1
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Dawson R, Wands DIF, Logan M, Bremner G, Efklides S, Benn L, Henderson P, Grant H, Meredith J, Armstrong K, Wilson DC, Gerasimidis K, Alex G, Russell RK. Comparing Effectiveness of a Generic Oral Nutritional Supplement With Specialized Formula in the Treatment of Active Pediatric Crohn's Disease. Inflamm Bowel Dis 2022; 28:1859-1864. [PMID: 35259266 DOI: 10.1093/ibd/izac039] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Exclusive enteral nutrition (EEN) is the recommended induction treatment of mild to moderate active pediatric Crohn's disease (CD). This study compared outcomes of 2 proprietary polymeric formulas. Treatment effectiveness was examined along with practical aspects of formula delivery and differences in estimated treatment costs. METHODS Data were retrospectively collected from patients with CD who received a generic oral nutritional supplement (Fortisip) across 2 centers (RCH, Melbourne and RHSC, Edinburgh). This was compared with a prospective cohort (RHC, Glasgow) that used a specialized formula (Modulen IBD). The data collected included patient demographics, remission rates, biochemical markers, administration method, and anthropometrics. The estimated treatment cost was performed by comparing price per kcal between each formula. RESULTS One hundred seventy-one patients were included (106 Fortisip, 65 Modulen IBD, 70 female; median age 13.3 yrs). No difference was demonstrated in remission rate (Fortisip n = 67 of 106 [63%] vs Modulen IBD n = 41 of 64 [64%], P = .89), nonadherence rate (Fortisip n = 7 of 106 [7%] vs Modulen IBD 3 of 64 [5%], P = .57) or method of administration (NGT Fortisip use n = 16 of 106 [12%] vs Modulen IBD 14 of 65 [22%]; P = .31). There was no difference in reduction of biochemical disease markers between the groups (C-reactive protein , P = .13; erythrocyte sedimentation rate, P = .49; fecal calprotectin, P = .94). However, there was a cost-saving of around £500/patient/course if the generic oral nutritional supplement was used. CONCLUSIONS The generic oral nutritional supplement and specialized formulas both had similar clinical effectiveness in induction of remission in pediatric CD. However, there is considerable cost-saving when using a generic oral nutritional supplement.
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Affiliation(s)
- R Dawson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - D I F Wands
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Department of Gastroenterology, Hepatology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - M Logan
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G Bremner
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - S Efklides
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - L Benn
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - P Henderson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
| | - H Grant
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - J Meredith
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - K Armstrong
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
| | - D C Wilson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
| | - K Gerasimidis
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - G Alex
- Department of Gastroenterology, Hepatology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - R K Russell
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children & Young people, Edinburgh, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
- Child Life and Health, University of Edinburgh, Royal Hospital for Children & Young people, Edinburgh, UK
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2
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Abohashem S, Osborne M, Choi K, Liu Z, Zureigat H, Mezue K, Gharios C, Armstrong K, Smoller J, Tawakol A. Genetic sensitivity to stress modifies the relationship between socioeconomic status and major adverse cardiovascular events. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2265] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Lower socioeconomic status (SES) associates with major adverse cardiovascular events (MACE), in part through stress-related neural pathways that elicit inflammation. However, it is unknown whether genes that heighten stress sensitivity modify the association between lower SES and MACE.
Purpose
To assess whether genetic predisposition to stress sensitivity would modify the link between low SES and MACE
Methods
13,154 participants (median age 60 yrs, 41% male) from the Mass General Brigham Biobank were studied. A polygenic risk score for neuroticism (nPRS) was used as a measure of genetic predisposition to stress sensitivity (GSS). Using home addresses, SES was evaluated as median income and area deprivation index (ADI). Stress-related neural activity (SNA) was assessed (N=978) using validated FDG PET/CT imaging methods. MACE, and cardiovascular disease (CVD) risk factors were evaluated. Mediation analyses were employed.
Results
Over median (IQR) 4.9 (4.1–5.9) years of follow-up, 1,030 (7.8%) individuals had MACE. Lower SES (as low income, or alternatively as high ADI) associated with incident MACE among individuals with higher GSS (nPRS ≥ median) but not lower GSS (Fig. 1A and 1B). Similarly, lower SES associated with SNA among individuals with higher but not lower GSS (Fig. 1C). SNA mediated the relationship between income and MACE (P<0.05**) among those with higher GSS.
