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Willder S, Kelsey E, O'Connor E, Grills R. Expanding urological services into regional Australia and reducing interhospital transfers: how the nurse practitioner can help. ANZ J Surg 2024. [PMID: 38619216 DOI: 10.1111/ans.18993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/25/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND A visiting urology service has been in existence at Hamilton Base Hospital, Western Victoria, over the past 25 years, serving an unmet need. A Urology Nurse Practitioner (UNP) provides the care and management of urology patients working in close association with visiting urologists. We aim to assess the impact of the UNP's role in the delivery of regional urological care. METHODS A retrospective analysis of medical records identified all clinical interventions by the UNP between January 2016 and December 2019. Each encounter was graded according to a clinical severity scale from grade 1 to 5 and assessed for UNP management of patients and the prevention of interhospital transfers. RESULTS One hundred eighty-four patients with 654 individual assessments were identified for inclusion and classified according to the adapted clinical severity scale. Most interventions for category 3 and 4 patients related to major bleeding, catheter difficulties, and haemodynamic instability. A total of 19 patients whose urological issues would typically require interhospital transfer were able to be managed locally. CONCLUSIONS Transferring an acute patient from a regional to a tertiary hospital for specialist care is often necessary but not ideal for the patient and their family. The presence of a dedicated UNP in a regional centre is important for patient care and has an important role in preventing unnecessary transfers. This is a vital component of a visiting urological service to a rural community.
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Affiliation(s)
- S Willder
- Depatment of Surgery, Western District Health Service, Hamilton, Victoria, Australia
| | - E Kelsey
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - E O'Connor
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
| | - R Grills
- Depatment of Surgery, Western District Health Service, Hamilton, Victoria, Australia
- Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia
- Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia
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2
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O'Connor E, Treacy A, Mitchell A, Swan N. The role of multidisciplinary team meeting histopathology review and its impact on revised reports: Analysis of a national quality improvement program. Am J Clin Pathol 2024:aqad183. [PMID: 38330196 DOI: 10.1093/ajcp/aqad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/19/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES We conducted the first Irish national study assessing the value of multidisciplinary team meeting review in pathology practice and its impact on error detection before treatment. METHODS Public and private pathology laboratories across Ireland capture their quality activities using standardized codes and submit their data to a centralized database (National Quality Assurance Intelligence System) overseen by the National Histopathology Quality Improvement (NHQI) program. A total of 1,437,746 histopathology and cytopathology cases submitted to the NHQI program over a 60-month period (January 2017 to December 2021) were included in this study. Cases were analyzed with respect to multidisciplinary team meeting peer review and the presence of a revised report (amended or corrected report), a surrogate marker for error detection before treatment. RESULTS Across all cases assessed, 13.74% (197,587) underwent multidisciplinary team meeting discussion. Cases discussed at review had a statistically significantly higher rate of revised reports (1.25% [2470]) than cases not discussed at review (0.16% [1959]) (Pearson χ2, 6619.26; P < .0001; odds ratio, 8.00 [95% CI, 7.54-8.49]). Overall, multidisciplinary team meeting review made it 8 times more likely to detect an error before treatment. Cancer resections had the highest rate of review at 55.29% (46,806), reflecting the prioritization of oncology case discussion at review meetings. CONCLUSIONS The multidisciplinary team meeting review process plays a valuable role in pathology error detection. A pathologist's participation in the review process comes with a clinically significant workload that needs to be recognized for future workforce planning. This study highlighted the positive role pathologists play in enhancing patient safety.
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Affiliation(s)
| | | | - Aine Mitchell
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Niall Swan
- St Vincent's University Hospital, Dublin, Ireland
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3
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Deane C, O'Connor E, O'Donovan H, McHale C, Alvain A, Shannon E, Tormey V, Hynes SO, Byrnes V. The strategic use of biopsy in the diagnosis of coeliac disease in adults. Dig Liver Dis 2023; 55:1647-1651. [PMID: 37596152 DOI: 10.1016/j.dld.2023.07.021] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND The paediatric guidelines support the use of the 'No Biopsy Approach' in the diagnosis of coeliac disease (CD). We aimed to determine the correlation between anti tissue transglutaminase (anti-TTG serology) ≥10 times the upper limit of normal (ULN), using the Celikey ® ELiA assay and histological findings. Our secondary aim was to determine the safety of this approach in our centre. METHODS A retrospective analysis of adult patients referred to a tertiary referral centre with raised anti-TTG titres and/or histological changes of coeliac on D2 biopsies between 2014 - 2019. Excluded patients were those who did not have a biopsy performed, or whose biopsy was unavailable for review, selective IgA deficiency, and gluten elimination prior to biopsy. Biopsies were classified according to Marsh, by two independent pathologists, blinded to the anti-TTG titre. RESULTS 164 patients had positive anti-TTG serology and duodenal biopsy in our centre prior to starting a gluten free diet (GFD) in the period 2014 - 2019. Of these 164 patients (median age 40yrs, 62% female), 68 (33%) had an anti-TTG titre ≥10 x ULN, 99% of which had a Marsh grading ≥ 3 and 1% had a Marsh of 2 on biopsy. 91% had either a normal index gastroscopy or findings of mild gastritis/oesophagitis. CONCLUSIONS We found a 98.5% positive predictive value (PPV) of determining CD (i.e., Marsh ≥ 3) in those with an anti-TTG ≥10 x ULN. In those with moderate to high-risk clinical suspicion of CD we propose that duodenal biopsy is unnecessary for diagnosis.
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Affiliation(s)
- Charlene Deane
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland.
| | - Eoghan O'Connor
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - Helen O'Donovan
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Ciaran McHale
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Aoife Alvain
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Eileen Shannon
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Vincent Tormey
- Department of Immunology, Galway University Hospital, Galway, Ireland
| | - Sean O Hynes
- Department of Pathology, Galway University Hospital, Galway, Ireland
| | - Valerie Byrnes
- Department of Gastroenterology, Galway University Hospital, Galway, Ireland
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4
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Versace J, Tazrin S, O'Connor E, Sekibo J, Morey E, Kasinopoulou A, O'Donoghue D, Simblett SK. The role of spirituality and identity formation in personal recovery from traumatic brain injury: A qualitative analysis through the personal experiences of survivors. Neuropsychol Rehabil 2023:1-31. [PMID: 38006578 DOI: 10.1080/09602011.2023.2274624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/04/2023] [Indexed: 11/27/2023]
Abstract
Traumatic brain injury (TBI) is a type of acquired brain injury (ABI) that happens when a sudden, external, physical assault damages the brain. TBI can cause long-term cognitive impairments and other lifestyle changes that may affect psychological wellbeing. Among the psychological challenges people recovering from TBI often face is the subjective loss of their pre-injury identity. Quantitative and qualitative research suggests that spirituality can play a positive role in recovery from TBI, increasing the quality of life and overall mental health. However, thus far, the research into this topic has not directly addressed the relationship between identity and spirituality after TBI. The present study sought to do this by thematically analyzing 22 public podcasts featuring interviews of people recovering from TBI telling their stories. The authors review the spiritual themes discussed in the podcasts and then propose a hypothesis about how, through a sense of connection to something self-transcendent, spirituality may enable people to test new meanings and identities, relatively free from the consequences of discrepancy in meaning and identity after TBI.
