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Sapey E, Crowley LE, Edgar RG, Griffiths D, Samanta S, Crisford H, Bolton CE, Hurst JR, Stockley RA. Cardiovascular disease in Alpha 1 antitrypsin deficiency: an observational study assessing the role of neutrophil proteinase activity and the suitability of validated screening tools. Orphanet J Rare Dis 2024; 19:130. [PMID: 38515138 PMCID: PMC10956254 DOI: 10.1186/s13023-024-03124-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Alpha 1 Antitrypsin Deficiency (AATD) is a rare, inherited lung disease which shares features with Chronic Obstructive Pulmonary Disease (COPD) but has a greater burden of proteinase related tissue damage. These proteinases are associated with cardiovascular disease (CVD) in the general population. It is unclear whether patients with AATD have a greater risk of CVD compared to usual COPD, how best to screen for this, and whether neutrophil proteinases are implicated in AATD-associated CVD. This study had three aims. To compare CVD risk in never-augmented AATD patients to non-AATD COPD and healthy controls (HC). To assess relationships between CVD risk and lung physiology. To determine if neutrophil proteinase activity was associated with CVD risk in AATD. Cardiovascular risk was assessed by QRISK2® score and aortic stiffness measurements using carotid-femoral (aortic) pulse wave velocity (aPWV). Medical history, computed tomography scans and post-bronchodilator lung function parameters were reviewed. Systemic proteinase 3 activity was measured. Patients were followed for 4 years, to assess CVD development. RESULTS 228 patients with AATD, 50 with non-AATD COPD and 51 healthy controls were recruited. In all COPD and HC participants, QRISK2® and aPWV gave concordant results (with both measures either high or in the normal range). This was not the case in AATD. Once aPWV was adjusted for age and smoking history, aPWV was highest and QRISK2® lowest in AATD patients compared to the COPD or HC participants. Higher aPWV was associated with impairments in lung physiology, the presence of emphysema on CT scan and proteinase 3 activity following adjustment for age, smoking status and traditional CVD risk factors (using QRISK2® scores) in AATD. There were no such relationships with QRISK2® in AATD. AATD patients with confirmed CVD at four-year follow up had a higher aPWV but not QRISK2® at baseline assessment. CONCLUSION aPWV measured CVD risk is elevated in AATD. This risk is not captured by QRISK2®. There is a relationship between aPWV, lung disease and proteinase-3 activity. Proteinase-driven breakdown of elastin fibres in large arteries and lungs is a putative mechanism and forms a potential therapeutic target for CVD in AATD.
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Affiliation(s)
- E Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW, UK
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, West Midlands, UK
| | - L E Crowley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW, UK.
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, West Midlands, UK.
| | - R G Edgar
- Institute of Applied Health, University of Birmingham, Birmingham, West Midlands, UK
| | - D Griffiths
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, West Midlands, UK
| | - S Samanta
- UCL Respiratory, University College London, London, UK
| | - H Crisford
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW, UK
| | - C E Bolton
- NIHR Nottingham BRC Respiratory Theme, School of Medicine, University of Nottingham, City Hospital NUH Trust, Nottingham, UK
| | - J R Hurst
- UCL Respiratory, University College London, London, UK
| | - R A Stockley
- University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, West Midlands, UK
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Hardy TA, Aouad P, Barnett MH, Blum S, Broadley S, Carroll WM, Crimmins D, Griffiths D, Hodgkinson S, Lechner-Scott J, Lee A, Malhotra R, McCombe P, Parratt J, Plummer C, Van der Walt A, Martel K, Walker RA. Onboarding of siponimod in secondary progressive multiple sclerosis patients in Australia: Novel, real-world evidence from the MSGo digital support programme. Mult Scler J Exp Transl Clin 2024; 10:20552173231226106. [PMID: 38222025 PMCID: PMC10787529 DOI: 10.1177/20552173231226106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/26/2023] [Indexed: 01/16/2024] Open
Abstract
Background Siponimod is approved for use in people with secondary progressive multiple sclerosis (pwSPMS). An integrated digital platform, MSGo, was developed for pwSPMS and clinicians to help navigate the multiple steps of the pre-siponimod work-up. Objective To explore real-world onboarding experiences of siponimod amongst pwSPMS in Australia. Methods Retrospective, non-interventional, longitudinal, secondary analysis of data extracted from MSGo (20 April 2022). The primary endpoint was the average time for siponimod onboarding; secondary endpoints were adherence and sub-group analyses of variables influencing onboarding. Results Mixed-cure modelling estimated that 58% of participants (N = 368, females 71%, median age of 59 years) registered in MSGo would ever initiate siponimod. The median time to initiation was 56 days (95% CI [47-59] days). Half of the participants cited 'waiting for vaccination' as the reason for initiation delay. Cox regression analyses found participants with a nominated care partner had faster onboarding (HR 2.1, 95% CI [1.5-3.0]) and were more likely to continue self-reporting daily siponimod dosing than were those without a care partner (HR 2.2, 95% CI [1.3-3.7]). Conclusions Despite the limitations of self-reported data and the challenges of the COVID-19 pandemic, this study provides insights into siponimod onboarding in Australia and demonstrates the positive impact of care partner support.
