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Brown DG, Murphy M, Cadeddu R, Bell R, Weis A, Chiaro T, Klag K, Morgan J, Coon H, Stephens WZ, Bortolato M, Round JL. Colitis reduces active social engagement in mice and is ameliorated by supplementation with human microbiota members. Nat Commun 2024; 15:2769. [PMID: 38553486 PMCID: PMC10980768 DOI: 10.1038/s41467-024-46733-7] [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: 11/01/2023] [Accepted: 03/08/2024] [Indexed: 04/01/2024] Open
Abstract
Multiple neurological disorders are associated with gastrointestinal (GI) symptoms, including autism spectrum disorder (ASD). However, it is unclear whether GI distress itself can modify aspects of behavior. Here, we show that mice that experience repeated colitis have impaired active social engagement, as measured by interactions with a foreign mouse, even though signs of colitis were no longer present. We then tested the hypothesis that individuals with ASD harbor a microbiota that might differentially influence GI health by performing microbiota transplantation studies into male germfree animals, followed by induction of colitis. Animals that harbor a microbiota from ASD individuals have worsened gut phenotypes when compared to animals colonized with microbiotas from familial neurotypical (NT) controls. We identify the enrichment of Blautia species in all familial NT controls and observe an association between elevated abundance of Bacteroides uniformis and reductions in intestinal injury. Oral treatment with either of these microbes reduces colon injury in mice. Finally, provision of a Blautia isolate from a NT control ameliorates gut injury-associated active social engagement in mice. Collectively, our data demonstrate that past intestinal distress is associated with changes in active social behavior in mice that can be ameliorated by supplementation of members of the human microbiota.
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Affiliation(s)
- D Garrett Brown
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Michaela Murphy
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Roberto Cadeddu
- Department of Pharmacology and Toxicology University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - Rickesha Bell
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Allison Weis
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Tyson Chiaro
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Kendra Klag
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Jubel Morgan
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Hilary Coon
- Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - W Zac Stephens
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA
| | - Marco Bortolato
- Department of Pharmacology and Toxicology University of Utah College of Pharmacy, Salt Lake City, UT, USA
| | - June L Round
- Department of Pathology, University of Utah School of Medicine, Huntsman Cancer Institute, Division of Microbiology and Immunology, Salt Lake City, UT, USA.
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Morgan J, MacInnes E, Erskine S, Walters SJ, Cook J, Collins K, Wyld L. Psychosocial outcomes after varying risk management strategies in women at increased familial breast cancer risk: a mixed methods study of patient and partner outcomes. Ann R Coll Surg Engl 2024; 106:78-91. [PMID: 37458196 PMCID: PMC10757884 DOI: 10.1308/rcsann.2023.0042] [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] [Accepted: 05/11/2023] [Indexed: 01/02/2024] Open
Abstract
INTRODUCTION Female carriers of BRCA1/2 genes have an increased lifetime risk of breast cancer. Options for managing risk include imaging surveillance or risk-reducing surgery (RRS). This mixed methods study aimed to identify factors affecting risk-management decisions and the psychosocial outcomes of these decisions for high-risk women and their partners. METHODS Semi-structured qualitative interviews were performed with women at high breast cancer risk who had faced these choices. Partners were also interviewed. Analysis used a framework approach. A bespoke questionnaire was developed to quantify and explore associations. RESULTS A total of 32 women were interviewed. Of these, 27 had partners of whom 7 (26%) agreed to be interviewed. Four main themes arose: perception of risk and impact of increased risk; risk-management strategy decision-making; impact of risk-management strategy; support needs and partner relationship issues. The questionnaire response rate was 36/157 (23%). Decision satisfaction was high in both surveillance and RRS groups. Relationship changes were common but not universal. Common causes of distress following RRS included adverse body image changes. Both groups experienced generalised and cancer-specific anxiety. Drivers for surgery included having children, deaths of close family from breast cancer and higher levels of cancer anxiety. CONCLUSIONS Levels of psychosocial and decision satisfaction were high for women choosing both RRS and surveillance but, for a minority, risk-reducing measures result in long-term psychosocial morbidity. Efforts to recognise women at increased risk of psychological morbidity may allow targeted support.
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Affiliation(s)
| | - E MacInnes
- Leeds Teaching Hospitals NHS Foundation Trust, UK
| | - S Erskine
- East of England School of General Practice, Norwich, UK
| | | | - J Cook
- Sheffield Childrens NHS Foundation Trust, UK
| | | | - L Wyld
- Leeds Teaching Hospitals NHS Foundation Trust, UK
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DiPiero M, Cordash H, Prigge MB, King CK, Morgan J, Guerrero-Gonzalez J, Adluru N, King JB, Lange N, Bigler ED, Zielinski BA, Alexander AL, Lainhart JE, Dean DC. Tract- and gray matter- based spatial statistics show white matter and gray matter microstructural differences in autistic males. Front Neurosci 2023; 17:1231719. [PMID: 37829720 PMCID: PMC10565827 DOI: 10.3389/fnins.2023.1231719] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental condition commonly studied in the context of early childhood. As ASD is a life-long condition, understanding the characteristics of brain microstructure from adolescence into adulthood and associations to clinical features is critical for improving outcomes across the lifespan. In the current work, we utilized Tract Based Spatial Statistics (TBSS) and Gray Matter Based Spatial Statistics (GBSS) to examine the white matter (WM) and gray matter (GM) microstructure in neurotypical (NT) and autistic males. Methods Multi-shell diffusion MRI was acquired from 78 autistic and 81 NT males (12-to-46-years) and fit to the DTI and NODDI diffusion models. TBSS and GBSS were performed to analyze WM and GM microstructure, respectively. General linear models were used to investigate group and age-related group differences. Within the ASD group, relationships between WM and GM microstructure and measures of autistic symptoms were investigated. Results All dMRI measures were significantly associated with age across WM and GM. Significant group differences were observed across WM and GM. No significant age-by-group interactions were detected. Within the ASD group, positive relationships with WM microstructure were observed with ADOS-2 Calibrated Severity Scores. Conclusion Using TBSS and GBSS our findings provide new insights into group differences of WM and GM microstructure in autistic males from adolescence into adulthood. Detection of microstructural differences across the lifespan as well as their relationship to the level of autistic symptoms will deepen to our understanding of brain-behavior relationships of ASD and may aid in the improvement of intervention options for autistic adults.
