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Moore G, Barry A, Carter J, Ready J, Wan Y, Elsayed M, Haill C, Khashu M, Williams OM, Brown CS, Demirjian A, Ready D. Detection, survival, and persistence of Staphylococcus capitis NRCS-A in neonatal units in England. J Hosp Infect 2023; 140:8-14. [PMID: 37487793 DOI: 10.1016/j.jhin.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The multidrug-resistant Staphylococcus capitis clone, NRCS-A, is increasingly associated with late-onset sepsis in low birthweight newborns in neonatal intensive care units (NICUs) in England and globally. Understanding where this bacterium survives and persists within the NICU environment is key to developing and implementing effective control measures. AIM To investigate the potential for S. capitis to colonize surfaces within NICUs. METHODS Surface swabs were collected from four NICUs with and without known NRCS-A colonizations/infections present at the time of sampling. Samples were cultured and S. capitis isolates analysed via whole-genome sequencing. Survival of NRCS-A on plastic surfaces was assessed over time and compared to that of non-NRCS-A isolates. The bactericidal activity of commonly used chemical disinfectants against S. capitis was assessed. FINDINGS Of 173 surfaces sampled, 40 (21.1%) harboured S. capitis with 30 isolates (75%) being NRCS-A. Whereas S. capitis was recovered from surfaces across the NICU, the NRCS-A clone was rarely recovered from outside the immediate neonatal bedspace. Incubators and other bedside equipment were contaminated with NRCS-A regardless of clinical case detection. In the absence of cleaning, S. capitis was able to survive for three days with minimal losses in viability (<0.5 log10 reduction). Sodium troclosene and a QAC-based detergent/disinfectant reduced S. capitis to below detectable levels. CONCLUSION S. capitis NRCS-A can be readily recovered from the NICU environment, even in units with no recent reported clinical cases of S. capitis infection, highlighting a need for appropriate national guidance on cleaning within the neonatal care environment.
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Affiliation(s)
- G Moore
- UK Health Security Agency, UK.
| | - A Barry
- UK Health Security Agency, UK
| | | | - J Ready
- UK Health Security Agency, UK
| | - Y Wan
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - M Elsayed
- Royal United Hospital, Bath NHS Foundation Trust, Bath, UK; Southmead Hospital, North Bristol Trust, Bristol, UK
| | - C Haill
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Khashu
- University Hospitals Dorset, Poole, UK
| | - O M Williams
- UK Health Security Agency, UK; Bristol Royal Infirmary, Bristol NHS Foundation Trust, UK
| | - C S Brown
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK
| | - A Demirjian
- UK Health Security Agency, UK; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Department of Infectious Disease, Imperial College London, London, UK; Department of Paediatric Infectious Diseases & Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - D Ready
- UK Health Security Agency, UK; Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Stukel M, Hariasz L, Di Stefano PCF, Rasco BC, Rykaczewski KP, Brewer NT, Stracener DW, Liu Y, Gai Z, Rouleau C, Carter J, Kostensalo J, Suhonen J, Davis H, Lukosi ED, Goetz KC, Grzywacz RK, Mancuso M, Petricca F, Fijałkowska A, Wolińska-Cichocka M, Ninkovic J, Lechner P, Ickert RB, Morgan LE, Renne PR, Yavin I. Rare ^{40}K Decay with Implications for Fundamental Physics and Geochronology. Phys Rev Lett 2023; 131:052503. [PMID: 37595241 DOI: 10.1103/physrevlett.131.052503] [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] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/09/2023] [Accepted: 05/19/2023] [Indexed: 08/20/2023]
Abstract
Potassium-40 is a widespread, naturally occurring isotope whose radioactivity impacts subatomic rare-event searches, nuclear structure theory, and estimated geological ages. A predicted electron-capture decay directly to the ground state of argon-40 has never been observed. The KDK (potassium decay) collaboration reports strong evidence of this rare decay mode. A blinded analysis reveals a nonzero ratio of intensities of ground-state electron-captures (I_{EC^{0}}) over excited-state ones (I_{EC^{*}}) of I_{EC^{0}}/I_{EC^{*}}=0.0095±[over stat]0.0022±[over sys]0.0010 (68% C.L.), with the null hypothesis rejected at 4σ. In terms of branching ratio, this signal yields I_{EC^{0}}=0.098%±[over stat]0.023%±[over sys]0.010%, roughly half of the commonly used prediction, with consequences for various fields [27L. Hariasz et al., companion paper, Phys. Rev. C 108, 014327 (2023)PRVCAN2469-998510.1103/PhysRevC.108.014327].
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Affiliation(s)
- M Stukel
- Department of Physics, Engineering Physics & Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - L Hariasz
- Department of Physics, Engineering Physics & Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - P C F Di Stefano
- Department of Physics, Engineering Physics & Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
| | - B C Rasco
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - K P Rykaczewski
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - N T Brewer
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Joint Institute for Nuclear Physics and Application, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - D W Stracener
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - Y Liu
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - Z Gai
- Center for Nanophase Materials Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - C Rouleau
- Center for Nanophase Materials Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - J Carter
- Berkeley Geochronology Center, Berkeley, California 94709, USA
| | - J Kostensalo
- Natural Resources Institute Finland, Joensuu FI-80100, Finland
| | - J Suhonen
- Department of Physics, University of Jyväskylä, Jyväskylä FI-40014, Finland
| | - H Davis
- Department of Nuclear Engineering, University of Tennessee, Knoxville, Tennessee 37996, USA
- Joint Institute for Advanced Materials, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - E D Lukosi
- Department of Nuclear Engineering, University of Tennessee, Knoxville, Tennessee 37996, USA
- Joint Institute for Advanced Materials, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - K C Goetz
- Nuclear and Extreme Environments Measurement Group, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - R K Grzywacz
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Joint Institute for Nuclear Physics and Application, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Mancuso
- Max-Planck-Institut für Physik, Munich D-80805, Germany
| | - F Petricca
- Max-Planck-Institut für Physik, Munich D-80805, Germany
| | - A Fijałkowska
- Faculty of Physics, University of Warsaw, Warsaw PL-02-093, Poland
| | - M Wolińska-Cichocka
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Joint Institute for Nuclear Physics and Application, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Heavy Ion Laboratory, University of Warsaw, Warsaw PL-02-093, Poland
| | - J Ninkovic
- MPG Semiconductor Laboratory, Munich D-80805, Germany
| | - P Lechner
- MPG Semiconductor Laboratory, Munich D-80805, Germany
| | - R B Ickert
- Department of Earth, Atmospheric, and Planetary Sciences, Purdue University, West Lafayette, Illinois 47907, USA
| | - L E Morgan
- U.S. Geological Survey, Geology, Geophysics, and Geochemistry Science Center, Denver, Colorado 80225, USA
| | - P R Renne
- Berkeley Geochronology Center, Berkeley, California 94709, USA
- Department of Earth and Planetary Science, University of California, Berkeley, California 94720, USA
| | - I Yavin
- Department of Physics, Engineering Physics & Astronomy, Queen's University, Kingston, Ontario K7L 3N6, Canada
- Physics Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Joint Institute for Nuclear Physics and Application, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Center for Nanophase Materials Sciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Berkeley Geochronology Center, Berkeley, California 94709, USA
- Natural Resources Institute Finland, Joensuu FI-80100, Finland
- Department of Physics, University of Jyväskylä, Jyväskylä FI-40014, Finland
- Department of Nuclear Engineering, University of Tennessee, Knoxville, Tennessee 37996, USA
- Joint Institute for Advanced Materials, University of Tennessee, Knoxville, Tennessee 37996, USA
- Nuclear and Extreme Environments Measurement Group, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996, USA
- Max-Planck-Institut für Physik, Munich D-80805, Germany
- Faculty of Physics, University of Warsaw, Warsaw PL-02-093, Poland
- Heavy Ion Laboratory, University of Warsaw, Warsaw PL-02-093, Poland
- MPG Semiconductor Laboratory, Munich D-80805, Germany
- Department of Earth, Atmospheric, and Planetary Sciences, Purdue University, West Lafayette, Illinois 47907, USA
- U.S. Geological Survey, Geology, Geophysics, and Geochemistry Science Center, Denver, Colorado 80225, USA
- Department of Earth and Planetary Science, University of California, Berkeley, California 94720, USA
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Rice W, Martin J, Hodgkin M, Carter J, Barrasa A, Sweeting K, Johnson R, Best E, Nahl J, Denton M, Hughes GJ. A protracted outbreak of difficult-to-treat resistant Pseudomonas aeruginosa in a haematology unit: a matched case-control study demonstrating increased risk with use of fluoroquinolone. J Hosp Infect 2023; 132:52-61. [PMID: 36563938 DOI: 10.1016/j.jhin.2022.11.013] [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: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Between September 2016 and November 2020, 17 cases of difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) were reported in haematology patients at a tertiary referral hospital in the North of England. AIM A retrospective case-control study was conducted to investigate the association between DTR-PA infection and clinical interventions, patient movement, antimicrobial use and comorbidities. METHODS Cases were patients colonized or infected with the outbreak strain of DTR-PA who had been admitted to hospital prior to their positive specimen. Exposures were extracted from medical records, and cases were compared with controls using conditional logistic regression. Environmental and microbiological investigations were also conducted. FINDINGS Seventeen cases and 51 controls were included. The final model included age [>65 years, adjusted OR (aOR) 6.85, P=0.232], sex (aOR 0.60, P=0.688), admission under the transplant team (aOR 14.27, P=0.43) and use of ciprofloxacin (aOR 102.13, P=0.030). Investigations did not indicate case-to-case transmission or a point source, although a common environmental source was highly likely. CONCLUSION This study found that the use of fluoroquinolones is an independent risk factor for DTR-PA in haematology patients. Antimicrobial stewardship and review of fluoroquinolone prophylaxis should be considered as part of PA outbreak investigations in addition to standard infection control interventions.
