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Drane DL, Acerbo E, Rogers A, Pedersen NP, Williamson A, Stern MA, Dickey AS, Howard BM, Bearden DJ, Okada N, Staikova E, Gutekunst CA, Alwaki A, Gershon T, Jirsa V, Gross RE, Loring DW, Kheder A, Willie JT. Selective Posterior Cerebral Artery Wada Better Predicts Good Memory and Naming Outcomes Following Selective Stereotactic Thermal Ablation for Medial Temporal Lobe Epilepsy Than Internal Carotid Artery Wada. medRxiv 2024:2024.03.24.24304488. [PMID: 38585976 PMCID: PMC10996748 DOI: 10.1101/2024.03.24.24304488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
The conventional intracarotid amobarbital (Wada) test has been used to assess memory function in patients being considered for temporal lobe epilepsy (TLE) surgery. Minimally invasive approaches that target the medial temporal lobe (MTL) and spare neocortex are increasingly used, but a knowledge gap remains in how to assess memory and language risk from these procedures. We retrospectively compared results of two versions of the Wada test, the intracarotid artery (ICA-Wada) and posterior cerebral artery (PCA-Wada) approaches, with respect to predicting subsequent memory and language outcomes, particularly after stereotactic laser amygdalohippocampotomy (SLAH). We included all patients being considered for SLAH who underwent both ICA-Wada and PCA-Wada at a single institution. Memory and confrontation naming assessments were conducted using standardized neuropsychological tests to assess pre- to post-surgical changes in cognitive performance. Of 13 patients who initially failed the ICA-Wada, only one patient subsequently failed the PCA-Wada (p=0.003, two-sided binomial test with p 0 =0.5) demonstrating that these tests assess different brain regions or networks. PCA-Wada had a high negative predictive value for the safety of SLAH, compared to ICA-Wada, as none of the patients who underwent SLAH after passing the PCA-Wada experienced catastrophic memory decline (0 of 9 subjects, p <.004, two-sided binomial test with p 0 =0.5), and all experienced a good cognitive outcome. In contrast, the single patient who received a left anterior temporal lobectomy after failed ICA- and passed PCA-Wada experienced a persistent, near catastrophic memory decline. On confrontation naming, few patients exhibited disturbance during the PCA-Wada. Following surgery, SLAH patients showed no naming decline, while open resection patients, whose surgeries all included ipsilateral temporal lobe neocortex, experienced significant naming difficulties (Fisher's exact test, p <.05). These findings demonstrate that (1) failing the ICA-Wada falsely predicts memory decline following SLAH, (2) PCA-Wada better predicts good memory outcomes of SLAH for MTLE, and (3) the MTL brain structures affected by both PCA-Wada and SLAH are not directly involved in language processing.
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Savcisens G, Eliassi-Rad T, Hansen LK, Mortensen LH, Lilleholt L, Rogers A, Zettler I, Lehmann S. Using sequences of life-events to predict human lives. Nat Comput Sci 2024; 4:43-56. [PMID: 38177491 DOI: 10.1038/s43588-023-00573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/15/2023] [Indexed: 01/06/2024]
Abstract
Here we represent human lives in a way that shares structural similarity to language, and we exploit this similarity to adapt natural language processing techniques to examine the evolution and predictability of human lives based on detailed event sequences. We do this by drawing on a comprehensive registry dataset, which is available for Denmark across several years, and that includes information about life-events related to health, education, occupation, income, address and working hours, recorded with day-to-day resolution. We create embeddings of life-events in a single vector space, showing that this embedding space is robust and highly structured. Our models allow us to predict diverse outcomes ranging from early mortality to personality nuances, outperforming state-of-the-art models by a wide margin. Using methods for interpreting deep learning models, we probe the algorithm to understand the factors that enable our predictions. Our framework allows researchers to discover potential mechanisms that impact life outcomes as well as the associated possibilities for personalized interventions.
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Affiliation(s)
| | - Tina Eliassi-Rad
- Network Science Institute, Northeastern University, Boston, MA, USA
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, USA
| | - Lars Kai Hansen
- DTU Compute, Technical University of Denmark, Lyngby, Denmark
| | - Laust Hvas Mortensen
- Data Science Lab, Statistics Denmark, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lau Lilleholt
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Anna Rogers
- Computer Science Department, IT University of Copenhagen, Copenhagen, Denmark
| | - Ingo Zettler
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Sune Lehmann
- DTU Compute, Technical University of Denmark, Lyngby, Denmark.
- Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark.
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Chatelain LS, Kourilsky A, Lot G, Rogers A. Airo® navigation versus freehand fluoroscopy technique: A comparative study of accuracy and radiological exposure for thoracolumbar screws placement. Neurochirurgie 2023; 69:101437. [PMID: 36967084 DOI: 10.1016/j.neuchi.2023.101437] [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: 10/21/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE The aim was to compare the accuracy of freehand fluoroscopy and CT based navigation on thoracolumbar screws placement and their respective effects on radiological exposure to the patient. No previous study directly compared the Airo® navigation system to freehand technique. METHODS In this monocentric retrospective study, 156 consecutive patients who underwent thoracolumbar spine surgery were included. Epidemiological data and surgical indications were noted. Heary classification was used for thoracic screws and Gertzbein-Robbins classification for lumbar screws. Radiological exposure was collected for each surgery. RESULTS A total of 918 screws were implanted. We analyzed 725 lumbar screws (Airo® 287; freehand fluoroscopy 438) and 193 thoracic screws (Airo® 49; freehand fluoroscopy 144). Overall, lumbar screws accuracy (Gertzbein-Robbins grade A and B) was good in both groups (freehand fluoroscopy 91.3%; Airo® 97.6%; P<0.05). We found significantly less Grade B and C in the Airo® group. Thoracic accuracy was also good in both groups (Heary 1 and 2; freehand fluoroscopy 77.8%; Airo® 93.9%), without reaching statistical significance. Radiological exposure was significantly higher in the Airo® group with a mean effective dose of 9.69 mSv versus 0.71mSv for freehand fluoroscopy. CONCLUSION Our study confirmed that the use of Airo® navigation yielded good accuracy. It however exposed the patient to higher radiological exposure compared with freehand fluoroscopy technique. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- L S Chatelain
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France.
| | - A Kourilsky
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - G Lot
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France
| | - A Rogers
- Fondation Rothschild, Department of Neurosurgery, 25-29, rue Manin, 75019 Paris, France; American Hospital of Paris, 55, boulevard du Château, 92200 Neuilly-sur-Seine, France
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Brent DA, Grupp-Phelan J, O’Shea BA, Patel SJ, Mahabee-Gittens EM, Rogers A, Duffy SJ, Shenoi RP, Chernick LS, Casper TC, Webb MW, Nock MK, King CA. A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients. Psychol Med 2023; 53:123-131. [PMID: 33947480 PMCID: PMC8568726 DOI: 10.1017/s0033291721001215] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. METHODS A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. RESULTS A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). CONCLUSIONS In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.
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Affiliation(s)
- D. A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - J. Grupp-Phelan
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - B. A. O’Shea
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Department of Psychology, University of Amsterdam, Netherlands
| | - S. J. Patel
- Departments of Emergency Medicine and Trauma Services at the Children’s National Health System, USA
| | | | - A. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - S. J. Duffy
- Departments of Emergency Medicine and Pediatrics at the Alpert Medical School at Brown University, USA
| | - R. P. Shenoi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - L. S. Chernick
- Department of Emergency Medicine, Columbia University, New York, NY, USA
| | - T. C. Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - M. W. Webb
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - M. K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - C. A. King
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Deb B, Selvalingam A, Alhusseini M, Rogers A, Ganesan P, Feng R, Clopton P, Ruiperez-Campillo S, Narayan S. Machine-learned physiological signatures from the ECG predict sudden death in ischemic cardiomyopathy. Europace 2022. [DOI: 10.1093/europace/euac053.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH)
Background
Low left ventricular ejection fraction (LVEF) is an imperfect predictor of sudden cardiac death (SCD) in patients with ischemic cardiomyopathy. Novel features from the ECG might provide a readily available tool to better predict risk.
Purpose
We hypothesized that machine learning (ML) of the ECG can be used to predict SCD, and the ML-learned ECG features could be referenced to interpretable intracardiac signals (monophasic action potentials: MAP) to provide mechanistic insights.
Methods
We studied 5603 ECG Lead V1 beats in 41 patients (64±10 Y) with coronary disease and LVEF≤40% in steady-state pacing. Patients were randomly allocated to independent training and test cohorts in a 70:30 ratio, repeated K=10-fold. Support vector machines were trained to predict mortality at 3Y from the top 20 features derived from these beats. Patient-level predictions were made by computing an ECG score that indicates the proportion of test set beats in that patient computed by the beat-level model to predict death. Explainability analysis was performed using the arithmetic mean of MAP and ECG beats that predicted SCD versus those that predicted survival.
Results
Fig 1A. shows ECG lead V1 and MAP in a 79 Y man with LVEF 29%. Fig 1B shows the dataflow in the study. Predictive accuracies of ML models were 78 and 70% and optimal with 20 features for both ECG and MAP models respectively (Fig. 1C). Beat-level predictions in the validation (n=1678 Lead I beats) cohorts yielded c-statistics of 0.78 with the ECG (95% CI, 0.62–0.91) and 0.75 with MAPs (95% CI, 0.75-0.76) (data not shown). In multivariable patient-level models, c-statistic was 0.87 with ECGs (95% CI, 0.76-0.98) (Fig 1D) and 0.82 with MAPs. On explainability analysis, ECG beats that predicted SCD (Fig 2; red) had lower amplitude and more notched T-waves in lead V1 than beats that predicted no SCD (Fig 2; blue). MAP that predicted SCD had higher repolarization current at the same time points. Both QT duration (ECG) and action potential duration (MAP) did not differ (Fig 2).
Conclusions
Machine learning of the ECG reveals novel predictors of SCD risk in patients with ischemic cardiomyopathy analogous to those identified in intracardiac signals. This approach can be used as a point-of-care ECG risk tool to improve risk stratification and allocation for ICD therapy beyond LVEF alone and may shed insights into the pathophysiology of ventricular arrhythmias.
