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Ewens M, Carroll C, Guenther E. Motivations and barriers to exercise among clinicians. PSYCHOL HEALTH MED 2024; 29:277-285. [PMID: 36576254 DOI: 10.1080/13548506.2022.2162938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
According to Kirk & Rhodes (2011), Nooijen et al. (2018), and Saridi et al. (2019), the motivators and barriers to exercise are influenced by one's occupation, especially among those in the healthcare field. We sought to examine the barriers and motivators to physical activity that are distinctive to clinicians. Community hospital clinicians were surveyed regarding motivators and barriers to exercise that they experience, their burnout levels as described by an adaptation of the Mini-Z single item burnout scale, and average weekly exercise habits. The top barriers and motivators were then correlated to burnout levels, levels of physical activity, and demographics. We received 64 total responses from clinicians. The overall average level of burnout was 2.37 and the median level was 2. Approximately 38% of clinicians reported adhering to American Heart Association (AHA) guidelines of 150 minutes of exercise per week, while 33% of clinicians exercise <75 minutes per week. The top general motivator was for one's own well-being and the top clinician-related motivator was reducing stress. The top two barriers to exercise were COVID-19 concerns at an indoor exercise facility and a lack of time. Higher average levels of burnout were experienced by those who marked being too stressed or too burnt out as barriers to exercise. Because of clinicians' roles in propagating healthy practices in their patients from their own habits, wellness programs should be aimed at capitalizing motivators to combat barriers that this group distinctively experiences. Efforts to improve physical and mental wellness among clinicians will translate into better provider and patient health outcomes.
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Affiliation(s)
- M Ewens
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
| | - C Carroll
- Woodland Clinic Medical Group, CommonSpirit Health, Woodland, CA, USA
| | - E Guenther
- COMP-NW, Western University of Health Sciences, Lebanon, OR, USA
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2
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Steins A, Carroll C, Choong FJ, George AJ, He JS, Parsons KM, Feng S, Man SM, Kam C, van Loon LM, Poh P, Ferreira R, Mann GJ, Gruen RL, Hannan KM, Hannan RD, Schulte KM. Cell death and barrier disruption by clinically used iodine concentrations. Life Sci Alliance 2023; 6:e202201875. [PMID: 36944419 PMCID: PMC10031031 DOI: 10.26508/lsa.202201875] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
Povidone-iodine (PVP-I) inactivates a broad range of pathogens. Despite its widespread use over decades, the safety of PVP-I remains controversial. Its extended use in the current SARS-CoV-2 virus pandemic urges the need to clarify safety features of PVP-I on a cellular level. Our investigation in epithelial, mesothelial, endothelial, and innate immune cells revealed that the toxicity of PVP-I is caused by diatomic iodine (I2), which is rapidly released from PVP-I to fuel organic halogenation with fast first-order kinetics. Eukaryotic toxicity manifests at below clinically used concentrations with a threshold of 0.1% PVP-I (wt/vol), equalling 1 mM of total available I2 Above this threshold, membrane disruption, loss of mitochondrial membrane potential, and abolition of oxidative phosphorylation induce a rapid form of cell death we propose to term iodoptosis. Furthermore, PVP-I attacks lipid rafts, leading to the failure of tight junctions and thereby compromising the barrier functions of surface-lining cells. Thus, the therapeutic window of PVP-I is considerably narrower than commonly believed. Our findings urge the reappraisal of PVP-I in clinical practice to avert unwarranted toxicity whilst safeguarding its benefits.
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Affiliation(s)
- Anne Steins
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Christina Carroll
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Fui Jiun Choong
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Amee J George
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- ANU Centre for Therapeutic Discovery, Australian National University, Acton, Australia
| | - Jin-Shu He
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Kate M Parsons
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Shouya Feng
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Si Ming Man
- Division of Immunology and Infectious Disease, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Cathelijne Kam
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Lex M van Loon
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Perlita Poh
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Rita Ferreira
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
| | - Graham J Mann
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Russell L Gruen
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Katherine M Hannan
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Ross D Hannan
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
| | - Klaus-Martin Schulte
- Division of Genome Sciences and Cancer, The John Curtin School of Medical Research, Australian National University, Acton, Australia
- College of Health and Medicine, Australian National University, Acton, Australia
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Fitzgerald A, Carroll C. Surgical management of injured Australian Defence Force personnel in Afghanistan: what can we learn? ANZ J Surg 2023; 93:800-801. [PMID: 37052055 DOI: 10.1111/ans.18373] [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] [Received: 02/13/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Affiliation(s)
- Ailene Fitzgerald
- Canberra Hospital, Trauma and General Surgery, Canberra, Australian Capital Territory, Australia
| | - Christina Carroll
- Canberra Hospital, Trauma Service, Canberra, Australian Capital Territory, Australia
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4
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Schrag A, Carroll C, Duncan G, Molloy S, Grover L, Hunter R, Brown R, Freemantle N, Whipps J, Serfaty MA, Lewis G. Antidepressants Trial in Parkinson's Disease (ADepT-PD): protocol for a randomised placebo-controlled trial on the effectiveness of escitalopram and nortriptyline on depressive symptoms in Parkinson's disease. BMC Neurol 2022; 22:474. [PMID: 36510237 PMCID: PMC9743717 DOI: 10.1186/s12883-022-02988-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Depressive symptoms are common in patients with Parkinson's disease and depression is a significant predictor of functional impairment, reduced quality of life and general well-being in Parkinson's disease. Despite the high prevalence of depression, evidence on the effectiveness and tolerability of antidepressants in this population is limited. The primary aim of this trial is to establish the clinical and cost effectiveness of escitalopram and nortriptyline for the treatment of depression in Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 408 people with Parkinson's disease with subsyndromal depression, major depressive disorder or persistent depressive disorder and a Beck Depression Inventory-II (BDI-II) score of 14 or above. Participants will be randomised into one of three groups, receiving either escitalopram, nortriptyline or placebo for 12 months. Trial participation is face-to-face, hybrid or remote. The primary outcome measure is the BDI-II score following 8 weeks of treatment. Secondary outcomes will be collected at baseline, 8, 26 and 52 weeks and following withdrawal, including severity of anxiety and depression scores as well as Parkinson's disease motor severity, and ratings of non-motor symptoms, cognitive function, health-related quality of life, levodopa-equivalence dose, changes in medication, overall clinical effectiveness, capability, health and social care resource use, carer health-related quality of life, adverse effects and number of dropouts. DISCUSSION This trial aims to determine the effectiveness of escitalopram and nortriptyline for reducing depressive symptoms in Parkinson's disease over 8 weeks, to provide information on the effect of these medications on anxiety and other non-motor symptoms in PD and on impact on patients and caregivers, and to examine their effect on change in motor severity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03652870 Date of registration - 29th August 2018.
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Affiliation(s)
- A Schrag
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK ,grid.437485.90000 0001 0439 3380Department of Neurology, Royal Free London NHS Foundation Trust, London, UK
| | - C Carroll
- grid.11201.330000 0001 2219 0747Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - G Duncan
- grid.39489.3f0000 0001 0388 0742NHS Lothian, Edinburgh, UK
| | - S Molloy
- grid.417895.60000 0001 0693 2181Department of Neurosciences, Imperial College Healthcare NHS Trust, London, UK
| | - L Grover
- grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - R Hunter
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - R Brown
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - N Freemantle
- grid.83440.3b0000000121901201Comprehensive Clinical Trials Unit, University College London, London, UK
| | - J Whipps
- PPI Representative, Plymouth, UK
| | - M. A Serfaty
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK ,Priory Hospital North London, London, UK
| | - G Lewis
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, London, UK
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Rousham EK, Goudet S, Markey O, Griffiths P, Boxer B, Carroll C, Petherick ES, Pradeilles R. Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis. Adv Nutr 2022; 13:1669-1696. [PMID: 35362512 PMCID: PMC9526862 DOI: 10.1093/advances/nmac032] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/25/2022] [Accepted: 03/25/2022] [Indexed: 01/28/2023] Open
Abstract
This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.
