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Beros JL, King ES, Clarke D, Jaeschke-Angi L, Rodger J, Tang AD. Static magnetic stimulation induces structural plasticity at the axon initial segment of inhibitory cortical neurons. Sci Rep 2024; 14:1479. [PMID: 38233493 PMCID: PMC10794225 DOI: 10.1038/s41598-024-51845-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Static magnetic stimulation (SMS) is a form of non-invasive brain stimulation that alters neural activity and induces neural plasticity that outlasts the period of stimulation. This can modify corticospinal excitability or motor behaviours, suggesting that SMS may alter the intrinsic excitability of neurons. In mammalian neurons, the axon initial segment (AIS) is the site of action potential initiation and undergoes structural plasticity (changes in length and position from the soma) as a homeostatic mechanism to counteract chronic changes in neuronal activity. We investigated whether the chronic application of SMS (6 and 48 h, 0.5 T) induces structural AIS plasticity in postnatally derived primary cortical neurons. Following 6 h of SMS, we observed a shortening in mean AIS length compared to control, that persisted 24 h post stimulation. In contrast, 48 h of SMS induced an immediate distal shift that persisted 24 h post-stimulation. Pharmacological blockade of voltage gated L/T-type calcium channels during stimulation did not prevent SMS-induced AIS structural plasticity. Our findings provide the foundation to expand the use of chronic SMS as a non-invasive method to promote AIS plasticity.
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Affiliation(s)
- J L Beros
- School of Biological Sciences, The University of Western Australia, Crawley, 6009, Australia.
- The Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia.
| | - E S King
- The Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
- School of Biomedical Sciences, The University of Western Australia, Crawley, 6009, Australia
| | - D Clarke
- Département de Neurosciences, Université de Montréal, Quebec, H3C 3J7, Canada
| | - L Jaeschke-Angi
- School of Biological Sciences, The University of Western Australia, Crawley, 6009, Australia
- The Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - J Rodger
- School of Biological Sciences, The University of Western Australia, Crawley, 6009, Australia
- The Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia
| | - A D Tang
- The Perron Institute for Neurological and Translational Science, Nedlands, 6009, Australia.
- School of Biomedical Sciences, The University of Western Australia, Crawley, 6009, Australia.
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Clarke D, Sartor L, Do V, Manolios N, Swaminathan S, Samarawickrama C. Biologics in peripheral ulcerative keratitis. Semin Arthritis Rheum 2023; 63:152269. [PMID: 37776666 DOI: 10.1016/j.semarthrit.2023.152269] [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: 05/20/2023] [Revised: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 10/02/2023]
Abstract
Over the past two decades biologic therapies have seen a rapid uptake in the management of ocular inflammation. Peripheral ulcerative keratitis (PUK), once a harbinger of blindness and mortality in refractory rheumatological disease, is now increasingly being treated with these agents. We conducted a review to evaluate the evidence base for this application and to provide a road map for their clinical usage in PUK, including dosage and adverse effects. A literature search across Medline, Embase and Cochrane Database of Systematic Reviews was undertaken to identify all patients with PUK that were treated with a biologic in a peer viewed article. Overall, whilst the evidence base for biologic use in PUK was poor, reported cases demonstrate an increasingly powerful and effective role for biologics in refractory PUK. This was particularly the case for rituximab in PUK secondary to granulomatous with polyangiitis.
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Affiliation(s)
- Daniel Clarke
- Department of Ophthalmology, Royal Hobart Hospital, Tasmania, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lauren Sartor
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vu Do
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas Manolios
- Department of Ophthalmology, Westmead Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sanjay Swaminathan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Rheumatology, Westmead Hospital, Westmead, Sydney, New South Wales, Australia; Department of Clinical Immunology and Immunopathology, Westmead Hospital, Sydney, New South Wales, Australia; Centre for Immunology and Allergy Research, The Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Chameen Samarawickrama
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Translational Ocular Research and Immunology Consortium, Sydney University, New South Wales, Australia.
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Brubacher JR, Chan H, Erdelyi S, Yuan Y, Daoust R, Vaillancourt C, Rowe B, Lee J, Mercier E, Atkinson P, Davis P, Clarke D, Taylor J, Macpherson A, Emond M, Al-Hakim D, Horwood C, Wishart I, Magee K, Rao J, Eppler J. High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision. Addiction 2023; 118:1507-1516. [PMID: 36898848 DOI: 10.1111/add.16186] [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: 10/09/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
DESIGN This was a prospective observational study. BACKGROUND AND AIMS The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations. SETTING The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021. CASES The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care. MEASUREMENTS We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership. FINDINGS Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group). CONCLUSIONS In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.
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Affiliation(s)
- J R Brubacher
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - H Chan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - S Erdelyi
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - Y Yuan
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - R Daoust
- Department of Emergency Medicine, University of Montréal, Montréal, QC, Canada
| | - C Vaillancourt
- Department of Emergency Medicine, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - B Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Lee
- Department of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - E Mercier
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - P Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, St John, NB, Canada
| | - P Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Clarke
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - J Taylor
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - A Macpherson
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - M Emond
- Department of Emergency Medicine, Université Laval, Québec City, QC, Canada
| | - D Al-Hakim
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
| | - C Horwood
- Department of Emergency Medicine, Memorial University, St John, NB, Canada
| | - I Wishart
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - K Magee
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - J Rao
- Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Eppler
- Department of Emergency Medicine, University of British Columbia, Columbia, BC, Canada
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Kong V, Cheung C, Buitendag J, Rajaretnam N, Xu W, Varghese C, Bruce J, Laing G, Clarke D. Abdominal stab wounds with retained knife: 15 years of experience from a major trauma centre in South Africa. Ann R Coll Surg Engl 2023; 105:407-412. [PMID: 35175869 PMCID: PMC10149242 DOI: 10.1308/rcsann.2021.0321] [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] [Accepted: 10/28/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study reviews our cumulative experience with the management of patients presenting with a retained knife following an abdominal stab wound (SW). METHODS A retrospective study was conducted at a major trauma centre in South Africa over a 15-year period from July 2006 to December 2020 including all patients who presented with a retained knife in the abdomen following a SW. RESULTS A total of 42 cases were included: 37 males (93%) with a mean age of 26 years. A total of 18 knives (43%) were in the anterior abdomen and 24 were posterior abdomen. Plain radiography was performed in 88% (37/42) of cases and computed tomography was performed in 81% (34/42); 90% (38/42) underwent extraction in the operating theatre. Laparotomy was performed in 62% (26/42). Of all the laparotomies performed, 77% (20/26) were positive for intra-abdominal organ or visceral injury. Overall morbidity was 31%. There were two mortalities (5%). Laparotomy was less commonly required for the posterior abdomen (33% (8/24) vs 100% (18/18), p<0.001). For retained knives in the anterior abdomen, 72% (13/18) of the laparotomies were positive for intra-abdominal organ or visceral injury. For the posterior abdomen, 7 of the 8 (88%) were positive for intra-abdominal organ or visceral injury. There were no differences in the need for intensive care unit admission, length of hospital stay, morbidities or mortalities. CONCLUSIONS Uncontrolled extraction of a retained knife in the abdomen outside of the operating theatre must be avoided. Retained knives in the anterior abdomen usually require formal laparotomy, but this is generally not required for posterior abdomen.
