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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Arundel CE, Welch C, Saramago P, Adderley U, Atkinson R, Chetter I, Cullum N, Davill T, Griffiths J, Hewitt C, Hirst C, Kletter M, Mullings J, Roberts G, Smart B, Soares M, Stather P, Strachan L, Stubbs N, Torgerson DJ, Watson J, Zahra S, Dumville J. A randomised controlled trial of compression therapies for the treatment of venous leg ulcers (VenUS 6): study protocol for a pragmatic, multicentre, parallel-group, three-arm randomised controlled trial. Trials 2023; 24:357. [PMID: 37237393 DOI: 10.1186/s13063-023-07349-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Venous leg ulcer(s) are common, recurring, open wounds on the lower leg, resulting from diseased or damaged leg veins impairing blood flow. Wound healing is the primary treatment aim for venous leg ulceration, alongside the management of pain, wound exudate and infection. Full (high) compression therapy delivering 40 mmHg of pressure at the ankle is the recommended first-line treatment for venous leg ulcers. There are several different forms of compression therapy available including wraps, two-layer hosiery, and two-layer or four-layer bandages. There is good evidence for the clinical and cost-effectiveness of four-layer bandage and two-layer hosiery but more limited evidence for other treatments (two-layer bandage and compression wraps). Robust evidence is required to compare clinical and cost-effectiveness of these and to investigate which is the best compression treatment for reducing time to healing of venous leg ulcers whilst offering value for money. VenUS 6 will therefore investigate the clinical and cost-effectiveness of evidence-based compression, two-layer bandage and compression wraps for time to healing of venous leg ulcers. METHODS VenUS 6 is a pragmatic, multi-centre, three-arm, parallel-group, randomised controlled trial. Adult patients with a venous leg ulcer will be randomised to receive (1) compression wraps, (2) two-layer bandage or (3) evidence-based compression (two-layer hosiery or four-layer bandage). Participants will be followed up for between 4 and 12 months. The primary outcome will be time to healing (full epithelial cover in the absence of a scab) in days since randomisation. Secondary outcomes will include key clinical events (e.g. healing of the reference leg, ulcer recurrence, ulcer/skin deterioration, amputation, admission/discharge, surgery to close/remove incompetent superficial veins, infection or death), treatment changes, adherence and ease of use, ulcer related pain, health-related quality of life and resource use. DISCUSSION VenUS 6 will provide robust evidence on the clinical and cost-effectiveness of the different forms of compression therapies for venous leg ulceration. VenUS 6 opened to recruitment in January 2021 and is currently recruiting across 30 participating centres. TRIAL REGISTRATION ISRCTN67321719 . Prospectively registered on 14 September 2020.
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Affiliation(s)
- C E Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - C Welch
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - P Saramago
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - U Adderley
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - R Atkinson
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - I Chetter
- University of Hull, Hull York Medical School and Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - T Davill
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Griffiths
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - C Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - C Hirst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - M Kletter
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - J Mullings
- Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK
| | - G Roberts
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - B Smart
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - M Soares
- Centre for Health Economics, University of York, York, YO10 5DD, UK
| | - P Stather
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich, NR4 7UY, UK
| | - L Strachan
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - N Stubbs
- NCS Woundcare Consulting Limited, Cornmill Lane, Leeds, LS17 9EQ, UK
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Watson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - S Zahra
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - J Dumville
- Division of Nursing, Midwifery and Social Work, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Puyalto A, Rodríguez-Remírez M, López I, Olmedo M, Vilalta A, Welch C, Vicent S, Calvo A, Gil-Bazo I. MA02.08 Trametinib Inhibition of MEK1 2 Upregulates PD-L1 Expression in KRAS-Mutant NSCLC Through ID1 Downregulation. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, 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Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Welch C, Copeland C. 814 GENERAL INTERNAL MEDICINE AND THE GERIATRIC MEDICINE WORKFORCE: RESULTS: OF THE RCP CENSUS AND WELLBEING SURVEY. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.814] [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
Background
In the UK, most geriatric medicine consultants also contribute to general internal medicine (‘acute take’) services. However, impact on workforce was unclear.
Methods
We used anonymised data available from the Royal College of Physicians (RCP) 2019 census, and the RCP wellbeing snapshot survey conducted in early 2020. We used multivariable analysis of covariance (adjusting for age, gender, nation, NHS academic or other contract type, contribution to general or acute medicine services, and less than full-time working) to assess for differences in mean excess Programmed Activities (PAs) worked above contracted PAs between geriatric medicine and other physician specialties. We used binary logistic regression analysis to assess for satisfaction in own specialty and general medicine (adjusting for variables above), and in perceived excess workload and excess hours (adjusting for age, gender, and nation).
Results
The RCP census included 16,746 consultant physicians, including 1,677 (10%) geriatricians. The wellbeing survey included 2,670 respondents, including 343 (12.8%) geriatricians. Geriatricians reported working excess programmed activities, but fewer than other specialties (adjusted means: 0.74, CI 0.59–0.89 vs. 0.95, CI 0.82–1.07; p < 0.001). Geriatricians were also less likely to report always or often working excess hours (OR 0.61, CI 0.47–0.78; p < 0.001) or having an excess workload (OR 0.60, CI 0.47–0.78; p < 0.001). There were no differences in satisfaction with their own specialty, but geriatricians were more likely to report increased satisfaction with general medicine (OR 1.65, CI 1.30–2.09; p < 0.001).
Conclusion
Physicians, in the UK, frequently report working excess hours beyond their contracted job plans. However, geriatricians report fewer excess hours than other specialties. Geriatricians also report greater perceived satisfaction working in general medicine than other physician specialties.
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Affiliation(s)
- C Welch
- Institute of Inflammation and Ageing, University of Birmingham
- Unviversity Hospitals Birmingham NHS Foundation Trust
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Gomindes A, Welch C, Chugh R, Appleton J. 150 Muscle Quantity at C3 And/or L3 on Routine Trauma Series Computed Tomography Correlate with Brain Frailty and Clinical Frailty Scale: A Cross-Sectional Study. Br J Surg 2022. [DOI: 10.1093/bjs/znac040.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Sarcopenia is increasingly recognised to impact the quality of life and patient outcomes. The relationship with brain frailty is unknown.
Objectives
Assess if muscle mass at C3 correlates with muscle mass at L3 on routine trauma imaging. Assess for associations between muscle-mass, brain-frailty, and Clinical Frailty Scale (CFS) on routine trauma imaging.
