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Sikombe K, Pry JM, Mody A, Rice B, Bukankala C, Eshun-Wilson I, Mutale J, Simbeza S, Beres LK, Mukamba N, Mukumbwa-Mwenechanya M, Mwamba D, Sharma A, Wringe A, Hargreaves J, Bolton-Moore C, Holmes C, Sikazwe IT, Geng E. Comparison of patient exit interviews with unannounced standardised patients for assessing HIV service delivery in Zambia: a study nested within a cluster randomised trial. BMJ Open 2023; 13:e069086. [PMID: 37407057 DOI: 10.1136/bmjopen-2022-069086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES To compare unannounced standardised patient approach (eg, mystery clients) with typical exit interviews for assessing patient experiences in HIV care (eg, unfriendly providers, long waiting times). We hypothesise standardised patients would report more negative experiences than typical exit interviews affected by social desirability bias. SETTING Cross-sectional surveys in 16 government-operated HIV primary care clinics in Lusaka, Zambia providing antiretroviral therapy (ART). PARTICIPANTS 3526 participants aged ≥18 years receiving ART participated in the exit surveys between August 2019 and November 2021. INTERVENTION Systematic sample (every nth file) of patients in clinic waiting area willing to be trained received pre-visit training and post-visit interviews. Providers were unaware of trained patients. OUTCOME MEASURES We compared patient experience among patients who received brief training prior to their care visit (explaining each patient experience construct in the exit survey, being anonymous, without manipulating behaviour) with those who did not undergo training on the survey prior to their visit. RESULTS Among 3526 participants who participated in exit surveys, 2415 were untrained (56% female, median age 40 (IQR: 32-47)) and 1111 were trained (50% female, median age 37 (IQR: 31-45)). Compared with untrained, trained patients were more likely to report a negative care experience overall (adjusted prevalence ratio (aPR) for aggregate sum score: 1.64 (95% CI: 1.39 to 1.94)), with a greater proportion reporting feeling unwelcome by providers (aPR: 1.71 (95% CI: 1.20 to 2.44)) and witnessing providers behaving rude (aPR: 2.28 (95% CI: 1.63 to 3.19)). CONCLUSION Trained patients were more likely to identify suboptimal care. They may have understood the items solicited better or felt empowered to be more critical. We trained existing patients, unlike studies that use 'standardised patients' drawn from outside the patient population. This low-cost strategy could improve patient-centred service delivery elsewhere. TRIAL REGISTRATION NUMBER Assessment was nested within a parent study; www.pactr.org registered the parent study (PACTR202101847907585).
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Affiliation(s)
- Kombatende Sikombe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Jake M Pry
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Aaloke Mody
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Brian Rice
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Chama Bukankala
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid Eshun-Wilson
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Jacob Mutale
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Sandra Simbeza
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Laura K Beres
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Njekwa Mukamba
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Daniel Mwamba
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Social and Behavioural Science Research Group, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Alison Wringe
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - James Hargreaves
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Carolyn Bolton-Moore
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Holmes
- Center for Innovation in Global Health, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Izukanji T Sikazwe
- Implementation Science Unit, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Internal Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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Kong Kam Wa T, Holmes C, O'Brien K. A case series of paediatric patients with spinal muscular atrophy type I undergoing scoliosis correction surgery. Anaesth Rep 2021; 9:e12138. [PMID: 34870210 DOI: 10.1002/anr3.12138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/08/2022] Open
Abstract
Spinal muscular atrophy is a neuromuscular disorder with degeneration of spinal motor neurons. Type I is a severe variant that was recently shown to be amenable to treatment with the antisense oligonucleotide nusinersen. As a result of increased life expectancy with this treatment, more children with spinal muscular atrophy type I are presenting for spinal correction surgery. In this case series, we present four such patients who underwent spinal surgery at our institution over the course of one year. Pre-operative assessment showed evidence of reduced respiratory function requiring nocturnal non-invasive ventilation in all four patients. A difficult airway was encountered in two of the four patients. Postoperative complications were ubiquitous and included CSF leak, poor wound healing, metal frame exposure, frame instability and wound infection. There were no postoperative respiratory complications and all four children returned to their respiratory baseline postoperatively. All patients underwent successful lumbar puncture and intrathecal nusinersen injection following their spinal surgeries. Given the risk of complications and prolonged recovery following spinal surgery, a detailed family discussion is advisable.
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Affiliation(s)
- T Kong Kam Wa
- Department of Anaesthesiology Children's Health Ireland at Temple Street Dublin Ireland
| | - C Holmes
- Department of Anaesthesiology Children's Health Ireland at Temple Street Dublin Ireland
| | - K O'Brien
- Department of Anaesthesiology Children's Health Ireland at Temple Street Dublin Ireland
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Walia N, Rao N, Garrett M, Yates K, Malone S, Holmes C. Proton pump inhibitor use and the risk of peritoneal dialysis associated peritonitis. Intern Med J 2021; 53:397-403. [PMID: 34719853 DOI: 10.1111/imj.15601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of proton-pump inhibitors (PPI) has been associated with an increased risk of developing spontaneous bacterial peritonitis in patients with cirrhosis. Whether PPI use confers a similar risk in developing peritonitis in peritoneal dialysis (PD) patients remains unclear. METHODS Patients on PD were retrospectively identified. Data such as PPI use during PD, underlying diagnoses, comorbidities, and baseline serum tests were collected. Univariable and multivariable analysis was conducted using logistic regression to assess whether PPI use and other factors were associated with PD peritonitis. RESULTS 57 patients were identified with a median(interquartile range(IQR)) age of 65.0(51.5-74.0) years. The median(IQR) time on PD was 29.0(17.5-45.0) months. 28 patients were on a PPI during PD. 57% of the PPI group went on to develop peritonitis, compared to 31% of patients without PPI exposure (OR=2.96, 95% CI:[1.00, 8.78], p=0.050). Months on PD (OR=1.03, 95% CI:[1.00, 1.06], p=0.026), serum urea (OR=0.88, 95% CI:[0.80, 0.97], p=0.017), congestive cardiac failure (OR=5.44, 95% CI:[1.29, 23.00], p=0.021) and renovascular disease (OR=14.59, 95% CI:[1.68, 126.67], p=0.015) were identified as possible risk factors for peritonitis on univariable analysis. Following adjustment for covariates, serum urea, but not PPI use, was associated with PD peritonitis (OR=0.87, 95% CI:[0.78,0.98], p=0.020). CONCLUSION PPI use during PD was not associated with peritonitis. Due to the small number of patients and the limited number of studies investigating the effect of PPI use on PD peritonitis, further research is needed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- N Walia
- Renal Department, Bendigo Health, VIC, Australia.,Austin Health, Melbourne, VIC, Australia
| | - N Rao
- Renal Department, Bendigo Health, VIC, Australia
| | - M Garrett
- Home Dialysis, Bendigo Health, Bendigo, VIC, Australia
| | - K Yates
- Home Dialysis, Bendigo Health, Bendigo, VIC, Australia
| | - S Malone
- Home Dialysis, Bendigo Health, Bendigo, VIC, Australia
| | - C Holmes
- Renal Department, Bendigo Health, VIC, Australia.,Monash Rural Health, Monash University, Bendigo, VIC, Australia
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4
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Auld AF, Fielding K, Agizew T, Maida A, Mathoma A, Boyd R, Date A, Pals SL, Bicego G, Liu Y, Shiraishi RW, Ehrenkranz P, Serumola C, Mathebula U, Alexander H, Charalambous S, Emerson C, Rankgoane-Pono G, Pono P, Finlay A, Shepherd JC, Holmes C, Ellerbrock TV, Grant AD. Risk scores for predicting early antiretroviral therapy mortality in sub-Saharan Africa to inform who needs intensification of care: a derivation and external validation cohort study. BMC Med 2020; 18:311. [PMID: 33161899 PMCID: PMC7650165 DOI: 10.1186/s12916-020-01775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Clinical scores to determine early (6-month) antiretroviral therapy (ART) mortality risk have not been developed for sub-Saharan Africa (SSA), home to 70% of people living with HIV. In the absence of validated scores, WHO eligibility criteria (EC) for ART care intensification are CD4 < 200/μL or WHO stage III/IV. METHODS We used Botswana XPRES trial data for adult ART enrollees to develop CD4-independent and CD4-dependent multivariable prognostic models for 6-month mortality. Scores were derived by rescaling coefficients. Scores were developed using the first 50% of XPRES ART enrollees, and their accuracy validated internally and externally using South African TB Fast Track (TBFT) trial data. Predictive accuracy was compared between scores and WHO EC. RESULTS Among 5553 XPRES enrollees, 2838 were included in the derivation dataset; 68% were female and 83 (3%) died by 6 months. Among 1077 TBFT ART enrollees, 55% were female and 6% died by 6 months. Factors predictive of 6-month mortality in the derivation dataset at p < 0.01 and selected for the CD4-independent score included male gender (2 points), ≥ 1 WHO tuberculosis symptom (2 points), WHO stage III/IV (2 points), severe anemia (hemoglobin < 8 g/dL) (3 points), and temperature > 37.5 °C (2 points). The same variables plus CD4 < 200/μL (1 point) were included in the CD4-dependent score. Among XPRES enrollees, a CD4-independent score of ≥ 4 would provide 86% sensitivity and 66% specificity, whereas WHO EC would provide 83% sensitivity and 58% specificity. If WHO stage alone was used, sensitivity was 48% and specificity 89%. Among TBFT enrollees, the CD4-independent score of ≥ 4 would provide 95% sensitivity and 27% specificity, whereas WHO EC would provide 100% sensitivity but 0% specificity. Accuracy was similar between CD4-independent and CD4-dependent scores. Categorizing CD4-independent scores into low (< 4), moderate (4-6), and high risk (≥ 7) gave 6-month mortality of 1%, 4%, and 17% for XPRES and 1%, 5%, and 30% for TBFT enrollees. CONCLUSIONS Sensitivity of the CD4-independent score was nearly twice that of WHO stage in predicting 6-month mortality and could be used in settings lacking CD4 testing to inform ART care intensification. The CD4-dependent score improved specificity versus WHO EC. Both scores should be considered for scale-up in SSA.
