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McCall KC, Liu M, Cheng SC, Abbott A, Dubey S, Young D, Johnston M, Van den Abbeele AD, Overmoyer B, Jacene H. Report on the PET/CT Image-Based Radiation Dosimetry of [ 18F]FDHT in Women, a Validated Imaging Agent with New Applications for Evaluation of Androgen Receptor Status in Women with Metastatic Breast Cancer. J Nucl Med Technol 2023; 51:204-210. [PMID: 37316304 DOI: 10.2967/jnmt.123.265623] [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: 01/03/2022] [Revised: 03/21/2023] [Indexed: 06/16/2023] Open
Abstract
In a prospective clinical trial, [18F]fluoro-5α-dihydrotestosterone ([18F]FDHT), the radiolabeled analog of the androgen dihydrotestosterone, was used as a PET/CT imaging agent for in vivo assessment of metastatic androgen receptor-positive breast cancer in postmenopausal women. To our knowledge, this article presents the first report of PET/CT image-based radiation dosimetry of [18F]FDHT in women. Methods: [18F]FDHT PET/CT imaging was performed on a cohort of 11 women at baseline before the start of therapy and at 2 additional time points during selective androgen receptor modulator (SARM) therapy for androgen receptor-positive breast cancer. Volumes of interest (VOIs) were placed over the whole body and within source organs seen on the PET/CT images, and the time-integrated activity coefficients of [18F]FDHT were derived. The time-integrated activity coefficients for the urinary bladder were calculated using the dynamic urinary bladder model in OLINDA/EXM software, with biologic half-life for urinary excretion derived from VOI measurements of the whole body in postvoid PET/CT images. The time-integrated activity coefficients for all other organs were calculated from VOI measurements in the organs and the physical half-life of 18F. Organ dose and effective dose calculations were then performed using MIRDcalc, version 1.1. Results: At baseline before SARM therapy, the effective dose for [18F]FDHT in women was calculated as 0.020 ± 0.0005 mSv/MBq, and the urinary bladder was the organ at risk, with an average absorbed dose of 0.074 ± 0.011 mGy/MBq. Statistically significant decreases in liver SUV or uptake of [18F]FDHT were found at the 2 additional time points on SARM therapy (linear mixed model, P < 0.05). Likewise, absorbed dose to the liver also decreased by a small but statistically significant amount at the 2 additional time points (linear mixed model, P < 0.05). Neighboring abdominal organs of the gallbladder wall, stomach, pancreas, and adrenals also showed statistically significant decreases in absorbed dose (linear mixed model, P < 0.05). The urinary bladder wall remained the organ at risk at all time points. Absorbed dose to the urinary bladder wall did not show statistically significant changes from baseline at any of the time points (linear mixed model, P ≥ 0.05). Effective dose also did not show statistically significant changes from baseline (linear mixed model, P ≥ 0.05). Conclusion: Effective dose for [18F]FDHT in women before SARM therapy was calculated as 0.020 ± 0.0005 mSv/MBq. The urinary bladder wall was the organ at risk, with an absorbed dose of 0.074 ± 0.011 mGy/MBq.
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Affiliation(s)
- Keisha C McCall
- Department of Radiology, Henry Ford Health, Detroit, Michigan;
| | - Mofei Liu
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Su-Chun Cheng
- Division of Biostatistics, Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amanda Abbott
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Shipra Dubey
- BiCOR, Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | - Annick D Van den Abbeele
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Radiology, Mass General Brigham, Boston, Massachusetts; and
| | - Beth Overmoyer
- Susan F. Smith Center for Women's Cancers, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Heather Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Radiology, Mass General Brigham, Boston, Massachusetts; and
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Katznelson E, Cascio WE, Bernstein A, Chaudhary R, Al-Roub N, Liu CL, Young D, McNichol M, Mickley L, Kramer DB, Rice M, Kazi D. CLIMATE CHANGE AND CARDIOVASCULAR HEALTH: A SYSTEMATIC REVIEW. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02776-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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3
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Maurer M, Metz M, Anderson J, Talreja N, Windom H, Alvarado D, Crowley E, Young D, Merchant K, Paradise EL, Heath-Chiozzi M, Bernstein J. Safety and Clinical Activity of Multiple Doses of Barzolvolimab, an anti-KIT Antibody, in Patients with Chronic Spontaneous Urticaria. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.418] [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: 02/05/2023]
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4
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Kelly CN, Young D, Zhang Y, Whitaker A, Laursen L. P005Effect of medicaid coverage on administration of anesthesia during abortion procedures: An interrupted time series analysis. Contraception 2022. [DOI: 10.1016/j.contraception.2022.09.030] [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: 11/19/2022]
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5
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Dunagan A, Green A, Hodges T, McCormick R, Painter L, Pierce C, Seibenhener S, Wilburn S, Young D. The Art of Discharge Planning: Teaching Nursing Students to Address Disparities Through Simulation. Creat Nurs 2022; 28:192-197. [DOI: 10.1891/cn-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Discharge planning is crucial to ensuring that patients’ care and recovery needs are addressed. A new nurse graduate must be prepared to enter a clinical practice environment in which hospitals face penalties for patient readmissions. Methods: Student nurses were assigned simulated patients with a variety of health disparities and health-care diagnoses to address. A qualitative research design evaluated student perceptions of discharge planning and cultural competency. Results: Students found the simulation to be vital to their clinical experience. Students were able to develop discharge teaching that was culturally congruent for each simulated patient. Conclusions: Incorporating discharge teaching simulation into the nursing curriculum can positively impact students’ ability to transition to clinical practice and build confidence in a skill that is rarely incorporated into nursing curricula.
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Qandeel H, Chew C, Young D, O'Dwyer PJ. Subcutaneous and visceral adipose tissue in patients with primary and recurrent incisional hernia. Hernia 2022; 26:953-957. [PMID: 33886018 PMCID: PMC9200868 DOI: 10.1007/s10029-021-02416-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/12/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE Visceral obesity rather than body mass index has been reported to be associated with a higher incidence of incisional hernias. The aim of this study was to examine the relationship between CT measured adipose tissue and muscle in primary and recurrent incisional hernia. METHODS Patients with a 'Primary' or 'Recurrent incisional hernia' were obtained from a prospective cohort of patients who were being assessed for incisional hernia repair over a 2-year period. Computerised tomography (CT)-images were analysed using NIH Image-J software to quantify adipose tissue and skeletal muscle cross-sectional areas at the level of lumber vertebra 3/4 using standard Hounsfield units. To test inter-observer 'absolute agreement', each parameter was measured independently by two investigators and reliability analysis performed. RESULTS Thirty-six patients were included in the study: 15 had a Primary while 21 had a Recurrent incisional hernia. Both groups had similar baseline characteristics. Reliability analysis for CT-measured areas showed very high interclass correlation coefficient (ICC) between observers. Patients in the recurrent group had significantly greater subcutaneous adipose tissue (SAT) [median = 321.9cm2 vs 230.9cm2, p = 0.04] and visceral adipose tissue (VAT) [median = 221.1cm2 vs 146.8cm2, p = 0.03] than those in the primary group. There was no difference in skeletal muscle areas for right [median = 2.8cm2 vs 2.9cm2] and left [median = 3.7cm2 vs 4.1cm2] rectus muscles between groups. CONCLUSION Our study shows that patients with a recurrent incisional hernia have significantly more subcutaneous and visceral adipose tissue than those with a primary incisional hernia. Further studies in this area are required if we are to reduce the burden of recurrent hernia following repair of a primary incisional hernia.
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Affiliation(s)
- H Qandeel
- Department of Surgery, Hashemite University, Zarqa, Jordan
| | - C Chew
- Department of Radiology, University Hospital Hairmyres, Glasgow, UK
| | - D Young
- Department of Mathematics and Statistics, Strathclyde University, Glasgow, UK
| | - P J O'Dwyer
- School of Medicine, Dentistry and Medicine, University of Glasgow, Glasgow, UK.