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Affiliation(s)
- W Rice
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK; Field Service, United Kingdom Health Security Agency, Leeds, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - M Hodgkin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Carter
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Barrasa
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK
| | - K Sweeting
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Best
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Nahl
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Denton
- Field Service, United Kingdom Health Security Agency, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G J Hughes
- Field Service, United Kingdom Health Security Agency, Leeds, UK.
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4
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Hargreaves S, Carter J, Mehrotra A, Knights F, Deal A, Crawshaw AF, Wurie F, Ciftci Y, Majeed A. Exploring barriers to vaccine delivery in adult migrants: a qualitative study in primary care. Eur J Public Health 2022. [PMCID: PMC9593771 DOI: 10.1093/eurpub/ckac130.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The COVID-19 pandemic has highlighted shortfalls in the delivery of vaccine programmes to older migrant groups. Guidelines exist, however, little is known around care pathways and engagement of these older cohorts in routine vaccinations in primary care, including catch-up programmes. We explored the views of primary care professionals around barriers and facilitators to catch-up vaccination in adult migrants (defined as foreign born; 18+ years) with incomplete or uncertain vaccination status. Methods We did a qualitative interview study with purposive sampling and thematic analysis in UK primary care (50 practices included nationally; 1 hour qualitative interviews) with 64 primary care professionals (PCPs): 48 clinical staff including GPs, Practice Nurses and healthcare assistants (HCAs); 16 administrative staff including practice managers and receptionists (mean age 45 years; 84.4% female; a range of ethnicities). Results Participants highlighted direct and indirect barriers to catch-up vaccines in adult migrants who may have missed vaccines as children, missed boosters, and not be aligned with the UK's vaccine schedule, from both a personal and service-delivery level, with themes including: lack of training and knowledge of guidance around catch-up vaccination among staff; unclear or incomplete vaccine records; and lack of incentivization (including financial reimbursement) and dedicated time and care pathways. Adult migrants were reported as being excluded from many vaccination initiatives, most of which focus exclusively on children. PCPs noted that migrants expressed to them a range of views around vaccines, from positivity to uncertainty, to refusal. Conclusions Vaccine uptake in adult migrants could be improved through implementing new financial incentives, strengthening care pathways and training, and working directly with local community groups to improve understanding around the benefits of vaccination at all ages. Key messages
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Mehrotra
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - AF Crawshaw
- Institute for Infection and Immunity, St George's University of London , London, UK
| | - F Wurie
- Office for Improvements and Disparities, UK Health Security Agency London , London, UK
| | - Y Ciftci
- Doctors of the World UK , London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London , London, UK
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5
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Deal A, Crawshaw AC, Salloum M, Hayward SE, Knights F, Goldsmith LP, Carter J, Rustage K, Mounier-Jack S, Hargreaves S. Strategies to increase catch-up vaccination among migrants: a qualitative study and rapid review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.116] [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
WHO’s Immunization Agenda 2030 has placed renewed focus on catch-up vaccination across the life course to meet global targets for reduction in vaccine-preventable diseases through increased vaccine coverage, including among migrant groups who may require catch-up vaccination to align them with host country vaccination schedules.
Methods
We did a global rapid review (01/2010 to 04/2022) to explore drivers of vaccine hesitancy among migrants followed by an in-depth qualitative study (semi-structured, telephone interviews) among recently arrived adult migrants (foreign-born, >18 years old, residing in the UK < 10 years). Interviews explored views on routine vaccination including accessibility, confidence and awareness. Data were analysed iteratively using thematic analysis.
Results
63 papers were included in the rapid review, including data from 22 countries/regions. Multiple factors driving under-immunisation and hesitancy in migrants were reported, including language barriers, low health literacy, social exclusion, low cultural competency and accessibility in healthcare systems. Our qualitative study recruited 40 migrants (mean age: 36.7 years; 62.5% female) resident in the UK (6 refugees, 19 asylum-seekers, 8 undocumented, 7 labour migrants). Major barriers to catch-up vaccination included a lack of provider recommendation and low awareness, with vaccination viewed as only relevant to children. Hesitancy around specific vaccines, such as MMR, was often influenced by misinformation. Participants suggested that novel strategies such as walk-in or mobile access points, consistent provider recommendations, and translation of information into relevant languages, may enhance accessibility and uptake of routine vaccinations.
Conclusions
Targeted and tailored information campaigns, versatile and proactive access pathways and education for healthcare staff on cultural competency will be needed to ensure uptake of catch-up vaccination among marginalised migrant groups.
Key messages
• Newly arrived adult migrants face barriers to catch-up vaccination in host countries, which may hinder immunisation coverage and increase the risk of vaccine-preventable disease outbreaks.
• Health systems must develop novel mechanisms to proactively offer culturally competent and accessible catch-up vaccination services to adult migrants on and after arrival.
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Affiliation(s)
- A Deal
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - AC Crawshaw
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - M Salloum
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - SE Hayward
- Institute for Infection and Immunity, St George’s, University of London , London, UK
- Faculty of Public Health and Policy, LSHTM , London, UK
| | - F Knights
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - J Carter
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George’s, University of London , London, UK
| | | | - S Hargreaves
- Institute for Infection and Immunity, St George’s, University of London , London, UK
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Goldfarb S, Carter J, Arkema A, Abdo N, Carpio A, Chang C, Vahdat L. Flibanserin Improves Libido In Women with Breast Cancer. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.05.024] [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: 10/16/2022]
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Rose A, Carter J. 383 Introduction of a Burns Admission Proforma to Improve Patient Admission Clerking and Management. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Patients who suffer burns present with a variation in the cause, depth, and size of their burns. A number of factors are important in determining the successful management of these patients such as age, cause, time since burn, first aid, co-morbidities, medication, burn size, depth and area, associated injuries, and social circumstances. Appropriate documentation, assessment, and examination in order to guide treatment is therefore imperative to good management and positive outcomes. We performed an audit of admission documentation to our burns unit and introduced a proforma to determine whether there was an improvement in important assessment criteria in order to enhance patient care.
Method
We retrospectively assessed burns admission documentation in 25 patients recently admitted against important assessment criteria. We then introduced a burns admission proforma to the unit and collected the results of 25 further patients in which the proforma was used.
Results
Introduction of the proforma showed an improvement in documentation, examination, and recorded management in almost all areas assessed, excluding allergies where there was a reduction.
Conclusions
Use of a proforma is beneficial in enhancing patient admission documentation and assessment, therefore directing appropriate management by focusing on all areas of patient care. However, the content of the proforma results in adherence to the assigned assessment parameters with limited deviation. Therefore, it is important when using a proforma to include all areas which are important to assessment otherwise they may be overlooked. Their use could be expanded to local emergency departments to ensure appropriate initial assessment, resuscitative management, and referral.
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Affiliation(s)
- A. Rose
- Canniesburn Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - J. Carter
- Canniesburn Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Pottage T, Garratt I, Onianwa O, Carter J, Bennett AM. Rapid inactivation of SARS-CoV-2 after exposure to vapour hydrogen peroxide. J Hosp Infect 2021; 118:77-78. [PMID: 34656661 PMCID: PMC8516439 DOI: 10.1016/j.jhin.2021.10.007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Affiliation(s)
- T Pottage
- UK Health Security Agency, Research and Evaluation, Porton Down, UK.
| | - I Garratt
- UK Health Security Agency, Research and Evaluation, Porton Down, UK
| | - O Onianwa
- UK Health Security Agency, Research and Evaluation, Porton Down, UK
| | - J Carter
- UK Health Security Agency, Research and Evaluation, Porton Down, UK
| | - A M Bennett
- UK Health Security Agency, Research and Evaluation, Porton Down, UK
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Carlisle N, Watson HA, Carter J, Kuhrt K, Seed PT, Tribe RM, Sandall J, Shennan AH. Clinicians' experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making. BMC Med Inform Decis Mak 2021; 21:320. [PMID: 34794405 PMCID: PMC8600728 DOI: 10.1186/s12911-021-01681-w] [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: 10/09/2020] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background As the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth. Methods Qualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach. Results Nineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app. Conclusion This study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL. Clinical trial registry and registration number ISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St Thomas' Hospital, 10th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
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Crawshaw AF, Farah Y, Deal A, Goldsmith LP, Carter J, Rustage K, Campos-Matos I, Vandrevala T, Forster AS, Hargreaves S. Analysing drivers of routine and COVID-19 vaccination in migrants to develop tailored interventions. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Migrants in Europe are at risk of under-immunisation and may also have lower COVID-19 vaccination intent and uptake. There is an urgent need to better understand the drivers of uptake in these groups to inform the development of migrant-sensitive interventions for COVID-19 vaccination and routine vaccination beyond the pandemic.
Methods
We did a systematic review (PROSPERO: CRD42020219214) following PRISMA guidelines to explore factors influencing vaccine uptake in migrants in the EU/EEA and identify determinants of under-immunisation. We also held 3 participatory workshops with multinational migrant community leaders (n = 23) in London, to explore solutions and approaches to strengthen COVID-19 vaccine roll-out.
Results
We included 66 papers reporting data on 262,761 migrants in the review. Numerous access-related factors (e.g. government policy, communication barriers) influenced uptake. Vaccine hesitancy was attributed to lack of information, concerns about side-effects, and cultural beliefs/stigma around specific vaccinations. Migrants who had recently arrived, were older, female or of African and Eastern Mediterranean origin were at risk for under-immunisation for key vaccine-preventable diseases. Migrant community leaders reported considerable hesitancy towards COVID-19 vaccination in their communities and misinformation circulating via social media. Leaders requested support in producing simple COVID-19 guidance that could be translated and adapted locally, alongside more meaningful engagement and partnership-working.
Conclusions
Access barriers and vaccine hesitancy may affect vaccine uptake in some migrant populations in Europe, which needs to be urgently addressed for COVID-19 vaccine roll-out but also beyond the pandemic to strengthen uptake of routine vaccinations. Actively involving migrant communities in the planning, co-production and implementation of tailored and targeted approaches will be essential.