Method
Routine trauma-series CT scans were retrospectively analysed for patients aged ≥16-years-old admitted to Queen-Elizabeth-Hospital in January2020. Paravertebral, sternocleidomastoid, and total muscle cross-sectional-area (CSA) at C3 (C3-SMM), and total psoas muscle CSA (TPA), total muscle CSA (L3-SMM), and total adipose CSA at L3 were calculated. Brain-frailty scores were calculated assessing for leukoaraiosis, cerebral atrophy, and old vascular lesions/infarcts. CFS was calculated retrospectively from clinical notes. We assessed for correlation against age, CFS, muscle-mass, and brain-frailty using Pearson’s correlations.
Results
We included 111 patients in this study (mean age 49, SD 25.6; 65.8% female). C3-SMM strongly correlated with L3-SMM (r=0.746, p<0.001). Paravertebral and sternocleidomastoid CSA correlated with C3-SMM (paravertebral: r=0.814, p<0.001; sternocleidomastoid: r=0.814, p<0.001). TPA strongly correlated with L3- SMM (r=0.800, p<0.001). Sternocleidomastoid CSA and TPA both negatively correlated moderately with age (sternocleidomastoid: r=−0.460, p<0.001; TPA: r=−0.468, p<0.001), CFS (sternocleidomastoid: r=−0.414, p<0.001; TPA: r=−0.431, p<0.001), and brain frailty (sternocleidomastoid: r=−0.395, p<0.001; TPA: r=−0.436, p<0.001). Adipose CSA at L3 did not correlate with age, CFS, brain-frailty, or muscle-mass.
Conclusions
Muscle-mass at C3 relates to muscle-mass at L3. Muscle-mass on routine trauma-imaging is negatively associated with age, CFS, and brain-frailty.
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Affiliation(s)
- A. Gomindes
- Queen Elizabeth Hospital, Birmingham, United Kingdom
- University of Edinburgh, Edinburgh, United Kingdom
| | - C. Welch
- Queen Elizabeth Hospital, Birmingham, United Kingdom
- Medical Research Council (MRC) - Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham and University of Nottingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - R. Chugh
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Appleton
- Stroke, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Battisti N, Welch C, DeBelder M, Deanfield J, Weston C, Peake M, Sweeting M, Adlam D, Ring A. 1831P Prevalence of cardiovascular disease in patients diagnosed with six common curable malignancies: A Virtual Cardio-Oncology Research Institute (VICORI) national registry dataset analysis. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.719] [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: 11/15/2022] Open
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Penfold RS, Zazzara MB, Roberts AL, Lee KA, Dooley H, Sudre CH, Welch C, Bowyer RCE, Visconti A, Mangino M, Freidin MB, El-Sayed Moustafa JS, Small K, Murray B, Modat M, Wolf J, Ourselin S, Martin FC, Steves CJ, Ni Lochlainn M. 144 Probable Delirium is A Presenting Symptom of COVID-19 in Frail, Older Adults: A Study of Hospitalised and Community-Based Cohorts. Age Ageing 2021. [PMCID: PMC7989598 DOI: 10.1093/ageing/afab030.105] [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
Introduction
COVID-19 exhibits a more severe disease course in older adults with frailty. Awareness of atypical presentations is critical to facilitate early disease identification. This study aimed to assess how frailty affects presenting symptoms of COVID-19 in older adults.
Methods
Observational study of two distinct cohorts: (i) Hospitalised patients aged 65 and over; unscheduled admission to a large London teaching hospital between March 1st, 2020-May 5th, 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab (n = 322); (ii) Community-based adults aged 65 and over enrolled in the COVID Symptom Study mobile application between March 24th (application launch)-May 8th, 2020; self-report or report-by-proxy data; reported test-positive for COVID-19 (n = 535). Multivariable logistic regression analysis performed on age-matched samples of both cohorts to determine associations between frailty and symptoms of COVID-19 including delirium, fever and cough.
Results
Hospital cohort: there was a significantly higher prevalence of delirium amongst the frail sample, with no difference in fever or cough. Of those presenting with delirium, 10/53 (18.9%) presented with delirium as the only documented symptom. Community-based cohort: there was a significantly higher prevalence of probable delirium in the frail sample, and also of fatigue and shortness of breath. Of those reporting probable delirium, 28/84 (33%) did not report fever or cough.
Conclusions
This study demonstrates a higher prevalence of delirium as a presenting symptom of COVID-19 infection in older adults with frailty compared to their age-matched non-frail counterparts. Clinicians should suspect COVID-19 in frail older adults presenting with delirium. Early detection facilitates infection control measures to mitigate against catastrophic spread and preventable hospitalisations and deaths amongst this population. Our findings emphasise the need for systematic frailty assessment for all acutely ill older patients in both hospital and community settings, as well as systematic evaluation of any change in mental status.
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Affiliation(s)
- R S Penfold
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M B Zazzara
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - A L Roberts
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - K A Lee
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - H Dooley
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - C H Sudre
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - C Welch
- Institute of Inflammation and Ageing, University of Birmingham, B15 2TT
| | - R C E Bowyer
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - A Visconti
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M Mangino
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M B Freidin
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - J S El-Sayed Moustafa
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - K Small
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - B Murray
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - M Modat
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - J Wolf
- Zoe Global Limited, 164 Westminster Bridge Road, London SE1 7RW, UK
| | - S Ourselin
- School of Biomedical Engineering and Imaging Sciences, King’s College London, Westminster Bridge Road, SE17EH, London, UK
| | - F C Martin
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - C J Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
| | - M Ni Lochlainn
- Department of Twin Research and Genetic Epidemiology, King’s College London, St Thomas’ Hospital, London, SE1 7EH
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9
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Saha R, Feng C, Welch C, Mehl GH, Feng J, Zhu C, Gleeson J, Sprunt S, Jákli A. The interplay between spatial and heliconical orientational order in twist-bend nematic materials. Phys Chem Chem Phys 2021; 23:4055-4063. [PMID: 33587066 DOI: 10.1039/d0cp06633h] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The helical pitch formed by organic molecules, such as the α-helix of proteins, usually requires hydrogen bonding between chiral units and long-range positional order. It was recently found that certain liquid crystal oligomers can have a twist-bend nematic (NTB) phase with nanoscale heliconical structure without hydrogen bonding, molecular chirality or positional order. To understand the nature of this unique structure, here we present hard and resonant tender X-ray scattering studies of two novel sulfur containing dimer materials. We simultaneously measure the temperature dependences of the helical pitch and the correlation length of both the helical and positional order. In addition to an unexpected strong variation of the pitch with the length of the spacer connecting the monomer units, we find that at the transition to the NTB phase the positional correlation length drops. The helical structure was found not only in the NTB phase but observed even in the upper range of a smectic phase that forms just below the NTB state. The coexistence of smectic layering and the heliconical order indicates a layered (SmATB) phase wherein the rigid units of the dimers are tilted with respect to the smectic layer normal in order to accommodate the bent conformation of the dimers and the tilt direction rotates along the heliconical axis.
