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Arora A, Sharma K, Tripathi SK. Impact of luminescent MoSe 2 quantum dots on activity of trypsin under different pH environment. Spectrochim Acta A Mol Biomol Spectrosc 2023; 302:122958. [PMID: 37406547 DOI: 10.1016/j.saa.2023.122958] [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: 12/19/2022] [Revised: 04/20/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023]
Abstract
It is vital that a straightforward detection approach for trypsin should be developed as it is important diagnostic tool for a number of diseases. Herein, the impact of luminescent MoSe2 quantum dots on trypsin activity under different pH environment has been studied. Addition of trypsin to MoSe2 quantum dots enhanced the fluorescence of quantum dots whereas quantum dots resulted in quenching of fluorescence of trypsin. The quenching behavior at various pH and temperature was examined and revealed that the MoSe2-trypsin complex stabilized through the electrostatic interactions. The obtained negative values of zeta potential of the complex -0.11 mV, -0.30 mV and -0.59 mV for pH 6.0,7.6 and 9.0 respectively confirmed the stability of the complex. The separation between the donor and acceptor atoms in energy transfer mechanism was found to decrease (1.48 nm to 1.44 nm to 1.30 nm) with increasing value of pH. It was also evident that trypsin retained its enzyme activity in the trypsin-MoSe2 complex and under different pH environment. The Vant Hoff plot from quenching revealed 1 binding site for quantum dots by trypsin for all pH of buffer solution. The complex formation of trypsin-MoSe2 quantum dots was verified for the first time using fluorescence spectroscopy and it revealed that tryspin form complex with MoSe2 quantum dots through electrostatic interactions. Our results revealed that the MoSe2 quantum dots stabilized and sheltered the active sites of trypsin, which was likely the cause of the increased bioavailability of MoSe2 quantum dots in enzymes.
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Affiliation(s)
- Anmol Arora
- Centre of Advanced Study in Physics, Department of Physics, Panjab University, Chandigarh 160014, India
| | - Kriti Sharma
- Department of Physics, Goswami Ganesh Dutta Sanatan Dharma College, Sector 32-C, Chandigarh 160030, India.
| | - S K Tripathi
- Centre of Advanced Study in Physics, Department of Physics, Panjab University, Chandigarh 160014, India.
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Arora A, Alderman JE, Palmer J, Ganapathi S, Laws E, McCradden MD, Oakden-Rayner L, Pfohl SR, Ghassemi M, McKay F, Treanor D, Rostamzadeh N, Mateen B, Gath J, Adebajo AO, Kuku S, Matin R, Heller K, Sapey E, Sebire NJ, Cole-Lewis H, Calvert M, Denniston A, Liu X. The value of standards for health datasets in artificial intelligence-based applications. Nat Med 2023; 29:2929-2938. [PMID: 37884627 PMCID: PMC10667100 DOI: 10.1038/s41591-023-02608-w] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023]
Abstract
Artificial intelligence as a medical device is increasingly being applied to healthcare for diagnosis, risk stratification and resource allocation. However, a growing body of evidence has highlighted the risk of algorithmic bias, which may perpetuate existing health inequity. This problem arises in part because of systemic inequalities in dataset curation, unequal opportunity to participate in research and inequalities of access. This study aims to explore existing standards, frameworks and best practices for ensuring adequate data diversity in health datasets. Exploring the body of existing literature and expert views is an important step towards the development of consensus-based guidelines. The study comprises two parts: a systematic review of existing standards, frameworks and best practices for healthcare datasets; and a survey and thematic analysis of stakeholder views of bias, health equity and best practices for artificial intelligence as a medical device. We found that the need for dataset diversity was well described in literature, and experts generally favored the development of a robust set of guidelines, but there were mixed views about how these could be implemented practically. The outputs of this study will be used to inform the development of standards for transparency of data diversity in health datasets (the STANDING Together initiative).
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Joseph E Alderman
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Joanne Palmer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | | | - Elinor Laws
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Genetics and Genome Biology, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lauren Oakden-Rayner
- The Australian Institute for Machine Learning, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Marzyeh Ghassemi
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Vector Institute, Toronto, Ontario, Canada
| | - Francis McKay
- The Ethox Centre and the Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Darren Treanor
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
- Department of Clinical Pathology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | | | - Bilal Mateen
- Institute for Health Informatics, University College London, London, UK
- Wellcome Trust, London, UK
| | - Jacqui Gath
- Patient and Public Involvement and Engagement (PPIE) Group, STANDING Together, Birmingham, UK
| | - Adewole O Adebajo
- Patient and Public Involvement and Engagement (PPIE) Group, STANDING Together, Birmingham, UK
| | | | - Rubeta Matin
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Elizabeth Sapey
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- PIONEER, HDR UK Hub in Acute Care, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Neil J Sebire
- National Institute for Health and Care Research, Great Ormond Street Hospital Biomedical Research Centre, London, UK
- Great Ormond Street Institute of Child Health, University Hospital London, London, UK
| | | | - Melanie Calvert
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Birmingham-Oxford Blood and Transplant Research Unit in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- DEMAND Hub, University of Birmingham, Birmingham, UK
- UK SPINE, University of Birmingham, Birmingham, UK
| | - Alastair Denniston
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital/University College London, London, UK
| | - Xiaoxuan Liu
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- National Institute for Health and Care Research Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.
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3
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Murthy V, Kashid SR, Vadassery A, Pal M, Maitre P, Arora A, Singh P, Menon S, Bakshi G, Joshi A, Prakash G. Prospective Comparative Study of Quality of Life in Bladder Cancer Patients Undergoing Cystectomy or Bladder Preservation. Int J Radiat Oncol Biol Phys 2023; 117:S112. [PMID: 37784294 DOI: 10.1016/j.ijrobp.2023.06.440] [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) Health-related Quality of life (HRQOL) may be decisive when different treatments yield comparable survival outcomes. We compared QOL in patients undergoing radical cystectomy with ileal conduit (RCIC) or bladder preservation (BP) with (chemo)radiotherapy for bladder cancer. MATERIALS/METHODS Patients with histological diagnosis of bladder cancer, stage T1-T4, N0-N1, M0 with a minimum follow-up of 6 months from the last treatment intervention (RCIC or BP) and alive without disease at the time of QOL assessment were eligible for inclusion. After ethics committee approval, two HRQOL instruments were translated, validated and administered: Bladder cancer index (BCI) for bladder cancer-specific HRQOL, which includes 36 items under three domains - bladder, bowel and sexual function and the EORTC QLQ C30 which includes 30 items under three domains - functional, symptom and global health. The mean QOL scores across various domains and specific questions were compared between the two treatment groups using the independent t-test. RESULTS Of the 104 patients enrolled, 56 had RCIC, and 48 received BP, and included 95 (91.3%) males. The median time from treatment completion to QOL assessment was 22 months (IQR 10-56). The median age for the entire cohort was 62 years (IQR 55-68), 65.5 years (IQR 55-71) in BP and 59.5 years (IQR 55-66) in RCIC. Overall, mean BCI urinary scores and bowel scores were high in both groups, with no significant difference in function or bother subdomains between the two groups (Table 1). Overall, BCI sexual scores were low in both the groups but significantly better after BP (BPmean 56.9, RCICmean 41.5, p = 0.01). Mean scores for sexual function BPmean 38.4 and RCIC mean 25 p (0.07) and sexual bother BPmean 81 RCICmean 62 (p 0.02) subdomains. There was no significant difference in EORTC QOL outcomes in functional (BPmean 91.4, RCICmean 88.7 p 0.23), symptom (BPmean 89.8, RCICmean 89, p = 0.68) and global health scale (BPmean 76.8, RCICmean 78.5, p = 0.69) in both groups. On question-wise assessment, the ability to perform an exercise (BPmean 94.2, RCICmean 85, p = 0.06) and urinary leakage at night time (BPmean 91.7, RCICmean 77.6, p = 0.01) were better in the BP group, while scores for blood in the urine (BPmean 89.1, RCICmean 97, p = 0.05) were better in the RCIC group compared to BP. CONCLUSION Overall, QOL was good in both groups in the urinary and bowel domains while it was low in the sexual domain. However, bladder preservation performed significantly better in the sexual domain than RCIC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S R Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Vadassery
- Department of Radiation Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - P Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India
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Arora A, Bojko L, Kumar S, Lillington J, Panesar S, Petrungaro B. Assessment of machine learning algorithms in national data to classify the risk of self-harm among young adults in hospital: A retrospective study. Int J Med Inform 2023; 177:105164. [PMID: 37516036 DOI: 10.1016/j.ijmedinf.2023.105164] [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: 11/22/2022] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Self-harm is one of the most common presentations at accident and emergency departments in the UK and is a strong predictor of suicide risk. The UK Government has prioritised identifying risk factors and developing preventative strategies for self-harm. Machine learning offers a potential method to identify complex patterns with predictive value for the risk of self-harm. METHODS National data in the UK Mental Health Services Data Set were isolated for patients aged 18-30 years who started a mental health hospital admission between Aug 1, 2020 and Aug 1, 2021, and had been discharged by Jan 1, 2022. Data were obtained on age group, gender, ethnicity, employment status, marital status, accommodation status and source of admission to hospital and used to construct seven machine learning models that were used individually and as an ensemble to predict hospital stays that would be associated with a risk of self-harm. OUTCOMES The training dataset included 23 808 items (including 1081 episodes of self-harm) and the testing dataset 5951 items (including 270 episodes of self-harm). The best performing algorithms were the random forest model (AUC-ROC 0.70, 95%CI:0.66-0.74) and the ensemble model (AUC-ROC 0.77 95%CI:0.75-0.79). INTERPRETATION Machine learning algorithms could predict hospital stays with a high risk of self-harm based on readily available data that are routinely collected by health providers and recorded in the Mental Health Services Data Set. The findings should be validated externally with other real-world, prospective data. FUNDING This study was supported by the Midlands and Lancashire Commissioning Support Unit.
