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Sattar S, Papadopoulos E, Smith GVH, Haase KR, Kobekyaa F, Tejero I, Bradley C, Nadler MB, Campbell KL, Santa Mina D, Alibhai SMH. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01427-9. [PMID: 37418170 DOI: 10.1007/s11764-023-01427-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS Some remote exercise interventions may be a viable way to increase PA for OACA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 108-4400 4th Ave, Regina, SK, S4T 0H6, Canada.
| | - E Papadopoulos
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
| | - G V H Smith
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - F Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - I Tejero
- Department of Geriatric Medicine, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - C Bradley
- Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M B Nadler
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - S M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON, M5T 3M6, Canada
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Bradley C, Snaith B. The radiation dose, clinical and anatomical implications of erect lumbar spine radiography: A single centre pre-post implementation evaluation. Radiography (Lond) 2023; 29:690-696. [PMID: 37187066 DOI: 10.1016/j.radi.2023.04.013] [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: 03/06/2023] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Lumbar radiographs remain a common imaging examination despite strategies to reduce their use. Many authors have demonstrated benefits in changing from traditional supine and recumbent lateral projections to a prone and/or erect orientation. Despite evidence of clinical and radiation dose optimisation, widespread adoption of these strategies has stalled. This article describes the single-centre implementation and evaluation of erect PA and lateral projections. METHOD This was an observational study pre- and post-implementation of an erect imaging protocol. Patient BMI, image field size, source image and source object distances and DAP were collected together with assessment of radiographic spinal alignment and disc space demonstration. Effective dose was calculated with organ specific doses. RESULTS 76 (53.5%) patients were imaged in the supine AP and recumbent lateral position, 66 (46.5%) had erect PA and lateral radiographs. Despite the larger BMI of the erect cohort and similar field sizes, effective dose was lower in the PA position by an average of 20% (p < 0.05), however, no significant difference in lateral dose. Anatomical improvements were evident with greater visualisation of intervertebral disc spaces in the PA erect (t = -9.03; p < .001) and lateral (t = -10.298; p < .001) orientations. Erect PA radiographs demonstrated a leg length discrepancy in 47.0% (0.3-4.7 cm) and a scoliosis in 21.2% of cases, with a significant link between these findings (r (64) = 0.44; p < .001). CONCLUSION Erect lumbar spine radiography provides information on clinical outcomes not available with recumbent projections. The improvements in anatomical visualisation and radiation dose reduction supports the local change in practice. IMPLICATIONS FOR PRACTICE - Erect imaging can reduce effective dose with an optimised acquisition protocol - additional pathological information can be revealed by the erect posture. - postural awareness is critical to interpret images accurately.
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Affiliation(s)
- C Bradley
- Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK.
| | - B Snaith
- Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK
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Bhavnani D, García Espinosa B, Baird M, Presley N, Le Menach A, Bradley C, Outten M, González O. Malaria surveillance and case management in remote and indigenous communities of Panama: results from a community-based health worker pilot. Malar J 2022; 21:297. [PMID: 36271383 PMCID: PMC9587600 DOI: 10.1186/s12936-022-04318-z] [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] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Panama is one of eight countries in Mesoamerica that aims to eliminate malaria by 2022. Malaria is concentrated in indigenous and remote regions like Guna Yala, a politically autonomous region where access to health services is limited and cases are predominately detected through intermittent active surveillance. To improve routine access to care, a joint effort was made by Guna Yala authorities and the Ministry of Health to pilot a network of community health workers (CHWs) equipped with rapid diagnostic tests and treatment. The impact of this pilot is described. Methods Access to care was measured using the proportion of villages targeted by the effort with active CHWs. Epidemiological impact was evaluated through standard surveillance and case management measures. Tests for differences in proportions or rates were used to compare measures prior to (October 2014-September 2016) and during the pilot (October 2016-September 2018). Results An active CHW was placed in 39 (95%) of 41 target communities. During the pilot, CHWs detected 61% of all reported cases from the region. Test positivity in the population tested by CHWs (22%) was higher than in those tested through active surveillance, both before (3.8%) and during the pilot (2.9%). From the pre-pilot to the pilot period, annual blood examination rates decreased (9.8 per 100 vs. 8.0 per 100), test positivity increased (4.2% to 8.5%, Χ2 = 126.3, p < 0.001) and reported incidence increased (4.1 cases per 1000 to 6.9 cases per 1000 [Incidence Rate Ratio = 1.83, 95% CI 1.52, 2.21]). The percent of cases tested on the day of symptom onset increased from 8 to 27% and those treated on the day of their test increased from 26 to 84%. Conclusions The CHW network allowed for replacement of routine active surveillance with strong passive case detection leading to more targeted and timely testing and treatment. The higher test positivity among those tested by CHWs compared to active surveillance suggests that they detected cases in a high-risk population that had not previously benefited from access to diagnosis and treatment. Surveillance data acquired through this CHW network can be used to better target active case detection to populations at highest risk.
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Affiliation(s)
- Darlene Bhavnani
- Clinton Health Access Initiative, Panama City, Panama. .,Department of Population Health, Dell Medical School, University of Texas at Austin, Austin, Texas, United States.
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Knott E, Zlevor A, Hinshaw L, Laeseke P, Longhurst C, Frank J, Bradley C, Couillard A, Xu Z, Lee F, Ziemlewicz T. Abstract No. 170 Histotripsy vs. microwave ablation in the liver: a comparison study in a porcine model. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lynch T, Ryan C, Bradley C, Foster D, Huff C, Hutchinson S, Lamberson N, Lynch L, Cadogan C. Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe: development of the SAFEGUARDING-BZRAs toolkit using a co-design approach. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac021.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Long-term benzodiazepine receptor agonist (BZRA) use (>3 months) persists worldwide and poses risks of harm. Effective interventions are needed to address this issue.
Aim
To develop an intervention to support discontinuation of long-term benzodiazepine receptor agonist (BZRA) use.
Methods
The intervention development process built on previous qualitative work that used the Theoretical Domains Framework (TDF) to explore perceived barriers and facilitators to discontinuing long-term BZRA use (1). A co-design approach was used whereby lay individuals and professionals worked as equals during the research process based on principles of authentic participation and collaboration (2). The co-design team included five ‘experts by lived experience’ with experience of long-term BZRA use who previously provided input on other related work as patient and public involvement representatives or responded to an expression of interest call on social media. Two online co-design team meetings were held. During the first meeting, a summary of previous findings was presented together with a long-list of behaviour change techniques (BCTs) generated using established mapping matrices in which BCTs were reliably allocated to the TDF. Each team member independently documented their decision as to whether each BCT should be included in a short-list for potential inclusion in the final intervention using online polling software. The a priori decision rule was that 70% of team members had to agree regarding the inclusion/exclusion of a BCT. All other BCTs were then discussed at a follow-up meeting. A finalised list of BCTs for inclusion in the intervention was agreed at the second meeting using a consensus-based approach involving the same decision rule. Potential ways in which BCTs could be operationalised were then discussed.
Results
Thirty BCTs were discussed and six BCTs were excluded. For example, team members recommended avoiding ‘Social comparison’ as individual circumstances and experiences of discontinuation and associated withdrawal symptoms are unique and not directly comparable. Given the number of included BCTs, the co-design team recommended presenting them as a toolkit. The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe) toolkit comprises 24 BCTs: ‘Goal setting (behaviour)’, ‘Review behaviour goal(s)’, ‘Review outcome goal(s)’, ‘Feedback on behaviour’, ‘Self-monitoring of behaviour’, ‘Social support (practical)’, ‘Social support (emotional)’, ‘Information about health consequences’, ‘Monitoring of emotional consequences’, ‘Information about emotional consequences’, ‘Prompts/cues’, ‘Habit reversal’, ‘Graded tasks’, ‘Pros and cons’, ‘Comparative imagining of future outcomes’, ‘Social reward’, ‘Self-reward’, ‘Reduce negative emotions’, ‘Distraction’, ‘Adding objects to the environment’, ‘Body changes’, ‘Verbal persuasion about capability’, ‘Focus on past success’ and ‘Credible source’. The toolkit includes recommendations targeted at primary care-based clinicians for operationalising each BCT to support BZRA discontinuation.
