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Pilot trial results of D-HOMES: a behavioral-activation based intervention for diabetes medication adherence and psychological wellness among people who have been homeless. Front Psychiatry 2024; 15:1329138. [PMID: 38487573 PMCID: PMC10937567 DOI: 10.3389/fpsyt.2024.1329138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
Introduction People living with type 2 diabetes who experience homelessness face a myriad of barriers to engaging in diabetes self-care behaviors that lead to premature complications and death. This is exacerbated by high rates of comorbid mental illness, substance use disorder, and other physical health problems. Despite strong evidence to support lay health coach and behavioral activation, little research has effectively engaged people living with type 2 diabetes who had experienced homelessness (DH). Methods We used community engaged research and incremental behavioral treatment development to design the Diabetes HOmeless MEdication Support (D-HOMES) program, a one-on-one, 3 month, coaching intervention to improve medication adherence and psychological wellness for DH. We present results of our pilot randomized trial (with baseline, 3 mo., 6 mo. assessments) comparing D-HOMES to enhanced usual care (EUC; brief diabetes education session and routine care; NCT05258630). Participants were English-speaking adults with type 2 diabetes, current/recent (<24 mo.) homelessness, and an HbA1c‗7.5%. We focused on feasibility (recruitment, retention, engagement) and acceptability (Client Satisfaction Questionnaire, CSQ-8). Our primary clinical outcome was glycemic control (HbA1c) and primary behavioral outcome was medication adherence. Secondary outcomes included psychological wellness and diabetes self-care. Results Thirty-six eligible participants enrolled, 18 in each arm. Most participants identified as Black males, had high rates of co-morbidities, and lived in subsidized housing. We retained 100% of participants at 3-months, and 94% at 6-months. Participants reported high satisfaction (mean CSQ-8 scores=28.64 [SD 3.94] of 32). HbA1c reduced to clinically significant levels in both groups, but we found no between group differences. Mean blood pressure improved more in D-HOMES than EUC between baseline and 6 mo. with between group mean differences of systolic -19.5 mmHg (p=0.030) and diastolic blood pressure -11.1 mmHg (p=0.049). We found no significant between group differences in other secondary outcomes. Conclusion We effectively recruited and retained DH over 6 months. Data support that the D-HOMES intervention was acceptable and feasible. We observe preliminary blood pressure improvement favoring D-HOMES that were statistically and clinically significant. D-HOMES warrants testing in a fully powered trial which could inform future high quality behavioral trials to promote health equity. Clinical trial registration https://clinicaltrials.gov/study/NCT05258630?term=D-HOMES&rank=1, identifier NCT05258630.
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Characteristics of a later life population in a general adult community mental health service setting. Ir J Psychol Med 2023; 40:450-456. [PMID: 34130771 DOI: 10.1017/ipm.2021.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Globally, increasing life expectancy has escalated demands on psychiatric services caring for a later life population. It is recognised that those with enduring mental illness may have specific needs with advancing age. In this study, we describe the characteristics of a population aged over 60 years attending a general adult community psychiatric service and compare demographic and clinical features across age and diagnostic categories. The study aims to gather preliminary information which may guide future local mental health service planning. METHODS We conducted a cross-sectional observational study using retrospective chart review of all patients aged over 60 years attending four community mental health teams in North Dublin. Cohorts of attenders were stratified by age comparing 60-64 year age group with the population aged 65 years and over. Attenders were also stratified by diagnosis and regression analysis was used to determine predictors of psychotic disorder diagnosis. RESULTS The study included 127 patients. There was a higher prevalence of psychotic disorders among those aged 65 years and over (n = 73), while those aged 60-64 years (n = 54) were more likely to have depression and non-affective, non-psychotic disorders. Among the population aged 65 years and over 78% (n = 57) were long-term psychiatric service attenders. CONCLUSIONS The majority of the sample aged 65 years and over were long-term service attenders with a diagnosis of severe mental illness. Further research is warranted to determine optimal service delivery for later life psychiatric service attenders.
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Pro-arrhythmic effects of gain-of-function potassium channel mutations in the short QT syndrome. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220165. [PMID: 37122211 PMCID: PMC10150212 DOI: 10.1098/rstb.2022.0165] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
The congenital short QT syndrome (SQTS) is a rare condition characterized by abbreviated rate-corrected QT (QTc) intervals on the electrocardiogram and by increased susceptibility to both atrial and ventricular arrhythmias and sudden death. Although mutations to multiple genes have been implicated in the SQTS, evidence of causality is particularly strong for the first three (SQT1-3) variants: these result from gain-of-function mutations in genes that encode K+ channel subunits responsible, respectively, for the IKr, IKs and IK1 cardiac potassium currents. This article reviews evidence for the impact of SQT1-3 missense potassium channel gene mutations on the electrophysiological properties of IKr, IKs and IK1 and of the links between these changes and arrhythmia susceptibility. Data from experimental and simulation studies and future directions for research in this field are considered. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.