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK; Health Economics Unit, NHS Midlands and Lancashire Commissioning Support Unit, Leyland, UK.
| | - Louis Bojko
- Health Economics Unit, NHS Midlands and Lancashire Commissioning Support Unit, Leyland, UK
| | - Santosh Kumar
- Health Economics Unit, NHS Midlands and Lancashire Commissioning Support Unit, Leyland, UK
| | - Joseph Lillington
- Health Economics Unit, NHS Midlands and Lancashire Commissioning Support Unit, Leyland, UK
| | - Sukhmeet Panesar
- Senior Adviser, Office of Chief Data and Analytics Officer, NHS England and NHS Improvement, UK
| | - Bruno Petrungaro
- Health Economics Unit, NHS Midlands and Lancashire Commissioning Support Unit, Leyland, UK
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Murthy V, Maitre P, Singh M, Pal M, Arora A, Pujari L, Kapoor A, Pandey H, Sharma R, Gudipudi D, Joshi A, Prabhash K, Noronha V, Menon S, Mehta P, Bakshi G, Prakash G. Study Protocol of the Bladder Adjuvant RadioTherapy (BART) Trial: A Randomised Phase III Trial of Adjuvant Radiotherapy Following Cystectomy in Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e506-e515. [PMID: 37208232 DOI: 10.1016/j.clon.2023.04.010] [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: 02/13/2023] [Revised: 04/10/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
AIMS To assess the efficacy and safety of adjuvant radiotherapy in patients with high-risk muscle-invasive bladder cancer (MIBC) following radical cystectomy (RC) and chemotherapy. MATERIALS AND METHODS The BART (Bladder Adjuvant RadioTherapy) trial is an ongoing multicentric, randomised, phase III trial comparing the efficacy and safety of adjuvant radiotherapy versus observation in patients with high-risk MIBC. The key eligibility criteria include ≥pT3, node-positive (pN+), positive margins and/or nodal yield <10, or, neoadjuvant chemotherapy for cT3/T4/N+ disease. In total, 153 patients will be accrued and randomised, in a 1:1 ratio, to either observation (standard arm) or adjuvant radiotherapy (test arm) following surgery and chemotherapy. Stratification parameters include nodal status (N+ versus N0) and chemotherapy (neoadjuvant chemotherapy versus adjuvant chemotherapy versus no chemotherapy). For patients in the test arm, adjuvant radiotherapy to cystectomy bed and pelvic nodes is planned with intensity-modulated radiotherapy to a dose of 50.4 Gy in 28 fractions using daily image guidance. All patients will follow-up with 3-monthly clinical review and urine cytology for 2 years and subsequently 6 monthly until 5 years, with contrast-enhanced computed tomography abdomen pelvis 6 monthly for 2 years and annually until 5 years. Physician-scored toxicity using Common Terminology Criteria for Adverse Events version 5.0 and patient-reported quality of life using the Functional Assessment of Cancer Therapy - Colorectal questionnaire is recorded pre-treatment and at follow-up. ENDPOINTS AND STATISTICS The primary endpoint is 2-year locoregional recurrence-free survival. The sample size calculation was based on the estimated improvement in 2-year locoregional recurrence-free survival from 70% in the standard arm to 85% in the test arm (hazard ratio 0.45) using 80% statistical power and a two-sided alpha error of 0.05. Secondary endpoints include disease-free survival, overall survival, acute and late toxicity, patterns of failure and quality of life. CONCLUSION The BART trial aims to evaluate whether contemporary radiotherapy after standard-of-care surgery and chemotherapy reduces pelvic recurrences safely and also potentially affects survival in high-risk MIBC.
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Affiliation(s)
- V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - P Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Pal
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Arora
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - L Pujari
- Department of Radiation Oncology, HBCH & MPMMMC, Varanasi, India
| | - A Kapoor
- Department of Medical Oncology, HBCH & MPMMMC, Varanasi, India
| | - H Pandey
- Department of Surgical Oncology, HBCH & MPMMMC, Varanasi, India
| | - R Sharma
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - D Gudipudi
- Department of Uro-Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Mehta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Bakshi
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Prakash
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Byrne MHV, Ashcroft J, Wan JCM, Alexander L, Harvey A, Arora A, Schindler N, Brown MEL, Brassett C. Examining medical student volunteering during the COVID-19 pandemic as a prosocial behaviour during an emergency. Postgrad Med J 2023; 99:883-893. [PMID: 37002858 DOI: 10.1093/postmj/qgad015] [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: 08/18/2022] [Revised: 01/05/2023] [Accepted: 01/21/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Understanding the factors that influence prosocial behaviour during the COVID-19 pandemic is essential due to the disruption to healthcare provision. METHODS We conducted an in-depth, mixed-methods cross-sectional survey, from 2 May 2020 to 15 June 2020, of medical students at medical schools in the United Kingdom. Data analysis was informed by Latané and Darley's theory of prosocial behaviour during an emergency. RESULTS A total of 1145 medical students from 36 medical schools responded. Although 947 (82.7%) of students were willing to volunteer, only 391 (34.3%) had volunteered. Of the students, 92.7% understood they may be asked to volunteer; however, we found deciding one's responsibility to volunteer was mitigated by a complex interaction between the interests of others and self-interest. Further, concerns revolving around professional role boundaries influenced students' decisions over whether they had the required skills and knowledge. CONCLUSION We propose two additional domains to Latané and Darley's theory that medical students consider before making their final decision to volunteer: 'logistics' and 'safety'. We highlight modifiable barriers to prosocial behaviour and provide suggestions regarding how the conceptual framework can be operationalized within educational strategies to address these barriers. Optimizing the process of volunteering can aid healthcare provision and may facilitate a safer volunteering process. Key messages What is already known on this topic: There is a discrepancy between the number of students willing to volunteer during pandemics and disasters, and those who actually volunteer. Understanding the factors that influence prosocial behaviour during the current COVID-19 pandemic and future pandemics and disasters is essential. What this study adds: We expanded on Latané and Darley's theory of prosocial behaviour in an emergency and used this to conceptualize students' motivations to volunteer, highlighting a number of modifiable barriers to prosocial behaviour during the COVID-19 pandemic. How this study might affect research, practice, or policy: We provide suggestions regarding how the conceptual framework can be operationalized to support prosocial behaviours during emergencies for the ongoing COVID-19 pandemic and future crises.