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Affiliation(s)
- V Kong
- University of the Witwatersrand, Johannesburg, South Africa
| | - C Cheung
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - W Xu
- University of Auckland, Auckland, New Zealand
| | - C Varghese
- University of Auckland, Auckland, New Zealand
| | - J Bruce
- University of KwaZulu Natal, Durban, South Africa
| | - G Laing
- University of KwaZulu Natal, Durban, South Africa
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Xiong X, Clarke D, Lai Y, Bai P, Png CE, Wu L, Hess O. Substrate engineering of plasmonic nanocavity antenna modes. Opt Express 2023; 31:2345-2358. [PMID: 36785250 DOI: 10.1364/oe.476521] [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] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/25/2022] [Indexed: 06/18/2023]
Abstract
Plasmonic nanocavities have emerged as a promising platform for next-generation spectroscopy, sensing and photonic quantum information processing technologies, benefiting from a unique confluence of nanoscale compactness and integrability, ultrafast functionality and room-temperature viability. Harnessing their unprecedented optical field confinement and enhancement properties for such diverse application domains, however, demands continued innovation in cavity design and robust strategies for engineering their plasmonic mode characteristics, with the aim of optimizing spatial and spectral matching conditions for strong light-matter interaction involving embedded quantum emitters. Adopting the canonical gold bowtie nanoantenna, we show that the complex refractive index, n + ik, of the substrate material provides additional design flexibility in tailoring the properties of plasmonic nanocavity modes, including their resonance wavelengths, hotspot locations, intracavity field polarization and radiative decay rates. In particular, we predict that highly refractive (n ≥ 4) or highly absorptive (k ≥ 4) substrates provide two complementary approaches to engineering nanocavity modes that are especially desirable for coupling two-dimensional quantum materials, featuring namely an elevated hotspot with a dominantly in-plane polarized near-field, as well as a strongly radiative character. Our study elucidates the benefits and intricacies of a largely unexplored facet of nanocavity mode manipulation, beyond the widely practiced synthetic control over the cavity topology or physical dimensions, and paves the way for plasmonic cavity quantum electrodynamics with two-dimensional excitonic matter.
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Kong L, Kong VY, Christey G, Ah Yen D, Amey J, Denize B, Marsden G, Clarke D. Clinical Decision Making For Abdominal Stab Wounds In High Resourced But Low Volume Centers Require Structured Guidelines To Be Effective. Surgery in Practice and Science 2022. [DOI: 10.1016/j.sipas.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Thomson S, Clarke D. Establishing and integrating datasets beyond instilling a culture of capture. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3922] [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: 11/05/2022]
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Reíd B, Kong V, Xu W, Thirayan V, Cheung C, Rajaretnam N, Manchev V, Bekker W, Bruce J, Laing G, Clarke D. An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3732] [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: 11/05/2022]
Abstract
BACKGROUND: This study reviews the indications and outcome of emergency laparotomy for paediatric trauma in a South African trauma centre. METHODS: This was a retrospective study of all children less than 18 years of age who underwent an emergency laparotomy for trauma between December 2012 and October 2020 at Grey's Hospital in Pietermaritzburg. RESULTS: During the eight-year period under review, a total of136 children of which 107 were male underwent a laparotomy for trauma. The median age was 14 years. There were 80 (57.1%) blunt mechanisms, and the rest were penetrating mechanisms. A total of 46 (33%) patients required ICU admission. Thirty-four patients developed a complication. These included nine cases of pneumonia, one case of renal failure, two patients developed abdominal collections, three wound-related complications, three neurological complications and one miscellaneous complication. There were seven (5%) deaths. The penetrating cohort were older than the blunt cohort. Solid viscera were more likely to be injured in the blunt cohort and hollow viscera more likely in the penetrating cohort. A total of 16 (11%) patients underwent damage control surgery (DCS). Of this cohort, there were three female children. Six sustained blunt trauma and ten penetrating trauma. A total of six (37%) of these children died. CONCLUSION: Emergency laparotomy for trauma in children is not infrequent in Pietermaritzburg and there is a high incidence of penetrating trauma in this cohort. The response to increased degrees of physiological derangement is the application of DCS. Ongoing efforts to develop and strengthen a paediatric trauma service appear to be justified.
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Laing G, Bekker W, Bruce J, Clarke D. Reflections on the development of the Hybrid Electronic Medical Registry in Pietermaritzburg. S AFR J SURG 2022. [DOI: 10.17159/2078-5151/sajs3919] [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: 11/05/2022]
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Kong V, Cheung C, Buitendag J, Rajaretnam N, Varghese C, Elsabagh A, Bekker W, Bruce J, Laing G, Clarke D. Management of penetrating thoracic trauma with retained knife blade: 15-year experience from a major trauma centre in South Africa. Ann R Coll Surg Engl 2021; 104:308-313. [PMID: 34931547 DOI: 10.1308/rcsann.2021.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This study reviews our experience with the management a retained knife in the setting of thoracic stab wounds. METHODS A retrospective study was conducted at a major trauma in South Africa over a 15-year period from January 2004 to December 2018. RESULTS There were 40 patients, of whom 37 were males (93%). Median age was 24 years; 78% of cases (31 of 40) were a retained knife and 23% (9 of 40) were a retained blade. The locations of the stab wounds were 19 (48%) anterior and 21 (53%) posterior. Plain x-ray was performed in 85% (34) of patients and computed tomography angiography was performed in 85% (34). Six patients had haemodynamic instability and were expedited to the operating room without further imaging. Three of these had cardiac tamponade and three a massive haemothorax. Simple extraction and wound exploration were performed in 58% (23 of 40) of cases and the remaining 43% (17 of 40) required operative exploration and extraction. The operative approach was anterolateral thoracotomy in nine cases, posterolateral thoracotomy in four and median sternotomy in three cases. One patient required extraction and concurrent vertebral laminectomy due to cord compression. Twelve patients (30%) experienced complications (nine wound sepsis and three hospital-acquired pneumonia). There was one mortality (3%). The median length of hospital stay was 6 days. CONCLUSION Uncontrolled extraction of a retained thoracic knife outside the operating room must be avoided. An unstable patient should proceed directly for operative exploration. For stable patients, cross-sectional imaging will allow for planned extraction in operating room.
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Affiliation(s)
- V Kong
- University of the Witwatersrand, Johannesburg, South Africa
| | - C Cheung
- Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | | | | | - C Varghese
- University of Auckland, Auckland, New Zealand
| | - A Elsabagh
- Flinders Medical Centre, Adelaide, Australia
| | - W Bekker
- University of KwaZulu Natal, Durban, South Africa
| | - J Bruce
- University of KwaZulu Natal, Durban, South Africa
| | - G Laing
- University of KwaZulu Natal, Durban, South Africa
| | - D Clarke
- University of KwaZulu Natal, Durban, South Africa
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Clarke D, Williamson G, Stebbings A. A Systematic Review and Narrative Synthesis of the Effectiveness of Peer- versus Faculty-led Simulation for Clinical Skills Acquisition in Undergraduate Student Nurses. MSc Project Findings. Open Nurs J 2021. [DOI: 10.2174/1874434602115010273] [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: 11/22/2022] Open
Abstract
Background:
Clinical skills learning is an integral part of undergraduate nursing programmes in United Kingdom nurse education. Faculty staff teach some elements of clinical skills, and some are taught by clinicians in practice. International evidence indicates that some students feel overly anxious when taught by faculty members but less so with their peers, meaning that peer-led clinical skills teaching and learning might reduce anxiety and facilitate the acquisition and retention of skills education.
Objective:
The objective of this systematic review was to explore the research relating to undergraduate student nurses’ acquisition of skills within the simulation setting, particularly the associations between peer-led and lecturer-led learning.
Methods:
A systematic review of the literature was used to find all available evidence. A search of nine healthcare databases using Boolean and MeSH search terms including ‘Peer-to-peer’, ‘Clinical Skill*’, ‘Simulat*’, and ‘Student Nurs*’ was undertaken. Due to the heterogeneity of the research found, statistical meta-analysis was not possible, and so a narrative synthesis based on thematic analysis was conducted, which involved three-person research team critically appraising nine articles for inclusion in the review.
Results:
Articles were located from worldwide sources.
Three main themes in the findings were: psychological factors, motor skills, and educational issues. The use of peers can help to increase students’ motor skills, improved the psychological impact of skills and learning, and offered students a chance to be active participants in their education.
Conclusion:
Having explored the literature, we conclude that peer-to-peer teaching and learning could have a place in undergraduate nursing education; however, it is not clear if student nurses’ skills acquisition is more effective if mediated by peer- or lecturer-led teaching. Further research is required in this area to quantify and compare outcomes.
