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Pagnamenta AT, Yu J, Walker S, Noble AJ, Lord J, Dutta P, Hashim M, Camps C, Green H, Devaiah S, Nashef L, Parr J, Fratter C, Ibnouf Hussein R, Lindsay SJ, Lalloo F, Banos-Pinero B, Evans D, Mallin L, Waite A, Evans J, Newman A, Allen Z, Perez-Becerril C, Ryan G, Hart R, Taylor J, Bedenham T, Clement E, Blair E, Hay E, Forzano F, Higgs J, Canham N, Majumdar A, McEntagart M, Lahiri N, Stewart H, Smithson S, Calpena E, Jackson A, Banka S, Titheradge H, McGowan R, Rankin J, Shaw-Smith C, Evans DG, Burghel GJ, Smith MJ, Anderson E, Madhu R, Firth H, Ellard S, Brennan P, Anderson C, Taupin D, Rogers MT, Cook JA, Durkie M, East JE, Fowler D, Wilson L, Igbokwe R, Gardham A, Tomlinson I, Baralle D, Uhlig HH, Taylor JC. The impact of inversions across 33,924 families with rare disease from a national genome sequencing project. Am J Hum Genet 2024:S0002-9297(24)00159-9. [PMID: 38776926 DOI: 10.1016/j.ajhg.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/25/2024] [Accepted: 04/25/2024] [Indexed: 05/25/2024] Open
Abstract
Detection of structural variants (SVs) is currently biased toward those that alter copy number. The relative contribution of inversions toward genetic disease is unclear. In this study, we analyzed genome sequencing data for 33,924 families with rare disease from the 100,000 Genomes Project. From a database hosting >500 million SVs, we focused on 351 genes where haploinsufficiency is a confirmed disease mechanism and identified 47 ultra-rare rearrangements that included an inversion (24 bp to 36.4 Mb, 20/47 de novo). Validation utilized a number of orthogonal approaches, including retrospective exome analysis. RNA-seq data supported the respective diagnoses for six participants. Phenotypic blending was apparent in four probands. Diagnostic odysseys were a common theme (>50 years for one individual), and targeted analysis for the specific gene had already been performed for 30% of these individuals but with no findings. We provide formal confirmation of a European founder origin for an intragenic MSH2 inversion. For two individuals with complex SVs involving the MECP2 mutational hotspot, ambiguous SV structures were resolved using long-read sequencing, influencing clinical interpretation. A de novo inversion of HOXD11-13 was uncovered in a family with Kantaputra-type mesomelic dysplasia. Lastly, a complex translocation disrupting APC and involving nine rearranged segments confirmed a clinical diagnosis for three family members and resolved a conundrum for a sibling with a single polyp. Overall, inversions play a small but notable role in rare disease, likely explaining the etiology in around 1/750 families across heterogeneous clinical cohorts.
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Affiliation(s)
- Alistair T Pagnamenta
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK.
| | - Jing Yu
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK; Novo Nordisk Oxford Research Centre, Oxford, UK
| | | | - Alexandra J Noble
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Jenny Lord
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK; Sheffield Institute for Translational Neuroscience, The University of Sheffield, Sheffield, UK
| | - Prasun Dutta
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Mona Hashim
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Carme Camps
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Hannah Green
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Smrithi Devaiah
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lina Nashef
- Department of Neurology, King's College Hospital, London, UK
| | - Jason Parr
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Carl Fratter
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rana Ibnouf Hussein
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Sarah J Lindsay
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Fiona Lalloo
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Benito Banos-Pinero
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Evans
- Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Lucy Mallin
- Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Adrian Waite
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, UK
| | - Julie Evans
- Bristol Genetics Laboratory, North Bristol NHS Trust, Bristol, UK
| | - Andrew Newman
- The All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Zoe Allen
- North Thames Rare and Inherited Disease Laboratory, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Cristina Perez-Becerril
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Gavin Ryan
- West Midlands Regional Genetics Laboratory, Central and South Genomic Laboratory Hub, Birmingham, UK
| | - Rachel Hart
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - John Taylor
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tina Bedenham
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Emma Clement
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ed Blair
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Eleanor Hay
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Francesca Forzano
- Clinical Genetics Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jenny Higgs
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Natalie Canham
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Anirban Majumdar
- Department of Paediatric Neurology, Bristol Children's Hospital, Bristol, UK
| | - Meriel McEntagart
- SW Thames Centre for Genomic Medicine, University of London & St George's University Hospitals NHS Foundation Trust, St George's, London, UK
| | - Nayana Lahiri
- SW Thames Centre for Genomic Medicine, University of London & St George's University Hospitals NHS Foundation Trust, St George's, London, UK
| | - Helen Stewart
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah Smithson
- Department of Clinical Genetics, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Eduardo Calpena
- Clinical Genetics Group, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK; Grupo de Investigación en Biomedicina Molecular, Celular y Genómica, Unidad CIBERER (CB06/07/1030), Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Adam Jackson
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Siddharth Banka
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Hannah Titheradge
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, Glasgow, UK
| | - Julia Rankin
- Department of Clinical Genetics, Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - Charles Shaw-Smith
- Department of Clinical Genetics, Royal Devon University Healthcare NHS Trust, Exeter, UK
| | - D Gareth Evans
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK; Division of Evolution, Infection and Genomics, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - George J Burghel
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Miriam J Smith
- Manchester Centre for Genomic Medicine, Manchester University Hospitals NHS Foundation Trust, Health Innovation Manchester, Manchester, UK
| | - Emily Anderson
- Liverpool Centre for Genomic Medicine, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Rajesh Madhu
- Paediatric Neurosciences Department, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Helen Firth
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Sian Ellard
- Exeter Genomics Laboratory, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Paul Brennan
- Institute of Genetic Medicine, Newcastle University, International Centre for Life, Newcastle University, Newcastle, UK
| | - Claire Anderson
- Canberra Clinical Genomics, Canberra Health Services and The Australian National University, Canberra, ACT, Australia
| | - Doug Taupin
- Cancer Research, Canberra Hospital, Canberra, ACT, Australia
| | - Mark T Rogers
- The All Wales Medical Genomics Service, University Hospital of Wales, Cardiff, UK
| | - Jackie A Cook
- Department of Clinical Genetics, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Miranda Durkie
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, North East and Yorkshire Genomic Laboratory Hub, Sheffield, UK
| | - James E East
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Darren Fowler
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Louise Wilson
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Rebecca Igbokwe
- Department of Clinical Genetics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Alice Gardham
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ian Tomlinson
- Department of Oncology, University of Oxford, Oxford, UK
| | - Diana Baralle
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Holm H Uhlig
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK; Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Jenny C Taylor
- Oxford Biomedical Research Centre, Centre for Human Genetics, University of Oxford, Oxford, UK.
