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Heath C, Johnston A, Siafarikas A, Price G, von Ungern-Sternberg BS. Perioperative steroid prophylaxis for adrenal insufficiency, a single-centre experience. Paediatr Anaesth 2024; 34:274-276. [PMID: 37947252 DOI: 10.1111/pan.14797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Management, Starship Children's Hospital, Auckland, New Zealand
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Angus Johnston
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Aris Siafarikas
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Medical School, Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
- Chronic Disease Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Glynis Price
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Perioperative Care Program, Perioperative Medicine Team, Telethon Kids Institute, Nedlands, Western Australia, Australia
- Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, Fuchs A, Garcia-Marcinkiewicz A, Habre W, Heath C, Johansen M, Kaufmann J, Kleine-Brueggeney M, Kovatsis PG, Kranke P, Lusardi AC, Matava C, Peyton J, Riva T, Romero CS, von Ungern-Sternberg B, Veyckemans F, Afshari A. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. Br J Anaesth 2024; 132:124-144. [PMID: 38065762 DOI: 10.1016/j.bja.2023.08.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 01/05/2024] Open
Abstract
Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong '1' or weak '2' recommendation with high 'A', medium 'B' or low 'C' quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1C). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1C). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).
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Affiliation(s)
- Nicola Disma
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - Takashi Asai
- Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
| | - Evelien Cools
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | | | - Thomas Engelhardt
- Department of Anaesthesia, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - John Fiadjoe
- Department of Anaesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Fuchs
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annery Garcia-Marcinkiewicz
- Department of Anaesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Walid Habre
- Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Chloe Heath
- Department of Anaesthesia and Pain Management, Starship Children's Hospital, Auckland, New Zealand; Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA, Australia
| | - Mathias Johansen
- Department of Anaesthesia, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada
| | - Jost Kaufmann
- Department for Pediatric Anesthesia, Children's Hospital Cologne, Cologne, Germany; Faculty for Health, University of Witten/Herdecke, Witten, Germany
| | - Maren Kleine-Brueggeney
- Department of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pete G Kovatsis
- Department of Anaesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Andrea C Lusardi
- Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - James Peyton
- Department of Anaesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Riva
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carolina S Romero
- Department of Anesthesia and Critical Care, Consorcio Hospital General Universitario de Valencia, Methodology Department, Universidad Europea de Valencia, Valencia, Spain
| | - Britta von Ungern-Sternberg
- Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA, Australia; Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
| | | | - Arash Afshari
- Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet & Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, Fuchs A, Garcia-Marcinkiewicz A, Habre W, Heath C, Johansen M, Kaufmann J, Kleine-Brueggeney M, Kovatsis PG, Kranke P, Lusardi AC, Matava C, Peyton J, Riva T, Romero CS, von Ungern-Sternberg B, Veyckemans F, Afshari A. Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. Eur J Anaesthesiol 2024; 41:3-23. [PMID: 38018248 PMCID: PMC10720842 DOI: 10.1097/eja.0000000000001928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong '1' or weak '2' recommendation with high 'A', medium 'B' or low 'C' quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO 2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).
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Affiliation(s)
- Nicola Disma
- From the Unit for Research in Anaesthesia, IRCCS Istituto Giannina Gaslini, Genoa, Italy (ND, AF, ACL), Department of Anesthesiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan (TA), Department of Anaesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland (EC, WH), Medical Library, Boston Children's Hospital, Boston, MA, USA (AC), Department of Anaesthesia, Montreal Children's Hospital, McGill University Health Centre, Montréal, QC, Canada (TE, MJ), Department of Anaesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA (JF, PGK, JP), Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (AF, TR), Department of Anaesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA (AG-M), Department of Anaesthesia and Pain Management, Starship Children's Hospital, Auckland, New Zealand (CH), Perioperative Medicine Team, Perioperative Care Program, Telethon Kids Institute, Perth, WA, Australia (CH, BvU-S), Department for Pediatric Anesthesia, Children's Hospital Cologne, Cologne, Germany (JK), Faculty for Health, University of Witten/Herdecke, Witten, Germany (JK), Department of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC) and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (MK-B), Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany (PK), Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada (CM), Department of Anesthesia and Critical Care, Consorcio Hospital General Universitario de Valencia, Methodology Department, Universidad Europea de Valencia, Valencia, Spain (CSR), Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia (BvU-S), Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia (BvU-S), Faculty of Medicine, UCLouvain, Brussels, Belgium (FV), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet & Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark (AA)
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Heath C, Bavich P, Sommerfield A, von Ungern-Sternberg BS. Kids Voices, the perioperative experience of emergency surgery from children's perspectives: A qualitative study. Patient Educ Couns 2023; 110:107674. [PMID: 36848717 DOI: 10.1016/j.pec.2023.107674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/07/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The study aimed to better understand children's emergency perioperative experience, a little researched topic. Current literature shows discrepancies between child and adult perceptions for the same healthcare experience. Acquisition of knowledge from the child's perspective can be utilized to improve perioperative care. METHOD This qualitative study included children (4-15 years) undergoing emergency surgery requiring general anesthesia for manipulation under anesthesia (MUA) and appendicectomy. Recruitment was opportunistic with the aim to recruit a minimum of 50 per surgical subgroup, with 109 children interviewed via telephone postoperatively. Data analysis was performed using qualitative content analysis. Participants varied in terms of age, gender, diagnosis and previous perioperative experience. RESULTS Qualitative content analysis found three overarching themes in association with the perioperative process: (1) fearful/apprehensive, (2) perception of powerlessness and (3) perception of trust and security. Two overarching themes were found from data relevant to the perioperative environment: (1) poor adaptation of the care environment to the children's needs and (2) positive adaptation of the care environment to the children's needs. CONCLUSION AND PRACTICE IMPLICATIONS The themes identified provide valuable insight into children's perioperative experience. Findings are of value to stakeholders in healthcare and are expected to inform strategies to optimize the quality of healthcare.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Paige Bavich
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, WA, Australia; Perioperative Medicine Team, Telethon Kids Institute, Perth, WA, Australia; Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia.
