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Saldaris JM, Jacoby P, Marsh ED, Suter B, Leonard H, Olson HE, Rajaraman R, Pestana-Knight E, Weisenberg J, Price D, Drummond C, Benke TA, Demarest S, Downs J. Adapting a measure of gross motor skills for individuals with CDKL5 deficiency disorder: A psychometric study. Epilepsy Res 2024; 200:107287. [PMID: 38237219 DOI: 10.1016/j.eplepsyres.2024.107287] [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: 10/17/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE Validated measures capable of demonstrating meaningful interventional change in the CDKL5 deficiency disorder (CDD) are lacking. The study objective was to modify the Rett Syndrome Gross Motor Scale (RSGMS) and evaluate its psychometric properties for individuals with CDD. METHODS Item and scoring categories of the RSGMS were modified. Caregivers registered with the International CDKL5 Clinical Research Network uploaded motor videos filmed at home to a protected server and completed a feedback questionnaire (n = 70). Rasch (n = 137), known groups (n = 109), and intra- and inter-rater reliability analyses (n = 50) were conducted. RESULTS The age of individuals with CDD ranged from 1.5 to 34.1 years. The modified scale, Gross Motor-Complex Disability (GM-CD), comprised 17 items. There were no floor or ceiling effects and inter- and intra-rater reliability were good. Rasch analysis demonstrated that the items encompassed a large range of performance difficulty, although there was some item redundancy and some disordered categories. One item, Prone Head Position, was a poor fit. Caregiver-reported acceptability was positive. Scores differed by age and functional abilities. SUMMARY GM-CD appears to be a suitable remotely administered measure and psychometrically sound for individuals with CDD. This study provides the foundation to propose the use of GM-CD in CDD clinical trials. Longitudinal evaluation is planned.
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Affiliation(s)
- J M Saldaris
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - P Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - E D Marsh
- Division of Child Neurology, Children's Hospital of Philadelphia and Departments of Neurology and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - B Suter
- Department of Pediatrics & Neurology, Baylor College of Medicine, Houston, TX, USA
| | - H Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - H E Olson
- Division of Epilepsy and Clinical Neurophysiology and Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - R Rajaraman
- UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | | | - J Weisenberg
- St. Louis Children's Hospital and Washington University School of Medicine, St Louis, MO, USA
| | - D Price
- NYU Langone Health and Department of Neurology, New York University, New York, NY, USA
| | - C Drummond
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - T A Benke
- University of Colorado, School of Medicine, Depts Pediatrics, Neurology and Pharmacology and Children's Hospital Colorado, Aurora, CO, USA
| | - S Demarest
- University of Colorado, School of Medicine, Depts Pediatrics, Neurology and Pharmacology and Children's Hospital Colorado, Aurora, CO, USA.
| | - J Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; Curtin School of Allied Health, Curtin University, Perth, WA, Australia.
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Parlatini V, Frangou L, Zhang S, Epstein S, Morris A, Grant C, Zalewski L, Jewell A, Velupillai S, Simonoff E, Downs J. Emotional and behavioral outcomes among youths with mental disorders during the first Covid lockdown and school closures in England: a large clinical population study using health care record integrated surveys. Soc Psychiatry Psychiatr Epidemiol 2024; 59:175-186. [PMID: 37353579 PMCID: PMC10799796 DOI: 10.1007/s00127-023-02517-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Emotional and behavioral problems in children and young people (CYP) have increased over the pandemic. Those with pre-existing mental disorders are more vulnerable but have been understudied. We investigated emotional and behavioral outcomes in this population; differences across diagnostic groups; and social, educational, and clinical determinants. METHODS We invited 5386 caregivers and CYP (aged 5-17) under child mental health services pre-pandemic to complete an online survey on CYP's emotional/behavioral symptoms and pandemic-related circumstances, and integrated responses with clinicodemographic information extracted from electronic health records. We compared four parent-rated outcomes (total emotional/behavioral scores and emotional/behavioral changes as compared to before the pandemic) across the three most common diagnostic groups in our population (Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and emotional disorders (EmD)). We then estimated the association of clinicodemographic and pandemic-related characteristics with emotional/behavioral outcomes. RESULTS A total of 1741 parents (32.3%) completed the survey. Parents of CYP with ADHD or ASD reported more behavioral difficulties (t(591) = 5.618 (0.001); t(663) = 6.527 (0.001)); greater emotional deterioration (t(591) = 2.592 (0.009); t(664) = 4.670 (< 0.001); and greater behavioral deterioration (t(594) = 4.529 (< 0.001); t(664) = 5.082 (< 0.001)) as compared to the EmD group. Those with ASD and EmD showed more emotional difficulties than ADHD (t(891) = - 4.431 (< 0.001); t(590) = - 3.254 (0.001)). Across diagnoses, poor parental mental health and challenges with education were most strongly associated with worse outcomes. CONCLUSIONS Within our clinical population, CYP with ADHD/ASD were the most adversely affected during lockdown. Enhancing clinical service provision that tackles parental stress and supports education may help mitigate the impact of future restrictions.
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Affiliation(s)
- V Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - L Frangou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Zhang
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Epstein
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - A Morris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - C Grant
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - L Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Jewell
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - S Velupillai
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - J Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Hsiao B, Downs J, Lanyon M, Curtis JR, Blalock S, Wiedmeyer C, Venkatachalam S, Nowell WB, Fraenkel L. AB1584-PARE UNDERSTANDING HETEROGENEITY IN PATIENTS’ CONCEPTUALIZATION OF TREATMENT FOR RHEUMATOID ARTHRITIS: A CLUSTER ANALYSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUptake of treat to target strategies for the management of rheumatoid arthritis (RA) is low. System-related barriers to accessing treatment are known, but poor adherence to starting and continuing treatment are prevalent causes of suboptimal care.ObjectivesTo better understand heterogeneity in patients’ conceptualization of RA treatment to inform interventions aimed at improving appropriate utilization of disease modifying antirheumatic drugs (DMARDs).MethodsParticipants (pts) were recruited from the ArthritisPower US online research registry. Pts who met eligibility criteria [physician diagnosed RA currently being treated with DMARD(s)] rated 56 items (coded on 5-point scales) reflecting concepts raised during in-depth patient interviews. To combine similar items for ease of analysis and interpretation, we conducted a principal components analysis using Varimax rotation. We then entered mean scores, weighted by how heavily each item loaded onto each factor, into a k-means cluster analysis. We examined whether demographic characteristics differed across clusters using ANOVA for continuous and chi-square for categorical variables.ResultsPts (N= 621) ranged in age from 22 to 93, with a mean of 57 years (SD= 11.5). Most (89%) were female and reported as non-Hispanic white (89%); 27% reported having a post-graduate degree. A scree plot revealed that a 4-factor solution explaining 36.8% of the variance would provide desirable interpretability, with a discontinuous drop in eigenvalues for additional factors slowly tapering and adding little discriminability between later solutions. The four factors (% variance explained, number of items) were: 1) Access to high quality care and support (12.10%, n= 21); 2) Comfortable adding/switching DMARDs (9.73%, n= 14); 3) Perceived favorable DMARD risk/benefit ratio (8.74%, n= 15); and 4) Confidence that testing reflects disease activity (6.20%, n= 6).A 5-cluster solution showed the most stable convergence of cluster centers after 10 iterations. Figure 1 shows the weighted mean scores for each factor across clusters. The largest group (31.7%) is characterized by mean scores on each of the four factors toward the high end of mean responses for the sample, reflecting positive experiences; we labeled this group “Successfully Engaged in Care” to indicate a positive rheumatologist relationship, feeling well-informed