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Gout T, Zoltie T, Woodward A, Coleman E, Boele F, Chang B, Bartlett P, Ronaldson S, Kalantzis G, Theaker M, El-Hindy N, Walshaw E, Watson J. A cross-over, randomised feasibility study of digitally printed versus hand-painted artificial eyes in adults: PERSONAL-EYE-S - a study protocol. NIHR Open Res 2023; 2:50. [PMID: 37056714 PMCID: PMC7614426 DOI: 10.3310/nihropenres.13311.2] [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] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
Background/objective Around 11,500 artificial eyes are required yearly for new and existing patients. Artificial eyes have been manufactured and hand-painted at the National Artificial Eye Service (NAES) since 1948, in conjunction with approximately 30 local artificial eye services throughout the country. With the current scale of demand, services are under significant pressure. Manufacturing delays as well as necessary repainting to obtain adequate colour matching, may severely impact a patient's rehabilitation pathway to a normal home, social and work life. However, advances in technology mean alternatives are now possible. The aim of this study is to establish the feasibility of conducting a large-scale study of the effectiveness and cost-effectiveness of digitally printed artificial eyes compared to hand-painted eyes. Methods A cross-over, randomised feasibility study evaluating a digitally-printed artificial eye with a hand-painted eye, in patients aged ≥18 years with a current artificial eye. Participants will be identified in clinic, via ophthalmology clinic databases and two charity websites. Qualitative interviews will be conducted in the later phases of the study and focus on opinions on trial procedures, the different artificial eyes, delivery times, and patient satisfaction. Discussion Findings will inform the feasibility, and design, of a larger fully powered randomised controlled trial. The long-term aim is to create a more life-like artificial eye in order to improve patients' initial rehabilitation pathway, long term quality of life, and service experience. This will allow the transition of research findings into benefit to patients locally in the short term and National Health Service wide in the medium to long term. ISRCTN registration ISRCTN85921622 (prospectively registered on 17/06/2021).
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Affiliation(s)
- Taras Gout
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Tim Zoltie
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Worsley Building, Leeds, LS2 9LU, UK
| | - Amie Woodward
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Florien Boele
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds,, Leeds, LS2 9JT, UK
- Leeds Institute of Medical Research at St James’s, St James’s University Hospital, University of Leeds, Leeds, LS9 7TF, UK
| | - Bernard Chang
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Paul Bartlett
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - George Kalantzis
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Mike Theaker
- Patient and Public Involvement representative, Leeds, UK
| | - Nabil El-Hindy
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - Emma Walshaw
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Worsley Building, Leeds, LS2 9LU, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
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Woodward A, Jenkins KJ, Harmon ME. Plant community succession following ungulate exclusion in a temperate rainforest. Ecosphere 2021. [DOI: 10.1002/ecs2.3889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A. Woodward
- U.S. Geological Survey Forest and Rangeland Ecosystem Science Center Seattle Washington 98115 USA
| | - K. J. Jenkins
- U.S. Geological Survey Forest and Rangeland Ecosystem Science Center Port Angeles, Washington 98362 USA
| | - M. E. Harmon
- College of Forestry Oregon State University Corvallis Oregon 97330 USA
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Fowler-Davis S, Platts K, Thelwell M, Woodward A, Harrop D. A mixed-methods systematic review of post-viral fatigue interventions: Are there lessons for long Covid? PLoS One 2021; 16:e0259533. [PMID: 34752489 PMCID: PMC8577752 DOI: 10.1371/journal.pone.0259533] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Fatigue syndromes have been widely observed following post-viral infection and are being recognised because of Covid19. Interventions used to treat and manage fatigue have been widely researched and this study aims to synthesise the literature associated with fatigue interventions to investigate the outcomes that may be applicable to 'long Covid'. METHOD The study was registered with PROSPERO (CRD42020214209) in October 2020 and five electronic databases were searched. Papers were screened, critically appraised and data extracted from studies that reported outcomes of fatigue interventions for post-viral syndromes. The narrative synthesis includes statistical analysis associated with effectiveness and then identifies the characteristics of the interventions, including identification of transferable learning for the treatment of fatigue in long Covid. An expert panel supported critical appraisal and data synthesis. RESULTS Over 7,000 research papers revealed a diverse range of interventions and fatigue outcome measures. Forty papers were selected for data extraction after final screening. The effectiveness of all interventions was assessed according to mean differences (MD) in measured fatigue severity between each experimental group and a control following the intervention, as well as standardised mean differences as an overall measure of effect size. Analyses identified a range of effects-from most effective MD -39.0 [95% CI -51.8 to -26.2] to least effective MD 42.28 [95% CI 33.23 to 51.34]-across a range of interventions implemented with people suffering varying levels of fatigue severity. Interventions were multimodal with a range of supportive therapeutic methods and varied in intensity and requirements of the participants. Those in western medical systems tended to be based on self- management and education principles (i.e., group cognitive behavioural therapy (CBT). CONCLUSION Findings suggest that the research is highly focussed on a narrow participant demographic and relatively few methods are effective in managing fatigue symptoms. Selected literature reported complex interventions using self-rating fatigue scales that report effect. Synthesis suggests that long Covid fatigue management may be beneficial when a) physical and psychological support, is delivered in groups where people can plan their functional response to fatigue; and b) where strengthening rather than endurance is used to prevent deconditioning; and c) where fatigue is regarded in the context of an individual's lifestyle and home-based activities are used.
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Affiliation(s)
- Sally Fowler-Davis
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Katharine Platts
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Michael Thelwell
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
| | - Amie Woodward
- Department of Health Sciences, University of York, York, United Kingdom
| | - Deborah Harrop
- Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom
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Munn R, Woodward A, Beths T, Whittem T. Observations on the use of a pain numbing device for repetitive percutaneous sampling in sheep. Aust Vet J 2021; 99:445-448. [PMID: 34180048 DOI: 10.1111/avj.13104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/09/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate the success of a commercially available analgesic device (CoolSense; Coolsense Ltd, Tel Aviv, Israel) in ameliorating pain while sampling from subcutaneous tissue cages in sheep. METHODS The CoolSense device was used as part of a major parent study involving repetitive percutaneous sampling of subcutaneous tissue cages in seven sheep. Sampling was performed by passing a hypodermic needle through the skin and withdrawing fluid from the tissue cage. Each sheep had 10 tissue cages that were individually sampled 14 times over 74 h. The device was placed on the skin of the sampling site immediately before sampling cooling and numbing the skin. The reaction of the sheep was observed by the operators, flinching or jumping as the needle was passed through the skin was deemed to be a failure. We recorded the success or failure of the device for each needle stick. This was opportunistic data collection as part of a pharmacokinetic trial, therefore no controls were included. RESULTS A total of 1655 observations were recorded and then analysed using a generalised linear mixed model. Overall, 1380 of 1655 (83.4%) observations were recorded as successfully providing analgesia. Marked inter-occasion variability was noted with success ranging from 61.42% to 92.86% across sheep:period (approximately 140 observations each). As no controls were available, the effect of treatment could not be evaluated. CONCLUSIONS AND CLINICAL RELEVANCE The CoolSense device is a viable option for veterinary research and clinical applications.