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Affiliation(s)
- Andrew F Auld
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Nico House, City Centre, P.O. Box 30016, Lilongwe 3, Malawi.
| | - Katherine Fielding
- TB Centre, London Sch. of Hygiene & Tropical Med, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tefera Agizew
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Alice Maida
- Division of Global HIV & TB, United States Centers for Disease Control and Prevention (CDC), Nico House, City Centre, P.O. Box 30016, Lilongwe 3, Malawi
| | - Anikie Mathoma
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Rosanna Boyd
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Anand Date
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherri L Pals
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - George Bicego
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yuliang Liu
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ray W Shiraishi
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Christopher Serumola
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Unami Mathebula
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - Heather Alexander
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Courtney Emerson
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Pontsho Pono
- Ministry of Health and Wellness, Gaborone, Botswana
| | - Alyssa Finlay
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana
| | - James C Shepherd
- Division of TB Elimination, Centers for Disease Control and Prevention, Gaborone, Botswana.,Yale University School of Medicine, New Haven, CT, USA
| | - Charles Holmes
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington D.C, USA
| | - Tedd V Ellerbrock
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alison D Grant
- TB Centre, London Sch. of Hygiene & Tropical Med, London, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Africa Health Research Institute, School of Nursing and Public Heath, University of KwaZulu-Natal, Durban, South Africa
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Grimsrud A, Wilkinson L, Eshun-Wilson I, Holmes C, Sikazwe I, Katz IT. Understanding Engagement in HIV Programmes: How Health Services Can Adapt to Ensure No One Is Left Behind. Curr HIV/AIDS Rep 2020; 17:458-466. [PMID: 32844274 PMCID: PMC7497373 DOI: 10.1007/s11904-020-00522-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Despite the significant progress in the HIV response, gaps remain in ensuring engagement in care to support life-long medication adherence and viral suppression. This review sought to describe the different points in the HIV care cascade where people living with HIV were not engaging and highlight promising interventions. RECENT FINDINGS There are opportunities to improve engagement both between testing and treatment and to support re-engagement in care for those in a treatment interruption. The gap between testing and treatment includes people who know their HIV status and people who do not know their status. People in a treatment interruption include those who interrupt immediately following initiation, early on in their treatment (first 6 months) and late (after 6 months or more on ART). For each of these groups, specific interventions are required to support improved engagement. There are diverse needs and specific populations of people living with HIV who are not engaged in care, and differentiated service delivery interventions are required to meet their needs and expectations. For the HIV response to realise the 2030 targets, engagement will need to be supported by quality care and patient choice combined with empowered patients who are treatment literate and have been supported to improve self-management.
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Affiliation(s)
- Anna Grimsrud
- International AIDS Society, 3 Doris Road, Claremont, Cape Town, 7708 South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Lynne Wilkinson
- International AIDS Society, 3 Doris Road, Claremont, Cape Town, 7708 South Africa
- Department of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Charles Holmes
- Center for Innovation in Global Health, Georgetown University, Washington, DC USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Ingrid T. Katz
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA USA
- Harvard Medical School, Boston, MA USA
- Massachusetts General Hospital Center for Global Health, Boston, MA USA
- Harvard Global Health Institute, Cambridge, MA USA
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Edwards C, Mcdowell B, Holroyd C, Cardwell C, Mchenry M, Meenagh G, Holmes C, Mcguiness B. THU0134 COGNITIVE IMPAIRMENT IN RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:Increasing evidence suggests that systemic inflammation may be associated with an increased risk of developing cognitive dysfunction and Alzheimer’s disease (AD). Some studies have found an association between rheumatoid arthritis (RA) and neurodegeneration with several finding increased incidence of mild cognitive impairment (MCI) in those with RA compared to healthy controls.Objectives:This study aims to use preliminary data from theRheumatoid arthritis, medication and memorystudy (RESIST) to investigate the prevalence of MCI in a population of patients with RA and explore the relationship between MCI and specific demographic and clinical characteristics.Methods:The Montreal Cognitive Assessment (MoCA) was used as a cognitive screening tool and was administered to subjects ≥55 years of age who had been diagnosed with RA according to the ACR/EULAR criteria. Demographic and clinical data was recorded at screening in face-to-face interviews and included age, gender, date of RA diagnosis and RA medication. RA disease activity score from 28 joints (DAS28), rheumatoid factor (RF) level, anti-cyclic citrullinated peptide (anti-CCP) level, erythrocyte sedimentation rate (ESR) were recorded. 260 participants completed both screening and baseline visits as part of the RESIST longitudinal study, MoCA scores from baseline were analysed for these participants. Statistical analysis was used to provide descriptive statistics and explore possible predictors of cognitive impairment.Results:A total of 636 participants (mean age 68.1 yrs, female 67.5%) were screened between May 2018 and December 2019. The mean MoCA for screened participants was 25.4; 45.3% scored <26 in the MoCA and were considered to have mild cognitive impairment. Age was negatively correlated with MoCA score and was the only significant predictor of cognitive impairment. For each year of increase in age the MoCA score reduced by a mean of 0.08 points (p<0.05). There was little evidence of a difference in mean MoCA score by gender, RA medication, duration of disease, DAS28 score, ESR, anti-CCP or RF levels. The mean MoCA scores increased by 0.4 points between screening and baseline (P<0.001).Conclusion:A large proportion of participants scored below the proposed cut-off for normal cognition in the MoCA suggesting a high prevalence of MCI in adults >55 years with moderately active RA. This provides further support for the role of chronic inflammation in cognitive dysfunction and AD. Screening for MCI in rheumatology clinics might be clinically useful.DemographicsOutcomeAge mean years (+/-SD) (n=633)68.1 (8.01)Gender (n=636)Female n (%)429 (67.5)RA Medication (n=636)csDMARD n (%)TNFi n (%)368 (57.9)268 (42.1)Duration of RA mean years (+/-SD) (n=484)14.4 (13.9)DAS28 mean (+/-SD) (n=306)3.5 (2.04)ESR mean (+/-SD) (n=501)23.4 (22.0)Anti-CCP (n=387)Positive n (%)236 (61)Rheumatoid Factor (n=377)Positive n (%)277 (73.5)MoCA Score points (n=636)≥26, n (%)<26 n (%)348 (54.7)288 (45.3)Subjective memory concerns (n=430)Yes n (%)No n (%)95 (22.1)335 (77.9)Disclosure of Interests:Christopher Edwards Grant/research support from: Abbvie, Biogen, Roche, Consultant of: Abbvie, Samsung, Speakers bureau: Abbvie, BMS, Biogen, Celgene, Fresenius, Gilead, Janssen, Lilly, Mundipharma, Pfizer, MSD, Novartis, Roche, Samsung, Sanofi, UCB, Bethany McDowell: None declared, Chris Holroyd: None declared, Chris Cardwell: None declared, Michelle McHenry Speakers bureau: Novartis, Pfizer, AbbVie, Celgene, Lilly, Gary Meenagh: None declared, Clive Holmes: None declared, Bernadette McGuiness: None declared
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Mukamba N, Chilyabanyama ON, Beres LK, Simbeza S, Sikombe K, Padian N, Holmes C, Sikazwe I, Geng E, Schwartz SR. Patients' Satisfaction with HIV Care Providers in Public Health Facilities in Lusaka: A Study of Patients who were Lost-to-Follow-Up from HIV Care and Treatment. AIDS Behav 2020; 24:1151-1160. [PMID: 31673912 PMCID: PMC7082366 DOI: 10.1007/s10461-019-02712-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prognosis among those who are HIV infected has improved but long-term retention is challenging. Health systems may benefit from routinely measuring patient satisfaction which is a potential driver of engagement in HIV care, but it is not often measured in Africa, and Zambia in particular. This study aims to internally validate a patient satisfaction tool, assess satisfaction among patients previously lost-to-follow up (LTFU) from HIV care in Lusaka province and to measure association between patient satisfaction with their original clinic and re-engagement in HIV care. A cross-sectional assessment of satisfaction was conducted by tracing sampled patients drawn from public health facilities. Our findings suggest that satisfaction tool, previously validated in USA, exhibits high internal consistency for measuring patient satisfaction in the Zambian health system. Patient satisfaction with healthcare providers is associated with re-engagement in HIV care. Future interventions on patient-centred care are likely to optimize and support retention in care.
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Affiliation(s)
- Njekwa Mukamba
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
| | | | - Laura K Beres
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Sandra Simbeza
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, CA, USA
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Centre for Global Health and Quality, Georgetown University Medical Center, Washington, DC, USA
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, ID and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Sheree R Schwartz
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
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Ford N, Geng E, Ellman T, Orrell C, Ehrenkranz P, Sikazwe I, Jahn A, Rabkin M, Ayisi Addo S, Grimsrud A, Rosen S, Zulu I, Reidy W, Lejone T, Apollo T, Holmes C, Kolling AF, Phate Lesihla R, Nguyen HH, Bakashaba B, Chitembo L, Tiriste G, Doherty M, Bygrave H. Emerging priorities for HIV service delivery. PLoS Med 2020; 17:e1003028. [PMID: 32059023 PMCID: PMC7021280 DOI: 10.1371/journal.pmed.1003028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention and treatment services.
