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Cook L, Coffey A, Brown Wilson C, Boland P, Stark P, Graham M, McMahon J, Tuohy D, Barry HE, Murphy J, Birch M, Tierney A, Anderson T, McCurtin A, Cunningham E, Curran GM, Mitchell G. Co-design and mixed methods evaluation of an interdisciplinary digital resource for undergraduate health profession students to improve the prevention, recognition, and management of delirium in Ireland: a study protocol. BMC Med Educ 2024; 24:475. [PMID: 38689311 PMCID: PMC11061903 DOI: 10.1186/s12909-024-05468-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Delirium is a common symptom of acute illness which is potentially avoidable with early recognition and intervention. Despite being a growing concern globally, delirium remains underdiagnosed and poorly reported, with limited understanding of effective delirium education for undergraduate health profession students. Digital resources could be an effective approach to improving professional knowledge of delirium, but studies utilising these with more than one profession are limited, and no evidence-based, interdisciplinary, digital delirium education resources are reported. This study aims to co-design and evaluate a digital resource for undergraduate health profession students across the island of Ireland to improve their ability to prevent, recognise, and manage delirium alongside interdisciplinary colleagues. METHODS Utilising a logic model, three workstreams have been identified. Workstream 1 will comprise three phases: (1) a systematic review identifying the format, methods, and content of existing digital delirium education interventions for health profession students, and their effect on knowledge, self-efficacy, and behavioural change; (2) focus groups with health profession students to determine awareness and experiences of delirium care; and (3) a Delphi survey informed by findings from the systematic review, focus groups, and input from the research team and expert reference group to identify resource priorities. Workstream 2 will involve the co-design of the digital resource through workshops (n = 4) with key stakeholders, including health profession students, professionals, and individuals with lived experience of delirium. Lastly, Workstream 3 will involve a mixed methods evaluation of the digital resource. Outcomes include changes to delirium knowledge and self-efficacy towards delirium care, and health profession students experience of using the resource. DISCUSSION Given the dearth of interdisciplinary educational resources on delirium for health profession students, a co-designed, interprofessional, digital education resource will be well-positioned to shape undergraduate delirium education. This research may enhance delirium education and the self-efficacy of future health professionals in providing delirium care, thereby improving practice and patients' experiences and outcomes. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Lana Cook
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Alice Coffey
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | | | - Pauline Boland
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Margaret Graham
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - James McMahon
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Dympna Tuohy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | | | - Jill Murphy
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Matt Birch
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Audrey Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Tara Anderson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Arlene McCurtin
- School of Allied Health, University of Limerick, Limerick, Ireland
| | - Emma Cunningham
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Geoffrey M Curran
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
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Mumin MA, McKenzie CA, Page VJ, Hadfield D, Aitken LM, Hanks F, Cunningham E, Blackwood B, Van Dellen E, Slooter AJC, Grocott MPW, McAuley DF, Spronk PE. Whole blood thiamine, intravenous thiamine supplementation and delirium occurrence in the intensive care unit: retrospective cohort analyses. Int J Clin Pharm 2024:10.1007/s11096-023-01690-x. [PMID: 38332207 DOI: 10.1007/s11096-023-01690-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Thiamine di-phosphate is an essential cofactor in glucose metabolism, glutamate transformation and acetylcholinesterase activity, pathways associated with delirium occurrence. We hypothesised that a deficiency in whole blood thiamine and intravenous thiamine supplementation could impact delirium occurrence. AIM To establish whether a deficiency in whole blood thiamine and/or intravenous thiamine supplementation within 72 h of intensive care admission is associated with delirium occurrence. METHOD The first dataset was secondary analysis of a previous study in an intensive care unit in the Netherlands, reported in 2017. The second dataset contained consecutive intensive care admissions 2 years before (period 1: October 2014 to October 2016) and after (period 2: April 2017 to April 2019) routine thiamine supplementation was introduced within 72 h of admission. Delirium was defined as a positive Confusion Assessment Method-Intensive Care Unit score(s) in 24 h. RESULTS Analysis of the first dataset (n = 57) using logistic regression showed no relationship between delirium and sepsis or whole blood thiamine, but a significant association with age (p = 0.014). In the second dataset (n = 3074), 15.1% received IV thiamine in period 1 and 62.6% during period 2. Hierarchical regression analysis reported reduction in delirium occurrence in the second period; this did not reach statistical significance, OR = 0.81 (95% CI 0.652-1.002); p = 0.052. CONCLUSION No relationship was detected between whole blood thiamine and delirium occurrence on admission, at 24 and 48 h. It remains unclear whether routine intravenous thiamine supplementation during intensive care admission impacts delirium occurrence. Further prospective randomised clinical trials are needed.
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Affiliation(s)
- Muhammad A Mumin
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
- Institute of Pharmaceutical Sciences, Kings College London, London, UK.
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK.
| | - Cathrine A McKenzie
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK
- Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Valerie J Page
- Intensive Care, West Hertfordshire NHS Foundation Trust, Watford General Hospital, Vicarage Road, Watford, Hertfordshire, UK
| | - Daniel Hadfield
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- King's Critical Care, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Leanne M Aitken
- School of Health and Psychological Sciences, City, University of London, Northampton Square, London, UK
| | - Fraser Hanks
- Institute of Pharmaceutical Sciences, Kings College London, London, UK
- Pharmacy, Guy's and St. Thomas' NHS Foundation Trust, Westminster Bridge Road, London, UK
| | - Emma Cunningham
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Bronagh Blackwood
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Edwin Van Dellen
- Departments of Psychiatry and Intensive Care, UMC Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurology, UZ Brussel and Vrrije Universiteit Brussel, Brussels, Belgium
| | - Arjen J C Slooter
- Departments of Psychiatry and Intensive Care, UMC Utrecht University Medical Center, Utrecht, The Netherlands
- Department of Neurology, UZ Brussel and Vrrije Universiteit Brussel, Brussels, Belgium
| | - Michael P W Grocott
- National Institute of Health and Social Care Research, Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton School of Medicine, Southampton, UK
- Pharmacy and Critical Care, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - Daniel F McAuley
- Centre for Public Health, Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter E Spronk
- Department of Intensive Care Medicine, Gelre Ziekenhuizen Apeldoorn, Apeldoorn, The Netherlands
- Expertise Center for Intensive Care Rehabilitation (ExpIRA), Apeldoorn, The Netherlands
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Cunningham E, Hays S, Wainstein T, Zierhut H, Virani A, Tryon R. Exploring genetic counselors' experiences with non-paternity in clinical settings. J Genet Couns 2024. [PMID: 38323428 DOI: 10.1002/jgc4.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
Non-paternity (NP) is a challenging dilemma faced by genetics providers and there is little consensus on whether this finding should be disclosed. Discussions in the literature are highly theoretical, with limited research regarding how disclosure decisions are enacted in practice. We explored genetic counselors' (GCs) clinical experiences with NP to understand if, how, and why this finding is communicated. Our semi-structured interviews with genetic counselors in the United States and Canada were analyzed using reflexive thematic analysis to analyze data inductively, describe themes, and present a meaningful interpretation of the data. Eighteen participants who responded to list-serv messages were interviewed. Our framework describes five salient themes: (1) GC-lab relationship: the GCs awareness of laboratory processes such as quality control metrics that can uncover NP findings and the way in which a finding of NP was disclosed by the laboratory had an impact on disclosure decisions. This triggered a decision-making trajectory that involved (2) consultation, (3) ethical reasoning, and (4) practical constraints. GCs frequently consulted other professionals during decision-making. These conversations impacted disclosure decisions with some consultations carrying greater weight than others. GCs weighed moral concepts of patient autonomy, medical relevance, and preventing harm to rationalize decisions. Access to patients and documentation requirements often dictated how disclosure occurred. Finally, once a decision had been made and enacted, GCs used the experience to reconsider their approach to (5) consenting in future cases, with some GCs altering their pre-test counseling to always include a discussion of NP. Although NP scenarios are frequently unique in context, our findings demonstrate several common decision-making factors GCs harness to navigate the identification of NP through clinical genetic testing.
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Affiliation(s)
- Emma Cunningham
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Hays
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tasha Wainstein
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alice Virani
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Ethics Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Rebecca Tryon
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
- Blood & Marrow Transplant Program, M Health Fairview, Minneapolis, Minnesota, USA
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Bradshaw D, Khawar A, Patel P, Tosswill J, Brown C, Ogaz D, Mason E, Osman R, Mitchell H, Dosekun O, Peris BM, Pickard G, Rayment M, Jones R, Hopkins M, Williams A, Kingston M, Machin N, Taha Y, Duncan S, Turner N, Gill N, Andrews N, Raza M, Tazzyman S, Nori A, Cunningham E, Taylor GP. HTLV seroprevalence in people using HIV pre-exposure prophylaxis in England. J Infect 2023; 86:245-247. [PMID: 36773896 DOI: 10.1016/j.jinf.2023.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVES HTLV-1 is predominantly a sexually-transmitted infection but testing is not mentioned in HIV-PrEP guidelines. We ascertained HTLV-1/HTLV-2 seroprevalence amongst HIV-PrEP users in England. METHODS An unlinked anonymous seroprevalence study. RESULTS Amongst 2015 HIV-PrEP users, 95% were men, 76% of white ethnicity and 83% had been born in Europe. There were no HTLV-1/HTLV-2 seropositive cases (95% confidence interval 0% - 0.18%). CONCLUSIONS There were no HTLV positive cases, likely reflecting the demographic of mostly white and European-born individuals. Similar studies are needed worldwide to inform public health recommendations for HIV-PrEP using populations, particularly in HTLV-endemic settings.
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Affiliation(s)
- Daniel Bradshaw
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK.
| | - Arham Khawar
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Poorvi Patel
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | | | - Colin Brown
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Dana Ogaz
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Emily Mason
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Roeann Osman
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Holly Mitchell
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Olamide Dosekun
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Borja Mora Peris
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Graham Pickard
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London W2 1NY, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Rachael Jones
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Mark Hopkins
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Andy Williams
- Barts Health NHS Trust, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Margaret Kingston
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Nicholas Machin
- Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
| | - Yusri Taha
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Sarah Duncan
- Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle NE1 4LP, UK
| | - Neil Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London SW10 9NH, UK
| | - Noel Gill
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nick Andrews
- UK Health Security Agency, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mohammad Raza
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Simon Tazzyman
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield S10 2JF, UK
| | - Achyuta Nori
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Emma Cunningham
- Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London SE1 9RT, UK
| | - Graham P Taylor
- Imperial College London, London W2 1PG, UK; National Centre for Human Retrovirology, Imperial College Healthcare NHS Trust, London W2 1NY, UK
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Gregg S, Cunningham E, O'Leary MJ. An Overview of the Impact of the Covid-19 Pandemic on the Provision of Palliative Care. Ir Med J 2023; 116:3. [PMID: 36916690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
The Sars-Cov-2 pandemic had an immeasurable impact on the provision of palliative care in Ireland, and continues to do so. Patients and families were affected by stringent infectious disease measures. Healthcare professionals were also impacted, with recent research demonstrating the psychological impact that the pandemic had on some of those working in palliative care during the pandemic. The services provided by palliative care services also shifted. Many patients opted to stay at home to receive end-of-life care or symptom management from their GP and community palliative homecare teams where possible. Palliative care services in the acute hospital setting were increasingly utilised to support teams to provide end-of-life care in a developing and challenging clinical environment. Communication technology was used to for multidisciplinary team meetings, to communicate with families and by community home care teams for some patient assessments. Our article outlines some of the major ways in which palliative care was impacted by the Sars-Cov-2 pandemic.
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Affiliation(s)
- S Gregg
- Marymount University Hospital and Hospice, Cork, Ireland
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Snell LB, Vink JP, Verlander NQ, Miah S, Lackenby A, Williams D, Mitchell H, Beviz C, Kabia M, Cunningham E, Batra R, Edgeworth JD, Zambon M, Nebbia G. Nosocomial acquisition of influenza is associated with significant morbidity and mortality: Results of a prospective observational study. J Infect Public Health 2022; 15:1118-1123. [PMID: 36137361 PMCID: PMC10166711 DOI: 10.1016/j.jiph.2022.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/04/2022] [Accepted: 08/31/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Nosocomial acquisition of influenza is known to occur but the risk after exposure to a known case and the outcomes after acquisition are poorly defined. METHODS Prospective observational study of patients exposed to influenza from another patient in a multi-site healthcare organisation, with follow-up of 7 days or until discharge, and PCR-confirmation of symptomatic disease. Multivariable analysis was used to investigate association of influenza acquisition with high dependency unit/intensive care unit (HDU/ITU) admission and in-hospital mortality. RESULTS 23/298 (7.7%) contacts of 11 cases were subsequently symptomatic and tested influenza-positive during follow-up. HDU/ITU admission was significantly higher in these secondary cases (6/23, 26%) compared to flu-negative contacts (20/275, 7.2%; p = 0.002). In-hospital mortality was significantly higher in secondary cases (5/23, 21.7%) compared to flu-negative contacts (11/275, 4%; p < 0.001). In multivariable analysis, age (OR 1.25 95% CI: 1.01-1.54, p = 0.02) and being a secondary case (OR 4.77, 95% CI: 1.63-13.9, p = 0.008) were significantly associated with HDU/ITU admission in contacts. Age (OR 1.00, 95% CI: 0.93-1.00, p = 0.02), being a secondary case after exposure to influenza (OR 3.81, 95% CI 1.09-13.3, p = 0.049) and co-morbidity (OR 1.29 per unit increment in the Charlson score, 95% CI 1.02-1.61, p = 0.03) were significantly associated with in-hospital mortality in contacts. CONCLUSIONS Nosocomial acquisition of influenza was significantly associated with increased risk of HDU/ITU admission and in-hospital mortality.