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Affiliation(s)
- TA Hardy
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P Aouad
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - MH Barnett
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Blum
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Broadley
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - WM Carroll
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Crimmins
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - D Griffiths
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - S Hodgkinson
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Lechner-Scott
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Lee
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - R Malhotra
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - P McCombe
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - J Parratt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - C Plummer
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - A Van der Walt
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - K Martel
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
| | - RA Walker
- Novartis Pharmaceuticals Australia, Macquarie Park, NSW, Australia
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3
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ter Avest E, Tunnicliff M, Griggs J, Griffiths D, Cody D, Nelson M, Hurst T, Lyon R. In-hospital extracorporeal cardiopulmonary resuscitation for patients with an out-of-hospital cardiac arrest in a semi-rural setting: An observational study on the implementation of a helicopter emergency medical services pathway. Resusc Plus 2022; 12:100339. [PMID: 36561209 PMCID: PMC9763671 DOI: 10.1016/j.resplu.2022.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Aim In this study, we aimed to investigate the efficacy of a helicopter emergency medical service (HEMS) facilitated pathway for in-hospital extracorporeal cardiopulmonary resuscitation (ECPR) for patients with an out of hospital cardiac arrest (OHCA) in a semi-rural setting. Methods We retrospectively reviewed all patients with an OHCA attended by a UK HEMS service between 1 January 2018 and 20 September 2021, when a dedicated ECPR pathway was in effect to facilitate transport of eligible patients to the nearest ECLS centre. The primary endpoint was the number of patients meeting ECPR eligibility criteria at three pre-defined time points: at HEMS dispatch, during on-scene evaluation and upon arrival in hospital. Results During the study period, 162 patients attended met ECPR pathway dispatch criteria. After on-scene evaluation, 74 patients (45%) had a return of spontaneously circulation before arrival of HEMS, 60 (37%) did not meet eligibility criteria regarding initial rhythm or etiology of the OHCA, and 15 (9%) had deteriorated (mainly into asystole) and were no longer suitable candidates upon arrival of HEMS. Eleven patients were eligible for ECPR and transported to hospital in arrest, and a further two patients were transported for post-ROSC ECLS. Nine patients deteriorated during transport and were no longer suitable ECPR candidates upon arrival. ECLS was successfully initiated in two patients (one intra-arrest, and one post-ROSC). Conclusion In-hospital ECPR is of limited value for patients with refractory OHCA in a semi-rural setting, even when a dedicated pathway is in place. Potentially eligible patients often cannot be transported within an appropriate timeframe and/or deteriorate before arrival in hospital.
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Affiliation(s)
- E. ter Avest
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK,Department of Emergency Medicine, University Hospital Groningen, the Netherlands,Corresponding author at: Kent, Surrey & Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey RH1 5YP, UK.
| | - M. Tunnicliff
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK,Kings College NHS Trust, Department of Emergency Medicine, UK
| | - J. Griggs
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK
| | - D. Griffiths
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK
| | - D. Cody
- South East Coast Ambulance Service, UK
| | - M. Nelson
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK,South East Coast Ambulance Service, UK
| | - T. Hurst
- Kings College NHS Trust, Department of Intensive Care Medicine, UK,London’s Airambulance, UK
| | - R.M. Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, UK,School of Health Sciences, University of Surrey, UK
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Balai E, Sabharwal S, Griffiths D, Reilly P. A type VI acromioclavicular joint injury: subcoracoid dislocation in a patient with polytrauma. Ann R Coll Surg Engl 2020; 102:e1-e3. [PMID: 32735136 DOI: 10.1308/rcsann.2020.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Rockwood type VI acromioclavicular joint injury describes subcoracoid dislocation of the distal end of the clavicle. This injury pattern is exceedingly rare, with only 12 cases described in the literature. Diagnosis can be challenging; it is often the result of a high-energy mechanism and patients frequently have other severe distracting injuries. We report the case of a 23-year-old man who presented to our department after falling from a fifth-floor balcony. Alongside multiple intra-abdominal and musculoskeletal injuries, the patient sustained a type VI acromioclavicular joint dislocation. This injury was not picked up on the initial clinical assessment or described in the initial radiology report, with the diagnosis only made upon subsequent repeat review of the imaging by the admitting team. Fortunately, this delay did not increase the time to the patient receiving appropriate treatment. Despite its rarity, awareness of this injury pattern and its association with polytrauma is essential to reduce the risk of the diagnosis being overlooked in the acute setting.
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Affiliation(s)
- E Balai
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Sabharwal
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D Griffiths
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Reilly
- St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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5
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Morphet J, Griffiths D, Beattie J, Velasquez Reyes D, Innes K. Prevention and management of occupational violence and aggression in healthcare: A scoping review. Collegian 2018. [DOI: 10.1016/j.colegn.2018.04.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lobban T, Breakwell N, Hamedi N, Antoniou S, Alves De Costa F, Tous S, Papastergiou J, Derango F, Griffiths D, Chaumais MC, Viola R, Ladova K, Paulino E, Hersberger K, Freedman B. 1357Identifying the undiagnosed AF patient through “Know Your Pulse” community pharmacy based events held in ten countries during Arrhythmia Alliance World Heart Rhythm Week 2017. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Lobban
- Arrhythmia Alliance, Chipping Norton, United Kingdom
| | - N Breakwell
- Arrhythmia Alliance, Chipping Norton, United Kingdom
| | - N Hamedi
- Health Innovation Network, London, United Kingdom
| | | | - F Alves De Costa
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM, ISCSEM), Caparica, Portugal
| | - S Tous
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Barcelona, Spain
| | - J Papastergiou
- University of Toronto, Centre for Practice Excellence, Toronto, Canada
| | | | | | | | - R Viola
- University of Szeged, Faculty of Pharmacy, Szeged, Hungary
| | - K Ladova
- Charles University in Prague, Faculty of Pharmacy, Hradec Kralove, Czech Republic
| | | | | | - B Freedman
- University of Sydney, Heart Research Institute, Sydney, Australia
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8
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Abstract
Hypothyroidism is a cause of secondary hyperlipidaemia. This study investigates the frequency of biochemically diagnosed hypothyroidism and its relationship with plasma cholesterol concentration in apparently healthy people. Thyroid function tests (total T4, TSH, and free T4) were performed on 272 apparently healthy men and women (179 vegetarians, 93 meat eaters) with a plasma cholesterol concentration above 7 mmol/l and on 90 individuals with a plasma cholesterol below 4.1 mmol/l who were matched for age, sex and dietary habits. Six per cent of those with a plasma cholesterol above 7 mmol/l had biochemical evidence of hypothyroidism as defined by a TSH greater than 10 mIU/l (reference range 1–6) and a low free T4 below 10 pmol/l (reference range 10.1–25). Eighty per cent of these people had a high titre of thyroid anti-microsomal antibodies. Of the 90 individuals with a plasma cholesterol level below 4.1 and the 25 randomly selected participants none had biochemical evidence of hypothyroidism. Hypothyroidism is relatively common in apparently healthy people with a raised plasma cholesterol. It appears no commoner in vegetarians than in meat eaters.