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Poljak B, Agarwal U, Alfirevic Z, Allen S, Canham N, Higgs J, Kaelin Agten A, Khalil A, Roberts D, Mone F, Navaratnam K. Prenatal exome sequencing and impact on perinatal outcome: cohort study. Ultrasound Obstet Gynecol 2023; 61:339-345. [PMID: 36508432 DOI: 10.1002/uog.26141] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/26/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES First, to determine the uptake of prenatal exome sequencing (pES) and the diagnostic yield of pathogenic (causative) variants in a UK tertiary fetal medicine unit following the introduction of the NHS England Rapid Exome Sequencing Service for fetal anomalies testing (R21 pathway). Second, to identify how the decision to proceed with pES and identification of a causative variant affect perinatal outcomes, specifically late termination of pregnancy (TOP) at or beyond 22 weeks' gestation. METHODS This was a retrospective cohort study of anomalous fetuses referred to the Liverpool Women's Hospital Fetal Medicine Unit between 1 March 2021 and 28 February 2022. pES was performed as part of the R21 pathway. Trio exome sequencing was performed using an Illumina next-generation sequencing platform assessing coding and splice regions of a panel of 974 prenatally relevant genes and 231 expert reviewed genes. Data on demographics, phenotype, pES result and perinatal outcome were extracted and compared. Descriptive statistics and the χ-square or Fisher's exact test were performed using IBM SPSS version 28.0.1.0. RESULTS In total, 72 cases were identified and two-thirds of eligible women (n = 48) consented to trio pES. pES was not feasible in one case owing to a low DNA yield and, therefore, was performed in 47 cases. In one-third of cases (n = 24), pES was not proposed or agreed. In 58.3% (14/24) of these cases, this was because invasive testing was declined and, in 41.7% (10/24) of cases, women opted for testing and underwent chromosomal microarray analysis only. The diagnostic yield of pES was 23.4% (11/47). There was no overall difference in the proportion of women who decided to have late TOP in the group in which pES was agreed compared with the group in which pES was not proposed or agreed (25.0% (12/48) vs 25.0% (6/24); P = 1.0). However, the decision to have late TOP was significantly more frequent when a causative variant was detected compared with when pES was uninformative (63.6% (7/11) vs 13.9% (5/36); P < 0.0009). The median turnaround time for results was longer in cases in which a causative variant was identified than in those in which pES was uninformative (22 days (interquartile range (IQR), 19-34) days vs 14 days (IQR, 10-15 days); P < 0.0001). CONCLUSIONS This study demonstrates the potential impact of identification of a causative variant by pES on decision to have late TOP. As the R21 pathway continues to evolve, we urge clinicians and policymakers to consider introducing earlier screening for anomalies, developing robust guidance for late TOP and ensuring optimized support for couples. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- B Poljak
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - U Agarwal
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - Z Alfirevic
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
| | - S Allen
- West Midlands Regional Genetics Laboratory and Clinical Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - N Canham
- Clinical Genetics Department, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - J Higgs
- Clinical Genetics Department, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - A Kaelin Agten
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D Roberts
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
| | - F Mone
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - K Navaratnam
- Fetal Medicine Unit, Liverpool Women's Hospital NHS Foundation Trust, Liverpool, UK
- Harris-Wellbeing Research Centre, University of Liverpool, Liverpool, UK
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Henry-Blake C, Treadwell K, Parmar S, Higgs J, Marshall M, Edwards J, Peat G. POS1400 A SYSTEMATIC REVIEW OF INTERNATIONAL GUIDELINES REGARDING THE ROLE OF RADIOGRAPHY IN THE DIAGNOSIS OF OSTEOARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A substantial proportion of primary care osteoarthritis (OA) consultations are associated with an X-ray request (1,2). Uncertainty exists regarding the ability of radiography to improve a clinical OA diagnosis, and the over-use of radiography may lead to inappropriate referrals due to severe radiographic features that do not correlate with patients’ symptoms. Additionally, there are cost implications of unnecessarily imaging such a prevalent disease. As evidence questions the utility of routine radiography in OA, the extent to which radiography is supported by international guidelines is unknown.Objectives:To undertake a systematic review and narrative synthesis of UK and international guideline recommendations on the role of radiography in the diagnosis of OA.Methods:A systematic search of eleven electronic databases (including EMBASE, MEDLINE CINAHL, Epistemonikos and Guideline Central) and the websites of nine professional organisations (including NICE, Royal College of Radiologists (RCR), EULAR, and the American College of Radiology (ACR)) identified the most recent evidence-based guidelines produced by professional organisations on the role of imaging in OA. Guidelines not addressing the role of radiography in the diagnosis of OA were excluded, as were non-English and spinal OA guidelines. Each title was screened by one reviewer whilst each abstract and full text underwent dual screening. A single reviewer, using a standard proforma, undertook data extraction. Each guideline was independently appraised by two reviewers using the AGREE II tool. A narrative synthesis of the nature and consistency of OA radiographic recommendations was performed.Results:18 evidence-based OA guidelines published between 1998-2019 were included. These guidelines considered OA at any joint (n=8), or at the knee (n=3), hip (n=2), hand (n=2), wrist (n=1), foot (n=1), and ankle (n=1). Seven guidelines were produced by European organisations; four guidelines were produced by EULAR. Guidelines were targeted at general practitioners (n=11), radiologists (n=7), rheumatologist (n=4) and orthopaedic surgeons (n=3). Using the AGREE II tool, the identified guidelines scored highly on rigour of development (mean score 69%) but poorly on applicability (32%). All 18 guidelines recommended X-rays as the first-line modality, where imaging was indicated. A clinical diagnosis of OA without radiographic confirmation was recommended by all eleven guidelines produced by organisations represented general practitioners, with seven guidelines justifying this due to a poor correlation between radiographic features and clinical symptoms. Only three guidelines explicitly discouraged the routine use of radiography for the diagnosis of OA and only two guidelines reassured practitioners of a low probability of missing serious pathology when not routinely requesting radiographs. Guidelines produced by organisations representing radiologists were more supportive of radiography. The ACR recommended radiographic confirmation in patients suspected to have OA at the hand, wrist, hip, knee, ankle, and foot. Conversely, the RCR recommended radiographic confirmation in patients suspected to have OA at the hand, feet, and hip, but not the knee.Conclusion:Differences in guideline recommendations on the utility of radiography in OA appear related to country/region, professional organisation, and joint. The use and utility of radiography in OA may need to be reviewed in light of a shift towards remote consultations, a change that has been accelerated by COVID-19 in many countries.References:[1]Yu D, Jordan K, Bedson J, Englund M, Blyth F, Turkiewicz A et al. Population trends in the incidence and initial management of osteoarthritis: age-period-cohort analysis of the Clinical Practice Research Datalink, 1992–2013. Rheumatology. 2017;56(11):1902-1917.[2]Brand C, Harrison C, Tropea J, Hinman R, Britt H, Bennell K. Management of Osteoarthritis in General Practice in Australia. Arthritis Care & Research. 2014;66(4):551-558Acknowledgements:JJE is funded by an Academic Clinical Lectureship from the National Institute for Health Research (NIHR) for this research project (CL-2016-10-003). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.Disclosure of Interests:None declared
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Tully PA, Ng B, McGagh D, Meehan N, Khachane A, Higgs J, Newman M, Morgan L, David E, McCulloch P. Improving the WHO Surgical Safety Checklist sign-out. BJS Open 2021; 5:6271349. [PMID: 33960366 PMCID: PMC8103495 DOI: 10.1093/bjsopen/zrab028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The WHO Surgical Safety Checklist has been shown to reduce perioperative morbidity and mortality worldwide. There is evidence to suggest that sign-out is the most poorly performed phase of the checklist as it coincides with a period of high workload for team members. This study aimed to see whether modification of this process might result in greater compliance. METHODS A controlled longitudinal (before and after) study was performed to evaluate the effect of a modified checklist sign-out on compliance in a single surgical department. Checklist quality was evaluated by measurement of checklist completion, active participation, and team member presence. Workload assessment was performed to identify the optimal moment for the sign-out process. The sign-out process was modified through an iterative multidisciplinary approach, informed by results from the workload assessment. Feedback was obtained through staff surveys. RESULTS A total of 185 operations were used, with an intervention group in vascular surgery and a control group in orthopaedics. The optimal timing for sign-out was identified as after final wound closure. The modified sign-out process improved active participation of team members (21 of 34 versus 31 of 34; P = 0.010). In the control group, complete compliance improved (48 of 76 versus 30 of 41; P = 0.041). However, active participation decreased (53 of 76 versus 19 of 41; P = 0.022). No differences were noted between groups in team member presence. Eighteen of 21 staff questioned viewed the modifications positively. CONCLUSION The optimal sign-out timing was identified as immediately after final wound closure prior to undraping the patient.