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Affiliation(s)
- R Saha
- Department of Physics, Kent State University, Kent, OH 44242, USA.
| | - C Feng
- Materials Science Graduate Program, Advanced Materials and Liquid Crystal Institute, Kent State University, Kent, OH 44242, USA and Advanced Light Source, Lawrence Berkeley National Lab, Berkeley, CA 94720, USA
| | - C Welch
- Department of Chemistry, University of Hull, Hull, UK
| | - G H Mehl
- Department of Chemistry, University of Hull, Hull, UK
| | - J Feng
- Advanced Light Source, Lawrence Berkeley National Lab, Berkeley, CA 94720, USA
| | - C Zhu
- Advanced Light Source, Lawrence Berkeley National Lab, Berkeley, CA 94720, USA
| | - J Gleeson
- Department of Physics, Kent State University, Kent, OH 44242, USA.
| | - S Sprunt
- Department of Physics, Kent State University, Kent, OH 44242, USA. and Materials Science Graduate Program, Advanced Materials and Liquid Crystal Institute, Kent State University, Kent, OH 44242, USA
| | - A Jákli
- Department of Physics, Kent State University, Kent, OH 44242, USA. and Materials Science Graduate Program, Advanced Materials and Liquid Crystal Institute, Kent State University, Kent, OH 44242, USA
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10
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Ang N, Egan A, Page S, Yadav S, Saxena P, Karamatic R, Welch C, Anstey C, Senthuran S. P42 Liver Compliance and Cardiac Surgery Outcomes Pilot Study. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.03.245] [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: 10/21/2022]
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11
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Nguyen U, Tinsley B, Sen Y, Stein J, Palacios Y, Ceballos A, Welch C, Nzenkue K, Penn A, Murphy L, Leodones K, Casiquin J, Ivory I, Ghenta K, Danziger K, Widman E, Newman J, Triplehorn M, Hindi Z, Mulligan K. Exposure to bisphenol A differentially impacts neurodevelopment and behavior in Drosophila melanogaster from distinct genetic backgrounds. Neurotoxicology 2020; 82:146-157. [PMID: 33309840 DOI: 10.1016/j.neuro.2020.12.007] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 12/13/2022]
Abstract
Bisphenol A (BPA) is a ubiquitous environmental chemical that has been linked to behavioral differences in children and shown to impact critical neurodevelopmental processes in animal models. Though data is emerging, we still have an incomplete picture of how BPA disrupts neurodevelopment; in particular, how its impacts may vary across different genetic backgrounds. Given the genetic tractability of Drosophila melanogaster, they present a valuable model to address this question. Fruit flies are increasingly being used for assessment of neurotoxicants because of their relatively simple brain structure and variety of measurable behaviors. Here we investigated the neurodevelopmental impacts of BPA across two genetic strains of Drosophila-w1118 (control) and the Fragile X Syndrome (FXS) model-by examining both behavioral and neuronal phenotypes. We show that BPA induces hyperactivity in larvae, increases repetitive grooming behavior in adults, reduces courtship behavior, impairs axon guidance in the mushroom body, and disrupts neural stem cell development in the w1118 genetic strain. Remarkably, for every behavioral and neuronal phenotype examined, the impact of BPA in FXS flies was either insignificant or contrasted with the phenotypes observed in the w1118 strain. This data indicates that the neurodevelopmental impacts of BPA can vary widely depending on genetic background and suggests BPA may elicit a gene-environment interaction with Drosophila fragile X mental retardation 1 (dFmr1)-the ortholog of human FMR1, which causes Fragile X Syndrome and is associated with autism spectrum disorder.
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Affiliation(s)
- U Nguyen
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - B Tinsley
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Y Sen
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Stein
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Y Palacios
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - A Ceballos
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - C Welch
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Nzenkue
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - A Penn
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - L Murphy
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Leodones
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Casiquin
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - I Ivory
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Ghenta
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Danziger
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - E Widman
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - J Newman
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - M Triplehorn
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - Z Hindi
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States
| | - K Mulligan
- Department of Biological Sciences, California State University, Sacramento, 6000 J Street, Sacramento, CA, 95819, United States.
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12
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Law J, Welch C, Javanmard-Emamghissi H, Clark M, Bisset CN, O'Neil P, Moug SJ. Decision-making for older patients undergoing emergency laparotomy: defining patient and clinician values and priorities. Colorectal Dis 2020; 22:1694-1703. [PMID: 32464712 DOI: 10.1111/codi.15165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/07/2020] [Indexed: 01/05/2023]
Abstract
AIM There remains limited knowledge on what patients value and prioritize in their decision to undergo emergency laparotomy (ELap) and during their subsequent recovery. The aim of this study was to explore factors in decision-making and to reach a consensus amongst patients on the 10 most important priorities in decision-making in ELap. METHODS Patients aged over 65 years who had required an ELap decision within the preceding 12 months (regardless of management) were identified and invited to attend a modified Delphi process focus group. RESULTS A total of 20 participants attended: eight patients, four relatives and eight perioperative specialists. The perioperative specialists group defined 12 important factors for perioperative decision-making. The patient group agreed that only six (50%) of these factors were important: independence, postoperative complications, readmission to hospital, requirement for stoma formation, delirium (including long-term cognition) and presence of an advocate (such as a friend or family member). Open discussion refined multiple themes. Agreement was reached by patients and relatives about 10 factors that they valued as most important in their ELap patient journey: return to independence, realistic expectations, postoperative complications, what to expect postoperatively, readmission to hospital, nutrition, postoperative communication, stoma, follow-up and delirium. CONCLUSION Patients and clinicians have different values and priorities when discussing the risks and implications of undergoing ELap. Patients value quality of life outcomes, in particular, the formation of a stoma, returning to their own home and remaining independent. This work is the first to combine both perspectives to guide future ELap research outcomes.
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Affiliation(s)
- J Law
- Blackpool Victoria Hospital, North West Deanery, UK
| | - C Welch
- Geriatric Medicine, University of Birmingham,, Birmingham, UK
| | | | - M Clark
- Royal Alexandra Hospital, Paisley, UK
| | | | - P O'Neil
- Royal Alexandra Hospital, Paisley, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
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13
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Abstract
Cell migration refers to the ability of cells to translocate across a substrate or through a matrix. To achieve net movement requires spatiotemporal regulation of the actin cytoskeleton. Computational approaches are necessary to identify and quantify the regulatory mechanisms that generate directed cell movement. To address this need, we developed computational tools, based on stochastic modeling, to analyze time series data for the position of randomly migrating cells. Our approach allows parameters that characterize cell movement to be efficiently estimated from cell track data. We applied our methods to analyze the random migration of Mouse Embryonic Fibroblasts (MEFS) and HeLa cells. Our analysis revealed that MEFs exist in two distinct states of migration characterized by differences in cell speed and persistence, whereas HeLa cells only exhibit a single state. Further analysis revealed that the Rho-family GTPase RhoG plays a role in determining the properties of the two migratory states of MEFs. An important feature of our computational approach is that it provides a method for predicting the current migration state of an individual cell from time series data. Finally, we applied our computational methods to HeLa cells expressing a Rac1 biosensor. The Rac1 biosensor is known to perturb movement when expressed at overly high concentrations; at these expression levels the HeLa cells showed two migratory states, which correlated with differences in the spatial distribution of active Rac1.