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Affiliation(s)
- M J Ball
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
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9
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Koppel S, Charlton JL, Hua P, Liu PY, Pham H, Stephan K, Logan D, St Louis RM, Gao G, Griffiths D, Williams G, Witharanage T, Di Stefano M, Darzins P, Odell M, Porter MM, Mazer B, Gelinas I, Vrkljan B, Marshall S. Are older drivers' driving patterns during an on-road driving task representative of their real-world driving patterns? Traffic Inj Prev 2018; 19:S173-S175. [PMID: 30841798 DOI: 10.1080/15389588.2018.1532219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The current study investigated whether older drivers' driving patterns during a customized on-road driving task were representative of their real-world driving patterns. METHODS Two hundred and eight participants (male: 68.80%; mean age = 81.52 years, SD = 3.37 years, range = 76.00-96.00 years) completed a customized on-road driving task that commenced from their home and was conducted in their own vehicle. Participants' real-world driving patterns for the preceding 4-month period were also collected via an in-car recording device (ICRD) that was installed in each participant's vehicle. RESULTS During the 4-month period prior to completing the on-road driving task, participants' median real-world driving trip distance was 2.66 km (interquartile range [IQR] = 1.14-5.79 km) and their median on-road driving task trip distance was 4.41 km (IQR = 2.83-6.35 km). Most participants' on-road driving task trip distances were classified as representative of their real-world driving trip distances (95.2%, n = 198). CONCLUSIONS These findings suggest that most older drivers were able to devise a driving route that was representative of their real-world driving trip distance. Future research will examine whether additional aspects of the on-road driving task (e.g., average speed, proportion of trips in different speed zones) are representative of participants' real-world driving patterns.
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Affiliation(s)
- S Koppel
- a Monash University Accident Research Centre , Victoria , Australia
| | - J L Charlton
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Hua
- a Monash University Accident Research Centre , Victoria , Australia
| | - P Y Liu
- a Monash University Accident Research Centre , Victoria , Australia
| | - H Pham
- a Monash University Accident Research Centre , Victoria , Australia
| | - K Stephan
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Logan
- a Monash University Accident Research Centre , Victoria , Australia
| | - R M St Louis
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Gao
- a Monash University Accident Research Centre , Victoria , Australia
| | - D Griffiths
- a Monash University Accident Research Centre , Victoria , Australia
| | - G Williams
- a Monash University Accident Research Centre , Victoria , Australia
| | - T Witharanage
- a Monash University Accident Research Centre , Victoria , Australia
| | | | - P Darzins
- c Eastern Health , Victoria, Australia
| | - M Odell
- d Victorian Institute of Forensic Medicine , Victoria, Australia
| | - M M Porter
- e Faculty of Kinesiology and Recreation Management, and Centre on Aging , University of Manitoba , Canada
| | - B Mazer
- f McGill University , Winnipeg, Canada
| | - I Gelinas
- f McGill University , Winnipeg, Canada
| | - B Vrkljan
- g McMaster University , Hamilton, Canada
| | - S Marshall
- h Ottawa Hospital Research Institute , Ottawa, Canada
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10
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Antoniou S, Papastergiou J, De Rango F, Griffiths D, Hamedi N, Williams H, Dolores Murillo M, Tous S, Lobban T, Alves Da Costa F. P4608Benefits of active involvement of community pharmacists in know your pulse awareness campaign. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Antoniou
- Barts Health NHS Trust, London, United Kingdom
| | - J. Papastergiou
- University of Toronto, Center for Practice Excellence, Toronto, Canada
| | - F. De Rango
- Shoppers Drug Mart, Pharmacy, Toronto, Canada
| | | | - N. Hamedi
- Southwark Clinical Commissioning Group, London, United Kingdom
| | - H. Williams
- Southwark Clinical Commissioning Group, London, United Kingdom
| | - M. Dolores Murillo
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Madrid, Spain
| | - S. Tous
- Sociedad Española de Farmacia Familiar y Comunitaria SEFAC, Madrid, Spain
| | - T. Lobban
- Atrial Fibrillation Association, Warwickshire, United Kingdom
| | - F. Alves Da Costa
- Centre for Interdisciplinary Research Egas Moniz (CiiEM, ISCSEM), Lisbon, Portugal
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11
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Goldberg L, Eccleston C, Lea E, Griffiths D, Robinson A. THE VALUE OF SYSTEMATIC INTERPROFESSIONAL EDUCATION FOR EFFECTIVE PRACTICE IN DEMENTIA CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L. Goldberg
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia,
| | - C. Eccleston
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia,
| | - E. Lea
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia,
| | - D. Griffiths
- Curtin University, Perth, Western Australia, Australia
| | - A.L. Robinson
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia,
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12
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Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly P. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysis. Bone Joint Res 2016; 5:470-480. [PMID: 27756738 PMCID: PMC5086838 DOI: 10.1302/2046-3758.510.2000638] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/08/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes. Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed. Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009). Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria. Cite this article: S. Sabharwal, N. K. Patel, D. Griffiths, T. Athanasiou, C. M. Gupte, P. Reilly. Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus: Findings of a meta-analysisBone Joint Res 2016;5:470–480. DOI: 10.1302/2046-3758.510.2000638.
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Affiliation(s)
- S Sabharwal
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - N K Patel
- Virginia Commonwealth University Medical Centre, Richmond, Virginia, USA
| | - D Griffiths
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - T Athanasiou
- Imperial College London, 1022, Queen Elizabeth the Queen Mother Wing (QEQM), St Mary's Campus, London, UK
| | - C M Gupte
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
| | - P Reilly
- Department of Trauma and Orthopaedics, St Mary's Hospital, Ground Floor Salton House, South Wharf Road, London, W2 1NY, UK
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13
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Anderson K, Griffiths D, DeBell L, Hancock S, Duffy JP, Shutler JD, Reinhardt WJ, Griffiths A. A Grassroots Remote Sensing Toolkit Using Live Coding, Smartphones, Kites and Lightweight Drones. PLoS One 2016; 11:e0151564. [PMID: 27144310 PMCID: PMC4856374 DOI: 10.1371/journal.pone.0151564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/01/2016] [Indexed: 11/26/2022] Open
Abstract
This manuscript describes the development of an android-based smartphone application for capturing aerial photographs and spatial metadata automatically, for use in grassroots mapping applications. The aim of the project was to exploit the plethora of on-board sensors within modern smartphones (accelerometer, GPS, compass, camera) to generate ready-to-use spatial data from lightweight aerial platforms such as drones or kites. A visual coding ‘scheme blocks’ framework was used to build the application (‘app’), so that users could customise their own data capture tools in the field. The paper reports on the coding framework, then shows the results of test flights from kites and lightweight drones and finally shows how open-source geospatial toolkits were used to generate geographical information system (GIS)-ready GeoTIFF images from the metadata stored by the app. Two Android smartphones were used in testing–a high specification OnePlus One handset and a lower cost Acer Liquid Z3 handset, to test the operational limits of the app on phones with different sensor sets. We demonstrate that best results were obtained when the phone was attached to a stable single line kite or to a gliding drone. Results show that engine or motor vibrations from powered aircraft required dampening to ensure capture of high quality images. We demonstrate how the products generated from the open-source processing workflow are easily used in GIS. The app can be downloaded freely from the Google store by searching for ‘UAV toolkit’ (UAV toolkit 2016), and used wherever an Android smartphone and aerial platform are available to deliver rapid spatial data (e.g. in supporting decision-making in humanitarian disaster-relief zones, in teaching or for grassroots remote sensing and democratic mapping).