On behalf of ESGITM.
Key messages
Access barriers and vaccine hesitancy (from information gaps, cultural factors) contribute to low vaccine uptake in some migrant populations in the EU/EEA, with implications for COVID-19 vaccination. Meaningful engagement and co-production of tailored approaches with under-immunised migrants are urgently needed to ensure their inclusion in COVID-19 and routine vaccination programmes.
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Affiliation(s)
- AF Crawshaw
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Y Farah
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's, University of London, London, UK
- Faculty of Public Health and Policy, LSHTM, London, UK
| | - LP Goldsmith
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - I Campos-Matos
- Health Improvement Division, Public Health England, London, UK
- UCL Collaborative Centre for Inclusion Health, University College London, London, UK
| | - T Vandrevala
- Department of Psychology, Kingston University London, London, UK
| | - AS Forster
- Department of Behavioural Science and Health, University College London, London, UK
| | - S Hargreaves
- Institute for Infection and Immunity, St George's, University of London, London, UK
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11
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Hargreaves S, Carter J, Knights F, Deal A, Goldsmith L, Crawshaw AF, Hayward S, Zenner D, Wurie F, Hall R. Digital screening tool (Health Catch-UP!) to promote multi-disease screening in migrants. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The ECDC has called for innovative strategies to deliver multi-disease screening (TB, LTBI, HIV, hepatitis B/C, Chagas, Strongyloidiasis and schistosomiasis) and catch-up vaccination (MMR, DTP) to adult migrants within the primary care context. We did a UK i qualitative study to explore current practice and seek views on a novel integrated digital tool to support delivery of screening recommendations for migrants https://emishealth.vids.io/videos/a49ad1bb1a18e4c72c/health-catch-up-with-requested-edits-mp4).
Methods
Phase 1 was conducted via telephone with clinical primary care practitioners (PCPs) (phase 1) and informed data collection and analysis for phase 2 with administrative staff. Data were analysed iteratively, informed by thematic analysis (Ethics no.20/HRA/1674).
Results
64 participants were recruited in Phase 1 (25 general practitioners [GPs], 15 nurses, 7 healthcare assistants, 1 pharmacist); Phase 2 comprised administrative staff (11 Practice-Managers, 5 receptionists). There was lack of consistency in delivery of screening and vaccination. Most GP practices adopted a practice-specific approach, or had no system in place; screening only for HIV and hepatitis B/C. Barriers to screening were perceived lack of knowledge/training and limited financial resources. Facilitators included having an infectious disease/migrant-health champion, incentivisation, and clear protocols. Participants responded positively to the integrated Health Catch-UP! tool, confirming that it would increase screening and vaccination, reduce missed opportunities for preventative healthcare, and raise awareness of migrant health.
Conclusions
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools like Health Catch-UP! could aid clinical decision-making and facilitating improved health outcomes for migrants. Further work is needed to evaluate this intervention.
Key messages
Infectious disease screening and catch-up vaccination is not currently delivered well in primary care in high-migrant receiving European countries. Innovative digital tools could aid clinical decision-making and facilitating improved health outcomes for migrants.
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Affiliation(s)
- S Hargreaves
- Migrant Health Research Group, St George's University of London, London, UK
| | - J Carter
- Migrant Health Research Group, St George's University of London, London, UK
| | - F Knights
- Migrant Health Research Group, St George's University of London, London, UK
| | - A Deal
- Migrant Health Research Group, St George's University of London, London, UK
| | - L Goldsmith
- Migrant Health Research Group, St George's University of London, London, UK
| | - AF Crawshaw
- Migrant Health Research Group, St George's University of London, London, UK
| | - S Hayward
- Migrant Health Research Group, St George's University of London, London, UK
| | - D Zenner
- Queen Mary's, University of London, London, UK
| | - F Wurie
- Health Improvement Directorate, Public Health England, London, UK
| | - R Hall
- Migrant Health Research Group, St George's University of London, London, UK
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12
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Curzen N, Nicholas Z, Stuart B, Wilding S, Hill K, Shambrook J, Eminton Z, Ball D, Barrett C, Johnson L, Nuttall J, Fox K, Connolly D, O'Kane P, Hobson A, Chauhan A, Uren N, Mccann GP, Berry C, Carter J, Roobottom C, Mamas M, Rajani R, Ford I, Douglas P, Hlatky MA. Fractional flow reserve derived from computed tomography coronary angiography in the assessment and management of stable chest pain: the FORECAST randomized trial. Eur Heart J 2021; 42:3844-3852. [PMID: 34269376 PMCID: PMC8648068 DOI: 10.1093/eurheartj/ehab444] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Aims Fractional flow reserve (FFRCT) using computed tomography coronary angiography (CTCA) determines both the presence of coronary artery disease and vessel-specific ischaemia. We tested whether an evaluation strategy based on FFRCT would improve economic and clinical outcomes compared with standard care. Methods and results Overall, 1400 patients with stable chest pain in 11 centres were randomized to initial testing with CTCA with selective FFRCT (experimental group) or standard clinical care pathways (standard group). The primary endpoint was total cardiac costs at 9 months. Secondary endpoints were angina status, quality of life, major adverse cardiac and cerebrovascular events, and use of invasive coronary angiography. Randomized groups were similar at baseline. Most patients had an initial CTCA: 439 (63%) in the standard group vs. 674 (96%) in the experimental group, 254 of whom (38%) underwent FFRCT. Mean total cardiac costs were higher by £114 (+8%) in the experimental group, with a 95% confidence interval from −£112 (−8%) to +£337 (+23%), though the difference was not significant (P = 0.10). Major adverse cardiac and cerebrovascular events did not differ significantly (10.2% in the experimental group vs. 10.6% in the standard group) and angina and quality of life improved to a similar degree over follow-up in both randomized groups. Invasive angiography was reduced significantly in the experimental group (19% vs. 25%, P = 0.01). Conclusion A strategy of CTCA with selective FFRCT in patients with stable angina did not differ significantly from standard clinical care pathways in cost or clinical outcomes, but did reduce the use of invasive coronary angiography.
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Affiliation(s)
- N Curzen
- Faculty of Medicine, University of Southampton.,Coronary Research Group, University Hospital Southampton
| | - Z Nicholas
- Coronary Research Group, University Hospital Southampton
| | - B Stuart
- Clinical Trials Unit, University of Southampton
| | - S Wilding
- Clinical Trials Unit, University of Southampton
| | - K Hill
- Clinical Trials Unit, University of Southampton
| | - J Shambrook
- Cardiothoracic Radiology, University Hospital Southampton
| | - Z Eminton
- Clinical Trials Unit, University of Southampton
| | - D Ball
- Clinical Trials Unit, University of Southampton
| | - C Barrett
- Clinical Trials Unit, University of Southampton
| | - L Johnson
- Clinical Trials Unit, University of Southampton
| | - J Nuttall
- Clinical Trials Unit, University of Southampton
| | - K Fox
- Imperial College, London, UK
| | | | - P O'Kane
- Dorset Heart Centre, University Hospitals Dorset, Bournemouth
| | - A Hobson
- Queen Alexandra Hospital, Portsmouth
| | | | - N Uren
- Royal Infirmary, Edinburgh
| | - G P Mccann
- Department of Cardiovascular Sciences, University of Leicester & NIHR Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow
| | - J Carter
- University Hospital of North Tees, Stockton on Tees
| | | | - M Mamas
- Royal Stoke University Hospital, Stoke-on-Trent
| | - R Rajani
- Guy's & St Thomas' Hospital, London
| | - I Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow
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David KA, Sundaram S, Kim S, Vaca R, Lin Y, Singer S, Malecek M, Carter J, Zayac A, Kim MS, Reddy N, Ney D, Habib A, Strouse C, Graber J, Bachanova V, Salman S, Vendiola JA, Hossain N, Tsang M, Major A, Bond DB, Agrawal P, Mier‐Hicks A, Torka P, Rajakumar P, Venugopal P, Berg S, Glantz M, Goldlust S, Kumar P, Ollila T, Cai J, Spurgeon S, Sieg A, Cleveland J, Epperla N, Karmali R, Naik S, Martin P, Smith SM, Rubenstein J, Kahl B, Evens AM. OLDER PATIENTS WITH PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL): REAL WORLD (RW) OUTCOMES OF POST‐INDUCTION THERAPY IN THE MODERN ERA. Hematol Oncol 2021. [DOI: 10.1002/hon.69_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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Doughty H, O'Hern K, Barton D, Carter J. 196 Rare presentation of Vesiculobullous Lyme Disease: A case series. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Carlisle N, Watson HA, Kuhrt K, Carter J, Seed PT, Tribe RM, Sandall J, Shennan AH. Ten women's decision-making experiences in threatened preterm labour: Qualitative findings from the EQUIPTT trial. Sex Reprod Healthc 2021; 29:100611. [PMID: 33882392 DOI: 10.1016/j.srhc.2021.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/15/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Clinical triage of women in threatened preterm labour (TPTL) could be improved through utilising the QUiPP App, as symptoms alone are poor predictors of early delivery. As most women in TPTL ultimately deliver at term, they must weigh this likelihood with their own personal considerations, and responsibilities. The importance of personal considerations was highlighted by the 2015 Montgomery ruling, and the significance of shared decision-making. AIMS Through qualitative interviews, the primary aim was to explore women's decision-making experiences in TPTL through onset of symptoms, triage, clinical assessment, and discharge. METHODS Qualitative interviews were undertaken as part of the EQUIPTT study (REC: 17/LO/1802) using a semi-structured interview schedule. Descriptive labels of the coding scheme were applied to the raw transcript data. This coding scheme was then increasingly refined into key themes and allowed parallels to be made within and between cases. RESULTS Ten ethnically diverse women who presented at six different London hospitals sites in TPTL were interviewed. Three final themes emerged from the data incorporating 10 sub-themes, 'Seeking help', 'Being "assessed" vs making clinical decisions together', and 'End result.' CONCLUSION Women described their busy lives and the need to juggle their commitments. Participants drew comparisons between their TPTL symptoms and 'period pain,' contrasting to typical medical terminology. Shared decision-making and the clinician-patient relationship could be improved through clinicians utilizing terminology women understand and relate to. Women used language that highlighted the clinician-patient power balance. While not fully involved in shared decision-making, women were overall satisfied with their care.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10(th) Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH, United Kingdom
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16
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James S, Tyrrell-Price J, Atkinson C, Hunt L, Searle A, Phillips K, Penfold C, Carter J, Ness A. Evaluation of urinary chloride dipsticks for the rapid estimation of hydration status in patients receiving artificial nutrition: Feasibility study. Clin Nutr ESPEN 2021; 42:339-347. [PMID: 33745603 DOI: 10.1016/j.clnesp.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIMS The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL). METHODS Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements. RESULTS 10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's rs = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading. CONCLUSIONS Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
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Affiliation(s)