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Affiliation(s)
- L B Snell
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK.
| | - J P Vink
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - S Miah
- UK Health Security Agency, Colindale, UK
| | - A Lackenby
- UK Health Security Agency, Colindale, UK
| | - D Williams
- UK Health Security Agency, Colindale, UK
| | - H Mitchell
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - C Beviz
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Kabia
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | | | - R Batra
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - J D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
| | - M Zambon
- UK Health Security Agency, Colindale, UK
| | - G Nebbia
- Centre for Clinical Infection and Diagnostics Research, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Department of Infection, Guy's and St Thomas' NHS Foundation Trust, UK
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Carroll H, Broderick A, McCarthy O, Kennedy M, Bambury R, Power D, Collins D, Connolly R, Noonan S, Collins D, Cunningham E, O'Driscoll K, Nuzum D, Twomey K, O'Riordan A, O'Sullivan F, Roe C, O'Leary M, Lowney A, O'Reilly S. 1292P A review of in-hospital end-of-life care (EOLC) for oncology patients during the COVID-19 pandemic. Ann Oncol 2022. [PMCID: PMC9472553 DOI: 10.1016/j.annonc.2022.07.1424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cunningham E. Longest and largest cohort study of delirium to date reinforces association while causation remains elusive. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329266. [PMID: 35697500 DOI: 10.1136/jnnp-2022-329266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/26/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Emma Cunningham
- Centre for Public Health, Queen's University Belfast Faculty of Medicine Health and Life Sciences, Belfast, UK
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Hale RS, Green A, Cunningham E, Paul J. Use of amplicon melt temperature to detect SARS-CoV-2 Lineage B.1.1.7 variant through the G28048T mutation in the ORF 8 gene. J Clin Virol Plus 2022; 1:100025. [PMID: 35262011 PMCID: PMC8179719 DOI: 10.1016/j.jcvp.2021.100025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/07/2021] [Accepted: 06/02/2021] [Indexed: 11/06/2022] Open
Abstract
A new variant of SARS-CoV-2 (Lineage B.1.1.7) was identified in the UK in December 2020 which was associated with higher transmissibility of COVID-19. The AusDiagnostics SARS-CoV-2, Influenza and RSV 8-well assay is used at sixteen UK hospitals and detects part of the ORF8 gene (together with a segment from the ORF1a gene). The objective of this study was to determine if the recently identified mutation in ORF8 (G28048T) in the B.1.1.7. lineage could be used to identify the new variant quickly in clinical cases with PCR positive results. The melt data from SARS-CoV-2 positives from two hospitals (October through December 2020) were reviewed, and distribution over time and location was evaluated. A low melt variant of the ORF8 amplicon started to appear in samples from Guy's and St. Thomas’ NHS Trust, London, at the start of November, and grew as a proportion of the total positives during the subsequent two months. These low melt variants were very rare during the same period at the Northern Care Alliance, Greater Manchester, North West of UK. It was confirmed that these carried the G28048T mutation. The geographic and temporal distribution of the low melt amplicons makes it very likely that these are lineage B.1.1.7 strains. The melt temperature of this amplicon could be used to discriminate between the original and new variants in advance of the full sequencing of the isolate. However, the appearance of other mutations in the same amplicon means that this approach would be of diminishing value over time.
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Affiliation(s)
- Richard S Hale
- AusDiagnostics UK Limited, Unit 3 Anglo Business Park, Asheridge Road, Chesham, Bucks, HP5 2QA, United Kingdom
| | - Ashleigh Green
- AusDiagnostics UK Limited, Unit 3 Anglo Business Park, Asheridge Road, Chesham, Bucks, HP5 2QA, United Kingdom
| | - Emma Cunningham
- Viapath, Infection Sciences - Virology, St. Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Joel Paul
- Department of Microbiology, The Royal Oldham Hospital, Rochdale Road, OL1 2JH, United Kingdom
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Snell LB, Fisher CL, Taj U, Stirrup O, Merrick B, Alcolea-Medina A, Charalampous T, Signell AW, Wilson HD, Betancor G, Kia Ik MT, Cunningham E, Cliff PR, Pickering S, Galao RP, Batra R, Neil SJD, Malim MH, Doores KJ, Douthwaite ST, Nebbia G, Edgeworth JD, Awan AR. Combined epidemiological and genomic analysis of nosocomial SARS-CoV-2 infection early in the pandemic and the role of unidentified cases in transmission. Clin Microbiol Infect 2022; 28:93-100. [PMID: 34400345 PMCID: PMC8361005 DOI: 10.1016/j.cmi.2021.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To analyse nosocomial transmission in the early stages of the coronavirus 2019 (COVID-19) pandemic at a large multisite healthcare institution. Nosocomial incidence is linked with infection control interventions. METHODS Viral genome sequence and epidemiological data were analysed for 574 consecutive patients, including 86 nosocomial cases, with a positive PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first 19 days of the pandemic. RESULTS Forty-four putative transmission clusters were found through epidemiological analysis; these included 234 cases and all 86 nosocomial cases. SARS-CoV-2 genome sequences were obtained from 168/234 (72%) of these cases in epidemiological clusters, including 77/86 nosocomial cases (90%). Only 75/168 (45%) of epidemiologically linked, sequenced cases were not refuted by applying genomic data, creating 14 final clusters accounting for 59/77 sequenced nosocomial cases (77%). Viral haplotypes from these clusters were enriched 1-14x (median 4x) compared to the community. Three factors implicated unidentified cases in transmission: (a) community-onset or indeterminate cases were absent in 7/14 clusters (50%), (b) four clusters (29%) had additional evidence of cryptic transmission, and (c) in three clusters (21%) diagnosis of the earliest case was delayed, which may have facilitated transmission. Nosocomial cases decreased to low levels (0-2 per day) despite continuing high numbers of admissions of community-onset SARS-CoV-2 cases (40-50 per day) and before the impact of introducing universal face masks and banning hospital visitors. CONCLUSION Genomics was necessary to accurately resolve transmission clusters. Our data support unidentified cases-such as healthcare workers or asymptomatic patients-as important vectors of transmission. Evidence is needed to ascertain whether routine screening increases case ascertainment and limits nosocomial transmission.
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Affiliation(s)
- Luke B Snell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Chloe L Fisher
- Genomics Innovation Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Usman Taj
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Blair Merrick
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | | | - Harry D Wilson
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Gilberto Betancor
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Mark Tan Kia Ik
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - Emma Cunningham
- Infection Sciences, Viapath, St Thomas' Hospital, London, UK
| | | | - Suzanne Pickering
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Rui Pedro Galao
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Rahul Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stuart J D Neil
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunological and Microbial Sciences, King's College London, UK
| | - Sam T Douthwaite
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ali R Awan
- Genomics Innovation Unit, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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11
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Merrick B, Noronha M, Batra R, Douthwaite S, Nebbia G, Snell L, Pickering S, Galao R, Whitfield J, Jahangeer A, Gunawardena R, Godfrey T, Laifa R, Webber K, Cliff P, Cunningham E, Neil S, Gettings H, Edgeworth J, Harrison H. Real-world deployment of lateral flow SARS-CoV-2 antigen detection in the emergency department to provide rapid, accurate and safe diagnosis of COVID-19. Infect Prev Pract 2021; 3:100186. [PMID: 34812417 PMCID: PMC8598289 DOI: 10.1016/j.infpip.2021.100186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Point-of-care (POC) SARS-CoV-2 lateral-flow antigen detection (LFD) testing in the emergency department (ED) could inform rapid infection control decisions but requirements for safe deployment have not been fully defined. METHODS Review of LFD test results, laboratory and POC-RT-PCR results and ED-performance metrics during a two-week high SARS-CoV-2 prevalence period followed by several months of falling prevalence. AIM Determine whether LFD testing can be safely deployed in ED to provide an effective universal SARS-CoV-2 testing capability. FINDINGS 93% (345/371) of COVID-19 patients left ED with a virological diagnosis during the 2-week universal LFD evaluation period compared to 77% with targeted POC-RT-PCR deployment alone, on background of approximately one-third having an NHS Track and Trace RT-PCR test-result at presentation. LFD sensitivity and specificity was 70.7% and 99.1% respectively providing a PPV of 97.7% and NPV of 86.4% with disease prevalence of 34.7%. ED discharge-delays (breaches) attributable to COVID-19 fell to 33/3532 (0.94%) compared with the preceding POC-RT-PCR period (107/4114 (2.6%); p=<0.0001). Importantly, LFD testing identified 1 or 2 clinically-unsuspected COVID-19 patients/day. Three clinically-confirmed LFD false positive patients were appropriately triaged based on LFD action-card flowchart, and only 5 of 95 false-negative LFD results were inappropriately admitted to non-COVID-19 areas where no onward-transmission was identified. LFD testing was restricted to asymptomatic patients when disease prevalence fell below 5% and detected 1-3 cases/week. CONCLUSION Universal SARS-CoV-2 LFD testing can be safely and effectively deployed in ED alongside POC-RT-PCR testing during periods of high and low disease prevalence.
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Affiliation(s)
- B. Merrick
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M. Noronha
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R. Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S. Douthwaite
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G. Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - L.B. Snell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - S. Pickering
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - R.P. Galao
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - J. Whitfield
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - A. Jahangeer
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - R. Gunawardena
- Guy's King's and Thomas' School of Medicine, King's College London, UK
| | - T. Godfrey
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - R. Laifa
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - S.J.D. Neil
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
| | - H. Gettings
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J.D. Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, UK
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - H.L. Harrison
- Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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12
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Macdonald J, Cunningham E, Gallagher N, Hamilton P, Cassidy R, Bryce L, Beverland D. Can patients with mild post-operative hyponatraemia following elective arthroplasty be discharged safely? A large-scale service evaluation suggests they can. Ann Clin Biochem 2021; 59:116-124. [PMID: 34663082 DOI: 10.1177/00045632211051526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Post-operative hyponatraemia is common following arthroplasty. Clinical hyponatraemia guidelines lack detail on when treatment is necessary, and there is a paucity of literature to guide best practice. METHODS Data were collected within retrospective service evaluations over two time periods in a single high throughput joint unit. The hospital's electronic database identified 1000 patients who were admitted electively between February 2012 and June 2013 and again between November 2018 and April 2019 for primary total hip, total knee or uni-compartmental knee arthroplasty. Hyponatraemia and non-hyponatraemia groups were compared. Logistic regression analysis was used to identify independent predictors of post-operative hyponatraemia, length of stay (LOS), re-attendance or re-admission to hospital. RESULTS Between 2012-2013 and 2018-2019, 32.1% and 25.7% of patients, respectively, developed post-operative hyponatraemia (serum sodium (s[Na]) ≤135 mmol/L). Those with post-operative hyponatraemia were significantly older, weighed less, were more comorbid and had lower pre-operative sodium. Multivariate analysis showed that increased age, knee surgery and lower pre-operative s[Na] independently predicted post-operative hyponatraemia. Post-operative hyponatraemia did not independently predict LOS, re-attendance or re-admission to hospital, within 90 days, in either cohort. CONCLUSION Post-operative hyponatraemia is common and may be a marker of pre-operative vulnerability. In these cohorts, it was not independently associated with LOS, re-attendance or re-admission to hospital. We suggest that otherwise well patients with mild hyponatraemia can be safely discharged earlier than is often the case and may not require extensive investigation. Further examination and research is required to develop a pre-operative approach to predict which patients will develop significant post-operative hyponatraemia.