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Affiliation(s)
- B Deb
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - A Selvalingam
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - M Alhusseini
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - A Rogers
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - P Ganesan
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - R Feng
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - P Clopton
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - S Ruiperez-Campillo
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
| | - S Narayan
- Stanford University School of Medicine, Cardiology, Palo Alto, United States of America
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Mahajan R, Adams A, Allmond J, Alvarez Pol H, Argo E, Ayyad Y, Bardayan D, Bazin D, Budner T, Chen A, Chipps K, Davids B, Dopfer J, Friedman M, Fynbo H, Grzywacz R, Jose J, Liang J, Pain S, Perez-Loureiro D, Pollacco E, Psaltis A, Ravishankar S, Rogers A, Schaedig L, Sun LJ, Surbrook J, Wheeler T, Weghorn L, Wrede C. Measuring the 15O( α, γ) 19Ne Reaction in Type I X-ray Bursts using the GADGET II TPC: Software. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202226011034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
15O(α,γ)19Ne is regarded as one of the most important thermonuclear reactions in type I X-ray bursts. For studying the properties of the key resonance in this reaction using β decay, the existing Proton Detector component of the Gaseous Detector with Germanium Tagging (GADGET) assembly is being upgraded to operate as a time projection chamber (TPC) at FRIB. This upgrade includes the associated hardware as well as software and this paper mainly focusses on the software upgrade. The full detector set up is simulated using the ATTPCROOTv 2 data analysis framework for 20Mg and 241Am.
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Wheeler T, Adams A, Allmond J, Alvarez Pol H, Argo E, Ayyad Y, Bardayan D, Bazin D, Budner T, Chen A, Chipps K, Davids B, Dopfer J, Friedman M, Fynbo H, Grzywacz R, Jose J, Liang J, Mahajan R, Pain S, Pérez-Loureiro D, Pollacco E, Psaltis A, Ravishankar S, Rogers A, Schaedig L, Sun LJ, Surbrook J, Weghorn L, Wrede C. Measuring the 15O(α, γ) 19Ne reaction in Type I X-ray bursts using the GADGET II TPC: Hardware. EPJ Web Conf 2022. [DOI: 10.1051/epjconf/202226011046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Sensitivity studies have shown that the 15O(α, γ)19Ne reaction is the most important reaction rate uncertainty affecting the shape of light curves from Type I X-ray bursts. This reaction is dominated by the 4.03 MeV resonance in 19Ne. Previous measurements by our group have shown that this state is populated in the decay sequence of 20Mg. A single 20Mg(βp α)15O event through the key 15O(α, γ)19Ne resonance yields a characteristic signature: the emission of a proton and alpha particle. To achieve the granularity necessary for the identification of this signature, we have upgraded the Proton Detector of the Gaseous Detector with Germanium Tagging (GADGET) into a time projection chamber to form the GADGET II detection system. GADGET II has been fully constructed, and is entering the testing phase.
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Geraghty R, Fowler W, Suntharasivam T, Thomas D, Rix D, Haslam P, Dorkin T, Williams R, Rogers A, Shaw M. Use of allium ureteral stents for managing iatrogenic ureteric injuries. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01046-6] [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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Valencia-Laver D, Buchanan B, McPheron C, Rogers A, DeTurck A, Shapiro J, Laver G. Examining the Efficacy and Results of a Short-Form Alzheimer's Survey With College Students. Innov Aging 2021. [PMCID: PMC8680455 DOI: 10.1093/geroni/igab046.1882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
College students are important stakeholders in addressing the significant costs of Alzheimer’s disease in their future roles as caretakers, health care consumers, taxpayers, and as individuals in the workforce whose careers may interact with and impact those with Alzheimer’s and their caregivers. To assess their knowledge of Alzheimer’s, a 10-item True/False on-line quiz was presented to 912 students in Introductory Psychology classes. Participants were 61% white, 13% Asian/Asian American, and 10% Latinx, with 14% reporting other racial and ethnic groups, including that of mixed heritage; 59% of the sample self-reported as female. The quiz was counterbalanced such that items appearing in one format (e.g., True) appeared in the other format (e.g., False) across the two forms of the quiz. A significant difference was found for percent correct in Form A (61.4%) versus Form B (59.3%). In order to prompt participants to consider the ways the disease may impact their own lives, additional questions examined students’ own experience with Alzheimer’s, their interest and willingness to take action towards supporting Alzheimer’s research, and their perceptions about how Alzheimer’s would impact their lives personally, financially, and in their career pursuits. The research extends the findings of earlier research on student knowledge of Alzheimer’s (e.g., Bailey, 2000; Eshbaugh, 2014) by allowing the results to be broken down by gender, race/ethnicity, and student major. It also expands upon those findings by identifying how college students project the societal effects and costs of Alzheimer’s to their own lives and livelihoods.
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Affiliation(s)
- Debra Valencia-Laver
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Brooke Buchanan
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Chelsea McPheron
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Anna Rogers
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Alex DeTurck
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Jasmine Shapiro
- California Polytechnic State University, San Luis Obispo, Cal Poly/San Luis Obispo, California, United States
| | - Gary Laver
- California Polytechnic State University, San Luis Obispo, Cal Poly, San Luis Obispo, California, United States
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11
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Jenkins P, MacCormick A, Stokes J, Lyall F, Rogers A, Gafoor N. Learning from mistakes when reporting urgent and emergency vascular studies. Clin Radiol 2021; 77:159-166. [PMID: 34903386 DOI: 10.1016/j.crad.2021.10.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
The majority of out-of-hours cases relate to neurological, chest, and gastrointestinal pathologies with acute vascular cases being encountered less commonly. Trainees and exposure of non-vascular/interventional radiology (IR) consultants to angiographic imaging is often limited in working hours and this may lead to reporting on-call cases outside of normal daytime practice. In a recent local review, a number on-call vascular studies were found to contain a number of vascular-related discrepancies. Vascular reporting is a complex subspecialty, which comprises many clear diagnoses (large vessel occlusions, large vessel aneurysms, or dissections); however, also several subtle and complex abnormalities. These more subtle abnormalities, at times, require dedicated vascular specialist review to ensure subtle findings are communicated appropriately to the clinical team. The recent increased complexity of endovascular treatments and their complications has also provided further challenge for the non-specialist reporter. Similarly, improved imaging techniques have allowed for non-obvious but significant findings that may require urgent management, such as small aneurysms and dissection flaps. We will review a range of key vascular findings that demonstrate learning opportunities, particularly within the acute and on-call settings. These will include gastrointestinal haemorrhage, subtle aortic pathologies, head and neck vascular emergencies, small to mid-sized vessel injuries and imaging of post-procedural complications. Educational hints and tips will be provided to enable learning from mistakes encountered by trainees and non-vascular specialist radiologists in the on-call or urgent reporting settings, and these will be reviewed with reference to the literature.
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Affiliation(s)
- P Jenkins
- Peninsula Radiology Academy, Plymouth, UK.
| | | | - J Stokes
- Department of Neuroradiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
| | - F Lyall
- Peninsula Radiology Academy, Plymouth, UK
| | - A Rogers
- Department of Radiology, Royal Cornwall NHS Trust, Cornwall, UK
| | - N Gafoor
- Department of Interventional Radiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
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12
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Jenkins B, Rogers A, Lawson S. Use of an electronic volume based feeding protocol to improve nutrition delivery in critical care. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Wineski RE, Panico E, Karas A, Rosen P, Van Diver B, Norwood TG, Grayson JW, Beltran-Ale G, Dimmitt R, Kassel R, Rogers A, Leonard M, Chapman A, Boehm L, Wiatrak B, Harris WT, Smith N. Optimal timing and technique for endoscopic management of dysphagia in pediatric aerodigestive patients. Int J Pediatr Otorhinolaryngol 2021; 150:110874. [PMID: 34392101 DOI: 10.1016/j.ijporl.2021.110874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. METHODS A 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. RESULTS 449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). CONCLUSION In pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.
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Affiliation(s)
- R E Wineski
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
| | - E Panico
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Karas
- Department of Otorhinolaryngology- Head and Neck Surgery, Rush University School of Medicine, Chicago, IL, USA
| | - P Rosen
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - B Van Diver
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - T G Norwood
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - J W Grayson
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - G Beltran-Ale
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - R Dimmitt
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - R Kassel
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - A Rogers
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - M Leonard
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; The Charity League Hearing and Speech Center, Children's of Alabama, Birmingham, AL, USA
| | - A Chapman
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - L Boehm
- Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - B Wiatrak
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
| | - W T Harris
- Division of Pediatric Pulmonology and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA
| | - N Smith
- Department of Otolaryngology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA; Children's of Alabama Aerodigestive Program, Birmingham, AL, USA; Pediatric ENT Associates, Birmingham, AL, USA
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Abstract
Few studies have examined how work-life balance may influence college student mental health. The current study addresses this gap in the literature by examining the process by which work-life balance may lead to college student anxiety and depressive symptoms. Participants: A total of 111 students from a private Midwestern college were sampled between October 2017 and November 2017. Method: A cross-sectional survey design was used to assess work-life balance, perceived stress, anxiety, and depressive symptoms. Results: Work-life balance was negatively related to students' perceived stress, general anxiety, and depressive symptoms. Path analysis results indicate that perceived stress fully mediated the relationship between work-life balance and anxiety, as well as the relationship between work-life balance and depressive symptoms. Conclusions: Work-life balance is an important antecedent of college students' mental health. Educational institutions should place more importance on assisting students with work-life balance in order to improve their college experience.
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Affiliation(s)
- Justin M Sprung
- Department of Psychology, Luther College, Decorah, Iowa, USA
| | - Anna Rogers
- Department of Psychology, University of Northern Iowa, Cedar Falls, Iowa, USA
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15
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Al Awadhi A, Benichi S, Lot G, Rogers A. A case of intramuscular lumbar myxoma: Uncertainty in the preoperative diagnosis of a spinal soft tissue tumour. Neurochirurgie 2021; 68:530-534. [PMID: 34537211 DOI: 10.1016/j.neuchi.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/15/2022]
Abstract
We report an uncommon case of a 76-year-old woman who presented with lower back pain, an intermittent L5 radiculopathy and a right palpable paraspinal mass. Imaging studies revealed a 7-cm lumbar paraspinal pseudo-cystic soft tissue tumour developed in the paravertebral musculature, without a clear radiological diagnosis. Gross total surgical resection was performed, resulting in complete resolution of pain. Histopathological studies revealed an intramuscular (IM) myxoma. With a low positive predictive value of radiological work-up and a poor yield of percutaneous biopsies, surgery remains the mainstay treatment for these rare soft tissue tumours of the lumbar spine. Intramuscular myxomas show excellent postoperative results.