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Affiliation(s)
- P A Tully
- Department for Continuing Education, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - B Ng
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - D McGagh
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - N Meehan
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - A Khachane
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - J Higgs
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - M Newman
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - L Morgan
- Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
| | - E David
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - P McCulloch
- Department for Continuing Education, University of Oxford, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,Patient Safety Academy, Health Education England Thames Valley, Oxford, UK
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Jurkute N, Shanmugarajah PD, Hadjivassiliou M, Higgs J, Vojcic M, Horrocks I, Nadjar Y, Touitou V, Lenaers G, Poh R, Acheson J, Robson AG, Raymond FL, Reilly MM, Yu-Wai-Man P, Moore AT, Webster AR, Arno G. Expanding the FDXR-Associated Disease Phenotype: Retinal Dystrophy Is a Recurrent Ocular Feature. Invest Ophthalmol Vis Sci 2021; 62:2. [PMID: 33938912 PMCID: PMC8107637 DOI: 10.1167/iovs.62.6.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023] Open
Abstract
Purpose The purpose of this study was to report retinal dystrophy as a novel clinical feature and expand the ocular phenotype in patients harboring biallelic candidate FDXR variants. Methods Patients carrying biallelic candidate FDXR variants were identified by whole genome sequencing (WGS) as part of the National Institute for Health Research BioResource rare-disease and the UK's 100,000 Genomes Project (100KGP) with an additional case identified by exome sequencing. Retrospective clinical data were collected from the medical records. Haplotype reconstruction was performed in families harboring the same missense variant. Results Ten individuals from 8 unrelated families with biallelic candidate variants in FDXR were identified. In addition to bilateral optic atrophy and variable extra-ocular findings, 7 of 10 individuals manifested retinal dystrophy comprising dysfunction and degeneration of both rod and cone photoreceptors. Five of 10 subjects had sensorineural hearing loss. The previously unreported missense variant (c.1115C > A, p.(Pro372His)) was found in 5 of 8 (62.5%) study families. Haplotype reconstruction using WGS data demonstrated a likely ancestral haplotype. Conclusions FDXR-associated disease is a phenotypically heterogeneous disorder with retinal dystrophy being a major clinical feature observed in this cohort. In addition, we hypothesize that a number of factors are likely to drive the pathogenesis of optic atrophy, retinal degeneration, and perhaps the associated systemic manifestations.
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Affiliation(s)
- Neringa Jurkute
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Priya D. Shanmugarajah
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Marios Hadjivassiliou
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jenny Higgs
- Liverpool Centre for Genomic Medicine, Liverpool Women's Hospital, Liverpool, United Kingdom
| | - Miodrag Vojcic
- Departments of Neurology and Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Iain Horrocks
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, Scotland
| | - Yann Nadjar
- Department of Neurology, Reference Center for Lysosomal Diseases, Neuro-Genetic and Metabolism Unit, Paris, France
| | - Valerie Touitou
- Sorbonne University, Paris, France
- Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, DHU Vision Et Handicaps, Paris, France
| | - Guy Lenaers
- Université Angers, MitoLab team, UMR CNRS 6015 - INSERM U1083, Angers, France
| | - Roy Poh
- Department of Neurogenetics, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom
| | - James Acheson
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS trust, London, United Kingdom
| | - Anthony G. Robson
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - F. Lucy Raymond
- NIHR BioResource - Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Mary M. Reilly
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patrick Yu-Wai-Man
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Anthony T. Moore
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
| | - Andrew R. Webster
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
| | - Gavin Arno
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Great Ormond Street Hospital for Children, London, United Kingdom
| | - for the Genomics England Research Consortium
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
- Institute of Ophthalmology, University College London, London, United Kingdom
- Academic Department of Neurosciences, Royal Hallamshire Hospital, Sheffield, United Kingdom
- Liverpool Centre for Genomic Medicine, Liverpool Women's Hospital, Liverpool, United Kingdom
- Departments of Neurology and Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, Scotland
- Department of Neurology, Reference Center for Lysosomal Diseases, Neuro-Genetic and Metabolism Unit, Paris, France
- Sorbonne University, Paris, France
- Groupe Hospitalier La Pitié Salpêtrière-Charles Foix, DHU Vision Et Handicaps, Paris, France
- Université Angers, MitoLab team, UMR CNRS 6015 - INSERM U1083, Angers, France
- Department of Neurogenetics, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, United Kingdom
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS trust, London, United Kingdom
- NIHR BioResource - Rare Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, United Kingdom
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
- Centre for Neuromuscular Diseases, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States
- Great Ormond Street Hospital for Children, London, United Kingdom
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Muraro A, Agache I, Clark A, Sheikh A, Roberts G, Akdis CA, Borrego LM, Higgs J, Hourihane JO, Jorgensen P, Mazon A, Parmigiani D, Said M, Schnadt S, van Os-Medendorp H, Vlieg-Boerstra BJ, Wickman M. EAACI food allergy and anaphylaxis guidelines: managing patients with food allergy in the community. Allergy 2014; 69:1046-57. [PMID: 24905609 DOI: 10.1111/all.12441] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2014] [Indexed: 12/14/2022]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) Food Allergy and Anaphylaxis Guidelines, managing patients with food allergy (FA) in the community, intend to provide guidance to reduce the risk of accidental allergic reactions to foods in the community. This document is intended to meet the needs of early-childhood and school settings as well as providers of non-prepackaged food (e.g., restaurants, bakeries, takeaway, deli counters, and fast-food outlets) and targets the audience of individuals with FA, their families, patient organizations, the general public, policymakers, and allergists. Food allergy is the most common trigger of anaphylaxis in the community. Providing children and caregivers with comprehensive information on food allergen avoidance and prompt recognition and management of allergic reactions are of the utmost importance. Provision of adrenaline auto-injector devices and education on how and when to use these are essential components of a comprehensive management plan. Managing patients at risk of anaphylaxis raises many challenges, which are specific to the community. This includes the need to interact with third parties providing food (e.g., school teachers and restaurant staff) to avoid accidental exposure and to help individuals with FA to make safe and appropriate food choices. Education of individuals at risk and their families, their peers, school nurses and teachers as well as restaurant and other food retail staff can reduce the risk of severe/fatal reactions. Increased awareness among policymakers may improve decision-making on legislation at local and national level.