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Abstract
Context: In a global environment of escalating antimicrobial resistance and limited new antibiotic development, there is a desire to optimize antibiotic use across all settings to preserve options for the future. Despite this, antibiotics continue to be prescribed inappropriately in many settings. Patients with a spinal cord injury (SCI) are particularly vulnerable to receiving multiple courses of antibiotics, yet there is limited data reviewing antimicrobial stewardship (AMS) programs in this patient population.Hypothesis: Adopting AMS rounds will reduce days of antibiotic treatment.Intervention: We implemented a systematic bedside AMS multidisciplinary team (MDT) ward round within the SCI Unit at our hospital, where a collaborative inter-speciality and inter-professional approach was undertaken to address antibiotic prescriptions. A retrospective audit of antibiotic prescriptions was performed one month prior and one month during the intervention.Outcome measures: An infectious disease consultant led a multidisciplinary, multispecialty ward rounding team, looking at antibiotic appropriateness and guideline compliance. The effectiveness of this intervention was assessed by retrospectively looking at antibiotic days of usage per patient day of occupancy.Results: Antibiotic consumption significantly decreased following the AMS intervention, from 69.8 to 24.3 days on treatment per 100 patient days (P < 0.001). Following implementation of the ward round the proportion of therapeutic guideline compliant prescriptions significantly rose from 18% in April to 56% in August (P < 0.001).Conclusions: Utilizing a collaborative inter-speciality and inter-professional AMS approach and providing face to face feedback about the appropriateness of antibiotic prescribing can help optimize antibiotic usage within a SCI unit.
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Affiliation(s)
| | - Daniel Nguyen
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Kristen Overton
- Department of Infectious Diseases, Prince of Wales Hospital, Randwick, NSW, Australia,Prince of Wales Clinical School, University of New South Wales, Randwick, NSW, Australia,Correspondence to: Kristen Overton, Infectious Diseases Department, Level 4 Dickinson Building, Prince of Wales Hospital, Barker St, Randwick, NSW2031, Australia; ph: +61-2-9382-3405.
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Shaw K, Bell L, Boyd K, Grijseels DM, Clarke D, Bonnar O, Crombag HS, Hall CN. Publisher Correction: Neurovascular coupling and oxygenation are decreased in hippocampus compared to neocortex because of microvascular differences. Nat Commun 2021; 12:4497. [PMID: 34282153 PMCID: PMC8289894 DOI: 10.1038/s41467-021-24833-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- K Shaw
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - L Bell
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - K Boyd
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - D M Grijseels
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - D Clarke
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - O Bonnar
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - H S Crombag
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - C N Hall
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom.
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Shaw PJ, Leung KC, Clarke D. The fractionation of phosphorus in UK chalk stream surface waters and its relevance to the regulation and management of water quality. J Environ Manage 2021; 289:112555. [PMID: 33848882 DOI: 10.1016/j.jenvman.2021.112555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 04/01/2021] [Accepted: 04/03/2021] [Indexed: 06/12/2023]
Abstract
The regulatory management of river water quality requires measurements of phosphorus that are operationally viable and meaningful in terms of insight into its effects. This need is a particular concern in globally rare and ecologically sensitive chalk streams. P data pertaining to rivers are commonly limited to soluble reactive P; other fractions of P may be of concern but are not routinely monitored. This study seeks to establish the nature and extent of non-regulated forms of P in UK chalk streams. Whilst soluble reactive P in two southern English chalk streams was found to comprise the majority of reactive P in surface waters in the majority of samples, 15-20% of the total reactive P was within other size fractions greater than 0.22 μm. The contribution of reactive P to the total P was highly variable. We conclude that, with some adjustments, the established method of regulatory monitoring of P in UK rivers is viable and valuable. In cases where the levels of reactive P are not consistent with ecological status and/or expected outcomes of programmes of measures, we recommend that targeted analysis of non-regulated forms of P is undertaken as a means to guide and focus management interventions.
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Affiliation(s)
- P J Shaw
- School of Geography and Environmental Science, Faculty of Environmental and Life Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - K-C Leung
- School of Geography and Environmental Science, Faculty of Environmental and Life Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.
| | - D Clarke
- School of Engineering, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton Boldrewood Innovation Campus, Burgess Road, Southampton, SO16 7QF, UK
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Ruberto AJ, Rodenburg D, Ross K, Sarkar P, Hungler PC, Etemad A, Howes D, Clarke D, McLellan J, Wilson D, Szulewski A. The future of simulation-based medical education: Adaptive simulation utilizing a deep multitask neural network. AEM Educ Train 2021; 5:e10605. [PMID: 34222746 PMCID: PMC8155693 DOI: 10.1002/aet2.10605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/19/2021] [Accepted: 04/16/2021] [Indexed: 05/20/2023]
Abstract
BACKGROUND In resuscitation medicine, effectively managing cognitive load in high-stakes environments has important implications for education and expertise development. There exists the potential to tailor educational experiences to an individual's cognitive processes via real-time physiologic measurement of cognitive load in simulation environments. OBJECTIVE The goal of this research was to test a novel simulation platform that utilized artificial intelligence to deliver a medical simulation that was adaptable to a participant's measured cognitive load. METHODS The research was conducted in 2019. Two board-certified emergency physicians and two medical students participated in a 10-minute pilot trial of a novel simulation platform. The system utilized artificial intelligence algorithms to measure cognitive load in real time via electrocardiography and galvanic skin response. In turn, modulation of simulation difficulty, determined by a participant's cognitive load, was facilitated through symptom severity changes of an augmented reality (AR) patient. A postsimulation survey assessed the participants' experience. RESULTS Participants completed a simulation that successfully measured cognitive load in real time through physiological signals. The simulation difficulty was adapted to the participant's cognitive load, which was reflected in changes in the AR patient's symptoms. Participants found the novel adaptive simulation platform to be valuable in supporting their learning. CONCLUSION Our research team created a simulation platform that adapts to a participant's cognitive load in real-time. The ability to customize a medical simulation to a participant's cognitive state has potential implications for the development of expertise in resuscitation medicine.
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Affiliation(s)
- Aaron J. Ruberto
- Kingston Health Sciences CentreDepartment of Emergency MedicineQueen's UniversityKingstonOntarioCanada
- Thunder Bay Regional Health Sciences CentreDepartment of Critical Care MedicineNorthern Ontario School of MedicineThunder BayOntarioCanada
| | - Dirk Rodenburg
- Faculty of Applied Engineering and Applied ScienceQueen's UniversityKingstonOntarioCanada
| | - Kyle Ross
- Department of Electrical and Computer EngineeringQueen's UniversityKingstonOntarioCanada
| | - Pritam Sarkar
- Department of Electrical and Computer EngineeringQueen's UniversityKingstonOntarioCanada
| | - Paul C. Hungler
- Department of Chemical EngineeringQueen's UniversityKingstonOntarioCanada
| | - Ali Etemad
- Department of Electrical and Computer EngineeringQueen's UniversityKingstonOntarioCanada
| | - Daniel Howes
- Department of Critical Care MedicineDepartment of Emergency MedicineKingston Health Sciences CentreQueen's UniversityKingstonOntarioCanada
| | | | - James McLellan
- Department of Chemical EngineeringQueen's UniversityKingstonOntarioCanada
| | - Daryl Wilson
- Department of PsychologyQueen’s UniversityKingstonOntarioCanada
| | - Adam Szulewski
- Kingston Health Sciences CentreDepartment of Emergency MedicineQueen's UniversityKingstonOntarioCanada
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Feast S, Fee C, Huber T, Clarke D. Printed monolith adsorption as an alternative to expanded bed adsorption for purifying M13 bacteriophage. J Chromatogr A 2021; 1652:462365. [PMID: 34246960 DOI: 10.1016/j.chroma.2021.462365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/14/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022]
Abstract
An ordered 3D printed chromatography stationary phase was used to purify M13 bacteriophage (M13) directly from crude cell culture. This new approach, which offers the same advantages as expanded bed adsorption (EBA) with regard to tolerating solids-laden feed streams but without the corresponding issues associated with fluidized bed stability that affect the latter, can be described as "printed monolith adsorption (PMA)". PMA columns (5, 10 and 15 cm length by 1 cm diameter) were made via a wax templating method from cross-linked cellulose hydrogel and functionalized with a quaternary amine ligand. The recovery of M13 was found to be strongly linked to load flow rate, with the highest recovery 89.7% ± 6% for 1.4 × 1011 pfu/mL of resin occurring at 76 cm/h with a 10 cm column length. A recovery of 87.7% ± 5% for 1.49 × 1011 pfu/mL of media was achieved with a 15 cm column length under conditions comparable to a reported EBA process. The PMA process was completed three times faster than EBA because PMA flow rates can readily be adjusted during operation, with high flow rates and low back pressure, which is unique to the ordered monolithic media geometry used. Equilibration, wash, and cleaning steps were carried out at high flow rates (611 cm/h), minimizing process time and were limited only by the volumetric flow rate capacity of the pumps used, rather than column back pressure (<0.1 MPa at 611 cm/hr). Initial capture of M13 appears to occur on the surface of the monolith solid phase (i.e. the mobile phase channel walls) and subsequently, at a slower rate, within the internal pores of the solid phase media. The difference in binding rate between these two sites is likely caused by slow pore diffusion of the large M13 particles into the pores, with similar slow diffusion out of the pores resulting in tailing of the elution peak. The results indicate that PMA is a promising technology for the efficient purification of viruses directly from crude cell culture.