Conclusion
The SAFEGUARDING-BZRAs toolkit has been developed using a systematic, theory-based approach that addresses identified limitations of previous research (e.g. lack of detailed intervention description). In terms of limitations, it is possible that a different group of individuals may have developed a different type of intervention. To overcome this, a priori decision rules were used for decision making. Further research is needed to assess the toolkit’s usability and acceptability by service users and clinicians.
References
(1) Lynch et al. Health Expect. [in press] DOI: 10.1111/hex.13392.
(2) O’Donnell et al. BMC Health Serv Res. 2019;19(1):797
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Affiliation(s)
- T Lynch
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - C Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - D Foster
- Benzodiazepine Action Work Group, Colorado Consortium for Prescription Drug Abuse Prevention, Aurora, Colorado, USA
| | - C Huff
- Benzodiazepine Information Coalition, Midvale, Utah, USA
| | | | | | | | - C Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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6
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Gilley KN, Baroudi L, Yu M, Gainsburg I, Reddy N, Bradley C, Cislo C, Rozwadowski ML, Clingan CA, DeMoss MS, Churay T, Birditt K, Colabianchi N, Chowdhury M, Forger D, Gagnier J, Zernicke RF, Cunningham JL, Cain SM, Tewari M, Choi SW. Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors. JMIR Ment Health 2022; 9:e34645. [PMID: 34992051 PMCID: PMC8834863 DOI: 10.2196/34645] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/14/2021] [Accepted: 01/06/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. OBJECTIVE This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. METHODS After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. RESULTS During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) students, respectively. Approximately one-third of students reported having a mental health disorder (n=656, 33%). The average daily steps recorded in this student population was approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). CONCLUSIONS Mental health problems were common in this student population. Several factors, including substance use, were associated with the risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. TRIAL REGISTRATION ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/29561.
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Affiliation(s)
- Kristen N Gilley
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Loubna Baroudi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Miao Yu
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Izzy Gainsburg
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Niyanth Reddy
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Christina Bradley
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Christine Cislo
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | | | - Caroline Ashley Clingan
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Matthew Stephen DeMoss
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Tracey Churay
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Kira Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Mosharaf Chowdhury
- Department of Computer Science Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Daniel Forger
- Department of Mathematics, University of Michigan, Ann Arbor, MI, United States
| | - Joel Gagnier
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States.,Department of Epidemiology, University of Michigan, Ann Arbor, MI, United States
| | - Ronald F Zernicke
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, United States.,Exercise & Sport Science Initiative, University of Michigan, Ann Arbor, MI, United States
| | - Julia Lee Cunningham
- Stephen M. Ross School of Business, University of Michigan, Ann Arbor, MI, United States
| | - Stephen M Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV, United States
| | - Muneesh Tewari
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Center for Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States.,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, United States
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Champagne C, Gerhards M, Lana J, García Espinosa B, Bradley C, González O, Cohen JM, Le Menach A, White MT, Pothin E. Using observed incidence to calibrate the transmission level of a mathematical model for Plasmodium vivax dynamics including case management and importation. Math Biosci 2021; 343:108750. [PMID: 34883106 PMCID: PMC8786669 DOI: 10.1016/j.mbs.2021.108750] [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] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/27/2022]
Abstract
In this work, we present a simple and flexible model for Plasmodium vivax dynamics which can be easily combined with routinely collected data on local and imported case counts to quantify transmission intensity and simulate control strategies. This model extends the model from White et al. (2016) by including case management interventions targeting liver-stage or blood-stage parasites, as well as imported infections. The endemic steady state of the model is used to derive a relationship between the observed incidence and the transmission rate in order to calculate reproduction numbers and simulate intervention scenarios. To illustrate its potential applications, the model is used to calculate local reproduction numbers in Panama and identify areas of sustained malaria transmission that should be targeted by control interventions.
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Affiliation(s)
- Clara Champagne
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, Basel, CH-4002, Switzerland; University of Basel, Petersplatz 1, P.O. Box, Basel, CH-4001, Switzerland.
| | - Maximilian Gerhards
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, Basel, CH-4002, Switzerland; University of Basel, Petersplatz 1, P.O. Box, Basel, CH-4001, Switzerland
| | - Justin Lana
- Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, 02127, MA, USA
| | | | - Christina Bradley
- Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, 02127, MA, USA
| | - Oscar González
- Ministerio de Salud de Panama, Calle culebra, Edificio 265 del Ministerio de Salud, Corregimiento de Ancón, Panama
| | - Justin M Cohen
- Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, 02127, MA, USA
| | - Arnaud Le Menach
- Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, 02127, MA, USA
| | - Michael T White
- Institut Pasteur, Université de Paris, G5 Épidémiologie et Analyse des Maladies Infectieuses, Département de Santé Globale, Paris, F-75015, France
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box, Basel, CH-4002, Switzerland; University of Basel, Petersplatz 1, P.O. Box, Basel, CH-4001, Switzerland; Clinton Health Access Initiative, 383 Dorchester Ave, Suite 400, Boston, 02127, MA, USA
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Geraghty A, Castro PD, Reynolds C, McBean L, Browne S, Clyne B, Bury G, Bradley C, Finnigan K, Clarke S, McCullagh L, Perrotta C, Murrin C, Gibney E, Kennelly S, Corish C. Evaluation of an online malnutrition management education module for general practitioners: the onspres project. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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9
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Browne S, Kelly L, Geraghty A, Reynolds C, McCallum K, McBean L, Clyne B, Bury G, Bradley C, McCullagh L, Finnigan K, Bardon L, Murrin C, Perrotta C, Gibney E, Kennelly S, Castro PD, Corish C. Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescription in the community: a qualitative study. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bradley C, Aggarwal A, Goatman K, Jones G, Berry C, Good R. Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2.
Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed.
Purpose
We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification.
Methods
We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported.
Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record.
Results
385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months.
CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1).
Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin.
Conclusions
A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- C Bradley
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Aggarwal
- University of Glasgow, Glasgow, United Kingdom
| | - K Goatman
- Canon Medical Europe, Edinburgh, United Kingdom
| | - G Jones
- Swansea University, Swansea, United Kingdom
| | - C Berry
- University of Glasgow, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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12
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Cislo C, Clingan C, Gilley K, Rozwadowski M, Gainsburg I, Bradley C, Barabas J, Sandford E, Olesnavich M, Tyler J, Mayer C, DeMoss M, Flora C, Forger DB, Cunningham JL, Tewari M, Choi SW. Monitoring beliefs and physiological measures in students at risk for COVID-19 using wearable sensors and smartphone technology: Protocol for a mobile health study. JMIR Res Protoc 2021; 10:e29561. [PMID: 34115607 PMCID: PMC8386373 DOI: 10.2196/29561] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted lives significantly and greatly affected an already vulnerable population, college students, in relation to mental health and public safety. Social distancing and isolation have brought about challenges to student's mental health. Mobile health apps and wearable sensors may help to monitor students at risk for COVID-19 and support their mental well-being. OBJECTIVE Through the use of a wearable sensor and smartphone-based survey completion, this study aimed to monitor students at risk for COVID-19. METHODS We conducted a prospective study of students, undergraduate and graduate, at a public university in the Midwest. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal mobile devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints - at baseline, 1-month later, 2-months later, 3-months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. RESULTS This study enrolled 2,158 college students between September 2020 and January 2021. Subjects are currently being followed on-study for one academic year. Data collection and analysis are ongoing. CONCLUSIONS This study examined student health and well-being during the COVID-19 pandemic. It also assessed the feasibility of wearable sensor use and survey completion in a college student population, which may inform the role of our mobile health tools on student health and well-being. Finally, using wearable sensor data, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data towards the development of a model for the early prediction and detection of COVID-19. CLINICALTRIAL ClinicalTrials.gov NCT04766788.