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5
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Heath C, Hii J, Thalayasingam P, von Ungern-Sternberg BS, Sommerfield D. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022; 33:336-346. [PMID: 36424875 DOI: 10.1111/pan.14608] [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] [Received: 03/03/2022] [Revised: 11/08/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Perioperative pain management impacts patient morbidity, quality of life, and hospitalization cost. In children, it impacts not only the child, but the whole family. Adjuncts for improved perioperative analgesia continue to be sought to minimize adverse side effects associated with opioids and for those in whom regional or neuraxial anesthesia is not suitable. The use of ketamine and alpha agonists may be useful in these settings but have noted adverse effects including hallucinations, hemodynamic instability, and excessive sedation. One alternative is intravenous lidocaine. Despite its off-label use, intravenous lidocaine has demonstrated anti-neuropathic, anti-hyperalgesic, and anti-inflammatory actions and is an emerging technique. Multiple studies in adults have demonstrated beneficial effects of perioperative intravenous lidocaine including improved perioperative analgesia with reduced postoperative opioid use, improved gastrointestinal function, earlier mobilization, and reduction in hospital length of stay. Despite the limited pediatric literature, some of these findings have been replicated. Large-scale trials providing evidence for the pediatric pharmacokinetics and high-quality safety data with respect to intravenous lidocaine are still however lacking. To date, dose ranges studied in the pediatric population have not been associated with serious side effects and current data suggests perioperative intravenous lidocaine in a subgroup of pediatric surgical patients seems well-tolerated and beneficial.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Justin Hii
- Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Department of Anaesthesia, Joondalup Health Campus, Joondalup, WA, Australia
| | - Priya Thalayasingam
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - David Sommerfield
- Department of Anaesthesia and Pain Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, Western Australia, Australia
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6
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Heath C, Hauser N. Is there a role for lung-protective ventilation in healthy children? Paediatr Anaesth 2022; 32:278-285. [PMID: 34839569 DOI: 10.1111/pan.14345] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/27/2022]
Abstract
Lung-protective ventilation (LPV) has been adopted in the theater environment as a strategy to reduce pulmonary complications under anesthesia. Postoperative pulmonary complications are not infrequent and may have significant implications on the postoperative length of stay as well as the morbidity and mortality of pediatric patients. There is evidence in the adult literature to suggest that intraoperative LPV strategies may reduce the risk of such complications. The utility of LPV strategies in healthy children is not well researched, and the data from critical care studies appear to be conflicting. To ascertain the value of intraoperative LPV in pediatric patients, it is important to understand the pathophysiology of pediatric ventilator-induced lung injury and the basis of LPV strategies. The current evidence in adult and pediatric populations, including pediatric intensive care, is reviewed to gain insight into the role and value of intraoperative LPV for pediatric patients.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - Neil Hauser
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Perioperative Medicine Team, Telethon Kids Institute, Nedlands, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, the University of Western Australia, Perth, WA, Australia
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7
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Heath C, Siafarikas A, Sommerfield A, Ungern‐Sternberg BS. Peri-operative steroid management in the paediatric population. Acta Anaesthesiol Scand 2021; 65:1187-1194. [PMID: 34263943 DOI: 10.1111/aas.13952] [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: 05/02/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life-threatening emergency in the peri-operative period due to their attenuated ability to mount a cortisol response. There is a lack of standardization regarding peri-operative stress-dose glucocorticoids in paediatric clinical practice with the absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra-physiologic glucocorticoid dosing in susceptible patients. Specific clinical concerns in the paediatric population include osteopenia, growth restriction and increased risk of cardiovascular disease in adulthood. This review aimed to identify and evaluate available literature in the field of peri-operative stress-dose glucocorticoids. METHODS A comprehensive literature search was conducted to construct a narrative review. RESULTS The outcome of this review identified that paediatric patients, unlike adults, do not show a graded response to surgical stress with implications for glucocorticoid stress dose regimens for general anaesthesia and less invasive surgical procedures. The studies highlight a lack of information on physiological steroid responses to stress situations and differences in the approach to glucocorticoid replacement strategies in the paediatric population. CONCLUSION The review identified there is a lack of high-quality paediatric-specific studies evaluating appropriate stress-dose glucocorticoid regimens in paediatric patients with or at risk of adrenal insufficiency. Further research is needed to establish clear evidence-based clinical guidelines for paediatric peri-operative practice regarding steroid stress dosing in adrenal insufficiency. Current knowledge would suggest that a balanced view of risks and benefits should be taken appropriate to the clinical context, to dictate peri-operative stress-dose glucocorticoids use that permits safe perioperative management.
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Affiliation(s)
- Chloe Heath
- Department of Anaesthesia and Pain Management Perth Children’s Hospital Perth Western Australia Australia
| | - Aris Siafarikas
- Department of Paediatric Endocrinology Perth Children’s Hospital Perth Western Australia Australia
- Faculty of Medicine, Paediatrics The University of Western Australia Nedlands Western Australia Australia
- Institute for Health ResearchUniversity of Notre Dame Fremantle Western Australia Australia
- Telethon Kids Institute Perth Western Australia Australia
| | - Aine Sommerfield
- Department of Anaesthesia and Pain Management Perth Children’s Hospital Perth Western Australia Australia
- Perioperative Medicine Team Telethon Kids Institute Perth Western Australia Australia
| | - Britta S. Ungern‐Sternberg
- Department of Anaesthesia and Pain Management Perth Children’s Hospital Perth Western Australia Australia
- Perioperative Medicine Team Telethon Kids Institute Perth Western Australia Australia
- Division of Emergency Medicine, Anaesthesia and Pain Medicine Medical School The University of Western Australia Perth Western Australia Australia
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McCluskey G, Kinney MO, Russell A, Smithson WH, Parsons L, Morrison PJ, Bromley R, MacKillop L, Heath C, Liggan B, Murphy S, Delanty N, Irwin B, Campbell E, Morrow J, Hunt SJ, Craig JJ. Zonisamide safety in pregnancy: Data from the UK and Ireland epilepsy and pregnancy register. Seizure 2021; 91:311-315. [PMID: 34273670 DOI: 10.1016/j.seizure.2021.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Animal data suggest teratogenic effects with zonisamide use and risk of pregnancy losses. Human data following zonisamide exposure are presently limited, but suggest low risk of malformation with elevated risk of low birth weight. OBJECTIVE To calculate the major congenital malformation (MCM) rate of zonisamide in human pregnancy and assess for a signal of any specific malformation pattern and associations with birth weight. METHODS AND MATERIALS Data were obtained from the UK and Ireland Epilepsy and Pregnancy register (UKIEPR) which is an observational, registration, and follow up study from December 1996 to July 2020. Eligibility criteria were use of zonisamide and to have been referred to the UKIEPR before the outcome of the pregnancy was known. Primary outcome was evidence of MCM. RESULTS From December 1996 through July 2020 there were 112 cases of first trimester exposure to zonisamide, including 26 monotherapy cases. There were 3 MCM for monotherapy cases (MCM rate 13.0% (95% confidence interval 4.5-32.1)), and 5 MCM for polytherapy cases (MCM rate 6.9% (95% confidence interval 3.0-15.2)). While the median birth weight was on 71st and 44th centile for monotherapy and polytherapy cases respectively, there was a high rate of infants born small for gestational age (21% for both). CONCLUSION These data raise concerns about a signal for potential teratogenicity with zonisamide in human pregnancy. Given the low numbers reported, further data will be required to adequately counsel women who use zonisamide in pregnancy.
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Affiliation(s)
- G McCluskey
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - M O Kinney
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - A Russell
- Scottish Epilepsy Centre, Glasgow, United Kingdom
| | - W H Smithson
- Department of General Practice, University College Cork, Cork, Ireland
| | - L Parsons
- Neurology Department, Luton & Dunstable Hospitals NHS Trust, Luton, United Kingdom
| | - P J Morrison
- Department of Medical Genetics, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, United Kingdom
| | - R Bromley
- Royal Manchester Children's Hospital, Central Manchester University Foundation NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - L MacKillop
- Women's Centre. Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - C Heath
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - B Liggan
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - S Murphy
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - N Delanty
- Department of Neurology, Beaumont Hospital, Dublin, Ireland; Department of Neurology, Beaumont Hospital, and FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Irwin
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - E Campbell
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - J Morrow
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - S J Hunt
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom
| | - J J Craig
- Department of Neurology, Royal Victoria Hospital (Belfast Health and Social Care Trust), Grosvenor Road, Belfast BT12 6BA, United Kingdom.