and active participation in care. The next group (24.3%) also had high scores for Factor 1 (access to high quality care/support) and Factor 3 (perceived favorable DMARD risk/benefit ratio), but were less comfortable adding/switching DMARDs (Factor 2) and had less confidence in testing reflecting their disease activity (Factor 4); we labeled this group “Worried About Medication”.The three remaining clusters are smaller. The third cluster (16.4%), labeled “Skeptical of Testing,” had a favorable view of DMARDs (Factor 3) despite lower scores related to access and quality of care (Factor 1) and confidence in testing (Factor 4). The fourth cluster (14.3%) expressed low perceived value of DMARDs as well as reduced scores for DMARD risk/benefit and confidence in testing; we labeled this group “Resistant to DMARDs.” The last cluster (13.2%) scored lowest on their rating of access to high quality care and support, indicating less access to, and satisfaction with, information needed to support decision making. Their perceived risk/benefit ratio for DMARDs was still favorable, so we labeled this group “Dissatisfied with Care.”ConclusionPatients’ conceptualization of RA treatment varies, but discomfort with adding/switching DMARDs appears to be ubiquitous regardless of perceived benefits associated with DMARDs and access to high quality care/support. Interventions outside of the traditional physician-patient relationship are needed to facilitate treatment escalation in patients with RA. Further research is required to understand residual variance not explained by our model.AcknowledgementsThe authors thank the patients for their participation.Disclosure of InterestsBetty Hsiao: None declared, Julie Downs: None declared, Mandy Lanyon: None declared, Jeffrey R. Curtis Consultant of: Gilead, Novartis, and Samsung, Grant/research support from: AbbVie, Amgen, BMS, Corrona, Eli Lilly and Company, Janssen, Myriad, Pfizer, Regeneron, Roche, and UCB, Susan Blalock: None declared, Carole Wiedmeyer: None declared, Shilpa Venkatachalam: None declared, W. Benjamin Nowell Grant/research support from: •William B. Nowell is the Principal Investigator on grants/contracts from AbbVie, Eli Lilly and Company, and PCORI, and an employee of the Global Healthy Living Foundation (GHLF). GHLF receives grants, sponsorships and contracts from pharmaceutical manufacturers and private foundations. A full list of GHLF funders is publicly available here: https://www.ghlf.org/our-partners/., Liana Fraenkel: None declared
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Fonseca De Freitas D, Patel I, Kadra-Scalzo G, Pritchard M, Shetty H, Broadbent M, Patel R, Downs J, Segev A, Khondoker M, Maccabe J, Bhui K, Hayes R. Ethnic inequalities in treatment with clozapine. Eur Psychiatry 2022. [PMCID: PMC9567955 DOI: 10.1192/j.eurpsy.2022.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Ethnic disparities in treatment with clozapine, the antipsychotic recommended for treatment-resistant schizophrenia (TRS), have been reported. However, these investigations frequently suffer from potential residual confounding. For example, few studies have restricted the analyses to TRS samples and none has controlled for benign ethnic neutropenia. Objectives This study investigated if service-users’ ethnicity influenced clozapine prescription in a cohort of people with TRS. Methods Information from the clinical records of South London and Maudsley NHS Trust was used to identify a cohort of service-users with TRS between 2007 and 2017. In this cohort, we used logistic regression to investigate any association between ethnicity and clozapine prescription while adjusting for potential confounding variables, including sociodemographic factors, psychiatric multimorbidity, substance use, benign ethnic neutropenia, and inpatient and outpatient care received. Results
We identified 2239 cases that met the criteria for TRS. Results show that after adjusting for confounding variables, people with Black African ethnicity had half the odds of being treated with clozapine and people with Black Caribbean or Other Black background had about two-thirds the odds of being treated with clozapine compared White British service-users. No disparities were observed regarding other ethnic groups, namely Other White background, South Asian, Other Asian, or any other ethnicity. Conclusions There was evidence of inequities in care among Black ethnic groups with TRS. Interventions targeting barriers in access to healthcare are recommended. Disclosure During the conduction of the study, DFdF, GKS, and RH received funds from the NIHR Maudsley Biomedical Research Centre. For other activities outside the submitted work, DFdF received research funding from the UK Department of Health and Social Care, Janss
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Fonseca De Freitas D, Agbedjro D, Kadra-Scalzo G, Francis E, Ridler I, Pritchard M, Shetty H, Segev A, Casetta C, Smart S, Morris A, Downs J, Christensen S, Bak N, Kinon B, Stahl D, Hayes R, Maccabe J. Correlates of late-onset antipsychotic treatment resistance. Eur Psychiatry 2022. [PMCID: PMC9567017 DOI: 10.1192/j.eurpsy.2022.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction There is emerging evidence of heterogeneity within treatment-resistance schizophrenia (TRS), with some people not responding to antipsychotic treatment from illness onset and a smaller group becoming treatment-resistant after an initial response period. It has been suggested that these groups have different aetiologies. Few studies have investigated socio-demographic and clinical differences between early and late onset of TRS. Objectives This study aims to investigate socio-demographic and clinical correlates of late-onset of TRS. Methods Using data from the electronic health records of the South London and Maudsley, we identified a cohort of people with TRS. Regression analyses were conducted to identify correlates of the length of treatment to TRS. Analysed predictors include gender, age, ethnicity, positive symptoms severity, problems with activities of daily living, psychiatric comorbidities, involuntary hospitalisation and treatment with long-acting injectable antipsychotics. Results We observed a continuum of the length of treatment until TRS presentation. Having severe hallucinations and delusions at treatment start was associated shorter duration of treatment until the presentation of TRS. Conclusions Our findings do not support a clear cut categorisation between early and late TRS, based on length of treatment until treatment resistance onset. More severe positive symptoms predict earlier onset of treatment resistance. Disclosure DFdF, GKS, EF and IR have received research funding from Janssen and H. Lundbeck A/S. RDH and HS have received research funding from Roche, Pfizer, Janssen and Lundbeck. SES is employed on a grant held by Cardiff University from Takeda Pharmaceutical Comp
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Wickersham A, Ford T, Stewart R, Downs J. Estimating the impact of child and early adolescent depression on subsequent educational attainment: secondary analysis of an existing data linkage. Epidemiol Psychiatr Sci 2021; 30:e76. [PMID: 35502824 PMCID: PMC8679834 DOI: 10.1017/s2045796021000603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 01/13/2023] Open
Abstract
AIMS Depression is thought to be associated with lower subsequent educational attainment during school. But, without longitudinal studies which take account of prior attainment and other potential confounders, estimates of the impact of clinically recognised depression in childhood and early adolescence are unknown. We investigated whether a clinical diagnosis of depression is associated with lower subsequent educational attainment, and whether the association is modified by gender, ethnicity and socioeconomic status. METHODS We conducted a secondary analysis of an existing administrative data linkage between national educational data and a large mental healthcare provider in London, UK (2007-2013). Depression diagnosis before age 15 (exposure) was measured from electronic health records, and subsequent educational attainment at age 15-16 (outcome) was measured from educational records. We fitted logistic regression models and adjusted for gender, ethnicity, socioeconomic status, relative age in school year, neurodevelopmental disorder diagnosis and prior attainment. We investigated effect modifiers using interaction terms. RESULTS In total, n = 63 623 were included in analysis, of whom n = 242 had record of a depression diagnosis before age 15. Depression was associated with lower odds of subsequently achieving expected attainment levels in national exams, after adjustment for all covariates (odds ratio = 0.60, 95% confidence interval = 0.43 to 0.84, p = 0.003). There was no evidence that gender, ethnicity or socioeconomic status modified this association. CONCLUSIONS These findings support a relationship between depression and lower subsequent educational attainment. This highlights the need for tailored educational interventions to support children and adolescents with depression, particularly in the lead up to key educational milestones.
