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Shah J, Moschovis PP, Rooney J, Singh D, Demokritou P, Yonker LM, Kinane TB. Aerosol Production by Children Performing Spirometry and Implications During a Pandemic. Respir Care 2023; 68:1254-1257. [PMID: 37041027 PMCID: PMC10468168 DOI: 10.4187/respcare.10200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Jhill Shah
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Department of Pediatrics, Emerson Hospital, Concord, Massachusetts
- Department of Pediatrics, Franciscan Children's Hospital, Brighton, Massachusetts
| | - Peter P Moschovis
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Rooney
- Division of Pediatric Global Health, Massachusetts General Hospital, Boston, Massachusetts
| | - Dilpreet Singh
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology, Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lael M Yonker
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - T Bernard Kinane
- Division of Pediatric Pulmonology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.
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2
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Burbank AJ, Atkinson CE, Espaillat AE, Schworer SA, Mills K, Rooney J, Loughlin CE, Phipatanakul W, Hernandez ML. Race-specific spirometry equations may overestimate asthma control in Black children and adolescents. Respir Res 2023; 24:203. [PMID: 37592259 PMCID: PMC10433634 DOI: 10.1186/s12931-023-02505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND A growing body of evidence suggests that use of race terms in spirometry reference equations underestimates disease burden in Black populations, which may lead to disparities in pulmonary disease outcomes. Data on asthma-specific health consequences of using race-adjusted spirometry are lacking. METHODS We performed a secondary analysis of 163 children from two observational asthma studies to determine the frequencies of participants with ppFEV1 < 80% (consistent with uncontrolled asthma) or ppFEV1 ≥ 80% using race-specific (GLI-African American or Caucasian) vs. race-neutral (GLI-Global) spirometry and their alignment with indicators of asthma control (Asthma Control Test™, ACT). Comparisons of mean ppFEV1 values were conducted using Wilcoxon matched-pairs signed-rank tests. Two group comparisons were conducted using Wilcoxon rank-sum tests. RESULTS Data from 163 children (100 Black, 63 White) were analyzed. Mean ppFEV1 was 95.4% (SD 15.8) using race-specific spirometry and 90.4% (16.3) using race-neutral spirometry (p < 0.0001). Among 54 Black children with uncontrolled asthma (ACT ≤ 19), 20% had ppFEV1 < 80% using race-specific spirometry compared to 40% using race-neutral spirometry. In Black children with controlled asthma (ACT > 19), 87% had ppFEV1 ≥ 80% using race-specific compared to 67% using race-neutral spirometry. Children whose ppFEV1 changed to ≤ 80% with race-neutral spirometry had lower FEV1/FVC compared to those whose ppFEV1 remained ≥ 80% [0.83 (0.07) vs. 0.77 (0.05), respectively; p = 0.04], suggesting greater airway obstruction. Minimal changes in alignment of ppFEV1 with ACT score were observed for White children. CONCLUSIONS Use of race-specific reference equations in Black children may increase the risk of inappropriately labeling asthma as controlled.
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Affiliation(s)
- Allison J Burbank
- Division of Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Children's Research Institute, University of North Carolina, Chapel Hill, NC, USA.
- , 5008B Mary Ellen Jones Building 116 Manning Drive, CB #7231, Chapel Hill, NC, 27599-7231, USA.
| | - Claire E Atkinson
- Division of Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Andre E Espaillat
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Stephen A Schworer
- Division of Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Katherine Mills
- Children's Research Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Jennifer Rooney
- Boston Children's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Ceila E Loughlin
- Division of Pediatric Pulmonology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Wanda Phipatanakul
- Division of Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michelle L Hernandez
- Division of Allergy & Immunology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Children's Research Institute, University of North Carolina, Chapel Hill, NC, USA
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3
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Myers B, Carney T, Rooney J, Malatesta S, Ragan EJ, White LF, Natcheva H, Bouton TC, Weber SE, Farhat M, McIlleron H, Theron D, Parry CDH, Horsburgh CR, Warren RM, Jacobson KR. Smoked drug use in patients with TB is associated with higher bacterial burden. Int J Tuberc Lung Dis 2023; 27:444-450. [PMID: 37231597 PMCID: PMC10407961 DOI: 10.5588/ijtld.22.0650] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND: Smoking of illicit drugs may lead to more rapid TB disease progression or late treatment presentation, yet research on this topic is scant. We examined the association between smoked drug use and bacterial burden among patients newly initiated on drug-susceptible TB (DS-TB) therapy.METHODS: Data from 303 participants initiating DS-TB treatment in the Western Cape Province, South Africa, were analyzed. Smoked drug use was defined as self-reported or biologically verified methamphetamine, methaqualone and/or cannabis use. Proportional hazard and logistic regression models (adjusted for age, sex, HIV status and tobacco use) examined associations between smoked drug use and mycobacterial time to culture positivity (TTP), acid-fast bacilli sputum smear positivity and lung cavitation.RESULTS: People who smoked drugs (PWSD) comprised 54.8% (n = 166) of the cohort. TTP was faster for PWSD (hazard ratio 1.48, 95% CI 1.10-1.97; P = 0.008). Smear positivity was higher among PWSD (OR 2.28, 95% CI 1.22-4.34; P = 0.011). Smoked drug use (OR 1.08, 95% CI 0.62-1.87; P = 0.799) was not associated with increased cavitation.CONCLUSIONS: PWSD had a higher bacterial burden at diagnosis than those who do not smoke drugs. Screening for TB among PWSD in the community may facilitate earlier linkage to TB treatment and reduce community transmission.
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Affiliation(s)
- B Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia, Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - T Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - J Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - E J Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - L F White
- Department of Biostatistics, School of Public Health, Boston University, MA, USA
| | - H Natcheva
- Department of Radiology, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - T C Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - S E Weber
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - M Farhat
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - D Theron
- Western Cape Department of Health, Pretoria, South Africa
| | - C D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - C R Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA, Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - R M Warren
- Department of Science and Technology, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Molecular Biology and Human Genetics, Stellenbosch University, Tygerberg, South Africa
| | - K R Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
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4
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Moschovis PP, Lombay J, Rooney J, Schenkel SR, Singh D, Rezaei SJ, Salo N, Gong A, Yonker LM, Shah J, Hayden D, Hibberd PL, Demokritou P, Kinane TB. The effect of activity and face masks on exhaled particles in children. Pediatr Investig 2023; 7:75-85. [PMID: 37324601 PMCID: PMC10262878 DOI: 10.1002/ped4.12376] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 01/29/2023] [Indexed: 06/17/2023] Open
Abstract
Importance Despite the high burden of respiratory infections among children, the production of exhaled particles during common activities and the efficacy of face masks in children have not been sufficiently studied. Objective To determine the effect of type of activity and mask usage on exhaled particle production in children. Methods Healthy children were asked to perform activities that ranged in intensity (breathing quietly, speaking, singing, coughing, and sneezing) while wearing no mask, a cloth mask, or a surgical mask. The concentration and size of exhaled particles were assessed during each activity. Results Twenty-three children were enrolled in the study. Average exhaled particle concentration increased by intensity of activity, with the lowest particle concentration during tidal breathing (1.285 particles/cm3 [95% CI 0.943, 1.627]) and highest particle concentration during sneezing (5.183 particles/cm3 [95% CI 1.911, 8.455]). High-intensity activities were associated with an increase primarily in the respirable size (≤ 5 µm) particle fraction. Surgical and cloth masks were associated with lower average particle concentration compared to no mask (P = 0.026 for sneezing). Surgical masks outperformed cloth masks across all activities, especially within the respirable size fraction. In a multivariable linear regression model, we observed significant effect modification of activity by age and by mask type. Interpretation Similar to adults, children produce exhaled particles that vary in size and concentration across a range of activities. Production of respirable size fraction particles (≤ 5 µm), the dominant mode of transmission of many respiratory viruses, increases significantly with coughing and sneezing and is most effectively reduced by wearing surgical face masks.
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Affiliation(s)
- Peter P. Moschovis
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jesiel Lombay
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jennifer Rooney
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Sara R. Schenkel
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Dilpreet Singh
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Mechanical and Aerospace EngineeringRutgers University School of Public HealthNew BrunswickNew JerseyUSA
| | - Shawheen J. Rezaei
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Nora Salo
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Amanda Gong
- David Geffen School of Medicinethe University of California Los AngelesLos AngelesCaliforniaUSA
| | - Lael M. Yonker
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Jhill Shah
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Douglas Hayden
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
| | - Patricia L. Hibberd
- Department of Global HealthBoston University School of Public HealthBostonMassachusettsUSA
| | - Philip Demokritou
- Department of Environmental HealthHarvard T. H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Mechanical and Aerospace EngineeringRutgers University School of Public HealthNew BrunswickNew JerseyUSA
| | - T. Bernard Kinane
- Department of PediatricsMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
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5
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Seppala M, Thivichon-Prince B, Xavier GM, Shaffie N, Sangani I, Birjandi AA, Rooney J, Lau JNS, Dhaliwal R, Rossi O, Riaz MA, Stonehouse-Smith D, Wang Y, Papageorgiou SN, Viriot L, Cobourne MT. Gas1 Regulates Patterning of the Murine and Human Dentitions through Sonic Hedgehog. J Dent Res 2021; 101:473-482. [PMID: 34796774 PMCID: PMC8935464 DOI: 10.1177/00220345211049403] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The mammalian dentition is a serially homogeneous structure that exhibits wide numerical and morphological variation among multiple different species. Patterning of the dentition is achieved through complex reiterative molecular signaling interactions that occur throughout the process of odontogenesis. The secreted signaling molecule Sonic hedgehog (Shh) plays a key role in this process, and the Shh coreceptor growth arrest-specific 1 (Gas1) is expressed in odontogenic mesenchyme and epithelium during multiple stages of tooth development. We show that mice engineered with Gas1 loss-of-function mutation have variation in number, morphology, and size of teeth within their molar dentition. Specifically, supernumerary teeth with variable morphology are present mesial to the first molar with high penetrance, while molar teeth are characterized by the presence of both additional and absent cusps, combined with reduced dimensions and exacerbated by the presence of a supernumerary tooth. We demonstrate that the supernumerary tooth in Gas1 mutant mice arises through proliferation and survival of vestigial tooth germs and that Gas1 function in cranial neural crest cells is essential for the regulation of tooth number, acting to restrict Wnt and downstream FGF signaling in odontogenic epithelium through facilitation of Shh signal transduction. Moreover, regulation of tooth number is independent of the additional Hedgehog coreceptors Cdon and Boc, which are also expressed in multiple regions of the developing tooth germ. Interestingly, further reduction of Hedgehog pathway activity in Shhtm6Amc hypomorphic mice leads to fusion of the molar field and reduced prevalence of supernumerary teeth in a Gas1 mutant background. Finally, we demonstrate defective coronal morphology and reduced coronal dimensions in the molar dentition of human subjects identified with pathogenic mutations in GAS1 and SHH/GAS1, suggesting that regulation of Hedgehog signaling through GAS1 is also essential for normal patterning of the human dentition.