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9
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Heath C, Sommerfield A, von Ungern-Sternberg BS. Resilience strategies to manage psychological distress among healthcare workers during the COVID-19 pandemic: a narrative review. Anaesthesia 2020; 75:1364-1371. [PMID: 32534465 PMCID: PMC7323405 DOI: 10.1111/anae.15180] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic marks an extraordinary global public health crisis unseen in the last century, with its rapid spread worldwide and associated mortality burden. The longevity of the crisis and disruption to normality is unknown. With COVID-19 set to be a chronic health crisis, clinicians will be required to maintain a state of high alert for an extended period. The support received before and during an incident is likely to influence whether clinicians experience psychological growth or injury. An abundance of information is emerging on disease epidemiology, pathogenesis and infection control prevention. However, literature on interventions for supporting the psychological well-being of healthcare workers during disease outbreaks is limited. This article summarises the available management strategies to increase resilience in healthcare workers during the COVID-19 pandemic and beyond. It focuses on self-care and organisational justice. It highlights various individual as well as organisational strategies. With the success of slowing disease spread in many countries to date, and reduced work-load due to limitations on elective surgery in many institutions, there is more time and opportunity to be pro-active in implementing measures to mitigate or minimise potential adverse psychological effects and improve, restore and preserve the well-being of the workforce now and for years to come. The purpose of this review is to review available literature on strategies for minimising the psychological impact of the COVID-19 pandemic on clinicians and to identify pro-active holistic approaches which may be beneficial for healthcare workers both for the current crisis and into the future.
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Affiliation(s)
- C Heath
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Department of Peri-operative Medicine, Telethon Kids Institute, Perth, WA, Australia
| | - B S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, WA, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, The University of Western Australia, Perth, WA, Australia
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Parker C, Clarke N, Cook A, Kynaston H, Meidahl Petersen P, Cross W, Persad R, Catton C, Logue J, Payne H, Saad F, Brasso K, Lindberg H, Zarkar A, Raman R, Roder M, Heath C, Parulekar W, Parmar M, Sydes M. Timing of radiotherapy (RT) after radical prostatectomy (RP): First results from the RADICALS RT randomised controlled trial (RCT) [NCT00541047]. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.042] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Tan B, Norman R, Litton E, Heath C, Hawkins DJ, Krishnamurthy R, Sonawane R, Anstey MH. Incidence and cost of stress ulcer prophylaxis after discharge from the intensive care unit: a retrospective study. CRIT CARE RESUSC 2016; 18:270-274. [PMID: 27903209] [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: 06/06/2023]
Abstract
OBJECTIVE To describe current patterns in initiation and cessation of proton pump inhibitors (PPIs) for stress ulcer prophylaxis (SUP) in intensive care units, and to assess the costs associated with inappropriate (non-evidence-based) SUP. DESIGN, SETTING AND PARTICIPANTS Retrospective observational study in five ICUs in Western Australia. We assessed the medical records of consecutive patients admitted to the ICUs between September 2013 and January 2015. Patients aged < 18 years were excluded. RESULTS We included 531 patients in the study. Of the 184 patients in whom PPIs were initiated for SUP in the ICU, 90 (48.9%) were still taking the therapy at the time of discharge from hospital. A documented indication for ongoing therapy was present in only nine patients (10%). We assumed a 10-year life expectancy after ICU discharge and that most patients continued taking a PPI, and calculated an additional cost of $180.20 per patient admitted to the ICU. This was based only on unnecessary PPI costs (ignoring costs of managing additional adverse events). The direct cumulative annual cost to the WA health system of PPIs continued unnecessarily for patients at discharge from hospital is estimated to be $250 800 for each year they continue to receive them. CONCLUSION A substantial proportion of patients prescribed SUP in the ICU continue receiving this therapy at hospital discharge despite no clear indication. In addition to potential adverse clinical effects, this is associated with major direct and indirect cost implications.
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Affiliation(s)
| | - Richard Norman
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Ed Litton
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Chloe Heath
- Sir Charles Gairdner Hospital, Perth, WA, Australia
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Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, Huddart R, Mcmenemin R, Patel P, Peters J, Payne H. Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415813512647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. Materials and methods A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC. Results Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data. Conclusion These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.
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Affiliation(s)
- A Thompson
- Urology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - A Adamson
- Department of Urology, Royal Hampshire County Hospital, UK
| | - A Bahl
- Bristol Oncology and Haematology Centre, UK
| | - J Borwell
- Department of Urology, Frimley Park Hospital, UK
| | - D Dodds
- Beatson West of Scotland Cancer Care, UK
| | - C Heath
- Southampton Oncology Centre, Southampton General Hospital, UK
| | | | | | - P Patel
- Queen Elizabeth Hospital, UK
| | - J Peters
- Whipps Cross Hospital, Barts Health NHS Trust, UK
| | - H Payne
- University College Hospital, UK
