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Alpizar SA, Accini J, Anderson DC, Eysa B, Medina-Piñón I, Ohmagari N, Ostrovskyy MM, Aggrey-Amable A, Beck K, Byrne D, Grayson S, Hwang PMT, Lonchar JD, Strizki J, Xu Y, Paschke A, De Anda CS, Sears PS. Molnupiravir for intra-household prevention of COVID-19: The MOVe-AHEAD randomized, placebo-controlled trial. J Infect 2023; 87:392-402. [PMID: 37690669 DOI: 10.1016/j.jinf.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVES To evaluate the efficacy and safety of molnupiravir for intra-household post-exposure prophylaxis (PEP) of COVID-19. METHODS MOVe-AHEAD was a randomized, controlled, double-blind, phase 3 trial comparing molnupiravir (800 mg twice daily for 5 days) with placebo. Eligible participants were adult, unvaccinated, asymptomatic household contacts of patients with laboratory-confirmed COVID-19. The primary efficacy endpoint was the incidence of COVID-19 through day 14 in modified intention-to-treat (MITT) participants (those who received ≥1 dose of study intervention) without detectable SARS-CoV-2 at baseline, termed the MITT-VN population. Superiority of molnupiravir was prespecified as a stratified one-sided p-value of <0.0249 for the treatment difference in this endpoint. RESULTS The MITT population comprised 763 participants randomized to molnupiravir and 764 to placebo; 83.6% had anti-SARS-CoV-2 antibodies at baseline. In the MITT-VN population, COVID-19 rates through day 14 were 6.5% with molnupiravir and 8.5% with placebo (one-sided p-value: 0.0848). In the molnupiravir arm, 25/35 of confirmed COVID-19 events (71.4%) occurred after completion of treatment (versus 17/49 [34.7%] for placebo). Adverse event rates were low and similar between molnupiravir and placebo. CONCLUSIONS Molnupiravir was well-tolerated but did not meet the prespecified superiority criterion, possibly influenced in part by the high pre-existing immunity in the trial population.
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Affiliation(s)
- Sady A Alpizar
- Clinical Research Trials of Florida, 2713 W. Virginia Ave., Tampa 33607, FL, USA.
| | - Jose Accini
- IPS Centro Científico Asistencial, Cra. 45 #85-49, Barranquilla 080020, Colombia.
| | - Duane C Anderson
- Excel Clinical Research LLC, 3059 S Maryland Pkwy., Las Vegas, NV 89109, USA.
| | - Basem Eysa
- National Hepatology and Tropical Medicine Research Institute, 10 Kasr El, Eini St., Fom Al Khalig Sq., Cairo 11796, Egypt.
| | - Isaí Medina-Piñón
- ICARO Investigaciones en Medicina, Calle Ignacio Allende No. 1015, Chihuahua 31000, Mexico.
| | - Norio Ohmagari
- National Center for Global Health and Medicine Hospital, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan.
| | - Mykola M Ostrovskyy
- Regional Phthisiopulmonological Center, 17 Franka St., Ivano-Frankivsk 76018, Ukraine.
| | | | - Karen Beck
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Dana Byrne
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Staci Grayson
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Peggy M T Hwang
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Julia D Lonchar
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Julie Strizki
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Yayun Xu
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | - Amanda Paschke
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA
| | | | - Pamela S Sears
- Merck & Co, Inc., 126 E. Lincoln Ave., Rahway, NJ 07065, USA.
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Conway R, Byrne D, O'Riordan D, Silke B. Short- and long-term mortality following acute medical admission. QJM 2023; 116:850-854. [PMID: 37527010 DOI: 10.1093/qjmed/hcad181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Short-term in-hospital mortality following acute medical admission has been widely investigated. Longer term mortality, particularly out-of-hospital mortality, has been less well studied. AIM The aim of this study is to evaluate short- and long-term mortality, and predictors of such, following acute medical admission. DESIGN Retrospective database study. METHODS We evaluated all acute medical admissions to our institution over 10 years (2002-11) with a minimum of a further 10 years follow-up to 2021 using the Irish National Death Register. Predictors of 30-day in-hospital and long-term mortality were analysed with logistic and Cox regression, with loss of life years estimated. RESULTS The 2002-11 cohort consisted of 62 184 admissions in 35 140 patients. 30-Day in hospital mortality (n = 3646) per patient was 10.4% and per admission was 5.9%. There were an additional 11 440 longer-term deaths by 2021-total mortality was 15 086 (42.9%). Deaths post hospital discharge had median age at admission of 75.4 years [interquartile range (IQR) 63.7, 82.8] and died at median age of 80 years (IQR 69, 87). The half-life of survival following admission was 195 months-representing a short fall of 8 life years (32.9%) compared with the projected population reference of 24.3 years. Age [odds ratio (OR) 1.73 (95% confidence interval (CI) 1.64, 1.81)], acute illness severity score [OR 1.39 (95% CI 1.36, 1.43)] and comorbidity score [OR 1.09 (95% CI 1.08, 1.10)] predicted long-term mortality. CONCLUSION Similar factors influence both short- and long-term mortality following acute medical admission, the magnitude of effect is attenuated over time.
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Affiliation(s)
- R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Byrne D, Fisher A, Baker L, Twomey EL, Gorman KM. Yield of brain MRI in children with autism spectrum disorder. Eur J Pediatr 2023; 182:3603-3609. [PMID: 37227501 PMCID: PMC10460367 DOI: 10.1007/s00431-023-05011-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/18/2023] [Accepted: 04/28/2023] [Indexed: 05/26/2023]
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental condition. The American Academy of Paediatrics and American Academy of Neurology do not recommend routine brain magnetic resonance imaging (MRI) in the assessment of ASD. The need for a brain MRI should be decided on atypical features in the clinical history and examination. However, many physicians continue to use brain MRI routinely in the assessment process. We performed a retrospective review of indications for requesting brain MRI in our institution over a 5-year period. The aim was to identify the yield of MRI in children with ASD and calculate the prevalence of significant neuroimaging abnormalities in children with ASD and identify clinical indications for neuroimaging. One hundred eighty-one participants were analysed. An abnormal brain MRI was identified in 7.2% (13/181). Abnormal brain MRI was more likely with an abnormal neurological examination (OR 33.1, p = 0.001) or genetic/metabolic abnormality (OR 20, p = 0.02). In contrast, abnormal MRI was not shown to be more likely in children with a variety of other indications such as behavioural issues and developmental delay. Conclusion: Thus, our findings support that MRI should not be a routine investigation in ASD, without additional findings. The decision to arrange brain MRI should be made on a case-by-case basis following careful evaluation of potential risks and benefits. The impact of any findings on the management course of the child should be considered prior to arranging imaging. What is Known: • Incidental brain MRI findings are common in children with and without ASD. • Many children with ASD undergo brain MRI in the absence of neurological comorbidities. What is New: • Brain MRI abnormalities in ASD are more likely with an abnormal neurological examination and genetic or metabolic conditions. • Prevalence of significant brain MRI abnormalities in ASD alone is low.
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Affiliation(s)
- D Byrne
- Department of Neurodisability, Children’s Health Ireland at Temple Street, Dublin 1, Ireland
| | - A Fisher
- Department of Neurodisability, Children’s Health Ireland at Temple Street, Dublin 1, Ireland
| | - L Baker
- Department of Neurodisability, Children’s Health Ireland at Temple Street, Dublin 1, Ireland
| | - EL Twomey
- Department of Radiology, Children’s Health Ireland at Temple Street, Dublin 1, Ireland
| | - K M Gorman
- Department of Paediatric Neurology and Clinical Neurophysiology, Children’s Health Ireland at Temple Street, Dublin 1, Ireland
- School of Medicine and Medical Sciences, University College Dublin, Dublin 4, Ireland
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4
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Doran S, Horan M, Hillery P, Glynn D, Harbison J, Walsh J, Calderon A, Bradley D, Byrne D. It's time to act FAST: A quality improvement program (QIP) to improve acute stroke imaging times. Ir Med J 2023; 116:744. [PMID: 37010507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Holmes MD, Vo N, Rafeq R, Byrne D, King M. Administration of β-lactam antibiotics to patients with reported penicillin allergy in the emergency department. Am J Emerg Med 2023; 68:119-123. [PMID: 36972634 DOI: 10.1016/j.ajem.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND β-lactam antibiotics are amongst the most commonly prescribed medications in the Emergency Department (ED) due to their role in empiric sepsis therapy; however, inferior therapeutic options are often utilized due to a reported allergy; penicillin (PCN) being most frequent. In the United States, 10% of the population endorses an allergic reaction to PCN while <1% experience IgE-mediated reactions. This study aimed to evaluate the frequency and outcome of patients in the ED whose PCN allergies were challenged with β-lactam antibiotics. METHODS We conducted a retrospective chart review of patients in the ED at an academic medical center aged ≥18, and who received a β-lactam despite a reported PCN allergy between January 2015 and December 2019. Patients who did not receive a β-lactam or did not report a PCN allergy prior to administration were excluded. The primary outcome was the frequency of IgE-mediated reactions in response to β-lactam administration. A secondary outcome assessed the frequency of continuation of β-lactams upon admission from the ED. RESULTS 819 patients were included (66% female) with prior reported PCN reactions: hives (22.5%), rash (15.4%), swelling (6.2%), anaphylaxis (3.5%), other (12.1%), or undocumented on medical electronic record (40.3%). No patients experienced an IgE-mediated reaction to the β-lactam administered in the ED. Previously reported allergies had no effect on the continuation of β-lactams when admitted or discharged (OR: 1, 95% CI: 0.7-1.44). Patients who had a history of an IgE-mediated penicillin allergy were frequently continued (77%) on a β-lactam after leaving the ED via admission or discharge. CONCLUSION β-lactam administration in patients with previously reported PCN allergies did not result in any IgE-mediated reactions nor in an increase in adverse reactions. Our data contributes to the body of evidence that supports the administration of β-lactams to patients with documented PCN allergies.
