OF THE RAPID ACCESS FRAILTY TEAM (RAFT) IN THE EMERGENCY DEPARTMENT OF A MODEL THREE HOSPITAL. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Rapid Access Frailty Team (RAFT) in the Emergency Department (ED) has evolved since 2016. The team comprises of 1 senior occupational therapist and 1 senior physiotherapist. The focus of the team is recognition and management of frailty in ED. Patients discharged by RAFT in ED are often followed up in our Rapid Access Frailty Hub. This audit examined the incidence and outcomes of frail older persons presenting to our ED and the impact of intervention from the Rapid Access Frailty team.
Methods
A Variable Indicative of Placement Risk (VIP) positive patient triggers an assessment by RAFTT in ED post triage. Analysis of intervention and discharge destination were used to assess the effectiveness and role of the team.
Results
We compared data over two distinct 6 month periods, between September – February 2019-2020 and 2021-2022. 2723 patients >75 presented to ED in 2019 - 2020. Of these, 1620 were VIP positive patients. 628/1620 patients were seen by RAFFT. 443/628 (70.5%) assessed by RAFT were discharged. In comparison to 2021-2022, we saw an increase with 2818 patients >75, 1657 of which were triaged as frail. 559 patients were assessed by RAFTT and 286/559 (51%) were discharged. We observed 20% reduction in our discharge rate. Most patients received on average five interventions each. 60% of patients received a mobility assessment, 45% received falls prevention intervention and 37% were provided with equipment to facilitate discharge.
Conclusion
Over a two year period we observed an increase in frail patients presenting to our ED. Comprehensive assessment by RAFT in ED is promoting discharge. The follow up through the frailty hub has enhanced our ability to follow up in a timely manner. We hypothesize that the reduction in discharge rates in 2021- 2022 may be due to deconditioning experienced by older adults post pandemic and the increased demand for medical intervention and admission.
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Affiliation(s)
- A O'Neill
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
| | - A Brady
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
| | - T Donnelly
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
| | - J McGlynn
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
| | - A Moore
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
| | - C Hopper
- Midlands Regional Hospital Tullamore , Tullamore, Ireland
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23
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Ogie R, Moore A, Wickramasuriya R, Amirghasemi M, James S, Dilworth T. Twitter data from the 2019-20 Australian bushfires reveals participatory and temporal variations in social media use for disaster recovery. Sci Rep 2022; 12:16914. [PMID: 36209222 PMCID: PMC9547919 DOI: 10.1038/s41598-022-21265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022] Open
Abstract
Social media platforms have proved to be vital sources of information to support disaster response and recovery. A key issue, though, is that social media conversation about disasters tends to tail off after the immediate disaster response phase, potentially limiting the extent to which social media can be relied on to support recovery. This situation motivates the present study of social media usage patterns, including who contributes to social media around disaster recovery, which recovery activities they contribute to, and how well that participation is sustained over time. Utilising Twitter data from the 2019-20 Australian bushfires, we statistically examined the participation of different groups (citizens, emergency agencies, politicians and others) across categories of disaster recovery activity such as donations & financial support or mental health & emotional support, and observed variations over time. The results showed that user groups differed in how much they contributed on Twitter around different recovery activities, and their levels of participation varied with time. Recovery-related topics also varied significantly with time. These findings are valuable because they increase our understanding of which aspects of disaster recovery currently benefit most from social media and which are relatively neglected, indicating where to focus resources and recovery effort.
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Affiliation(s)
- R. Ogie
- grid.1007.60000 0004 0486 528XSMART Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - A. Moore
- grid.1007.60000 0004 0486 528XSchool of Humanities and Social Inquiry, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - R. Wickramasuriya
- grid.1007.60000 0004 0486 528XSMART Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - M. Amirghasemi
- grid.1007.60000 0004 0486 528XSMART Infrastructure Facility, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
| | - S. James
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC 3168 Australia
| | - T. Dilworth
- grid.1007.60000 0004 0486 528XSchool of Geography and Sustainable Communities, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, NSW 2522 Australia
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24
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Moore A, Fiske C, Gershon C, Nazer B, Kea B. 22 Efficacy of Emergency Department-Initiated 14-Day Ambulatory ECG Patch Monitors in Patients With Unexplained Syncope. Ann Emerg Med 2022. [DOI: 10.1016/j.annemergmed.2022.08.045] [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: 11/01/2022]
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25