- S James
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
| | - J Tyrrell-Price
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Atkinson
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - L Hunt
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - A Searle
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - K Phillips
- Department of Biochemistry, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - C Penfold
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
| | - J Carter
- Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - A Ness
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, UK
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Suff N, Carter J, Chandiramani M, Shennan A. Pregnancy outcomes following transabdominal cerclage after recurrent failed vaginal cerclage. Eur J Obstet Gynecol Reprod Biol 2021; 258:469-470. [PMID: 33446389 DOI: 10.1016/j.ejogrb.2020.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- N Suff
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - M Chandiramani
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - A Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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McKeon G, Stone G, Ahrens D, Carter J, Cobon D, Irvine S, Syktus J. Queensland’s multi-year Wet and Dry periods: implications for grazing enterprises and pasture resources. Rangel J 2021. [DOI: 10.1071/rj20089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Year-to-year variability in rainfall has long been recognised as a major issue in managing livestock enterprises across Australia’s grazing lands. Extension products documenting rainfall variability have been developed over the last 30 years and have been keenly sought by producers and their advisors. This paper describes multi-year rainfall variability from 1889 to 2020 and provides the basis for classifying the 131 years of rainfall into 18 discrete Wet (7), Average (2) and Dry (9) periods as presented in the ‘Queensland’s Extended Wet and Dry Periods’ poster. The classification was consistent with: analysis of fluctuations and trends in the long-term time series of reported livestock numbers; drought declarations for government assistance; and documented periods of pasture resource degradation and recovery. Rainfall during the nine Wet and Average periods was +18% above the long-term average annual rainfall (LTAAR), in contrast to the Dry periods with −17% below LTAAR. Wet periods (including Average) were on average 7 years in duration, ranging from 5 to 9 years. Dry periods were on average 8 years in duration and ranged from 5 to 13 years. Detailed analysis of the effects of the El Niño Southern Oscillation (ENSO) phenomenon indicated that: (a) the Wet/Dry periods were dominated by different frequencies and amounts of rainfall in La Niña/El Niño years; (b) rainfall in ENSO neutral years was generally above and below average rainfall for the Wet or Dry periods respectively; (c) the frequency of ENSO year-types was less important than the overall rainfall surplus (or deficit) in La Niña (or El Niño) years within the Wet (or Dry) periods respectively; and (d) the timing of Wet and Dry periods was correlated with indices of quasi-decadal and inter-decadal variability in components (sea surface temperatures and atmospheric pressures) of the global climate system. Climatic risk assessment systems for grazing management at multi-year timescales are yet to be developed.
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Stone G, Zhang B, Carter J, Fraser G, Whish G, Paton C, McKeon G. An online system for calculating and delivering long-term carrying capacity information for Queensland grazing properties. Part 1: background and development. Rangel J 2021. [DOI: 10.1071/rj20084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This paper (Part 1) describes the development of a new online system that estimates long-term carrying capacity (LTCC) for grazing properties across Queensland, Australia. High year-to-year and multi-year rainfall variability is a dominating feature of the climate of Queensland’s grazing lands, and poses major challenges for extensive livestock production. The use of LTCC is one approach used by graziers to reduce the impact of rainfall variability on land condition and financial performance. Over the past 30 years, scientists, graziers and their advisors have developed a simple approach to calculating LTCC ((average annual pasture growth × safe pasture utilisation) ÷ annual animal intake). This approach has been successful at a property scale (regional south-west Queensland) and in a wider application through Grazing Land Management (GLM) regional workshops. We have built on these experiences to develop an online system (as described in detail in Part 2; Zhang et al. 2021; this issue) that incorporates the simple LTCC approach with advances in technology and grazing science to provide LTCC information for Queensland grazing properties. Features of the LTCC system are: (1) assimilation of spatial datasets (cadastral data, grazing land types, climate data, remotely-sensed woody vegetation cover); (2) a pasture growth simulation model; (3) land type parameter sets of biophysical attributes; and (4) estimates of safe pasture utilisation. The ‘FORAGE LTCC report’ is a major product of the system, describing individual property information that allows detailed analysis and explanation of the components of the LTCC calculation by land type and land condition. The online system rapidly analyses property spatial data and calculates paddock/property LTCC information. For the 10 months between November 2020 and August 2021, over 4000 grazing property reports have been requested in Queensland, and has proven to be a sound basis for ‘discussion support’ with grazier managers and their advisors.
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Zhang B, Fraser G, Carter J, Stone G, Irvine S, Whish G, Willcocks J, McKeon G. An online system for calculating and delivering long-term carrying capacity information for Queensland grazing properties. Part 2: modelling and outputs. Rangel J 2021. [DOI: 10.1071/rj20088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A combination of field data and models have been used to estimate long-term carrying capacity (LTCC) of domestic livestock in Queensland grazing lands. These methods have been synthesised and coupled with recent developments in science and information technology to provide a fully-automated approach of modelling LTCC through the FORAGE online system. In this study, the GRASP model was used to simulate pasture growth with parameter sets and safe pasture utilisation rates defined for 225 land types across Queensland. Distance to water points was used to assess the accessibility of pastures to livestock. Spatial analysis classified the property into unique areas based on paddock, land type and distance to water points, which estimated pasture growth, pasture utilisation and accessibility at a sub-paddock scale. Thirteen foliage projective cover (FPC) classes were used in modelling the pasture system to deal with the non-linear relationship between tree and grass interactions. As ‘proof of concept’, remotely-sensed individual-date green ground cover data were used to optimise the GRASP model parameters to improve the model performance, and a Monte Carlo analysis provided uncertainty estimates for model outcomes. The framework provides an efficient and standardised method for estimating LTCC. To test the system, LTCCs from 43 ‘benchmark’ properties were compared with simulated LTCCs, and 65% of the modelled LTCCs were within ± 25% of the benchmark LTCCs. Due to uncertainties in model inputs at the property scale and in model simulation, the modelled LTCC should be used as a starting point for further refinement of actual property LTCC.
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Koriath C, Kenny J, Adamson G, Druyeh R, Taylor W, Beck J, Quinn L, Mok TH, Dimitriadis A, Norsworthy P, Bass N, Carter J, Walker Z, Kipps C, Coulthard E, Polke JM, Bernal-Quiros M, Denning N, Thomas R, Raybould R, Williams J, Mummery CJ, Wild EJ, Houlden H, Tabrizi SJ, Rossor MN, Hummerich H, Warren JD, Rowe JB, Rohrer JD, Schott JM, Fox NC, Collinge J, Mead S. Predictors for a dementia gene mutation based on gene-panel next-generation sequencing of a large dementia referral series. Mol Psychiatry 2020; 25:3399-3412. [PMID: 30279455 PMCID: PMC6330090 DOI: 10.1038/s41380-018-0224-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 06/28/2018] [Accepted: 07/18/2018] [Indexed: 11/09/2022]
Abstract
Next-generation genetic sequencing (NGS) technologies facilitate the screening of multiple genes linked to neurodegenerative dementia, but there are few reports about their use in clinical practice. Which patients would most profit from testing, and information on the likelihood of discovery of a causal variant in a clinical syndrome, are conspicuously absent from the literature, mostly for a lack of large-scale studies. We applied a validated NGS dementia panel to 3241 patients with dementia and healthy aged controls; 13,152 variants were classified by likelihood of pathogenicity. We identified 354 deleterious variants (DV, 12.6% of patients); 39 were novel DVs. Age at clinical onset, clinical syndrome and family history each strongly predict the likelihood of finding a DV, but healthcare setting and gender did not. DVs were frequently found in genes not usually associated with the clinical syndrome. Patients recruited from primary referral centres were compared with those seen at higher-level research centres and a national clinical neurogenetic laboratory; rates of discovery were comparable, making selection bias unlikely and the results generalisable to clinical practice. We estimated penetrance of DVs using large-scale online genomic population databases and found 71 with evidence of reduced penetrance. Two DVs in the same patient were found more frequently than expected. These data should provide a basis for more informed counselling and clinical decision making.
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Affiliation(s)
- C Koriath
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Kenny
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - G Adamson
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - R Druyeh
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - W Taylor
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J Beck
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - L Quinn
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - T H Mok
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - A Dimitriadis
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - P Norsworthy
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - N Bass
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - J Carter
- UCL Division of Psychiatry, Maple House, University College London, London, UK
| | - Z Walker
- UCL Division of Psychiatry, Maple House, University College London, London, UK
- Essex Partnership University NHS Foundation Trust, Essex, SS11 7XX, UK
| | - C Kipps
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Coulthard
- Institute of Clinical Neuroscience, University of Bristol, Level 1 Learning and Research Building, Bristol, BS10 5NB, UK
| | - J M Polke
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - M Bernal-Quiros
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - N Denning
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Thomas
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - R Raybould
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - J Williams
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - C J Mummery
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - E J Wild
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Houlden
- Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - S J Tabrizi
- Huntington's Disease Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - M N Rossor
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - H Hummerich
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - J D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, CB2 0SZ, UK
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, CB2 7EF, UK
| | - J D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J M Schott
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - N C Fox
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - J Collinge
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK
| | - S Mead
- MRC Prion Unit at UCL, UCL Institute of Prion Diseases, Courtauld Building, London, W1W 7FF, UK.