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Affiliation(s)
- Christine Cislo
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Caroline Clingan
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Kristen Gilley
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
| | - Michelle Rozwadowski
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Izzy Gainsburg
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Christina Bradley
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Jenny Barabas
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Erin Sandford
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Mary Olesnavich
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Jonathan Tyler
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Caleb Mayer
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Matthew DeMoss
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Christopher Flora
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
| | - Daniel B Forger
- Department of Mathematics, University of Michigan, Ann Arbor, US
| | - Julia Lee Cunningham
- Management and Organizations Area, Ross School of Business, University of Michigan, Ann Arbor, US
| | - Muneesh Tewari
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, US
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, US
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, US
| | - Sung Won Choi
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E. Medical Center DrD4118 Medical Professional Building, Ann Arbor, US
- Rogel Comprehensive Cancer Center, University of Michigan, Ann Arbor, US
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13
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Khamis K, Bradley C, Gunter HJ, Basevi G, Stevens R, Hannah DM. Calibration of an in-situ fluorescence-based sensor platform for reliable BOD 5 measurement in wastewater. Water Sci Technol 2021; 83:3075-3091. [PMID: 34185701 DOI: 10.2166/wst.2021.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reliance on biochemical oxygen demand (BOD5) as an indicator of wastewater quality has hindered the development of efficient process control due to the associated uncertainty and lag-times. Surrogate measurements have been proposed, with fluorescence spectroscopy a promising technique. Yet, assessment of in-situ fluorescence sensors across multiple wastewater treatment plants (WwTPs), and at different treatment stages, is limited. In this study a multi-parameter sonde (two fluorescence peaks, turbidity, temperature and electrical conductivity) was used to provide a BOD5 surrogate measurement. The sonde was deployed at three WwTPs, on post primary settlement tanks (PST) and final effluent (FE). Triplicate laboratory measurements of BOD5, from independent laboratories were used to calibrate the sensor, with high variability apparent for FE samples. Site and process specific sensor calibrations yielded the best results (R2cv = 0.76-0.86; 10-fold cross-validation) and mean BOD5 of the three laboratory measurements improved FE calibration. When combining PST sites a reasonable calibration was still achieved (R2cv = 0.67) suggesting transfer of sensors between WwTPs may be possible. This study highlights the potential to use online optical sensors as robust BOD5 surrogates in WwTPs. However, careful calibration (i.e. replicated BOD5 measurements) is required for FE as laboratory measurements can be associated with high uncertainty.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - C Bradley
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - H J Gunter
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail: ; RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - G Basevi
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - R Stevens
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - D M Hannah
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
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14
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Uberoi A, Bartow-McKenney C, Zheng Q, Flowers L, Campbell A, Knight S, Chan N, Wei M, Lovins V, Bugayev J, Horwinski J, Bradley C, Meyer J, Crumrine D, Sutter C, Elias P, Mauldin E, Sutter T, Grice E. 190 Commensal microbiota regulates skin barrier function and repair via signaling through the aryl hydrocarbon receptor. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Miklin D, Bradley C, Salimbangon A, Wolfson A, Vaidya A, Depasquale E. Outcomes of Septuagenarians Undergoing Heart Transplant after the UNOS Allocation Policy Change. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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16
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Yarnoff B, Honeycutt A, Bradley C, Khavjou O, Bates L, Bass S, Kaufmann R, Barker L, Briss P. Validation of the Prevention Impacts Simulation Model (PRISM). Prev Chronic Dis 2021; 18:E09. [PMID: 33544072 PMCID: PMC7879963 DOI: 10.5888/pcd18.200225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Demonstrating the validity of a public health simulation model helps to establish confidence in the accuracy and usefulness of a model’s results. In this study we evaluated the validity of the Prevention Impacts Simulation Model (PRISM), a system dynamics model that simulates health, mortality, and economic outcomes for the US population. PRISM primarily simulates outcomes related to cardiovascular disease but also includes outcomes related to other chronic diseases that share risk factors. PRISM is openly available through a web application. Methods We applied the model validation framework developed independently by the International Society of Pharmacoeconomics and Outcomes Research and the Society for Medical Decision Making modeling task force to validate PRISM. This framework included model review by external experts and quantitative data comparison by the study team. Results External expert review determined that PRISM is based on up-to-date science. One-way sensitivity analysis showed that no parameter affected results by more than 5%. Comparison with other published models, such as ModelHealth, showed that PRISM produces lower estimates of effects and cost savings. Comparison with surveillance data showed that projected model trends in risk factors and outcomes align closely with secular trends. Four measures did not align with surveillance data, and those were recalibrated. Conclusion PRISM is a useful tool to simulate the potential effects and costs of public health interventions. Results of this validation should help assure health policy leaders that PRISM can help support community health program planning and evaluation efforts.
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Affiliation(s)
- Benjamin Yarnoff
- RTI International, Research Triangle Park, North Carolina.,RTI International, 3040 E. Cornwallis Rd, Research Triangle Park, NC 27709.
| | | | | | - Olga Khavjou
- RTI International, Research Triangle Park, North Carolina
| | - Laurel Bates
- RTI International, Research Triangle Park, North Carolina
| | - Sarah Bass
- RTI International, Research Triangle Park, North Carolina
| | - Rachel Kaufmann
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lawrence Barker
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter Briss
- Centers for Disease Control and Prevention, Atlanta, Georgia
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17
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Dharmaprani D, Jenkins E, Quah J, Lahiri A, Tiver K, Mitchell L, Bradley C, Hayward M, Paterson D, Taggart P, Clayton R, Nash M, Ganesan A. A Governing Equation for Human Ventricular Fibrillation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Brooke J, Safavi S, Prayle A, Ng C, Alappadan J, Bradley C, Cooper A, Munidasa S, Zanette B, Santyr G, Barr H, Major G, Smyth A, Gowland P, Francis S, Hall I. P109 Regional assessment of lung function using non-contrast MRI in people with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Reynolds C, Dominguez Castro P, Bardon L, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. It Takes A Village: Patient Perspectives On The Management Of Malnutrition In The Community. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.178] [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: 12/01/2022]
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20
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Bradley C, Cordaro DT. Impacts of the four pillars of wellbeing curriculum: A 3-year pilot study. Translational Issues in Psychological Science 2020. [DOI: 10.1037/tps0000275] [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: 11/08/2022]
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21
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Castro PD, Reynolds C, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. “Don’t Go Near The Word Malnutrition”; A qualitative study of community healthcare professionals and patients views on the term malnutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.557] [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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22
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Dominguez Castro P, Reynolds C, Bizzaro G, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. Large number of prescribed central nervous system drugs and younger age predict the use of more oral nutritional supplements units. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.271] [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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23
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Reynolds C, Dominguez Castro P, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E. Healthcare professionals’ preferences for the delivery, content and structure of a malnutrition education programme: An exploratory qualitative Study. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Sattar S, Haase K, Kuster S, Puts M, Spoelstra S, Bradley C, Wildes TM, Alibhai S. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2020; 29:21-33. [PMID: 32671565 DOI: 10.1007/s00520-020-05619-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [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: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? METHODS MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. RESULTS A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. CONCLUSION This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Room 108, Regina, Saskatchewan, S4T 0H8, Canada.
| | - K Haase
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - S Kuster
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, Canada
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - S Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - C Bradley
- Library, University of Regina, Regina, Canada
| | - T M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - S Alibhai
- Department of Medicine, Institute of Health Policy, Management, and Evaluations, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
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Seppälä EM, Bradley C, Moeller J, Harouni L, Nandamudi D, Brackett MA. Promoting Mental Health and Psychological Thriving in University Students: A Randomized Controlled Trial of Three Well-Being Interventions. Front Psychiatry 2020; 11:590. [PMID: 32760296 PMCID: PMC7373803 DOI: 10.3389/fpsyt.2020.00590] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 02/19/2020] [Accepted: 06/08/2020] [Indexed: 12/20/2022] Open
Abstract
This study aimed to address the decline in mental health on U.S. university campuses by examining the effects of three interventions. University students suffer from high levels of anxiety, depression, and suicide. Counseling centers on university campuses are struggling to meet increased demand. The cost to students and universities could be buffered by offering preventative, psychoeducational, and skill-building training programs that promote mental health and psychological thriving. To date, the research literature has not yielded systematically evaluated and recommendable preventative mental health and well-being programs for university students. In a registered, randomized controlled trial, 131 university students were either placed in a non-intervention control group (N = 47) or received training in one of three 30-hour, eight-week semester-long well-being programs: SKY Campus Happiness ("SKY"; N = 29), Foundations of Emotional Intelligence ("EI"; N = 21) or Mindfulness-Based Stress Reduction ("MBSR"; N = 34). Compared to the control group and controlling for variance of baseline measurements and multiple comparisons, SKY Campus Happiness showed the greatest impact, benefiting six outcomes: depression, stress, mental health, mindfulness, positive affect and social connectedness. EI benefited one outcome: mindfulness. The MBSR group showed no change. Delivering SKY or EI to university students may be a cost-effective and efficient way to proactively and preventatively address mental health for university students and reduce the financial strain on universities.