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Affiliation(s)
- Matthew D Holmes
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA.
| | - Nina Vo
- Philadelphia College of Pharmacy, University of the Sciences, 600 South 43rd, Philadelphia, PA 19104, USA
| | - Rachel Rafeq
- Cooper University Health Care, 1 Cooper Plaza, Camden, NJ 08103, USA.
| | - Dana Byrne
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA; Cooper University Health Care, 1 Cooper Plaza, Camden, NJ 08103, USA
| | - Madeline King
- Philadelphia College of Pharmacy, University of the Sciences, 600 South 43rd, Philadelphia, PA 19104, USA; Cooper University Health Care, 1 Cooper Plaza, Camden, NJ 08103, USA
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6
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Conway R, Byrne D, O'Riordan D, Silke B. Blood Culture and Troponin Testing in Suspected Bacteraemic Admissions - Example of Risk Stratification Based on Clinical Testing. Acute Med 2023; 21:176-181. [PMID: 36809448 DOI: 10.52964/amja.0921] [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: 02/23/2023]
Abstract
AIM To investigate the clinical predictive value of troponin (hscTnT) and blood culture testing. METHODS We examined all medical admissions from 2011-2020. Prediction of 30-day in-hospital mortality, dependent on blood culture and hscTnT requests/results, was evaluated using multiple variable logistic regression. Length of stay was related to utilization of procedures/services with truncated Poisson regression. RESULTS There were 77,566 admissions in 42,325 patients. With both blood cultures and hscTnT requested, 30-day in-hospital mortality increased to 20.9% (95%CI: 19.7, 22.1) vs 8.9% (95%CI: 8.5, 9.4) for blood cultures alone and 2.3% (95%CI: 2.2, 2.4) with neither. Blood culture 3.93 (95%CI: 3.50, 4.42) or hsTnT requests 4.58 (95%CI: 4.10, 5.14) were prognostic. CONCLUSION Blood culture and hscTnT requests and results predict worse outcomes.
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Affiliation(s)
- R Conway
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- MD, PhD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- MD DSc, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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7
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Conway R, Byrne D, O'Riordan D, Silke B. Outcomes and Utility of Troponin and NT-proBNP testing in Dyspnoea Presentations. Ir Med J 2023; 116:12. [PMID: 36916739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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8
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Conway R, Byrne D, O'Riordan D, Silke B. Outcomes for Emergency Department Final Diagnosis of Non-specific Complaint compared to Dyspnoea and Pain. Acute Med 2023; 22:180-187. [PMID: 38284632] [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: 01/30/2024]
Abstract
AIM To compare outcomes in Emergency Department (ED) final diagnoses of (non-specific complaint) NSC, dyspnoea and pain. METHODS We studied all ED final diagnoses of NSC, dyspnoea, and pain over 6 years (2015-2020). Multivariable logistic regression was performed. RESULTS There were 49,965 admissions. 30-day in-hospital mortality was significantly lower for pain, 3.0% (95%CI 2.4%, 3.6%), compared to NSC, 4.2% (95%CI 3.8%, 4.7%), and dyspnoea, 4.6% (95%CI 4.2%, 5.0%). NSC did not predict 30-day in-hospital mortality- univariate OR 1.05 (95%CI 0.93, 1.19), multivariable OR 1.07 (95%CI 0.93, 1.23). Comorbidity and Acute Illness Severity Scores demonstrated a curvilinear relationship with 30-day in-hospital mortality. CONCLUSION An ED final diagnosis of NSC did not predict 30-day in-hospital mortality.
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Affiliation(s)
- R Conway
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- MD DSc, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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9
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Lewin J, Saridogan E, Byrne D, Clark TJ, Vashisht A. Impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK: a national database study. Facts Views Vis Obgyn 2022; 14:309-315. [PMID: 36724422 PMCID: PMC10364332 DOI: 10.52054/fvvo.14.4.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background The COVID-19 pandemic has had a significant effect on healthcare services, particularly affecting patients who suffer from chronic conditions. However, the pandemic's effect on endometriosis surgery is not yet known. Objectives To determine the impact of the COVID-19 pandemic on surgery for severe endometriosis in the UK at a national, regional and centre-level. Materials and Methods The British Society for Gynaecological Endoscopy (BSGE) collects data nationally on all operations for severe endometriosis which involve dissection of the pararectal space. Annual audits of this database were obtained from the BSGE. Publicly available data on COVID-19 cases and population were obtained from the UK Office for National Statistics. Main outcome measures Numbers of annual BSGE-registered endometriosis operations. Results A total of 8204 operations were performed. The number of operations decreased by 49.4% between 2019 and 2020 and then increased in 2021, but remained 10.5% below average pre-pandemic levels, indicating at least 980 missed operations between 2019-2020. Median operations per centre decreased by 51.0% in 2020 (IQR 29.4% - 75.0%) and increased in 2021 but remained 33% below pre-pandemic levels. There was no change in the type of surgery performed. All 11 administrative regions of Great Britain had reduced numbers of operations in 2020 compared with the average for 2017-2019, with a median 44.2% decrease (range 13.3% - 67.5%). Regional reduction in operations was correlated with COVID-19 infection rates (r=0.54, 95% CI of r 0.022 - 1.00, p=0.043). Conclusion The number of operations performed annually in the UK for severe endometriosis fell dramatically during the COVID-19 pandemic and is yet to normalise. What's new? This study shows the dramatic effect that the COVID-19 pandemic has had on UK services for endometriosis surgery, which may continue to affect patients and clinicians for a considerable time to come.
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Alsharif M, Armstrong R, Sheehy N, Byrne D. Pericardial Fat Necrosis. Ir Med J 2022; 115:679. [PMID: 36920441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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Artner C, Bohrer B, Pasquini L, Mazurenko I, Lahrach N, Byrne D, de Poulpiquet A, Lojou E. Effects of interactions between SPEEK or Nafion ionomers and bilirubin oxidase on O2 enzymatic reduction. Electrochim Acta 2022. [DOI: 10.1016/j.electacta.2022.140787] [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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12
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Yan C, Byrne D, Ondry JC, Kahnt A, Moreno-Hernandez IA, Kamat GA, Liu ZJ, Laube C, Crook MF, Zhang Y, Ercius P, Alivisatos AP. Facet-selective etching trajectories of individual semiconductor nanocrystals. Sci Adv 2022; 8:eabq1700. [PMID: 35947667 DOI: 10.1126/sciadv.abq1700] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The size and shape of semiconductor nanocrystals govern their optical and electronic properties. Liquid cell transmission electron microscopy (LCTEM) is an emerging tool that can directly visualize nanoscale chemical transformations and therefore inform the precise synthesis of nanostructures with desired functions. However, it remains difficult to controllably investigate the reactions of semiconductor nanocrystals with LCTEM, because of the highly reactive environment formed by radiolysis of liquid. Here, we harness the radiolysis processes and report the single-particle etching trajectories of prototypical semiconductor nanomaterials with well-defined crystalline facets. Lead selenide nanocubes represent an isotropic structure that retains the cubic shape during etching via a layer-by-layer mechanism. The anisotropic arrow-shaped cadmium selenide nanorods have polar facets terminated by either cadmium or selenium atoms, and the transformation trajectory is driven by etching the selenium-terminated facets. LCTEM trajectories reveal how nanoscale shape transformations of semiconductors are governed by the reactivity of specific facets in liquid environments.
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Affiliation(s)
- Chang Yan
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
- Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Dana Byrne
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Justin C Ondry
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
- Kavli Energy NanoScience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Axel Kahnt
- Leibniz Institute of Surface Engineering (IOM), Permoserstr. 15, D-04318 Leipzig, Germany
| | | | - Gaurav A Kamat
- Department of Chemical and Biomolecular Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Zi-Jie Liu
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Christian Laube
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
- Leibniz Institute of Surface Engineering (IOM), Permoserstr. 15, D-04318 Leipzig, Germany
| | - Michelle F Crook
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Ye Zhang
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Peter Ercius
- National Center for Electron Microscopy, Molecular Foundry, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - A Paul Alivisatos
- Department of Chemistry, University of California, Berkeley, Berkeley, CA 94720, USA
- Materials Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
- Kavli Energy NanoScience Institute, University of California, Berkeley, Berkeley, CA 94720, USA
- Department of Materials Science and Engineering, University of California, Berkeley, Berkeley, CA 94720, USA
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Surdey J, Byrne D, Fox T. Developing Irelands first National Student Mental Health and Suicide Prevention Framework for Higher Education. Ir J Psychol Med 2022:1-5. [PMID: 35379368 DOI: 10.1017/ipm.2022.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article focuses on the development of Ireland's first National Student Mental Health and Suicide Prevention Framework for Higher Education. There is growing concern for student mental health in higher education nationally and globally. The majority of students are aged between 18 and 24, which is identified as a high-risk group for mental health difficulties. Recent surveys of student mental illness, mental distress, and low well-being have been recognized by the World Health Organization, the Union of Students in Ireland National Report on Student Mental Health in Third Level Education, the My World survey and the My World 2 study. The Higher Education Authority in Ireland made a commitment to the Department of Health Connecting for Life (Ireland's National Strategy to Reduce Suicide 2015-2020) to form national guidelines for suicide prevention in higher education. In order to deliver on this commitment, The National Student Mental Health and Suicide Prevention Framework was developed. The Framework is informed by international evidence and was the product of a collaborative cross sector and cross disciplinary team including health professionals, government representatives, educators, students, policy makers, community organizations, researchers and clinicians.