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Affiliation(s)
- Sean Feast
- School of Product Design and the Biomolecular Interaction Centre, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
| | - Conan Fee
- School of Product Design and the Biomolecular Interaction Centre, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
| | - Tim Huber
- School of Product Design and the Biomolecular Interaction Centre, University of Canterbury, Private Bag 4800, Christchurch 8020, New Zealand.
| | - Daniel Clarke
- School of Chemical and Physical Sciences, Victoria University of Wellington, PO Box 600, Wellington 6140, New Zealand.
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17
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Shaw K, Bell L, Boyd K, Grijseels DM, Clarke D, Bonnar O, Crombag HS, Hall CN. Neurovascular coupling and oxygenation are decreased in hippocampus compared to neocortex because of microvascular differences. Nat Commun 2021; 12:3190. [PMID: 34045465 PMCID: PMC8160329 DOI: 10.1038/s41467-021-23508-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/26/2021] [Indexed: 02/04/2023] Open
Abstract
The hippocampus is essential for spatial and episodic memory but is damaged early in Alzheimer's disease and is very sensitive to hypoxia. Understanding how it regulates its oxygen supply is therefore key for designing interventions to preserve its function. However, studies of neurovascular function in the hippocampus in vivo have been limited by its relative inaccessibility. Here we compared hippocampal and visual cortical neurovascular function in awake mice, using two photon imaging of individual neurons and vessels and measures of regional blood flow and haemoglobin oxygenation. We show that blood flow, blood oxygenation and neurovascular coupling were decreased in the hippocampus compared to neocortex, because of differences in both the vascular network and pericyte and endothelial cell function. Modelling oxygen diffusion indicates that these features of the hippocampal vasculature may restrict oxygen availability and could explain its sensitivity to damage during neurological conditions, including Alzheimer's disease, where the brain's energy supply is decreased.
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Affiliation(s)
- K Shaw
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - L Bell
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - K Boyd
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - D M Grijseels
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - D Clarke
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - O Bonnar
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - H S Crombag
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom
| | - C N Hall
- School of Psychology and Sussex Neuroscience, University of Sussex, Falmer, Brighton, United Kingdom.
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18
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Goddard S, Diwakar L, Hughes D, Clarke D, Graham J. Impact of stopping long-term immunoglobulin therapy in patients with secondary antibody deficiency due to haematological disease. Br J Haematol 2021; 193:e12-e15. [PMID: 33713431 DOI: 10.1111/bjh.17328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah Goddard
- Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Lavanya Diwakar
- Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Deborah Hughes
- Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Daniel Clarke
- Immunology, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Jane Graham
- Haematology, University Hospitals North Midlands, Stoke-on-Trent, UK
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Abstract
There has been steady progress in understanding the pathogenesis, clinical features, and effective treatment of acute anterior uveitis (AU) over the past 5 years. Large gene wide association studies have confirmed that AU is a polygenic disease, with overlaps with the seronegative arthropathies and inflammatory bowel diseases, associations that have been repeatedly confirmed in clinical studies. The role of the microbiome in AU has received increased research attention, with recent evidence indicating that human leukocyte antigen B27 (HLA B27) may influence the composition of the gut microbiome in experimental animals. Extensive clinical investigations have confirmed the typical features of acute AU (AAU) and its response to topical, regional and systemic immunosuppressive treatment. Increased understanding of the role of cytokines has resulted in studies confirming the value of anti-cytokine therapy [anti-tumor necrosis factor (anti-TNF) and interleukin 6 (IL-6) therapy] in severe and recurrent cases of AAU, particularly in subjects with an associated spondyloarthopathy (SpA) and in juvenile idiopathic arthritis (JIA)-associated AAU.
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Affiliation(s)
- Denis Wakefield
- Faculty of Medicine, University of NSW Sydney, Kensington, NSW, Australia
- NSW Health Pathology and South Eastern Sydney, LHD, Sydney, NSW, Australia
| | - Daniel Clarke
- Department of Medicine, South Eastern Sydney, LHD, Sydney, NSW, Australia
| | - Peter McCluskey
- Save Sight Institute, The University of Sydney, Sydney, NSW, Australia
- Discipline of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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20
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Niemiec B, Gawor J, Nemec A, Clarke D, McLeod K, Tutt C, Gioso M, Steagall PV, Chandler M, Morgenegg G, Jouppi R. World Small Animal Veterinary Association Global Dental Guidelines. J Small Anim Pract 2020; 61:E36-E161. [PMID: 32715504 DOI: 10.1111/jsap.13132] [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] [Indexed: 12/16/2022]
Abstract
Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.
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21
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O'Meara FM, Gardiner GE, Clarke D, Cummins W, O'Doherty JV, Lawlor PG. Microbiological assessment of liquid feed for finisher pigs on commercial pig units. J Appl Microbiol 2020; 130:356-369. [PMID: 32681565 DOI: 10.1111/jam.14785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 04/15/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the microbiological and nutritional quality of liquid finisher pig feed on commercial production units and the factors influencing this. METHODS AND RESULTS Microbiological and physio-chemical analyses were performed on liquid feed sampled from the mixing tank and troughs of the finisher section of eight commercial pig units. Lactic acid bacteria, yeast and Escherichia coli counts, as well as lactic acid, ethanol and acetate concentrations were higher in residual feed sampled from the troughs compared with mixing tank samples (P < 0·001). Feed pH, as well as lysine, methionine and threonine concentrations and gross energy were all lower in the residual trough samples (P < 0·001). Liquid co-products reduced E. coli counts in the residual trough samples (P < 0·05), pH in the mixing tank (P < 0·01) and fresh trough samples (P < 0·05) and mould counts at all three sampling locations (P < 0·01) but sanitation practices had no impact. CONCLUSIONS Even when considered unfermented, a considerable degree of spontaneous fermentation occurs in liquid feed, with resultant negative effects on nutritional quality. SIGNIFICANCE AND IMPACT OF THE STUDY This is one of the first studies showing that uncontrolled fermentation of fresh liquid pig feed is commonplace on commercial units, highlighting the need for implementation of suitable control strategies.