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Abdullah N, Defaye M, Hassan A, Cumenal M, Iftinca M, Young D, Ohland CL, Dufour A, McCoy K, Altier C. A230 THE ROLE OF THE MICROBIOTA IN NOCICEPTOR DEVELOPMENT AND PAIN SENSITIVITY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859168 DOI: 10.1093/jcag/gwab049.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Pain is the most common cause of disability in IBD. What causes inter-individual variability in chronic pain after successful treatment of inflammation remains elusive. We have shown that activation of TRPV1+ colonic nociceptors is essential for the establishment of persistent pain in DSS colitis. Nociceptor development coincides with microbial colonization, while early life dysbiosis can lead to visceral hypersensitivity in adulthood. Whether the microbiota dictates nociceptor development and pain susceptibility remains unknown. Here we test the hypothesis that the microbiota programs nociceptor specification during early development, rendering them more susceptible to sensitization later in life. We have identified the aryl hydrocarbon receptor (AHR) that senses bacterial-derived metabolites as a candidate target that orchestrates transcriptional regulation in nociceptors. Aims We investigated the developmental regulation of nociceptors by the microbiome and how it influences pain sensitivity. We will determine the effects of AHR activation on nociceptor lineage and function as well as the long term impact of AHR signaling on pain sensitivity. Methods We have developed a germ-free (GF) TRPV1-GFP reporter mouse that was used to phenotype and visualise TRPV1+ nociceptors in the absence of a microbiota. We will isolate TRPV1+ neurons by FACS to identify genes that are under the control of the microbiota and to characterise the phosphoproteome of TRPV1+ nociceptors in GF conditions. Finally, we will investigate the role of AHR signaling in nociceptors both acutely and during development. Results We showed a reduction in thermal pain threshold and a reduction in capsaicin test responses in GF mice. The number and size of DRG neurons was unchanged in GF mice. Examination of molecular markers for peptidergic (CGRP) and non-peptidergic (IB4) neurons did not show a difference. Finally, there was no difference in the expression of TRPV1, suggesting post-translational modification of the channel. In cultured DRG neurons, we found a decrease in capsaicin induced action potentials and a decrease in the amplitude of the capsaicin response in GF mice. Using RNAscope, we showed that TRPV1+ neurons express AHR. Conclusions Our results highlight the importance of bacterial composition in regulating the development of nociceptors and pain sensitivity in adulthood. Furthermore, we are the first to demonstrate the expression of AHR in sensory neurons. These findings point to a role of the microbiota in programming nociceptors during development. My work will advance our understanding of the role of commensal bacteria in regulating pain and could lead to recommendations for the treatment of neonates in early life to reduce their risk of developing chronic pain later in life. Funding Agencies CAG, CIHR
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Affiliation(s)
- N Abdullah
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - M Defaye
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - A Hassan
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - M Cumenal
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - M Iftinca
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - D Young
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - C L Ohland
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - A Dufour
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - K McCoy
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - C Altier
- Physiology and Pharmacology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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8
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Alvarado D, Maurer M, Gedrich R, Seibel SB, Murphy MB, Crew L, Goldstein J, Crocker A, Vitale LA, Morani PA, Thomas LJ, Hawthorne TR, Keler T, Young D, Crowley E, Kankam M, Heath‐Chiozzi M. Anti-KIT monoclonal antibody CDX-0159 induces profound and durable mast cell suppression in a healthy volunteer study. Allergy 2022; 77:2393-2403. [PMID: 35184297 PMCID: PMC9544977 DOI: 10.1111/all.15262] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [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: 11/30/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 12/18/2022]
Abstract
Background Mast cells (MC) are powerful inflammatory immune sentinel cells that drive numerous allergic, inflammatory, and pruritic disorders when activated. MC‐targeted therapies are approved in several disorders, yet many patients have limited benefit suggesting the need for approaches that more broadly inhibit MC activity. MCs require the KIT receptor and its ligand stem cell factor (SCF) for differentiation, maturation, and survival. Here we describe CDX‐0159, an anti‐KIT monoclonal antibody that potently suppresses MCs in human healthy volunteers. Methods CDX‐0159‐mediated KIT inhibition was tested in vitro using KIT‐expressing immortalized cells and primary human mast cells. CDX‐0159 safety and pharmacokinetics were evaluated in a 13‐week good laboratory practice (GLP)‐compliant cynomolgus macaque study. A single ascending dose (0.3, 1, 3, and 9 mg/kg), double‐blinded placebo‐controlled phase 1a human healthy volunteer study (n = 32) was conducted to evaluate the safety, pharmacokinetics, and pharmacodynamics of CDX‐0159. Results CDX‐0159 inhibits SCF‐dependent KIT activation in vitro. Fc modifications in CDX‐0159 led to elimination of effector function and reduced serum clearance. In cynomolgus macaques, multiple high doses were safely administered without a significant impact on hematology, a potential concern for KIT inhibitors. A single dose of CDX‐0159 in healthy human subjects was generally well tolerated and demonstrated long antibody exposure. Importantly, CDX‐0159 led to dose‐dependent, profound suppression of plasma tryptase, a MC‐specific protease associated with tissue MC burden, indicative of systemic MC suppression or ablation. Conclusion CDX‐0159 administration leads to systemic mast cell ablation and may represent a safe and novel approach to treat mast cell‐driven disorders.
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Affiliation(s)
| | - Marcus Maurer
- Dermatological Allergology Allergie‐Centrum‐Charité Department of Dermatology and Allergy Charité ‐ Universtätsmedizin Berlin Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology Berlin Germany
| | | | | | | | - Linda Crew
- Celldex Therapeutics Hampton New Jersey USA
| | | | | | | | | | | | | | | | | | | | - Martin Kankam
- Altasciences Clinical Kansas Overland Park Kansas USA
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Jacene HA, Liu M, Cheng SC, Abbott A, Dubey S, McCall K, Young D, Johnston M, Van den Abbeele AD, Overmoyer B. Imaging Androgen Receptors in Breast Cancer with 18F-fluoro-5α-dihydrotestosterone-PET: A Pilot Study. J Nucl Med 2021; 63:22-28. [PMID: 34049982 DOI: 10.2967/jnumed.121.262068] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/20/2021] [Indexed: 11/16/2022] Open
Abstract
Most breast cancers express androgen receptors (AR). This prospective imaging sub-study explored imaging AR with 18F-fluoro-5α-dihydrotestosterone (FDHT)-PET in patients with metastatic breast cancer (MBC) receiving selective AR modulation (SARM) therapy (GTx-024, GTx, Inc). Methods: 11 post-menopausal women with estrogen receptor positive MBC underwent FDHT-PET/CT at baseline, 6, and 12 weeks after starting SARM therapy. Abnormal tumor FDHT uptake was quantified using maximum SUV (SUVmax). AR status was determined from tumor biopsy specimens. FDHT-SUVmax percent change between scans was calculated. Best overall response was categorized as clinical benefit (CB: non-progressive disease [PD]), or PD using RECIST 1.1. Results: Median baseline FDHT-SUVmax was 4.1 (range 1.4-5.9) for AR+ tumors versus 2.3 (range 1.5-3.2) for AR- tumors (p=0.22). Quantitative AR expression and baseline FDHT uptake were weakly correlated (Pearson rho=0.39, p=0.30). Seven participants with CB at 12 weeks tended to have larger declines in FDHT uptake compared to those with PD at both 6 (median decline, range: -26.8%, -42.9 to -14.1% vs. -3.7%, -31% to +29%, respectively, p=0.11) and 12 weeks (median decline, range: -35.7%, -69.5 to -7.7% vs. -20.1%, -26.6% to +56.5%, respectively, p=0.17) after starting GTx-024. Conclusion: This hypothesis-generating data suggests that FDHT-PET/CT is worth further study as an imaging biomarker for evaluating response of MBC to SARM therapy and reiterates the feasibility of including molecular imaging in multidisciplinary therapeutic trials.
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Affiliation(s)
| | - Mofei Liu
- Dana-Farber Cancer Institute, United States
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Hodges T, Seibenhener S, Young D. Incorporating health care concepts addressing the needs of the lesbian, gay, bisexual, and transgender population in an associate of science in nursing curriculum: Are faculty prepared? Teaching and Learning in Nursing 2021. [DOI: 10.1016/j.teln.2020.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Henry A, Dawoud B, Kent S, McDonald C, Logan G, Hennedige A, Exely R, Regan A, Kulkarni R, Gilbert K, Basyuni S, Young D, Kyzas P, Morrison R, McCaul J. Clinical features and presentation of cervicofacial infection: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2021; 59:433-438. [PMID: 33715891 DOI: 10.1016/j.bjoms.2020.08.102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022]
Abstract
Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management, and clinical features of patients hospitalised with CFI. Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis, and presenting clinical features. One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median (range) age was 34 (1-94) years. The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%). Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team, and members of the OMFS team.
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Affiliation(s)
- A Henry
- Morriston Hospital, Swansea, United Kingdom.
| | - B Dawoud
- Leeds Teaching Hospitals Trust, Leeds, United Kingdom
| | - S Kent
- Morriston Hospital, Swansea, United Kingdom
| | - C McDonald
- Ninewells Hospital, Dundee, United Kingdom
| | - G Logan
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - A Hennedige
- Manchester Royal Infirmary, Manchester, United Kingdom
| | - R Exely
- Northwick Park Hospital, London, United Kingdom
| | - A Regan
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - R Kulkarni
- Northampton General Hospital, Northampton, United Kingdom
| | - K Gilbert
- The Whittington Hospital NHS Trust, London, United Kingdom
| | - S Basyuni
- Cambridge University Hospitals, Cambridge, United Kingdom
| | - D Young
- Department of Mathematics, University of Strathclyde, Glasgow, United Kingdom
| | - P Kyzas
- East Lancashire Teaching Hospital NHS Trust, United Kingdom
| | - R Morrison
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - J McCaul
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Strayer DR, Young D, Mitchell WM. Effect of disease duration in a randomized Phase III trial of rintatolimod, an immune modulator for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. PLoS One 2020; 15:e0240403. [PMID: 33119613 PMCID: PMC7595369 DOI: 10.1371/journal.pone.0240403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 09/01/2019] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rintatolimod is a selective TLR3 agonist, which has demonstrated clinical activity for ME/CFS in Phase II and Phase III double-blind, placebo-controlled, randomized, multi-site clinical trials. METHODS AND FINDINGS A hypothesis-based post-hoc analysis of the Intent to Treat (ITT) population diagnosed with ME/CFS from 12 independent clinical sites of a Phase III trial was performed to evaluate the effect of rintatolimod therapy based on disease duration. The clinical activity of rintatolimod was evaluated by exercise treadmill tolerance (ETT) using a modified Bruce protocol. The ITT population (n = 208) was divided into two subsets of symptom duration. Patients with symptom duration of 2-8 years were identified as the Target Subset (n = 75); the remainder (<2 year plus >8 year) were identified as the Non-Target Subset (n = 133). Placebo-adjusted percentage improvements in exercise duration and the vertical rise for the Target Subset (n = 75) were more than twice that of the ITT population. The Non-Target Subset (n = 133) failed to show any clinically significant ETT response to rintatolimod when compared to placebo. Within the Target Subset, 51.2% of rintatolimod-treated patients improved their exercise duration by ≥25% (p = 0.003) despite reduced statistical power from division of the original ITT population into two subsets. CONCLUSION/SIGNIFICANCE Analysis of ETT from a Phase III trial has identified within the ITT population, a subset of ME/CFS patients with ≥2 fold increased exercise response to rintatolimod. Substantial improvement in physical performance was seen for the majority (51.2%) of these severely debilitated patients who improved exercise duration by ≥25%. This magnitude of exercise improvement was associated with clinically significant enhancements in quality of life. The data indicate that ME/CFS patients have a relatively short disease duration window (<8 years) to expect a significant response to rintatolimod under the dosing conditions utilized in this Phase III clinical trial. These results may have direct relevance to the cognitive impairment and fatigue being experienced by patients clinically recovered from COVID-19 and free of detectable SARS-CoV-2. TRIAL REGISTRATION ClinicalTrials.gov: NCT00215800.