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Fantastic bacteriophages and where to find them. ACTA CRYSTALLOGRAPHICA SECTION A FOUNDATIONS AND ADVANCES 2022. [DOI: 10.1107/s2053273322093081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Frailty in Secure Forensic Mental Health Settings: A Study from Dundrum Hospital, Ireland. Eur Psychiatry 2022. [PMCID: PMC9566090 DOI: 10.1192/j.eurpsy.2022.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Frailty is defined as a clinical syndrome that encompasses a combination of decreased physiological reserve and low resistance to stressors. There is an association between mental illness and frailty among elderly cohorts. Frailty is also associated with obesity and smoking. There are high rates of treatment resistant schizophrenia among patients in secure forensic services. Patients with schizophrenia have high rates of morbidity and early mortality.
Objectives
The primary aim of this study was to examine the rates of frailty present in a complete cohort of forensic in-patients.
Methods
An assessment using Fried Frailty criteria was offered to all in-patients (n=95) in Ireland’s National Forensic Service, which included measures of walking speed, grip strength, low physical activity and exhaustion. Demographic details and details pertaining to diagnoses and medications were also gathered.
Results
Of the 95 in-patients, 92 patients agreed to participate. The majority were male (89%). The most common diagnosis was schizophrenia (71.7%). Mean age was 44.7 years (SD 11.42), and 58.2% met criteria for obesity. Of the total group, 47 patients met criteria for ‘pre-frail’ and 10 met criteria for ‘frail’ using Fried criteria.
Conclusions
This is the first study examining frailty in a cohort of patients in secure forensic settings. We found high rates of patients meeting frailty criteria at very young ages. Rates of frailty in this group were comparable to those found amongst elders in community settings. We consider this demonstrates significant medical vulnerability in this patient group.
Disclosure
No significant relationships.
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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] [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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163 Treatment with gonadotrophin-releasing hormone at the time of AI in beef heifers that fail to express oestrus after an estradiol-based synchronisation protocol improves pregnancies per AI. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Oestrus expression between progesterone (P4) withdrawal and fixed-time AI (FTAI) has been shown to improve pregnancies per AI (P/AI) by 27% in beef cattle. As a result, cattle that do not express oestrus after P4 withdrawal present a challenge to the efficiency of FTAI. The present study was designed to test the hypothesis that administration of gonadotrophin-releasing hormone (GnRH) at the time of AI in heifers that do not express oestrus can improve fertility. Two-year-old Angus heifers (n=1032) with a condition score of 2.75 to 3.5 at two locations in Argentina were used. On Day 0, heifers received an intravaginal device containing 0.5g of P4 (Cronipres, Biogenesis) and 2mg of oestradiol benzoate intramuscularly (Bioestrogen, Biogenesis). On Day 8, devices were removed and heifers received 150µg of d-cloprostenol intramuscularly (Enzaprost, Biogenesis), 0.5mg of oestradiol cipionate intramuscularly (Croni-Cip, Biogenesis), and an oestrus detection patch (Estrotect, Rockway Inc.). On Day 10, AI was performed in all heifers 50 to 54h after device removal. Heifers were categorised based on oestrus expression, and those that did not express oestrus were randomised to receive 100µg of gonadorelin acetate intramuscularly (Gonasyn, Syntex; n=158) concurrent with AI or remain as untreated controls (n=151). Pregnancy was determined using ultrasonography at Days 38 and 111 after AI. Differences in fertility were evaluated using generalised linear mixed models, and the results are shown in Table 1. Oestrus expression between device removal and FTAI was 70.1% (723/1032). Pregnancies per AI at Days 38 and 111 were different between groups (P<0.01). Heifers that expressed oestrus had greater P/AI than those that did not regardless of treatment (P<0.01). However, in heifers that did not express oestrus, treatment with GnRH at the time of AI resulted in greater P/AI than in control heifers (P=0.004). Similarly, P/AI at Day 111 were greater in heifers that expressed oestrus than in those that did not regardless of treatment (P<0.01). Heifers that did not express oestrus and were treated with GnRH had greater P/AI than those that did not express oestrus and remained as controls (P=0.02). Pregnancy loss between Days 38 and 111 was not different between groups; however, there was a tendency (P=0.06) for greater pregnancy loss in heifers that did not express oestrus and were treated with GnRH compared with heifers that expressed oestrus. In summary, treatment with GnRH at the time of AI is a suitable strategy to improve P/AI in heifers that fail to exhibit oestrus after an oestradiol-based synchronisation protocol. However, this strategy appears to increase pregnancy loss, and thus further research is needed to confirm this observation and the mechanisms underlying it.
Table 1.Pregnancies per AI (P/AI) and pregnancy loss (%; no. in parentheses) in Angus heifers based on oestrus expression and treatment with GnRH
Group
P/AI Day 38
P/AI Day 111
Pregnancy loss
Oestrus
68.9 (498/723)A
65.2 (471/723)A
5.4 (27/498)
No oestrus control
29.8 (45/151)B
28.5 (43/151)B
4.4 (2/45)
No oestrus + GnRH
45.6 (72/158)C
40.5 (64/158)C
11.1 (8/72)
P-value
<0.001
<0.001
0.15
A-CValues within a column with different superscripts differ significantly (P<0.05).
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Imaging of intestinal transplantation. Clin Radiol 2019; 74:613-622. [DOI: 10.1016/j.crad.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/11/2018] [Indexed: 12/30/2022]
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Evaluation of Outpatient Anticoagulation Bridging after Left Ventricular Assist Device (LVAD) Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
Intestinal failure is the inability to maintain adequate nutrition or hydration through the gut. It is caused by a diverse range of benign and malignant aetiologies. Imaging takes a central role in the multidisciplinary assessment of patients with intestinal failure.