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Affiliation(s)
- E K Rousham
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - S Goudet
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - O Markey
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - P Griffiths
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - B Boxer
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - C Carroll
- School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | - E S Petherick
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, United Kingdom
| | - R Pradeilles
- Centre for Global Health and Human Development, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Affiliation(s)
- C Carroll
- Klamath Center for Conservation Research, Orleans, CA 95556, USA
| | - R F Noss
- Florida Institute for Conservation Science, Melrose, FL 32666, USA
| | - Bruce A Stein
- National Wildlife Federation, Washington, DC 20005, USA
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7
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White P, Boland M, O’Sullivan M, Bambury N, Deignan P, Dean J, Carroll C, Doyle S, Barrett P. Transmission of SARS-CoV-2 arising from international flights arriving in Ireland in December 2020: a descriptive analysis using national surveillance data. Public Health 2022; 204:49-53. [PMID: 35172222 PMCID: PMC8747967 DOI: 10.1016/j.puhe.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/05/2022] [Indexed: 10/25/2022]
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8
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Walsh K, Carroll C, Scharf T, O’Donovan D. 257 POSITIVE HEALTH AND AGING FOR OLDER IRISH TRAVELLERS AND OLDER PEOPLE WHO HAVE EXPERIENCED HOMELESSNESS: LIFE-COURSE MEANINGS AND DETERMINANTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.257] [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: 02/25/2023] Open
Abstract
Abstract
Background
The position of marginalized groups of older people remains neglected in positive health and aging (PHA) agendas, whether they concern healthy, active or positive aging. Questions exist around the meaning of such constructs, and the factors that enable disadvantaged populations to achieve equitable later-life experiences. In focusing on two such groups, this study investigates the constituent dimensions of PHA for older Irish Travellers and older people who have experienced homelessness, and the role of life-course and structural determinants in constructing PHA trajectories for these groups.
Methods
The study involves a multi-method qualitative, participatory voice-led methodology, but the analysis draws primarily on 49 in-depth life-course interviews with the populations.
Results
In addition to five interconnected dimensions of PHA, four determinants related to life-course experiences and structural factors are identified: social relations; material and accommodation circumstances; formal supports and systems; and critical transitions and resilience.
Conclusion
While illustrating the validity of PHA agendas for these groups when understood through their lived experiences, the findings highlight the significant deprivations and risks to rights that must be accounted for to secure meaningful gains in PHA for the groups.
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Affiliation(s)
- K Walsh
- Irish Centre for Social Gerontology, National University of Ireland Galway , Galway, Ireland
| | - C Carroll
- Irish Centre for Social Gerontology, National University of Ireland Galway , Galway, Ireland
| | - T Scharf
- Newcastle University , Newcastle, United Kingdom
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9
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Correction to: Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:37. [PMID: 33685389 PMCID: PMC7941694 DOI: 10.1186/s12862-021-01769-x] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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10
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Affiliation(s)
- C Carroll
- Salford Royal NHS Foundation Trust, Salford, UK
| | - F Young
- Salford Royal NHS Foundation Trust, Salford, UK
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11
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Peach DAH, Carroll C, Meraj S, Gomes S, Galloway E, Balcita A, Coatsworth H, Young N, Uriel Y, Gries R, Lowenberger C, Moore M, Gries G. Nectar-dwelling microbes of common tansy are attractive to its mosquito pollinator, Culex pipiens L. BMC Ecol Evol 2021; 21:29. [PMID: 33593286 PMCID: PMC7885224 DOI: 10.1186/s12862-021-01761-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/14/2022] Open
Abstract
Background There is widespread interkingdom signalling between insects and microbes. For example, microbes found in floral nectar may modify its nutritional composition and produce odorants that alter the floral odor bouquet which may attract insect pollinators. Mosquitoes consume nectar and can pollinate flowers. We identified microbes isolated from nectar of common tansy, Tanacetum vulgare, elucidated the microbial odorants, and tested their ability to attract the common house mosquito, Culex pipiens. Results We collected 19 microbial isolates from T. vulgare nectar, representing at least 12 different taxa which we identified with 16S or 26S rDNA sequencing as well as by biochemical and physiological tests. Three microorganisms (Lachancea thermotolerans, Micrococcus lactis, Micrococcus luteus) were grown on culture medium and tested in bioassays. Only the yeast L. thermotolerans grown on nectar, malt extract agar, or in synthetic nectar broth significantly attracted Cx. pipiens females. The odorant profile produced by L. thermotolerans varied with the nutritional composition of the culture medium. All three microbes grown separately, but presented concurrently, attracted fewer Cx. pipiens females than L. thermotolerans by itself. Conclusions Floral nectar of T. vulgare contains various microbes whose odorants contribute to the odor profile of inflorescences. In addition, L. thermotolerans produced odorants that attract Cx. pipiens females. As the odor profile of L. thermotolerans varied with the composition of the culture medium, we hypothesize that microbe odorants inform nectar-foraging mosquitoes about the availability of certain macro-nutrients which, in turn, affect foraging decisions by mosquitoes.
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Affiliation(s)
- D A H Peach
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada. .,The University of British Columbia, 2329 West Mall, Vancouver, BC, Canada.
| | - C Carroll
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Meraj
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - S Gomes
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - E Galloway
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - A Balcita
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,University of Saskatchewan, 129-72 Campus Drive, Saskatoon, SK, Canada
| | - H Coatsworth
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.,Emerging Pathogens Institute, University of Florida, 2055 Mowry Road, Gainesville, FL, USA
| | - N Young
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - Y Uriel
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - R Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - C Lowenberger
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - M Moore
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
| | - G Gries
- Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada
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Carroll C, Conway R, O'Donnell D, Norton C, Hogan E, Browne M, Buckley CM, Kavanagh P, Martin J, Doyle S. Routine testing of close contacts of confirmed COVID-19 cases - National COVID-19 Contact Management Programme, Ireland, May to August 2020. Public Health 2020; 190:147-151. [PMID: 33386140 PMCID: PMC7577651 DOI: 10.1016/j.puhe.2020.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/10/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The objective of this study was to inform public health practitioners who are designing, adapting and implementing testing and tracing strategies for Coronavirus disease (COVID-19) control. STUDY DESIGN The study design is monitoring and evaluation of a national public health protection programme. METHODS All close contacts of laboratory-confirmed cases of COVID-19 identified between the 19th May and 2nd August were included; secondary attack rates and numbers needed to test were estimated. RESULTS Four thousand five hundred eighty six of 7272 (63%) close contacts of cases were tested with at least one test. The secondary attack rate in close contacts who were tested was 7% (95% Confidence Interval [CI]: 6.3 - 7.8%). At the 'day 0' test, 14.6% (95% CI: 11.6-17.6%) of symptomatic close contacts tested positive compared with 5.2% (95% CI: 4.4-5.9%) of asymptomatic close contacts. CONCLUSIONS The application of additional symptom-based criteria for testing in this high-incidence population (close contacts) is of limited utility because of the low negative predictive value of absence of symptoms.