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Hoxha T, Pienkowski M, Khan K, Moore A, Balaratnam K, Chowdhury M, Walia P, Sabouhanian A, Herman J, Strom E, Hueniken K, Corke L, Leighl N, Shepherd F, Bradbury P, Sacher A, Cheng S, Brown M, Mai V, Garcia M, Zhan L, Xu W, Liu G. EP02.04-009 Real World Survival Outcome Analysis of Adjuvant Therapies in Non-EGFR, Non-ALK Early Stage Resected NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.394] [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: 10/14/2022]
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26
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Moore A, Nooruddin Z, Reveles K, Datta P, Brannman L, Cotarla I, Frankart A, Mulrooney T, Jones X, Frei C. EP05.02-013 Immune-Related Adverse Effects and Durvalumab Treatment Patterns in VHA Patients with Unresectable Stage III NSCLC. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.495] [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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27
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Duma N, Acharya R, Wei Z, Seaborne L, Heisler C, Fidler M, Elkins I, Feldman J, Moore A, King J, Kushner D. MA14.04 Sexual Health Assessment in Women with Lung Cancer (SHAWL) Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mack P, Gomez J, Rodilla A, Carreño J, Hsu CY, Rolfo C, Meshulami N, Moore A, Brody R, King J, Treatman J, Lee S, Raskin A, Srivastava K, Gleason C, Tcheou J, Bielak D, Acharya R, Gerber D, Rohs N, Henschke C, Yankelevitz D, Simon V, Minna J, Bunn P, García- Sastre A, Krammer F, Shyr Y, Hirsch F. OA06.03 Serological Response to SARS-CoV-2 Vaccination in Patients Lung Cancer: A Mount Sinai-Led Prospective Matched Controlled Study. J Thorac Oncol 2022. [PMCID: PMC9452018 DOI: 10.1016/j.jtho.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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29
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Gatu Johnson M, Johnson TM, Lahmann BJ, Séguin FH, Sperry B, Bhandarkar N, Bionta RM, Casco E, Casey DT, Mackinnon AJ, Masters N, Moore A, Nikroo A, Hoppe M, Mohammed R, Sweet W, Freeman C, Picciotto V, Roumell J, Frenje JA. High-yield magnetic recoil neutron spectrometer on the National Ignition Facility for operation up to 60 MJ. Rev Sci Instrum 2022; 93:083513. [PMID: 36050054 DOI: 10.1063/5.0099317] [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] [Received: 05/16/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
Recent progress at the National Ignition Facility (NIF), with neutron yields of order 1 × 1017, places new constraints on diagnostics used to characterize implosion performance. The Magnetic Recoil neutron Spectrometer (MRS), which is routinely used to measure yield, ion temperature (Tion), and down-scatter ratio (dsr), has been adapted to allow measurements of dsr up to 5 × 1017, and yield and Tion up to 2 × 1018 in the near term with new data processing techniques and conversion foil solutions. This paper presents a solution for extending MRS operation up to a yield of 2 × 1019 (60 MJ) by moving the spectrometer outside of the NIF shield wall. This will not only enhance the upper yield limit by 10× but also improve signal-to-background by 5×.
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Affiliation(s)
- M Gatu Johnson
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - T M Johnson
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B J Lahmann
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - F H Séguin
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - B Sperry
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - N Bhandarkar
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - R M Bionta
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - E Casco
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D T Casey
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A J Mackinnon
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Masters
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Nikroo
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - M Hoppe
- General Atomics, San Diego, California 92186, USA
| | - R Mohammed
- General Atomics, San Diego, California 92186, USA
| | - W Sweet
- General Atomics, San Diego, California 92186, USA
| | - C Freeman
- State University of New York at Geneseo, Geneseo, New York 14454, USA
| | - V Picciotto
- State University of New York at Geneseo, Geneseo, New York 14454, USA
| | - J Roumell
- State University of New York at Geneseo, Geneseo, New York 14454, USA
| | - J A Frenje
- Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
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30
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Meaney KD, Kim Y, Hoffman NM, Geppert-Kleinrath H, Jorgenson J, Hochanadel M, Appelbe B, Crilly A, Basu R, Saw EY, Moore A, Schlossberg D. Design of multi neutron-to-gamma converter array for measuring time resolved ion temperature of inertial confinement fusion implosions. Rev Sci Instrum 2022; 93:083520. [PMID: 36050061 DOI: 10.1063/5.0101887] [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] [Received: 06/03/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The ion temperature varying during inertial confinement fusion implosions changes the amount of Doppler broadening of the fusion products, creating subtle changes in the fusion neutron pulse as it moves away from the implosion. A diagnostic design to try to measure these subtle effects is introduced-leveraging the fast time resolution of gas Cherenkov detectors along with a multi-puck array that converts a small amount of the neutron pulse into gamma-rays, one can measure multiple snapshots of the neutron pulse at intermediate distances. Precise measurements of the propagating neutron pulse, specifically the variation in the peak location and the skew, could be used to infer time-evolved ion temperature evolved during peak compression.