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Affiliation(s)
- A Al Awadhi
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France.
| | - S Benichi
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
| | - G Lot
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
| | - A Rogers
- Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Service de Neurochirurgie, 29, rue Manin, 75019 Paris, France
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16
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Cornelius BG, Clark D, Williams B, Rogers A, Popa A, Kilgore P, Cvek U, Trutschl M, Boykin K, Cornelius A. A retrospective analysis of calcium levels in pediatric trauma patients. Int J Burns Trauma 2021; 11:267-274. [PMID: 34336394 PMCID: PMC8310872] [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] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
Traumatic injury is a major cause of morbidity and mortality in pediatric patients. Hemorrhage is a known but treatable component of these outcomes. Evidence exists that major trauma patients are at high risk for hypocalcemia but the rate of pediatric occurrence is not documented. The purpose of this study was to determine the incidence of hypocalcemia in pediatric trauma patients, as well as to investigate any correlation between hypocalcemia and the need for transfusion and operative intervention. After IRB approval a retrospective analysis was conducted of all pediatric trauma patients seen in our Adult Level One, Pediatric Level Two trauma center. Significance testing for mortality was performed using Pearson's χ2 test. For the remaining numeric variables, association was determined one-way analysis of variance (when comparing all classes) or Welch's two-sample t-test (when comparing subsets based on calcium or mortality). In any event, significance was determined using α=0.05. A total of 2,928 patients were identified, 1623 were excluded, primarily due to incomplete data. Patients were predominantly male following blunt trauma. Initial calcium levels were 8.73 mg/dL, 95% CI [4-10.9] and 8.97 mg/dL, 95% CI [6.42-13.1] when correcting for albumin levels. Acute declines were noted when comparing initial and corrected serum calcium levels in patients requiring transfusion (7.99 mg/dL and 8.72 mg/dL) and operative intervention (8.54 mg/dL and 8.91 mg/dL). 456 (34.9%) patients required operative intervention, 138 (10.6%) required transfusion and 29 (2.2%) required massive transfusion. Patients in our cohort arrived with calcium values on the low end of normal, with a trend towards hypocalcemia if operative intervention or blood transfusion was required. This has been previously associated with increased mortality. Patients requiring operative intervention and transfusion are at increased risk for hypocalcemia and recognition of this potential is key for improved outcomes.
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Affiliation(s)
- Brian G Cornelius
- Graduate Program in Nurse Anesthesia, Texas Wesleyan UniversityFort Worth, TX, USA
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith HospitalFort Worth, TX, USA
| | - Daniel Clark
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
| | - Ben Williams
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
| | - Anna Rogers
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
| | - Andreea Popa
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
| | - Phillip Kilgore
- Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University ShreveportLA, USA
| | - Urska Cvek
- Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University ShreveportLA, USA
| | - Marjan Trutschl
- Laboratory for Advanced Biomedical Informatics, Department of Computer Science, Louisiana State University ShreveportLA, USA
| | - Kevin Boykin
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
| | - Angela Cornelius
- Department of Emergency Medicine, Louisiana State University Health Sciences CenterShreveport, LA, USA
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith HospitalFort Worth, TX, USA
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17
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Veeratterapillay R, Gravestock P, Rogers A, Harding C, Keltie K, Cognigni P, Sims A. Infective complications following ureteroscopy for stone disease: An analysis of nhs hospital episode statistics in England. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00680-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Veeratterapillay R, Geraghty R, Pandian R, Roy C, Stenhouse G, Soomro N, Paez E, Rogers A, Page T, Rix D, Thomas D, Rai B. Ten-year oncological outcomes of diagnostic ureteroscopy prior to nephroureterectomy for upper tract urothelial carcinoma. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01153-2] [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: 11/26/2022]
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19
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Rogers A, Fowler W, Williams R, Haslam P, Rix D, Suntharisavam T, Thomas D, Dorkin T, Shaw M. The use of allium metal ureteric stents in the treatment of ureteric obstruction or injury. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01273-2] [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: 11/17/2022]
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20
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Geraghty R, Wilson I, Olinger E, Cook P, Troup S, Kennedy D, Rogers A, Shaw M, Somani B, Dhayat N, Fuster D, Sayer J. Routine urinary biochemistry does not accurately predict stone type nor recurrence in kidney stone formers: A multi-centre, multi-model, externally validated machine-learning study. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00625-4] [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: 10/20/2022]
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21
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Rizvi I, Abroaf A, Veeratterapillay R, Rogers A, Shaw M, Fitzpatrick J. Management of acute ureteric colic in a large tertiary centre during the initial COVID-19 pandemic - How did our practice change? Eur Urol 2021. [PMCID: PMC8263123 DOI: 10.1016/s0302-2838(21)00636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Zhu C, Rogers A, Asleh K, Won J, Gao D, Leung S, Li S, Vij KR, Zhu J, Held JM, You Z, Nielsen TO, Shao J. Phospho-Ser 784-VCP Is Required for DNA Damage Response and Is Associated with Poor Prognosis of Chemotherapy-Treated Breast Cancer. Cell Rep 2021; 31:107745. [PMID: 32521270 PMCID: PMC7282751 DOI: 10.1016/j.celrep.2020.107745] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022] Open
Abstract
Spatiotemporal protein reorganization at DNA damage sites induced by genotoxic chemotherapies is crucial for DNA damage response (DDR), which influences treatment response by directing cancer cell fate. This process is orchestrated by valosin-containing protein (VCP), an AAA+ ATPase that extracts polyubiquinated chromatin proteins and facilitates their turnover. However, because of the essential and pleiotropic effects of VCP in global proteostasis, it remains challenging practically to understand and target its DDR-specific functions. We describe a DNA-damage-induced phosphorylation event (Ser784), which selectively enhances chromatin-associated protein degradation mediated by VCP and is required for DNA repair, signaling, and cell survival. These functional effects of Ser784 phosphorylation on DDR correlate with a decrease in VCP association with chromatin, cofactors NPL4/UFD1, and polyubiquitinated substrates. Clinically, high phospho-Ser784-VCP levels are significantly associated with poor outcome among chemotherapy-treated breast cancer patients. Thus, Ser784 phosphorylation is a DDR-specific enhancer of VCP function and a potential predictive biomarker for chemotherapy treatments.
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Affiliation(s)
- Cuige Zhu
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Anna Rogers
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karama Asleh
- Department of Pathology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jennifer Won
- Department of Pathology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Dongxia Gao
- Department of Pathology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Samuel Leung
- Department of Pathology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Shan Li
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Kiran R Vij
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jian Zhu
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jason M Held
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhongsheng You
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Torsten O Nielsen
- Department of Pathology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jieya Shao
- Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110, USA.
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23
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Rogers A, Fraser L, Geary T. 684 Use of Overnight Pulse Oximetry and STBUR Questionnaire for Paediatric OSA In A District General Setting. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.469] [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
Introduction
Overnight pulse oximetry (OPO) is often used to support the diagnosis of obstructive sleep apnoea (OSA) and stratify risk of peri-operative breathing difficulties in children undergoing adenotonsillectomy for OSA. Our objective was to audit our indications for OPO and the impact on subsequent ENT management. We sought to assess the correlation of STBUR (Snoring, Troubled-breathing, Unrefreshed Questionnaire) score with OPO values in these patients.
Method
Retrospective review of 32 OPO reports over a 7-month period. Data collected included age, weight, indication, mean spO2, number of dips >4%, outcome and STBUR score.
Results
The commonest indication (19) for OPO was to assess severity of OSA in children <3 or those with significant comorbidity to determine best setting for surgery; 50% were ultimately managed in a tertiary centre. 10 children underwent OPO due to diagnostic uncertainty but significant parental concern; all studies normal and parents reassured. STBUR score correlated poorly with number of dips >4% (R = 0.0109) and mean nadir >4% (R = 0.0031) Weight poorly recorded (19%).
Conclusions
Referrals were generally appropriate and influenced management in all cases. STBUR scores insufficiently sensitive to stratify severity of OSA. New protocol developed.
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Affiliation(s)
- A Rogers
- University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - L Fraser
- University Hospital Crosshouse, Kilmarnock, United Kingdom
| | - T Geary
- University Hospital Crosshouse, Kilmarnock, United Kingdom
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24
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Rogers A, Ramasubbu R, Ramasubbu B. 345 A Novel Study Exploring the Hidden Cost of Insufficient Investment in Computer Technology in a District General Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.009] [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
Introduction
The NHS’ move towards increasing digitisation is limited by inadequate resourcing. It is estimated 70% of a junior doctor’s time is spent completing computer-based administrative work. Aging and insufficient equipment leads to inefficiency. The objective of this study is to investigate the hidden cost of insufficient and poorly performing computer technology.
Method
Surveys were disseminated to doctors and data was collected regarding designation, ward, salary and estimated ‘minutes-waiting’ for computers to become free (CF) and to load (CL).
Results
33 surveys were completed. The hospital-wide average CF and CL were 25 minutes and 31.06 minutes respectively, with a corresponding average daily cost per doctor of £10.16 (CF) and £12.63 (CL), totalling £22.79/doctor/day. In the highest-expense ward, CF (31.66 minutes) and CL (38.33 minutes) equated to £30.28/doctor/day. Following acquisition of new hardware and re-audit, CL was significantly reduced to 20.4 minutes (p = 0.0142).
Conclusions
This study highlights the hidden cost of insufficient, poorly performing hardware. Every day the total cost of time-wasted greatly surpasses the cost of a single computer unit, illustrating the false economy of reduced capital investment in computer technology.
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Affiliation(s)
- A Rogers
- Inverclyde Royal Hospital, Greenock, United Kingdom
| | - R Ramasubbu
- University of Glasgow, Glasgow, United Kingdom
| | - B Ramasubbu
- Inverclyde Royal Hospital, Greenock, United Kingdom
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25
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Horan J, M Sahebally S, Rogers A, Winter D. O38: TACKING VERSUS NO TACKING IN LAPAROSCOPIC TOTALLY EXTRAPERITONEAL REPAIR OF PRIMARY INGUINAL HERNIA - A SYSTEMATIC REVIEW AND META-ANALYSIS. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.038] [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
The necessity of mesh fixation in laparoscopic totally extraperitoneal (TEP) inguinal hernia repair remains controversial. We performed a systematic review and meta-analysis to compare the effectiveness of mesh tacking versus no tacking in laparoscopic TEP repair for primary inguinal hernia.