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Affiliation(s)
- Marissa DiPiero
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Hassan Cordash
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Molly B. Prigge
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Carolyn K. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Jubel Morgan
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | | | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jace B. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Nicholas Lange
- Department of Psychiatry, Harvard School of Medicine, Boston, MA, United States
| | - Erin D. Bigler
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Brandon A. Zielinski
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Departments of Pediatrics and Neurology, University of Florida, Gainesville, FL, United States
- McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Janet E. Lainhart
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas C. Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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Prigge MBD, Bigler ED, Lange N, Morgan J, Froehlich A, Freeman A, Kellett K, Kane KL, King CK, Taylor J, Dean DC, King JB, Anderson JS, Zielinski BA, Alexander AL, Lainhart JE. Longitudinal Stability of Intellectual Functioning in Autism Spectrum Disorder: From Age 3 Through Mid-adulthood. J Autism Dev Disord 2022; 52:4490-4504. [PMID: 34677753 PMCID: PMC9090201 DOI: 10.1007/s10803-021-05227-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Accepted: 07/29/2021] [Indexed: 12/02/2022]
Abstract
Intelligence (IQ) scores are used in educational and vocational planning for individuals with autism spectrum disorder (ASD) yet little is known about the stability of IQ throughout development. We examined longitudinal age-related IQ stability in 119 individuals with ASD (3-36 years of age at first visit) and 128 typically developing controls. Intelligence measures were collected over a 20-year period. In ASD, Full Scale (FSIQ) and Verbal (VIQ) Intelligence started lower in childhood and increased at a greater rate with age relative to the control group. By early adulthood, VIQ and working memory stabilized, whereas nonverbal and perceptual scores continued to change. Our results suggest that in individuals with ASD, IQ estimates may be dynamic in childhood and young adulthood.
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Affiliation(s)
- Molly B D Prigge
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA.
| | - Erin D Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Department of Neurology, University of California-Davis, Davis, CA, USA
| | - Nicholas Lange
- Department of Psychiatry, Harvard School of Medicine, Boston, MA, USA
| | - Jubel Morgan
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Alyson Froehlich
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Abigail Freeman
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristina Kellett
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Karen L Kane
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Carolyn K King
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - June Taylor
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Jace B King
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Jeff S Anderson
- Department of Radiology and Imaging Sciences, Radiology Research, University of Utah, 729 Arapeen Drive, Salt Lake City, UT, 84108, USA
| | - Brandon A Zielinski
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Janet E Lainhart
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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5
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Morgan J, McNeil BWJ. X-ray pulse generation with ultra-fast flipping of its orbital angular momentum. Opt Express 2022; 30:31171-31181. [PMID: 36242205 DOI: 10.1364/oe.470503] [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] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 06/16/2023]
Abstract
A method to temporally tailor the properties of X-ray radiation carrying Orbital Angular Momentum (OAM) is presented. In simulations, an electron beam is prepared with a temporally modulated micro-bunching structure which, when radiating at the second harmonic in a helical undulator, generates OAM light with a corresponding temporally modulated intensity. This method is shown to generate attosecond pulse trains of OAM light without the need for any additional external optics, making the wavelength range tunable. In addition to the OAM pulse train, the method can be adapted to generate radiation where the handedness of the OAM mode may also be temporally modulated (flipped).
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6
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Liu F, Ryan S, Fahnoe K, Morgan J, Bieber K, Schmidt E, Verschoor A, Ludwig R, Salant D, Thurman J, Holers V, Violette S, WAWERSIK S. POS-042 C3d-Directed Factor H Targeting Delivers Potent and Durable Complement Inhibition and Disease-Modifying Efficacy In Kidney and Skin Without Inhibiting Systemic Complement. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Morgan J, Jin D, Dwyer N. Infective Endocarditis in the Tasmanian Population. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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8
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Morgan J, Jin D, Dwyer N. Surgical Management of IE Patients Within the Tasmanian Population. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Dando M, Grenfell J, Morgan J, Jones E, Knight-Davis M, Letchford R. Shared Decision Making training improves confidence in clinicians to facilitate collaborative decisions in musculoskeletal physiotherapy. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.152] [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: 10/19/2022]
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10
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van der Plas-Krijgsman W, Morgan J, de Glas N, de Boer A, Martin C, Holmes G, Ward S, Chater T, Reed M, Merkus J, van Dalen T, Vulink A, van Gerven L, Guicherit O, Linthorst E, Bastiaannet E, Portielje J, Liefers G, Wyld L. Differences in treatment and survival of older patients with operable breast cancer between the United Kingdom and the Netherlands – a comparison of two national prospective longitudinal multi-centre cohort studies. J Geriatr Oncol 2021. [DOI: 10.1016/s1879-4068(21)00472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morgan J, Bindoff A, Doherty K, Vickers J, Alty J. Are tomorrow's doctors prepared to prevent dementia? A cross-sectional study of Tasmanian medical students' knowledge of dementia risk factors. J Clin Neurosci 2021; 96:133-137. [PMID: 34789417 DOI: 10.1016/j.jocn.2021.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/26/2021] [Accepted: 11/04/2021] [Indexed: 11/29/2022]
Abstract
Tomorrow's doctors are unprepared to prevent dementia. This cross-sectional study invited medical students enrolled in the University of Tasmania 5-year medical degree (MBBS) to participate in an online questionnaire during 2019. This study measured students' recall of risk factors, prompted and unprompted, for dementia and cardiovascular disease (CVD), and Dementia Knowledge Assessment Scale (DKAS) score. Data were collected via an online survey comprising the DKAS, and risk factor questions adapted from the Alzheimer's Research UK National Monitor Survey, with questions on CVD risk factors added for comparison. Medical students (n = 82) proffered fewer unprompted risk factors for dementia than for CVD and were less proficient at recognizing dementia risk factors from a prompted list. Knowledge of vascular risk factors for dementia was particularly limited. Their broader dementia knowledge was generally adequate and DKAS scores were at the level of a qualified doctor by final year. Whilst medical students' general knowledge of dementia was satisfactory, their knowledge of modifiable risk factors of dementia was limited. If replicated elsewhere, this raises concerns about whether the future medical workforce is equipped to take a necessary lead role in managing dementia risk reduction. As dementia incidence rises worldwide, and 40% cases are attributable to modifiable risk factors, educational programs may need to urgently address these deficiencies.
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Affiliation(s)
- J Morgan
- Wicking Dementia Research and Education Centre (WDREC), University of Tasmania, Australia.
| | - A Bindoff
- Wicking Dementia Research and Education Centre (WDREC), University of Tasmania, Australia
| | - K Doherty
- Wicking Dementia Research and Education Centre (WDREC), University of Tasmania, Australia
| | - J Vickers
- Wicking Dementia Research and Education Centre (WDREC), University of Tasmania, Australia
| | - J Alty
- Wicking Dementia Research and Education Centre (WDREC), University of Tasmania, Australia
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12
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Wheldon L, Morgan J, Lee MJ, Riley S, Brown SR, Wyld L. EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique. Br J Surg 2021. [DOI: 10.1093/bjs/znab309.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP.