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Affiliation(s)
- David R. Strayer
- AIM ImmunoTech Inc., Philadelphia, Pennsylvania, United States of America
| | - Diane Young
- AIM ImmunoTech Inc., Philadelphia, Pennsylvania, United States of America
| | - William M. Mitchell
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
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Douglas C, Crosbie R, Young D, Montgomery J, O'Neill G, McArthur C. Accuracy of contrast-enhanced CT and predictive factors for extracapsular spread in unknown primary head and neck squamous cell cancer. Clin Radiol 2019; 75:77.e23-77.e28. [PMID: 31679816 DOI: 10.1016/j.crad.2019.09.138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine the accuracy of contrast-enhanced computed tomography (CECT) for nodal extracapsular spread (ECS) and identify predictive radiological signs and clinicopathological features for ECS in unknown-primary head and neck squamous cell cancer (UPHNSCC). MATERIALS AND METHODS The CECT imaging of patients who underwent primary neck dissection for UPHNSCC during 2011-2015 was analysed. The largest pathological-looking node at each radiologically involved level was evaluated in consensus by two head and neck radiologists. Parameters included longest diameter, margin sharpness, haziness in adjacent fat, necrosis, and loss of fat plane with adjacent structures. Independent assessment was also made regarding the presence/absence of ECS. Findings and clinicopathological parameters were correlated with histopathology. RESULTS Thirty-one patients with 39 neck levels had metastatic nodal involvement determined on CECT. Confirmed ECS was found at 26 levels in 23 patients. Sensitivity of radiological assessment for ECS by nodal level was 81-85% (95% confidence interval [CI]=65-93%) and specificity 46-54% (95% CI=19-81%); kappa 0.87. On univariate analysis based on the largest involved node per patient, longest diameter being ≥30 mm (p=0.007), haziness in adjacent fat (p=0.023), increasing age (p=0.006), and more advanced pathological nodal status (p=0.027) were statistically significantly associated with ECS. Haziness and increasing age were independent predictors on multivariate analysis (odds ratio [OR]=26.4 and 1.24). CONCLUSION Expert assessment of ECS on CECT had good sensitivity with excellent interobserver agreement. A longest nodal diameter of ≥30 mm, haziness in the surrounding fat on CECT, advanced pathological nodal status, and advancing patient age were significantly associated with ECS in UPHNSCC patients, findings not previously reported.
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Affiliation(s)
- C Douglas
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - R Crosbie
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - D Young
- Department of Mathematics and Statistics, Strathclyde University, 16 Richmond Street, Glasgow G1 1XQ, UK
| | - J Montgomery
- Department of Otolaryngology - Head and Neck Surgery, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK
| | - G O'Neill
- Department of Radiology - Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - C McArthur
- Department of Radiology - Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
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Abstract
The demand for Advanced Practice Registered Nurses, nursing faculty, and nursing leaders is driving the increase in nurses seeking doctoral degrees (Bednash, Brelin, Kirschling, & Rosseter, 2014). A variety of programs have emerged to prepare nurses for careers in health administration, research, and advanced clinical practice. Prospective graduate level nursing students can choose from doctoral programs focused on research or practice. Potential doctoral students now have several different degrees to choose from, and deciding which one is right for them can be a daunting task.
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15
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Young D, Willett F, Memberg WD, Murphy B, Walter B, Sweet J, Miller J, Hochberg LR, Kirsch RF, Ajiboye AB. Signal processing methods for reducing artifacts in microelectrode brain recordings caused by functional electrical stimulation. J Neural Eng 2019; 15:026014. [PMID: 29199642 DOI: 10.1088/1741-2552/aa9ee8] [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: 12/18/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) is a promising technology for restoring movement to paralyzed limbs. Intracortical brain-computer interfaces (iBCIs) have enabled intuitive control over virtual and robotic movements, and more recently over upper extremity FES neuroprostheses. However, electrical stimulation of muscles creates artifacts in intracortical microelectrode recordings that could degrade iBCI performance. Here, we investigate methods for reducing the cortically recorded artifacts that result from peripheral electrical stimulation. APPROACH One participant in the BrainGate2 pilot clinical trial had two intracortical microelectrode arrays placed in the motor cortex, and thirty-six stimulating intramuscular electrodes placed in the muscles of the contralateral limb. We characterized intracortically recorded electrical artifacts during both intramuscular and surface stimulation. We compared the performance of three artifact reduction methods: blanking, common average reference (CAR) and linear regression reference (LRR), which creates channel-specific reference signals, composed of weighted sums of other channels. MAIN RESULTS Electrical artifacts resulting from surface stimulation were 175 × larger than baseline neural recordings (which were 110 µV peak-to-peak), while intramuscular stimulation artifacts were only 4 × larger. The artifact waveforms were highly consistent across electrodes within each array. Application of LRR reduced artifact magnitudes to less than 10 µV and largely preserved the original neural feature values used for decoding. Unmitigated stimulation artifacts decreased iBCI decoding performance, but performance was almost completely recovered using LRR, which outperformed CAR and blanking and extracted useful neural information during stimulation artifact periods. SIGNIFICANCE The LRR method was effective at reducing electrical artifacts resulting from both intramuscular and surface FES, and almost completely restored iBCI decoding performance (>90% recovery for surface stimulation and full recovery for intramuscular stimulation). The results demonstrate that FES-induced artifacts can be easily mitigated in FES + iBCI systems by using LRR for artifact reduction, and suggest that the LRR method may also be useful in other noise reduction applications.
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Affiliation(s)
- D Young
- Case Western Reserve University, Cleveland, OH, United States of America. Department of VA Medical Center, FES Center of Excellence, Rehabilitation R&D Service, Louis Stokes Cleveland, Cleveland, OH, United States of America
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16
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Chiner-Oms Á, Sánchez-Busó L, Corander J, Gagneux S, Harris SR, Young D, González-Candelas F, Comas I. Genomic determinants of speciation and spread of the Mycobacterium tuberculosis complex. Sci Adv 2019; 5:eaaw3307. [PMID: 31448322 PMCID: PMC6691555 DOI: 10.1126/sciadv.aaw3307] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 05/10/2019] [Indexed: 06/10/2023]
Abstract
Models on how bacterial lineages differentiate increase our understanding of early bacterial speciation events and the genetic loci involved. Here, we analyze the population genomics events leading to the emergence of the tuberculosis pathogen. The emergence is characterized by a combination of recombination events involving core pathogenesis functions and purifying selection on early diverging loci. We identify the phoR gene, the sensor kinase of a two-component system involved in virulence, as a key functional player subject to pervasive positive selection after the divergence of the Mycobacterium tuberculosis complex from its ancestor. Previous evidence showed that phoR mutations played a central role in the adaptation of the pathogen to different host species. Now, we show that phoR mutations have been under selection during the early spread of human tuberculosis, during later expansions, and in ongoing transmission events. Our results show that linking pathogen evolution across evolutionary and epidemiological time scales points to past and present virulence determinants.
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Affiliation(s)
- Á. Chiner-Oms
- Unidad Mixta “Infección y Salud Pública” FISABIO-CSISP/Universidad de Valencia, Instituto de Biología Integrativa de Sistemas (ISysBio), Valencia, Spain
| | - L. Sánchez-Busó
- Pathogen Genomics, Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK
| | - J. Corander
- Pathogen Genomics, Wellcome Trust Sanger Institute, Cambridge CB10 1SA, UK
- Department of Biostatistics, University of Oslo, 0317 Oslo, Norway
- Helsinki Institute of Information Technology (HIIT), Department of Mathematics and Statistics, University of Helsinki, 00014 Helsinki, Finland
| | - S. Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - S. R. Harris
- Microbiotica, BioData Innovation Centre, Wellcome Genome Campus, Cambridge CB10 1DR, UK
| | - D. Young
- The Francis Crick Institute, 1 Midland Road, London NW1 1AT, UK
| | - F. González-Candelas
- Unidad Mixta “Infección y Salud Pública” FISABIO-CSISP/Universidad de Valencia, Instituto de Biología Integrativa de Sistemas (ISysBio), Valencia, Spain
- CIBER en Epidemiología y Salud Pública, Valencia, Spain
| | - I. Comas
- CIBER en Epidemiología y Salud Pública, Valencia, Spain
- Instituto de Biomedicina de Valencia (IBV-CSIC), Valencia, Spain
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17
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Rigby M, Park S, Saito T, Western LM, Redington AL, Fang X, Henne S, Manning AJ, Prinn RG, Dutton GS, Fraser PJ, Ganesan AL, Hall BD, Harth CM, Kim J, Kim KR, Krummel PB, Lee T, Li S, Liang Q, Lunt MF, Montzka SA, Mühle J, O'Doherty S, Park MK, Reimann S, Salameh PK, Simmonds P, Tunnicliffe RL, Weiss RF, Yokouchi Y, Young D. Increase in CFC-11 emissions from eastern China based on atmospheric observations. Nature 2019; 569:546-550. [PMID: 31118523 DOI: 10.1038/s41586-019-1193-4] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/02/2019] [Indexed: 11/09/2022]
Abstract
The recovery of the stratospheric ozone layer relies on the continued decline in the atmospheric concentrations of ozone-depleting gases such as chlorofluorocarbons1. The atmospheric concentration of trichlorofluoromethane (CFC-11), the second-most abundant chlorofluorocarbon, has declined substantially since the mid-1990s2. A recently reported slowdown in the decline of the atmospheric concentration of CFC-11 after 2012, however, suggests that global emissions have increased3,4. A concurrent increase in CFC-11 emissions from eastern Asia contributes to the global emission increase, but the location and magnitude of this regional source are unknown3. Here, using high-frequency atmospheric observations from Gosan, South Korea, and Hateruma, Japan, together with global monitoring data and atmospheric chemical transport model simulations, we investigate regional CFC-11 emissions from eastern Asia. We show that emissions from eastern mainland China are 7.0 ± 3.0 (±1 standard deviation) gigagrams per year higher in 2014-2017 than in 2008-2012, and that the increase in emissions arises primarily around the northeastern provinces of Shandong and Hebei. This increase accounts for a substantial fraction (at least 40 to 60 per cent) of the global rise in CFC-11 emissions. We find no evidence for a significant increase in CFC-11 emissions from any other eastern Asian countries or other regions of the world where there are available data for the detection of regional emissions. The attribution of any remaining fraction of the global CFC-11 emission rise to other regions is limited by the sparsity of long-term measurements of sufficient frequency near potentially emissive regions. Several considerations suggest that the increase in CFC-11 emissions from eastern mainland China is likely to be the result of new production and use, which is inconsistent with the Montreal Protocol agreement to phase out global chlorofluorocarbon production by 2010.