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Affiliation(s)
- Emma M. Seppälä
- Yale Child Study Center & Yale Center for Emotional Intelligence, Yale University, New Haven, CT, United States
- Center for Compassion and Altruism Research and Education, Stanford University, Stanford, CA, United States
| | - Christina Bradley
- Yale Child Study Center & Yale Center for Emotional Intelligence, Yale University, New Haven, CT, United States
| | - Julia Moeller
- Department of Education, Leipzig University, Leipzig, Germany
| | - Leilah Harouni
- Yale Child Study Center & Yale Center for Emotional Intelligence, Yale University, New Haven, CT, United States
- Yale School of Management, Yale University, New Haven, CT, United States
| | - Dhruv Nandamudi
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Marc A. Brackett
- Yale Child Study Center & Yale Center for Emotional Intelligence, Yale University, New Haven, CT, United States
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26
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Bradley C, McKeown C, Rutherford C, Downey D, Addy C, Caskey S. P149 A review of the clinical trajectory of adults with cystic fibrosis prescribed nebulised Aztreonam Lysine (Cayston™). J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Bradley C, Rutherford C, McParland C, Addy C, Downey D, McKeown C, Caskey S. WS03.3 A review of ursodeoxycholic acid prescribing in an adult cystic fibrosis population. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30179-x] [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: 10/24/2022]
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28
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Rutherford C, Bradley C, McKeown C, Caskey S, Downey D, Addy C. P197 The effect of ivacaftor on clinical trajectory of adults with cystic fibrosis carrying a R117H mutation. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Khamis K, Bradley C, Hannah DM. High frequency fluorescence monitoring reveals new insights into organic matter dynamics of an urban river, Birmingham, UK. Sci Total Environ 2020; 710:135668. [PMID: 31785904 DOI: 10.1016/j.scitotenv.2019.135668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Natural organic matter (NOM) is fundamental to many biogeochemical processes in river ecosystems. Currently, however, we have limited knowledge of NOM dynamics across the spectrum of flow conditions as previous studies have focused largely on storm events. Field deployable fluorescence technology offers new opportunities to explore both stochastic and predictable diel NOM dynamics at finer time-steps and for longer periods than was hitherto possible, thus yielding new insight into NOM sources, processing, and pathways. Hourly fluorescence data (humic-like fluorescence [Peak C] and tryptophan-like fluorescence [Peak T]) and a suite of hydro-climatological variables were collected from an urban river (Birmingham, UK). We explored monthly concentration-discharge (C-Q) patterns using segmented regression and assessed hysteretic and flushing behaviour for Peak C, T and turbidity to infer source zone activation. Diel patterns were assessed during low flow periods. Wavelet analysis identified strong diurnal variations in Peak C with early morning peaks while no diel dynamics were apparent for Peak T. Using generalised linear modelling relationships between Peak C periodicity and both solar radiation and time since previous storm/scouring event were identified. Breakpoints and positive slopes for C-Q relationship highlighted chemodynamic behaviour for NOM over most of the monitoring period, with Peak T mobilised more relative to Peak C during high Q. Hysteresis patterns were highly variable but flushing behaviour of Peak T and C suggested exhaustion of humic compounds during long duration events and following successive rainfall events. Peak T flushing was correlated with Q magnitude highlighting the potential for combined sewer overflows to act as important NOM sources despite significant dilution potential. This research highlights the potential of real-time, field deployable fluorescence spectroscopy as a viable method for providing insight into diel and transport driven NOM dynamics.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK.
| | - C Bradley
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK
| | - D M Hannah
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK
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Lu H, Yan H, Masey O’Neill H, Bradley C, Bedford M, Wilcock P, Nakatsu C, Adeola O, Ajuwon K. Effect of timing of postweaning xylanase supplementation on growth performance, nutrient digestibility, and fecal microbial composition in weanling pigs. Can J Anim Sci 2020. [DOI: 10.1139/cjas-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effect of timing of xylanase supplementation to weanling pigs and its effect on growth performance, nutrient digestibility, and fecal microbiota was investigated. A total of 128 weanling pigs [(Hampshire × Duroc) × (Yorkshire × Landrace); 6.2 ± 0.6 kg body weight (BW); weaning age: 21 d] were assigned to four treatments, with eight replicate pens and four pigs per pen. Treatments were a combination of two dietary treatments (without or with xylanase) in two periods; (period 1, days 0–14) and period 2 (days 14–42): xylanase–xylanase, xylanase–control, control–xylanase, and control–control. Fecal microbiota diversity and apparent total tract digestibility (ATTD) were determined. From days 0–14, pigs had lower (P < 0.01) BW, average daily gain (ADG), and feed efficiency when xylanase was included in the diets. The final BW (P < 0.05) and overall ADG (P < 0.02) at day 42 were greater when xylanase was supplemented from day 14 compared with supplementation from day 0. The apparent ileal digestibility and ATTD of dry matter, gross energy, nitrogen, and phosphorus were increased (P < 0.05) by xylanase. Xylanase significantly decreased (P < 0.05) the relative abundance of Veillonella spp. and tended (P = 0.08) to decrease the relative abundance of Megasphaera spp. in period 2 compared with the non-supplemented group.