Conclusions
Genetic predisposition to stress sensitivity appears to heighten CVD risk associated with lower SES. This relationship may result from differential activation of stress-related neural pathways.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Abohashem
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - M Osborne
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - K Choi
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - Z Liu
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - H Zureigat
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - K Mezue
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - C Gharios
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - K Armstrong
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - J Smoller
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
| | - A Tawakol
- Massachusetts General Hospital - Harvard Medical School , Boston , United States of America
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3
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Rodenas-Alesina E, Aleksova N, Armstrong K, Kozuszko S, Moayedi Y, Duero-Posada J, McDonald M, Ross H, Dipchand A. CARDIAC ALLOGRAFT VASCULOPATHY AND SURVIVAL IN PEDIATRIC HEART TRANSPLANT RECIPIENTS TRANSITIONED TO ADULT CARE. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.106] [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: 11/02/2022] Open
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4
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Ward J, Gill S, Armstrong K, Fogarty T, Tan D, Scott A, Yahya A, Dhaliwal S, Jacques A, Tang C. PO-1384 Simethicone use to Reduce Rectal Variability During Prostate Cancer Radiotherapy, a Randomised Trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03348-5] [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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5
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Lynch A, Ahuja S, Miron A, Nakano S, Howard T, Villa C, Armstrong K, Kaufman B, Gardin L, Whitehill R, Parent J, Godown J, Henderson H, Aziz P, Colan S, Seshadri B, Kantor P, Russell M, Lal A, Butts R, Richmond M, Conway J, Weintraub R, Rossano J, Mital S. Sudden Cardiac Death and ICD Use in Rasopathy-Associated Hypertrophic Cardiomyopathy. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1821] [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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6
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Armstrong K, Larson C, Asfour H, Ransbury T, Sarvazyan N. A Percutaneous Catheter for In Vivo Hyperspectral Imaging of Cardiac Tissue: Challenges, Solutions and Future Directions. Cardiovasc Eng Technol 2020; 11:560-575. [PMID: 32666326 PMCID: PMC7530025 DOI: 10.1007/s13239-020-00476-w] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/30/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Multiple studies have shown that spectral analysis of tissue autofluorescence can be used as a live indicator for various pathophysiological states of cardiac tissue, including ischemia, ablation-induced damage, or scar formation. Yet today there are no percutaneous devices that can detect autofluorescence signals from inside a beating heart. Our aim was to develop a prototype catheter to demonstrate the feasibility of doing so. METHODS AND RESULTS Here we summarize technical solutions leading to the development of a percutaneous catheter capable of multispectral imaging of intracardiac surfaces. The process included several iterations of light sources, optical filtering, and image acquisition techniques. The developed system included a compliant balloon, 355 nm laser irradiance, a high-sensitivity CCD, bandpass filtering, and image acquisition synchronized with the cardiac cycle. It enabled us to capture autofluorescence images from multiple spectral bands within the visible range while illuminating the endocardial surface with ultraviolet light. Principal component analysis and other spectral unmixing post-processing algorithms were then used to reveal target tissue. CONCLUSION Based on the success of our prototype system, we are confident that the development of ever more sensitive cameras, recent advances in tunable filters, fiber bundles, and other optical and computational components makes it possible to create percutaneous catheters capable of acquiring hyper or multispectral hypercubes, including those based on autofluorescence, in real-time. This opens the door for widespread use of this methodology for high-resolution intraoperative imaging of internal tissues and organs-including cardiovascular applications.
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Affiliation(s)
- Kenneth Armstrong
- Nocturnal Product Development, LLC, 8128 Renaissance Pkwy #210, Durham, NC, 27713, USA.
| | - Cinnamon Larson
- Nocturnal Product Development, LLC, 8128 Renaissance Pkwy #210, Durham, NC, 27713, USA
| | - Huda Asfour
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street NW, Washington, DC, 20037, USA
| | - Terry Ransbury
- LuxMed Systems, Inc, 124 Country Drive, Weston, MA, 02493, USA
| | - Narine Sarvazyan
- Department of Pharmacology and Physiology, The George Washington University, 2300 Eye Street NW, Washington, DC, 20037, USA.
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7
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McSweeney SM, Christou EAA, Dand N, Boalch A, Holmes S, Harries M, Palamaras I, Cunningham F, Parkins G, Kaur M, Farrant P, McDonagh A, Messenger A, Jones J, Jolliffe V, Ali I, Ardern-Jones M, Mitchell C, Burrows N, Atkar R, Banfield C, Alexandroff A, Champagne C, Cooper HL, Patel GK, Macbeth A, Page M, Bryden A, Mowbray M, Wahie S, Armstrong K, Cooke N, Goodfield M, Man I, de Berker D, Dunnil G, Takwale A, Rao A, Siah TW, Sinclair R, Wade MS, Bhargava K, Fenton DA, McGrath JA, Tziotzios C. Frontal fibrosing alopecia: a descriptive cross-sectional study of 711 cases in female patients from the UK. Br J Dermatol 2020; 183:1136-1138. [PMID: 32652611 DOI: 10.1111/bjd.19399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S M McSweeney
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - E A A Christou
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - N Dand
- Department of Medical and Molecular Genetics, King's College London, Guy's Hospital, London, SE1 9RT, UK
| | - A Boalch
- Greenwich and Lewisham NHS Foundation Trust, London, SE13 6LH, UK
| | - S Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | - F Cunningham
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | - G Parkins
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, G51 4TF, UK.,UK FFA Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K Bhargava
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - D A Fenton
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK.,UK FFA Consortium
| | - J A McGrath
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