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Affiliation(s)
- J Surdey
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - D Byrne
- Department of Business and Social Sciences, Sligo Institute of Technology, Sligo, Ireland
| | - T Fox
- SynthSCS Project Lead and Head of Student Counselling Services, Technological University Shannon Midlands, Athlone, Ireland
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Conway R, Byrne D, O'Riordan D, Silke B. The 'Unwell' clinical presentation- an opportunity for admission avoidance? Acute Med 2022; 21:12-18. [PMID: 35342905 DOI: 10.52964/amja.0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND An 'unwell' patient is a common presentation. METHODS We studied all ED 'unwell' admissions over 6 years, assessing factors influencing mortality with logistic regression. RESULTS From 49,965 admissions, the ED diagnosis was 'unwell' in 3650 (7.3%). 'Unwell' presentations were older and had longer length of stay. Mortality was not different 4.2% vs 4.6 % (p=0.28). Respiratory patients and those >=70 years had increased mortality, 8.3% (95%CI: 5.9%, 10.6%) and 7.1% (5.7%, 8.4%) respectively. Being unwell predicted a better outcome - univariate OR 0.35 (95%CI: 0.24, 0.52), multivariable OR 0.68 (95%CI: 0.44, 1.03). CONCLUSION A diagnosis of 'unwell' applied to a heterogenous group; clinical trajectories and outcomes were sufficiently different to preclude targeted admission avoidance as a strategy.
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Affiliation(s)
- R Conway
- PhD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- MD, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- MD DSc, Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Rose L, Lai L, Byrne D. Successful prolonged treatment of a carbapenem-resistant Acinetobacter baumannii hip infection with cefiderocol: A case report. Pharmacotherapy 2022; 42:268-271. [PMID: 35075683 DOI: 10.1002/phar.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/09/2022]
Abstract
We report a 50-year-old Caucasian male with a complicated past medical history who developed extensive polymicrobial osteomyelitis, including a carbapenem-resistant Acinetobacter baumannii (CRAB). In order to streamline therapy, the patient received compassionate use cefiderocol for 6 weeks which was well tolerated. In addition, the patient's infection was considered cured at end of treatment. Few cases on the use of prolonged cefiderocol for treatment of osteomyelitis due to CRAB have been published. Our patient did not report adverse reactions, nor did he develop laboratory abnormalities which were assessed throughout and at the end of the 6-week course.
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Affiliation(s)
- Lucia Rose
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Lauren Lai
- Division of Infectious Disease, Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
| | - Dana Byrne
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
- Division of Infectious Disease, Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA
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Yao B, Peng H, Zhang H, Kang J, Zhu C, Delgado G, Byrne D, Faulkner S, Freyman M, Lu X, Worsley MA, Lu JQ, Li Y. Printing Porous Carbon Aerogels for Low Temperature Supercapacitors. Nano Lett 2021; 21:3731-3737. [PMID: 33719451 DOI: 10.1021/acs.nanolett.0c04780] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Maintaining fast charging capability at low temperatures represents a significant challenge for supercapacitors. The performance of conventional porous carbon electrodes often deteriorates quickly with the decrease of temperature due to sluggish ion and charge transport. Here we fabricate a 3D-printed multiscale porous carbon aerogel (3D-MCA) via a unique combination of chemical methods and the direct ink writing technique. 3D-MCA has an open porous structure with a large surface area of ∼1750 m2 g-1. At -70 °C, the symmetric device achieves outstanding capacitance of 148.6 F g-1 at 5 mV s-1. Significantly, it retains a capacitance of 71.4 F g-1 at a high scan rate of 200 mV s-1, which is 6.5 times higher than the non-3D printed MCA. These values rank among the best results reported for low temperature supercapacitors. These impressive results highlight the essential role of open porous structures for preserving capacitive performance at ultralow temperatures.
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Affiliation(s)
- Bin Yao
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Huarong Peng
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Haozhe Zhang
- MOE of the Key Laboratory of Bioinorganic and Synthetic Chemistry, The Key Lab of Low-carbon Chemistry & Energy Conservation of Guangdong Province, School of Chemistry, Sun Yat-Sen University, Guangzhou 510275, P. R. China
| | - Junzhe Kang
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Cheng Zhu
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, United States
| | - Gerardo Delgado
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Dana Byrne
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Soren Faulkner
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Megan Freyman
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
| | - Xihong Lu
- MOE of the Key Laboratory of Bioinorganic and Synthetic Chemistry, The Key Lab of Low-carbon Chemistry & Energy Conservation of Guangdong Province, School of Chemistry, Sun Yat-Sen University, Guangzhou 510275, P. R. China
| | - Marcus A Worsley
- Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, California 94550, United States
| | - Jennifer Q Lu
- School of Engineering, University of California, Merced, California 95343, United States
| | - Yat Li
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California 95064, United States
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17
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Fitzpatrick I, Byrne D, Cranwell J, Gilmore A. Tobacco content in video on demand services in low- and middle-income countries. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
There is clear evidence that exposure to tobacco is linked to smoking uptake. The economic and social burden of diseases associated with smoking is particularly high in low-and middle-income countries, where smoking uptake is high and exposure to tobacco use and branded content is widespread. Streamed content exhibits consistently higher levels of tobacco content than broadcast media and these levels have increased. The prevalence of smoking and tobacco content in video-on-demand (VOD) services is troubling given their popularity with youth audiences and the ease with which content can be accessed by children. This is because barriers to youth consumption that exist for film or broadcast media, including content gatekeepers, are absent.
Methods
The most popular VOD series from 10 low- and middle-income countries (Bangladesh, Brazil, China, India, Indonesia, Mexico, Pakistan, Philippines, Ukraine and Vietnam) were identified based on demand expressions and coded for individual depictions of tobacco. 18 series were analysed, representing a mix of international content in several languages. 111 episodes, totalling 81.4 hours of coded content, were analysed for tobacco depictions and characterisation of smoking characters.
Results
Tobacco content was prevalent and particularly prominent in non-English language series, where readily identifiable “stars” frequently partook in smoking. Cigarettes dominated tobacco imagery, with other forms (pipes and electronic nicotine delivery systems) rarely appearing. Notably, there were several incidents featuring well-known brands. Given that access to VOD services is difficult to moderate, youth audiences can easily access programming featuring high levels of tobacco use by identifiable characters, played by well-known actors. A lack of control regarding consumption of streamed content means that it is extremely important for content producers like Netflix and Amazon to ensure VOD content is suitable for youth audiences.
Key messages
Tobacco content in video-on demand services is increasing. Tobacco exposure is linked to smoking uptake.
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Affiliation(s)
| | - D Byrne
- Department of Health, University of Bath, Bath, UK
| | - J Cranwell
- Department of Health, University of Bath, Bath, UK
| | - A Gilmore
- Department of Health, University of Bath, Bath, UK
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18
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Fitzpatrick I, Gilmore A, Cranwell J, Byrne D. The brand narratives of Philip Morris International: developing methods to identify corporate voices. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Existing research into marketing and advertising of tobacco companies shows the industry continues to spend huge sums of money promoting harmful products. In the face of increasing controls on the advertising of these products, and restrictions on their participation in policy development enshrined in a global treaty, tobacco companies must adapt to remain competitive in an unfavourable climate. Although there has been much engagement with the development of corporate messages by the 4 big tobacco brands, no systematic review of textual and visual corporate messaging used by these companies exists. This research presents the case of Philip Morris International (PMI), and maps out its key messages to investors and public audiences.
Methods
This research combines corpus linguistics with inductive coding to illustrate key topics, themes and the linguistic habits of PMI. A linguistic comparison with the messaging of 40 other transnational corporations provides a reference from which the unique characteristics of PMI's language can be identified.
Results
Thematic analysis of written and visual content highlights several dominant themes, namely Science, Transformation, Sustainability and Permissibility. Redemptive tropes were common in the sample, apparent in repeated reference to a desire to be and do better and to improve the lives of smokers around the world. Similarly, a strong emphasis on science was apparent in both the use of imagery and language, including scientific notation, laboratories and individual scientists.
The identification of linguistic and visual brand strategies will facilitate the education of advocates and consumers about the approach of the tobacco industry in their pursuit of continued business. Identifying the core values PMI is actively promoting could help to identify emerging corporate strategies in influencing public health policy, including the promotion of corporate goodwill in markets where product-specific advertising is banned.