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Affiliation(s)
- Jonathan Macdonald
- Outcomes Unit, Musgrave Park Hospital, 1602Belfast Health and Social Care Trust, Belfast, UK
| | - Emma Cunningham
- Centre for Public Health, 1596Queen's University, Belfast, Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, UK
| | - Nicola Gallagher
- Outcomes Unit, Musgrave Park Hospital, 1602Belfast Health and Social Care Trust, Belfast, UK
| | - Paul Hamilton
- Centre for Medical Education, 1596Queen's University Belfast Belfast, UK.,Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, UK
| | - Roslyn Cassidy
- Outcomes Unit, Musgrave Park Hospital, 1602Belfast Health and Social Care Trust, Belfast, UK
| | - Leeann Bryce
- Outcomes Unit, Musgrave Park Hospital, 1602Belfast Health and Social Care Trust, Belfast, UK
| | - David Beverland
- Outcomes Unit, Musgrave Park Hospital, 1602Belfast Health and Social Care Trust, Belfast, UK
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13
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Lista MJ, Matos PM, Maguire TJA, Poulton K, Ortiz-Zapater E, Page R, Sertkaya H, Ortega-Prieto AM, Scourfield E, O’Byrne AM, Bouton C, Dickenson RE, Ficarelli M, Jimenez-Guardeño JM, Howard M, Betancor G, Galao RP, Pickering S, Signell AW, Wilson H, Cliff P, Kia Ik MT, Patel A, MacMahon E, Cunningham E, Doores K, Agromayor M, Martin-Serrano J, Perucha E, Mischo HE, Shankar-Hari M, Batra R, Edgeworth J, Zuckerman M, Malim MH, Neil S, Martinez-Nunez RT. Resilient SARS-CoV-2 diagnostics workflows including viral heat inactivation. PLoS One 2021; 16:e0256813. [PMID: 34525109 PMCID: PMC8443028 DOI: 10.1371/journal.pone.0256813] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/21/2021] [Accepted: 08/17/2021] [Indexed: 12/23/2022] Open
Abstract
There is a worldwide need for reagents to perform SARS-CoV-2 detection. Some laboratories have implemented kit-free protocols, but many others do not have the capacity to develop these and/or perform manual processing. We provide multiple workflows for SARS-CoV-2 nucleic acid detection in clinical samples by comparing several commercially available RNA extraction methods: QIAamp Viral RNA Mini Kit (QIAgen), RNAdvance Blood/Viral (Beckman) and Mag-Bind Viral DNA/RNA 96 Kit (Omega Bio-tek). We also compared One-step RT-qPCR reagents: TaqMan Fast Virus 1-Step Master Mix (FastVirus, ThermoFisher Scientific), qPCRBIO Probe 1-Step Go Lo-ROX (PCR Biosystems) and Luna® Universal Probe One-Step RT-qPCR Kit (Luna, NEB). We used primer-probes that detect viral N (EUA CDC) and RdRP. RNA extraction methods provided similar results, with Beckman performing better with our primer-probe combinations. Luna proved most sensitive although overall the three reagents did not show significant differences. N detection was more reliable than that of RdRP, particularly in samples with low viral titres. Importantly, we demonstrated that heat treatment of nasopharyngeal swabs at 70°C for 10 or 30 min, or 90°C for 10 or 30 min (both original variant and B 1.1.7) inactivated SARS-CoV-2 employing plaque assays, and had minimal impact on the sensitivity of the qPCR in clinical samples. These findings make SARS-CoV-2 testing portable in settings that do not have CL-3 facilities. In summary, we provide several testing pipelines that can be easily implemented in other laboratories and have made all our protocols and SOPs freely available at https://osf.io/uebvj/.
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Affiliation(s)
- Maria Jose Lista
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Pedro M. Matos
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Thomas J. A. Maguire
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Inflammation Biology, School of Immunology and Microbial Sciences, Asthma UK Centre in Allergic Mechanisms of Asthma, King’s College London, London, United Kingdom
| | - Kate Poulton
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Elena Ortiz-Zapater
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Randall Centre for Cell & Molecular Biophysics, King’s College London, London, United Kingdom
- Peter Gorer Department of Immunobiology, King’s College London, London, United Kingdom
| | - Robert Page
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- King’s Health Partners Integrated Cancer Centre, School of Cancer and Pharmaceutical Sciences, Guy’s Hospital, King’s College London, London, United Kingdom
| | - Helin Sertkaya
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Ana M. Ortega-Prieto
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Edward Scourfield
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Aoife M. O’Byrne
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Centre for Inflammation Biology and Cancer Immunology (CIBCI), Centre for Rheumatic Diseases (CRD–EULAR Centre of Excellence), King’s College London, London, United Kingdom
| | - Clement Bouton
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Ruth E. Dickenson
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Mattia Ficarelli
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Jose M. Jimenez-Guardeño
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Mark Howard
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Peter Gorer Department of Immunobiology, King’s College London, London, United Kingdom
| | - Gilberto Betancor
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rui Pedro Galao
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Suzanne Pickering
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Adrian W. Signell
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Harry Wilson
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Penelope Cliff
- Viapath pathology laboratories at St Thomas’ Hospital, London, United Kingdom
| | - Mark Tan Kia Ik
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Amita Patel
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Eithne MacMahon
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Emma Cunningham
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Katie Doores
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Monica Agromayor
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Juan Martin-Serrano
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Esperanza Perucha
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Centre for Inflammation Biology and Cancer Immunology (CIBCI), Centre for Rheumatic Diseases (CRD–EULAR Centre of Excellence), King’s College London, London, United Kingdom
| | - Hannah E. Mischo
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Manu Shankar-Hari
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rahul Batra
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Jonathan Edgeworth
- Centre for Infectious Diseases Research, St Thomas’ Hospital, London, United Kingdom
| | - Mark Zuckerman
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- South London Specialist Virology Centre, King’s College Hospital, London, United Kingdom
| | - Michael H. Malim
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Stuart Neil
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
| | - Rocio Teresa Martinez-Nunez
- King’s College London Diagnostics Team at Guy’s Campus, London, United Kingdom
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences, King’s College London, London, United Kingdom
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14
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Pickering S, Batra R, Merrick B, Snell LB, Nebbia G, Douthwaite S, Reid F, Patel A, Kia Ik MT, Patel B, Charalampous T, Alcolea-Medina A, Lista MJ, Cliff PR, Cunningham E, Mullen J, Doores KJ, Edgeworth JD, Malim MH, Neil SJD, Galão RP. Comparative performance of SARS-CoV-2 lateral flow antigen tests and association with detection of infectious virus in clinical specimens: a single-centre laboratory evaluation study. Lancet Microbe 2021; 2:e461-e471. [PMID: 34226893 PMCID: PMC8245061 DOI: 10.1016/s2666-5247(21)00143-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lateral flow devices (LFDs) for rapid antigen testing are set to become a cornerstone of SARS-CoV-2 mass community testing, although their reduced sensitivity compared with PCR has raised questions of how well they identify infectious cases. Understanding their capabilities and limitations is, therefore, essential for successful implementation. We evaluated six commercial LFDs and assessed their correlation with infectious virus culture and PCR cycle threshold (Ct) values. METHODS In a single-centre, laboratory evaluation study, we did a head-to-head comparison of six LFDs commercially available in the UK: Innova Rapid SARS-CoV-2 Antigen Test, Spring Healthcare SARS-CoV-2 Antigen Rapid Test Cassette, E25Bio Rapid Diagnostic Test, Encode SARS-CoV-2 Antigen Rapid Test Device, SureScreen COVID-19 Rapid Antigen Test Cassette, and SureScreen COVID-19 Rapid Fluorescence Antigen Test. We estimated the specificities and sensitivities of the LFDs using stored naso-oropharyngeal swabs collected at St Thomas' Hospital (London, UK) for routine diagnostic SARS-CoV-2 testing by real-time RT-PCR (RT-rtPCR). Swabs were from inpatients and outpatients from all departments of St Thomas' Hospital, and from health-care staff (all departments) and their household contacts. SARS-CoV-2-negative swabs from the same population (confirmed by RT-rtPCR) were used for comparative specificity determinations. All samples were collected between March 23 and Oct 27, 2020. We determined the limit of detection (LOD) for each test using viral plaque-forming units (PFUs) and viral RNA copy numbers of laboratory-grown SARS-CoV-2. Additionally, LFDs were selected to assess the correlation of antigen test result with RT-rtPCR Ct values and positive viral culture in Vero E6 cells. This analysis included longitudinal swabs from five infected inpatients with varying disease severities. Furthermore, the sensitivities of available LFDs were assessed in swabs (n=23; collected from Dec 4, 2020, to Jan 12, 2021) confirmed to be positive (RT-rtPCR and whole-genome sequencing) for the B.1.1.7 variant, which was the dominant genotype in the UK at the time of study completion. FINDINGS All LFDs showed high specificity (≥98·0%), except for the E25Bio test (86·0% [95% CI 77·9-99·9]), and most tests reliably detected 50 PFU/test (equivalent SARS-CoV-2 N gene Ct value of 23·7, or RNA copy number of 3 × 106/mL). Sensitivities of the LFDs on clinical samples ranged from 65·0% (55·2-73·6) to 89·0% (81·4-93·8). These sensitivities increased to greater than 90% for samples with Ct values of lower than 25 for all tests except the SureScreen fluorescence (SureScreen-F) test. Positive virus culture was identified in 57 (40·4%) of 141 samples; 54 (94·7%) of the positive cultures were from swabs with Ct values lower than 25. Among the three LFDs selected for detailed comparisons (the tests with highest sensitivity [Innova], highest specificity [Encode], and alternative technology [SureScreen-F]), sensitivity of the LFDs increased to at least 94·7% when only including samples with detected viral growth. Longitudinal studies of RT-rtPCR-positive samples (tested with Innova, Encode, and both SureScreen-F and the SureScreen visual [SureScreen-V] test) showed that most of the tests identified all infectious samples as positive. Test performance (assessed for Innova and SureScreen-V) was not affected when reassessed on swabs positive for the UK variant B.1.1.7. INTERPRETATION In this comprehensive comparison of antigen LFDs and virus infectivity, we found a clear relationship between Ct values, quantitative culture of infectious virus, and antigen LFD positivity in clinical samples. Our data support regular testing of target groups with LFDs to supplement the current PCR testing capacity, which would help to rapidly identify infected individuals in situations in which they would otherwise go undetected. FUNDING King's Together Rapid COVID-19, Medical Research Council, Wellcome Trust, Huo Family Foundation, UK Department of Health, National Institute for Health Research Comprehensive Biomedical Research Centre.
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Affiliation(s)
- Suzanne Pickering
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Rahul Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Blair Merrick
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luke B Snell
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sam Douthwaite
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fiona Reid
- School of Population Health and Environmental Sciences, King's College London, London, UK
| | - Amita Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Tan Kia Ik
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Bindi Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Themoula Charalampous
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Adela Alcolea-Medina
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
- Viapath Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Jose Lista
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Penelope R Cliff
- Viapath Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Emma Cunningham
- Viapath Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jane Mullen
- Viapath Group, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Katie J Doores
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Jonathan D Edgeworth
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael H Malim
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Stuart J D Neil
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
| | - Rui Pedro Galão
- Department of Infectious Diseases, School of Immunology and Microbial Sciences, King's College London, London, UK
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15
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Cunningham E, Gallagher N, Hamilton P, Bryce L, Beverland D. Prevalence, risk factors, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty. Perioper Med (Lond) 2021; 10:25. [PMID: 34340717 PMCID: PMC8330106 DOI: 10.1186/s13741-021-00197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/31/2021] [Indexed: 11/12/2022] Open
Abstract
Background Hyponatraemia, defined as a serum sodium [Na] concentration below 135 mmol/L, is common following surgery. As inpatient peri-operative stays shorten, there is a need to recognise pre-operative risk factors for post-operative hyponatraemia and complications associated with a peri-operative drop in Na. This audit aimed to investigate the prevalence of, risk factors for, and complications associated with hyponatraemia following elective primary hip and knee arthroplasty. Methods Data were collected within a retrospective audit of inpatient complications and unplanned reattendance or readmission at hospital in consecutive elective primary hip and knee arthroplasty patients in a single high throughput elective primary joint unit. The hospital’s electronic database identified 1000 patients who were admitted electively between February 2012 and June 2013 under the care of a single consultant orthopaedic surgeon for either total hip arthroplasty, total knee arthroplasty, or uni-compartmental knee arthroplasty. Groups were compared using appropriate tests, including chi-square analysis (or Fisher’s exact test), Mann-Whitney U test, Kruskal-Wallis test, and Wilcoxin signed-rank test. Logistic regression analysis was used to determine factors associated with hyponatraemia. Results Of the total 1000 patients, 217 (21.7%) developed post-operative hyponatraemia. Of these, 177 (81.6%) had mild (Na 130–134 mmol/L), 37 (17.1%) had moderate (Na 125–129 mmol/L), and 3 (1.4%) had severe (Na < 125 mmol/L) hyponatraemia. In multivariate analysis, age, pre-operative Na, and fasting glucose on day 1 remained significantly associated with having hyponatraemia post-operatively. There were no significant differences in reattendance at emergency departments and/or readmission within 90 days between those who had post-operative hyponatraemia whilst in hospital (39/217 = 18.0%) and those who did not (103/783 = 13.2%), or between those who were discharged with hyponatraemia (18/108 = 16.7%) and those discharged with normal Na (124/880 = 14.1%). Conclusion Approximately one fifth of elective joint arthroplasty patients had post-operative hyponatraemia. In these patients, older age, lower pre-operative Na and higher fasting glucose predicted post-operative hyponatraemia. We found no evidence that those discharged with hyponatraemia had more reattendance at emergency departments or readmission to hospital. We suggest that otherwise well patients with mild hyponatraemia can safely be discharged and followed up in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00197-1.
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Affiliation(s)
- Emma Cunningham
- Centre for Public Health (Queen's University, Belfast), Institute of Clinical Sciences, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Nicola Gallagher
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland.
| | - Paul Hamilton
- Centre for Medical Education, Queen's University Belfast, Mulhouse Road, Belfast, BT12 6BA, Northern Ireland.,Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, BT12 6BA, Northern Ireland
| | - Leeann Bryce
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland
| | - David Beverland
- Outcomes Unit, Musgrave Park Hospital, Belfast Health and Social Care Trust, Stockman's Lane, Belfast, BT9 7JB, Northern Ireland
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16
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Lütgert J, Vorberger J, Hartley NJ, Voigt K, Rödel M, Schuster AK, Benuzzi-Mounaix A, Brown S, Cowan TE, Cunningham E, Döppner T, Falcone RW, Fletcher LB, Galtier E, Glenzer SH, Laso Garcia A, Gericke DO, Heimann PA, Lee HJ, McBride EE, Pelka A, Prencipe I, Saunders AM, Schölmerich M, Schörner M, Sun P, Vinci T, Ravasio A, Kraus D. Measuring the structure and equation of state of polyethylene terephthalate at megabar pressures. Sci Rep 2021; 11:12883. [PMID: 34145307 PMCID: PMC8213800 DOI: 10.1038/s41598-021-91769-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/25/2021] [Indexed: 11/09/2022] Open
Abstract
We present structure and equation of state (EOS) measurements of biaxially orientated polyethylene terephthalate (PET, \documentclass[12pt]{minimal}
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\begin{document}$$({\hbox {C}}_{10} {\hbox {H}}_8 {\hbox {O}}_4)_n$$\end{document}(C10H8O4)n, also called mylar) shock-compressed to (\documentclass[12pt]{minimal}
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\begin{document}$$155 \pm 20$$\end{document}155±20) GPa and (\documentclass[12pt]{minimal}
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\begin{document}$$6000 \pm 1000$$\end{document}6000±1000) K using in situ X-ray diffraction, Doppler velocimetry, and optical pyrometry. Comparing to density functional theory molecular dynamics (DFT-MD) simulations, we find a highly correlated liquid at conditions differing from predictions by some equations of state tables, which underlines the influence of complex chemical interactions in this regime. EOS calculations from ab initio DFT-MD simulations and shock Hugoniot measurements of density, pressure and temperature confirm the discrepancy to these tables and present an experimentally benchmarked correction to the description of PET as an exemplary material to represent the mixture of light elements at planetary interior conditions.