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Affiliation(s)
- M Seppala
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - B Thivichon-Prince
- Laboratoire de Biologie tissulaire et Ingénierie Thérapeutique (LBTI), UMR CNRS 5305/Université de Lyon 1, IBCP, Lyon, France.,Faculté d'Odontologie, Université de Lyon 1, Université de Lyon, Lyon, France.,Service d'Odontologie, Hospices Civils de Lyon, Lyon, France
| | - G M Xavier
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - N Shaffie
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - I Sangani
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - A A Birjandi
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J Rooney
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - J N S Lau
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - R Dhaliwal
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - O Rossi
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - M A Riaz
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - D Stonehouse-Smith
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Y Wang
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - S N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - L Viriot
- Laboratoire de Biologie tissulaire et Ingénierie Thérapeutique (LBTI), UMR CNRS 5305/Université de Lyon 1, IBCP, Lyon, France
| | - M T Cobourne
- Centre for Craniofacial & Regenerative Biology, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK.,Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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6
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Agostino M, Rooney J, Herat L, Matthews J, Simonds A, Northfield SE, Hopper D, Schlaich MP, Matthews VB. TNFSF14-Derived Molecules as a Novel Treatment for Obesity and Type 2 Diabetes. Int J Mol Sci 2021; 22:ijms221910647. [PMID: 34638990 PMCID: PMC8508965 DOI: 10.3390/ijms221910647] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022] Open
Abstract
Obesity is one of the most prevalent metabolic diseases in the Western world and correlates directly with glucose intolerance and insulin resistance, often culminating in Type 2 Diabetes (T2D). Importantly, our team has recently shown that the TNF superfamily (TNFSF) member protein, TNFSF14, has been reported to protect against high fat diet induced obesity and pre-diabetes. We hypothesized that mimics of TNFSF14 may therefore be valuable as anti-diabetic agents. In this study, we use in silico approaches to identify key regions of TNFSF14 responsible for binding to the Herpes virus entry mediator and Lymphotoxin β receptor. In vitro evaluation of a selection of optimised peptides identified six potentially therapeutic TNFSF14 peptides. We report that these peptides increased insulin and fatty acid oxidation signalling in skeletal muscle cells. We then selected one of these promising peptides to determine the efficacy to promote metabolic benefits in vivo. Importantly, the TNFSF14 peptide 7 reduced high fat diet-induced glucose intolerance, insulin resistance and hyperinsulinemia in a mouse model of obesity. In addition, we highlight that the TNFSF14 peptide 7 resulted in a marked reduction in liver steatosis and a concomitant increase in phospho-AMPK signalling. We conclude that TNFSF14-derived molecules positively regulate glucose homeostasis and lipid metabolism and may therefore open a completely novel therapeutic pathway for treating obesity and T2D.
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MESH Headings
- Animals
- Binding Sites
- Blood Glucose/metabolism
- Computer Simulation
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/etiology
- Diabetes Mellitus, Type 2/metabolism
- Diet, High-Fat/adverse effects
- Disease Models, Animal
- Glucose Intolerance/drug therapy
- Glucose Intolerance/metabolism
- Homeostasis/drug effects
- Hyperinsulinism/drug therapy
- Hyperinsulinism/metabolism
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/chemical synthesis
- Insulin Resistance
- Lymphotoxin beta Receptor/chemistry
- Lymphotoxin beta Receptor/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Obesity/complications
- Obesity/drug therapy
- Obesity/etiology
- Obesity/metabolism
- Peptides/administration & dosage
- Peptides/chemical synthesis
- Receptors, Tumor Necrosis Factor, Member 14/chemistry
- Receptors, Tumor Necrosis Factor, Member 14/metabolism
- Signal Transduction/drug effects
- Treatment Outcome
- Tumor Necrosis Factor Ligand Superfamily Member 14/administration & dosage
- Tumor Necrosis Factor Ligand Superfamily Member 14/chemistry
- Tumor Necrosis Factor Ligand Superfamily Member 14/metabolism
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Affiliation(s)
- Mark Agostino
- Curtin Medical School, Curtin University, Bentley, WA 6102, Australia; (M.A.); (A.S.)
- Curtin Health and Innovation Research Institute, Curtin University, Perth, WA 6845, Australia
- Curtin Institute for Computation, Curtin University, Perth, WA 6845, Australia
| | - Jennifer Rooney
- Dobney Hypertension Centre, School of Biomedical Sciences—Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6009, Australia; (J.R.); (L.H.); (J.M.)
| | - Lakshini Herat
- Dobney Hypertension Centre, School of Biomedical Sciences—Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6009, Australia; (J.R.); (L.H.); (J.M.)
| | - Jennifer Matthews
- Dobney Hypertension Centre, School of Biomedical Sciences—Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6009, Australia; (J.R.); (L.H.); (J.M.)
| | - Allyson Simonds
- Curtin Medical School, Curtin University, Bentley, WA 6102, Australia; (M.A.); (A.S.)
| | - Susan E. Northfield
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia; (S.E.N.); (D.H.)
| | - Denham Hopper
- Department of Biochemistry and Pharmacology, School of Biomedical Sciences, The University of Melbourne, Parkville, VIC 3010, Australia; (S.E.N.); (D.H.)
- School of Chemistry, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Markus P. Schlaich
- Department of Cardiology, Royal Perth Hospital, Perth, WA 6000, Australia;
- Department of Nephrology, Royal Perth Hospital, Perth, WA 6000, Australia
- Department of Medicine, Royal Perth Hospital, Perth, WA 6000, Australia
| | - Vance B. Matthews
- Dobney Hypertension Centre, School of Biomedical Sciences—Royal Perth Hospital Unit, University of Western Australia, Perth, WA 6009, Australia; (J.R.); (L.H.); (J.M.)
- Correspondence: ; Tel.: +61-8-9224-0239; Fax: +61-8-9224-0374
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7
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Bowe CM, Bean T, Loke R, Gallagher N, Rooney J, Surwald C, Dhanda J, Moody A, Bisase B, Norris P, Barrett AW, Lachanas V, Doumas S. Merkel cell carcinoma of the head and neck in the south-east of England. Br J Oral Maxillofac Surg 2021; 59:1280-1286. [PMID: 34465487 DOI: 10.1016/j.bjoms.2021.06.009] [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: 03/07/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Merkel cell carcinoma (MCC) is a rare and highly aggressive neuroendocrine malignancy of the skin. Its incidence is increasing with half of cases involving the head and neck. To the best of our knowledge, few large studies have been published in the UK, and to date this is the largest reported series of head and neck MCC. We retrospectively reviewed the outcomes of patients with MCC in three hospitals in the south-east of England over a 12-year period (2008-2019). Diagnosis was based on histological data following biopsy. Overall survival and disease-specific survival were calculated using Kaplan-Meier and log-rank tests. Fifty-eight patients met the inclusion criteria (24 stage I, 22 stage II, 9 stage III, and 3 unclassified). Median disease-free survival was 36 months (95% CI 0 to 77.2) and median overall survival 50 months (95% CI 29.9 to 70). Overall five-year survival was 34.4% (95% CI 17% to 52%) with two-year survival at 62% (95% CI 48% to 76%). Five-year disease-free survival was 26.7% (95% CI 17 to 52%) with two-year disease-free survival at 54% (95% CI 40% to 68%). To date, this is the largest UK based study reporting overall and disease-free survival associated with MCC of the head and neck. Half the patients presented late, and surgery was the mainstay of treatment, augmented by adjuvant radiotherapy. There is a need to better stratify patients at risk of developing metastatic disease, with the use of sentinel lymph node biopsy and positron-emission tomography-computed tomography (PET-CT), as immunotherapy and targeted agents are now available to treat advanced disease.