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Affiliation(s)
- R. J. Allen
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - C. Welch
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Neha Pankow
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Klaus M. Hahn
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Computational Medicine Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Timothy C. Elston
- Department of Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Computational Medicine Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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14
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Salazar M, James D, Welch C, Viles J, Karnad A, Arora S. IMPLEMENTATION OF A GERIATRIC ONCOLOGY ASSESSMENT TOOL (G8) IN AN ACADEMIC ONCOLOGY PRACTICE SERVING A HISPANIC-RICH POPULATION. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31288-3] [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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15
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Merkel K, Welch C, Ahmed Z, Piecek W, Mehl GH. Dielectric response of electric-field distortions of the twist-bend nematic phase for LC dimers. J Chem Phys 2019; 151:114908. [PMID: 31542029 DOI: 10.1063/1.5114824] [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: 01/06/2023] Open
Abstract
Wide band dielectric spectroscopy of bent-shaped achiral liquid-crystal dimers 1″-n″-bis(4-cyanobiphenyl-4'-yl) n-alkanes (CBnCB n = 7, 9, 11) has been investigated in a frequency range 0.1 Hz-100 MHz using planar-aligned cells of sample thicknesses ranging from 2 to 10 (μm) over a temperature range that covers both nematic and twist bend nematic phases. Two peaks in the dielectric spectrum in the higher frequency range are assigned to the molecular relaxation processes. The peak at the highest frequency, ∼40 to 80 MHz, is assigned to an internal precessional rotation of a single unit of the dimer around the director. The mode in the next lower frequency range of 2-10 MHz is assigned to the spinning rotation of the dimer around its long axis. This involves fluctuations of the dipole moment of the bent-shaped conformation that is directed along its arrow direction of the bow shape formed by the dimer. The peak in the frequency range 100 kHz-1 MHz can be assigned to the collective fluctuations of the local director with reference to the helical axis of the NTB structure. The dependence of its frequency on temperature is reminiscent of the soft mode observed at the SmA* to SmC* phase transition. This result clearly corresponds to the electro-clinic effect-the response of the director to the applied electric field in an electro-optic experiment. The lowest frequency mode, observed in the frequency range of 0.1 Hz-100 Hz, is identified with the Goldstone mode. This mode is concerned with the long range azimuthal angle fluctuations of the local director. This leads to an alternating compression and expansion of the periodic structure of the NTB phase.
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Affiliation(s)
- K Merkel
- Faculty of Computer Science and Material Science, Institute of Technology and Mechatronics, University of Silesia in Katowice, Katowice, Poland
| | - C Welch
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - Z Ahmed
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - W Piecek
- Faculty of Advanced Technologies and Chemistry, Military University of Technology, Warszawa, Poland
| | - G H Mehl
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
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16
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Welch C, Greig C, Hassan-Smith Z, Pinkney T, Lord J, Jackson T. 48REDUCED BASELINE INFLAMMATION MAY BE ASSOCIATED WITH GREATER ACUTE DECLINES IN MUSCLE MASS FOLLOWING ELECTIVE COLORECTAL SURGERY. Age Ageing 2019. [DOI: 10.1093/ageing/afz076.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Welch C, Bangash A, Wears R, Rice D, Aziz V. 65GERIATRIC MEDICINE AND OLD AGE PSYCHIATRY JOINT TRAINING PILOT: AN INNOVATIVE APPROACH TO COLLABORATIVE POSTGRADUATE TRAINING. Age Ageing 2019. [DOI: 10.1093/ageing/afz057.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Welch
- University of Birmingham; Health Education West Midlands; RCPsych, Old Age Faculty; BGS Education and Training
| | - A Bangash
- University of Birmingham; Health Education West Midlands; RCPsych, Old Age Faculty; BGS Education and Training
| | - R Wears
- University of Birmingham; Health Education West Midlands; RCPsych, Old Age Faculty; BGS Education and Training
| | - D Rice
- University of Birmingham; Health Education West Midlands; RCPsych, Old Age Faculty; BGS Education and Training
| | - V Aziz
- University of Birmingham; Health Education West Midlands; RCPsych, Old Age Faculty; BGS Education and Training
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18
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Merkel K, Kocot A, Welch C, Mehl GH. Soft modes of the dielectric response in the twist–bend nematic phase and identification of the transition to a nematic splay bend phase in the CBC7CB dimer. Phys Chem Chem Phys 2019; 21:22839-22848. [DOI: 10.1039/c9cp04952e] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Two collective processes resulting from distortion of the heliconical structure of the twist–bend nematic phase of an achiral dimer: one tilt mode due to distortions of the conical angle and second related to long range fluctuation of the cone phase.