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Affiliation(s)
- A. Wickersham
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - T. Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - R. Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - J. Downs
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Lai YYL, Downs J, Zafar S, Wong K, Walsh L, Leonard H. Oral health care and service utilisation in individuals with Rett syndrome: an international cross-sectional study. J Intellect Disabil Res 2021; 65:561-576. [PMID: 33764620 DOI: 10.1111/jir.12834] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There is a dearth of literature available on the comparative oral health status of those with Rett syndrome (RTT) despite diurnal bruxism being a supportive diagnostic criterion for the disorder. This study was designed to investigate the dental experiences of individuals with RTT in terms of perceived at-home and professional dental care. METHODS Using data in the InterRett database, provided by English-speaking families of individuals with a confirmed MECP2 genetic mutation, the study investigated relationships between dental problems, oral care, child factors including bruxism and use of gastrostomy, and socioeconomic indicators. The study also explored relationships between dental presentations and socioeconomic, child, and family-related factors. RESULTS Individuals with RTT exhibiting bruxism were more likely to access dental treatment. Those who had full oral feeding had a higher incidence rate of dental treatment than those with full tube feeding. A conservative (under) estimation of the overall dental caries progression rate revealed that this may be similar to that of the normal population. CONCLUSIONS Drivers for dental treatment in RTT include bruxism as well as dental caries. Those who have full oral feeding experience more dental treatment than those with full tube feeding. A higher maternal education level may confer a protective effect for oral health outcomes in those with RTT. Nevertheless, families generally tended to value the importance of oral health despite reported difficulties in day-to-day mouth care.
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Affiliation(s)
- Y Y L Lai
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Herston, Queensland, Australia
- Child Disability, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - J Downs
- Child Disability, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - S Zafar
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Herston, Queensland, Australia
| | - K Wong
- Child Disability, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - L Walsh
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Herston, Queensland, Australia
| | - H Leonard
- Child Disability, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Patel R, Irving J, Brinn A, Broadbent M, Shetty H, Pritchard M, Downs J, Stewart R, Harland R. Insights from electronic health record data to improve mental health service delivery during the COVID-19 pandemic. Eur Psychiatry 2021. [PMCID: PMC9471467 DOI: 10.1192/j.eurpsy.2021.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BackgroundRemote consultation technology has been rapidly adopted due to the COVID-19 pandemic. However, some healthcare settings have faced barriers in implementation. We present a study to investigate changes in rates of remote consultation during the pandemic using a large electronic health record (EHR) dataset.MethodsThe Clinical Record Interactive Search tool (CRIS) was used to examine de-identified EHR data of people receiving mental healthcare in South London, UK. Data from around 37,500 patients were analysed for each week from 7th January 2019 and 20th September 2020 using linear regression and locally estimated scatterplot smoothing (LOESS) to investigate changes in the number of clinical contacts (in-person, remote or non-attended) with mental healthcare professionals and prescribing of antipsychotics and mood stabilisers. The data are presented in an interactive dashboard: http://rpatel.co.uk/TelepsychiatryDashboard.ResultsThe frequency of in-person contacts was substantially reduced following the onset of the pandemic (β coefficient: -5829.6 contacts, 95% CI -6919.5 to -4739.6, p<0.001), while the frequency of remote contacts increased significantly (β coefficient: 3338.5 contacts, 95% CI 3074.4 to 3602.7, p<0.001). Rates of remote consultation were lower in older adults than in working age adults, children and adolescents. Despite the increase in remote contact, antipsychotic and mood stabiliser prescribing remained at similar levels.ConclusionsThe COVID-19 pandemic has been associated with a marked increase in remote consultation, particularly among younger patients. However, there was no evidence that this has led to changes in prescribing. Further work is needed to support older patients in accessing remote mental healthcare.DisclosureAll authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: RS has received funding from Janssen, GSK and Takeda outside the submitted work. RP has received funding from Janssen, Induction Healthcare and H
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Pearson RJ, Jewell A, Wijlaars L, Bedston S, Finch E, Broadhurst K, Downs J, Gilbert R. Linking data on women in public family law court proceedings concerning their children to mental health service records in South London. Int J Popul Data Sci 2021; 6:1385. [PMID: 34036180 PMCID: PMC8133060 DOI: 10.23889/ijpds.v5i2.1385] [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] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Maternal mental health problems and substance misuse are key risk factors for child neglect or abuse and court-mandated placement into care. Linkage between mental health records and family court data could raise awareness about parent mental health needs and inform approaches to address them. OBJECTIVES To evaluate data linkage between administrative family court data and electronic mental health records for a population-based mental health service for 1.3 million people in South London. METHODS We deterministically linked administrative family court data for women (n=5463) involved in care proceedings in South London with service user records from the South London and Maudsley NHS Mental Health Trust (SLaM). We restricted the cohort to women involved in proceedings between 2007 and 2019, in local authorities where SLaM solely provides secondary/tertiary mental health services and the Improving Access to Psychological Therapies (IAPT) (n=3226). We analysed the associations between match status and sociodemographic/case characteristics using multivariable logistic regression. RESULTS Two-thirds (2317/3226; 66%) of women linked to a SLaM service user record at some point; most (91%) who linked accessed secondary/tertiary mental health services, indicating serious mental illness. Accounting for possible missed matches, we estimated that 70-83% of women accessed SLaM services at some point. Older women at index proceedings (>35yrs OR: 0.69, 95%CI: 0.54-0.88vs <25yrs) and Black women or women from other ethnic groups (Black ethnic groups 0.65, 0.50-0.83; other ethnicity 0.59, 0.43-0.81 vs White ethnic groups) had lower odds of linking. Odds of linking were higher for women with an infant in proceedings (1.42, 1.18-1.71), or with curtailed/terminated parental responsibility (1.44, 1.20-1.73). CONCLUSION Our linkage supports growing evidence of a high burden of mental health problems and substance misuse among women whose children enter care in England, compared to the general population. Research using this linkage should inform strategies to address the considerable mental health needs of vulnerable women and their children.