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A summary of 10 years of transplant activity and outcomes from a UK centre for intestinal and multivisceral transplantation. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.2063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND Home haemodialysis (HHD) has the potential to impact positively on patient outcomes and health resource management. There has been rejuvenated international interest in HHD in recent years. AIM We aimed to review the activity and outcomes of the Irish HHD Programme since inception (2009-16). DESIGN Retrospective review. METHODS Patient data were collected using the national electronic Renal Patient database (eMEDRenal version 3.2.1) and individual centre records. All data were recorded in a coded fashion on a Microsoft Excel Spread-sheet and analysed with Stata SE software. RESULTS One hundred and one patients completed training and commenced HHD; a further fourty-five patients were assessed for HHD suitability but did not ultimately dialyse at home. Twenty patients switched to nocturnal HHD when this resource became available. The switch from conventional in-centre dialysis to HHD led to an increase in the mean weekly hours on haemodialysis (HD) and a reduction in medication burden for the majority of patients. The overall rate of arteriovenous fistula (AVF) as primary vascular access was 62%. Most HHD complications were related to access function or access-related infection. Over the 7-years, 29 HHD patients were transplanted and 9 patients died. No deaths resulted directly from a HHD complication or technical issue. CONCLUSIONS Patient and technique survival rates compared favourably to published international reports. However, we identified several aspects that require attention. A small number of patients were receiving inadequate dialysis and require targeted education. Ongoing efforts to increase AVF and self-needling rates in HD units must continue. Psychosocial support is critical during the transition between dialysis modalities.
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A335 BILIARY ATRESIA HOME SCREENING PROGRAM IN BRITISH COLUMBIA: EVALUATION OF FIRST TWO YEARS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Psychosurgery: description and outcome study of a regional service. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.21.2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The report indicates that a psychosurgery service can be established on a regional basis. The outcome study of the Yorkshire Regional Psychosurgery Service indicates that the treatment should retain a place in the treatment of patients who have failed to respond to other available approaches. For such patients (and their carers) life is a state of persisting torment. Some psychiatrists consider psychosurgery as a procedure not to be countenanced, or outmoded, but patients have a right to know what may be achieved by the treatment and at what cost in terms of possible failure to improve and adverse effects. An audit of the Regional Psychosurgery Service indicates a favourable result of the Intervention. All patients improved to some extent, some very remarkably, and no adverse effects were encountered.
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BILIARY ATRESIA HOME SCREENING PROGRAM IN BRITISH COLUMBIA: EVALUATION OF FIRST TWO YEARS. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx086.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Cytomegalovirus Infection and Rates of Antiviral Resistance Following Intestinal and Multivisceral Transplantation. Transplant Proc 2017; 48:492-6. [PMID: 27109985 DOI: 10.1016/j.transproceed.2015.09.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) disease is a common and clinically significant complication following intestinal or multivisceral transplantation. CMV disease is more common in cases of serologic mismatch between donor and recipient. Though in some cases it may be asymptomatic, in the immunosuppressed population it often manifests with evidence of systemic infection or end-organ disease. METHODS We conducted a retrospective review of all patients undergoing intestinal or multivisceral transplantation over 8 years at our institution. RESULTS Forty-eight transplantations were performed, with 40% of the patients (19/48) having ≥1 episode of CMV viremia, which rose to 90% in the "donor-positive, recipient-negative" (DPRN) serologic mismatch group. The median time to 1st episode following transplantation was 22.3 weeks (range, 1-78) and median duration of each episode was 4.9 weeks (range, 1.6-37.4). Six of the 19 viremic patients (31.6%) developed virologic resistance with 4 of these occurring in the DPRN group. Four of the 6 patients with drug-resistant CMV died with CMV viremia. All patients with drug resistance acquired ganciclovir resistance; these patients were more challenging to manage with second-line toxicity-limited treatments, including foscarnet, cidofovir, and leflunomide. CMV immunoglobulin has been used and we briefly discuss the use of CMV-specific adoptive T-lymphocyte transfer in the management of 1 case. CONCLUSIONS Post-transplantation CMV disease continues to be challenging to manage, and there is little consensus on optimal management strategies in this patient group, with a significant requirement for novel therapies; these may be pharmacologic or cell based. Extensive multidisciplinary discussion is important for most cases, but particularly for those patients who acquire virologic resistance.
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ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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A retrospective review in the management of T3 laryngeal squamous cell carcinoma: an expanding indication for transoral laser microsurgery. J Otolaryngol Head Neck Surg 2016; 45:34. [PMID: 27233357 PMCID: PMC4884416 DOI: 10.1186/s40463-016-0147-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/19/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the functional and oncological outcomes of patients treated for T3 laryngeal squamous cell carcinoma. Specifically comparing transoral laser microsurgery and radiotherapy/chemoradiotherapy treatment modalities. METHOD A retrospective review of patients treated for T3 laryngeal SCC between 2002 and 2010 was undertaken. RESULTS Forty-nine patients were included. 15 cases were glottic, (9 treated with TLM, 6 with RT/CRT), 33 supraglottic (6 treated with TLM, 27 with RT/CRT) and 1 subglottic subsite (treated with RT/CRT). There was no statistical difference between treatment groups for 24 month locoregional control (72.3 %), overall survival (glottis 86.7 %, supraglottic 70.4 %) and disease specific survival (glottic 93.3 % and supraglottic 74.1 %). Overall laryngeal preservation (84.9 %) was also similar in both groups. CONCLUSION Our institution is expanding the application of TLM to selected patients with T3 laryngeal carcinoma. Oncological outcomes have not been jeopardized by this approach and the treatment is well tolerated by patients with few complications.