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Hoskin P, King P, Wylie J, Lydon A, Sreenivasan T, Bahl A, Henry A, Ahmed I, Elwell C, Heath C. OC-0068: Single dose HDR boost for prostate cancer: a multicentre prospectiveUK study. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sertyel S, Kolankaya A, Yigit A, Cengiz F, Kunacaf G, Akman MA, Gurgan T, Yu B, DeCherney A, Segars J, Russanova V, Howard B, Serafini P, Kimati C, Hassun P, Cuzzi J, Peres M, Riboldi M, Gomes C, Fettback P, Alegretti J, motta E, Lappa C, Ottolini CS, Summers MC, Sage K, Rogers S, Griffin DK, Handyside AH, Thornhill AR, Ubaldi F, Capalbo A, Wright G, Elliott T, Maggiulli R, Rienzi L, Nagy ZP, Cinar Yapan C, Beyazyurek C, Ekmekci CG, Altin G, Yesil M, Yelke H, Kahraman S, Khalil M, Rittenberg V, Khalaf Y, El-toukhy T, Alvaro Mercadal B, Imbert R, Demeestere I, De Leener A, Englert Y, Costagliola S, Delbaere A, Zimmermann B, Ryan A, Baner J, Gemelos G, Dodd M, Rabinowitz M, Hill M, Sandalinas M, Garcia-Guixe E, Jimenez-Macedo A, Gimenez C, Hill M, Wemmer N, Potter D, Keller J, Gemelos G, Rabinowitz M, Cater E, Lynch C, Jenner L, Berrisford K, Campbell A, Keown N, Rouse H, Craig A, Fishel S, Palomares AR, Lendinez Ramirez AM, Martinez F, Ruiz Galdon M, Reyes Engel A, Mamas T, Xanthopoulou L, Heath C, Doshi A, Serhal P, SenGupta SB, Plaza S, Templin C, Saguet F, Claustres M, Girardet A, Rienzi L, Biricik A, Capalbo A, Colamaria S, Bono S, Spizzichino L, Ubaldi F, Fiorentino F, Hassun P, Alegretti JR, Kimati C, Barros B, Riboldi M, Cuzzi J, Motta ELA, Serafini P, Tulay P, Naja RP, Cascales-Roman O, Cawood S, Doshi A, Serhal P, SenGupta SB, Montjean D, Ravel C, Belloc S, Cohen-Bacrie P, Bashamboo A, McElreavey K, Benkhalifa M, Filippini G, Radovanovic J, Spalvieri S, Marabella D, Timperi P, Suter T, Jemec M, Traversa M, Marshall J, Leigh D, McArthur S, Zhang L, Yilmaz A, Zhang XY, Son WY, Holzer H, Ao A, Horcajadas JA, Munne S, Fisher J, Ketterson K, Wells D, Bisignano A, Rubio C, Mateu E, Milan M, Mercader A, Bosch E, Labarta E, Crespo J, Remohi J, Simon C, Pellicer A, Mercader A, Garrido N, Rubio C, Buendia P, Delgado A, Escrich L, Poo ME, Simon C, Held K, Baukloh V, Arps S, Wittmann ST, Petrussa L, Van de Velde H, De Rycke M, Beyazyurek C, Ekmekci CG, Ajredin N, Cinar Yapan C, Tac HA, Yelke HK, Altin G, Kahraman S, Basile N, Bronet F, Nogales MC, Ariza M, Martinez E, Linan A, Gaytan A, Meseguer M, Christopikou D, Tsorva E, Economou K, Davies S, Mastrominas M, Handyside AH, Avo Santos M, M. Lens S, C. Fauser B, S. E. Laven J, B. Baart E, Nakano T, Akamatsu Y, Sato M, Hashimoto S, Maezawa T, Himeno T, Ohnishi Y, Inoue T, Ito K, Nakaoka Y, Morimoto Y, Al Sharif J, Alhalabi M, Abou Alchamat G, Madania A, Khatib A, Kinj M, Monem F, Mahayri Z, Ajlouni A, Othman A, Chung JT, Son WY, Zhang XY, Ao A, Tan SL, Holzer H, Burnik Papler T, Fon Tacer K, Devjak R, Juvan P, Virant-Klun I, Vrtacnik Bokal E, Zheng HY, Chen SL, Chen X, Tang Y, Li L, Ye DS, Yang XH, Eichenlaub-Ritter U, Trapphoff T, Hastreiter S, Haaf T, Asada H, Maekawa R, Tamura I, Tamura H, Sugino N, Zakharova E, Zaletova V, Krivokharchenko I, Ata B, Kaplan B, Danzer H, Glassner M, Opsahl M, Tan SL, Munne S. REPRODUCTIVE (EPI) GENETICS. Hum Reprod 2012. [DOI: 10.1093/humrep/27.s2.87] [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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Heath C. A Case of Aneurism of the External Carotid Artery; ligature of the Common Carotid, with cure of the Aneurism; death from Paralysis on the thirty-fifth day. Med Chir Trans 2011; 66:69-80.1. [PMID: 20896621 DOI: 10.1177/095952878306600105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Heath C. The Surgery of the Nose and Accessory Cavities: An Abstract of the Bradshaw Lecture delivered at the Royal College of Surgeons of England on December 1st, 1892. Br Med J 2011; 2:1282-4. [PMID: 20753960 DOI: 10.1136/bmj.2.1667.1282] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Parle J, Roberts L, Wilson S, Pattison H, Roalfe A, Haque MS, Heath C, Sheppard M, Franklyn J, Hobbs FDR. A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham Elderly Thyroid study. J Clin Endocrinol Metab 2010; 95:3623-32. [PMID: 20501682 DOI: 10.1210/jc.2009-2571] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Subclinical hypothyroidism (SCH) and cognitive dysfunction are both common in the elderly and have been linked. It is important to determine whether T4 replacement therapy in SCH confers cognitive benefit. OBJECTIVE Our objective was to determine whether administration of T4 replacement to achieve biochemical euthyroidism in subjects with SCH improves cognitive function. DESIGN AND SETTING We conducted a double-blind placebo-controlled randomized controlled trial in the context of United Kingdom primary care. PATIENTS Ninety-four subjects aged 65 yr and over (57 females, 37 males) with SCH were recruited from a population of 147 identified by screening. INTERVENTION T4 or placebo was given at an initial dosage of one tablet of either placebo or 25 microg T4 per day for 12 months. Thyroid function tests were performed at 8-weekly intervals with dosage adjusted in one-tablet increments to achieve TSH within the reference range for subjects in treatment arm. Fifty-two subjects received T4 (31 females, 21 males; mean age 73.5 yr, range 65-94 yr); 42 subjects received placebo (26 females, 16 males; mean age 74.2 yr, 66-84 yr). MAIN OUTCOME MEASURES Mini-Mental State Examination, Middlesex Elderly Assessment of Mental State (covering orientation, learning, memory, numeracy, perception, attention, and language skills), and Trail-Making A and B were administered. RESULTS Eighty-two percent and 84% in the T4 group achieved euthyroidism at 6- and 12-month intervals, respectively. Cognitive function scores at baseline and 6 and 12 months were as follows: Mini-Mental State Examination T4 group, 28.26, 28.9, and 28.28, and placebo group, 28.17, 27.82, and 28.25 [not significant (NS)]; Middlesex Elderly Assessment of Mental State T4 group, 11.72, 11.67, and 11.78, and placebo group, 11.21, 11.47, and 11.44 (NS); Trail-Making A T4 group, 45.72, 47.65, and 44.52, and placebo group, 50.29, 49.00, and 46.97 (NS); and Trail-Making B T4 group, 110.57, 106.61, and 96.67, and placebo group, 131.46, 119.13, and 108.38 (NS). Linear mixed-model analysis demonstrated no significant changes in any of the measures of cognitive function over time and no between-group difference in cognitive scores at 6 and 12 months. CONCLUSIONS This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.
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Affiliation(s)
- J Parle
- School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B152TT, United Kingdom.
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Aub JC, Bauer W, Heath C, Ropes M. STUDIES OF CALCIUM AND PHOSPHORUS METABOLISM: III. The Effects of the Thyroid Hormone and Thyroid Disease. J Clin Invest 2006; 7:97-137. [PMID: 16693856 PMCID: PMC434781 DOI: 10.1172/jci100223] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- J C Aub
- Medical Clinic of the Massachusetts General Hospital, Boston
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Heath C, Belfort G. Immobilization of suspended mammalian cells: analysis of hollow fiber and microcapsule bioreactors. Adv Biochem Eng Biotechnol 2005; 34:1-31. [PMID: 3113180 DOI: 10.1007/bfb0000671] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Abstract
The t(4;14)(p16.3;q32), associated with 10-20% of cases of multiple myeloma (MM), deregulates the expression of MMSET and FGFR3. To assess the potential of FGFR3 as a drug target, we evaluated the effects of selective inhibitors on MM and control cell lines. SU5402 and PD173074 specifically inhibited the growth of the two t(4;14)-positive MM lines, KMS-11 and OPM-2. Importantly, inhibition was still observed in the presence of IL-6, a growth factor known to play an important role in MM. Both compounds induced a dose-dependent reduction in cell viability and an increase in apoptosis, accompanied by a decrease in extracellular signal-related kinase phosphorylation. In contrast, no inhibition was seen with either compound against t(4;14)-negative cell lines or NCI-H929, a t(4;14)-positive, FGFR3-negative MM cell line. FGFR3 is thus a plausible candidate for targeted therapy in a subset of MM patients.