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Affiliation(s)
- R Munn
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - A Woodward
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - T Beths
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - T Whittem
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
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Hendrickx M, Woodward A, Fuhr DC, Sondorp E, Roberts B. The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighboring countries: a systematic review. J Public Health (Oxf) 2021; 42:e299-e310. [PMID: 31686110 DOI: 10.1093/pubmed/fdz097] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [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: 04/10/2019] [Revised: 07/16/2019] [Accepted: 07/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries. METHODS A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted. RESULTS Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes. CONCLUSIONS The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions-particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.
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Affiliation(s)
- M Hendrickx
- London School of Hygiene & Tropical Medicine, London, UK
| | - A Woodward
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - D C Fuhr
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - E Sondorp
- KIT Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands
| | - B Roberts
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Klonizakis M, Hunt BE, Woodward A. The Association Between Cardiovascular Function, Measured as FMD and CVC, and Long-Term Aquatic Exercise in Older Adults (ACELA Study): A Cross-Sectional Study. Front Physiol 2020; 11:603435. [PMID: 33312129 PMCID: PMC7703693 DOI: 10.3389/fphys.2020.603435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction Cardiovascular aging is implicated in the development of cardiovascular disease (CVD). Aquatic exercise is being considered as a co-adjuvant form of rehabilitation, but there is limited evidence for its cardiovascular risk-reduction properties for older people. Our study aimed to address this by exploring the cardiovascular effects of long-term aquatic exercise in older adults in comparison to those who are either inactive or engaged in land-based/mixed training by measurement of micro- and macro-circulation. Flow Mediated Dilatation (FMD) was the primary outcome. Methods This was a pragmatic, 4-group, cross-sectional study. Eighty normotensive adults constituted four (n = 20) groups. The Aqua group (aged 63.7 ± 7 years) and Land group (aged 65 ± 6 years) consisted of participants engaged in aquatic and land-based training, respectively. The mixed group (Mix) (aged 66 ± 6 years) consisted of participants engaged in both land-based and aquatic training. Self-reported training consisted of ≥2/week for ≥6 months (mean sessions/week = 4 ± 1, 4 ± 1, and 5 ± 2 for each group, respectively). The sedentary group (Sed) (aged 63 ± 6 years) consisted of people who were sedentary for ≥6 months (mean sessions/week 0 ± 0). The primary outcome was %FMD. Secondary outcomes included raw cutaneous vascular conductance (CVC) and CVC max. Results Statistically significant differences (%FMD, raw CVC variables other than baseline) were found between each of the exercise groups (Aqua, Land, Mix) and the sedentary group (Sed) (i.e., 11.2 (4.2) vs. 5.0 (2.3); p < 0.0005, between the Aqua group and Sed group, for %FMD). No specific advantage could be attributed to any one of the exercise groups. Conclusion We reported improvements in NO-mediated endothelial function at micro- and macro-circulatory levels, observing no differences between exercise modes. Our findings provide evidence for the role of aquatic exercise as a "shield" against CVD in older populations.
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Affiliation(s)
- Markos Klonizakis
- Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, United Kingdom.,Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
| | - Beatrice E Hunt
- Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, United Kingdom
| | - Amie Woodward
- Lifestyle, Exercise and Nutrition Improvement Research Group, Sheffield Hallam University, Sheffield, United Kingdom.,Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, United Kingdom
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Woodward A, Broom D, Dalton C, Metwally M, Klonizakis M. Supervised exercise training and increased physical activity to reduce cardiovascular disease risk in women with polycystic ovary syndrome: study protocol for a randomized controlled feasibility trial. Trials 2020; 21:101. [PMID: 31959233 PMCID: PMC6972016 DOI: 10.1186/s13063-019-3962-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) affects up to 20% of women and is characterised by higher amounts of visceral fat, obesity, insulin resistance, dyslipidemia and reproductive and cardiometabolic complications. Increased oxidised low-density lipoprotein (LDL) concentrations have been associated with an increased risk of cardiovascular disease (CVD)-related events. Oxidised LDL is rarely used as a marker for CVD risk in PCOS-related studies despite its widely accepted role in atherogenesis and the increased risk factors associated with PCOS. Additionally, prolonged periods of sedentary behaviour can negatively affect metabolic health. No studies have specifically examined the effects of reducing sedentary behaviour on CVD risk in PCOS with a lifestyle physical activity intervention. The aim of the current study is to measure the feasibility of a randomised controlled trial (RCT) examining the effects of supervised exercise and reducing sedentary behaviour in women with PCOS on CVD risk. METHODS/DESIGN A feasibility, exploratory RCT will be conducted. Fifty-one pre-menopausal females will be randomly allocated between an exercise group (EG), a lifestyle physical activity group (LPAG) and a control group. Participants in the EG will undertake a 12-week supervised aerobic exercise programme. The LPAG will aim to increase daily physical activity and reduce sedentary behaviour for 12 weeks. The control group will not take part in any intervention. Primary outcomes are feasibility and acceptability of the intervention and procedures. Secondary outcomes are oxidised LDL, aerobic fitness, blood lipid profile, fasting glucose and insulin, testosterone and inflammatory markers. DISCUSSION PCOS is associated with various increased risk factors for CVD, including hypertension, dyslipidemia, abdominal obesity, insulin resistance, and inflammation. Whether oxidised LDL has a role in this increased risk is not yet known. The present study aims to measure the feasibility of implementing structured exercise training and/or increased lifestyle physical activity in women with PCOS, so that a subsequent adequately powered RCT can be designed. The results from the study will be used to refine the interventions and determine the acceptability of the study design. A limitation is that some self-monitoring in the lifestyle physical activity group may not be reliable or replicable, for example inputting information about time spent cleaning/gardening. TRIAL REGISTRATION ClinicalTrials.gov, NCT03678714. Registered 20 September 2018.