| | - C Tziotzios
- St John's Institute of Dermatology, Guy's Hospital, London, SE1 9RT, UK
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8
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Middleton D, Armstrong K, Baba Y, Balslev H, Chayamarit K, Chung R, Conn B, Fernando E, Fujikawa K, Kiew R, Luu H, Aung MM, Newman M, Tagane S, Tanaka N, Thomas D, Tran T, Utteridge T, van Welzen P, Widyatmoko D, Yahara T, Wong K. Progress on Southeast Asia’s Flora projects. ACTA ACUST UNITED AC 2019. [DOI: 10.26492/gbs71(2).2019-02] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Travers N, Dean A, Armstrong K, Peeperkorn L, Tan M, Das A. The tolerability and efficacy of FOLFIRINOX in gastro-oesophageal carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.072] [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: 11/13/2022] Open
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10
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Dean A, Peeperkorn L, Armstrong K, De Marie A, Watanabe Y, Tan M, Travers N. Prospective evaluation of FOLFIRINOX in Neo-adjuvant treatment of gastro-oesophageal junction carcinomas. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.301] [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: 11/14/2022] Open
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11
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Armstrong K, Ward J, Hughes N, Mihai A, Blayney A, Mascott C, Kileen R, Armstrong J. Guidelines for Clinical Target Volume Definition for Perineural Spread of Major Salivary Gland Cancers. Clin Oncol (R Coll Radiol) 2018; 30:773-779. [DOI: 10.1016/j.clon.2018.08.018] [Citation(s) in RCA: 2] [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] [Received: 12/03/2017] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022]
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12
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Winkelman W, Armstrong K, Rosenblatt P. Electrostatic Precipitation: A Novel Smoke Management System for Laparoscopic Surgery. J Minim Invasive Gynecol 2018. [DOI: 10.1016/j.jmig.2018.09.718] [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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13
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Swift LM, Asfour H, Muselimyan N, Larson C, Armstrong K, Sarvazyan NA. Hyperspectral imaging for label-free in vivo identification of myocardial scars and sites of radiofrequency ablation lesions. Heart Rhythm 2017; 15:564-575. [PMID: 29246829 DOI: 10.1016/j.hrthm.2017.12.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Treatment of cardiac arrhythmias often involves ablating viable muscle tissue within or near islands of scarred myocardium. Yet, today there are limited means by which the boundaries of such scars can be visualized during surgery and distinguished from the sites of acute injury caused by radiofrequency (RF) ablation. OBJECTIVE We sought to explore a hyperspectral imaging (HSI) methodology to delineate and distinguish scar tissue from tissue injury caused by RF ablation. METHODS RF ablation of the ventricular surface of live rats that underwent thoracotomy was followed by a 2-month animal recovery period. During a second surgery, new RF lesions were placed next to the scarred tissue from the previous ablation procedure. The myocardial infarction model was used as an alternative way to create scar tissue. RESULTS Excitation-emission matrices acquired from the sites of RF lesions, scar region, and the surrounding unablated tissue revealed multiple spectral changes. These findings justified HSI of the heart surface using illumination with 365 nm UV light while acquiring spectral images within the visible range. Autofluorescence-based HSI enabled to distinguish sites of RF lesions from scar or unablated myocardium in open-chest rats. A pilot version of a percutaneous HSI catheter was used to demonstrate the feasibility of RF lesion visualization in atrial tissue of live pigs. CONCLUSION HSI based on changes in tissue autofluorescence is a highly effective tool for revealing-in vivo and with high spatial resolution-surface boundaries of myocardial scar and discriminating it from areas of acute necrosis caused by RF ablation.
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Affiliation(s)
- Luther M Swift
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Huda Asfour
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Narine Muselimyan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | | | | | - Narine A Sarvazyan
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
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14
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Szogi E, Darvell M, Freeman J, Truelove V, Palk G, Davey J, Armstrong K. Does getting away with it count? An application of stafford and warr's reconceptualised model of deterrence to drink driving. Accid Anal Prev 2017; 108:261-267. [PMID: 28923516 DOI: 10.1016/j.aap.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/03/2017] [Accepted: 08/03/2017] [Indexed: 05/05/2023]
Abstract
Drink drivers continue to be disproportionately represented in road mortalities and morbidities. Given these costs, countermeasures that effectively reduce the behaviour (and its consequences) are imperative. Research has produced inconsistent findings regarding the deterrent effects of some countermeasures on drink driving behaviour, namely legal sanctions, suggesting other factors may be more influential. This study aimed to determine which deterrence measures based on Classical Deterrence Theory and Stafford and Warr's (1993) reconceptualised model of deterrence influence the propensity to drink and drive over the legal blood alcohol content limit of 0.05. In total, 1257 Australian drivers aged from 16 to 85 years completed a questionnaire assessing their self-reported drink driving behaviour and perceptions of legal sanctions. Consistent with previous research, past experiences of direct punishment avoidance was the most significant predictor of drink driving. Additionally, perceptions of personal certainty of apprehension were a significant (albeit weak) negative predictor of drink driving. Counterintuitively, experiences of indirect punishment were predictive of self-reported drink driving. Similarly, penalty severity produced mixed results as those who considered a penalty would be severe were less likely to drink and drive. However those that considered the penalty would cause a considerable impact on their lives, were more likely to drink and drive. Taken together, these findings suggest that while the threat of apprehension and punishment may influence self-reported drink driving behaviours, committing and offence while avoiding detection is a significant influence upon ongoing offending. This paper will further elaborate on the findings in regards to developing salient and effective deterrents that produce a lasting effect.