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Affiliation(s)
- K. Merkel
- Faculty of Computer Science and Material Science
- Institute of Technology and Mechatronics
- University of Silesia in Katowice
- Poland
| | - A. Kocot
- Faculty of Computer Science and Material Science
- Institute of Technology and Mechatronics
- University of Silesia in Katowice
- Poland
| | - C. Welch
- Department of Chemistry
- University of Hull
- Hull HU6 7RX
- UK
| | - G. H. Mehl
- Department of Chemistry
- University of Hull
- Hull HU6 7RX
- UK
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19
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Welch C, Adlam D, Peake M, Sweeting M, Rutherford M, Lambert P. Resection rates in patients with non-small cell lung cancer and cardiovascular co-morbidities. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30175-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Welch C, Pinkney T, Greig CA, Hassan-Smith ZK, Lord JM, Jackson TA. 6ADMISSION FOR AN ELECTIVE COLORECTAL SURGERY PROCEDURE IS ASSOCIATED WITH REDUCED QUADRICEPS MUSCLE THICKNESS AT ONE WEEK POST-OPERATIVELY? Age Ageing 2018. [DOI: 10.1093/ageing/afy122.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Welch
- Institute of Inflammation and Ageing, University of Birmingham
| | - T Pinkney
- Institute of Inflammation and Ageing, University of Birmingham
| | - C A Greig
- Institute of Inflammation and Ageing, University of Birmingham
| | | | - J M Lord
- Institute of Inflammation and Ageing, University of Birmingham
| | - T A Jackson
- Institute of Inflammation and Ageing, University of Birmingham
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21
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Titano J, Di Capua J, Welch C, Biederman D, Patel R, Ranade M, Bishay V, Kim E, Nowakowski F, Lookstein R, Fischman A. Abstract No. 515 RAPID TACE: radial access provides improved discharge times in transarterial chemoembolization. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.560] [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: 11/29/2022] Open
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22
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Loewenstern J, Welch C, Lekperic S, Bishay V, Ranade M, Patel R, Kim E, Nowakowski F, Lookstein R, Fischman A. 3:00 PM Abstract No. 121 Patient radiation exposure in transradial vs. transfemoral yttrium-90 radioembolization: a propensity score–matched analysis of over 1000 procedures. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.138] [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] Open
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23
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Stevenson WD, Ahmed Z, Zeng XB, Welch C, Ungar G, Mehl GH. Molecular organization in the twist-bend nematic phase by resonant X-ray scattering at the Se K-edge and by SAXS, WAXS and GIXRD. Phys Chem Chem Phys 2018; 19:13449-13454. [PMID: 28513674 DOI: 10.1039/c7cp01404j] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Using a magnetically aligned liquid crystal mixture containing a novel Se-labelled dimer and the difluoroterphenyl dimer DTC5C7, the twist-bend nematic phase (Ntb) was studied by the resonant scattering of hard X-rays and by conventional small and wide-angle X-ray scattering (SAXS, WAXS). Resonant diffraction spots indicated a helix with a 9-12 nm pitch in the Ntb phase and an unprecedentedly high helix orientation. This enabled deconvolution of global and local order parameters. These findings, combined with the simultaneously recorded resonant and non-resonant SAXS and WAXS data, allowed us to construct a locally layered molecular model of the Ntb phase, where the average twisted conformation of each molecule was idealised as a helical segment, matching the local heliconical director field. The dimers were found to be less bent in the Ntb phase than in their minimum energy conformation, and straightening further with increasing temperature. It is proposed that on further heating their low bend angle allows the transition to the normal nematic phase, where the molecules can freely move longitudinally, without the need to perform screw-like motion as in the Ntb phase. At the low-temperature end, the increasing molecular twist becomes unsustainable, leading to a transition to a smectic phase, where no twist is required.
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Affiliation(s)
- W D Stevenson
- Department of Materials Science and Engineering, University of Sheffield, Sheffield S1 3JD, UK.
| | - Z Ahmed
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - X B Zeng
- Department of Materials Science and Engineering, University of Sheffield, Sheffield S1 3JD, UK.
| | - C Welch
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - G Ungar
- Department of Materials Science and Engineering, University of Sheffield, Sheffield S1 3JD, UK. and Department of Physics, Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - G H Mehl
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
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24
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Cox R, Welch C, Cameron D, Roche E. Gastrointestinal: Verrucous cell carcinoma (VCC) of the esophagus: A rare variant of esophageal squamous cell carcinoma (SCC). J Gastroenterol Hepatol 2017; 32:544. [PMID: 28320062 DOI: 10.1111/jgh.13513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/09/2022]
Affiliation(s)
- R Cox
- Department of Gastroenterology, The Townsville Hospital, Douglas, Queensland, Australia
| | - C Welch
- Department of Gastroenterology, The Townsville Hospital, Douglas, Queensland, Australia
| | - D Cameron
- Department of General Surgery, The Townsville Hospital, Douglas, Queensland, Australia
| | - E Roche
- Department of Gastroenterology, The Townsville Hospital, Douglas, Queensland, Australia
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25
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Melzer M, Welch C. Does the presence of a urinary catheter predict severe sepsis in a bacteraemic cohort? J Hosp Infect 2017; 95:376-382. [PMID: 28202189 DOI: 10.1016/j.jhin.2017.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sepsis is a major cause of mortality with an estimated 37,000 deaths in the UK each year. This study aimed to determine host factors that can predict severe sepsis in a bacteraemic cohort. METHODS From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia at a London teaching hospital. These data were used to categorize patients as having severe or non-severe sepsis. Multi-variate logistic regression was used to determine the association between host factors and severe sepsis. FINDINGS Five hundred and ninety-four bacteraemic episodes occurred in 500 patients. The majority of cases were in patients aged >50 years (382/594, 64.3%) and in males (346/594, 58.2%). The most common isolates were Escherichia coli (207/594, 34.8%) and meticillin-susceptible Staphylococcus aureus (57/594, 9.6%). In logistic regression multi-variable analysis, site of infection was significantly associated with severe sepsis. For catheter-associated urinary tract infections, the association was significant after adjustment for age, sex, Charlson comorbidity index and where infection was acquired (odds ratio 3.94, 95% confidence interval 1.70-9.11). CONCLUSIONS Urinary catheters increase the risk of severe sepsis. They should only be used if clinically indicated. If inserted, a care bundle approach should be used and the anticipated removal date should be recorded unless a long-term catheter is required. In the context of sepsis, the presence of a urinary catheter should prompt immediate implementation of 'Sepsis Six' and consideration of transfer to a critical care unit.
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Affiliation(s)
- M Melzer
- Royal London Hospital, Barts Health NHS Trust, London, UK.
| | - C Welch
- Department of Epidemiology and Public Health, University College London, London, UK
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26
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Parsouzi Z, Pardaev SA, Welch C, Ahmed Z, Mehl GH, Baldwin AR, Gleeson JT, Lavrentovich OD, Allender DW, Selinger JV, Jakli A, Sprunt S. Light scattering study of the "pseudo-layer" compression elastic constant in a twist-bend nematic liquid crystal. Phys Chem Chem Phys 2016; 18:31645-31652. [PMID: 27834978 DOI: 10.1039/c6cp06292j] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The nematic twist-bend (TB) phase, exhibited by certain achiral thermotropic liquid crystalline (LC) dimers, features a nanometer-scale, heliconical rotation of the average molecular long axis (director) with equally probable left- and right-handed domains. On meso to macroscopic scales, the TB phase may be considered as a stack of equivalent slabs or "pseudo-layers", each one helical pitch in thickness. The long wavelength fluctuation modes should then be analogous to those of a smectic-A phase, and in particular the hydrodynamic mode combining "layer" compression and bending ought to be characterized by an effective layer compression elastic constant Beff and average director splay constant K. The magnitude of K is expected to be similar to the splay constant of an ordinary nematic LC, but due to the absence of a true mass density wave, Beff could differ substantially from the typical value of ∼106 Pa in a conventional smectic-A. Here we report the results of a dynamic light scattering study, which confirms the "pseudo-layer" structure of the TB phase with Beff in the range 103-104 Pa. We show additionally that the temperature dependence of Beff at the TB to nematic transition is accurately described by a coarse-grained free energy density, which is based on a Landau-deGennes expansion in terms of a heli-polar order parameter that characterizes the TB state and is linearly coupled to bend distortion of the director.