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Affiliation(s)
- K. Anderson
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Cornwall, United Kingdom
- * E-mail:
| | - D. Griffiths
- FoAM Kernow, Jubilee Warehouse, Penryn, Cornwall, United Kingdom
| | - L. DeBell
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Cornwall, United Kingdom
| | - S. Hancock
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Cornwall, United Kingdom
| | - J. P. Duffy
- Environment and Sustainability Institute, University of Exeter, Penryn Campus, Cornwall, United Kingdom
| | - J. D. Shutler
- Centre for Geography, Environment and Society, University of Exeter, Penryn Campus, Cornwall, United Kingdom
| | - W. J. Reinhardt
- Centre for Geography, Environment and Society, University of Exeter, Penryn Campus, Cornwall, United Kingdom
| | - A. Griffiths
- FoAM Kernow, Jubilee Warehouse, Penryn, Cornwall, United Kingdom
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McClelland D, Barlow D, Moores TS, Wynn-Jones C, Griffiths D, Ogrodnik PJ, Thomas PBM. Medium- and long-term results of high tibial osteotomy using Garches external fixator and gait analysis for dynamic correction in varus osteoarthritis of the knee. Bone Joint J 2016; 98-B:601-7. [DOI: 10.1302/0301-620x.98b5.34875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/04/2016] [Indexed: 11/05/2022]
Abstract
In arthritis of the varus knee, a high tibial osteotomy (HTO) redistributes load from the diseased medial compartment to the unaffected lateral compartment. We report the outcome of 36 patients (33 men and three women) with 42 varus, arthritic knees who underwent HTO and dynamic correction using a Garches external fixator until they felt that normal alignment had been restored. The mean age of the patients was 54.11 years (34 to 68). Normal alignment was achieved at a mean 5.5 weeks (3 to 10) post-operatively. Radiographs, gait analysis and visual analogue scores for pain were measured pre- and post-operatively, at one year and at medium-term follow-up (mean six years; 2 to 10). Failure was defined as conversion to knee arthroplasty. Pre-operative gait analysis divided the 42 knees into two equal groups with high (17 patients) or low (19 patients) adductor moments. After correction, a statistically significant (p < 0.001, t-test,) change in adductor moment was achieved and maintained in both groups, with a rate of failure of three knees (7.1%), and 89% (95% confidence interval (CI) 84.9 to 94.7) survivorship at medium-term follow-up. At final follow-up, after a mean of 15.9 years (12 to 20), there was a survivorship of 59% (95% CI 59.6 to 68.9) irrespective of adductor moment group, with a mean time to conversion to knee arthroplasty of 9.5 years (3 to 18; 95% confidence interval ± 2.5). HTO remains a useful option in the medium-term for the treatment of medial compartment osteoarthritis of the knee but does not last in the long-term. Cite this article: Bone Joint J 2016;98-B:601–7.
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Affiliation(s)
- D. McClelland
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - D. Barlow
- Wrexham Maelor Hospital, Croesnewydd
Road, Wrexham, LL13 7TD, UK
| | - T. S. Moores
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - C. Wynn-Jones
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | - D. Griffiths
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
| | | | - P. B. M. Thomas
- Royal Stoke University Hospital, Newcastle
Road, Stoke-on-Trent ST4 6QG, UK
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15
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Innes K, Crawford K, Jones T, Blight R, Trenham C, Williams A, Griffiths D, Morphet J. Transdisciplinary care in the emergency department: A qualitative analysis. Int Emerg Nurs 2015; 25:27-31. [PMID: 26248807 DOI: 10.1016/j.ienj.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/18/2015] [Revised: 07/10/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital. The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff. Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction. This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team.
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Affiliation(s)
- Kelli Innes
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia
| | - Kimberley Crawford
- School of Nursing & Midwifery, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Tamsin Jones
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia
| | - Renee Blight
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Catherine Trenham
- Peninsula Health, 2 Hastings Road, Frankston, Victoria 3199, Australia
| | - Allison Williams
- School of Nursing & Midwifery, Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - D Griffiths
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia
| | - Julia Morphet
- School of Nursing & Midwifery, Monash University, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia.
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16
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Eyre DW, Tracey L, Elliott B, Slimings C, Huntington PG, Stuart RL, Korman TM, Kotsiou G, McCann R, Griffiths D, Fawley WN, Armstrong P, Dingle KE, Walker AS, Peto TE, Crook DW, Wilcox MH, Riley TV. Emergence and spread of predominantly community-onset Clostridium difficile PCR ribotype 244 infection in Australia, 2010 to 2012. ACTA ACUST UNITED AC 2015; 20:21059. [PMID: 25788254 DOI: 10.2807/1560-7917.es2015.20.10.21059] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe an Australia-wide Clostridium difficile outbreak in 2011 and 2012 involving the previously uncommon ribotype 244. In Western Australia, 14 of 25 cases were community-associated, 11 were detected in patients younger than 65 years, 14 presented to emergency/outpatient departments, and 14 to non-tertiary/community hospitals. Using whole genome sequencing, we confirm ribotype 244 is from the same C. difficile clade as the epidemic ribotype 027. Like ribotype 027, it produces toxins A, B, and binary toxin, however it is fluoroquinolone-susceptible and thousands of single nucleotide variants distinct from ribotype 027. Fifteen outbreak isolates from across Australia were sequenced. Despite their geographic separation, all were genetically highly related without evidence of geographic clustering, consistent with a point source, for example affecting the national food chain. Comparison with reference laboratory strains revealed the outbreak clone shared a common ancestor with isolates from the United States and United Kingdom (UK). A strain obtained in the UK was phylogenetically related to our outbreak. Follow-up of that case revealed the patient had recently returned from Australia. Our data demonstrate new C. difficile strains are an on-going threat, with potential for rapid spread. Active surveillance is needed to identify and control emerging lineages.