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Affiliation(s)
- C M Bowe
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead.
| | - T Bean
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - R Loke
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - N Gallagher
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - J Rooney
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - C Surwald
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - J Dhanda
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead; Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
| | - A Moody
- Department of Oral & Maxillofacial Surgery, Eastbourne General Hospital
| | - B Bisase
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - P Norris
- Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead
| | - A W Barrett
- Department of Pathology Queen Victoria Hospital Foundation Trust, East Grinstead
| | - V Lachanas
- Department of Ear Nose Throat, University Hospital of Larissa, Greece
| | - S Doumas
- Department of Oral & Maxillofacial Surgery, Brighton Sussex University Hospital
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8
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Ragan EJ, Gill CJ, Banos M, Bouton TC, Rooney J, Horsburgh CR, Warren RM, Myers B, Jacobson KR. Directly Observed Therapy to Measure Adherence to Tuberculosis Medication in Observational Research: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2021; 10:e24510. [PMID: 34132642 PMCID: PMC8277341 DOI: 10.2196/24510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/10/2021] [Accepted: 02/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background A major challenge for prospective, clinical tuberculosis (TB) research is accurately defining a metric for measuring medication adherence. Objective We aimed to design a method to capture directly observed therapy (DOT) via mobile health carried out by community workers. The program was created specifically to measure TB medication adherence for a prospective TB cohort in Western Cape Province, South Africa. Methods Community workers collect daily adherence data on mobile smartphones. Participant-level adherence, program-level adherence, and program function are systematically monitored to assess DOT program implementation. A data dashboard allows for regular visualization of indicators. Numerous design elements aim to prevent or limit data falsification and ensure study data integrity. Results The cohort study is ongoing and data collection is in progress. Enrollment began on May 16, 2017, and as of January 12, 2021, a total of 236 participants were enrolled. Adherence data will be used to analyze the study’s primary aims and to investigate adherence as a primary outcome. Conclusions The DOT program includes a mobile health application for data collection as well as a monitoring framework and dashboard. This approach has potential to be adapted for other settings to improve the capture of medication adherence in clinical TB research. Trial Registration Clinicaltrials.gov NCT02840877; https://clinicaltrials.gov/ct2/show/NCT02840877
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Affiliation(s)
- Elizabeth J Ragan
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Matthew Banos
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Tara C Bouton
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States
| | - Jennifer Rooney
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States
| | - Charles R Horsburgh
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States.,Department of Global Health, Boston University School of Public Health, Boston, MA, United States.,Departments of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Robin M Warren
- Department of Science and Innovation-The National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research and The South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Karen R Jacobson
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, United States
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Myers B, Carney T, Rooney J, Malatesta S, White LF, Parry CDH, Bouton TC, Ragan EJ, Horsburgh CR, Warren RM, Jacobson KR. Alcohol and Tobacco Use in a Tuberculosis Treatment Cohort during South Africa's COVID-19 Sales Bans: A Case Series. Int J Environ Res Public Health 2021; 18:5449. [PMID: 34069737 PMCID: PMC8161406 DOI: 10.3390/ijerph18105449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND South Africa temporarily banned alcohol and tobacco sales for about 20 weeks during the COVID-19 lockdown. We described changes in alcohol and tobacco consumption after implementation of these restrictions among a small number of participants in a tuberculosis treatment cohort. METHOD The timeline follow-back procedure and Fägerstrom test for nicotine dependence was used to collect monthly alcohol and tobacco use information. We report changes in heavy drinking days (HDD), average amount of absolute alcohol (AA) consumed per drinking day, and cigarettes smoked daily during the alcohol and tobacco ban compared to use prior to the ban. RESULTS Of the 61 participants for whom we have pre-ban and within-ban alcohol use information, 17 (27.9%) reported within-ban alcohol use. On average, participants reported one less HDD per fortnight (interquartile range (IQR): -4, 1), but their amount of AA consumed increased by 37.4 g per drinking occasion (IQR: -65.9 g, 71.0 g). Of 53 participants who reported pre-ban tobacco use, 17 (32.1%) stopped smoking during the ban. The number of participants smoking >10 cigarettes per day decreased from 8 to 1. CONCLUSIONS From these observations, we hypothesize that policies restricting alcohol and tobacco availability seem to enable some individuals to reduce their consumption. However, these appear to have little effect on the volume of AA consumed among individuals with more harmful patterns of drinking in the absence of additional behavior change interventions.
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Division of Addiction Psychiatry, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Jennifer Rooney
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Samantha Malatesta
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Laura F. White
- Department of Biostatistics, School of Public Health, Boston University, MA 02119, USA; (S.M.); (L.F.W.)
| | - Charles D. H. Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg 7505, South Africa; (T.C.); (C.D.H.P.)
- Department of Psychiatry, Stellenbosch University, Tygerberg 7505, South Africa
| | - Tara C. Bouton
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Elizabeth J. Ragan
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
| | - Charles Robert Horsburgh
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
- Departments of Epidemiology, Biostatistics and Global Health, Boston University School of Public Health, Boston, MA 02119, USA
| | - Robin M. Warren
- Department of Science and Innovation, National Research Foundation Centre of Excellence in Biomedical Tuberculosis Research, South Africa Medical Research Council for Tuberculosis Research, Stellenbosch University, Tygerberg 7505, South Africa;
| | - Karen R. Jacobson
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA 02119, USA; (J.R.); (T.C.B.); (E.J.R.); (C.R.H.J.); (K.R.J.)
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Gill K, Johnson L, Dietrich J, Myer L, Marcus R, Wallace M, Pidwell T, Mendel E, Fynn L, Jones K, Wiesner L, Slack C, Strode A, Spiegel H, Hosek S, Rooney J, Gray G, Bekker LG. Acceptability, safety, and patterns of use of oral tenofovir disoproxil fumarate and emtricitabine for HIV pre-exposure prophylaxis in South African adolescents: an open-label single-arm phase 2 trial. Lancet Child Adolesc Health 2020; 4:875-883. [PMID: 33222803 PMCID: PMC9832157 DOI: 10.1016/s2352-4642(20)30248-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/22/2020] [Accepted: 07/14/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND HIV incidence among adolescents in southern Africa remains unacceptably high. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention but there are few data on its implementation among adolescents. We aimed to investigate the safety, feasibility, and acceptability of PrEP with oral tenofovir disoproxil fumarate and emtricitabine as part of a comprehensive HIV prevention package in an adolescent population in South Africa. METHODS This open-label single-arm phase 2 study (PlusPills) was done in two research clinics in Cape Town and Johannesburg, South Africa. Adolescents aged 15-19 years were recruited into the study through recruitment events and outreach in the community. Potential participants were eligible for enrolment if they reported being sexually active. Exclusion criteria were a positive test for HIV or pregnancy at enrolment, breastfeeding, or any relevant co-morbidities. Participants were given oral tenofovir disoproxil fumarate and emtricitabine for PrEP to take daily for the first 12 weeks and were then given the choice to opt in or out of PrEP use at three monthly intervals during scheduled clinic visits. Participants were invited to monthly visits for adherence counselling and HIV testing during the study period. The primary outcomes were acceptability, use, and safety of PrEP. Acceptability was measured by the proportion of participants who reported willingness to take up PrEP and remain on PrEP at each study timepoint. Use was defined as the number of participants who continued to use PrEP after the initial 12-week period until the end of the study (week 48). Safety was measured by grade 2, 3, and 4 laboratory and clinical adverse events using the Division of AIDS table for grading the severity of adult and paediatric adverse events, version 1.0. Dried blood spot samples were collected at each study time-point to measure tenofovir diphosphate concentrations. This trial is registered with ClinicalTrials.gov, NCT02213328. FINDINGS Between April 28, 2015, and Nov 11, 2016, 244 participants were screened, and 148 participants were enrolled (median age was 18 years; 99 participants [67%] were female) and initiated PrEP. PrEP was stopped by 26 of the 148 (18%) participants at 12 weeks. Cumulative PrEP opt-out, from the total cohort, was 41% (60 of 148 participants) at week 24 and 43% (63 of 148 participants) at week 36. PrEP was well tolerated with only minor adverse events (grade 2) thought to be related to study drug, which included headache (n=4, 3%), gastrointestinal upset (n=8, 5%), and skin rash (n=2, 1%). Two participants (1%) experienced grade 3 weight loss, which was deemed related to the study drug and resolved fully when PrEP was discontinued. Tenofovir diphosphate concentrations were detectable (>16 fmol/punch) in dried blood spot samples in 108 (92%) of 118 participants who reported PrEP use at week 12, in 74 (74%) of 100 participants at week 24, and in 22 (59%) of 37 participants by the study end at week 48. INTERPRETATION In this cohort of self-selected South African adolescents at risk of HIV acquisition, PrEP appears safe and tolerable in those who continued use. PrEP use decreased throughout the course of the study as the number of planned study visits declined. Adolescents in southern Africa needs access to PrEP with tailored adherence support and possibly the option for more frequent and flexible visit schedules. FUNDING National Institute of Allergy and Infectious Diseases of the US National Institutes of Health.
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Affiliation(s)
- K Gill
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
| | - L Johnson
- Centre for Infectious Diseases Epidemiology and Research, University of Cape Town, South Africa
| | - J Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - L Myer
- Health Systems Research Unit, South African Medical Research Council, Western Cape, South Africa
| | - R Marcus
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
| | - M Wallace
- Cancer Association of South Africa (CANSA)
| | - T Pidwell
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
| | - E Mendel
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
| | - L Fynn
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
| | - K Jones
- Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - L Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, South Africa
| | - C Slack
- HIV AIDS Vaccines Ethics Group, University of KwaZulu- Natal, South Africa
| | - A Strode
- School of Socio Legal Studies, School of Law, Pietermaritzburg, University of KwaZulu-Natal, Private Bag X01, Scottsville
| | - H Spiegel
- Kelly Government Solutions, Contractor to National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, Rockville, USA
| | - S Hosek
- Stroger Hospital of Cook County, Chicago, USA
| | - J Rooney
- Gilead Sciences, 333 Lakeside Drive, Building 300, Foster City, USA
| | - G Gray
- Office of the President, South African Medical Research Council, Western Cape, South Africa
| | - LG Bekker
- Desmond Tutu HIV Centre, University of Cape town, Observatory, Cape Town, South Africa
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Tattersall R, Murray D, Heverin M, Rooney J, Tobin K, Vance R, Hardiman O, Meldrum D. Respiratory measurements and airway clearance device prescription over one year in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:70-77. [PMID: 31823661 DOI: 10.1080/21678421.2019.1697887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 12/11/2022]
Abstract
Objective: The rates of decline in respiratory measurements, including Peak Cough Flow (PCF) have not been established in Amyotrophic Lateral Sclerosis (ALS). Additionally, optimal prescription of cough adjuncts which aim to increase cough strength are unknown. The primary aim of this study was to quantify declines in respiratory function in ALS using PCF, Sniff Nasal Inspiratory Pressure (SNIP) and Slow Vital Capacity (SVC). Secondary aims were to measure respiratory morbidity, audit the characteristics of those prescribed cough adjuncts, and compare outcomes between treated and untreated cohorts. Methods: A prospective, longitudinal, observational, cohort study evaluated respiratory measures, morbidity, and physical function in ALS patients at three monthly intervals, over one year. Patient and disease characteristics of those prescribed cough adjuncts were profiled at the time of device prescription. Results: one hundred and eight participants with mean age 62.1 ± 11.5 years participated. PCF declined rapidly at a rate of 124.8L/min/year (p < 0.001). SNIP, SVC (%predicted), and ALSFRS-R also declined significantly at rates of 18.72cmH2O, 17.49%, and 9.62 units per year respectively (p < 0.001). Thirty-two (29.6%) patients reported 56 incidences of chest infection and 21 died. Patients prescribed a cough adjunct (44.4%) had significantly lower average PCF, SNIP, SVC percent predicted, and ALSFRS-R (p < 0.001). Conclusions: This study identified a rapid rate of decline in PCF, a similar decline in SNIP, and slower declines in SVC and ALSFRS-R. Cough adjunct prescription was triggered by declining respiratory measures and recommended PCF thresholds, but also by respiratory symptoms. Chest infections were common in patients regardless of cough adjunct prescription and should be closely monitored.
