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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Straiton N, McKenzie A, Bowden J, Nichol A, Murphy R, Snelling T, Zalcberg J, Clements J, Stubbs J, Economides A, Kent D, Ansell J, Symons T. Facing the Ethical Challenges: Consumer Involvement in COVID-19 Pandemic Research. J Bioeth Inq 2020; 17:743-748. [PMID: 33169265 PMCID: PMC7651817 DOI: 10.1007/s11673-020-10060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Consumer involvement in clinical research is an essential component of a comprehensive response during emergent health challenges. During the COVID-19 pandemic, the moderation of research policies and regulation to facilitate research may raise ethical issues. Meaningful, diverse consumer involvement can help to identify practical approaches to prioritize, design, and conduct rapidly developed clinical research amid current events. Consumer involvement might also elucidate the acceptability of flexible ethics review approaches that aim to protect participants whilst being sensitive to the challenging context in which research is taking place. This article describes the main ethical challenges arising from pandemic research and how involving consumers and the community could enable resolution of such issues.
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Affiliation(s)
- N Straiton
- Australian Clinical Trials Alliance, Suite 1, Level 2, 24 Albert Road, Melbourne, VIC, 3205, Australia.
| | - A McKenzie
- Telethon Kids Institute, Consumer Engagement, Perth, Australia
| | | | - A Nichol
- Monash University, Melbourne, Australia
- St. Vincent's University Hospital, Dublin, Ireland
| | - R Murphy
- University of Auckland, Auckland, New Zealand
| | - T Snelling
- University of Sydney, Faculty of Medicine and Health, Sydney, Australia
| | - J Zalcberg
- Monash University, Cancer Research, Melbourne, Australia
| | - J Clements
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Stubbs
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - A Economides
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - D Kent
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
| | - J Ansell
- Consumers Health Forum, Canberra, Australia
| | - T Symons
- Australian Clinical Trials Alliance, Consumer Engagement, Melbourne, Australia
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DiGuardo M, Krull A, Dietz A, Soiney K, Chicos A, Wayne J, Skaer C, Wadewitz M, Bowler C, Schmidt G, Stubbs J, Jacob E. The Mayo Clinic Cellular Therapy Fellowship: Training the Next Generation of Cellular Therapy Leaders. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.077] [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: 11/26/2022]
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Zielinski MD, Stubbs JR, Polites SF, Xue A, Haugen DAL, Emery R, Jenkins DH, Park MS. In vitro Analysis of the Hemostatic Properties of Whole Blood Products Prepared with a Platelet-Sparing Leukoreduction Filter. J Thromb Circ Open Access 2018; 4:124. [PMID: 36937038 PMCID: PMC10022254 DOI: 10.4172/2572-9462.1000124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background Warm fresh whole blood (WFWB) is an ideal resuscitation fluid for exsanguinating patients but there are myriad logistic and infectious issues associated with its use. Cold whole blood (CWB) may be an acceptable alternative to the reconstituted whole blood (RWB), the current standard of care. A leukoreduction filter has been developed which maintains platelet count while eliminating white blood cells but its effect on platelet function is unknown. We hypothesize that CWB will retain an acceptable functional coagulation profile after filtration and over time. Study Design and Methods WFWB and CWB samples were obtained from eight donors and four units of RWB were created. The quantitative and qualitative in vitro coagulation profiles of WFWB, RWB, and CWB over time were compared. Results Filtration was successful at removing white blood cells (5.5 ± 1.2 vs. 0.3 ± 0.3 × 106/L) while retaining an adequate platelet count (172.0 ± 47.0 to 166.0 ± 42.3 × 109/L) and hemoglobin concentration (13.7 ± 0.5 vs. 13.0 ± 0.7 g/dL). Rotational Thromboelastography (ROTEM) results revealed a similar clotting time (CT) before and after filtration (64.9 ± 5.1 vs. 64.1 ± 6.8 s) but a decreased maximum clot firmness (MCF) (58.6 ± 4.2 vs. 54.9 ± 4.6 mm). Platelet aggregation decreased substantially (28.8 ± 6.7 vs. 9.3 ± 2.1 ohm) immediately after filtration. CWB function continued to diminish over time. Conclusion CWB holds great promise as a surrogate for WFWB, but use of a platelet-sparing LR filter diminishes platelet function almost immediately after filtration.