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Affiliation(s)
- D W Eyre
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
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17
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Vayalapra S, Edgar R, Griffiths D, Stockley R, Turner A. P58 A Comparison Between The Clinical Features Of Pisz And Pizz Patients With Alpha-1 Antitrypsin Deficiency. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Mudariki T, Lea RW, Griffiths D, Clemens G, Baker MJ. P66 * AN INVESTIGATION INTO SUBSTRATE EFFECTS AND TISSUE PRE-PROCESSING IN SPECTRAL HISTOPATHOLOGY USING RAMAN SPECTROSCOPY. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.52] [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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19
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Berney DM, Algaba F, Camparo P, Compérat E, Griffiths D, Kristiansen G, Lopez-Beltran A, Montironi R, Varma M, Egevad L. Variation in reporting of cancer extent and benign histology in prostate biopsies among European pathologists. Virchows Arch 2014; 464:583-7. [PMID: 24590584 DOI: 10.1007/s00428-014-1554-1] [Citation(s) in RCA: 15] [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: 12/18/2013] [Revised: 01/27/2014] [Accepted: 02/09/2014] [Indexed: 12/17/2022]
Abstract
It is not known how uropathologists currently report histopathological features of prostate biopsies such as core length, tumor extent, perineural invasion, and non-tumor-associated features such as inflammation and hyperplasia in needle biopsies. A web-based survey was distributed among 661 members of the European Network of Uropathology. Complete replies were received from 266 pathologists in 22 European countries. Total core lengths were reported by 64 %. The numbers of cores positive for cancer was given by 79 %. Linear cancer extent was reported by 81 %, most often given in millimeters for each core (53 %) followed by the estimation of percentage of cancer in each core (40 %). A gap of benign tissue between separate cancer foci in a single core would always be subtracted by 48 % and by 63 % if cancer foci were minute and widely separated. Perineural invasion was reported by 97 %. Fat invasion by tumor was interpreted as extraprostatic extension by 81 %. Chronic and active/acute inflammation was always reported by 32 and 56 % but only if pronounced by 54 and 39 %, respectively. While most (79 %) would never diagnose benign prostatic hyperplasia on needle biopsy, 21 % would attempt to make this diagnosis. Reporting practices for prostate biopsies are variable among European pathologists. The great variation in some methodologies used suggests a need for further international consensus, in order for retrospective data to be comparable between different institutions.
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Affiliation(s)
- D M Berney
- Queen Mary, University of London, London, UK,
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20
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Griffiths D, Sturm J, Heard R, Reyneke E, Whyte S, Clarke T, O'Brien W, Crimmins D. Can lower risk patients presenting with transient ischaemic attack be safely managed as outpatients? J Clin Neurosci 2013; 21:47-50. [PMID: 23683740 DOI: 10.1016/j.jocn.2013.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 02/05/2013] [Accepted: 02/10/2013] [Indexed: 12/01/2022]
Abstract
This study aimed to examine outcome in low risk transient ischaemic attack (TIA) patients presenting to emergency departments (ED) in a regional Australian setting discharged on antiplatelet therapy with expedited neurology review. All patients presenting to Gosford or Wyong Hospital ED with TIA, for whom faxed referrals to the neurology department were received between October 2008 and July 2010, were included in this prospective cohort study. Classification of low risk was based on an age, blood pressure, clinical features, duration of symptoms and diabetes (ABCD2) score <4 and the absence of high risk features, including known carotid disease, crescendo TIA, or atrial fibrillation. Patients with ABCD2 scores > or =4 or with high risk features were discussed with the neurologist on call (a decision regarding discharge or admission was then made at the neurologist's discretion). Patients were investigated with a brain CT scan and/or CT angiography, routine pathology, and an electrocardiogram. All discharged patients were commenced on antiplatelet therapy and asked to follow up with their local medical officer within 7 days. The patients were contacted by the neurology department to arrange follow-up. Our primary outcome was the number of subsequent strokes occurring within 90 days. Of 200 discharged patients for whom referrals were received, three patients had a stroke within 90 days. None of these would have been prevented through hospitalisation. In conclusion, medical assessment, expedited investigation with immediate commencement of secondary prevention and outpatient neurology review may be a reasonable alternative to admission for low risk patients presenting to the ED with TIA.
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Affiliation(s)
- D Griffiths
- Department of Neurology, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW 2065, Australia.
| | - J Sturm
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - R Heard
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - E Reyneke
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - S Whyte
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - T Clarke
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - W O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - D Crimmins
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
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Feldman MA, Owen F, Andrews A, Hamelin J, Barber R, Griffiths D. Health self-advocacy training for persons with intellectual disabilities. J Intellect Disabil Res 2012; 56:1110-1121. [PMID: 23106754 DOI: 10.1111/j.1365-2788.2012.01626.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disabilities (ID) have unequal access to health care. While systemic efforts are addressing health inequalities, there remains a need to demonstrate that persons with ID can increase their health self-advocacy skills. METHOD A randomised control design with up to 6-month follow-up was used to evaluate the 3Rs (Rights, Respect and Responsibility) health self-advocacy training program for persons with ID (n = 31). Training involved teaching participants to recognise and redress health rights violations in the context of respect and responsibility. Training materials included PowerPoint slides and interactive video scenarios illustrating health rights, respect and responsibility problem and non-problems. Two-hour training sessions were conducted twice a week in a group format where participants played a game and answered questions. RESULTS The health rights training group made significantly more correct responses on post training and follow-up tests than the control group. Training effects generalised to untrained scenarios and in situ health interviews. CONCLUSIONS The results of this study suggest that persons with ID can learn complex skills related to health self-advocacy. More research is needed to improve in situ generalisation.
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Affiliation(s)
- M A Feldman
- Centre for Applied Disability Studies, Brock University, St. Catharines, Ontario, Canada.