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Affiliation(s)
- J Lütgert
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany. .,Institute for Solid State and Materials Physics, Technische Universität Dresden, 01069, Dresden, Germany.
| | - J Vorberger
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany
| | - N J Hartley
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - K Voigt
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,Institute for Solid State and Materials Physics, Technische Universität Dresden, 01069, Dresden, Germany
| | - M Rödel
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,Institute for Solid State and Materials Physics, Technische Universität Dresden, 01069, Dresden, Germany
| | - A K Schuster
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,Institute for Solid State and Materials Physics, Technische Universität Dresden, 01069, Dresden, Germany
| | - A Benuzzi-Mounaix
- LULI, CNRS, CEA, Sorbonne Université, Ecole Polytechnique - Institut Polytechnique de Paris, 91128, Palaiseau, France
| | - S Brown
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - T E Cowan
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,Institute of Nuclear and Particle Physics, Technische Universität Dresden, 01069, Dresden, Germany
| | - E Cunningham
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - T Döppner
- Lawrence Livermore National Laboratory, Livermore, CA, 94550, USA
| | - R W Falcone
- Department of Physics, University of California, Berkeley, CA, 94720, USA.,Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | - L B Fletcher
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - E Galtier
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - S H Glenzer
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - A Laso Garcia
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany
| | - D O Gericke
- CFSA, Department of Physics, University of Warwick, Coventry, CV4 7AL, UK
| | - P A Heimann
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - H J Lee
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - E E McBride
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA.,European XFEL GmbH, Holzkoppel 4, 22869, Schenefeld, Germany
| | - A Pelka
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany
| | - I Prencipe
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany
| | - A M Saunders
- Department of Physics, University of California, Berkeley, CA, 94720, USA
| | - M Schölmerich
- European XFEL GmbH, Holzkoppel 4, 22869, Schenefeld, Germany
| | - M Schörner
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA.,Institut für Physik, Albert-Einstein-Str. 23, Universität Rostock, 18059, Rostock, Germany
| | - P Sun
- SLAC National Accelerator Laboratory, Menlo Park, CA, 94025, USA
| | - T Vinci
- LULI, CNRS, CEA, Sorbonne Université, Ecole Polytechnique - Institut Polytechnique de Paris, 91128, Palaiseau, France
| | - A Ravasio
- LULI, CNRS, CEA, Sorbonne Université, Ecole Polytechnique - Institut Polytechnique de Paris, 91128, Palaiseau, France
| | - D Kraus
- Helmholtz-Zentrum Dresden-Rossendorf, Bautzner Landstrasse 400, 01328, Dresden, Germany.,Institut für Physik, Albert-Einstein-Str. 23, Universität Rostock, 18059, Rostock, Germany
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Fergie R, McCaughan J, Eves P, Prabhavalkhar S, Shivashankar G, Cunningham E. MO152CORRELATION OF PERCEIVED FRAILTY WITH MEASURED FRAILTY IN AN ADULT HAEMODIALYSIS POPULATION. Nephrol Dial Transplant 2021. [PMCID: PMC8194989 DOI: 10.1093/ndt/gfab092.0030] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Aims Frailty is a measure of physiological reserve and the ability to respond to physiological stress. Increasing frailty predicts adverse health outcomes in patients with end stage renal disease (ESRD) Despite this, frailty is not routinely measured in clinical practice where clinician perception of frailty is used to inform decision making. The Clinical Frailty Scale (CFS) is a clinical judgement-based score that is a useful screening tool for frailty. Increasing frailty measured by CFS is predictive of adverse outcomes in patients with advanced chronic kidney disease (CKD) including falls, worsening disability, care home admissions, hospitalizations and ultimately mortality. It has been widely used in the assessment of patients with COVID-19 to help inform decisions regarding ceiling of care. This study aimed to assess the correlation between clinician perception of frailty and frailty as measured using the CFS. Method Frailty was assessed for all patients undergoing in centre hospital haemodialysis (n=53) in a single dialysis unit in Northern Ireland. A CFS score was calculated for all patients by a clinician who routinely uses the CFS in clinical practice. Patients with a score of 1-3 were classified as not frail, 4-5 as intermediately frail and 6-9 as frail. Nephrologists received basic education about frailty. They were then asked to categorize their patients as non-frail, intermediately frail or frail. The relationship between measured and perceived frailty was assessed using percent agreement. Participant characteristics of frail patients who were misclassified as intermediately frail or non-frail by clinicians were compared to those patients correctly classified as non-frail by clinicians. Fisher’s exact test was employed for categorical variables and t-tests were employed for pseudo normally distributed continuous variables. Results Of the 53 participants, the median age was 59 years (26-89). 41.5% were women. The median time on dialysis was 1.6 years. According to the CFS, 6 patients were categorised as non-frail, 30 patients as intermediately frail and 17 as frail. Among frail participants, 41% were correctly perceived as frail by their nephrologist. Among non-frail participants, 100% were correctly perceived as non-frail by their nephrologist. Among those who were frail according to the CFS, those misclassified as intermediately frail or non-frail, were younger (median age of those misclassified 49 years vs 62 years of those not mis-classified, P=0.03) but did not differ by sex (P=1), time on dialysis (P=0.39), presence of diabetes (P=0.30) or presence of vascular disease (P=1). Conclusion In this study of adult patients undergoing chronic haemodialysis, perceived frailty correlated with measured frailty using the CFS less than 50% of the time. This suggests that clinical perception is not an accurate surrogate for frailty status in this population group. Additionally, this study suggests that younger patients with ESRD are less likely to be correctly perceived as frail. Such misclassification could influence clinical decisions for treatment, including candidacy for kidney transplantation.
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Affiliation(s)
- Ruth Fergie
- Altnagelvin Hospital, Renal Unit, Altnagelvin, United Kingdom
| | | | - Peter Eves
- Altnagelvin Hospital, Renal Unit, Altnagelvin, United Kingdom
| | | | | | - Emma Cunningham
- Belfast Health & Social Care Trust, United Kingdom
- Queen's University Belfast, Centre for Public Health, United Kingdom
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18
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Lista MJ, Matos PM, Maguire TJA, Poulton K, Ortiz-Zapater E, Page R, Sertkaya H, Ortega-Prieto AM, O’Byrne AM, Bouton C, Dickenson RE, Ficarelli M, Jimenez-Guardeño JM, Howard M, Betancor G, Galao RP, Pickering S, Signell AW, Wilson H, Cliff P, Ik MTK, Patel A, MacMahon E, Cunningham E, Doores K, Agromayor M, Martin-Serrano J, Perucha E, Mischo HE, Shankar-Hari M, Batra R, Edgeworth J, Zuckerman M, Malim MH, Neil S, Martinez-Nunez RT. Resilient SARS-CoV-2 diagnostics workflows including viral heat inactivation. medRxiv 2021:2020.04.22.20074351. [PMID: 33851184 PMCID: PMC8043481 DOI: 10.1101/2020.04.22.20074351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a worldwide need for reagents to perform SARS-CoV-2 detection. Some laboratories have implemented kit-free protocols, but many others do not have the capacity to develop these and/or perform manual processing. We provide multiple workflows for SARS-CoV-2 nucleic acid detection in clinical samples by comparing several commercially available RNA extraction methods: QIAamp Viral RNA Mini Kit (QIAgen), RNAdvance Blood/Viral (Beckman) and Mag-Bind Viral DNA/RNA 96 Kit (Omega Bio-tek). We also compared One-step RT-qPCR reagents: TaqMan Fast Virus 1-Step Master Mix (FastVirus, ThermoFisher Scientific), qPCRBIO Probe 1-Step Go Lo-ROX (PCR Biosystems) and Luna ® Universal Probe One-Step RT-qPCR Kit (Luna, NEB). We used primer-probes that detect viral N (EUA CDC) and RdRP (PHE guidelines). All RNA extraction methods provided similar results. FastVirus and Luna proved most sensitive. N detection was more reliable than that of RdRP, particularly in samples with low viral titres. Importantly, we demonstrate that treatment of nasopharyngeal swabs with 70 degrees for 10 or 30 min, or 90 degrees for 10 or 30 min (both original variant and B 1.1.7) inactivates SARS-CoV-2 employing plaque assays, and that it has minimal impact on the sensitivity of the qPCR in clinical samples. These findings make SARS-CoV-2 testing portable to settings that do not have CL-3 facilities. In summary, we provide several testing pipelines that can be easily implemented in other laboratories and have made all our protocols and SOPs freely available at https://osf.io/uebvj/ .
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Affiliation(s)
- Maria Jose Lista
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
- All these authors contributed equally to the completion of this work
| | - Pedro M. Matos
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
- All these authors contributed equally to the completion of this work
| | - Thomas J. A. Maguire
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Inflammation Biology, School of Immunology and Microbial Sciences. Asthma UK Centre in Allergic Mechanisms of Asthma. Guy’s Campus, King’s College London SE1 9RT, UK
- All these authors contributed equally to the completion of this work
| | - Kate Poulton
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
- All these authors contributed equally to the completion of this work
| | - Elena Ortiz-Zapater
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Randall Centre for Cell & Molecular Biophysics. Guy’s Campus, King’s College London, SE1 1UL, UK
- Peter Gorer Department of Immunobiology. Guy’s Campus, King’s College London, SE1 9RT, UK
| | - Robert Page
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Inflammation Biology, School of Immunology and Microbial Sciences. Asthma UK Centre in Allergic Mechanisms of Asthma. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Helin Sertkaya
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Ana M. Ortega-Prieto
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Aoife M. O’Byrne
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Centre for Inflammation Biology and Cancer Immunology (CIBCI). Centre for Rheumatic Diseases (CRD – EULAR Centre of Excellence). Guy’s Campus, King’s College London SE1 1UL, UK
| | - Clement Bouton
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Ruth E Dickenson
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Mattia Ficarelli
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Jose M. Jimenez-Guardeño
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Mark Howard
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Peter Gorer Department of Immunobiology. Guy’s Campus, King’s College London, SE1 9RT, UK
| | - Gilberto Betancor
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Rui Pedro Galao
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Suzanne Pickering
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Adrian W Signell
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Harry Wilson
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | | | - Mark Tan Kia Ik
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Amita Patel
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Eithne MacMahon
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Emma Cunningham
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Katie Doores
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Monica Agromayor
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Juan Martin-Serrano
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Esperanza Perucha
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Centre for Inflammation Biology and Cancer Immunology (CIBCI). Centre for Rheumatic Diseases (CRD – EULAR Centre of Excellence). Guy’s Campus, King’s College London SE1 1UL, UK
| | - Hannah E. Mischo
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Manu Shankar-Hari
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Rahul Batra
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Jonathan Edgeworth
- Centre for Infectious Diseases Research, St Thomas’ Hospital (London, UK)
| | - Mark Zuckerman
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Virology. King’s College Hospital (London, UK)
| | - Michael H. Malim
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Stuart Neil
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
| | - Rocio Teresa Martinez-Nunez
- King’s College London Diagnostics Team at Guy’s Campus (London, UK)
- Dept. Infectious Diseases, School of Immunology and Microbial Sciences. Guy’s Campus, King’s College London SE1 9RT, UK
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Sawada H, Trzaska J, Curry CB, Gauthier M, Fletcher LB, Jiang S, Lee HJ, Galtier EC, Cunningham E, Dyer G, Daykin TS, Chen L, Salinas C, Glenn GD, Frost M, Glenzer SH, Ping Y, Kemp AJ, Sentoku Y. 2D monochromatic x-ray imaging for beam monitoring of an x-ray free electron laser and a high-power femtosecond laser. Rev Sci Instrum 2021; 92:013510. [PMID: 33514225 DOI: 10.1063/5.0014329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
In pump-probe experiments with an X-ray Free Electron Laser (XFEL) and a high-power optical laser, spatial overlap of the two beams must be ensured to probe a pumped area with the x-ray beam. A beam monitoring diagnostic is particularly important in short-pulse laser experiments where a tightly focused beam is required to achieve a relativistic laser intensity for generation of energetic particles. Here, we report the demonstration of on-shot beam pointing measurements of an XFEL and a terawatt class femtosecond laser using 2D monochromatic Kα imaging at the Matter in Extreme Conditions end-station of the Linac Coherent Light Source. A thin solid titanium foil was irradiated by a 25-TW laser for fast electron isochoric heating, while a 7.0 keV XFEL beam was used to probe the laser-heated region. Using a spherical crystal imager (SCI), the beam overlap was examined by measuring 4.51 keV Kα x rays produced by laser-accelerated fast electrons and the x-ray beam. Measurements were made for XFEL-only at various focus lens positions, laser-only, and two-beam shots. Successful beam overlapping was observed on ∼58% of all two-beam shots for 10 μm thick samples. It is found that large spatial offsets of laser-induced Kα spots are attributed to imprecise target positioning rather than shot-to-shot laser pointing variations. By applying the Kα measurements to x-ray Thomson scattering measurements, we found an optimum x-ray beam spot size that maximizes scattering signals. Monochromatic x-ray imaging with the SCI could be used as an on-shot beam pointing monitor for XFEL-laser or multiple short-pulse laser experiments.