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Affiliation(s)
- M Rigby
- School of Chemistry, University of Bristol, Bristol, UK
| | - S Park
- Department of Oceanography, Kyungpook National University, Daegu, South Korea.
| | - T Saito
- National Institute for Environmental Studies, Tsukuba, Japan
| | - L M Western
- School of Chemistry, University of Bristol, Bristol, UK
| | | | - X Fang
- Center for Global Change Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - S Henne
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | | | - R G Prinn
- Center for Global Change Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - G S Dutton
- Global Monitoring Division, Earth System Research Laboratory, National Oceanic and Atmospheric Administration, Boulder, CO, USA.,Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO, USA
| | - P J Fraser
- Climate Science Centre, CSIRO Oceans and Atmosphere, Aspendale, Victoria, Australia
| | - A L Ganesan
- School of Geographical Sciences, University of Bristol, Bristol, UK
| | - B D Hall
- Global Monitoring Division, Earth System Research Laboratory, National Oceanic and Atmospheric Administration, Boulder, CO, USA
| | - C M Harth
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - J Kim
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - K-R Kim
- Department of Oceanography, Kyungpook National University, Daegu, South Korea
| | - P B Krummel
- Climate Science Centre, CSIRO Oceans and Atmosphere, Aspendale, Victoria, Australia
| | - T Lee
- Department of Oceanography, Kyungpook National University, Daegu, South Korea
| | - S Li
- Kyungpook Institute of Oceanography, Kyungpook National University, Daegu, South Korea
| | - Q Liang
- NASA Goddard Space Flight Center, Greenbelt, MD, USA
| | - M F Lunt
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - S A Montzka
- Global Monitoring Division, Earth System Research Laboratory, National Oceanic and Atmospheric Administration, Boulder, CO, USA
| | - J Mühle
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - S O'Doherty
- School of Chemistry, University of Bristol, Bristol, UK
| | - M-K Park
- Kyungpook Institute of Oceanography, Kyungpook National University, Daegu, South Korea
| | - S Reimann
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - P K Salameh
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - P Simmonds
- School of Chemistry, University of Bristol, Bristol, UK
| | | | - R F Weiss
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - Y Yokouchi
- National Institute for Environmental Studies, Tsukuba, Japan
| | - D Young
- School of Chemistry, University of Bristol, Bristol, UK
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18
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O'Reilly SL, Dunbar JA, Best JD, Versace V, Ford D, Young D, Shih S, Bills R, Shepherdley W, Janus ED. GooD4Mum: A general practice-based quality improvement collaborative for diabetes prevention in women with previous gestational diabetes. Prim Care Diabetes 2019; 13:134-141. [PMID: 30448412 DOI: 10.1016/j.pcd.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
Abstract
AIMS Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. METHODS Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. RESULTS Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. CONCLUSIONS GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.
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Affiliation(s)
- S L O'Reilly
- Institute of Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - J A Dunbar
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC 3280, Australia.
| | - J D Best
- Lee Kong Chian School of Medicine, Imperial College London and Nanyang Technological University, 11 Mandalay Road, 308232, Singapore.
| | - V Versace
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, VIC 3280, Australia.
| | - D Ford
- Improvement Foundation, 8/19 Grenfell St, Adelaide, SA 5000, Australia.
| | - D Young
- Faculty of Medicine, Dentistry and Health Sciences, Building 181, University of Melbourne, Grattan Street, Melbourne, VIC 3010, Australia.
| | - S Shih
- Centre for Population Health Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia.
| | - R Bills
- Brooke Street Medical Centre, 14 Brooke Street, Woodend, VIC 3422, Australia.
| | - W Shepherdley
- Brooke Street Medical Centre, 14 Brooke Street, Woodend, VIC 3422, Australia.
| | - E D Janus
- General Internal Medicine Unit, Western Health, Sunshine Hospital, 176 Furlong Rd, St Albans, VIC 3021, Australia; Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, 176 Furlong Rd, St Albans, VIC 3021, Australia.
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19
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Young D, Klepacka D, McGarvey M, Schoolcraft WB, Katz-Jaffe MG. Infertility patients with chromosome inversions are not susceptible to an inter-chromosomal effect. J Assist Reprod Genet 2018; 36:509-516. [PMID: 30554392 DOI: 10.1007/s10815-018-1376-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/14/2018] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the incidence of an inter-chromosomal effect (ICE) in blastocyst-stage embryos from carriers of balanced chromosome inversions. METHODS Infertility patients (n = 52) with balanced inversions (n = 66 cycles), and maternal age-matched controls that concurrently cycled (n = 66), consented to an IVF cycle with preimplantation genetic testing for aneuploidy (PGT-A). Blastocyst-stage embryos underwent trophectoderm biopsy for PGT-A with only euploid blastocysts transferred in a subsequent frozen embryo transfer. Subtypes of inversions were included in aggregate: paracentric/pericentric, polymorphic/non-polymorphic, male/female carriers, and varying inversion sizes. RESULTS The incidence of aneuploidy was not significantly higher for the inversion patients compared to the controls (inversion = 48.8% vs. control = 47.2% ns). Following euploid blastocyst transfer, there were excellent live birth outcomes. CONCLUSIONS Carriers of balanced chromosome inversions did not exhibit higher aneuploidy rates for chromosomes that were not involved in the inversion compared to maternal age-matched controls, signifying the absence of an inter-chromosomal effect for this data set. These results provide the largest investigation of blastocyst embryos regarding the debated existence of an ICE resulting from the presence of an inversion during meiosis. However, further studies are warranted to investigate an ICE among inversions subtypes that were outside the scope of this study.
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Affiliation(s)
- D Young
- Department of Genetics, Colorado Center for Reproductive Medicine, Lone Tree, USA
| | - D Klepacka
- Department of Genetics, Colorado Center for Reproductive Medicine, Lone Tree, USA
| | - M McGarvey
- Department of Genetics, Colorado Center for Reproductive Medicine, Lone Tree, USA
| | | | - M G Katz-Jaffe
- Colorado Center for Reproductive Medicine, 10290 RidgeGate Circle, Lone Tree, CO, 80124, USA.
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20
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Poole J, McDowell C, Lall R, Perkins G, McAuley D, Gao F, Young D. Individual patient data analysis of tidal volumes used in three large randomized control trials involving patients with acute respiratory distress syndrome. Br J Anaesth 2018; 118:570-575. [PMID: 28403395 PMCID: PMC8542892 DOI: 10.1093/bja/aew465] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 01/20/2023] Open
Abstract
Background. The acute respiratory distress syndrome (ARDS) is a condition with a high mortality and morbidity. Mechanical ventilation prevents immediate mortality but may further damage patients' lungs. Low tidal volume lung-protective strategies have been shown to increase survival by reducing this iatrogenic damage. Current guidelines recommend tidal volumes of 6-8 ml kg -1 of predicted body weight. We used data from three large randomized controlled trials of treatments for ARDS to determine compliance with these recommendations. Methods. We used the tidal volume recorded at randomization for all patients in the OSCAR, HARP-2, and BALTI-2 studies. In addition, we used the ventilation data for control arm patients in OSCAR and all patients in HARP-2 at days 1 and 7 after randomization. Results. The three trials enrolled 1660 patients, with tidal volume data available at least at one time point in 1412 patients. Compliance with the 6-8 ml kg -1 recommendation for tidal volume ranged from 20 to 39% of patients across all time points in all three trials. Conclusion. Poor compliance with the guidelines for tidal volume in patients with ARDS has been demonstrated before in case series, but not in clinical trials where the patient population is specifically selected against standard ARDS diagnostic criteria and the investigators were encouraged to use low tidal volumes. This study may indicate a need to improve implementation and compliance with protective lung ventilation.