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22
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Bloomer M, O’Connor M, Lee S, Morphet J, Griffiths D. Focus on family care: An exploration of nursing care for families during and after a death in the intensive care unit (ICU). Aust Crit Care 2012. [DOI: 10.1016/j.aucc.2011.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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23
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Chen CM, Mullan J, Su YY, Griffiths D, Kreis IA, Chiu HC. The Longitudinal Relationship Between Depressive Symptoms and Disability for Older Adults: A Population-Based Study. J Gerontol A Biol Sci Med Sci 2012; 67:1059-67. [DOI: 10.1093/gerona/gls074] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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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24
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Griffiths D, Gikas PD, Jowett C, Bayliss L, Aston W, Skinner J, Cannon S, Blunn G, Briggs TWR, Pollock R. Proximal humeral replacement using a fixed-fulcrum endoprosthesis. ACTA ACUST UNITED AC 2011; 93:399-403. [PMID: 21357964 DOI: 10.1302/0301-620x.93b3.24421] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation.
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Affiliation(s)
- D Griffiths
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
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25
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26
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Abu-Ain M, Aazem S, Morton C, Kumwenda M, Griffiths D, Jacob A. A rare potentially treatable cause of bilateral optic disc swelling. BMJ Case Rep 2010; 2010:2010/oct12_2/bcr0320102835. [PMID: 22789833 DOI: 10.1136/bcr.03.2010.2835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Rapid onset bilateral optic disc swelling generally indicates an intracranial problem-that is, papilloedema. However, when there is also visual loss, disease affecting the optic nerves themselves must be considered. We present the diagnostic problem of a patient with optic disc swelling and progressive visual loss. Investigations finally revealed hypocalcaemia secondary to primary hypoparathyroidism. With treatment a marked improvement in vision occurred. This reversible rare cause of optic disc swelling should not be forgotten.
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Affiliation(s)
- M Abu-Ain
- Department of Ophthalmology, Royal Gwent Hospital, Newport, UK
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27
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Chandra A, Griffiths D, McWilliam LJ. Best practice: gross examination and sampling of surgical specimens from the urinary bladder. J Clin Pathol 2010; 63:475-9. [DOI: 10.1136/jcp.2009.071191] [Citation(s) in RCA: 23] [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: 11/03/2022]
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28
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Griffiths D. John James Griffiths. West J Med 2010. [DOI: 10.1136/bmj.c2465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Drake MJ, Fowler CJ, Griffiths D, Mayer E, Paton JFR, Birder L. Neural control of the lower urinary and gastrointestinal tracts: supraspinal CNS mechanisms. Neurourol Urodyn 2010; 29:119-27. [PMID: 20025025 DOI: 10.1002/nau.20841] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Normal urinary function is contingent upon a complex hierarchy of CNS regulation. Lower urinary tract afferents synapse in the dorsal horn of the spinal cord and ascend to the midbrain periaqueductal gray (PAG), with a separate nociception path to the thalamus. A spino-thalamo-cortical sensory pathway is present in some primates, including humans. In the brainstem, the pontine micturition center (PMC) is a convergence point of multiple influences, representing a co-ordinating center for voiding. Many PMC neurones have characteristics necessary to categorize the center as a pre-motor micturition nucleus. In the lateral pontine brainstem, a separate region has some characteristics to suggest a "continence center." Cerebral control determines that voiding is permitted if necessary, socially acceptable and in a safe setting. The frontal cortex is crucial for decision making in an emotional and social context. The anterior cingulate gyrus and insula co-ordinate processes of autonomic arousal and visceral sensation. The influence of these centers on the PMC is primarily mediated via the PAG, which also integrates bladder sensory information, thereby moderating voiding and storage of urine, and the transition between the two phases. The parabrachial nucleus in the pons is also important in behavioral motivation of waste evacuation. Lower urinary tract afferents can be modulated at multiple levels by corticolimbic centers, determining the interoception of physiological condition and the consequent emotional motor responses. Alterations in cognitive modulation, descending modulation, and hypervigilance are important in functional (symptom-based) clinical disorders.
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Affiliation(s)
- M J Drake
- Bristol Urological Institute, Southmead Hospital, Bristol, UK.
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30
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Griffiths D, Bryant L, Arkuta S. I139 Marie Stopes International: Innovative reproductive health service delivery. Models for underserved communities. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60139-9] [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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31
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Oh S, Griffiths D, John T, Lee Y, Yu L, McCarthy N, Heath P, Crook D, Ramsay M, Moxon E, Pollard A. School‐Aged Children: A Reservoir for Continued Circulation ofHaemophilus influenzaeType b in the United Kingdom. J Infect Dis 2008; 197:1275-81. [DOI: 10.1086/586716] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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35
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Dodge J, Treleaven C, Yang W, Clarke J, Martin H, Handy C, Hester M, Taksir T, Griffiths D, Cheng S, Kaspar B, Shihabuddin L. G.P.11.07 AAV mediated gene transfer of IGF-1 and VEGF to the ventricular system provides significant therapeutic benefit in a mouse model of amyotrophic lateral sclerosis. Neuromuscul Disord 2007. [DOI: 10.1016/j.nmd.2007.06.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Abstract
Increased gap junction expression in lamina propria myofibroblasts and urothelial cells may be involved in detrusor overactivity, leading to incontinence. Immunohistochemistry was used to compare connexin (Cx) 26, 43, and 45 expression in the bladders of neonatal, adult, and spinal cord-transected rats, while optical imaging was used to map the spread of spontaneous activity and the effects of gap junction blockade. Female adult Sprague-Dawley rats were deeply anesthetized, a laminectomy was performed, and the spinal cord was transected (T8/T9). After 14 days, their bladders and those of age-matched adults (4 mo old) and neonates (7-21 day old) were excised and studied immunohistochemically using frozen sections or optically using whole bladders stained with voltage- and Ca(2+)-sensitive dyes. The expression of Cx26 was localized to the urothelium, Cx43 to the lamina propria myofibroblasts, and Cx45 to the detrusor smooth muscle. While the expression of Cx45 was comparable in all bladders, the expression of Cx43 and Cx26 was increased in neonate and transected animals. In the bladders of adults, spontaneous activity was initiated at multiple sites, resulting in a lack of coordination. Alternatively, in neonate and transected animals spontaneous activity was initiated at a focal site near the dome and spread in a coordinated fashion throughout the bladder. Gap junction blockade (18beta-glycyrrhetinic acid, 1 microM) abolished this coordinated activity but had no effect on the uncoordinated activity in adult bladders. These data suggest that coordinated spontaneous activity requires gap junction upregulation in urothelial cells and lamina propria myofibroblasts.