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Dedicated Orthogeriatric Service Saves the HSE a Million Euro. IRISH MEDICAL JOURNAL 2016; 109:385. [PMID: 27685479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hip fracture is common in older adults and is associated with high morbidity, mortality and significant health care costs. A pilot orthogeriatrics service was established in an acute hospital. We aimed to establish the cost effectiveness of this service. Length of hospital stay, discharge destination and rehabilitation requirements were analysed for a one year period and compared to patients who received usual care prior to the service. We calculated the costs incurred and savings produced by the orthogeriatric service. Median length of stay was reduced by 3 days (p < 0.001) saving €266,976. There was a 19% reduction in rehabilitation requirements saving €192,600. Median rehabilitation length of stay was reduced by 6.5 days saving €171,093. Reductions in long term care requirements led to savings of €10,934 per week. Costs to establish such a service amount to €171,564. The introduction of this service led to improved patient outcomes in a cost effective manner.
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Abstract P6-08-10: Mutational signatures impact the breast cancer transcriptome and distinguish mitotic from immune response pathways. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-08-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
A comprehensive whole genome analysis of a large breast cancer cohort of 560 cases (Nik-Zainal et al, submitted 2015) reports novel and existing DNA substitution and rearrangement signatures next a comprehensive list of events driving the breast cancer cell to its malignant potency. In the current study, we linked the observed genetic diversity to the breast cancer transcriptome for 260 cases for which whole genome and whole transcriptome data were both available.
Cluster analysis of the global gene expression showed the familiar view of a coherent basal-like and a heterogeneous luminal subgroup. New and previously reported1 subtype-specific aberrations with concordant expression changes were found in TP53, PIK3CA, PTEN, CCND1, CDH1 and GATA3, and mutations in PIK3CA, PTEN, AKT1 and AKT2 were mutually exclusive confirming they are active in the same pathway in breast cancer.
Integrating the identified DNA substitutions signatures with the transcriptome, we observed that the total number of substitutions in a cancer, irrespective of substitution type, was positively associated with cell cycle regulated gene expression and with adverse outcome.
In addition and more remarkably, we observed that the number substitution of two substitution signatures2 particularly associated with immune-response specific gene expression, with increased amount of tumor infiltrating lymphocytes and with a better outcome. These two signatures comprised 1) mutations of the APOBEC-type (predominant C>G in a TCN context), and 2) mutations which lacks specific features but which are strongly associated with genetic and epigenetic inactivating aberrations in BRCA1 and BRCA2.
Thus, while earlier reports3-5 imply that the sheer number of driver events triggers an immune-response, we refine this statement by observing that substitutions of a particular type are much very effective in doing so explaining the superior outcome of cancer having these particular types of substitutions. This result also implies that purposefully augmenting T-cell reactivity against amino-acid substitutions resulting from either of these two DNA substitution types could potentially improve immunotherapies in breast cancer.
1. Comprehensive molecular portraits of human breast tumours. Nature 490, 61-70 (2012).
2. Alexandrov, L.B., et al. Signatures of mutational processes in human cancer. Nature 500, 415-421 (2013).
3. Rizvi, N.A., et al. Cancer immunology. Mutational landscape determines sensitivity to PD-1 blockade in non-small cell lung cancer. Science 348, 124-128 (2015).
4. Schumacher, T.N. & Schreiber, R.D. Neoantigens in cancer immunotherapy. Science 348, 69-74 (2015).
5. Snyder, A., et al. Genetic basis for clinical response to CTLA-4 blockade in melanoma. N Engl J Med 371, 2189-2199 (2014).
Citation Format: Martens JWM, Smid M, Rodríguez-González G, Sieuwerts AM, Prager-Van der Smissen WJC, Van Der Vlugt - Daane M, Van Galen A, Nik-Zainal S, Staaf J, Brinkman AB, Van de Vijver MJ, Richardson AL, Berentsen K, Caldas C, Butler A, Martin S, Davies HD, Debets R, Meijer-Van Gelder ME, Van Deurzen CHM, Ramakrishna MR, Ringnér M, Viari A, Birney E, Børresen-Dale A-L, Stunnenberg HG, Stratton M, Foekens JA. Mutational signatures impact the breast cancer transcriptome and distinguish mitotic from immune response pathways. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-08-10.