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Affiliation(s)
- H Sawada
- Department of Physics, University of Nevada Reno, Reno, Nevada 89557, USA
| | - J Trzaska
- Department of Physics, University of Nevada Reno, Reno, Nevada 89557, USA
| | - C B Curry
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M Gauthier
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - L B Fletcher
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S Jiang
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - H J Lee
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - E C Galtier
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - E Cunningham
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - G Dyer
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - T S Daykin
- Department of Physics, University of Nevada Reno, Reno, Nevada 89557, USA
| | - L Chen
- Department of Physics, University of Nevada Reno, Reno, Nevada 89557, USA
| | - C Salinas
- Department of Physics, University of Nevada Reno, Reno, Nevada 89557, USA
| | - G D Glenn
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - M Frost
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - S H Glenzer
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - Y Ping
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A J Kemp
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - Y Sentoku
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
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Hayes A, Nguyen D, Andersson M, Antón A, Bailly J, Beard S, Benschop KSM, Berginc N, Blomqvist S, Cunningham E, Davis D, Dembinski JL, Diedrich S, Dudman SG, Dyrdak R, Eltringham GJA, Gonzales‐Goggia S, Gunson R, Howson‐Wells HC, Jääskeläinen AJ, López‐Labrador FX, Maier M, Majumdar M, Midgley S, Mirand A, Morley U, Nordbø SA, Oikarinen S, Osman H, Papa A, Pellegrinelli L, Piralla A, Rabella N, Richter J, Smith M, Söderlund Strand A, Templeton K, Vipond B, Vuorinen T, Williams C, Wollants E, Zakikhany K, Fischer TK, Harvala H, Simmonds P. A European multicentre evaluation of detection and typing methods for human enteroviruses and parechoviruses using RNA transcripts. J Med Virol 2020; 92:1065-1074. [PMID: 31883139 PMCID: PMC7496258 DOI: 10.1002/jmv.25659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022]
Abstract
Polymerase chain reaction (PCR) detection has become the gold standard for diagnosis and typing of enterovirus (EV) and human parechovirus (HPeV) infections. Its effectiveness depends critically on using the appropriate sample types and high assay sensitivity as viral loads in cerebrospinal fluid samples from meningitis and sepsis clinical presentation can be extremely low. This study evaluated the sensitivity and specificity of currently used commercial and in-house diagnostic and typing assays. Accurately quantified RNA transcript controls were distributed to 27 diagnostic and 12 reference laboratories in 17 European countries for blinded testing. Transcripts represented the four human EV species (EV-A71, echovirus 30, coxsackie A virus 21, and EV-D68), HPeV3, and specificity controls. Reported results from 48 in-house and 15 commercial assays showed 98% detection frequencies of high copy (1000 RNA copies/5 µL) transcripts. In-house assays showed significantly greater detection frequencies of the low copy (10 copies/5 µL) EV and HPeV transcripts (81% and 86%, respectively) compared with commercial assays (56%, 50%; P = 7 × 10-5 ). EV-specific PCRs showed low cross-reactivity with human rhinovirus C (3 of 42 tests) and infrequent positivity in the negative control (2 of 63 tests). Most or all high copy EV and HPeV controls were successfully typed (88%, 100%) by reference laboratories, but showed reduced effectiveness for low copy controls (41%, 67%). Stabilized RNA transcripts provide an effective, logistically simple and inexpensive reagent for evaluation of diagnostic assay performance. The study provides reassurance of the performance of the many in-house assay formats used across Europe. However, it identified often substantially reduced sensitivities of commercial assays often used as point-of-care tests.
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Affiliation(s)
- A. Hayes
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - D. Nguyen
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - M. Andersson
- Microbiology Laboratory, John Radcliffe Hospital, Headley Way, HeadingtonOxfordUK
| | - A. Antón
- Respiratory Viruses Unit, Virology Section, Microbiology DepartmentHospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'HebronBarcelonaSpain
| | - J.‐L. Bailly
- Université Clermont Auvergne, LMGE UMR CNRS, UFR MédecineClermont‐FerrandFrance
- CHU Clermont‐Ferrand, National Reference Center for EV and Parechovirus‐Associated LaboratoryClermont‐FerrandFrance
| | - S. Beard
- Enteric Virus Unit, Virus Reference DepartmentNational Infection Service, Public Health EnglandLondonUK
| | - K. S. M. Benschop
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - N. Berginc
- Department for Public Health VirologyNational Laboratory of Health, Environment and FoodLjubljanaSlovenia
| | - S. Blomqvist
- National Institute for Health and Welfare, MannerheimintieHelsinkiFinland
| | - E. Cunningham
- Viapath Infection Sciences, St. Thomas' HospitalLondonUK
| | - D. Davis
- Microbiology, Virology and infection Prevention & ControlGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - J. L. Dembinski
- Department of VirologyNorwegian Institute of Public HealthOsloNorway
| | - S. Diedrich
- National Reference Center for Poliomyelitis and Enteroviruses, Robert Koch InstituteBerlinGermany
| | - S. G. Dudman
- Department of MicrobiologyOslo University Hospital Rikshospitalet, Inst. Clinical Medicine, University of OsloOsloNorway
| | - R. Dyrdak
- Department of Clinical MicrobiologyKarolinska University HospitalStockholmSweden
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstituteStockholmSweden
| | - G. J. A. Eltringham
- Molecular Diagnostics Laboratory, Microbiology, Freeman HospitalNewcastle Upon TyneUK
| | - S. Gonzales‐Goggia
- Public Health England Poliovirus Reference Laboratory, National Infection Service, Public Health EnglandLondonUK
| | - R. Gunson
- West of Scotland Specialist Virology CentreGlasgow Royal InfirmaryGlasgowUK
| | - H. C. Howson‐Wells
- Nottingham University Hospitals NHS Trust, Clinical Microbiology, Queens Medical CentreNottinghamUK
| | - A. J. Jääskeläinen
- University of Helsinki and Helsinki University Hospital, HUSLAB, Virology and ImmunologyHelsinkiFinland
| | - F. X. López‐Labrador
- Virology Laboratory, Joint Units in Genomics and Health and Infection and Health, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO‐Public Health)/Universitat de València, Av. CatalunyaValènciaSpain
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos IIIMadridSpain
| | - M. Maier
- Institute of VirologyLeipzig University HospitalLeipzigGermany
| | - M. Majumdar
- The National Institute for Biological Standards and ControlHertfordshireUK
| | - S. Midgley
- Department of Virus and Special Microbiological DiagnosticsVirus Surveillance and Research Section, Statens Serum InstitutCopenhagenDenmark
| | - A. Mirand
- CHU Clermont‐Ferrand, Laboratoire de Virologie—Centre National de Référence des Entérovirus et Parechovirus, Laboratoire Associé—Clermont‐FerrandFrance
| | - U. Morley
- UCD National Virus Reference LaboratoryUniversity College Dublin, BelfieldDublinIreland
| | - S. A. Nordbø
- Department of Medical MicrobiologySt. Olavs University HospitalTrondheimNorway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - S. Oikarinen
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - H. Osman
- Public Health England Birmingham Public Health Laboratory, Heartlands HospitalBirminghamUK
| | - A. Papa
- Department of MicrobiologyMedical School, Aristotle University of ThessalonikiThessalonikiGreece
| | - L. Pellegrinelli
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - A. Piralla
- Molecular Virology Unit, Microbiology and Virology DepartmentFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - N. Rabella
- Virology Section, Santa Creu i Sant Pau University HospitalBarcelonaSpain
| | - J. Richter
- Department of Molecular VirologyCyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - M. Smith
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
- King's College Hospital, Bessemer Wing, Denmark HillLondonUK
| | - A. Söderlund Strand
- Laboratory Medicine, Department of Clinical MicrobiologyLund University Hospital, SölvegatanLundSweden
| | - K. Templeton
- Edinburgh Specialist Virology, Royal Infirmary of EdinburghEdinburghUK
| | - B. Vipond
- Public Health England, South West Regional Laboratory, Pathology Sciences Building, Science QuarterSouthmead HospitalBristolUK
| | - T. Vuorinen
- Clinical MicrobiologyTurku University Hospital and Institute of Biomedicine University of TurkuTurkuFinland
| | | | - E. Wollants
- Clinical and Epidemiological Virology, KU Leuven, REGA Institute, Clinical and Epidemiological VirologyLeuvenBelgium
| | - K. Zakikhany
- Katherina Zakikhany‐Gilg, Public Health Agency of Sweden, Department of MicrobiologyUnit of Laboratory Surveillance of Viral Pathogens and Vaccine Preventable DiseasesStockholmSweden
| | - T. K. Fischer
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos IIIMadridSpain
- Department of Virus and Special Microbiological DiagnosticsVirus Surveillance and Research Section, Statens Serum InstitutCopenhagenDenmark
| | - H. Harvala
- NHS Blood and Transplant, ColindaleLondonUK
| | - P. Simmonds
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
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Whitby J, Bampoe S, Fullerton JN, Smaje A, Hornby J, Hajdu B, Schofield N, Stafford R, Zetterberg H, McAuley DF, Passmore P, Cunningham E, Whittle J, Walker D, Davis D. Prospective Investigation of Markers of Elevated Delirium Risk (PRIMED Risk) study protocol: a prospective, observational cohort study investigating blood and cerebrospinal fluid biomarkers for delirium and cognitive dysfunction in older patients. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15658.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Delirium is a common post-operative complication, particularly in older adults undergoing major or emergency procedures. It is associated with increased length of intensive care and hospital stay, post-operative mortality and subsequent dementia risk. Current methods of predicting delirium incidence, duration and severity have limitations. Investigation of blood and cerebrospinal fluid (CSF) biomarkers linked to delirium may improve understanding of the underlying pathophysiology, particularly with regard to the extent this is shared or distinct with underlying dementia. Together, these have the potential for development of better risk stratification tools and perioperative interventions. Methods: 200 patients over the age of 70 scheduled for surgery with routine spinal anaesthetic will be recruited from UK hospitals. Their cognitive and functional baseline status will be assessed pre-operatively by telephone. Time-matched CSF and blood samples will be taken at the time of surgery and analysed for known biomarkers of neurodegeneration and neuroinflammation. Patients will be assessed daily for delirium until hospital discharge and will have regular cognitive follow-up for two years. Primary outcomes will be change in modified Telephone Interview for Cognitive Status (TICS-m) score at 12 months and rate of change of TICS-m score. Delirium severity, duration and biomarker levels will be treated as exposures in a random effects linear regression models. PRIMED Risk has received regulatory approvals from Health Research Authority and London – South East Research Ethics Committee. Discussion: The main anticipated output from this study will be the quantification of biomarkers of acute and chronic contributors to cognitive impairment after surgery. In addition, we aim to develop better risk prediction models for adverse cognitive outcomes.
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Kantrowitz-Gordon I, Cunningham E, Reynolds N. Measurement of Maternal Mindful Awareness of Fetal Movement. J Midwifery Womens Health 2019; 64:604-612. [PMID: 31237110 DOI: 10.1111/jmwh.12981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Decreased fetal movement is a common concern late in pregnancy that may be associated with increased fetal morbidity and mortality. Limited research suggests a relationship between maternal psychological factors and perception of fetal movement. The goal of this study was to test the reliability and external validity of a novel self-report instrument for maternal mindful awareness of fetal movement. METHODS Pregnant women who were at 20 weeks' gestation or later and feeling regular fetal movement (N = 497) were recruited online through a commercial pregnancy website to complete an internet survey from April to May 2016. The online survey included demographic and pregnancy characteristics, psychological and mindfulness measures, and investigator-developed items on mindful awareness of fetal movement. Reliability and validity of the instrument were tested with exploratory factor analysis, correlations with psychological variables, and hierarchical linear regression. RESULTS Exploratory factor analysis of mindful awareness of fetal movement items using principal components analysis showed a 2-factor structure, noticing and distracted, with internal consistency of α equal to .69 and .57, respectively. Hierarchical multiple regression analysis showed that noticing was associated with increased gestational age, mindfulness (observing facet), and maternal-fetal attachment. Distracted was associated with increased education level and prenatal anxiety and with decreased mindfulness (nonjudging facet). DISCUSSION There was moderate internal consistency in the items measuring mindful awareness of fetal movement. Findings suggest relationships between mindful awareness of fetal movement and state mindfulness, maternal-fetal attachment, and prenatal anxiety. More research is needed to further develop items for a mindful awareness of fetal movement scale suitable for research and clinical practice.