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Affiliation(s)
- E Szogi
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
| | - M Darvell
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
| | - J Freeman
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia.
| | - V Truelove
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
| | - G Palk
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
| | - J Davey
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
| | - K Armstrong
- Queensland University of Technology (QUT),Centre for Accident Research and Road Safety - Queensland(CARRS-Q), 130 Victoria Park Road, Kelvin Grove, 4059, Australia
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15
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Ponce R, Armstrong K, Andrews K, Hensler J, Waggie K, Heffernan J, Reynolds T, Rogge M. Safety of Recombinant Human Factor XIII in a Cynomolgus Monkey Model of Extracorporeal Blood Circulation. Toxicol Pathol 2017; 33:702-10. [PMID: 16243775 DOI: 10.1080/15459620500330625] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Factor XIII (FXIII) is a thrombin-activated plasma coagulation factor critical for blood clot stabilization and longevity. Administration of exogenous FXIII to replenish depleted stores after major surgery, including cardiopulmonary bypass, may reduce bleeding complications and transfusion requirements. Thus, a model of extracorporeal circulation (ECC) was developed in adult male cynomolgus monkeys ( Macaca fascicularis) to evaluate the nonclinical safety of recombinant human FXIII (rFXIII). The hematological and coagulation profile in study animals during and after 2 h of ECC was similar to that reported for humans during and after cardiopulmonary bypass, including observations of anemia, thrombocytopenia, and activation of coagulation and platelets. Intravenous slow bolus injection of 300 U/kg (2.1 mg/kg) or 1000 U/kg (7 mg/kg) rFXIII after 2 h of ECC was well tolerated in study animals, and was associated with a dose-dependent increase in FXIII activity. No clinically significant effects in respiration, ECG, heart rate, blood pressure, body temperature, clinical chemistry, hematology (including platelet counts), or indicators of thrombosis (thrombin:antithrombin complex and D-Dimer) or platelet activation (platelet factor 4 and beta-thromboglobulin) were related to rFXIII administration. Specific examination of brain, heart, lung, liver, and kidney from rFXIII-treated animals provided no evidence of histopathological alterations suggestive of subclinical hemorrhage or thrombosis. Taken as a whole, the results demonstrate the ECC model suitably replicated the clinical presentation reported for humans during and after cardiopulmonary bypass surgery, and do not suggest significant concerns regarding use of rFXIII in replacement therapy after extracorporeal circulation.
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Affiliation(s)
- R Ponce
- ZymoGenetics, Inc, Seattle, Washington 98102, USA.
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16
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Affiliation(s)
- I. Sebbag
- Western University; London ON Canada
| | - F. Qasem
- Western University; London ON Canada
| | | | | | - S. Singh
- Western University; London ON Canada
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17
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Brookes J, Sondekoppam R, Armstrong K, Uppal V, Dhir S, Terlecki M, Ganapathy S. Comparative evaluation of the visibility and block characteristics of a stimulating needle and catheter vs an echogenic needle and catheter for sciatic nerve block with a low-frequency ultrasound probe. Br J Anaesth 2015; 115:912-9. [DOI: 10.1093/bja/aev351] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Dhir S, Armstrong K, Armstrong P, Bouzari A, Mall J, Yu J, Ganapathy S, King G. A randomised comparison between ultrasound and nerve stimulation for infraclavicular catheter placement. Anaesthesia 2015; 71:198-204. [DOI: 10.1111/anae.13302] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Affiliation(s)
- S. Dhir
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - K. Armstrong
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - P. Armstrong
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - A. Bouzari
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - J. Mall
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - J. Yu
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - S. Ganapathy
- Department of Anaesthesia and Peri-operative Medicine; St. Joseph's Health Care; Western University; London Ontario Canada
| | - G. King
- Hand and Upper Limb Centre; Department of Orthopaedics and Plastic Surgery; St. Joseph's Health Care; Western University; London Ontario Canada
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19
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Armstrong K, De Souza A, Sneddon P, Potts J, Claydon V, Sherwin E, Sanatani S. DOES AN 8-WEEK LOWER BODY EXERCISE PROGRAM IMPROVE QUALITY OF LIFE IN TEENAGERS WITH DYSAUTONOMIA? Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ward J, Armstrong J, Armstrong K, Mascott C, Thirion P, Rock L, Mihai A. 3318 Outcomes of Stereotactic Radiosurgery in Patients with Brain Metastases from Melanoma Primary: Single Institution Experience. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31836-6] [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: 10/22/2022]
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Armstrong K, Mihai A, Ward J, Mascott C, Rock L, Thirion P, Armstrong J. 1842 Impact of Her 2/Neu status on the outcomes of patients with breast cancer metastatic to the brain, treated with stereotactic radiosurgery. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Couroux P, Patel D, Armstrong K, Larché M, Hafner RP. Fel d 1-derived synthetic peptide immuno-regulatory epitopes show a long-term treatment effect in cat allergic subjects. Clin Exp Allergy 2015; 45:974-981. [DOI: 10.1111/cea.12488] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/02/2014] [Accepted: 01/04/2015] [Indexed: 02/04/2023]
Affiliation(s)