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Affiliation(s)
- K D Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - Y Kim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - N M Hoffman
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | | | - J Jorgenson
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - M Hochanadel
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - B Appelbe
- Centre for Inertial Fusion Studies, Imperial College London, London, United Kingdom
| | - A Crilly
- Centre for Inertial Fusion Studies, Imperial College London, London, United Kingdom
| | - R Basu
- Centre for Inertial Fusion Studies, Imperial College London, London, United Kingdom
| | - E Y Saw
- Centre for Inertial Fusion Studies, Imperial College London, London, United Kingdom
| | - A Moore
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Schlossberg
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
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Peoples C, Moore A, Georgalas N. Service Level Agreement (SLA) Chains Supported by Cloud in a Complex Port Ecosystem with Competing Stakeholder Goals: Editorial. EAI Endorsed Transactions on Cloud Systems 2022. [DOI: 10.4108/eai.26-7-2022.174394] [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: 11/05/2022] Open
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Sun CL, Li DK, Zenteno AC, Bravard MA, Carolan P, Daily B, Elamin S, Ha J, Moore A, Safavi K, Yun BJ, Dunn P, Levi R, Richter JM. Low-Volume Bowel Preparation Is Associated With Reduced Time to Colonoscopy in Hospitalized Patients: A Propensity-Matched Analysis. Clin Transl Gastroenterol 2022; 13:e00482. [PMID: 35347098 PMCID: PMC10476773 DOI: 10.14309/ctg.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/09/2022] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Delays in inpatient colonoscopy are commonly caused by inadequate bowel preparation and result in increased hospital length of stay (LOS) and healthcare costs. Low-volume bowel preparation (LV-BP; sodium sulfate, potassium sulfate, and magnesium sulfate ) has been shown to improve outpatient bowel preparation quality compared with standard high-volume bowel preparations (HV-BP; polyethylene glycol ). However, its efficacy in hospitalized patients has not been well-studied. We assessed the impact of LV-BP on time to colonoscopy, hospital LOS, and bowel preparation quality among inpatients. METHODS We performed a propensity score-matched analysis of adult inpatients undergoing colonoscopy who received either LV-BP or HV-BP before colonoscopy at a quaternary academic medical center. Multivariate regression models with feature selection were developed to assess the association between LV-BP and study outcomes. RESULTS Among 1,807 inpatients included in this study, 293 and 1,514 patients received LV-BP and HV-BP, respectively. Among the propensity score-matched population, LV-BP was associated with a shorter time to colonoscopy (β: -0.43 [95% confidence interval: -0.56 to -0.30]) while having similar odds of adequate preparation (odds ratio: 1.02 [95% confidence interval: 0.71-1.46]; P = 0.92). LV-BP was also significantly associated with decreased hospital LOS among older patients (age ≥ 75 years), patients with chronic kidney disease, and patients who were hospitalized with gastrointestinal bleeding. DISCUSSION LV-BP is associated with decreased time to colonoscopy in hospitalized patients. Older inpatients, inpatients with chronic kidney disease, and inpatients with gastrointestinal bleeding may particularly benefit from LV-BP. Prospective studies are needed to further establish the role of LV-BP for inpatient colonoscopies.
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Affiliation(s)
- Christopher L.F. Sun
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Darrick K. Li
- Section of Digestive Diseases, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ana Cecilia Zenteno
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marjory A. Bravard
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Carolan
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bethany Daily
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sami Elamin
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasmine Ha
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amber Moore
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kyan Safavi
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Brian J. Yun
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Dunn
- Healthcare Systems Engineering, Massachusetts General Hospital, Boston, Massachusetts, USA
- Perioperative Services, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
| | - Retsef Levi
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - James M. Richter
- Harvard Medical School, Harvard, Boston, Massachusetts, USA
- Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
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Moore A, Laxton C, Weale N. P.80 Use of vaginal cell salvage in an unusual case of abnormally invasive placenta. Int J Obstet Anesth 2022. [DOI: 10.1016/j.ijoa.2022.103376] [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: 10/18/2022]
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Leslie DL, Fick DM, Moore A, Inouye SK, Jung Y, Ngo LH, Boltz M, Husser E, Shrestha P, Boustani M, Marcantonio ER. Comparative salary-related costs of a brief app-directed delirium identification protocol by hospitalists, nurses, and nursing assistants. J Am Geriatr Soc 2022; 70:2371-2378. [PMID: 35441698 PMCID: PMC9378349 DOI: 10.1111/jgs.17789] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systematic screening can improve delirium identification among hospitalized older adults. Prior studies have shown clinicians and health system leaders may believe they do not have the time and resources for assessment. We conducted a comparative salary-related cost analysis of an adaptive delirium identification protocol directed by an iPad app. METHODS We recruited 527 older adult medicine patients from an urban academic medical center (n = 269) and a rural community hospital (n = 258). Physicians and nurses completed the two-step Ultra-brief Confusion Assessment Method (UB-CAM) protocol (with or without a skip pattern), while certified nursing assistants completed only the UB-2 ultra-brief screen. The sample included 527 patients (average age 80, 57% women, 35% with dementia). Time required to administer the protocol was collected automatically by the iPad app. Salary-related costs of screening were determined by multiplying the time required by the hourly wage for the three disciplines, as obtained from national and regional published healthcare salary cost data. Cost estimates for entire hospital implementation were also calculated. RESULTS Participants were screened on 924 hospital days by 399 clinicians (53 physicians, 236 nurses, 110 CNAs). For the UB-2, CNAs cost per screen was lower than the other clinician types ($0.37 per screen vs. $0.73 for nurses and $2.39 for hospitalists). For the UB-CAM with skip (UB-CAM), costs per protocol were $1.10 for nurses vs. $3.61 for physicians. The annual salary-related costs of hospital-wide implementation of a nurse-based UB-CAM protocol in a medium-sized (300-bed) hospital was $63,015 plus $4356 for initial and annual training. CONCLUSIONS CNAs and nurses had the lowest salary-associated costs for app-directed CAM-based delirium screening and identification, respectively. Salary-related annual hospital costs for the most efficient protocols in a medium-sized hospital were less than the annual cost of hiring 1 FTE of the discipline performing the protocols.