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Affiliation(s)
- MD Zielinski
- Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic, USA
- Corresponding author: Prof. Martin D. Zielinski, Division of Trauma, Critical Care and General Surgery, Mary Brigh 2-810, St. Mary’s Hospital, Mayo Clinic, 1216 Second St. SW, Rochester, MN 55902, USA, Tel: +507-255-2923;
| | - JR Stubbs
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - SF Polites
- Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic, USA
| | - A Xue
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - DAL Haugen
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - R Emery
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - DH Jenkins
- Division of Trauma, Emergency Surgery, University of Texas Health Science Center, San Antonio, Texas, USA
| | - MS Park
- Division of Trauma, Critical Care and General Surgery, St. Mary’s Hospital, Mayo Clinic, USA
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Panickar A, Singatullina N, Stubbs J, Johnson C, Porter R, Bryden D. Frailty predicts increased resource use and postoperative care requirements after revision hip surgery. Crit Care 2015. [PMCID: PMC4471458 DOI: 10.1186/cc14624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Haw C, Stubbs J, Dickens GL. Barriers to the reporting of medication administration errors and near misses: an interview study of nurses at a psychiatric hospital. J Psychiatr Ment Health Nurs 2014; 21:797-805. [PMID: 24646372 DOI: 10.1111/jpm.12143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 12/01/2022]
Abstract
Medication administration errors and near misses are common including in mental health settings. Nurses should report all errors and near misses so that lessons can be learned and future mistakes avoided. We interviewed 50 nurses to find out if they would report an error that a colleague had made or if they would report a near-miss that they had. Less than half of nurses said they would report an error made by a colleague or a near-miss involving themselves. Nurses commonly said they would not report the errors or near misses because there was a good excuse for the error/near miss, because they lacked knowledge about whether it was an error/near miss or how to report it, because they feared the consequences of reporting it, or because reporting it was too much work. Mental health nurses mostly report similar reasons for not reporting errors and near misses as nurses working in general medical settings. We have not seen another study where nurses would not report an error or near miss because they thought there was a good excuse for it. Training programmes and policies should address all the reasons that prevent reporting of errors and near misses. Medication errors are a common and preventable cause of patient harm. Guidance for nurses indicates that all errors and near misses should be immediately reported in order to facilitate the development of a learning culture. However, medication errors and near misses have been under-researched in mental health settings. This study explored the reasons given by psychiatric nurses for not reporting a medication error made by a colleague, and the perceived barriers to near-miss reporting. We presented 50 nurses with clinical vignettes about error and near-miss reporting and interviewed them about their likely actions and about their views and perceptions. Less than half of participants would report an error made by a colleague (48%) or a near-miss involving themselves (40%). Thematic analysis revealed common themes for both not reporting an error or a near-miss were knowledge, fear, burden of work, and excusing the error. The first three themes are similar to results obtained from research in general medical settings, but the fourth appears to be novel. Many mental health nurses are not yet fully convinced of the need to report all errors and near misses, and that improvements could be made by increasing knowledge while reducing fear, burden of work, and excusing of errors.
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Affiliation(s)
- C Haw
- University of Northampton School of Health, St Andrew's Academic Centre, King's College London Institute of Psychiatry
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Chadwick DD, Stubbs J, Fovargue S, Anderson D, Stacey G, Tye S. Training support staff to modify fluids to appropriate safe consistencies for adults with intellectual disabilities and dysphagia: an efficacy study. J Intellect Disabil Res 2014; 58:84-98. [PMID: 23336612 DOI: 10.1111/jir.12013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Modifying the consistency of food and drink is a strategy commonly used in the management of dysphagia for people with intellectual disabilities (ID). People with ID often depend on others for the preparation of food and drink and therefore depend on those caregivers achieving the correct consistency to keep them safe and avoid discomfort during mealtimes. Clinical experience and prior research have demonstrated that although training can improve modification, carers often find modification difficult and potentially stressful and recommend additional support for carers. Fluid consistency is often modified through the addition of powdered thickener. This study investigates the efficacy of typical training and use of consistency guides, the Thickness Indicator Model (TIM) tubes, in helping carers to modify fluids accurately. METHOD A 3 × 3 pre-post experimental design with a control group was employed to compare the observed accuracy of modification across three groups and at three time points (pre-intervention baseline, immediately post-training intervention and 3-10 months post-training). Sixty-two paid carers who supported people with ID were recruited to participate in the study and each was randomly allocated to one of the three groups: a control group given written guidance only, a group who received typical training and written guidance and a group who received training, written guidance and the TIM tubes. RESULTS & CONCLUSIONS Typical training resulted in significantly greater carer accuracy in modifying fluid consistencies when compared with written guidance alone. Use of the TIM tubes also significantly improved accuracy in the modification of drinks compared with the group who modified with the aid of written guidance alone. At 3-10-month follow-up only the group who received typical training alongside the TIM tubes were significantly more accurate than the Written Guidance group. Further research is warranted to ascertain the effectiveness of the training and the utility of the TIM tubes in improving accuracy over a longer time scale and in individuals' usual living environments.
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Affiliation(s)
- D D Chadwick
- School of Applied Sciences, The University of Wolverhampton, Wolverhampton, UK
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McConnon A, Gribble R, Raats MM, Stubbs J, Shepherd R. Health professionals', expert patients' and dieters' beliefs and attitudes about obesity. J Hum Nutr Diet 2013; 26:612-6. [PMID: 23496807 DOI: 10.1111/jhn.12085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research has suggested that patients and treatment providers hold different beliefs and models of obesity. This could impact upon the consistency and quality of interventions for weight management. The present study investigated the attitudes and beliefs of health professionals, commercial weight management advisors (expert patients) and overweight and obese dieters, towards obesity. METHODS Data were collected using a self-administered questionnaire from 287 health professionals, 85 expert patients and 116 dieters. Respondents gave their views on obesity causation and consequences, and the most efficacious means to manage obesity. Demographic data and self-reported height and weight were also collected. Factor analysis, analysis of variance and t-tests were used to analyse the data. RESULTS Health professionals, expert patients and dieters held similar models of obesity, identifying the same causes (lifestyle causes), consequences (medical consequences) and treatments (current recommended options) of obesity/overweight. CONCLUSIONS The findings of the present study indicate a broader similarity between beliefs and attitudes of those involved in obesity treatment and those that they aim to treat than was previously assumed. The concordance of beliefs between patients and treatment providers is an encouraging finding and may have important implications for public health strategies in this area.