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Affiliation(s)
- Nathan Ford
- Department HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- * E-mail:
| | - Elvin Geng
- Center for Dissemination and Implementation, Institute for Public Health, Washington University, St. Louis, Missouri, United States of America
| | - Tom Ellman
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - Catherine Orrell
- Department of Medicine, Faculty of Health Sciences, Cape Town, South Africa
| | - Peter Ehrenkranz
- Bill and Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | | | - Miriam Rabkin
- ICAP, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | | | | | - Sydney Rosen
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Isaac Zulu
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - William Reidy
- ICAP, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Thabo Lejone
- SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho
| | - Tsitsi Apollo
- Ministry of Health and Child Care Zimbabwe, Harare, Zimbabwe
| | - Charles Holmes
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
- Georgetown University, Washington, DC, United States of America
| | - Ana Francisca Kolling
- Department of Surveillance, Prevention and Control of STIs, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasilia, Brazil
| | | | - Huu Hai Nguyen
- Treatment and Care Department, Viet Nam Authority of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam
| | | | | | - Ghion Tiriste
- Department HIV, World Health Organization, Addis Ababa, Ethiopia
| | - Meg Doherty
- Department HIV & Global Hepatitis Programme, World Health Organization, Geneva, Switzerland
| | - Helen Bygrave
- Southern African Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
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Roy M, Holmes C, Sikazwe I, Savory T, Mwanza MW, Bolton Moore C, Mulenga K, Czaicki N, Glidden DV, Padian N, Geng E. Application of a Multistate Model to Evaluate Visit Burden and Patient Stability to Improve Sustainability of Human Immunodeficiency Virus Treatment in Zambia. Clin Infect Dis 2019; 67:1269-1277. [PMID: 29635466 DOI: 10.1093/cid/ciy285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Differentiated service delivery (DSD) for human immunodeficiency virus (HIV)-infected persons who are clinically stable on antiretroviral therapy (ART) has been embraced as a solution to decrease access barriers and improve quality of care. However, successful DSD implementation is dependent on understanding the prevalence, incidence, and durability of clinical stability. Methods We evaluated visit data in a cohort of HIV-infected adults who made at least 1 visit between 1 March 2013 and 28 February 2015 at 56 clinics in Zambia. We described visit frequency and appointment intervals using conventional stability criteria and used a mixed-effects linear regression model to identify predictors of appointment interval. We developed a multistate model to characterize patient stability over time and calculated incidence rates for transition between states. Results Overall, 167819 patients made 3418018 post-ART initiation visits between 2004 and 2015. Fifty-four percent of visits were pharmacy refill-only visits, and 24% occurred among patients on ART for >6 months and whose current CD4 was >500 cells/mm3. Median appointment interval at clinician visits was 59 days, and time on ART and current CD4 were not strong predictors of appointment interval. Cumulative incidence of clinical stability was 66.2% at 2 years after enrollment, but transition to instability (31 events per 100 person-years) and lapses in care (41 events per100 person-years) were common. Conclusions Current facility-based care was characterized by high visit burden due to pharmacy refills and among treatment-experienced patients. Differentiated service delivery models targeted toward stable patients need to be adaptive given that clinical stability was highly transient and lapses in care were common.
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Affiliation(s)
- Monika Roy
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
| | - Charles Holmes
- Centre for Infectious Diseases Research in Zambia, Lusaka.,Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Thea Savory
- Centre for Infectious Diseases Research in Zambia, Lusaka
| | | | - Carolyn Bolton Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka.,University of Alabama, Birmingham
| | - Kafula Mulenga
- Centre for Infectious Diseases Research in Zambia, Lusaka
| | - Nancy Czaicki
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nancy Padian
- Division of Epidemiology, University of California Berkeley
| | - Elvin Geng
- Division of HIV/AIDS, Infectious Diseases, and Global Medicine, University of California, San Francisco, San Francisco General Hospital
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10
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Sikombe K, Hantuba C, Musukuma K, Sharma A, Padian N, Holmes C, Czaicki N, Simbeza S, Somwe P, Bolton-Moore C, Sikazwe I, Geng E. Accurate dried blood spots collection in the community using non-medically trained personnel could support scaling up routine viral load testing in resource limited settings. PLoS One 2019; 14:e0223573. [PMID: 31622394 PMCID: PMC6797100 DOI: 10.1371/journal.pone.0223573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
Regular plasma HIV-RNA testing for persons living with HIV on antiretroviral therapy (ART) is now the global standard, but as many as 60% of persons in Africa today on ART do not have access to standard laboratory HIV-RNA assays. As a result, patients in Zambia often receive treatment without any means of determining true virologic failure, which poses a risk of premature switch of ART regimens and widespread HIV drug resistance. Dry blood spots (DBS) on the other hand require unskilled personnel and less complex storage supply chain so are ideal to capture viral-load results from HIV patients outside clinic settings. We assess collection of DBS in the community using non-medically trained personnel (NMP) and documented challenges. We trained 23 NMP to collect DBS from lost to follow-up (LTFU) patients in 4 rural and urban Zambian districts. We developed a phlebotomy box to transport DBS without contamination at ambient temperature and concomitant training and standard operating procedures. We evaluated this through field observations, bi-weekly meetings, reports, and staff meetings. The laboratory assessed DBS quality for testing validity. We attempted to collect DBS from 357 participants in the community. Though individual reasons for refusal from the remaining 37% were not collected, NMPs reported privacy concerns, awkward box-size which drew attention in the community and fears of undisclosed uses of samples related to witchcraft and circulating narratives about past research. Successful DBS collection was not associated with patient gender, age, time on ART, enrolment CD4, facility. DBS viral-load collection by NMP is feasible in Zambia. Our training approach and assessments of NMP not part of the health system can be extended to patients by giving them more responsibility to manage their own differentiated care groups. Concerted efforts that compare collection of DBS by NMP to those collected by skilled-medical personnel are needed.
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Affiliation(s)
| | - Cardinal Hantuba
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Kalo Musukuma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Anjali Sharma
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley, Berkeley, California, United States of America
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Center for Global Health and Quality, Georgetown University, Washington, District of Columbia, United States of America
| | - Nancy Czaicki
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
| | - Sandra Simbeza
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Paul Somwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
- Division of Infectious Diseases, University of Alabama, Birmingham, Alabama, United States of America
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Zuckerberg San Francisco General Hospital, San Francisco, California, United States of America
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11
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Mody A, Roy M, Sikombe K, Savory T, Holmes C, Bolton-Moore C, Padian N, Sikazwe I, Geng E. Improved Retention With 6-Month Clinic Return Intervals for Stable Human Immunodeficiency Virus-Infected Patients in Zambia. Clin Infect Dis 2019; 66:237-243. [PMID: 29020295 DOI: 10.1093/cid/cix756] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Extending appointment intervals for stable HIV-infected patients in sub-Saharan Africa can reduce patient opportunity costs and decongest overcrowded facilities. Methods We analyzed a cohort of stable HIV-infected adults (on treatment with CD4 >200 cells/μL for more than 6 months) who presented for clinic visits in Lusaka, Zambia. We used multilevel, mixed-effects logistic regression adjusting for patient characteristics, including prior retention, to assess the association between scheduled appointment intervals and subsequent missed visits (>14 days late to next visit), gaps in medication (>14 days late to next pharmacy refill), and loss to follow-up (LTFU; >90 days late to next visit). Results A total of 62084 patients (66.6% female, median age 38, median CD4 438 cells/μL) made 501281 visits while stable on antiretroviral therapy. Most visits were scheduled around 1-month (25.0% clinical, 44.4% pharmacy) or 3-month intervals (49.8% clinical, 35.2% pharmacy), with fewer patients scheduled at 6-month intervals (10.3% clinical, 0.4% pharmacy). After adjustment and compared to patients scheduled to return in 1 month, patients with six-month clinic return intervals were the least likely to miss visits (adjusted odds ratio [aOR], 0.20; 95% confidence interval [CI], 0.17-0.24); miss medication pickups (aOR, 0.47; 95% CI 0.39-0.57), and become LTFU prior to the next visit (aOR, 0.41; 95% CI, 0.31-0.54). Conclusions Six-month clinic return intervals were associated with decreased lateness, gaps in medication, and LTFU in stable HIV-infected patients and may represent a promising strategy to reduce patient burdens and decongest clinics.
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Affiliation(s)
- Aaloke Mody
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
| | - Monika Roy
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
| | | | - Thea Savory
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Charles Holmes
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carolyn Bolton-Moore
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia.,Division of Infectious Diseases, University of Alabama, Birmingham
| | - Nancy Padian
- Division of Epidemiology, University of California, Berkeley
| | - Izukanji Sikazwe
- Centre for Infectious Diseases Research in Zambia, Lusaka, Zambia
| | - Elvin Geng
- Division of HIV, ID, and Global Medicine, University of California, San Francisco and Zuckerberg San Francisco General Hospital
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12
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Doody K, Barry D, Holmes C. Key Performance Indicators in Paediatric Anaesthesia. Ir Med J 2019; 112:948. [PMID: 31535837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims Currently no national guidelines on performance measurement exist for paediatric anaesthesia in Ireland1. The purpose of this study was to ascertain if we are achieving Key Performance Indicators (KPIs) in areas of post-operative nausea and vomiting (PONV) and post-operative pain when compared to international standards. Methods The study was carried out from January 2018 to February 2018 at Temple Street Children’s University Hospital. In total 743 patients were included. Results 743 patients were included in the study. 86 (12%) were recorded as having a post-operative pain score of >4/10. 15 (1.2%) of patients were recorded as experiencing PONV. Orthopaedic surgery had the highest frequency of post-operative pain accounting for 33% of all cases. General surgery was associated with highest risk of PONV. Discussion The results from the study indicate we are achieving results similar to data from international centres. There is a paucity of published data from Irish centres and as national guidelines are developed for a model of care for paediatric anaesthesia we hope this data can be used when comparing other paediatric centres within Ireland.