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Affiliation(s)
- Douglas L Leslie
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Donna M Fick
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.,The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Amber Moore
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sharon K Inouye
- Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Yoojin Jung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Boltz
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Erica Husser
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Priyanka Shrestha
- The Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Malaz Boustani
- Division of Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edward R Marcantonio
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Divisions of General Medicine and Gerontology, Harvard Medical School, Boston, Massachusetts, USA.,Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Hall K, Grinstead A, Lewis J, Mercer C, Moore A, Ridehalgh C. Rotator cuff related shoulder pain. Describing home exercise adherence and behavior change interventions: A systematic review of randomised controlled trials. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.178] [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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Marcantonio ER, Fick DM, Jung Y, Inouye SK, Boltz M, Leslie DL, Husser EK, Shrestha P, Moore A, Sulmonte K, Siuta J, Boustani M, Ngo LH. Comparative Implementation of a Brief App-Directed Protocol for Delirium Identification by Hospitalists, Nurses, and Nursing Assistants : A Cohort Study. Ann Intern Med 2022; 175:65-73. [PMID: 34748377 PMCID: PMC8938856 DOI: 10.7326/m21-1687] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic screening improves delirium identification among hospitalized older adults. Little data exist on how to implement such screening. OBJECTIVE To test implementation of a brief app-directed protocol for delirium identification by physicians, nurses, and certified nursing assistants (CNAs) in real-world practice relative to a research reference standard delirium assessment (RSDA). DESIGN Prospective cohort study. SETTING Large urban academic medical center and small rural community hospital. PARTICIPANTS 527 general medicine inpatients (mean age, 80 years; 35% with preexisting dementia) and 399 clinicians (53 hospitalists, 236 nurses, and 110 CNAs). MEASUREMENTS On 2 study days, enrolled patients had an RSDA. Subsequently, CNAs performed an ultra-brief 2-item screen (UB-2) for delirium, whereas physicians and nurses performed a 2-step protocol consisting of the UB-2 followed in those with a positive screen result by the 3-Minute Diagnostic Assessment for the Confusion Assessment Method. RESULTS Delirium was diagnosed in 154 of 924 RSDAs (17%) and in 114 of 527 patients (22%). The completion rate for clinician protocols exceeded 97%. The CNAs administered the UB-2 in a mean of 62 seconds (SD, 51). The 2-step protocols were administered in means of 104 seconds (SD, 99) by nurses and 106 seconds (SD, 105) by physicians. The UB-2 had sensitivities of 88% (95% CI, 72% to 96%), 87% (CI, 73% to 95%), and 82% (CI, 65% to 91%) when administered by CNAs, nurses, and physicians, respectively, with specificities of 64% to 70%. The 2-step protocol had overall accuracy of 89% (CI, 83% to 93%) and 87% (CI, 81% to 91%), with sensitivities of 65% (CI, 48% to 79%) and 63% (CI, 46% to 77%) and specificities of 93% (CI, 88% to 96%) and 91% (CI, 86% to 95%), for nurses and physicians, respectively. Two-step protocol sensitivity for moderate to severe delirium was 78% (CI, 54% to 91%). LIMITATION Two sites; limited diversity. CONCLUSION An app-directed protocol for delirium identification was feasible, brief, and accurate, and CNAs and nurses performed as well as hospitalists. PRIMARY FUNDING SOURCE National Institute on Aging.
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Affiliation(s)
- Edward R Marcantonio
- Divisions of General Medicine and Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (E.R.M.)
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, and College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania (D.M.F.)
| | - Yoojin Jung
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Y.J.)
| | - Sharon K Inouye
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and Aging Brain Center, Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts (S.K.I.)
| | - Marie Boltz
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Douglas L Leslie
- College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania (D.L.L.)
| | - Erica K Husser
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Priyanka Shrestha
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, Pennsylvania (M.B., E.K.H., P.S.)
| | - Amber Moore
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, and Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts (A.M.)
| | - Kimberlyann Sulmonte
- Department of Nursing, Beth Israel Deaconess Medical Center, Boston, Massachusetts (K.S.)
| | - Jonathan Siuta
- Department of Medicine, Mount Nittany Medical Center, State College, Pennsylvania (J.S.)
| | - Malaz Boustani
- Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana (M.B.)
| | - Long H Ngo
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts (L.H.N.)
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Khaw P, Do V, Lim K, Cunninghame J, Dixon J, Vassie J, Bailey M, Johnson C, Kahl K, Gordon C, Cook O, Foo K, Fyles A, Powell M, Haie-Meder C, D'Amico R, Bessette P, Mileshkin L, Creutzberg CL, Moore A. Radiotherapy Quality Assurance in the PORTEC-3 (TROG 08.04) Trial. Clin Oncol (R Coll Radiol) 2021; 34:198-204. [PMID: 34903431 DOI: 10.1016/j.clon.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/09/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
AIMS Quality assurance in radiotherapy (QART) is essential to ensure the scientific integrity of a clinical trial. This paper reports the findings of the retrospective QART assessment for all centres that participated in PORTEC-3; a randomised controlled trial that compared pelvic radiotherapy with concurrent chemoradiotherapy to the pelvis followed by adjuvant chemotherapy. The trial showed an overall survival benefit for the addition of the chemotherapy in the management of women with high-risk endometrial cancer. MATERIALS AND METHODS Clinicians were invited to upload a randomly selected case/s treated at each of the participating sites. Panel reviewers analysed the contours to certify that the target volumes and organ at risk structures were contoured according to guidelines. The results were categorised into acceptable, minor variation, major variation or unevaluable. The radiotherapy plans were dosimetrically evaluated using the well-established Trans-Tasman Radiation Oncology Group (TROG) protocol. RESULTS Between August 2010 and January 2018, data from 146 patients of 686 consecutively treated patients were retrospectively reviewed. All 16 Australia and New Zealand and 71 of 77 international centres uploaded data for evaluation. In total, 3514 dosimetric and contour variables were reviewed. Of these, 3136 variables were deemed acceptable (89.2%), with 335 minor (9.6%) and 43 major variations (1.2%). Major contour variations included the clinical target volume vaginal vault, clinical target volume parametria and differential planning target volume vault expansion. CONCLUSION The results of the QART assessment confirmed high uniformity and low rates of both minor and major deviations in contouring and dosimetry in all sites. This supports the safe introduction of the PORTEC-3 treatment protocol into routine clinical practice.