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Affiliation(s)
- A. Muraro
- Department of Mother and Child Health; The Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region; Padua General University Hospital; Padua Italy
| | - I. Agache
- Theramed Medical Center; Brasov Romania
| | - A. Clark
- Allergy Department; Addenbrookes NHS Foundation Trust; Cambridge UK
| | - A. Sheikh
- Allergy & Respiratory Research Group; Centre for Population Health Sciences; The University of Edinburgh; Edinburgh UK
- Division of General Internal Medicine and Primary Care; Brigham and Women's Hospital; Boston MA USA
- Department of Medicine; Harvard Medical School; Boston MA USA
| | - G. Roberts
- David Hide Asthma and Allergy Research Centre; St Mary's Hospital; Isle of Wight UK
- Human Development in Health and Clinical and Experimental Sciences Academic Units; Faculty of Medicine; University of Southampton; Southampton UK
- Respiratory Biomedical Research Unit; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
- Christine Kühne-Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - L. M. Borrego
- Centro de Alergia; Hospital CUF Descobertas and Departamento de Imunologia; NOVA Medical School; Lisboa Portugal
| | - J. Higgs
- Health Education Trust; Greens Norton; Northamptonshire UK
| | | | | | - A. Mazon
- Pediatric Allergy and Pneumology Unit; Children's Hospital La Fe; Instituto de Investigacion Sanitaria La Fe; Valencia Spain
| | - D. Parmigiani
- Association for Teacher Education in Europe; Bruxelles Belgium
- Department of Education; University of Genoa; Genoa Italy
| | - M. Said
- Allergy & Anaphylaxis Australia; Hornsby NSW Australia
| | - S. Schnadt
- Deutscher Allergie- und Asthmabund e.V.; Mönchengladbach Germany
| | - H. van Os-Medendorp
- Department of Dermatology & Allergology; UMC Utrecht; Utrecht The Netherlands
| | - B. J. Vlieg-Boerstra
- Department of Respiratory Medicine and Allergy; Emma Children's Hospital; Academic Medical Center; University of Amsterdam; Amsterdam the Netherlands
| | - M. Wickman
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Department of Pediatrics; Sachs’ Children's Hospital; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
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Abstract
The role of physiotherapists has changed considerably over the last few decades. Autonomous professionals have replaced clinicians who applied technical skills under the direction of medical practitioners. The physiotherapy profession needs more than ever to produce clinicians who demonstrate competence in clinical reasoning and decision making. The challenge presented to all physiotherapists involved in teaching is to contribute to the development of clinicians who can use the complex skill of clinical reasoning in association with a sound clinical knowledge base. This paper discusses issues and strategies associated with achieving this goal.
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Higgs J, Walford C. Why carry a file or pick up a pen? All our records are paperless! BMJ Support Palliat Care 2011. [DOI: 10.1136/bmjspcare-2011-000105.194] [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: 11/04/2022]
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Colakoglu M, Toy H, Icen MS, Vural M, Mahmoud AS, Yazici F, Buendgen N, Cordes T, Schultze-Mosgau A, Diedrich K, Beyer D, Griesinger G, Oude Loohuis EJ, Nahuis MJ, Bayram N, Hompes PGA, Oosterhuis GJE, Bossuyt PM, van der Veen F, Mol BWJ, van Wely M, Nahuis MJ, Oude Loohuis EJ, Kose N, Bayram N, Hompes PGA, Oosterhuis GJE, Bossuyt PM, van der Veen F, Mol BWJ, van Wely M, Yaba A, Demir N, Allegra A, Pane A, Marino A, Scaglione P, Ruvolo G, Manno M, Volpes A, Lunger F, Wildt L, Seeber B, Kolibianakis EM, Venetis CA, Bosdou J, Toulis K, Goulis DG, Tarlatzi TB, Tarlatzis BC, Franz M, Keck C, Daube S, Pietrowski D, Demir N, Yaba A, Iannetta R, Santos RDS, Lima TP, Giolo F, Iannetta O, Martins WP, Paula FJ, Ferriani RA, Rosa e Silva ACJS, Martinelli CE, Reis RM, Devesa M, Rodriguez I, Coroleu B, Tur R, Gonzalez C, Barri PN, Nardo LG, Mohiyiddeen L, Mulugeta B, McBurney H, Roberts SA, Newman WG, Grynberg M, Lamazou F, Even M, Gallot V, Frydman R, Fanchin R, Abdalla H, Nicopoullos J, Leader A, Pang S, Witjes H, Gordon K, Devroey P, Arrivi C, Ferraretti AP, Magli MC, Tartaglia ML, Fasolino MC, Gianaroli L, Macek sr. M, Feldmar P, Kluckova H, Hrehorcak M, Diblik J, Cernikova J, Paulasova P, Turnovec M, Macek jr. M, Hillensjo T, Yeko T, Witjes H, Elbers J, Devroey P, Mardesic T, Abuzeid M, Witjes H, Mannaerts B, Okubo T, Matsuo R, Kuwayama M, Teramoto S, Chakraborty P, Goswami SK, Chakravarty BN, Nandi SS, Kabir SN, Ramos Vidal J, Prados N, Caligara C, Garcia J, Carranza FJ, Gonzalez-Ravina A, Salazar A, Tocino A, Rodriguez I, Fernandez-Sanchez M, Ito H, Iwasa T, Hasegawa E, Hatano K, Nakayama D, Kazuka M, Usuda S, Isaka K, Ventura V, Doria S, Fernandes S, Barros A, Valkenburg O, Lao O, Schipper I, Louwers YV, Uitterlinden AG, Kayser M, Laven JSE, Sharma S, Goswami S, Goswami SK, Ghosh S, Chattopadhyay R, Sarkar A, Chakravarty BN, Louwers YV, Valkenburg O, Lie Fong S, van Dorp W, de Jong FH, Laven JSE, Ghosh S, Chattopadhyay R, Goswami SK, Radhika KL, Chakravarty BN, Benkhalifa M, Demirol A, Montjeant D, Delagrange P, Gentien D, Giakoumakis G, Menezo Y, Dattilo M, Gurgan T, Engels S, Blockeel C, Haentjens P, De Vos M, Camus M, Devroey P, Dimitraki M, Koutlaki N, Gioka T, Messini CI, Dafopoulos K, Messinis IE, Gurlek B, Batioglu S, Ozyer S, Nafiye Y, Kale I, Karayalcin R, Uncu G, Kasapoglu I, Uncu Y, Celik N, Ozerkan K, Ata B, Ferrero H, Gomez R, Delgado F, Simon C, Gaytan F, Pellicer A, Osborn JC, Fien L, Wolyncevic J, Esler JH, Choi D, Kim N, Choi J, Jo M, Lee E, Lee D, Fujii R, Neyatani N, Waseda T, Oka Y, Takagi H, Tomizawa H, Sasagawa T, Makinoda S, Ajina M, Zorgati H, Ben