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Affiliation(s)
- F M O'Meara
- Teagasc, Pig Development Department, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy, County Cork, Ireland.,Department of Science, Waterford Institute of Technology, Waterford, Ireland
| | - G E Gardiner
- Department of Science, Waterford Institute of Technology, Waterford, Ireland
| | - D Clarke
- Teagasc, Pig Development Department, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy, County Cork, Ireland
| | - W Cummins
- Department of Science, Waterford Institute of Technology, Waterford, Ireland
| | - J V O'Doherty
- School of Agriculture and Food Science, University College Dublin, Belfield, Dublin, Ireland
| | - P G Lawlor
- Teagasc, Pig Development Department, Animal and Grassland Research and Innovation Centre, Moorepark, Fermoy, County Cork, Ireland
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22
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Niemiec B, Gawor J, Nemec A, Clarke D, McLeod K, Tutt C, Gioso M, Steagall PV, Chandler M, Morgenegg G, Jouppi R, McLeod K. World Small Animal Veterinary Association Global Dental Guidelines. J Small Anim Pract 2020; 61:395-403. [DOI: 10.1111/jsap.13113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/26/2022]
Affiliation(s)
- B. Niemiec
- Veterinary Dental Specialties & Oral Surgery San Diego CA USA
| | - J. Gawor
- Klinika Weterynaryjna Arka Kraków Poland
| | - A. Nemec
- Veterinary Faculty, Small Animal Clinic, University of LjubljanaLjubljanaSlovenia
| | - D. Clarke
- David Clarke Dental Care for Pets MelbourneAustralia
| | - K. McLeod
- The Veterinary Dentist Cape Town South Africa
| | - C. Tutt
- The Veterinary Dentist Cape Town South Africa
| | - M. Gioso
- Department of SurgeryUniversity of São Paulo São Paulo Brazil
| | - P. V. Steagall
- Department of Clinical Sciences, Faculty of Veterinary MedicineUniversité de Montréal Saint‐Hyacinthe QC Canada
| | | | | | - R. Jouppi
- Laurentian University Sudbury ON Canada
| | - K. McLeod
- Conundrum Consulting Toronto ON Canada
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23
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Lam DV, Clarke D, Tafsir M, Martinez J, Si Q, Khoubrouy SA, Tan CT. Wireless And Portable Daily Soundscape Monitoring System For Auditory Profiling: Diagnostic Tool For Alzheimer's Disease. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2020:4226-4228. [PMID: 33018929 DOI: 10.1109/embc44109.2020.9176034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The purpose of this paper is to develop an inexpensive, wearable, and portable monitoring system with wireless capabilities for signal acquisition of the user's surrounding soundscape and electroencephalography (EEG). The end-goal of this device is to monitor high-risk populations that are developing into earlier stages of Alzheimer's Disease (AD). Currently, the development of such device is still within preliminary phase and has only been tested in healthy individuals. Future applications of our monitoring system may be used as a non-invasive and inexpensive diagnostic tool for early detection of AD, potentially paving a new platform for therapeutic intervention. The system consists of low-weight bearing components, including an analog front-end and a single-board computer. The analog front-end contains three independent EEG, reference, bias, and auditory recording channels. The single-board computer timestamps and encrypts the incoming channels prior to local or "cloud" storage. Cloud storage provides ease-of-access and offline data analysis without the need to physically extract the data from the monitoring system. A portable/rechargeable battery provides power to the entire monitoring system for over 4 hours of operation. A graphical user-interface (GUI) was developed for secured remote access to data, parameter settings, and system configurations. The performance of the system was tested by measuring the frequency following response (FFR) in the captured EEG signals with respect to periodic auditory stimuli.
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24
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Danczyk M, Meaclem T, Mehdizad M, Clarke D, Galvosas P, Fullard L, Holland D. Influence of contact parameters on Discrete Element method (DEM) simulations of flow from a hopper: Comparison with magnetic resonance imaging (MRI) measurements. POWDER TECHNOL 2020. [DOI: 10.1016/j.powtec.2020.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Aronsson J, Clarke D, Grose J, Richardson J. Student nurses exposed to sustainability education can challenge practice: A cohort study. Nurs Health Sci 2020; 22:803-811. [DOI: 10.1111/nhs.12734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Jennie Aronsson
- School of Nursing and Midwifery University of Plymouth Plymouth UK
| | - Daniel Clarke
- School of Nursing and Midwifery University of Plymouth Plymouth UK
| | - Jane Grose
- School of Nursing and Midwifery University of Plymouth Plymouth UK
| | - Janet Richardson
- School of Nursing and Midwifery University of Plymouth Plymouth UK
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26
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Harmon-Jones E, Clarke D, Paul K, Harmon-Jones C. The Effect of Perceived Effort on Reward Valuation: Taking the Reward Positivity (RewP) to Dissonance Theory. Front Hum Neurosci 2020; 14:157. [PMID: 32477082 PMCID: PMC7241252 DOI: 10.3389/fnhum.2020.00157] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/09/2020] [Indexed: 11/13/2022] Open
Abstract
The present research was designed to test whether the subjective experience of more effort related to more reward valuation as measured by a neural response. This prediction was derived from the theory of cognitive dissonance and its effort justification paradigm. Young adult participants (n = 82) engaged in multiple trails of a low or high effort task that resulted in a loss or reward on each trial. Neural responses to the reward (loss) cue were measured using EEG so that the event-related potential known as the Reward Positivity (RewP) could be assessed. Results revealed no significant differences between low and high effort conditions on the RewP. However, within the high effort condition, a more subjective experience of effort was associated with a larger RewP. This research extends past research on the effort justification paradigm of cognitive dissonance theory by suggesting that effort justification is associated with an implicit measure of reward valuation. It, therefore, challenges recent perspectives on dissonance processes that posit that these evaluative changes should only occur on explicit but not implicit measures.
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Affiliation(s)
- Eddie Harmon-Jones
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - Daniel Clarke
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
| | - Katharina Paul
- Department of Experimental, Clinical, and Health Psychology, Ghent University, Ghent, Belgium
| | - Cindy Harmon-Jones
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
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Williams R, Hull K, Clarke D, Graham L, Hawkins R, Cundill B, Ellwood A, Farrin A, Fisher J, Goodwin M, Holland M, Hulme C, Kelly C, Forster A. Process evaluation exploring the delivery and uptake of a posture and mobility training package in care homes. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.270] [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: 11/16/2022]
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28
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Williams R, Clarke D, Graham L, Hawkins R, Cundill B, Ellwood A, Farrin A, Fisher J, Goodwin M, Holland M, Hull K, Hulme C, Kelly C, Forster A. 102 Process Evaluation Exploring the Delivery and Uptake of Posture and Mobility Training for Staff in Care Homes. Age Ageing 2020. [DOI: 10.1093/ageing/afz196.04] [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
Introduction
Provision of care for care home residents with complex needs is challenging. Physiotherapists can play a major role in enhancing the confidence, skills and abilities of care home staff. The Skilful Care Training Package (SCTP) aims to provide staff with an understanding of good posture and training in skilled facilitation of movement. This process evaluation explored barriers and facilitators to delivery and uptake of the SCTP within the context of a feasibility cluster randomised controlled trial (cRCT) in 10 care homes.
Methods
A mixed methods process evaluation, incorporating non-participant observations and interviews, conducted in the five care homes receiving the SCTP intervention. Interviews were audio recorded and transcribed verbatim; resident conversations were captured via a Dictaphone and/or field-notes. Data analysis used the Framework approach.
Results
Fourteen staff training sessions were observed. Interviews with 22 staff and four trainers, and 13 conversations with residents were completed. Five factors influenced delivery and uptake of the SCTP:Organisational factors: strategies to publicise and facilitate access to training improved attendance; a convenient training location and trainer flexibility encouraged attendance and staff engagement.Intervention delivery: a practical participatory element to the training was highly valued; adapting the training to meet the needs of the homes was well-received.Engagement and interaction: relating training to workplace and residents’ experiences engaged staff; high levels of engagement and positive interaction within the training sessions were reported; challenges relating to staff hierarchy affected training delivery in some homes.Intervention content: posture and mobility elements were seen as important; however, some repetition with prior training was highlighted.Training impact: there were indications that staff adopted SCTP techniques. Staff reported an increase in their wellbeing and confidence in movement facilitation; cascade training was reported in some homes.