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Affiliation(s)
- P Khaw
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia.
| | - V Do
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - K Lim
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J Cunninghame
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J Dixon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - J Vassie
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Bailey
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - C Johnson
- Blood & Cancer Centre, Wellington Hospital, Wellington, New Zealand
| | - K Kahl
- Shoalhaven Cancer Care Centre, Nowra, New South Wales, Australia
| | - C Gordon
- Illawarra Cancer Care Centre, Wollongong, New South Wales, Australia
| | - O Cook
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
| | - K Foo
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - A Fyles
- Canadian Cancer Trials Group, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - M Powell
- Department of Clinical Oncology, Barts Health NHS Trust, London, UK
| | - C Haie-Meder
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - R D'Amico
- Division of Radiation Oncology, ASST-Lecco, Ospedale A. Manzoni, Lecco, Italy
| | - P Bessette
- Gynaecologic Oncology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - L Mileshkin
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - C L Creutzberg
- Department of Radiation Oncology, Leiden University Medical Centre, Leiden, the Netherlands
| | - A Moore
- Trans-Tasman Radiation Oncology Group (TROG), Waratah, New South Wales, Australia
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Gohil K, Moore A, Jaffe W. Split Skin Grafting Precipitated Bullous Pemphigoid. JPRAS Open 2021; 31:137-140. [PMID: 35198718 PMCID: PMC8850676 DOI: 10.1016/j.jpra.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune subepidermal blistering dermatological condition that can be triggered by several external factors. Here, we present a case of an immunocompetent patient with no prior dermatological history, who developed BP as a result of autologous skin graft surgery. It is an uncommon surgical complication and was most likely triggered by the trauma of the surgery itself. Our patient's bullae first developed a month after his surgery at both surgical sites and subsequently became widespread. The diagnosis was confirmed histologically using punch biopsies of a bulla and the perilesional skin for direct immunofluorescence together with indirect immunofluorescence of the serum for anti-skin antibodies. Initial topical treatment and regular wound care were not improving the patient's condition at a satisfactory rate. Therefore, the patient was started on systemic steroids, which unfortunately resulted in a presumed split skin graft infection requiring admission. After histological diagnosis confirmation was achieved, the Dermatology team formulated a treatment plan, which combined both topical and systemic medication. The patient is currently making a good recovery and the graft loss resulting from the condition is only partial, requiring no further surgery. We present this case as a reminder to all clinicians that, although rare, BP can be triggered by skin grafting, even in patients with no prior history of it or any predisposing conditions. This autoimmune condition needs to be recognised and treated promptly to ensure optimal clinical outcomes and minimise graft loss.
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Affiliation(s)
- K. Gohil
- Plastic Surgery Department, Royal Stoke University Hospital, Newcastle Road Stoke-on-Trent, ST4 6QG, UK
- University Hospitals of North Midlands NHS Trust
- Correspondence author: Miss Kajal Gohil, Burns and Plastic Surgery Department, Wythenshawe Hospital, Southmoor Road, Manchester, M23 9LT
| | - A. Moore
- Plastic Surgery Department, Royal Stoke University Hospital, Newcastle Road Stoke-on-Trent, ST4 6QG, UK
- University Hospitals of North Midlands NHS Trust
| | - W. Jaffe
- Plastic Surgery Department, Royal Stoke University Hospital, Newcastle Road Stoke-on-Trent, ST4 6QG, UK
- University Hospitals of North Midlands NHS Trust
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Bell-Mandla NF, Sloot R, Maarman G, Griffith S, Moore A, Floyd S, Hayes R, Fidler S, Ayles H, Bock P. Improving retention of community-recruited participants in HIV prevention research through Saturday household visits; findings from the HPTN 071 (PopART) study in South Africa. BMC Med Res Methodol 2021; 21:242. [PMID: 34749654 PMCID: PMC8574030 DOI: 10.1186/s12874-021-01415-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Identifying successful strategies to improve participant retention in longitudinal studies remains a challenge. In this study we evaluated whether non-traditional fieldworker shifts (after hours during the week and weekends) enhanced participant retention when compared to retention during traditional weekday shifts in the HPTN 071 (PopART) population cohort (PC). METHODS HPTN 071 (PopART) PC participants were recruited and followed up in their homes on an annual basis by research fieldworkers over a 3-4 year period. The average number of successful follow-up visits, where a PC participant was found and retained in the study, was calculated for each of 3 visit schedules (early weekday shift, late weekday shift, and Saturday shift), and standardized to account for variation in fieldwork shift duration. We used one-way univariate analysis of variance (ANOVA) to describe differences in mean-successful visits and 95% confidence intervals between the shift types. RESULTS Data on 16 651 successful visits were included. Successful visit rates were higher when conducting Saturday visits (14.0; 95% CI: 11.3-16.6) compared to both regular (4.5; 95% CI: 3.7-5.3) and late weekday shifts (5.3; 95% CI: 4.7-5.8) overall and in all subgroup analyses (P<0.001). The successful visit rate was higher amongst women than men were during all shift types (3.2 vs. 1.3, p<0.001). Successful visit rates by shift type did not differ significantly by age, over time, by PC round or by community triplet. CONCLUSION The number of people living with HIV continues to increase annually. High quality evidence from longitudinal studies remains critical for evaluating HIV prevention and treatment strategies. This study showed a significant benefit on participant retention through introduction of Saturday shifts for home visits and these data can make an important contribution to the emerging body of evidence for improving retention in longitudinal research. TRIAL REGISTRATION PopART was approved by the Stellenbosch University Health Research Ethics Committees (N12/11/074), London School of Hygiene and Tropical Medicine (6326) ethics committee and the Division of AIDS (DAIDS) (Protocol ID 11865). PopART was registered with ClinicalTrials.gov (registration number NCT01900977 ).