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Affiliation(s)
- H. Lu
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - H. Yan
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | | | - C. Bradley
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - M.R. Bedford
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - P. Wilcock
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - C.H. Nakatsu
- Department of Agronomy, Purdue University, West Lafayette, IN 47907, USA
| | - O. Adeola
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - K.M. Ajuwon
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
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Wiffen L, Lodge D, Fox L, Bradley C, Ibrahim W, Bentley K, Cook C, Nutkins K, Brown T, Rupani H, Chauhan A, Bishop L, Hicks A. Patient experience of telephone consultations in the lung cancer pathway. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30078-7] [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: 12/01/2022]
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Sattar S, Puts M, Spoelstra S, Yokom D, Haase K, Kuster S, Bradley C, Fazalzad R, Wildes T, Alibhai S. FALLS IN OLDER ADULTS WITH CANCER: PRELIMINARY ANALYSIS OF AN UPDATED SYSTEMATIC REVIEW OF PREVALENCE, INJURIOUS FALLS, AND IMPACT ON CANCER TREATMENT. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sattar S, Haase K, Bradley C, Papadopoulos E, Kuster S, Mina D, Joshua A, Souied O, Rediger C, Alibhai S. PERCEPTION OF STRUCTURED EXERCISE PROGRAMS AND FACTORS ASSOCIATED WITH PARTICIPATION AND ADHERENCE AMONG MEN WITH PROSTATE CANCER: A SCOPING REVIEW. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yarnoff B, Khavjou O, Elmi J, Lowe-Beasley K, Bradley C, Amoozegar J, Wachtmeister D, Tzeng J, Chapel JM, Teixeira-Poit S. Estimating Costs of Implementing Stroke Systems of Care and Data-Driven Improvements in the Paul Coverdell National Acute Stroke Program. Prev Chronic Dis 2019; 16:E134. [PMID: 31580797 PMCID: PMC6795072 DOI: 10.5888/pcd16.190061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose and Objectives We evaluated the costs of implementing coordinated systems of stroke care by state health departments from 2012 through 2015 to help policy makers and planners gain a sense of the potential return on investments in establishing a stroke care quality improvement (QI) program. Intervention Approach State health departments funded by the Paul Coverdell National Acute Stroke Program (PCNASP) implemented activities to support the start and proficient use of hospital stroke registries statewide and coordinate data-driven QI efforts. These efforts were aimed at improving the treatment and transition of stroke patients from prehospital emergency medical services (EMS) to in-hospital care and postacute care facilities. Health departments provided technical assistance and data to support hospitals, EMS agencies, and posthospital care agencies to carry out small, rapid, incremental QI efforts to produce more effective and efficient stroke care practices. Evaluation Methods Six of the 11 PCNASP-funded state health departments in the United States volunteered to collect and report programmatic costs associated with implementing the components of stroke systems of care. Six health departments reported costs paid directly by Centers for Disease Control and Prevention–provided funds, 5 also reported their own in-kind contributions, and 4 compiled data from a sample of their partners’ estimated costs of resources, such as staff time, involved in program implementation. Costs were analyzed separately for PCNASP-funded expenditures and in-kind contributions by the health department by resource category and program activity. In-kind contributions by partners were also analyzed separately. Results PCNASP-funded expenditures ranged from $790,123 to $1,298,160 across the 6 health departments for the 3-year funding period. In-kind contributions ranged from $5,805 to $1,394,097. Partner contributions (n = 22) ranged from $3,912 to $362,868. Implications for Public Health Our evaluation reports costs for multiple state health departments and their partners for implementing components of stroke systems of care in the United States. Although there are limitations, our findings represent key estimates that can guide future program planning and efforts to achieve sustainability.
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Affiliation(s)
- Benjamin Yarnoff
- RTI International, Public Health Economics Program, 3040 E. Cornwallis Rd, Research Triangle Park, NC 27709.
| | - Olga Khavjou
- RTI International, Public Health Economics Program, Research Triangle Park, North Carolina
| | - Joanna Elmi
- Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Atlanta, Georgia
| | - Kincaid Lowe-Beasley
- Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Atlanta, Georgia
| | - Christina Bradley
- RTI International, Public Health Economics Program, Research Triangle Park, North Carolina
| | - Jacqueline Amoozegar
- RTI International, Public Health Economics Program, Research Triangle Park, North Carolina
| | - Devon Wachtmeister
- RTI International, Public Health Economics Program, Research Triangle Park, North Carolina
| | - Janice Tzeng
- RTI International, Public Health Economics Program, Research Triangle Park, North Carolina
| | - John McCoy Chapel
- Centers for Disease Control and Prevention, Division of Heart Disease and Stroke Prevention, Atlanta, Georgia
| | - Stephanie Teixeira-Poit
- North Carolina Agricultural and Technical State University, College of Health and Human Sciences, Greensboro, North Carolina
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Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, McAuliffe C, Perry IJ, Griffin E, Cassidy EM, Bradley C, Kapur N, Kinahan J, Cleary A, Foster T, Gallagher J, Malone K, Ramos Costa AP, Greiner BA. Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19:275. [PMID: 31492119 PMCID: PMC6728991 DOI: 10.1186/s12888-019-2249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
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Affiliation(s)
- E. Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. Larkin
- 0000 0001 0742 0364grid.168645.8Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, 01655 USA
| | | | - S. Leitao
- 0000 0004 0617 6269grid.411916.aSchool of Public Health, College of Medicine and Health and National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Hospital Maternity Hospital, Wilton, Cork, Ireland
| | - P. Corcoran
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Williamson
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. McAuliffe
- St. Patrick’s Mental Health Services, Cork, Ireland
| | - I. J. Perry
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Griffin
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. M. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - C. Bradley
- 0000000123318773grid.7872.aDepartment of General Practice, University College Cork, Western Gateway Building, Cork, Ireland
| | - N. Kapur
- 0000 0004 0430 6955grid.450837.dCentre for Mental Health and Safety, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Kinahan
- 0000 0004 0575 9497grid.411785.eNorth Lee Psychiatric Services, Mercy University Hospital, Cork, Ireland
| | - A. Cleary
- 0000 0001 0768 2743grid.7886.1Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - T. Foster
- Consultant Psychiatrist, Omagh and Fermanagh, Northern Ireland
| | - J. Gallagher
- 0000000123318773grid.7872.aSchool of Public Health, University College Cork, Cork, Ireland
| | - K. Malone
- 0000 0001 0768 2743grid.7886.1School of Medicine, University College Dublin, Dublin, Ireland
| | - A. P. Ramos Costa
- 0000000123318773grid.7872.aSchool of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - B. A. Greiner
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
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Yarnoff B, Bradley C, Honeycutt AA, Soler RE, Orenstein D. Estimating the Relative Impact of Clinical and Preventive Community-Based Interventions: An Example Based on the Community Transformation Grant Program. Prev Chronic Dis 2019; 16:E87. [PMID: 31274409 PMCID: PMC6638589 DOI: 10.5888/pcd16.180594] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Public health focuses on a range of evidence-based approaches for addressing chronic conditions, from individual-level clinical interventions to broader changes in policies and environments that protect people’s health and make healthy living easier. This study examined the potential long-term impact of clinical and community interventions as they were implemented by Community Transformation Grant (CTG) program awardees. Methods We used the Prevention Impacts Simulation Model, a system dynamics model of cardiovascular disease prevention, to simulate the potential 10-year and 25-year impact of clinical and community interventions implemented by 32 communities receiving a CTG program award, assuming that program interventions were sustained during these periods. Results Sustained clinical interventions implemented by CTG awardees could potentially avert more than 36,000 premature deaths and $3.2 billion in discounted direct medical costs (2017 US dollars) over 10 years and 109,000 premature deaths and $8.1 billion in discounted medical costs over 25 years. Sustained community interventions could avert more than 24,000 premature deaths and $3.4 billion in discounted direct medical costs over 10 years and 88,000 premature deaths and $9.1 billion in discounted direct medical costs over 25 years. CTG clinical activities had cost-effectiveness of $302,000 per death averted at the 10-year mark and $188,000 per death averted at the 25-year mark. Community interventions had cost-effectiveness of $169,000 and $57,000 per death averted at the 10- and 25-year marks, respectively. Conclusion Clinical interventions have the potential to avert more premature deaths than community interventions. However, community interventions, if sustained over the long term, have better cost-effectiveness.
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Affiliation(s)
- Benjamin Yarnoff
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709.
| | | | | | - Robin E Soler
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Diane Orenstein
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Yarnoff B, Khavjou O, Bradley C, Leis J, Filene J, Honeycutt A, Herzfeldt-Kamprath R, Peplinski K. Standardized Cost Estimates for Home Visiting: Pilot Study of the Home Visiting Budget Assistance Tool (HV-BAT). Matern Child Health J 2019; 23:470-478. [PMID: 30547353 DOI: 10.1007/s10995-018-2657-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Using a standardized approach and metrics to estimate home visiting costs across multiple evidence-based models and regions could improve the consistency and accuracy of cost estimates, allow stakeholders to observe trends in cost allocation, analyze how home visiting costs vary, and develop future program budgets. Between October 2015 and December 2018, we developed and pilot-tested the Home Visiting Budget Assistance Tool (HV-BAT) to standardize the collection of home visiting program costs and analyze costs for local implementing agencies (LIAs). Methods We recruited LIAs that implemented at least one of nine evidence-based home visiting models in 15 states implementing the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program. LIAs reported their costs to implement a home visiting model using the HV-BAT and provided feedback on the tool. We estimated annual total cost and cost per family served for each LIA, examined cost summary statistics for the sample, and analyzed whether and how LIA characteristics affected home visiting costs using regression analyses. Results Of the 168 LIAs invited to participate in the HV-BAT pilot study, 75 agreed to participate, and 45 across 14 states completed the HV-BAT. We estimated home visiting costs of approximately $8500 per family per year, but costs varied across LIAs (range $1970-$39,770; standard deviation = $5794). The marginal cost of adding a family declined as the number of families served by an LIA increased. Feedback from LIAs indicated that users had difficulty providing some details on costs (e.g., mileage for specific services), needed more detailed instructions, and desired a summary of subtotals and total costs reported in the HV-BAT. Conclusions The HV-BAT provides an approach to standardize cost data collection for home visiting programs. Pilot study results indicate that there may be significant economies of scale for home visiting services. This study provides preliminary estimates of costs that can help in program planning and budgeting.