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Affiliation(s)
- J Versace
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S Tazrin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E O'Connor
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - J Sekibo
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Morey
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - A Kasinopoulou
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - D O'Donoghue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S K Simblett
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Nic An Ríogh E, McCombe G, Connolly SP, Fawsitt R, McHugh T, O'Connor E, Stewart S, Swan D, Tinago W, Cullen W, Lambert JS. A mixed methods study of attendance and treatment rates among patients with Hepatitis C. Ir Med J 2023; 116:742. [PMID: 37010498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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O'Connor E, O'Riordan M, Morrissey MC, Dever N, O'Mahony C, Romanowski S, Boland M. A methodological approach to intra-action reviews - application and adaptation of existing global guidance during the COVID-19 pandemic response in Ireland, 2021. Euro Surveill 2023; 28. [PMID: 36995372 PMCID: PMC10064645 DOI: 10.2807/1560-7917.es.2023.28.13.2200475] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Many countries were under-prepared for the arrival of an emergency such as the COVID-19 pandemic. An intra-action review allows countries, systems and services to reflect on their preparedness and response to date, and revise their policies and approaches as needed. We describe the approach to undertaking an intra-action review of Ireland's Health Protection COVID-19 response during 2021. A project team within National Health Protection developed a project plan, identified key stakeholders, trained facilitators and designed workshop programmes, employing integrated collaborative web tools. Multidisciplinary representatives participated in three half-day, independently facilitated workshops on challenges and solutions within specific response areas: communication, governance and cross-cutting themes such as staff well-being. An all-stakeholder survey sought further in-depth detail. Participants reviewed the ongoing pandemic response in terms of good practice and challenges and recommended implementable solutions. We customised our mixed-methods approach using existing ECDC/WHO guidance, producing consensus recommendations during Ireland's fourth wave of COVID-19, with particular focus on pathways to implementation. Our adaptations may help others in formulating and customising methodological approaches. During an emergency, identifying and reflecting on good practices to retain, and areas for strengthening, with a clear action plan of implementing recommendations, will enhance preparedness now, and for future emergencies.
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Affiliation(s)
- Eoghan O'Connor
- Specialist Registrar Training Programme, Health Service Executive, Dublin, Ireland
| | - Mary O'Riordan
- National Health Protection Service, Health Service Executive, Dublin, Ireland
| | - Mary C Morrissey
- National Health Intelligence Unit, Research and Evidence, Health Service Executive, Dublin, Ireland
| | - Niamh Dever
- National Health Protection Service, Health Service Executive, Dublin, Ireland
- Specialist Registrar Training Programme, Health Service Executive, Dublin, Ireland
| | - Cliodhna O'Mahony
- National Health Protection Service, Health Service Executive, Dublin, Ireland
| | - Shem Romanowski
- National Health Protection Service, Health Service Executive, Dublin, Ireland
| | - Máirín Boland
- Public Health and Primary Care Dept, School of Medicine, Trinity College Dublin, Ireland
- National Health Protection Service, Health Service Executive, Dublin, Ireland
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7
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Nic An Ríogh E, McCombe G, Connolly SP, Fawsitt R, McHugh T, O'Connor E, Stewart S, Swan D, Tinago W, Cullen W, Lambert JS. A mixed methods study of Attendance and Treatment Rates among Patients with Hepatitis C. Ir Med J 2023; 116:742. [PMID: 36976262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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O'Mahony L, O'Shea E, O'Connor E, Tierney A, Dunne N, Harkin M, Harrington J, Tobin K, Kennelly S, Arendt E, O'Toole P, Timmons S. 36 WHAT DO OLDER ADULTS AND HEALTH CARE PROFESSIONALS LOOK FOR IN A FOOD PRODUCT? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Mediterranean diet (Medi-diet) has proven benefits for healthy ageing but isn’t the habitual diet of most middle-aged or older adults in Ireland; there can be accessibility and tolerability issues with high amounts of fresh fruit and vegetables. Providing key Medi-diet nutrients in a food product is a novel approach to this challenge. This research aims to explore what ‘younger-old’ adults and healthcare professionals (HCPs) would value in such a novel food product.
Methods
Semi-structured 1:1 interviews and Focus Groups (FGs) were conducted remotely from July 2021 to January 2022. Older adults, defined as over 55’s, were recruited through relevant social, retirement and disease-support groups. Purposive sampling recruited a gender balance and a range of ages and disease profiles. HCPs were recruited through researcher networks and professional associations. Interviews/FGs were recorded, transcribed, and subsequently examined using inductive thematic analysis.
Results
Older adults (n=47; 50% male) were mostly aged 60-69 years (48.9%). Recruited HCPs (n=26) included dieticians (n=8); geriatricians (n=5); therapists (n=4); and nurses, pharmacists, catering managers (community; residential), and meal delivery service coordinators (n=2 each). Participants supported a food product for older adults requiring a nutrient-dense “boost”, or supplementary fibre or protein, but generally preferred a “food-first” approach, as opposed to a “silver bullet” product. Older adults largely associated functional foods with probiotic products “to repair the gut”, something to have “every now and then”. Product texture and portion size should consider changing dentition and appetite, and consider packaging (dexterity) and preparation ease, but should not stigmatize older adults through targeted branding. Participants felt pre-made soups or cake-type bars would be appealing, but not drinks.
Conclusion
A novel food product could supplement a balanced diet for older adults, providing high-protein content, and high-fibre for gut health, complimenting an overall lifestyle approach to health improvement and disease prevention.
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Affiliation(s)
- L O'Mahony
- University College Cork Centre for Gerontology and Rehabilitation, School of Medicine, , Cork, Ireland
| | - E O'Shea
- University College Cork Centre for Gerontology and Rehabilitation, School of Medicine, , Cork, Ireland
| | - E O'Connor
- University of Limerick Department of Biological Sciences, , Limerick, Ireland
- University of Limerick Health Research Institute, , Limerick, Ireland
- University College Cork APC Microbiome Ireland, Alimentary Pharmabiotic Centre, , Cork, Ireland
| | - A Tierney
- University of Limerick School of Allied Health, Health Implementation Science and Technology Research Group, , Limerick, Ireland
| | - N Dunne
- Family Carers Ireland , Dublin, Ireland
| | - M Harkin
- Age & Opportunity , Dublin, Ireland
| | - J Harrington
- University College Cork School of Public Health, , Cork, Ireland
| | - K Tobin
- Munster Technological University Clean Technology Centre, , Cork, Ireland
| | - S Kennelly
- National Primary Care Strategy and Planner, Health Service Executive, Ireland , Dublin, Ireland
| | - E Arendt
- University College Cork School of Food and Nutritional Sciences, , Cork, Ireland
| | - P O'Toole
- University College Cork School of Microbiology, , Cork, Ireland
- University College Cork APC Microbiome Ireland, Alimentary Pharmabiotic Centre, , Cork, Ireland
| | - S Timmons
- University College Cork Centre for Gerontology and Rehabilitation, School of Medicine, , Cork, Ireland
- University College Cork APC Microbiome Ireland, Alimentary Pharmabiotic Centre, , Cork, Ireland
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9
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Hughes C, Barron F, O'Sullivan E, O'Connor E. Applying learning from 1st to the 3rd wave of the COVID19 pandemic: nutritional provision in critical care. Clin Nutr ESPEN 2022. [PMCID: PMC8937579 DOI: 10.1016/j.clnesp.2022.02.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Barron F, Hughes C, O'Sullivan E, Wrenne A, O'Connor E. An analysis of nutrition support in the intensive care unit during the covid19 pandemic. Clin Nutr ESPEN 2021. [PMCID: PMC8629537 DOI: 10.1016/j.clnesp.2021.09.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Hughes C, Barron F, O'Sullivan E, Wreene A, O'Connor E. Applying learning from 1st to the 3rd wave of the covid19 pandemic: nutritional provision in critical care. Clin Nutr ESPEN 2021. [PMCID: PMC8629574 DOI: 10.1016/j.clnesp.2021.09.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Cairns G, Burté F, Price R, O'Connor E, Toms M, Mishra R, Moosajee M, Pyle A, Sayer JA, Yu-Wai-Man P. A mutant wfs1 zebrafish model of Wolfram syndrome manifesting visual dysfunction and developmental delay. Sci Rep 2021; 11:20491. [PMID: 34650143 PMCID: PMC8516871 DOI: 10.1038/s41598-021-99781-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/28/2021] [Indexed: 11/09/2022] Open
Abstract
Wolfram syndrome (WS) is an ultra-rare progressive neurodegenerative disorder defined by early-onset diabetes mellitus and optic atrophy. The majority of patients harbour recessive mutations in the WFS1 gene, which encodes for Wolframin, a transmembrane endoplasmic reticulum protein. There is limited availability of human ocular and brain tissues, and there are few animal models for WS that replicate the neuropathology and clinical phenotype seen in this disorder. We, therefore, characterised two wfs1 zebrafish knockout models harbouring nonsense wfs1a and wfs1b mutations. Both homozygous mutant wfs1a-/- and wfs1b-/- embryos showed significant morphological abnormalities in early development. The wfs1b-/- zebrafish exhibited a more pronounced neurodegenerative phenotype with delayed neuronal development, progressive loss of retinal ganglion cells and clear evidence of visual dysfunction on functional testing. At 12 months of age, wfs1b-/- zebrafish had a significantly lower RGC density per 100 μm2 (mean ± standard deviation; 19 ± 1.7) compared with wild-type (WT) zebrafish (25 ± 2.3, p < 0.001). The optokinetic response for wfs1b-/- zebrafish was significantly reduced at 8 and 16 rpm testing speeds at both 4 and 12 months of age compared with WT zebrafish. An upregulation of the unfolded protein response was observed in mutant zebrafish indicative of increased endoplasmic reticulum stress. Mutant wfs1b-/- zebrafish exhibit some of the key features seen in patients with WS, providing a versatile and cost-effective in vivo model that can be used to further investigate the underlying pathophysiology of WS and potential therapeutic interventions.