Conclusions
Training was well-received, and feedback on its impact was largely positive. Practical elements were viewed favourably over classroom-based learning. Intervention content should be revised to optimise focus and avoid overlap with other training.
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Affiliation(s)
- R Williams
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - D Clarke
- Leeds Institute of Health Sciences, University of Leeds
| | - L Graham
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - R Hawkins
- Leeds Institute of Health Sciences, University of Leeds
| | - B Cundill
- Clinical Trials Research Unit, University of Leeds
| | - A Ellwood
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
| | - A Farrin
- Clinical Trials Research Unit, University of Leeds
| | | | - M Goodwin
- Clinical Trials Research Unit, University of Leeds
| | - M Holland
- Clinical Trials Research Unit, University of Leeds
| | | | - C Hulme
- Institute of Health Research, University of Exeter
| | - C Kelly
- Leeds Institute of Health Sciences, University of Leeds
| | - A Forster
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research
- Leeds Institute of Health Sciences, University of Leeds
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29
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Nunan J, Clarke D, Malakouti A, Tannetta D, Calthrop A, Xu XH, Chan NB, Khalil R, Li W, Walden A. Triage Into the Community for COVID-19 (TICC-19) Patients Pathway - Service evaluation of the virtual monitoring of patients with COVID pneumonia. Acute Med 2020; 19:183-191. [PMID: 33215171] [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
INTRODUCTION COVID-19 pneumonia presented a unique problem for healthcare systems with the potential to overwhelm hospitals and lead to unnecessary morbidity and mortality. Safe triage and follow up systems are required to manage this unprecedented demand. METHODS We designed a pathway for the triage and assessment of patients based on their resting oxygen saturations and response to a 30 metre rapid walking test. We admitted patients to a 'Virtual Ward' for remote oximetry monitoring from the Emergency Department, step down from inpatient wards and from the local Primary Care 'Hot Hub'. This allowed the safe and managed readmission of those patients who deteriorated at home. RESULTS During the first wave of COVID-19 we entered 273 onto the pathway for Virtual Ward follow up. Of these, 31 patients were readmitted to hospital, two were admitted to Intensive Care and one patient died. Median oxygen saturation at presentation was 97 % (IQR 96-98%) and following a 30 metre walk test 96% (IQR 94-97%). Median NEWS-2 score was 2 (IQR 1-3). On feedback 99.5% of patients were likely or extremely likely to recommend the service to their family and friends. There was a cost avoidance of £107,600 per month. CONCLUSION It is safe, feasible and cost effective to set up a triage system with remote oximetry monitoring for patients with COVID-19 and overwhelmingly patients find it a positive experience.
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Affiliation(s)
- J Nunan
- Department of Acute Medicine, Royal Berkshire Hospital, Berkshire
| | - D Clarke
- Department of Emergency Medicine, Royal Berkshire Hospital, Berkshire
| | | | - D Tannetta
- University of Reading, Reading, Berkshire
| | - A Calthrop
- Department of Emergency Medicine, Royal Berkshire Hospital, Berkshire
| | - X H Xu
- Newcastle Medical School, Framlington Place, Newcastle upon Tyne
| | - N B Chan
- Informatics Research Centre, Henley Business School, University of Reading, Whiteknight Campus, United Kingdom
| | - R Khalil
- University of Reading, Reading, Berkshire
| | - W Li
- Informatics Research Centre, Henley Business School, University of Reading, Whiteknight Campus, United Kingdom
| | - A Walden
- Department of Acute Medicine, Royal Berkshire Hospital, Berkshire
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Tayyar Y, Shiels R, Bulmer AC, Lam AK, Clarke D, Idris A, McMillan NA. Development of an intravaginal ring for the topical delivery of Aurora kinase A inhibitor, MLN8237. PLoS One 2019; 14:e0225774. [PMID: 31774882 PMCID: PMC6880999 DOI: 10.1371/journal.pone.0225774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/12/2019] [Indexed: 11/27/2022] Open
Abstract
Human papilloma virus (HPV) is the main culprit in cervical cancers. Although the HPV vaccine is now available, the slow and gradual process for HPV cancers to form means little will change, even for vaccinated individuals. This warrants the development of new therapeutic strategies in both the newly diagnosed and recurrent patients. We have previously shown that Alisertib (MLN8237), an Aurora A kinase inhibitor, potently and selectively kills HPV-positive cervical cancer cells. However, Alisertib is known for its unfavorable side effects when administered systemically. A targeted delivery approach is therefore warranted. The topical delivery of drugs to the cervix for the treatment of cervical cancer is an underexplored area of research that has the potential to significantly improve therapeutic outcome. Here, we design a novel topical drug delivery system for localized delivery in the vaginal tract using intravaginal silicone rings loaded with Alisertib. We assessed the suitability of the drug for the application and delivery method and develop a high-performance liquid chromatography method, then show that the vaginal rings were effective at releasing Alisertib over an extended period of time. Furthermore, we showed that Alisertib-loaded vaginal rings did not induce overt inflammation in the mouse vaginal tract. Our work has major translational implications for the future development of vaginal ring devices for the topical treatment of cervical cancer.
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Affiliation(s)
- Yaman Tayyar
- School of Medical Science, Griffith University, Southport, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Ryan Shiels
- School of Medical Science, Griffith University, Southport, Australia
| | - Andrew C. Bulmer
- School of Medical Science, Griffith University, Southport, Australia
| | - Alfred K. Lam
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
| | - Daniel Clarke
- School of Medical Science, Griffith University, Southport, Australia
| | - Adi Idris
- School of Medical Science, Griffith University, Southport, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
- * E-mail:
| | - Nigel A. McMillan
- School of Medical Science, Griffith University, Southport, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, Australia
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van Hengel AJ, Capelletti C, Brohee M, Anklam E, Baumgartner MCS, Abbott M, Baumgartner S, Bremer M, Clarke D, Cleroux C, Demeulemester C, Eckhart F, Gelencser E, Hefle S, Herrnegger H, Hörtner H, Kyriakidis S, Lowe R, Marx G, Mayer W, Paschke A, Robert MC, Schneede K, Sherlock R, Suter D, Warner K, Werner M. Validation of Two Commercial Lateral Flow Devices for the Detection of Peanut Proteins in Cookies: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/89.2.462] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Results are reported for an interlaboratory validation study of 2 commercially available lateral flow devices (dipstick tests) designed to detect peanut residues in food matrixes. The test samples used in this study were cookies containing peanuts at 7 different concentrations in the range of 030 mg peanuts/kg food matrix. The test samples with sufficient and proven homogeneity were prepared in our laboratory. The analyses of the samples (5 times per level by each laboratory) were performed by 18 laboratories worldwide, which submitted a total of 1260 analytical results. One laboratory was found to be an outlier for one of the test kits. In general, both test kits performed well. However, some false-negative results were reported for all matrixes containing <21 mg peanuts/kg cookie. It must be stressed that the test kits were challenged beyond their cut-off limits (5 mg/kg, depending on the food matrix). One test kit showed fewer false-negative results, but it led to some false-positive results for the blank materials. The sensitivity of the dipstick tests approaches that achieved with enzyme-linked immunosorbent assays.