Key messages
Big tobacco using new platforms to influence policy making. Corporate narratives impact perception of tobacco harm.
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Affiliation(s)
| | - A Gilmore
- Department of Health, University of Bath, Bath, UK
| | - J Cranwell
- Department of Health, University of Bath, Bath, UK
| | - D Byrne
- Department of Health, University of Bath, Bath, UK
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19
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Affiliation(s)
- C T O'Connor
- Department of Cardiology, Tallaght University Hospital, Dublin, Ireland
| | - P C Murray
- Medical Professorial Unit, Tallaght University Hospital, Dublin, Ireland
| | - M F Ryan
- Department of Radiology, Saint James's Hospital, Dublin, Ireland
| | - D Byrne
- Department of Internal Medicine, Saint James's Hospital, Dublin, Ireland
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20
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Abstract
Although acute ischemic stroke remains one of the most common causes of death and disability worldwide, it is a potentially treatable condition if appropriately managed in a timely manner. The goals of acute stroke imaging include establishing a diagnosis as fast as possible with (1) accurate infarct quantification, (2) intracranial and cervical vasculature assessment, and (3) brain perfusion analysis for detection of infarct core and potentially salvageable penumbra allowing optimal patient selection for appropriate therapy. Given the extensive number of images generated from acute stroke imaging studies and as "time is brain," this article aims to highlight a logical approach for the radiologist in acute stroke computed tomography imaging in order to accurately interpret and communicate results in a timely manner.
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Affiliation(s)
- D Byrne
- Division of Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
| | - J P Walsh
- University of British Columbia, Vancouver, British Columbia, Canada.,Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - G Sugrue
- University of British Columbia, Vancouver, British Columbia, Canada.,Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - S Nicolaou
- University of British Columbia, Vancouver, British Columbia, Canada.,Division of Emergency Radiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - A Rohr
- Division of Neuroradiology, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of British Columbia, Vancouver, British Columbia, Canada
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21
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Carr S, McDermott BR, McInerney N, Hussey A, Byrne D, Potter S. Determining the Effect of External Stressors and Cognitive Distraction on Microsurgical Skills and Performance. Front Surg 2020; 6:77. [PMID: 32039230 PMCID: PMC6987403 DOI: 10.3389/fsurg.2019.00077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/28/2019] [Accepted: 12/20/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Microsurgery is an essential element of Plastic Surgery practice. There is a paucity of studies assessing the impact of stress and cognitive distraction on technical microsurgical performance. The ability to complete cognitive and technical skills in parallel has not been assessed in a microsurgical setting. Aim: To test the hypothesis that cognitive distraction and external stressors negatively affect microsurgical performance in a high fidelity simulation setting. Materials/Methods: Fourteen surgeons across all levels of training undertook 2 microsurgical skills sessions, 1 month apart. Session one established baseline microsurgical skill. In session two, skills were assessed with the introduction of realistic operative room cognitive distractions (ORDIs). Outcome measures were efficiency and accuracy, measured by Time to Completion (TTC) and Anastomosis Lapse Index (ALI), respectively. Key Results: Fourteen participants (6 novices, 5 plastic surgery specialist trainees and 3 consultants) completed both microsurgical skills sessions. In total, 28-microvascular anastomosis were analyzed. Mean baseline TTC for the group was 20.36 min. With cognitive distraction and external stress mean TTC decreased to 17.87 min. Mean baseline ALI score for the group was 3.32 errors per anastomosis. The introduction of cognitive distraction and external stress increased the mean to 4.86 errors per anastomosis. Total errors per anastomosis increased from 91 errors at baseline to 137 errors with cognitive distraction and external stress. Under stress, participants were more efficient but had reduced anastomotic accuracy. Conclusion: Under stress, surgeons were more efficient, this translated into faster completion of a microsurgical anastomosis. Efficiency, however, came at the expense of accuracy.
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Affiliation(s)
- Shane Carr
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Bronwyn Reid McDermott
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| | - Niall McInerney
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - Alan Hussey
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
| | - D Byrne
- Irish Centre for Applied Patient Safety and Simulation, Galway University Hospital, Galway, Ireland
| | - Shirley Potter
- Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland
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22
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Byrne D, Walsh JP, Schmiedeskamp H, Settecase F, Heran MKS, Niu B, Salmeen AK, Rohr B, Field TS, Murray N, Rohr A. Prediction of Hemorrhage after Successful Recanalization in Patients with Acute Ischemic Stroke: Improved Risk Stratification Using Dual-Energy CT Parenchymal Iodine Concentration Ratio Relative to the Superior Sagittal Sinus. AJNR Am J Neuroradiol 2020; 41:64-70. [PMID: 31896566 DOI: 10.3174/ajnr.a6345] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/08/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Brain parenchymal hyperdensity on postthrombectomy CT in patients with acute stroke can be due to hemorrhage and/or contrast staining. We aimed to determine whether iodine concentration within contrast-stained parenchyma compared with an internal reference in the superior sagittal sinus on dual-energy CT could predict subsequent intracerebral hemorrhage. MATERIALS AND METHODS Seventy-one patients with small infarct cores (ASPECTS ≥ 7) and good endovascular recanalization (modified TICI 2b or 3) for anterior circulation large-vessel occlusion were included. Brain parenchymal iodine concentration as per dual-energy CT and the percentage of contrast staining relative to the superior sagittal sinus were recorded and correlated with the development of intracerebral hemorrhage using Mann-Whitney U and Fisher exact tests. RESULTS Forty-three of 71 patients had parenchymal hyperdensity on initial dual-energy CT. The median relative iodine concentration compared with the superior sagittal sinus was significantly higher in those with subsequent intracerebral hemorrhage (137.9% versus 109.2%, P = .007). By means of receiver operating characteristic analysis, a cutoff value of 100% (iodine concentration relative to the superior sagittal sinus) enabled identification of patients going on to develop intracerebral hemorrhage with 94.75% sensitivity, 43.4% specificity, and a likelihood ratio of 1.71. CONCLUSIONS Within our cohort of patients, the relative percentage of iodine concentration at dual-energy CT compared with the superior sagittal sinus was a reliable predictor of intracerebral hemorrhage development and may be a useful imaging biomarker for risk stratification after endovascular treatment.
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Affiliation(s)
- D Byrne
- From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.) .,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - J P Walsh
- Department of Emergency Radiology (J.P.W., N.M.).,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | | | - F Settecase
- From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.).,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - M K S Heran
- From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.).,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - B Niu
- Vancouver Imaging (B.N.), Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - A K Salmeen
- Division of Neurology (A.K.S., T.S.F.), Department of Medicine, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada
| | - B Rohr
- University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - T S Field
- Division of Neurology (A.K.S., T.S.F.), Department of Medicine, Vancouver Stroke Program, Brain Research Center, University of British Columbia, Vancouver, British Columbia, Canada.,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - N Murray
- Department of Emergency Radiology (J.P.W., N.M.).,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
| | - A Rohr
- From the Division of Neuroradiology (D.B., F.S., M.K.S.H., A.R.).,University of British Columbia (D.B., J.P.W., F.S., M.K.S.H., B.R., T.S.F., N.M., A.R.), Vancouver, British Columbia, Canada
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23
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Conway R, O'Connell B, Byrne D, O'Riordan D, Silke B. Prognostic Value Of Blood Cultures as an Illness Severity Marker In Emergency Medical Admissions. Acute Med 2020; 19:83-89. [PMID: 32840258] [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: 06/11/2023]
Abstract
BACKGROUND Positive blood cultures predict mortality. The prognostic value of blood culture performance itself has not been fully defined. METHODS We evaluated medical admissions from 2002-2017. We defined blood culture category as 1) no culture 2) negative culture 3) positive culture. We employed a multivariable logistic regression model to evaluate outcomes. RESULTS We evaluated 78,568 blood cultures in 106,586 admissions. 30-day in-hospital mortality for no culture was 2.8% (95%CI 2.7, 2.9), culture negative 8.9% (95%CI 8.5, 9.3) and culture positive 16.7% (95%CI 15.5, 17.9). There was significant interaction between blood culture category and illness severity, OR 1.06 (95%CI 1.05, 1.08), and comorbidity, OR 1.09 (95%CI 1.09, 1.10). CONCLUSION Performance and results of blood cultures are independently associated with increased mortality.
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Affiliation(s)
- R Conway
- PhD MRCPI, MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - B O'Connell
- MD FRC Path, FRCPI, LabMed Directorate, St. James's Hospital, Dublin 8, Ireland
| | - D Byrne
- MB MSc FRCPI FRCP Edin, MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- MD FRCPI, MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- MD DSc FRCPI, MED Directorate, St James's Hospital, Dublin 8, Ireland
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24
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Conway R, Byrne D, O'Riordan D, Silke B. Limited Prognostic Utility of a Simplified Vital Sign Based Risk Calculator in Acute Medical Admissions. Acute Med 2020; 19:138-144. [PMID: 33020757] [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: 06/11/2023]
Abstract
BACKGROUND Accurate efficient prognostication in acute medical admissions remains challenging. METHODS We constructed a Vital Sign based Risk Calculator using vital parameters and Major Disease Categories to predict 30-day in-hospital mortality using a multivariable fractional polynomial model. RESULTS We evaluated 113,807 admissions in 58,126 patients. The Vital Sign based Risk Calculator predicted 30-day inhospital mortality to increase from 2 points - 3.6% (95%CI 3.4, 3.7) to 12 points - 14.8% (95%CI 14.0, 15.7). AUROC was 0.74 (95%CI 0.72, 0.74). The addition of illness severity and comorbidity data improved AUROC to 0.90 (95%CI 0.89, 0.90). CONCLUSION The Vital Sign based Risk Calculator is limited by its simplicity; inclusion of illness severity and comorbidity data improve prediction.