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Affiliation(s)
- Matthew H V Byrne
- Department of Urology, Oxford University Hospitals Trust, University of Oxford, Oxford, OX3 7LE, United Kingdom
| | - James Ashcroft
- Department of Surgery, Cambridge University Hospitals Trust, University of Cambridge, Cambridge, CB2 0QQ, United Kingdom
| | | | - Laith Alexander
- Guy's and St Thomas' Hospital, London, SE1 7EH, United Kingdom
| | - Anna Harvey
- King's College London, London, WC2R 2LS, United Kingdom
| | - Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, United Kingdom
| | - Nicholas Schindler
- Paediatric Department, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, NR4 7UY, United Kingdom
- Institute of Continuing Education, University of Cambridge, Cambridge, CB23 8AQ, United Kingdom
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, YO10 5DD, United Kingdom
| | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, CB2 3EL, United Kingdom
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Arora A. Moravec's paradox and the fear of job automation in health care. Lancet 2023; 402:180-181. [PMID: 37453744 DOI: 10.1016/s0140-6736(23)01129-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
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Hamm SE, Yuan C, McQueen LF, Wallace MA, Zhang H, Arora A, Garafalo AM, McMillan RP, Lawlor MW, Prom MJ, Ott EM, Yan J, Addington AK, Morris CA, Gonzalez JP, Grange RW. Prolonged voluntary wheel running reveals unique adaptations in mdx mice treated with microdystrophin constructs ± the nNOS-binding site. Front Physiol 2023; 14:1166206. [PMID: 37435312 PMCID: PMC10330712 DOI: 10.3389/fphys.2023.1166206] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/10/2023] [Indexed: 07/13/2023] Open
Abstract
We tested the effects of prolonged voluntary wheel running on the muscle function of mdx mice treated with one of two different microdystrophin constructs. At 7 weeks of age mdx mice were injected with a single dose of AAV9-CK8-microdystrophin with (gene therapy 1, GT1) or without (gene therapy 2, GT2) the nNOS-binding domain and were assigned to one of four gene therapy treated groups: mdxRGT1 (run, GT1), mdxGT1 (no run, GT1), or mdxRGT2 (run,GT2), mdxGT2 (no run, GT2). There were two mdx untreated groups injected with excipient: mdxR (run, no gene therapy) and mdx (no run, no gene therapy). A third no treatment group, Wildtype (WT) received no injection and did not run. mdxRGT1, mdxRGT2 and mdxR performed voluntary wheel running for 52 weeks; WT and remaining mdx groups were cage active. Robust expression of microdystrophin occurred in diaphragm, quadriceps, and heart muscles of all treated mice. Dystrophic muscle pathology was high in diaphragms of non-treated mdx and mdxR mice and improved in all treated groups. Endurance capacity was rescued by both voluntary wheel running and gene therapy alone, but their combination was most beneficial. All treated groups increased in vivo plantarflexor torque over both mdx and mdxR mice. mdx and mdxR mice displayed ∼3-fold lower diaphragm force and power compared to WT values. Treated groups demonstrated partial improvements in diaphragm force and power, with mdxRGT2 mice experiencing the greatest improvement at ∼60% of WT values. Evaluation of oxidative red quadriceps fibers revealed the greatest improvements in mitochondrial respiration in mdxRGT1 mice, reaching WT levels. Interestingly, mdxGT2 mice displayed diaphragm mitochondrial respiration values similar to WT but mdxRGT2 animals showed relative decreases compared to the no run group. Collectively, these data demonstrate that either microdystrophin construct combined with voluntary wheel running increased in vivo maximal muscle strength, power, and endurance. However, these data also highlighted important differences between the two microdystrophin constructs. GT1, with the nNOS-binding site, improved more markers of exercise-driven adaptations in metabolic enzyme activity of limb muscles, while GT2, without the nNOS-binding site, demonstrated greater protection of diaphragm strength after chronic voluntary endurance exercise but decreased mitochondrial respiration in the context of running.
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Affiliation(s)
- S. E. Hamm
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. Yuan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - L. F. McQueen
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. A. Wallace
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - H. Zhang
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. Arora
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. M. Garafalo
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - R. P. McMillan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - M. W. Lawlor
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - M. J. Prom
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - E. M. Ott
- Department of Pathology and Neuroscience Research Center, Medical College of Wisconsin and Diverge Translational Science Laboratory, Milwaukee, WI, United States
| | - J. Yan
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - A. K. Addington
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
| | - C. A. Morris
- Solid Biosciences, Inc., Cambridge, MA, United States
| | | | - R. W. Grange
- Department of Human Nutrition, Foods and Exercise and Metabolism Core, Virginia Tech, Blacksburg, VA, United States
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9
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Gurumurthy S, Arora A, Krishna H, Chinnusamy V, Hazra KK. Genotypic capacity of post-anthesis stem reserve mobilization in wheat for yield sustainability under drought and heat stress in the subtropical region. Front Genet 2023; 14:1180941. [PMID: 37408776 PMCID: PMC10318140 DOI: 10.3389/fgene.2023.1180941] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023] Open
Abstract
Wheat productivity is severely affected by drought and heat stress conditions worldwide. Currently, stem reserve mobilization (SRM) is receiving increased attention as a trait that can sustain wheat yields under adverse environments. However, the significance of SRM in sustaining wheat yields under drought and heat stress conditions remains uncertain in the tropical climate of Indo-Gangetic Plain region. Therefore, this study aimed to investigate genotypic variations in SRM in wheat and their influence on yield sustainability under drought and heat stress environments. The experiment was designed in an alpha-lattice layout, accommodating 43 genotypes under four simulated environments [timely sown and well irrigated (non-stress); timely sown and water-deficit/drought stress; late-sown and well-irrigated crop facing terminally high temperature; and late-sown and water-deficit stress (both water-deficit and heat stress)]. The water-deficit stress significantly increased SRM (16%-68%, p < 0.01) compared to the non-stress environment, while the heat stress conditions reduced SRM (12%-18%). Both SRM and stem reserve mobilization efficiency exhibited positive correlations with grain weight (grain weight spike-1) under all three different stress treatments (p < 0.05). Strong positive correlations between stem weight (at 12 days after anthesis) and grain weight were observed across the environments (p < 0.001); however, a significant positive correlation between stem weight and SRM was observed only with stress treatments. Results revealed that the SRM trait could effectively alleviate the impacts of water-deficit stress on yields. However, the SRM-mediated yield protection was uncertain under heat stress and combined water-deficit and heat stress treatments, possibly due to sink inefficiencies caused by high temperature during the reproductive period. Defoliated plants exhibited higher SRM than non-defoliated plants, with the highest increment observed in the non-stress treatment compared to all the stress treatments. Results revealed that wider genetic variability exists for the SRM trait, which could be used to improve wheat yield under drought stress conditions.
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Affiliation(s)
- S. Gurumurthy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
- School of Water Stress Management, ICAR–National Institute of Abiotic Stress Management, Baramati, Maharashtra, India
| | - A. Arora
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - Hari Krishna
- Division of Genetics, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - V. Chinnusamy
- Division of Plant Physiology, ICAR–Indian Agricultural Research Institute, New Delhi, India
| | - K. K. Hazra
- Crop Production Division, ICAR–Indian Institute of Pulses Research, Kanpur, Uttar Pradesh, India
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10
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Swann JR, Diaz Heijtz R, Mayneris-Perxachs J, Arora A, Isaksson J, Bölte S, Tammimies K. Characterizing the metabolomic signature of attention-deficit hyperactivity disorder in twins. Neuropharmacology 2023; 234:109562. [PMID: 37100381 DOI: 10.1016/j.neuropharm.2023.109562] [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: 12/17/2022] [Revised: 03/05/2023] [Accepted: 04/21/2023] [Indexed: 04/28/2023]
Abstract
Emerging evidence implicate the gut microbiota as a potential susceptibility factor in attention-deficit hyperactivity disorder (ADHD), a common multifactorial neurodevelopmental condition. However, little is known about the biochemical signature of ADHD, including the metabolic contribution of the microbiota via the gut-brain axis, and the relative contribution of genetics and environmental factors. Here, we perform unbiased metabolomic profiling of urine and fecal samples collected from a well-characterized Swedish twin cohort enriched for ADHD (33 ADHD, 79 non-ADHD), using 1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry. Our results highlight sex-specific patterns in the metabolic phenotype of individuals with ADHD. Specifically, the urine profile of males, but not females, with ADHD was characterized by greater excretion of hippurate, a product of microbial-host co-metabolism that can cross the blood-brain-barrier with bioactivity of potential relevance to ADHD. This trans-genomic metabolite was also negatively correlated with IQ in males and was significantly correlated with fecal metabolites associated with gut microbial metabolism. The fecal profile of ADHD individuals was characterized by increased excretion of stearoyl-linoleoyl-glycerol, 3,7-dimethylurate, and FAD and lower amounts of glycerol 3-phosphate, thymine, 2(1H)-quinolinone, aspartate, xanthine, hypoxanthine, and orotate. These changes were independent of ADHD medication, age, and BMI. Furthermore, our specific twins' models revealed that many of these gut metabolites had a stronger genetic influence than environmental. These findings suggest that metabolic disturbances in ADHD, involving combined gut microbial and host metabolic processes, may largely derive from gene variants previously linked to behavioral symptoms in this disorder.
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Affiliation(s)
- J R Swann
- School of Human Development and Health, Faculty of Medicine, University of Southampton, UK; Department of Metabolism, Digestion, and Reproduction, Faculty of Medicine, Imperial College London, UK.
| | - R Diaz Heijtz
- Department of Neuroscience, Karolinska Institutet Region Stockholm, Stockholm, Sweden
| | - J Mayneris-Perxachs
- Department of Diabetes, Endocrinology and Nutrition, Girona Biomedical Research Institute, Girona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - A Arora
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
| | - J Isaksson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - S Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - K Tammimies
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet Region Stockholm, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden
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11
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Hussain RN, Chiu A, Pittam B, Taktak A, Damato BE, Kacperek A, Errington D, Cauchi P, Chadha V, Connolly J, Salvi S, Rundle P, Cohen V, Arora A, Sagoo M, Bekir O, Kopsidas K, Heimann H. Proton beam radiotherapy for choroidal and ciliary body melanoma in the UK-national audit of referral patterns of 1084 cases. Eye (Lond) 2023; 37:1033-1036. [PMID: 35840716 PMCID: PMC10050435 DOI: 10.1038/s41433-022-02178-0] [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: 03/25/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. METHODS Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. RESULTS A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9-90 years), basal diameter of 11.5 mm (range 2.0-23.4 mm) and tumour thickness of 3.9 mm (range 0.1-15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. DISCUSSION In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.