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Affiliation(s)
- Ira Kantrowitz-Gordon
- School of Nursing, University of Washington, Seattle, Washington.,Providence Medical Group, Everett, Washington
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Hall RJ, Watne LO, Cunningham E, Zetterberg H, Shenkin SD, Wyller TB, MacLullich AMJ. CSF biomarkers in delirium: a systematic review. Int J Geriatr Psychiatry 2018; 33:1479-1500. [PMID: 28585290 DOI: 10.1002/gps.4720] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/16/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE In recent years, there has been a blossoming of studies examining cerebrospinal fluid (CSF) as a method of studying the pathophysiology of delirium. We systematically reviewed the literature for CSF studies in delirium and provide here a summary of the implications for our understanding of delirium pathophysiology. We also summarise the methods used for CSF analysis and discuss challenges and implications for future studies. METHODS In this systematic review, we screened MEDLINE, EMBASE, PsycINFO, Web of Science, PubMed and the Cochrane Library for articles on CSF biomarkers in delirium, published on 3 September 2016. Studies were required to use Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases criteria for delirium or a validated tool. We excluded case reports. There were no other restrictions on study type. RESULTS We identified 3280 articles from our initial search, and 22 articles were included in this review. All studies were prospective, including over 400 patients with delirium and 700 controls. More than 70 different biomarkers were studied. Studies could not be compared with each other for meta-analysis because of their heterogeneity and varied widely in their risk of bias and quality assessments. CONCLUSIONS The 22 studies identified in this review reveal a small but growing literature, in which many of the important hypotheses in delirium pathogenesis have been examined, but from which few firm conclusions can currently be drawn. Nevertheless, the overall interpretation of the literature supports the vulnerable brain concept, that is, that biomarker evidence of, for example, Alzheimer's disease pathology and/or neuroinflammation, is associated with delirium.
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Affiliation(s)
- Roanna J Hall
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
| | - Leiv Otto Watne
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Emma Cunningham
- Centre for Public Health, Queen's University of Belfast, Belfast, Ireland
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Susan D Shenkin
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
| | - Torgeir Bruun Wyller
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alasdair M J MacLullich
- Edinburgh Delirium Research Group, Geriatric Medicine, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland
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24
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Pluard T, Oh SY, Oliveira M, Cescon D, Tan-Chiu E, Wu Y, Carpenter C, Cunningham E, Ballas M, Dhar A, Sparano J. Abstract OT3-06-07: A phase I/II dose escalation and expansion study to investigate the safety, pharmacokinetics, pharmacodynamics and clinical activity of GSK525762 in combination with fulvestrant in subjects with ER+ breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-06-07] [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] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Advanced or metastatic ER+BC (estrogen receptor positive breast cancer) is an incurable illness that will prove fatal for most afflicted women. Current standards of care include endocrine, targeted, and chemotherapy. Preclinical data suggest that altering the expression of the estrogen receptor (ER) as well as other ER-responsive genes may provide therapeutic benefit for women for whom endocrine therapy alone has proven inadequate. The bromodomain (BRD) and extra-terminal (BET) family of proteins (BRD2, BRD3, BRD4 and BRDT) bind to acetyl-histone residues and epigenetically control transcription of genes driving cell survival and proliferation. BET proteins have been implicated in carcinogenesis and treatment resistance in multiple tumors including ER+BC, and are a novel target for therapy in breast cancer. GSK525762 is a pan-BET inhibitor that has shown strong synergistic activity with fulvestrant in killing ER+BC cells in vitro and in xenograft models. The combination of BET agents with endocrine therapy may provide therapeutic benefit and restore sensitivity to ER targeting agents like fulvestrant.
Trial Design & Specific Aims:
This study is a Phase I/II dose-escalation, expansion (Phase I) and randomized control (Phase II) study with oral administration of GSK525762 in combination with fulvestrant in advanced or metastatic ER+BC subjects, whose disease has progressed on prior treatment with at least one line of endocrine therapy.
Phase I of the study is designed as parallel single arms to determine a recommended Phase 2 dose (RP2D) based on safety, tolerability, pharmacokinetic, and efficacy profiles in two distinct populations of ER+ breast cancer:
Subjects with disease that relapsed during treatment or within 12 months of adjuvant therapy with an AI, OR disease that progressed during treatment with an AI for advanced/metastatic disease.
OR
Subjects with disease that progressed during treatment with the combination of a CDK4/6 inhibitor plus letrozole for advanced or metastatic disease.
Phase II of the study is a randomized, double-blind, placebo-controlled cohort, designed to evaluate the efficacy of the combination.
Key Eligibility Criteria: Patients must have received <3 lines of systemic anti-cancer therapy (≤1 line of chemo), measurable disease, and PS 0-1.
Statistical Methods: A modified toxicity probability interval (mTPI) design will be used to monitor safety. A Bayesian adaptive design will be used to evaluate efficacy in Phase 1.
Present and Target Accrual: Target enrolment will be ˜300 subjects across ˜50 sites worldwide. To date, 2 subjects have been enrolled.
Contact Information: Elizabeth Cunningham, Elizabeth.A.Cunningham@GSK.com.
NCT02964507
Funding: GSK
Citation Format: Pluard T, Oh SY, Oliveira M, Cescon D, Tan-Chiu E, Wu Y, Carpenter C, Cunningham E, Ballas M, Dhar A, Sparano J. A phase I/II dose escalation and expansion study to investigate the safety, pharmacokinetics, pharmacodynamics and clinical activity of GSK525762 in combination with fulvestrant in subjects with ER+ breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-06-07.
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Affiliation(s)
- T Pluard
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - SY Oh
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - M Oliveira
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - D Cescon
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - E Tan-Chiu
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - Y Wu
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - C Carpenter
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - E Cunningham
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - M Ballas
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - A Dhar
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
| | - J Sparano
- St. Luke's Cancer Institute, Kansas City, MO; Montefiore-Einstein Cancer Center, Bronx, NY; Hospital Universitari Vall d'Hebron, Barcelona, Spain; Princess Margaret Cancer Centre, Toronto, ON, Canada; Florida Cancer Research Institute, Plantation, FL; GlaxoSmithKline, Collegeville, PA
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Little H, Themistou E, Clarke SA, Cunningham E, Buchanan F. Process-induced degradation of bioresorbable PDLGA in bone tissue scaffold production. J Mater Sci Mater Med 2017; 29:14. [PMID: 29285611 DOI: 10.1007/s10856-017-6019-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/05/2017] [Indexed: 06/07/2023]
Abstract
Process-induced degradation of clinically relevant resorbable polymers was investigated for two thermal techniques, filament extrusion followed by fused deposition modelling (FDM). The aim was to develop a clear understanding of the relationship between temperature, processing time and resultant process-induced degradation. This acts to address the current knowledge gap in studies involving thermal processing of resorbable polymers. Poly(DL-lactide-co-glycolide) (PDLGA) was chosen for its clinically relevant resorption properties. Furthermore, a comparative study of controlled thermal exposure was conducted through compression moulding PDLGA at a selected range of temperatures (150-225 °C) and times (0.5-20 min). Differential scanning calorimetry (DSC) and gel permeation chromatography (GPC) were used to characterise thermally induced degradation behaviour. DSC proved insensitive to degradation effects, whereas GPC demonstrated distinct reductions in molecular weight allowing for the quantification of degradation. A near-exponential pattern of degradation was identified. Through the application of statistical chain scission equations, a predictive plot of theoretical degradation was created. Thermal degradation was found to have a significant effect on the molecular weight with a reduction of up to 96% experienced in the controlled processing study. The proposed empirical model may assist prediction of changes in molecular weight, however, accuracy limitations are highlighted for twin-screw extrusion, accredited to high-shear mixing. The results from this study highlight the process sensitivity of PDLGA and proposes a methodology for quantification and prediction, which contributes to efforts in understanding the influence of manufacture on performance of degradable medical implants.
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Affiliation(s)
- H Little
- School of Mechanical and Aerospace Engineering, Queens University Belfast, Ashby Building, Stranmillis Road, BT9 5AH, Belfast, UK
| | | | - S A Clarke
- School of Nursing and Midwifery, Queens University Belfast, Belfast, BT7 1NN, UK
| | - E Cunningham
- School of Mechanical and Aerospace Engineering, Queens University Belfast, Ashby Building, Stranmillis Road, BT9 5AH, Belfast, UK
| | - F Buchanan
- School of Mechanical and Aerospace Engineering, Queens University Belfast, Ashby Building, Stranmillis Road, BT9 5AH, Belfast, UK.
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Cunningham E, Amin J, Bretana N, Luciani F, Degenhardt L, Larney S, Hajarizadeh B, Dore G, Lloyd A, Grebely J. P10 Injecting risk behaviours among people who inject drugs in an Australian prison setting, 2005–2014: the HITS-p study. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30751-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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27
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Bajis S, Lamoury F, Applegate T, Maher L, Treloar C, Mowat Y, Schulz M, Hajarizadeh B, Marshall A, Cunningham E, Cock V, Ezard N, Gorton C, Hayllar J, Smith J, Dore G, Grebely J. P4 Acceptability of point of care finger-stick and venepuncture hepatitis C virus testing among people who inject drugs and homeless people. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30745-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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28
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Pollock D, Cunningham E, McGuinness B, Passmore AP. Pisa syndrome due to donepezil: pharmacokinetic interactions to blame? Age Ageing 2017; 46:529-530. [PMID: 28104598 DOI: 10.1093/ageing/afw253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/13/2016] [Accepted: 12/22/2016] [Indexed: 11/12/2022] Open
Abstract
We report a case of Pisa syndrome (PS) due to the acetylcholinesterase inhibitor donepezil which may have been precipitated by pharmacokinetic interactions with commonly used medications. PS is defined as a reversible lateral bending of the trunk with a tendency to lean to one side. This is a rare but very distressing complication with this commonly used medication which was not initially recognised, leading to increasing disability for the patient and significant carer stress. Cessation of donepezil and modulation of potential interacting medications resulted in complete resolution.
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Affiliation(s)
- David Pollock
- Elderly Care Unit, Belfast Health and Social Care trust, 51 Lisburn Road, Belfast BT9 7AB, UK
| | - Emma Cunningham
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK
| | - Bernadette McGuinness
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK
| | - Anthony Peter Passmore
- Centre for Public Health, Institute of Clinical Sciences, Queens University Belfast, Block B, Grosvenor Road, Belfast BT12 6BJ, UK
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Anathan J, Cunningham E, Foradori L, Stuart-Shor E, Sayeed S, Kerry V. Cultivating the Next Generation of Health Care Providers in Sub-Saharan
Africa: The Global Health Service Partnership – Update 2016. Ann Glob Health 2017. [DOI: 10.1016/j.aogh.2017.03.043] [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] Open
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Cunningham E, Chan YT, Aghaizu A, Bibby DF, Murphy G, Tosswill J, Harris RJ, Myers R, Field N, Delpech V, Cane PA, Gill ON, Mbisa JL. Enhanced surveillance of HIV-1 drug resistance in recently infected MSM in the UK. J Antimicrob Chemother 2016; 72:227-234. [PMID: 27742812 DOI: 10.1093/jac/dkw404] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/19/2016] [Accepted: 08/26/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the prevalence of inferred low-frequency HIV-1 transmitted drug resistance (TDR) in MSM in the UK and its predicted effect on first-line therapy. METHODS The HIV-1 pol gene was amplified from 442 newly diagnosed MSM identified as likely recently infected by serological avidity testing in 2011-13. The PCR products were sequenced by next-generation sequencing with a mutation frequency threshold of >2% and TDR mutations defined according to the 2009 WHO surveillance drug resistance mutations list. RESULTS The majority (75.6%) were infected with subtype B and 6.6% with rare complex or unique recombinant forms. At a mutation frequency threshold of >20%, 7.2% (95% CI 5.0%-10.1%) of the sequences had TDR and this doubled to 15.8% (95% CI 12.6%-19.6%) at >2% mutation frequency (P < 0.0001). The majority (26/42, 62%) of low-frequency variants were against PIs. The most common mutations detected at >20% and 2%-20% mutation frequency differed for each drug class, these respectively being: L90M (n = 7) and M46IL (n = 10) for PIs; T215rev (n = 9) and D67GN (n = 4) for NRTIs; and K103N (n = 5) and G190E (n = 2) for NNRTIs. Combined TDR was more frequent in subtype B than non-B (OR = 0.38; 95% CI = 0.17-0.88; P = 0.024) and had minimal predicted effect on recommended first-line therapies. CONCLUSIONS The data suggest differences in the types of low-frequency compared with majority TDR variants that require a better understanding of the origins and clinical significance of low-frequency variants. This will better inform diagnostic and treatment strategies.