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Affiliation(s)
- RJ Pearson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - A Jewell
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
| | - L Wijlaars
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - S Bedston
- Centre for Child and Family Justice Research, Lancaster University, Lancaster, UK
| | - E Finch
- Central Acute and Addictions Directorate, South London and Maudsley NHS Foundation Trust, London, UK
| | - K Broadhurst
- Centre for Child and Family Justice Research, Lancaster University, Lancaster, UK
| | - J Downs
- NIHR South London and Maudsley NHS Foundation Trust Biomedical Research Centre, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK † indicates joint senior authorship
| | - R Gilbert
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Schofield C, Evans K, Young H, Paguinto SG, Carroll K, Townsend E, Kiefer M, McGuire M, Sodhi J, Bray P, Bayley K, Vorster NM, Downs J. The development of a consensus statement for the prescription of powered wheelchair standing devices in Duchenne muscular dystrophy. Disabil Rehabil 2020; 44:1889-1897. [DOI: 10.1080/09638288.2020.1810786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Schofield
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | | | - H. Young
- The Children’s Hospital at Westmead, Westmead, Australia
| | | | - K. Carroll
- The Royal Children’s Hospital, Parkville, Australia
- Murdoch Children’s Research Institute, Melbourne, Australia
| | - E. Townsend
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. Kiefer
- School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, USA
| | - M. McGuire
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - J. Sodhi
- Institute of Genetic Medicine, International Centre for Life, John Walton Muscular Dystrophy Research Centre, Newcastle Upon Tyne, UK
| | - P. Bray
- The Children’s Hospital at Westmead, Westmead, Australia
- School of Health Sciences, The University of Sydney, Sydney, Australia
| | - K. Bayley
- Centre for Community-Driven Research, Perth, Australia
| | - N. M. Vorster
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - J. Downs
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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11
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Wong K, Glasson EJ, Jacoby P, Srasuebkul P, Forbes D, Ravikumara M, Wilson A, Bourke J, Trollor J, Leonard H, Nagarajan L, Downs J. Survival of children and adolescents with intellectual disability following gastrostomy insertion. J Intellect Disabil Res 2020; 64:497-511. [PMID: 32319159 DOI: 10.1111/jir.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Positive health outcomes have been observed following gastrostomy insertion in children with intellectual disability, which is being increasingly used at younger ages to improve nutritional intake. This study investigated the effect of gastrostomy insertion on survival of children with severe intellectual disability. METHODS We used linked disability and health data of children and adolescents who were born in Western Australia between 1983 and 2009 to compare survival of individuals with severe intellectual disability by exposure to gastrostomy status. For those born in 2000-2009, we employed propensity score matching to adjust for confounding by indication. Effect of gastrostomy insertion on survival was compared by pertinent health and sociodemographic risk factors. RESULTS Compared with children born in the 1980s-1990s, probability of survival following first gastrostomy insertion for those born in 2000-2009 was higher (2 years: 94% vs. 83%). Mortality risk was higher in cases than that in their matched controls (hazard ratio 2.9, 95% confidence interval 1.1, 7.3). The relative risk of mortality (gastrostomy vs. non-gastrostomy) may have differed by sex, birthweight and time at first gastrostomy insertion. Respiratory conditions were a common immediate or underlying cause of death among all children, particularly among those undergoing gastrostomy insertion. CONCLUSIONS Whilst gastrostomy insertion was associated with lower survival rates than children without gastrostomy, survival improved with time, and gastrostomy afforded some protection for the more vulnerable groups, and earlier use appears beneficial to survival. Specific clinical data that may be used to prioritise the need for gastrostomy insertion may be responsible for the survival differences observed.
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Affiliation(s)
- K Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - E J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - P Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - P Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - D Forbes
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - M Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - A Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - J Bourke
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - J Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - H Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - L Nagarajan
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - J Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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12
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Ho P, Bulsara M, Patman S, Downs J, Bulsara C, Hill AM. Incidence and associated risk factors for falls in adults with intellectual disability. J Intellect Disabil Res 2019; 63:1441-1452. [PMID: 31497918 DOI: 10.1111/jir.12686] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/03/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with intellectual disability (ID) experience age-related changes earlier in life, and as such, falls among people with ID are of serious concern. Falls can cause injury and consequently reduce quality of life. Limited studies have investigated the incidence of falls among people with ID and the associated risk factors. The purpose of this study was to investigate the incidence of falls and risk factors for falling in people with ID living in the community. METHODS A prospective observational cohort (n = 78) of community-dwelling adults with ID. Characteristics measured at baseline included falls history, medication use, balance and mobility. Falls were reported for 6 months using monthly calendars and phone calls. Data were analysed using univariate and multivariate logistic regression to identify risk factors associated with falling. RESULTS Participants [median (interquartile range) age 49 (43-60) years, female n = 32 (41%)] experienced 296 falls, with 36 (46.2%) participants having one or more falls. The incidence of falls was 5.7 falls (injurious falls = 0.8) per person year (one outlier removed from analysis). A history of falls [adjusted odds ratio (OR): 6.37, 95% confidence interval (CI) (1.90-21.34)] and being ambulant [adjusted OR: 4.50, 95% CI (1.15-17.67)] were associated with a significantly increased risk of falling. Falls were significantly less frequent among participants taking more than four medications [adjusted OR: 0.22, 95% CI (0.06-0.83)] and participants who were continent [adjusted OR: 0.25, 95% CI (0.07-0.91)]. CONCLUSIONS People with ID fall at a younger age compared with the broader community. The associated falls risk factors also differ to older community-dwelling adults. Health professionals should prioritise assessment and management of falls risk in this population.
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Affiliation(s)
- P Ho
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - M Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - S Patman
- School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - J Downs
- Telethon Kids Institute, Perth Children's Hospital, West Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - C Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - A-M Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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13
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Cho J, Hayes RD, Jewell A, Kadra G, Shetty H, MacCabe JH, Downs J. Clozapine and all-cause mortality in treatment-resistant schizophrenia: a historical cohort study. Acta Psychiatr Scand 2019; 139:237-247. [PMID: 30478891 PMCID: PMC6492259 DOI: 10.1111/acps.12989] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Large-scale epidemiological studies have demonstrated a protective effect of clozapine on mortality in people with schizophrenia. Clozapine is reserved for use in patients with treatment-resistant schizophrenia (TRS), but evidence of clozapine's effect on mortality exclusively within TRS samples is inconclusive. Hence, we aimed to investigate the effect of clozapine use on all-cause mortality in TRS patients. METHODS A historical patient cohort sample of 2837 patients, who met criteria for TRS between 1 Jan 2008 and 1 Jan 2016, were selected from the South London and Maudsley NHS Foundation Trust (SLAM) electronic health records (EHR). The national Zaponex Treatment Access System (ZTAS) mandatory monitoring system linked to the SLAM EHR was used to distinguish which patients were initiated on clozapine (n = 1025). Cox proportional hazard models were used, adjusting for sociodemographics, clinical monitoring, mental and physical illness severity and functional status. RESULTS After controlling for potential confounders, the protective effect of clozapine on all-cause mortality was significant (adjusted hazard ratio 0.61; 95% confidence interval 0.38-0.97; P = 0.04). CONCLUSIONS Clozapine reduces the risk of mortality in patients who meet criteria for TRS. We provide further evidence that improving access to clozapine in TRS is likely to reduce the mortality gap in schizophrenia.