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Affiliation(s)
- K Doody
- Department of Anaesthesiology, Temple Street Children’s University Hospital, Dublin
| | - D Barry
- Department of Anaesthesiology, Temple Street Children’s University Hospital, Dublin
| | - C Holmes
- Department of Anaesthesiology, Temple Street Children’s University Hospital, Dublin
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13
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Pyett A, Holmes C, Enever C, Fryer A, Paynter D, Rixham P, Weston S. EP-1807 Use of SPC techniques to generate assessment criteria for transit dosimetry analysis. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32227-3] [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: 10/26/2022]
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McLean K, Glasbey J, Borakati A, Brooks T, Chang H, Choi S, Goodson R, Nielsen M, Pronin S, Salloum N, Sewart E, Vanniasegaram D, Drake T, Gillies M, Harrison E, Chapman S, Khatri C, Kong C, Claireaux H, Bath M, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald J, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth R, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen J, Sykes M, Sethi R, Suresh S, Patel P, Patel M, Varma R, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy E, Ong K, Tan Y, Gabriel J, Bakhsh A, Low J, Yener A, Paraoan V, Preece R, Tilston T, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement K, Gratton R, Mills E, Chiu S, Hung G, Rafiq N, Hayes J, Robertson K, Dynes K, Huang H, Assadullah S, Duncumb J, Moon R, Poo S, Mehta J, Joshi K, Callan R, Norris J, Chilvers N, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton E, Martin A, Ratu S, Roberts E, Phan P, Dyal A, Rogers J, Henson A, Reid N, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong C, Wan J, Copley H, Raut P, Chaudhry F, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew L, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan E, Maclennan D, McGregor R, Chisholm E, Griffin E, Bell L, Hughes B, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham R, Lee A, Batt E, Bullock N, Francescon C, Davies J, Shafiq N, Zhao J, Vivekanantham S, Barai I, Allen J, Marshall D, McIntyre C, Wilson H, Ashton A, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn J, Craig-McQuaide A, Gatfield W, Leong S, Demetri A, Kerr A, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin K, Bright M, Chitnis A, Abdelhadi M, Semana A, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson L, Boon Xuan JL, Crozier L, McAleer S, Lees D, Adebayo A, Das M, Amphlett A, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild J, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong B, Lim K, Ho S, Crewdson J, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon W, Karia M, Rasiah M, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner E, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney C, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah J, Giles J, Sanders J, McLure S, Pal S, Rangedara A, Baker A, Asbjoernsen C, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan Y, Ng J, Kumar A, Park J, Tan D, Choo K, Raman K, Buakuma P, Xiao C, Govinden S, Thompson O, Charalambos M, Brown E, Karsan R, Dogra T, Bullman L, Dawson P, Frank A, Abid H, Tung L, Qureshi U, Tahmina A, Matthews B, Harris R, O'Connor A, Mazan K, Iqbal S, Stanger S, Thompson J, Sullivan J, Uppal E, MacAskill A, Bamgbose F, Neophytou C, Carroll A, Rookes C, Datta U, Dhutia A, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore C, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar S, Burney L, Patel J, Al-Obaedi O, Roberts A, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley P, Brewster O, Xu G, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street A, Thakker C, O'Reilly D, Bravo M, Pizzolato A, Khokhar H, Ryan M, Cheskes L, Carr R, Salih A, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar M, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima C, Peroos S, Kosasih S, Chin H, Ashken L, Pearse R, O'Loughlin R, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema I, Kotecha D, Afzal Z, Syeed J, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull J, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly M, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron R, Trimble A, Cox S, Ashfaq U, Campbell J, Holliday R, McCabe G, Morris F, Priestland R, Vernon O, Ledsam A, Vaughan R, Lim D, Bakewell Z, Hughes R, Koshy R, Jackson H, Narayan P, Cardwell A, Jubainville C, Arif T, Elliott L, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman Y, North A, McClymont L, Hussain N, Ibrahim I, Ng G, Wong V, Lim A, Harris L, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer H, Narwani V, Sandhu K, Wingfield L, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko A, Meek J, Boxall N, Heywood E, Wiltshire J, Toh C, Ward A, Shurovi B, Horth D, Patel B, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan A, Ng J, Hirst F, Brewer C, Logan A, Lockey J, Forrest P, Keelty N, Wood A, Springford L, Avery P, Schulz T, Bemand T, Howells L, Collier H, Khajuria A, Tharakan R, Parsons S, Buchan A, McGalliard R, Mason J, Cundy O, Li N, Redgrave N, Watson R, Pezas T, Dennis Y, Segall E, Hameed M, Lynch A, Chamberlain M, Peck F, Neo Y, Russell G, Elseedawy M, Lee S, Foster N, Soo Y, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn C, Walford R, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid K, Williams M, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes M, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner R, Yong N, Atraszkiewicz B, Mehdi A, Tahir M, Sherliker G, Tear A, Pandey A, Broyd A, Omer H, Raphael M, Chaudhry W, Shahidi S, Jawad A, Gill C, Fisher IH, Adeleja I, Clark I, Aidoo-Micah G, Stather P, Salam G, Glover T, Deas G, Sim N, Obute R, Wynell-Mayow W, Sait M, Mitha N, de Bernier G, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley G, Keane C, Shatkar V, Maxwell-Armstrong C, Henderson L, Maple N, Manson R, Adams R, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell P, Whatling E, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson D, Abuhussein N, Deekonda P, Abid A, Harrison P, Aildasani L, Turley H, Sherif M, Pandey G, Filby J, Johnston A, Burke E, Mohamud M, Gohil K, Tsui A, Singh R, Lim S, O'Sullivan K, McKelvey L, O'Neill S, Roberts H, Brown F, Cao Y, Buckle R, Liew Y, Sii S, Ventre C, Graham C, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell G, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance H, English W, Lakhani S, Ashraf S, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig A, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher S, Hewitt C, Stoddart M, Kerai A, Trist A, Cole S, Knight C, Stevens S, Cooper G, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins T, Reehal R, Bookless L, McLean R, Stone E, Wright E, Abdikadir H, Roberts C, Spence O, Srikantharajah M, Ruiz E, Matthews J, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani S, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith D, Mistry B, Hickling S, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng A, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh A, McKerr C, Edison M, Patel B, Dear K, Hardy M, Williams P, Hassan S, Sajjad U, O'Neill E, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo S, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim J, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith A, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui Z, Lim S, Piquet A, Anderson S, McCormack D, Gulati J, Ibrahim A, Murray S, Walsh S, McGrath A, Ziprin P, Chua E, Lou C, Bloomer J, Paine H, Osei-Kuffour D, White C, Szczap A, Gokani S, Patel K, Malys M, Reed A, Torlot G, Cumber E, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye M, Cheung F, Coffey D, Heer R, Singh S, Seager E, Cumming S, Suresh R, Verma S, Ptacek I, Gwozdz A, Yang T, Khetarpal A, Shumon S, Fung T, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor B, Shanahan D, Yan A, Jafree D, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis P, Miranda B, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates J, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett R, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee J, Abdulmajid A, Chung A, Warwick H, Livesey A, Holton P, Theodoreson M, Jenkin S, Turner J, Entwisle J, Marchal S, O'Connor S, Blege H, Aithie J, Sabine L, Stewart G, Jackson S, Kishore A, Lankage C, Acquaah F, Joyce H, McKevitt K, Coffey C, Fawaz A, Dolbec K, O'Sullivan D, Geraghty J, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill P, Harbhajan Singh G, Loughran D, Golding D, Keeling R, Williams R, Whitham R, Yoganathan S, Nachiappan R, Egan R, Owasil R, Kwan M, He A, Goh R, Bhome R, Wilson H, Teoh P, Raji K, Jayakody N, Matthams J, Chong J, Luk C, Greig R, Trail M, Charalambous G, Rocke A, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown E, Khanijau R, Gandhi K, Morris S, Boulton A, Chandan N, Barthorpe A, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer C, Clarke A, Heskin J, Hurst P, Farmer J, O'Flynn L, Doan L, Shuker B, Stott G, Vithanage N, Hoban K, Nesargikar P, Kennedy H, Grossart C, Tan E, Roy C, Sim P, Leslie K, Sim D, Abul M, Cody N, Tay A, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing V, Mills H, Li M, Barrow T, Balaji S, Jordan H, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi A, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison C, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie H, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. Br J Anaesth 2019; 122:42-50. [PMID: 30579405 DOI: 10.1016/j.bja.2018.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. METHODS This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. RESULTS Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. CONCLUSIONS After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
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Wallis D, Holmes C, Holroyd C, Sonpal K, Zarroug J, Adams J, Edwards CJ. Dose reduction of biological therapies for inflammatory rheumatic diseases: what do patients think? Scand J Rheumatol 2018; 48:251-252. [DOI: 10.1080/03009742.2018.1533034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D Wallis
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Holmes
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Holroyd
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K Sonpal
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - J Zarroug
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - J Adams
- Centre for Innovation and Leadership in Health Sciences, University of Southampton, Southampton, UK
| | - CJ Edwards
- Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
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Airo AM, Urbanowski MD, Lopez-Orozco J, You JH, Skene-Arnold TD, Holmes C, Yamshchikov V, Malik-Soni N, Frappier L, Hobman TC. Expression of flavivirus capsids enhance the cellular environment for viral replication by activating Akt-signalling pathways. Virology 2018; 516:147-157. [PMID: 29358114 DOI: 10.1016/j.virol.2018.01.009] [Citation(s) in RCA: 12] [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: 10/16/2017] [Revised: 01/04/2018] [Accepted: 01/09/2018] [Indexed: 01/23/2023]
Abstract
Flaviviruses depend on multiple host pathways during their life cycles and have evolved strategies to avoid the innate immune response. Previously, we showed that the West Nile virus capsid protein plays a role in this process by blocking apoptosis. In this study, we examined how expression of capsid proteins from several flaviviruses affects apoptosis and other host processes that impact virus replication. All of the tested capsid proteins protected cells from Fas-dependent apoptosis through a mechanism that requires activated Akt. Capsid expression upregulated other Akt-dependent cellular processes including expression of glucose transporter 1 and mitochondrial metabolism. Protein phosphatase 1, which is known to inactivate Akt, was identified as a DENV capsid interacting protein. This suggests that DENV capsid expression activates Akt by sequestering phosphatases that downregulate phospho-Akt. Capsid-dependent upregulation of Akt would enhance downstream signalling pathways that affect cell survival and metabolism, thus providing a favourable environment for virus replication.