Materials and Methods
PubMed, EMBASE and Cochrane databases were searched for relevant articles from inception until November 2019. All studies that compared tacking versus no tacking in TEP repairs for inguinal herniae were included. Recurrent and femoral herniae were excluded from the current analysis. The primary outcome measure was recurrence, while secondary outcomes included postoperative pain scores at discharge and at 1 month, mean operative time, length of stay and seroma rates. Random effects models were used to calculate pooled effect size estimates.
Result
Eight randomised controlled trials were included capturing 557 patients and 715 inguinal herniae. On random effects analysis, there were no significant differences between tacking and no tacking in terms of recurrence (OR 0.94, 95% CI=0.10 to 9.28, p=0.96), postoperative pain scores on discharge (Mean difference 0.82, 95% CI=-0.35 to 2.00, p=0.17) or at 1 month (Mean difference 0.53, 95% CI=-0.75 to 1.82, p=0.41), mean operative time (Mean difference 1.58 mins, 95% CI=-0.22 to 3.37, p=0.09), seroma (OR=0.70, 95% CI=0.28 to 1.74, p=0.44) or length of stay (Mean difference 0.11 days, 95% CI=-0.04 to 0.25, p=0.14).
Conclusion
Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted.
Take-home message
Mesh tacking in laparoscopic TEP repair for primary inguinal herniae does not translate into improved postoperative outcomes and may be omitted.
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Affiliation(s)
- J Horan
- Department of Colorectal Surgery, St Vincent's University Hospital, Ballsbridge, Dublin 4
| | - S M Sahebally
- Department of Colorectal Surgery, St Vincent's University Hospital, Ballsbridge, Dublin 4
| | - A Rogers
- Department of Colorectal Surgery, St Vincent's University Hospital, Ballsbridge, Dublin 4
| | - D Winter
- Department of Colorectal Surgery, St Vincent's University Hospital, Ballsbridge, Dublin 4
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26
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Geldsetzer P, Mukama T, Jawad N, Riffe T, Rogers A, Sudharsanan N. Sex differences in the mortality rate for coronavirus disease 2019 compared to other causes of death. medRxiv 2021. [PMID: 33655277 DOI: 10.1101/2021.02.23.21252314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Men are more likely than women to die due to coronavirus disease 2019 (COVID-19). This paper sets out to examine whether the magnitude of the sex differences in the COVID-19 mortality rate are unusual when compared to other common causes of death. In doing so, we aim to provide evidence as to whether the causal pathways for the sex differences in the mortality rate of COVID-19 likely differ from those for other causes of death. We found that sex differences in the age-standardized COVID-19 mortality rate were substantially larger than for the age-standardized all-cause mortality rate and most other common causes of death. These differences were especially large in the oldest age groups. One Sentence Summary The sex difference in the mortality rate of coronavirus disease 2019 is substantially larger than for other common causes of death.
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Caudron Y, Le Guerinel C, Boissonnet H, Rogers A. Idiopathic biventricular hydrocephalus: A clinical case report. Neurochirurgie 2021; 67:628-629. [PMID: 33529692 DOI: 10.1016/j.neuchi.2021.01.011] [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: 12/06/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Y Caudron
- Fondation ophtalmologique Adolphe de Rothschild, Department of Neurosurgery, 29 Rue Manin, 75019, Paris, France.
| | - C Le Guerinel
- Fondation ophtalmologique Adolphe de Rothschild, Department of Neurosurgery, 29 Rue Manin, 75019, Paris, France
| | - H Boissonnet
- Fondation ophtalmologique Adolphe de Rothschild, Department of Neurosurgery, 29 Rue Manin, 75019, Paris, France
| | - A Rogers
- Fondation ophtalmologique Adolphe de Rothschild, Department of Neurosurgery, 29 Rue Manin, 75019, Paris, France
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Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial. Br J Dermatol 2020; 184:828-839. [PMID: 33006767 DOI: 10.1111/bjd.19592] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence for the effectiveness of vitiligo treatments is limited. OBJECTIVES To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo. METHODS A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment). CONCLUSIONS Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.
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Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - P Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N J Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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Rogers A, Akram P, Batchelor JM, Crutchley J, Grocki M, Haines RH, Meakin G, O'Dowd K, Ravenscroft J, Thomas KS. Quality assurance and characterization of narrowband ultraviolet B devices for use at home: lessons from the HI-Light Vitiligo Trial. Br J Dermatol 2020; 184:954-955. [PMID: 33107975 PMCID: PMC8246568 DOI: 10.1111/bjd.19630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/08/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - P Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
| | - J Crutchley
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Grocki
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - G Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - K O'Dowd
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Ravenscroft
- Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, King's Meadow Campus, Lenton Lane, Nottingham, NG7 2NR, UK
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Sach TH, Thomas KS, Batchelor JM, Perways A, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell N, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. An economic evaluation of the randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo (the HI-Light Vitiligo Trial). Br J Dermatol 2020; 184:840-848. [PMID: 32920824 DOI: 10.1111/bjd.19554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Economic evidence for vitiligo treatments is absent. OBJECTIVES To determine the cost-effectiveness of (i) handheld narrowband ultraviolet B (NB-UVB) and (ii) a combination of topical corticosteroid (TCS) and NB-UVB compared with TCS alone for localized vitiligo. METHODS Cost-effectiveness analysis alongside a pragmatic, three-arm, placebo-controlled randomized controlled trial with 9 months' treatment. In total 517 adults and children (aged ≥ 5 years) with active vitiligo affecting < 10% of skin were recruited from secondary care and the community and were randomized 1: 1: 1 to receive TCS, NB-UVB or both. Cost per successful treatment (measured on the Vitiligo Noticeability Scale) was estimated. Secondary cost-utility analyses measured quality-adjusted life-years using the EuroQol 5 Dimensions 5 Levels for those aged ≥ 11 years and the Child Health Utility 9D for those aged 5 to < 18 years. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS The mean ± SD cost per participant was £775 ± 83·7 for NB-UVB, £813 ± 111.4 for combination treatment and £600 ± 96·2 for TCS. In analyses adjusted for age and target patch location, the incremental difference in cost for combination treatment compared with TCS was £211 (95% confidence interval 188-235), corresponding to a risk difference of 10·9% (number needed to treat = 9). The incremental cost was £1932 per successful treatment. The incremental difference in cost for NB-UVB compared with TCS was £173 (95% confidence interval 151-196), with a risk difference of 5·2% (number needed to treat = 19). The incremental cost was £3336 per successful treatment. CONCLUSIONS Combination treatment, compared with TCS alone, has a lower incremental cost per additional successful treatment than NB-UVB only. Combination treatment would be considered cost-effective if decision makers are willing to pay £1932 per additional treatment success.
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Affiliation(s)
- T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - A Perways
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M Santer
- Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Whipps Cross Hospital and The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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Rogers A, Tung J, Tooley J, Bhatia N, Kang G, Alhusseini M, Baykaner T, Wang P, Perez M, Clifford G, Tereshchenko L, Narayan S. Deep neural network trained on surface ECG improves diagnostic accuracy of prior myocardial infarction over Q wave analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3440] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Detection of prior myocardial infarction (MI) may inform arrhythmia treatment and prognosis, yet cardiac imaging is resource intensive. ECG Q-wave analysis is quick and inexpensive but has poor accuracy for assessing prior MI.
Purpose
To evaluate the ability of a deep neural network (DNN) trained on the surface ECG to identify patients with prior MI.
Methods
We assessed 608 well-characterized patients (61.4±14.5 years, 31.2% female) at 2 academic centers. From one 12-lead ECG, median beats were calculated in 3 orthogonal planes (X, Y, Z; Fig. 1A) and used to train a DNN to identify a history of prior MI. Accuracy was compared to manual assessment of pathologic Q waves, defined as a deflection >25% of the subsequent R wave, >40ms in width, and >0.2mV amplitude in 1 of 3 ECG planes.
Results
Of 608 patients, 175 had history of MI (28.7%). The DNN outperformed the accuracy of pathologic Q waves. In training, DNN converged to >98% accuracy and in testing, its accuracy was 71±5% (Fig. 1B) (k=5-fold cross validation). This outperformed the 62% accuracy of pathologic Q waves in this study (red dotted line, Fig. 1B). In the validation cohort, DNN provided an area under the receiver operating characteristics curve of 0.730 (Fig. 1C).
Conclusion
Deep learning of a 12-lead ECG can identify features of prior myocardial injury more accurately than Q-wave analysis. In attempting to improve these results further, studies should explain what inputs weighted DNN decisions, and identify those that reflect abnormalities detectable clinically or on imaging.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIH NRSA F32
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Affiliation(s)
- A Rogers
- Stanford University, Palo Alto, United States of America
| | - J.S Tung
- Stanford University, Palo Alto, United States of America
| | - J Tooley
- Stanford University, Palo Alto, United States of America
| | - N.K Bhatia
- Stanford University, Palo Alto, United States of America
| | - G Kang
- Stanford University, Palo Alto, United States of America
| | - M.I Alhusseini
- Stanford University, Palo Alto, United States of America
| | - T Baykaner
- Stanford University, Palo Alto, United States of America
| | - P.J Wang
- Stanford University, Palo Alto, United States of America
| | - M Perez
- Stanford University, Palo Alto, United States of America
| | - G Clifford
- Emory University School of Medicine, Atlanta, United States of America
| | - L Tereshchenko
- Oregon Health and Science University, Portland, United States of America
| | - S.M Narayan
- Stanford University, Palo Alto, United States of America
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Rogers A, Ravi N, Bhatia N, Shah R, Pong T, Tung J, Purewal S, Baykaner T, Rappel W, Brodt C, Wang P, Lee A, Narayan S. Complete transmural epicardial ablation reduces organized areas in atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The surgical maze is suggested to be effective in persistent atrial fibrillation (AF) by reducing the area for fibrillatory wavelets. However, the mechanism for recurrence and next treatment steps are unclear.
Purpose
We set out to evaluate the impact of complete transmural epicardial maze lesion sets on the extent atrial organization using novel analyses of wide-area recordings of AF.