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Affiliation(s)
- E K Grand
- Wessex Regional Genetics Laboratory, Salisbury, UK
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Demiroglu A, Steer EJ, Heath C, Taylor K, Bentley M, Allen SL, Koduru P, Brody JP, Hawson G, Rodwell R, Doody ML, Carnicero F, Reiter A, Goldman JM, Melo JV, Cross NC. The t(8;22) in chronic myeloid leukemia fuses BCR to FGFR1: transforming activity and specific inhibition of FGFR1 fusion proteins. Blood 2001; 98:3778-83. [PMID: 11739186 DOI: 10.1182/blood.v98.13.3778] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This report describes 2 patients with a clinical and hematologic diagnosis of chronic myeloid leukemia (CML) in chronic phase who had an acquired t(8;22)(p11;q11). Analysis by fluorescence in situ hybridization (FISH) and reverse transcription-polymerase chain reaction (RT-PCR) indicated that both patients were negative for the BCR-ABL fusion, but suggested that the BCR gene was disrupted. Further FISH indicated a breakpoint within fibroblast growth factor receptor 1 (FGFR1), the receptor tyrosine kinase that is known to be disrupted in a distinctive myeloproliferative disorder, most commonly by fusion to ZNF198. RT-PCR confirmed the presence in both cases of an in-frame messenger RNA fusion between BCR exon 4 and FGFR1 exon 9. Expression of BCR-FGFR1 in the factor-dependent cell line Ba/F3 resulted in interleukin 3-independent clones that grew at a comparable rate to cells transformed with ZNF198-FGFR1. The growth of transformed cells was inhibited by the phosphatidylinositol 3-kinase inhibitor LY294002, the farnesyltransferase inhibitors L744832 and manumycin A, the p38 inhibitors SB202190 and SB203580 but not by the MEK inhibitor PD98059. The growth of BaF3/BCR-FGFR1 and BaF3/ZNF198-FGFR1 was not significantly inhibited by treatment with STI571, but was inhibited by SU5402, a compound with inhibitory activity against FGFR1. Inhibition with this compound was associated with decreased phosphorylation of ERK1/2 and BCR-FGFR1 or ZNF198-FGFR1, and was dose dependent with an inhibitory concentration of 50% of approximately 5 microM. As expected, growth of BaF3/BCR-ABL was inhibited by STI571 but not by SU5402. The study demonstrates that the BCR-FGFR1 fusion may occur in patients with apparently typical CML. Patients with constitutively active FGFR1 fusion genes may be amenable to treatment with specific FGFR1 inhibitors.
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MESH Headings
- Aged
- Amino Acid Sequence
- Base Sequence
- Cell Division
- Chromosomes, Human, Pair 22
- Chromosomes, Human, Pair 8
- Enzyme Inhibitors/pharmacology
- Female
- Fusion Proteins, bcr-abl/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Middle Aged
- Molecular Sequence Data
- Oncogene Proteins/chemistry
- Oncogene Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Phosphoinositide-3 Kinase Inhibitors
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Proto-Oncogene Proteins
- Proto-Oncogene Proteins c-bcr
- Pyrroles/pharmacology
- RNA, Messenger/analysis
- Receptor Protein-Tyrosine Kinases/chemistry
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Fibroblast Growth Factor, Type 1
- Receptors, Fibroblast Growth Factor/chemistry
- Receptors, Fibroblast Growth Factor/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Signal Transduction
- Transfection
- Translocation, Genetic
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Affiliation(s)
- A Demiroglu
- Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
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Murray R, Mallal S, Heath C, French M. Cerebral Mycobacterium avium Infection in an HIV-Infected Patient Following Immune Reconstitution and Cessation of Therapy for Disseminated Mycobacterium avium Complex Infection. Eur J Clin Microbiol Infect Dis 2001. [DOI: 10.1007/s100960100465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Murray R, Mallal S, Heath C, French M. Cerebral Mycobacterium avium Infection in an HIV-Infected Patient Following Immune Reconstitution and Cessation of Therapy for Disseminated Mycobacterium avium Complex Infection. Eur J Clin Microbiol Infect Dis 2001; 20:199-201. [PMID: 11347672 DOI: 10.1007/pl00011252] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Reported here is a case of cerebral Mycobacterium avium complex infection that occurred in an HIV-infected patient, who had been treated for disseminated infection and had discontinued clarithromycin and ethambutol following a significant rise in his CD4+ T-cell count after starting highly active antiretroviral therapy. He responded well to excision of the lesion and reinstitution of multidrug therapy. Caution should be exercised when considering ceasing maintenance therapy for disseminated Mycobacterium avium complex infection in HIV-infected patients who demonstrate an apparently good immunologic response to highly active antiretroviral therapy, as this response may not necessarily restore protective immunity against all opportunistic pathogens.
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Affiliation(s)
- R Murray
- Department of Microbiology, Royal Darwin Hospital, Casuarina, Northern Territory, Australia.
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Kulkarni S, Heath C, Parker S, Chase A, Iqbal S, Pocock CF, Kaeda J, Cwynarski K, Goldman JM, Cross NC. Fusion of H4/D10S170 to the platelet-derived growth factor receptor beta in BCR-ABL-negative myeloproliferative disorders with a t(5;10)(q33;q21). Cancer Res 2000; 60:3592-8. [PMID: 10910073] [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: 02/17/2023]
Abstract
We have studied a patient who presented with clinical features suggestive of chronic myeloid leukemia in accelerated phase. BCR-ABL transcripts were undetectable by reverse transcription-PCR, but a novel reciprocal translocation, t(5;10)(q33;q21.2), was seen by standard cytogenetic analysis. Chromosome band 5q33 contains the gene encoding the platelet-derived growth factor beta receptor (PDGFbetaR), the receptor tyrosine kinase that is disrupted by the t(5;7), t(5;12), and t(5;14) in myeloid disorders, resulting in the fusion of PDGFbetaR to HIP1, TEL/ETV6, and CEV14, respectively. Southern analysis with PDGFbetaR cDNA revealed novel bands in patient but not control DNA after digestion with several restriction enzymes, indicating that this gene is also targeted by the t(5;10). Fluorescence in situ hybridization analysis of chromosome 5 indicated that a small inversion at 5q33 had taken place in addition to the interchromosomal translocation. The site of the chromosome 10 breakpoint fell within YAC 940e4. Because all PDGFbetaR fusions described thus far result in splicing to a common exon of this gene, we performed 5'-rapid amplification of cDNA ends PCR on patient RNA. Several clones were isolated in which PDGFbetaR fused in frame to H4/D10S170, a previously described ubiquitously expressed gene that is fused to the ret protein tyrosine kinase to form the PTC-1 oncogene in approximately 20% of papillary thyroid carcinomas. The presence of H4-PDGFbetaR chimeric mRNA in the patient was confirmed by reverse transcription-PCR; reciprocal PDGFbeta1R-H4 transcripts were not detected. We conclude that t(5;10)(q33;q21.2) is a novel translocation in BCR-ABL-negative chronic myeloid leukemia and that this abnormality results in an H4-PDGFbetaR fusion gene. This finding further strengthens the association between myeloproliferative disorders and deregulated tyrosine kinases.