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Affiliation(s)
- J. Cho
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - R. D. Hayes
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK,NIHR Maudsley Biomedical Research CentreLondonUK
| | - A. Jewell
- South London and Maudsley NHS Foundation TrustLondonUK
| | - G. Kadra
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK
| | - H. Shetty
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK,NIHR Maudsley Biomedical Research CentreLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - J. H. MacCabe
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK,NIHR Maudsley Biomedical Research CentreLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - J. Downs
- Institute of Psychiatry Psychology and NeuroscienceKing's College LondonLondonUK,NIHR Maudsley Biomedical Research CentreLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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14
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Lai YYL, Wong K, King NM, Downs J, Leonard H. Oral health experiences of individuals with Rett syndrome: a retrospective study. BMC Oral Health 2018; 18:195. [PMID: 30497449 PMCID: PMC6267076 DOI: 10.1186/s12903-018-0651-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 10/23/2018] [Indexed: 12/24/2022] Open
Abstract
Background There is relatively little literature on the oral health experiences of individuals with Rett syndrome. This study described the incidence of dental extractions and restorations in a population-based cohort, according to a range of demographic and clinical factors. The association between bruxism and age was also investigated. Methods Existing questionnaire data in the population-based Australian Rett Syndrome Database for the years 2004, 2006, 2009 or 2011 on genetically confirmed female cases (n = 242) were analysed. Results The incidence rate of restorations and extractions were 6.8 per 100 person years (py) and 9.3 per 100 py respectively. The incidence of extractions decreased with increasing levels of income. Compared to those with a C-terminal mutation, the incidence rate of extraction was higher for those with large deletions (Incidence Rate Ratio (IRR) 4.93; 95% CI 1.46–16.7, p = 0.01). There was a 5% decrease in the risk of frequent bruxism for every one-year increase in age (Risk Ratio 0.95; 95% CI 0.94–0.97). Conclusions Social advantage may provide some protection for dental health in individuals with Rett syndrome. Those with more severe genotypes seemed to have poorer oral health outcomes.
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Affiliation(s)
- Y Y L Lai
- Department of Paediatric Dentistry, School of Dentistry, The University of Western Australia, Perth, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - K Wong
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - N M King
- Department of Paediatric Dentistry, School of Dentistry, The University of Western Australia, Perth, WA, Australia
| | - J Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - H Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.
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15
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Somaiah N, Anbalagan S, Strom C, Downs J, Jeggo P, Wilkins A, Boyle S, Rothkamm K, Yarnold J. OC-0380: Cell cycle checkpoint modulates radiotherapy fraction size sensitivity in normal and malignant cells. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30690-x] [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: 11/24/2022]
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16
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Davis E, Reddihough D, Murphy N, Epstein A, Reid SM, Whitehouse A, Williams K, Leonard H, Downs J. Exploring quality of life of children with cerebral palsy and intellectual disability: What are the important domains of life? Child Care Health Dev 2017; 43:854-860. [PMID: 28748578 DOI: 10.1111/cch.12501] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although it is estimated that half of all children with cerebral palsy also have comorbid intellectual disability, the domains of quality of life (QOL) important for these children are not well understood. The aim of this study was to identify important domains of QOL for these children and adolescents. METHODS Due to the children's communication impairments, qualitative semi-structured interviews were conducted with 18 parents. The children (9 males) had a median age of 12 (range 7 to 17) years at interview and nearly two thirds were classified as Gross Motor Function Classification System IV or V. A grounded theory approach was used to identify domains of QOL. RESULTS The 11 domains identified as important to QOL were physical health, body comfort, behaviour and emotion, communication, predictability and routine, movement and physical activity, nature and outdoors, variety of activity, independence and autonomy, social connectedness, and access to services. CONCLUSIONS The domains of QOL that emerged from this study will be useful for professionals who support children with cerebral palsy and their families. They will also be important for developing a QOL instrument essential for informing the development of interventions and their monitoring and evaluation.
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Affiliation(s)
- E Davis
- The Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - D Reddihough
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - N Murphy
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - A Epstein
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - S M Reid
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - A Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - K Williams
- Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - H Leonard
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - J Downs
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia
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17
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Lim Z, Downs J, Wong K, Ellaway C, Leonard H. Expanding the clinical picture of the MECP2 Duplication syndrome. Clin Genet 2016; 91:557-563. [PMID: 27247049 DOI: 10.1111/cge.12814] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/15/2022]
Abstract
Individuals with two or more copies of the MECP2 gene, located at Xq28, share clinical features and a distinct facial phenotype known as MECP2 Duplication syndrome. We have examined perinatal characteristics, early childhood development and medical co-morbidities in this disorder. The International Rett Syndrome Phenotype Database (InterRett), which collects information from caregivers and clinicians on individuals with Rett syndrome and MECP2 associated disorders, was used as the data source. Data were available on 56 cases (49 males and 7 females) with MECP2 Duplication syndrome. Median age at ascertainment was 7.9 years (range: 1.2-37.6 years) and at diagnosis 3.0 years (range: 3 weeks-37 years). Less than a third (29%) learned to walk. Speech deterioration was reported in 34% and only 20% used word approximations or better at ascertainment. Over half (55%) had been hospitalised for respiratory infections in the first 2 years of life. Just under half (44%) had seizures, occurring daily in nearly half of this group. The majority (89%) had gastrointestinal problems and a third had a gastrostomy. Following the recent demonstration of phenotype reversal in a mouse model of MECP2 Duplication, a clear understanding of the natural history is crucial to the design and implementation of future therapeutic strategies.