Methods
19 patients (age 50.9±12.0, 78% male) underwent maze followed by endocardial mapping of AF with a 64-pole basket catheter. Block across roof, floor, and pulmonary vein lesions sets was assessed by high-density voltage mapping and organized zones of AF were assessed by panoramic recordings. Total organized area and mean area of the dominant site were evaluated using automated custom scripts.
Results
Patients had 3.2±0.9 organized regions in 1 minute of LA recordings. A 54 yo F showed residual conduction to the posterior wall from the roof (purple, Fig. 1A) and a figure-of-8 propagation pattern during AF (arrows, fig B) which terminated with localized ablation (yellow lesions, Fig. 1A, red X, Fig. 1B). Overall, patients with complete block on epicardial lesion set had smaller areas of organization (13.7±8% vs. 45.7±32% of mapped areas, p=0.029) vs. those with gaps. The average size of the dominant area was smaller with complete transmural lines than with gaps (5.7±3% vs. 15.9±10%, p=0.033) (Fig. 1C).
Conclusion
These results show that complete transmural lesion sets constrain the critical mass available for AF, with smaller resulting organized zones. Future studies that quantify how partitioning the atrial surface affects AF may help personalize lesion sets after maze.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): NIH NRSA F32 United States
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Affiliation(s)
- A Rogers
- Stanford University, Palo Alto, United States of America
| | - N Ravi
- Stanford University, Palo Alto, United States of America
| | - N.K Bhatia
- Stanford University, Palo Alto, United States of America
| | - R.L Shah
- Stanford University, Palo Alto, United States of America
| | - T Pong
- Stanford University, Palo Alto, United States of America
| | - J.S Tung
- Stanford University, Palo Alto, United States of America
| | - S Purewal
- Stanford University, Palo Alto, United States of America
| | - T Baykaner
- Stanford University, Palo Alto, United States of America
| | - W.J Rappel
- University of San Diego, Physics, La Jolla, United States of America
| | - C.R Brodt
- Stanford University, Palo Alto, United States of America
| | - P.J Wang
- Stanford University, Palo Alto, United States of America
| | - A Lee
- Stanford University, Palo Alto, United States of America
| | - S.M Narayan
- Stanford University, Palo Alto, United States of America
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Ellis J, Vassilev I, James E, Rogers A. Implementing a social network intervention: can the context for its workability be created? A quasi-ethnographic study. Implement Sci Commun 2020; 1:93. [PMID: 33123686 PMCID: PMC7590694 DOI: 10.1186/s43058-020-00087-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Policy makers and researchers recognise the challenges of implementing evidence-based interventions into routine practice. The process of implementation is particularly complex in local community environments. In such settings, the dynamic nature of the wider contextual factors needs to be considered in addition to capturing interactions between the type of intervention and the site of implementation throughout the process. This study sought to examine how networks and network formation influence the implementation of a self-management support intervention in a community setting. Methods An ethnographically informed approach was taken. Data collection involved obtaining and analysing documents relevant to implementation (i.e. business plan and health reports), observations of meetings and engagement events over a 28-month period and 1:1 interviews with implementation-network members. Data analysis utilised the adaptive theory approach and drew upon the Consolidated Framework for Implementation Research. The paper presents the implementation events in chronological order to illustrate the evolution of the implementation process. Results The implementation-network was configured from the provider-network and commissioning-network. The configuration of the implementation-network was influenced by both the alignment between the political landscape and the intervention, and also the intervention having a robust evidence base. At the outset of implementation, the network achieved stability as members were agreed on roles and responsibilities. The stability of the implementation-network was threatened as progress slowed. However, with a period of reflection and evaluation, and with a flexible and resilient network, implementation was able to progress. Conclusions Resilience and creativity of all involved in the implementation in community settings is required to engage with a process which is complex, dynamic, and fraught with obstacles. An implementation-network is required to be resilient and flexible in order to adapt to the dynamic nature of community contexts. Of particular importance is understanding the demands of the various network elements, and there is a requirement to pause for "reflection and evaluation" in order to modify the implementation process as a result of learning.
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Affiliation(s)
- J Ellis
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, University Road, Building 67, Southampton, SO17 1BJ UK
| | - I Vassilev
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, University Road, Building 67, Southampton, SO17 1BJ UK
| | - E James
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, University Road, Building 67, Southampton, SO17 1BJ UK
| | - A Rogers
- NIHR CLAHRC Wessex, School of Health Sciences, University of Southampton, University Road, Building 67, Southampton, SO17 1BJ UK
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Parihar V, Katz L, Siyam MA, Rogers A, Patterson L, Zacharias R. Mandatory pharmacist-led education session for patients seeking medical cannabis. Pharm Pract (Granada) 2020; 18:2088. [PMID: 33343771 PMCID: PMC7732211 DOI: 10.18549/pharmpract.2020.4.2088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
Objective: The primary objectives of this pre-post session study, was to evaluate the impact of a pharmacist-led education session on the perceived benefits and safety of cannabis among patients with chronic pain, as well as determine the influence of pharmacist education on the selection of safer cannabis products and dosage forms for medical use among patients. Methods: A retrospective analysis of completed pre-post session questionnaires was conducted among chronic pain patients attending a mandatory education session led by a pharmacist, prior to being authorized cannabis in clinic. All questionnaire data was analyzed using SPSS v. 25. Demographic and sample characteristics were reviewed using univariate analyses. Chi-Square tests were employed to determine if the group-based education significantly affected knowledge, perception of efficacy and safety of cannabis. Results: Of the 260 session participants, 203 completed pre-post session questionnaires. After the session, a majority of current cannabis users (33.8%) and cannabis naïve/past users (56.9%) reported they would use a low THC product in the future, and a majority of current users (54.5%) would use a high CBD product in the future. After education, participants were more likely to report cannabis as having the potential for addiction (chi-square =42.6, p <0.0001) and harm (chi-square =34.0, p <0.0001). Conclusions: Pharmacist counselling and education has the potential to influence patient selection and use of cannabis, from more harmful to safer products, as well as moderate the potential perceived benefits of use.
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Affiliation(s)
- Vikas Parihar
- BSc(Pharm), PharmD. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Anesthesia, McMaster University. Hamilton, ON (Canada).
| | - Laura Katz
- PhD, CPsych. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Psychology, Neuroscience and Behavior, McMaster University. Hamilton, ON (Canada).
| | - Mahmoud A Siyam
- BSc. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & School of Pharmacy, University of Waterloo. Waterloo, ON (Canada).
| | - Anna Rogers
- BSc(Pharm). Michael G. DeGroote Pain Clinic, Hamilton Health Sciences. Hamilton, ON (Canada).
| | - Lisa Patterson
- BA. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences. Hamilton, ON (Canada).
| | - Ramesh Zacharias
- MD, FRSC, DAAPM, CMD. Michael G. DeGroote Pain Clinic, Hamilton Health Sciences, & Department of Anesthesia, McMaster University. Hamilton, ON (Canada).
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Yu JS, Rink T, Yu SM, Liu K, Carver K, Lather JD, Payne J, Rogers A, Erdal BS. The broken circle method: a novel technique that enhances detection of Hill-Sachs lesions on internal rotation shoulder radiographs. Clin Radiol 2020; 76:158.e1-158.e12. [PMID: 33008621 DOI: 10.1016/j.crad.2020.09.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022]
Abstract
AIM To describe and test a new method that increases the conspicuity of a Hill-Sachs lesion on internal rotation (IR) radiographs. MATERIALS AND METHODS This study had institutional review board approval. A retrospective search for patients with a prior shoulder dislocation and a Hill-Sachs lesion documented on magnetic resonance imaging (MRI) was performed over a 10-year period identifying 256 test patients. In Part 1, the IR radiographs from test cases were randomised with controls, and three readers scored them independently for the defect. The readers were then taught the Broken Circle (BC) method and re-scored the radiographs. In Part 2, 15 cases of Hill-Sachs lesions that were missed by all readers in Part 1 were randomised with controls, and were shown to 25 radiology residents before (pre-test) and after (post-test) learning the BC method. A paired t-test was used to compare the differences in sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). RESULTS In Part 1, the sensitivity increased 19.7% (54.1%-73.8%; p<0.05) and NPV increased 10.8% (62.5%-73.3%; p<0.01). In Part 2, post-test sensitivity for residents increased 16.3% (55.2%-71.5%; p<0.0001), accuracy increased 13.4% (64%-77.4%; p<0.0001), and NPV increased 13.3% (40.8%-54.1%; p<0.0001) independent of the level of training. The change in accuracy was also statistically significant for every individual class. CONCLUSION The BC method was an effective technique that facilitated detection of a Hill-Sachs lesion at all levels of training, and was useful as a teaching tool.
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Affiliation(s)
- J S Yu
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA.