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Affiliation(s)
- J Poole
- Department of Anaesthesia and Critical Care, John Radcliffe Hospital, Oxford, UK
| | - C McDowell
- Northern Ireland Clinical Trials Unit, Queen's University of Belfast, UK
| | - R Lall
- Clinical Trials Unit, University of Warwick, UK
| | - G Perkins
- Clinical Trials Unit, University of Warwick, UK.,Warwick Medical School, University of Warwick, UK.,Directorate of Anaesthetics, Heart of England NHS Foundation Trust, Birmingham, UK
| | - D McAuley
- Centre for Experimental Medicine, Queen's University of Belfast, UK.,Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK
| | - F Gao
- Directorate of Anaesthetics, Heart of England NHS Foundation Trust, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, UK
| | - D Young
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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21
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Young D, Willett F, Memberg WD, Murphy B, Rezaii P, Walter B, Sweet J, Miller J, Shenoy KV, Hochberg LR, Kirsch RF, Ajiboye AB. Closed-loop cortical control of virtual reach and posture using Cartesian and joint velocity commands. J Neural Eng 2018; 16:026011. [PMID: 30523839 DOI: 10.1088/1741-2552/aaf606] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Brain-computer interfaces (BCIs) are a promising technology for the restoration of function to people with paralysis, especially for controlling coordinated reaching. Typical BCI studies decode Cartesian endpoint velocities as commands, but human arm movements might be better controlled in a joint-based coordinate frame, which may match underlying movement encoding in the motor cortex. A better understanding of BCI controlled reaching by people with paralysis may lead to performance improvements in brain-controlled assistive devices. APPROACH Two intracortical BCI participants in the BrainGate2 pilot clinical trial performed a visual 3D endpoint virtual reality reaching task using two decoders: Cartesian and joint velocity. Task performance metrics (i.e. success rate and path efficiency) and single feature and population tuning were compared across the two decoder conditions. The participants also demonstrated the first BCI control of a fourth dimension of reaching, the arm's swivel angle, in a 4D posture matching task. MAIN RESULTS Both users achieved significantly higher success rates using Cartesian velocity control, and joint controlled trajectories were more variable and significantly more curved. Neural tuning analyses showed that most single feature activity was best described by a Cartesian kinematic encoding model, and population analyses revealed only slight differences in aggregate activity between the decoder conditions. Simulations of a BCI user reproduced trajectory features seen during closed-loop joint control when assuming only Cartesian-tuned features passed through a joint decoder. With minimal training, both participants controlled the virtual arm's swivel angle to complete a 4D posture matching task, and achieved significantly higher success using a Cartesian + swivel velocity decoder compared to a joint velocity decoder. SIGNIFICANCE These results suggest that Cartesian velocity command interfaces may provide better BCI control of arm movements than other kinematic variables, even in 4D posture tasks with swivel angle targets.
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Affiliation(s)
- D Young
- Case Western Reserve University, Cleveland, OH, United States of America. Department of VA Medical Center, FES Center of Excellence, Rehabilitation R&D Service, Louis Stokes Cleveland, Cleveland, OH, United States of America
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22
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Yonkof J, Young D, Maheshwari B, Crespo M. COLCHICINE TOXICITY IN A PATIENT WITH CHRONIC URTICARIA MASQUERADING WITH FEATURES OF HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Bartoli A, King A, Hornberger K, Klepacka D, Young D, Schoolcraft W, Katz-Jaffe M. The impact of aneuploidy screening for embryo selection in preimplantation genetic testing for monogenenic disorders. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2018.07.424] [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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24
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Lapp L, Young D, Kavanagh K, Bouamrane MM, Schraag S. Using machine learning for predicting severe postoperative complications after cardiac surgery. J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2018.08.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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25
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Ali SR, Shaheen I, Young D, Ramage I, Maxwell H, Hughes DA, Athavale D, Shaikh MG. Fludrocortisone-a treatment for tubulopathy post-paediatric renal transplantation: A national paediatric nephrology unit experience. Pediatr Transplant 2018; 22. [PMID: 29345400 DOI: 10.1111/petr.13134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
Calcineurin inhibitors post-renal transplantation are recognized to cause tubulopathies in the form of hyponatremia, hyperkalemia, and acidosis. Sodium supplementation may be required, increasing medication burden and potentially resulting in poor compliance. Fludrocortisone has been beneficial in addressing tubulopathies in adult studies, with limited paediatric data available. A retrospective review of data from an electronic renal database from December 2014 to January 2016 was carried out. Forty-seven post-transplant patients were reviewed with 23 (49%) patients on sodium chloride or bicarbonate. Nine patients, aged 8.3 years (range 4.9-16.4), commenced fludrocortisone 22 months (range 1-80) after transplant and were followed up for 9 months (range 2-20). All patients stopped sodium bicarbonate; all had a reduction or no increase in total daily doses of sodium chloride. Potassium levels were significantly lower on fludrocortisone, 5.2 vs 4.5 mmol/L, P = .04. No difference was noted in renal function (eGFR 77.8 vs 81.7 mL/min/1.73 m2 , P = .45) and no significant increase in systolic blood pressure (z-scores 0.99 vs 0.85, P = .92). No side effects secondary to treatment with fludrocortisone were reported. A significant proportion of renal transplant patients were on sodium supplementation and fludrocortisone reduced sodium supplementation without significant effects on renal function or blood pressure. Fludrocortisone appears to be safe and effective for tubulopathies in children post-transplantation.
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Affiliation(s)
- S R Ali
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - I Shaheen
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - D Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - I Ramage
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - H Maxwell
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - D A Hughes
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - D Athavale
- Department of Paediatric Nephrology, Royal Hospital for Children, Glasgow, UK
| | - M G Shaikh
- Department of Paediatric Endocrinology and Diabetes, Royal Hospital for Children, Glasgow, UK
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26
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Kahnert K, Alter P, Young D, Lucke T, Heinrich J, Huber RM, Behr J, Wacker M, Biertz F, Watz H, Bals R, Welte T, Wirtz H, Herth FJF, Vestbo J, Wouters EFM, Vogelmeier C, Jörres RA. The revised GOLD 2017 COPD categorization in relation to comorbidities. Pneumologie 2018. [DOI: 10.1055/s-0037-1619396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- K Kahnert
- Medizinische Klinik V, Klinikum der Universität München LMU
| | - P Alter
- Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Gießen und Marburg, Standort Marburg
| | - D Young
- David Young Communications, Horsham, UK
| | - T Lucke
- Klinikum der Universität München
| | - J Heinrich
- Institut für Epidemiologie I, Helmholtz Zentrum München – Deutsches Forschungszentrum für Gesundheit und Umwelt; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL); German Research Center for Environmental Health
| | - RM Huber
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Ludwig Maximilian University of Munich and Thoracic Oncology Centre
| | - J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der LMU München, Comprehensive Pneumology Center
| | - M Wacker
- Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München; Comprehensive Pneumology Center Munich (CPC-M), Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - F Biertz
- Institut für Biometrie, Medizinische Hochschule Hannover
| | - H Watz
- Pneumologisches Forschungsinstitut an der Lungenclinic Grosshansdorf
| | - R Bals
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover
| | - H Wirtz
- Pneumologie, Universitätsklinikum der Universität Leipzig
| | - FJF Herth
- Pneumology, Institute of Internal Medicine III, Thoraxklinik, University Hospital Heidelberg
| | - J Vestbo
- Respiratory Research Group, Manchester Academic Health Sciences Centre
| | | | - C Vogelmeier
- Pulmonary and Critical Care Medicine, Department of Medicine, University Medical Centre Gießen and Marburg, Phillips-University Marburg, Member of the German Centre for Lung Research (DZL)
| | - RA Jörres
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, Klinikum der LMU München
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Young D, Collins S, Culbertson S, Iyer S, Letko J, Valaitis S. 87: Predictors of surgical vs. non-surgical management of pelvic organ prolapse. Am J Obstet Gynecol 2018. [DOI: 10.1016/j.ajog.2017.12.106] [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: 10/18/2022]
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Abstract
5-Fluorouracil (5-FU) is an effective anti-tumor drug, which has been used both as a single agent and in combination with other chemotherapeutic agents for the treatment of tumors such as breast and colorectal carcinoma. We synthesized 5-FU with trace amounts of 18F-5-FU and administered the compounds intravenously to 6 cancer patients. The patients were scanned at 2 hr intervals for 12 hrs and their urine collected whenever possible. We also injected 5-FU with the tracer 18F-5-FU, at pharmacological doses, into non-tumored rats, and sampled their bile and blood for 95 mins post-injection. For comparison, 2-14C-5-FU was injected into non-tumored rats and their bile and blood sampled at the same intervals. Minute quantities of rat bile and serum were analyzed chromatographically by high-performance TLC. 5-FU and two of its metabolites (FBAL and FUPA) were identified and quantified by this technique. Both percentage and absolute amounts of 5-FU in the bile follow comparative kinetic patterns. While the liver and the urinary bladder were clearly observable in all 6 patients, the detectability of the gall-bladder was correlated to the inverse of the alkaline phosphatase level in the blood. This work suggests that the diversity of the 5-FU metabolism in cancer patients may allow the use of 18F-5-FU as a probe for understanding those individual variabilities in clinical situations.