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Affiliation(s)
- R Tattersall
- Physiotherapy Department, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - D Murray
- Physiotherapy Department, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - M Heverin
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - J Rooney
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
| | - K Tobin
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - R Vance
- Physiotherapy Department, Beaumont Hospital, Dublin 9, Ireland
| | - O Hardiman
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland.,Department of Neurology, Beaumont Hospital, Dublin 9, Ireland
| | - D Meldrum
- Academic Unit of Neurology, School of Medicine, Trinity Biomedical Sciences Institute, Trinity College, Dublin 2, Ireland
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Yeowell G, Rooney J, Goodwin PC. Exploring the disclosure decisions made by physiotherapists with a specific learning difficulty. Physiotherapy 2018; 104:203-208. [PMID: 29301650 DOI: 10.1016/j.physio.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 10/17/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore the disclosure decisions made in the workplace by physiotherapy staff with a specific learning difficulty (SpLD). DESIGN & SETTING An exploratory qualitative design was used, which was informed by the social model of disability. The research was undertaken in North West England. It is presented according to the Consolidated Criteria for Reporting Qualitative Research. PARTICIPANTS A purposive sample of eight physiotherapists recognised as having a SpLD were recruited. All participants had studied on one of two programmes at a university in England between 2004-2012. Their NHS workplace experience was from across the UK. DATA GENERATION In-depth, semi-structured interviews were undertaken within the university setting or via telephone. Interviews lasted 40 to 70minutes and were digitally recorded. An interview guide was used to direct the interview. DATA ANALYSIS Interview data were transcribed verbatim and analysed using thematic analysis. FINDINGS Four participants were female. The mean number of years qualified as a physiotherapist was 4.5years (SD=2.27). Three themes were identified: 'Disclosing during the workplace application'; 'Positive about disabled people scheme'; 'Disclosing in the workplace'. CONCLUSIONS Disclosure of dyslexia is a selective process and is a central dilemma in the lives of individuals who have a concealable stigmatised identity. As a consequence, physiotherapy staff with dyslexia may choose to conceal their disability and not disclose to their employer. In order for staff with dyslexia to get the support they need in the workplace, disclosure is recommended. A number of recommendations have been made to facilitate the disclosure process.
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Affiliation(s)
- G Yeowell
- Department of Health Professions, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6XJ, UK.
| | - J Rooney
- Department of Health Professions, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6XJ, UK.
| | - P C Goodwin
- Department of Health Professions, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6XJ, UK.
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13
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Charles J, Lessey L, Rooney J, Prokop I, Yearwood K, Da Breo H, Rooney P, Walker RH, Sobering AK. Presentation and care of a family with Huntington disease in a resource-limited community. J Clin Mov Disord 2017; 4:4. [PMID: 28413688 PMCID: PMC5389109 DOI: 10.1186/s40734-017-0050-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/25/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND In high-income countries patients with Huntington disease (HD) typically present to healthcare providers after developing involuntary movements, or for pre-symptomatic genetic testing if at familial risk. A positive family history is a major guide when considering the decision to perform genetic testing for HD, both in affected and unaffected patients. Management of HD is focused upon control of symptoms, whether motor, cognitive, or psychiatric. There is no clear evidence to date of any disease-modifying agents. Referral of families and caregivers for psychological and social support, whether to HD-focused centers, or through virtual communities, is viewed as an important consequence of diagnosis. The experience of healthcare for such progressive neurodegenerative diseases in low- and middle-income nations is in stark contrast with the standard of care in high-income countries. METHODS An extended family with many members affected with an autosomal dominantly inherited movement disorder came to medical attention when one family member presented following a fall. Apart from one family member who was taking a benzodiazepine for involuntary movements, no other affected family members had sought medical attention. Members of this family live on several resource-limited Caribbean islands. Care of the chronically ill is often the responsibility of the family, and access to specialty care is difficult to obtain, or is unavailable. Computed tomography scan of one patient's brain revealed severe caudate atrophy and moderate generalized cortical atrophy. Genetic diagnosis of HD was obtained. RESULTS Through family recollection and by direct observation we identified four generations of individuals affected with HD. Outreach programs and collaborations helped to provide medical imaging and genetic diagnosis. Additionally these efforts helped with patient and family support, education, and genetic counseling to many members of this family. CONCLUSIONS Affected members of this family have limited healthcare access, and rely heavily on family support for care. Genetic and clinical diagnosis of these patients was impeded by lack of resources and lack of access to specialty care. Importantly, obtaining a definitive diagnosis has had a positive impact for this family by facilitating genetic counseling, education, community outreach, and dispelling myths regarding this hereditary disease and its progression.
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Affiliation(s)
| | | | | | | | | | | | | | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY USA.,Department of Neurology, Mount Sinai School of Medicine, New York City, NY USA
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Goodwin P, Rooney J, Yeowell G. To disclose or not to disclose? Benchmarking disclosure of a specific learning difficulty in physiotherapy education and the NHS workplace. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.141] [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: 10/20/2022]
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Abstract
It is well known that there exist surfaces whose motion cannot be completely constrained by non-frictional contact forces. We give a new proof of the classification of these surfaces based on group theory. Having derived a simple character ization of these "surfaces that cannot be gripped, " we show that they are equivalent to the Reuleaux lower pairs. The proof emphasizes the symmetry of the surfaces rather than their analytic form. We also show that the screw system of such a surface is isomorphic to the Lie algebra of the surface's symmetry group.
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Affiliation(s)
- J.M. Selig
- Department of Electrical and Electronic Engineering Polytechnic of the South Bank London SE1 0AA, U.K
| | - J. Rooney
- Centre for Configuration Studies Faculty of Technology The Open University Milton Keynes MK7 6AA, U.K
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van Brunt K, Corrigan SM, Pedersini R, Rooney J. Cross-sectional survey study to understand behaviours, thoughts and perceptions of Mealtime Insulin (MTI) usage in patients with Type 1 and Type 2 Diabetes (T1D, T2D). DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580968] [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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Rooney J, Zou Y, Cowling B, Mitchell C, Bönnemann C. Late-onset mild myopathy with protein aggregates in two transgenic mouse models of FHL1. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.334] [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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18
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Mohassel P, Rooney J, Zou Y, Bönnemann C. Col6A2 null mice are a new mouse model of collagen-VI related dystrophies and relevant to the human disease. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.292] [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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Abstract
OBJECTIVES On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the epidemiology of this disease and whether such studies have advanced our knowledge of its aetiopathogenesis and management. METHODS The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. RESULTS This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts investigating the populations susceptible, the geographic distribution of these affected populations and the associated sociological and genetic elements that might contribute to its occurrence, polymyalgia rheumatica remains a difficult problem for the public health services of the developed world. CONCLUSIONS Polymyalgia rheumatica remains a clinical enigma and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely. Until then, clear guidelines on the future incidence and prevalence of polymyalgia rheumatica and the public health problems of the disease and its management, especially in relation to the use of long term corticosteroids, will be difficult to provide.
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Affiliation(s)
- Patrick J Rooney
- Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Jennifer Rooney
- Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Geza Balint
- Consultant Rheumatologist, National Institute of Rheumatology and Physiotherapy, Hungary
| | - Peter Balint
- Head of Department and Consultant Rheumatologist, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Hungary
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Abstract
OBJECTIVES On the 125th anniversary of the first recognised publication on polymyalgia rheumatica, a review of the literature was undertaken to assess what progress has been made from the point of view of the clinical care of affected patients. METHODS The authors searched Medline and PubMed using the search terms 'polymyalgia rheumatica', 'giant cell arteritis' and 'temporal arteritis'. As much as possible, efforts were made to focus on studies where polymyalgia rheumatica and giant cell arteritis were treated as separate entities. The selection of articles was influenced by the authors' bias that polymyalgia rheumatica is a separate clinical condition from giant cell arteritis and that, as yet, the diagnosis is a clinical one. Apart from the elevation of circulating acute phase proteins, which has been recognised as a feature of polymyalgia rheumatica for over 60 years, the diagnosis receives no significant help from the laboratory or from diagnostic imaging. RESULTS This review has shown that, following the recognition of polymyalgia as a distinct clinical problem of the elderly, the results of a considerable amount of research efforts including those using the advances in clinical imaging technology over the past 60 years, have done little to change the ability of clinicians to define the disease more accurately. Since the introduction of corticosteroids in the 1950s, there has been also very little change in the clinical management of the condition. CONCLUSIONS Polymyalgia rheumatica remains a clinical enigma, and its relationship to giant cell arteritis is no clearer now than it has been for the past 125 years. Diagnosing this disease is still almost exclusively dependent on the clinical acumen of a patient's medical attendant. Until an objective method of identifying it clearly in the clinical setting is available, uncovering the aetiology is still unlikely, and until then, preventing the pain and stiffness of the disease while avoiding the problems of prolonged exoposure to corticosteroids is likely to remain elusive or serendipitous.