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Affiliation(s)
- N. F. Bell-Mandla
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - R. Sloot
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - G. Maarman
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - S. Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R. Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - S. Fidler
- Department of Medicine, Imperial College London, St Mary’s Campus, London, UK
| | - H. Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
| | - P. Bock
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - on behalf of the HPTN 071 (PopART) study team
- Desmond Tutu TB Centre, Department of Pediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- FHI 360, Durham, NC USA
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Medicine, Imperial College London, St Mary’s Campus, London, UK
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
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Koehn AC, Bjorneberg DL, Malone RW, Leytem AB, Moore A, Ma L, Bartling PNS. Simulating soil nitrogen fate in irrigated crop production with manure applications. Sci Total Environ 2021; 793:148510. [PMID: 34328956 DOI: 10.1016/j.scitotenv.2021.148510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/07/2021] [Accepted: 06/13/2021] [Indexed: 06/13/2023]
Abstract
Dairy manure is commonly applied to irrigated agricultural crops in the Magic Valley Region of southern Idaho, which has reported to impact the quality of surface and ground water. In this study, we used the Root Zone Water Quality Model (RZWQM2) to provide information about the long-term implications of manure applications. RZWQM2 was first calibrated and validated using 4 years of data from a long-term study with annual and biennial manure application rates of 18 Mg ha-1, 36 Mg ha-1, and 52 Mg ha-1, along with a control and conventional fertilizer treatment for crop yield, soil water and soil N. The 4-yr crop rotation was spring wheat (2013), potato (2014), spring barley (2015), and sugar beets (2016). RZWQM2 simulated soil water content, crop yield, total soil nitrogen, and soil nitrogen mineralization effectively as PBIAS and RRMSE for soil water content and crop yields were within the acceptable range (±25% for PBIAS and <1.0 for RRMSE). Nitrate in the soil profile was overestimated, however in the acceptable range for the validation treatments. The calibrated model was then run for 16 years by repeating the management practices of the 4-year scenarios (4 crop rotations) for all treatments and 24 years for the 52 T Annual treatment (6 crop rotations). The 16-year simulation results showed that nitrogen seepage from annual manure treatments (for example, 18 T Annual vs 18 T Biennial) was 2.0 to 2.3 times higher than the nitrogen seepage from the biennial manure treatments. Increasing manure applications from 18 T Annual to 52 T Annual increased N seepage an average of 3.2 times for the 16-year rotation. Nitrogen seepage increased dramatically in rotations 3 and 4 compared to rotations 1 and 2 in the sixteen-year simulation. The 24-year simulation results showed after manure had been applied annually for 16 years and then applications terminated, the amount of N seepage returned initial levels in 8 years. In conclusion, to maintain clean ground water, manure applications would be best applied biennially, and high applications should be discouraged.
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Affiliation(s)
- Anita C Koehn
- USDA-ARS, Northwest Irrigation and Soils Research Lab, 3793 N. 3600 E., Kimberly, ID 83341, United States of America
| | - David L Bjorneberg
- USDA-ARS, Northwest Irrigation and Soils Research Lab, 3793 N. 3600 E., Kimberly, ID 83341, United States of America.