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Affiliation(s)
- G Cairns
- International Centre for Life, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Interdisciplinary School of Health Science, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - F Burté
- International Centre for Life, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - R Price
- International Centre for Life, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - E O'Connor
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - M Toms
- UCL Institute of Ophthalmology, University College London, London, UK
| | - R Mishra
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - M Moosajee
- UCL Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Great Ormond Street Hospital for Children NHS Foundation, Trust, London, UK
| | - A Pyle
- The Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - J A Sayer
- International Centre for Life, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
- Department of Renal Medicine, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - P Yu-Wai-Man
- UCL Institute of Ophthalmology, University College London, London, UK.
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
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O'Connor E, Mullins M, O'Connor D, Phelan S, Bruzzi J. The relationship between ultrasound microcalcifications and psammoma bodies in thyroid tumours: a single-institution retrospective study. Clin Radiol 2021; 77:e48-e54. [PMID: 34627599 DOI: 10.1016/j.crad.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
AIM To investigate the diagnostic accuracy of ultrasound microcalcifications for the detection of malignancy in thyroid nodules and determine the validity of the concept that ultrasound microcalcification reflects the presence of psammoma body calcification in thyroid nodules. MATERIALS AND METHODS The laboratory information system at University Hospital Galway, a tertiary referral hospital, was used to compile a list of patients who underwent thyroid lobectomy or complete thyroidectomy over a continuous 12-month period with both preoperative ultrasound and postoperative histology available (n=106) from January to December 2019. The haematoxylin and eosin-stained histology slides of each case were sourced and reviewed under light microscopy by a histopathologist to determine the presence of psammoma body calcification within both benign and malignant thyroid nodules. Two radiologists reviewed preoperative thyroid ultrasound images of each case independently and blindly, and reported on the presence of ultrasonographic microcalcification. RESULTS There was a strong and significant relationship between the presence of preoperative ultrasound microcalcification and thyroid malignancy (p<0.001). Ultrasound microcalcification had a high specificity (93%) and positive predictive value (75%) for thyroid malignancy, with a diagnostic accuracy of 76%. Negative predictive value was high at 76.7%, while sensitivity was low at 42.8%. There was a strong and significant association between the presence of preoperative ultrasound microcalcification in thyroid nodules and the presence of pathological psammoma bodies on histology (p<0.001). DISCUSSION Ultrasound microcalcification has a strong and significant association with malignancy in thyroid nodules. This study supported the theory that ultrasound microcalcification occurs secondary to the presence of psammoma bodies within thyroid nodules.
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Affiliation(s)
- E O'Connor
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland.
| | - M Mullins
- Radiology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - D O'Connor
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - S Phelan
- Histopathology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
| | - J Bruzzi
- Radiology Department, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
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14
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O'Connor E, O'Connor D, Murray D, Quinn AM. Impact of the COVID-19 pandemic on cytopathology services in the West of Ireland. J Clin Pathol 2021; 75:359-360. [PMID: 34518363 DOI: 10.1136/jclinpath-2021-207850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 01/12/2023]
Affiliation(s)
- Eoghan O'Connor
- Histopathology, Galway University Hospitals, Galway, Ireland
| | | | - David Murray
- Histopathology, Galway University Hospitals, Galway, Ireland
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15
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Newman C, Egan AM, Ahern T, Al-Kiyumi M, Balan G, Brassill MJ, Brosnan E, Carmody L, Clarke H, Coogan Kelly C, Culliney L, Davern R, Durkan M, Fenlon M, Ferry P, Hanlon G, Higgins T, Hoashi S, Khamis A, Kinsley B, Kirwan B, Kyithar P, Liew A, Matthews L, McGurk C, McHugh C, Murphy MS, Murphy P, Nagodra D, Noctor E, Nolan M, O'Connor E, O'Halloran D, O'Mahoney L, O'Sullivan E, Peters M, Roberts G, Rooney H, Smyth A, Tarachand B, Todd M, Tuthill A, Wan Mahmood WA, Yousif O, Dunne FP. Diabetes care and pregnancy outcomes for women with pregestational diabetes in Ireland. Diabetes Res Clin Pract 2021; 173:108685. [PMID: 33548336 DOI: 10.1016/j.diabres.2021.108685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/16/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
AIMS Pre-gestational diabetes mellitus (PGDM) is associated with adverse outcomes. We aimed to examine pregnancies affected by PGDM; report on these pregnancy outcomes and compare outcomes for patients with type 1 versus type 2 diabetes mellitus; compare our findings to published Irish and United Kingdom (UK) data and identify potential areas for improvement. METHODS Between 2016 and 2018 information on 679 pregnancies from 415 women with type 1 Diabetes Mellitus and 244 women with type 2 diabetes was analysed. Data was collected on maternal characteristics; pregnancy preparation; glycaemic control; pregnancy related complications; foetal and maternal outcomes; unscheduled hospitalisations; congenital anomalies and perinatal deaths. RESULTS Only 15.9% of women were adequately prepared for pregnancy. Significant deficits were identified in availability and attendance at pre-pregnancy clinic, use of folic acid, attaining appropriate glycaemic targets and appropriate retinal screening. The majority of pregnancies (n = 567, 83.5%) resulted in a live birth but the large number of infants born large for gestational age (LGA) (n = 280, 49.4%), born prematurely <37 weeks and requiring neonatal intensive care unit (NICU) admission continue to be significant issues. CONCLUSIONS This retrospective cohort study identifies multiple targets for improvements in the provision of care to women with pre-gestational DM which are likely to translate into better pregnancy outcomes.