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Affiliation(s)
- Z Parsouzi
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - Shokir A Pardaev
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - C Welch
- G. W. Gray Centre for Advanced Materials, Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - Z Ahmed
- G. W. Gray Centre for Advanced Materials, Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - G H Mehl
- G. W. Gray Centre for Advanced Materials, Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - A R Baldwin
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - J T Gleeson
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - O D Lavrentovich
- Chemical Physics Interdisciplinary Program and Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - D W Allender
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - J V Selinger
- Chemical Physics Interdisciplinary Program and Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - A Jakli
- Chemical Physics Interdisciplinary Program and Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - S Sprunt
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
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Salili SM, Tamba MG, Sprunt SN, Welch C, Mehl GH, Jákli A, Gleeson JT. Anomalous Increase in Nematic-Isotropic Transition Temperature in Dimer Molecules Induced by a Magnetic Field. Phys Rev Lett 2016; 116:217801. [PMID: 27284674 DOI: 10.1103/physrevlett.116.217801] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Indexed: 06/06/2023]
Abstract
We have determined the nematic-isotropic transition temperature as a function of an applied magnetic field in three different thermotropic liquid crystalline dimers. These molecules are comprised of two rigid calamitic moieties joined end to end by flexible spacers with odd numbers of methylene groups. They show an unprecedented magnetic field enhancement of nematic order in that the transition temperature is increased by up to 15 K when subjected to a 22 T magnetic field. The increase is conjectured to be caused by a magnetic-field-induced decrease of the average bend angle in the aliphatic spacers connecting the rigid mesogenic units of the dimers.
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Affiliation(s)
- S M Salili
- Chemical Physics Interdisciplinary Program & Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - M G Tamba
- Department of Nonlinear Phenomena, Institute for Experimental Physics, Otto von Guericke University Magdeburg, Magdeburg 39106, Germany
| | - S N Sprunt
- Department of Physics, Kent State University, Kent, Ohio 44242, USA
| | - C Welch
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - G H Mehl
- Department of Chemistry, University of Hull, Hull HU6 7RX, United Kingdom
| | - A Jákli
- Chemical Physics Interdisciplinary Program & Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - J T Gleeson
- Department of Physics, Kent State University, Kent, Ohio 44242, USA
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Pardaev SA, Shamid SM, Tamba MG, Welch C, Mehl GH, Gleeson JT, Allender DW, Selinger JV, Ellman B, Jakli A, Sprunt S. Second harmonic light scattering induced by defects in the twist-bend nematic phase of liquid crystal dimers. Soft Matter 2016; 12:4472-4482. [PMID: 27089236 DOI: 10.1039/c6sm00585c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The nematic twist-bend (NTB) phase, exhibited by certain thermotropic liquid crystalline (LC) dimers, represents a new orientationally ordered mesophase - the first distinct nematic variant discovered in many years. The NTB phase is distinguished by a heliconical winding of the average molecular long axis (director) with a remarkably short (nanoscale) pitch and, in systems of achiral dimers, with an equal probability to form right- and left-handed domains. The NTB structure thus provides another fascinating example of spontaneous chiral symmetry breaking in nature. The order parameter driving the formation of the heliconical state has been theoretically conjectured to be a polarization field, deriving from the bent conformation of the dimers, that rotates helically with the same nanoscale pitch as the director field. It therefore presents a significant challenge for experimental detection. Here we report a second harmonic light scattering (SHLS) study on two achiral, NTB-forming LCs, which is sensitive to the polarization field due to micron-scale distortion of the helical structure associated with naturally-occurring textural defects. These defects are parabolic focal conics of smectic-like "pseudo-layers", defined by planes of equivalent phase in a coarse-grained description of the NTB state. Our SHLS data are explained by a coarse-grained free energy density that combines a Landau-deGennes expansion of the polarization field, the elastic energy of a nematic, and a linear coupling between the two.
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Affiliation(s)
- Shokir A Pardaev
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - S M Shamid
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - M G Tamba
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - C Welch
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - G H Mehl
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK
| | - J T Gleeson
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - D W Allender
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - J V Selinger
- Chemical Physics Interdisciplinary Program and Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - B Ellman
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
| | - A Jakli
- Chemical Physics Interdisciplinary Program and Liquid Crystal Institute, Kent State University, Kent, Ohio 44242, USA
| | - S Sprunt
- Department of Physics, Kent State University, Kent, Ohio 44242, USA.
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Abstract
The phase behaviour of mixtures between two symmetric dimers, CBC9CB and the ether-linked analogue CBOC9OCB was investigated by Polarizing Optical Microscopy (POM), Differential Scanning Calorimetry (DSC) and X-Ray Diffraction (XRD) studies. The dimeric constituents are fully miscible and the construction of a temperature-composition phase diagram reveals a surprising amplification of the stability of the Nx phase in compositions of up to 37 wt% of CBOC9OCB in CBC9CB. The origin for this enhancement of stability is discussed and an explanation based on chiral recognition is developed.
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Affiliation(s)
- E Ramou
- Department of Chemistry, University of Hull, Hull HU6 7RX, UK.
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Sebastián N, Tamba MG, Stannarius R, de la Fuente MR, Salamonczyk M, Cukrov G, Gleeson J, Sprunt S, Jákli A, Welch C, Ahmed Z, Mehl GH, Eremin A. Mesophase structure and behaviour in bulk and restricted geometry of a dimeric compound exhibiting a nematic–nematic transition. Phys Chem Chem Phys 2016; 18:19299-308. [DOI: 10.1039/c6cp03899a] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We demonstrate a liquid crystal system exhibiting a variety of modulated structures on different length-scales: from helicoidal nematic to modulated smectic.
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Melzer M, Wickramasinghe D, Welch C. Outcomes in consecutive hospitalized UK patients with bacteraemia or fungaemia caused by medical devices and procedures. J Hosp Infect 2015; 91:146-52. [DOI: 10.1016/j.jhin.2015.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 11/25/2022]
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Coates A, Welch C, Ketterson K, Munne S. CCS improves pregnancy outcomes in egg donor FET cycles. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.867] [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: 10/23/2022]
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Abstract
Non-symmetric nematic dimers are designed and investigated by OPM, DSC and XRD; assembly models for the Nx phase are developed.