| | - Rob W Malone
- USDA-ARS National Laboratory for Agriculture and the Environment, Ames, IA 50011, United States of America
| | - April B Leytem
- USDA-ARS, Northwest Irrigation and Soils Research Lab, 3793 N. 3600 E., Kimberly, ID 83341, United States of America
| | - Amber Moore
- Oregon State University, Dept. of Crop and Soil Science, 3063 Ag & Life Sciences, Corvallis, OR 97331, United States of America
| | - Liwang Ma
- USDA-ARS Rangeland Resources and Systems Research Unit, Fort Collins, CO 80526, United States of America
| | - Pat N S Bartling
- USDA-ARS Rangeland Resources and Systems Research Unit, Fort Collins, CO 80526, United States of America
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Ng V, Boas F, Cohen G, Moore A, Kemeny N, Weiser M, Paty P, Crane C. CT-Guided Interstitial Low Dose-RATE Brachytherapy for Recurrent Colorectal Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.416] [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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Snyder LB, Lai Y, Doviak H, Freeburg LA, Laney VK, Moore A, Zellars KN, Matesic LE, Spinale FG. Ubiquitin ligase Wwp1 gene deletion attenuates diastolic dysfunction in pressure-overload hypertrophy. Am J Physiol Heart Circ Physiol 2021; 321:H976-H984. [PMID: 34559578 DOI: 10.1152/ajpheart.00032.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023]
Abstract
Heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF) often arises from a prolonged LV pressure overload (LVPO) and accompanied by abnormal extracellular matrix (ECM) accumulation. The E3 ubiquitin ligase WWP1 is a fundamental determinant ECM turnover. We tested the hypothesis that genetic ablation of Wwp1 would alter the progression of LVPO-induced HFpEF. LV echocardiography in mice with global Wwp1 deletion (n = 23; Wwp1-/-) was performed at 12 wk of age (baseline) and then at 2 and 4 wk following LVPO (transverse aortic banding) or surgery without LVPO induction. Age-matched wild-type mice (Wwp1+/+; n = 23) underwent identical protocols. LV EF remained constant and unchanged with LVPO and LV mass increased in both groups but was lower in the Wwp1-/- mice. With LVPO, the E/A ratio, an index of LV filling, was 3.97 ± 0.46 in Wwp1+/+ but was 1.73 ± 0.19 in the Wwp1-/- group (P < 0.05). At the transcriptional level, mRNA for fibrillar collagens (types I and III) decreased by approximately 50% in Wwp1-/- compared with the Wwp1+/+ group at 4 wk post-LVPO (P < 0.05) and was paralleled by a similar difference in LV fibrillar collagen content as measured by histochemistry. Moreover, mRNA levels for determinants favoring ECM accumulation, such as transforming growth factor (TGF), increased with LVPO, but were lower in the Wwp1-/- group. The absence of Wwp1 reduced the development of left ventricular hypertrophy and subsequent progression to HFpEF. Modulating the WWP1 pathway could be a therapeutic target to alter the natural history of HFpEF.NEW & NOTEWORTHY Heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF) often arises from a prolonged LV pressure overload (LVPO) and is accompanied by abnormal extracellular matrix (ECM) accumulation. It is now recognized that the ECM is a dynamic entity that is regulated at multiple post-transcriptional levels, including the E3 ubiquitin ligases, such as WWP1. In the present study, WWP1 deletion in the context of an LVPO stimulus reduced functional indices of HFpEF progression and determinants of ECM remodeling.
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MESH Headings
- Animals
- Aorta/physiopathology
- Aorta/surgery
- Diastole
- Disease Models, Animal
- Disease Progression
- Extracellular Matrix/metabolism
- Extracellular Matrix/pathology
- Female
- Fibrillar Collagens/genetics
- Fibrillar Collagens/metabolism
- Gene Deletion
- Heart Failure/enzymology
- Heart Failure/genetics
- Heart Failure/pathology
- Heart Failure/physiopathology
- Heart Ventricles/enzymology
- Heart Ventricles/pathology
- Heart Ventricles/physiopathology
- Hypertrophy, Left Ventricular/enzymology
- Hypertrophy, Left Ventricular/genetics
- Hypertrophy, Left Ventricular/pathology
- Hypertrophy, Left Ventricular/physiopathology
- Male
- Mice, Inbred C57BL
- Mice, Knockout
- Time Factors
- Ubiquitin-Protein Ligases/deficiency
- Ubiquitin-Protein Ligases/genetics
- Ventricular Dysfunction, Left/enzymology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
- Mice
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Affiliation(s)
- Laura B Snyder
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Yimu Lai
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Heather Doviak
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Lisa A Freeburg
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Valerie K Laney
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Amber Moore
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Kia N Zellars
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
| | - Lydia E Matesic
- Department of Biological Sciences, University of South Carolina, Columbia, South Carolina
| | - Francis G Spinale
- Cell Biology and Anatomy, University of South Carolina School of Medicine and Columbia Veterans Affairs Health Care System, Columbia, South Carolina
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Larsen N, Smothers C, Martin D, Moore A, Lima J, Cao L. Analytical and Clinical Performance Evaluation of ARK Fentanyl II Assay on Beckman Coulter AU System. Am J Clin Pathol 2021. [DOI: 10.1093/ajcp/aqab191.057] [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
Introduction/Objective
Drugs of abuse, specifically opioids, have been in recent years an important focus in both medicine and media due to the ‘opioid epidemic’ and large numbers of overdose deaths. Synthetic opioids such as fentanyl have contributed to this epidemic. The CDC reports that of roughly 50,000 opioid overdose deaths in 2019, nearly 73% were due to synthetic opioids. The objective of this study is to assess the analytical and clinical performance of the Fentanyl II Assay by ARK Diagnostics, Inc.
Methods/Case Report
Fentanyl was qualitatively determined by the ARK Fentanyl II Assay, a homogenous enzyme immunoassay based on competition between drug in the specimen and drug labeled with recombinant glucose-6- phosphate dehydrogenase (rG6PDH) for antibody binding sites. The presence of drug in urine increases enzyme activity, which converts nicotinamide adenine dinucleotide (NAD) to NADH in the presence of glucose-6-phosphate, resulting in an absorbance change measured by spectrophotometry. The evaluation was performed following CLSI guidelines. The analytical performance was evaluated for accuracy and precision.