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Carter J, Re F, Hammami I, Littlejohns T, Arnold M, Clarke R. Effects of within-person variability in spot urinary sodium measurements on the associations with blood pressure and risk of cardiovascular disease in 0.5 Million adults in UK Biobank. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Randomised control trials have demonstrated direct positive and causal associations of 24-hr measurements of urinary sodium excretion on blood pressure. However, prospective studies, which often used spot (not 24-hr) measurements of urinary sodium, have reported J-shaped associations with higher risks of cardiovascular disease (CVD) at sodium intake <4 g/day. The reasons for the discrepant results are not fully understood, but have prompted some to question the World Health Organisation's recommendations to restrict sodium intake to <2.3g/day.
Purpose
We examined the effects of within-person variability in spot urinary sodium (UNa) measurements on immediate and delayed associations of UNa with blood pressure at baseline and at resurvey, and with incident cardiovascular disease in the UK Biobank (UKB).
Methods
Baseline spot urine samples were measured in 502,619 adults at baseline and in 20,346 participants who were resurveyed at 4 years after baseline. Linear regression was used to assess associations of baseline UNa measurements with systolic blood pressure (SBP; mmHg) at baseline and at resurvey. Cox regression was used estimate the associations between baseline measures of UNa with incident CVD events (recorded from linkage with hospital records). All analyses were adjusted for confounders and corrected for regression dilution bias.
Results
After excluding participants with prevalent diseases, the primary analyses involved 386,060 adults who were followed-up for a median of 7.8 years, during which ∼13,000 CVD events occurred. Estimated mean (SD) urinary sodium excretion was 77.4 mmol/L (SD 44.4, IQR = 42.8–103.7 mmol/L), and mean SBP/DBP were 137.5/82.3 (SD 18.5/10.1) mmHg, respectively. Within-person variability in UNa was high, with a self-correlation of 0.35 at 4 years between measurements. After adjustment for confounders and correction for regression dilution bias, a 100 mmol/L higher UNa was associated with an immediate 3.2 mmHg higher SBP (95% confidence interval [CI]: 2.8–3.6) in cross-sectional analyses (Figure 1). However, the corresponding associations of baseline UNa with SBP at resurvey was completely attenuated (p=0.20). The predicted risk of CVD was 1.06 (95% CI 1.06–1.07, p<0.001) for a 3.2 mmHg higher SBP, but the observed risk for a 100 mmol/L higher UNa was 0.95 (95% CI 0.82–1.10, p=0.47) (Figure 1).
Conclusions
While spot measurements of UNa were strongly associated with immediate effects on SBP, the magnitude of within-person variability in UNa precluded detection of associations with SBP several years after baseline or with risk of CVD. The extreme within-person variability in spot UNa may explain the discrepant results of the trials and observational studies of sodium and blood pressure.
Figure 1. Spot UNa with SBP and CVD in UK Biobank
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Core funding from the Medical Research Council-Population Health Research Unit, British Heart Foundation
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Affiliation(s)
- J Carter
- University of Oxford, Oxford, United Kingdom
| | - F Re
- University of Oxford, Oxford, United Kingdom
| | - I Hammami
- University of Oxford, Oxford, United Kingdom
| | | | - M Arnold
- University of Oxford, Oxford, United Kingdom
| | - R Clarke
- University of Oxford, Oxford, United Kingdom
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Carter J, Doorgakant A, Rigby M, Robb C. A space suit modification for the COVID-19 era. Ann R Coll Surg Engl 2020; 102:756-757. [DOI: 10.1308/rcsann.2020.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- J Carter
- Warrington Hospital, Warrington, UK
| | | | - M Rigby
- Warrington Hospital, Warrington, UK
| | - C Robb
- Warrington Hospital, Warrington, UK
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Carlisle N, Watson HA, Seed PT, Carter J, Kuhrt K, Tribe RM, Shennan AH. Impact of a medical mobile phone app (QUiPP) for predicting preterm birth on the anxiety and decisional conflicts faced by women in threatened preterm labour. Midwifery 2020; 92:102864. [PMID: 33137547 DOI: 10.1016/j.midw.2020.102864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The QUiPP app is a free, validated mobile phone application (app) that supports clinical decision-making for women in threatened preterm labour by providing an individualised risk of delivery within clinically important time points. Alongside generating a percentage risk score, the QUiPP app also provides the risk score in an infographic donut chart, allowing the clinician to communicate with the woman in an easy to understand format. Informing women of their risk status using the QUIPP app may help to reduce anxiety in women and decrease decisional conflict. METHOD A subset of participants from the EQUIPTT study [REC Ref. 17/LO/1802] were asked to complete a questionnaire booklet which was used to evaluate decisional conflict and anxiety. Seven sites were randomised to the QUiPP app intervention (to use as a decision and communication tool) and six sites were randomised to the control (continued their normal practice). The first section of the questionnaire booklet was completed by the woman before her assessment, and the second section after. The pre and postassessment anxiety scores utilised the Visual Analogue Scale for Anxiety (Hornblow and Kidson, 1976). The Decisional Conflict Scale (O'Connor, 1995) measured decisional conflict post assessment. The data were then analysed to determine the impact of the QUiPP App on the anxiety and decisional conflicts faced by women in threatened preterm labour. RESULTS Questionnaires were completed by 221 women from 12 of the potential 13 sites. After exclusions 202 questionnaires were included in the analysis. There was a significant reduction in difference between anxiety scores before and after clinical assessment. While there were reductions in anxiety and decisional conflict for women who were aware of the QUiPP app use, this failed to reach statistical significance. CONCLUSIONS The QUiPP app has potential to reduce anxiety and decisional conflict in women who are aware that it is being used in their care. Additional work is required to ensure clinicians are aware of the QUiPP app and optimise using it as a communication tool when counselling women.
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Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH.
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, SE1 7EH
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Cusimano M, Classen C, Koval J, Barbera L, Brotto L, Chivers M, Carter J, Robinson J, Ferguson S. Association of treatment modality with sexual dysfunction in gynecologic cancer survivors: A secondary analysis of the gyne-GALS randomized controlled trial. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.06.120] [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: 12/01/2022]
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Hargreaves S, Deal A, Mounier-Jack S, Campos-Matos I, Edelstein M, Hayward S, Friedland J, Carter J, Rustage K, Majeed A. Migration and outbreaks of vaccine-preventable disease in Europe: a systematic analysis (1990-2019). Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date.
Methods
We did both a temporal analysis to map published reports of migrant-related outbreaks against data from the ECDC's Surveillance Atlas of Infectious Disease, and a systematic review (PROSPERO CRD42019157473; 1990-2019) adhering to PRISMA guidelines, to explore whether migrants are involved in outbreaks in Europe and which particular subpopulations may be at increased risk. Studies on VPD outbreaks (measles, mumps, rubella, diphtheria, pertussis, polio, hepatitis A, N meningitidis, and H influenzae) in migrants residing in the EU/EEA were included.
Results
46 studies were included, reporting on 50 VPD outbreaks across 13 EU/EEA countries, of which 98% (n = 49) occured since January 2000. Measles had the highest number of reports of outbreaks involving migrants (n = 21; 5043 cases), followed by varicella (n = 10; 595 cases) and hepatitis A (n = 10; 1226 cases). 21 (40%) of outbreaks were reported from shelters for asylum seekers and refugees (mainly varicella or measles). Of 27 outbreaks where the index case was defined, 20 (74.1%) were migrants, including 9 (33.3%) from Eastern Europe and 6 (22.2%) from Africa. When mapped against the ECDC timeline of measles outbreaks, migrant-related outbreaks coincide with Europe-wide peaks in measles incidence (in 2006, 2010, and 2018).
Conclusions
Migrants represent one key group involved in VPD outbreaks, with refugees/asylum seekers residing in shelters or camps particularly at risk. Measles accounted for 38% of all reported outbreaks. Improved data collection on migrant status across Europe is crucial to understanding the complex relationship between migration and occurrence of VPD outbreaks to inform policy decisions on the most effective strategies to prevent future outbreaks.
Key messages
Migrants represent one key group involved in vaccine-preventable diseases outbreaks in Europe. Refugees and asylum seekers may be particularly at risk.