| | - T Rink
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - S M Yu
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - K Liu
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - K Carver
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - J D Lather
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - J Payne
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - A Rogers
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
| | - B S Erdal
- Department of Radiology, The Ohio State University Wexner Medical Center, 452 Doan Tower, 395 West 12th Avenue, Columbus, OH 43210, USA
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Cummings D, Kershaw S, Ong J, Reid F, Toellner H, Alwandi A, Amer M, George D, Haynes K, Hughes K, Peakall L, Premakumar Y, Punjabi N, Ramwell A, Sawkins H, Ashwood J, Baker A, Baron C, Bhide I, Blake E, De Cates C, Esmail R, Hosamuddin H, Kapp J, Nguru N, Raja M, Thomson F, Ahmed H, Aishwarya G, Al-Huneidi R, Ali S, Aziz R, Burke D, Clarke B, Kausar A, Maskill D, Mecia L, Myers L, Smith ACD, Walker G, Wroe N, Donohoe C, Gibbons D, Jordan P, Keogh C, Kiely A, Lalor P, McCrohan M, Powell C, Foley MP, Reynolds J, Silke E, Thorpe O, Kong JTH, White C, Ali Q, Dalrymple J, Ge Y, Khan H, Luo RS, Paine H, Paraskeva B, Parker L, Pillai K, Salciccioli J, Selvadurai S, Sonagara V, Springford LR, Tan L, Appleton S, Leadholm N, Zhang Y, Ahern D, Cotter M, Cremen S, Durrigan T, Flack V, Hrvacic N, Jones H, Jong B, Keane K, O'Connell PR, O'sullivan J, Pek G, Shirazi S, Barker C, Brown A, Carr W, Chen Y, Guillotte C, Harte J, Kokayi A, Lau K, McFarlane S, Morrison S, Broad J, Kenefick N, Makanji D, Printz V, Saito R, Thomas O, Breen H, Kirk S, Kong CH, O'Kane A, Eddama M, Engledow A, Freeman SK, Frost A, Goh C, Lee G, Poonawala R, Suri A, Taribagil P, Brown H, Christie S, Dean S, Gravell R, Haywood E, Holt F, Pilsworth E, Rabiu R, Roscoe HW, Shergill S, Sriram A, Sureshkumar A, Tan LC, Tanna A, Vakharia A, Bhullar S, Brannick S, Dunne E, Frere M, Kerin M, Kumar KM, Pratumsuwan T, Quek R, Salman M, Van Den Berg N, Wong C, Ahluwalia J, Bagga R, Borg CM, Calabria C, Draper A, Farwana M, Joyce H, Khan A, Mazza M, Pankin G, Sait MS, Sandhu N, Virani N, Wong J, Woodhams K, Croghan N, Ghag S, Hogg G, Ismail O, John N, Nadeem K, Naqi M, Noe SM, Sharma A, Tan S, Begum F, Best R, Collishaw A, Glasbey J, Golding D, Gwilym B, Harrison P, Jackman T, Lewis N, Luk YL, Porter T, Potluri S, Stechman M, Tate S, Thomas D, Walford B, Auld F, Bleakley A, Johnston S, Jones C, Khaw J, Milne S, O'Neill S, Singh KKR, Smith R, Swan A, Thorley N, Yalamarthi S, Yin ZD, Ali A, Balian V, Bana R, Clark K, Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Rogers A, Morrison SC, Gorst T, Paton J, Freeman J, Marsden J, Cramp MC. Repeatability of plantar pressure assessment during barefoot walking in people with stroke. J Foot Ankle Res 2020; 13:39. [PMID: 32600388 PMCID: PMC7325079 DOI: 10.1186/s13047-020-00407-x] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Stroke-related changes in foot structure and function affect balance and mobility and quantifying foot function following stroke could offer clinically useful information to inform rehabilitation. The aim of this work was to explore the feasibility of undertaking plantar pressure assessment during barefoot walking in people with stroke, and evaluate the repeatability of the assessment protocol and regional footprint analysis as a measure of dynamic foot characteristics. Materials & methods Plantar pressure analysis was undertaken using a pressure platform (Tekscan HR Mat) on two test sessions, approximately two weeks apart (mean = 15.64 ± 11.64 days). Peak plantar pressure (kPa) and contact area (cm2) for foot regions were extracted and repeatability analysis undertaken. Descriptive evaluation of field notes and experiences of the participants was undertaken to inform the feasibility of the data collection protocol. Results Twenty-one participants (61.8 ± 9.2 years; 11 male, 10 female; 8 right-sided, 13 left-sided stroke) were recruited and 18 returned for retesting. Full data capture was achieved from 14 participants. Peak pressure and contact area demonstrated moderate to good repeatability for at the toes (ICC 0.76 and 0.58 respectively) and good to excellent repeatability for the other foot regions (ICC ≥ 0.82). Conclusion The protocol adopted in this study was feasible and yielded good to excellent repeatability for the foot regions, except the toes. The challenges with data collection in our study cohort could help inform future studies adopting similar protocols. This work also has relevance for use of pressure technology in clinical practice for assessing and monitoring foot function following stroke.
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Affiliation(s)
- A Rogers
- School of Health and Rehabilitation Sciences, Keele University, Keele, UK
| | - S C Morrison
- School of Health Sciences, University of Brighton, Darley Road, Eastbourne, BN20 7UR, UK.
| | - T Gorst
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Paton
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Freeman
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - J Marsden
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - M C Cramp
- School of Allied Health Professions, University of the West of England, Bristol, UK
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Seixas A, Jin P, Liu M, Nunes J, Grandner M, Rogers A, McFarlane S, Jean-Louis G. 1062 The Role of Sleep in Sex and Racial/Ethnic Differences in 10-Year CVD Risk in the Sleep Heart Health Study: The Use of Machine-Learnt and Precision Insights to Understand Racial/Ethnic and Sex Differences in Sleep-CVD Disparity. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1058] [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] Open
Abstract
Abstract
Introduction
The current study investigated whether insufficient sleep (<7 hrs.) explains differences in 10-year CVD risk, using Framingham risk (FRS) and Reynolds risk (RRS) scores, between blacks and whites and characterized risk and protective CVD risk profiles.
Methods
Using the Sleep Heart Health Study (SHHS) (N=6,441) data, we investigated the independent role of insufficient sleep in explaining differences in 10-years CVD between blacks and whites via a proportional odds model of four 10-year CVD risk groups: low (<5%), low-medium (5% to <10%), medium-high (10% to <20%) and high (≥20%), adjusting for age, sex, and apnea-hypopnea index (AHI). We performed two levels of cluster analyses; via hierarchical cluster algorithm with entire sample (Level 1), and latent profiles in the low (protective profiles) and high (risk profiles) CVD risk groups (Level 2) to determine overall CVD risk, and risk and protective CVD profiles.
Results
Blacks had a higher prevalence of smoking behavior, diabetes, mean systolic blood pressure, body mass index, total cholesterol compared to whites. Conversely, whites had a higher mean HDL cholesterol, sleep hours, and sleep efficiency compared to blacks. Men had higher 10-year CVD risk than women. AHI and race/ethnicity-sleep interaction were positively associated, while sleep was negatively associated with FRS and RRS. Across all CVD risk groups, whites who slept less than 5.5 hrs. had a higher CVD risk and those who slept more than 6.5 hrs. had a lower CVD risk compared to blacks. In Level 1 cluster analyses, we found two clusters: Cluster 1 (n= 3233): 6.17 sleep hours, apnea-index 11.84, age 59, SBP 125.43, total cholesterol 209, HDL 51.39, BMI 29.03, and slightly more than 50% female; and Cluster 2 (n=1657): 5.61 sleep hours, apnea-index 13.41, age 74, SBP 131, total cholesterol 204, HDL 50.30, BMI 26.45, and slightly less than 50% female. In Level 2 cluster analyses, we found two profiles within the low and high CVD risk groups.
Conclusion
These findings suggest that blacks may not receive full protection from long-term CVD risk with longer sleep duration, as their white counterparts.
Support
K01HL135452, R01MD007716, R01HL142066, K07AG052685
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Affiliation(s)
- A Seixas
- NYU Grossman School of Medicine, New York, NY
| | - P Jin
- NYU Grossman School of Medicine, New York, NY
| | - M Liu
- NYU Grossman School of Medicine, New York, NY
| | - J Nunes
- City University of New York School of Medicine, New York, NY
| | - M Grandner
- University of Arizona College of Medicine, Tuscon, AZ
| | - A Rogers
- St. John’s University, Queens, NY
| | - S McFarlane
- State University of New York, Downstate Health Science University, New York, NY
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Williams S, Seixas A, Avirappattu G, Robbins R, Lough L, Rogers A, Beaugris L, Bernard M, Jean-Louis G. 1058 Modeling Self-reported Sleep Duration And Hypertension Using Deep Learning Network: Analysis Of The National Health And Nutrition Examination Survey Data. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1054] [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] Open
Abstract
Abstract
Introduction
Epidemiologic data show strong associations between self-reported sleep duration and hypertension (HTN). Modeling these associations is suboptimal when utilizing traditional logistic regressions. In this study, we modeled the associations of sleep duration and HTN using Deep Learning Network.
Methods
Data were extracted from participants (n=38,540) in the National Health and Nutrition Examination Survey (2006-2016), a nationally representative study of the US civilian non-institutionalized population. Self-reported demographic, medical history and sleep duration were determined from household interview questions. HTN was determined as SBP ≥ 130 mmHg and DBP ≥ 80 mmHg. We used a deep neural network architecture with three hidden layers with two input features and one binary output to model associations of sleep duration with HTN. The input features are the hours of sleep (limited to between 4 and 10 hours) and its square; and the output variable HTN. Probability predictions were generated 100 times from resampled (with replacement) data and averaged.
Results
Participants ranged from 18 to 85 years old; 51% Female, 41% white, 22% black, 26% Hispanic, 46% married, and 25% < high school. The model showed that sleeping 7 hours habitually was associated with the least observed HTN probabilities (P=0.023%). HTN probabilities increased as sleep duration decreased (6hrs=0.05%; 5hrs=0.110%; 4hrs=0.16%); HTN probabilities for long sleepers were: (8hrs=0.027; 9hrs=0.024; 10hrs=0.022). Whites showed sleeping 7hrs or 9hrs was associated with lowest HTN probabilities (0.008 vs. 0.005); blacks showed the lowest HTN probabilities associated with sleeping 8hrs (0.07), and Hispanics showed the lowest HTN probabilities sleeping 7hrs (0.04).
Conclusion
We found that sleeping 7 hours habitually confers the least amount of risk for HTN. Probability of HTN varies as a function of individual’s sex and race/ethnicity. Likewise, the finding that blacks experience the lowest HTN probability when they sleep habitually 8 hours is of great public health importance.
Support
This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, T32HL129953, K01HL135452, and K07AG052685.
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Affiliation(s)
- S Williams
- NYU Grossman School of Medicine, New York, NY
| | - A Seixas
- NYU Grossman School of Medicine, New York, NY
| | | | | | - L Lough
- NYU Grossman School of Medicine, New York, NY
| | - A Rogers
- St. John’s University, Queens, NY
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Garcia J, Moore J, Payano L, Rogers A, Poke P, Casimir G, Jean-Louis G, Seixas A. 1102 Relationship Between Emotional Distress And Sleep Duration Among Hispanics Using The 2018 National Health Interview Survey Dataset. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1097] [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] Open
Abstract
Abstract
Introduction
Although Hispanics experience a high level of shorter sleep duration (< 7 hrs./24 period), a clear mechanism or cause is lacking. Previous research indicate that emotional distress may explain the burden of shorter sleep among blacks. Applying these findings to Hispanics, we investigated whether emotional distress explains the burden of short sleep duration (< 7 hrs.) among Hispanics and if this relationship varies by sex
Methods
We used data from the 2018 National Health Interview Survey (NHIS) dataset, a nationally representative sample, in which only Hispanic ethnicity participants (N=3,091) were analyzed. Average sleep duration was self-reported and measured in hours. Emotional distress was measured using Kessler 6, which measures how an individual felt over the past 30 days: nervous, hopeless, restless/fidgety, depressed, effortful and worthless. To assess the association between short sleep duration and emotional distress, we performed Pearson correlation, hierarchical regression analyses, and stratified this relationship by sex to determine if this relationship differed between males and females, adjusting for covariates.