Results (if a Case Study enter NA)
To evaluate the accuracy, twelve positive and eight negative specimens were tested by the ARK immunoassay performed on two Beckman Coulter instruments (AU480 and AU680) and by LC- MS/MS. The results from both instruments showed 100% agreement with the results from LC-MS/MS. On instrument AU480, the within-run CVs were 18.0% at the level of 22.510 ng/mL and 0.8% at the level of 552.628 ng/mL. The between-run CVs were 8.8% at the level of 68.928 ng/mL and 3.7% at the level of 158.947 ng/mL. On instrument AU680, the within-run CVs were 273.4% at the level of 1.052 ng/mL and 0.8% at the level of 523.788 ng/mL. The between-run CVs were 7.8% at the level of 53.779 ng/mL and 3.1% at the level of 145.263 ng/mL. In May 2021, 2,075 fentanyl assays were run at UAB. Of those, 476 returned a positive result with a positive rate of 22.9%, and 1,599 were negative with a negative rate of 77.1%. One positive result was confirmed by LC-MS/MS as negative for fentanyl but positive for norfentanyl, a metabolite of fentanyl. The clinical specificity was 99.9% and sensitivity was 100%.
Conclusion
In Conclusion, the ARK fentanyl Assay II on Beckman Coulter AU system has good accuracy, sensitivity and specificity. The precision at medium and high levels are good. However, the precision at low level needs to be improved.
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Affiliation(s)
- N Larsen
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
| | - C Smothers
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
| | - D Martin
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
| | - A Moore
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
| | - J Lima
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
| | - L Cao
- Pathology, University of Alabama Birmingham, Birmingham, Alabama, UNITED STATES
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Smith K, Moore A, Popov S, Adams M, Folaranmi E, Sekaran P. 671 Fetus-In-Fetu Found at Excision of An Antenatally Diagnosed Abdominal Mass: Multi-Disciplinary Approach. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
We present a case of antenatally detected abdominal mass and an alternative diagnostic course for suspected neonatal neuroblastoma as a result of investigative findings. A female infant presented antenatally with a left upper quadrant mass initially managed as a suspected neonatal neuroblastoma; further cross-sectional imaging suggested a wider differential including teratoma and aided surgical planning. The multi-disciplinary team (MDT) decision was for an early excision at 31 days and post-operative histology identified a diagnosis of fetus-in-fetu (FIF). We describe this case as a compliment to the current literature and an example of a necessary variation to recognised diagnostic and treatment pathways as a result of investigative findings.
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Affiliation(s)
- K Smith
- University Hospital Wales, Cardiff, United Kingdom
| | - A Moore
- University Hospital Wales, Cardiff, United Kingdom
| | - S Popov
- University Hospital Wales, Cardiff, United Kingdom
| | - M Adams
- University Hospital Wales, Cardiff, United Kingdom
| | - E Folaranmi
- University Hospital Wales, Cardiff, United Kingdom
| | - P Sekaran
- University Hospital Wales, Cardiff, United Kingdom
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Hasselbacher L, Moore A, Rodriguez-Ortiz A, Tyler C, Gilliam ML. POSTER ABSTRACTS. Contraception 2021. [DOI: 10.1016/j.contraception.2021.07.044] [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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Freeman-Daily J, Moore A, Selig W, Roy U. FP11.01 Sustaining and Accelerating Research in Rare Oncogene-Driven Lung Cancers: Lessons From The 2020 ROS1der Research Roundtable. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mutai R, Barkan T, Moore A, Sarfaty M, Stemmer S, Shohat T, Yerushlami R, Goldvaser H. 146P Prognostic impact of HER2-low expression according to the oncotype Dx recurrence score in hormone receptor-positive early breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.427] [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] Open
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Williams N, Moore A, Woods M, Forman S. Audit of waist measurement methods during statutory diving medical assessments. Occup Med (Lond) 2021; 71:kqab110. [PMID: 34415343 DOI: 10.1093/occmed/kqab110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Measurement of waist circumference is used to assess abdominal fat and risk of heart disease, type 2 diabetes, cancer and stroke. It is performed in several clinical settings for health promotion and medical assessment purposes, including statutory medical assessments where results may influence decisions on fitness to work. Under the Diving at Work Regulations 1997, working divers must have an annual assessment of their fitness to dive performed by an approved medical examiner of divers (AMED), appointed by the Health and Safety Executive (HSE). The assessment includes measurement of height, weight and waist circumference, the latter used as an indicator of central adiposity and associated health risks. AIMS To establish the practice of AMEDs in measuring waist circumference of working divers undergoing medical assessment to determine their fitness to dive. METHODS Ninety-seven AMEDs were sent a questionnaire and asked to describe their current practice in measuring waist circumference. The response rate was 79%. The audit standard used was the consensus document published by the World Health Organization (WHO). RESULTS Of the 77 responses, 76 were completed sufficiently to allow analysis. When the waist was measured, there was consistency in the diver's level of clothing, stage of breathing and posture for the procedure but variability in the site of measurement. Only 7/76 (9%) respondents carried out waist measurement fully in line with WHO guidance. CONCLUSIONS The audit has identified that there is a need for guidance for AMEDs on measuring waist circumference in the statutory medical assessment of working divers.
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Affiliation(s)
- N Williams
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - A Moore
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - M Woods
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - S Forman
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
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Lehmann J, Hussein M, Siva S, Moore A, Standen T, Subramanian B, Greer P, Clark C. OC-0428 Improving local Patient Specific Quality Assurance – a novel remote auditing approach. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Hardcastle N, Cook O, Ray X, Moore A, Moore K, Pryor D, Rossi A, Foroudi F, Kron T, Siva S. OC-0426 Prospective knowledge-based planning for personalised plan QA in a multi-centre kidney SABR trial. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06913-9] [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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