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Affiliation(s)
- Y Ikeda
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
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37
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Bloch-Zupan A, Stachtou J, Emmanouil D, Arveiler B, Griffiths D, Lacombe D. Oro-dental features as useful diagnostic tool in Rubinstein-Taybi syndrome. Am J Med Genet A 2007; 143A:570-3. [PMID: 17318847 DOI: 10.1002/ajmg.a.31622] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rubinstein-Taybi syndrome (RTS; OMIM # 180849) is a well-known disorder characterized by mental and growth retardation, broad thumbs and great toes, and unusual facial characteristics. We studied oro-dental findings in a group of RTS patients: 12 from the UK, 2 from Greece, and 26 from France. All were examined by two investigators, using the Diagnosing Dental Defects Database record form to document these. Various oro-dental features were found: small mouth, retrognathia, micrognathia, highly arched and narrow palate, talon cusps, expressed crowding, screwdriver incisors, cross bites, and enamel hypoplasia. Eruption was usually normal. Specific attention for these anomalies should facilitate diagnosis and help adequate management.
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Affiliation(s)
- A Bloch-Zupan
- Faculté de Chirurgie Dentaire, Université Louis Pasteur, Strasbourg, France.
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38
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Nelson M, Schmidt T, Griffiths D, DeIorio N, McConnell KJ, McClure K. A Comparison of the Responses to Different Methods of Community Consultation for a Study Using Exception to Informed Consent. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Affiliation(s)
- M J Lamyman
- Department of Plastic Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, UK.
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Kanai A, Roppolo J, Ikeda Y, Zabbarova I, Tai C, Birder L, Griffiths D, de Groat W, Fry C. Origin of spontaneous activity in neonatal and adult rat bladders and its enhancement by stretch and muscarinic agonists. Am J Physiol Renal Physiol 2006; 292:F1065-72. [PMID: 17107944 PMCID: PMC3033037 DOI: 10.1152/ajprenal.00229.2006] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study examined the origin of spontaneous activity in neonatal and adult rat bladders and the effect of stretch and muscarinic agonists and antagonists on spontaneous activity. Rats were anesthetized and their bladders were excised, cannulated, and loaded with voltage- and Ca(2+)-sensitive dyes. Intracellular Ca(2+) and membrane potential transients were mapped using photodiode arrays in whole bladders, bladder sheets, or cross-section preparations at 37 degrees C. Intravesical pressure was recorded from whole bladders. In neonatal bladders and sheets, spontaneous Ca(2+) and electrical signals arose at a site near the dome and spread in a coordinated manner throughout the bladder with different dome-to-neck conduction velocities (Ca(2+): 3.7 +/- 0.4 mm/s; membrane potential: 46.2 +/- 3.1 mm/s). In whole bladders, optical signals were associated with spontaneous contractions (10-20 cmH(2)O). By contrast, in adult bladders spontaneous Ca(2+) and electrical activity was uncoordinated, originating at multiple sites and was associated with smaller (2-5 cmH(2)O) contractions. Spontaneous contractions and optical signals were insensitive to tetrodotoxin (2 muM) but were blocked by nifedipine (10 muM). Stretch or low carbachol concentrations (50 nM) applied to neonatal whole bladders enhanced the amplitude (to 20-35 cmH(2)O) of spontaneous activity, which was blocked by atropine. Bladder cross sections revealed that Ca(2+) and membrane potential transients produced by stretch or carbachol began near the urothelial-suburothelial interface and then spread to the detrusor. In conclusion, spontaneous activity in neonatal bladders, unlike activity in adult bladders, is highly organized, originating in the urothelium-suburothelium near the dome. Activity is enhanced by stretch or carbachol and this enhancement is blocked by atropine. It is hypothesized that acetylcholine is released from the urothelium during bladder filling to enhance spontaneous activity.
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Affiliation(s)
- A Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, A1224 Scaife Hall, Pittsburgh, PA 15261, USA.
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Cole AJ, Griffiths D, Lavender S, Summers P, Rich K. Relevance of postmortem radiology to the diagnosis of fatal cerebral gas embolism from compressed air diving. J Clin Pathol 2006; 59:489-91. [PMID: 16489175 PMCID: PMC1860292 DOI: 10.1136/jcp.2005.031708] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To test the hypothesis that artefact caused by postmortem off-gassing is at least partly responsible for the presence of gas within the vascular system and tissues of the cadaver following death associated with compressed air diving. METHODS Controlled experiment sacrificing sheep after a period of simulated diving in a hyperbaric chamber and carrying out sequential postmortem computed tomography (CT) on the cadavers. RESULTS All the subject sheep developed significant quantities of gas in the vascular system within 24 hours, as demonstrated by CT and necropsy, while the control animals did not. CONCLUSIONS The presence of gas in the vascular system of human cadavers following diving associated fatalities is to be expected, and is not necessarily connected with gas embolism following pulmonary barotrauma, as has previously been claimed.
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Affiliation(s)
- A J Cole
- Department of Radiology, the Townsville Hospital, Douglas, Queensland, Australia
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Harrod C, Griffiths D. Ichthyocotylurus erraticus (Digenea: Strigeidae): factors affecting infection intensity and the effects of infection on pollan ( Coregonus autumnalis ), a glacial relict fish. Parasitology 2005; 131:511-9. [PMID: 16174416 DOI: 10.1017/s0031182005007985] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Revised: 03/16/2005] [Accepted: 03/22/2005] [Indexed: 11/07/2022]
Abstract
Lough Neagh pollan are heavily infected with the strigeid Ichthyocotylurus erraticus , with 100% prevalence and median infection intensities of 600+ metacercariae in the pericardial cavity of mature fish. Female fish were more heavily infected than males. Infection intensity, which rose in summer, varied with pollan size, year, sampling bay within the lough and water depth within bays. Heavily infected pollan were caught further offshore than lightly infected fish. Spatial variation in pollan infection intensity corresponded to variation in the abundance of the first intermediate host, Valvata snails. The data suggest that heavily infected fish had lower food intakes. Parasitism reduced condition and liver size in male fish but condition in heavily parasitized females increased. Infection intensity was greater in larger fish of a given age. These patterns are discussed in the context of risks and rewards. The data suggest that inshore waters in summer are the preferred habitat of pollan and that the greater infection intensity of offshore fish results from their reduced competitive ability as a consequence of parasitism and the increased risk of infection there.