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Affiliation(s)
- A McConnon
- Food Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, UK; School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland
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Avery A, Pallister C, Allan J, Stubbs J, Lavin J. An initial evaluation of a family-based approach to weight management in adolescents attending a community weight management group. J Hum Nutr Diet 2012; 25:469-76. [PMID: 22834988 PMCID: PMC3468722 DOI: 10.1111/j.1365-277x.2012.01277.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family-based approaches are recommended for the prevention and management of childhood obesity. Given the large numbers of obese children, scalable practical solutions are required. The present study evaluated a family-based national programme that aimed to empower adolescents to adopt healthier lifestyles. METHODS Group facilitators supporting more than six young members (11-15 years) participated in the study. A questionnaire was designed to determine the characteristics of the adult attending with the adolescent, any health professional recommendations given and the young member's integration within traditional adult weight management groups. Data on measured height and weight [and calculated body mass index (BMI)], sex and attendance were collated from member's records. RESULTS Questionnaires were completed by 22 facilitators (15% response rate), representing data for 128 young members with complete weight data available for 106. All members had a joining BMI > 91st centile, with 68% >98th centile. The mean (SD) number of weeks attended was 12.5 (8.1), with 19% (20) having attended for more than 20 weeks with 62% still attending. A mean (SD) BMI Z-score change of 2.49 (0.72) to 2.27 (0.74) was achieved (P < 0.001). The relationship of the adult supporter to the young member was varied, with 62% either already members or joining alongside their daughter/son. Limited guidance was provided by health professionals before or during attendance. Facilitators were comfortable about the age mix within groups. CONCLUSIONS The community weight management organisation studied takes a family-based approach and successfully supports young members to manage their weight.
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Affiliation(s)
- A Avery
- Nutrition and Research Team at Slimming World, Alfreton, Derbyshire, UK.
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Stubbs J, Pallister C, Avery A, Allan J, Lavin J. Weight, body mass index and behaviour change in a commercially run lifestyle programme for young people. J Hum Nutr Diet 2012; 25:161-6. [PMID: 22320706 DOI: 10.1111/j.1365-277x.2011.01224.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are few practical, scalable, community-based solutions that provide ongoing support to combat the recent rapid rise in obesity in young people. A commercial weight management organisation (CWMO) has developed a tailored version of its programme for young people. The present study assessed the programme's impact on self-reported body weight, body mass index (BMI; kg m(-2) ) and health-related behaviour changes in participating young people. METHODS Seventy-nine current young members completed a web-based questionnaire on age, height, weight and self-reported eating and activity behaviours for when they joined the programme and at the time of survey. Inclusion criteria were age 11-15 years old and membership for at least 1 month. Subjects completed the questionnaire online via the CWMO website. This was a retrospective observational study without a control group. All data were self-reported. RESULTS Mean (SD) age was 13.4 (1.4) years and start weight was 78.5 (16.7) kg; 67% were >99th centile for BMI. Mean (SD) attendance was 23 (19) weeks; weight change was -5.0 (4.5) kg; BMI change was -2.5 (2.0) kg m(-2) ; and BMI Z-score change was -0.5 (0.4) (all P < 0.001). Height increased by 0.01 (0.03) m (P < 0.01); however, height Z-score remained unchanged. Regression analysis showed that BMI Z-score change was related to increased fruit and vegetable intake (P = 0.012), as well as a decrease in avoidance of moderate and intense activity (both P < 0.003). CONCLUSIONS This programme for overweight and obese young people helped implement behaviour and lifestyle changes that were associated with significant reductions in self-reported weight and BMI Z-score, without compromising growth in height.
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Affiliation(s)
- J Stubbs
- Nutrition and Research Department, Slimming World, Clover Nook Road, Alfreton, Derbyshire, UK.
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Stubbs J, Whybrow S, Teixeira P, Blundell J, Lawton C, Westenhoefer J, Engel D, Shepherd R, McConnon A, Gilbert P, Raats M. Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change. Obes Rev 2011; 12:688-708. [PMID: 21535362 DOI: 10.1111/j.1467-789x.2011.00883.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 12/24/2022]
Abstract
Weight management is a dynamic process, with a pre-treatment phase, a treatment (including process) phase and post-treatment maintenance, and where relapse is possible during both the treatment and maintenance. Variability in the statistical power of the studies concerned, heterogeneity in the definitions, the complexity of obesity and treatment success, the constructs and measures used to predict weight loss and maintenance, and an appreciation of who and how many people achieve it, make prediction difficult. In models of weight loss or maintenance: (i) predictors explain up to 20-30% of the variance; (ii) many predictors are the sum of several small constituent variables, each accounting for a smaller proportion of the variance; (iii) correlational or predictive relationships differ across study populations; (iv) inter-individual variability in predictors and correlates of outcomes is high and (v) most of the variance remains unexplained. Greater standardization of predictive constructs and outcome measures, in more clearly defined study populations, tracked longitudinally, is needed to better predict who sustains weight loss. Treatments need to develop a more individualized approach that is sensitive to patients' needs and individual differences, which requires measuring and predicting patterns of intra-individual behaviour variations associated weight loss and its maintenance. This information will help people shape behaviour change solutions to their own lifestyle needs.
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Matthay KK, Weiss BD, Villablanca J, Maris JM, Yanik GA, Groshen SG, Jackson H, Hawkins R, Goodarzian F, Panigrahy A, DuBois SG, Stubbs J, Towbin A, Barrett JA, LaFrance ND, Babich JW. Dosimetry, toxicity, and response in a phase IIa trial of no-carrier added iobenguane I-131 (nca-MIBG): A New Approach to Neuroblastoma Therapy (NANT) study. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9512] [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: 11/20/2022] Open
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Abstract
The aim of the study was to review published studies of covert medicines administration in older people, as well as carrying out a broad review of the subject. A review of MEDLINE, EMBASE, PsycINFO, BNI and CINAHL was conducted in order to identify studies providing quantitative or qualitative data on covert administration in older adults. National guidance on covert medication and the ethics and legality of the practice were also reviewed. Data were extracted from eight studies and one inspection report. In addition, one qualitative study was identified. Nine studies included a questionnaire or interview with staff and only one involved non-professional carers. Seven studies were from the UK. Disguising medication in food or drink was reported in 43-71% of nursing homes. In total, 1.5-17% of institutional patients were receiving medication covertly. Despite legislation, incomplete documentation was common and nursing staff alone often made the decision to administer medication covertly. Covert administration appears to be common in older adults with dementia but despite legislation it often takes place without documentation and consultation of all relevant parties. Staff education and training and local audit are needed to improve standards and safeguard vulnerable patients in institutions.