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Affiliation(s)
- Benjamin Yarnoff
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Olga Khavjou
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Christina Bradley
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Julie Leis
- James Bell Associates, 3033 Wilson Blvd. #650, Arlington, VA, 22201, USA
| | - Jill Filene
- James Bell Associates, 3033 Wilson Blvd. #650, Arlington, VA, 22201, USA
| | - Amanda Honeycutt
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Rachel Herzfeldt-Kamprath
- Division of Home Visiting and Early Childhood Systems, HRSA, Maternal and Child Health Bureau, 5600 Fishers Lane, Rockville, MD, 20857, USA
| | - Kyle Peplinski
- Division of Home Visiting and Early Childhood Systems, HRSA, Maternal and Child Health Bureau, 5600 Fishers Lane, Rockville, MD, 20857, USA.
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Honeycutt A, Bradley C, Khavjou O, Yarnoff B, Soler R, Orenstein D. Simulated impacts and potential cost effectiveness of Communities Putting Prevention to Work: Tobacco control interventions in 21 U.S. communities, 2010-2020. Prev Med 2019; 120:100-106. [PMID: 30659909 DOI: 10.1016/j.ypmed.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 12/24/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
In 2010, the Centers for Disease Control and Prevention (CDC) funded communities to implement policy, systems, and environmental (PSE) changes under the Communities Putting Prevention to Work (CPPW) program to make it easier for people to make healthier choices to prevent chronic disease. Twenty-one of 50 funded communities implemented interventions intended to reduce tobacco use. To examine the potential cost-effectiveness of tobacco control changes implemented under CPPW from a healthcare system perspective, we compared program cost estimates with estimates of potential impacts. We used an existing simulation model, the Prevention Impacts Simulation Model (PRISM), to estimate the potential cumulative impact of CPPW tobacco interventions on deaths and medical costs averted through 2020. We collected data on the costs to implement CPPW tobacco interventions from 2010 to 2013. We adjusted all costs to 2010 dollars. CPPW tobacco interventions cost $130.5 million across all communities, with an average community cost of $6.2 million. We found $735 million in potentially averted medical costs cumulatively from 2010 through 2020 because of the CPPW-supported interventions. If the CPPW tobacco control PSE changes are sustained through 2020 without additional funding after 2013, we find that medical costs averted will likely exceed program costs by $604 million. Our results suggest that the medical costs averted through 2020 may more than offset the initial investment in CPPW tobacco control interventions, implying that such interventions may be cost saving, especially over the long term.
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Affiliation(s)
| | | | - Olga Khavjou
- RTI International, Research Triangle Park, NC, USA
| | | | - Robin Soler
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane Orenstein
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rafferty M, Bradley C. Counselling in Primary Care – A General Practitioner’s Perspective. Ir Med J 2019; 112:869. [PMID: 30892002] [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: 06/09/2023]
Abstract
Introduction Counselling in Primary care (CIPC) is a new service introduced by the HSE in 2013, providing short-term counselling for medical-card holders, suffering from mild to moderate mental health problems. Aims To explore GP’s views on CIPC for the treatment of mild to moderate mental health disorders. Methods Qualitative semi-structured interviews were conducted with GPs who had previously utilized the CIPC service in the Cork/ Kerry region. Forty GPs were identied and sent invitation letters. GPs were purposefully sampled based on criteria of location (urban/rural), gender, practice size (single handed/group) and length of time qualied. A total sample size was generated using the ‘ten plus three’ method. Interviews were carried out in person, transcribed verbatim and analyzed using the framework analysis method. Results Nineteen GPs were interviewed. Core themes emerged and were analyzed. 1. GPs unanimously agreed that CIPC has been of benet in treating mild to moderate mental health disorders. 2. Suggested improvements to the service were made, including allowing GP visit card holders to avail of the service (n=10) and adolescents aged between 16 and 18 (n=5). 3. A majority (n=12) of GPs interviewed expressed the opinion that a combination of talk therapy and medication was associated with the best outcomes in treating mild to moderate mental health disorders. Conclusion CIPC seems to improve mental health services at a primary care level. While improvements can certainly be made to the service, GPs report positive patient outcomes and a reduction in psychiatric referrals for patients who can be suitably managed within the community.
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Affiliation(s)
| | - C Bradley
- 2. Department of General Practice, University College Cork, Co. Cork
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Bradley C, Scott RA, Cox E, Palaniyappan N, Thomson BJ, Ryder SD, Irving WL, Aithal GP, Guha IN, Francis S. Short-term changes observed in multiparametric liver MRI following therapy with direct-acting antivirals in chronic hepatitis C virus patients. Eur Radiol 2018; 29:3100-3107. [PMID: 30506214 PMCID: PMC6510871 DOI: 10.1007/s00330-018-5788-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/04/2018] [Accepted: 09/21/2018] [Indexed: 12/11/2022]
Abstract
Methods We applied multiparametric MRI to assess changes in liver composition, perfusion and blood flow in 17 patients before direct-acting antiviral (DAA) therapy and after treatment completion (within 12 weeks of last DAA tablet swallowed). Results We observed changes in hepatic composition indicated by a reduction in both liver longitudinal relaxation time (T1, 35 ± 4 ms), transverse relaxation time (T2, 2.5 ± 0.8 ms; T2* 3.0 ± 0.7 ms), and liver perfusion (28.1 ± 19.7 ml/100 g/min) which we suggest are linked to reduced pro-inflammatory milieu, including interstitial oedema, within the liver. No changes were observed in liver or spleen blood flow, splenic perfusion, or superior mesenteric artery blood flow. Conclusion For the first time, our study has shown that treatment of HCV with DAAs in patients with cirrhosis leads to an acute reduction in liver T1, T2 and T2* and an increase in liver perfusion measured using MR parameters. The ability of MRI to characterise changes in the angio-architecture of patients with cirrhosis after intervention in the short term will enhance our understanding of the natural history of regression of liver disease and potentially influence clinical decision algorithms. Key Points • DAAs have revolutionised the treatment of hepatitis C and achieve sustained virological response in over 95% of patients, even with liver cirrhosis. • Currently available non-invasive measures of liver fibrosis are not accurate after HCV treatment with DAAs, this prospective single-centre study has shown that MRI can sensitively measure changes within the liver, which could reflect the reduction in inflammation with viral clearance. • The ability of MRI to characterise changes in structural and haemodynamic MRI measures in the liver after intervention will enhance our understanding of the progression/regression of liver disease and could potentially influence clinical decision algorithms.
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Affiliation(s)
- C Bradley
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - R A Scott
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - E Cox
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - N Palaniyappan
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - B J Thomson
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - S D Ryder
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - W L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - G P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, the University Of Nottingham, Nottingham, UK
| | - I N Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, the University Of Nottingham, Nottingham, UK
| | - S Francis
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK. .,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK.