Background
Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK.
Methods
Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated.
Results
Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma.
Conclusion
Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.
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Affiliation(s)
- L Wheldon
- Sheffield Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - J Morgan
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - MJ Lee
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
- Department of Oncology and Metabolism, The University of Sheffield
| | - S Riley
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - SR Brown
- Sheffield Teaching Hospitals NHS Foundation Trust
| | - L Wyld
- Department of Oncology and Metabolism, The University of Sheffield
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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Morgan J, Manning K, Wyld L. 626 Barriers Faced by Female Surgical Trainees – A Qualitative Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab258.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Today women make up 56% of medical students, yet just 12% of surgical consultants, a number that has remained static since 2013. This qualitative study aimed to explore the barriers to female success in modern surgery.
Method
Semi-structured qualitative interviews were undertaken primarily with female surgical trainees to determine the barriers they face. Male trainees and Training Programme Directors were also interviewed for triangulation.
Results
Nineteen interviews were performed (15 female trainees, 3 male trainees and 1 TPD) between October 2019 and March 2020. Family pressures and becoming a mother were significant barriers for women training in surgery, a barrier that did not apply to male trainees who were fathers, often resulting in women choosing to train less than full time (LTFT). Unfortunately, LTFT training presents further obstacles for female trainees. The set-up of the National training programme in surgery provides many non-gender specific barriers, chiefly moving hospital every 6 months resulting in disrupted training and long commutes. Sexism and discrimination are still common, both from colleagues and patients. Many participants perceived inherent differences between genders in communication and methods for coping with stress.
Conclusions
Greater gender equality in surgery may be achieved by changes in the structure and organisation of training to reduce the tension between the professional role and the predominantly female-led role of raising children. Better equality and diversity training and awareness at all levels in surgery may help to mitigate some of the conscious and unconscious bias that still exists.
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Affiliation(s)
- J Morgan
- University of Sheffield, Sheffield, United Kingdom
- Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Doncaster, United Kingdom
| | - K Manning
- University of Sheffield, Sheffield, United Kingdom
| | - L Wyld
- University of Sheffield, Sheffield, United Kingdom
- Doncaster and Bassetlaw Teaching Hospitals NHS Trust, Doncaster, United Kingdom
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Elahi M, Morgan J, Stillie A, Zahra M. PO-1282 Single Institution Outcomes for CT Guided Brachytherapy for Cervical Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07733-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wyld L, Reed MWR, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters SJ, Ring A, Robinson TG, Martin C, Chater T, Pemberton K, Shrestha A, Nettleship A, Murray C, Brown M, Richards P, Cheung KL, Todd A, Harder H, Brain K, Audisio RA, Wright J, Simcock R, Armitage F, Bursnall M, Green T, Revell D, Gath J, Horgan K, Holcombe C, Winter M, Naik J, Parmeshwar R, Gosney M, Hatton M, Thompson AM. Bridging the age gap in breast cancer: cluster randomized trial of two decision support interventions for older women with operable breast cancer on quality of life, survival, decision quality, and treatment choices. Br J Surg 2021; 108:499-510. [PMID: 33760077 PMCID: PMC10364907 DOI: 10.1093/bjs/znab005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/04/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of surgery and adjuvant therapy for breast cancer vary widely between breast units. This may contribute to differences in survival. This cluster RCT evaluated the impact of decision support interventions (DESIs) for older women with breast cancer, to ascertain whether DESIs influenced quality of life, survival, decision quality, and treatment choice. METHODS A multicentre cluster RCT compared the use of two DESIs against usual care in treatment decision-making in older women (aged at least ≥70 years) with breast cancer. Each DESI comprised an online algorithm, booklet, and brief decision aid to inform choices between surgery plus adjuvant endocrine therapy versus primary endocrine therapy, and adjuvant chemotherapy versus no chemotherapy. The primary outcome was quality of life. Secondary outcomes included decision quality measures, survival, and treatment choice. RESULTS A total of 46 breast units were randomized (21 intervention, 25 usual care), recruiting 1339 women (670 intervention, 669 usual care). There was no significant difference in global quality of life at 6 months after the baseline assessment on intention-to-treat analysis (difference -0.20, 95 per cent confidence interval (C.I.) -2.69 to 2.29; P = 0.900). In women offered a choice of primary endocrine therapy versus surgery plus endocrine therapy, knowledge about treatments was greater in the intervention arm (94 versus 74 per cent; P = 0.003). Treatment choice was altered, with a primary endocrine therapy rate among women with oestrogen receptor-positive disease of 21.0 per cent in the intervention versus 15.4 per cent in usual-care sites (difference 5.5 (95 per cent C.I. 1.1 to 10.0) per cent; P = 0.029). The chemotherapy rate was 10.3 per cent at intervention versus 14.8 per cent at usual-care sites (difference -4.5 (C.I. -8.0 to 0) per cent; P = 0.013). Survival was similar in both arms. CONCLUSION The use of DESIs in older women increases knowledge of breast cancer treatment options, facilitates shared decision-making, and alters treatment selection. Trial registration numbers: EudraCT 2015-004220-61 (https://eudract.ema.europa.eu/), ISRCTN46099296 (http://www.controlled-trials.com).