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Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - A Chiu
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - B Pittam
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| | - A Taktak
- Department of Eye and Vision Science and Department of Biostatistics, University of Liverpool, Liverpool, L69 3GL, UK
| | - B E Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Kacperek
- University College London, London, WC1E 6BT, UK
| | - D Errington
- Clatterbridge Cancer Centre, Clatterbridge Road, Bebington, Wirral, CH63 4JY, UK
| | - P Cauchi
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - V Chadha
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - J Connolly
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - S Salvi
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - P Rundle
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - V Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - M Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - O Bekir
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - K Kopsidas
- The National Sheffield Ocular Oncology Service, Royal Hallamshire Hospital, S10 2JF, Sheffield, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
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12
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Arora A. Synthetic data: the future of open-access health-care datasets? Lancet 2023; 401:997. [PMID: 36965971 DOI: 10.1016/s0140-6736(23)00324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
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13
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Byrne MHV, Alexander L, Wan JCM, Brown MEL, Arora A, Harvey A, Ashcroft J, Clelland AD, Hayes S, Kinder F, Dominic C, Asif A, Mogg J, Freer R, Lakhani A, Pace S, Bandyopadhyay S, Schindler N, Brassett C, Burford B, Vance G, Allan R. Clinical support during covid-19: An opportunity for service and learning? A cross-sectional survey of UK medical students. Med Teach 2023:1-12. [PMID: 36927278 DOI: 10.1080/0142159x.2023.2184235] [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] [Indexed: 06/18/2023]
Abstract
PURPOSE Medical students providing support to clinical teams during Covid-19 may have been an opportunity for service and learning. We aimed to understand why the reported educational impact has been mixed to inform future placements. METHODS We conducted a cross-sectional survey of medical students at UK medical schools during the first Covid-19 'lockdown' period in the UK (March-July 2020). Analysis was informed by the conceptual framework of service and learning. RESULTS 1245 medical students from 37 UK medical schools responded. 57% of respondents provided clinical support across a variety of roles and reported benefits including increased preparedness for foundation year one compared to those who did not (p < 0.0001). However, not every individual's experience was equal. For some, roles complemented the curriculum and provided opportunities for clinical skill development, reflection, and meaningful contribution to the health service. For others, the relevance of their role to their education was limited; these roles typically focused on service provision, with few opportunities to develop. CONCLUSION The conceptual framework of service and learning can help explain why student experiences have been heterogeneous. We highlight how this conceptual framework can be used to inform clinical placements in the future, in particular the risks, benefits, and structures.[Box: see text].
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Affiliation(s)
- Matthew H V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | - Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Harvey
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - James Ashcroft
- Department of Surgery, Cambridge University Hospitals Trust, University of Cambridge, Cambridge, UK
| | - Andrew D Clelland
- Department of Surgery, Cambridge University Hospitals Trust, University of Cambridge, Cambridge, UK
| | - Siena Hayes
- Cardiff University School of Medicine, Cardiff University, Cardiff, UK
| | | | - Catherine Dominic
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Aqua Asif
- Leicester Medical School, University of Leicester, Leicestershire, UK
| | - Jasper Mogg
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rosie Freer
- School of Medical and Biomedical Sciences, University of Oxford, Oxford, UK
| | - Arjun Lakhani
- School of Medical and Biomedical Sciences, University of Oxford, Oxford, UK
| | - Samuel Pace
- School of Medical and Biomedical Sciences, University of Oxford, Oxford, UK
| | - Soham Bandyopadhyay
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nicholas Schindler
- Paediatric Department, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
- Institute of Continuing Education, University of Cambridge, Cambridge, UK
| | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Bryan Burford
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Vance
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Rachel Allan
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
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Tiribelli S, Monnot A, Shah SFH, Arora A, Toong PJ, Kong S. Ethics Principles for Artificial Intelligence-Based Telemedicine for Public Health. Am J Public Health 2023; 113:577-584. [PMID: 36893365 PMCID: PMC10088937 DOI: 10.2105/ajph.2023.307225] [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: 03/11/2023]
Abstract
The use of artificial intelligence (AI) in the field of telemedicine has grown exponentially over the past decade, along with the adoption of AI-based telemedicine to support public health systems. Although AI-based telemedicine can open up novel opportunities for the delivery of clinical health and care and become a strong aid to public health systems worldwide, it also comes with ethical risks that should be detected, prevented, or mitigated for the responsible use of AI-based telemedicine in and for public health. However, despite the current proliferation of AI ethics frameworks, thus far, none have been developed for the design of AI-based telemedicine, especially for the adoption of AI-based telemedicine in and for public health. We aimed to fill this gap by mapping the most relevant AI ethics principles for AI-based telemedicine for public health and by showing the need to revise them via major ethical themes emerging from bioethics, medical ethics, and public health ethics toward the definition of a unified set of 6 AI ethics principles for the implementation of AI-based telemedicine. (Am J Public Health. Published online ahead of print March 9, 2023:e1-e8. https://doi.org/10.2105/AJPH.2022.307225).
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Affiliation(s)
- Simona Tiribelli
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
| | - Annabelle Monnot
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
| | - Syed F H Shah
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
| | - Anmol Arora
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
| | - Ping J Toong
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
| | - Sokanha Kong
- Simona Tiribelli is with the Department of Political Sciences, Communication, and International Relations, University of Macerata, Macerata, Italy, and the Institute for Technology and Global Health, Cambridge, MA. Annabelle Monnot is with Polygeia, Global Health Think Tank, Cambridge, UK. Syed F. H. Shah and Anmol Arora are with the School of Clinical Medicine, University of Cambridge, Cambridge. Ping J. Toong is with the Department of Pathology, University of Cambridge. Sokanha Kong is with the Department of Medical Genetics, University of Cambridge
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15
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Arora A, Dessai TD, Bhat RJ. Screening for Auditory Processing Difficulties in Older Adults with Hearing Impairment Using Screening Checklist for Auditory Processing in Adults. J Int Adv Otol 2023; 19:87-92. [PMID: 36975079 PMCID: PMC10152099 DOI: 10.5152/iao.2023.22752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Aging enhances changes in the central and peripheral auditory systems. It is expected that older adults population would experience auditory processing deficits. Therefore, early identification of these individuals will help in making appropriate referrals, which in turn might help in early diagnosis and management of the problem. METHODS Fifty-five participants diagnosed with hearing impairment were screened for the existence of auditory processing difficulties using Screening Checklist for Auditory Processing for Adults-Modified 2-point rating scale. The data were collected using direct interview and telephonic interview with the participant. RESULTS A total of 26 participants with bilateral symmetrical sensorineural hearing loss (47.3%) exhibited auditory processing difficulties. CONCLUSION It can be understood that all older adults with hearing impairment need to undergo screening using Screening Checklist for Auditory Processing for Adults. This will further help in deciding and customizing the management options required for each older adult with bilateral symmetrical sensorineural hearing loss.
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Affiliation(s)
- Anmol Arora
- Department of Hearing Studies Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bangalore, India
| | - Teja Deepak Dessai
- Department of Hearing Studies Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bangalore, India
| | - Rashmi J Bhat
- Department of Hearing Studies Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bangalore, India
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16
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK.
| | - Ananya Arora
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
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17
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Prakash G, Chandankhede U, Nadkarni S, Pal M, Arora A, Gujela A, Bakshi G. The Belly-Up technique for pericaval nodal dissection in RPLND - Saving caval resections and reconstructions. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01409-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Arora A, Arora A. Machine learning models trained on synthetic datasets of multiple sample sizes for the use of predicting blood pressure from clinical data in a national dataset. PLoS One 2023; 18:e0283094. [PMID: 36928534 PMCID: PMC10019654 DOI: 10.1371/journal.pone.0283094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The potential for synthetic data to act as a replacement for real data in research has attracted attention in recent months due to the prospect of increasing access to data and overcoming data privacy concerns when sharing data. The field of generative artificial intelligence and synthetic data is still early in its development, with a research gap evidencing that synthetic data can adequately be used to train algorithms that can be used on real data. This study compares the performance of a series machine learning models trained on real data and synthetic data, based on the National Diet and Nutrition Survey (NDNS). METHODS Features identified to be potentially of relevance by directed acyclic graphs were isolated from the NDNS dataset and used to construct synthetic datasets and impute missing data. Recursive feature elimination identified only four variables needed to predict mean arterial blood pressure: age, sex, weight and height. Bayesian generalised linear regression, random forest and neural network models were constructed based on these four variables to predict blood pressure. Models were trained on the real data training set (n = 2408), a synthetic data training set (n = 2408) and larger synthetic data training set (n = 4816) and a combination of the real and synthetic data training set (n = 4816). The same test set (n = 424) was used for each model. RESULTS Synthetic datasets demonstrated a high degree of fidelity with the real dataset. There was no significant difference between the performance of models trained on real, synthetic or combined datasets. Mean average error across all models and all training data ranged from 8.12 To 8.33. This indicates that synthetic data was capable of training equally accurate machine learning models as real data. DISCUSSION Further research is needed on a variety of datasets to confirm the utility of synthetic data to replace the use of potentially identifiable patient data. There is also further urgent research needed into evidencing that synthetic data can truly protect patient privacy against adversarial attempts to re-identify real individuals from the synthetic dataset.