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Affiliation(s)
- C Haw
- Consultant Psychiatrist, and Research Pharmacist, St Andrew's Healthcare, Northampton, UK.
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Abstract
Psychotropic drug prescribing for children and adolescents is frequently off-label and has increased over time and can be controversial. Psychotropic prescribing in two large UK medium secure units for young people has been studied. A total of 89 patients were included, 64% being aged less than 18 years. A total of 137 of 202 (67.8%) of prescriptions were off-label. The most common reasons for a prescription being off-label were the indication (N = 103) and the patient's age (N = 41). The main classes of drugs involved were antipsychotics (N = 59), antiepileptics as mood stabilisers (N = 22), anticholinergics and hyoscine (N = 15) and antidepressants (N = 11). Aggression (N = 48) and post-traumatic stress disorder (N = 30) were the most common off-label indications. Some antidepressant prescriptions were contrary to advice of the Committee on Safety of Medicines (CSM). Meta-analyses or randomised controlled trials supported 27% of off-label prescriptions, with lesser quality studies supporting a further 29.2% and expert opinion 38.7%, whereas for 5.1% no evidence could be found. Prescribers tended to over-estimate the level of evidence from clinical trials or extrapolated from findings in adults. They often quoted their own experience rather than expert sources to justify their prescribing practice. It is important that prescribers are fully aware of the quality of experimental data and the risk-benefit ratio when prescribing off-label for young persons. If the evidence base is limited, it is particularly important to provide information about the risks and benefits of the treatment to the patient/relatives. A second opinion may be helpful. Both target symptoms and side effects should be monitored and regularly reviewed.
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Affiliation(s)
- C Haw
- St Andrew's Hospital, Northampton, UK.
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17
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18
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Liu H, Pancholi M, Stubbs J, Raghavan D. Influence of hydroxyvalerate composition of polyhydroxy butyrate valerate (PHBV) copolymer on bone cell viability andin vitrodegradation. J Appl Polym Sci 2010. [DOI: 10.1002/app.31915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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19
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Pallister C, Avery A, Stubbs J, Lavin J. Influence of Slimming World’s lifestyle programme on diet, activity behaviour and health of participants and their families. J Hum Nutr Diet 2009; 22:351-8. [DOI: 10.1111/j.1365-277x.2009.00959.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [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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20
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Avery A, Pallister C, Lavin J, Stubbs J. Is Slimming World on Referral an effective option to help people with learning difficulties manage their weight? J Hum Nutr Diet 2008. [DOI: 10.1111/j.1365-277x.2008.00881_5.x] [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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21
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Bundy KL, Foss ML, Stubbs JR. Transfusion service disaster planning. Immunohematology 2008; 24:93-101. [PMID: 19845076] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Mayo Clinic, in Rochester, Minnesota, recently set forth a directive to develop a Mayo Emergency Incident Command System (MEICS) plan to respond to major disasters. The MEICS plan that was developed interfaces with national response plans to ensure effective communication and coordination between our institution and local, state, and federal agencies to establish a common language and communication structure. The MEICS plan addresses multiple aspects of dealing with resource needs during a crisis, including the need for blood and transfusion medicine services. The MEICS plan was developed to supplement our current local emergency preparedness procedures and provide a mechanism for responding to the escalating severity of an emergency to deal with situations of a magnitude that is outside the normal experience. A plan was developed to interface the existing Transfusion Medicine disaster plan standard operating procedures (SOP) with the institutional and Department of Laboratory Medicine (DLMP) MEICS plans. The first step in developing this interface was defining MEICS. Other major steps were defining the chain of command, developing a method for visually indicating who is "in charge," planning communication, defining the actions to be taken, assessing resource needs, developing flowcharts and updating SOPs, and developing a blood rationing team to deal with anticipated blood shortages. Several key features of the interface and updated disaster plan that were developed are calling trees for response personnel, plans for relocating leadership to alternative command centers, and action sheets to assist with resource assessment. The action sheets also provide documentation of key actions by response personnel.
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Affiliation(s)
- K L Bundy
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN 55905, USA
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22
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Richa EM, Stowers RE, Tauscher CD, Benidt GR, Van Valkenburg JM, Bryant SC, Stubbs JR, James SR. The safety of electronic cross-match in patients with warm autoantibodies. Vox Sang 2007; 93:92. [PMID: 17547573 DOI: 10.1111/j.1423-0410.2007.00918.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Eisen DP, Stubbs J, Spilsbury D, Carnie J, Leydon J, Howden BP. Low mannose-binding lectin complement activation function is associated with predisposition to Legionnaires' disease. Clin Exp Immunol 2007; 149:97-102. [PMID: 17425652 PMCID: PMC1942031 DOI: 10.1111/j.1365-2249.2007.03390.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Innate immune system deficiency may predispose to severe infections such as Legionnaires' disease. We have investigated the role of mannose-binding lectin (MBL) deficiency in the Melbourne Aquarium Legionnaires' disease outbreak. Serum samples from patients and controls that were exposed but shown to be uninfected from the Melbourne Aquarium Legionnaires' disease outbreak were tested for MBL function (C4 deposition) and level (mannan-binding). MBL function was lower in Legionnaires' disease cases than in age- and sex-matched uninfected, exposed controls. The frequency of MBL deficiency with C4 deposition < 0.2 U/microl was significantly higher in Legionnaires' disease cases than in controls. This also applied to Legionnaires' disease cases requiring hospital care. There was no difference in MBL mannan-binding levels between Legionnaires' disease patients and controls. There was no significant interval change in MBL function or level after a mean of 46 days. MBL complement activation functional deficiency appears to predispose to Legionnaires' disease.