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Affiliation(s)
- Emma Cunningham
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Yuen-Ting Chan
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Adamma Aghaizu
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - David F Bibby
- Virus Reference Department, National Infection Service, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Gary Murphy
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Jennifer Tosswill
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Ross J Harris
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, UK
| | - Richard Myers
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Nigel Field
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Valerie Delpech
- HIV and STI Department, National Infection Service, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Patricia A Cane
- Virus Reference Department, National Infection Service, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - O Noel Gill
- HIV and STI Department, National Infection Service, Public Health England, London, UK.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Jean L Mbisa
- Virus Reference Department, National Infection Service, Public Health England, London, UK .,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
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Clarke SA, Choi SY, McKechnie M, Burke G, Dunne N, Walker G, Cunningham E, Buchanan F. Osteogenic cell response to 3-D hydroxyapatite scaffolds developed via replication of natural marine sponges. J Mater Sci Mater Med 2016; 27:22. [PMID: 26704539 PMCID: PMC4690835 DOI: 10.1007/s10856-015-5630-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/13/2015] [Indexed: 06/05/2023]
Abstract
Bone tissue engineering may provide an alternative to autograft, however scaffold optimisation is required to maximize bone ingrowth. In designing scaffolds, pore architecture is important and there is evidence that cells prefer a degree of non-uniformity. The aim of this study was to compare scaffolds derived from a natural porous marine sponge (Spongia agaricina) with unique architecture to those derived from a synthetic polyurethane foam. Hydroxyapatite scaffolds of 1 cm(3) were prepared via ceramic infiltration of a marine sponge and a polyurethane (PU) foam. Human foetal osteoblasts (hFOB) were seeded at 1 × 10(5) cells/scaffold for up to 14 days. Cytotoxicity, cell number, morphology and differentiation were investigated. PU-derived scaffolds had 84-91% porosity and 99.99% pore interconnectivity. In comparison marine sponge-derived scaffolds had 56-61% porosity and 99.9% pore interconnectivity. hFOB studies showed that a greater number of cells were found on marine sponge-derived scaffolds at than on the PU scaffold but there was no significant difference in cell differentiation. X-ray diffraction and inductively coupled plasma mass spectrometry showed that Si ions were released from the marine-derived scaffold. In summary, three dimensional porous constructs have been manufactured that support cell attachment, proliferation and differentiation but significantly more cells were seen on marine-derived scaffolds. This could be due both to the chemistry and pore architecture of the scaffolds with an additional biological stimulus from presence of Si ions. Further in vivo tests in orthotopic models are required but this marine-derived scaffold shows promise for applications in bone tissue engineering.
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Affiliation(s)
- S A Clarke
- School of Nursing and Midwifery, Queen's University of Belfast, Medical Biology Centre, 97, Lisburn Road, Belfast, BT9 7BL, UK.
| | - S Y Choi
- School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Ashby Building, 121 Stranmillis Road, Belfast, BT9 5AH, UK
| | - Melanie McKechnie
- School of Biological Sciences, Queen's University of Belfast, Medical Biology Centre, 97, Lisburn Road, Belfast, BT9 7BL, UK
| | - G Burke
- Engineering Research Institute, School of Engineering, Ulster University, Jordanstown Campus, Shore Rd, Newtownabbey, BT37 0QB, UK
| | - N Dunne
- School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Ashby Building, 121 Stranmillis Road, Belfast, BT9 5AH, UK
- School of Mechanical and Manufacturing Engineering, Dublin City University, Glasnevin, Dublin, 9, Ireland
| | - G Walker
- School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Ashby Building, 121 Stranmillis Road, Belfast, BT9 5AH, UK
| | - E Cunningham
- School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Ashby Building, 121 Stranmillis Road, Belfast, BT9 5AH, UK
| | - F Buchanan
- School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Ashby Building, 121 Stranmillis Road, Belfast, BT9 5AH, UK
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Ashworth K, Douthwaite S, Mullender C, Cunningham E, O'Shea S. Dried Blood Spot (DBS) testing; An alternative approach to screening. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cunningham E, Cliff P, O'Shea S, MacMahon E. Utility of the AusDiagnostics HighPlex platform for diagnosis of respiratory viruses and atypical pneumonia pathogens. J Clin Virol 2015. [DOI: 10.1016/j.jcv.2015.07.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Pain may adversely affect cognition through its effects on mood and sleep, and chronic pain has been associated with brain atrophy. Studies suggest that chronic pain is undertreated in cognitively impaired people. Pain assessment should involve direct enquiry with the patient; where this is not possible, a proxy history from a caregiver or nurse should be obtained, and observational scales may also be useful. This report is adapted from paineurope 2014; Issue 1, Haymarket Medical Publications Ltd., and is presented with permission. paineurope is provided as a service to pain management by Mundipharma International, Ltd., and is distributed free of charge to health care professionals in Europe. Archival issues can be accessed via the Web site: http://www.paineurope.com, at which European health professionals can register online to receive copies of the quarterly publication.
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Kerry V, Daoust P, May F, Cunningham E, Mullan F, Scott J, Anathan J, Mitha K, Day D, Foradori L, Morgenthau S, McLoed M, Ahaisibwe B, Nyeka T, Meena H, Hayes L, Novotny K, O'Malley E, Fleming K. Partnering to build healthcare capacity in Uganda, Tanzania and
Malawi. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Kerry V, Daoust P, May F, Cunningham E, Mullan F, Scott J, Anathan J, Mitha K, Foradori L, Sayeed S. Evaluating the global health service partnership: Year one and future
directions. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fayolle G, Levick W, Lajiness-O'Neill R, Fastenau P, Briskin S, Bass N, Silva M, Critchfield E, Nakase-Richardson R, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Anderson A, Peery S, Chafetz M, Maris M, Ramezani A, Sylvester C, Goldberg K, Constantinou M, Karekla M, Hall J, Edwards M, Balldin V, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, lacritz L, Reisch J, Massman P, Royall D, Barber R, Younes S, Wiechmann A, O'Bryant S, Patel K, Suhr J, Patel K, Suhr J, Chari S, Yokoyama J, Bettcher B, Karydas A, Miller B, Kramer J, Zec R, Fritz S, Kohlrus S, Robbs R, Ala T, Gifford K, Cantwell N, Romano R, Jefferson A, Holland A, Newton S, Bunting J, Coe M, Carmona J, Harrison D, Puente A, Terry D, Faraco C, Brown C, Patel A, Watts A, Kent A, Siegel J, Miller S, Ernst W, Chelune G, Holdnack J, Sheehan J, Duff K, Pedraza O, Crawford J, Terry D, Puente A, Brown C, Faraco C, Watts A, Patel A, Kent A, Siegel J, Miller L, Younes S, Hobson Balldin V, Benavides H, Johnson L, Hall J, Tshuma L, O'Bryant S, Dezhkam N, Hayes L, Love C, Stephens B, Webbe F, Allen C, Lemann E, Davis A, Pierson E, Lutz J, Piehl J, Holler K, Kavanaugh B, Tayim F, Llanes S, Mulligan K, Poston K, Riccio C, Beathard J, Cohen M, Stolberg P, Hart J, Jones W, Mayfield J, Allen D, Weller J, Dunham K, Demireva P, McInerney K, Suhr J, Dykstra J, Riddle T, Suhr J, Primus M, Riccio C, Highsmith J, Everhart D, Shadi S, Lehockey K, Sullivan S, Lucas M, Mandava S, Murphy B, Donovick P, Lalwani L, Rosselli M, Coad S, Carrasco R, Sofko C, Scarisbrick D, Golden C, Coad S, Zuckerman S, Golden C, Perna R, Loughan A, Hertza J, Brand J, Rivera Mindt M, Denney R, Schaffer S, Alper K, Devinsky O, Barr W, Langer K, Fraiman J, Scagliola J, Roman E, Martinez A, Cohen M, Dunham K, Riccio C, Martin P, Robbins J, Golden C, Axelrod B, Etherton J, Konopacki K, Moses J, Juliano A, Whiteside D, Rolin S, Widmann G, Franzwa M, Sokal B, Mark V, Doyle K, Morgan E, Weber E, Bondi M, Delano-Wood L, Grant I, Sibson J, Woods S, Andrews P, McGregor S, Golden C, Etherton J, Allen C, Cormier R, Cumley N, Elek M, Green M, Ogbeide S, Kruger A, Pacheco L, Robinson G, Welch H, Etherton J, Allen C, Cormier R, Cumley N, Kruger A, Pacheco L, Glover M, Parriott D, Jones W, Loe S, Hughes L, Natta L, Moses J, Vincent A, Roebuck-Spencer T, Bryan C, Padua M, Denney R, Moses J, Quenicka W, McGoldirck K, Bennett T, Soper H, Collier S, Connolly M, Hanratty A, Di Pinto M, Magnuson S, Dunham K, Handel E, Davidson K, Livers E, Frantz S, Allen J, Jerard T, Moses J, Pierce S, Sakhai S, Newton S, Warchol A, Holland A, Bunting J, Coe M, Carmona J, Harrison D, Barney S, Thaler N, Sutton G, Strauss G, Allen D, Hunter B, Bennett T, Quenicka W, McGoldrick K, Soper H, Sordahl J, Torrence N, John S, Gavett B, O'Bryant S, Shadi S, Denney R, Nichols C, Riccio C, Cohen M, Dennison A, Wasserman T, Schleicher-Dilks S, Adler M, Golden C, Olivier T, Schleicher-Dilks S, Golden C, LeMonda B, McGinley J, Pritchett A, Chang L, Cloak C, Cunningham E, Lohaugen G, Skranes J, Ernst T, Parke E, Thaler N, Etcoff L, Allen D, Andrews P, McGregor S, Golden C, Northington S, Daniels R, Loughan A, Perna R, Hertza J, Hochsztein N, Miles-Mason E, Granader Y, Vasserman M, MacAllister W, Casto B, Peery S, Patrick K, Hurewitz F, Chute D, Booth A, Koch C, Roid G, Balkema N, Kiefel J, Bell L, Maerlender A, Belkin T, Katzenstein J, Semerjian C, Culotta V, Band E, Yosick R, Burns T, Arenivas A, Bearden D, Olson K, Jacobson K, Ubogy S, Sterling C, Taub E, Griffin A, Rickards T, Uswatte G, Davis D, Sweeney K, Llorente A, Boettcher A, Hill B, Ploetz D, Kline J, Rohling M, O'Jile J, Holler K, Petrauskas V, Long J, Casey J, Long J, Petrauskas V, Duda T, Hodsman S, Casey J, Stricker S, Martner S, Hansen R, Ferraro F, Tangen R, Hanratty A, Tanabe M, O'Callaghan E, Houskamp B, McDonald L, Pick L, Guardino D, Pick L, Pietz T, Kayser K, Gray R, Letteri A, Crisologo A, Witkin G, Sanders J, Mrazik M, Harley A, Phoong M, Melville T, La D, Gomez R, Berthelson L, Robbins J, Lane E, Golden C, Rahman P, Konopka L, Fasfous A, Zink D, Peralta-Ramirez N, Perez-Garcia M, Puente A, Su S, Lin G, Kiely T, Gomez R, Schatzberg A, Keller J, Dykstra J, Suhr J, Feigon M, Renteria L, Fong M, Piper L, Lee E, Vordenberg J, Contardo C, Magnuson S, Doninger N, Luton L, Balkema N, Drane D, Phelan A, Stricker W, Poreh A, Wolkenberg F, Spira J, Lin G, Su S, Kiely T, Gomez R, Schatzberg A, Keller J, DeRight J, Jorgensen R, Fitzpatrick L, Crowe S, Woods S, Doyle K, Weber E, Cameron M, Cattie J, Cushman C, Grant I, Blackstone K, Woods S, Weber E, Grant I, Moore D, Roberg B, Somogie M, Thelen J, Lovelace C, Bruce J, Gerstenecker A, Mast B, Litvan I, Hargrave D, Schroeder R, Buddin W, Baade L, Heinrichs R, Thelen J, Roberg B, Somogie M, Lovelace C, Bruce J, Boseck J, Berry K, Koehn E, Davis A, Meyer B, Gelder B, Sussman Z, Espe-Pfeifer P, Musso M, Barker A, Jones G, Gouvier W, Weber E, Woods S, Grant I, Johnson V, Zaytsev L, Freier-Randall M, Sutton G, Thaler N, Ringdahl E, Allen D, Olsen J, Byrd D, Rivera-Mindt M, Fellows R, Morgello S, Wheaton V, Jaehnert S, Ellis C, Olavarria H, Loftis J, Huckans M, Pimental P, Frawley J, Welch M, Jennette K, Rinehardt E, Schoenberg M, Strober L, Genova H, Wylie G, DeLuca J, Chiaravalloti N, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Hertza J, Loughan A, Perna R, Northington S, Boyd S, Ibrahim E, Seiam A, Ibrahim E, Bohlega S, Rinehardt E, Lloyd H, Goldberg M, Marceaux J, Fallows R, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Fulton R, Stevens P, Erickson S, Dodzik P, Williams R, Dsurney J, Najafizadeh L, McGovern J, Chowdhry F, Acevedo A, Bakhtiar A, Karamzadeh N, Amyot F, Gandjbakhche