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Affiliation(s)
- C Newman
- Galway University Hospital, Galway, Ireland.
| | - A M Egan
- Division of Endocrinology Mayo Clinic, Rochester, United States
| | - T Ahern
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - M Al-Kiyumi
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - G Balan
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - M J Brassill
- South Tipperary General Hospital, Clonmel, Co Tipperary, Ireland
| | - E Brosnan
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - L Carmody
- Galway University Hospital, Galway, Ireland
| | - H Clarke
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - C Coogan Kelly
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - L Culliney
- Cork University Hospital, Cork, Co Cork, Ireland
| | - R Davern
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - M Durkan
- Bons Secours Hospital, Cork, Co Cork, Ireland
| | - M Fenlon
- Wexford General Hospital, Co Wexford, Ireland
| | - P Ferry
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - G Hanlon
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - T Higgins
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - S Hoashi
- Mullingar Regional Hospital, Mullingar, Co Westmeath, Ireland
| | - A Khamis
- Letterkenny General Hospital, Letterkenny, Co Donegal, Ireland
| | - B Kinsley
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Kirwan
- Galway University Hospital, Galway, Ireland
| | - P Kyithar
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - A Liew
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - L Matthews
- Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland
| | - C McGurk
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - C McHugh
- Sligo University Hospital, Co Sligo, Ireland
| | - M S Murphy
- South Infirmary Victoria Hospital, Cork, Co Cork, Ireland
| | - P Murphy
- Cork University Hospital, Cork, Co Cork, Ireland
| | - D Nagodra
- Portlaoise General Hospital, Portlaoise, Co Laois, Ireland
| | - E Noctor
- Limerick University Hospital, Co Limerick, Ireland
| | - M Nolan
- University Hospital Kerry, Tralee, Co Kerry, Ireland
| | - E O'Connor
- Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - D O'Halloran
- Cork University Hospital, Cork, Co Cork, Ireland
| | - L O'Mahoney
- Cork University Hospital, Cork, Co Cork, Ireland
| | | | - M Peters
- University Hospital Waterford, Co Waterford, Ireland
| | - G Roberts
- University Hospital Waterford, Co Waterford, Ireland
| | - H Rooney
- St Luke's General Hospital, Kilkenny, Co Kilkenny, Ireland
| | - A Smyth
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - B Tarachand
- University Hospital Waterford, Co Waterford, Ireland
| | - M Todd
- Mayo University Hospital, Castlebar, Co Mayo, Ireland
| | - A Tuthill
- Cork University Hospital, Cork, Co Cork, Ireland
| | - W A Wan Mahmood
- Coombe Women and Infants University Hospital, Dublin, Ireland
| | - O Yousif
- Wexford General Hospital, Co Wexford, Ireland
| | - F P Dunne
- Galway University Hospital, Galway, Ireland
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16
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O'Connor E, O'Dowd G, Phelan S. Impact of COVID-19 on small biopsy diagnostic procedures and cancer resection surgeries in the North-West of Ireland. J Clin Pathol 2021; 75:270-273. [PMID: 33542109 DOI: 10.1136/jclinpath-2021-207425] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/22/2021] [Indexed: 11/04/2022]
Abstract
AIMS To quantify the impact of COVID-19 on small biopsy procedures and cancer resection surgeries in the North-West of Ireland. METHODS Data was obtained from the Histopathology Departments of University Hospital Galway (UHG) and Letterkenny University Hospital (LUH) Laboratory Information Systems to establish the impact of COVID-19 on both the small biopsy (coded P01) and cancer resection (coded P03) caseloads reported from January to June 2020, with comparison made to January to June 2019. RESULTS From January to June 2020 compared with January to June 2019, UHG had an overall decrease of 714 P01 cases (21.5%) and a decrease of 152 P03 cases (14.4%). In this time, LUH had an increase of 9 P01 cases (0.8%) but a decrease of 48 P03 cases (58.5%). CONCLUSIONS There has been a significant impact on the provision of both diagnostic and therapeutic services in North-West of Ireland due to the COVID-19 pandemic.
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Affiliation(s)
- Eoghan O'Connor
- Histopathology, Galway University Hospitals, Galway, Ireland
| | - Gerard O'Dowd
- Histopathology, Letterkenny University Hospital, Letterkenny, Donegal, Ireland
| | - Sine Phelan
- Histopathology, Galway University Hospitals, Galway, Ireland
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17
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Keane KG, Redmond EJ, McIntyre C, O'Connor E, Madden A, O'Connell C, Inder SM, Smyth LG, Thomas AZ, Flynn RJ, Manecksha RP. Does instillation of lidocaine gel following flexible cystoscopy decrease the severity of post procedure symptoms? A randomised controlled trial assessing the efficacy of lidocaine gel post flexible cystoscopy. Ir J Med Sci 2021; 190:1553-1559. [PMID: 33449326 PMCID: PMC7809241 DOI: 10.1007/s11845-020-02458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 12/03/2020] [Indexed: 12/02/2022]
Abstract
Objective To assess whether instillation of lidocaine gel both before and after flexible cystoscopy is more effective at reducing post procedural symptoms than instillation of lidocaine gel pre flexible cystoscopy alone. We hypothesise that inadequate urethral dwell time and dilution of lidocaine gel by the irrigation fluid during flexible cystoscopy limits its anaesthetic efficacy. Only one other study has attempted to reduce bothersome urinary symptoms through an intervention after flexible cystoscopy. Methods This was a randomised controlled trial in which patients were randomised 1:1 to receive lidocaine gel pre and post flexible cystoscopy (treatment) or lidocaine gel pre flexible cystoscopy only (control). Patient-reported outcome measures were used to assess symptoms and quality of life prior to cystoscopy, on day 2 and day 7 post cystoscopy. Result Fifty patients were divided equally between the treatment and control groups. There were no significant differences in baseline characteristics between the groups (p = 1.000). An overall symptoms variable was measured, though no significant difference was found in the distribution of responses between the groups at baseline, 2 or 7 days after the flexible cystoscopy (p = 0.423, 0.651,0.735). In the treatment group, 1 patient (4.0%) presented to a doctor for review following flexible cystoscopy, and 4 patients (16.0%) presented in the control group (p = 0.349). Conclusion Initial study results suggest that post-operative lidocaine does not significantly limit the exacerbation of urinary symptoms following flexible cystoscopy; however, our results are not powered to detect a small difference. We do not recommend a change in practice based on our results.
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Affiliation(s)
- K G Keane
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.
| | - E J Redmond
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - C McIntyre
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - E O'Connor
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - A Madden
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - C O'Connell
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - S M Inder
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - L G Smyth
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - A Z Thomas
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R J Flynn
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - R P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland
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18
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19
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Blake A, Collins D, O'Connor E, Bergin C, McLaughlin AM, Martin-Loeches I. Clinical and biochemical characteristics of patients admitted to ICU with SARS-CoV-2. Med Intensiva 2020; 44:589-590. [PMID: 32425288 PMCID: PMC7229922 DOI: 10.1016/j.medin.2020.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- A Blake
- Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - D Collins
- Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - E O'Connor
- Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland
| | - C Bergin
- Department of Infectious Diseases, St James's Hospital, Dublin, Ireland
| | - A M McLaughlin
- Department of Respiratory Medicine, St James's Hospital, Dublin, Ireland
| | - I Martin-Loeches
- Department of Intensive Care Medicine, St James's Hospital, Dublin, Ireland.