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Affiliation(s)
- D P Eisen
- Clinical Centre for Research Excellence in Infectious Diseases, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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24
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Stowers RE, Richa EM, Stubbs JR, Moore SB. Red blood cell transfusion in a patient with anti-AnWj: a case report. Immunohematology 2007; 23:55-58. [PMID: 18004934] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Anti-AnWj (Anton) has been associated with clinically significant hemolytic transfusion reactions. More than 99 percent of studied populations have RBCs that express the antigen. Reported here is a patient with anti-AnWj who was transfused with antigen-positive RBCs without adverse reaction.
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Affiliation(s)
- R E Stowers
- Division of Transfusion Medicine, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905, USA
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25
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Abstract
Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.
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Affiliation(s)
- G Dickens
- St Andrew's Hospital, Northampton, UK.
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26
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Abstract
BACKGROUND The term 'off-label prescribing' refers to the use of a drug outside the terms of its Marketing Authorisation, including prescribing for an unlicensed indication. There have been few reports about off-label prescribing in psychiatry. The aims of the study were to determine the frequency of off-label prescribing of psychotropics for inpatients with mild intellectual disability (ID) and mental illness resident in a large psychiatric hospital, the nature of the off-label clinical indications and details about patient consent and case note documentation of the off-label usage. METHODS Cross-sectional survey of inpatients of the ID division of a charitable hospital was carried out. Interviews with consultant psychiatrists about off-label use of psychotropics were also made. RESULTS Of the 56 patients studied, 38 (67.9%) were receiving one or more psychotropic drugs and 26 (46.4%) were receiving at least one off-label psychotropic. The most frequently cited off-label indications were: reduction of aggression, arousal and behavioural disturbance (14 cases) and mood stabilization of affective disturbance (13). The principle psychotropics involved were atypical antipsychotics (17 cases) and mood stabilizers (13). Although in most instances the psychiatrist was aware the drug was being used off-label and had consulted other professionals, in only two (6%) instances had the patient been informed of the off-label usage, largely because the psychiatrist felt they lacked the capacity to understand the off-label concept. In most cases the off-label usage had not been documented in the case notes. CONCLUSIONS Off-label prescribing is common in patients with comorbid ID and mental disorder. When prescribing off-label, psychiatrists need to consider the evidence that the drug is likely to be effective for the unlicensed indication and any risks involved. Where there is limited evidence of benefit a trial of the drug, with clinical monitoring may be indicated. Patients should be fully informed about their medication. However, many patients with ID cannot understand the off-label concept. In some circumstances psychiatrists may find it helpful to consult other professionals before prescribing off-label. Good case note documentation of the process is important and supports the prescriber.
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Affiliation(s)
- C Haw
- St. Andrew's Hospital, Northampton, UK.
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Vassy D, Hallil A, Stubbs J, Webster M, Turmel J, Salazar B. SU-FF-T-56: Verifying Correct Location of HDR Source Dwell Position in the MammoSite Catheter Using An Integral Linear MOSFET Dosimeter Array. Med Phys 2005. [DOI: 10.1118/1.1997727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Merriman S, Haw C, Kirk J, Stubbs J. Risk factors for coronary heart disease among inpatients who have mild intellectual disability and mental illness. J Intellect Disabil Res 2005; 49:309-316. [PMID: 15817048 DOI: 10.1111/j.1365-2788.2005.00600.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of morbidity and mortality in the UK. The aim of this study was to screen inpatients with mild or borderline intellectual disability, many of whom also have mental illness, for risk factors for CHD. METHODS Cross sectional survey. Participants were interviewed, measured and had blood samples taken. RESULTS Of the 53 participants, 20 (37.7%) were overweight and 18 (34.0%) obese. The mean body mass index (BMI) of those participants prescribed regular antipsychotics was higher than those who were not. Nine (20.9%) had waist circumference measurements placing them at increased risk of CHD and 21 (48.8%) were at substantially increased risk. Twenty-eight (52.8%) were current smokers. Of the 49 participants who had their blood pressure measured, 3 (6.1%) had readings above the reference range. Of the 19 participants who had random blood tests, one (5.3%) had an elevated cholesterol level. CONCLUSIONS In this population there was a high prevalence of two risk factors for CHD (obesity and smoking), requiring ongoing monitoring and long-term measures to reduce risk.
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29
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Tesema Y, Raghavan D, Stubbs J. Bone cell viability on methacrylic acid grafted and collagen immobilized porous poly(3-hydroxybutrate-co-3-hydroxyvalerate). J Appl Polym Sci 2005. [DOI: 10.1002/app.22352] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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30
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Tesema Y, Raghavan D, Stubbs J. Bone cell viability on collagen immobilized poly(3-hydroxybutrate-co-3-hydroxyvalerate) membrane: Effect of surface chemistry. J Appl Polym Sci 2004. [DOI: 10.1002/app.20787] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Horgan GW, Stubbs J. Predicting basal metabolic rate in the obese is difficult. Eur J Clin Nutr 2003; 57:335-40. [PMID: 12571669 DOI: 10.1038/sj.ejcn.1601542] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2001] [Revised: 05/15/2002] [Accepted: 05/28/2002] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To reassess the validity of the Schofield equations for predicting basal metabolic rate (BMR) in the obese. DATA The data collection compiled from many studies by Schofield in 1985. METHODS Nonparametric curve fitting and comparison of groups. RESULTS BMR increases more slowly at heavier weights in men (above about 75 kg) and women (above about 65 kg), and to ignore this is to predict overestimates of BMR. Data obtained from studies of different populations show substantial differences, which are influential when data are combined. CONCLUSIONS The Schofield equations are unsuitable for obese populations. Given that current Western populations exhibit prevalences of obesity many times greater than those in the Schofield database, this indicates the need for further study of suitable predictors for these individuals.
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Affiliation(s)
- G W Horgan
- Biomathematics and Statistics Scotland, Aberdeen, UK.