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Affiliation(s)
- Patrick J Rooney
- Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Jennifer Rooney
- Associate Professor of Medicine, Department of Clinical Skills, St George's University, Grenada
| | - Geza Balint
- Consultant Rheumatologist, National Institute of Rheumatology and Physiotherapy, Hungary
| | - Peter Balint
- Head of Department and Consultant Rheumatologist, 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Hungary
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Abstract
BACKGROUND Respiratory conditions such as asthma, bronchitis, hypersensitivity pneumonitis and upper airways symptoms have been ascribed to fungal exposures. Mushroom workers may be at risk of these as a consequence. AIMS To assess the prevalence of respiratory symptoms in mushroom workers. METHODS A cross-sectional study assessed 4 weeks of respiratory symptoms among mushroom workers divided into four categories of exposure, using a self-administered respiratory questionnaire and spirometry. RESULTS The population of 191 subjects was predominantly (66%) from Eastern Europe; 61% were women and 39% were under 30. It included 73 growers, 38 composters, 26 administrators and 52 packers. Among all workers, there was a high prevalence (67%) of one or more respiratory symptoms which did not appear to vary by age, gender, pack-years of smoking or duration of employment. There was a significant improvement in respiratory symptoms in workers during absence from the workplace (P < 0.001). Spirometry readings across all groups were within normal values. Symptom profiles suggest that as many as 22 workers had symptoms of airways disease; 18 (82%) of these were mushroom growers. Growers were significantly more likely to have symptoms consistent with airways disease than all other workers, odds ratio 9.2 (95% CI 3.0-28.4). CONCLUSIONS There was a high prevalence of respiratory symptoms among mushroom workers. Mushroom growers may be at high risk of airways disease, possibly from fungal antigens or related exposures.
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Affiliation(s)
- J P Hayes
- Department of Respiratory Medicine, Cavan Monaghan Hospital, Lisdaran, Cavan, Ireland,
| | - J Rooney
- Academic Institute of Neurology, Trinity Bioscience Institute, Dublin 2, Ireland
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Affiliation(s)
- J Rooney
- Department of Pharmaceutical and Medicinal Chemistry, Royal College of Surgeons in Ireland, 123, St Stephen's Green, Ireland ; Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
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Sharma NC, Qaqish J, Klukowska M, Grender J, Rooney J. The plaque removal efficacy of a novel power brush head. J Clin Dent 2011; 22:19-22. [PMID: 21290982] [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: 05/30/2023]
Abstract
OBJECTIVE To assess the plaque removal efficacy of an oscillating/rotating power toothbrush with novel brush head (Oral-B Precision Clean) in comparison to an American Dental Association (ADA) reference manual toothbrush. METHODS This was a replicate-use, single-brushing, two-treatment, examiner-blind, randomized, four-period (visit) study with a crossover design. At each visit, subjects disclosed their plaque with disclosing solution for one minute, and an examiner performed a baseline (pre-brushing) plaque examination (Rustogi, et al. Modification of the Navy Plaque Index). Subjects were then instructed to brush for two minutes (according to manufacturer's instructions) with their assigned power toothbrush or as they normally do with the ADA manual brush under supervision, after which they again disclosed their plaque and were given a post-brushing plaque examination. RESULTS Both the power brush and manual brush showed statistically significant plaque reductions from baseline for the whole mouth, along the gingival margin, and on approximal surfaces. The power brush showed statistically significant advantages (p < 0.001) over the manual brush in plaque reduction for whole mouth (28.8%), gingival margin (44.3%), and approximal surfaces (20.7%). CONCLUSION The oscillating/rotating power toothbrush with a novel brush head showed statistically significantly superior plaque reduction (whole mouth, gingival margin, and approximal surfaces) compared to a manual toothbrush.
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Affiliation(s)
- N C Sharma
- BioSci Research Canada, LTD, Mississauga, Ontario, Canada
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Bonta J, Wallace-Capretta S, Rooney J, Mcanoy K. An outcome evaluation of a restorative justice alternative to incarceration. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/10282580214772] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reeves A, Harvey N, Dubé C, Forde-Folle K, Case S, Corso B, Hill A, McNab W, Hupalo R, Reeves C, Rooney J, Sanchez J, Schwickerath A, Salman M. Building Capacity for Epidemiologic Modeling: Experiences of the NAADSM Development Team. Ann Epidemiol 2010. [DOI: 10.1016/j.annepidem.2010.07.070] [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: 11/16/2022]
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Mugyenyi P, Walker AS, Hakim J, Munderi P, Gibb DM, Kityo C, Reid A, Grosskurth H, Darbyshire JH, Ssali F, Bray D, Katabira E, Babiker AG, Gilks CF, Grosskurth H, Munderi P, Kabuye G, Nsibambi D, Kasirye R, Zalwango E, Nakazibwe M, Kikaire B, Nassuna G, Massa R, Fadhiru K, Namyalo M, Zalwango A, Generous L, Khauka P, Rutikarayo N, Nakahima W, Mugisha A, Todd J, Levin J, Muyingo S, Ruberantwari A, Kaleebu P, Yirrell D, Ndembi N, Lyagoba F, Hughes P, Aber M, Lara AM, Foster S, Amurwon J, Wakholi BN, Whitworth J, Wangati K, Amuron B, Kajungu D, Nakiyingi J, Omony W, Fadhiru K, Nsibambi D, Khauka P, Mugyenyi P, Kityo C, Ssali F, Tumukunde D, Otim T, Kabanda J, Musana H, Akao J, Kyomugisha H, Byamukama A, Sabiiti J, Komugyena J, Wavamunno P, Mukiibi S, Drasiku A, Byaruhanga R, Labeja O, Katundu P, Tugume S, Awio P, Namazzi A, Bakeinyaga GT, Katabira H, Abaine D, Tukamushaba J, Anywar W, Ojiambo W, Angweng E, Murungi S, Haguma W, Atwiine S, Kigozi J, Namale L, Mukose A, Mulindwa G, Atwiine D, Muhwezi A, Nimwesiga E, Barungi G, Takubwa J, Murungi S, Mwebesa D, Kagina G, Mulindwa M, Ahimbisibwe F, Mwesigwa P, Akuma S, Zawedde C, Nyiraguhirwa D, Tumusiime C, Bagaya L, Namara W, Kigozi J, Karungi J, Kankunda R, Enzama R, Latif A, Hakim J, Robertson V, Reid A, Chidziva E, Bulaya-Tembo R, Musoro G, Taziwa F, Chimbetete C, Chakonza L, Mawora A, Muvirimi C, Tinago G, Svovanapasis P, Simango M, Chirema O, Machingura J, Mutsai S, Phiri M, Bafana T, Chirara M, Muchabaiwa L, Muzambi M, Mutowo J, Chivhunga T, Chigwedere E, Pascoe M, Warambwa C, Zengeza E, Mapinge F, Makota S, Jamu A, Ngorima N, Chirairo H, Chitsungo S, Chimanzi J, Maweni C, Warara R, Matongo M, Mudzingwa S, Jangano M, Moyo K, Vere L, Mdege N, Machingura I, Katabira E, Ronald A, Kambungu A, Lutwama F, Mambule I, Nanfuka A, Walusimbi J, Nabankema E, Nalumenya R, Namuli T, Kulume R, Namata I, Nyachwo L, Florence A, Kusiima A, Lubwama E, Nairuba R, Oketta F, Buluma E, Waita R, Ojiambo H, Sadik F, Wanyama J, Nabongo P, Oyugi J, Sematala F, Muganzi A, Twijukye C, Byakwaga H, Ochai R, Muhweezi D, Coutinho A, Etukoit B, Gilks C, Boocock K, Puddephatt C, Grundy C, Bohannon J, Winogron D, Gibb DM, Burke A, Bray D, Babiker A, Walker AS, Wilkes H, Rauchenberger M, Sheehan S, Spencer-Drake C, Taylor K, Spyer M, Ferrier A, Naidoo B, Dunn D, Goodall R, Darbyshire JH, Peto L, Nanfuka R, Mufuka-Kapuya C, Kaleebu P, Pillay D, Robertson V, Yirrell D, Tugume S, Chirara M, Katundu P, Ndembi N, Lyagoba F, Dunn D, Goodall R, McCormick A, Lara AM, Foster S, Amurwon J, Wakholi BN, Kigozi J, Muchabaiwa L, Muzambi M, Weller I, Babiker A, Bahendeka S, Bassett M, Wapakhabulo AC, Darbyshire JH, Gazzard B, Gilks C, Grosskurth H, Hakim J, Latif A, Mapuchere C, Mugurungi O, Mugyenyi P, Burke C, Jones S, Newland C, Pearce G, Rahim S, Rooney J, Smith M, Snowden W, Steens JM, Breckenridge A, McLaren A, Hill C, Matenga J, Pozniak A, Serwadda D, Peto T, Palfreeman A, Borok M, Katabira E. Routine versus clinically driven laboratory monitoring of HIV antiretroviral therapy in Africa (DART): a randomised non-inferiority trial. Lancet 2010; 375:123-31. [PMID: 20004464 PMCID: PMC2805723 DOI: 10.1016/s0140-6736(09)62067-5] [Citation(s) in RCA: 220] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND HIV antiretroviral therapy (ART) is often managed without routine laboratory monitoring in Africa; however, the effect of this approach is unknown. This trial investigated whether routine toxicity and efficacy monitoring of HIV-infected patients receiving ART had an important long-term effect on clinical outcomes in Africa. METHODS In this open, non-inferiority trial in three centres in Uganda and one in Zimbabwe, 3321 symptomatic, ART-naive, HIV-infected adults with CD4 counts less than 200 cells per microL starting ART were randomly assigned to laboratory and clinical monitoring (LCM; n=1659) or clinically driven monitoring (CDM; n=1662) by a computer-generated list. Haematology, biochemistry, and CD4-cell counts were done every 12 weeks. In the LCM group, results were available to clinicians; in the CDM group, results (apart from CD4-cell count) could be requested if clinically indicated and grade 4 toxicities were available. Participants switched to second-line ART after new or recurrent WHO stage 4 events in both groups, or CD4 count less than 100 cells per microL (LCM only). Co-primary endpoints were new WHO stage 4 HIV events or death, and serious adverse events. Non-inferiority was defined as the upper 95% confidence limit for the hazard ratio (HR) for new WHO stage 4 events or death being no greater than 1.18. Analyses were by intention to treat. This study is registered, number ISRCTN13968779. FINDINGS Two participants assigned to CDM and three to LCM were excluded from analyses. 5-year survival was 87% (95% CI 85-88) in the CDM group and 90% (88-91) in the LCM group, and 122 (7%) and 112 (7%) participants, respectively, were lost to follow-up over median 4.9 years' follow-up. 459 (28%) participants receiving CDM versus 356 (21%) LCM had a new WHO stage 4 event or died (6.94 [95% CI 6.33-7.60] vs 5.24 [4.72-5.81] per 100 person-years; absolute difference 1.70 per 100 person-years [0.87-2.54]; HR 1.31 [1.14-1.51]; p=0.0001). Differences in disease progression occurred from the third year on ART, whereas higher rates of switch to second-line treatment occurred in LCM from the second year. 283 (17%) participants receiving CDM versus 260 (16%) LCM had a new serious adverse event (HR 1.12 [0.94-1.32]; p=0.19), with anaemia the most common (76 vs 61 cases). INTERPRETATION ART can be delivered safely without routine laboratory monitoring for toxic effects, but differences in disease progression suggest a role for monitoring of CD4-cell count from the second year of ART to guide the switch to second-line treatment. FUNDING UK Medical Research Council, the UK Department for International Development, the Rockefeller Foundation, GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim, and Abbott Laboratories.