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Ananya Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
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Arora A, Arora A. Effects of smart voice control devices on children: current challenges and future perspectives. Arch Dis Child 2022; 107:1129-1130. [PMID: 36167481 DOI: 10.1136/archdischild-2022-323888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/10/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Ananya Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Menon S, Shah A, Sali A, Prakash G, Bakshi G, Pal M, Joshi A, Murthy V, Maitre P, Arora A, Desai S. Concordance of histological grade between pre-operative biopsy and resection specimen in penile squamous cell carcinoma. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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21
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Kumar M, Arora A, Kumar M. P-138 PREDICTORS OF COMPLICATIONS IN COMPLEX VENTRAL HERNIA REPAIR USING POSTERIOR COMPONENT SEPARATION TECHNIQUE WITH RETRO RECTUS MESH PLACEMENT – AN OBSERVATIONAL STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Incisional Hernia has an incidence ranging from 2–20%. Large and complex incisional hernias are difficult to treat with standard procedures. PCS-TAR is a relatively novel procedure. There persists a gap in knowledge regarding its outcomes, especially in the Indian population.
Aims & Objective
To identify the pre-operative clinical and radiological factors that predict the risk of re-herniation and wound and mesh-related complications after CVH (Complex Ventral Hernia)
Methodology
In a prospective observational study, patients undergoing open PCS-TAR with retro rectus mesh for Complex Ventral Hernia repair included in the study. The patient demographics, hernia characteristics, radiological details, operative data, post- operative outcomes, and follow-up data were entered in a pre-designed proforma. Data were analyzed with SPSS softwere.
Results
35 patients with CVH were included, of which 30 (85%) women and 5 men. The mean age was 51.8 years and the mean BMI was 29.7 kg/m2. The mean size of defect was 12 cm. 83% hernia were midline primary and 255 were recurrent hernias. We observed zero recurrences at six months of follow-up, but a high wound morbidity rate of up to 49%, of which most common was seroma formation. 23% of patients developed SSI.
Conclusion
In conclusion, PCS-TAR is a promising novel procedure for complex ventral hernias not amenable to primary closure using the traditional retro rectus approach, with excellent short term outcomes. Wound morbidity is a significant concern with this procedure, which can be prevented or reduced by thorough pre-operative optimization on a case-to-case basis.
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Affiliation(s)
- M Kumar
- General Surgery, AIIMS Patna , Patna , India
| | - A Arora
- General Surgery, AIIMS Patna , Patna , India
| | - M Kumar
- General Surgery, AIIMS Patna , Patna , India
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Lamarca A, Palmer D, Wasan H, Ross P, Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maravellas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. 54MO Quality of life (QoL) and value of health (V-He) in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+FOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.082] [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] Open
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23
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Arora A, Kivelä A, Taskinen J, Raiborg C, Olkkonen V. Role of Protrudin in endothelial cell function. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Arora A, Storr SJ, Reddy H, Lobo DN, Madhusudan S, Zaitoun AM. O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.085] [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: 11/06/2022]
Abstract
Abstract
Introduction
Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.
Methods
We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.
Results
In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.
Conclusion
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
Take-home message
The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
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Affiliation(s)
- A Arora
- Nottingham University Hospitals NHS Foundation Trust
| | - SJ Storr
- Nottingham University Hospitals NHS Foundation Trust
| | - H Reddy
- Nottingham University Hospitals NHS Foundation Trust
| | - DN Lobo
- Nottingham University Hospitals NHS Foundation Trust
| | - S Madhusudan
- Nottingham University Hospitals NHS Foundation Trust
| | - AM Zaitoun
- Nottingham University Hospitals NHS Foundation Trust
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25
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Arora A, Arora A. Generative adversarial networks and synthetic patient data: current challenges and future perspectives. Future Healthc J 2022; 9:190-193. [DOI: 10.7861/fhj.2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Lamarca A, Palmer D, Wasan H, Ross P, Ting Ma Y, Arora A, Falk S, Gillmore R, Wadsley J, Patel K, Anthoney A, Maraveyas A, Waters J, Hoobs C, Macdonald T, Ryder D, Ramage J, Davies L, Bridgewater J, Valle J. P-88 Clinical role of tumour markers in advanced biliary cancers (ABC) treated with second-line active-symptom-control (ASC) alone or ASC with oxaliplatin/5-FU chemotherapy (ASC+mFOLFOX) in the randomised phase III, multi-centre, open-label ABC-06 trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.178] [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: 11/30/2022] Open
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27
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Manimaran M, Arora A, Lovejoy CA, Gao W, Maruthappu M. Role of artificial intelligence and machine learning in haematology. J Clin Pathol 2022; 75:585-587. [PMID: 35470252 DOI: 10.1136/jclinpath-2021-208127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Christopher A Lovejoy
- University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
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28
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Ha DH, Arora A, Harford J, Luzzi L, Chrisopoulos S, Do LG. Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children. JDR Clin Trans Res 2022:23800844221091701. [PMID: 35466760 DOI: 10.1177/23800844221091701] [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] [Indexed: 11/15/2022] Open
Abstract
KNOWLEDGE TRANSFER STATEMENT The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.
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Affiliation(s)
- D H Ha
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia.,Health Equity Laboratory, Campbelltown, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, Surry Hills, NSW, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Westmead, NSW, Australia
| | - J Harford
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - L Luzzi
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - S Chrisopoulos
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | - L G Do
- School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Australia.,Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK.
| | - Ananya Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
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30
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Affiliation(s)
- A Arora
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0SP, UK
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31
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Koelmel JP, Tan WY, Li Y, Bowden JA, Ahmadireskety A, Patt AC, Orlicky DJ, Mathé E, Kroeger NM, Thompson DC, Cochran JA, Golla JP, Kandyliari A, Chen Y, Charkoftaki G, Guingab‐Cagmat JD, Tsugawa H, Arora A, Veselkov K, Kato S, Otoki Y, Nakagawa K, Yost RA, Garrett TJ, Vasiliou V. Lipidomics and Redox Lipidomics Indicate Early Stage Alcohol-Induced Liver Damage. Hepatol Commun 2022; 6:513-525. [PMID: 34811964 PMCID: PMC8870008 DOI: 10.1002/hep4.1825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
Alcoholic fatty liver disease (AFLD) is characterized by lipid accumulation and inflammation and can progress to cirrhosis and cancer in the liver. AFLD diagnosis currently relies on histological analysis of liver biopsies. Early detection permits interventions that would prevent progression to cirrhosis or later stages of the disease. Herein, we have conducted the first comprehensive time-course study of lipids using novel state-of-the art lipidomics methods in plasma and liver in the early stages of a mouse model of AFLD, i.e., Lieber-DeCarli diet model. In ethanol-treated mice, changes in liver tissue included up-regulation of triglycerides (TGs) and oxidized TGs and down-regulation of phosphatidylcholine, lysophosphatidylcholine, and 20-22-carbon-containing lipid-mediator precursors. An increase in oxidized TGs preceded histological signs of early AFLD, i.e., steatosis, with these changes observed in both the liver and plasma. The major lipid classes dysregulated by ethanol play important roles in hepatic inflammation, steatosis, and oxidative damage. Conclusion: Alcohol consumption alters the liver lipidome before overt histological markers of early AFLD. This introduces the exciting possibility that specific lipids may serve as earlier biomarkers of AFLD than those currently being used.