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32
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Kirsch S, Stubbs J, Leuninger J, Pfau A, Sundberg D. Control of particle morphology and film structures of carboxylated poly(methyl methacrylate)/poly (n-butylacrylate) composite latex particles. J Appl Polym Sci 2003. [DOI: 10.1002/app.13475] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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33
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Brumit MC, Carnahan GE, Stubbs JR, Storry JR, Reid ME. Moderate hemolytic disease of the newborn (HDN) due to anti-Rh17 produced by a black female with an e variant phenotype. Immunohematology 2002; 18:40-2. [PMID: 15373563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The Rh blood group antigen e is of high incidence and has many epitopes. Partial expression may occur, more commonly in black persons. Individuals with e variant phenotypes can make antibodies to epitopes they lack. While some of these antibodies may be specific for an antigen, e.g., hrB, others, like anti-Rh17 (anti-Hro), show broader specificity, compatible only with D-- and Rhnull red blood cells (RBCs). Anti-Rh17 in persons of the D-- phenotype has been reported to cause mild to fatal HDN. We report an example of anti-Rh17 produced by a black female with an e variant RBC phenotype that caused moderate HDN. A panel of seven monoclonal anti-e demonstrated her RBCs carried a variant e antigen, and her genotype was RHD, RHce by PCR-RFLP analysis. Amniotic fluid with.OD450 values from 30 to 35 weeks' gestation predicted moderate HDN probability by the Liley method. At 38+ weeks, a viable 3165 g female infant was delivered. The infant's direct antiglobulin test was 2+ with anti-IgG. Total bilirubin rose to 14.2 mg/dL within 48 hours. Indirect bilirubin peaked at 14.7 mg/dL. The bilirubin responded to triple phototherapy. The infant was discharged on day 6. Potential for infant morbidity due to anti-Rh17- mediated HDN and the importance of specifying risks to women with this antibody if they contemplate pregnancy are discussed.
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Affiliation(s)
- M C Brumit
- University of South Alabama Medical Center, Department of Pathology, 2451 Fillingim St., Mobile, AL 36617, USA
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Abstract
Map-based positional cloning of Drosophila melanogaster genes is hampered by both the time-consuming, error-prone nature of traditional methods for genetic mapping and the difficulties in aligning the genetic and cytological maps with the genome sequence. The identification of sequence polymorphisms in the Drosophila genome will make it possible to map mutations directly to the genome sequence with high accuracy and resolution. Here we report the identification of 7,223 single-nucleotide polymorphisms (SNPs) and 1,392 insertions/deletions (InDels) in common laboratory strains of Drosophila. These sequence polymorphisms define a map of 787 autosomal marker loci with a resolution of 114 kb. We have established PCR product-length polymorphism (PLP) or restriction fragment-length polymorphism (RFLP) assays for 215 of these markers. We demonstrate the use of this map by delimiting two mutations to intervals of 169 kb and 307 kb, respectively. Using a local high-density SNP map, we also mapped a third mutation to a resolution of approximately 2 kb, sufficient to localize the mutation within a single gene. These methods should accelerate the rate of positional cloning in Drosophila.
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Affiliation(s)
- J Berger
- Research Institute of Molecular Pathology, Dr. Bohr-Gasse 7 A-1030, Vienna, Austria
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Kirsch S, Pfau A, Stubbs J, Sundberg D. Control of particle morphology and film structures of carboxylated poly (n butylacrylate)/poly (methyl methacrylate) composite latex particles. Colloids Surf A Physicochem Eng Asp 2001. [DOI: 10.1016/s0927-7757(01)00499-x] [Citation(s) in RCA: 24] [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: 11/29/2022]
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36
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Engelhard S, Stubbs J, Weston P, Fitzgerald S, Giles-Corti B, Milat AJ, Honeysett D. Methodological considerations when conducting direct observation in an outdoor environment: our experience in local parks. Aust N Z J Public Health 2001; 25:149-51. [PMID: 11357911 DOI: 10.1111/j.1753-6405.2001.tb01837.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This paper discusses some of the inherent methodological limitations of gathering data via direct observation using local parks as a case study. METHODS Direct observation was carried out in five parks on seven non-consecutive days in 1998 and on matched days in 1999. Information recorded for each person included the time of park entry and exit, gender, age group, and activity/ies undertaken while in the park. METHODOLOGICAL CONSIDERATIONS: The location of the observation point, observer reliability, recording and accuracy of data, and specific issues related to outdoor observation areas should all be considered when designing a study incorporating direct observation as a data collection method. CONCLUSIONS Direct observation can provide valuable information. However, pilot testing is essential for minimising potential problems associated with this method and optimising data quality. IMPLICATIONS The issues discussed in this paper provide a useful guide for other researchers undertaking direct observation in outdoor environments.
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Affiliation(s)
- S Engelhard
- Health Promotion, Western Sydney Area Health Service, Parramatta BC, New South Wales.
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37
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Abstract
This article examines the importance of dietary energy density (ED) as a major factor that may influence human appetite and energy intake (EI). The article examines whether the effects of diet composition on appetite and EI can be explained in terms of ED. There is clear evidence that dietary macronutrients exert differential effects on energy intake (EI), both in the laboratory and in real life. Under normal conditions where fat contributes disproportionately to ED, protein, carbohydrate, and fat exert hierarchical effects on satiety in the order protein >carbohydrate > fat. Alcohol appears to stimulate EI. In human appetite studies the main effect of controlling ED is to diminish the impact of differences in the satiating effects of fat and carbohydrate. ED exerts profound effects in constraining EI in short-to-medium term studies. Subjects behave differently in longer term interventions. In short-to-medium term laboratory studies, increases in ED are more effective at increasing EI than at decreasing food intake. In longer term and cross-sectional studies conducted in naturalistic environments, increased ED appears more effective at decreasing food intake and less effective at elevating EI. The available evidence suggests that we should be evolving more complex, multifactor models to account for the observations that both macronutrients and ED affect EI rather than substituting one simplistic model with another.