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Affiliation(s)
- Z Lim
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - J Downs
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - K Wong
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - C Ellaway
- Discipline of Genetic Medicine, The University of Sydney, Sydney, Australia.,Discipline of Child and Adolescent Health, The University of Sydney, The Children's Hospital at Westmead, Sydney, Australia.,Western Sydney Genetic Program, Sydney Children's Hospitals Network (Westmead), Sydney, NSW, Australia
| | - H Leonard
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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18
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Stahlhut M, Downs J, Syhler B, Pedersen AMB. Is it possible to assess walking performance and functional capacity in persons with Rett syndrome? Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1390] [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: 11/17/2022]
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19
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Stuart E, Jensen L, Downs J. Motor development and activity in toddlers who were born preterm. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1412] [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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20
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Downs J, Wong K, Torode I, Ellaway C, Elliott E, Christodoulou J, Jacoby P, Leoanrd H. Survival following surgical correction of scoliosis in Rett syndrome: a population-based study in Australia. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.529] [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: 11/15/2022]
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21
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Jensen L, Piek J, Kane R, Downs J. Male infants and infants born small for gestational age are at risk of fine motor delay in infancy. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.3521] [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: 11/15/2022]
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22
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Travlos V, Downs J, Wilson A, Patman S. How is engagement in health care more than adherence or participation? Supporting adolescents living with neuromuscular and rare disease. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1522] [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: 11/28/2022]
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23
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Downs J, Marr C, Torode I, Leonard H. Family perspectives and recovery of motor skills following surgical correction of scoliosis in Rett syndrome. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.530] [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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24
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Lye J, Downs J, Parkinson S, Morris S. A study of the development of normal and abnormal gait in primary school aged children using clinical gait analysis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.2098] [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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25
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Pokharel RK, Brisco L, Mandal M, Agrawal JP, Dillon D, Vitale M, Woodland P, Jacoby P, Downs J. Effect of sitting posture on development of scoliosis in Duchenne Muscular Dystrophy cases. J Nepal Health Res Counc 2014; 12:94-99. [PMID: 25575000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Scoliosis is a frequent association in boys with Duchenne Muscular Dystrophy when the ability to walk is lost around nine to 12 years of age. This study assessed the contribution of physical factors including lumbar posture to scoliosis in non-ambulatory youth with DMD in Nepal. METHODS Linear regression was used to assess effects of time since loss of ambulation, muscle strength, functional severity and lumbar angle as a binary variable on coronal Cobb angle; again logistic regression was used to assess effects of muscle strength and cross-legged sitting on the presence of a lordotic lumbar posture in 22 non-ambulant boys and young men. RESULTS The boys and young men had a mean (SD) age of 15.1 (4.0) years, had been non-ambulant for 48.6 (33.8) months and used a median of 3.5 (range 2 to 7) postures a day. The mean Cobb angle was 15.1 (range 0 to 70) degrees. Optimal accuracy in predicting scoliosis was obtained with a lumbar angle of -6° as measured by skin markers, and both a lumbar angle ≤-6° (P=0.112) and better functional ability (P=0.102) were associated with less scoliosis. Use of cross-legged sitting postures during the day was associated with a lumbar angle ≤-6° (OR 0.061; 95% CI 0.005 - 0.672; P=0.022). CONCLUSIONS Use of cross-legged sitting posture was associated with increase in lumbar lordosis. Higher angle of lumbar lordosis and better functional ability are associated with lesser degree of scoliosis.
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Affiliation(s)
- R K Pokharel
- Department of Orthopaedics, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu Nepal
| | - L Brisco
- Muscular Dystrophy Foundation, Kathmandu, Nepal
| | - M Mandal
- Muscular Dystrophy Foundation, Kathmandu, Nepal
| | - J P Agrawal
- Department of Medicine, Institute of Medicine Tribhuvan University, Maharajgunj, Kathmandu, Nepal
| | - D Dillon
- Department of Orthopaedics, Princess Margaret Hospital, Perth, Australia
| | - M Vitale
- Morgan Stanley Children's Hospital of New York - Presbyterian, Columbia University Medical Centre, New York
| | - P Woodland
- Department of Orthopaedics, Princess Margaret Hospital, Perth, Australia
| | - P Jacoby
- Centre for Child Health Research, Telethon Institute for Child Health Research, The University of Western Australia, Perth, Australia
| | - J Downs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
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26
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Downs J. Nutritional management of acute kidney injury in the critically ill: a focus on enteral feeding. South African Journal of Clinical Nutrition 2014. [DOI: 10.1080/16070658.2014.11734508] [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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27
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Lee JYL, Leonard H, Piek JP, Downs J. Early development and regression in Rett syndrome. Clin Genet 2013; 84:572-6. [DOI: 10.1111/cge.12110] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/21/2013] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- JYL Lee
- School of Psychology and Speech Pathology and Curtin Health Innovation Research Institute; Curtin University; Perth Australia
| | - H Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research; University of Western Australia; Perth Australia
| | - JP Piek
- School of Psychology and Speech Pathology and Curtin Health Innovation Research Institute; Curtin University; Perth Australia
| | - J Downs
- Telethon Institute for Child Health Research, Centre for Child Health Research; University of Western Australia; Perth Australia
- School of Physiotherapy and Curtin Health Innovation Research Institute; Curtin University; Perth Australia
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28
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Davies GM, Bakker JD, Dettweiler-Robinson E, Dunwiddie PW, Hall SA, Downs J, Evans J. Trajectories of change in sagebrush steppe vegetation communities in relation to multiple wildfires. Ecol Appl 2012; 22:1562-1577. [PMID: 22908714 DOI: 10.1890/10-2089.1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Repeated perturbations, both biotic and abiotic, can lead to fundamental changes in the nature of ecosystems, including changes in state. Sagebrush steppe communities provide important habitat for wildlife and grazing for livestock. Fire is an integral part of these systems, but there is concern that increased ignition frequencies and invasive species are fundamentally altering them. Despite these issues, the majority of studies of fire effects in systems dominated by Artemisia tridentata wyomingensis have focused on the effects of single burns. The Arid Lands Ecology Reserve (ALE), in south-central Washington (U.S.A.), was one of the largest contiguous areas of sagebrush steppe habitat in the state until large wildfires burned the majority of it in 2000 and 2007. We analyzed data from permanent vegetation transects established in 1996 and resampled in 2002 and 2009. Our objective was to describe how the fires, and subsequent postfire restoration efforts, affected communities' successional pathways. Plant communities differed in response to repeated fire and restoration; these differences could largely be ascribed to the functional traits of the dominant species. Low-elevation communities, previously dominated by obligate seeders, moved furthest from their initial composition and were dominated by weedy, early-successional species in 2009. Higher-elevation sites with resprouting shrubs, native bunchgrasses, and few invasive species were generally more resilient to the effects of repeated disturbances. Shrub cover has been almost entirely removed from ALE, although there was some recovery where communities were dominated by resprouters. Bromus tectorum dominance was reduced by herbicide application in areas where it was previously abundant, but it increased significantly in untreated areas. Several resprouting species, notably Phlox longifolia and Poa secunda, expanded remarkably following competitive release from shrub canopies and/or abundant B. tectorum. Our results suggest that community dynamics can be understood through a state and transition model with two axes (shrub/grass and native/invasive abundance), although such models also need to account for differences in plant functional traits and disturbance regimes. We use our results to develop a conceptual model that will be validated with further research.
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Affiliation(s)
- G M Davies
- School of Environmental and Forest Sciences, University of Washington, Box 354115, Seattle, Washington 98195-4115, USA.
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Abstract
OBJECTIVES Some associations between antiepileptic drugs (AEDs) and fracture risk have been reported in the general population. This study investigated the relationships between fracture risk and commonly used AEDs in Rett syndrome, a genetic disorder associated with intellectual and physical disability. STUDY DESIGN Cases (n=233) were sourced from the population-based Australian Rett Syndrome Database and longitudinal data were used. The Cox proportional hazard model was used to analyse relationships between fracture and prescribed AEDs, mobility, epilepsy diagnosis and genotype. RESULTS After controlling for mobility, epilepsy diagnosis and genotype, use of valproate increased the risk of fracture threefold after at least 1 year (HR 3.56; 95% CI 1.85 to 6.82) and after 2 or more years (HR 3.02; 95% CI 1.90 to 4.80). There was a lesser increased risk (HR 1.99; 95% CI 0.99 to 4.02) with lamotrigine in the first year of use but not for subsequent years of use. Carbamazepine slightly decreased the risk (HR 0.60; 95% CI 0.35 to 1.02) after 2 or more years of use. CONCLUSIONS The effect of valproate on bone health should be considered when managing epilepsy in Rett syndrome. Multiple mechanisms could be contributing to this effect.