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Affiliation(s)
- Jeremy P. Koelmel
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
| | - Wan Y. Tan
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
- Internal Medicine Residency ProgramDepartment of Internal MedicineNorwalk HospitalNorwalkCTUSA
| | - Yang Li
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
| | - John A. Bowden
- Department of ChemistryUniversity of FloridaGainesvilleFLUSA
- Center for Environmental and Human Toxicology and Department of Physiological SciencesUniversity of FloridaGainesvilleFLUSA
| | | | - Andrew C. Patt
- Division of Preclinical InnovationNational Center for Advancing Translational SciencesNational Institutes of HealthRockvilleMDUSA
| | - David J. Orlicky
- Department of PathologyUniversity of Colorado School of MedicineDenverCOUSA
| | - Ewy Mathé
- Division of Preclinical InnovationNational Center for Advancing Translational SciencesNational Institutes of HealthRockvilleMDUSA
| | - Nicholas M. Kroeger
- Computer and Information Science and EngineeringUniversity of FloridaGainesvilleFLUSA
| | - David C. Thompson
- Department of Clinical PharmacyUniversity of Colorado Skaggs School of Pharmacy and Pharmaceutical SciencesUniversity of ColoradoAuroraCOUSA
| | - Jason A. Cochran
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
- Computer and Information Science and EngineeringUniversity of FloridaGainesvilleFLUSA
| | - Jaya Prakash Golla
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Aikaterini Kandyliari
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
- Unit of Human NutritionDepartment of Food Science and Human NutritionAgricultural University of AthensAthensGreece
| | - Ying Chen
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Georgia Charkoftaki
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
| | - Joy D. Guingab‐Cagmat
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
| | - Hiroshi Tsugawa
- RIKEN Center for Sustainable Resource ScienceKanagawaJapan
- RIKEN Center for Integrative Medical SciencesKanagawaJapan
- Department of Biotechnology and Life ScienceTokyo University of Agriculture and TechnologyTokyoJapan
| | - Anmol Arora
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
- School of Clinical MedicineUniversity of CambridgeCambridgeUnited Kingdom
| | - Kirill Veselkov
- Department of Metabolism, Digestion and ReproductionImperial CollegeLondonUnited Kingdom
| | - Shunji Kato
- Food and Biodynamic Chemistry Laboratory, Graduate School of Agricultural ScienceTohoku UniversitySendaiJapan
| | - Yurika Otoki
- Food and Biodynamic Chemistry Laboratory, Graduate School of Agricultural ScienceTohoku UniversitySendaiJapan
| | - Kiyotaka Nakagawa
- Food and Biodynamic Chemistry Laboratory, Graduate School of Agricultural ScienceTohoku UniversitySendaiJapan
| | - Richard A. Yost
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
- Department of ChemistryUniversity of FloridaGainesvilleFLUSA
| | - Timothy J. Garrett
- Department of Pathology, Immunology and Laboratory MedicineUniversity of FloridaGainesvilleFLUSA
- Department of ChemistryUniversity of FloridaGainesvilleFLUSA
| | - Vasilis Vasiliou
- Department of Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
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Arora A, Arkle T, Sreedharan L, Kumar B. 60 Neoadjuvant Imatinib Mesylate – an Ace of Spaces for Surgical Management of an Oesophago-Gastric Junction Gastro-Intestinal Stromal Tumour. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Oesophageal gastro-intestinal stromal tumours (GISTs) are rare, accounting for less than five percent of all GIST, with the majority of these occurring at the oesophago-gastric junction (OGJ). Due to the anatomical location and size of these tumours at presentation, surgical resection is often a major undertaking.
Neoadjuvant treatment with tyrosine kinase inhibitors, such as Imatinib mesylate, have the potential to downstage such tumours, thereby limiting the extent of subsequent surgical resection. This may therefore reduce any potentially associated morbidity and mortality.
Case Description
We report the case of a 75-year-old gentleman who presented with a large OGJ GIST, which presented with dysphagia. The tumour was deemed too large for local excision due to the risk of compromising the lumen at the OGJ in attempting to obtain a clear resection margin. Given the patient’s co-morbidity, oesophagectomy or total gastrectomy was deemed too major an undertaking. Therefore, endoscopic biopsies were obtained with a view to possible neoadjuvant therapy. These confirmed DOG-1 and Exon-11 mutations, suggesting sensitivity to Imatinib mesylate. A standard dose regime of 400mg daily for a planned 36-month course was commenced. Subsequent imaging showed a substantial decrease in tumour bulk and the decision was made to perform a local excision. A local enucleation procedure was performed, and the patient made a sound recovery.
Post-operative histology of resected tumour showed almost complete tumour regression.
Discussion
This significant response to neoadjuvant Imatinib mesylate therapy demonstrates clear potential for its use in similar cases, where radical resection would cause significant morbidity and risk mortality.
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Affiliation(s)
- A. Arora
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - T. Arkle
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - L. Sreedharan
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
| | - B. Kumar
- Norfolk and Norwich University Hopsital, Norwich, United Kingdom
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O’Kelly E, Arora A, Pirog S, Pearson C, Ward J, Clarkson PJ. Face mask fit hacks: Improving the fit of KN95 masks and surgical masks with fit alteration techniques. PLoS One 2022; 17:e0262830. [PMID: 35108287 PMCID: PMC8809580 DOI: 10.1371/journal.pone.0262830] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction During the course of the COVID-19 pandemic, there have been suggestions that various techniques could be employed to improve the fit and, therefore, the effectiveness of face masks. It is well recognized that improving fit tends to improve mask effectiveness, but whether these fit modifiers are reliable remains unexplored. In this study, we assess a range of common “fit hacks” to determine their ability to improve mask performance. Methods Between July and September 2020, qualitative fit testing was performed in an indoor living space. We used quantitative fit testing to assess the fit of both surgical masks and KN95 masks, with and without ‘fit hacks’, on four participants. Seven fit hacks were evaluated to assess impact on fit. Additionally, one participant applied each fit hack multiple times to assess how reliable hacks were when reapplied. A convenience of four participants took part in the study, three females and one male with a head circumference range of 54 to 60 centimetres. Results and discussion The use of pantyhose, tape, and rubber bands were effective for most participants. A pantyhose overlayer was observed to be the most effective hack. High degrees of variation were noted between participants. However, little variation was noted within participants, with hacks generally showing similar benefit each time they were applied on a single participant. An inspection of the fit hacks once applied showed that individual facial features may have a significant impact on fit, especially the nose bridge. Conclusions Fit hacks can be used to effectively improve the fit of surgical and KN95 masks, enhancing the protection provided to the wearer. However, many of the most effective hacks are very uncomfortable and unlikely to be tolerated for extended periods of time. The development of effective fit-improvement solutions remains a critical issue in need of further development.
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Affiliation(s)
- Eugenia O’Kelly
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Anmol Arora
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Sophia Pirog
- Feinberg School of Medicine, Northwestern University, Evanston, IL, United States of America
| | - Charlotte Pearson
- Lundquist College of Business, University of Oregon, Eugene, OR, United States of America
| | - James Ward
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - P. John Clarkson
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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Chandankhede U, Arora A, Prakash G, Pal M, Tummala M, Mohan A, Bakshi G. Outcomes of penile cancer stratified by nodal staging: Importance of pelvic nodal involvement. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00772-2] [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: 11/27/2022]
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35
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Arora A, Prakash G, Pal M, Chandankhede U, Tummala M, Mohan A, Bakshi G, Chandankhede U, Chandankhede U. Patterns of recurrence in penile cancer: Implications for surveillance strategies. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00774-6] [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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36
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Lovejoy CA, Arora A, Buch V, Dayan I. Key considerations for the use of artificial intelligence in healthcare and clinical research. Future Healthc J 2021; 9:75-78. [DOI: 10.7861/fhj.2021-0128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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37
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Kalra M, Bakhshi S, Singh M, Seth R, Verma N, Jain S, Radhakrishnan V, Mandal P, Mahajan A, Arora R, Dinand V, Kapoor G, Sajid M, Thulkar S, Arora A, Taluja A, Chandra J. PET-CT vs CECT for response assessment in childhood Hodgkin Lymphoma - Subset analysis of InPOG HL-15-01 study. Pediatric Hematology Oncology Journal 2021. [DOI: 10.1016/j.phoj.2022.04.011] [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: 10/18/2022] Open
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38
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39
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Eapen V, Woolfenden S, Schmied V, Jalaludin B, Lawson K, Liaw ST, Lingam R, Page A, Cibralic S, Winata T, Mendoza Diaz A, Lam-Cassettari C, Burley J, Boydell K, Lin P, Masi A, Katz I, Dadich A, Preddy J, Bruce J, Raman S, Kohlhoff J, Descallar J, Karlov L, Kaplun C, Arora A, Di Mento B, Smead M, Doyle K, Grace R, McClean T, Blight V, Wood A, Raine KH. "Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol. BMC Health Serv Res 2021; 21:1240. [PMID: 34789234 PMCID: PMC8596348 DOI: 10.1186/s12913-021-07243-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/29/2021] [Indexed: 11/11/2022] Open
Abstract
Background The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) – developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents’ mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the ‘care-as-usual’ group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and ‘warm hand over’ by a ‘service navigator’ to ensure their needs are met. Methods Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the ‘care-as-usual’ or ‘intervention’ group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. Conclusions Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. Trial registration The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.