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Female pelvic malignancy: spectrum encountered in district hospital: an aid to a general radiologist. Cancer Imaging 2015. [PMCID: PMC4601820 DOI: 10.1186/1470-7330-15-s1-p45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nutritional outcomes following small bowel transplantation – The first year post-operative nutritional nadir. Clin Nutr ESPEN 2015; 10:e190-e191. [DOI: 10.1016/j.clnesp.2015.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Updated Overall Survival (OS) Analysis of the FIRST Study: Lenalidomide Plus Low-Dose Dexamethasone (Rd) Continuous vs Melphalan, Prednisone, and Thalidomide (MPT) in Patients (Pts) With Newly Diagnosed Multiple Myeloma (NDMM). CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2015. [DOI: 10.1016/j.clml.2015.07.330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dose-response effect of fluoride dentifrice on remineralisation and further demineralisation of erosive lesions: A randomised in situ clinical study. J Dent 2015; 43:823-31. [PMID: 25837532 DOI: 10.1016/j.jdent.2015.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective was to evaluate the ability of fluoride in a conventional, non-specialised sodium fluoride-silica dentifrice to promote tooth remineralisation and enamel fluoride uptake (EFU), and assess the resistance of the newly formed mineral to attack by dietary acid, across the concentration range used in mass-market dentifrices. METHODS Subjects wore a palatal appliance containing eight polished bovine enamel specimens, each including an early erosive lesion. In a randomised full-crossover sequence, 62 healthy subjects were treated with dentifrices containing four different fluoride concentrations: no fluoride; 250ppm, 1150ppm and 1426ppm fluoride. At each treatment visit, under supervision, subjects brushed with 1.5g dentifrice and rinsed once while wearing the appliance; the appliance was removed after a 4-h remineralisation period and effects on the enamel specimens determined. The primary efficacy variable was surface microhardness recovery (SMHR); others included EFU, relative erosion resistance (RER) and comparative erosion resistance. RESULTS Highly significant linear and, with the exception of SMHR, quadratic dose-response relationships were observed between all efficacy variables and fluoride concentration. For SMHR, EFU and RER, values for the different fluoride concentrations were statistically resolved from one another, with the exception of the two highest fluoride concentrations. The degree of remineralisation and the acid resistance of enamel after treatment were closely related to EFU. CONCLUSION After a single brushing, conventional non-specialised sodium fluoride-silica dentifrices promoted remineralisation of early enamel lesions, and imparted increased acid-resistance to the enamel surface, in a dose-dependent manner at least up to 1500ppm fluoride. CLINICAL SIGNIFICANCE Enamel erosive tissue loss is an increasing concern, associated with modern diets. This study demonstrated that sodium fluoride, in a conventional non-specialised dentifrice formulation, can promote repair of the earliest stages of enamel erosion after a single application, in a dose-dependent fashion across the fluoride concentration range used in mass-market dentifrices. This study is registered in the GlaxoSmithKline Study Register (ID RH01299), available at: www.gsk-clinicalstudyregister.com/study/RH01299.
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Abstract
The worldwide influenza outbreak of 1918-19 was a medical catastrophe, causing the deaths of around 50 million people. There is evidence however that the major wave, in November 1918, was not part of the pandemic that started in the summer of 1918. The virus responsible for the major wave has been isolated but the structural features responsible for its severity remain incompletely understood. In 1918-19 influenza was an infection so little understood that the government was unsure of what action to take. In contrast, during the pandemic starting in 2009, international and national bodies used many means of communication to keep the public fully informed, with beneficial results. In addition, antiviral agents, a vaccine and antibiotics to treat secondary infection were available. Such a response is possible only with appropriate funding and a comprehensive medical infrastructure, making the potential outbreak of severe influenza in a poor part of the world a matter of grave concern.
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Adult Small Intestinal and Multivisceral Transplantation: Lessons Through the “Retrospecto-scope” at a Single UK Centre From 1991 to 2013. Transplant Proc 2014; 46:2114-8. [DOI: 10.1016/j.transproceed.2014.06.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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An early Cambrian agglutinated tubular lophophorate with brachiopod characters. Sci Rep 2014; 4:4682. [PMID: 24828016 PMCID: PMC4021322 DOI: 10.1038/srep04682] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/18/2014] [Indexed: 02/04/2023] Open
Abstract
The morphological disparity of lophotrochozoan phyla makes it difficult to predict the morphology of the last common ancestor. Only fossils of stem groups can help discover the morphological transitions that occurred along the roots of these phyla. Here, we describe a tubular fossil Yuganotheca elegans gen. et sp. nov. from the Cambrian (Stage 3) Chengjiang Lagerstätte (Yunnan, China) that exhibits an unusual combination of phoronid, brachiopod and tommotiid (Cambrian problematica) characters, notably a pair of agglutinated valves, enclosing a horseshoe-shaped lophophore, supported by a lower bipartite tubular attachment structure with a long pedicle with coelomic space. The terminal bulb of the pedicle provided anchorage in soft sediment. The discovery has important implications for the early evolution of lophotrochozoans, suggesting rooting of brachiopods into the sessile lophotrochozoans and the origination of their bivalved bauplan preceding the biomineralization of shell valves in crown brachiopods.