Results
Of the total sample of 3,091 Hispanics, 1,762 were female, and 1,329 were male. Sleep duration and emotional distress were negatively correlated among females (r = -.27, p <.001) and males (r=-.18, p <.001). Among Hispanic females, sleep duration significantly predicted emotional distress, β = -.27, t = -11.60, p <.001, and explained a significant portion of variance in emotional distress, R2 = .07, F= 134.63, p <.001. While, among Hispanic males, sleep significantly predicted emotional distress (β = -.18, t =-6.5, p <.001) and explained a significant portion of the variance in emotional distress (R2 = .03, F= 42.37, p <.001).
Conclusion
Our findings indicate that a negative sleep-ED relationship, suggesting that shorter sleep was predictive of higher levels of emotional distress among Hispanics and that this relationship is greater among Hispanic females, compared males.
Support
K01HL135452, R01MD007716, R01HL142066, and K07AG052685
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Affiliation(s)
- J Garcia
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - L Payano
- NYU Grossman School of Medicine, New York, NY
| | - A Rogers
- St. John’s University, Queens, NY
| | - P Poke
- NYU Grossman School of Medicine, New York, NY
| | - G Casimir
- SUNY Downstate Medical Center, Brooklyn, NY
| | | | - A Seixas
- NYU Grossman School of Medicine, New York, NY
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Rogers A, Seixas A, Moore J, Zizi F, Williams S, Gyamfi L, Pichardo Y, Jean-Louis G. 0621 Utilization of the Ares to Predict OSA Among Blacks Using Home-Based Watchpat Recording. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
In two waves of data we collected in Brooklyn New York, we observed blacks were at high risk for obstructive sleep apnea (OSA). In the NIH-funded study ‘Metabolic Syndrome Outcome Study (MetSO), blacks enrolled from primary-care settings had a 59% risk of OSA. Similarly, blacks surveyed in churches and barbershops had a 43% risk of OSA. While these studies showed higher than expected risk as noted in the general population (29%), it remains uncertain how many of those blacks would be diagnosed with OSA in that population. The purpose of this study was to explore the rate of OSA using the WatchPat device in a community-based setting.
Methods
Data were collected from an NIH-funded study ‘Peer-Enhanced Education to Reduce Sleep Ethnic Disparities, designed to navigate blacks at risk of OSA to receive timely diagnosis and treatment using peer-delivered linguistically and culturally tailored sleep health education. Blacks were screened for OSA using the Apnea Risk Evaluation System (ARES) Questionnaire; a score ≥6 denoted moderate-high OSA risk. Individuals were asked to wear the WatchPAT 200 for one night during a week-long sleep assessment. WatchPat 200 measures SaO2 to determine respiratory-related arousals, defined as an Apnea-Hypopnea Index (AHI) ≥5, which is used to identify and diagnose OSA. We used SPSS 25.0 to perform logical regression analysis to assess associations between ARES and WatchPat AHI.
Results
A sample of 111 blacks provided valid ARES and WatchPat data for the present analyses. Of the sample, the mean age was 62.26 (SD=13.52 years; female = 55%); 49% reported annual income >20K and 79.5% reported a high school education. Moreover, 27% reported high blood pressure, 13%, diabetes, and 65% were overweight/obese. Multivariate-adjusted logical regression analyses indicated that blacks at risk for OSA were 66% more likely to receive an OSA diagnosis based on WatchPat AHI data (OR = 1.662, p < 0.01). The model adjusted for age, sex, income, and education.
Conclusion
The present study demonstrated that blacks at risk for OSA at the community level have a significant likelihood of receiving an OSA diagnosis using home-based recordings.
Support
NIH Support (T32HL129953, RO1MD007716, K01HL135452 and K07AG052685).
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Affiliation(s)
- A Rogers
- St. John’s University, Queens, NY
| | - A Seixas
- NYU Grossman School of Medicine, New York, NY
| | - J Moore
- NYU Grossman School of Medicine, New York, NY
| | - F Zizi
- NYU Grossman School of Medicine, New York, NY
| | - S Williams
- NYU Grossman School of Medicine, New York, NY
| | - L Gyamfi
- NYU Grossman School of Medicine, New York, NY
| | - Y Pichardo
- NYU Grossman School of Medicine, New York, NY
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Lough L, Seixas A, Avirappattu G, Robbins R, Rogers A, Williams S, Jean-Louis G. 1046 Assessing Sleep-Related Hypertension Risks Using JNC 8 Guidelines: Analysis Of The National Health And Nutrition Examination Survey Data. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Associations between self-reported sleep duration and risk of hypertension (HTN) are well established. The level of sleep-related HTN risk based on the new JNC 8 classification guidelines requires further research. In this study, we modeled the associations of insufficient sleep with HTN using the National Health and Nutrition Examination Survey (NHANES).
Methods
Data were extracted from the 2006-2016 NHANES (n=38,540), a nationally representative study of the US civilian population. Self-reported demographic and sleep duration were determined from household interview questions. Insufficient sleep was categorized as sleeping <7hrs. Using 2017 ACC/AHA guidelines, HTN was classified as elevated (SBP:120-129mmHg and DBP <80mmHg, Stage I (SBP:130-139mmHg and DBP:80-89mmHg), or Stage II (SBP ≥140mmHg and DBP ≥90mmHg). Logistic regression modeling was performed using R.
Results
Participants’ ages ranged from 18-85 years. Of the sample, 51% were female, 41% white, 22% black, 26% Hispanic, 8% others; 46% were married, and 25% completed <high school. The model showed strong age and BMI-adjusted associations of insufficient sleep with HTN at all levels: (elevated: OR=1.079, CI=1.03-1.13; Stage I: OR=1.127, CI=1.07-1.18, and Stage II: OR=1.334, CI=1.17-1.52). Important sex and race/ethnicity differences in sleep-related HTN risks were observed: males (elevated: OR=1.024, CI=0.95-1.10; Stage I: OR=1.077, CI=1.01-1.15, and Stage II: OR=1.254, CI=1.06-1.48); females (elevated: OR=1.125, CI=1.05-1.21; Stage I: OR=1.170, CI=1.08-1.26, and Stage II: OR=1.445, CI=1.17-1.79); whites (elevated: OR=1.007, CI=0.93-1.08; Stage I: OR=1.030, CI=0.95-1.12, and Stage II: OR=1.131, CI=0.90-1.43); blacks (elevated: OR=1.047, CI=0.94-1.16; Stage I: OR=1.080, CI=0.97-1.20, and Stage II: OR=1.179, CI=0.95-1.46); and Hispanics (elevated: OR=1.066, CI=0.94-1.21; State I: OR=1.089, CI=0.96-1.24, and Stage II: OR=1.337, CI=0.92-1.92).
Conclusion
Our analyses showed that sleep-related HTN risks vary as a function of individual’s sex and race/ethnicity. Increasing sleep duration at all HTN severity level is important and males and Hispanics at Stage II HTN might benefit the most.
Support
This study was supported by funding from the NIH: R01MD007716,R01HL142066, R01AG056531, T32HL129953, K01HL135452 and K07AG052685
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Affiliation(s)
- L Lough
- NYU Grossman School of Medicine, New York, NY
| | - A Seixas
- NYU Grossman School of Medicine, New York, NY
| | | | | | - A Rogers
- St. John’s University, Queens, NY
| | - S Williams
- NYU Grossman School of Medicine, New York, NY
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Ellis J, Band R, Kinsella K, Cheetham-Blake T, James E, Ewings S, Rogers A. Optimising and profiling pre-implementation contexts to create and implement a public health network intervention for tackling loneliness. Implement Sci 2020; 15:35. [PMID: 32429961 PMCID: PMC7238736 DOI: 10.1186/s13012-020-00997-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background The implementation of complex interventions experiences challenges that affect the extent to which they become embedded and scaled-up. Implementation at scale in complex environments like community settings defies universal replication. Planning for implementation in such environments requires knowledge of organisational capacity and structure. Pre-implementation work is an important element of the early phase of preparing the setting for the introduction of an intervention, and the factors contributing towards the creation of an optimal pre-implementation community context are under-acknowledged. Methods To explore the factors contributing towards the creation of an optimal pre-implementation context, a quasi-ethnographic approach was taken. The implementation of a social network intervention designed to tackle loneliness in a community setting acts as the case in example. Observations (of meetings), interviews (with community partners) and documentary analysis (national and local policy documents and intervention resources) were conducted. Layder’s adaptive theory approach was taken to data analysis, with the Consolidated Framework for Implementation Research (CFIR) and a typology of third-sector organisations used to interpret the findings. Results Community settings were found to sit along a continuum with three broad categories defined as Fully Professionalised Organisations; Aspirational Community, Voluntary and Social Enterprises; and Non-Professionalised Community-Based Groups. The nature of an optimal pre-implementation context varied across these settings. Using the CFIR, the results illustrate that some settings were more influenced by political landscape (Fully professional and Aspirational setting) and others more influenced by their founding values and ethos (Non-Professionalised Community-Based settings). Readiness was achieved at different speeds across the categories with those settings with more resource availability more able to achieve readiness (Fully Professional settings), and others requiring flexibility in the intervention to help overcome limited resource availability (Aspirational and Non-Professionalised Community-Based settings). Conclusions The CFIR is useful in highlighting the multiple facets at play in creating the optimal pre-implementation context, and where flex is required to achieve this. The CFIR illuminates the similarities and differences between and across settings, highlighting the complexity of open system settings and the important need for pre-implementation work. Trial registration ISRCTN19193075
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Affiliation(s)
- J Ellis
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK.
| | - R Band
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - K Kinsella
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - T Cheetham-Blake
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - E James
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - S Ewings
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - A Rogers
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
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Lefevre E, Rogers A. Carotid artery vein-pouch bifurcation aneurysm in rats: An experimental model for microneurosurgical training. Neurochirurgie 2020; 66:183-188. [PMID: 32277998 DOI: 10.1016/j.neuchi.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/12/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the era of endovascular treatment of intracranial aneurysms, surgical clipping is still a relevant treatment method in some cases. However, it has become harder to teach this skill, as the number of surgical cases has decreased over the past years. We therefore decided to use a previously described experimental aneurysm model for surgical training. MATERIAL AND METHODS We operated on 8 rats and constructed a vein-pouch aneurysm at a surgically created carotid bifurcation. Survivors were kept alive for 1 month and operated on to clip the aneurysm. RESULTS Only 3 rats had survived at 1 month. All the carotid arteries were permeable. Only 2 aneurysms were circulating at 1 month, as 1 had thrombosed. They were successfully clipped at 1 month. CONCLUSIONS These preliminary results enabled our junior surgeon to clip two circulating aneurysms, under an operative microscope reproducing surgical conditions. Although the efficacy of the model could be improved, we believe it could be used as a first step in training neurosurgical residents in the basics of aneurysm clipping and microsurgical techniques in a realistic setting.