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Affiliation(s)
- C Carroll
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - R Conway
- Joint First Author; COVID-19 Contact Management Programme, Health Service Executive, Ireland.
| | - D O'Donnell
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - C Norton
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
| | - E Hogan
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - M Browne
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - C M Buckley
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - P Kavanagh
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; Health Intelligence Unit Strategic Planning and Transformation, Dublin, Ireland; Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J Martin
- COVID-19 Contact Management Programme, Health Service Executive, Ireland; National Quality Improvement Team, Health Service Executive, Ireland
| | - S Doyle
- COVID-19 Contact Management Programme, Health Service Executive, Ireland
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Chiu WC, Powers DB, Hirshon JM, Shackelford SA, Hu PF, Chen SY, Chen HH, Mackenzie CF, Miller CH, DuBose JJ, Carroll C, Fang R, Scalea TM. Impact of trauma centre capacity and volume on the mortality risk of incoming new admissions. BMJ Mil Health 2020; 168:212-217. [PMID: 32474436 DOI: 10.1136/bmjmilitary-2020-001483] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Trauma centre capacity and surge volume may affect decisions on where to transport a critically injured patient and whether to bypass the closest facility. Our hypothesis was that overcrowding and high patient acuity would contribute to increase the mortality risk for incoming admissions. METHODS For a 6-year period, we merged and cross-correlated our institutional trauma registry with a database on Trauma Resuscitation Unit (TRU) patient admissions, movement and discharges, with average capacity of 12 trauma bays. The outcomes of overall hospital and 24 hours mortality for new trauma admissions (NEW) were assessed by multivariate logistic regression. RESULTS There were 42 003 (mean=7000/year) admissions having complete data sets, with 36 354 (87%) patients who were primary trauma admissions, age ≥18 and survival ≥15 min. In the logistic regression model for the entire cohort, NEW admission hospital mortality was only associated with NEW admission age and prehospital Glasgow Coma Scale (GCS) and Shock Index (SI) (all p<0.05). When TRU occupancy reached ≥16 patients, the factors associated with increased NEW admission hospital mortality were existing patients (TRU >1 hour) with SI ≥0.9, recent admissions (TRU ≤1 hour) with age ≥65, NEW admission age and prehospital GCS and SI (all p<0.05). CONCLUSION The mortality of incoming patients is not impacted by routine trauma centre overcapacity. In conditions of severe overcrowding, the number of admitted patients with shock physiology and a recent surge of elderly/debilitated patients may influence the mortality risk of a new trauma admission.
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Affiliation(s)
- William C Chiu
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | - D B Powers
- Director, Craniomaxillofacial Trauma Program, Duke University Hospital, Durham, North Carolina, USA
| | - J M Hirshon
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - P F Hu
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - S Y Chen
- National Yunlin University of Science and Technology, Douliou, Taiwan
| | - H H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C F Mackenzie
- Shock Trauma and Anesthesiology Research - Organized Research Center (STAR-ORC), University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - C H Miller
- US Air Force Materiel Command, Wright-Patterson AFB, Ohio, USA
| | - J J DuBose
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,Center for Sustainment of Trauma and Readiness Skills - Baltimore, US Air Force Medical Service, Baltimore, Maryland, USA
| | | | - R Fang
- Surgery, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - T M Scalea
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
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Mc Loughlin L, Carroll C. Vaccination - A Vital Protection. Ir Med J 2020; 113:73. [PMID: 32603569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- L Mc Loughlin
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2
| | - C Carroll
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin 2
- National Clinical Programme in Surgery
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Eke CS, Jammeh E, Li X, Carroll C, Pearson S, Ifeachor E. Identification of Optimum Panel of Blood-based Biomarkers for Alzheimer's Disease Diagnosis Using Machine Learning. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2018:3991-3994. [PMID: 30441233 DOI: 10.1109/embc.2018.8513293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With the increasing number of people living with Alzheimer's disease (AD), there is a need for low-cost and easy to use methods to detect AD early to facilitate access to appropriate care pathways. Neuroimaging biomarkers (such as those based on PET and MRI) and biochemical biomarkers (such as those based on CSF) are recommended by international guidelines to facilitate diagnosis. However, neuroimaging is expensive and may not be widely available and CSF testing is invasive. Bloodbased biomarkers offer the potential for the development of a low-cost and more time efficient tool to detect AD to complement CSF and neuroimaging as blood is much easier to obtain. Although no single blood biomarker is yet able to detect AD, combinations of biomarkers (also called panels) have shown good results. However, a large number of biomarkers are often needed to achieve a satisfactory detection performance. In addition, it is difficult to reproduce reported results within and across different study cohorts because of data overfitting and lack of access to the datasets used in the studies. In this study, our focus is to identify an optimum panel (in terms of the least number of blood biomarkers to meet the specified diagnostic performance of 80% sensitivity and specificity) based on a widely accessible data set, and to demonstrate a testing methodology that reinforces reproducibility of results. Realizing a panel with reduced number of markers will have significant impact on the complexity and cost of diagnosis and potential development of cost-effective point of care devices.
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16
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Carroll C, Dickson R, Boland A, Houten R, Walton M. Decision-making by the NICE Interventional Procedures Advisory Committee. Br J Surg 2019; 106:1769-1774. [PMID: 31654418 DOI: 10.1002/bjs.11334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 07/16/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND This study explored the evidence base for recommendations by the National Institute of Health and Care Excellence (NICE) Interventional Procedures Advisory Committee, the only NICE committee not to consider cost. The four potential recommendations are: Standard Arrangements (can be performed as routine practice in the NHS); Special Arrangements (can be done under certain conditions); Research Only; and Do Not Do. METHODS Quantitative content analysis of data extracted from all published Interventional Procedure Guidance (IPG) for 2003-2018 (n = 496) was undertaken. All data were extracted independently by two researchers; disagreements were clarified by consensus. Data were tabulated, descriptive statistics produced, and regression analyses performed. RESULTS The proportion of IPGs by recommendation was: 50·0 per cent Standard Arrangements; 37·2 per cent Special Arrangements; 11·1 per cent Research Only; and 1·6 per cent Do Not Do. There was a clear trend over time: the proportion of recommendations for Standard Arrangements decreased, whereas the evidence threshold increased. Adjusted mean numbers of patients in the evidence base by recommendation type were: Standard, 4867; Special, 709; Research Only, 386. Regression analyses confirmed that the year of recommendation, numbers of patients and levels of evidence all affected the likely recommendation. CONCLUSION This study suggests that the likelihood of achieving the most positive recommendation (Standard Arrangements) is decreasing, and that this is most likely due to evidential requirements becoming more demanding. These findings are distinct from those reported for other NICE committees, for which the cost and statistical superiority of new therapies are among the drivers of recommendations.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - R Dickson
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - A Boland
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - R Houten
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - M Walton
- Centre for Reviews and Dissemination, University of York, York, UK
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17
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Rogers SN, Swain A, Carroll C, Lowe D. Incidence, timing, presentation, treatment, and outcomes of second primary head and neck squamous cell carcinoma after oral cancer. Br J Oral Maxillofac Surg 2019; 57:1074-1080. [PMID: 31611034 DOI: 10.1016/j.bjoms.2019.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
After their initial presentation of oral squamous cell carcinoma (SCC), patients have a lifelong risk of developing another new SCC of the head and neck. The aim of this study was to establish second primary rates, baseline characteristics (site, clinical or pathological stage, and smoking and alcohol history), timing, presentation, treatment, and outcomes. From the regional unit we analysed records of patients treated with curative intent for their first oral cancer between 2002 and 2007 inclusive. All patients had had at least 10 years of follow up either to death or the end of 2017. A total of 347 patients had been treated with curative intent, and of them, 29 had a second primary at a median (IQR) of 52 (30-79) months after the index operation. The incidence of developing a second primary tumour within two years was 1.7% (95% CI: 0.7% to 3.7%), within five years was 4.9% (95% CI: 2.9% to 7.7%), and within 10 years was 7.8% (95% CI: 5.1% to 11.1%). Early stage of first cancer was the only significant factor (p=0.001) for development of a second primary within 10 years, reflecting survivorship. Most second primaries (21 patients) were staged as early, and by visual inspection. Most (n=20) were within the oral cavity, one of which overlapped the oropharynx; eight others were in the oropharynx, and one in the larynx. Most patients (n=22) were treated by operation with curative intent. Three were treated palliatively. Patients need to be aware of the risk of a second primary and, as most are in the mouth or oropharynx, there is a role for surveillance by primary dental care practitioners.
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Affiliation(s)
- S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK; Liverpool Head and Neck Centre, Aintree University Hospital, Liverpool, L9 1AE, UK.
| | - A Swain
- Medical School, Liverpool University, Cedar House, Ashton Street, Liverpool, L69 3GE, UK.
| | - C Carroll
- Medical School, Liverpool University, Cedar House, Ashton Street, Liverpool, L69 3GE, UK.
| | - D Lowe
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, UK.