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Affiliation(s)
- Z. Ahmed
- Department of Chemistry
- University of Hull
- UK
| | - C. Welch
- Department of Chemistry
- University of Hull
- UK
| | - G. H. Mehl
- Department of Chemistry
- University of Hull
- UK
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Koseki M, Hsieh J, Yakushiji E, Welch C, Iqbal J, Hussain M, Takiguchi S, Rader D, Sakata Y, Yamashita S, Tall A. TTC39B deficiency promotes HDL production and impairs non-hdl absorption in small intestine. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Welch C, Helderman J, Williamson E, O'Shea TM. Brain wave maturation and neurodevelopmental outcome in extremely low gestational age neonates. J Perinatol 2013; 33:867-71. [PMID: 23867962 DOI: 10.1038/jp.2013.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 05/26/2013] [Accepted: 05/30/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Infants born at extremely low gestational ages are at high risk for developmental impairments. Early predictors of these impairments are useful for both clinicians and researchers. Our objective was to assess the correlation between the rate of brain wave maturation as measured by serial amplitude-integrated electroencephalograms (aEEGs) and scores on standardized measures of infant development in extremely low gestational age neonates. STUDY DESIGN This was a prospective observational study of 65 infants born before 28 weeks' gestational age who were assessed with an aEEG monthly between 28 and 36 weeks' postmenstrual age and with the Bayley Scales of Infant and Toddler Development-III at 18 to 22 months adjusted age. We analyzed the correlation between the rate of brain wave maturation on aEEG and Bayley Scales of Infant and Toddler Development-III Cognitive and Motor Scales. RESULT The mean rate of brain wave maturation was 0.83 (±0.36) points per week. Brain wave maturation was not correlated with either the Cognitive or Motor Scale (adjusted regression coefficients for Cognitive and Motor Scales were 1.61 (s.e.: 4.20; P=0.70) and 2.39 (s.e.: 4.62; P=0.61), respectively. CONCLUSION Among extremely preterm infants, the rate of maturational changes in brain wave characteristics between 28 and 36 weeks' postmenstrual age is not predictive of developmental abilities at 18 to 22 months adjusted age.
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Affiliation(s)
- C Welch
- Department of Pediatrics, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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Barritt J, Hill D, Surrey M, Tormasi S, Welch C, Munne S. Estimated number of mature oocytes needed for fertility preservation patients based on the number of euploid blastocysts diagnosed following preimplantation genetic screening (PGS). Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1878] [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: 10/26/2022]
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Abstract
OBJECTIVES To determine 7 and 30-day mortality in consecutive patients with bacteraemic community-acquired pneumonia (CAP) and the association between predicted variables and likelihood of death. METHODS From August 2007 to July 2011, demographic, clinical and microbiological data were prospectively collected on patients with bacteraemic CAP. Patients were followed until death, hospital discharge or recovery from infection. Univariate and multivariate analysis was performed to determine the association between predictor variables and 30-day mortality. RESULTS 7-day mortality was 61/252 [24.4%, 95% confidence interval (CI) 19.1-30.0%] and by 30 days, this had risen to 77/252 (30.6%, 95% CI 24.9-36.6%). In univariate analysis, factors associated with 30-day mortality were age, speciality within 48 h of admission, blood culture isolate and Charlson co-morbidity index (CCI). In multivariate analysis, age and CCI remained significantly associated. There was also a trend towards significance for meticillin-sensitive Staphylococcus aureus (MSSA) and Pseudomonas aeruginosa blood culture isolates compared to Streptococcus pneumoniae. CONCLUSIONS Overall, bacteraemic CAP was associated with high inpatient mortality. Because of their association with poor outcomes, patients with MSSA and P. aeruginosa bacteraemic CAP require further study.
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Affiliation(s)
- M Melzer
- Department of Infection, Barts Health NHS Trust, 3rd Floor Pathology and Pharmacy Building, 80 Newark Street, London, E1 2ES, UK,
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Melzer M, Welch C. Thirty-day mortality in UK patients with community-onset and hospital-acquired meticillin-susceptible Staphylococcus aureus bacteraemia. J Hosp Infect 2013; 84:143-50. [PMID: 23602415 DOI: 10.1016/j.jhin.2012.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 12/31/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND The difference in mortality between patients with community-onset and hospital-acquired Staphylococcus aureus infections has rarely been described and where it has, results have been conflicting. AIM To determine 30-day mortality in consecutive patients with meticillin-susceptible Staphylococcus aureus (MSSA) bacteraemia and the association between community-onset infection and outcome. METHODS From August 2007 to July 2011, demographic, clinical and microbiological data were prospectively collected on patients with MSSA bacteraemia. Patients were followed until death, hospital discharge or recovery from infection. Multivariate logistic regression was used to determine the association between community-onset infection and 30-day mortality. FINDINGS A total of 403 bacteraemic episodes occurred in 392 patients. Overall, there were 44 deaths (11.2%; 95% confidence interval: 7.9-14.0%) at 7 days and 101 deaths (25.8%; 21.5-30.4%) at 30 days. The difference in 30-day mortality between patients with community-onset and hospital-acquired infection was 71/256 (27.7%) versus 31/147 21.1%). Community-onset infection more frequently caused infective endocarditis (13/14, 92.9%), vertebral osteomyelitis (12/13, 92.3%) and skin and soft tissue infection (61/71, 85.9%) whereas intravascular catheter-associated infections were predominantly hospital-acquired (60/82, 73.2%). Age, Pitt score, Charlson comorbidity index (CCI), specific sites of infection (skin and soft tissue, lower respiratory tract and peripheral joints) and delay in appropriate treatment were strongly associated with 30-day mortality. In multivariate analysis, after adjustment for age, CCI and delay in appropriate treatment, community-onset infection was strongly associated with 30-day mortality (odds ratio: 1.59; 95% confidence interval: 0.91-2.80). CONCLUSIONS Compared with hospital-acquired MSSA bacteraemic infection, community-onset infection was associated with worse 30-day outcomes. Hospital-acquired MSSA bacteraemic infections were rarely metastatic, frequently associated with medical devices and patients had better outcomes.
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Affiliation(s)
- M Melzer
- Department of Infection, Barts Health NHS Trust, London, UK.