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Outcomes of allogeneic haemopoietic stem cell transplants at a small New Zealand centre: does size matter? Intern Med J 2014; 44:683-9. [PMID: 24750295 DOI: 10.1111/imj.12456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 04/06/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Reduced intensity conditioning (RIC) protocols for allogeneic haemopoietic cell transplants (HCT) have become commonplace treatments for patients with haematological disease, extending allogeneic HCT to older and less fit patients. There is a perception that centres treating larger numbers of patients have improved outcomes. AIMS We wanted to examine whether outcomes for adult allogeneic HCT patients from our smaller centre were equivalent to those expected at larger centres internationally. METHODS Clinical and laboratory data were collected on all patients who received allogeneic HCT during 2000-2012. Outcomes, including overall survival (OS) and progression-free survival, were compared between patients receiving myeloablative conditioning (MAC) and RIC protocols. RESULTS One hundred and eighteen adult patients underwent allogeneic HCT with MAC (n = 51) or RIC (n = 67). The mean age of patients receiving MAC (35.8 years, range 18-56) was lower than those receiving RIC (48.4 years, range 19-64). Two-year OS was similar for MAC and RIC patients (66% vs 62%, P = 0.17), whereas 2-year progression-free survival was superior in MAC patients (63% vs 50%, P = 0.01) due to fewer relapses. OS was reduced in older patients irrespective of conditioning. Patients with chronic graft-versus-host disease had improved survival due to fewer relapses. OS was unaffected by HCT comorbidity index, donor, cell source or patient/donor cytomegalovirus status. CONCLUSION RIC protocols have resulted in long-term survival in many patients ineligible for MAC protocols. In our smaller centre, patient age but not conditioning intensity influenced survival, which was equivalent to reports from larger centres.
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Use of lean principals to improve flow of patients with fractured neck of femur--the HOPE study. IRISH MEDICAL JOURNAL 2014; 107:70-72. [PMID: 24757887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We describe the implementation of a care pathway for patients with fractured neck of femur (NOF) using Lean and Six Sigma principles. After introduction of the Lean pathway, 32 patients out a total of 86 (37%) with fractured NOF were admitted to the Trauma Ward within 4 hours of presentation to the hospital; prior to implementation this was 16 patients out of a total of 59 (27%). Post-Lean an earlier mean theatre start time of 8.40am was achieved, resulting in a 38 minute increase in daily theatre time. An additional 52 patients (12%) received surgery within 24 hours of admission, resulting in 1 night length of stay reduction. Lean methodology proved an effective method to guide change resulting in an improved journey for the patient and significant workflow gains.
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A continuously monitored colorimetric method for detection of Mycobacterium tuberculosis complex in sputum. Int J Tuberc Lung Dis 2013; 17:1607-12. [DOI: 10.5588/ijtld.13.0317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Adverse event recording post hip fracture surgery. IRISH MEDICAL JOURNAL 2013; 106:300-302. [PMID: 24579408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Accurate recording of adverse events post hip fracture surgery is vital for planning and allocating resources. The purpose of this study was to compare adverse events recorded prospectively at point of care with adverse recorded by the Hospital In-Patient Enquiry (HIPE) System. The study examined a two month period from August to September 2011 at University Hospital Limerick. Out of a sample size of 39, there were 7 males (17.9%) and 32 females (82.1%) with an age range of between 53 and 98 years. The mean age was 80.5 years. 55 adverse events were recorded, in contrast to the HIPE record of 13 (23.6%) adverse events. The most common complications included constipation 10 (18.2%), anaemia 8 (14.5%), urinary retention 8 (14.50%), pneumonia 5 (9.1%) and delirium 5 (9.1%). Of the female cohort, 24 (68.8%) suffered an adverse event, while only 4 (57%) males suffered an adverse event.
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X-ray image enhancement via determinant based feature selection. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2013; 36:449-55. [PMID: 24104449 DOI: 10.1007/s13246-013-0221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
Previous work has investigated the feasibility of using Eigenimage-based enhancement tools to highlight abnormalities on chest X-rays (Butler et al in J Med Imaging Radiat Oncol 52:244-253, 2008). While promising, this approach has been limited by computational restrictions of standard clinical workstations, and uncertainty regarding what constitutes an adequate sample size. This paper suggests an alternative mathematical model to the above referenced singular value decomposition method, which can significantly reduce both the required sample size and the time needed to perform analysis. Using this approach images can be efficiently separated into normal and abnormal parts, with the potential for rapid highlighting of pathology.
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Abstract 2: The development and characterization of ovarian cancer bowel metastases in individual patient tumorgraft models. Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Identifying environmental drivers of insect phenology across space and time: Culicoides in Scotland as a case study. BULLETIN OF ENTOMOLOGICAL RESEARCH 2013; 103:155-170. [PMID: 22846228 DOI: 10.1017/s0007485312000466] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Interpreting spatial patterns in the abundance of species over time is a fundamental cornerstone of ecological research. For many species, this type of analysis is hampered by datasets that contain a large proportion of zeros, and data that are overdispersed and spatially autocorrelated. This is particularly true for insects, for which abundance data can fluctuate from zero to many thousands in the space of weeks. Increasingly, an understanding of the ways in which environmental variation drives spatial and temporal patterns in the distribution, abundance and phenology of insects is required for management of pests and vector-borne diseases. In this study, we combine the use of smoothing techniques and generalised linear mixed models to relate environmental drivers to key phenological patterns of two species of biting midges, Culicoides pulicaris and C. impunctatus, of which C. pulicaris has been implicated in transmission of bluetongue in Europe. In so doing, we demonstrate analytical tools for linking the phenology of species with key environmental drivers, despite using a relatively small dataset containing overdispersed and zero-inflated data. We demonstrate the importance of landcover and climatic variables in determining the seasonal abundance of these two vector species, and highlight the need for more empirical data on the effects of temperature and precipitation on the life history traits of palearctic Culicoides spp. in Europe.