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20
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Sullivan R, Yau WY, Chelban V, Rossi S, O'Connor E, Wood NW, Cortese A, Houlden H. RFC1 Intronic Repeat Expansions Absent in Pathologically Confirmed Multiple Systems Atrophy. Mov Disord 2020; 35:1277-1279. [PMID: 32333430 DOI: 10.1002/mds.28074] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/24/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Roisin Sullivan
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom
| | - Wai Yan Yau
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Viorica Chelban
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Salvatore Rossi
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom
| | - E O'Connor
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Nicholas W Wood
- Movement Disorders, Queen's Square Institute of Neurology, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Andrea Cortese
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom.,Department of Brain and Behavioural Science, University of Pavia, Pavia, Italy
| | - Henry Houlden
- Department of Neuromuscular Disease, Queen's Square Institute of Neurology, London, United Kingdom.,The National Hospital for Neurology and Neurosurgery, London, United Kingdom
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21
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Haile-Mariam M, MacLeod IM, Bolormaa S, Schrooten C, O'Connor E, de Jong G, Daetwyler HD, Pryce JE. Value of sharing cow reference population between countries on reliability of genomic prediction for milk yield traits. J Dairy Sci 2019; 103:1711-1728. [PMID: 31864746 DOI: 10.3168/jds.2019-17170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/24/2019] [Indexed: 01/08/2023]
Abstract
Increasing the reliability of genomic prediction (GP) of economic traits in the pasture-based dairy production systems of New Zealand (NZ) and Australia (AU) is important to both countries. This study assessed if sharing cow phenotype and genotype data of NZ and AU improves the reliability of GP for NZ bulls. Data from approximately 32,000 NZ genotyped cows and their contemporaries were included in the May 2018 routine genetic evaluation of the Australian Dairy cattle in an attempt to provide consistent phenotypes for both countries. After the genetic evaluation, deregressed proofs of cows were calculated for milk yield traits. The April 2018 multiple across-country evaluation of Interbull was also used to calculate deregressed proofs for bulls on the NZ scale. Approximately 1,178 Jersey (Jer) and 6,422 Holstein (Hol) bulls had genotype and phenotype data. In addition to NZ cows, phenotype data of close to 60,000 genotyped Australian (AU) cows from the same genetic evaluation run as NZ cows were used. All AU and NZ females were genotyped using low-density SNP chips (<10K SNP) and were imputed first to 50K and then to ∼600K (referred to as high density; HD). We used up to 98,000 animals in the reference populations, both by expanding the NZ reference set (cow, bull, single breed to multi-breed set) and by adding AU cows. Reliabilities of GP were calculated for 508 Jer and 1,251 Hol bulls whose sires are not included in the reference set (RS) to ensure that real differences are not masked by close relationships. The GP was tested using 50K or high-density SNP chip using genomic BLUP in bivariate (considering country as a trait) or single trait models. The RS that gave the highest reliability for each breed were also tested using a hybrid GP method that combines expectation maximization with Bayes R. The addition of the AU cows to an NZ RS that included either NZ cows only, or cows and bulls, improved the reliability of GP for both NZ Hol and Jer validation bulls for all traits. Using single breed reference populations also increased reliability when NZ crossbred cows were added to reference populations that included only purebred NZ bulls and cows and AU cows. The full multi-breed RS (all NZ cows and bulls and AU cows) provided similar reliabilities in NZ Hol bulls, when compared with the single breed reference with crossbred NZ cows. For Jer validation bulls, the RS that included Jer cows and bulls and crossbred cows from NZ and Jer cows from AU was marginally better than the all-breed, all-country RS. In terms of reliability, the advantage of the HD SNP chip was small but captured more of the genomic variance than the 50K, particularly for Hol. The expectation maximization Bayes R GP method was slightly (up to 3 percentage points) better than genomic BLUP. We conclude that GP of milk production traits in NZ bulls improves by up to 7 percentage points in reliability by expanding the NZ reference population to include AU cows.
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Affiliation(s)
- M Haile-Mariam
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia.
| | - I M MacLeod
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia
| | - S Bolormaa
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia
| | | | | | - G de Jong
- CRV, 6800 AL Arnhem, the Netherlands
| | - H D Daetwyler
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; School of Applied Systems Biology, La Trobe University, Bundoora, VIC 3083, Australia
| | - J E Pryce
- Agriculture Victoria, Department of Jobs, Precincts and Regions, Bundoora, VIC 3083, Australia; School of Applied Systems Biology, La Trobe University, Bundoora, VIC 3083, Australia
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22
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Wolters M, Volkert D, Streicher M, Kiesswetter E, Torbahn G, O'Connor E, O'Keeffe M, O'Herlihy E, O'Toole P, Timmons S, O'Shea E, Kearney P, van Zwienen-Pot J, Visser M, Maitre I, van Wymelbeke V, Sulmont-Rossé C, Nagel G, Flechtner-Mors M, Teh R, Hebestreit A. Prevalence rates of malnutrition using harmonized definitions in older adults from different settings in Europe and New Zealand – a manuel study. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Kelly M, Purtill H, Leahy S, Grace M, O'Toole P, O'Herlihy E, O'Connor E. Determinants of malnutrition in older Irish adults. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Borhan F, Borhan N, Ahmed S, Varghese L, O'Connor E. Identifying factors that influence the '6-hour target' in the Emergency Department by applying Regression Analysis. Ir Med J 2018; 111:699. [PMID: 29952447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To determine factors within the Emergency Department (ED) that have maximum influence on the '6-hour target'. METHODS Regression Analysis methodology employed to analyse the influence of 9 ED variables on the '6-hour target' compliance. RESULTS The number of patients waiting to be seen an ED physician at 8pm exerts maximum influence on the '6-hour target' (r = -0.581, p<0.05). CONCLUSION The '6-hour target' compliance rises with lesser number of patients waiting to be seen by an ED physician at 8pm. Also, the '6-hour target' compliance rises by increasing the number of ED Registrar working hours and the number of ED SHO working hours per day.