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Affiliation(s)
- Amie Woodward
- Centre for Sports and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - David Broom
- Centre for Sports and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Caroline Dalton
- Biomolecular Research Centre, Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB UK
| | | | - Markos Klonizakis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
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Abstract
Polycystic ovary syndrome (PCOS) is a complex endocrinopathy affecting both the metabolism and reproductive system of women of reproductive age. Prevalence ranges from 6.1-19.9% depending on the criteria used to give a diagnosis. PCOS accounts for approximately 80% of women with anovulatory infer-tility, and causes disruption at various stages of the reproductive axis. Evidence suggests lifestyle modification should be the first line of therapy for women with PCOS. Several studies have examined the impact of exercise interventions on reproductive function, with results indicating improvements in menstrual and/or ovulation frequency following exercise. Enhanced insulin sensitivity underpins the mechanisms of how exercise restores reproductive function. Women with PCOS typically have a cluster of metabolic abnormalities that are risk factors for CVD. There is irrefutable evidence that exercise mitigates CVD risk factors in women with PCOS. The mechanism by which exercise improves many CVD risk factors is again associated with improved insulin sensitivity and decreased hyperinsulinemia. In addition to cardiometabolic and reproductive complications, PCOS has been associated with an increased prevalence of mental health disorders. Exercise improves psychological well-being in women with PCOS, dependent on certain physiological factors. An optimal dose-response relationship to exercise in PCOS may not be feasible because of the highly individualised characteristics of the disorder. Guidelines for PCOS suggest at least 150 min of physical activity per week. Evidence confirms that this should form the basis of any clinician or healthcare professional prescription.
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Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - David Broom
- Faculty of Health and Wellbeing, Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK.
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Soussa RW, Woodward A, Marty M, Cannon CM. Breed is associated with the ABCB1-1Δ mutation in Australian dogs. Aust Vet J 2019; 98:79-83. [PMID: 31743433 DOI: 10.1111/avj.12896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The ABCB1 gene encodes P-glycoprotein (P-gp), a cellular membrane pump. One functional mutation that leads to expression of a less functional form of P-gp, ABCB1-1Δ, has been described in dogs. Individuals with this mutation can have severe adverse reactions to common veterinary pharmaceuticals that are known substrates of this pump. We investigated the detection of this mutation in samples submitted to two Australian diagnostic laboratories. METHODS A total of 4842 dogs across 27 breeds were tested for the ABCB1-1Δ mutation from buccal swabs or EDTA blood using standard PCR, multiplex PCR, or genotyping chip. Statistical analysis was applied to determine the proportions and odds ratios of the ABCB1-1Δ mutation in herding breeds compared with non-herding breeds. RESULTS The ABCB1-1Δ mutation was detected in nine breeds. The most commonly affected breeds were collies, Australian shepherds, white Swiss shepherds, and Shetland sheepdogs. Of 32 dogs in 18 non-herding breeds tested, one cocker spaniel and one labradoodle were positive for the mutation, both heterozygous. CONCLUSION The most frequently affected breeds for ABCB1-1Δ mutation are the collie, Australian shepherd, white Swiss shepherd and Shetland sheepdog. As the mutation is associated with an increased incidence of adverse reactions to commonly used pharmaceuticals, veterinarians need to be aware of the breeds at most risk of carrying this mutation and consider testing these individuals prior to administering these medications.
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Affiliation(s)
- R W Soussa
- Internal Medicine Department, Southpaws Specialty Surgery for Animals, Moorabbin, Victoria, 3189, Australia
| | - A Woodward
- Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Victoria, 3030, Australia
| | - M Marty
- Genetic Testing Division, Genomic Diagnostics, Heidelberg, Victoria, 3084, Australia
| | - C M Cannon
- Department of Veterinary Clinical Sciences, Melbourne Veterinary School, The University of Melbourne, Werribee, Victoria, 3030, Australia
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Fuhr DC, Ataturk C, McGrath M, Ilkkursun Z, Woodward A, Sondorp E, Roberts B. Treatment gap and mental health service use among Syrian refugees in Turkey. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction
Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey.
Methods
A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used.
Results
The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported.
Conclusions
To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness.
Key messages
This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.
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Affiliation(s)
- D C Fuhr
- Public Health and Policy, LSHTM, London, UK
| | - C Ataturk
- Public Health and Policy, LSHTM, London, UK
| | - M McGrath
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - Z Ilkkursun
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - A Woodward
- KIT, Royal Tropical Institute, Amsterdam, Netherlands
| | - E Sondorp
- KIT, Royal Tropical Institute, Amsterdam, Netherlands
| | - B Roberts
- Public Health and Policy, LSHTM, London, UK
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Woodward A, Broom D, Harrop D, Lahart I, Carter A, Dalton C, Metwally M, Klonizakis M. The effects of physical exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: a systematic review and meta-analysis. J Diabetes Metab Disord 2019; 18:597-612. [PMID: 31890686 PMCID: PMC6915192 DOI: 10.1007/s40200-019-00425-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/09/2019] [Indexed: 01/03/2023]
Abstract
Purpose Women with polycystic ovary syndrome (PCOS) exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease risk. Exercise may promote improvements in lipid profile and insulin sensitivity in women with PCOS. There is however, a knowledge gap on the optimal dose of exercise, regarding duration, intensity, type, and frequency of exercise. The aim of this systematic review and meta-analysis was to define effective types of exercise to improve cardiometabolic profile in PCOS. Methods We included randomised controlled trials (RCT), quasi-RCT, and controlled clinical trials focusing on reproductive-aged women diagnosed with PCOS. Eligible interventions included those with at least two weeks of supervised exercise sessions. Primary outcomes were blood lipids, blood glucose, blood pressure, measures of abdominal adiposity, and inflammation markers. Secondary outcomes were total and free testosterone, sex hormone binding globulin, and measures of insulin resistance. Nine electronic databases were searched from inception to present for English language publications. The Cochrane Risk Assessment tool was used to assess bias in the included studies. Outcomes were quantitatively synthesised and a meta- analysis was performed. Pooled effect estimates and 95% confidence intervals were presented. Results This systematic review identified three trials, including 231 participants with PCOS, that examined the effect of structured, supervised exercise on cardiometabolic outcomes. Analysis of pooled data indicated statistical favourable effects of exercise on total cholesterol, fasting glucose, waist circumference and waist-to-hip ratio, systolic blood pressure, C-reactive protein, total testosterone, and sex hormone binding globulin using post-intervention scores. Conclusions Moderate aerobic exercise interventions ≥3 months in duration, with a frequency of 3/week for at least 30-min, may have favourable effects on various cardiometabolic risk factors in women with PCOS. However, results should be interpreted with caution. Many of the outcomes were based on studies with serious methodological limitations, and only one “gold-standard” RCT was identified. PROSPERO ID: CRD42018086117. Electronic supplementary material The online version of this article (10.1007/s40200-019-00425-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - David Broom
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Deborah Harrop