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Affiliation(s)
- C Harrod
- School of Environmental Sciences, University of Ulster, Coleraine BT52 1SA, UK
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Visvikis D, Griffiths D, Costa DC, Bomanji J, Ell PJ. Clinical evaluation of 2D versus 3D whole-body PET image quality using a dedicated BGO PET scanner. Eur J Nucl Med Mol Imaging 2005; 32:1050-6. [PMID: 15846487 DOI: 10.1007/s00259-005-1809-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Accepted: 03/03/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE Three-dimensional positron emission tomography (3D PET) results in higher system sensitivity, with an associated increase in the detection of scatter and random coincidences. The objective of this work was to compare, from a clinical perspective, 3D and two-dimensional (2D) acquisitions in terms of whole-body (WB) PET image quality with a dedicated BGO PET system. METHODS 2D and 3D WB emission acquisitions were carried out in 70 patients. Variable acquisition parameters in terms of time of emission acquisition per axial field of view (aFOV) and slice overlap between sequential aFOVs were used during the 3D acquisitions. 3D and 2D images were reconstructed using FORE+WLS and OSEM respectively. Scatter correction was performed by convolution subtraction and a model-based scatter correction in 2D and 3D respectively. All WB images were attenuation corrected using segmented transmission scans. Images were blindly assessed by three observers for the presence of artefacts, confidence in lesion detection and overall image quality using a scoring system. RESULTS Statistically significant differences between 2D and 3D image quality were only obtained for 3D emission acquisitions of 3 min. No statistically significant differences were observed for image artefacts or lesion detectability scores. Image quality correlated significantly with patient weight for both modes of operation. Finally, no differences were seen in image artefact scores for the different axial slice overlaps considered, suggesting the use of five slice overlaps in 3D WB acquisitions. CONCLUSION 3D WB imaging using a dedicated BGO-based PET scanner offers similar image quality to that obtained in 2D considering similar overall times of acquisitions.
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Affiliation(s)
- D Visvikis
- U650 INSERM, Laboratoire de Traitement de l'Information Medicale (LaTIM), CHU Morvan, Brest, 29609, France.
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Abstract
AIMS To investigate the effect of exposure to coke oven emissions on the lung function of coke oven workers. METHODS The study population, followed from 1978 and 1990, was 580 male workers with at least two sets of lung function measurements (FVC, FEV1, FEV1/FVC, and FEF25-75%). An annual rate of change (time slope) for age and height adjusted lung function index was estimated for each subject. This "time slope" was then treated as the response variable in a weighted multiple regression analysis with selected predictors. RESULTS For all 580 subjects, each year of working in the "operation" group (the most exposed) was found to increase the FVC decline by around 0.7 ml/year (95% CI 0.1 to 1.3 ml/year). After the exclusion of 111 subjects without detailed work history, the above finding was confirmed and each year of exposure in "operation" was also found to increase the FEV1 decline by around 0.8 ml/year (95% CI 0.1 to 1.4 ml/year). CONCLUSIONS These findings are consistent with the results of previous cross-sectional studies. Work duration in the most exposed position in the coke ovens was associated with increased annual decline for FVC and FEV1. The estimated effect of one year of work exposure in "operation" is equivalent, in terms of the reduction in lung function, to an estimated 2.1 pack-years of smoking for FVC and 1.2 pack-years of smoking for FEV1.
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Affiliation(s)
- J Wu
- Graduate School of Public Health, University of Wollongong, NSW 2522, Australia.
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Morris-Stiff G, Steel A, Savage P, Devlin J, Griffiths D, Portman B, Mason M, Jurewicz WA. Transmission of donor melanoma to multiple organ transplant recipients. Am J Transplant 2004; 4:444-6. [PMID: 14962000 DOI: 10.1111/j.1600-6143.2004.00335.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Malignant melanoma represents the most common tumour responsible for donor-derived post transplantation malignancies. We report the varied presentation and outcome of three graft recipients (two kidney and hepatic) who developed metastatic melanoma following cadaveric organ transplantation from a single multiorgan donor. Two of the recipients presented with symptomatic metastatic lesions and the third patient, despite being carefully monitored, developed evidence of metastatic cutaneous melanoma. Two of the patients died as a direct result of their melanomas. The recipients of corneal and cardiac grafts remain disease-free. We conclude that despite careful screening, donor-derived tumours remain a not uncommon clinical entity. The identification of a lesion in one recipient should prompt immediate examination and investigation of the remaining recipients of multiorgan donations.
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Affiliation(s)
- G Morris-Stiff
- University of Wales College of Medicine, Cardiff, Wales, UK
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Peacock SJ, Justice A, Griffiths D, de Silva GDI, Kantzanou MN, Crook D, Sleeman K, Day NPJ. Determinants of acquisition and carriage of Staphylococcus aureus in infancy. J Clin Microbiol 2004; 41:5718-25. [PMID: 14662966 PMCID: PMC308978 DOI: 10.1128/jcm.41.12.5718-5725.2003] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nasal carriage of Staphylococcus aureus is a major risk factor for invasive S. aureus disease. The aim of this study was to define factors associated with carriage. We conducted a prospective, longitudinal community-based study of infants and their mothers for a period of 6 months following delivery. The epidemiology of carriage was examined for 100 infant-mother pairs. Infant carriage varied significantly with age, falling from 40 to 50% during the first 8 weeks to 21% by 6 months. Determinants of infant S. aureus carriage included maternal carriage, breastfeeding, and number of siblings. Bacterial typing of S. aureus was performed by pulsed-field gel electrophoresis and multilocus sequence typing. The majority of individuals carried a single strain of S. aureus over time, and the mother was the usual source for colonizing isolates in infants. The effect of other components of the normal nasal flora on the development of S. aureus carriage was examined in 157 consecutive infants. Negative associations (putative bacterial interference) between S. aureus and other species occurred early in infancy but were not sustained. An increasing antistaphylococcal effect observed over time was not attributable to bacterial interference. S. aureus carriage in infants is likely to be determined by a combination of host, environmental, and bacterial factors, but bacterial interference does not appear to be an ultimate determinant of carrier status.
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Affiliation(s)
- Sharon J Peacock
- Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, United Kingdom.
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Pease C, Priestley A, McEwen A, Pendlington R, Sanders D, York M, Griffiths D, Wood S, de Ligt R, Verwei M, Aynaou AE, van de Sandt J. 725 CaCo-2 cell predictivity & absorption of lipophilic analogues in man. Toxicol Lett 2003. [DOI: 10.1016/s0378-4274(03)90724-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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