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Affiliation(s)
- F Borhan
- Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - N Borhan
- Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - S Ahmed
- Government Health and Human Services Analytics, IBM Watson Health, Dublin 15, Ireland
| | - L Varghese
- Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - E O'Connor
- Emergency Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
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25
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Wentlandt K, Weiss A, O'Connor E, Kaya E. Palliative and end of life care in solid organ transplantation. Am J Transplant 2017; 17:3008-3019. [PMID: 28976070 DOI: 10.1111/ajt.14522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
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Affiliation(s)
- K Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - E O'Connor
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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26
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Topf A, Azuma Y, Gorokhova S, O'Connor E, Porter A, Harris E, Evangelista T, Cox D, Lorenzoni P, McMacken G, Bartoli M, McArthur D, Magnusson O, Abicht A, Senderek J, Roos A, Abicht A, Lochmüller H. Next generation sequencing technologies in the genetic diagnosis of congenital myasthenic syndrome. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Niermeyer M, Franchow E, Barron C, Heyrend R, Ray A, Meredith S, Ziemnik R, O'Connor E, Suchy Y. A-07Reported Expressive Suppression in Daily Life is Related to Lower Executive Functioning and Slower Action Planning Among Older Adults. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Ziemnik R, Niermeyer M, Nilssen R, Ocanovic Z, Bateman C, O'Connor E, Suchy Y. C-34Expressive Suppression as Predictors of Medication Management in Healthy Older Adults. Arch Clin Neuropsychol 2017. [DOI: 10.1093/arclin/acx076.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Borhan F, Ahmed S, Varghese L, O'Connor E. A Statistical Methodology to determine factors affecting Patient Experience Time Targets in the Emergency Department. Ir Med J 2017; 110:506. [PMID: 28657283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- F Borhan
- Department of Emergency Medicine, Connolly Hospital , Blanchardstown, Dublin 15, Ireland
| | - S Ahmed
- Department of Emergency Medicine, Connolly Hospital , Blanchardstown, Dublin 15, Ireland
| | - L Varghese
- Department of Emergency Medicine, Connolly Hospital, Blanchardstown, Dublin 15, Ireland
| | - E O'Connor
- Department of Emergency Medicine, Connolly Hospital , Blanchardstown, Dublin 15, Ireland
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30
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Di Capua-Sacoto C, Sanchez-Llopis A, O'Connor E, Martinez A, Ruiz-Cerdá JL. Study of the apoptotic effect of urine as a diagnostic biomarker in patients with interstitial cystitis. Actas Urol Esp 2016; 40:570-576. [PMID: 27174573 DOI: 10.1016/j.acuro.2016.03.010] [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: 01/24/2016] [Revised: 03/15/2016] [Accepted: 03/17/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The main objective of the study was to assess the apoptotic effect of urine from patients with interstitial cystitis (IC) in cell cultures and to study its value as a diagnostic biomarker for IC. MATERIAL AND METHODS A prospective study was conducted between January 2010 and January 2015 and included 57 patients diagnosed with IC and 50 healthy patients from the Hospital Clinic of Barcelona and the La Paz University Hospital. The urine of these patients was exposed to cell cultures, and its ability to induce apoptosis in the cultures was analysed. Using flow cytometry, we then measured the degree of apoptosis, quantified by the percentage of cells of the cell cycle in phase sub G0. RESULTS The cell cultures exposed to the urine of patients with IC had a sub G1 peak and a G2 phase, which was significantly greater than that of the control group, and a significantly lower percentage in the S phase than the control group. The mean apoptosis values in the urine cultures from patients with IC were significantly higher than those of the control group. Using a value >10% of the apoptosis test as a positive result, we observed a specificity of 96% and a positive predictive value of 92%. CONCLUSIONS The urine of patients with IC exerts an apoptotic effect on tumour cell cultures that is significantly greater than that exerted by the urine of healthy control patients. A≥10% cutoff for the apoptosis test presented very low sensitivity (40%) but had a very high specificity (96%), thereby able to confirm the diagnosis of IC when positive.
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Affiliation(s)
- C Di Capua-Sacoto
- Departamento de Urología, Hospital La Plana de Villarreal, Castellón, España
| | - A Sanchez-Llopis
- Departamento de Urología, Hospital Universitario General de Castellón, Castellón, España.
| | - E O'Connor
- Departamento de Citómica, Instituto de Investigación Príncipe Felipe, Valencia, España
| | - A Martinez
- Departamento de Citómica, Instituto de Investigación Príncipe Felipe, Valencia, España
| | - J L Ruiz-Cerdá
- Departamento de Urología, Hospital Universitario La Fe, Valencia, España
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Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [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: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
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Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
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Font A, Grimmond CSB, Kotthaus S, Morguí JA, Stockdale C, O'Connor E, Priestman M, Barratt B. Daytime CO2 urban surface fluxes from airborne measurements, eddy-covariance observations and emissions inventory in Greater London. Environ Pollut 2015; 196:98-106. [PMID: 25463702 DOI: 10.1016/j.envpol.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 10/01/2014] [Accepted: 10/04/2014] [Indexed: 06/04/2023]
Abstract
Airborne measurements within the urban mixing layer (360 m) over Greater London are used to quantify CO(2) emissions at the meso-scale. Daytime CO(2) fluxes, calculated by the Integrative Mass Boundary Layer (IMBL) method, ranged from 46 to 104 μmol CO(2) m(-2) s(-1) for four days in October 2011. The day-to-day variability of IMBL fluxes is at the same order of magnitude as for surface eddy-covariance fluxes observed in central London. Compared to fluxes derived from emissions inventory, the IMBL method gives both lower (by 37%) and higher (by 19%) estimates. The sources of uncertainty of applying the IMBL method in urban areas are discussed and guidance for future studies is given.
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Doherty M, O'Connor E, Hannon D, O'Reilly A, Grogan L, Hennessy B, Breathnach O, Morris P. Effect of Thyroid Transcription Factor-1 (TTF-1) on Outcome Following Chemotherapy for Advanced Pulmonary Adenocarcinoma. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.08.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Doherty M, Keenan L, McHugh J, O'Brien M, O'Reilly A, Reilly C, Hannan E, De Golden PH, O'Connor E, Hannon D, Tierney N, Henderson R, Doyle P, McHugh C, Grogan W, Hennessy B, Morris P, Breathnach O. Patterns of Treatment and Rates of Admission in a Specialist Oncology Clinic. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu353.25] [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: 11/13/2022] Open
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Abstract
Hyperlactataemia and lactic acidosis are commonly encountered during and after cardiac surgery. Perioperative lactate production increases in the myocardium, skeletal muscle, lungs and in the splanchnic circulation during cardiopulmonary bypass. Hyperlactataemia has a bimodal distribution in the perioperative period. An early increase in lactate levels, arising intraoperatively or soon after intensive care unit admission, is a familiar and concerning finding for most clinicians. It is highly suggestive of tissue ischaemia and is associated with a prolonged intensive care unit stay, a prolonged requirement for respiratory and cardiovascular support and increased postoperative mortality. Its presence should prompt a thorough search for potential causes of tissue hypoxia. In contrast, late-onset hyperlactataemia, a less well recognised complication, occurs 4 to 24 hours after completion of surgery and is typically associated with preserved cardiac output and oxygen delivery. Risk factors for late-onset hyperlactataemia include hyperglycaemia, long cardiopulmonary bypass time and elevated endogenous catecholamines. Although patients with this complication may have a longer duration of ventilation and intensive care unit length of stay than those with normolactataemia, an association with increased mortality has not been demonstrated. The discovery of late-onset hyperlactataemia should not delay the postoperative progress of an otherwise stable patient following cardiac surgery.
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Affiliation(s)
- E O'Connor
- Adult Intensive Care Services, Prince Charles Hospital, Chermside, Queensland, Australia.
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Ott CD, Reisswig C, Schnetter E, O'Connor E, Sperhake U, Löffler F, Diener P, Abdikamalov E, Hawke I, Burrows A. Dynamics and gravitational wave signature of collapsar formation. Phys Rev Lett 2011; 106:161103. [PMID: 21599351 DOI: 10.1103/physrevlett.106.161103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Indexed: 05/21/2023]
Abstract
We perform 3+1 general relativistic simulations of rotating core collapse in the context of the collapsar model for long gamma-ray bursts. We employ a realistic progenitor, rotation based on results of stellar evolution calculations, and a simplified equation of state. Our simulations track self-consistently collapse, bounce, the postbounce phase, black hole formation, and the subsequent early hyperaccretion phase. We extract gravitational waves from the spacetime curvature and identify a unique gravitational wave signature associated with the early phase of collapsar formation.
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Affiliation(s)
- C D Ott
- TAPIR, California Institute of Technology, Pasadena, California 91125, USA.