Salem A, Ben Ali H, Mehri S, Touhami M, Saad A, Piouka A, Karkanaki A, Katsikis I, Delkos D, Mousatat T, Daskalopoulos G, Panidis D, Pantos K, Stavrou D, Sfakianoudis K, Angeli E, Chronopoulou M, Vaxevanoglou T, Jones R GMJ, Lee WD, Kim SD, Jee BC, Kim KC, Kim KH, Kim SH, Kim YJ, Park KA, Chae SJ, Lim KS, Hur CY, Kang YJ, Lee WD, Lim JH, Tomizawa H, Makinoda S, Fujita S, Waseda T, Fujii R, Utsunomiya R T, Vieira C, Martins WP, Fernandes JBF, Soares GM, Reis RM, Silva de Sa MF, Ferriani R RA, Yoo JH, Kim HO, Cha SH, Koong MK, Song IO, Kang IS, Hatakeyama N, Jinno M, Watanabe A, Hirohama J, Hiura R, Konig TE, Beemsterboer SN, Overbeek A, Hendriks ML, Heymans MW, Hompes P, Homburg R, Schats R, Lambalk CB, van der Houwen L, Konig TE, Overbeek A, Hendriks ML, Beemsterboer SN, Kuchenbecker WK, Renckens CNM, Bernardus RE, Schats R, Homburg R, Hompes P, Lambalk CB, Potdar N, Gelbaya TA, Nardo LG, de Groot PCM, Dekkers OM, Romijn JA, Dieben SWM, Helmerhorst FM, Guivarch Leveque A, Homer L, Broux PL, Moy L, Priou G, Vialard J, Colleu D, Arvis P, Dewailly D, Aghahosseini M, Aleyasin A, Sarvi F, Safdarian L, Rahmanpour H, Akhtar MA, Navaratnam K, Ankers D, Sharma SD, Son WY, Chung JT, Reinblatt S, Dahan M, Demirtas M, Holzer H, Aspichueta F, Exposito A, Crisol L, Prieto B, Mendoza R, Matorras R, Kim K, Lee J, Jee B, Lee W, Suh C, Moon J, Kim S, Sarapik A, Velthut A, Haller-Kikkatalo K, Faure GC, Bene MC, de Carvalho M, Massin F, Uibo R, Salumets A, Alhalabi M, Samawi S, Taha A, Kafri N, Modi S, Khatib A, Sharif J, Othman A, Hamamah S, Assou S, Anahory T, Loup V, Dechaud H, Dewailly D, Mousavi Fatemi H, Doody K, Witjes H, Mannaerts B, Basconi V, Jungblut L, Young E, Van Thillo G, Paz D, Pustovrh MC, Fabbri R, Pasquinelli G, Magnani V, Macciocca M, Parazza I, Battaglia C, Paradisi R, Venturoli S, Ono M, Teranisi A, Fumino T, Ohama N, Hamai H, Chikawa A, Takata R, Teramura S, Iwahasi K, Shigeta M, Heidari M, Farahpour M, Talebi S, Edalatkhah H, Zarnani AH, Ardekani AM, Pietrowski D, Szabo L, Sator M, Just A, Franz M, Egarter C, Hope N, Motteram C, Rombauts LJ, Lee W, Chang E, Han J, Won H, Yoon T, Seok H, Diao FY, Mao YD, Wang W, Ding W, Liu JY, Chang E, Yoon T, Lee W, Cho J, Kwak I, Kim Y, Afshan I, Cartwright R, Trew G, Lavery S, Lockwood G, Niyani K, Banerjee S, Chambers A, Pados G, Tsolakidis D, Billi H, Athanatos D, Tarlatzis B, Salumets A, Laanpere M, Altmae S, Kaart T, Stavreus-Evers A, Nilsson TK, van Dulmen-den Broeder E, van der Stroom E, Konig TE, van Montfrans J, Overbeek A, van den Berg MH, van Leeuwen FE, Lambalk CB, Taketani T, Tamura H, Tamura I, Asada H, Sugino N, Al - Azemi M, Kyrou D, Papanikolaou EG, Polyzos NP, Devroey P, Fatemi HM, Qiu Z, Yang L, Yan G, Sun H, Hu Y, Mohiyiddeen L, Higgs J, Roberts S, Newman W, Nardo LG, Ho C, Guijarro JA, Nunez R, Alonso J, Garcia A, Cordeo C, Cortes S, Caballero P, Soliman S, Baydoun R, Wang B, Shreeve N, Cagampang F, Sadek K, Hill CM, Brook N, Macklon N, Cheong Y, Santana R, Setti AS, Maldonado LG, Valente FM, Iaconelli C, Braga DPAF, Iaconelli Jr. A, Borges Jr. E, Yoon JS, Won MY, Kim SD, Jung JH, Yang SH, Lim JH, Kavrut M, Kahraman S, Sadek KH, Bruce KB, Macklon N, Cagampang FR, Cheong YC, Cota AMM, Oliveira JBA, Petersen CG, Mauri AL, Massaro FC, Silva LFI, Vagnini LD, Nicoletti A, Pontes A, Cavagna M, Baruffi RLR, Franco Jr. JG, Won MY, Kim SD, Yoon JS, Jung JH, Yang SH, Lim JH, Kim SD, Kim JW, Yoon TK, Lee WS, Han JE, Lyu SW, Shim SH, Kuwabara Y, Katayama A, Tomiyama R, Piao H, Ono S, Shibui Y, Abe T, Ichikawa T, Mine K, Akira S, Takeshita T, Hatzi E, Lazaros L, Xita N, Kaponis A, Makrydimas G, Sofikitis N, Stefos T, Zikopoulos K, Georgiou I, Guimera M, Casals G, Fabregues F, Estanyol JM, Balasch J, Mochtar MH, Van den Wijngaard L, Van Voorst S, Koks CAM, Van Mello NM, Mol BWJ, Van der Veen F, Van Wely M, Fabregues F, Iraola A, Casals G, Creus M, Carmona F, Balasch J, Villarroel C, Lopez P, Merino P, Iniguez G, Codner E, Xu B, Cui Y, Gao L, Xue KAI, Li MEI, Zhang YUAN, Diao F, Ma X, Liu J, Leonhardt H, Gull B, Kishimoto K, Kataoka M, Stener-Victorin E, Hellstrom M, Cui Y, Wang X, Zhang Z, Ding G, HU X, Sha J, Zhou Z, Liu J, Liu J, Kyrou D, Kolibianakis EM, Fatemi HM, Camus M, Tournaye H, Tarlatzis BC, Devroey P, Davari F, Rashidi B, Rahmanpour Zanjani H, Al-Inany H, Youssef M, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, Abousetta A, Van Dessel H, Van Leeuwen J, McGee EA, Bodri D, Guillen JJ, Rodriguez A, Trullenque M, Coll O, Vernaeve V, Snajderova M, Keslova P, Sedlacek P, Formankova R, Kotaska K, Stary J, Weghofer A, Dietrich W, Barad DH, Gleicher N, Rustamov O, Pemberton P, Roberts S, Smith A, Yates A, Patchava S, Nardo L, Toulis KA, Mintziori G, Goulis DG, Kintiraki E, Eukarpidis E, Mouratoglou SA, Pavlaki A, Stergianos S, Poulasouhidou M, Tzellos TG, Tarlatzis BC, Nasiri R, Ramezanzadeh F, Sarafraz Yazdi M, Baghrei M, Lee RKK, Wu FS, Lin S, Lin MH, Hwu YM. POSTER VIEWING SESSION - REPRODUCTIVE ENDOCRINOLOGY. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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10