| | - D. Patel
- Cetero Research; Mississauga ON Canada
| | | | - M. Larché
- Clinical Immunology & Allergy and Respirology Divisions; Department of Medicine and Firestone Institute for Respiratory Health; McMaster University; Hamilton ON Canada
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Shafai F, Armstrong K, Iarocci G, Oruc I. Orientation discrimination profiles identify distinct subgroups within autism spectrum disorder. J Vis 2014. [DOI: 10.1167/14.10.679] [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: 11/24/2022] Open
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Affiliation(s)
- K Armstrong
- Department of Paediatrics, Cork University Hospital, Cork, Ireland Department of Paediatrics & Paediatric Neurology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - O O'Mahony
- Department of Paediatrics, Cork University Hospital, Cork, Ireland
| | - L Farah
- Department of Paediatrics & Paediatric Neurology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - D Webb
- Department of Paediatrics & Paediatric Neurology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
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Rolls K, Armstrong K, Keating L, Wrightson D, Walker S, Masters J. Measurement of temperature in critically ill adults: A systematic review and clinical practice guideline. Aust Crit Care 2014. [DOI: 10.1016/j.aucc.2013.10.021] [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: 10/25/2022] Open
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Armstrong K, Boot B, Jaklitsch M. Sleep deprivation in elderly thoracic surgery patients. J Geriatr Oncol 2013. [DOI: 10.1016/j.jgo.2013.09.269] [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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Abstract
A plasmid library of oat chromosome No21, the smallest chromosome of the complement, was constructed by microdissection and microcloning. The chromosome was deproteinized with proteinase K and digested with Sau3A and linker adaptors were ligated to the DNA fragments. From the single chromosome (less than 0.4 pg), 10 μg of DNA was obtained after 2 rounds of PCR amplification. Cloning experiments with the amplified DNA produced as many as 500 000 recombinant clones from the single chromosome. The 500 clones evaluated ranged in size from 150 to 1700 base pairs (bp) with an average size of 650 bp. These were approximately 41% high-copy and 59% low/unique copy clones. Tandem repeats were absent in the library and may have been selected against by a combination of the Sau3A digestion, which is sensitive to C-methylation, and the PCR amplification. Many low-copy dispersed repetitive sequences were present in the library. These were present primarily on A- and D-genome chromosomes. Southern blot analysis revealed that the unique-copy clones were suitable for restriction fragment length polymorphism analysis and that they mapped to the pertinent oat nullisomic lines.
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Abstract
Genomic fluorescent in situ hybridization was employed in the study of the genome organization and evolution of hexaploid oat (Avena sativa L. cv. Sun II, AACCDD, 2n = 6x = 42). Genomic DNAs from two diploid oat species, Avena strigosa (genomic constitution AsAs, 2n = 14) and Avena pilosa (genomic constitution CpCp, 2n = 14), were used as probes in the study. The DNA from A. strigosa labelled 28 of the 42 (2/3) chromosomes of the hexaploid oat, while 14 of the 42 (1/3) chromosomes were labelled with A. pilosa DNA, indicating a close relationship between the A and D genomes. Results also suggested that at least 18 chromosomes (9 pairs) were involved in intergenomic interchanges between the A and C genomes.
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Panda P, Fiers M, Armstrong K, Pitman A. First report of blackleg and soft rot of potato caused by
Pectobacterium carotovorum
subsp.
brasiliensis
in New Zealand. ACTA ACUST UNITED AC 2012. [DOI: 10.5197/j.2044-0588.2012.026.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- P. Panda
- Bio‐Protection Research CentreLincoln UniversityPO Box 84CanterburyNew Zealand
| | - M.A.W.J. Fiers
- New Zealand Institute for Plant & Food Research LtdPrivate Bag 4704ChristchurchNew Zealand
| | - K. Armstrong
- Bio‐Protection Research CentreLincoln UniversityPO Box 84CanterburyNew Zealand
| | - A.R. Pitman
- Bio‐Protection Research CentreLincoln UniversityPO Box 84CanterburyNew Zealand
- New Zealand Institute for Plant & Food Research LtdPrivate Bag 4704ChristchurchNew Zealand
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Mao J, Desai K, Watkins-Brunner D, Frankel E, Palmer S, Xie S, Barg F, Armstrong K. P04.65. Development and validation of an instrument for measuring decision making about complementary and alternative medicine (CAM) use among cancer patients. BMC Complement Altern Med 2012. [PMCID: PMC3373866 DOI: 10.1186/1472-6882-12-s1-p335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
A patient undergoing elective total shoulder arthroplasty had an Arrow Stimucath™ (Arrow International Reading, PA, USA) stimulating catheter inserted in the region of the interscalene brachial plexus using an ultrasound-guided in-plane approach. There was subsequent difficulty in removing the catheter and traction was associated with painful paraesthesia in the patient's thumb. Plain X-ray revealed a hook-shaped deformity of the tip and surgical exploration was required to remove the catheter, the tip of which appeared to be trapped within the sheath of the brachial plexus. We speculate that the mechanism for entrapment in this case was deformation of the catheter tip into a hook-like shape. The subsequent catheter-neural interaction prevented asymptomatic removal. We recommend that removal of peripheral nerve catheters be attempted only after resolution of sensory block so as to enable patients to report pain or paraesthesia. Imaging with ultrasound or X-rays may help ascertain catheter tip location and confirm whether deformity is present. We also recommend a low threshold for proceeding to surgical extraction, particularly if neurological symptoms are present.