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Affiliation(s)
- Arjon J van Hengel
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg 111, B-2440, Geel, Belgium
| | - Claudia Capelletti
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg 111, B-2440, Geel, Belgium
| | - Marcel Brohee
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg 111, B-2440, Geel, Belgium
| | - Elke Anklam
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg 111, B-2440, Geel, Belgium
| | - M-C S Baumgartner
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg 111, B-2440, Geel, Belgium
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Hughes D, Dailianis A, Duncan L, Briggs J, McKintyre DA, Silbernagel K, Anderson G, Anderson J, Bannach B, Barratt C, Booyens C, Briggs J, Brooks R, Bryant D, Burnie A, Carver C, Chambers D, Chong J, Clarke D, Coates E, Comontofski G, Deiss K, Destro C, Dillon J, Duncan L, Dundas M, Dymond N, Dziedziczak D, Eglezos S, Gasanov U, Gebler J, Graham T, Haley E, Johnson L, Kurien S, Maczuga J, Matera J, Matthew K, Munyard S, Ramine A, Reed J, Remes A, Subasinghe N, Tan A, Tan J, Tatum M, Taylor M, Torrance H, Twohy C, Vialpando M, Watts K. Modification of Enrichment Protocols for TECRA Listeria Visual Immunoassay Method 995.22: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.2.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted to validate new enrichment methods for the TECRA Listeria Visual Immunoassay (TLVIA). These new methods incorporate a newly formulated medium, TECRA Listeria Enrichment Broth, which does not contain the highly toxic antifungal agent, cycloheximide. The new procedures will provide an alternative to the enrichment procedures described in AOAC Method 995.22. Three food types (raw ground beef, lettuce, and ice cream) were analyzed in the United States, and 2 food types (cooked turkey and cooked fish fillets) were analyzed in Australasia. Thirty collaborators participated in the study, 16 in Australasia and 14 in the United States. With the exception of one batch of ground beef, comparison of the proportion of positive test portions (p ≥ 0.05) showed no significant difference between the TLVIA and the reference method for the 5 foods at 3 inoculation levels. For the one batch of naturally contaminated raw ground beef, the TLVIA gave significantly more confirmed positive results than the reference method.
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Affiliation(s)
- Denise Hughes
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Angela Dailianis
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Louise Duncan
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Julie Briggs
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | | | - Karen Silbernagel
- rtech laboratories, Lexington Ave, N. Arden Hills, Minneapolis, MN 55126
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Zhang F, Martinez CM, Clarke D, Cao D, Knoll A. Neural Network Based Uncertainty Prediction for Autonomous Vehicle Application. Front Neurorobot 2019; 13:12. [PMID: 31133839 PMCID: PMC6524408 DOI: 10.3389/fnbot.2019.00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/18/2019] [Indexed: 11/30/2022] Open
Abstract
This paper proposes a framework for uncertainty prediction in complex fusion networks, where signals become available sporadically. Assuming there is no information of the sensor characteristics available, a surrogated model of the sensor uncertainty is yielded directly from data through artificial neural networks. The strategy developed is applied to autonomous vehicle localization through odometry sensors (speed and orientation), so as to determine the location uncertainty in the trajectory. The results obtained allow for fusion of autonomous vehicle location measurements, and effective correction of the accumulated odometry error in most scenarios. The neural networks applicability and generalization capacity are proven, evidencing the suitability of the presented methodology for uncertainty estimation in non-linear and intractable processes.
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Affiliation(s)
- Feihu Zhang
- School of Marine Science and Technology, Northwestern Polytechnical University, Xi'an, China
| | | | - Daniel Clarke
- Cogsense Technologies Limited, London, United Kingdom
| | - Dongpu Cao
- Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Alois Knoll
- Department of Informatics, Technical University of Munich, Munich, Germany
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Clarke D, Lawrence N. Crypopreservation of the clinical apheresis starting material maintains quality and offers options to extend stability. Cytotherapy 2019. [DOI: 10.1016/j.jcyt.2019.03.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stewart BT, Kazerooni Y, Mishra B, Adu EK, Clarke D, Pham TN, Gibran N. 278 A Comprehensive Legislative Framework to Address Chemical Assault. J Burn Care Res 2019. [DOI: 10.1093/jbcr/irz013.196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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]
Affiliation(s)
- B T Stewart
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - Y Kazerooni
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - B Mishra
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - E K Adu
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - D Clarke
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - T N Pham
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
| | - N Gibran
- University of Washington, Seattle, WA; The Ohio State University College of Medicine, Columbus, OH; King Georges Medical University, Lucknow, India; Kwame Nkumrah University of Science and Technology, Kumasi, Ghana; Nelson Mandela School of Medicine, University of Kwa Zulu Natal, Durban, South Africa
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Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Abstract P3-03-11: Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-03-11] [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: 11/16/2022]
Abstract
Abstract
Introduction
The intraoperative assessment of the sentinel node in women with breast cancer enables an immediate axillary node clearance to be done as part of the same operative procedure if the sentinel node is positive. This has significant benefits for the Patient, the Surgeon and the Health Care Provider. There are a variety of methods for the intra-operative assessment of the sentinel node which include: Touch Imprint Cytology, Frozen Section Analysis and Polymerase Chain Reaction (PCR) based molecular assays. OSNA is an automated molecular assay using a Polymerase Chain Reaction (PCR), which detects the presence of cytokeratin 19 in the sentinel node. We report our experience of OSNA for the intraoperative assessment of the sentinel node in our institution with 1148 patients.
Methods
All patients with operable breast cancer who were found to be node negative on clinical and radiological assessment of the axilla, and who had their axilla staged by a sentinel node biopsy at the Breast Unit at Warwick Hospital, UK over a 7 year period were included in this study. Data was collected from a prospective database maintained at the Breast Unit. The axillary node positivity rate and the number of patients with macrometastatic and micrometastatic disease as detected by OSNA was collected and compared with a group of 411 patients who had the intraoperative assessment by Touch Imprint Cytology and final histology by conventional Haematoxylin & Eosin (H&E) assessment, prior to the introduction of OSNA. The Chi-square test were used for statistical significance.
Results
1148 patients had their sentinel node assessed intraoperatively using OSNA in this 7 year study period. The sentinel node was positive in 376 patients (32.8%). Of those who had a positive node, 183 (15.9%) had macro-metastatic disease and 193 (16.8%) had micro-metastatic disease. When compared to 411 patients in the pre-OSNA period, that were assessed by Touch Imprint Cytology and H&E sections, the node positivity rate increased from 23.8% to 32.8% (p<0.05) with the introduction of OSNA. Whilst there was no significant increase in the rate of macrometastatic disease – 20.4% versus 15.9 % ( p0.038), there was a significant increase in the patients who had micrometastases detected on OSNA - 3.4% versus 16.8 % ( p<0.05) as shown in the table.
Conclusion
Our results demonstrate that OSNA is a more sensitive test for picking up metastatic disease, especially micrometastatic disease, in the sentinel node. Whilst this did cause some anxiety initially, the results of recent trials like ACSOG Z-11 and IBCSG 23-01 have shown that small volume disease or micrometastases in the sentinel node do not require an axillary node clearance. Intraoperative assessment of the sentinel node with OSNA significantly upstages the axillary nodal status, especially with regard to micrometastatic disease, but the ability to proceed to an axillary node clearance at the same operation as the sentinel node biopsy, still has significant advantages for the Patient, Surgeon and Health Care Providers.
Citation Format: Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-11.
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Affiliation(s)
- D Clarke
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - A Sinha
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - L Ion
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - S Weston
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - L Jones
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - M Kham
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
| | - S Harries
- Warwick Hospital, Warwick, Warwickshire, United Kingdom
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Clarke D, Idris A, McMillan NAJ. Development of novel lipidic particles for siRNA delivery that are highly effective after 12 months storage. PLoS One 2019; 14:e0211954. [PMID: 30735545 PMCID: PMC6368384 DOI: 10.1371/journal.pone.0211954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/24/2019] [Indexed: 01/30/2023] Open
Abstract
Liposomes are versatile and well-proven as a means to deliver nucleic acids into cells. Most of the formulation procedures used are labour intensive and result in unstable end products. We have previously reported on the development of a simple, yet efficient, hydration-of-freeze-dried-matrix (HFDM) method to entrap siRNA within lipid particles. Here we show that the particles are stable up to 12 months after storage at room temperature (RT), 4°C or -20°C. While RT storage results in changes in particle size and polydispersity, gene silencing of all particles was similar to freshly prepared particles following storage for 3, 6, 9 or 12 months at all temperatures. This is the first report of such long-term stability in siRNA-loaded liposomes.