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Affiliation(s)
- L Wyld
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M W R Reed
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Collins
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - M Burton
- College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - K Lifford
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - A Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - S Ward
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - G Holmes
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - J Morgan
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - M Bradburn
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - S J Walters
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Ring
- Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - T G Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, Glenfield General Hospital, Leicester, UK
| | - C Martin
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - T Chater
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - K Pemberton
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Shrestha
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - A Nettleship
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - C Murray
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - M Brown
- EpiGenesys, University of Sheffield, Sheffield, UK
| | - P Richards
- Department of Health Economics and Decision Science, School for Health and Related Research, ScHARR, University of Sheffield, Sheffield, UK
| | - K L Cheung
- University of Nottingham, Royal Derby Hospital, Derby, UK
| | - A Todd
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - H Harder
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - K Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - R A Audisio
- University of Gothenberg, Sahlgrenska Universitetssjukhuset, Gothenberg, Sweden
| | - J Wright
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | - R Simcock
- Brighton and Sussex Medical School, Falmer, Brighton, UK
| | | | - M Bursnall
- Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK
| | - T Green
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - D Revell
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - J Gath
- Yorkshire and Humber Consumer Research Panel (yhcrp.org.uk), Leeds, UK
| | - K Horgan
- Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - M Winter
- Weston Park Hospital, Sheffield, UK
| | - J Naik
- Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK
| | - R Parmeshwar
- University Hospitals of Morecambe Bay, Lancaster, UK
| | - M Gosney
- Royal Berkshire NHS Foundation Trust, Reading, UK
| | - M Hatton
- Weston Park Hospital, Sheffield, UK
| | - A M Thompson
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Wattoo G, Nayak S, Khan S, Morgan J, Hocking H, MacInnes E, Kolar KM, Rogers C, Olubowale O, Rigby K, Kazzazi NH, Wyld L. Long-term outcomes of latissimus dorsi flap breast reconstructions: A single-centre observational cohort study with up to 12 years of follow up. J Plast Reconstr Aesthet Surg 2020; 74:2202-2209. [PMID: 33451948 DOI: 10.1016/j.bjps.2020.12.058] [Citation(s) in RCA: 4] [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: 03/27/2020] [Revised: 11/22/2020] [Accepted: 12/19/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Latissimus Dorsi Myocutaneous Flap (LDMF) is used in post-mastectomy reconstruction. This study has evaluated long-term (up to 12 years) surgical- and patient-reported outcomes from LDMF procedures. METHOD A retrospective analysis of consecutive LDMF procedures in two UK hospitals, performed between 2006 and 2016. Case notes were reviewed for indications and outcomes. Patients were sent the BREAST-QⓇ survey by post. Outcomes, including surgical adverse events, revision, and implant loss rates, were correlated with patient risk factors. RESULTS A BREAST-Q was posted to 199/248 LDMF patients in 2018, (excluding 49 patients due to death, reduced cognitive function and incorrect coding) of whom 77 patients responded (38.7%). In 188 cases (representing 208 LDMFs), surgical outcomes were assessable. Median time since LDMF surgery was 7 years (range 2-12). Rates of acute implant loss were 9/139 (6.4%), flap necrosis 7/208 (3.4%), shoulder stiffness 4/208 (1.9%), chronic pain 24/208 (11.5%) and unplanned revision surgery 13/208 (7%). Median satisfaction levels were high with 78% of patients satisfied with treatment outcomes, 65% of patients satisfied with their breasts, 71% of patients satisfied psychosocially and 75% of patients satisfied with their chest. Receipt of radiotherapy was not associated with a higher risk of flap necrosis or capsule formation. CONCLUSION Long-term follow-up of a large cohort of LDMF reconstruction patients show relatively low levels of adverse events and unplanned revision surgery and high patient satisfaction, which demonstrates how temporally robust the technique is. With the rise in popularity of acellular dermal matrix reconstructions, the LDMF has relatively fallen out of favour but its potential in primary and delayed reconstruction is demonstrated.
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Affiliation(s)
- G Wattoo
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - S Nayak
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - S Khan
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - J Morgan
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom; Department of Oncology and Metabolism, E Floor, Medical School, Beech Hill Road, University of Sheffield, S10 2RX, United Kingdom
| | - H Hocking
- Clinical Audit Department, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - E MacInnes
- Leeds Teaching Hospitals NHS FT, Leeds, United Kingdom
| | - K M Kolar
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - C Rogers
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - O Olubowale
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - K Rigby
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - N H Kazzazi
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom
| | - L Wyld
- Jasmine Breast Unit, Doncaster and Bassetlaw Teaching Hospitals NHS FT, Armthorpe Road, Doncaster, United Kingdom; Department of Oncology and Metabolism, E Floor, Medical School, Beech Hill Road, University of Sheffield, S10 2RX, United Kingdom.
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Quality of life outcomes following breast surgery in older women with operable breast cancer: Analysis of the Bridging the Age Gap study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30598-0] [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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Wyld L, Reed M, Collins K, Burton M, Lifford K, Edwards A, Ward S, Holmes G, Morgan J, Bradburn M, Walters S, Ring A, Martin C, Shrestha A, Nettleship A, Brown M, Richards P, Todd A, Harder H, Brain K. Cluster randomised trial to evaluate the clinical benefits of decision support interventions for older women with operable breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30545-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Morgan J, Holmes G, Martin C, Ward S, Walters S, Cheung K, Audisio R, Reed M, Wyld L. Variation in the rates of surgical treatment of older women with operable breast cancer between UK breast units: Analysis of the Bridging the Age Gap Study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Scaglioni D, Catapano F, Ellis M, Torelli S, Chambers D, Feng L, Husayni S, Malhotra J, Harriman S, Koenig E, Dugar A, Steiner D, Morgan J, Phadke R, Muntoni F. DMD – BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.126] [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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Falzarano M, Spedicato N, Rossi R, Dani RE, Margutti A, Morgan J, Ala P, Torelli S, Montanaro F, Muntoni F, Ferlini A. DMD – BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.127] [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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Battisti N, Herbert E, Bradburn M, Morgan J, Wyld L, Ring A. 190P Impact of chemotherapy for early stage breast cancer on quality of life in older adults: Results from 2811 women enrolled in the Bridging the Age Gap study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Kasradze A, Shadaker S, Kuchuloria T, Gamkrelidze A, Nasrullah M, Gvinjilia L, Baliashvili D, Chitadze N, Kodani M, Tejada-Strop A, Drobeniuc J, Hagan L, Morgan J, Imnadze P, Averhoff F. The burden and epidemiology of hepatitis B and hepatitis D in Georgia: findings from the national seroprevalence survey. Public Health 2020; 185:341-347. [PMID: 32738575 DOI: 10.1016/j.puhe.2020.06.024] [Citation(s) in RCA: 4] [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: 04/30/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The burden of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections is unknown in Georgia. This analysis describes the prevalence of hepatitis B and coinfection with HDV and the demographic characteristics and risk factors for persons with HBV infection in Georgia. STUDY DESIGN This is a cross-sectional seroprevalence study. METHODS A cross-sectional, nationwide survey to assess hepatitis B prevalence among the general adult Georgian population (age ≥18 years) was conducted in 2015. Demographic and risk behavior data were collected. Blood specimens were screened for anti-hepatitis B core total antibody (anti-HBc). Anti-HBc-positive specimens were tested for hepatitis B surface antigen (HBsAg). HBsAg-positive specimens were tested for HBV and HDV nucleic acid. Nationally weighted prevalence estimates and adjusted odds ratios (aORs) for potential risk factors were determined for anti-HBc and HBsAg positivity. RESULTS The national prevalence of anti-HBc and HBsAg positivity among adults were 25.9% and 2.9%, respectively. Persons aged ≥70 years had the highest anti-HBc positivity (32.7%), but the lowest HBsAg positivity prevalence (1.3%). Anti-HBc positivity was associated with injection drug use (aOR = 2.34; 95% confidence interval [CI] = 1.46-3.74), receipt of a blood transfusion (aOR = 1.68; 95% CI = 1.32-2.15), and sex with a commercial sex worker (aOR = 1.46; 95% CI = 1.06-2.01). HBsAg positivity was associated with receipt of a blood transfusion (aOR = 2.72; 95% CI = 1.54-4.80) and past incarceration (aOR = 2.72; 95% CI = 1.25-5.93). Among HBsAg-positive persons, 0.9% (95% CI = 0.0-2.0) were HDV coinfected. CONCLUSIONS Georgia has an intermediate to high burden of hepatitis B, and the prevalence of HDV coinfection among HBV-infected persons is low. Existing infrastructure for hepatitis C elimination could be leveraged to promote hepatitis B elimination.