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Affiliation(s)
- R Conway
- MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- MED Directorate, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- MED Directorate, St James's Hospital, Dublin 8, Ireland
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25
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Olive L, Telford R, Byrne D, Cunningham R, Telford R. Is physical education in Australian primary schools helping or hindering the mental health of young girls? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Lodi S, Phillips A, Lundgren J, Logan R, Sharma S, Cole SR, Babiker A, Law M, Chu H, Byrne D, Horban A, Sterne JAC, Porter K, Sabin C, Costagliola D, Abgrall S, Gill J, Touloumi G, Pacheco AG, van Sighem A, Reiss P, Bucher HC, Montoliu Giménez A, Jarrin I, Wittkop L, Meyer L, Perez-Hoyos S, Justice A, Neaton JD, Hernán MA. Effect Estimates in Randomized Trials and Observational Studies: Comparing Apples With Apples. Am J Epidemiol 2019; 188:1569-1577. [PMID: 31063192 DOI: 10.1093/aje/kwz100] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 04/17/2019] [Indexed: 12/25/2022] Open
Abstract
Effect estimates from randomized trials and observational studies might not be directly comparable because of differences in study design, other than randomization, and in data analysis. We propose a 3-step procedure to facilitate meaningful comparisons of effect estimates from randomized trials and observational studies: 1) harmonization of the study protocols (eligibility criteria, treatment strategies, outcome, start and end of follow-up, causal contrast) so that the studies target the same causal effect, 2) harmonization of the data analysis to estimate the causal effect, and 3) sensitivity analyses to investigate the impact of discrepancies that could not be accounted for in the harmonization process. To illustrate our approach, we compared estimates of the effect of immediate with deferred initiation of antiretroviral therapy in individuals positive for the human immunodeficiency virus from the Strategic Timing of Antiretroviral Therapy (START) randomized trial and the observational HIV-CAUSAL Collaboration.
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Affiliation(s)
- Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Andrew Phillips
- Institute for Global Health, University College London, United Kingdom
| | - Jens Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - Roger Logan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Shweta Sharma
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | | | - Abdel Babiker
- Medical Research Council, Clinical Trials Unit in University College London, London, United Kingdom
| | | | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Dana Byrne
- Division of Infectious Diseases, Department of Medicine, Cooper University Hospital, Cooper Medical School at Rowan University, New Jersey
| | - Andrzej Horban
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
| | - Jonathan A C Sterne
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
- Department of Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Kholoud Porter
- Institute for Global Health, University College London, United Kingdom
| | - Caroline Sabin
- Institute for Global Health, University College London, United Kingdom
| | - Dominique Costagliola
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Sophie Abgrall
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Paris, France
- AP-HP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, France
| | - John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Canada
| | - Giota Touloumi
- National and Kapodistrian University of Athens, Faculty of Medicine, Dept. of Hygiene, Epidemiology and Medical Statistics, Greece
| | - Antonio G Pacheco
- Programa de Computação Científica, Fundacao Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Amsterdam University Medical Centres, University of Amsterdam, Department of Global Health and Division of Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Switzerland
| | - Alexandra Montoliu Giménez
- Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Badalona, Spain
| | - Inmaculada Jarrin
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Linda Wittkop
- Univ. Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, team MORPH3EUS, UMR 1219, CIC-EC 1401, Bordeaux, France
| | - Laurence Meyer
- CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
- Université Paris Sud, UMR 1018, le Kremlin Bicêtre, France
| | | | - Amy Justice
- Yale University School of Medicine, New Haven, Connecticut
| | - James D Neaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Miguel A Hernán
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health
- Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts
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Conway R, Byrne D, Cournane S, O'Riordan D, Silke B. The Problems with Risk Prediction during an Emergency Medical Admission Using Laboratory Data - Evidence from Potassium. Acute Med 2019; 18:20-26. [PMID: 32608389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The prediction of clinical outcomes using biochemical markers is an important tool. METHODS We calculated a risk score for all emergency admissions 2002-2017. We related potassium and mortality in a multivariable fractional polynomial model. We investigated the potassium distribution and relationship of potassium to mortality over time. RESULTS There were 106,586 admissions in 54,928 patients. Mortality was higher for those with an admission potassium above the median - 6.1% vs 4.6% (p<0.001), OR 1.07 (95%CI: 1.06, 1.09). There was a progressive increase in mortality from the lowest - 8.9% (95%CI: 8.3%, 9.4%) to highest potassium decile - 14.2% (95%CI: 13.5%, 14.8%). The frequency of admission hypokalaemia and the mortality at any given potassium decreased over time. CONCLUSION Admission potassium predicts mortality.
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Affiliation(s)
- R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - S Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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28
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Byrne D, Cournane S, Conway R, O'Riordan D, Silke B. Socio-Economic Status and MultiOriginal morbidity - Fact or Fiction? Acute Med 2019; 18:64-70. [PMID: 31127794] [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: 06/09/2023]
Abstract
BACKGROUND Areas of low socio-economic status (SES) have a disproportionate number of emergency medical admissions; we quantitate the profile of multi-morbidity related to SES. METHODS We developed a logistic multiple variable regression model, based on over 15 years of hospital data, to examine the effect of socio-demography on hospital outcomes. RESULTS Admissions from low SES cohort were a decade younger, and had a shorter hospital stay, and lower 30-day episode mortality outcome. The number of morbidities was equivalent between groups, but the more disadvantaged were more likely to have a respiratory diagnosis or diabetes. CONCLUSION Low SES emergency admissions present > 10 yr. earlier than the high SES population; their equivalent multimorbidity, despite a lower age, could reflect accelerated disease progression.
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Affiliation(s)
- D Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - S Cournane
- Medical Physics and Bioengineering Department, St. Vincent's University Hospital, Dublin 4
| | - R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Fox M, Zeqollari K, Lee G, Pontiggia L, Byrne D, Adams J, King M, Rose L. 1062. Daptomycin/Ceftaroline in Combination vs. Vancomycin for the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2018. [PMCID: PMC6253523 DOI: 10.1093/ofid/ofy210.899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Vancomycin has historically been the mainstay of therapy for MRSA bacteremia, but severe infections due to vancomycin-intermediate Staphylococcus aureus have emerged. In vitro studies have shown that the combination of a β-lactam antibiotic, such as ceftaroline with daptomycin, was synergistic against MRSA. The purpose of this study was to compare outcomes in patients who received daptomycin and ceftaroline in combination vs. vancomycin for the treatment of MRSA bacteremia. Methods This was a retrospective exploratory cohort study approved by the institutional review board at Cooper University Hospital. Patients were included if they received daptomycin/ceftaroline (cases) or vancomycin (controls) for the treatment of MRSA bacteremia between November 2010 and March 2017. Cases were matched 1:1 with controls based on source of MRSA bacteremia, age within 10 years, and renal function. The primary endpoint was clinical cure, defined as the improvement of signs and symptoms of bacteremia. Secondary endpoints included microbiologic cure, time to sterilization of blood cultures, duration of hospital stay, overall mortality, and MRSA-related mortality. Results Forty-one cases were included. There was no statistical difference between the two groups in microbiologic cure, time to sterilization of blood cultures, overall mortality, or MRSA-related mortality. There were no significant differences between patients in each group including in those with ICU admissions and who required vasopressors. Cases were significantly more likely to have hardware compared with the control group (43.9% vs. 12.2%; P = 0.0014). Clinical cure was achieved in 27 patients (65.9%) in the case group and 26 patients (63.4%) in the control group (P = 0.8173). Patients in the case group had a statistically longer mean hospital duration (29 days vs. 21 days, respectively, P = 0.0206) and more secondary complications such as bone infection (P = 0.0076). Conclusion Time to sterilization of blood cultures and overall mortality were similar in both groups. Patients in the combination group had longer hospital stays compared with vancomycin monotherapy. Daptomycin/ceftaroline combination therapy is an option for complicated MRSA bacteremia. Larger studies should be conducted to further evaluate this combination. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Matthew Fox
- University of the Sciences, Philadelphia, Pennsylvania
| | | | - Grant Lee
- University of the Sciences, Philadelphia, Pennsylvania
| | | | - Dana Byrne
- Cooper University Hospital, Camden, New Jersey
| | - Jessica Adams
- University of the Sciences, Philadelphia, Pennsylvania
| | - Madeline King
- Pharmacy, University of the Sciences, Philadelphia College of Pharmacy, Philadelphia, Pennsylvania
| | - Lucia Rose
- Cooper University Hospital, Camden, New Jersey
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Lerman DT, Hamilton KW, Byrne D, Lee DF, Zeitler K, Claridge T, Gray J, Minamoto GY. The impact of infection among left ventricular assist device recipients on post-transplantation outcomes: A retrospective review. Transpl Infect Dis 2018; 20:e12995. [PMID: 30199584 DOI: 10.1111/tid.12995] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/11/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Left ventricular assist device (LVAD) infections are common, and the consequences of LVAD infections on orthotopic heart transplantation (OHT) outcomes are not well described. AIMS The aim of this study was to describe clinical characteristics and evaluate risk factors for developing LVAD infections, and examine outcomes of LVAD-specific infections (VSI) after OHT. METHODS We retrospectively investigated the records of 74 consecutive patients at two institutions who had undergone LVAD placement and subsequent OHT between January 2007 and December 2012. RESULTS Forty-six of 74 (62%) LVAD recipients who underwent OHT had pre-transplant infections, and 18 (24%) had LVAD-specific infection (VSI), of which 71% were caused by gram-negative organisms. Of pre-transplant non-LVAD infections, Clostridium difficile infection (CDI) was the most common (26%) followed by urinary tract infection (UTI, 16%) and pneumonia (PNA 15%). Univariate analysis comparing subjects with VSI to those without VSI showed a significant association with time spent outside the hospital prior to transplantation (median 231.8 days vs 142.2 days, P < 0.03) and total time between VAD placement and OHT (244.0 days and 150.5 days, P < 0.002). Logistic regression was performed and significant predictors for VAD-related infection were age and the presence of diabetes, with type of device as an effect modifier. Six months post-OHT survival was not significantly affected by the presence of VSI prior to transplant. There was a trend toward an association between the presence of any infection and post-transplant rejection (P < 0.09). There were 10 post-transplant deaths by 6 months. Of these deaths, 4/10 (40%) were cardiopulmonary and 6/10 (60%) were related to infections. CONCLUSIONS Advanced age and presence of diabetes were predictors of VSI, as well as type of VAD device, although device choice is likely affected by many clinical factors including age and comorbidities, as well as institution-specific preferences. VSI was not associated with a decrease in 6-month post-OHT survival. However, infections remain the major causes of death by 6 months post-transplant. Certain infections are associated with an increased risk of rejection, which merits further investigation.