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Walton MJ, O'Connor J, Carroll C, Claxton L, Hodgson R. A Review of Issues Affecting the Efficiency of Decision Making in the NICE Single Technology Appraisal Process. Pharmacoecon Open 2019; 3:403-410. [PMID: 30617953 PMCID: PMC6710310 DOI: 10.1007/s41669-018-0113-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Escalating demands upon the National Institute for Health and Care Excellence's (NICE's) Single Technology Appraisal (STA) programme require a 2.5-times increase upon 2015 capacity by 2020. This additional strain on committee resources threatens to compromise the rigour of the STA process. In 2018, NICE introduced changes to the appraisal process, aiming to expedite final decisions, including consultation opportunities prior to the company's evidence submission, a 'Technical Engagement' stage prior to the first committee meeting, and powers for committee chairs to recommend technologies without a second formal meeting. OBJECTIVE This study reviews recent STAs and aims to understand why appraisals require multiple meetings, and whether recent reforms can address the underlying issues. METHODS NICE STAs published between January 2010 and January 2018 were reviewed, excluding updates or re-considerations. Data on cost, clinical, and decision-making outcomes from 146 appraisals were extracted and analysed thematically. RESULTS Drugs for advanced cancers were least likely to be recommended (28/43 [65.1%] vs 71/74 [96%] for non-cancer) and took longer (2.36 meetings for a final decision vs 1.97 for non-cancer). The academic review increased upon the company's base-case incremental cost-effectiveness ratio by a median of 32.7%. Eighty-four technologies (57.5%) received a negative preliminary recommendation, deferring a final decision by an average of 142 days. Of these, 85.1% were not considered cost-effective. Uncertainty in economic (34.3%) and clinical (22.3%) data also prevented a positive decision. The majority (72.6% [61/84]) of negative preliminary decisions were overturned following further committee discussion; important considerations were Patient Access Schemes, decision optimisation, and the Cancer Drugs Fund. CONCLUSIONS Value considerations are the primary driver of negative preliminary recommendations. It is unclear if new opportunities for additional interaction between NICE, review groups, and manufacturers will meaningfully improve the efficiency of the appraisal process, particularly given the proportion of technologies requiring further committee discussion for decision optimisation or admission into the CDF.
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Affiliation(s)
- M J Walton
- Centre for Reviews and Dissemination, University of York, York, UK.
| | - J O'Connor
- Centre for Reviews and Dissemination, University of York, York, UK
| | - C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - L Claxton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - R Hodgson
- Centre for Reviews and Dissemination, University of York, York, UK
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Carroll C, Encarnacion A, Khan M, Fisher A, Rodriguez K. ELUCIDATING THE ROLE OF SMALL HEAT SHOCK PROTEIN 25 IN PROTEIN AGGREGATION. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Martinez-Martin P, Rizos AM, Wetmore J, Antonini A, Odin P, Pal S, Sophia R, Carroll C, Martino D, Falup-Pecurariu C, Kessel B, Andrews T, Paviour D, Trenkwalder C, Chaudhuri KR. First comprehensive tool for screening pain in Parkinson's disease: the King's Parkinson's Disease Pain Questionnaire. Eur J Neurol 2018; 25:1255-1261. [PMID: 29806962 DOI: 10.1111/ene.13691] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 01/04/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Pain is highly prevalent in Parkinson's disease (PD), impacting patients' ability, mood and quality of life. Detecting the presence of pain in its multiple modalities is necessary for adequate personalized management of PD. A 14-item, PD-specific, patient-based questionnaire (the King's Parkinson's Disease Pain Questionnaire, KPPQ) was designed corresponding to the rater-based KPP Scale (KPPS). The present multicentre study was aimed at testing the validity of this screening tool. METHODS First, a comparison between the KPPQ scores of patients and matched controls was performed. Next, convergent validity, reproducibility (test-retest) and diagnostic performance of the questionnaire were analysed. RESULTS Data from 300 patients and 150 controls are reported. PD patients declared significantly more pain symptoms than controls (3.96 ± 2.56 vs. 2.17 ± 1.39; P < 0.0001). The KPPQ convergent validity was high with KPPS total score (rS = 0.80) but weak or moderate with other pain assessments. Test-retest reliability was satisfactory with kappa values ≥0.65 except for item 5, Dyskinetic pains (κ = 0.44), and the intraclass correlation coefficient (ICC) for the KPPQ total score was 0.98. After the scores of the KPPS were adapted for screening (0, no symptom; ≥1, symptom present), a good agreement was found between the KPPQ and the KPPS (ICC = 0.88). A strong correlation (rS = 0.80) between the two instruments was found. The diagnostic parameters of the KPPQ were very satisfactory as a whole, with a global accuracy of 78.3%-98.3%. CONCLUSIONS These results suggest that the KPPQ is a useful, reliable and valid screening instrument for pain in PD to advance patient-related outcomes.
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Affiliation(s)
- P Martinez-Martin
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain.,Center for Networked Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain
| | - A M Rizos
- Institute of Psychiatry, Psychology & Neuroscience at King's College, King's College Hospital NHS Foundation Trust, London, UK
| | - J Wetmore
- National Center of Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - A Antonini
- Neurology, University of Padua, Venice, Italy
| | - P Odin
- Neurology, University of Lund, Lund, Sweden
| | - S Pal
- Neurology, Forth Valley Royal Hospital, Larbert, Scotland, UK
| | - R Sophia
- Geriatric Medicine, Yeovil Hospital, Somerset, UK
| | - C Carroll
- Neurology, Derriford Hospital, Plymouth, UK
| | - D Martino
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | | | - B Kessel
- Medicine for the Elderly, Princess Royal University Hospital site, King's College Hospital, Kent, UK
| | - T Andrews
- Neurology, Guy's Hospital, London, UK
| | - D Paviour
- Neurology, St Georges's Hospital, London, UK
| | - C Trenkwalder
- Department of Neurosurgery, University Medical Center, Goettingen, Germany
| | - K R Chaudhuri
- Institute of Psychiatry, Psychology & Neuroscience at King's College, King's College Hospital NHS Foundation Trust, London, UK
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Jammeh E, Zhao P, Carroll C, Pearson S, Ifeachor E. Identification of blood biomarkers for use in point of care diagnosis tool for Alzheimer's disease. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2016:2415-2418. [PMID: 28268812 DOI: 10.1109/embc.2016.7591217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Early diagnosis of Alzheimer's Disease (AD) is widely regarded as necessary to allow treatment to be started before irreversible damage to the brain occur and for patients to benefit from new therapies as they become available. Low-cost point-of-care (PoC) diagnostic tools that can be used to routinely diagnose AD in its early stage would facilitate this, but such tools require reliable and accurate biomarkers. However, traditional biomarkers for AD use invasive cerebrospinal fluid (CSF) analysis and/or expensive neuroimaging techniques together with neuropsychological assessments. Blood-based PoC diagnostics tools may provide a more cost and time efficient way to assess AD to complement CSF and neuroimaging techniques. However, evidence to date suggests that only a panel of biomarkers would provide the diagnostic accuracy needed in clinical practice and that the number of biomarkers in such panels can be large. In addition, the biomarkers in a panel vary from study to study. These issues make it difficult to realise a PoC device for diagnosis of AD. An objective of this paper is to find an optimum number of blood biomarkers (in terms of number of biomarkers and sensitivity/specificity) that can be used in a handheld PoC device for AD diagnosis. We used the Alzheimer's disease Neuroimaging Initiative (ADNI) database to identify a small number of blood biomarkers for AD. We identified a 6-biomarker panel (which includes A1Micro, A2Macro, AAT, ApoE, complement C3 and PPP), which when used with age as covariate, was able to discriminate between AD patients and normal subjects with a sensitivity of 85.4% and specificity of 78.6%.