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Affiliation(s)
- A Kasradze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - S Shadaker
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA.
| | | | - A Gamkrelidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - M Nasrullah
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | | | - D Baliashvili
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - N Chitadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - M Kodani
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - A Tejada-Strop
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - J Drobeniuc
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - L Hagan
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - J Morgan
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
| | - P Imnadze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - F Averhoff
- Centers for Disease Control and Prevention, Division of Viral Hepatitis National Center for HIV, Hepatitis, STD&TB Prevention, Atlanta, USA
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Orjingene O, Morgan J. Effectiveness of Community Based Interventions in Reducing Maternal Mortality in Sub-Saharan Africa: A Systematic Review. ACTA ACUST UNITED AC 2020. [DOI: 10.9734/ijtdh/2020/v41i930314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background & Aim: Maternal mortality ratio for sub- Saharan Africa in 2010 was estimated to be about 600 per 100,000 live births, which is approximately higher than what is obtainable in advanced countries. To this end, several community-based interventions have been put in place by governments and developmental partners in the region to address the situation. This review aimed to seek evidence from existing literature on the level of effectiveness of these interventions in improving maternal health outcomes in the region. The literature search process resulted in retrieval of six full text studies that were written in English, published between 2000 and 2019 and were focused on intervention based at the community level which resulted in the reduction of maternal deaths in some sub-Saharan African countries. The Critical Appraisal Skills Programme (CASP) tool was used to critically review retrieved literature.
Findings: Findings from the articles reviewed show that community based interventions with direct reduction on maternal mortality were implemented in Ethiopia and Nigeria and were effective since maternal mortality declined by 64% and 43.5% respectively. Other community based interventions did not directly address reduction in maternal mortality but rather addressed leading causes of maternal mortality such as home and unskilled birth attendance, low Ante-Natal Care (ANC) & Post-Natal Care (PNC) services utilization, Eclampsia, delay in accessing care and Postpartum Hemorrhage (PPH). Such interventions were implemented in Nigeria, Zambia, Tanzania and the Democratic Republic of Congo and were proved to be effective in reducing maternal mortality.
Conclusions and Recommendations: Based on the literatures reviewed, it was concluded that community based interventions were effective in reducing maternal mortality in Sub-Saharan Africa. The following recommendations were made based on gaps observed in the implementation of some interventions. Introduction of emergency transport scheme in countries where they do not exist as despite the existence of maternity waiting homes and dedicated maternity ambulances in Zambia, many expectant mothers still had difficulty reaching the health facilities in time to deliver, Engagement and training of more health workers so as to avoid human resources challenges that may be associated with increased demand for health facility deliveries.
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Yao J, Joshi S, Morgan J, Lee M. 441 An Atypical Case of Marantic Endocarditis in Undiagnosed Antiphospholipid Syndrome. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.448] [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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Scaglioni D, Catapano F, Ellis M, Torelli S, Chambers D, Feng L, Frank D, Nair A, Harriman S, Dugar A, Morgan J, Phadke R, Muntoni F. P.146Novel high-throughput digital analysis to quantify the amount of functional sarcolemmal dystrophin and myofibre regeneration in Duchenne muscular dystrophy clinical trial samples (exon 53 skipping with golodirsen). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.202] [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: 10/25/2022]
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Catapano F, Scaglioni D, Maresh K, Selby V, Ala P, Domingos J, Ricotti V, Phillips L, van der Holst M, Servais L, Seferian A, de Groot I, Krom Y, Voit T, Verschuuren J, Niks E, Straub V, Morgan J, Muntoni F. P.144A cross sectional and longitudinal miRNA profiling study identified a set of novel free-circulating and exosomal miRNAs dysregulated in plasma from Duchenne muscular dystrophy patients. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.200] [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: 10/25/2022]
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Morgan J, Potter S, Sharma N, McIntosh SA, Coles CE, Dodwell D, Elder K, Gaunt C, Lyburn ID, McIntosh SA, Morgan J, Paramasivan S, Pinder S, Pirrie S, Potter S, Rea D, Roberts T, Sharma N, Stobart H, Taylor-Phillips S, Wallis M, Wilcox M. The SMALL Trial: A Big Change for Small Breast Cancers. Clin Oncol (R Coll Radiol) 2019; 31:659-663. [PMID: 31160130 DOI: 10.1016/j.clon.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/16/2019] [Accepted: 05/13/2019] [Indexed: 11/16/2022]
Affiliation(s)
- J Morgan
- University of Sheffield, FU32, The Medical School, Sheffield, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK; Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - N Sharma
- Breast Unit, St James Hospital, Leeds, UK
| | - S A McIntosh
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK.