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Affiliation(s)
- Adriana M Airo
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada
| | | | | | - Jae Hwan You
- Department of Cell Biology, University of Alberta, Edmonton, Canada
| | | | - Charles Holmes
- Department of Biochemistry, University of Alberta, Edmonton, Canada
| | | | - Natasha Malik-Soni
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Lori Frappier
- Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Tom C Hobman
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Canada; Department of Cell Biology, University of Alberta, Edmonton, Canada; Li Ka Shing Institute of Virology, University of Alberta, Canada; Women & Children's Health Research Institute, University of Alberta, Canada.
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Roy M, Czaicki N, Holmes C, Chavan S, Tsitsi A, Odeny T, Sikazwe I, Padian N, Geng E. Understanding Sustained Retention in HIV/AIDS Care and Treatment: a Synthetic Review. Curr HIV/AIDS Rep 2017; 13:177-85. [PMID: 27188300 DOI: 10.1007/s11904-016-0317-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sustained retention represents an enduring and evolving challenge to HIV treatment programs in Africa. We present a theoretical framework for sustained retention borrowing from ecologic principles of sustainability and dynamic adaptation. We posit that sustained retention from the patient perspective is dependent on three foundational principles: (1) patient activation: the acceptance, prioritization, literacy, and skills to manage a chronic disease condition, (2) social normalization: the engagement of a social network and harnessing social capital to support care and treatment, and (3) livelihood routinization: the integration of care and treatment activities into livelihood priorities that may change over time. Using this framework, we highlight barriers specific to sustained retention and review interventions addressing long-term, sustained retention in HIV care with a focus on Sub-Saharan Africa.
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Affiliation(s)
- Monika Roy
- University of California San Francisco, San Francisco, USA.
| | | | - Charles Holmes
- Centre for Infectious Diseases Research Zambia, Zambia, Africa.,Johns Hopkins University, Baltimore, USA
| | - Saurabh Chavan
- University of California San Francisco, San Francisco, USA
| | | | - Thomas Odeny
- Kenya Medical Research Institute, Center for Microbiology Research, Nairobi, Kenya.,University of Washington, Seattle, USA
| | | | - Nancy Padian
- University of California Berkeley, Berkeley, USA
| | - Elvin Geng
- University of California San Francisco, San Francisco, USA
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Wendel-Hummell C, Sellon A, Kang H, Lassmann H, Swartzendruber L, Holmes C, Nary D, LaPierre T. IMPLEMENTING KANSAS’S UNIVERSAL ASSESSMENT IN A MANAGED LONG-TERM SERVICES AND SUPPORTS ENVIRONMENT. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2411] [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)
| | - A. Sellon
- University of Kansas, Lawrence, Kansas
| | - H. Kang
- University of Kansas, Lawrence, Kansas
| | | | | | - C. Holmes
- University of Kansas, Lawrence, Kansas
| | - D. Nary
- University of Kansas, Lawrence, Kansas
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Meyer T, Harland A, Haworth B, Holmes C, Lucas T, Sherratt P. The Influence of Different Melt Temperatures on the Mechanical Properties of Injection Molded PA-12 and the Post Process Detection by Thermal Analysis. INT POLYM PROC 2017. [DOI: 10.3139/217.3288] [Citation(s) in RCA: 3] [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] [Indexed: 11/20/2022]
Abstract
Abstract
Polyamide 12 (PA-12) test plates were injection molded using different melt temperatures and the influence on mechanical properties was investigated using quasi-static tensile and instrumented impact behavior in two conditioned states: dried, and following accelerated moisture intake. Energy absorption in tension is strongly dependent on process temperature (variations up to 99%) and additional variation (around 18%) was evident when testing at different conditioning states. Under high-velocity loading, the total impact energy varied by up to 8.70% and 9.05%, when systematic changes were made to process melt temperature and at moisture content, respectively, with all samples failing ductile. Differential Scanning Calorimetry (DSC) was used to characterise the unique endothermic melting behavior of molded PA-12 samples, by linking different process histories to the respective mechanical properties. With focus on the first heating curve progression, significant changes within the endothermic melting region were pointed out and quantified by using MatLab (software), proving DSC as a reliable testing tool for post-production analysis with increased practical implications regarding quality control as well as failure analysis. Findings for the initial heating curve progression were explained by studying the re-crystallisation peak values during cooling phase and obtained data for the second heating.
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Affiliation(s)
- T. Meyer
- Sport Technology Institute , Loughborough University, Loughborough , UK
| | - A. Harland
- Sport Technology Institute , Loughborough University, Loughborough , UK
| | - B. Haworth
- Department of Materials , Loughborough University, Loughborough , UK
| | - C. Holmes
- Adidas Future Team , Adidas AG, Herzogenaurach , Germany
| | - T. Lucas
- Adidas Future Team , Adidas AG, Herzogenaurach , Germany
| | - P. Sherratt
- Sport Technology Institute , Loughborough University, Loughborough , UK
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Sikombe K, Hantuba C, Czaicki N, Geng E, Holmes C, Musukuma K, Simbeza S, Somwe P, Sikazwe I. MEETING FIELD-BASED CHALLENGES: INNOVATIVE APPROACHES TO COLLECTING DRY BLOOD SPOT SAMPLES IN THE COMMUNITY. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.123] [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] Open
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Topp S, Mwamba C, Beres L, Padian N, Sikazwe I, Geng E, Holmes C. UNDERSTANDING PATIENT DECISIONS TO TRANSFER OR DISENGAGE FROM HIV CARE AND TREATMENT IN ZAMBIA. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.122] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Watson J, Nieto-Barajas L, Holmes C. Characterizing variation of nonparametric random probability measures using the Kullback–Leibler divergence. STATISTICS-ABINGDON 2016. [DOI: 10.1080/02331888.2016.1258072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- J. Watson
- Department of Statistics, University of Oxford, Oxford, UK
| | - L. Nieto-Barajas
- Department of Statistics, University of Oxford, Oxford, UK
- Department of Statistics, ITAM, Mexico City, Mexico
| | - C. Holmes
- Department of Statistics, University of Oxford, Oxford, UK
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Goldstein D, Holmes C, Sullivan P, Mash D, Sidransky E, Stefani A, Kopin I, Sharabi Y. Biomarkers and mechanisms of central catecholamine deficiency in MSA. Auton Neurosci 2015. [DOI: 10.1016/j.autneu.2015.07.353] [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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Wootton L, Holmes C, Sahoo N, Beddar S. TH-CD-BRA-06: Proton Beam Entrance Dosimetry with the Exradin W1 Plastic Scintillation Detector. Med Phys 2015. [DOI: 10.1118/1.4926231] [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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Salem Y, Liu H, Podgore J, Schwarz B, Holmes C. Benefits and barriers of physical therapy students participation in resource-poor international clinical education. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1253] [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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Duncombe C, Rosenblum S, Hellmann N, Holmes C, Wilkinson L, Biot M, Bygrave H, Hoos D, Garnett G. Reframing HIV care: putting people at the centre of antiretroviral delivery. Trop Med Int Health 2015; 20:430-47. [PMID: 25583302 PMCID: PMC4670701 DOI: 10.1111/tmi.12460] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/29/2022]
Abstract
The delivery of HIV care in the initial rapid scale-up of HIV care and treatment was based on existing clinic-based models, which are common in highly resourced settings and largely undifferentiated for individual needs. A new framework for treatment based on variable intensities of care tailored to the specific needs of different groups of individuals across the cascade of care is proposed here. Service intensity is characterised by four delivery components: (i) types of services delivered, (ii) location of service delivery, (iii) provider of health services and (iv) frequency of health services. How these components are developed into a service delivery framework will vary across countries and populations, with the intention being to improve acceptability and care outcomes. The goal of getting more people on treatment before they become ill will necessitate innovative models of delivering both testing and care. As HIV programmes expand treatment eligibility, many people entering care will not be 'patients' but healthy, active and productive members of society. To take the framework to scale, it will be important to: (i) define which individuals can be served by an alternative delivery framework; (ii) strengthen health systems that support decentralisation, integration and task shifting; (iii) make the supply chain more robust; and (iv) invest in data systems for patient tracking and for programme monitoring and evaluation.