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MESH Headings
- Amino Acid Sequence
- Base Sequence
- Chromosome Mapping
- Chromosomes, Artificial, Yeast
- Chromosomes, Human, Pair 10
- Chromosomes, Human, Pair 5
- Drosophila Proteins
- Fusion Proteins, bcr-abl/analysis
- Humans
- In Situ Hybridization, Fluorescence
- Karyotyping
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Molecular Sequence Data
- Myeloproliferative Disorders/genetics
- Proto-Oncogene Proteins/genetics
- Proto-Oncogene Proteins c-ret
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Platelet-Derived Growth Factor beta/genetics
- Recombinant Fusion Proteins/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Translocation, Genetic
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Affiliation(s)
- S Kulkarni
- Department of Haematology, Imperial College School of Medicine Hammersmith Hospital, London, United Kingdom
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McFadzen I, Eufemia N, Heath C, Epel D, Moore M, Lowe D. Multidrug resistance in the embryos and larvae of the mussel Mytilus edulis. Mar Environ Res 2000; 50:319-323. [PMID: 11460711 DOI: 10.1016/s0141-1136(00)00057-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Cells exhibiting the multidrug resistance (MDR) phenotype demonstrate a decreased intracellular drug accumulation due to an active outward transport and decreased intracellular flux. This study demonstrates the inhibition of MDR in mussel (Mytilus edulis) embryos and larvae based on a simple bioassay. The development of embryos was assessed and abnormalities identified at key stages of development, including gastrulation, trochophore and prodissoconch stages. The incidence of developmental abnormalities was significantly increased in the presence of vinblastine, MMS, chloroquine, mitomycin-C, cadmium chloride and colchicine, compared to clean seawater. Consistently, there was a further increase in the number and severity of deformities observed when each toxin was added in the presence of verapamil. Larval growth was also significantly impaired in the presence of verapamil. Increased accumulation of fluorescent MDR dyes, such as rhodamine B, has been measured and shown to be verapamil sensitive. This bioassay encompasses a period of intense cellular activity during which the impairment of a number of critical processes results in abnormal growth and development.
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Affiliation(s)
- I McFadzen
- CCMS, Plymouth Marine Laboratory, Prospect Place, The Hoe, Plymouth PL1 3DH, UK.
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35
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Abstract
Despite the substantial body of literature concerned with the ways in which digital media are transforming contemporary society and institutional life, we have relatively little understanding of the ways in which new technologies feature in day to day organizational conduct and interaction. There is however a growing corpus of empirical research which places the situated and contingent character of new technologies at the heart of the analytic agenda, but as yet, these studies are relatively little known within sociology. They include ethnographies of command and control centres, financial institutions, the news media, and the construction industry. They address the ways in which tools and technologies, ranging from paper documents through to complex multimedia systems, feature in work and collaboration. In this paper, we discuss these so-called 'workplace studies' and consider their implications for our understanding of organizational conduct, social interaction and new technology.
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36
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Heath C. An opportunity for nursing students to author patient teaching materials. CIN Plus 2000; 3:1, 4-5. [PMID: 10890840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- C Heath
- Sonoma State University, USA
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37
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Smedley D, Demiroglu A, Abdul-Rauf M, Heath C, Cooper C, Shipley J, Cross NC. ZNF198-FGFR1 transforms Ba/F3 cells to growth factor independence and results in high level tyrosine phosphorylation of STATS 1 and 5. Neoplasia 1999; 1:349-55. [PMID: 10935490 PMCID: PMC1508104 DOI: 10.1038/sj.neo.7900035] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/1999] [Accepted: 06/09/1999] [Indexed: 11/08/2022]
Abstract
The ZNF198- FGFR1 fusion gene arises as a result of the t(8;13)(p11;q12) in the 8p11 myeloproliferative syndrome. To determine the transforming properties of this chimeric protein we transfected ZNF198-FGFR1 into the interleukin (IL)-3 dependent cell line Ba/F3. Growth factor independent subclones were obtained in which ZNF198-FGFR1, STAT1, and STAT5 were constitutively tyrosine phosphorylated, as determined by immunoprecipitation and Western blot analysis. To test the hypothesis that constitutive activation of ZNF198-FGFR1 tyrosine kinase activity is a result of self-association of the fusion protein, we in vitro transcribed and translated ZNF198-FGFR1 and a derivative construct, ZNF198- FGFR1deltaC-myc, in which the C-terminal FGFR1 epitope was replaced by a c-myc tag. As expected, an anti-FGFR1 antibody immunoprecipitated ZNF198-FGFR1 but not ZNF198-FGFRdeltaC-myc. However when both products were translated together, both were coimmunoprecipitated by anti-FGFR1 antisera. Similar results were obtained by using an anti-myc antibody and demonstrated a physical interaction between the two proteins. Analysis of COS-7 cells transfected with ZNF198-FGFR1 demonstrated that the fusion gene, in contrast to normal FGFR1, is located in the cytoplasm. We conclude that ZNF198-FGFR1 is a cytoplasmic protein that self-associates and has constitutive transformation activity. These data suggest that ZNF198-FGFR1 plays a primary role in the pathogenesis of the t(8;13) myeloproliferative syndrome and is the first report to implicate STAT proteins in FGFR1-mediated signaling.
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Affiliation(s)
- D Smedley
- Molecular Carcinogenesis Section, Institute of Cancer Research, Haddow Laboratories, Belmont, Surrey, UK
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38
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Heath C. On the Social Psychology of Agency Relationships: Lay Theories of Motivation Overemphasize Extrinsic Incentives. Organ Behav Hum Decis Process 1999; 78:25-62. [PMID: 10092470 DOI: 10.1006/obhd.1999.2826] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Three laboratory studies and one field study show that people generally hold lay theories which contain an extrinsic incentives bias-people predict that others are more motivated than themselves by extrinsic incentives (job security, pay) and less motivated by intrinsic incentives (learning new things). The extrinsic incentives bias can be separated from a self-serving bias and it provides an empirical counterexample to the traditional actor-observer effect in social psychology (although its theoretical explanation is similar). This kind of bias may hinder organizations from organizing because people who act as principals may use improper lay theories to offer inappropriate deals to agents. Copyright 1999 Academic Press.