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Drayson J, Kaur Y, Williams L, Woodbridge S, Carroll C. 11EXPERIENCE OF SETTING UP A HOSPITAL CARERS CAFE IN SALISBURY DISTRICT HOSPITAL. Age Ageing 2017. [DOI: 10.1093/ageing/afx115.11] [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: 11/14/2022] Open
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Heptinstall L, Carroll C, Siddiqi J, Kamel D, Petkar M. Sclerosing Mucoepidermoid Carcinoma of the Submandibular Gland Presenting as Chronic Sialadenitis: A Case Report and Review of Literature. Head Neck Pathol 2017; 11:506-512. [PMID: 28516348 PMCID: PMC5677076 DOI: 10.1007/s12105-017-0821-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/19/2017] [Accepted: 05/04/2017] [Indexed: 11/28/2022]
Abstract
Sclerosing mucoepidermoid carcinoma of the salivary gland (SMEC) is a rare subtype of mucoepidermoid carcinoma (MEC), first described in 1987 by Chan and Saw. As far as we are aware, only 30 cases have been published since then. Most cases were located in the parotid gland with some cases described in the submandibular and minor salivary glands. SMEC typically presents as a long-standing mass, with a non-specific enhancing appearance on imaging and is often non-diagnostic on fine needle aspiration, making pre-operative diagnosis very difficult. It is characterised by dense sclerosis within an otherwise typical MEC, frequently with lymphoid proliferation and eosinophils at the periphery. The histological diagnosis of SMEC can be challenging, as the sclerosis may obscure the other morphological features, which can lead to misdiagnosis. Grading can also be difficult, and the prognostic value of grading for SMEC remains unclear. Herein is described a new case of SMEC, presenting clinically as chronic sialadenitis in the left submandibular gland of a 41 year old male. A brief literature review and the issues surrounding diagnosis and grading are also discussed.
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Affiliation(s)
- L. Heptinstall
- Department of Histopathology, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET UK
| | - C. Carroll
- Department of Oral and Maxillofacial Surgery, Basildon University Hospital, Basildon, UK
| | - J. Siddiqi
- Department of Oral and Maxillofacial Surgery, Basildon University Hospital, Basildon, UK
| | - D. Kamel
- Department of Histopathology, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET UK
| | - M. Petkar
- Department of Histopathology, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET UK
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McCormick B, Hannan J, Huot-Marchand J, Carroll C, Carrier S, deBlois D, Hale T. 058 Bradykinin B1 Receptor Antagonism Prevents Angiotensin II-Induced Erectile Dysfunction. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2016.12.072] [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: 11/27/2022]
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Dave N, Brunet B, Carroll C, Abdul-Rahman O, Famuyide M. P188 Unique heterozygous presentation in an infant with DNA Ligase IV syndrome. Ann Allergy Asthma Immunol 2016. [DOI: 10.1016/j.anai.2016.09.199] [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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Carroll C, Olsen KD, Chaston JM, Robinson TF. 1694 Dietary effects of grass hay and alfalfa hay on the digestive microbiome of the alpaca. J Anim Sci 2016. [DOI: 10.2527/jam2016-1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lambert L, Azzi L, Harvey R, Kouz S, Maire S, Racine N, Rinfret S, Ross D, Segal E, Déry J, L'Allier P, Boothroyd L, Carroll C, Beauchamp C, Bogaty P. A COMPARISON OF QUALITY OF CARE OF PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION BY CHOICE OF REPERFUSION STRATEGY: RESULTS OF A QUÉBEC-WIDE, SYSTEMATIC FIELD EVALUATION (2013-14). Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.322] [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: 11/24/2022] Open
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Daly N, Carroll C, Flynn I, Harley R, Maguire PJ, Turner MJ. Evaluation of point-of-care maternal glucose measurements for the diagnosis of gestational diabetes mellitus. BJOG 2016; 124:1746-1752. [DOI: 10.1111/1471-0528.14255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- N Daly
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - C Carroll
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - I Flynn
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - R Harley
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - PJ Maguire
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
| | - MJ Turner
- UCD Centre for Human Reproduction; Coombe Women and Infants University Hospital; Dublin Ireland
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Lambert L, Boothroyd L, Azzi L, Segal E, Ross D, Maire S, Harvey R, Racine N, Kouz S, L'Allier P, Rinfret S, Carroll C, Beauchamp C, Bogaty P. PRIMARY ANGIOPLASTY TREATMENT DELAYS AFTER THE IMPLEMENTATION OF A PROVINCE-WIDE PREHOSPITAL ECG PROGRAM. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.032] [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: 10/22/2022] Open
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Lambert L, Azzi L, Harvey R, Kouz S, L'Allier P, Maire S, Racine N, Rinfret S, Ross D, Segal E, Carroll C, Beauchamp C, Boothroyd L, Bogaty P. TREATMENT DELAYS ON HOURS VERSUS OFF HOURS IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION ACROSS ALL HOSPITALS PERFORMING PRIMARY ANGIOPLASTY IN QUÉBEC, CANADA: RESULTS OF A THIRD FIELD EVALUATION. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.036] [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: 10/22/2022] Open
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Kosnik-Infinger L, Carroll C, Greiner H, Leach J, Mangano FT. Management of cerebral cavernous malformations in the pediatric population: a literature review and case illustrations. J Neurosurg Sci 2015; 59:283-294. [PMID: 25998208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cavernous malformations (CM) are vascular malformations of the central nervous system that may occur in the brain and spinal cord. They are one of the four major types of vascular malformations that also includes developmental venous anomalies (DVA)s, arteriovenous malformations (AVMs), and capillary telangiectasias. CMs are a common vascular malformation, and 25% of them occur in the pediatric age group. They can present with acute or chronic symptoms including headache, neurologic deficits secondary to hemorrhage, mass effect, or epilepsy. This review will focus on the neurosurgical management of intracranial cavernous malformations in children. Pediatric CMs have special considerations different from CM that occur in the adult population which are highlighted throughout this review. Characteristics specific to pediatric CM epidemiology, genetics, presentation, pathology, location, size, epilepsy, and management will be discussed. Specific considerations must be entertained with the diagnosis of pediatric CM in that management needs to include consideration of the lifetime risk of hemorrhage, as well as the possibility of development of epilepsy. If in an accessible location, most cavernomas should be surgically removed in a timely fashion to provide lifelong cure for pediatric patients. The review closes with the discussion of two interesting cavernous malformation cases occurring in a 12-year old male and a 12-year old female that exhibit many of the important aspects specific to the management of a pediatric patient with CM, highlighting the importance of a multidisciplinary approach to treatment.