| | | | | | - K Elder
- Western General Hospital, Edinburgh, UK
| | - C Gaunt
- CRCTU, University of Birmingham, UK
| | | | | | | | | | | | - S Pirrie
- CRCTU, University of Birmingham, UK
| | | | - D Rea
- University of Birmingham, UK
| | | | - N Sharma
- St James's University Hospital, Leeds, UK
| | - H Stobart
- Independent Cancer Patients' Voice, UK
| | | | - M Wallis
- Addenbrooke's Hospital, Cambridge, UK
| | - M Wilcox
- Independent Cancer Patients' Voice, UK
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King JB, Prigge MBD, King CK, Morgan J, Weathersby F, Fox JC, Dean DC, Freeman A, Villaruz JAM, Kane KL, Bigler ED, Alexander AL, Lange N, Zielinski B, Lainhart JE, Anderson JS. Generalizability and reproducibility of functional connectivity in autism. Mol Autism 2019; 10:27. [PMID: 31285817 PMCID: PMC6591952 DOI: 10.1186/s13229-019-0273-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 04/24/2019] [Indexed: 12/18/2022] Open
Abstract
Background Autism is hypothesized to represent a disorder of brain connectivity, yet patterns of atypical functional connectivity show marked heterogeneity across individuals. Methods We used a large multi-site dataset comprised of a heterogeneous population of individuals with autism and typically developing individuals to compare a number of resting-state functional connectivity features of autism. These features were also tested in a single site sample that utilized a high-temporal resolution, long-duration resting-state acquisition technique. Results No one method of analysis provided reproducible results across research sites, combined samples, and the high-resolution dataset. Distinct categories of functional connectivity features that differed in autism such as homotopic, default network, salience network, long-range connections, and corticostriatal connectivity, did not align with differences in clinical and behavioral traits in individuals with autism. One method, lag-based functional connectivity, was not correlated to other methods in describing patterns of resting-state functional connectivity and their relationship to autism traits. Conclusion Overall, functional connectivity features predictive of autism demonstrated limited generalizability across sites, with consistent results only for large samples. Different types of functional connectivity features do not consistently predict different symptoms of autism. Rather, specific features that predict autism symptoms are distributed across feature types. Electronic supplementary material The online version of this article (10.1186/s13229-019-0273-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jace B King
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA.,2Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT 84112 USA
| | - Molly B D Prigge
- 3Department of Pediatrics, University of Utah, Salt Lake City, UT 84108 USA.,4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Carolyn K King
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA.,3Department of Pediatrics, University of Utah, Salt Lake City, UT 84108 USA
| | - Jubel Morgan
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA.,3Department of Pediatrics, University of Utah, Salt Lake City, UT 84108 USA.,4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Fiona Weathersby
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA.,5Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112 USA
| | - J Chancellor Fox
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA
| | - Douglas C Dean
- 4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Abigail Freeman
- 4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA.,6Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719 USA
| | | | - Karen L Kane
- 4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Erin D Bigler
- 7Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT 84604 USA
| | - Andrew L Alexander
- 4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA.,6Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719 USA.,8Department of Medical Physics, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Nicholas Lange
- 9McLean Hospital and Department of Psychiatry, Harvard University, Cambridge, MA 02478 USA
| | - Brandon Zielinski
- 3Department of Pediatrics, University of Utah, Salt Lake City, UT 84108 USA.,10Department of Neurology, University of Utah, Salt Lake City, UT 84132 USA
| | - Janet E Lainhart
- 4Waisman Center, University of Wisconsin-Madison, Madison, WI 53705 USA.,6Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53719 USA
| | - Jeffrey S Anderson
- 1Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84108 USA.,2Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City, UT 84112 USA.,5Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112 USA
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Abstract
Infant mental health (IMH) is a growing area of practice for health, education and social care practitioners, as links are increasingly made between experiences in the early years and subsequent child development, mental health and well-being. It is unclear how parents perceive IMH and use knowledge relating to IMH with their children. We conducted a systematic review, the aim of which was to determine parents' perceptions of IMH and how they utilize this knowledge with their infants. We undertook a search of relevant databases and journals and from an initial list of 4147 potential papers, identified 16 for the review. Original data were extracted and presented in a table, and the content of all papers was analysed thematically and presented in narrative form. Three main themes emerged from the available research: knowledge and understanding of child development, influences of society and culture, and interpretation of emotions and expressions. Our results indicate that research is limited in terms of parental perspectives of IMH and how they obtain and use this knowledge. Further research is needed to investigate this topic to maximize mental well-being in infancy and later life.
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Affiliation(s)
- Jane Peters
- 1 School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK
| | - H Skirton
- 1 School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, Devon, UK
| | - J Morgan
- 2 Department of Psychology, Social Work and Counselling, Faculty of Education and Health, University of Greenwich, London, UK
| | - M Clark
- 3 Institute of Clinical Sciences, College of Medical and Dental Sciences, School of Nursing, University of Birmingham, Birmingham, UK
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Chou B, Lamba H, Long G, Parikh V, Chatterjee S, George J, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J. Outcomes of LVAD Implantation in Ischemic versus Nonischemic Cardiomyopathy. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Critsinelis A, Lamba H, Chatterjee S, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J. Prediction of GIB Using R2 CHA2DS2 VASc Risk Score. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Critsinelis A, Kraus J, Lamba H, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J. Gastrointestinal Bleeding Ceases after Heart Transplantation in Patients Bridged on Continuous-Flow LVAD Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.474] [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: 10/27/2022] Open
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Critsinelis A, Lamba H, Oberton S, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J. INTERMACS Profile Does Not Predict Required Flow Rate of CF-LVAD at Discharge. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lamba H, Kim M, Hart L, Chou B, Rao C, Chatterjee S, Sattee S, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J. Different Risk Factors for Ischemic and Hemorrhagic Stroke on Continuous Flow Left Ventricular Assist Device Support. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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36
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Kim M, Lamba H, Miller R, George J, Sattee S, Cheema F, Civitello A, Delgado R, Nair A, Shafii A, Loor G, Rosengart T, Frazier O, Morgan J, Chatterjee S. Predictors and Impact of Vasoplegia after Continuous-Flow Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.297] [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] Open
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37
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La A, Nguyen T, Tran K, Sauble E, Tu D, Gonzalez A, Kidane TZ, Soriano C, Morgan J, Doan M, Tran K, Wang CY, Knutson MD, Linder MC. Mobilization of iron from ferritin: new steps and details. Metallomics 2019; 10:154-168. [PMID: 29260183 DOI: 10.1039/c7mt00284j] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Much evidence indicates that iron stored in ferritin is mobilized through protein degradation in lysosomes, but concerns about this process have lingered, and the mechanistic details of its aspects are lacking. In the studies presented here, 59Fe-labeled ferritin was induced by preloading hepatic (HepG2) cells with radiolabeled Fe. Placing these cells in a medium containing desferrioxamine resulted in the loss of ferritin-59Fe, but adding high concentrations of reducing agents or modulating the internal GSH concentration failed to alter the rates of ferritin-59Fe release. Confocal microscopy showed that Fe deprivation increased the movement of ferritin into lysosomes and hyperaccumulation was observed when lysosomal proteolysis was inhibited. It also resulted in the rapid movement of DMT1 to lysosomes, which was inhibited by bafilomycin. Ferrihydrite crystals isolated from purified rat liver/spleen ferritin were solubilized at pH 5 and 7 by GSH, ascorbate, citrate and lysosomal fluids obtained from livers and J774a.1 macrophages. The inhibition of DMT1/Nramp2 and siRNA knockdown of Nramp1 each reduced the transfer of 59Fe from lysosomes to the cytosol; and hepatocyte-specific knockout of DMT1 in mice prevented the release of Fe from the liver responding to EPO treatment, but did not inhibit lysosomal ferritin degradation. We conclude that ferritin-Fe mobilization does not occur through changes in cellular concentrations of reducing/chelating agents but by the coordinated movement of ferritin and DMT1 to lysosomes, where the ferrihydrite crystals exposed by ferritin degradation dissolve in the lysosomal fluid, and the reduced iron is transported back to the cytosol via DMT1 in hepatocytes, and by both DMT1 and Nramp1 in macrophages, prior to release into the blood or storage in ferritin.
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Affiliation(s)
- A La
- Department of Chemistry and Biochemistry, California State University, Fullerton, CA 92834-6866, USA.