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Grace S, Higgs J. Practitioner-client relationships in integrative medicine clinics in Australia: a contemporary social phenomenon. Complement Ther Med 2010; 18:8-12. [PMID: 20178873 DOI: 10.1016/j.ctim.2009.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 12/13/2009] [Accepted: 12/15/2009] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The increasing use of complementary and alternative medicine (CAM) in developed countries has been attributed more to contemporary cultural trends than to inherent problems in mainstream medicine. The aim of this study was to examine the impact of post-modern values on relationships between practitioners and clients in integrative medicine (IM) clinics in Australia. DESIGN This research used hermeneutic phenomenology to uncover experiences of practitioner-client relationships in IM and the meanings clients and practitioners attached to these relationships. Data were collected using cumulative case studies, focus groups and key informant interviews. Data analysis consisted of reading and re-reading texts derived from interview transcripts and field notes and constantly comparing texts to identify meanings and patterns. Themes extracted from the data set were continually refined, discarded and elaborated until meta-themes emerged. SETTING Australian IM clinics where general medical practitioners and CAM practitioners were co-located. RESULTS Post-modern values were evident in practitioner-client relationships in Australian IM clinics and were manifested in two ways. (1) Clients did not bring an expectation that they would receive prescriptive treatment regimens. They regarded consultations as opportunities for obtaining information or advice, or for monitoring their health. (2) Practitioners valued clients' knowledge and judgments and respected clients' right to choose and direct their health care. CONCLUSIONS In the IM clinics in this research, the traditional role of the practitioner as sole possessor of expertise had changed. Practitioners had become one among a number of resources that informed clients used when designing personal health care plans or negotiating health care with practitioners.
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Affiliation(s)
- S Grace
- The Education for Practice Institute, Charles Sturt University, 16 Masons Drive, North Parramatta 2151, Sydney, NSW 2151, Australia.
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11
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Waheed S, Higgs J, Shrotria S. Oncological safety of periareolar approach for mammographic lesions. Eur J Surg Oncol 2008. [DOI: 10.1016/j.ejso.2008.06.134] [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] Open
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12
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13
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Fuwa TJ, Hori K, Sasamura T, Higgs J, Baron M, Matsuno K. The first deltex null mutant indicates tissue-specific deltex-dependent Notch signaling in Drosophila. Mol Genet Genomics 2006; 275:251-63. [PMID: 16395579 DOI: 10.1007/s00438-005-0087-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 12/04/2005] [Indexed: 01/06/2023]
Abstract
Notch (N) is a single-pass transmembrane receptor. The N signaling pathway is an evolutionarily conserved mechanism that controls various cell-specification processes. Drosophila Deltex (Dx), a RING-domain E3 ubiquitin ligase, binds to the N intracellular domain, promotes N's endocytic trafficking to late endosomes, and was proposed to activate Suppressor of Hairless [Su(H)]-independent N signaling. However, it has been difficult to evaluate the importance of dx, because no null mutant of a dx family gene has been available in any organism. Here, we report the first null mutant allele of Drosophila dx. We found that dx was involved only in the subsets of N signaling, but was not essential for it in any developmental context. A strong genetic interaction between dx and Su(H) suggested that dx might function in Su(H)-dependent N signaling. Our epistatic analyses suggested that dx functions downstream of the ligands and upstream of activated Su(H). We also uncovered a novel dx activity that suppressed N signaling downstream of N.
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Affiliation(s)
- Takashi J Fuwa
- Department of Biological Science and Technology, Tokyo University of Science, 2641 Yamazaki, 278-8510 Noda, Chiba, Japan
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Turnipseed AA, Huey LG, Nemitz E, Stickel R, Higgs J, Tanner DJ, Slusher DL, Sparks JP, Flocke F, Guenther A. Eddy covariance fluxes of peroxyacetyl nitrates (PANs) and NOyto a coniferous forest. ACTA ACUST UNITED AC 2006. [DOI: 10.1029/2005jd006631] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [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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Wilkin MB, Carbery AM, Fostier M, Aslam H, Mazaleyrat SL, Higgs J, Myat A, Evans DAP, Cornell M, Baron M. Regulation of Notch Endosomal Sorting and Signaling by Drosophila Nedd4 Family Proteins. Curr Biol 2004; 14:2237-44. [PMID: 15620650 DOI: 10.1016/j.cub.2004.11.030] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2004] [Revised: 10/28/2004] [Accepted: 10/28/2004] [Indexed: 11/17/2022]
Abstract
The Notch receptor mediates a short-range signal that regulates many cell fate decisions. The misregulation of Notch has been linked to cancer and to developmental disorders. Upon binding to its ligands, Delta (Dl) or Serrate (Ser), the Notch ectodomain is shed by the action of an ADAM protease. The Notch intracellular domain is subsequently released proteolytically from the membrane by Presenilin and translocates to the nucleus to activate the transcription factor, Suppressor of Hairless. We show in Drosophila that Notch signaling is limited by the activity of two Nedd4 family HECT domain proteins, Suppressor of deltex [Su(dx)] and DNedd4. We rule out models by which Su(dx) downregulates Notch through modulating Deltex or by limiting the adherens junction accumulation of Notch. Instead, we show that Su(dx) regulates the postendocytic sorting of Notch within the early endosome to an Hrs- and ubiquitin-enriched subdomain en route to the late endosome. We propose a model in which endocytic sorting of Notch mediates a decision between its activation and downregulation. Such intersections between trafficking routes may provide key points at which other signals can modulate Notch activity in both normal development and in the pathological misactivation of Notch.