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Affiliation(s)
- J Stubbs
- The Rowett Research Institute, Bucksburn, Aberdeen, UK
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Stubbs J, Palmer A, Vidovic M, Marotte LR. Graded expression of EphA3 in the retina and ephrin-A2 in the superior colliculus during initial development of coarse topography in the wallaby retinocollicular projection. Eur J Neurosci 2000; 12:3626-36. [PMID: 11029633 DOI: 10.1046/j.1460-9568.2000.00251.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the expression of EphA3 and EphA7 receptors and ephrin-A2 ligand in the retina and the superior colliculus during the development of the retinocollicular projection in the marsupial wallaby (Macropus eugenii), using immunoblotting and immunohistochemistry. EphA3 in the retina was in a striking, low central to high peripheral gradient, superimposed on which was a high temporal to low nasal level of expression. This distribution was evident from postnatal day 30, when axons are growing into the colliculus and forming a coarsely organized topographic projection, to postnatal day 65, when axons have arborized in their correct retinotopic positions. EphA7 showed a shallow centroperipheral gradient with no nasotemporal differences in expression. In the superior colliculus no rostrocaudal differences in distribution were detected for either of these receptors. Ephrin-A2 was distributed in a gradient increasing from the rostral to the caudal pole in the superficial layers of the superior colliculus only up to postnatal day 30. Ephrin-A2 was evenly distributed in the retina throughout development of the projection. Expression of EphA3 in the retina increased, while the expression of ephrin-A2 in the colliculus was downregulated over time. The graded expression of EphA3 and ephrin-A2 early in the development of the projection suggests that they play a role in establishment of coarse topography of retinal axons along the rostrocaudal axis of the superior colliculus. However, the gradients were not complementary, meaning that EphA3 alone cannot mediate the repulsive interactions with ephrin-A2 that have been postulated to underlie formation of the topographic map.
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Affiliation(s)
- J Stubbs
- Developmental Neurobiology and Endocrinology Group, Research School of Biological Sciences, Australian National University, Canberra, ACT 0200, Australia
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39
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Stubbs J. Gender in development: a long haul -- but we're getting there! Dev Pract 2000; 10:535-542. [PMID: 12349748 DOI: 10.1080/09614520050116695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
While women's movements in Latin America and elsewhere have succeeded in putting many issues that are relevant to women and to gender relations onto the political agenda, and although most international aid agencies have made efforts to incorporate gender analysis into their work, this progress has been neither comprehensive nor unproblematic. This article focuses on ways in which the development cooperation agenda, and the priorities and working methods of development agencies and nongovernmental organizations, have served to distort the vision and practice of the women's organizations whose work they seek to support.
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Stubbs J, Rangan A. Discussing alternative therapies with your patients. Aust Fam Physician 1999; 28:877-8. [PMID: 10561883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- J Stubbs
- NSW Breast Cancer Institute, University of Sydney, Westmead, New South Wales
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Abstract
BACKGROUND Information on the treatment of women with breast cancer in Australia is generally available only from special surveys. Analysis of routinely collected datasets may be more timely and cost effective, if the data are sufficiently accurate and complete. OBJECTIVE To evaluate the accuracy and completeness of data on treatment in linked records of breast cancer from two routinely collected datasets. METHODS The NSW Department of Health linked NSW Central Cancer Registry (CCR) records for 2,636 women diagnosed with breast cancer in NSW in 1992 to all hospital admission records in the NSW In-patient Statistics Collection (ISC) from January 1991 to June 1994. We queried the original paper records of subsets of women to identify missing or miscoded information and cases not notified to the CCR. We also compared the treatment data with data collected independently from the medical records of 19% of the women. RESULTS ISC records linked to 89% of the CCR records. The CCR had identified 94.9% of women with breast cancer treated as hospital in-patients and 83% of these women had surgical treatment recorded in the ISC. The linked dataset under-estimated the percentage of women having breast-conserving therapy (-4%) and slightly over-estimated the percentage having mastectomy (+1%). We estimated that 42% of women treated surgically for breast cancer had actually had breast-conserving surgery, compared with 39% in the original dataset. There was no evident bias by age or by urban or rural residence in the under-recording of breast conservation. There was 94% agreement on the type of surgery between the linked dataset and the independent dataset.
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Affiliation(s)
- K McGeechan
- NHMRC National Breast Cancer Centre, New South Wales
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42
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Smith CD, Stubbs J, Hananel D. Simulation technology in surgical education: can we assess manipulative skills and what does it mean to the learner. Stud Health Technol Inform 1997; 50:379-80. [PMID: 10180579] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- C D Smith
- Emory University School of Medicine, Atlanta, GA, USA
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43
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Stubbs J. Nutrition. Under-reporting in epidemiological and intervention studies: is identifying the under reporters enough? Curr Opin Lipidol 1997; 8:U61-2. [PMID: 9335959] [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: 02/05/2023]
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Stubbs JR. Coagulation for blood bankers. Clin Lab Med 1996; 16:837-71. [PMID: 8974198] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J R Stubbs
- Department of Pathology and Medicine, University of South Alabama School of Medicine, Mobile, USA
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Nyyssönen E, Amutan M, Enfield L, Stubbs J, Dunn-Coleman NS. The transposable element Tan1 of Aspergillus niger var. awamori, a new member of the Fot1 family. Mol Gen Genet 1996; 253:50-6. [PMID: 9003286 DOI: 10.1007/s004380050295] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aspergillus niger var. awamori has transposable elements that we refer to as Vader and Tan1 (transposon A. niger). Vader was identified by screening unstable nitrate reductase (niaD) mutants for insertions. Four of the isolated niaD mutants were shown to contain a small insertion element. This 437 bp insertion element, Vader, is flanked by 44 bp inverted repeats (IR) and is present in approximately 15 copies in the genomes of two A. niger strains examined. A synthetic 44 bp oligomer of the inverted repeat of Vader has now been used to clone, via the polymerase chain reaction, a 2.3 kb Tan1 element. The Tan1 element has also been isolated from a partial genomic library. Tan1 is present as a single copy in A. niger var. awamori. The Tan1 element has a unique organization: IR-ORF-IR-IR-Vader-IR. The single open reading frame (ORF) (1668 bp) encodes a putative transposase homologous to Fusarium oxysporum Fot1 and Magnaporthe grisea Pot2. Immediately 3' to the second inverted repeat, which bounds the transposase, is a copy of the AT-rich Vader element. We hypothesize that at some stage the independent Vader element, although inactive by itself, arose from Tan1, resulting in current strains with only one copy of Tan1 providing transposase activity and numerous mobile copies of Vader dispersed in the genome.