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Affiliation(s)
- H Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, West Perth, Western Australia.
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Afoakwa E, Badham J, Blaauw R, Bourne L, Conradie N, Cooper P, Dannhauser A, Downs J, Faber M, Gericke G, Hanekom S, Hattingh Z, Hendricks M, Herselman M, Hussey G, Jerling J, Jooste P, Kinabo J, Kogi-Makau W, Kruger S, Kunneke E, Labuschagne I, MacIntyre U, Marais D, Marais M, Matji J, Maunder E, Muhammed Dhansay A, Naudé C, Norris S, Pettifor J, Saloojee H, Schaaf H, Schonfeldt H, Senekal M, Smalberger R, Smith A, Smuts M, Steenkamp L, Steyn N, Swart R, Van der Spuy D, Van Graan A, Van Jaarsveld P, Van Stuijvenberg M, Venter C, Venter I, Visser J, Vorster E, Walsh C, Wenhold F, Wentzel-Viljoen E, Wolmarans P. Editor’s Note. South African Journal of Clinical Nutrition 2008. [DOI: 10.1080/16070658.2008.11734170] [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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Fyfe S, Downs J, McIlroy O, Burford B, Lister J, Reilly S, Laurvick CL, Philippe C, Msall M, Kaufmann WE, Ellaway C, Leonard H. Development of a Video-based Evaluation Tool in Rett Syndrome. J Autism Dev Disord 2006; 37:1636-46. [PMID: 17180458 DOI: 10.1007/s10803-006-0293-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 01/25/2006] [Accepted: 09/20/2006] [Indexed: 11/30/2022]
Abstract
This paper describes the development of a video-based evaluation tool for use in Rett syndrome (RTT). Components include a parent-report checklist, and video filming and coding protocols that contain items on eating, drinking, communication, hand function and movements, personal care and mobility. Ninety-seven of the 169 families who initially agreed to participate returned a videotape within 8 months of the first request. Subjects whose videos were returned had a similar age profile to those who did not provide a video but were more likely to have classical than atypical RTT. Evidence of the content and social validity and inter-rater reliability on 11 videos is provided. Video may provide detailed, objective assessment of function and behaviour in RTT.
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Affiliation(s)
- S Fyfe
- Curtin University of Technology, Perth, WA, Australia
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Affiliation(s)
- J. Downs
- a School of Chemical Engineering, Cornell University , Ithaca , New York , 14853 , U.S.A
| | - K.E. Gubbins
- a School of Chemical Engineering, Cornell University , Ithaca , New York , 14853 , U.S.A
| | - S. Murad
- a School of Chemical Engineering, Cornell University , Ithaca , New York , 14853 , U.S.A
| | - C.G. Gray
- b Department of Physics , University of Guelph , Guelph , Ontario , Canada
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Fischhoff B, Parker AM, Downs J, Palmgren C, Dawes R, Manski CF. Teen expectations for significant life events. Public Opin Q 2000; 64:189-205. [PMID: 10984333 DOI: 10.1086/317762] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- B Fischhoff
- Carnegie Mellon University. Eindhoven University of Technology. Carnegie Mellon University. Northwestern University
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Abstract
This paper presents research into the application of the fuzzy ARTMAP neural network model to medical pattern classification tasks. A number of domains, both diagnostic and prognostic, are considered. Each such domain highlights a particularly useful aspect of the model. The first coronary care patient prognosis, demonstrates the ARTMAP voting strategy involving 'pooled' decision-making using a number of networks, each of which has learned a slightly different mapping of input features to pattern classes. The second domain, breast cancer diagnosis, demonstrates the model's symbolic rule extraction capabilities which support the validation and explanation of a network's predictions. The final domain, diagnosis of acute myocardial infarction, demonstrates a novel category pruning technique allowing the performance of a trained network to be altered so as to favour predictions of one class over another (e.g. trading sensitivity for specificity or vice versa). It also introduces a 'cascaded' variant of the voting strategy intended to allow identification of a subset of cases which the network has a very high certainty of classifying correctly.
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Affiliation(s)
- J Downs
- Department of Automatic Control and Systems Engineering, University of Sheffield, UK
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Hsu F, Liu A, Downs J, Rigamonti D, Humphrey J. A triplane video-based experimental system for studying axisymmetrically inflated biomembranes. IEEE Trans Biomed Eng 1995. [DOI: 10.1109/10.376148] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zuo JM, Spence JCH, Downs J, Mayer J. Measurement of individual structure-factor phases with tenth-degree accuracy: the 00.2 reflection in BeO studied by electron and X-ray diffraction. Acta Crystallogr A 1993. [DOI: 10.1107/s0108767392010699] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Abstract
Findings are presented on the precision of a clinical biochemistry analyser designed specifically for veterinary use. Twenty biochemical analytes have been examined in detail for variation within and between runs. The results indicate that the analyser can provide high precision for all the analytes with the possible exception of calcium, and suggest that the instrument can be used with confidence in the practice laboratory to aid diagnosis and to monitor biochemical changes in animals receiving treatment.
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Affiliation(s)
- C J Little
- Department of Veterinary Medicine, Glasgow University Veterinary School, Bearsden
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Downs J, Ward J, Farmer R. Preoccupation with suicide in patients treated with fluoxetine. Am J Psychiatry 1991; 148:1090-1. [PMID: 1853968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Halperin HR, Tsitlik JE, Gelfand M, Downs J, Yin FC. Servo-controlled indenter for determining the transverse stiffness of ventricular muscle. IEEE Trans Biomed Eng 1991; 38:602-7. [PMID: 1879850 DOI: 10.1109/10.81586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Regional ventricular wall stress is a critical determinant of cardiac function. There are, however, no validated methods for accurately estimating this stress. We have shown in the isolated ventricular septum that, during steady-state indentations, the transverse stiffness (the ratio of indentation stress [pressure acting on indenter face] to indentation strain [amount of indentation/nonindented thickness]) can be used as an estimate of the in-plane wall stress. Because of the long acquisition time for those transverse stiffness determinations, it was not possible to follow changes in wall stress over a single contraction. We recently developed a dynamic indentation system that can determine transverse stiffness in as little as 10 ms, allowing estimation of wall stress over a single contraction cycle. The apparatus consists of an indentation probe coupled to a linear motor. This indentation system was tested on two beating canine ventricular septa that were mounted in a biaxial system the could apply strains in the plane of the septa and measure the resulting in-plane stresses. The probe indented the septa with peak displacements of 0.1-0.5 mm at frequencies of 20 and 50 Hz. The transverse stiffness was calculated as the slope of the relation between the indentation stress and indentation strain during each high-frequency indentation. Consistent with earlier studies, the transverse stiffness was related to the inplane stress. In contrast to earlier studies, however, these dynamic transverse stiffness determinations could be made during a single contraction. Thus, dynamic transverse stiffness determinations allow estimation of wall stress in the isolated septa by minimal surface contact, and may lead to methods for estimating wall stress in the intact heart.