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Affiliation(s)
- S. D. Adhikary
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
| | - K. Armstrong
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
| | - K. J. Chin
- Department of Anesthesiology and Perioperative Medicine, University of Western Ontario, London, Ontario, Canada
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Abstract
UNLABELLED Following a perinatal hypoxic-ischaemic insult, term infants commonly develop cardiovascular dysfunction. Troponin-T, troponin-I and brain natriuretic peptide are sensitive indicators of myocardial compromise. The long-term effects of cardiovascular dysfunction on neurodevelopmental outcome following perinatal hypoxic ischaemia remain controversial. Follow-up studies are warranted to ensure optimal cardiac function in adulthood. CONCLUSION Cardiac biomarkers may improve the diagnosis of myocardial injury, help guide management, estimate mortality risk and may also aid in longterm neurodevelopmental outcome prediction following neonatal hypoxic-ischaemia.
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Affiliation(s)
- D Sweetman
- Neonatology, National Maternity Hospital, Dublin, Ireland.
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Abstract
Despite an increase in direct-to-consumer (DTC) genetic testing, little is known about how variations in website content might alter consumer behavior. We evaluated the impact of risk information provision on women's attitudes about DTC BRCA testing. We conducted a randomized experiment; women viewed a 'mock' BRCA testing website without [control group (CG)] or with information on the potential risks of DTC testing [RG; framed two ways: unattributed risk (UR) information and risk information presented by experts (ER)]. Seven hundred and sixty-seven women participated; mean age was 37 years, mean education was 15 years, and 79% of subjects were white. Women in the RG had less positive beliefs about DTC testing (mean RG = 23.8, CG = 25.2; p = 0.001), lower intentions to get tested (RG = 2.8, CG = 3.1; p = 0.03), were more likely to prefer clinic-based testing (RG = 5.1, CG = 4.8; p = 0.03) and to report that they had seen enough risk information (RG = 5.3, CG = 4.7; p < 0.001). UR and ER exposure produced similar effects. Effects did not differ for women with or without a personal/family history of breast/ovarian cancer. Exposing women to the potential risks of DTC BRCA testing altered their beliefs, preferences, and intentions. Risk messages appear to be salient to women irrespective of their chance of having a BRCA mutation.
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Affiliation(s)
- S W Gray
- Population Sciences, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
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Lefort MC, Boyer S, Worner SP, Armstrong K. Noninvasive molecular methods to identify live scarab larvae: an example of sympatric pest and nonpest species in New Zealand. Mol Ecol Resour 2011; 12:389-95. [PMID: 22189059 DOI: 10.1111/j.1755-0998.2011.03103.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Despite the negative impact that many scarab larvae have on agro-ecosystems, very little attention has been paid to their taxonomy. Their often extremely similar morphological characteristics have probably contributed to this impediment, which has also meant that they are very difficult to identify in the field. Molecular methods can overcome this challenge and are particularly useful for the identification of larvae to enable management of pest species occurring sympatrically with nonpest species. However, the invasive collection of DNA samples for such molecular methods is not compatible with subsequent behavioural, developmental or fitness studies. Two noninvasive DNA sampling and DNA analysis methods suitable for the identification of larvae from closely related scarab species were developed here. Using the frass and larval exuviae as sources of DNA, field-collected larvae of Costelytra zealandica (White) and Costelytra brunneum (Broun) (Scarabaeidae: Melolonthinae) were identified by multiplex PCR based on the difference in size of the resulting PCR products. This study also showed that small quantities of frass can be used reliably even 7 days after excretion. This stability of the DNA is of major importance in ecological studies where timeframes rarely allow daily monitoring. The approach developed here is readily transferable to the study of any holometabolous insect species for which morphological identification of larval stages is difficult.
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Affiliation(s)
- M-C Lefort
- Bio-Protection Research Centre, PO Box 84, Lincoln University, Lincoln 7647, Christchurch, New Zealand.