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Abstract
We tested the feasibility of using plastic scintillation detectors (PSDs) for proton entrance dosimetry. A PSD built with BCF-12 scintillating fiber was used to measure the absolute entrance dose of a passively scattered proton beam for energies ranging from 140 to 250 MeV, and for a range of spread out Bragg peak (SOBP) widths at two energies, to quantify the effect of ionization quenching on the response of the detector and to determine the necessity of Cerenkov radiation correction in proton beams. The overall accuracy and precision of the PSD was evaluated by measuring lateral beam profiles and comparing the results with profiles measured using film. The PSD under-responded owing to ionization quenching, exhibiting approximately a 7% loss of signal at the highest energy studied (250 MeV) and a 10% loss of signal at the lowest energy studied (140 MeV). For a given nominal energy, varying the SOBP width did not significantly alter the response of the PSD. Cerenkov radiation contributed negligibly to the PSD signal and can be safely ignored without introducing more than 1% error in the measured dose. Profiles measured with the PSD and film agreed to within the uncertainty of the detector, demonstrating good relative accuracy. Although correction factors were necessary to account for ionization quenching, the magnitude of the correction varied minimally over a broad range of energies; PSDs therefore represent a practical detector for proton entrance dosimetry.
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Affiliation(s)
- Landon Wootton
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, Texas, USA
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Mackin D, Zhu XR, Poenisch F, Li H, Sahoo N, Kerr M, Holmes C, Li Y, Lii M, Wu R, Suzuki K, Gillin MT, Frank SJ, Grosshans D, Zhang X. Spot-Scanning Proton Therapy Patient-Specific Quality Assurance: Results from 309 Treatment Plans. Int J Part Ther 2014. [DOI: 10.14338/ijpt-d-14-00017.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mackin D, Zhu XR, Poenisch F, Li H, Sahoo N, Kerr M, Holmes C, Li Y, Lii M, Wu R, Suzuki K, Gillin MT, Frank SJ, Grosshans D, Zhang X. Spot-Scanning Proton Therapy Patient-Specific Quality Assurance: Results from 309 Treatment Plans. Int J Part Ther 2014. [DOI: 10.14338/ijpt-14-00017.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Mackin D, Li Y, Taylor MB, Kerr M, Holmes C, Sahoo N, Poenisch F, Li H, Lii J, Amos R, Wu R, Suzuki K, Gillin MT, Zhu XR, Zhang X. Improving spot-scanning proton therapy patient specific quality assurance with HPlusQA, a second-check dose calculation engine. Med Phys 2014; 40:121708. [PMID: 24320494 DOI: 10.1118/1.4828775] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this study was to validate the use of HPlusQA, spot-scanning proton therapy (SSPT) dose calculation software developed at The University of Texas MD Anderson Cancer Center, as second-check dose calculation software for patient-specific quality assurance (PSQA). The authors also showed how HPlusQA can be used within the current PSQA framework. METHODS The authors compared the dose calculations of HPlusQA and the Eclipse treatment planning system with 106 planar dose measurements made as part of PSQA. To determine the relative performance and the degree of correlation between HPlusQA and Eclipse, the authors compared calculated with measured point doses. Then, to determine how well HPlusQA can predict when the comparisons between Eclipse calculations and the measured dose will exceed tolerance levels, the authors compared gamma index scores for HPlusQA versus Eclipse with those of measured doses versus Eclipse. The authors introduce the αβγ transformation as a way to more easily compare gamma scores. RESULTS The authors compared measured and calculated dose planes using the relative depth, z∕R × 100%, where z is the depth of the measurement and R is the proton beam range. For relative depths than less than 80%, both Eclipse and HPlusQA calculations were within 2 cGy of dose measurements on average. When the relative depth was greater than 80%, the agreement between the calculations and measurements fell to 4 cGy. For relative depths less than 10%, the Eclipse and HPlusQA dose discrepancies showed a negative correlation, -0.21. Otherwise, the correlation between the dose discrepancies was positive and as large as 0.6. For the dose planes in this study, HPlusQA correctly predicted when Eclipse had and had not calculated the dose to within tolerance 92% and 79% of the time, respectively. In 4 of 106 cases, HPlusQA failed to predict when the comparison between measurement and Eclipse's calculation had exceeded the tolerance levels of 3% for dose and 3 mm for distance-to-agreement. CONCLUSIONS The authors found HPlusQA to be reasonably effective (79% ± 10%) in determining when the comparison between measured dose planes and the dose planes calculated by the Eclipse treatment planning system had exceeded the acceptable tolerance levels. When used as described in this study, HPlusQA can reduce the need for patient specific quality assurance measurements by 64%. The authors believe that the use of HPlusQA as a dose calculation second check can increase the efficiency and effectiveness of the QA process.
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Affiliation(s)
- Dennis Mackin
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
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Mackin D, Zhang X, Li Y, Li H, Wu R, Poenisch F, Suzuki K, Kerr M, Holmes C, Zhu X, Sahoo N, Gillin M. MO-F-16A-05: Spot-Scanning Proton Therapy Patient-Specific Quality Assurance: Our Methodology and Results From 295 Treatment Plans. Med Phys 2014. [DOI: 10.1118/1.4889176] [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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Doherty K, Essajee S, Penazzato M, Holmes C, Resch S, Ciaranello A. Estimating age-based antiretroviral therapy costs for HIV-infected children in resource-limited settings based on World Health Organization weight-based dosing recommendations. BMC Health Serv Res 2014; 14:201. [PMID: 24885453 PMCID: PMC4021070 DOI: 10.1186/1472-6963-14-201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 04/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric antiretroviral therapy (ART) has been shown to substantially reduce morbidity and mortality in HIV-infected infants and children. To accurately project program costs, analysts need accurate estimations of antiretroviral drug (ARV) costs for children. However, the costing of pediatric antiretroviral therapy is complicated by weight-based dosing recommendations which change as children grow. METHODS We developed a step-by-step methodology for estimating the cost of pediatric ARV regimens for children ages 0-13 years old. The costing approach incorporates weight-based dosing recommendations to provide estimated ARV doses throughout childhood development. Published unit drug costs are then used to calculate average monthly drug costs. We compared our derived monthly ARV costs to published estimates to assess the accuracy of our methodology. RESULTS The estimates of monthly ARV costs are provided for six commonly used first-line pediatric ARV regimens, considering three possible care scenarios. The costs derived in our analysis for children were fairly comparable to or slightly higher than available published ARV drug or regimen estimates. CONCLUSIONS The methodology described here can be used to provide an accurate estimation of pediatric ARV regimen costs for cost-effectiveness analysts to project the optimum packages of care for HIV-infected children, as well as for program administrators and budget analysts who wish to assess the feasibility of increasing pediatric ART availability in constrained budget environments.
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Affiliation(s)
- Kathleen Doherty
- Medical Practice Evaluation Center, Divisions of General Medicine, Massachusetts General Hospital, Boston, MA, USA.
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Cook GA, Sullivan P, Holmes C, Goldstein DS. Cardiac sympathetic denervation without Lewy bodies in a case of multiple system atrophy. Parkinsonism Relat Disord 2014; 20:926-8. [PMID: 24794098 DOI: 10.1016/j.parkreldis.2014.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/27/2014] [Accepted: 04/05/2014] [Indexed: 11/25/2022]
Affiliation(s)
- G A Cook
- Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD 20892, USA.