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Affiliation(s)
- V Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia. .,South Western Sydney Local Health District, Liverpool, Australia.
| | - S Woolfenden
- Sydney Children's Hospital Randwick, Randwick, Australia
| | - V Schmied
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - B Jalaludin
- South Western Sydney Local Health District, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - K Lawson
- School of Business, Western Sydney University, Sydney, Australia
| | - S T Liaw
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,WHO Collaborating Centre for eHealth, University of New South Wales, Sydney, Australia
| | - R Lingam
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - A Page
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - S Cibralic
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - T Winata
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Mendoza Diaz
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - C Lam-Cassettari
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - J Burley
- Population Child Health Research Group, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - K Boydell
- Black Dog Institute, Sydney, Australia
| | - P Lin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,South Western Sydney Local Health District, Liverpool, Australia
| | - A Masi
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - I Katz
- Social Policy Research Centre, Faculty of Arts, Design, & Architecture, University of New South Wales, Sydney, Australia
| | - A Dadich
- School of Business, Western Sydney University, Sydney, Australia
| | - J Preddy
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - J Bruce
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - S Raman
- South Western Sydney Local Health District, Liverpool, Australia
| | - J Kohlhoff
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Karitane, Carramar, Australia
| | - J Descallar
- Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - L Karlov
- South Western Sydney Local Health District, Liverpool, Australia
| | - C Kaplun
- Ingham Institute for Applied Medical Research, Liverpool, Australia.,TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | - A Arora
- School of Health Sciences, Western Sydney University, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - B Di Mento
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - M Smead
- Murrumbidgee Local Health District, Wagga Wagga, Australia
| | - K Doyle
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - R Grace
- TeEACH -Transforming early Education and Child Health Research Centre, Western Sydney University, Sydney, Australia
| | | | - V Blight
- South Western Sydney Local Health District, Liverpool, Australia
| | - A Wood
- Karitane, Carramar, Australia
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Kumar S, Ashok V, Jain D, Arora A, Singh A, Sikka P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study. Int J Obstet Anesth 2021; 49:103235. [PMID: 34810053 DOI: 10.1016/j.ijoa.2021.103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Received: 05/07/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. METHODS In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. RESULTS The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min). CONCLUSION The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.
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Affiliation(s)
- S Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - V Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
| | - D Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Singh
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - P Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
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Arshad Z, Maughan HD, Pettit MH, Kumar KHS, Arora A, Khanduja V. 1300 Version Abnormalities of the Femur and Acetabulum in Patients with Femoroacetabular Impingement: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
This systematic review aims to understand the relationship between version abnormalities of the femur and acetabulum in patients with primary and secondary femoroacetabular impingement (FAI).
Method
A systematic review was conducted according to PRISMA guidelines. A computer-based search was performed using the EMBASE, MEDLINE, PubMed and Cochrane databases for articles relating to version and torsional abnormalities in FAI, Legg-Calve-Perthes disease (LCPD) and slipped capital femoral epiphysis (SCFE). The study was registered in the Open Science Framework. Two authors independently performed title/abstract and full text screening according to predetermined inclusion criteria.
Results
A total of 1206 articles were identified 55 articles, involving 10, 091 hips, met the inclusion criteria. All studies evaluating femoral/acetabular version in FAI reported ‘normal’ mean version values (10o to 25o). However, distribution analysis revealed that an estimated 31.4% and 51.3% of patients with FAI displayed abnormal acetabular and femoral version, respectively. Abnormal femoral version was reported in an estimated 74.5% of hips with LCPD, and abnormal acetabular version in an estimated 20%. Acetabular version was significantly lower in hips with SCFE compared to controls (Z=-3.26, P < 0.01).
Conclusions
Patients presenting with hip pain attributed to FAI are likely to display an abnormality in femoral or acetabular version. This highlights the importance of evaluating these parameters during assessment of these patients, in order to guide clinical decision making.
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Affiliation(s)
- Z Arshad
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - H D Maughan
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - M H Pettit
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | - K H S Kumar
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - A Arora
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - V Khanduja
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's hospital, Cambridge university Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1075] [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]
Abstract
Abstract
Aim
Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy.
Method
1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre.
Results
There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p < 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p < 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145).
Conclusions
SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.
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Affiliation(s)
- A Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - M Fricker
- University of Newcastle, Newcastle, United Kingdom
| | - R De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - A Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Y Phuah
- University College London, London, United Kingdom
| | - K Flora
- University College London, London, United Kingdom
| | - S Patel
- University College London, London, United Kingdom
| | - V Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - A Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - G Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - J Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - T Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - P Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - P Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - S Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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Arora A, Raffaele A, Agarwala S, Parigi GB, Manzoni F, Klersy C, Bhatnagar V. 1124 Is Delayed Presentation A Prognostic Factor for The Survival of Patients with Esophageal Atresia More Than Associated Anomalies? Comparison Between Different Social Realities. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The aim is to evaluate if different social reality could represent a prognostic factor as associated anomalies affecting survival of neonates with esophageal atresia (EA).
Method
Retrospective analysis of records of neonates with EA with or without Tracheoesophageal Fistula (TEF) from January 2011 to September 2018 at Policlinico San Matteo Pavia, Italy(SMAT) and the All India Institute of Medical Sciences New Delhi, India (AIIMS).Survival was correlated with the presence of anomalies, different types and the number of organ systems involved.Age at presentation and birth weight were considered to find an association with mortality.
Results
Out of 180 patients,162 were from AIIMS and 18 from SMAT.The overall mortality was 28.85%, which occurred at AIIMS, being 0% at SMAT.83.33% at SMAT and 72.84% at AIIMS had associated anomalies.The mortality was 25% for neonates without an anomaly, being 26.15% for those with one (p > 0.05).No statistically significant correlation between outcome and associated anomalies was found.Instead, survival declines gradually as the age at presentation increases.
Conclusions
The presence of associated anomalies paradoxically does not affect the outcome because incidence of delayed presentation has a stronger effect than the presence of associated anomalies. Sensibilization is necessary to improve survival in EA neonates in developing countries, such as India.
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Affiliation(s)
- A Arora
- Università Degli Studi di Pavia, Pavia, Italy
| | - A Raffaele
- Università Degli Studi di Pavia, Pavia, Italy
| | - S Agarwala
- All India Institute of Medical Sciences, New Delhi, India
| | - G B Parigi
- Università Degli Studi di Pavia, Pavia, Italy
| | - F Manzoni
- Università Degli Studi di Pavia, Pavia, Italy
| | - C Klersy
- Università Degli Studi di Pavia, Pavia, Italy
| | - V Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
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Kathiravelupillai A, Arora A, Jeannon JP, Brunet-Garcia A, Faulkner J, Sandison A. 1079 Analysis of Human Papilloma Virus (HPV) Status in Metastatic Oropharyngeal Squamous Cell Carcinoma (OPSCC). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
OPSCC often (80%) presents with ipsilateral neck metastasis. Presentation may be as carcinoma of unknown primary (CUP). Sampling via ultrasound guided Fine Needle Aspiration Cytology (FNAC) and/or Core Biopsy (CB) from nodal metastases is required for diagnosis, comparison with primary tumour and to assess human papilloma virus (HPV) status. HPV positive biopsy from CUP may indicate oropharynx primary. HPV positive OPSCC has better prognosis. HPV association is ascertained by p16 immunocytochemistry (p16- IHC) and HPV DNA in situ hybridization (HPV-ISH). In a cohort of OPSCC patients from a single referral centre 68% had metastatic disease. Core biopsy was optimal for HPV testing.
Method
Retrospective review of records from Transoral Robotic Surgery (TORS) patients treated for OPSCC between December 2017-2019 was conducted. Cohort included patients undergoing TORS for diagnostic purposes and with curative intent.
Results
Data was available from 23 patients who had TORS for OPSCC. 47.8% (n = 11) presented with lymphadenopathy. 82.6% (n = 19) underwent FNAC. 68.4% (n = 13) were diagnosed with metastatic OPSCC and 56.5% (n = 13) underwent neck dissections. 52.2% (n = 12) had confirmed HPV positive metastases, 75% (n = 9) had 1 node positive, 25% (n = 3) had >1 node positive. FNAC yielded enough tissue for p16 IHC and HPV-ISH in 10.5% (n = 2). CB yielded sufficient tissue for analysis in all cases 39.1% (n = 9).
Conclusions
The study confirms high incidence of neck metastases in HPV associated OPSCC patients. Needle core biopsy appears superior to FNAC for tissue sampling to assess HPV status in tumours metastatic to neck.