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Affiliation(s)
- Marian B Wilkin
- Faculty of Life Sciences, Michael Smith Building, University of Manchester, Stopford Road, Manchester M13 9PT, UK
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Abstract
Evidence-based practice involves basing clinical decisions and practice on the best available evidence. What do nurses need to think about when seeking to pursue evidence-based practice? What challenges do practitioners face in blending clinical reasoning with evidence-based practice? In this article, the authors argue against basing clinical practice on narrow definitions of evidence, relying solely on experimental findings or, even more exclusively, on randomized controlled trials. Instead of defining best practice narrowly by the strength of the current empirical evidence used to guide clinical decisions, it should be defined broadly by what is the best information to use to make decisions for a given patient in a particular setting. Credible and accountable clinical decisions rely on a number of forms of knowledge and evidence. This evidence includes findings from across the range of research methods, including experimental, interpretive, and action research. In nursing, it also includes evidence that has arisen from the depth of practice knowledge of expert clinical nurses. Professionals, particularly advanced and expert clinicians such as critical care nurses, use clinical reasoning to guide their practice in the uncertainty of clinical practice contexts. This reasoning helps the nurse make judgments about the relevance of particular research and clinical evidence for a specific patient and setting.
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Affiliation(s)
- J Higgs
- Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe 1825, Australia.
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18
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Abstract
As a profession integral to health promotion, prevention, acute care and rehabilitation physiotherapy plays an essential role in the health care system. This paper explores the nature of physiotherapy, the role of physiotherapy in health care, the practice of physiotherapy internationally, the education of physiotherapists, the regulation of physiotherapy practice and the maintenance of practice standards.
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Affiliation(s)
- J Higgs
- School of Physiotherapy, Centre for Professional Education Advancement, Faculty of Health Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia.
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Higgs J, Hunt A. Preparing for the workplace: fostering generic attributes in allied health education programs. J Allied Health 1999; 28:230-6; discussion 237-9. [PMID: 10614556] [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: 02/15/2023]
Abstract
Allied health curricula need to extend beyond the learning of discipline-specific skills to encompass broader learning goals. In particular, the acquisition of generic skills is necessary to enable graduates to function more competently and confidently within their rapidly changing work, professional, and societal environments. In health sciences education particularly, the rate of change in practice and education is rapid and unprecedented. If educators focus on components of the curriculum rather than the entire learning experience, they are likely to significantly limit the students' acquisition of such generic skills. To achieve the desired generic skills outcomes, an overarching, integrated, and consistently applied curriculum strategy is advocated. This article considers a number of such strategies relevant to allied health education.
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Affiliation(s)
- J Higgs
- School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia
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Abstract
Photographs of a burn injury provide an objective description of the patient's disease course and may be important in the medicolegal documentation of child abuse or other criminal and civil actions. Accurate and reproducible photographs require careful composition and choice of equipment. Standardized clinical positioning is described with recommendations for timing of serial photographs.
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Affiliation(s)
- E C Smoot
- Division of Plastic and Reconstructive Surgery, Southern Illinois University School of Medicine, Springfield 62794-9230
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Ramudu L, Bellet B, Higgs J, Latimer C, Smith R. How effectively do we use double staff time? AUST J ADV NURS 1994; 11:5-10. [PMID: 7980883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This paper describes a group of registered nurses' investigation of the use of 'double staff time' in a neonatal unit. Using participatory action research, the nurses explored why it was difficult for the unit's staff to take part in continuing education programs that were provided during double staff time. The group drew on their personal experiences as well as data collected from peers in the neonatal unit. The data illustrated that nursing activities and nursing handovers were two factors that encroached on nurses' professional development time.
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Abstract
OBJECTIVE To determine the efficacy and safety of fluconazole treatment of coccidioidal meningitis. DESIGN Uncontrolled clinical trial. SETTING Four university-based treatment centers in California, Arizona, and Texas. Most therapy was conducted without hospitalization. PATIENTS Fifty consecutive patients with active coccidioidal meningitis, of which 47 (94%) were evaluable. Twenty-five patients had received no previous treatment for their meningitis, and nine had coinfection with human immunodeficiency virus (HIV). INTERVENTION Fluconazole was administered in an oral dose of 400 mg once per day for up to 4 years (median, 37 months) in responding patients. Concurrent therapy with another antifungal agent was prohibited. MEASUREMENTS Predefined assessment of infection-related abnormalities was done at the time of enrollment and was repeated at least every 4 months during treatment. Elimination of 40% or more of baseline abnormalities was considered a response. RESULTS Thirty-seven of 47 (79%; 95% CI, 61% to 90%) evaluable patients responded to treatment. Response rates were similar for patients with and without previous therapy, for patients with and without concomitant HIV infection, and for patients with and without pre-existing hydrocephalus. Most improvement occurred within 4 to 8 months after starting treatment. Patient symptoms resolved more quickly than did cerebrospinal fluid abnormalities. In 15 of 20 responding patients followed for 20 months or more, residual low-level cerebrospinal fluid abnormalities remained throughout therapy. No patient discontinued therapy because of drug-related side effects, although confusion developed in two patients that resolved when the dose of fluconazole was reduced. CONCLUSION Fluconazole therapy is often effective in suppressing coccidioidal meningitis.
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Affiliation(s)
- J N Galgiani
- Medical Service, Veterans Affairs Medical Service, Tucson, AZ 85723
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23
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Abstract
This paper presents a clinical reasoning course for postgraduate physiotherapy students, conducted at the University of Sydney. The course was designed to foster the development of students' clinical reasoning skills and clinical knowledge. The rationale and nature of the course are discussed, along with evaluation findings. Results indicate that the course has succeeded in stimulating students' interest and enjoyment in clinical reasoning and promoting students' understanding of and competence in this complex ability.
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Affiliation(s)
- J Higgs
- School of Physiotherapy, Faculty of Health Sciences, University of Sydney, Lidcombe Australia
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Fox DA, Millard JA, Kan L, Zeldes WS, Davis W, Higgs J, Emmrich F, Kinne RW. Activation pathways of synovial T lymphocytes. Expression and function of the UM4D4/CDw60 antigen. J Clin Invest 1990; 86:1124-36. [PMID: 2212003 PMCID: PMC296841 DOI: 10.1172/jci114817] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Accumulating evidence implicates a central role for synovial T cells in the pathogenesis of rheumatoid arthritis, but the activation pathways that drive proliferation and effector function of these cells are not known. We have recently generated a novel monoclonal antibody against a rheumatoid synovial T cell line that recognizes an antigen termed UM4D4 (CDw60). This antigen is expressed on a minority of peripheral blood T cells, and represents the surface component of a distinct pathway of human T cell activation. The current studies were performed to examine the expression and function of UM4D4 on T cells obtained from synovial fluid and synovial membranes of patients with rheumatoid arthritis and other forms of inflammatory joint disease. The UM4D4 antigen is expressed at high surface density on about three-fourths of synovial fluid T cells and on a small subset of synovial fluid natural killer cells; in synovial tissue it is present on more than 90% of T cells in lymphoid aggregates, and on approximately 50% of T cells in stromal infiltrates In addition, UM4D4 is expressed in synovial tissue on a previously undescribed population of HLA-DR/DP-negative non-T cells with a dendritic morphology. Anti-UM4D4 was co-mitogenic for both RA and non-RA synovial fluid mononuclear cells, and induced IL-2 receptor expression. The UM4D4/CDw60 antigen may represent a functional activation pathway for synovial compartment T cells, which could play an important role in the pathogenesis of inflammatory arthritis.