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Affiliation(s)
- S Hargreaves
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Deal
- Institute for Infection and Immunity, St George's University of London, London, UK
| | | | | | | | - S Hayward
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Friedland
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - J Carter
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - K Rustage
- Institute for Infection and Immunity, St George's University of London, London, UK
| | - A Majeed
- Department Primary Care and Public Health, Imperial College London, London, UK
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Carter J, Abu-Rustum N, Saban S, Chen L, Vickers A, Billanti G, Connors N, Broach V, Brown C, Chi D, Gardner G, Goldfrank D, Jewell E, Leitao M, Long Roche K, Mueller J, Sonoda Y, Zivanovic O. 013 The Development and Implementation of a Gynecologic Cancer Survivorship Tool. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carter J, Saban S, Arkema A, Goldfrank D, Goldfarb S. 042 Breast Cancer Patients in a Female Sexual Medicine and Women’s Health Program: A Cross-sectional Retrospective Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.278] [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: 10/23/2022]
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Watson HA, Seed PT, Carter J, Hezelgrave NL, Kuhrt K, Tribe RM, Shennan AH. Development and validation of predictive models for QUiPP App v.2: tool for predicting preterm birth in asymptomatic high-risk women. Ultrasound Obstet Gynecol 2020; 55:348-356. [PMID: 31325332 DOI: 10.1002/uog.20401] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/20/2019] [Accepted: 07/05/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Accurate mid-pregnancy prediction of spontaneous preterm birth (sPTB) is essential to ensure appropriate surveillance of high-risk women. Advancing the QUiPP App prototype, QUiPP App v.2 aimed to provide individualized risk of delivery based on cervical length (CL), quantitative fetal fibronectin (qfFN) or both tests combined, taking into account further risk factors, such as multiple pregnancy. Here we report development of the QUiPP App v.2 predictive models for use in asymptomatic high-risk women, and validation using a distinct dataset in order to confirm the accuracy and transportability of the QUiPP App, overall and within specific clinically relevant time frames. METHODS This was a prospective secondary analysis of data of asymptomatic women at high risk of sPTB recruited in 13 UK preterm birth clinics. Women were offered longitudinal qfFN testing every 2-4 weeks and/or transvaginal ultrasound CL measurement between 18 + 0 and 36 + 6 weeks' gestation. A total of 1803 women (3878 visits) were included in the training set and 904 women (1400 visits) in the validation set. Prediction models were created based on the training set for use in three groups: patients with risk factors for sPTB and CL measurement alone, with risk factors for sPTB and qfFN measurement alone, and those with risk factors for sPTB and both CL and qfFN measurements. Survival analysis was used to identify the significant predictors of sPTB, and parametric structures for survival models were compared and the best selected. The estimated overall probability of delivery before six clinically important time points (< 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks after testing) was calculated for each woman and analyzed as a predictive test for the actual occurrence of each event. This allowed receiver-operating-characteristics curves to be plotted, and areas under the curve (AUC) to be calculated. Calibration was performed to measure the agreement between expected and observed outcomes. RESULTS All three algorithms demonstrated high accuracy for the prediction of sPTB at < 30, < 34 and < 37 weeks' gestation and within 1, 2 and 4 weeks of testing, with AUCs between 0.75 and 0.90 for the use of qfFN and CL combined, between 0.68 and 0.90 for qfFN alone, and between 0.71 and 0.87 for CL alone. The differences between the three algorithms were not statistically significant. Calibration confirmed no significant differences between expected and observed rates of sPTB within 4 weeks and a slight overestimation of risk with the use of CL measurement between 22 + 0 and 25 + 6 weeks' gestation. CONCLUSIONS The QUiPP App v.2 is a highly accurate prediction tool for sPTB that is based on a unique combination of biomarkers, symptoms and statistical algorithms. It can be used reliably in the context of communicating to patients the risk of sPTB. Whilst further work is required to determine its role in identifying women requiring prophylactic interventions, it is a reliable and convenient screening tool for planning follow-up or hospitalization for high-risk women. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - N L Hezelgrave
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - K Kuhrt
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Carter J, Seed PT, Watson HA, David AL, Sandall J, Shennan AH, Tribe RM. Development and validation of predictive models for QUiPP App v.2: tool for predicting preterm birth in women with symptoms of threatened preterm labor. Ultrasound Obstet Gynecol 2020; 55:357-367. [PMID: 31385343 DOI: 10.1002/uog.20422] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/11/2019] [Accepted: 07/25/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To develop enhanced prediction models to update the QUiPP App prototype, a tool providing individualized risk of spontaneous preterm birth (sPTB), for use in women with symptoms of threatened preterm labor (TPTL), incorporating risk factors, transvaginal ultrasound assessment of cervical length (CL) and cervicovaginal fluid quantitative fetal fibronectin (qfFN) test results. METHODS Participants were pregnant women between 23 + 0 and 34 + 6 weeks' gestation with symptoms of TPTL, recruited as part of four prospective cohort studies carried out at 16 UK hospitals between October 2010 and October 2017. The training set comprised all women whose outcomes were known in May 2017 (n = 1032). The validation set comprised women whose outcomes were gathered between June 2017 and March 2018 (n = 506). Parametric survival models were developed for three combinations of predictors: risk factors plus qfFN test results alone, risk factors plus CL alone, and risk factors plus both qfFN and CL. The best models were selected using the Akaike and Bayesian information criteria. The estimated probability of sPTB < 30, < 34 or < 37 weeks' gestation and within 1 or 2 weeks of testing was calculated and receiver-operating-characteristics (ROC) curves were created to demonstrate the diagnostic ability of the prediction models. RESULTS Predictive statistics were similar between the training and the validation sets at most outcome time points and for each combination of predictors. Areas under the ROC curves (AUC) demonstrated that all three algorithms had good accuracy for the prediction of sPTB at < 30, < 34 and < 37 weeks' gestation and within 1 and 2 weeks' post-testing in the validation set, particularly the model combining risk factors plus qfFN alone (AUC: 0.96 at < 30 weeks; 0.85 at < 34 weeks; 0.77 at < 37 weeks; 0.91 at < 1 week from testing; and 0.92 at < 2 weeks from testing). CONCLUSIONS Validation of the new prediction models suggests that the QUiPP App v.2 can reliably calculate risk of sPTB in women with TPTL. Use of the QUiPP App in practice could lead to better targeting of intervention, while providing reassurance and avoiding unnecessary intervention in women at low risk. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - P T Seed
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - H A Watson
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A L David
- Institute for Women's Health, University College London, London, UK
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
| | - J Sandall
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - R M Tribe
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Carter J, Goldfarb S, Baser R, Goldfrank D, Seidel B, Milli L, Saban S, Kollmeier M, Stabile C, Canty J, Gardner G, Jewell E, Sonoda Y, Alektiar K. A Single-Arm Clinical Trial Investigating the Effectiveness of a Non-Hormonal Vaginal Moisturizer in Endometrial Cancer Survivors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1764] [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: 10/26/2022]
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Zelenetz A, Jagadeesh D, Kenkre V, Reddy N, Stathis A, Salman H, Asch A, Soumerai J, Jhangiani H, Iasonos A, Patel K, Carter J, LLorin-Sangalang J, Pagel J. THE PI3Kδ INHIBITOR ME-401 ± RITUXIMAB IN RELAPSED/REFRACTORY (R/R) FOLLICULAR LYMPHOMA (FL), CHRONIC LYMPHOCYTIC LEUKEMIA (CLL), AND SMALL LYMPHOCYTIC LYMPHOMA (SLL). Hematol Oncol 2019. [DOI: 10.1002/hon.133_2629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A.D. Zelenetz
- Lymphoma; Memorial Sloane Kettering Cancer Center; New York City United States
| | - D. Jagadeesh
- Hematology; Cleveland Clinic Taussig Cancer Institute; Cleveland United States
| | - V.P. Kenkre
- Hematology; University of Wisconsin Medical Center; Madison United States
| | - N.M. Reddy
- Hematology; Vanderbilt University Ingram Cancer Center; Nashville United States
| | - A. Stathis
- Hematology; IOSI - Oncology Institute of Southern Switzerland; Bellinzona Switzerland
| | - H.S. Salman
- Hematology; Stony Brook Medical Center; Stony Brook United States
| | - A.S. Asch
- Hematology; University of Oklahoma Stephenson Cancer Center; Oklahoma United States
| | - J. Soumerai
- Hematology; Massachussets General Hospital; Boston United States
| | - H.S. Jhangiani
- Hematology/Oncology; Compassionate Care Cancer Center; Fountain Valley United States
| | - A. Iasonos
- Lymphoma; Memorial Sloane Kettering Cancer Center; New York City United States
| | - K. Patel
- Hematology; Swedish Cancer Institute; Seattle United States
| | - J. Carter
- Lymphoma; Memorial Sloane Kettering Cancer Center; New York City United States
| | | | - J.M. Pagel
- Hematology; Swedish Cancer Institute; Seattle United States
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Lu K, Nebgen D, Norquist B, Bowen D, Bakkum-Gamez J, Romero I, Roche KL, Levine D, Soletsky B, Carter J, Hickey M, Crase J, Gavin K, Polinsky D, Swisher E. WISP: A prospective, multi-center trial of salpingectomy with delayed oophorectomy versus risk reducing salpingo-oophorectomy in women at increased risk for hereditary ovarian cancer. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Filippova O, Cowan R, Baser R, Suidan R, Andikyan V, Sonoda Y, Zivanovic O, Bochner B, Carter J, Chi D. A prospective study assessing quality of life in women after pelvic exenteration. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Carter J, Goldfarb S, Baser R, Goldfrank D, Seidel B, Milli L, Stabile C, Canty J, Dickler M, Alektiar K. A single-arm clinical trial investigating the effectiveness of a non-hormonal vaginal moisturizer in postmenopausal cancer survivors. Gynecol Oncol 2019. [DOI: 10.1016/j.ygyno.2019.04.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Popp TJ, Henshaw MH, Carter J, Thomas TN, Chowdhury SM. Racial differences in myocardial deformation in obese children: Significance of inflammatory state. Nutr Metab Cardiovasc Dis 2019; 29:378-382. [PMID: 30850223 PMCID: PMC6492271 DOI: 10.1016/j.numecd.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The association between racial differences in myocardial deformation and cardiometabolic risk factors is unknown in obese children. Our objective was to: 1) investigate for racial differences in myocardial deformation between white and black obese children and 2) identify biomarkers associated with these observed racial differences. We hypothesized that decreased myocardial deformation observed in black obese children could be accounted for by the differences in the markers of metabolic syndrome between the groups. METHODS AND RESULTS Obese children were recruited prospectively. All clinical and laboratory tests for the metabolic syndrome were conducted during a single assessment using a standardized protocol. Speckle-tracking echocardiography was performed to obtain longitudinal and circumferential measures of deformation. 310 patients were included in the analysis; 158 (51%) white and 152 (49%) black. The median age was 11.3 years (IQR 5.9). Blacks demonstrated worse longitudinal strain (-14.7 ± 2.7% vs. -15.4 ± 2.9%, p = 0.04). There was no difference in circumferential strain between the groups. Multivariable linear regression showed a significant relationship between longitudinal strain and hsCRP (β = 0.16, p = 0.03) and HOMA-IR (β = 0.15, p = 0.04); there was no independent association between longitudinal strain and race. CONCLUSION Black subjects demonstrated worse longitudinal strain than whites. Only hsCRP and HOMA-IR levels, not race, had an independent association with longitudinal strain, suggesting that the observed racial differences in longitudinal strain may be secondary to differences in inflammation and insulin resistance between the groups.