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Ian Lahart
- Institute of Human Science, University of Wolverhampton, Wolverhampton, WV1 1LY UK
| | - Anouska Carter
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Caroline Dalton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB UK
| | - Mostafa Metwally
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Tree Root Walk, Sheffield, S10 2SF UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
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Woodward A, Klonizakis M, Lahart I, Carter A, Dalton C, Metwally M, Broom D. The effects of exercise on cardiometabolic outcomes in women with polycystic ovary syndrome not taking the oral contraceptive pill: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:116. [PMID: 31097035 PMCID: PMC6524277 DOI: 10.1186/s13643-019-1030-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common endocrinopathy, affecting 4-12% of reproductive-aged women. Women with PCOS often exhibit many metabolic abnormalities that are associated with an increased cardiovascular disease (CVD) risk, independent of obesity. Exercise interventions from 12 to 24 weeks have been shown to have positive effects on blood lipid profile, ovulation and insulin resistance in women with PCOS. However, no consensus on which exercise interventions are effective (i.e. duration, type of exercise, frequency), including for different phenotypes, currently exists. The aim of this systematic review and meta-analysis is to define effective types of exercise interventions to improve cardiometabolic profile, across the range of phenotypes of PCOS. METHODS We will conduct electronic database searches, including randomised-controlled trials (RCT), quasi-RCT and clinical trials. Primary outcomes sought will be lipid profile, carotid-intima media thickness, fasting blood glucose, %HbA1c, blood pressure, waist circumference, waist-to-hip ratio, abdominal adiposity and inflammation markers. Secondary outcomes sought will be free and total testosterone, sex hormone binding globulin and insulin resistance. The Cochrane Risk Assessment Tool will be used to assess study quality. Data will be analysed in RevMan. Analysis of heterogeneity will be undertaken using the I2 statistic. Significant heterogeneity will be explored, and sensitivity analyses carried out as appropriate. A subgroup analysis based on androgen profile will be undertaken if data are sufficient. DISCUSSION A large proportion of women are affected by PCOS. It is prudent to examine how CVD risk can be mitigated in this high-risk population, and this review aims to provide evidence-driven recommendations on the types of exercise interventions that are effective for this. The review will seek to provide recommendations regarding type, frequency and duration of exercise interventions to improve cardiometabolic profile in PCOS. The subgroup analysis may be able to highlight difference in intervention effects between normo-androgenic and hyper-androgenic profile. Limitations include heterogeneity across studies and a scarcity of clinical trials involving a PCOS control group not undertaking any intervention. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086117.
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Affiliation(s)
- Amie Woodward
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Markos Klonizakis
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Ian Lahart
- Institute of Sports and Human Science, University of Wolverhampton, Wolverhampton, WV1 1LY UK
| | - Anouska Carter
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
| | - Caroline Dalton
- Faculty of Health and Wellbeing, Sheffield Hallam University, Howard Street, Sheffield, S1 1WB UK
| | - Mostafa Metwally
- Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF UK
| | - David Broom
- Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP UK
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Hughes A, Woodward A, Fritz M, Reeves M. UNMET NEEDS AMONG ACUTE STROKE SURVIVORS TRANSITIONING HOME. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Hughes
- Michigan State University School of Social Work
| | - A Woodward
- Michigan State University School of Social Work
| | - M Fritz
- Michigan State University Department of Epidemiology
| | - M Reeves
- Michigan State University Department of Epidemiology
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Kwon I, Woodward A. THE PATTERNS OF OLDER ADULTS’ HEALTH CONDITIONS AND ITS EFFECTS ON MENTAL HEALTH SERVICE USE. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- I Kwon
- Michigan State University
| | - A Woodward
- Michigan State University School of Social Work
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Macmillan AK, Mackie H, Hosking JE, Witten K, Smith M, Field A, Woodward A, Hoskins R, Stewart J, van der Werf B, Baas P. Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design. BMC Public Health 2018; 18:850. [PMID: 29986679 PMCID: PMC6038249 DOI: 10.1186/s12889-018-5758-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions. METHODS In this paper we describe the design of Te Ara Mua - Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure . DISCUSSION While building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy. The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334.
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Affiliation(s)
- A. K. Macmillan
- Department of Preventive and Social Medicine, University of Otago, 18 Frederick St, Dunedin, 9054 New Zealand
| | - H. Mackie
- Mackie Research, Ltd, Auckland, New Zealand
| | - J. E. Hosking
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - K. Witten
- SHORE Whariki, Massey University, Auckland, New Zealand
| | - M. Smith
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - A. Field
- Dovetail Research Ltd, Auckland, New Zealand
| | - A. Woodward
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - R. Hoskins
- DesignTribe Architects, Auckland, New Zealand
| | - J. Stewart
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - B. van der Werf
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - P. Baas
- TERNZ Transport Research, Auckland, New Zealand
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16
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Woodward A, Ward D, Jackson J. Exploring the Long-term Influence of the Family Nurse Partnership on the Lives of Young Mothers. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx186.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - D Ward
- University of Derby, Derby, UK
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Lassemillante A, Nitis S, McCoy S, Fawcett J, Jarrett M, Woodward A, Macdonald G, Campbell K, Hickman I. Food and dietary behaviours as cardiometabolic risk factors in liver transplant recipients. Journal of Nutrition & Intermediary Metabolism 2017. [DOI: 10.1016/j.jnim.2017.04.229] [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] Open
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Williams A, Salih I, Woodward A. Inguinal hernia repair in wales – Are welsh surgeons following the guidleines? Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.250] [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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Woodward A, Ward D. Supporting Teenage Mothers: A Mixed Method Analysis of the Family Nurse Partnership in one UK site. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw172.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jones A, Dave J, Fisher R, Hulme K, Rill L, Zamora D, Woodward A, Brady S, MacDougall R, Goldman L, Lang S, Peck D, Apgar B, Shepard S, Uzenoff R, Willis C. TU-FG-209-08: Distribution of the Deviation Index (DI) in Digital Radiography Practices Across the United States. Med Phys 2016. [DOI: 10.1118/1.4957578] [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: 11/07/2022] Open
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Chiu KW, Robson S, Devi JL, Woodward A, Whittem T. The cardiopulmonary effects and quality of anesthesia after induction with alfaxalone in 2-hydroxypropyl-β
-cyclodextrin in dogs and cats: a systematic review. J Vet Pharmacol Ther 2016; 39:525-538. [DOI: 10.1111/jvp.12312] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/20/2016] [Indexed: 11/30/2022]
Affiliation(s)
- K. W. Chiu
- Translational Research and Animal Clinical Trials Study (TRACTS) Group; Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee Vic. Australia
| | - S. Robson
- Translational Research and Animal Clinical Trials Study (TRACTS) Group; Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee Vic. Australia
| | - J. L. Devi
- Translational Research and Animal Clinical Trials Study (TRACTS) Group; Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee Vic. Australia