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Affiliation(s)
- D A Fox
- Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109
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25
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Abstract
UM4D4 is a recently defined antigen that is expressed on approximately 25% of peripheral blood T cells, but on the majority of T cells in inflammatory synovial fluid. Anti-UM4D4 activates peripheral blood T cells in the presence of accessory cells and/or phorbol ester. UM4D4 has been assigned to a new antigen cluster termed CDw60. The present study examined the ability of anti-UM4D4 to activate T cell clones derived from the synovial fluid of patients with rheumatoid arthritis. UM4D4 was expressed at varying levels on both lectin-generated and antigen-specific clones, including clones of CD4+, CD8+, and CD4-CD8- phenotypes. Anti-UM4D4 used in soluble form as a single stimulus was typically mitogenic for the CD4+ and some of the CD8+ clones, but not for the CD4-CD8- clones. Phorbol ester boosted the response to anti-UM4D4 in some clones, had no effect in others, and diminished the responses in some cases. In contrast to anti-UM4D4, anti-CD3 was generally not mitogenic in soluble form, although it was mitogenic when conjugated to beads. The data show that T cell clones derived from an inflammatory T cell infiltrate can be readily activated through the UM4D4/CDw60 antigen.
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Affiliation(s)
- D A Fox
- Department of Internal Medicine, Rackham Arthritis Research Unit, University of Michigan, Ann Arbor
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26
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Wellde BT, Preston JM, Kovatch RM, Higgs J, Chumo DA. Trypanosoma congolense: erythrocyte indices, plasma iron turnover and effects of treatment in infected cattle. Ann Trop Med Parasitol 1989; 83 Suppl 1:201-6. [PMID: 2619395 DOI: 10.1080/00034983.1989.11812425] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Early during the course of Trypanosoma congolense infection in cattle decreases in PCV occurred and coincided with increases in both MCV and MCH. The indices reached highest levels between eight and 12 weeks post-infection. By week 20 of infection MCV and MCH had decreased to pre-infection levels even though a substantial anemia persisted. Serum iron levels were elevated at eight weeks postinfection. (Infected 271 mg dl-1 v. control 140 mg dl-1) but decreased to low levels in infected animals by Week 28 (63 mg dl-1). At eight weeks post-infection PITR was elevated in infected animals (infected 2.6 mg dl-1 day-1 v. control 0.82 mg dl-1 day-1). By Week 28, however, PITR had fallen in infected animals to 0.62 mg dl-1 day-1 indicating a severe dyshaemopoesis since PCV levels averaged only 22%. Cattle which were treated with Berenil or that self-cured the infection had normal iron parameters when tested 61 weeks post-infection. Cattle treated early during the course of infection showed a significantly greater PCV response that those treated later during infection.
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MESH Headings
- Anemia, Hemolytic/blood
- Anemia, Hemolytic/etiology
- Anemia, Hemolytic/veterinary
- Animals
- Cattle
- Cattle Diseases/blood
- Cattle Diseases/etiology
- Diminazene/analogs & derivatives
- Diminazene/therapeutic use
- Erythrocyte Count/veterinary
- Erythrocyte Indices
- Hematocrit/veterinary
- Iron/blood
- Trypanocidal Agents/therapeutic use
- Trypanosoma congolense
- Trypanosomiasis, African/blood
- Trypanosomiasis, African/complications
- Trypanosomiasis, African/drug therapy
- Trypanosomiasis, African/veterinary
- Trypanosomiasis, Bovine/blood
- Trypanosomiasis, Bovine/complications
- Trypanosomiasis, Bovine/drug therapy
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Affiliation(s)
- B T Wellde
- Walter Reed Project, Veterinary Research Laboratory, Ministry of Agriculture and Livestock Development, Kabete, Kenya
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27
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Abstract
In a prospective study, 10 patients with well-documented osteoarthritis (O.A.) of the hips were imaged using spin-echo pulse sequences (TR = 0.5 to 1.5 s and TE = 28 to 60 ms). After analyzing the changes observed, an MR grading system for assessing severity of O.A. in the hips was developed. Using this grading system and an established grading system for osteoarthritis using roentgenograms (both systems use grades 0-4), two radiologists independently graded the MR studies and plain films separately, twice. The roentgenogram grading system was more accurate in predicting symptoms in the more severe cases, whereas the MR grading system was slightly more useful in the less severe cases. Our results show that MR can demonstrate a spectrum of changes of O.A. in the hips. Its ability to directly image articular cartilage makes it a powerful research and clinical tool.
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Affiliation(s)
- K C Li
- Department of Radiology, University of Michigan Medical Center, Ann Arbor 48109
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28
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Abstract
Physiotherapists have an important role to play in the rehabilitation of patients with chronic obstructive pulmonary disease. Individually-tailored programmes including the following components, namely education, exercise, secretion removal, breathing 'training', home programmes, ventilatory muscle training, medications, support systems and counselling can provide subjective and objective benefits for these patients. A primary consideration is to involve patients in the planning, implementation and evaluation of the programme and to encourage them to develop self-help skills. Guidelines for designing a pulmonary rehabilitation programme are outlined,' and pertinent literature reviewed.
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29
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Abstract
A quality continuing education programme may be seen as one which is of a high standard, relevant and viable. Efforts made to ensure the quality of continuing education should be directed towards these three ends. Where possible learners should be involved in programme planning, implementation and evaluation and should be encouraged to put their learning into practice. This paper will explore the issues and practicalities involved in attempts to ensure the quality of educational activities provided for qualified professionals by groups or bodies who are concerned with the professional development and quality of service of both individuals and professional groups.
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Abstract
This article reviews the value and limitations of I.P.P.B. as opposed to other treatment methods available to the respiratory physiotherapist. In the treatment of patients with airways obstruction I.P.P.B. is presented as having a limited role. Alternative measures such as the use of simple nebulisation, relaxation therapy and manual methods to remove secretions are described as being preferable to I.P.P.B. in most cases. I.P.P.B. has some value in the early post-operative care of some patients undergoing surgery which results in limitation to spontaneous deep breathing postoperatively. However other methods, notably incentive spirometry should also be considered for these patients. In the treatment and prevention of respiratory complications associated with neuromuscular and skeletal disorders I.P.P.B. can play a significant role in counteracting the possible effects of hypoventilation. I.P.P.B. should be considered as one method among many which is available to the physiotherapist to assist in the treatment of respiratory complications associated with medical and surgical conditions.
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Affiliation(s)
- J Higgs
- Prince Henry Hospital, Sydney, NSW
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Löhr KF, Otieno PS, Meyer H, Higgs J, Ashford WA. Haematological reactions to experimental Babesia bigemina infection in splenectomised and non-splenectomised cattle. Zentralbl Veterinarmed B 1977; 24:508-16. [PMID: 888605 DOI: 10.1111/j.1439-0450.1977.tb01019.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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