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Young D, Seibenhener S. Preferred Teaching Strategies for Students in an Associate of Science Nursing Program. Teaching and Learning in Nursing 2018. [DOI: 10.1016/j.teln.2017.09.005] [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: 10/18/2022]
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Affiliation(s)
- Diane Young
- Department of Anthropology University of Wisconsin-Madison Madison, WI 53706
| | - Suzanne Patrick
- Department of Anthropology Texas A&M University College Station, TX 77843
| | - D. Gentry Steele
- Department of Anthropology Texas A&M University College Station, TX 77843
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Brooks D, Polubothu P, Young D, Booth MG, Smith A. Sepsis caused by bloodstream infection in patients in the intensive care unit: the impact of inactive empiric antimicrobial therapy on outcome. J Hosp Infect 2017; 98:369-374. [PMID: 28993134 DOI: 10.1016/j.jhin.2017.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sepsis is one of the leading causes of death in the UK. AIMS To identify the rate of inactive antimicrobial therapy (AMT) in the intensive care unit (ICU) and whether inactive AMT has an effect on in-hospital mortality, ICU mortality, 90-day mortality and length of hospital stay. A further aim was to identify risk factors for receiving inactive AMT. METHODS This was a retrospective observational study conducted at Glasgow Royal Infirmary ICU between January 2010 and December 2013. In total, 12,000 blood cultures were taken over this time period, of which 127 were deemed clinically significant. Multi-variate logistic regression was used to identify risk factors independently associated with mortality. Univariate analysis followed by multi-variate analysis was performed to identify risk factors for receiving inactive AMT. RESULTS The rate of inactive AMT was 47% (N = 60). Multi-variate analysis showed that receiving antibiotics within the first 24h of ICU admission led to reduced mortality [relative risk 1.70, 95% confidence interval (CI) 1.19-2.44]. Furthermore, it showed that severity of illness (as defined by SIRS criteria sepsis vs septic shock) increased mortality [odds ratio (OR) 9.87, 95% CI 1.73-55.5]. However, inactive AMT did not increase mortality (OR 1.07, 95% CI 0.47-2.41) or length of hospital stay (53.2 vs 69.1 days, P = 0.348). Fungal bloodstream infection was found to be a risk factor for receiving inactive AMT (OR 5.10, 95% CI 1.29-20.14). CONCLUSION Mortality from sepsis is influenced by multiple factors. This study was unable to demonstrate that inactive AMT had an effect on mortality in sepsis.
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Affiliation(s)
- D Brooks
- School of Medicine, Glasgow University, Glasgow, UK.
| | - P Polubothu
- Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - D Young
- Clinical Microbiology, Glasgow Royal Infirmary, Glasgow, UK
| | - M G Booth
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - A Smith
- School of Medicine, Glasgow University, Glasgow, UK
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Hornberger K, Bartoli A, King A, Bachman N, Young D, Klepacka D, Schoolcraft W, Katz-Jaffe M. Maternal obesity is not associated with increased miscarriage rates following euploid blastocyst transfer. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.756] [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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Karlin B, Young D, Dash K, Landon M. A MULTI-COMPONENT CAREGIVER TRAINING PROGRAM FOR MANAGING BEHAVIORAL SYMPTOMS OF DEMENTIA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B. Karlin
- Education Development Center, Waltham, Massachusetts,
- Johns Hopkins University, Baltimore, Maryland,
- Northeastern University, Boston, Massachusetts,
| | - D. Young
- Seniorlink, Boston, Massachusetts
| | - K. Dash
- Education Development Center, Waltham, Massachusetts,
| | - M.K. Landon
- Education Development Center, Waltham, Massachusetts,
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Hall M, Wang Y, Granholm AC, Stevens JO, Young D, Hoffer BJ. Comparison of Fetal Rabbit Brain Xenografts to Three Different Strains of Athymic Nude Rats: Electrophysiological and Immunohistochemical Studies of Intraocular Grafts. Cell Transplant 2017; 1:71-82. [PMID: 1344293 DOI: 10.1177/096368979200100111] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interest in the use of neural tissue transplantation for the study of CNS development and maturation and the potential use of this technique for the treatment of certain degenerative CNS disorders has led to our use of transplantation of neural tissue across species lines. Prior to extensive transplantation studies using athymic rats as recipients, we wished to evaluate the currently available strains of athymic rat for their suitability as host animals for xenografts of neural tissue. Fetal cerebellar and cerebral cortex tissue from rabbit brain of gestational age 20-25 days was dissected and transplanted to the anterior chamber of the eye of Harlan Wisconsin, Fisher 344 Jnu, or NCI-Harlan athymic nude rat strains. The brain tissue grafts were allowed to mature for 3 mo during which time the size and vascularity of each graft was monitored through the cornea of anesthetized hosts. In each group all of the transplants survived and grew to varying extents in the anterior chamber of the eye. Following the growth study in vivo extracellular recording of single neuronal activity was performed. Spontaneous neural activity was found in most transplants in all three groups with no difference in the viability or discharge rates of neurons between the groups. Illumination of the ipsilateral eye increased the firing rate of neurons in all three groups, suggesting excitatory cholinergic innervation of the grafted neurons from the host parasympathetic iris ground plexus. Antibodies directed against neurofilament protein, glial fibrillary acidic protein, synapsin, and tyrosine hydroxylase were used to characterize the transplants immunocytochemically and revealed no differences between the grafts in the three groups of recipients. All transplants contained significant numbers of glial and neuronal elements with the distribution resembling that in adult brain tissue. Some of the transplants contained a sparse innervation of tyrosine hydroxylase–positive fibers from the sympathetic plexus of the host iris. Furthermore, synapsin-immunoreactivity suggested that synaptogenesis had taken place within the grafts. Histological examination of the grafts revealed that 67% of the grafts had been infiltrated, to varying extents, by lymphocytes which led to areas of cell lysis and necrosis. All host animals had populations of T-cell receptor positive cells, most of which also expressed the T-cell surface antigens CD4 and CD8. However, no transplants were overtly rejected over the 15 wk period of study. Our investigation demonstrates that all of the athymic strains used in this study are able to mount an immune response against grafted fetal tissue, despite the absence of rejection, and that none of these strains is superior to the others with respect to suitability as a host for the long-term study of fetal CNS xenografts in oculo.
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Affiliation(s)
- M Hall
- Department of Pharmacology, University of Colorado Health Sciences Center, Denver
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Surrey E, Ciric D, Cox SJ, Hackett L, Homfray D, Jenkins I, Jones TTC, Keeling D, King R, Whitehead A, Young D. Neutral Beam Injection in the JET Trace Tritium Experiment. Fusion Science and Technology 2017. [DOI: 10.13182/fst05-a927] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- E. Surrey
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D. Ciric
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - S. J. Cox
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - L. Hackett
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D. Homfray
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - I. Jenkins
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - T. T. C. Jones
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D. Keeling
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - R. King
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - A. Whitehead
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
| | - D. Young
- EURATOM/UKAEA Fusion Association, Culham Science Centre, Abingdon, Oxfordshire OX14 3DB, United Kingdom
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36
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McNamee JJ, Gillies MA, Barrett NA, Agus AM, Beale R, Bentley A, Bodenham A, Brett SJ, Brodie D, Finney SJ, Gordon AJ, Griffiths M, Harrison D, Jackson C, McDowell C, McNally C, Perkins GD, Tunnicliffe W, Vuylsteke A, Walsh TS, Wise MP, Young D, McAuley DF. pRotective vEntilation with veno-venouS lung assisT in respiratory failure: A protocol for a multicentre randomised controlled trial of extracorporeal carbon dioxide removal in patients with acute hypoxaemic respiratory failure. J Intensive Care Soc 2016; 18:159-169. [PMID: 28979565 DOI: 10.1177/1751143716681035] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
One of the few interventions to demonstrate improved outcomes for acute hypoxaemic respiratory failure is reducing tidal volumes when using mechanical ventilation, often termed lung protective ventilation. Veno-venous extracorporeal carbon dioxide removal (vv-ECCO2R) can facilitate reducing tidal volumes. pRotective vEntilation with veno-venouS lung assisT (REST) is a randomised, allocation concealed, controlled, open, multicentre pragmatic trial to determine the clinical and cost-effectiveness of lower tidal volume mechanical ventilation facilitated by vv-ECCO2R in patients with acute hypoxaemic respiratory failure. Patients requiring intubation and mechanical ventilation for acute hypoxaemic respiratory failure will be randomly allocated to receive either vv-ECCO2R and lower tidal volume mechanical ventilation or standard care with stratification by recruitment centre. There is a need for a large randomised controlled trial to establish whether vv-ECCO2R in acute hypoxaemic respiratory failure can allow the use of a more protective lung ventilation strategy and is associated with improved patient outcomes.