| | - A. Woodward
- Translational Research and Animal Clinical Trials Study (TRACTS) Group; Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee Vic. Australia
| | - T. Whittem
- Translational Research and Animal Clinical Trials Study (TRACTS) Group; Faculty of Veterinary and Agricultural Sciences; University of Melbourne; Werribee Vic. Australia
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Williams E, Jones H, Woodward A, Kumar N, Shinkwin M. Regional referral pattern to wales' tertiary hepatobilary unit. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.281] [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: 10/22/2022]
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Williams E, Griffiths A, Visser T, Shinkwin M, Woodward A, Rasheed A. Changing trends in diagnosis and management of appendicitis: A 9-year study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.545] [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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24
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Shinkwin M, Williams E, Woodward A, Rasheed A, Nutt M. A 9-year review of laparoscopic fundoplication with EMPHASIS on age and outcome. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.564] [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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25
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Rees M, Richardson K, Woodward A. Use of the risk adjusted mortality index (rami): A valid index of in-hospital mortality risk in surgical patients? Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.326] [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: 10/22/2022]
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Sanjay P, Fulke JL, Shaikh IA, Woodward A. Anatomical differentiation of direct and indirect inguinal hernias: Is it worthwhile in the modern era? Clin Anat 2015; 23:848-50. [PMID: 20641068 DOI: 10.1002/ca.21022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 05/09/2010] [Accepted: 06/08/2010] [Indexed: 11/10/2022]
Abstract
The study aimed to assess the clinical accuracy of differentiating direct and indirect inguinal hernias preoperatively by different grades of surgeons. A retrospective audit was conducted over a 9-year period and comprised all adult inguinal hernia patients operated by one consultant surgeon. The hernias were differentiated into direct and indirect hernias based on the direction of cough impulse and the deep ring occlusion test. The preoperative diagnosis was compared with intraoperative findings. During the study period, 503 patients were examined. Of these, 272 patients were diagnosed as having indirect hernias and 56 patients as having direct hernias. In 175 patients, no attempt was made to differentiate indirect and direct hernias. When compared with intraoperative findings, the diagnosis was correct in 77% of the indirect hernias and 55% of direct hernias. Of the patients in whom no differentiation was attempted, 115 patients had indirect hernias, 56 had direct hernias, and four had both. For indirect hernias, the diagnostic accuracy was 82, 63, and 30% for consultant, registrars, and senior house officers. For direct hernias, the diagnostic accuracy was 66, 50, and 44%, respectively. This study demonstrates relatively poor accuracy in diagnosing direct inguinal hernias regardless of seniority.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Royal Glamorgan Hospital, Llantrisant, Wales, United Kingdom.
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Woodward A, Berger L, Skerratt L. In vitro sensitivity of the amphibian pathogen Batrachochytrium dendrobatidis to antifungal therapeutics. Res Vet Sci 2014; 97:364-6. [DOI: 10.1016/j.rvsc.2014.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 06/26/2014] [Accepted: 06/28/2014] [Indexed: 10/24/2022]
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Gill GV, Wallymahmed ME, Wallymahmed A, MacFarlane IA, Woodward A. Glycaemic streaming in type 1 diabetes: implications for intervention? Practical Diabetes 2013. [DOI: 10.1002/pdi.1781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Stephenson BM, Sanders DL, Woodward A, Kingsnorth AN. Familial female femoral herniation. Hernia 2013; 17:191-2. [PMID: 23430041 DOI: 10.1007/s10029-013-1062-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
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Sanjay P, Marioud A, Woodward A. Anaesthetic preference and outcomes for elective inguinal hernia repair: a comparative analysis of public and private hospitals. Hernia 2012; 17:745-8. [DOI: 10.1007/s10029-012-1011-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/29/2012] [Indexed: 11/28/2022]
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31
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Tin ST, Woodward A, Ameratunga S. TAUPO BICYCLE STUDY: FOLLOW UP RESPONSE, PERSONAL CHARACTERISTICS AND INJURY OUTCOME. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590w.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tin Tin S, Woodward A, Ameratunga S. COMPLETENESS OF INJURY OUTCOME DATA IN A COHORT OF CYCLISTS. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040580g.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Williamson JS, Harries RL, Davies G, Woodward A. Spontaneous resolution of an inferior epigastric artery pseudoaneurysm secondary to surgical drain placement. Ann R Coll Surg Engl 2012; 94:e193-4. [PMID: 22943319 PMCID: PMC3954359 DOI: 10.1308/003588412x13373405384855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report the case of a 73-year-old woman who was found to have an inferior epigastric artery pseudoaneurysm caused by surgical drain placement during a laparotomy for an appendix abscess. She presented with pain around the drain site two months following surgery and intravenous contrast computed tomography (CT) revealed a right inferior epigastric artery pseudoaneurysm. A decision was made to manage this expectantly as she remained stable with no other complications. Following a period of nine months of observation, repeat intravenous contrast CT showed evidence of spontaneous regression and thrombosis of the pseudoaneurysm. She remains well and her symptoms have now resolved.
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Cardis E, Armstrong BK, Bowman JD, Giles GG, Hours M, Krewski D, McBride M, Parent ME, Sadetzki S, Woodward A, Brown J, Chetrit A, Figuerola J, Hoffmann C, Jarus-Hakak A, Montestruq L, Nadon L, Richardson L, Villegas R, Vrijheid M. Risk of brain tumours in relation to estimated RF dose from mobile phones: results from five Interphone countries. Occup Environ Med 2011; 68:631-40. [PMID: 21659469 PMCID: PMC3158328 DOI: 10.1136/oemed-2011-100155] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [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] [Indexed: 12/12/2022]
Abstract
Objectives The objective of this study was to examine the associations of brain tumours with radio frequency (RF) fields from mobile phones. Methods Patients with brain tumour from the Australian, Canadian, French, Israeli and New Zealand components of the Interphone Study, whose tumours were localised by neuroradiologists, were analysed. Controls were matched on age, sex and region and allocated the ‘tumour location’ of their matched case. Analyses included 553 glioma and 676 meningioma cases and 1762 and 1911 controls, respectively. RF dose was estimated as total cumulative specific energy (TCSE; J/kg) absorbed at the tumour's estimated centre taking into account multiple RF exposure determinants. Results ORs with ever having been a regular mobile phone user were 0.93 (95% CI 0.73 to 1.18) for glioma and 0.80 (95% CI 0.66 to 0.96) for meningioma. ORs for glioma were below 1 in the first four quintiles of TCSE but above 1 in the highest quintile, 1.35 (95% CI 0.96 to 1.90). The OR increased with increasing TCSE 7+ years before diagnosis (p-trend 0.01; OR 1.91, 95% CI 1.05 to 3.47 in the highest quintile). A complementary analysis in which 44 glioma and 135 meningioma cases in the most exposed area of the brain were compared with gliomas and meningiomas located elsewhere in the brain showed increased ORs for tumours in the most exposed part of the brain in those with 10+ years of mobile phone use (OR 2.80, 95% CI 1.13 to 6.94 for glioma). Patterns for meningioma were similar, but ORs were lower, many below 1.0. Conclusions There were suggestions of an increased risk of glioma in long-term mobile phone users with high RF exposure and of similar, but apparently much smaller, increases in meningioma risk. The uncertainty of these results requires that they be replicated before a causal interpretation can be made.