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Affiliation(s)
| | - A Arora
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Brunet-Garcia
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - J Faulkner
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - A Sandison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Gao C, Al-Lami A, Al-Zuhir N, Simo R, Arora A, Jeannon JP. 1692 No Longer Unknown: A Systematic Review & Meta-Analysis of The Effectiveness of Trans-Oral Surgical Techniques in Identifying Head and Neck Primary Cancer in Carcinoma Unknown Primary. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.034] [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]
Abstract
Abstract
Aim
The use of transoral robotic surgery (TORS), transoral laser microsurgery (TLM) and more recently reported transoral endoscopic electrocautery (TOEC) in the identification of the primary cancer in CUP patients has gained popularity. This systematic review aims to assess the effectiveness of TORS, TLM and TOEC.
Method
A systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting methodology was carried out to assess the effectiveness of the three trans-oral surgical techniques. EMBASE, MEDLINE and CINAHL databases were searched from inception to September 2020. Primary outcome measure was detection rates of primary cancer of the different techniques. Secondary outcome measures were complications and length of hospital stay.
Results
289 studies were identified of which 30 met the inclusion criteria (28 case series and 2 case reports). The overall combined primary identification rate was 72.3% (567 /777 patients). The primary identification rates were 49.7% and 34.2% in lingual (n = 273) and palatine tonsillectomy (n = 118) respectively. The primary cancer identification rates by surgical techniques are: TORS was 60% (CI 0.49, 0.70), TLM was 80% (CI 0.58, 1.01), TOEC was 41% (CI 0.05, 0.76). The commonest complication was haemorrhage (5.3%).
Conclusions
This is the largest systematic review in the subject and incorporates the more recently published surgical technique of TOEC. Lingual tonsillectomy is an effective procedure in CUP work up. Further larger, multi-centre, prospective studies of PET CT negative CUP patients is needed to draw conclusive results
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Affiliation(s)
- C Gao
- William Harvey Hospital, Ashford, United Kingdom
| | - A Al-Lami
- William Harvey Hospital, Ashford, United Kingdom
| | - N Al-Zuhir
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - R Simo
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - A Arora
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
| | - J P Jeannon
- Guys' and St. Thomas's NHS Foundation Trust, London, United Kingdom
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Kumar M, Kumar M, Kumar Jha A, Arora A. Snapshots Quiz. Br J Surg 2021; 108:1104. [PMID: 34160031 DOI: 10.1093/bjs/znab227] [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: 05/13/2021] [Accepted: 05/23/2021] [Indexed: 11/13/2022]
Abstract
A 55-year-old male presented with a 6 month history of multiple swellings on the right buttock and sacral region with yellowish discharge. The patient frequently walked bare foot, but denied any history trauma. Fine needle aspirate cytology showed acute dense inflammation, nuclear debris and numerous filamentous bacilli, which on staining revealed gram positive bacilli. What is the diagnosis?
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Affiliation(s)
- M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - M Kumar
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Kumar Jha
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
| | - A Arora
- Department of General Surgery, All India Institute of Medical Sciences, Patna, India
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Arora A, Wright A, Cheng TKM, Khwaja Z, Seah M. Innovation Pathways in the NHS: An Introductory Review. Ther Innov Regul Sci 2021; 55:1045-1058. [PMID: 34009551 PMCID: PMC8132486 DOI: 10.1007/s43441-021-00304-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/05/2021] [Indexed: 01/02/2023]
Abstract
Healthcare as an industry is recognised as one of the most innovative. Despite heavy regulation, there is substantial scope for new technologies and care models to not only boost patient outcomes but to do so at reduced cost to healthcare systems and consumers. Promoting innovation within national health systems such as the National Health Service (NHS) in the United Kingdom (UK) has been set as a key target for health care professionals and policy makers. However, while the UK has a world-class biomedical research industry, several reports in the last twenty years have highlighted the difficulties faced by the NHS in encouraging and adopting innovations, with the journey from idea to implementation of health technology often taking years and being very expensive, with a high failure rate. This has led to the establishment of several innovation pathways within and around the NHS, to encourage the invention, development and implementation of cost-effective technologies that improve health care delivery. These pathways span local, regional and national health infrastructure. They operate at different stages of the innovation pipeline, with their scope and work defined by location, technology area or industry sector, based on the specific problem identified when they were set up. In this introductory review, we outline each of the major innovation pathways operating at local, regional and national levels across the NHS, including their history, governance, operating procedures and areas of expertise. The extent to which innovation pathways address current challenges faced by innovators is discussed, as well as areas for improvement and future study.
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0SP, UK.
| | - Andrew Wright
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Tsz Kin Mark Cheng
- Department of Medical Sciences, Faculty of Biology, University of Cambridge, Cambridge, UK
| | - Zahra Khwaja
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Matthew Seah
- Department of Surgery, University of Cambridge, Cambridge, UK
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Rai A, Arora A, Jain A, Panneerselvam E. Modified vertical osteotomy cut in bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2021; 59:965-967. [PMID: 34456077 DOI: 10.1016/j.bjoms.2020.10.018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/23/2020] [Indexed: 11/15/2022]
Abstract
Bilateral sagittal split osteotomy (BSSO) is the most common orthognathic surgical procedure for the correction of facial deformities. Like any other surgical procedure, it is also associated with a risk of complications. One of these is described in the literature as notching at the lower inferior border of the mandible. Such discontinuity in the contour of the lower border is often a concern for patients. To overcome this complication, we recommend a modified vertical osteotomy cut while performing BSSO.
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Affiliation(s)
- A Rai
- Department of Dentistry, AIIMS, Saket Nagar, Bhopal, MP, India.
| | - A Arora
- Department of Oral and Maxillofacial Surgery, Shree Bankey Bihari Dental College & Research Centre, Ghaziabad, UP, India.
| | | | - E Panneerselvam
- Department of Oral and Maxillofacial Surgery, SRM Dental College & Hospital, Chennai, India.
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Raniga S, Parikh N, Arora A, Vaghani M, Vora PA, Vaidya V. Is HRCT reliable in determining disease activity in pulmonary tuberculosis? Indian J Radiol Imaging 2021. [DOI: 10.4103/0971-3026.29096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abstract
Aims and Objectives
The purpose of our study is to [1] determine the activity of disease based on the HRCT findings (2) to define indications for the use of HRCT in evaluation of Pulmonary TB and (3) to determine whether additional information provided by HRCT alters clinical management of the disease.
Materials and Methods
The present study was carried out at Shree Sayajirao General Hospital (SSGH), Baroda, Gujarat, India from January 2002 to December 2002. Twenty five patients with sputum positive post-primary pulmonary TB were studied prospectively with chest radiographs and HRCT. The diagnosis of active TB was based on detection of acid-fast bacilli in sputum. None of the patients in our study population was HIV positive. All patients underwent x-ray chest and HRCT chest (Philips Tomoscan, Best, Netherlands). The pattern, extent and severity of HRCT findings were recorded and compared with the plain x-ray findings. The gathered information and investigations were subjected to statistical analysis.
Results
Our study population consisted of sputum positive (AFB positive) 25 patients, 22 of them were newly diagnosed/suspected post-primary tuberculosis (GROUP 1) and 3 of them had taken six months of AKT (GROUP 2). Our study included 22 males and 3 females with average age of 38 years (range, 14-65 years.) In total chest radiographic signs of active tuberculosis were seen in twelve (48%) patients. HRCT showed evidences of active tuberculosis in all 22 patients of newly diagnosed tuberculosis; and in 2 out of 3 patients with prior history of AKT. Thus, total of 24 (96%) patients had evidence of active pulmonary TB on HRCT. One patient with prior history of AKT showed evidence of pulmonary Koch′s sequel.
Conclusion
Although chest radiography remains the foremost imaging technique in the evaluation of pulmonary TB, HRCT can be useful in certain circumstances and can provide important information in the diagnosis and management of the disease. HRCT is helpful in the distinction of active form inactive TB. HRCT is better than plain chest radiograph in identification of extent of pulmonary TB, especially subtle areas of consolidation, cavitation, bronchogenic and miliary spread. HRCT is recommended when the radiographic findings are normal or inconclusive and tuberculosis is suspected clinically for the confirmation of diagnosis and determination of activity.
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Affiliation(s)
- S Raniga
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - N Parikh
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - A Arora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - M Vaghani
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - P A Vora
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
| | - V Vaidya
- Department of Radiology, S.S.G. Hospital and Medical College, Vadodara, India
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50
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Ramskold L, Lemaître S, Arora A. Iris metastasis from renal cell carcinoma. J Fr Ophtalmol 2021; 44:1278-1280. [PMID: 34353666 DOI: 10.1016/j.jfo.2021.02.008] [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] [Received: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 10/20/2022]
Affiliation(s)
- L Ramskold
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom.
| | - S Lemaître
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
| | - A Arora
- Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, 162, City Road, London, EC1V 2PD, United Kingdom
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