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Affiliation(s)
- J J McNamee
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.,Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
| | - M A Gillies
- Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.,Chief Scientists Office NHS Research Scotland, Clydebank, UK
| | - N A Barrett
- Guy's and St Thomas' NHS Foundation Trust, King's College London, UK.,King's Health Partners Academic Health Science Centre, London, UK
| | - A M Agus
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - R Beale
- Guy's and St Thomas' NHS Foundation Trust, King's College London, UK.,King's Health Partners Academic Health Science Centre, London, UK
| | - A Bentley
- Acute Intensive Care Unit, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.,Centre for Respiratory Medicine & Allergy, University of Manchester, UK
| | - A Bodenham
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, UK
| | - S J Brett
- Centre for Perioperative Medicine and Critical Care Research, Imperial College Healthcare NHS Trust, London, UK
| | - D Brodie
- Columbia College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, USA
| | - S J Finney
- Adult Intensive Care Unit, Royal Brompton Hospital, London, UK
| | - A J Gordon
- Section of Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - M Griffiths
- National Heart & Lung Institute, Imperial College, London, UK.,National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - D Harrison
- Intensive Care National Audit and Research Centre, London, UK
| | - C Jackson
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - C McDowell
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - C McNally
- Northern Ireland Clinical Trials Unit, The Royal Hospitals, Belfast, UK
| | - G D Perkins
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.,Heart of England NHS Foundation Trust, Birmingham, UK
| | - W Tunnicliffe
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - A Vuylsteke
- Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - T S Walsh
- Anaesthetics, Critical Care and Pain Medicine, School of Clinical Sciences, College of Medicine, Edinburgh University, Edinburgh, UK
| | - M P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - D Young
- Kadoorie Centre for Critical Care Research and Education, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - D F McAuley
- Regional Intensive Care Unit, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK.,Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Wellcome Wolfson Institute for Experimental Medicine, Queens University Belfast, Belfast, UK
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37
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Affiliation(s)
- D. Young
- The George Williams Hooper Foundation for Medical Research and the Division of Dental Medicine, College of Dentistry, University of California, San Francisco, California
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Lackeyram D, Young D, Kim CJ, Yang C, Archbold TL, Mine Y, Fan MZ. Interleukin-10 is differentially expressed in the small intestine and the colon experiencing chronic inflammation and ulcerative colitis induced by dextran sodium sulfate in young pigs. Physiol Res 2016; 66:147-162. [PMID: 27782738 DOI: 10.33549/physiolres.933259] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Intestinal inflammation induced with dextran sodium sulfate (DSS) is used to study acute or chronic ulcerative colitis in animal models. Decreased gut tissue anti-inflammatory cytokine IL-10 concentration and mRNA abundance are associated with the development of chronic bowel inflammation. Twelve piglets of 3 days old were fitted with an intragastric catheter and randomly allocated into control and DSS groups by administrating either sterile saline or 1.25 g of DSS/kg body weight (BW) in saline per day, respectively, for 10 days. Growth rate and food conversion efficiency were reduced (p<0.05) in the DSS piglets compared with the control group. Quantitative histopathological grading of inflammation in the jejunum and colon collectively showed that the DSS treatment resulted in 12 fold greater (p<0.05) inflammation severity scoring in the colon than in the jejunum, indicative of chronic ulcerative colitis in the colon. Upper gut permeability endpoint was 27.4 fold higher (p<0.05) in the DSS group compared with the control group. The DSS group had higher concentrations and mRNA abundances (p<0.05) of TNF-alpha and IL-6 in the jejunal and colonic tissues compared with the control group. Colonic concentration and mRNA abundance of IL-10 were reduced (p<0.05), however, jejunal IL-10 mRNA abundance was increased (p<0.05) in the DSS group compared with the control group. In conclusion, administration of DSS at 1.25 g/kg BW for 10 days respectively induced acute inflammation in the jejunum and chronic inflammation and ulcerative colitis in the colon with substantially decreased colonic concentration and mRNA abundance of IL-10 in the young pigs, mimicking the IL-10 expression pattern in humans Associated with chronic bowel inflammation.
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Affiliation(s)
- D Lackeyram
- Department of Animal Biosciences, University of Guelph, Guelph, Ontario, Canada.
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39
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Galvin S, Doobay-Persaud A, Peterson C, Young D, Murphy R, Cohen M. A new workforce for a new era: characteristics of Master of Science in
Global Health students. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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40
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Alter P, Jörres RA, Watz H, Welte T, Gläser S, Schulz H, Bals R, Karch A, Wouters E, Vestbo J, Young D, Vogelmeier CF. Lung function impairment is associated with increased left ventricular cardiac wall stress in COPD: The German multicenter COSYCONET study. Pneumologie 2016. [DOI: 10.1055/s-0036-1584656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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41
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Yap WW, Young D, Pathi V. Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass - a randomised controlled trial. Perfusion 2016; 22:57-61. [PMID: 17633136 DOI: 10.1177/0267659107077903] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Perioperative volume replacement after cardiopulmonary bypass is complicated by post-bypass systemic inflammatory process. The aim of this study was to assess the effects of using two different colloid solutions as priming fluids in cardiopulmonary bypass. The study's primary end point was to measure the amount of fluid replacement needed during and post-cardiopulmonary bypass; blood loss, change in blood profile and intraocular pressure were secondary end points, used as measures of plasma oncotic pressures. Patients undergoing coronary artery bypass grafting were recruited. Both patients and surgeons were blinded to receive either Gelofusine® or Voluven® as priming fluids. At fixed intervals during cardiopulmonary bypass, the patients had their intraocular pressures measured. Intra and postoperative fluid replacement was in the form of 4.5% human albumin and the amount was recorded for each subject. The result did not show any significant differences in the amount of fluid needed to be replaced, in blood loss or in blood profile between the two groups. However, it showed an increase in intraocular pressure in both groups once cardiopulmonary bypass commenced. The average intraocular pressure was higher in the Gelofusine ® group compared to the Voluven® group. The significant increase in intraocular pressure measurements in the Gelofusine® group compared to the Voluven® group support the hypothesis that Voluven maintains the plasma oncotic pressure better and reduces fluid shift. Perfusion (2007) 22, 57—62.
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Affiliation(s)
- W W Yap
- Department of Cardiothoracic Surgery, Western Infirmary, Glasgow, United Kingdom.
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Gibbs L, de Silva AM, Christian B, Gold L, Gussy M, Moore L, Calache H, Young D, Riggs E, Tadic M, Watt R, Gondal I, Waters E. Child oral health in migrant families: A cross-sectional study of caries in 1-4 year old children from migrant backgrounds residing in Melbourne, Australia. Community Dent Health 2016; 33:100-106. [PMID: 27352463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Early Childhood Caries (ECC) is the most common, preventable disease of childhood. It can affect children's health and wellbeing and children from migrant families may be at greater risk of developing ECC. OBJECTIVE To describe ECC in children from migrant families, and explore possible influences. BASIC RESEARCH DESIGN Cross-sectional analysis of caries data collected as baseline data for an oral health promotion study. PARTICIPANTS The analysis sample included 630 1-4 year-old children clustered within 481 Iraqi, Lebanese and Pakistani families in Melbourne, Australia. METHOD Child participants received a community-based visual dental examination. Parents completed a self-administered questionnaire on demographics, ethnicity, and oral health knowledge, behaviour and attitudes. MAIN OUTCOME MEASURE Child caries experience. Bivariate associations between oral health behaviours and ethnicity were tested for significance using chi-square. Multivariate logistic regression analyses were performed to identify associations with ECC, adjusting for demographic variables and accounting for clustering by family. RESULTS Overall, 34% of children in the sample experienced caries (both non-cavitated and cavitated). For all caries lesions, parent' length of residence in Australia, consumption of sweet drinks and parental education remained as independent predictors of child caries experience. Adding sugar to drinks was an additional risk factor for cavitation. Ethnicity was associated with some individual oral health behaviours suggesting cultural influences on health, however the relationship was not independent of other predictors. CONCLUSION Culturally competent oral health promotion interventions should aim to support migrant families with young children, and focus on reducing sweet drink consumption.
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Manski-Nankervis J, Yates CJ, Blackberry I, Furler J, Ginnivan L, Cohen N, Jenkins A, Vasanthakumar S, Gorelik A, Young D, Best J, O'Neal D. Impact of insulin initiation on glycaemic variability and glucose profiles in a primary healthcare Type 2 diabetes cohort: analysis of continuous glucose monitoring data from the INITIATION study. Diabet Med 2016; 33:803-11. [PMID: 26435033 DOI: 10.1111/dme.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 01/13/2023]
Abstract
AIM To use continuous glucose monitoring to examine the effects of insulin initiation with glargine, with or without glulisine, on glycaemic variability and glycaemia in a cohort of people with Type 2 diabetes receiving maximum oral hypoglycaemic agents in primary healthcare. METHODS We conducted a post hoc analysis of continuous glucose monitoring data from 89 participants at baseline and at 24 weeks after insulin commencement. Indicators of glycaemic variability (standard deviation, J-index and mean amplitude of glycaemic excursion) and glycaemia (HbA1c , mean glucose, area under the glucose-time curve) were assessed. Multi-level regression analysis was used to identify the predictors of change. RESULTS Complete glycaemic variability data were available for 78 participants. Of these participants, 41% were women, their mean (sd) age was 59.2 (10.4) years, the median (interquartile range) diabetes duration was 10.4 (6.5, 13.3) years and the median (interquartile range) baseline HbA1c was 82.5 (71.6, 96.7) mmol/mol [9.7 (8.7, 11.0)%]. At baseline, BMI correlated negatively with standard deviation (r = -0.30) and mean amplitude of glycaemic excursion (r = -0.26), but not with J-index; HbA1c correlated with J-index (r = 0.61) but not with mean amplitude of glycaemic excursion and standard deviation. After insulin initiation the mean (sd) glucose level decreased [from 12.0 (3.0) to 8.5 (1.6) mmol/l; P < 0.001], as did the median (interquartile range) J-index [from 66.9 (47.7, 95.1) to 36.9 (27.6, 49.8) mmol/l; P < 0.001]. Baseline HbA1c correlated with a greater J-index reduction (r = -0.45; P < 0.001). The mean amplitude of glycaemic excursion and standard deviation values were unchanged. The baseline temporal profile, showing elevated postprandial morning glucose levels, was unchanged after insulin initiation, despite an overall reduction in glycaemia. CONCLUSION Insulin initiation reduced hyperglycaemia but did not alter glycaemic variability in adults with Type 2 diabetes receiving maximum oral hypoglycaemic agents. The most significant postprandial excursions were seen in the morning, which identifies prebreakfast as the most effective target for short-acting insulin therapy.