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Affiliation(s)
- T J Popp
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - M H Henshaw
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - J Carter
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - T N Thomas
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - S M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA.
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G, Browning T, Coughenour M, Sulk E, Tsalikan M, Tansey J, Cabbage N. Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes. Diabetes Care 2019; 42:192-199. [PMID: 30061316 PMCID: PMC6341285 DOI: 10.2337/dc18-0288] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 06/28/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings. RESEARCH DESIGN AND METHODS Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years. RESULTS At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects. CONCLUSIONS Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.
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Affiliation(s)
- Taylor M. Triolo
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Alexandra Fouts
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Liping Yu
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Peter A. Gottlieb
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Andrea K. Steck
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO
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Carter J, Fitzgerald C, Mansell J, Murray J, Murphy D, Lannigan A. Breast phyloddes tumours - a clinicopathological review. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stone G, Pozza RD, Carter J, McKeon G. Long Paddock: climate risk and grazing information for Australian rangelands and grazing communities. Rangel J 2019. [DOI: 10.1071/rj18036] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Queensland Government’s Long Paddock website has been redeveloped on Amazon Web Services cloud computing platform, to provide Australian rangelands and grazing communities (i.e. rural landholders, managers, pastoralists (graziers), researchers, advisors, students, consultants and extension providers) with easier access to seasonal climate and pasture condition information. The website provides free, tailored information and services to support management decisions to maximise productivity, while maintaining the natural resource base. For example, historical rainfall and pasture analyses (i.e. maps, posters and data) have been developed to assist in communicating the risk of multi-year droughts that are a feature of Queensland’s highly variable climate.
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Carlisle N, Chandiramani M, Carter J, Shennan AH. Reply: Evaluation of the quantitative fetal fibronectin test and PAMG-1 test for the prediction of spontaneous preterm birth in patients with signs and symptoms suggestive of preterm labor. J Matern Fetal Neonatal Med 2018; 33:2505. [PMID: 30526197 DOI: 10.1080/14767058.2018.1547704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- N Carlisle
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | | | - J Carter
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - A H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
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Carter J, Cresswell A, Kinnaird T, Carmichael L, Murphy S, Sanderson D. Non-Poisson variations in photomultipliers and implications for luminescence dating. RADIAT MEAS 2018. [DOI: 10.1016/j.radmeas.2018.05.010] [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: 11/25/2022]
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Fremlin GA, van der Oord K, Carter J, Carr R. An unusual case of multiple nodules on the lower legs. Clin Exp Dermatol 2018; 43:959-961. [DOI: 10.1111/ced.13664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/29/2022]
Affiliation(s)
- G. A. Fremlin
- Department of Dermatology; South Warwickshire NHS Foundation Trust; Warwick Hospital; Warwick UK
| | - K. van der Oord
- Department of Histopathology; South Warwickshire NHS Foundation Trust; Warwick Hospital; Warwick UK
| | - J. Carter
- Department of Dermatology; South Warwickshire NHS Foundation Trust; Warwick Hospital; Warwick UK
| | - R. Carr
- Department of Histopathology; South Warwickshire NHS Foundation Trust; Warwick Hospital; Warwick UK
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O’Connell M, Scerbe A, Wiley K, Gould B, Carter J, Bourassa C, Morgan D, Jacklin K, Warry W. Anticipated needs and worries about maintaining independence of rural/remote older adults: Opportunities for technology development in the context of the double digital divide. ACTA ACUST UNITED AC 2018. [DOI: 10.4017/gt.2018.17.3.001.00] [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: 10/28/2022]
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Carter J, Huang H, Armer J, Carlson J, Lockwood S, Nolte S, Stewart B, Wenzel L, Kauderer J, Hutson A, Walker J, Fleury A, Soper J, Mathews C, Zivanovic O, Richards W, Alberts D, Barakat R. GOG 244, The lymphedema and gynecologic cancer (LEG) study: The association between the gynecologic cancer lymphedema questionnaire (GCLQ) and lower extremity lymphedema. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zaidat OO, Bozorgchami H, Ribó M, Saver JL, Mattle HP, Chapot R, Narata AP, Francois O, Jadhav AP, Grossberg JA, Riedel CH, Tomasello A, Clark WM, Nordmeyer H, Lin E, Nogueira RG, Yoo AJ, Jovin TG, Siddiqui AH, Bernard T, Claffey M, Andersson T, Ribo M, Hetts S, Hacke W, Mehta B, Hacein-Bey L, Kim A, Abou-Chebl A, Shabe P, Hetts S, Hacein-Bey L, Kim A, Abou-Chebl A, Dix J, Gurian J, Zink W, Dabus G, O’Leary, N, Reilly A, Lee K, Foley J, Dolan M, Hartley E, Clark T, Nadeau K, Shama J, Hull L, Brown B, Priest R, Nesbit G, Horikawa M, Hoak D, Petersen B, Beadell N, Herrick K, White C, Stacey M, Ford S, Liu J, Ribó M, Sanjuan, E, Sanchis M, Molina C, Rodríguez-Luna, D, Boned Riera S, Pagola J, Rubiera M, Juega J, Rodríguez N, Muller N, Stauder M, Stracke P, Heddier M, Charron V, Decock A, Herbreteau D, Bibi R, De Sloovere A, Doutreloigne I, Pieters D, Dewaele T, Bourgeois P, Vanhee F, Vanderdouckt P, Vancaster E, Baxendell L, Gilchrist V, Cannon Y, Graves C, Armbruster K, Jovin T, Jankowitz B, Ducruet A, Aghaebrahim A, Kenmuir C, Shoirah H, Molyneaux B, Tadi P, Walker G, Starr M, Doppelheuer S, Schindler K, Craft L, Schultz M, Perez H, Park J, Hall A, Mitchell A, Webb L, Haussen D, Frankel M, Bianchi N, Belagaje S, Mahdi N, Lahoti S, Katema A, Winningham M, Anderson A, Tilley D, Steinhauser T, Scott D, Thacker A, Calderon V, Lin E, Becke S, Krieter S, Jansen O, Wodarg F, Larsen N, Binder A, Wiesen C, Hartney M, Bookhagan L, Ross H, Gay J, Snyder K, Levy E, Davies J, Sonig A, Rangel-Castilla L, Mowla A, Shakir H, Fennell V, Atwal G, Natarajan S, Beecher J, Thornton J, Cullen A, Brennan P, O’Hare A, Asadi H, Budzik R, Taylor M, Jennings M, Laube F, Jackson J, Gatrell R, Reebel L, Albon A, Gerniak J, Groezinger K, Lauf M, Voraco N, Pema P, Davis T, Hicks W, Mejilla J, Teleb M, Sunenshine P, Russo E, Flynn R, Twyford J, Ver Hage A, Smith E, Apolinar L, Blythe S, Maxan J, Carter J, Taschner T, Bergmann U, Meckel S, Elsheik S, Urbach H, Maurer C, Egger K, Niesen W, Baxter B, Knox, A, Hazelwood B, Quarfordt S, Calvert J, Hawk H, Malek, R, Padidar A, Tolley U, Gutierrez A, Mordasini P, Seip T, Balasubramaniam R, Gralla J, Fischer U, Zibold F, Piechowiak E, DeLeacy R, Apruzzeses R, Alfonso C, Haslett J, Fifi J, Mocco J, Starkman S, Guzy, J, Grunberg N, Szeder V, Tateshima S, Duckwiler G, Nour M, Liebeskind D, Tang X, Hinman J, Tipirneni A, Yavagal D, Guada L, Bates K, Balladeras S, Bokka S, Suir S, Caplan J, Kandewall P, Peterson E, Starke R, Puri A, Hawk M, Brooks C, L’Heurex J, Ty K, Rex D, Massari F, Wakhloo A, Lozano D, Rodrigua K, Pierot L, Fabienne M, Sebastien S, Emmoinoli M. Primary Results of the Multicenter ARISE II Study (Analysis of Revascularization in Ischemic Stroke With EmboTrap). Stroke 2018; 49:1107-1115. [DOI: 10.1161/strokeaha.117.020125] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/05/2018] [Accepted: 02/26/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Osama O. Zaidat
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | | | - Marc Ribó
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
| | - Jeffrey L. Saver
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles (J.L.S.)
| | - Heinrich P. Mattle
- Department of Neurology, Inselspital, University of Bern, Switzerland (H.P.M.)
| | - René Chapot
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Ana Paula Narata
- Centre Hospitalier Régional Universitaire, Hôpitaux de Tours, France (A.P.N.)
| | | | - Ashutosh P. Jadhav
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | | | - Alejandro Tomasello
- Department of Neuroradiology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden (T.A.)
| | - Wayne M. Clark
- Oregon Health and Science University Hospital, Portland (H.B., W.M.C.)
| | - Hannes Nordmeyer
- Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus, Essen, Germany (R.C., H.N.)
| | - Eugene Lin
- From the Department of Neuroscience, Mercy St. Vincent Medical Center, Toledo, OH (O.O.Z., E.L.)
| | - Raul G. Nogueira
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA (J.A.G., R.G.N.)
| | - Albert J. Yoo
- Department of Interventional Radiology, Texas Stroke Institute, Dallas–Fort Worth (A.J.Y.)
| | - Tudor G. Jovin
- Department of Neurology, University of Pittsburgh Medical Center, PA (A.P.J., T.G.J.)
| | | | | | | | - Tommy Andersson
- Department of Neuroradiology, Vall d’Hebron University Hospital, Barcelona, Spain (M.R., A.T.)