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Characteristics of Methylcellulose Acid Gel Lesions Created in Human and Bovine Enamel. Caries Res 2013; 47:50-5. [DOI: 10.1159/000343164] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 08/27/2012] [Indexed: 11/19/2022] Open
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Artificial neural network processing of stripping analysis responses for identifying and quantifying heavy metals in the presence of intermetallic compound formation. Anal Chem 2012; 69:2373-8. [PMID: 21639371 DOI: 10.1021/ac970217k] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Feed-forward neural networks have been trained to identify and quantify heavy metals in mixtures under conditions where there were significant complications due to intermetallic compound formation. The networks were shown to be capable of (i) correlating voltammetric responses with individual heavy metals in complex mixtures, (ii) determining the relationship between responses and concentrations (including nonlinear relationships due to overlapping peaks and intermetallic compound formation), and (iii) rapidly determining concentrations of individual components from mixtures once trained. Using simulated data, modeled after complex interactions experimentally observed in samples containing Cu and Zn, it has been demonstrated that networks containing two layers of neurons (a nonlinear hidden layer and a linear output layer) can be trained to calculate concentrations under a variety of complicated situations. These include, but are not limited to, cases where the response of the intermetallic compound formed is observed as a shoulder of one of the pure metals and cases where the response of the intermetallic compound formed is not observed in the potential window. In addition, the network described above was trained to simultaneously determine concentrations of four metals (Cu, Pb, Cd, and Zn) in a concentration range where all responses were complicated by intermetallic compound formation (1-500 ppb).
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Preformed donor HLA-DP-specific antibodies mediate acute and chronic antibody-mediated rejection following renal transplantation. Am J Transplant 2012; 12:2845-8. [PMID: 22759079 PMCID: PMC4143589 DOI: 10.1111/j.1600-6143.2012.04172.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Donor-specific HLA alloantibodies may cause acute and chronic antibody-mediated rejection (AMR) and significantly compromise allograft survival. The clinical relevance of antibodies directed against some HLA class II antigens, particularly HLA-DP, is less clear with conflicting reports on their pathogenicity. We report two patients with high levels of pretransplant donor-specific HLA-DP antibodies who subsequently developed recurrent acute AMR and graft failure. In both cases, there were no other donor-specific HLA alloantibodies, suggesting that the HLA-DP-specific antibodies may be directly pathogenic.
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Broadly reactive polymerase chain reaction for pathogen detection in canine granulomatous meningoencephalomyelitis and necrotizing meningoencephalitis. J Vet Intern Med 2012; 26:962-8. [PMID: 22686439 PMCID: PMC7166683 DOI: 10.1111/j.1939-1676.2012.00954.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 03/25/2012] [Accepted: 04/23/2012] [Indexed: 12/01/2022] Open
Abstract
Background Granulomatous meningoencephalomyelitis (GME) and necrotizing meningoencephalitis (NME) are common inflammatory conditions of the central nervous system of dogs. Infectious pathogens, particularly viruses, are suspected to contribute to the etiopathogenesis of GME and NME. Hypothesis Broadly reactive PCR might aid in the identification of infectious agents in GME and NME. Animals Sixty‐eight client‐owned dogs evaluated by necropsy at 1 university referral hospital. Methods A mixed prospective/retrospective case‐control study was performed. Brain tissue prospectively collected at necropsy from GME, NME, and control cases was evaluated by broadly reactive polymerase chain reaction (PCR) for adenoviruses, bunyaviruses, coronaviruses, enteroviruses, flaviviruses, herpesviruses, paramyxoviruses, and parechoviruses. In addition, these tissues were retrospectively evaluated for the presence of mycoplasmas by PCR, culture, and immunohistochemistry (IHC). Results Brain tissue was collected from 11 GME and 27 NME cases and 30 controls. Viral nucleic acids were not identified in the 6 GME cases, 25 NME cases, and 2 controls evaluated by viral PCR. Mycoplasma canis was identified by Mycoplasma genus PCR in 1/5 GME and 4/25 NME cases and subsequently was cultured from 4/5 GME and 4/8 NME cases as well as 2/9 controls. The IHC did not detect M. canis in any of the 11 GME and 27 NME cases or 14 controls evaluated with strain PG14 polyclonal antiserum. Conclusions and Clinical Importance The negative results suggest that viral pathogens are not common in the brain tissue of dogs with GME and NME. Further investigation is warranted to determine the importance of M. canis in cases of GME and NME.