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Affiliation(s)
- J Manski-Nankervis
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - C J Yates
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, Vic., Australia
| | - I Blackberry
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
- La Trobe University, Wodonga, Vic., Australia
| | - J Furler
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - L Ginnivan
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - N Cohen
- Baker IDI Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - A Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - S Vasanthakumar
- Monash Medical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Vic., Australia
| | - A Gorelik
- Melbourne EpiCentre, Royal Melbourne Hospital, University of Melbourne, Parkville, Vic., Australia
| | - D Young
- Department of General Practice, University of Melbourne, Carlton, Vic., Australia
| | - J Best
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - D O'Neal
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic., Australia
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Holmes S, Ryan T, Young D, Harries M. Frontal Fibrosing Alopecia Severity Index (FFASI): a validated scoring system for assessing frontal fibrosing alopecia. Br J Dermatol 2016; 175:203-7. [PMID: 26847608 DOI: 10.1111/bjd.14445] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, U.K..
| | - T Ryan
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, U.K
| | - D Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, U.K
| | - M Harries
- The Dermatology Centre, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester, U.K
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45
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Lüders I, Tindall B, Young D, van der Horst G, Botha S, Luther I, Maree L, Bertschinger HJ. Standing sedation with medetomidine and butorphanol in captive African elephants (Loxodonta africana). Vet J 2016; 209:190-2. [PMID: 26831175 DOI: 10.1016/j.tvjl.2015.07.014] [Citation(s) in RCA: 4] [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: 09/08/2014] [Revised: 07/10/2015] [Accepted: 07/12/2015] [Indexed: 11/30/2022]
Abstract
Doses for standing sedation allowing for various procedures in otherwise inaccessible, untrained captive African elephant bulls are presented. Thirty-three standing sedations were performed in 12 males aged 8-30 years (one to four sedations per animal). Each bull received a combination of 0.009 ± 0.002 mg/kg medetomidine and 0.03 ± 0.007 mg/kg butorphanol. Full sedation was reached on average 25.5 min after injection. The addition of hyaluronidase (1000-2000 IU) significantly reduced time to full sedation to 16.5 min (paired t test, P = 0.024). Reversal was induced with intramuscular atipamezole 0.008 (±0.002) and naltrexone 0.035 (±0.015) mg/kg. Recovery took on average 7 min (3-18 min). The medetomidine/butorphanol combination provided safe standing sedation for smaller procedures.
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Affiliation(s)
- I Lüders
- Department of Medical Biosciences, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa; National Zoological Gardens of South Africa, 323 Boom Street, Pretoria 0110, South Africa
| | - B Tindall
- Robberg Veterinary Clinic, 56 Longships, Plettenberg Bay 6600, South Africa
| | - D Young
- African Elephant Research Unit, Plettenberg Bay, South Africa
| | - G van der Horst
- Department of Medical Biosciences, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa; National Zoological Gardens of South Africa, 323 Boom Street, Pretoria 0110, South Africa
| | - S Botha
- African Lion Safari, 1386 Cooper Road, Cambridge, ON N1R 5S, Canada
| | - I Luther
- Department of Medical Biosciences, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa; National Zoological Gardens of South Africa, 323 Boom Street, Pretoria 0110, South Africa
| | - L Maree
- Department of Medical Biosciences, University of the Western Cape, Private Bag X17, Bellville 7535, South Africa; National Zoological Gardens of South Africa, 323 Boom Street, Pretoria 0110, South Africa
| | - H J Bertschinger
- Section of Reproduction, Faculty of Veterinary Science, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa.
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46
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Scheinert M, Ferraccioli F, Schwabe J, Bell R, Studinger M, Damaske D, Jokat W, Aleshkova N, Jordan T, Leitchenkov G, Blankenship DD, Damiani TM, Young D, Cochran JR, Richter TD. New Antarctic Gravity Anomaly Grid for Enhanced Geodetic and Geophysical Studies in Antarctica. Geophys Res Lett 2016; 43:600-610. [PMID: 29326484 PMCID: PMC5759340 DOI: 10.1002/2015gl067439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gravity surveying is challenging in Antarctica because of its hostile environment and inaccessibility. Nevertheless, many ground-based, airborne and shipborne gravity campaigns have been completed by the geophysical and geodetic communities since the 1980s. We present the first modern Antarctic-wide gravity data compilation derived from 13 million data points covering an area of 10 million km2, which corresponds to 73% coverage of the continent. The remove-compute-restore technique was applied for gridding, which facilitated levelling of the different gravity datasets with respect to an Earth Gravity Model derived from satellite data alone. The resulting free-air and Bouguer gravity anomaly grids of 10 km resolution are publicly available. These grids will enable new high-resolution combined Earth Gravity Models to be derived and represent a major step forward towards solving the geodetic polar data gap problem. They provide a new tool to investigate continental-scale lithospheric structure and geological evolution of Antarctica.
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Affiliation(s)
- M. Scheinert
- Institut für Planetare Geodäsie, Technische Universität Dresden, Dresden, Germany
| | - F. Ferraccioli
- British Antarctic Survey, High Cross, Madingley Road, Cambridge, UK
| | - J. Schwabe
- Institut für Planetare Geodäsie, Technische Universität Dresden, Dresden, Germany
| | - R. Bell
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | | | - D. Damaske
- Bundesanstalt für Geowissenschaften und Rohstoffe, Hannover, Germany
| | - W. Jokat
- Alfred-Wegener-Institut, Helmholtz-Zentrum für Polar- und Meeresforschung, Bremerhaven, Germany
- University of Bremen, Geoscience, Department, Bremen, Germany
| | | | - T. Jordan
- British Antarctic Survey, High Cross, Madingley Road, Cambridge, UK
| | - G. Leitchenkov
- VNIIOkeangeologia, St. Petersburg, Russia
- St. Petersburg State University, St. Petersburg, Russia
| | - D. D. Blankenship
- Institute for Geophysics, Jackson School of Geosciences, University of Texas at Austin, TX, USA
| | - T. M. Damiani
- National Geodetic Survey, NOAA, Silver Spring, MD, USA
| | - D. Young
- Institute for Geophysics, Jackson School of Geosciences, University of Texas at Austin, TX, USA
| | - J. R. Cochran
- Lamont-Doherty Earth Observatory of Columbia University, Palisades, NY, USA
| | - T. D. Richter
- Institute for Geophysics, Jackson School of Geosciences, University of Texas at Austin, TX, USA
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47
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Zimmerman M, Morgan TA, Young D, Chelminski I, Dalrymple K, Walsh E. Does Borderline Personality Disorder Manifest Itself Differently in Patients With Bipolar Disorder and Major Depressive Disorder? J Pers Disord 2015; 29:847-53. [PMID: 25248008 DOI: 10.1521/pedi_2014_28_169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Perugi and colleagues (2013) recently reported that some features of borderline personality disorder (BPD) significantly predicted a diagnosis of bipolar disorder among depressed patients. They interpreted these findings as indicating that some BPD criteria are nonspecific and are indicators of bipolar disorder rather than BPD, whereas other criteria are more specific to BPD. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors tested the hypothesis that BPD presents itself differently in psychiatric outpatients diagnosed with bipolar disorder or major depressive disorder. The authors found that the patients with bipolar disorder were significantly more likely to report impulsive behavior and transient dissociation. No criterion was significantly more common in the BPD patients with MDD. The authors therefore do not consider the BPD criteria to be nonspecific with regard to the distinction between BPD and bipolar disorder.
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Affiliation(s)
| | | | | | | | | | - Emily Walsh
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence
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48
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Vollmer H, Harvey E, Barker G, Young D. Outcomes of isolated small bowel transplants in a single UK centre. Intensive Care Med Exp 2015. [PMCID: PMC4798144 DOI: 10.1186/2197-425x-3-s1-a357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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49
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Lamb RC, Young D, Holmes S. Retrospective review of diphencyprone in the treatment of alopecia areata. Clin Exp Dermatol 2015; 41:352-8. [DOI: 10.1111/ced.12776] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 02/02/2023]
Affiliation(s)
- R. C. Lamb
- The Alan Lyell Centre for Dermatology; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; Glasgow UK
| | - D. Young
- Department of Mathematics and Statistics; University of Strathclyde; Glasgow UK
| | - S. Holmes
- The Alan Lyell Centre for Dermatology; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; Glasgow UK
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50
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Zimmerman M, Ellison W, Morgan TA, Young D, Chelminski I, Dalrymple K. Psychosocial morbidity associated with bipolar disorder and borderline personality disorder in psychiatric out-patients: comparative study. Br J Psychiatry 2015; 207:334-8. [PMID: 25906793 DOI: 10.1192/bjp.bp.114.153569] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 11/02/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such commentary exists for the improved detection of borderline personality disorder. Clinical experience suggests that it is as disabling as bipolar disorder, but no study has directly compared the two disorders. AIMS To compare the levels of psychosocial morbidity in patients with bipolar disorder and borderline personality disorder. METHOD Patients were assessed with semi-structured interviews. We compared 307 patients with DSM-IV borderline personality disorder but without bipolar disorder and 236 patients with bipolar disorder but without borderline personality disorder. RESULTS The patients with borderline personality disorder less frequently were college graduates, were diagnosed with more comorbid disorders, more frequently had a history of substance use disorder, reported more suicidal ideation at the time of the evaluation, more frequently had attempted suicide, reported poorer social functioning and were rated lower on the Global Assessment of Functioning. There was no difference between the two patient groups in history of admission to psychiatric hospital or time missed from work during the past 5 years. CONCLUSIONS The level of psychosocial morbidity associated with borderline personality disorder was as great as (or greater than) that experienced by patients with bipolar disorder. From a public health perspective, efforts to improve the detection and treatment of borderline personality disorder might be as important as efforts to improve the recognition and treatment of bipolar disorder.
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Affiliation(s)
- Mark Zimmerman
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | - William Ellison
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | - Theresa A Morgan
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | - Diane Young
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | - Iwona Chelminski
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
| | - Kristy Dalrymple
- Mark Zimmerman, MD, William Ellison, PhD, Theresa A. Morgan, PhD, Diane Young, PhD, Iwona Chelminski, PhD, Kristy Dalrymple, PhD, Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island, USA
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