| | - P Sullivan
- Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD 20892, USA
| | - C Holmes
- Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD 20892, USA
| | - D S Goldstein
- Clinical Neurocardiology Section, NINDS, NIH, Bethesda, MD 20892, USA
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Brant S, Holmes C, West L, Cobert M, Jessen M, Peltz M. Influence of Oxidative and Anaplerotic Subtrates on Myocardial Metabolism During Hypothermic Machine Perfusion. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.680] [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] Open
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Lambert JC, Ibrahim-Verbaas CA, Harold D, Naj AC, Sims R, Bellenguez C, DeStafano AL, Bis JC, Beecham GW, Grenier-Boley B, Russo G, Thorton-Wells TA, Jones N, Smith AV, Chouraki V, Thomas C, Ikram MA, Zelenika D, Vardarajan BN, Kamatani Y, Lin CF, Gerrish A, Schmidt H, Kunkle B, Dunstan ML, Ruiz A, Bihoreau MT, Choi SH, Reitz C, Pasquier F, Cruchaga C, Craig D, Amin N, Berr C, Lopez OL, De Jager PL, Deramecourt V, Johnston JA, Evans D, Lovestone S, Letenneur L, Morón FJ, Rubinsztein DC, Eiriksdottir G, Sleegers K, Goate AM, Fiévet N, Huentelman MW, Gill M, Brown K, Kamboh MI, Keller L, Barberger-Gateau P, McGuiness B, Larson EB, Green R, Myers AJ, Dufouil C, Todd S, Wallon D, Love S, Rogaeva E, Gallacher J, St George-Hyslop P, Clarimon J, Lleo A, Bayer A, Tsuang DW, Yu L, Tsolaki M, Bossù P, Spalletta G, Proitsi P, Collinge J, Sorbi S, Sanchez-Garcia F, Fox NC, Hardy J, Deniz Naranjo MC, Bosco P, Clarke R, Brayne C, Galimberti D, Mancuso M, Matthews F, Moebus S, Mecocci P, Del Zompo M, Maier W, Hampel H, Pilotto A, Bullido M, Panza F, Caffarra P, Nacmias B, Gilbert JR, Mayhaus M, Lannefelt L, Hakonarson H, Pichler S, Carrasquillo MM, Ingelsson M, Beekly D, Alvarez V, Zou F, Valladares O, Younkin SG, Coto E, Hamilton-Nelson KL, Gu W, Razquin C, Pastor P, Mateo I, Owen MJ, Faber KM, Jonsson PV, Combarros O, O'Donovan MC, Cantwell LB, Soininen H, Blacker D, Mead S, Mosley TH, Bennett DA, Harris TB, Fratiglioni L, Holmes C, de Bruijn RF, Passmore P, Montine TJ, Bettens K, Rotter JI, Brice A, Morgan K, Foroud TM, Kukull WA, Hannequin D, Powell JF, Nalls MA, Ritchie K, Lunetta KL, Kauwe JS, Boerwinkle E, Riemenschneider M, Boada M, Hiltuenen M, Martin ER, Schmidt R, Rujescu D, Wang LS, Dartigues JF, Mayeux R, Tzourio C, Hofman A, Nöthen MM, Graff C, Psaty BM, Jones L, Haines JL, Holmans PA, Lathrop M, Pericak-Vance MA, Launer LJ, Farrer LA, van Duijn CM, Van Broeckhoven C, Moskvina V, Seshadri S, Williams J, Schellenberg GD, Amouyel P. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease. Nat Genet 2013; 45:1452-8. [PMID: 24162737 PMCID: PMC3896259 DOI: 10.1038/ng.2802] [Citation(s) in RCA: 2947] [Impact Index Per Article: 267.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 09/27/2013] [Indexed: 12/12/2022]
Abstract
Eleven susceptibility loci for late-onset Alzheimer's disease (LOAD) were identified by previous studies; however, a large portion of the genetic risk for this disease remains unexplained. We conducted a large, two-stage meta-analysis of genome-wide association studies (GWAS) in individuals of European ancestry. In stage 1, we used genotyped and imputed data (7,055,881 SNPs) to perform meta-analysis on 4 previously published GWAS data sets consisting of 17,008 Alzheimer's disease cases and 37,154 controls. In stage 2, 11,632 SNPs were genotyped and tested for association in an independent set of 8,572 Alzheimer's disease cases and 11,312 controls. In addition to the APOE locus (encoding apolipoprotein E), 19 loci reached genome-wide significance (P < 5 × 10(-8)) in the combined stage 1 and stage 2 analysis, of which 11 are newly associated with Alzheimer's disease.
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Sima C, Gates JC, Holmes C, Mennea PL, Zervas MN, Smith PGR. Terahertz bandwidth photonic Hilbert transformers based on synthesized planar Bragg grating fabrication. Opt Lett 2013; 38:3448-3451. [PMID: 23988981 DOI: 10.1364/ol.38.003448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Terahertz bandwidth photonic Hilbert transformers are proposed and experimentally demonstrated. The integrated device is fabricated via a direct UV grating writing technique in a silica-on-silicon platform. The photonic Hilbert transformer operates at bandwidths of up to 2 THz (~16 nm) in the telecom band, a 10-fold greater bandwidth than any previously reported experimental approaches. Achieving this performance requires detailed knowledge of the system transfer function of the direct UV grating writing technique; this allows improved linearity and yields terahertz bandwidth Bragg gratings with improved spectral quality. By incorporating a flat-top reflector and Hilbert grating with a waveguide coupler, an ultrawideband all-optical single-sideband filter is demonstrated.
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Affiliation(s)
- Chaotan Sima
- Optoelectronics Research Centre, University of Southampton, Southampton, UK.
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Butchart JW, Wolfe LJ, Holmes C, Brewer L, Bennett K, Williams D, O'Halloran AM, King-Kallimanis BL, Kenny RA, McDonald C, Pearce MS, Newton JL, Kerr S, Dean KJ, Jenkinson C, Wilcock GK, McCrory C, Gallagher D, Kenny RA, Robinson SM, Canavan M, O'Keeffe ST, Jackson TA, Nicolson P, Sheehan B. Psychiatry and mental health. Age Ageing 2013. [DOI: 10.1093/ageing/aft108] [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: 11/13/2022] Open
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Banerjee S, Hellier J, Romeo R, Dewey M, Knapp M, Ballard C, Baldwin R, Bentham P, Fox C, Holmes C, Katona C, Lawton C, Lindesay J, Livingston G, McCrae N, Moniz-Cook E, Murray J, Nurock S, Orrell M, O'Brien J, Poppe M, Thomas A, Walwyn R, Wilson K, Burns A. Study of the use of antidepressants for depression in dementia: the HTA-SADD trial--a multicentre, randomised, double-blind, placebo-controlled trial of the clinical effectiveness and cost-effectiveness of sertraline and mirtazapine. Health Technol Assess 2013; 17:1-166. [PMID: 23438937 DOI: 10.3310/hta17070] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Depression is common in dementia, causing considerable distress and other negative impacts. Treating it is a clinical priority, but the evidence base is sparse and equivocal. This trial aimed to determine clinical effectiveness of sertraline and mirtazapine in reducing depression 13 weeks post randomisation compared with placebo. DESIGN Multicentre, parallel-group, double-blind placebo-controlled randomised controlled trial of the clinical effectiveness of sertraline and mirtazapine with 13- and 39-week follow-up. SETTING Nine English old-age psychiatry services. PARTICIPANTS A pragmatic trial. Eligibility: probable or possible Alzheimer's disease (AD), depression (4+ weeks) and Cornell Scale for Depression in Dementia (CSDD) score of 8+. EXCLUSIONS clinically too critical (e.g. suicide risk); contraindication to medication; taking antidepressants; in another trial; and having no carer. INTERVENTIONS (1) Sertraline; (2) mirtazapine; and (3) placebo, all with normal care. Target doses: 150 mg of sertraline or 45 mg of mirtazapine daily. MAIN OUTCOME MEASURES OUTCOME CSDD score. Randomisation: Allocated 1 : 1 : 1 through Trials Unit, independently of trial team. Stratified block randomisation by centre, with randomly varying block sizes; computer-generated randomisation. Blinding: Double blind: medication and placebo identical for each antidepressant. Referring clinicians, research workers, participants and pharmacies were blind. Statisticians blind until analyses completed. RESULTS Numbers randomised: 326 participants randomised (111 placebo, 107 sertraline and 108 mirtazapine). OUTCOME Differences in CSDD at 13 weeks from an adjusted linear-mixed model: mean difference (95% CI) placebo-sertraline 1.17 (-0.23 to 2.78; p = 0.102); placebo-mirtazapine 0.01 (-1.37 to 1.38; p = 0.991); and mirtazapine-sertraline 1.16 (-0.27 to 2.60; p = 0.112). HARMS Placebo group had fewer adverse reactions (29/111, 26%) than sertraline (46/107, 43%) or mirtazapine (44/108, 41%; p = 0.017); 39-week mortality equal, five deaths in each group. CONCLUSIONS This is a trial with negative findings but important clinical implications. The data suggest that the antidepressants tested, given with normal care, are not clinically effective (compared with placebo) for clinically significant depression in AD. This implies a need to change current practice of antidepressants being the first-line treatment of depression in AD. From the data generated we formulated the following recommendations for future work. (1) The secondary analyses presented here suggest that there would be value in carrying out a placebo-controlled trial of the clinical effectiveness and cost-effectiveness of mirtazapine in the management of Behavioural and Psychological Symptoms of Dementia. (2) A conclusion from this study is that it remains both ethical and essential for trials of new medication for depression in dementia to have a placebo arm. (3) Further research is required to evaluate the impact that treatments for depression in people with dementia can have on their carers not only in terms of any impacts on their quality of life, but also the time they spend care-giving. (4) There is a need for research into alternative biological and psychological therapies for depression in dementia. These could include evaluations of new classes of antidepressants (such as venlafaxine) or antidementia medication (e.g. cholinesterase inhibitors). (5) Research is needed to investigate the natural history of depression in dementia in the community when patients are not referred to secondary care services. (6) Further work is needed to investigate the cost modelling results in this rich data set, investigating carer burden and possible moderators to the treatment effects. (7) There is scope for reanalysis of the primary outcome in terms of carer and participant CSDD results.
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Affiliation(s)
- S Banerjee
- Brighton and Sussex Medical School, BSMS Teaching Building, University of Sussex, Brighton, UK
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Sima C, Gates JC, Rogers HL, Mennea PL, Holmes C, Zervas MN, Smith PGR. Ultra-wide detuning planar Bragg grating fabrication technique based on direct UV grating writing with electro-optic phase modulation. Opt Express 2013; 21:15747-15754. [PMID: 23842361 DOI: 10.1364/oe.21.015747] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A direct UV grating writing technique based on phase-controlled interferometry is proposed and demonstrated in a silica-on-silicon platform, with a wider wavelength detuning range than any previously reported UV writing technology. Electro-optic phase modulation of one beam in the interferometer is used to manipulate the fringe pattern and thus control the parameters of the Bragg gratings and waveguides. Various grating structures with refractive index apodization, phase shifts and index contrasts of up to 0.8 × 10(-3) have been demonstrated. The method offers significant time/energy efficiency as well as simplified optical layout and fabrication process. We have shown Bragg gratings can be made from 1200 nm to 1900 nm exclusively under software control and the maximum peak grating reflectivity only decreases by 3 dBover a 250 nm (~32 THz) bandwidth.
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Affiliation(s)
- C Sima
- Optoelectronics Research Centre, University of Southampton, Southampton, SO17 1BJ, UK.