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Hu B, Kainz K, Rooney J, Li X. TU-C-303A-09: Can Lung Dose-Volume Criteria Derived From 3D Era Be Safely Used for 4D Planning? Med Phys 2009. [DOI: 10.1118/1.3182346] [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: 11/07/2022] Open
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Singer A, McClain S, Zimmerman T, Romanov A, Rooney J. The Effect of N-acetyl Cysteine on Burn Progression in Rats. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.747] [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: 11/10/2022]
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Singer A, McClain S, Romanov A, Rooney J, Zimmerman T. Validation of an Ischemic Comb Burn Model in Swine. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.746] [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: 11/10/2022]
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Leb L, Khanani S, Rooney J, Seidler C. P143 Combination of erythropoietin and low-dose thalidomide for the management of anemia of low-grade myelodysplasia. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70213-8] [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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Singer A, McClain S, Romanov A, Rooney J, Zimmerman T. Curcumin Reduces Burn Progression in Rats. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1116] [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: 11/10/2022]
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Singer A, Huang J, McClain S, Romanov A, Rooney J, Zimmerman T, Huang S. A Novel TGF-Beta Antagonist Speeds Reepithelialization and Reduces Scarring of Partial Thickness Porcine Burns. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.748] [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: 11/10/2022]
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Gandhi L, Harding M, Neubauer M, Langer CJ, Crawford J, Moore M, Rooney J, Ross H, Einhorn LH, Johnson BE, Lynch TJ. A phase II study of the safety and efficacy of the MDR inhibitor VX-710 combined with doxorubicin and vincristine in small cell lung cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17001 Background: Tumors with multidrug resistance (MDR) frequently show upregulation of efflux proteins MDR protein (MRP-1) and P-glycoprotein (Pgp). MDR represents a major obstacle to successful chemotherapy treatment and can be reversed in Pgp or MRP1-expressing cells by the MDR inhibitor VX-710. A phase II study was designed to evaluate the safety/tolerability and efficacy of VX-710 combined with doxorubicin (D) and vincristine (V) in patients (pts) with relapsed SCLC. Methods: Eligible pts had progressive, measurable disease and a PS <2 after response to 1st-line chemotherapy. Stage I safety evaluation was done with planned expansion to a second stage if 9 responses were confirmed in the first 35 pts. Pts were treated with VX-710 (120 mg/m2/h) for 72 hours with D (45 mg/m2) and V (1.4 mg/m2) given 4 hours after the start of VX-710. Pts were treated q 21 days until progression or intolerable adverse events (AEs). Severe neutropenia was noted in the first 15 pts, so the protocol was amended to include prophylactic G-CSF or ciprofloxacin. Interim analysis was performed after 36 pts were treated. Results: 36 pts were enrolled from 12/98 to 12/00. Neutropenia was the major toxicity, occurring in 25/36 (69%) pts. This was more severe (30% vs. 20% grade 4) and occurred earlier (58% vs. 38% in cycle 1) among the 15 pts enrolled prior to an amendment requiring neutropenia prophylaxis vs. those enrolled afterward. Other common treatment-related AE’s: asthenia (53%), nausea (50%), constipation (44%), alopecia (42%), dyspnea (42%), anemia (42%). 67% were grade 1 or 2 in severity. Four pts died on study or within 30 days of termination: 2 from infections likely related to therapy and 2 from disease progression. Among 32 evaluable pts, 7 (22%) had partial responses; 6 of these sustained responses through 6 cycles (with one response lasting 3 years). Three additional pts had unconfirmed responses. Median survival was 6 months (95% CI 4–7 months). Conclusions: The addition of VX-710 to D and V therapy did not improve anti-tumor activity or survival. Hematologic toxicity was severe, causing 2 pt deaths from neutopenic fever. Although there were some durable responses, response criteria were not met to proceed with stage 2. Further development with VX-710 has since stopped. [Table: see text]
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Affiliation(s)
- L. Gandhi
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - M. Harding
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - M. Neubauer
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - C. J. Langer
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - J. Crawford
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - M. Moore
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - J. Rooney
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - H. Ross
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - L. H. Einhorn
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - B. E. Johnson
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
| | - T. J. Lynch
- Dana-Farber Cancer Institute, Boston, MA; Vertex Pharmaceuticals, Cambridge, MA; Kansas City Cancer Center, Overland Park, KS; University of Pennsylvania, Philadelphia, PA; Duke University, Durham, NC; Georgia Cancer Specialists, Decatur, GA; Fallon Clinic, Worcester, MA; Providence Cancer Center, Portland, OR; Indiana University School of Medicine, Indianapolis, IN; Massachusetts General Hospital, Boston, MA
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Seidler CW, Scepansky E, Khanani S, Rooney J, Gordon J, Walsh W. Phase I-II trial of daily thalidomide in combination with docetaxel in patients with relapsed non-small cell lung cancer: A final analysis. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17060 Background: Recent studies have shown that inhibition of vascular endothelium growth factor (VEGF) in combination with chemotherapy can improve the antitumor efficacy of chemotherapy in NSCLC. This study tested the effectivness and toxicity of thalidomide (an inhibitor of VEGF) combined with docetaxel as second-line therapy for progressive NSCLC. Methods: Patients(pts) with recurrent/progressive NSCLC, prior chemotherapy, measurable/evaluable disease, ECOG performance status (PS) 0–2 and adequate hematologic, renal and hepatic function were enrolled. Pts with uncontrolled CNS disease or hypercoagulable state were excluded. Doxetaxel 75 mg/M2 was administered every 3 weeks (maximum of 8 cycles). Thalidomide was administered orally at a starting dose of 50 mg daily escalated by 50 mg every 3 weeks to a maximum dose of 200mg day and continued until disease progression, dose limiting toxicity, or completion of chemotherapy. Primary end-point was overall survival (OS), secondary end points were time to disease progression(TTP) by Kaplan Meyer method and response rate (RECIST criteria). Results: Of 28 enrolled patients, 26 were eligible for treatment and 25 were evaluable for disease progression and survival. For evaluable pts: mean PS = 1, median age 64.5 years, median number of prior chemotherapy regimens + 1.2. Response rate was 19.1% (1 complete response, 4 partial responses). Stable disease was observed in 9 patients (34.6%). TTP was 2.7 months (95% confidence interval [CI] 2.1–5.0+): median OS was 5.4 months (95% CI 3.1–9.3+). One episode each of febrile neutropenia requiring hospitalization and pulmonary embolism was observed. No grade 3–4 neuropathy was shown. Nonhematologic adverse events included constipation, alopecia, nausea and anorexia. Conclusions: These data suggest thalidomide in doses of 200mg/ day may be combined with docetaxel 75 mg/m2 every 3 weeks in the second line treatment of NSCLC. The response rate, TTP and OS compare favorably with previously reported studies with docetaxel in this population. No significant financial relationships to disclose.