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Affiliation(s)
- E Lefevre
- Department of Neurosurgery, hôpital universitaire Pitié Salpêtrière, Paris, France.
| | - A Rogers
- Department of Neurosurgery, fondation ophtalmologique Adolphe-de-Rothschild, Paris, France.
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Reidy C, Foster C, Rogers A. A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed-methods study. Diabet Med 2020; 37:298-310. [PMID: 31618464 PMCID: PMC7003843 DOI: 10.1111/dme.14155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 10/14/2019] [Indexed: 12/14/2022]
Abstract
AIMS To establish what practical and emotional means of support are required on initiation of insulin pump therapy and how needs change over time, using GENIE, a social network intervention. METHODS The study's longitudinal design used semi-structured interviews, surveys (PAID, CLARKE) and HbA1c values at time of pump initiation, and at 3 and 6 months. Interviews used GENIE to capture participants' expectations and experiences of pump therapy and associated support and resources. Thematic analysis was used with sequential, time-ordered matrices. RESULTS A total of 16 adults undertook 47 interviews. A total of 94 services, resources and activities were acquired, while tally, frequency and value of network members increased over time. The novelty of pump therapy impacted on participants' self-management needs. Key themes included: 1) the independent nature of managing diabetes; 2) overcoming the challenges and illness burden associated with pump use; 3) the need for responsive and tailored emotional and practical support; and 4) useful resources when incorporating pump therapy. GENIE was thought to be novel and beneficial. CONCLUSIONS A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness-related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation.
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Affiliation(s)
- C. Reidy
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex School of Health SciencesFaculty of Environmental and Life Sciences, University of Southampton
| | - C. Foster
- Macmillan Survivorship Research GroupSchool of Health Sciences, Faculty of Environmental and Life Sciences, University of SouthamptonSouthamptonUK
| | - A. Rogers
- National Institute of Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex School of Health SciencesFaculty of Environmental and Life Sciences, University of Southampton
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Bakewell L, Bradley J, Doe J, Parker H, Stellwegan A, White S, Worsfold A, Akbar T, Rogers A, Smith T. The case for electronic nutrition screening tools. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.055] [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: 10/25/2022]
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Lei JT, Shao J, Zhang J, Iglesia M, Chan DW, Cao J, Anurag M, Singh P, He X, Kosaka Y, Matsunuma R, Crowder R, Hoog J, Phommaly C, Goncalves R, Ramalho S, Peres RMR, Punturi N, Schmidt C, Bartram A, Jou E, Devarakonda V, Holloway KR, Lai WV, Hampton O, Rogers A, Tobias E, Parikh PA, Davies SR, Li S, Ma CX, Suman VJ, Hunt KK, Watson MA, Hoadley KA, Thompson EA, Chen X, Kavuri SM, Creighton CJ, Maher CA, Perou CM, Haricharan S, Ellis MJ. Functional Annotation of ESR1 Gene Fusions in Estrogen Receptor-Positive Breast Cancer. Cell Rep 2020; 24:1434-1444.e7. [PMID: 30089255 PMCID: PMC6171747 DOI: 10.1016/j.celrep.2018.07.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 05/08/2018] [Accepted: 07/01/2018] [Indexed: 01/29/2023] Open
Abstract
RNA sequencing (RNA-seq) detects estrogen receptor alpha gene (ESR1) fusion transcripts in estrogen receptor-positive (ER+) breast cancer, but their role in disease pathogenesis remains unclear. We examined multiple ESR1 fusions and found that two, both identified in advanced endocrine treatment-resistant disease, encoded stable and functional fusion proteins. In both examples, ESR1-e6>YAP1 and ESR1-e6>PCDH11X, ESR1 exons 1-6 were fused in frame to C-terminal sequences from the partner gene. Functional properties include estrogen-independent growth, constitutive expression of ER target genes, and anti-estrogen resistance. Both fusions activate a metastasis-associated transcriptional program, induce cellular motility, and promote the development of lung metastasis. ESR1-e6>YAP1- and ESR1-e6>PCDH11X-induced growth remained sensitive to a CDK4/6 inhibitor, and a patient-derived xenograft (PDX) naturally expressing the ESR1-e6>YAP1 fusion was also responsive. Transcriptionally active ESR1 fusions therefore trigger both endocrine therapy resistance and metastatic progression, explaining the association with fatal disease progression, although CDK4/6 inhibitor treatment is predicted to be effective.
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Affiliation(s)
- Jonathan T Lei
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Interdepartmental Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jieya Shao
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; Siteman Cancer Center, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jin Zhang
- Cancer Biology Division, Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110, USA; Institute for Informatics (I(2)), Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Michael Iglesia
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Doug W Chan
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Jin Cao
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Meenakshi Anurag
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Purba Singh
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Xiaping He
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Yoshimasa Kosaka
- Department of Breast and Endocrine Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa 252-0375, Japan
| | - Ryoichi Matsunuma
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka 431-3192, Japan
| | - Robert Crowder
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Jeremy Hoog
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Chanpheng Phommaly
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Rodrigo Goncalves
- Department of Obstetrics and Gynecology, University of São Paulo School of Medicine (FMUSP), Cerqueira César, São Paulo 01246-903, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Science, State University of Campinas - UNICAMP, Campinas, São Paulo 13083-970, Brazil
| | - Raquel Mary Rodrigues Peres
- Department of Obstetrics and Gynecology, Faculty of Medical Science, State University of Campinas - UNICAMP, Campinas, São Paulo 13083-970, Brazil
| | - Nindo Punturi
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Cheryl Schmidt
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Alex Bartram
- Queens' College, University of Cambridge, Cambridge CB3 9ET, UK
| | - Eric Jou
- Queens' College, University of Cambridge, Cambridge CB3 9ET, UK
| | - Vaishnavi Devarakonda
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Kimberly R Holloway
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - W Victoria Lai
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Oliver Hampton
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Anna Rogers
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Ethan Tobias
- University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Poojan A Parikh
- School of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sherri R Davies
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Shunqiang Li
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Cynthia X Ma
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Vera J Suman
- Alliance Statistical Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Kelly K Hunt
- Department of Breast Surgical Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark A Watson
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - E Aubrey Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Jacksonville, FL 32224, USA
| | - Xi Chen
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Shyam M Kavuri
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Chad J Creighton
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Christopher A Maher
- Department of Medicine, Washington University in St. Louis, St. Louis, MO 63110, USA; The McDonnell Genome Institute, Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Charles M Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Svasti Haricharan
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA
| | - Matthew J Ellis
- Department of Medicine, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, TX 77030, USA; Interdepartmental Graduate Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX 77030, USA; Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, TX 77030, USA.
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McMahon G, Rogers A, Woulfe Z, Tuthill E, Doyle M, Burke G, Imcha M. Women's Opinions on Cardiotocograph Monitoring and Staff Communication During Labour. Ir Med J 2019; 112:1022. [PMID: 32311252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- G McMahon
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - A Rogers
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - Z Woulfe
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - E Tuthill
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Doyle
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - G Burke
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Imcha
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
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Mozola MA, Peng X, Wendorf M, Alles S, Artiga L, Buchholz T, Camacho A, Charveron N, Clayborn J, Decker C, Deibel C, Donohue T, Draughon A, Ewings J, Feldworth M, Gane P, Goodwin J, Gunter T, Gutierrez M, Hovland R, Jechorek R, Jones W, Keskinen L, Lamproe B, Larson E, Manwarren H, Merkling A, Osing C, Pangloli P, Remes A, Richter E, Rogers A, Rose B, Ryser E, Secraw S, Slupik M, Wessinger A, Westmoreland R, Yan Z, Zahoor T, Zhang L. Evaluation of the GeneQuence® DNA Hybridization Method in Conjunction with 24-Hour Enrichment Protocols for Detection of Salmonella spp. in Select Foods: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/90.3.738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A multilaboratory study was conducted to compare performance of the GeneQuence® DNA hybridization (DNAH) method incorporating new 24 h enrichment protocols and reference culture procedures for detection of Salmonella spp. in select foods. Six food types (raw ground turkey, raw ground beef, dried whole egg, milk chocolate, walnuts, and dry pet food) were tested by the DNAH method and by the culture methods of either the U.S. Department of Agriculture-Food Safety and Inspection Service (USDA-FSIS) or the U.S. Food and Drug Administration's Bacteriological Analytical Manual (FDA/BAM). Fifteen laboratories participated in the study. Four of the foods tested (raw ground turkey, dried whole egg, milk chocolate, and dry pet food), showed no statistically significant differences in performance between the DNAH method and the reference procedure as determined by Chi square analysis. Sensitivity rates for the DNAH method ranged from 92 to 100. The DNAH method, with the specific enrichment protocol evaluated, was found to be ineffective for detection of Salmonella spp. in walnuts. For raw ground beef, results from one trial showed a statistically significant difference in performance, with more positives obtained by the reference method. However, evidence suggests that the difference in the number of positives was likely due to lack of homogeneity of the test samples rather than to DNAH method performance.
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Affiliation(s)
| | - Xuan Peng
- Neogen Corp., 620 Lesher Pl, Lansing, MI 48912
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Richards A, Rogers A. Interdisciplinary Event with Undergraduate Dietetic and Nursing Students Increases Positive Attitudes Towards Team Based Practice. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.08.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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