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39
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Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in overweight white men aged 40-64 years. Am J Epidemiol 1999; 149:491-503. [PMID: 10084238 DOI: 10.1093/oxfordjournals.aje.a009843] [Citation(s) in RCA: 151] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Although 25% of US men indicate that they are trying to lose weight, the association between intentional weight loss and longevity in men is unknown. The authors analyzed prospective data from 49,337 overweight (initial body mass index > or =27) white men aged 40-64 years who, in 1959-1960, answered questions on weight change direction, amount, time interval, and intent. Vital status was determined in 1972. Proportional hazards regression estimated mortality rate ratios for men who intentionally lost weight compared with men with no weight change. Analyses were stratified by health status and adjusted for age, initial body mass index, smoking status, alcohol intake, education, physical activity, health history, and physical symptoms. Among men with no reported health conditions (n = 36,280), intentional weight loss was not associated with total, cardiovascular (CVD), or cancer mortality, but diabetes-associated mortality was increased 48% (95% confidence interval (CI) -7% to +133%) among those who lost 20 pounds (9.1 kg) or more; this increase was largely related to non-CVD mortality. Among men with reported health conditions (n = 13,057), intentional weight loss had no association with total or CVD mortality, but cancer mortality increased 25% (95% confidence interval -4% to +63%) among those who lost 20 pounds or more. Diabetes-associated mortality was reduced 32% (95% confidence interval -52% to -5%) among those who lost less than 20 pounds and 36% (95% confidence interval -49% to -20%) among those who lost more than 20 pounds. These results and those from our earlier study in women (Williamson et al., Am J Epidemiol 1995;141:1128-41) suggest that intentional weight loss may reduce the risk of dying from diabetes, but not from CVD. In observational studies, however, it is difficult to separate intentional weight loss from unintentional weight loss due to undiagnosed, underlying disease. Well-designed observational studies, as well as randomized controlled trials, are needed to determine whether intentional weight loss reduces CVD mortality.
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Affiliation(s)
- D F Williamson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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40
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Abstract
We argue that goals serve as reference points and alter outcomes in a manner consistent with the value function of Prospect Theory (Kahneman & Tversky, 1979; Tversky & Kahneman, 1992). We present new evidence that goals inherit the properties of the value function-not only a reference point, but also loss aversion and diminishing sensitivity. We also use the value function to explain previous empirical results in the goal literature on affect, effort, persistence, and performance.
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Affiliation(s)
- C Heath
- Fuqua School of Business, Duke University, Durham, NC 27708, USA.
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41
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Gérard HC, Branigan PJ, Balsara GR, Heath C, Minassian SS, Hudson AP. Viability of Chlamydia trachomatis in fallopian tubes of patients with ectopic pregnancy. Fertil Steril 1998; 70:945-8. [PMID: 9806581 DOI: 10.1016/s0015-0282(98)00304-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To use standard molecular methods to define the prevalence and metabolic characteristics of Chlamydia trachomatis during infection of fallopian tubes in women with ectopic pregnancies. DESIGN Polymerase chain reaction (PCR)- and reverse transcription-PCR (RT-PCR)-based assessment of presence of chlamydial DNA and various RNA species in fallopian tube biopsy samples. SETTING Hospital and molecular genetics laboratory. PATIENTS Ten women of varying ages, each presenting with ectopic pregnancy. MAIN OUTCOME MEASURE(S) Positive signal in specific chlamydia-directed PCR and RT-PCR assays. RESULT(S) Nucleic acid preparations from 7 of the 10 fallopian tube patient samples were PCR-positive for C. trachomatis DNA. Each of the 7 PCR-positive samples also showed the presence of several transcripts from the bacterium, including primary transcripts from the ribosomal RNA operons. CONCLUSION(S) A higher proportion of ectopic pregnancies than was believed previously may be attributable to infection of the fallopian tubes by C. trachomatis. The presence of various chlamydial RNA molecules suggests that viable, metabolically active bacteria were present in fallopian tubes of the patients studied.
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Affiliation(s)
- H C Gérard
- Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Mantovani F, Covaceuszach S, Rustighi A, Sgarra R, Heath C, Goodwin GH, Manfioletti G. NF-kappaB mediated transcriptional activation is enhanced by the architectural factor HMGI-C. Nucleic Acids Res 1998; 26:1433-9. [PMID: 9490789 PMCID: PMC147413 DOI: 10.1093/nar/26.6.1433] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
High mobility group I proteins (HMGI, HMGY and HMGI-C) are a family of low molecular mass non-histone nuclear proteins which constitute an important component of the active chromatin structure. Two members of this family, HMGI and HMGY, have been demonstrated to contribute to the transcriptional regulation of several promoters by interacting with the DNA and with different transcription factors. On the contrary, very little is known about the third member, HMGI-C, which plays an important role during embryonic growth and in the process of cell transformation, its gene being rearranged in a large number of mesenchimal tumors. In this paper we show for the first time that HMGI-C is also able to function as architectural factor, enhancing the activity of a transcription factor, NF-kappaB, through the PRDII element of the beta-interferon enhancer. Moreover we show that this enhancement is absolutely dependent on the binding of HMGI-C to its target sequence. The demonstration that HMGI-C is able to modulate transcription is thus an important initial step in the identification of genes regulated by this factor.
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Affiliation(s)
- F Mantovani
- Dipartimento di Biochimica, Biofisica e Chimica delle Macromolecole, Università di Trieste, via Giorgieri, 134127 Trieste, Italy
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43
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Del Priore V, Heath C, Snay C, MacMillan A, Gorsch L, Dagher S, Cole C. A structure/function analysis of Rat7p/Nup159p, an essential nucleoporin of Saccharomyces cerevisiae. J Cell Sci 1997; 110 ( Pt 23):2987-99. [PMID: 9359887 DOI: 10.1242/jcs.110.23.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Rat7p/Nup159p is an essential nucleoporin of Sac-charomyces cerevisiae originally isolated in a genetic screen designed to identify yeast temperature-sensitive mutants defective in mRNA export. Here we describe a detailed structural-functional analysis of Rat7p/Nup159p. The mutation in the rat7-1 ts allele, isolated in the original genetic screen, was found to be a single base pair change that created a stop codon approximately 100 amino acids upstream of the actual stop codon of this 1,460 amino acid polypeptide, thus eliminating one of the two predicted coiled-coil regions located near the carboxyl terminus of the protein. These coiled-coil regions are essential since an allele lacking both coiled-coil regions was unable to support growth under any conditions. In contrast, no other region of the protein was absolutely required. The SAFG/PSFG repeat region in the central third of the protein was completely dispensable for growth at temperatures between 16 degrees C and 37 degrees C and cells expressing this mutant allele were indistinguishable from wild type. Deletion of the amino-terminal third of the protein, upstream from the repeat region, or the portion between the repeat region and the coiled-coils resulted in temperature-sensitivity, but the two alleles showed distinct phenotypes with respect to the behavior of nuclear pore complexes (NPCs). Taken together, our data suggest that Rat7p/Nup159p is anchored within the NPC through its coiled-coil region and adjacent sequences. In addition, we postulate that the N-terminal third of Rat7p/Nup159p plays an important role in mRNA export.
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Affiliation(s)
- V Del Priore
- Department of Biochemistry, Dartmouth Medical School, Hanover, NH 03755, USA
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44
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Abstract
Islets were selectively isolated from rat pancreatic digests using magnetic microspheres coated with anti-islet monoclonal antibodies. The isolation process was optimized as a function of bead concentration and time of incubation with the tissue digest. Apparent and normalized islet yields of 92 +/- 6% and 81 +/- 7%, respectively, were obtained by incubating the digests with 10(7) beads/mL for 40 min followed by isolation of the bead-coated islets under a magnetic field. While some fragmentation occurred, the isolation process did not alter islet functionality as demonstrated by an insulin secretion response to glucose stimulation equivalent to that of handpicked controls. The technique is fast, reproducible, and potentially scaleable to larger pancreases as a secondary purification step.