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Lee MJ, Morgan J, Watson AJM, Jones GL, Brown SR. A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials. Tech Coloproctol 2019; 23:33-41. [PMID: 30725242 PMCID: PMC6394714 DOI: 10.1007/s10151-019-01936-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is a lack of standardised outcomes for haemorrhoidal disease making comparison between trials difficult. A need for a very well validated severity score is essential to facilitate meta-analysis of comparative studies, enabling evidence-based clinical practice. METHODS The Hubble trial provides a large cohort of patients with haemorrhoidal disease randomised to rubber band ligation (RBL) or haemorrhoidal artery ligation. The haemorrhoid severity score (HSS) was collected on each patient at baseline, 6 weeks and 1 year after intervention. This allows for the responsiveness of the HSS instrument to be examined and compared with a more specific instrument, the Vaizey incontinence score (also collected). Responsiveness was tested using four methods (effect size, standardised response means (SRM), significance of change, and responsiveness statistic). RESULTS The four tests of responsiveness demonstrated that the HSS was more responsive to changes in the patient's health status following both of the interventions compared to the Vaizey questionnaire. For example, between baseline and 6 weeks, the RBL intervention effect size scores and SRM calculations indicated a non-significant small amount of change (0.20 and 0.16 respectively). However, using the HSS, the effect size and SRM demonstrated a large magnitude of change (1.12 and 1.01, respectively) which was significant. Similar results were observed at 1 year. Significance of change scores and the index of responsiveness were also higher for the HSS questionnaire than the Vaizey across both treatment modalities. CONCLUSIONS The HSS is a highly responsive tool for the detection of changes in haemorrhoid symptoms. It should form an essential patient-reported outcome tool for future studies on haemorrhoidal disease.
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Affiliation(s)
- M J Lee
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK
| | - J Morgan
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A J M Watson
- Department of Colorectal Surgery, Raigmore Hospital, Inverness, UK
| | - G L Jones
- Department of Psychology, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - S R Brown
- Department of Surgery, Sheffield Teaching Hospitals, Northern General Hospital, Sheffield, UK.
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King JB, Prigge MBD, King CK, Morgan J, Dean DC, Freeman A, Villaruz JAM, Kane KL, Bigler ED, Alexander AL, Lange N, Zielinski BA, Lainhart JE, Anderson JS. Evaluation of Differences in Temporal Synchrony Between Brain Regions in Individuals With Autism and Typical Development. JAMA Netw Open 2018; 1:e184777. [PMID: 30646371 PMCID: PMC6324391 DOI: 10.1001/jamanetworkopen.2018.4777] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Despite reports of widespread but heterogeneous atypicality of functional connectivity in individuals with autism, little is known regarding the temporal dynamics of functional brain connections and how they relate to autistic traits. OBJECTIVE To investigate differences in temporal synchrony between brain regions in individuals with autism and those with typical development. DESIGN, SETTING, AND PARTICIPANTS This cohort study, conducted at the University of Utah, included 90 adolescent and adult male participants. A larger sample from the multisite Autism Brain Imaging Data Exchange (ABIDE) was also used as a replication sample. The study includes data acquired between December 2016 and April 2018. Aggregate data included in the replication sample were released to the public in August 2012 (ABIDE I) and June 2016 (ABIDE II). Data analysis were conducted between January 2018 and April 2018. EXPOSURES Male individuals diagnosed as having autism (n = 52) and typically developing male individuals (n = 38). MAIN OUTCOMES AND MEASURES Long duration (30 minutes/individual) of multiband, multiecho functional magnetic resonance imaging was acquired to estimate functional connectivity between brain regions. Sustained connectivity, a measure of functional connectivity duration, as well as lagged temporal dynamics related to functional connectivity, were compared between groups for 361 gray matter regions of interest and a 17-network parcellation. Lagged findings were replicated in the larger ABIDE sample (n = 1402). Sustained connectivity findings were also associated with behavioral and cognitive variables. RESULTS In 52 males with autism (mean [SD] age, 27.73 [8.66] years) and 38 control males with typical development (mean [SD] age, 27.09 [7.49] years), increases in both sustained and functional connectivity at several lags were found in individuals with autism compared with the control group. Group differences in functional connectivity were replicated in the larger ABIDE data set at a 6-second lag. Measures of symptom severity in individuals with autism were positively associated with sustained connectivity values. In the control group, sustained connectivity was negatively associated with cognitive processing. A replication sample (n = 1402) composed of 579 individuals with autism (80 female and 499 male; mean [SD] age, 15.08 [6.89] years) and 823 in the control group (211 female and 612 male; mean [SD] age, 15.06 [6.79] years) from the ABIDE data set was also analyzed. CONCLUSIONS AND RELEVANCE Whereas the magnitude of functional connectivity in autism is variable across brain regions, participant samples, and development, prolonged temporal synchrony of functional connections is reproducibly observed in autism, suggesting a potential mechanism for core symptoms.