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Affiliation(s)
- C. W. Seidler
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - E. Scepansky
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - S. Khanani
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - J. Rooney
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - J. Gordon
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - W. Walsh
- Worcester Medical Center, Worcester, MA; Saint Vincent Hospital, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
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Raghupathy RV, Seidler CW, Emani S, Rooney J. A retrospective pilot study of serum lipid levels and the risk of breast cancer. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10539 Background: Prior prospective cohort studies have provided conflicting data regarding lipid levels as a breast cancer risk factor. These studies were either designed to study cardiovascular diseases or included a small number of incident cases. This retrospective pilot study compared the lipid profiles of breast cancer patients to a normal cohort obtained from a large community based HMO database. Methods: Fallon Clinic automated outpatient billing and laboratory databases were used to identify patients with breast cancer (ICD9–174.9) and retrieve average lipid profiles at least two years prior to the first identified diagnosis date. The outpatient billing record of a central Massachusetts HMO was used to randomly generate a control group without an ICD9 diagnosis of breast cancer. Patients were classified into two groups based on age to approximate menopausal state (pre menopausal <50 yr, post menopausal ≥50 yr). T-tests were conducted to compare the total cholesterol, LDL, HDL and triglycerides of the two groups. Results: See table. Conclusions: In the pre-menopausal population, total cholesterol and LDL were significantly higher in the breast cancer group. In the post-menopausal group, triglycerides were higher and HDL lower. Though the HDL association is in concurrence with two large prior studies, other associations have not been demonstrated. An average of fasting levels obtained more than two years before diagnosis eliminates the lipid profile response to meals, variability in isolated values and influence of pre-clinical cancer on the data. However, the patients have not been matched for other breast cancer risk factors or variable menstrual phase while obtaining samples in the pre-menopausal population. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- R. V. Raghupathy
- St.Vincent Hospital, Worcester, MA; Fallon Clinic, Worcester, MA; Meyers Primary Care Institute, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - C. W. Seidler
- St.Vincent Hospital, Worcester, MA; Fallon Clinic, Worcester, MA; Meyers Primary Care Institute, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - S. Emani
- St.Vincent Hospital, Worcester, MA; Fallon Clinic, Worcester, MA; Meyers Primary Care Institute, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - J. Rooney
- St.Vincent Hospital, Worcester, MA; Fallon Clinic, Worcester, MA; Meyers Primary Care Institute, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
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Seidler CW, Rooney J, Kodali D, Khanani S, Walsh W, Gordon J. A phase I-II trial of docetaxel and daily thalidomide in patients with previously treated recurrent non-small cell lung cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C. W. Seidler
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - J. Rooney
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - D. Kodali
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - S. Khanani
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - W. Walsh
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
| | - J. Gordon
- Fallon Clinic/Worcester Medical Center, Worcester, MA; University of Massachusetts Medical School, Worcester, MA
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37
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Abstract
Stress fractures of the fibula commonly occur distally in runners, whereas stress fractures of the proximal fibula are uncommon and typically occur in jumpers. Furthermore, it is rare for a stress fracture to be repeated in the same bone. We report a case of a repeated stress fracture of the proximal fibula in a male runner with abnormal gait that primarily involved excessive pronation. Unusual risk factors in this case were anorexia nervosa and use of an inhaled corticosteroid. The patient was treated conservatively, and healing of the fracture was completed at 12 weeks.
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Affiliation(s)
- S Myers
- Orthopaedic Department, Prince of Wales Hospital, Randwick, New South Wales 2031, Australia.
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38
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Rooney J, Wade WG, Sprague SV, Newcombe RG, Addy M. Adjunctive effects to non-surgical periodontal therapy of systemic metronidazole and amoxycillin alone and combined. A placebo controlled study. J Clin Periodontol 2002; 29:342-50. [PMID: 11966932 DOI: 10.1034/j.1600-051x.2002.290410.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.6] [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: 11/23/2022]
Abstract
BACKGROUND AND AIM Several studies have reported adjunctive benefits to scaling and root planing (SRP) of systemic amoxycillin and metronidazole in the treatment of periodontal diseases. To date no comparisons have been made of these antimicrobials alone or in combination. The aim of this study was to compare the adjunctive benefits to SRP of amoxycillin and metronidazole alone and combined. METHODS 66 subjects <46 years of age with advanced chronic periodontal disease participated in this randomised, double blind, 4 parallel treatment group designed study. All subjects received quadrant SRP and then were prescribed amoxycillin capsules (250 mg) and metronidazole tablets (200 mg) (AM) or lactate capsules and metronidazole (PM) or amoxycillin and calcium lactate tablets (AP) or lactate and calcium lactate (PP). All medication was 3 of each per day for 7 days. Subgingival plaque samples were obtained and probing depth (PD), loss of attachment (LOA), bleeding on probing (BOP), suppuration (SUPP) and plaque (DEP) were recorded pre-treatment, 1, 3 and 6 months post-treatment. RESULTS Final group sizes were: AM=15, PM=16, AP=16 and PP=15. PD improved in all groups. Treatment effects were highly significantly different and always greatest in the AM and least in the PP groups. Benefits of PM and AP over PP were also noted. LOA improved in all groups and showed the same highly significant treatment differences, again favouring AM. BOP improved in all groups, particularly in AM compared to the other groups. SUPP improved in all groups and was virtually eradicated in AM with differences among treatments highly significant. DEP changed little in any group and there were no significant differences among groups. Microbiological data showed significant differences in favour of AM compared to PP and PM for total aerobes and anaerobes at 1 month. P. intermedia counts were always lower in active groups compared to PP and reached significance for AM and AP at 1 month and AM and PM at 3 months. CONCLUSION The significant differences among treatment groups and the overall trend in the data, in line with other studies, support the considerable adjunctive benefits to SRP of amoxycillin and metronidazole combined in the treatment of advanced chronic periodontal disease.
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Affiliation(s)
- J Rooney
- Division of Restorative Dentistry, Dental School, Bristol, UK
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39
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Bruce WJ, Rooney J, Hutabarat SR, Atkinson MC, Goldberg JA, Walsh WR. Exposure in difficult total knee arthroplasty using coronal tibial tubercle osteotomy. J Orthop Surg (Hong Kong) 2000; 8:61-65. [PMID: 12468877 DOI: 10.1177/230949900000800111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Exposure in a total knee arthroplasty can be challenging regardless of whether it is a difficult primary or a revision. Various techniques both proximal and distal to the patella have been described and implemented to gain exposure and improve knee flexion. When patella eversion is not possible due to previous surgery or severe preoperative knee flexion contracture, a coronal tibial tubercle osteotomy may be utilized. We present successful results utilizing the coronal tibial tubercle osteotomy procedure. The technique involved in this series is based on that described by Whiteside. It involves the development of a long lateral musculoperiosteal flap incorporating the tibial tubercle and anterior tibia, and leaving the proximal tibial cortex intact. This is extended along the tibia distally for 10 cm. It finishes by gradually osteotomising the anterior surface of the tibial crest. The tubercle is reattached with wires at the end of the procedure. This technique minimizes complications that have been associated with the tibial tubercle osteotomy. The 10 knees in 9 patients, who had total knee arthroplasty with a coronal tibial tubercle osteotomy, were reviewed pre and postoperatively. All knees were assessed using the Hospital for Special Surgery knee score (HSS). The scores averaged 43.6 preoperatively (range, 29 57) and 79.2 postoperatively (range, 67 90), and the mean range of motion was 59.5 degrees preoperatively and 78.0 degrees postoperatively. There were no cases of extension lag. Fixed flexion deformity was present in 3 cases postoperatively. Average time to union at the proximal and distal ends of the osteotomy was 8 and 24 weeks respectively. There was no evidence of nonunion and no other significant complications occurred.
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Affiliation(s)
- W J Bruce
- Concord Hospital, Hospital Road, Concord, NSW, Australia
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40
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Jensen WA, Fall MZ, Rooney J, Kordick DL, Breitschwerdt EB. Rapid identification and differentiation of Bartonella species using a single-step PCR assay. J Clin Microbiol 2000; 38:1717-22. [PMID: 10790087 PMCID: PMC86570 DOI: 10.1128/jcm.38.5.1717-1722.2000] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.5] [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] Open
Abstract
Five species of Bartonella have been reported to infect humans and cause a variety of diseases that can be difficult to diagnose. Four species of Bartonella have been reported to infect cats and dogs, and two of these species are considered to be zoonotic pathogens. Diagnosis of Bartonella infections is hampered by the slow, fastidious growth characteristics of Bartonella species. We report on the development of a single-step PCR-based assay for the detection and differentiation of medically relevant Bartonella species. PCR-mediated amplification of the 16S-23S rRNA intergenic region resulted in a product of a unique size for each Bartonella species, thereby allowing differentiation without the necessity of restriction fragment length polymorphism analysis or sequencing of the amplified product. The ability of the single-step PCR assay to differentiate between Bartonella species was determined with characterized isolates and blood samples from animals known to be infected with either Bartonella henselae, B. clarridgeiae, or B. vinsonii subsp. berkhoffii. The sensitivity of the single-step PCR assay relative to that of in vitro culture was determined with blood samples from B. henselae-infected cats. B. henselae target DNA was amplified from 100% of samples with greater than 50 CFU/ml and 80% of samples with 10 to 30 CFU/ml. The single-step assay described in the report expedites PCR-based detection and differentiation of medically relevant Bartonella species.
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Affiliation(s)
- W A Jensen
- Heska Corporation, Fort Collins, Colorado 80525, USA.
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41
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42
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Haas DW, Lavelle J, Nadler JP, Greenberg SB, Frame P, Mustafa N, St Clair M, McKinnis R, Dix L, Elkins M, Rooney J. A randomized trial of interferon alpha therapy for HIV type 1 infection. AIDS Res Hum Retroviruses 2000; 16:183-90. [PMID: 10710206 DOI: 10.1089/088922200309278] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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: 11/12/2022] Open
Abstract
The immunologic and virologic efficacy and safety of interferon a (IFN-alpha) administered in combination with zidovudine (ZDV) and zalcitabine (ddC) was evaluated in HIV-infected subjects with CD4+ cell counts between 300 and 500 cells/ml and no more than 14 weeks of prior antiretroviral therapy. A total of 256 subjects enrolled in an open-label, randomized controlled trial. Subjects were randomized equally into treatment groups. All subjects received ZDV and ddC, while half also receive IFN-alpha (3 MU subcutaneously every 24 hr). At 48 weeks the median average area under the curve minus baseline (AAUCMB) for plasma HIV-1 RNA for the two-drug group was -0.68 versus -0.75 log10 copies/ml for the IFN-alpha group (p = 0.046). Mean HIV-1 RNA changes from baseline to 48 weeks for these groups were -0.65 and -1.12 log10 copies/ml, respectively (p = 0.010). The median AAUCMB for CD4+ cell count for the two-drug group was 28 versus -1 cells/mm3 for the IFN-alpha group (p = 0.011). Neutropenia, anemia, and drug intolerance were more common in the IFN-alpha group. This study demonstrates that IFN-alpha inhibits HIV-1 replication but attenuates the CD4+ cell response to dual therapy with ZDV and ddC.