A, Haddad M, Taub E, Johnson M, Wade J, Harper L, Rickards T, Sterling C, Barghi A, Uswatte G, Mark V, Balkema N, Christopher G, Marcus D, Spady M, Bloom J, Wiechmann A, Hall J, Loughan A, Perna R, Hertza J, Northington S, Zimmer A, Webbe F, Miller M, Schuster D, Ebner H, Mortimer B, Webbe F, Palmer G, Happe M, Paxson J, Jurek B, Graca J, Meyers J, Lange R, Brickell T, French L, Lange R, Iverson G, Shewchuk J, Madler B, Heran M, Brubacher J, Brickell T, Lange R, Ivins B, French L, Baldassarre M, Paper T, Herrold A, Chin A, Zgaljardic D, Oden K, Lambert M, Dickson S, Miller R, Plenger P, Jacobson K, Olson K, Sutherland E, Glatts C, Schatz P, Walker K, Philip N, McClaughlin S, Mooney S, Seats E, Carnell V, Raintree J, Brown D, Hodges C, Amerson E, Kennedy C, Moore J, Schatz P, Ferris C, Roebuck-Spencer T, Vincent A, Bryan C, Catalano D, Warren A, Monden K, Driver S, Chau P, Seegmiller R, Baker M, Malach S, Mintz J, Villarreal R, Peterson A, Leininger S, Strong C, Donders J, Merritt V, Vargas G, Rabinowitz A, Arnett P, Whipple E, Schultheis M, Robinson K, Iacovone D, Biester R, Alfano D, Nicholls M, Vargas G, Rabinowitz A, Arnett P, Rabinowitz A, Vargas G, Arnett P, Klas P, Jeffay E, Zakzanis K, Vandermeer M, Jeffay E, Zakzanis K, Womble M, Rohling M, Hill B, Corley E, Considine C, Fichtenberg N, Harrison J, Pollock M, Mouanoutoua A, Brimager A, Lebby P, Sullivan K, Edmed S, Silva M, Nakase-Richardson R, Critchfield E, Kieffer K, McCarthy M, Wiegand L, Lindsey H, Hernandez M, Puente A, Noniyeva Y, Lapis Y, Padua M, Poole J, Brooks B, McKay C, Mrazik M, Meeuwisse W, Emery C, Brooks B, Mazur-Mosiewicz A, Sherman E, Brooks B, Mazur-Mosiewicz A, Kirkwood M, Sherman E, Gunner J, Miele A, Silk-Eglit G, Lynch J, McCaffrey R, Stewart J, Tsou J, Scarisbrick D, Chan R, Bure-Reyes A, Cortes L, Gindy S, Golden C, Hunter B, Biddle C, Shah D, Jaberg P, Moss R, Horner M, VanKirk K, Dismuke C, Turner T, Muzzy W, Dunnam M, Miele A, Warner G, Donnelly K, Donnelly J, Kittleson J, Bradshaw C, Alt M, Margolis S, Ostroy E, Rolin S, Higgins K, Denney R, Rolin S, Eng K, Biddle C, Akeson S, Wall J, Davis J, Hansel J, Hill B, Rohling M, Wang B, Womble M, Gervais R, Greiffenstein M, Denning J, Denning J, Schroeder R, Buddin W, Hargrave D, VonDran E, Campbell E, Brockman C, Heinrichs R, Baade L, Buddin W, Hargrave D, Schroeder R, Teichner G, Waid R, Buddin W, Schroeder R, Teichner G, Waid R, Buican B, Armistead-Jehle P, Bailie J, Dilay A, Cottingham M, Boyd C, Asmussen S, Neff J, Schalk S, Jensen L, DenBoer J, Hall S, DenBoer J, Schalk S, Jensen L, Hall S, Miele A, Lynch J, McCaffrey R, Holcomb E, Axelrod B, Demakis G, Rimland C, Ward J, Ross M, Bailey M, Stubblefield A, Smigielski J, Geske J, Karpyak V, Reese C, Larrabee G, Suhr J, Silk-Eglit G, Gunner J, Miele A, Lynch J, McCaffrey R, Allen L, Celinski M, Gilman J, Davis J, Wall J, LaDuke C, DeMatteo D, Heilbrun K, Swirsky-Sacchetti T, Lindsey H, Puente A, Dedman A, Withers K, Chafetz M, Deneen T, Denney R, Fisher J, Spray B, Savage R, Wiener H, Tyer J, Ningaonkar V, Devlin B, Go R, Sharma V, Tsou J, Golden C, Fontanetta R, Calderon C, Coad S, Golden C, Calderon C, Fontaneta R, Coad S, Golden C, Ringdahl E, Thaler N, Sutton G, Vertinski M, Allen D, Verbiest R, Thaler N, Snyder J, Kinney J, Allen D, Rach A, Young J, Crouse E, Schretlen D, Weaver J, Buchholz A, Gordon B, Macciocchi S, Seel R, Godsall R, Brotsky J, DiRocco A, Houghton-Faryna E, Bolinger E, Hollenbeck C, Hart J, Thaler N, Vertinski M, Ringdahl E, Allen D, Lee B, Strauss G, Adams J, Martins D, Catalano L, Waltz J, Gold J, Haas G, Brown L, Luther J, Goldstein G, Kiely T, Kelley E, Lin G, Su S, Raba C, Gomez R, Trettin L, Solvason H, Schatzberg A, Keller J, Vertinski M, Thaler N, Allen D, Gold J, Buchanan R, Strauss G, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Fallows R, Marceaux J, McCoy K, Yehyawi N, Luther E, Hilsabeck R, Etherton J, Phelps T, Richmond S, Tapscott B, Thomlinson S, Cordeiro L, Wilkening G, Parikh M, Graham L, Grosch M, Hynan L, Weiner M, Cullum C, Hobson Balldin V, Menon C, Younes S, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum M, Lacritz L, Reisch J, Massman P, Royall D, Barber R, O'Bryant S, Castro-Couch M, Irani F, Houshyarnejad A, Norman M, Peery S, Fonseca F, Bure-Reyes A, Browne B, Alvarez J, Jiminez Y, Baez V, Cortes L, Golden C, Fonseca F, Bure-Reyes A, Coad S, Alvarez J, Browne B, Baez V, Golden C, Resendiz C, Scott B, Farias G, York M, Lozano V, Mahoney M, Strutt A, Hernandez Mejia M, Puente A, Bure-Reyes A, Fonseca F, Baez V, Alvarez J, Browne B, Coad S, Jiminez Y, Cortes L, Golden C, Bure-Reyes A, Pacheco E, Homs A, Acevedo A, Ownby R, Nici J, Hom J, Lutz J, Dean R, Finch H, Pierce S, Moses J, Mann S, Feinberg J, Choi A, Kaminetskaya M, Pierce C, Zacharewicz M, Axelrod B, Gavett B, Horwitz J, Edwards M, O'Bryant S, Ory J, Gouvier W, Carbuccia K, Ory J, Carbuccia K, Gouvier W, Morra L, Garcon S, Lucas M, Donovick P, Whearty K, Campbell K, Camlic S, Donovick P, Edwards M, Balldin V, Hall J, Strutt A, Pavlik V, Marquez de la Plata C, Cullum C, Lacritz L, Reisch J, Massman P, Barber R, Royall D, Younes S, O'Bryant S, Brinckman D, Schultheis M, Ehrhart L, Weisser V, Medaglia J, Merzagora A, Reckess G, Ho T, Testa S, Gordon B, Schretlen D, Woolery H, Farcello C, Klimas N, Thaler N, Allen D, Meyer J, Vargas G, Rabinowitz A, Barwick F, Arnett P, Womble M, Rohling M, Hill B, Corley E, Drayer K, Rohling M, Ploetz D, Womble M, Hill B, Baldock D, Ringdahl E, Sutton G, Thaler N, Allen D, Galusha J, Schmitt A, Livingston R, Stewart R, Quarles L, Pagitt M, Barke C, Baker A, Baker N, Cook N, Ahern D, Correia S, Resnik L, Barnabe K, Gnepp D, Benjamin M, Zlatar Z, Garcia A, Harnish S, Crosson B, Rickards T, Mark V, Taub E, Sterling C, Vaughan L, Uswatte G, Fedio A, Sexton J, Cummings S, Logemann A, Lassiter N, Fedio P, Gremillion A, Nemeth D, Whittington T, Hansen R, Reckow J, Ferraro F, Lewandowski C, Cole J, Lewandowski A, Spector J, Ford-Johnson L, Lengenfelder J, Genova H, Sumowski J, DeLuca J, Chiaravalloti N, Loughan A, Perna R, Hertza J, Morse C, McKeever J, Zhao L, Leist T, Schultheis M, Marcinak J, Piecora K, Al-Khalil K, Webbe F, Mulligan K, Robbins J, Berthelson L, Martin P, Golden C, Piecora K, Marcinak J, Al-Khalil K, Webbe F, Mulligan K, Stewart J, Acevedo A, Ownby R, Thompson L, Kowalczyk W, Golub S, Davis A, Lemann E, Piehl J, Rita N, Moss L, Davis A, Boseck J, Berry K, Koehn E, Meyer B, Gelder B, Davis A, Nogin R, Moss L, Drapeau C, Malm S, Davis A, Lemann E, Koehn E, Drapeau C, Malm S, Boseck J, Armstrong L, Glidewell R, Orr W, Mears G. Grand Rounds. Arch Clin Neuropsychol 2012. [DOI: 10.1093/arclin/acs070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cunningham E, Dunne N. Comparative Characterisation of 3-D Hydroxyapatite Scaffolds Developed Via Replication of Synthetic Polymer Foams and Natural Marine Sponges. ACTA ACUST UNITED AC 2011. [DOI: 10.4172/2157-7552.s1-001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cunningham E, Dunne N, Walker G, Buchanan F. High-solid-content hydroxyapatite slurry for the production of bone substitute scaffolds. Proc Inst Mech Eng H 2009; 223:727-37. [DOI: 10.1243/09544119jeim564] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Key to various bone substitute scaffold production techniques is the development of free-flowing ceramic slurry with optimum rheological properties. The aim is to achieve a colloidal suspension with as high a solid content as possible while maintaining a low viscosity which easily penetrates the pores of relevant sacrificial templates. The following investigation describes the optimization of a hydroxyapatite slip and demonstrates its potential application in scaffold production. Using predominantly spherical particles of hydroxyapatite of between 0.82 μm and 16.2 μm, coupled with a 2 wt % addition of the anionic polyelectrolyte, ammonium polyacrylate, an 80 wt % (55.9 vol %) hydroxyapatite solid loaded slip with a viscosity of approximately 126 mPa s has been developed. Its ability to infiltrate and replicate porous preforms has been shown using polyurethane foam. The enhanced particle packing achieved has allowed for the production of scaffolds with highly dense and uniform grain structures. The results represent a significant improvement in current slurry production techniques and can be utilized to develop high-density ceramic bone substitute scaffolds.
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Affiliation(s)
- E Cunningham
- Department of Mechanical Engineering, Queen's University Belfast, Belfast, UK
| | - N Dunne
- Department of Mechanical Engineering, Queen's University Belfast, Belfast, UK
| | - G Walker
- School of Chemistry and Chemical Engineering, Queen's University Belfast, David Keir Institute, Belfast, UK
| | - F Buchanan
- Department of Mechanical Engineering, Queen's University Belfast, Belfast, UK
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Wroe S, Huber DR, Lowry M, McHenry C, Moreno K, Clausen P, Ferrara TL, Cunningham E, Dean MN, Summers AP. Three-dimensional computer analysis of white shark jaw mechanics: how hard can a great white bite? J Zool (1987) 2008. [DOI: 10.1111/j.1469-7998.2008.00494.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Singerman LJ, Masonson H, Patel M, Adamis AP, Buggage R, Cunningham E, Goldbaum M, Katz B, Guyer D. Pegaptanib sodium for neovascular age-related macular degeneration: third-year safety results of the VEGF Inhibition Study in Ocular Neovascularisation (VISION) trial. Br J Ophthalmol 2008; 92:1606-11. [PMID: 18614570 PMCID: PMC2584239 DOI: 10.1136/bjo.2007.132597] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aims: To evaluate the safety of up to 3 years of pegaptanib sodium therapy in the treatment of neovascular age-related macular degeneration (NV-AMD). Methods: Two concurrent, prospective, multicentre, double-masked studies randomised subjects with all angiographic lesion compositions of NV-AMD to receive intravitreous pegaptanib sodium (0.3, 1 and 3 mg) or sham injections every 6 weeks for 54 weeks. Those initially assigned to pegaptanib were rerandomised to continue or discontinue therapy for 48 more weeks; sham-treated subjects continued sham, discontinued or received pegaptanib. At 102 weeks, subjects receiving pegaptanib 0.3 mg or 1 mg in years 1 or 2 continued; those receiving pegaptanib 3 mg or who did not receive treatment in years 1 and 2 were rerandomised to 0.3 mg or 1 mg for year 3. Results: As in years 1 and 2, pegaptanib was well tolerated in year 3. Adverse events were mainly ocular in nature, mild, transient and injection-related. Serious adverse events were rare. No evidence of systemic safety signals attributed to vascular endothelial growth factor inhibition arose in year 3. There were no findings in relation to vital signs or electrocardiogram results suggesting a relationship to pegaptanib treatment. Conclusion: The 3-year safety profile of pegaptanib sodium was favourable in patients with NV-AMD.
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Affiliation(s)
- L J Singerman
- Retina Associates of Cleveland, 3401 Enterprise Parkway, Suite 300, Cleveland, OH 44122, USA.
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Cameron B, Cunningham E, Lindner A, Nicol L, Chenoweth L, Driscoll C. Hearing Aid Use and Satisfaction in Young Australian Adults With Severe to Profound Hearing Loss. ACTA ACUST UNITED AC 2008. [DOI: 10.1375/audi.30.1.59] [Citation(s) in RCA: 4] [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: 11/05/2022]
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De Jesus-Monge WE, Santos R, Serrano J, Cunningham E. 1 APICAL PLEURAL EMPYEMA IN A HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE AND INJECTION DRUG USER MALE. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006] [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: 11/18/2022]
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De Jesus-Monge WE, Santos R, Serrano J, Cunningham E. 198 STERILE PLEURAL EMPYEMA IN A HUMAN IMMUNODEFICIENCY VIRUS-POSITIVE AND INJECTION DRUG USER MALE. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.197] [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: 11/18/2022]
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Affiliation(s)
- E Cunningham
- American Dietetic Association's Knowledge Center, Chicago, IL, USA.
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