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Affiliation(s)
- L Kosnik-Infinger
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital, Cincinnati, OH, USA -
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Chaudhuri KR, Rizos A, Trenkwalder C, Rascol O, Pal S, Martino D, Carroll C, Paviour D, Falup-Pecurariu C, Kessel B, Silverdale M, Todorova A, Sauerbier A, Odin P, Antonini A, Martinez-Martin P. King's Parkinson's disease pain scale, the first scale for pain in PD: An international validation. Mov Disord 2015; 30:1623-31. [DOI: 10.1002/mds.26270] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 04/02/2015] [Accepted: 04/13/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- K. Ray Chaudhuri
- King's College Hospital; London UK
- King's College London; London UK
- University Hospital Lewisham; London UK
| | - A. Rizos
- King's College Hospital; London UK
| | | | - O. Rascol
- Clinical Investigation Center 1436 and Departments of Clinical Pharmacology and Neurosciences, INSERM and University Hospital of Toulouse; Toulouse France
| | - S. Pal
- Forth Valley Royal Hospital; Scotland UK
| | - D. Martino
- Lewisham & Greenwich NHS Trust; London UK
| | - C. Carroll
- Plymouth University and Plymouth Hospitals NHS Trust; Plymouth UK
| | | | | | - B. Kessel
- Princess Royal University Hospital site; King's College Hospital; Orpington UK
| | - M. Silverdale
- Greater Manchester Neuroscience Centre; Manchester UK
| | | | | | - P. Odin
- University of Lund; Lund Sweden
- Klinikum Bremerhaven Reinkenheide; Bremerhaven Germany
| | - A. Antonini
- Parkinson and Movement Disorders Unit; IRCCS Hospital San Camillo; Venice Italy
| | - P. Martinez-Martin
- National Center of Epidemiology and CIBERNED; Carlos III Institute of Health; Madrid Spain
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Carroll C, Beecroft C, Miller L. The Future of Education In HTA and Health Economics. Value Health 2014; 17:A436. [PMID: 27201157 DOI: 10.1016/j.jval.2014.08.1123] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Carroll
- The University of Sheffield, Sheffield, UK
| | - C Beecroft
- The University of Sheffield, Sheffield, UK
| | - L Miller
- The University of Sheffield, Sheffield, UK
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Tappenden P, Harnan S, Uttley L, Mildred M, Carroll C, Cantrell A. Colistimethate sodium powder and tobramycin powder for inhalation for the treatment of chronic Pseudomonas aeruginosa lung infection in cystic fibrosis: systematic review and economic model. Health Technol Assess 2014; 17:v-xvii, 1-181. [PMID: 24290164 DOI: 10.3310/hta17560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cystic fibrosis (CF) is an inherited condition characterised by the abnormal transport of chloride ions across transporting epithelia. This leads to the production of thick sticky mucus in the lungs, pancreas, liver, intestine and reproductive tract, and an increase in the salt content in sweat. Among other problems, people with CF experience recurrent respiratory infections and have difficulties digesting food. CF affects over 9000 individuals in the UK. CF shortens life expectancy and adversely affects quality of life. In 2010, CF was recorded as the cause of 103 deaths in England and Wales. OBJECTIVE To evaluate the clinical effectiveness and cost-effectiveness of colistimethate sodium dry powder for inhalation (DPI) (Colobreathe(®), Forest Laboratories) and tobramycin DPI (TOBI Podhaler(®), Novartis Pharmaceuticals) for the treatment of Pseudomonas aeruginosa lung infection in CF. DATA SOURCES Electronic databases were searched in February and March 2011 [MEDLINE, MEDLINE In-Process & Other Non-Indexed citations, EMBASE, The Cochrane Library databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Conference Proceedings Citation Index (CPCI) and Bioscience Information Service (BIOSIS) Previews]. Relevant databases were searched for ongoing and unpublished studies, and bibliographies of relevant systematic reviews and the manufacturers' submissions were also hand-searched. REVIEW METHODS A systematic review of the clinical effectiveness and cost-effectiveness of colistimethate sodium DPI and tobramycin DPI for the treatment of chronic P. aeruginosa lung infection in CF was conducted. Existing economic evidence within the literature was reviewed and a de novo health economic model was also developed. RESULTS Three randomised controlled trials (RCTs) were included in the clinical effectiveness review. Both colistimethate sodium DPI and tobramycin DPI were reported to be non-inferior to nebulised tobramycin for the outcome forced expiratory volume in first second percentage predicted (FEV1%). It was not possible to draw any firm conclusions as to the relative efficacy of colistimethate sodium DPI compared with tobramycin DPI. The economic analysis suggests that colistimethate sodium DPI produces fewer quality-adjusted life-years (QALYs) than nebulised tobramycin. Given the incremental discounted lifetime cost of tobramycin DPI compared with nebulised tobramycin, it highly unlikely that tobramycin DPI has an incremental cost-effectiveness ratio that is better than £30,000 per QALY gained. LIMITATION The uncertainty surrounding the short-term evidence base inevitably results in uncertainty surrounding the long-term clinical effectiveness and cost-effectiveness of colistimethate sodium DPI. CONCLUSIONS Both DPI formulations have been shown to be non-inferior to nebulised tobramycin as measured by FEV1%. The results of these trials should be interpreted with caution owing to the means by which the results were analysed, the length of follow-up, and concerns about the ability of FEV1% to accurately represent changes in lung health. Although the increase in QALYs is expected to be lower with colistimethate sodium DPI than with nebulised tobramycin, a price for this intervention had not been agreed at the time of the assessment. Depending on the price of colistimethate sodium DPI, this results either in a situation whereby colistimethate sodium DPI is dominated by nebulised tobramycin or in one whereby the incremental cost-effectiveness of nebulised tobramycin compared with colistimethate sodium DPI is in the range of £24,000-277,000 per QALY gained. The economic analysis also suggests that, given its price, it is unlikely that tobramycin DPI has a cost-effectiveness ratio of < £30,000 per QALY gained when compared with nebulised tobramycin. A RCT to assess the longer-term (≥ 12 months) efficacy of colistimethate sodium DPI and tobramycin DPI in comparison with nebulised treatments would be beneficial. Such a study should include the direct assessment of HRQoL using a relevant preference-based instrument. Future studies should ensure that the European Medicines Agency guidelines are adhered to. In addition, high-quality research concerning the relationship between forced expiratory volume in first second % (FEV1%) predicted or other measures of lung function and survival/health-related quality of life (HRQoL) would be useful. STUDY REGISTRATION PROSPERO CRD42011001350. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- P Tappenden
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Cantrell A, Michaels J. Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins. Br J Surg 2014; 101:1040-52. [PMID: 24964976 DOI: 10.1002/bjs.9566] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/27/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND A Health Technology Assessment was conducted to evaluate the relative clinical effectiveness and cost-effectiveness of minimally invasive techniques (foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA)) for managing varicose veins, in comparison with traditional surgery. METHODS A systematic review of randomized clinical trials (RCTs) was undertaken to assess the effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search conducted in July 2011 identified 1453 unique citations: 31 RCTs (51 papers) satisfied the criteria for effectiveness review. Differences between treatments were negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Total FS costs were estimated to be lowest, and FS was marginally more effective than surgery. However, relative effectiveness was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs were similar to those for surgery. These findings are subject to various uncertainties, including the risk of bias present in the evidence base and variation in reported costs. CONCLUSION This assessment of currently available evidence suggests there is little to choose between surgery and the minimally invasive techniques in terms of efficacy or safety, so the relative cost of the treatments becomes one of the deciding factors. High-quality RCT evidence is needed to verify and further inform these findings.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Everson-Hock E, Cantrell A, Stevenson M, Michaels J. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2014; 17:i-xvi, 1-141. [PMID: 24176098 DOI: 10.3310/hta17480] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. OBJECTIVE The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. DATA SOURCES A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. REVIEW METHODS A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. LIMITATIONS The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. CONCLUSIONS This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. STUDY REGISTRATION PROSPERO number CRD42011001355. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Carroll
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
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Ongondo FO, Williams ID, Dietrich J, Carroll C. ICT reuse in socio-economic enterprises. Waste Manag 2013; 33:2600-2606. [PMID: 24045170 DOI: 10.1016/j.wasman.2013.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/07/2013] [Accepted: 08/23/2013] [Indexed: 06/02/2023]
Abstract
In Europe, socio-economic enterprises such as charities, voluntary organisations and not-for-profit companies are involved in the repair, refurbishment and reuse of various products. This paper characterises and analyses the operations of socio-economic enterprises that are involved in the reuse of Information and Communication Technology (ICT) equipment. Using findings from a survey, the paper specifically analyses the reuse activities of socio-economic enterprises in the U.K. from which Europe-wide conclusions are drawn. The amount of ICT products handled by the reuse organisations is quantified and potential barriers and opportunities to their operations are analysed. By-products from reuse activities are discussed and recommendations to improve reuse activities are provided. The most common ICT products dealt with by socio-economic enterprises are computers and related equipment. In the U.K. in 2010, an estimated 143,750 appliances were reused. However, due to limitations in data, it is difficult to compare this number to the amount of new appliances that entered the U.K. market or the amount of waste electrical and electronic equipment generated in the same period. Difficulties in marketing products and numerous legislative requirements are the most common barriers to reuse operations. Despite various constraints, it is clear that organisations involved in reuse of ICT could contribute significantly to resource efficiency and a circular economy. It is suggested that clustering of their operations into "reuse parks" would enhance both their profile and their products. Reuse parks would also improve consumer confidence in and subsequently sales of the products. Further, it is advocated that industrial networking opportunities for the exchange of by-products resulting from the organisations' activities should be investigated. The findings make two significant contributions to the current literature. One, they provide a detailed insight into the reuse operations of socio-economic enterprises. Previously unavailable data has been presented and analysed. Secondly, new evidence about the by-products/materials resulting from socio-economic enterprises' reuse activities has been obtained. These contributions add substantially to our understanding of the important role of reuse organisations.