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Medrano JV, Marqués-Marí AI, Aguilar CE, Riboldi M, Garrido N, Martínez-Romero A, O'Connor E, Gil-Salom M, Simón C. Comparative analysis of the germ cell markers c-KIT, SSEA-1 and VASA in testicular biopsies from secretory and obstructive azoospermias. Mol Hum Reprod 2010; 16:811-7. [PMID: 20508065 DOI: 10.1093/molehr/gaq044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testicular biopsy is needed to confirm diagnosis in azoospermic patients and to recover spermatozoa, if possible. This report aims to quantitatively analyse the germline markers stage-specific embryonic antigen (SSEA-1), c-KIT and VASA in testicular biopsies with distinct azoospermic aetiologies. Twenty-three testicular biopsies were analysed by flow cytometry and RT-qPCR for c-KIT, SSEA-1 and VASA. In all the Sertoli cell-only (SCO) samples, significantly lower VASA mRNA expression and fewer VASA+ cells were found compared with obstructive controls. Maturation arrest (MA) cases showed significant differences only with the non-mosaic SCO samples when compared for VASA mRNA expression and percentage of VASA+ cells, but not with the mosaics. However, the normalized VASA-KIT parameter obtained by subtracting the percentage of c-KIT+ cells from the percentage of VASA+ cells showed significant differences between the MA and all the SCO samples. RT-qPCR consistently found differences for the VASA expression between SCO mosaic and non-mosaic samples. However, by flow cytometry, only VASA-KIT showed significant differences between them. Conversely, the percentage of SSEA-1+ cells revealed no inter-group differences. In conclusion, testicular biopsies display different expression profiles for c-KIT and VASA depending on the azoospermic aetiology. These results can be used as a complementary tool to create new molecular categories for diagnoses in azoospermic patients, particularly useful to discriminate between mosaic and non-mosaic SCO patients.
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Affiliation(s)
- J V Medrano
- Valencia Stem Cell Bank, Centro de Investigación Príncipe Felipe (CIPF), Valencia 46012, Spain
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O'Connor E, Freeman TCA, Margrain TH. Sensitivity to retinal and extra-retinal motion signals as a function of age. J Vis 2010. [DOI: 10.1167/8.6.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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O'Connor E. Explorations in the social history of medicine. CMAJ 2009. [DOI: 10.1503/cmaj.091706] [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: 11/01/2022] Open
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Buckland KF, O'Connor E, Murray LA, Hogaboam CM. Toll like receptor-2 modulates both innate and adaptive immune responses during chronic fungal asthma in mice. Inflamm Res 2008; 57:379-87. [PMID: 18787777 DOI: 10.1007/s00011-008-8004-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE AND DESIGN We investigated the effect of TLR2 gene deletion in a murine model of chronic fungal asthma. METHODS TLR2 wildtype (TLR2(+/+)) and TLR2 deficient (TLR2(-/-)) mice were sensitized to soluble A. fumigatus antigens and challenged with live A. fumigatus conidia, and the extent of allergic airways disease was analyzed in both groups of mice at 3, 7, 14, and 30 days after conidia. RESULTS At day 7 post-conidia, TLR2(-/-) mice exhibited significantly lower airway hyperresponsiveness, airway inflammation, and whole lung Th2 cytokine levels compared with the TLR2(+ / +) group. TLR2 deletion also significantly reduced mucus cell metaplasia and peribronchial fibrosis at day 30 after conidia. However, fungal material persisted in the TLR2(-/-) group, and at day 30 after conidia TLR2(-/-) mice exhibited enhanced airway neutrophil recruitment and airway hyperresponsiveness. CONCLUSION Thus, during chronic fungal asthma in mice, TLR2 is a major contributor to the maintenance of the adaptive Th2-cytokine driven and anti-fungal innate responses.
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Affiliation(s)
- K F Buckland
- Immunology Program, Department of Pathology, University of Michigan Medical School, Rm 4057, BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109-2200, USA
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Skolnik J, Jayaraman B, Patel D, O'Connor E, Barrett JS, Adamson PC. A clinical trial simulation study of a new pediatric phase I trial methodology: The rolling six design. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9564 Background: Phase I cancer trials have traditionally used the 3+3 study design in which cohorts of three patients at a time are enrolled. The study is suspended to accrual with every 3rd patient, and again suspended to replace inevaluable patients. As the pediatric phase I starting dose is based on adult phase I safety data, we hypothesized that pediatric study timelines could be shortened without increasing risk using a novel rolling six design, in which up to 6 patients are concurrently enrolled per dose level. Methods: A trial simulation approach comparing the standard 3+3 design to the rolling six design was performed. Discrete time events (accrual/enrollment, evaluation and/or time to dose limiting toxicity (DLT) or inevaluability) with outcome probabilities (DLT/inevaluability) assigned to each subject based on historical data from phase I pediatric oncology trials. The probability of DLT was a function of dose level and varied distributions were used to assign discrete time elements. Metrics for study efficiency (time to complete study, total number of patients required) were determined for each design. Simulated trials and decision rule logic were coded using PC/Windows SAS v9.1. Results: The rolling six design outperformed the 3+3 design for the most relevant metrics. Average (±SD) time to study completion was 373±90 days vs. 431±98 days and the total number of patients required was 20±5 vs. 17±4 for the rolling six vs. 3+3 designs, respectively. There was no difference in the number of DLTs per study (3±1) between designs. Conclusions: The rolling six design is predicted to shorten pediatric phase 1 study timelines and will be tested prospectively in upcoming COG phase I trials. No significant financial relationships to disclose.
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Affiliation(s)
- J. Skolnik
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - B. Jayaraman
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - D. Patel
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - E. O'Connor
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - J. S. Barrett
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
| | - P. C. Adamson
- Children's Hospital of Philadelphia, Philadelphia, PA; Children's Oncology Group, Arcadia, CA
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O'Connor E, Allen LE, Bradshaw K, Boylan J, Moore AT, Trump D. Congenital stationary night blindness associated with mutations in GRM6 encoding glutamate receptor MGluR6. Br J Ophthalmol 2006; 90:653-4. [PMID: 16622103 PMCID: PMC1857053 DOI: 10.1136/bjo.2005.086678] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wang T, Zhou A, Waters CT, O'Connor E, Read RJ, Trump D. Molecular pathology of X linked retinoschisis: mutations interfere with retinoschisin secretion and oligomerisation. Br J Ophthalmol 2006; 90:81-6. [PMID: 16361673 PMCID: PMC1856892 DOI: 10.1136/bjo.2005.078048] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIM X linked retinoschisis (XLRS) is caused by mutations in RS1 which encodes the discoidin domain protein retinoschisin, secreted by photoreceptors and bipolar cells. Missense mutations occur throughout the gene and some of these are known to interfere with protein secretion. This study was designed to investigate the functional consequences of missense mutations at different locations in retinoschisin. METHODS AND RESULTS The authors developed a structural model of the retinoschisin discoidin domain and used this to predict the effects of missense mutations. They expressed disease associated mutations and found that those affecting conserved residues prevented retinoschisin secretion. Most of the remaining mutations cluster within a series of loops on the surface of the beta barrel structure and do not interfere with secretion, suggesting this region may be a ligand binding site. They also demonstrated that wild type retinoschisin octamerises and associates with the cell surface. A subgroup of secreted mutations reduce oligomerisation (C59S, C219G, C223R). CONCLUSIONS It is suggested that there are three different molecular mechanisms which lead to XLRS: mutations interfering with secretion, mutations interfering with oligomerisation, and mutations that allow secretion and oligomerisation but interfere with retinoschisin function. The authors conclude that binding of oligomerised retinoschisin at the cell surface is important in its presumed role in cell adhesion.