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Mackin D, Zhang X, Li Y, Taylor M, Kerr M, Holmes C, Sahoo N, Poenisch F, Li H, Lii M, Amos R, Wu R, Suzuki K, Gillin M, Zhu X. SU-E-T-157: Improving Spot Scanning Proton Therapy Patient-Specific Quality Assurance Through Early Application of Second-Check Dose Calculation Software. Med Phys 2013. [DOI: 10.1118/1.4814592] [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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Butchart JW, Wolfe LJ, Holmes C, O'Hare CJ, Lawlor BA, Kenny RA, Goldberg SE, Whittamore KH, Harwood RH, Gladman JR, Schneider JM. Psychiatry and mental health. Age Ageing 2013. [DOI: 10.1093/ageing/aft025] [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: 11/13/2022] Open
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Sima C, Gates JC, Rogers HL, Mennea PL, Holmes C, Zervas MN, Smith PGR. Phase controlled integrated interferometric single-sideband filter based on planar Bragg gratings implementing photonic Hilbert transform. Opt Lett 2013; 38:727-729. [PMID: 23455279 DOI: 10.1364/ol.38.000727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The monolithically integrated all-optical single-sideband (SSB) filter based on photonic Hilbert transform and planar Bragg gratings is proposed and experimentally demonstrated. An SSB suppression of 12 dB at 6 GHz and sideband switching are achieved via thermal tuning. An X-coupler, photonic Hilbert transformer, flat top reflector, and a micro heater are incorporated in a single silicon-on-silica substrate. The device can be thermally tuned by the micro heater on top of the channel waveguide. The device is fabricated using a combination of direct UV grating writing technology and photolithography.
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Affiliation(s)
- Chaotan Sima
- Optoelectronics Research Centre, University of Southampton, Southampton, UK.
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Affiliation(s)
- C. Holmes
- University of Southampton; Division of Clinical and Experimental Science; Memory Assessment and Research Centre; Moorgreen Hospital; Southampton; UK
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Holmes C, Shah J, Modha D, Herzallah R, Patel H, Haldar K, Barer M, Rajakumar K, Gaillard E. S80 A Clinical Evaluation of Quantitative, Culture-Independent Methods For the Identification of Bacteria in Cystic Fibrosis Sputum and Broncho-Alveolar Lavage Fluids. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.086] [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: 11/04/2022]
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Fok S, Schwartz R, Wronkiewicz M, Holmes C, Zhang J, Somers T, Bundy D, Leuthardt E. An EEG-based brain computer interface for rehabilitation and restoration of hand control following stroke using ipsilateral cortical physiology. Annu Int Conf IEEE Eng Med Biol Soc 2012; 2011:6277-80. [PMID: 22255773 DOI: 10.1109/iembs.2011.6091549] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The loss of motor control severely impedes activities of daily life. Brain computer interfaces (BCIs) offer new possibilities to treat nervous system injuries, but conventional BCIs use signals from primary motor cortex, the same sites most likely damaged in a stroke causing paralysis. Recent studies found distinct cortical physiology associated with contralesional limb movements in regions distinct from primary motor cortex. To capitalize on these findings, we designed and implemented a BCI that localizes and acquires these brain signals to drive a powered, hand orthotic which opens and closes a patient's hand.
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Affiliation(s)
- Sam Fok
- Biomedical Engineering and Electrical Engineering Department, Washington University in St Louis, MO 63130, USA.
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Cohen MS, Holmes C, Padian N, Wolf M, Hirnschall G, Lo YR, Goosby E. HIV Treatment As Prevention: How Scientific Discovery Occurred And Translated Rapidly Into Policy For The Global Response. Health Aff (Millwood) 2012; 31:1439-49. [DOI: 10.1377/hlthaff.2012.0250] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Myron S. Cohen
- Myron S. Cohen is the J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology, and Public Health at the University of North Carolina at Chapel Hill
| | - Charles Holmes
- Charles Holmes is chief medical officer in the Office of the US Global AIDS Coordinator, in Washington, D.C
| | - Nancy Padian
- Nancy Padian is a senior technical adviser in the Office of the US Global AIDS Coordinator
| | - Megan Wolf
- Megan Wolf is a program support officer in the Office of the US Global AIDS Coordinator
| | - Gottfried Hirnschall
- Gottfried Hirnschall is the director of the HIV/AIDS Department of the World Health Organization, in Geneva, Switzerland
| | - Ying-Ru Lo
- Ying-Ru Lo is global coordinator of the World Health Organization’s HIV Prevention Programme, in Geneva
| | - Eric Goosby
- Eric Goosby is the US Global AIDS Coordinator
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Das A, Wallace GC, Holmes C, McDowell ML, Smith JA, Marshall JD, Bonilha L, Edwards JC, Glazier SS, Ray SK, Banik NL. Hippocampal tissue of patients with refractory temporal lobe epilepsy is associated with astrocyte activation, inflammation, and altered expression of channels and receptors. Neuroscience 2012; 220:237-46. [PMID: 22698689 DOI: 10.1016/j.neuroscience.2012.06.002] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2012] [Revised: 05/17/2012] [Accepted: 06/03/2012] [Indexed: 11/24/2022]
Abstract
Temporal lobe epilepsy (TLE) is the most common form of focal epilepsy. Previous research has demonstrated several trends in human tissue that, undoubtedly, contribute to the development and progression of TLE. In this study we examined resected human hippocampus tissue for a variety of changes including gliosis that might contribute to the development and presentation of TLE. The study subjects consisted of six TLE patients and three sudden-death controls. Clinicopathological characteristics were evaluated by H&E staining. Immunohistological staining and Western blotting methods were used to analyze the samples. Neuronal hypertrophy was observed in resected epileptic tissue. Immunohistological staining demonstrated that activation of astrocytes was significantly increased in epileptic tissue as compared to corresponding regions of the control group. The Western blot data also showed increased CX43 and AQP4 in the hippocampus and downregulation of Kir4.1, α-syntrophin, and dystrophin, the key constituents of AQP4 multi-molecular complex. These tissues also demonstrated changes in inflammatory factors (COX-2, TGF-β, NF-κB) suggesting that these molecules may play an important role in TLE pathogenesis. In addition we detected increases in metabotropic glutamate receptor (mGluR) 2/3, mGluR5 and kainic acid receptor subunits KA1 (Grik4) and KA2 (Grik5) in patients' hippocampi. We noted increased expression of the α1c subunit comprising class C L-type Ca(2+) channels and calpain expression in these tissues, suggesting that these subunits might have an integral role in TLE pathogenesis. These changes found in the resected tissue suggest that they may contribute to TLE and that the kainic acid receptor (KAR) and deregulation of GluR2 receptor may play an important role in TLE development and disease course. This study identifies alterations in number of commonly studied molecular targets associated with astrogliosis, cellular hypertrophy, water homeostasis, inflammation, and modulation of excitatory neurotransmission in hippocampal tissues from TLE patients.
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Affiliation(s)
- A Das
- Department of Neurosciences (Divisions of Neurology and Neurosurgery), Medical University of South Carolina, Charleston, SC 29425, USA
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Degail MA, Hughes GJ, Maule C, Holmes C, Lilley M, Pebody R, Bonnet J, Bermingham A, Bracebridge S. A human metapneumovirus outbreak at a community hospital in England, July to September 2010. Euro Surveill 2012; 17:20145. [PMID: 22516049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
We describe an outbreak of human metapneumovirus (hMPV) which occurred in July-September 2010 at a community hospital in the East of England. Based on the medical and nursing records, cases were retrospectively defined as suspected if they had had an influenza-like illness (ILI), and probable if they had had an ILI and an epidemiological link to a laboratory-confirmed case. Of a total of 17 symptomatic inpatients, five were classified as probable cases, five were laboratory confirmed and seven were suspected. The attack rate was 29.4% for confirmed and probable cases combined. The median age of symptomatic inpatients was 85 years-old (range 68-96) and the majority (16/17) of symptomatic inpatients had an underlying medical condition. Control measures introduced appeared to restrict further exposure of susceptible patients to infection although modelling suggested that up to four of 10 confirmed and probable cases (40%) could have been prevented through more timely diagnosis and recognition of an outbreak. These findings suggest that there should be increased awareness of hMPV infection within healthcare settings, particularly when the population at risk has a high prevalence of underlying co-morbidities.
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Affiliation(s)
- M A Degail
- Health Protection Agency, Colindale, United Kingdom
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Degail MA, Hughes GJ, Maule C, Holmes C, Lilley M, Pebody R, Bonnet J, Bermingham A, Bracebridge S. A human metapneumovirus outbreak at a community hospital in England, July to September 2010. Euro Surveill 2012. [DOI: 10.2807/ese.17.15.20145-en] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- M A Degail
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Protection Agency, Colindale, United Kingdom
| | - G J Hughes
- Health Protection Agency East of England, Cambridge, United Kingdom
| | - C Maule
- Hertfordshire Community NHS Trust, Welwyn Garden City, United Kingdom
| | - C Holmes
- Hertfordshire Community NHS Trust, Welwyn Garden City, United Kingdom
| | - M Lilley
- Bedfordshire and Hertfordshire Health Protection Unit, Letchworth, United Kingdom
| | - R Pebody
- Health Protection Agency, Colindale, United Kingdom
| | - J Bonnet
- Hertfordshire Community NHS Trust, Welwyn Garden City, United Kingdom
| | - A Bermingham
- Health Protection Agency, Colindale, United Kingdom
| | - S Bracebridge
- Health Protection Agency East of England, Cambridge, United Kingdom
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