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Suneja G, Epstein A, Pollack C, Guzzo T, Lipschultz A, Armstrong K, Bekelman J. Association between an Integrated Prostate Cancer Center and Prostate Cancer Treatment Trends in Louisiana: A Study from 2004-2007. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Armstrong K, Ahmad I, Kalna G, Tan SS, Edwards J, Robson CN, Leung HY. Upregulated FGFR1 expression is associated with the transition of hormone-naive to castrate-resistant prostate cancer. Br J Cancer 2011; 105:1362-9. [PMID: 21952621 PMCID: PMC3241546 DOI: 10.1038/bjc.2011.367] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prostate cancer (PC) represents a global health issue. Treatment for locally advanced and metastatic PC remains unsatisfactory. The androgen receptor (AR) has been validated in having a key role in both naïve and castrate-resistant PC (CRPC). However, the significance of other signalling pathways in CRPC is less well validated. METHODS To gain a better insight into the molecular signalling cascades involved in clinical CRPC, we performed gene expression profiling using the Illumina DASL assay and studied matched hormone-naive (HN) and CR prostate tumours (n=10 pairs). Ingenuity Pathways Analysis (IPA) was used to identify potential networks involved, and further validation was performed in in vitro cell models and clinical tumours. RESULTS Expression of 50 genes was significantly different between HN and CRPC. IPA revealed two networks of particular interest, including AR and FGFR1, respectively. FGFR1 expression was confirmed to be significantly upregulated in CRPC (P ≤ 0.005), and abnormal FGFR1 expression was associated with shorter time to biochemical relapse in HNPC (P=0.006) and less favourable disease-specific survival in CRPC (P=0.018). CONCLUSION For the first time, our gene expression profiling experiment on archival tumour materials has identified upregulated FGFR1 expression to be associated with PC progression to the CR state.
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Affiliation(s)
- K Armstrong
- Solid Tumour Target Discovery Group, Northern Institute for Cancer Research, Newcastle University, Newcastle NE2 4HH, UK
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Armstrong K, Conant E, Chen J, Handorf E, Jones M, Boghossian L, Domchek SM. Incremental impact of breast cancer SNP panel on risk classification and screening. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.1522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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40
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Abstract
AIMS To determine whether healthcare providers apply the best interest principle equally to different resuscitation decisions. METHODS An anonymous questionnaire was distributed to consultants, trainees in neonatology, paediatrics, obstetrics and 4th medical students. It examined resuscitation scenarios of critically ill patients all needing immediate resuscitation. Outcomes were described including survival and potential long-term sequelae. Respondents were asked whether they would intubate, whether resuscitation was in the patients best interest, would they accept surrogate refusal to initiate resuscitation and in what order they would resuscitate. RESULTS The response rate was 74%. The majority would wish resuscitation for all except the 80-year-old. It was in the best interest of the 2-month-old and the 7-year-old to be resuscitated compared to the remaining scenarios (p value <0.05 for each comparison). Approximately one quarter who believed it was in a patient best interests to be resuscitated would nonetheless accept the family refusing resuscitation. Medical students were statistically more likely to advocate resuscitation in each category. CONCLUSION These results suggest resuscitation is not solely related to survival or long-term outcome and the best interest principle is applied differently, more so at the beginning of life.
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Affiliation(s)
- K Armstrong
- Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland
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41
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Yeboa D, Sunderland R, Liao K, Armstrong K, Bekelman J. Trends in Treatment with Intensity Modulated (IMRT) vs. 3D Conformal (CRT) Radiotherapy for Non-metastatic Prostate Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.811] [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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Armstrong K, Obst P, Davey J, Thunstrom H. Developing guidelines for interventions to reduce risk of low-speed vehicle run-overs of young children. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.326] [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: 11/03/2022]
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Yeboa DN, Liao K, Guzzo T, Haas NB, Christodouleas JP, Vapiwala N, Sunderland R, Mitra N, Armstrong K, Bekelman JE. PSA surveillance in men with localized prostate cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.6024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bonants P, Groenewald E, Rasplus JY, Maes M, de Vos P, Frey J, Boonham N, Nicolaisen M, Bertacini A, Robert V, Barker I, Kox L, Ravnikar M, Tomankova K, Caffier D, Li M, Armstrong K, Freitas-Astúa J, Stefani E, Cubero J, Mostert L. QBOL: a new EU project focusing on DNA barcoding of Quarantine organisms. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1365-2338.2009.02350.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [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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46
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Abstract
BACKGROUND Benchmarking is that process through which best practice is identified and continuous quality improvement pursued through comparison and sharing. The Vermont Oxford Neonatal Network (VON) is the largest international external reference centre for very low birth weight (VLBW) infants. This report from 2004-7 compares survival and morbidity throughout Ireland and benchmarks these results against VON. METHODS A standardised VON database for VLBW infants was created in 14 participating centres across Ireland and Northern Ireland. RESULTS Data on 716 babies were submitted in 2004, increasing to 796 babies in 2007, with centres caring for from 10 to 120 VLBW infants per year. In 2007, mortality rates in VLBW infants varied from 4% to 19%. Standardised mortality ratios indicate that the number of deaths observed was not significantly different from the number expected, based on the characteristics of infants treated. There was no difference in the incidence of severe intraventricular haemorrhage between all-Ireland and VON groups (5% vs 6%, respectively). All-Ireland rates for chronic lung disease (CLD; 15-21%) remained lower than rates seen in the VON group (24-28%). The rates of late onset nosocomial infection in the all-Ireland group (25-26%) remained double those in the VON group (12-13%). DISCUSSION This is the first all-Ireland international benchmarking report in any medical specialty. Survival, severe intraventricular haemorrhage and CLD compare favourably with international standards, but rates of nosocomial infection in neonatal units are concerning. Benchmarking clinical outcomes is critical for quality improvement and informing decisions concerning neonatal intensive care service provision.