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Bradley C, Cordaro DT, Zhu F, Vildostegui M, Han RJ, Brackett M, Jones J. Supporting improvements in classroom climate for students and teachers with the four pillars of wellbeing curriculum. Translational Issues in Psychological Science 2018. [DOI: 10.1037/tps0000162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Murphy A, Kirby A, Bradley C. Knowledge is power: general practitioners prescribing of new oral anticoagulants in Ireland. BMC Res Notes 2018; 11:478. [PMID: 30012204 PMCID: PMC6048694 DOI: 10.1186/s13104-018-3597-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE New oral anticoagulants (NOACs) aim to overcome warfarin's shortcomings, however their pharmacokinetic characteristics make prescribing complex. Thus it is imperative that general practitioners (GPs) are aware of specific treatments so as to maximise their benefits and minimise their pitfalls. This study explores GPs attitudes and experiences with prescribing NOACs in Ireland where, despite clear national prescribing guidelines advocating warfarin as first line therapy, the number of patients being prescribed NOACs for the first time is growing. RESULTS Using primary data collected from GPs in Ireland the factors influencing the likelihood of a GP initiating a prescription for a NOAC are determined using a probit model. Results indicate 46% of the sample initiated NOAC prescriptions and GP practice size is a significant factor influencing this. Analysis revealed no difference regarding the sources of information considered important amongst GPs when prescribing new drugs. However, there were differences in which factors were considered important when prescribing anticoagulants between initiating and non-initiating NOAC prescribers. The results of this study suggest better utilisation of existing information and education tools for GPs prescribing NOACs and managing NOAC patients is imperative, to ensure the right anticoagulant is prescribed for the right patient at the right time.
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Affiliation(s)
- A Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
| | - A Kirby
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - C Bradley
- Department of General Practice, College of Medicine, University College Cork, Cork, Ireland
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Khavjou OA, Honeycutt AA, Yarnoff B, Bradley C, Soler R, Orenstein D. Costs of community-based interventions from the Community Transformation Grants. Prev Med 2018; 112:138-144. [PMID: 29678616 DOI: 10.1016/j.ypmed.2018.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/09/2017] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
Limited data are available on the costs of evidence-based community-wide prevention programs. The objective of this study was to estimate the per-person costs of strategies that support policy, systems, and environmental changes implemented under the Community Transformation Grants (CTG) program. We collected cost data from 29 CTG awardees and estimated program costs as spending on labor; consultants; materials, travel, and services; overhead activities; partners; and the value of in-kind contributions. We estimated costs per person reached for 20 strategies. We assessed how per-person costs varied with the number of people reached. Data were collected in 2012-2015, and the analysis was conducted in 2015-2016. Two of the tobacco-free living strategies cost less than $1.20 per person and reached over 6 million people each. Four of the healthy eating strategies cost less than $1.00 per person, and one of them reached over 6.5 million people. One of the active living strategies cost $2.20 per person and reached over 7 million people. Three of the clinical and community preventive services strategies cost less than $2.30 per person, and one of them reached almost 2 million people. Across all 20 strategies combined, an increase of 10,000 people in the number of people reached was associated with a $0.22 reduction in the per-person cost. Results demonstrate that interventions, such as tobacco-free indoor policies, which have been shown to improve health outcomes have relatively low per-person costs and are able to reach a large number of people.
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Affiliation(s)
- Olga A Khavjou
- RTI International, Research Triangle Park, NC, United States.
| | | | | | | | - Robin Soler
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Diane Orenstein
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Roura M, Bradley C, Hannigan A, Basogomba A, Adshead M, LeMaster J, Villarroel N, Romer A, Papyan A, McCarthy S, Nurse D, MacFarlane A. 2.3-O3Unveiling participation of ethnic minorities and other stakeholders in heath research decision-making in Ireland. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Roura
- University of Limerick, Ireland
| | - C Bradley
- Shannon Family Resource Centre, Dublin, Ireland
| | | | - A Basogomba
- Intercultural and Diversity Education Centre, Dublin, Ireland
| | | | - J LeMaster
- Kansas University Medical Centre, United States
| | | | - A Romer
- Shannon Family Resource Centre, Dublin, Ireland
| | - A Papyan
- Shannon Family Resource Centre, Dublin, Ireland
| | - S McCarthy
- Shannon Family Resource Centre, Dublin, Ireland
| | - D Nurse
- Health Service Executive, Dublin, Ireland
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Koblik PD, Whitehair JG, Kass PH, Bradley C, Mathews KG. Fragmented palmar metacarpophalangeal sesamoids in dogs: a long-term evaluation. Vet Comp Orthop Traumatol 2018. [DOI: 10.1055/s-0038-1632666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryLong-term clinical and radiographicresponse to surgical and conservativemanagement of 22 dogs with fragmentedsesamoids was evaluated. Mean follow-up was 3.6 years (range = 3 monthsto 11.0 years).Initial (retrospective) and follow-up(prospective) radiographs of the affectedpalmar sesamoids and associatedmetacarpophalangeal joints were evaluatedusing a graded scoring system. A lameness evaluation and physicalexamination were performed at followupin a blinded manner. In addition,owners were asked to complete a questionnaireregarding their pet’s thoraciclimb lameness.There was not any difference betweengroups (sesamoidectomy, conservativemanagement, incidental finding)in age at onset, duration of lamenessprior to therapy, body weight at treatment, time to follow-up, number ofaffected joints, nor owner perceptionsof whether they thought the lamenessimproved, resolved, or recurred, andwhether or not they were pleased withthe outcome.Sesamoid fragmentation treated bysesamoidectomy resulted in significantlygreater progression of radiographicchanges that were consistentwith degenerative joint disease.Chronic lameness resolved or improvedto the point of owner satisfactionwith conservative therapy in most cases. Continued lameness, or recurrent,although improved lameness associatedwith heavy activity, occurred followingsurgical extirpation of the affectedsesamoids in many cases. Given thesefindings, a more conservative approachto the treatment of chronic lamenessassociated with sesamoid fragmentationmay be warranted.Long-term clinical and radiographic response to surgical and conservative management of 22 dogs with fragmented sesamoids was evaluated. Mean follow-up was 3.6 years. Sesamoid fragmentation treated by sesamoidectomy resulted in significantly greater progression of radiographic changes that were consistent with degenerative joint disease. Chronic lameness resolved or improved to the point of owner satisfaction with conservative therapy in most cases. Continued or recurrent lameness was common following sesamoidectomy. Conservative therapy should be attempted prior to sesamoidectomy for dogs with chronic lameness associated with palmar metacarpophalangeal sesamoid fragmentation.
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Harrison SL, Kouladjian O'Donnell L, Milte R, Dyer SM, Gnanamanickam ES, Bradley C, Liu E, Hilmer SN, Crotty M. Costs of potentially inappropriate medication use in residential aged care facilities. BMC Geriatr 2018; 18:9. [PMID: 29325531 PMCID: PMC5765623 DOI: 10.1186/s12877-018-0704-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 01/01/2018] [Indexed: 01/25/2023] Open
Abstract
Background The potential harms of some medications may outweigh their potential benefits (inappropriate medication use). Despite recommendations to avoid the use of potentially inappropriate medications (PIMs) in older adults, the prevalence of PIM use is high in different settings including residential aged care. However, it remains unclear what the costs of these medications are in this setting. The main objective of this study was to determine the costs of PIMs in older adults living in residential care. A secondary objective was to examine if there was a difference in costs of PIMs in a home-like model of residential care compared to an Australian standard model of care. Methods Participants included 541 participants from the Investigation Services Provided in the Residential Environment for Dementia (INSPIRED) Study. The INSPIRED study is a cross-sectional study of 17 residential aged care facilities in Australia. 12 month medication costs were determined for the participants and PIMs were identified using the 2015 updated Beers Criteria for older adults. Results Of all of the medications dispensed in 1 year, 15.9% were PIMs and 81.4% of the participants had been exposed to a PIM. Log-linear models showed exposure to a PIM was associated with higher total medication costs (Adjusted β = 0.307, 95% CI 0.235 to 0.379, p < 0.001). The mean proportion (±SD) of medication costs that were spent on PIMs in 1 year was 17.5% (±17.8) (AUD$410.89 ± 479.45 per participant exposed to a PIM). The largest PIM costs arose from proton-pump inhibitors (34.4%), antipsychotics (21.0%) and benzodiazepines (18.7%). The odds of incurring costs from PIMs were 52% lower for those residing in a home-like model of care compared to a standard model of care. Conclusions The use of PIMs for older adults in residential care facilities is high and these medications represent a substantial cost which has the potential to be lowered. Further research should investigate whether medication reviews in this population could lead to potential cost savings and improvement in clinical outcomes. Adopting a home-like model of residential care may be associated with reduced prevalence and costs of PIMs. Electronic supplementary material The online version of this article (10.1186/s12877-018-0704-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S L Harrison
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia. .,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.