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Affiliation(s)
- E Cardis
- Centre for Research in Environmental Epidemiology (CREAL), Hospital del Mar Research Institute (IMIM), CIBER Epidemiologia y Salud Pública (CIBERESP), Doctor Aiguader 88, 08003 Barcelona, Spain.
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Tin ST, Woodward A, Ameratunga S. Injuries to pedal cyclists on New Zealand Roads, 1988-2007. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tin ST, Woodward A, Ameratunga S. Multiple injury profiles of different road users in New Zealand, 2000-2007. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Tin ST, Woodward A, Ameratunga S. Regional differences in pedal cyclist injuries in New Zealand: risk in scarcity? Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
AIMS The primary aim was to assess long-term blood pressure in 110 patients with Type 2 diabetes who had achieved optimal blood pressure control during attendance at a protocol-based nurse-led hypertension intensive intervention clinic 7 years previously. The secondary aim was to assess modifiable cardiovascular risk factor status. METHODS One hundred and ten patients who attended the clinic during 2000-2002 were selected to reattend to have their blood pressure measured to the same standard as it was during the intensive intervention clinic, by the same specialist nurse. Treatment details were recorded. RESULTS Of the 110 patients, 36 (33%) had died; 69 (63%) of the remaining 74 patients were eligible to be contacted by letter; and 35 (51%) agreed to reattend. Age was 70 +/- 9 years; 21 (60%) were male; and the duration of diabetes was 17 +/- 7 years. Compared with 7 years previously, there was no difference in blood pressure control (systolic 130 +/- 17 vs. 131 +/- 16 mmHg, P = 0.62; diastolic 68 +/- 9 vs. 65 +/- 9 mmHg, P = 0.11). The number of patients with blood pressure <130/80 mmHg remained the same: 17 (49%) vs. 17 (49%; P > 0.99). During the 7 year period, 14 (40%) vs. 20 (57%) had macrovascular disease (P = 0.23), and 14 (40%) vs. 19 (54%) microvascular disease (P = 0.33). Thirteen (37%) vs. 18 (51%) were taking three or more antihypertensive drugs (P = 0.33), and 26 (74%) vs. 28 (80%) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (P = 0.77). CONCLUSIONS Optimal blood pressure control was sustained with no significant changes to antihypertensive medication, demonstrating the effectiveness of a protocol-based nurse-led clinic in achieving strict BP control.
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Affiliation(s)
- A Woodward
- Aintree University Hospitals, Liverpool, UK.
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Kirby A, Woodward A, Jackson S, Wang Y, Crawford MA. The association of fatty acid deficiency symptoms (FADS) with actual essential fatty acid status in cheek cells. Prostaglandins Leukot Essent Fatty Acids 2010; 83:1-8. [PMID: 20356721 DOI: 10.1016/j.plefa.2010.02.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/22/2010] [Accepted: 02/24/2010] [Indexed: 11/25/2022]
Abstract
Seven clinical symptoms have been utilised in several studies as a means of potentially identifying children with a deficiency in essential polyunsaturated fatty acids (PUFAs). The purpose of this study was to investigate whether there was any correlation between parental reports of the frequency of these seven 'fatty acid deficiency symptoms' (FADS) with actual levels of fatty acids in buccal cell samples of 450 children aged 8-10 years old. Additionally, the relationship between FADS and cognitive test performance, ratings of attention and behaviour and other somatic complaints were explored. The severity of reported FADS was not related to the levels of omega-6 or omega-3 in buccal cell samples. There was a relationship between parental reports of child behaviour and reported FADS; with high FADS being related to higher ratings of behaviour problems. Using FADS as a marker of PUFA deficiency may not be appropriate especially when assessing typically developing children.
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Affiliation(s)
- A Kirby
- The Dyscovery Centre, Allt-yr-yn Campus, University of Wales, Newport NP20 5DA, UK
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Bailey RB, Benitez T, Woodward A. Saccharomyces cerevisiae Mutants Resistant to Catabolite Repression: Use in Cheese Whey Hydrolysate Fermentation. Appl Environ Microbiol 2010; 44:631-9. [PMID: 16346092 PMCID: PMC242069 DOI: 10.1128/aem.44.3.631-639.1982] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Mutants of an industrial-type strain of Saccharomyces cerevisiae which rapidly and completely fermented equimolar mixtures of glucose and galactose to ethanol were isolated. These mutants fell into two general phenotypic classes based upon their fermentation kinetics and enzyme induction patterns. One class apparently specifically effects the utilization of galactose and allows sequential utilization of first glucose and then galactose in an anaerobic fermentation. The second class of mutants was resistant to general catabolite repression and produced maltase, invertase, and galactokinase in the presence of repressive levels of glucose. These mutants were completely dominant and appear to represent an as yet undescribed class of mutant.