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Affiliation(s)
- P Nandigala
- Department of Chemical Engineering, Iowa State University, Ames 50011, USA
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45
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Heath C. Do People Prefer to Pass Along Good or Bad News? Valence and Relevance of News as Predictors of Transmission Propensity. Organ Behav Hum Decis Process 1996; 68:79-94. [PMID: 8954872 DOI: 10.1006/obhd.1996.0091] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anecdotal evidence seems to indicate that exaggeratedly bad news may propagate in the marketplace of ideas. Three studies investigate whether people prefer to pass along pieces of bad news or good news that are equated for "surprisingness." People typically prefer to pass along central rather than extreme information (i.e., news that is less surprising rather than more surprising). However, when confronted with extreme information, the results support a preference for congruence, that is, people prefer to pass along news that is congruent with the emotional valence of the domain in question. This means that in emotionally negative domains, contrary to some theoretical predictions, people are willing to pass along bad news even when it is exaggeratedly bad. At the same time, however, people transmit exaggeratedly good news in emotionally positive domains. The general discussion indicates how these results may inform research on word of mouth for consumer products and social relations in organizations.
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46
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Abstract
We propose that individuals practice "mental depreciation," that is, they implicitly spread the fixed costs of their expenses over time or use. Two studies explore how people spread fixed costs on durable goods. A third study shows that depreciation can lead to two distinct errors in marginal decisions: First, people sometimes invest too much effort to get their money's worth from an expense (e.g., they may use a product a lot to spread the fixed expense across more uses). Second, people sometimes invest too little effort to get their money's worth: When people add a portion of the fixed cost to the current costs, their perceived marginal (i.e., incremental) costs exceed their true marginal costs. In response, they may stop investing because their perceived costs surpass the marginal benefits they are receiving. The latter effect is supported by two field studies that explore real board plan decisions by university students.
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47
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Abstract
BACKGROUND Thirteen of 14 epidemiological studies have shown an increased risk of approximately 20% for coronary heart disease (CHD) for never-smokers exposed to environmental tobacco smoke (ETS), but this association remains controversial. If true, ETS might account for an estimated 35,000 to 40,000 heart disease deaths per year in the United States. METHODS AND RESULTS We have conducted the largest study to date, a prospective study of 353,180 female and 126,500 male never-smokers enrolled in 1982 in the American Cancer Society's Cancer Prevention Study II and followed through 1989. Analyses focused on subcohorts of 309,599 married pairs and of 135,237 subjects concordant for self-reported exposure and exposure reported by each one's spouse. More than 2800 CHD deaths (ICD 410-414) occurred among married pairs; 10% of married men and 28% of married women were married to currently smoking spouses, while 10% and 32%, respectively, were married to former smokers. After controlling for many cardiovascular risk factors, we found 22% higher CHD mortality (rate ratio, 1.22; 95% CI, 1.07 to 1.40) among never-smoking men married to currently smoking wives compared with those married to wives who had never smoked. The corresponding rate ratio for women was 1.10 (0.96 to 1.27). Never-smokers living with former smokers showed no increased risk. When analyses were restricted to subjects whose ETS exposure was classified via both their own self-report and a spouse's report, the rate ratio was 1.23 (1.03 to 1.47) for currently exposed men and 1.19 (0.97 to 1.45) for women. CONCLUSIONS Results are consistent with prior reports that never-smokers currently exposed to ETS have about 20% higher CHD death rates. However, our data do not show consistent dose-response trends and are possibly subject to confounding by unmeasured risk factors.
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Affiliation(s)
- K Steenland
- National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA.
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48
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Abstract
Four laboratory studies documented systematic performance illusions for individuals and group members. After completing a task, most individuals typically rank their performance below the median (a negative performance illusion) and most group members rank their group performance above the median (a positive performance illusion). This evaluation gap surfaced in all studies; group members consistently assign their group a higher rank than individuals assign themselves. This gap contradicts a number of theories assuming that group biases merely extend individual biases.
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Affiliation(s)
- F J Jourden
- College of Business Administration, University of Illinois, USA
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49
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Abstract
Estimates are made of the numbers and proportions of deaths attributable to smoking in 44 developed countries in 1990. In developed countries as a whole, tobacco was responsible for 24% of all male deaths and 7% of all female deaths, rising to over 40% in men in some former socialist economies and 17% in women in the USA. The average loss of life for all cigarette smokers was about 8 years and for those whose deaths were attributable to tobacco about 16 years. Trends in mortality attributable to tobacco differed between countries. In some the mortality in middle age (35-69 years) had decreased by half in men since 1965; in others it was continuing to increase. In women, the proportion was mostly increasing, almost universally in old age. Mortality not attributable to smoking decreased since 1955 in all OECD (Organization for European Collaboration and Development) countries, by up to 60% in men and more in women. No precise estimate can be made of the number of deaths attributable to smoking in undeveloped countries, but the prevalence of smoking suggests that it will be large. In the world as a whole, some 3 million deaths a year are estimated to be attributable to smoking, rising to 10 million a year in 30-40 years' time.
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Affiliation(s)
- R Peto
- ICRF/MRC/BHF Clinical Trial Service Unit, Radcliffe Infirmary, Oxford, UK
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50
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Williamson DF, Pamuk E, Thun M, Flanders D, Byers T, Heath C. Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40-64 years. Am J Epidemiol 1995; 141:1128-41. [PMID: 7771451 DOI: 10.1093/oxfordjournals.aje.a117386] [Citation(s) in RCA: 354] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Although 40% of US women indicate they are currently trying to lose weight, the association between intentional weight loss and longevity is unknown. The authors analyzed prospective data from 43,457 overweight, never-smoking US white women aged 40-64 years who in 1959-1960 completed a questionnaire that included questions on weight change direction, amount, time interval, and intentionality. Vital status was determined in 1972. Proportional hazards regression was used to estimate mortality rate ratios for women who intentionally lost weight compared with women who had no change in weight. Women who died within the first 3 years of follow-up were excluded. Analyses were stratified by preexisting illness and adjusted for age, beginning body mass index, alcohol intake, education, physical activity, and health conditions. In women with obesity-related health conditions (n = 15,069), intentional weight loss of any amount was associated with a 20% reduction in all-cause mortality, primarily due to a 40-50% reduction in mortality from obesity-related cancers; diabetes-associated mortality was also reduced by 30-40% in those who intentionally lost weight. In women with no preexisting illness (n = 28,388), intentional weight loss of > or = 20 lb (> or = 9.1 kg) that occurred within the previous year was associated with about a 25% reduction in all-cause, cardiovascular, and cancer mortality; however, loss of < 20 lb (< 9.1 kg) or loss that occurred over an interval of > or = 1 year was generally associated with small to modest increases in mortality. The association between intentional weight loss and longevity in middle-aged overweight women appears to depend on their health status. Intentional weight loss among women with obesity-related conditions is generally associated with decreased premature mortality, whereas among women with no preexisting illness, the association is equivocal.
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Affiliation(s)
- D F Williamson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA
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