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Smotrich D, Wang S, Welch C, Tormasi S, Kung A, Botes A. 100% pregnancy rate per transfer with egg donation and PGD. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.519] [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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Behr B, Tormasi S, Anderson S, Glassner M, Welch C, Smotrich D. High implantation rates with blastocyst biopsy, array comparative genome hybridization (aCGH) and day-6 (D6) replacement. Fertil Steril 2012. [DOI: 10.1016/j.fertnstert.2012.07.502] [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: 10/28/2022]
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41
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Welch C, Petersen I, Walters K, Morris RW, Nazareth I, Kalaitzaki E, White IR, Marston L, Carpenter J. Two-stage method to remove population- and individual-level outliers from longitudinal data in a primary care database. Pharmacoepidemiol Drug Saf 2011; 21:725-732. [PMID: 22052713 DOI: 10.1002/pds.2270] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 08/24/2011] [Accepted: 09/20/2011] [Indexed: 11/10/2022]
Abstract
PURPOSE: In the UK, primary care databases include repeated measurements of health indicators at the individual level. As these databases encompass a large population, some individuals have extreme values, but some values may also be recorded incorrectly. The challenge for researchers is to distinguish between records that are due to incorrect recording and those which represent true but extreme values. This study evaluated different methods to identify outliers. METHODS: Ten percent of practices were selected at random to evaluate the recording of 513,367 height measurements. Population-level outliers were identified using boundaries defined using Health Survey for England data. Individual-level outliers were identified by fitting a random-effects model with subject-specific slopes for height measurements adjusted for age and sex. Any height measurements with a patient-level standardised residual more extreme than ±10 were identified as an outlier and excluded. The model was subsequently refitted twice after removing outliers at each stage. This method was compared with existing methods of removing outliers. RESULTS: Most outliers were identified at the population level using the boundaries defined using Health Survey for England (1550 of 1643). Once these were removed from the database, fitting the random-effects model to the remaining data successfully identified only 75 further outliers. This method was more efficient at identifying true outliers compared with existing methods. CONCLUSIONS: We propose a new, two-stage approach in identifying outliers in longitudinal data and show that it can successfully identify outliers at both population and individual level. Copyright © 2011 John Wiley & Sons, Ltd.
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Affiliation(s)
- C Welch
- Department of Primary Care & Population Health, University College London, London, UK
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Vargo J, Plants B, Welch C, Mihailidis D, Mallah J, Clark G, Farinash L, Raja P, Harmon M, Whaley L. Prophylactic Whole Brain Radiation Therapy (WBRT) with Simultaneous Integrated Boost (SIB) via Image Guided-Intensity Modulated Radiation Therapy (IG-IMRT), focal SBRT, and cWBRT: Clinical Outcomes for 3 Different Types of Radiation for Brain Metastases. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.664] [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: 10/19/2022]
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Cotsapas C, Prokunina-Olsson L, Welch C, Saxena R, Weaver C, Usher N, Guiducci C, Bonakdar S, Turner N, LaCroix B, Hall JL. Expression analysis of loci associated with type 2 diabetes in human tissues. Diabetologia 2010; 53:2334-9. [PMID: 20703447 DOI: 10.1007/s00125-010-1861-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
AIMS/HYPOTHESIS Genetic mapping has identified over 20 loci contributing to genetic risk of type 2 diabetes. The next step is to identify the genes and mechanisms regulating the contributions of genetic risk to disease. The goal of this study was to evaluate the effect of age, height, weight and risk alleles on expression of candidate genes in diabetes-associated regions in three relevant human tissues. METHODS We measured transcript abundance for WFS1, KCNJ11, TCF2 (also known as HNF1B), PPARG, HHEX, IDE, CDKAL1, CDKN2A, CDKN2B, IGF2BP2, SLC30A8 and TCF7L2 by quantitative RT-PCR in human pancreas (n = 50), colon (n = 195) and liver (n = 50). Tissue samples were genotyped for single nucleotide polymorphisms (SNPs) associated with type 2 diabetes. The effects of age, height, weight, tissue and SNP on RNA expression were tested by linear modelling. RESULTS Expression of all genes exhibited tissue bias. Immunohistochemistry confirmed the findings for HHEX, IDE and SLC30A8, which showed strongest tissue-specific mRNA expression bias. Neither age, height nor weight were associated with gene expression. We found no evidence that type 2 diabetes-associated SNPs affect neighbouring gene expression (cis-expression quantitative trait loci) in colon, pancreas and liver. CONCLUSIONS/INTERPRETATION This study provides new evidence that tissue-type, but not age, height, weight or SNPs in or near candidate genes associated with increased risk of type 2 diabetes are strong contributors to differential gene expression in the genes and tissues examined.
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Welch C, Harrison D, Rowan K. Association between volume and outcome for adult general critical care units in England, Wales and Northern Ireland. Br J Soc Med 2009. [DOI: 10.1136/jech.2009.096727y] [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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Dugas J, Varnes M, Welch C, Sajo E, Hogstrom K. TH-D-BRD-09: Dependence of CHO Cell Survival On IUdR Uptake for 35-KeV Photoactivated Auger Electron Therapy. Med Phys 2009. [DOI: 10.1118/1.3182663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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46
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Borthwick E, Harris S, Welch C, Maxwell A, McAuley DF, Glover P, Harrison D, Rowan K. Early acute kidney injury in Northern Ireland ICUs. Crit Care 2009. [PMCID: PMC4084149 DOI: 10.1186/cc7427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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47
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Griffith G, Welch C, Cardone A, Valdemoro A, Jo C. The global momentum for smokefree public places: best practice in current and forthcoming smokefree policies. Salud Publica Mex 2008; 50 Suppl 3:S299-308. [PMID: 18604350 DOI: 10.1590/s0036-36342008000900006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 04/28/2008] [Indexed: 11/21/2022] Open
Abstract
The Global Smokefree Partnership has recently prepared a map of smokefree campaigns and policies around the world. It focuses primarily on countries that are parties to the WHO Framework Convention on Tobacco Control, but other countries were included. The smokefree status of 172 countries was mapped. Of these countries, 31 (18.0%) have established comprehensive smokefree policies, either nationally or at state or city level - best practice; 25 (14.6%) are planning to implement smokefree policies in 2008 or 2009; and 51(29.6%) are making significant progress with smokefree policies. Only 65 countries (37.8%) have limited or no smokefree polices. A selection of countries representing best practices in smokefree policies or planning to implement smokefree policies in 2008 or 2009 is highlighted. They illustrate the significant global momentum for smokefree policies, the success of established policies, the importance of civil society and the sharing of experience between countries.
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Welch C, Matthews K, Dugas J, Ham K, Hogstrom K. WE-C-332-04: Computed Tomography Imaging to Quantify Iodine Distribution in IUdR-Labeled DNA. Med Phys 2008. [DOI: 10.1118/1.2962718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Dugas J, Varnes M, Sajo E, Welch C, Hogstrom K. SU-GG-T-401: Cell Survival Following X-Ray Activated Auger Electron Radiotherapy. Med Phys 2008. [DOI: 10.1118/1.2962151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Affiliation(s)
| | | | | | | | | | - V Gupta
- Intensive care Unit, University Hospital of Hartlepool, Hartlepool
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