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Affiliation(s)
- F O Ongondo
- Centre for Environmental Sciences, Faculty of Engineering and the Environment, Lanchester Building, University of Southampton, University Rd., Highfield, Southampton, Hampshire SO17 1BJ, UK.
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Fishwick D, Carroll C, McGregor M, Drury M, Webster J, Bradshaw L, Rick J, Leaviss J. Smoking cessation in the workplace. Occup Med (Lond) 2013; 63:526-36. [DOI: 10.1093/occmed/kqt107] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lambert L, Xiao Y, Carrier M, Langlois Y, Voisine P, Carroll C, Beauchamp C, Morin J, Bogaty P. Characteristics and Outcomes of Patients Who Underwent Multi-Vessel Coronary Bypass Surgery in Québec, 2010-2012. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.408] [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: 11/27/2022] Open
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Muhammad A, Mychasiuk R, Hosain S, Nakahashi A, Carroll C, Gibb R, Kolb B. Training on motor and visual spatial learning tasks in early adulthood produces large changes in dendritic organization of prefrontal cortex and nucleus accumbens in rats given nicotine prenatally. Neuroscience 2013; 252:178-89. [PMID: 23968593 DOI: 10.1016/j.neuroscience.2013.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/01/2013] [Accepted: 08/09/2013] [Indexed: 11/30/2022]
Abstract
Experience-dependent plasticity is an ongoing process that can be observed and measured at multiple levels. The first goal of this study was to examine the effects of prenatal nicotine on the performance of rats in three behavioral tasks (elevated plus maze (EPM), Morris water task (MWT), and Whishaw tray reaching). The second goal of this experiment sought to examine changes in dendritic organization following exposure to the behavioral training paradigm and/or low doses of prenatal nicotine. Female Long-Evans rats were administered daily injections of nicotine for the duration of pregnancy and their pups underwent a regimen of behavioral training in early adulthood (EPM, MWT, and Whishaw tray reaching). All offspring exposed to nicotine prenatally exhibited substantial increases in anxiety. Male offspring also showed increased efficiency in the Whishaw tray-reaching task and performed differently than the other groups in the probe trial of the MWT. Using Golgi-Cox staining we examined the dendritic organization of the medial and orbital prefrontal cortex as well as the nucleus accumbens. Participation in the behavioral training paradigm was associated with dramatic reorganization of dendritic morphology and spine density in all brain regions examined. Although both treatments (behavior training and prenatal nicotine exposure) markedly altered dendritic organization, the effects of the behavioral experience were much larger than those of the prenatal drug exposure, and in some cases interacted with the drug effects.
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Affiliation(s)
- A Muhammad
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4, Canada
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Carroll C, Clare I, Watson P, Hawkins M, Spoudeas H, Walker D, Holland A, Ring H. EFFECTS OF EARLY CHILDHOOD POSTERIOR FOSSA TUMOURS ON IQ. Journal of Neurology, Neurosurgery & Psychiatry 2013. [DOI: 10.1136/jnnp-2013-306103.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Goodacre S, Thokala P, Carroll C, Stevens JW, Leaviss J, Al Khalaf M, Collinson P, Morris F, Evans P, Wang J. Systematic review, meta-analysis and economic modelling of diagnostic strategies for suspected acute coronary syndrome. Health Technol Assess 2013; 17:v-vi, 1-188. [PMID: 23331845 DOI: 10.3310/hta17010] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current practice for suspected acute coronary syndrome (ACS) involves troponin testing 10-12 hours after symptom onset to diagnose myocardial infarction (MI). Patients with a negative troponin can be investigated further with computed tomographic coronary angiography (CTCA) or exercise electrocardiography (ECG). OBJECTIVES We aimed to estimate the diagnostic accuracy of early biomarkers for MI, the prognostic accuracy of biomarkers for major adverse cardiac adverse events (MACEs) in troponin-negative patients, the diagnostic accuracy of CTCA and exercise ECG for coronary artery disease (CAD) and the prognostic accuracy of CTCA and exercise ECG for MACEs in patients with suspected ACS. We then aimed to estimate the cost-effectiveness of using alternative biomarker strategies to diagnose MI, and using biomarkers, CTCA and exercise ECG to risk-stratify troponin-negative patients. DATA SOURCES We searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations; Cumulative Index of Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, Cochrane Central Database of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), NHS Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment database from 1985 (CTCA review) or 1995 (biomarkers review) to November 2010, reviewed citation lists and contacted experts to identify relevant studies. REVIEW METHODS Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and prognostic studies using a framework adapted for the project. Meta-analysis was conducted using bayesian Markov chain Monte Carlo simulation. We developed a decision-analysis model to evaluate the cost-effectiveness of alternative biomarker strategies to diagnose MI, and the cost-effectiveness of biomarkers, CTCA or exercise ECG to risk-stratify patients with a negative troponin. Strategies were applied to a theoretical cohort of patients with suspected ACS. Cost-effectiveness was estimated as the incremental cost per quality-adjusted life-year (QALY) of each strategy compared with the next most effective, taking a health-service perspective and a lifetime horizon. RESULTS Sensitivity and specificity (95% predictive interval) were 77% (29-96%) and 93% (46-100%) for troponin I, 80% (33-97%) and 91% (53-99%) for troponin T (99th percentile threshold), 81% (50-95%) and 80% (26-98%) for quantitative heart-type fatty acid-binding protein (H-FABP), 68% (11-97%) and 92% (20-100%) for qualitative H-FABP, 77% (19-98%) and 39% (2-95%) for ischaemia-modified albumin and 62% (35-83%) and 83% (35-98%) for myoglobin. CTCA had 94% (61-99%) sensitivity and 87% (16-100%) specificity for CAD. Positive CTCA and positive-exercise ECG had relative risks of 5.8 (0.6-24.5) and 8.0 (2.3-22.7) for MACEs. In most scenarios in the economic analysis presentation, high-sensitivity troponin measurement was the most effective strategy with an incremental cost-effectiveness ratio (ICER) of less than the £20,000-30,000/QALY threshold (ICER £7487-17,191/QALY). CTCA appeared to be the most cost-effective strategy for patients with a negative troponin, with an ICER of £11,041/QALY. However, when a lower MACE rate was assumed, CTCA had a high ICER (£262,061/QALY) and the no-testing strategy was optimal. LIMITATIONS There was substantial variation between the primary studies and heterogeneity in their results. Findings of the economic model were dependent on assumptions regarding the value of detecting and treating positive cases. CONCLUSIONS Although presentation troponin has suboptimal sensitivity, measurement of a 10-hour troponin level is unlikely to be cost-effective in most scenarios compared with a high-sensitivity presentation troponin. CTCA may be a cost-effective strategy for troponin-negative patients, but further research is required to estimate the effect of CTCA on event rates and health-care costs. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- S Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Mychasiuk R, Muhammad A, Carroll C, Kolb B. Does prenatal nicotine exposure alter the brain's response to nicotine in adolescence? A neuroanatomical analysis. Eur J Neurosci 2013; 38:2491-503. [DOI: 10.1111/ejn.12245] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/21/2013] [Accepted: 04/03/2013] [Indexed: 11/30/2022]
Affiliation(s)
- R. Mychasiuk
- Canadian Centre for Behavioural Neurosciences; University of Lethbridge; Lethbridge; AB; Canada; T1K 3M4
| | - A. Muhammad
- Canadian Centre for Behavioural Neurosciences; University of Lethbridge; Lethbridge; AB; Canada; T1K 3M4
| | - C. Carroll
- Canadian Centre for Behavioural Neurosciences; University of Lethbridge; Lethbridge; AB; Canada; T1K 3M4
| | - B. Kolb
- Canadian Centre for Behavioural Neurosciences; University of Lethbridge; Lethbridge; AB; Canada; T1K 3M4
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Biwer LA, Broderick TL, Xu H, Carroll C, Hale TM. Protection against L-NAME-induced reduction in cardiac output persists even after cessation of angiotensin-converting enzyme inhibitor treatment. Acta Physiol (Oxf) 2013; 207:156-65. [PMID: 22834875 DOI: 10.1111/j.1748-1716.2012.02474.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 06/12/2012] [Accepted: 07/19/2012] [Indexed: 01/19/2023]
Abstract
AIM We have demonstrated that short-term angiotensin-converting enzyme (ACE) inhibition in adult spontaneously hypertensive rats produces cardiac changes that persist following cessation of treatment that result in a reduced inflammatory, proliferative and fibrotic response to the nitric oxide synthase inhibitor N(ω) -Nitro-l-arginine methyl ester (L-NAME). The present study examines whether prior ACE inhibition with enalapril also protects against L-NAME-induced cardiac dysfunction. METHODS Rats were treated with enalapril (Enal + L) or tap water (Con, Con + L) for 2 weeks followed by a 2-week washout period. At this point, Con + L and Enal + L rats were treated with L-NAME for 10 days. Hearts were perfused in the working mode, mean arterial pressure (MAP) was assessed via radiotelemetry, and myocardial injury was evaluated in hematoxylin and eosin-stained sections. RESULTS L-NAME increased MAP by a similar magnitude in Con + L and Enal + L. L-NAME-induced statistically significant decreases in flow-mediated functional parameters in Con + L rats including cardiac output, stroke volume and coronary flow. This was prevented by prior enalapril treatment. Prior enalapril did not prevent L-NAME-induced myocardial injury, but may have lessened the degree of it. Regardless of treatment, changes in cardiac function did not correlate with myocardial injury. CONCLUSION Despite equivalent impact on MAP and incidence of myocardial infarction, prior enalapril treatment resulted in the preservation of cardiac function following L-NAME. Understanding the mechanisms by which transient ACE inhibition protects against reductions in cardiac function in the absence of ongoing treatment may reveal novel targets for heart failure treatment.