| | - L Kouladjian O'Donnell
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - R Milte
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Institute for Choice, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - S M Dyer
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - E S Gnanamanickam
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
| | - C Bradley
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Infection & Immunity - Aboriginal Health, SAHMRI, PO Box 11060, Adelaide, SA, 5001, Australia
| | - E Liu
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring Street, Melbourne, VIC, 3000, Australia
| | - S N Hilmer
- NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia.,Kolling Institute of Medical Research, University of Sydney and Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - M Crotty
- Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Level 4, Rehabilitation Building, Flinders Medical Centre, Flinders Drive, Bedford park, SA, 5042, Australia.,NHMRC Cognitive Decline Partnership Centre, University of Sydney, Sydney, NSW, Australia
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Harrison JL, Turek BJ, Brown DC, Bradley C, Callahan Clark J. Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004-2014). J Vet Intern Med 2017; 32:172-180. [PMID: 29131399 PMCID: PMC5787197 DOI: 10.1111/jvim.14866] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
Background Cholangitis in dogs appears to be more common than previously thought, but understanding of the disease remains incomplete. Objective To describe a population of dogs with cholangitis or cholangiohepatitis. Animals Fifty‐four client‐owned dogs with cholangitis or cholangiohepatitis. Methods Medical records of dogs with cholangitis or cholangiohepatitis confirmed by histopathology between January 2004 and December 2014 were identified using a computer‐based search and retrospectively reviewed. Results Clinical signs included vomiting (72.2%), lethargy (70.4%), and inappetence (64.8%). Most dogs (49/50) had increased liver enzyme activities, hyperbilirubinemia (32/50), and hypercholesterolemia (24/43). Ultrasonographic abnormalities of the hepatobiliary system were seen in 84% of cases. On histopathology, 53 of 54 affected dogs had neutrophilic cholangitis (NC) or cholangiohepatitis, whereas 1 dog had lymphocytic cholangitis. Most cases (42/54) were chronic. Evidence of concurrent biliary disease (46.2%) and biliary tract obstruction (42.6%) was common. Seventeen of 36 biliary and 11 of 25 liver cultures were positive for bacterial growth; Escherichia coli and Enterococcus spp. were most common. Median patient survival was 671 days (95% confidence interval [CI]: 114–1,426). On Cox regression, dogs that did not have a cholecystectomy performed had a 2.1 greater hazard for death (P = 0.037; 95% CI: 1.0–4.3) compared to cholecystectomized dogs. Dogs >13 years old had a 5.0 greater hazard for death (P = 0.001; 95% CI: 1.9–13.2) compared to younger dogs. Conclusions and Clinical Significance Chronic NC or cholangiohepatitis was most common. Cholecystitis and biliary tract obstruction often occurred in conjunction with cholangitis. Cholecystectomized dogs had decreased risk of death; thus, cholecystectomy may improve patient outcome.
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Affiliation(s)
- J L Harrison
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - B J Turek
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - D C Brown
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bradley
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Callahan Clark
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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Harrison S, Bradley C, Milte R, Liu E, Kouladjian O’Donnell L, Hilmer S, Crotty M. PSYCHOTROPIC MEDICATIONS AND QUALITY OF LIFE IN RESIDENTIAL AGED CARE FACILITIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Harrison
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - C. Bradley
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - R. Milte
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - E. Liu
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
| | - L. Kouladjian O’Donnell
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- University of Sydney, Sydney, New South Wales, Australia,
| | - S.N. Hilmer
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- University of Sydney, Sydney, New South Wales, Australia,
| | - M. Crotty
- NHMRC Cognitive Decline Partnership Centre, Sydney, New South Wales, Australia,
- Flinders University, Adelaide, South Australia, Australia
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Artymowicz D, Bradley C, Xing B, Newman RC. Adhesion of Oxides Grown in Supercritical Water on Selected Austenitic and Ferritic/Martensitic Alloys. Journal of Nuclear Engineering and Radiation Science 2017. [DOI: 10.1115/1.4035331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A series of austenitic alloys (800H, H214, I625, 310S, and 347) with different surface finishes were exposed to supercritical water (SCW) at 550 °C and 2.5 × 107 Pa for 120 h, 260 h, and 450 h in a static autoclave with an initial level of dissolved oxygen of 8 ppm. Indentation with a hardness indenter was used for assessment of oxide adhesion. This was compared with the results of a similar test on SCW-oxidized ferritic alloys. Delamination in all the tested ferritic alloys was insufficient for quantification of the results but allowed for qualitative comparison within this group. In the set of austenitic alloys, oxide on stainless steel (SS) 347 exfoliated during cooling from 550 °C, and from the remaining four alloys, only oxide on H214 delaminated, which made the qualitative comparison across the whole group impossible. Energy dispersive X-ray spectroscopy (EDX) revealed that under delaminated external Cr2O3 on H214 alloy, there was a submicron thick layer of Al-rich oxide. To investigate a possible oxide spallation on austenitic samples during exposure, mass loss obtained through descaling was compared with mass gain due to SCW exposure. The results indicated that the applied descaling procedure did not, in most cases, fully remove the scale. Apart from one case (SS 347 with alumina surface finish), there was no clear indication of oxide spallation.
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Affiliation(s)
- D. Artymowicz
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada e-mail:
| | - C. Bradley
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - B. Xing
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
| | - R. C. Newman
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada
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Swift R, Cook W, Bradley C, Newman R. Validation of Constant Load C-Ring Apex Stresses for Stress Corrosion Cracking Testing in Supercritical Water. Journal of Nuclear Engineering and Radiation Science 2017. [DOI: 10.1115/1.4034567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In selecting the materials for the Canadian supercritical water-cooled reactor (SCWR), the effects and extent of stress corrosion cracking (SCC) on candidate alloys of construction, under various operational conditions, must be considered. Several methods of applying stress to a corroding material are available for investigating SCC and each have their benefits and drawbacks; for simplicity of the experimental setup at University of New Brunswick (UNB), a constant load C-ring assembly has been used with Inconel 718 Belleville washers acting as a spring to deliver a near-constant load to the sample. To predict the stress at the apex of the C-ring, a mechanistic model has been developed to determine the force applied by the spring due to the thermal expansion of each component constrained within a fixed length when the temperature of the assembly is increased from ambient conditions to SCWR operational temperatures. In an attempt to validate the mechanistic model, trials to measure the force applied by the washers as the assembly thermally expanded were performed using an Instron machine and an environmental chamber. Accounting for the thermal expansion of the pull rods, the force was measured as temperature was increased while maintaining a constant displacement between the platens holding the C-ring. Results showed the initial model to be insufficient as it could not predict the force measured through this simple experiment. The revised model presented here considers the thermal expansion of the C-ring and all the components of the testing apparatus including the tree, backing washers, and Belleville washers. Further validation using the commercial finite element (FE) package abaqus is presented, as are preliminary results from the use of the apparatus to study the SCC of a zirconium-modified 310 s SS exposed to supercritical water.
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Affiliation(s)
- R. Swift
- Department of Chemical Engineering, University of New Brunswick, 15 Dineen Drive, Fredericton, NB E3B 5A3, Canada e-mail:
| | - W. Cook
- Department of Chemical Engineering, University of New Brunswick, 15 Dineen Drive, Fredericton, NB E3B 5A3, Canada e-mail:
| | - C. Bradley
- Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada e-mail:
| | - R.C. Newman
- Chemical Engineering and Applied Chemistry, University of Toronto, 200 College Street, Toronto, ON M5S 3E5, Canada e-mail:
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