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Affiliation(s)
- R B Bailey
- Biotechnology Branch, Solar Energy Research Institute, Golden, Colorado 80401
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Kirby A, Woodward A, Jackson S, Wang Y, Crawford MA. A double-blind, placebo-controlled study investigating the effects of omega-3 supplementation in children aged 8-10 years from a mainstream school population. Res Dev Disabil 2010; 31:718-730. [PMID: 20171055 DOI: 10.1016/j.ridd.2010.01.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/25/2010] [Indexed: 05/28/2023]
Abstract
Despite the increased interest in the effects of omega-3 supplementation on children's learning and behaviour, there are a lack of controlled studies of this kind that have utilised a typically developing population. This study investigated the effects of omega-3 supplementation in 450 children aged 8-10 years old from a mainstream school population, using a randomised, double-blind, placebo-controlled design. Participants were supplemented with either active supplements (containing docosahexaenoic acid, DHA and eicosapentaenoic acid, EPA) or a placebo for 16 weeks. Cheek cell fatty acid levels were recorded pre- and post-supplementation and a range of cognitive tests and parent and teacher questionnaires were used as outcome measures. After supplementation, changes in the relationship between omega-6 and omega-3 were significant in the active group. Despite the wide range of cognitive and behavioural outcome measures employed, only three significant differences between groups were found after 16 weeks, one of which was in favour of the placebo condition. Exploring the associations between changes in fatty acid levels and changes in test and questionnaire scores also produced equivocal results. These findings are discussed in relation to previous findings with clinical populations and future implications for research.
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Affiliation(s)
- A Kirby
- The Dyscovery Centre, Allt-yr-yn Campus, University of Wales, Newport NP20 5DA, UK
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Kirby A, Woodward A, Jackson S, Wang Y, Crawford MA. Childrens' learning and behaviour and the association with cheek cell polyunsaturated fatty acid levels. Res Dev Disabil 2010; 31:731-742. [PMID: 20172688 DOI: 10.1016/j.ridd.2010.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/26/2010] [Indexed: 05/28/2023]
Abstract
Increasing interest in the role of omega-3 fatty acids in relation to neurodevelopmental disorders (e.g. ADHD, dyslexia, autism) has occurred as a consequence of some international studies highlighting this link. In particular, some studies have shown that children with ADHD may have lower concentrations of polyunsaturated fatty acids (PUFAs), particularly omega-3, in their red blood cells and plasma, and that supplementation with omega-3 fatty acids may alleviate behavioural symptoms in this population. However, in order to compare levels it seems appropriate to establish fatty acid levels in a mainstream school aged population and if levels relate to learning and behaviour. To date no study has established this. For this study, cheek cell samples from 411 typically developing school children were collected and analysed for PUFA content, in order to establish the range in this population. In addition, measures of general classroom attention and behaviour were assessed in these children by teachers and parents. Cognitive performance tests were also administered in order to explore whether an association between behaviour and/or cognitive performance and PUFA levels exists. Relationships between PUFA levels and socio-economic status were also explored. Measures of reading, spelling and intelligence did not show any association with PUFA levels, but some associations were noted with the level of omega-3 fatty acids and teacher and parental reports of behaviour, with some evidence that higher omega-3 levels were associated with decreased levels of inattention, hyperactivity, emotional and conduct difficulties and increased levels of prosocial behaviour. These findings are discussed in relation to previous findings from omega-3 supplementation studies with children.
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Affiliation(s)
- A Kirby
- The Dyscovery Centre, Allt-yr-yn Campus, University of Wales, Newport NP20 5DA, UK
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Harris M, Woodward A, Bond M. Do tertiary-trained nurses smoke less than hospital-trained nurses? Community Health Stud 2010; 11:41s-44s. [PMID: 3581786 DOI: 10.1111/j.1753-6405.1987.tb00512.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Woodward A, Roberts L, Reynolds C. The Nanny State strikes back: the South Australian Tobacco Products Control Act Amendment Act, 1988. Community Health Stud 2010; 13:403-9. [PMID: 2627777 DOI: 10.1111/j.1753-6405.1989.tb00698.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Matthews C, Schubert C, Woodward A, Gill E. Evaluation of Variability in Abdominal Wall Dimensions in Women Undergoing Robotic Gynecologic Surgery. J Minim Invasive Gynecol 2009. [DOI: 10.1016/j.jmig.2009.08.587] [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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Vrijheid M, Mann S, Vecchia P, Wiart J, Taki M, Ardoino L, Armstrong BK, Auvinen A, Bédard D, Berg-Beckhoff G, Brown J, Chetrit A, Collatz-Christensen H, Combalot E, Cook A, Deltour I, Feychting M, Giles GG, Hepworth SJ, Hours M, Iavarone I, Johansen C, Krewski D, Kurttio P, Lagorio S, Lönn S, McBride M, Montestrucq L, Parslow RC, Sadetzki S, Schüz J, Tynes T, Woodward A, Cardis E. Determinants of mobile phone output power in a multinational study: implications for exposure assessment. Occup Environ Med 2009; 66:664-71. [PMID: 19465409 DOI: 10.1136/oem.2008.043380] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The output power of a mobile phone is directly related to its radiofrequency (RF) electromagnetic field strength, and may theoretically vary substantially in different networks and phone use circumstances due to power control technologies. To improve indices of RF exposure for epidemiological studies, we assessed determinants of mobile phone output power in a multinational study. METHODS More than 500 volunteers in 12 countries used Global System for Mobile communications software-modified phones (GSM SMPs) for approximately 1 month each. The SMPs recorded date, time, and duration of each call, and the frequency band and output power at fixed sampling intervals throughout each call. Questionnaires provided information on the typical circumstances of an individual's phone use. Linear regression models were used to analyse the influence of possible explanatory variables on the average output power and the percentage call time at maximum power for each call. RESULTS Measurements of over 60,000 phone calls showed that the average output power was approximately 50% of the maximum, and that output power varied by a factor of up to 2 to 3 between study centres and network operators. Maximum power was used during a considerable proportion of call time (39% on average). Output power decreased with increasing call duration, but showed little variation in relation to reported frequency of use while in a moving vehicle or inside buildings. Higher output powers for rural compared with urban use of the SMP were observed principally in Sweden where the study covered very sparsely populated areas. CONCLUSIONS Average power levels are substantially higher than the minimum levels theoretically achievable in GSM networks. Exposure indices could be improved by accounting for average power levels of different telecommunications systems. There appears to be little value in gathering information on circumstances of phone use other than use in very sparsely populated regions.
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Affiliation(s)
- M Vrijheid
- International Agency for Research on Cancer (IARC), Lyon, France.