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Affiliation(s)
- D W Haas
- Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
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43
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Abstract
Quantitative ultrasound (QUS) parameters are temperature dependent. We examined the effect of temperature on QUS using Lunar Achilles+ and Hologic Sahara units. In vivo studies were performed in a cadaveric foot and in 5 volunteers. QUS scans were performed in the cadaveric foot, using both machines, at temperatures ranging from 15 to 40 degrees C. To assess the effect of change in water bath temperature in the Achilles+, independently of foot temperature, 5 volunteers were studied at water temperatures ranging from 10 to 42 degrees C. In the cadaveric foot there were strong negative correlations between temperature and speed of sound (SOS) but a moderately positive correlation between temperature and broadband ultrasound attenuation (BUA). Stiffness and the Quantitative Ultrasound Index (QUI) in the cadaveric foot showed strong negative correlations with temperature, reflecting their high dependence on SOS. In the 5 volunteers, in whom foot temperature was assumed to be constant, there was a small change in Stiffness in the Achilles+, with variation in water temperature. In conclusion, while there are opposite effects of temperature on SOS and BUA in vivo, there is still a significant effect of temperature variation on Stiffness and the QUI. This may have clinical significance in particular subjects. The precision of QUS may be affected by temperature variation of the environment or of the patient's limb. Instruments utilizing a water bath may be able partly to compensate for changes in environmental temperature, but standardization of water bath temperature is crucial to maximize precision.
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Affiliation(s)
- N A Pocock
- Department of Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia
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44
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Rooney J. Differential allocation of male-derived nutrients in two lampyrid beetles with contrasting life-history characteristics. Behav Ecol 1999. [DOI: 10.1093/beheco/10.1.97] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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45
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Rooney J. Secure units. Safety measures. Health Serv J 1998; 108:26-7. [PMID: 10176462] [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: 02/11/2023]
Abstract
More than 20 years after the publication of the Butler report which led to the establishment of medium-secure units, many of its recommendations have not been implemented. There is still a shortage of beds in medium-secure units. A survey of 18 of the 25 units in England and Wales has revealed wide variations in size as well as staffing ratios. National leadership and more coherent planning is needed.
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St Clair MH, Millard J, Rooney J, Tisdale M, Parry N, Sadler BM, Blum MR, Painter G. In vitro antiviral activity of 141W94 (VX-478) in combination with other antiretroviral agents. Antiviral Res 1996; 29:53-6. [PMID: 8721545 DOI: 10.1016/0166-3542(95)00916-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [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: 02/01/2023]
Abstract
141W94 (VX-478) is a novel HIV-1 protease inhibitor with an IC50 of 0.08 microM against HIV-1 (strain IIIB) and a mean IC50 of 0.012 microM against six HIV clinical isolates. 141W94 was synergistic on the basis of isobologram analysis with each of the following reverse transcriptase inhibitors: AZT, 935U83, 524W91, 1592U89 and ddl, 141W94 was also synergistic with saquinavir and additive with either indinavir or ritonavir. Resistance to 141W94 has been reported in vitro passage experiments. The binding of 141W94 to human alpha 1-acid glycoprotein was relatively weak (Kd = 4 microM) and the off-rate for the drug is very fast (> or = 100 s-1). Only a 2-fold reduction of in vitro antiviral activity was observed in the presence of 45% human plasma. No serious drug associated adverse experiences were reported in a Phase I placebo-controlled, single-dose escalation, pharmacokinetic and safety study. The average concentration of 141W94 at 8 and 12 h after single doses of 900 and 1200 mg, respectively, was in excess of 10 times the IC50. As 141W94 is synergistic with a variety of anti-HIV-1 agents and exhibits a unique cross resistance profile compared to other protease inhibitors, 141W94 is considered a good candidate for combination therapy.
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Affiliation(s)
- M H St Clair
- Division of Virology, Glaxo Wellcome Inc., NC 27709, USA
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47
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Dallam L, Smyth C, Jackson BS, Krinsky R, O'Dell C, Rooney J, Badillo C, Amella E, Ferrara L, Freeman K. Pressure ulcer pain: assessment and quantification. J Wound Ostomy Continence Nurs 1995; 22:211-5; discussion 217-8. [PMID: 7550776 DOI: 10.1097/00152192-199509000-00007] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A cross-sectional study design was used to document perception of pressure ulcer pain in 132 patients in an acute care setting. Subjects were evaluated by means of the Folstein Mini-Mental State Examination, Beck's Depression Inventory, the Faces Pain Rating Scale, and the Visual Analog Scale for pain intensity. Charts were reviewed for demographic data and related medical treatments. The group comprised 44 subjects (33.3%) who were able to respond to the evaluation instruments and 88 subjects (66.7%) who were unable to respond to the evaluation tools. Forty-one percent of the respondents denied pressure ulcer pain and 59% reported pain of some type. According to the Faces Rating Scale, 32% of this group reported no pain and 68% reported some degree of pain. The respondents included 48% who scored below 24 on the Folstein Mini-Mental State Examination, indicative of cognitive impairment, and 52% who were found to be cognitively intact, with scores of 24 or above. Only 2% (n = 3) were given analgesics for pressure ulcer pain within 4 hours of the interview.
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48
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Volberding PA, Lagakos SW, Grimes JM, Stein DS, Rooney J, Meng TC, Fischl MA, Collier AC, Phair JP, Hirsch MS. A comparison of immediate with deferred zidovudine therapy for asymptomatic HIV-infected adults with CD4 cell counts of 500 or more per cubic millimeter. AIDS Clinical Trials Group. N Engl J Med 1995; 333:401-7. [PMID: 7616988 DOI: 10.1056/nejm199508173330701] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The clinical benefits of zidovudine remain unproved in patients with asymptomatic human immunodeficiency virus (HIV) infection when CD4 cell counts exceed 500 per cubic millimeter. We compared zidovudine therapy given immediately with deferred therapy in such subjects. METHODS Beginning in 1987, subjects with asymptomatic HIV infection and 500 or more CD4 cells per cubic millimeter were randomly assigned to receive placebo or zidovudine (either 500 or 1500 mg per day, starting immediately). In 1989, the study was modified so that open-label treatment with 500 mg of zidovudine per day (deferred therapy) was offered when CD4 cell counts fell below 500 per cubic millimeter. The study end points included overall survival, survival free of the acquired immunodeficiency syndrome (AIDS), toxic effects, and changes in CD4 cell counts. RESULTS There were 1637 subjects who could be evaluated: 547 in the deferred-therapy group, 549 in the group receiving 500 mg of zidovudine immediately, and 541 in the 1500-mg group. The subjects were followed for up to 6.5 years (group medians, 4.8, 4.8, and 4.9, respectively). There was no significant difference in AIDS-free survival in the deferred-therapy group as compared with the low-dose or high-dose groups (81 cases of progression to AIDS or death vs. 81 and 74, respectively; P = 0.95 and P = 0.13) or in overall survival (51 deaths vs. 47 and 46; P = 0.25 and P = 0.16). The decline in CD4 cells was slower in both immediate-therapy groups than in the deferred-therapy group (P < 0.001 for both). Adverse effects were uncommon, and before the study modification their incidence was similar among the treatment groups, but severe anemia and granulocytopenia were more frequent in the 1500-mg group than in the deferred-therapy group (P < 0.001). CONCLUSIONS In asymptomatic, HIV-infected adults with 500 or more CD4 cells per cubic millimeter, treatment with zidovudine slows the decline in the CD4 cell count but does not significantly prolong either AIDS-free or overall survival. These results do not encourage the routine use of zidovudine monotherapy in this population.
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Soo W, Nauss-Karol C, Elkins M, Rooney J, Barry DW. Inter-Company Collaboration Combination Trials. Clinical Trial Subcommittee of the Inter-Company Collaboration for AIDS Drug Development. J Acquir Immune Defic Syndr Hum Retrovirol 1995; 10 Suppl 2:S92-S96. [PMID: 7552520] [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: 05/21/2023]
Abstract
The Inter-Company Collaboration for AIDS Drug Development (ICC) represents a collaborative effort among member companies to facilitate the conduct of clinical trials on AIDS drugs. One of the goals of the ICC is to expedite the development of combination antiretroviral therapy through data and compound sharing. Recently, the ICC formed a consensus master protocol to evaluate rapidly the safety and efficacy of triple-drug combinations of antiretroviral therapy for treatment of HIV-infected patients. This concept builds upon historical work with combination chemotherapy that resulted in treatments to successfully control chronic immunosuppressive, infectious or malignant diseases, such as tuberculosis, leprosy, childhood acute lymphoblastic leukemia, and Hodgkin's lymphoma. Because of limitations on potency and the continuing emergence of drug resistance seen with use of currently available antiretroviral agents in monotherapy and two-drug combination regimens, triple-combination regimens should represent a more promising approach to maximize antiviral activity, maintain long-term efficacy, and reduce the incidence of drug resistance. The ICC master protocol is a randomized, controlled, double-blind study with a treatment duration of 52 weeks. Patients eligible to enroll in this study must have documented HIV infection, with CD4 counts between 200 and 500 cells/mm3, and no history of antiretroviral therapy. The first four triple-drug combinations will be evaluated in two trials. These regimens have been selected based on encouraging data from laboratory and clinical studies. Each ICC trial will consist of three arms, with 75 patients per arm. Protocol ICC 001 will include AZT + zalcitabine (ddC) + saquinavir, AZT + ddC + nevirapine, and AZT + ddC as the control arm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- W Soo
- Hoffmann-La Roche Inc., Nutley, NJ 07110-1199, USA
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50
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Rooney J. Fitting children with glasses. J Ophthalmic Nurs Technol 1995; 14:29, 33. [PMID: 7699728] [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: 01/26/2023]
Abstract
1. When fitting children for glasses, the emphasis must always be on ensuring that the glasses not only correct the visual problems but also feel and look good. Otherwise, they will not be worn. 2. There is a great value in creating an atmosphere in an optical shop that makes children want to visit. The process of visiting and selecting glasses should be fun for a child. Children's theme sections or toys are an effective method of making a visit pleasurable for a child. 3. For all the extra features an optical shop may offer, perhaps the most special are the intangibles of patience, respect, and genuine affection.
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