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Affiliation(s)
- Dana T Lerman
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Keith W Hamilton
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dana Byrne
- Cooper University Hospital, Camden, New Jersey
| | - Doreen F Lee
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Tamara Claridge
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jaime Gray
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace Y Minamoto
- Departments of Medicine, Division of Infectious Diseases at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Byrne D, Walsh JP, Lynch T, Kavanagh EC. Medullary Edema and Enhancement with a Straight Upper Border in Cases of Dural Arteriovenous Fistulas. AJNR Am J Neuroradiol 2018; 39:E90-E91. [PMID: 30072369 DOI: 10.3174/ajnr.a5681] [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: 11/07/2022]
Affiliation(s)
- D Byrne
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland
| | - J P Walsh
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland
| | - T Lynch
- Dublin Neurologic Institute, Department of Neurology Mater Misericordiae University Hospital Dublin, Ireland
| | - E C Kavanagh
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland.,School of Medicine University College Dublin, Ireland
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Byrne D, Silke B. Re: Validation of the medical admission risk system (MARS): a combined physiological and laboratory risk prediction tool for 5- to 7-day in-hospital mortality. Ohman MC, et al. QJM. 2018. PMID: 29538743. QJM 2018; 111:509-510. [PMID: 29660068 DOI: 10.1093/qjmed/hcy082] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- D Byrne
- From the Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- From the Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Greaves G, Milani M, Byrne D, Carter R, Butterworth M, Luo X, Eyers P, Cohen G, Varadarajan S. PO-061 BCL-2 family of proteins, BCL-XL and MCL-1, regulate apoptosis and cancer cell survival by different mechanisms. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Byrne D, Walsh JP, MacMahon PJ. Reply. AJNR Am J Neuroradiol 2018; 39:E48. [PMID: 29301778 DOI: 10.3174/ajnr.a5536] [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: 11/07/2022]
Affiliation(s)
- D Byrne
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland
| | - J P Walsh
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland
| | - P J MacMahon
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland.,School of Medicine University College Dublin Dublin, Ireland
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Waqas S, Bannan C, Fe Talento A, Byrne D, O'Connell S, Clarke S, Merry C. A Unique Case of Concurrent Long Bone Osteomyelitis and Empyema Caused by Fusobacterium nucleatum. Ir Med J 2018; 111:675. [PMID: 29869856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We describe a patient presenting with constitutional symptoms, poor oral hygiene and leg swelling who was diagnosed with Fusobacterium nucleatum osteomyelitis of femur and empyema. Long bone osteomyelitis is rarely caused by this microorganism. This unusual case was successfully managed with drainage and antimicrobial therapy.
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Affiliation(s)
- S Waqas
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James' Hospital, Dublin
| | - C Bannan
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James' Hospital, Dublin
| | - A Fe Talento
- Department of Clinical Microbiology, St. James' Hospital, Dublin
| | - D Byrne
- Acute Medical Assessment Unit, St. James' Hospital, Dublin
| | - S O'Connell
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James' Hospital, Dublin
| | - S Clarke
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James' Hospital, Dublin
| | - C Merry
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James' Hospital, Dublin
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Byrne D, Browne JG, Conway R, Cournane S, O'Riordan D, Silke B. Mortality outcomes and emergency department wait times - the paradox in the capacity limited sytem. Acute Med 2018; 17:130-136. [PMID: 30129945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is concern that undue ED wait times may result in adverse outcomes. METHODS We studied 30-day in-hospital mortality (2002-2017) for all medical admissions (106,586 episodes; 54,928 patients) focusing on clinical risk profile. RESULTS Comparing 2002-09 vs. 2010-17, median ED waits > 6 hours (hr) increased 10h (95% CI: 8,13) to 15h (95% CI: 9,19). 30-day mortality declined 6.2% to 4.9%- (RRR- 20.8%/ NNT- 78). 30-day-mortality by ED wait: - < 4hr 6.6% (95% CI: 6.3%, 6.9%), 4-8hr 4.8% (95% CI: 4.6%, 5.0%), 8-12hr 4.3% (95% CI: 4.1%, 4.5%) or >=12hr 4.2% (95% CI: 3.9%, 4.5%). CONCLUSION Admissions with shorter waits are overrepresented with high clinical acuity. Higher Risk Score patient with extended wait times had worse clinical outcomes.
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Affiliation(s)
- D Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - J G Browne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - S Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8,Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Kelly MA, Clesham K, Fahey J, Reid-McDermott B, Murphy C, Byrne D. Teaching Musculoskeletal Medicine to Undergraduate Students in a Simulated Environment. Ir Med J 2017; 110:664. [PMID: 29465854] [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: 06/08/2023]
Affiliation(s)
- M A Kelly
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway
| | - K Clesham
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway
| | - J Fahey
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway
| | - B Reid-McDermott
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway
| | - C Murphy
- Department of Trauma and Orthopaedic Surgery, University Hospital Galway
| | - D Byrne
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway
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Byrne D, MacMahon PJ. Reply. AJNR Am J Neuroradiol 2017; 39:E46. [PMID: 29242357 DOI: 10.3174/ajnr.a5511] [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: 11/07/2022]
Affiliation(s)
- D Byrne
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland
| | - P J MacMahon
- Department of Radiology Mater Misericordiae University Hospital Dublin, Ireland School of Medicine University College Dublin Dublin, Ireland
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Conway R, Cournane S, Byrne D, O'Riordan D, Coveney S, Silke B. Interaction of Broadband Access and Education Levels in Determining the Rate of Emergency Medical Admissions. Ir Med J 2017; 110:636. [PMID: 29372951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Background We examined the effect of broadband access, educational status and their interaction on local population health. Methods We calculated the annual admission incidence rates for each small area population unit within our hospital catchment, relating quintiles of broadband access to two groups a) full time education to primary level (less than or equal to 15 years) and b) full time education to tertiary level (>18 years). Univariate and multivariable risk estimates were calculated, using truncated Poisson regression. Results 82,368 admissions in 44,628 patients were included. Broadband access was a linear predictor of the admission incidence rate with decreases from Q1 (least access) 50.8 (95%CI 30.2 to 71.4) to Q5 (highest access) 17.9 (95%CI 13.4 to 22.4). Areas with greater numbers educated only to primary level were more influenced by broadband access. Conclusion Broadband access is a predictor of the emergency medical admission rate; this effect is modulated by the baseline education level.