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Abstract
INTRODUCTION Local anaesthetic inguinal hernia repair may be technically demanding. There are minimal data regarding the outcomes of local anaesthetic hernia repair by trainees in comparison with consultants. PATIENTS AND METHODS All consecutive local anaesthetic repairs performed by trainees and one consultant over a 9-year period were reviewed. Operation time, volume of local anaesthetic used, early and long-term complications were assessed. A postal survey was conducted to assess chronic groin pain and satisfaction rates. RESULTS A total of 369 repairs were reviewed of which 265 repairs were performed by the consultant and 104 by trainees. The male-to-female ratio was 25:1 and the median age of the study group was 61 years (range, 18-93 years). The volume of local anaesthetic used was significantly higher for trainees than the consultant (42 ml versus 69 ml; P = 0.03). The operative time for the consultant and the trainees was 35 min and 40 min (P = 0.8). The day-case rate was higher for the consultant than the trainees (84% versus 69%; P = 0.02). Three patients operated by trainees required conversion to a general anaesthetic repair. No difference was noted in chronic groin pain (consultant 28% versus trainees 32%; P = 0.52) on the postal survey. The median follow-up was 5 years (range, 2-7 years). CONCLUSIONS Local anaesthetic inguinal hernia repair can be performed safely by surgical trainees under consultant supervision with minimal short- and long-term morbidity. A large volume dilute solution of Lignocaine and Marcaine is recommended when hernia repair is undertaken by trainees.
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Affiliation(s)
- P Sanjay
- Department of Surgery, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
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Abstract
BACKGROUND Nocturnal hypoglycaemia (NH) remains a problem in type 1 diabetes and spontaneous asymptomatic NH may be a risk factor for sudden death ('Dead in Bed' syndrome). AIMS To explore whether any predictive relationship exists between the average or time-specific glycaemia and the occurrence of NH. METHODS Twenty-five healthy patients with type 1 diabetes underwent two separate overnight periods of continuous glucose monitoring (CGM) using a MMT-7002 Medtronic MiniMed System. There was a 6-week interval before the second monitoring period. CGM glucose levels recorded between 23:00 and 08:00 h defined the nocturnal period and recorded glucose monitoring levels <3.5 mmol/l for at least 10 min during this time-defined NH. A CGM recording at 23:00 h and 08:00 h were taken as the bedtime and fasting glucose levels, respectively. RESULTS The mean +/- SD age was 37 +/- 7 years and duration of diabetes 13 +/- 7 years; 16 (64%) were on long-acting analogue insulin. Forty-nine CGM data sets were recorded. Fourteen episodes of NH occurred in 12 patients (Group 1), 13 patients (Group 2) had no NH. Group 1 (NH) had a lower mean bedtime glucose recorded compared with Group 2 (7.7 +/- 4.3 vs. 11.4 +/- 4.0 mmol/l, P = 0.0035). Fasting glucose level was also lower in Group 1 following the occurrence of NH (P = 0.014). There was no difference in the type of insulin used between the two groups. CONCLUSION Our data show that in normal day to day settings, NH is common and that the bedtime glucose level is a significant predictive factor.
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Affiliation(s)
- A Woodward
- Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, L9 7AL, UK.
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Gill GV, Woodward A, Casson IF, Weston PJ. Cardiac arrhythmia and nocturnal hypoglycaemia in type 1 diabetes--the 'dead in bed' syndrome revisited. Diabetologia 2009; 52:42-5. [PMID: 18972096 DOI: 10.1007/s00125-008-1177-7] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 09/19/2008] [Indexed: 12/19/2022]
Abstract
AIMS/HYPOTHESIS Sudden nocturnal death in type 1 diabetes ('dead in bed' syndrome) is thought to be due to ECG QT prolongation with subsequent ventricular tachyarrhythmia in response to nocturnal hypoglycaemia. We investigated this theoretical mechanism using continuous ECG and continuous glucose monitoring in a group of patients with type 1 diabetes. METHODS Twenty-five patients with type 1 diabetes (age 20-50 years) underwent two separate 24 h ECG and continuous glucose monitoring periods. Patients were fully ambulant and carried out normal daily activities. RESULTS There were 13 episodes (26% of recordings) of nocturnal hypoglycaemia, eight of <2.2 mmol/l and five of 2.2-3.4 mmol/l. Corrected QT interval (QTc) was longer during nocturnal hypoglycaemia compared with normoglycaemic control periods (445 +/- 40 vs 415 +/- 23 ms; p = 0.037). Cardiac rate and rhythm disturbances (excluding sinus tachycardia) were seen in eight of the 13 nocturnal hypoglycaemia episodes (62%). These were sinus bradycardia (<40 beats/min; three episodes), ventricular ectopics (three episodes), atrial ectopics (one) and P wave abnormalities (one). CONCLUSIONS/INTERPRETATION This study demonstrates QTc prolongation and cardiac rate/rhythm disturbances in response to episodes of nocturnal hypoglycaemia in ambulant patients with type 1 diabetes. This may support an arrhythmic basis for the 'dead in bed' syndrome.
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Affiliation(s)
- G V Gill
- Department of Diabetes and Endocrinology, University of Liverpool, Clinical Sciences Centre, Aintree University Hospital, Liverpool, UK.
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Gillespie-Bennett J, Pierse N, Wickens K, Crane J, Nicholls S, Shields D, Boulic M, Viggers H, Baker M, Woodward A, Howden-Chapman P. Sources of nitrogen dioxide (NO2) in New Zealand homes: findings from a community randomized controlled trial of heater substitutions. Indoor Air 2008; 18:521-8. [PMID: 19120502 DOI: 10.1111/j.1600-0668.2008.00554.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
UNLABELLED Houses in New Zealand have inadequate space heating and a third of households use unflued gas heaters. As part of a large community intervention trial to improve space heating, we replaced ineffective heaters with more effective, non-polluting heaters. This paper assesses the contribution of heating and household factors to indoor NO2 in almost 350 homes and reports on the reduction in NO2 levels due to heater replacement. Homes using unflued gas heaters had more than three times the level of NO2 in living rooms [geometric mean ratio (GMR) = 3.35, 95% CI: 2.83-3.96, P < 0.001] than homes without unflued gas heaters, whereas homes using gas stove-tops had significantly elevated living room NO2 levels (GMR = 1.42, 95% CI: 1.05-1.93, P = 0.02). Homes with heat pumps, flued gas heating, or enclosed wood burners had significantly lower levels of NO2 in living areas and bedrooms. In homes that used unflued gas heaters as their main form of heating at baseline, the intervention was associated with a two-third (67%) reduction in NO2 levels in living rooms, when compared with homes that continued to use unflued gas heaters. Reducing the use of unflued gas heating would substantially lower NO2 exposure in New Zealand homes. PRACTICAL IMPLICATIONS Understanding the factors influencing indoor NO2 levels is critical for the assessment and control of indoor air pollution. This study found that homes that used unflued gas combustion appliances for heating and cooking had higher NO2 levels compared with homes where other fuels were used. These findings require institutional incentives to increase the use of more effective, less polluting fuels, particularly in the home environment.
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Affiliation(s)
- J Gillespie-Bennett
- He Kainga Oranga/Housing and Health, Department of Public Health, University of Otago, Wellington, Wellington South, New Zealand.
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