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Affiliation(s)
- T Wang
- Academic Unit of Medical Genetics, University of Manchester, Manchester M13 0JH, UK
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Cullen W, Grogan L, O'Connor E, Bury G. "Why are we working so hard?" A cross-sectional survey of factors influencing GP workload in the Eastern Regional Health Authority area. Ir Med J 2002; 95:209-12, 214. [PMID: 12227528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
There is increasing evidence to suggest that the subjective workload of GPs in Ireland is too heavy. The aims of this study, therefore, were to identify the social and demographic issues that GPs perceive as being implicated in determining their workload. A self-administered questionnaire, inviting GPs to score a series of factors according to the degree to which it increased their workload, was sent to one-quarter of GPs practising in the Eastern Regional Health Authority (ERHA) area. The response rate was 71%. Seventy-nine (60%) felt their workload was 'too heavy,' while 109 (85%) felt they could improve the quality of care they provide, if their workload was reduced. Access to OPD services (mean score = 7.31), access to other hospital services (mean score = 7.16), and the number of elderly patients (mean score = 6.28) were considered to be the most important factors in determining workload. This paper describes the factors that impact on self-perceived workload for GPs, factors which need to be considered when planning and funding future developments in primary care.
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Affiliation(s)
- W Cullen
- Department of General Practice, UCD, Dublin
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Auricchio A, Kobinger G, Anand V, Hildinger M, O'Connor E, Maguire AM, Wilson JM, Bennett J. Exchange of surface proteins impacts on viral vector cellular specificity and transduction characteristics: the retina as a model. Hum Mol Genet 2001; 10:3075-81. [PMID: 11751689 DOI: 10.1093/hmg/10.26.3075] [Citation(s) in RCA: 284] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recombinant vectors based on adeno-associated virus (AAV) or human immunodeficiency 1 (lentivirus) are promising tools for long term in vivo gene delivery. Their design allows the exchange of capsids or envelopes, respectively, theoretically providing the opportunity to transduce a range of cell types. We constructed AAV vectors encoding enhanced green fluorescent protein (EGFP) within an AAV serotype 2 (AAV2) genome contained in an AAV2, five or one capsid (called AAV2/2, AAV2/5 and AAV2/1, respectively). Similarly we produced lentiviral vectors, encoding the same expression cassette present in the AAV vectors, pseudotyped with proteins from vesicular stomatitis virus glycoprotein (VSVG) or Mokola envelopes. Transduction characteristics of these vectors were evaluated in the murine retina following subretinal or intravitreal administration. The time of onset of transgene expression and the targeted cell types differed between the various recombinants. Onset of transgene expression was 3-4 days for lentiviral vectors and AAV2/1. In contrast, onset was at 2-4 weeks for AAV2/5 and AAV2/2, respectively. After subretinal injection, both lenti-VSVG and AAV2/5 transduced the retinal pigment epithelium (RPE) and photoreceptors efficiently whereas transgene expression was restricted to RPE cells using lenti with the Mokola envelope or AAV2/1. After intravitreal administration, only AAV2/2 and lenti-VSVG transduced the inner retina. Vector-mediated fluorescence was detected in the retina for over 12 weeks for all of the vectors. We conclude that pseudotyping provides a useful means to manipulate viral vector cell targeting specificity as well as retinal transduction characteristics of vectors containing the same genome.
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Affiliation(s)
- A Auricchio
- Institute for Human Gene Therapy, Department of Molecular and Cellular Engineering, The Wistar Institute, Philadelphia, PA, USA
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O'Connor E, Venkatesh B, Lipman J, Mashongonyika C, Hall J. Procalcitonin in critical illness. CRIT CARE RESUSC 2001; 3:236-43. [PMID: 16573512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2001] [Accepted: 11/28/2001] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To detail the biology and diagnostic usefulness of serum procalcitonin in critical illness. DATA SOURCES A review of articles published in peer reviewed journals from 1990 to 2001 and identified through a MEDLINE search on procalcitonin. SUMMARY OF REVIEW Procalcitonin (PCT) is a prohormone of calcitonin. Serum levels are elevated during sepsis and have been identified as a potential marker of infection in critical illness. However, its function and precise source of origin during sepsis remain unclear. The value of estimating serum PCT appears to be in the differentiation of infectious from non-infectious forms of systemic inflammatory response syndrome. A number of studies also point to its usefulness in distinguishing between bacterial and viral meningitis. However, there are a number of non-infectious conditions, where elevations in serum PCT occur, reducing its specificity. Its superiority as a marker of sepsis compared with other acute phase reactants continues to be debated. CONCLUSIONS The utility of serum procalcitonin as a diagnostic test of sepsis is still under evaluation. Moreover, a number of unanswered questions remain regarding the biological role of PCT during sepsis, its target receptors and its protective value to the patient.
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Affiliation(s)
- E O'Connor
- Department of Intensive Care, Royal Brisbane Hospital, Brisbane, Queensland
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Clarke GN, Hornbrook M, Lynch F, Polen M, Gale J, Beardslee W, O'Connor E, Seeley J. A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Arch Gen Psychiatry 2001; 58:1127-34. [PMID: 11735841 DOI: 10.1001/archpsyc.58.12.1127] [Citation(s) in RCA: 354] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescent offspring of depressed parents are at high risk for development of depression. Cognitive restructuring therapy holds promise for preventing progression to depressive episodes. METHODS A randomized, controlled trial was conducted to prevent depressive episodes in at-risk offspring (aged 13-18 years) of adults treated for depression in a health maintenance organization (HMO). Potential adult cases were found by reviewing the HMO pharmacy records for dispensation of antidepressant medication and the mental health appointment system. Medical charts were reviewed for a depression diagnosis. Recruitment letters signed by treating physicians were mailed to adults. Eligible offspring had subdiagnostic depressive symptoms insufficient to meet full DSM-III-R criteria for affective disorder and/or a past mood disorder. These youth were randomized to usual HMO care (n = 49) or usual care plus a 15-session group cognitive therapy prevention program (n = 45). RESULTS We detected significant treatment-by-time (program) effects for the Center for Epidemiological Studies Depression Scale (P=.005) and the Global Assessment of Functioning scores (P =.04). Survival analysis of incident major depressive episodes during a median 15-month follow-up found a significant advantage (P =.003) for the experimental condition (9.3% cumulative major depression incidence) compared with the usual-care control condition (28.8%). CONCLUSION A brief, group cognitive therapy prevention program can reduce the risk for depression in the adolescent offspring of parents with a history of depression.
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Affiliation(s)
- G N Clarke
- Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland OR 97227-1098, USA.
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Abstract
The brain circuitry processing rewarding and aversive stimuli is hypothesized to be at the core of motivated behavior. In this study, discrete categories of beautiful faces are shown to have differing reward values and to differentially activate reward circuitry in human subjects. In particular, young heterosexual males rate pictures of beautiful males and females as attractive, but exert effort via a keypress procedure only to view pictures of attractive females. Functional magnetic resonance imaging at 3 T shows that passive viewing of beautiful female faces activates reward circuitry, in particular the nucleus accumbens. An extended set of subcortical and paralimbic reward regions also appear to follow aspects of the keypress rather than the rating procedures, suggesting that reward circuitry function does not include aesthetic assessment.
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Affiliation(s)
- I Aharon
- Motivation and Emotion Neuroscience Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02129, USA
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Abstract
Here we describe a single-step affinity column for purification of vectors based on adeno-associated virus type 5 (AAV5). A sialic-acid-rich protein called mucin was covalently attached to Sepharose and was found to bind AAV5 vectors. Elution with high salt efficiently recovered highly active vectors of greater purity than what is achieved with CsCl(2) sedimentation.
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Affiliation(s)
- A Auricchio
- Institute for Human Gene Therapy, Department of Molecular and Cellular Engineering, University of Pennsylvania and The Wistar Institute, Philadelphia, Pennsylvania 19104, USA
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