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Affiliation(s)
- Jace B. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City
| | - Molly B. D. Prigge
- Department of Pediatrics, University of Utah, Salt Lake City
- Waisman Center, University of Wisconsin–Madison, Madison
| | - Carolyn K. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Jubel Morgan
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
- Department of Pediatrics, University of Utah, Salt Lake City
- Waisman Center, University of Wisconsin–Madison, Madison
| | | | - Abigail Freeman
- Waisman Center, University of Wisconsin–Madison, Madison
- Department of Psychiatry, University of Wisconsin–Madison, Madison
| | | | - Karen L. Kane
- Waisman Center, University of Wisconsin–Madison, Madison
- Department of Psychiatry, University of Wisconsin–Madison, Madison
| | - Erin D. Bigler
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, Utah
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin–Madison, Madison
- Department of Psychiatry, University of Wisconsin–Madison, Madison
- Department of Medical Physics, University of Wisconsin–Madison, Madison
| | - Nicholas Lange
- McLean Hospital and Department of Psychiatry, Harvard University, Cambridge, Massachusetts
| | - Brandon A. Zielinski
- Department of Pediatrics, University of Utah, Salt Lake City
- Department of Neurology, University of Utah, Salt Lake City
| | - Janet E. Lainhart
- Waisman Center, University of Wisconsin–Madison, Madison
- Department of Psychiatry, University of Wisconsin–Madison, Madison
| | - Jeffrey S. Anderson
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City
- Interdepartmental Program in Neuroscience, University of Utah, Salt Lake City
- Department of Bioengineering, University of Utah, Salt Lake City
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Thompson A, Roberts C, Edwards A, Morgan J. Outpatient removal of ureteric stents in renal transplant patients improves patient outcomes. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.517] [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: 10/28/2022]
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Nanduri SA, Metcalf BJ, Arwady MA, Edens C, Lavin MA, Morgan J, Clegg W, Beron A, Albertson JP, Link-Gelles R, Ogundimu A, Gold J, Jackson D, Chochua S, Stone N, Van Beneden C, Fleming-Dutra K, Beall B. Prolonged and large outbreak of invasive group A Streptococcus disease within a nursing home: repeated intrafacility transmission of a single strain. Clin Microbiol Infect 2018; 25:248.e1-248.e7. [PMID: 29783026 DOI: 10.1016/j.cmi.2018.04.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 12/11/2017] [Revised: 04/19/2018] [Accepted: 04/30/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Multiple invasive group A Streptococcus (GAS) infections were reported to public health by a skilled nursing facility (facility A) in Illinois between May 2014 and August 2016. Cases continued despite interventions including antibiotic prophylaxis for all residents and staff. Two other geographically close facilities reported contemporaneous outbreaks of GAS. We investigated potential reasons for ongoing transmission. METHODS We obtained epidemiologic data from chart review of cases and review of facility and public health records from previous investigations into the outbreak. Infection control practices at facility A were observed and evaluated. Whole genome sequencing followed by phylogenetic analysis was performed on available isolates from the three facilities. RESULTS From 2014 to 2016, 19 invasive and 60 noninvasive GAS infections were identified at facility A occurring in three clusters. Infection control evaluations during clusters 2 and 3 identified hand hygiene compliance rates of 14% to 25%, appropriate personal protective equipment use in only 33% of observed instances, and deficient wound-care practices. GAS isolates from residents and staff of all three facilities were subtype emm89.0; on phylogenetic analysis, facility A isolates were monophyletic and distinct. CONCLUSIONS Inadequate infection control and improper wound-care practices likely led to this 28-month-long outbreak of severe infections in a skilled nursing facility. Whole genome sequencing and phylogenetic analysis suggested that intrafacility transmission of a single highly transmissible GAS strain was responsible for the outbreak in facility A. Integration of genomic epidemiology tools with traditional epidemiology and infection control assessments was helpful in investigation of a facility-wide outbreak.
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Affiliation(s)
- S A Nanduri
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - B J Metcalf
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M A Arwady
- Chicago Department of Public Health, Chicago, IL, USA
| | - C Edens
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA; National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M A Lavin
- Lavin Consulting LLC, San Francisco, CA, USA
| | - J Morgan
- Illinois Department of Public Health, Springfield, IL, USA
| | - W Clegg
- Chicago Department of Public Health, Chicago, IL, USA
| | - A Beron
- Illinois Department of Public Health, Springfield, IL, USA
| | - J P Albertson
- Illinois Department of Public Health, Springfield, IL, USA
| | - R Link-Gelles
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Ogundimu
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Gold
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - D Jackson
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S Chochua
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - N Stone
- National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - C Van Beneden
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - K Fleming-Dutra
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Beall
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Lamba H, Cheema F, Alnajar A, Morgan J, Loor G, Rosengart T, Letsou G, Frazier O. Is Pre-operative Dialysis a Contraindication to Continuous-flow Left Ventricular Assist Device (CF-LVAD) Implantation? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.733] [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: 10/17/2022] Open
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Lamba H, Marcano J, Kurihara C, Kawabori M, Sugiura T, Santiago A, Cheema F, Alnajar A, Civatello A, Delgado R, Simpson L, Nair A, Letsou G, Ghanta R, Rosengart T, Frazier O, Morgan J, George J, Chatterjee. S. Extra-Corporeal Membrane Oxygenation (ECMO) as a Bridge to A Long-Term, Implantable Left Ventricular Assist Device. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.088] [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: 10/17/2022] Open
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O’Callaghan B, Hanna M, Morgan J, Houlden H, Madej M. In vitro modelling of mitochondrial disease using human induced pluripotent stem cell (hIPSC) derived myotubes harbouring mtDNA mutations. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30386-9] [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: 11/29/2022]
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Santiago A, Lamba H, Alnajar A, Cheema F, Hyak J, Conyer R, Kim M, Chou B, Nair A, Oberton S, Ghanta R, George J, Taimeh Z, Civatello A, Frazier O, Morgan J. Evaluation of the CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 Risk Assessment Scores in Continuous Flow LVADs. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Catapano F, Domingos J, Perry M, Ricotti V, Phillips L, Servais L, de Groot I, Niks E, Verschuuren J, Straub V, Voit T, Morgan J, Muntoni F. Downregulation of miR-29 and miR-23 in urine of Duchenne muscular dystrophy patients. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30344-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Lamba H, Rubio F, Santiago A, Alnajar A, Cheema F, Civitello A, Delgado R, Simpson L, Ghanta R, Rosengart T, Frazier O, Morgan J, Chatterjee S. Socioeconomic Disparities Do Not Impact Outcomes After Continuous Flow Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.994] [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: 11/30/2022] Open
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Letsou G, Musfee F, Cheema F, Lee A, Loor G, Morgan J, Rosengart T, Frazier O. Heterotopic Cardiac Transplantation: Time for Another Look? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tyrer P, Gordon F, Nourmand S, Lawrence M, Curran C, Southgate D, Oruganti B, Tyler M, Tottle S, North B, Kulinskaya E, Kaleekal JT, Morgan J. Controlled comparison of two crisis resolution and home treatment teams. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.108.023077] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Aims and methodTo compare an existing crisis resolution service with a new crisis resolution team (CRT) in Wales. The impact of the new team was measured by changes in bed days and admissions. A random sample of patients from each service was assessed for service satisfaction, social functioning and quality of life after first presentation.ResultsThe total number of bed days was reduced following the introduction of the new CRT (27.3%). The frequency and duration of compulsory admissions increased by 31% in the CRT between the first and second years and by 7% in the control service, offset by a greater reduction in informal admissions in the CRT (23.5%) compared with the control group (13.3%); overall bed usage was unchanged. Service satisfaction, social functioning and quality of life showed no important differences between the services.Clinical implicationsCrisis resolution teams may reduce informal admissions in the short term but at the cost of more compulsory admissions later.
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Bennett TA, Morgan J, Timor-Tritsch IE, Dolin C, Dziadosz M, Tsai M. Fifth recurrent Cesarean scar pregnancy: observations of a case and historical perspective. Ultrasound Obstet Gynecol 2017; 50:658-660. [PMID: 28295733 DOI: 10.1002/uog.17461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 01/31/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Affiliation(s)
- T-A Bennett
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University Langone Medical Center, New York, NY, USA
| | - J Morgan
- New York University School of Medicine, New York, NY, USA
| | - I E Timor-Tritsch
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University Langone Medical Center, New York, NY, USA
| | - C Dolin
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York University Langone Medical Center, New York, NY, USA
| | - M Dziadosz
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - M Tsai
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
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