- AZ Groeninge, Kortrijk, Belgium (O.F., T.A.)
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Abstract
Numerous oral complaints have been attributed to the female climacteric including altered taste, a burning sensation and xerostomia. However, the data relating these symptoms to the climacteric require elucidation as there have been no adequately controlled studies. In the present investigation, a group of 145 oöphorectomized women were followed for one year. Approximately half were treated with oestrogen replacement and the remainder with a placebo. The results indicate that the hormone had no direct effect upon the oral symptoms but that there was a general increase in somatic complaints which appeared to be related to the degree of neurosis experienced. This is turn can be attributed to vasomotor changes which are under the control of oestrogen.
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Hosseini A, Khoury AL, Carter J, Wong JM, Alvarado MD, Ewing C, Esserman LJ, Mukhtar RA. Abstract P5-12-04: The impact of bariatric surgery on mammographic breast density. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-12-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:
Bariatric surgery decreases breast cancer risk, but its impact on mammographic findings is not well understood. Obesity and breast density both increase breast cancer risk, but paradoxically are inversely related. We investigated how mammographic density changes after bariatric surgery, and whether or not that change is related to amount of weight loss.
Methods:
We reviewed records for 349 prospectively collected patients who underwent bariatric surgery between 2013-2015, and identified 45 women with pre- and post-operative screening mammograms within 1.5 years of surgery. We recorded body mass index (BMI), Breast Imaging-Reporting and Data System density, and calculated excess BMI loss. Data were analyzed in Stata 14.2.
Results:
Average age was 54 years, mean pre-operative BMI was 44 (range 36-72), and mean percentage excess BMI lost was 73% at 1.3 years. One third had a change in mammographic breast density, which increased 93% of the time (p<0.001). Amount of weight loss was not associated with density change; in fact, weight loss was lower in those with a density change than in those without a density change (68% versus 75% excess BMI lost).
Conclusions:
The majority of women with a mammographic change had an increase in breast density, despite bariatric surgery being associated with reduced breast cancer risk. Interestingly, the amount of weight loss was not associated with change in breast density. These findings suggest the metabolic effects of bariatric surgery have an effect on breast cancer risk independent of BMI reduction. Future work will include studying mammographic changes associated with non-surgical weight loss.
Citation Format: Hosseini A, Khoury AL, Carter J, Wong JM, Alvarado MD, Ewing C, Esserman LJ, Mukhtar RA. The impact of bariatric surgery on mammographic breast density [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-12-04.
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Affiliation(s)
- A Hosseini
- University of California, San Francisco, San Francisco, CA
| | - AL Khoury
- University of California, San Francisco, San Francisco, CA
| | - J Carter
- University of California, San Francisco, San Francisco, CA
| | - JM Wong
- University of California, San Francisco, San Francisco, CA
| | - MD Alvarado
- University of California, San Francisco, San Francisco, CA
| | - C Ewing
- University of California, San Francisco, San Francisco, CA
| | - LJ Esserman
- University of California, San Francisco, San Francisco, CA
| | - RA Mukhtar
- University of California, San Francisco, San Francisco, CA
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Martin D, von Neumann-Cosel P, Tamii A, Aoi N, Bassauer S, Bertulani CA, Carter J, Donaldson L, Fujita H, Fujita Y, Hashimoto T, Hatanaka K, Ito T, Krugmann A, Liu B, Maeda Y, Miki K, Neveling R, Pietralla N, Poltoratska I, Ponomarev VY, Richter A, Shima T, Yamamoto T, Zweidinger M. Test of the Brink-Axel Hypothesis for the Pygmy Dipole Resonance. Phys Rev Lett 2017; 119:182503. [PMID: 29219585 DOI: 10.1103/physrevlett.119.182503] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Indexed: 06/07/2023]
Abstract
The gamma strength function and level density of 1^{-} states in ^{96}Mo have been extracted from a high-resolution study of the (p[over →], p[over →]^{'}) reaction at 295 MeV and extreme forward angles. By comparison with compound nucleus γ decay experiments, this allows a test of the generalized Brink-Axel hypothesis in the energy region of the pygmy dipole resonance. The Brink-Axel hypothesis is commonly assumed in astrophysical reaction network calculations and states that the gamma strength function in nuclei is independent of the structure of the initial and final state. The present results validate the Brink-Axel hypothesis for ^{96}Mo and provide independent confirmation of the methods used to separate gamma strength function and level density in γ decay experiments.
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Affiliation(s)
- D Martin
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - P von Neumann-Cosel
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - A Tamii
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - N Aoi
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - S Bassauer
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - C A Bertulani
- Department of Physics and Astronomy, Texas A&M University-Commerce, Commerce, Texas 75429, USA
| | - J Carter
- School of Physics, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - L Donaldson
- School of Physics, University of the Witwatersrand, Johannesburg 2050, South Africa
| | - H Fujita
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - Y Fujita
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - T Hashimoto
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - K Hatanaka
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - T Ito
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - A Krugmann
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - B Liu
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - Y Maeda
- Faculty of Engineering, Miyazaki University, Miyazaki 889-2192, Japan
| | - K Miki
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - R Neveling
- iThemba LABS, Somerset West 7129, South Africa
| | - N Pietralla
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - I Poltoratska
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - V Yu Ponomarev
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - A Richter
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
| | - T Shima
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - T Yamamoto
- Research Center for Nuclear Physics, Osaka University, Ibaraki, Osaka 567-0047, Japan
| | - M Zweidinger
- Institut für Kernphysik, Technische Universität Darmstadt, D-64289 Darmstadt, Germany
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50
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Gallant NM, Leydiker K, Wilnai Y, Lee C, Lorey F, Feuchtbaum L, Tang H, Carter J, Enns GM, Packman S, Lin HJ, Wilcox WR, Cederbaum SD, Abdenur JE. Biochemical characteristics of newborns with carnitine transporter defect identified by newborn screening in California. Mol Genet Metab 2017; 122:76-84. [PMID: 28711408 DOI: 10.1016/j.ymgme.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/30/2022]
Abstract
Carnitine transporter defect (CTD; also known as systemic primary carnitine deficiency; MIM 212140) is due to mutations in the SLC22A5 gene and leads to extremely low carnitine levels in blood and tissues. Affected individuals may develop early onset cardiomyopathy, weakness, or encephalopathy, which may be serious or even fatal. The disorder can be suggested by newborn screening. However, markedly low newborn carnitine levels can also be caused by conditions unrelated to CTD, such as the low carnitine levels often associated with normal pregnancies and some metabolic disorders occurring in the mother. In order to clarify the biochemical characteristics most useful for identification of CTD in newborns, we examined California Department of Public Health newborn screening data for CTD from 2005 to 12 and performed detailed chart reviews at six metabolic centers in California. The reviews covered 14 cases of newborn CTD, 14 cases of maternal disorders (CTD, 6 cases; glutaric aciduria, type 1, 5; medium-chain acyl CoA dehydrogenase deficiency, 2; and cobalamin C deficiency, 1), and 154 false-positive cases identified by newborn screening. Our results show that newborns with CTD identified by NBS exhibit different biochemical characteristics, compared to individuals ascertained clinically. Newborns with CTD may have NBS dried blood spot free carnitine near the lower cutoff and confirmatory plasma total and free carnitine levels near the normal lower limit, particularly if obtained within two weeks after birth. These findings raise the concern that true cases of CTD may exist that could have been missed by newborn screening. CTD should be considered as a possible diagnosis in cases with suggestive clinical features, even if CTD was thought to be excluded in the newborn period. Maternal plasma total carnitine and newborn urine total carnitine values are the most important predictors of true CTD in newborns. However, biochemical testing alone does not yield a discriminant rule to distinguish true CTD from low carnitine in newborns due to other causes. Because of this biochemical variability and overlap, molecular genetic testing is imperative to confirm CTD in newborns. Additionally, functional testing of fibroblast carnitine uptake remains necessary for cases in which other confirmatory testing is inconclusive. Even with utilization of all available diagnostic testing methods, confirmation of CTD ascertained by NBS remains lengthy and challenging. Incorporation of molecular analysis as a second tier step in NBS for CTD may be beneficial and should be investigated.
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Affiliation(s)
- N M Gallant
- Division of Genetic and Genomic Medicine, University of California, Irvine, Irvine, CA, United States; Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; Stramski Children's Developmental Center, Miller Children's and Women's Hospital, Long Beach, CA, United States
| | - K Leydiker
- Division of Metabolic Disorders, Children's Hospital of Orange County, Orange, CA, United States
| | - Y Wilnai
- Lucile Packard Children's Hospital, Division of Medical Genetics, Stanford University Medical Center, Stanford, CA, United States
| | - C Lee
- Lucile Packard Children's Hospital, Division of Medical Genetics, Stanford University Medical Center, Stanford, CA, United States
| | - F Lorey
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, United States
| | - L Feuchtbaum
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, United States
| | - H Tang
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, United States
| | - J Carter
- Genetic Disease Screening Program, California Department of Public Health, Richmond, CA, United States
| | - G M Enns
- Lucile Packard Children's Hospital, Division of Medical Genetics, Stanford University Medical Center, Stanford, CA, United States
| | - S Packman
- Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| | - H J Lin
- Division of Medical Genetics, Department of Pediatrics, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, CA, United States
| | - W R Wilcox
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, United States
| | - S D Cederbaum
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States; Intellectual and Developmental Disabilities Research Center at UCLA, Los Angeles, CA, United States; Semel Institute for Neuroscience, UCLA, Los Angeles, CA, United States
| | - J E Abdenur
- Department of Pediatrics, University of California, Irvine, Irvine, CA, United States; Division of Metabolic Disorders, Children's Hospital of Orange County, Orange, CA, United States.
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