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Affiliation(s)
- L. A. Biwer
- Department of Basic Medical Sciences; University of Arizona, College of Medicine - Phoenix; Phoenix; AZ; USA
| | - T. L. Broderick
- Department of Physiology, Laboratory of Diabetes and Exercise Metabolism; Midwestern University; Glendale; AZ; USA
| | - H. Xu
- Department of Pathology and Laboratory Medicine; University of Rochester School of Medicine and Dentistry; Rochester; NY; USA
| | - C. Carroll
- Department of Physiology, Laboratory of Diabetes and Exercise Metabolism; Midwestern University; Glendale; AZ; USA
| | - T. M. Hale
- Department of Basic Medical Sciences; University of Arizona, College of Medicine - Phoenix; Phoenix; AZ; USA
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Carroll C, Turner F, Watson P, Hawkins M, Spoudeas H, Walker D, Holland T, Ring H. P2 Apathy in long-term survivors of posterior fossa tumours in early childhood. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-303538.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Carroll C, Enlow M, Hurtukova D. Evaluating the Aggregate Safety Profile of Disease Modifying Therapies Used in the Treatment of Relapsing Forms of Multiple Sclerosis (P06.159). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lage M, Carroll C, Oleen-Burkey M. Time to New Onset Depression in Newly Diagnosed Patients with Multiple Sclerosis Treated-Implications for Practice (P04.103). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Muhammad A, Carroll C, Kolb B. Stress during development alters dendritic morphology in the nucleus accumbens and prefrontal cortex. Neuroscience 2012; 216:103-9. [PMID: 22542675 DOI: 10.1016/j.neuroscience.2012.04.041] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/30/2012] [Accepted: 04/17/2012] [Indexed: 10/28/2022]
Abstract
The long-term effects of stress during development have been well characterized. However, the effects of developmental stress on the underlying neurological mechanisms related to the reward system are not well understood. The present report studied the long term effects of stress during development on the structural plasticity in the cortical and subcortical regions. Rats exposed to stress during embryonic development (prenatal stress; PS) or soon after birth (maternal separation; MS) were studied for structural alteration at the neuronal level in the nucleus accumbens (NAc), orbital frontal cortex (OFC), and medial prefrontal cortex (mPFC). The findings show that stress during development increased dendritic branching, length, and spine density in the NAc, and subregions of the PFC. PS experience increased dendritic branching and length in the mPFC apical and basilar dendrites. In contrast, a PS-associated decrease in dendritic branching and length was observed in the basilar branches of the OFC. MS resulted in an increase in dendritic growth and spine density in the subregions of the PFC. The effect of PS on neuroanatomy was more robust than MS despite the shorter duration and intensity. The altered dendritic growth and spine density associated with stress during development could have potential impact on NAc and PFC related behaviors.
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Carroll C, Stevenson M, Scope A, Evans P, Buckley S. Hemiarthroplasty and total hip arthroplasty for treating primary intracapsular fracture of the hip: a systematic review and cost-effectiveness analysis. Health Technol Assess 2012; 15:1-74. [PMID: 21978400 DOI: 10.3310/hta15360] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hip fracture is a common problem in people aged > 60 years. The treatment options for individuals with high pre-fracture mobility, function and independence are hemiarthroplasty (HA) and total hip arthroplasty (THA). OBJECTIVE The aim of this report is to assess the clinical effectiveness and cost-effectiveness evidence of THA compared with HA in patients with displaced intracapsular fracture who are cognitively intact with high pre-fracture mobility or function. DATA SOURCES A systematic search was made of 11 databases of published and unpublished literature from their inception to december 2010: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library, Biological Science Citation Index, Social Science Citation Index, Conference Proceedings Citation Index - Science, UK Clinical Trials Research Network and the National Research Register archive, Current Controlled Trials and ClinicalTrials.gov. REVIEW METHODS A systematic review of randomised controlled trials (RCTs) to assess the effectiveness of THA compared with HA in terms of dislocations, revisions, pain and function, and quality of life. Meta-analysis, independent subgroup analyses and exploratory cost-effectiveness modelling were performed. RESULTS The literature search identified 532 unique citations, of which eight RCTs with almost 1000 participants satisfied the criteria for the effectiveness review. Meta-analysis found a statistically significant increased risk of dislocation for patients treated with THA compared with HA (p = 0.01), but a reduced risk of revision (p = 0.0003). There were no differences in terms of mortality. In all trials, individuals treated with THA reported better function and mobility and less pain than those treated with HA. Four trials reporting utility data found similar trends. Sensitivity analyses indicated that there were no statistically significant differences in outcomes based on follow-up, study quality, surgical approach taken, type of head or the use of cement. Four papers reported a cost-utility analysis or the cost-effectiveness of THA compared with HA. Exploratory modelling was undertaken that showed that THA is likely to be cost-effective compared with HA even when the limitations of the data and methodology are considered. LIMITATIONS The costs and disutilities associated with revisions and dislocations were not included in the economic evaluation. CONCLUSIONS THA appears to be more cost-effective than HA. It is likely that THA will be associated with increased costs in the initial 2-year period, but lower longer-term costs, owing to potentially lower revision rates. However, these longer-term costs have not been modelled. The capacity and experience of surgeons to perform THA have not been explored and these would need to be addressed at local level were THA to become recommended for active, elderly patients in whom THA is not contraindicated. Further studies examining the impact of surgeon experience on performing the two procedures may offer more robust evidence on outcomes. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Carroll C, Lloyd-Jones M, Cooke J, Owen J. Reasons for the use and non-use of school sexual health services: a systematic review of young people's views. J Public Health (Oxf) 2011; 34:403-10. [DOI: 10.1093/pubmed/fdr103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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