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Affiliation(s)
- R Conway
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - S Cournane
- Medical Physics and Bioengineering Department, St James' Hospital
| | - D Byrne
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
| | - S Coveney
- Envo-Geo Environmental Geoinformatics, Ireland
| | - B Silke
- Department of Internal Medicine, St James' Hospital, Dublin 8, Ireland
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Byrne D, Sugrue G, Stanley E, Walsh JP, Murphy S, Kavanagh EC, MacMahon PJ. Improved Detection of Anterior Circulation Occlusions: The "Delayed Vessel Sign" on Multiphase CT Angiography. AJNR Am J Neuroradiol 2017; 38:1911-1916. [PMID: 28798219 DOI: 10.3174/ajnr.a5317] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/27/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Multiphase CTA, a technique to dynamically assess the vasculature in acute ischemic stroke, was primarily developed to evaluate collateral filling. We have observed that it is also useful in identifying distal anterior circulation occlusions due to delayed anterior circulation opacification on multiphase CTA, an observation we term the "delayed vessel sign." We aimed to determine the usefulness of this sign by comparing multiphase CTA with single-phase CTA. MATERIALS AND METHODS All 23 distal anterior circulation occlusions during a 2-year period were included. Ten M1-segment occlusions and 10 cases without a vessel occlusion were also included. All patients had follow-up imaging confirming the diagnosis. Initially, the noncontrast CT and first phase of the multiphase CTA study for each patient were blindly evaluated (2 neuroradiologists, 2 radiology trainees) for an anterior circulation occlusion. Readers' confidence, speed, and sensitivity of detection were recorded. Readers were then educated on the "delayed vessel sign," and each multiphase CTA study was re-examined for a vessel occlusion after at least 14 days. RESULTS There was significant improvement in the sensitivity of detection of distal anterior circulation vessel occlusions (P < .001), overall confidence (P < .001), and time taken to interpret (P < .001) with multiphase CTA compared with single-phase CTA. Readers preferred MIP images compared with source images in >90% of cases. CONCLUSIONS The delayed vessel sign is a reliable indicator of anterior circulation vessel occlusion, particularly in cases involving distal branches. Assessment of the later phases of multiphase CTA for the delayed vessel sign leads to a significant improvement in the speed and confidence of interpretation, compared with single-phase CTA.
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Affiliation(s)
- D Byrne
- From the Departments of Radiology (D.B., G.S., E.S., E.C.K., P.J.M.)
| | - G Sugrue
- From the Departments of Radiology (D.B., G.S., E.S., E.C.K., P.J.M.)
| | - E Stanley
- From the Departments of Radiology (D.B., G.S., E.S., E.C.K., P.J.M.)
| | - J P Walsh
- Department of Radiology (J.P.W.), St. James's Hospital, Dublin, Ireland
| | - S Murphy
- Stroke Medicine (S.M.), Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine (S.M., E.C.K., P.J.M.), University College Dublin, Dublin, Ireland.,Royal College of Surgeons in Ireland Medical School (S.M.), Dublin, Ireland
| | - E C Kavanagh
- From the Departments of Radiology (D.B., G.S., E.S., E.C.K., P.J.M.).,School of Medicine (S.M., E.C.K., P.J.M.), University College Dublin, Dublin, Ireland
| | - P J MacMahon
- From the Departments of Radiology (D.B., G.S., E.S., E.C.K., P.J.M.).,School of Medicine (S.M., E.C.K., P.J.M.), University College Dublin, Dublin, Ireland
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Lindley RI, Anderson CS, Billot L, Forster A, Hackett ML, Harvey LA, Jan S, Li Q, Liu H, Langhorne P, Maulik PK, Murthy GVS, Walker MF, Pandian JD, Alim M, Felix C, Syrigapu A, Tugnawat DK, Verma SJ, Shamanna BR, Hankey G, Thrift A, Bernhardt J, Mehndiratta MM, Jeyaseelan L, Donnelly P, Byrne D, Steley S, Santhosh V, Chilappagari S, Mysore J, Roy J, Padma MV, John L, Aaron S, Borah NC, Vijaya P, Kaul S, Khurana D, Sylaja PN, Halprashanth DS, Madhusudhan BK, Nambiar V, Sureshbabu S, Khanna MC, Narang GS, Chakraborty D, Chakraborty SS, Biswas B, Kaura S, Koundal H, Singh P, Andrias A, Thambu DS, Ramya I, George J, Prabhakar AT, Kirubakaran P, Anbalagan P, Ghose M, Bordoloi K, Gohain P, Reddy NM, Reddy KV, Rao TNM, Alladi S, Jalapu VRR, Manchireddy K, Rajan A, Mehta S, Katoch C, Das B, Jangir A, Kaur T, Sreedharan S, Sivasambath S, Dinesh S, Shibi BS, Thangaraj A, Karunanithi A, Sulaiman SMS, Dehingia K, Das K, Nandini C, Thomas NJ, Dhanya TS, Thomas N, Krishna R, Aneesh V, Krishna R, Khullar S, Thouman S, Sebastian I. Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial. Lancet 2017; 390:588-599. [PMID: 28666682 DOI: 10.1016/s0140-6736(17)31447-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most people with stroke in India have no access to organised rehabilitation services. The effectiveness of training family members to provide stroke rehabilitation is uncertain. Our primary objective was to determine whether family-led stroke rehabilitation, initiated in hospital and continued at home, would be superior to usual care in a low-resource setting. METHODS The Family-led Rehabilitation after Stroke in India (ATTEND) trial was a prospectively randomised open trial with blinded endpoint done across 14 hospitals in India. Patients aged 18 years or older who had had a stroke within the past month, had residual disability and reasonable expectation of survival, and who had an informal family-nominated caregiver were randomly assigned to intervention or usual care by site coordinators using a secure web-based system with minimisation by site and stroke severity. The family members of participants in the intervention group received additional structured rehabilitation training-including information provision, joint goal setting, carer training, and task-specific training-that was started in hospital and continued at home for up to 2 months. The primary outcome was death or dependency at 6 months, defined by scores 3-6 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) as assessed by masked observers. Analyses were by intention to treat. This trial is registered with Clinical Trials Registry-India (CTRI/2013/04/003557), Australian New Zealand Clinical Trials Registry (ACTRN12613000078752), and Universal Trial Number (U1111-1138-6707). FINDINGS Between Jan 13, 2014, and Feb 12, 2016, 1250 patients were randomly assigned to intervention (n=623) or control (n=627) groups. 33 patients were lost to follow-up (14 intervention, 19 control) and five patients withdrew (two intervention, three control). At 6 months, 285 (47%) of 607 patients in the intervention group and 287 (47%) of 605 controls were dead or dependent (odds ratio 0·98, 95% CI 0·78-1·23, p=0·87). 72 (12%) patients in the intervention group and 86 (14%) in the control group died (p=0·27), and we observed no difference in rehospitalisation (89 [14%]patients in the intervention group vs 82 [13%] in the control group; p=0·56). We also found no difference in total non-fatal events (112 events in 82 [13%] intervention patients vs 110 events in 79 [13%] control patients; p=0·80). INTERPRETATION Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care. FUNDING The National Health and Medical Research Council of Australia.
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Conway R, Cournane S, Byrne D, O’Riordan D, Silke B. Improved mortality outcomes over time for weekend emergency medical admissions. Ir J Med Sci 2017; 187:5-11. [DOI: 10.1007/s11845-017-1627-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/27/2017] [Indexed: 01/12/2023]
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Abstract
BACKGROUND We previously reported weekend emergency admissions to have a higher mortality; we have now examined the time profile of deaths, by weekday or weekend admission, in all emergency medical patients admitted between 2002 and 2014. METHODS We divided admissions by a weekday or weekend (After 17.00 Friday-Sunday) hospital arrival. We examined survival following an admission using Cox proportional hazard models and Kaplan-Meier time to event analysis. RESULTS In total 82 368 admissions were recorded in 44, 628 patients. Weekend admissions had an increased mortality of 5.0% (95% CI 4.7, 5.4) compared with weekday admissions of 4.5% (95% CI 4.3, 4.7) ( P = 0.007). The univariate adjusted Odds Ratio (OR) of death for a weekend admission was significantly increased OR = 1.15 (95% CI 1.05, 1.24) ( P = 0.001). Mortality following an admission declined exponentially over time with a long tail, ∼25% of deaths occurred after day 28. Only 11.4% of deaths occurred on the weekend of the admission. Survival curves showed no mortality difference at 28 days ( P = 0.21) but a difference at 90 days ( P = 0.05). The higher mortality for a weekend admission was attributable to late deaths in the cohort with an extended stay; compared with weekday, these weekend admissions were more likely to be older and have greater co-morbidity. CONCLUSION Survival rates following a weekend or weekday admission were similar out to 28 days. The higher overall mortality for weekend admissions is due to divergence in survival between 28 and 90 days. Most deaths in weekend admissions occurred when the hospital was fully staffed.
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Affiliation(s)
- R Conway
- From the Department of Internal Medicine, St James's Hospital, James's Street, Dublin 8, Ireland
| | - S Cournane
- Department of Medical Physics and Bioengineering, St. James Hospital, James's Street, Dublin 8, Ireland
| | - D Byrne
- From the Department of Internal Medicine, St James's Hospital, James's Street, Dublin 8, Ireland
| | - D O'Riordan
- From the Department of Internal Medicine, St James's Hospital, James's Street, Dublin 8, Ireland
| | - Bernard Silke
- From the Department of Internal Medicine, St James's Hospital, James's Street, Dublin 8, Ireland
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McCabe JJ, Cournane S, Byrne D, Conway R, O'Riordan D, Silke B. Age and the economics of an emergency medical admission-what factors determine costs? QJM 2017; 110:83-88. [PMID: 27654502 DOI: 10.1093/qjmed/hcw161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The ageing of the population may be anticipated to increase demand on hospital resources. We have investigated the relationship between hospital episode costs and age profile in a single centre. METHODS All Emergency Medical admissions (33 732 episodes) to an Irish hospital over a 6-year period, categorized into three age groups, were evaluated against total hospital episode costs. Univariate and adjusted incidence rate ratios (IRRs) were calculated using zero truncated Poisson regression. RESULTS The total hospital episode cost increased with age ( P < 0.001). The multi-variable Poisson regression model demonstrated that the most important drivers of overall costs were Acute Illness Severity-IRR 1.36 (95% CI: 1.30, 1.41), Sepsis Status -1.46 (95% CI: 1.42, 1.51) and Chronic Disabling Disease Score -1.25 (95% CI: 1.22, 1.27) and the Age Group as exemplified for those 85 years IRR 1.23 (95% CI: 1.15, 1.32). CONCLUSION Total hospital episode costs are a product of clinical complexity with contributions from the Acute Illness Severity, Co-Morbidity, Chronic Disabling Disease Score and Sepsis Status. However age is also an important contributor and an increasing patient age profile will have a predictable impact on total hospital episode costs.