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Affiliation(s)
- E Nyyssönen
- Microbiology Department, Genencor International, Palo Alto, CA 94304-1013, USA
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Amutan M, Nyyssonen E, Stubbs J, Diaz-Torres MR, Dunn-Coleman N. Identification and cloning of a mobile transposon from Aspergillus niger var. awamori. Curr Genet 1996; 29:468-73. [PMID: 8625427 DOI: 10.1007/bf02221516] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aspergillus niger var. awamori contains multiple copies of a transposable element, Vader. This element was detected as a 437-bp insertion in four independently isolated spontaneous mutants of the niaD (nitrate reductase) gene. The Vader element is present in approximately 15 copies in both A. niger var. awamori and A. niger. A single copy of Vader was detected from only one of the two laboratory strains of A. nidulans which were also examined. Insertion of the Vader element into the niaD gene of A. niger var. awamori caused a 2-bp duplication (TA) of the target sequence. The Vader element is flanked by a 44-bp inverted repeat. The genetic stabilities of the inserted Vader elements at niaD were examined by studying reversion frequencies resulting in colonies able to grow on nitrate as a sole nitrogen source. Mutants niaD392 and niaD436 reverted at a frequency of 9x10(-3) and 4x10(-2), respectively. Two of the mutants, niaD587 and niaD410, reverted at a lower frequency of 6x10(-4).
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Affiliation(s)
- M Amutan
- Microbiology Department, Genencor International, 180 Kimball Way, South San Francisco, CA 94080, USA
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Affiliation(s)
- J Stubbs
- Hospital of the University of Pennsylvania, Philadelphia 19104-4283, USA
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Barrett VJ, O'Brien MM, Moulds JJ, Spruell P, Jackson V, Stubbs JR. Anti-Holley detected in a primary immune response. Immunohematology 1996; 12:62-5. [PMID: 15387742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Anti-Holley (Hy) has been reported as an IgG antibody occurring in previously transfused or multiparous black patients. In this case anti- Hy was identified in a 16-year-old black, primigravida female admitted at 32 weeks gestation because of premature rupture of the membranes. On admission, her blood type was determined to be A2B, D-positive and an antibody screen was negative. A second antibody screen, performed 4 days later, was positive in all three cells. Anti-Hy was subsequently identified. The antibody was reactive at room temperature, 37 degrees C, and in the antiglobulin phase. IgG and IgM components of anti-Hy were demonstrated in the maternal serum, documenting a primary immune response. This resulted in serologic findings not previously described for anti-Hy. A direct antiglobulin test on the newborn red cells was negative and there was no clinical evidence of hemolytic disease of the newborn (HDN). A monocyte monolayer assay performed with maternal serum yielded negative results. Recent scientific information has resulted in the placement of Hy in the Dombrock blood group system. Alloantibodies to Dombrock system antigens have not been associated with severe HDN.
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Affiliation(s)
- V J Barrett
- University of South Alabama, Department of Medical Technology, 1504 Springhill Avenue, Room 2309, Mobile, AL 36604- 3273, USA
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Barrett VJ, Stubbs JR, Stuardi K, Hollis A, Clear L. Analysis of the routine use of polyethylene glycol (PEG) as an enhancement medium. Immunohematology 1995; 11:11-3. [PMID: 15447072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
This study compared the performance of polyethylene glycol (PEG) and low-ionic saline solutions (LISS) as enhancement media for routine use in a large transfusion service. A PEG additive solution (PEG plus LISS) was compared to a LISS additive (LISS plus polymers) and to an albumin-indirect antiglobulin test (A-IAT). Fifty serum samples containing clinically significant alloantibodies and fifty samples without alloantibodies were tested. Following an acute hemolytic transfusion reaction (HTR) involving an anti-K that was not detected with LISS but was retrospectively found to be reactive with PEG, an additional 151 samples received for antibody screening were prospectively evaluated in parallel using PEG and LISS. PEG detected all clinically significant antibodies in the 50 previously tested samples, with mean reactivity scores greater than LISS or A-IAT. In the prospective study, PEG detected 35 clinically significant antibodies and 10 clinically insignificant antibodies, while LISS detected only 15 clinically significant antibodies and 33 clinically insignificant antibodies. PEG appears to increase detection of significant antibodies while decreasing detection of insignificant antibodies. PEG was therefore substituted for LISS as an enhancement medium and has been in routine use for 12 months, with no reported acute or anamnestic HTRs in 6,353 transfusions.
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Affiliation(s)
- V J Barrett
- Dept. of Medical Technology, University of South Alabama, 1504 Springhill Ave., Room 2309, Mobile, AL 36604, USA
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Watson E, Stabin M, Stubbs J. Dosimetry of technetium-94m-teboroxime. J Nucl Med 1994; 35:923-4. [PMID: 8176485] [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] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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