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Affiliation(s)
- H R Halperin
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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42
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Abstract
We present an improved video-based computer system for on-line tracking of small markers moving in a plane. The system consists of a CCD camera, a video monitor, a dedicated 80386/20 microcomputer, a video frame grabber, and custom software. Up to four markers can be tracked at the 30-Hz video frame rate using a two-step, correlation-based search procedure. We discuss the requisite hardware and software requirements and illustrate how this tracking system can be used to collect strain data during biaxial stretching tests on planar soft tissues. Operating at 30 Hz, this system is an improvement over those previously reported, which are either slower or yield less information.
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Affiliation(s)
- J Downs
- Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD 21205
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Downs J, Dahmer SK, Battle AO. Multiple personality disorder in India. Am J Psychiatry 1990; 147:1260-1. [PMID: 2386273 DOI: 10.1176/ajp.147.9.aj14791260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
High dietary intake of linoleic acid lowers arterial pressure, and, in vitro, linoleic acid inhibits the enzymatic activity of renin. The purpose of the present study was 1) to evaluate the effect of intravenous infusion of linoleic acid on blood pressure in normotensive and hypertensive Sprague-Dawley rats and 2) to determine whether the hypotensive response to linoleic acid infusion is caused by inhibition of circulating renin. Blood pressure was decreased (P less than 0.01) by linoleic acid infusion in normotensive sodium chloride-deprived animals and in animals with two-kidney, one-clip hypertension. In contrast, linoleic acid infusion did not affect blood pressure in normotensive rats on a "normal" or high sodium chloride intake, in rats with deoxycorticosterone acetate (DOCA)-salt hypertension, and in anephric rats. In sodium chloride-deprived rats, the reduction of blood pressure by linoleic acid infusion was associated with increased plasma renin activity (P less than 0.05); serum angiotensin-converting enzyme activity was unchanged. The in vitro enzymatic activity of exogenous renin in plasma of anephric rats was not affected by linoleic acid infusion. In two-kidney, one-clip hypertensive animals, pretreatment with indomethacin did not alter the hypotensive response to linoleic acid. Thus, although linoleic acid infusion lowered blood pressure in high renin but not in low renin states, the reduction of blood pressure was not related to inhibition of circulating renin or to alterations of endogenous prostaglandin biosynthesis.
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Affiliation(s)
- S R Reddy
- Department of Medicine, West Virginia University School of Medicine, Morgantown 26506
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Burch EA, Downs J. Development of neuroleptic malignant syndrome during simultaneous amoxapine treatment and alprazolam discontinuation. J Clin Psychopharmacol 1987; 7:55-6. [PMID: 3818996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Mirra JM, Gold R, Downs J, Eckardt JJ. A new histologic approach to the differentiation of enchondroma and chondrosarcoma of the bones. A clinicopathologic analysis of 51 cases. Clin Orthop Relat Res 1985:214-37. [PMID: 4064409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Fifty-one cases of central, hyalin cartilage tumors of the long and flat bones were analyzed. Although Grade 2 and 3 chondrosarcomas could be diagnosed on the basis of cytologic features alone, low-grade chondrosarcoma could not be adequately differentiated from pure, benign enchondroma(s) by cytology alone. The tumors can be distinguished by a new histologic approach based on tissue patterns. The crucial enchondroma patterns consist of multiple nodules of hyalin cartilage separated by normal marrow in conjunction with partial to complete encompassing plates of lamellar bone that conform to the irregular shapes of the cartilage nodules. The chondrosarcomatous patterns consist of a single confluent mass of cartilage, which commonly permeates the marrow, "trapping" host lamellar bone on all sides, and which forms bands of fibrosis between the confluent peripheral cartilage lobules. Other less common patterns included cartilagenous infiltration of the Haversian systems or marrow fat and/or the development of a soft tissue mass. A central secondary chondrosarcoma is defined as one that shows the combination of both the enchondromatous and chondrosarcomatous patterns. All 18 of the pure enchondromas diagnosed by the methods proposed in this article behaved with strict benignity (i.e., without evidence of recurrence or metastasis with an average follow-up period of 7.2 years). The 33 primary and secondary chondrosarcomas diagnosed using the described patterns behaved with the predicted frequency of recurrence, metastasis, and patient demise.
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Akiskal HS, Downs J, Jordan P, Watson S, Daugherty D, Pruitt DB. Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course. Arch Gen Psychiatry 1985; 42:996-1003. [PMID: 4037989 DOI: 10.1001/archpsyc.1985.01790330076009] [Citation(s) in RCA: 262] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We studied 68 referred juvenile offspring or siblings of adult bipolar patients. Mean age at onset of affective and related disturbances was 15.9 years (range, 6 to 24 years). Although four of the ten prepubertal children had hypomanic features, full-blown manic psychosis did not appear before puberty. In the sample at large, 12 were classified as dysthymic and ten as cyclothymic. Eleven additional subjects with polysubstance abuse, who at onset did not meet criteria for affective disorder, were reclassified as having either a dysthymic or a cyclothymic disorder during follow-up. Of the remaining patients--24 depressive, eight manic, and three mixed state--71% experienced recurrences; mood-incongruent features, present in four cases at onset, recurred in only one patient during subsequent episodes. Overall, half the sample evidenced signs of bipolarity during a mean prospective follow-up period of three years.
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Abstract
The therapeutic efficacy of continuous positive airway pressure (CPAP) administered by face mask was studied in 40 patients with acute cardiogenic pulmonary edema and respiratory failure. Arterial blood gas values and pH, systemic arterial pressure, heart rate and respiratory rate were measured during administration of 30% oxygen with a high-flow face mask apparatus at ambient airway pressure. Twenty patients were then randomly chosen to continue ambient airway pressure breathing and 20 received 10 cm H2O of CPAP. The measurements were repeated 10, 60 and 180 minutes after therapy was initiated. During the first 10 minutes of CPAP treatment, arterial blood oxygen partial pressure increased 8 +/- 9 mm Hg (mean +/- 1 standard deviation), (p less than 0.01) and respiratory rate decreased 5 +/- 5 breaths/min (p less than 0.001). Systolic arterial pressure decreased 12 +/- 21 mm Hg (p less than 0.05), and heart rate by 10 +/- 11 beats/min (p less than 0.001). A decrease in respiratory rate by 2 +/- 5 breaths/min (p less than 0.05) was the only change that occurred in the control group. The improvement in arterial blood oxygenation persisted throughout the investigation period (p less than 0.05). Thirteen patients (65%) in the control group and 7 patients (35%) in the CPAP group met our criteria for treatment failure during the study (p = 0.068). Thus, CPAP administered by face mask improves gas exchange, decreases respiratory work, unloads circulatory stress, and may reduce the need for ventilator treatment in acute cardiogenic pulmonary edema.
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Babb JR, Phelps M, Downs J, Ayliffe GA. Evaluation of an ethylene oxide sterilizer. Sterile World 1983; 5:5. [PMID: 10261351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Ethylene oxide gas can be used under controlled conditions to sterilize heat and moisture sensitive articles, particularly those which cannot be steam sterilized or immersed in disinfectants. The ethylene oxide process is essentially one of sterilization and all micro-organisms, including bacterial spores, are destroyed.
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