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Affiliation(s)
- Daniel Clarke
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Australia
| | - Adi Idris
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Australia
- * E-mail:
| | - Nigel A. J. McMillan
- Menzies Health Institute Queensland, School of Medical Science, Griffith University, Southport, Australia
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Segan L, Andrianopoulos N, Brennan A, Hiew C, Reid C, Freeman M, Oqueli E, Ajani A, Clarke D, Duffy S, Yip T. Impact of Lunar Phase on Outcomes following ST-Elevation Myocardial Infarction. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toner L, Scully T, Yeoh J, Yudi M, Farouque O, Clarke D. Safety and Long-Term Clinical Outcomes of Fractional Flow Reserve (FFR): An 8-year Study in a Real-world Setting. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clarke D, Gorman I, Ringholz F, McDermott M, Cox DW, Greally P, Linnane B, Mc Nally P. Pulmonary aspiration in preschool children with cystic fibrosis. Respir Res 2018; 19:255. [PMID: 30558606 PMCID: PMC6296125 DOI: 10.1186/s12931-018-0954-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/03/2018] [Accepted: 11/23/2018] [Indexed: 12/13/2022] Open
Abstract
Pulmonary aspiration of gastric refluxate (PAGR) has been demonstrated in association with pulmonary inflammation in school aged children with Cystic Fibrosis (CF). We sought to determine if similar findings were present in preschool children. Pepsin was measured in Broncho-alveolar lavage (BAL) fluid collected from clinically stable preschool children with CF and controls. Elevated pepsin levels were found in a subgroup of children with CF, but this was not found to be associated with pulmonary infection, pulmonary inflammation or respiratory or gastrointestinal symptoms.
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Affiliation(s)
- D Clarke
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - I Gorman
- National Children's Research Centre, Crumlin, Dublin 12, Ireland. .,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
| | - F Ringholz
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - M McDermott
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - D W Cox
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - P Greally
- National Children's Hospital, Tallaght, Dublin, Ireland
| | - B Linnane
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,University Hospital Limerick, Limerick, Ireland.,Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - P Mc Nally
- National Children's Research Centre, Crumlin, Dublin 12, Ireland.,Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.,Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
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Clarke D, Williamson G, Kane A. Could students’ experiences of clinical placements be enhanced by implementing a Collaborative Learning in Practice (CliP) model? Nurse Educ Pract 2018; 33:A3-A5. [DOI: 10.1016/j.nepr.2018.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/09/2018] [Accepted: 03/03/2018] [Indexed: 11/28/2022]
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Horsfall L, Echavarri-Bravo V, Tinzl M, Kew W, Mackay L, Clarke D. Revealing the complex composition of lignin and resulting products by ultra-high resolution mass spectrometry (FT-ICR MS). N Biotechnol 2018. [DOI: 10.1016/j.nbt.2018.05.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Park TK, Athwal R, Harries S, Clarke D, Jones L. Assessment of pre-operative factors in breast cancer patients to avoid the use of one step nucleic acid amplification analysis of the sentinel lymph node. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Wadman R, Armstrong M, Clarke D, Harroe C, Majumder P, Sayal K, Vostanis P, Townsend E. Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis. Arch Suicide Res 2018; 22:365-379. [PMID: 28786765 DOI: 10.1080/13811118.2017.1355286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.
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Weale RD, Kong VY, Blodgett JM, Buitendag J, Ras A, Laing G, Bruce JL, Bekker W, Manchev V, Clarke D. Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma. J ROY ARMY MED CORPS 2018; 164:428-431. [PMID: 29950299 DOI: 10.1136/jramc-2018-000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/24/2018] [Accepted: 05/25/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The modern concept of damage control surgery (DCS) for trauma was first introduced less than three decades ago. This audit aims to describe the spectrum and outcome of patients requiring DCS, to benchmark our experience against that reported from other centres and countries and to distil the pertinent teaching lessons from this experience. METHODS All patients over the age of 15 years undergoing a laparotomy for trauma over the period from December 2012 to July 2016 were retrieved from the trauma registry of the Pietermaritzburg Metropolitan Trauma Service, South Africa. Physiological parameters and visceral injuries were assessed. Statistical analysis was performed using STATA V.15.0. RESULTS A total of 562 patients underwent trauma laparotomy during the period under review. The mechanism was penetrating trauma in 81% of cases (453/562). A great proportion of trauma victims were male (503/562, 90%), with a mean age of 29.5±10.8. A total of 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. Out of the 99 who required DCS, there were 32 mortalities (32%). The mean physiological parameters for the DCS patient demonstrated acidosis (pH 7.28±0.15) with a raised lactate (5.25 mmol/L±3.71). Our primary repair rates for enteric injuries were surprisingly high. CONCLUSION Just under 20% of trauma laparotomies require DCS. In this cohort of patients, the mortality rate is just under one-third. Further attention must be paid to refining the appropriate indications for DCS as the margin for error in such a cohort is very small and poor decision-making is difficult to correct. The major lesson from this analysis is that the decision to perform DCS must be made early and communicated appropriately to all those managing the patient.
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Affiliation(s)
| | - V Y Kong
- Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Durban, South Africa
| | - J M Blodgett
- Department of Epidemiology, MRC Unit, University College London, London, United Kingdom
| | - J Buitendag
- Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Durban, South Africa
| | | | | | | | | | | | - D Clarke
- Department of Surgery, Pietermaritzburg Metropolitan Trauma Service, Durban, South Africa.,Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Ravishankar Rao A, Clarke D, Vargas M. Building an Open Health Data Analytics Platform: a Case Study Examining Relationships and Trends in Seniority and Performance in Healthcare Providers. J Healthc Inform Res 2018; 2:44-70. [DOI: 10.1007/s41666-018-0014-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/24/2022]
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Alexander K, Northrup N, Clarke D, Lindell H, Laver T. Engineering controls in veterinary oncology: A survey of 148 ACVIM board-certified oncologists and environmental surveillance in 20 specialty hospitals. Vet Comp Oncol 2018; 16:385-391. [PMID: 29446222 DOI: 10.1111/vco.12390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 11/29/2022]
Abstract
Engineering controls (EC, facility and equipment barriers between hazards and people) are used to avoid exposure to chemotherapy drugs. In this study, American College of Veterinary Internal Medicine board-certified veterinary oncologists were surveyed about their use of containment primary EC (C-PEC) and supplemental EC (closed system transfer devices, CSTD). The survey was completed by 148 (38%) of practicing diplomates. All used EC. Both C-PEC and CSTD were used at 92% of hospitals; however, US Pharmacopoeial Convention Chapter <800> (USP <800>) standards were met at only 19% of hospitals and oncologists did not know the type of C-PEC at 18% of hospitals. Next, surface contamination and EC use were assessed with environmental surveillance for carboplatin, cyclophosphamide, doxorubicin, and vincristine in 20 veterinary specialty hospitals using a commercially available kit. No contamination with carboplatin, doxorubicin, or vincristine was detected, however, there was contamination with cyclophosphamide at 4 hospitals. Based on this study, most veterinary oncologists use C-PEC and CSTD, but few meet USP <800> standards. Current measures appear effective for preventing contamination with IV drugs, but additional measures are needed for oral drugs.
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Affiliation(s)
- K Alexander
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - N Northrup
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - D Clarke
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - H Lindell
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
| | - T Laver
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia
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MacIntosh A, Switzer L, Hwang S, Schneider ALJ, Clarke D, Graham TN, Fehlings DL. Ability-Based Balancing Using the Gross Motor Function Measure in Exergaming for Youth with Cerebral Palsy. Games Health J 2017; 6:379-385. [DOI: 10.1089/g4h.2017.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexander MacIntosh
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Lauren Switzer
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Susan Hwang
- School of Computing, Queen's University, Kingston, Canada
| | | | - Daniel Clarke
- School of Computing, Queen's University, Kingston, Canada
| | | | - Darcy L. Fehlings
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Pediatrics, University of Toronto, Toronto, Canada
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