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Byrne D, Tate JP, Forde K, Kostman JR, Roy J, Lo Re V. The Risk of Acute Liver Injury With Statin Use in Chronic Hepatitis C Virus Infection. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dana Byrne
- Cooper University Hospital, Camden, New Jersey
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kimberly Forde
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jay R. Kostman
- Jonathan Lax Treatment Center, Philadelphia FIGHT, Philadelphia, Pennsylvania
| | - Jason Roy
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vincent Lo Re
- Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Conway R, Byrne D, O'Riordan D, Cournane S, Coveney S, Silke B. Influence of social deprivation, overcrowding and family structure on emergency medical admission rates. QJM 2016; 109:675-680. [PMID: 27118873 DOI: 10.1093/qjmed/hcw053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/18/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Patients from deprived backgrounds have a higher in-patient mortality following emergency medical admission. AIM To evaluate the influence of Deprivation Index, overcrowding and family structure on hospital admission rates. DESIGN Retrospective cohort study. METHODS All emergency medical admissions from 2002 to 2013 were evaluated. Based on address, each patient was allocated to an electoral division, whose small area population statistics were available from census data. Patients were categorized by quintile of Deprivation Index, overcrowding and family structure, and these were evaluated against hospital admission rate, calculated as rate/1000 population. Univariate and multivariable risk estimates (Odds Ratios or Incidence Rate Ratios) were calculated, using logistic or zero truncated Poisson regression as appropriate. RESULTS There were 66 861 admissions in 36 214 patients over the 12-year study period. Deprivation Index quintile independently predicted the admission rate, with rates of Q1 12.0 (95% CI 11.8-12.2), Q2 19.5 (95% CI 19.3-19.6), Q3 33.7 (95% CI 33.3-34.0), Q4 31.4 (95% CI 31.2-31.6) and Q5 38.1 (95% CI 37.7-38.5). Similarly the proportions of families with children <15 years old, was an independent predictor of the admission rate with rates of Q1 20.8 (95% CI 20.4-21.1), Q2 23.0 (95% CI 22.7-23.3), Q3 32.2 (95% CI 31.9-32.5), Q4 32.4 (95% CI 32.2-32.7) and Q5 37.2 (95% CI 36.6-37.8). The proportion of families with children ≥15-years old was also predictive but quintile of overcrowding was only predictive in the univarate model. CONCLUSION Deprivation Index and family structure strongly predict emergency medical hospital admission rates.
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Affiliation(s)
- R Conway
- From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland
- CARD Newman Research Fellow, University College Dublin, Belfield, Ireland
| | - D Byrne
- From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland
| | - S Cournane
- From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland
| | - S Coveney
- School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK
| | - B Silke
- From the Department of Internal Medicine St James's Hospital, Dublin 8, Ireland
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Cournane S, Conway R, Byrne D, O'Riordan D, Coveney S, Silke B. Social deprivation and the rate of emergency medical admission for older persons. QJM 2016; 109:645-651. [PMID: 26966100 DOI: 10.1093/qjmed/hcw029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Deprivation Status increases the annual admission incidence of emergency medical admissions; the extent to which deprivation influences the admission of older persons is less well known. AIM To examine whether deprivation within a hospital catchment area influences emergency medical admissions for the elderly population. DESIGN The relationship between Deprivation Status, Dependency Ratio (population proportion of non-working age (<15 or ≥65 years) and age for all emergency admissions (82 368 episodes of 44 628 patients), over a 13-year period, were examined and ranked by quintile. METHODS Univariate and multi-variable risk estimates (incidence rate ratios) were calculated, using truncated Poisson regression. RESULTS The Dependency Ratio and the Deprivation index independently predicted the annual incidence rate of medical emergencies; however, when calculated for older persons, the corresponding incidence rate ratios showed a falling trend with increasing Deprivation Status-Q2 0.51 (95% confidence interval [CI]: 0.50, 0.52), Q3 0.59 (95% CI: 0.58, 0.60), Q4 0.51 (95% CI: 0.50, 0.52) and Q5 0.37 (95% CI: 0.36, 0.38). Thus, with increasing Deprivation Status, the proportion of total admission from the ≥65-year cohort fell substantially. CONCLUSION The admission incidence rate for emergency medical patients is strongly influenced by the catchment area Deprivation Status. However, because of its greater impact on the younger population, increasing deprivation alters the ratio of younger to older persons as a proportion of total emergency admissions.
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Affiliation(s)
- S Cournane
- From the Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland
| | - R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D O'Riordan
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - S Coveney
- School of Geographical and Earth Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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Sandys V, Byrne D. Acute Interstitial Nephritis Secondary to Metamizole; The Rise of Drug Tourism. Ir Med J 2016; 109:445. [PMID: 27834095] [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: 06/06/2023]
Affiliation(s)
- V Sandys
- Department of Medicine, St James's Hospital, James's St, Dublin 8
| | - D Byrne
- Department of Medicine, St James's Hospital, James's St, Dublin 8
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Macdonald S, Byrne D, Rogers P, Moss JG, Edwards RD. Common Iliac Artery Access during Endovascular Thoracic Aortic Repair Facilitated by a Transabdominal Wall Tunnel. J Endovasc Ther 2016; 8:135-8. [PMID: 11357972 DOI: 10.1177/152660280100800206] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe a technique for common iliac artery (CIA) access during endovascular aortic aneurysm repair when unfavorable angulation between the CIA and the delivery sheath precludes direct arterial access. Technique: After retroperitoneal exposure of the CIA, a puncture site is chosen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or skin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcutaneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the proximal aorta. A CIA arteriotomy is performed and the delivery system introduced over the guidewire through the tunnel into the iliac artery. Conclusions: Retroperitoneal exposure of the CIA with tunneled transabdominal wall delivery of the stent-graft avoids both external iliac artery injury and creation of a temporary access conduit in patients with iliac tortuosity and/or occlusive disease.
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Affiliation(s)
- S Macdonald
- Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, Scotland, UK.
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Byrne D, Münnich M, Frenger I, Gruber N. Mesoscale atmosphere ocean coupling enhances the transfer of wind energy into the ocean. Nat Commun 2016; 7:ncomms11867. [PMID: 27292447 PMCID: PMC4910005 DOI: 10.1038/ncomms11867] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 05/09/2016] [Indexed: 11/25/2022] Open
Abstract
Although it is well established that the large-scale wind drives much of the world's ocean circulation, the contribution of the wind energy input at mesoscales (10–200 km) remains poorly known. Here we use regional simulations with a coupled high-resolution atmosphere–ocean model of the South Atlantic, to show that mesoscale ocean features and, in particular, eddies can be energized by their thermodynamic interactions with the atmosphere. Owing to their sea-surface temperature anomalies affecting the wind field above them, the oceanic eddies in the presence of a large-scale wind gradient provide a mesoscale conduit for the transfer of energy into the ocean. Our simulations show that this pathway is responsible for up to 10% of the kinetic energy of the oceanic mesoscale eddy field in the South Atlantic. The conditions for this pathway to inject energy directly into the mesoscale prevail over much of the Southern Ocean north of the Polar Front. The precise mechanism for wind energy input into the ocean at mesoscales remains uncertain. Here, using a high-resolution atmosphere-ocean model of the South Atlantic, the authors show that a mesoscale conduit associated with oceanic eddies is responsible for up to 10% of kinetic energy transfer.
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Affiliation(s)
- D Byrne
- Environmental Physics, Institute of Biogeochemistry and Pollutant Dynamics, ETH Zurich, CHN E 23.2, Universitatstrasse 16, Zürich 8092, Switzerland.,Center for Climate Systems Modeling (C2SM), ETH Zurich, Zürich 8092, Switzerland
| | - M Münnich
- Environmental Physics, Institute of Biogeochemistry and Pollutant Dynamics, ETH Zurich, CHN E 23.2, Universitatstrasse 16, Zürich 8092, Switzerland
| | - I Frenger
- Princeton University, Princeton, New Jersey 08544, USA.,GEOMAR, Helmholtz Centre for Ocean Research, Kiel 24105, Germany
| | - N Gruber
- Environmental Physics, Institute of Biogeochemistry and Pollutant Dynamics, ETH Zurich, CHN E 23.2, Universitatstrasse 16, Zürich 8092, Switzerland.,Center for Climate Systems Modeling (C2SM), ETH Zurich, Zürich 8092, Switzerland
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