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Effect of Fluoride, Lesion Baseline Severity and Mineral Distribution on Lesion Progression. Caries Res 2012; 46:23-30. [DOI: 10.1159/000334787] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022] Open
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Active motor learning of audiovisual objects. J Vis 2011. [DOI: 10.1167/11.11.940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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SIMS(DAIRY): a modelling framework to identify sustainable dairy farms in the UK. Framework description and test for organic systems and N fertiliser optimisation. THE SCIENCE OF THE TOTAL ENVIRONMENT 2011; 409:3993-4009. [PMID: 21703662 DOI: 10.1016/j.scitotenv.2011.05.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 05/18/2011] [Accepted: 05/22/2011] [Indexed: 05/31/2023]
Abstract
Multiple demands are placed on farming systems today. Society, national legislation and market forces seek what could be seen as conflicting outcomes from our agricultural systems, e.g. food quality, affordable prices, a healthy environmental, consideration of animal welfare, biodiversity etc., Many of these demands, or desirable outcomes, are interrelated, so reaching one goal may often compromise another and, importantly, pose a risk to the economic viability of the farm. SIMS(DAIRY), a farm-scale model, was used to explore this complexity for dairy farm systems. SIMS(DAIRY) integrates existing approaches to simulate the effect of interactions between farm management, climate and soil characteristics on losses of nitrogen, phosphorus and carbon. The effects on farm profitability and attributes of biodiversity, milk quality, soil quality and animal welfare are also included. SIMS(DAIRY) can also be used to optimise fertiliser N. In this paper we discuss some limitations and strengths of using SIMS(DAIRY) compared to other modelling approaches and propose some potential improvements. Using the model we evaluated the sustainability of organic dairy systems compared with conventional dairy farms under non-optimised and optimised fertiliser N use. Model outputs showed for example, that organic dairy systems based on grass-clover swards and maize silage resulted in much smaller total GHG emissions per l of milk and slightly smaller losses of NO(3) leaching and NO(x) emissions per l of milk compared with the grassland/maize-based conventional systems. These differences were essentially because the conventional systems rely on indirect energy use for 'fixing' N compared with biological N fixation for the organic systems. SIMS(DAIRY) runs also showed some other potential benefits from the organic systems compared with conventional systems in terms of financial performance and soil quality and biodiversity scores. Optimisation of fertiliser N timings and rates showed a considerable scope to reduce the (GHG emissions per l milk too).
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Abstract
The use of herbs as cures for human ailments is as old as modern man, but has now been replaced by synthetic drugs. However, the mixture of bioactive substances found in many traditional herbal remedies has similarities with modern combination therapies, like those developed by Sir John Crofton in Edinburgh for the treatment of tuberculosis. It is suggested that, in the development of these therapies, it might be possible to learn from the drug ‘cocktails’ found in plants.
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Effect of ampicillin on bleeding time in very low birth-weight neonates during the first week after birth. J Perinatol 2011; 31:477-80. [PMID: 21372796 DOI: 10.1038/jp.2010.154] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE On the day of birth, the bleeding time of very low birth-weight (VLBW, <1500 g) neonates is generally prolonged, compared with term neonates. However, their bleeding time generally improves (shortens) over the next 7 to 10 days. Ampicillin can prolong the bleeding times of term and late preterm neonates, but its effect on VLBW neonates, who already have a somewhat prolonged bleeding time initially, is not known. STUDY DESIGN This was a prospective, single-centered, paired, before vs after test of the effect of ampicillin on template bleeding time and PFA-100 time (platelet function analyzer). Ampicillin was dosed at every 12 h intravenously, but decisions about discontinuation were made by the responsible clinician, independent of this study. RESULT A total of 20 VLBW neonates were studied. They ranged from 23- to 30-weeks gestation at birth and weighed 500 t 1410 g. Initial bleeding times averaged 166 s (95% CI, 138 to 194) and initial PFA-100 times averaged 119 s (95% CI, 90 to 148). In all, 10 had ampicillin dosing stopped after a shorter course (4 to 7 doses) and 10 had it continued for a longer course (10 to 15 doses). Blood cultures were sterile in all 20, and no differences in laboratory or clinical features were found between those treated with a shorter vs longer course. After stopping the ampicillin following a short course the bleeding times and PFA-100 times were similar to the initial values. However, after a longer course the bleeding times were prolonged by an average of 2 min, to 284 s (95% CI, 242 to 326; P=0.001 vs initial). The PFA-100 times also trended longer by an average of 44 s (P=0.07). The number of doses of ampicillin received in the first week correlated with the degree of prolongation in bleeding time (r=0.68). CONCLUSION Over the first week of life, a period when the bleeding time of VLBW neonates normally shortens, the opposite occurred (the bleeding time lengthened) if ≥ 10 doses of ampicillin were administered.
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Effects of Zinc and Fluoride on the Remineralisation of Artificial Carious Lesions under Simulated Plaque Fluid Conditions. Caries Res 2011; 45:313-22. [DOI: 10.1159/000324804] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 01/27/2011] [Indexed: 11/19/2022] Open
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Enamel Demineralization and Remineralization under Plaque Fluid-Like Conditions: A Quantitative Light-Induced Fluorescence Study. Caries Res 2011; 45:155-61. [DOI: 10.1159/000325743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/16/2011] [Indexed: 11/19/2022] Open
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Abstract
Suicidal behaviour shows evidence of familial clustering and the twin data on completed suicide suggest moderate heritability. The extent to which the genetics of suicidal behaviour overlaps with the genetics of affective disorders is unclear but there is overwhelming evidence that both bipolar and unipolar disorder are substantially influenced by genes. So far, candidate gene studies of suicidality have provoked much interest, but recently, attention has also turned to candidate gene approaches to suicidal ideation emerging during antidepressant treatment. The advent of genome-wide association studies (GWAS) has had a major impact on studies of affective disorder with some provocative new findings. The GWAS approach is also beginning to be applied in the search for genes that underlie suicidal ideation and behaviour.
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