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Affiliation(s)
- B P Murphy
- Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork, Ireland.
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Gray SW, Smith D, Karp L, O'Grady C, Hornik R, Armstrong K. Correlation of education, age, and health insurance status with attitudes about and preferences for direct-to-consumer BRCA testing. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22116 Background: Direct-to-consumer (DTC) cancer genetic testing is increasingly common. However, little is know about peoples' attitudes about or preferences for DTC testing as compared to clinic-based genetic testing. Methods: We surveyed a convenience sample of 257 women without prior BRCA testing/counseling experience about their attitudes about and intentions to get online BRCA testing (90% participation rate). Subjects completed baseline interviews, viewed a modified commercial DTC website and completed an online survey. Results: Sample characteristics: mean age 37 (range 19–71), 80% white, mean education 3 years college, 45% with a household income <$50,000, 3% with a history of breast/ovarian cancer and mean Frank risk 4.7%. 64% of women expressed interest in BRCA testing at baseline and 24% intended to get tested in the next year. After viewing the website, 22% of women said that they would prefer DTC testing, 60% said that they would prefer clinic-based testing and 18% were indifferent. Overall, women believed that DTC testing would be more convenient (p <0.001), offer greater privacy (p <0.01), and be less likely to lead to discrimination (p <0.001) while clinic testing would provide more information (p <0.001) and counseling (p <0.001). After adjusting for confounders, older and less highly educated women had more positive attitudes about DTC BRCA testing (adjusted odds ratio (OR) 4.20, p= 0.02 and OR 10.3, p=0.03 high school (HS) vs. college and OR 16.1, p=0.02 HS vs. graduate school). Women with no health insurance and more positive attitudes about DTC genetic testing were more likely to prefer DTC genetic testing over clinic testing (adjusted OR 3.1, p=0.03 and OR 3.7, p<0.01). There were no associations between race and outcomes. Conclusions: A substantial minority of women expressed a preference for DTC BRCA testing after viewing a modified commercial website. Preferential interest in DTC testing by less educated and uninsured populations makes it especially critical that these sites provide high quality services. Without high quality service, the availability of DTC testing may only exacerbate disparities in genetic services and prevention. No significant financial relationships to disclose.
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Affiliation(s)
- S. W. Gray
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
| | - D. Smith
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
| | - L. Karp
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
| | - C. O'Grady
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
| | - R. Hornik
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
| | - K. Armstrong
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania, Philadelphia, PA; Tufts University, Boston, MA
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Gray SW, O'Grady C, Karp L, Smith D, Hornik R, Armstrong K. Exposure to risk information and women's interest in direct to consumer testing for BRCA 1 and 2 mutations. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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49
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Paulson EC, Wirtalla C, Armstrong K, Mahmoud N. Lymph node harvest and survival in rectal cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Silber JH, Rosenbaum PR, Polsky D, Millman AM, Ross RN, Even-Shoshan O, Schwartz JS, Armstrong K, Randall T. Beware of the isolated intermediate quality measure: A lesson in choosing an ovarian cancer surgeon. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.6546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6546 Background: Measuring surgical quality has recently focused on isolated processes (such as P4P measures) and intermediate outcomes (such as infection rates). Some have argued that such isolated measures are inherently flawed since they may have only minor influence on more important primary outcomes such as survival. Hence, referral decisions based on such isolated processes or intermediate outcomes may lead to less than optimal care. We asked whether surgeon type influenced isolated process measures (longer operative time, thought to be a function of increased node sampling), intermediate outcomes (deep wound infection, often found to be a function of operative time) and the primary outcome of survival. Methods: We obtained SEER-Medicare claims for the years 1991–2001 for ovarian cancer. We identified the first definitive cancer surgery and the surgical provider type for that procedure: General Surgeon (GS) N=545 and GYN Oncologist (GO) N=1,554. We determined operative time from the anesthesia claims, number of nodes sampled from the SEER record, deep wound infection from the ICD9CM secondary diagnoses and survival from Medicare vital status files. Models were adjusted for 30 patient characteristics and comorbidities. To account for potential reclassification bias due to variations in the pattern of node dissection across GO and GS surgical types, which can potentially influence stage identification, we report survival results both with and without stage adjustments. Results: Definitive surgery by GOs was associated with more extensive node dissection and longer operative time. GO patients also displayed a trend for increased deep wound infection as compared to cases operated on by GS. However, 5-year survival was significantly longer in the GO group, with or without stage adjustment. Conclusions: GO cases took longer, tended to have higher infection rates, yet had better overall 5-year survival. Isolated intermediate outcome measures, such as deep wound infection, may not be good quality indicators. No significant financial relationships to disclose. [Table: see text]
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Affiliation(s)
- J. H. Silber
- The University of Pennsylvania, Philadelphia, PA
| | | | - D. Polsky
- The University of Pennsylvania, Philadelphia, PA
| | | | - R. N. Ross
- The University of Pennsylvania, Philadelphia, PA
| | | | | | - K. Armstrong
- The University of Pennsylvania, Philadelphia, PA
| | - T. Randall
- The University of Pennsylvania, Philadelphia, PA
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