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Golder G, Ladd E, Mills K, Thain R, Disney S. International recruitment of radiographers and the development of a workplace integration support package: Project evaluation. Radiography (Lond) 2023; 29:442-449. [PMID: 36809691 DOI: 10.1016/j.radi.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION In October 2020, a regional workforce action group was established jointly by Health Education England (HEE) and NHS England and Improvement (NHSEI) in the South West to work collaboratively to address the workforce challenges within diagnostic imaging. Fifty-eight internationally recruited radiographers were offered employment in departments across the region, the majority of them taking up their posts in the UK in early 2021. The aim of the study presented here was to evaluate the efficacy of a training resource developed by Plymouth Marjon University, with input from HEE and NHSEI, to support workplace and cultural integration for the new recruits. METHODS The training package to help newly recruited radiographers from outside the UK integrate into their host departments was developed using flexible learning opportunities centred on reusable digital learning assets. Self-paced e-learning sessions were augmented by group 'connected' sessions online. Two surveys were undertaken, exploring the impact of this workforce integration programme for International radiographers joining the NHS. RESULTS Survey results indicate that the integration programme's three-phase strategy has seen an impact on 6 out of 12 self-efficacy measures, raised awareness of challenges, and increased personal awareness of implications for practice. By the end of the programme, delegates were in the top two quintiles for their average well-being score. CONCLUSION Principal recommendations include ensuring digital accessibility for new recruits as part of the on-boarding process, considering the timing of delivery of any online connected support sessions, the provision of long-term pastoral support; and mandating the training requirement for managers and team leaders. IMPLICATIONS FOR PRACTICE Success of international recruitment campaigns can be enhanced through the implementation of an online integration package.
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Affiliation(s)
- G Golder
- Teacher Education Plymouth Marjon University, Derriford Road, Plymouth PL68BH, UK.
| | - E Ladd
- NHS England (South West), South West House, Blackbrook Park Avenue, Taunton TA1 2PX, UK.
| | - K Mills
- Cancer and Diagnostics Programme, Health Education England, 4, Stewart House, 32 Russell Square, London WC1B 5DN, UK.
| | - R Thain
- Learning Solutions and Innovation Plymouth Marjon University, Derriford Road, Plymouth PL68BH, UK.
| | - S Disney
- Plymouth Marjon University, Derriford Road, Plymouth PL68BH, UK.
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Barker KJ, Cole E, Courtemanch A, Dewey S, Gustine D, Mills K, Stephenson J, Wise B, Middleton AD. Large carnivores avoid humans while prioritizing prey acquisition in anthropogenic areas. J Anim Ecol 2023; 92:889-900. [PMID: 36757108 DOI: 10.1111/1365-2656.13900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Large carnivores are recovering in many landscapes where the human footprint is simultaneously growing. When carnivores encounter humans, the way they behave often changes, which may subsequently influence how they affect their prey. However, little research investigates the behavioural mechanisms underpinning carnivore response to humans. As a result, it is not clear how predator-prey interactions and their associated ecosystem processes will play out in the human-dominated areas into which carnivore populations are increasingly expanding. We hypothesized that humans would reduce predation risk for prey by disturbing carnivores or threatening their survival. Alternatively, or additionally, we hypothesized that humans would increase predation risk by providing forage resources that congregate herbivorous prey in predictable places and times. Using grey wolves Canis lupus in Jackson Hole, Wyoming, USA as a study species, we investigated 170 kill sites across a spectrum of human influences ranging from heavily restricted human activities on protected federal lands to largely unregulated activities on private lands. Then, we used conditional logistic regression to quantify how the probability of predation changed across varied types and amounts of human influences, while controlling for environmental characteristics and prey availability. Wolves primarily made kills in environmental terrain traps and where prey availability was high, but predation risk was significantly better explained with the inclusion of human influences than by environmental characteristics alone. Different human influences had different, and even converse, effects on the risk of wolf predation. For example, where prey were readily available, wolves preferentially killed animals far from motorized roads but close to unpaved trails. However, wolves responded less strongly to humans, if at all, where prey were scarce, suggesting they prioritized acquiring prey over avoiding human interactions. Overall, our work reveals that the effects of large carnivores on prey populations can vary considerably among different types of human influences, yet carnivores may not appreciably alter predatory behaviour in response to humans if prey are difficult to obtain. These results shed new light on the drivers of large carnivore behaviour in anthropogenic areas while improving understanding of predator-prey dynamics in and around the wildland-urban interface.
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Affiliation(s)
- Kristin J Barker
- Department of Environmental Science, Policy, and Management, University of California - Berkeley, Berkeley, California, USA
| | - Eric Cole
- National Elk Refuge, United States Fish and Wildlife Service, Jackson, Wyoming, USA
| | | | - Sarah Dewey
- National Park Service, Grand Teton National Park, Moose, Wyoming, USA
| | - David Gustine
- National Park Service, Grand Teton National Park, Moose, Wyoming, USA
| | - Kenneth Mills
- Wyoming Game and Fish Department, Pinedale, Wyoming, USA
| | - John Stephenson
- National Park Service, Grand Teton National Park, Moose, Wyoming, USA
| | - Benjamin Wise
- Wyoming Game and Fish Department, Jackson, Wyoming, USA
| | - Arthur D Middleton
- Department of Environmental Science, Policy, and Management, University of California - Berkeley, Berkeley, California, USA
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Heffernan O, Eastburn J, Raper D, Mills K. Covid-19 abruptly halted the 2020 afl season. what was the impact on athlete performance? J Sci Med Sport 2022. [PMCID: PMC9664143 DOI: 10.1016/j.jsams.2022.09.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - D. Raper
- Sydney Swans Australian Football Club, Australia
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Ducker G, Mills K, Yong C, Jones C, Mukhtyar C. POS0793 IMPROVED RELAPSE-FREE SURVIVAL WITH THE NORWICH PREDNISOLONE REGIMEN FOR GIANT CELL ARTERITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundGlucocorticoid therapy is the mainstay treatment for GCA. There is no consensus on the dose of prednisolone to be used. Prednisolone regimens used in clinical trials have reported relapse rates of 66 to 92%. The long-term follow-up of Tocilizumab and prednisolone for 1-year showed a relapse rate of 74% at 2 years. The Norwich Regimen is a bespoke prednisolone plan with an initial dose of 1mg/kg of lean body mass. It delivers 164.64 mg/kg of lean body mass in a logarithmic taper over 100 weeks. It was devised to reduce the risk of relapse and allow patients to be in control of their prednisolone reduction.ObjectivesTo document drug-free survival at 150 weeks of people with GCA treated with a bespoke prednisolone taperMethodsAll patients were diagnosed by biopsy, ultrasonography or PET scan and provided with a printed prednisolone plan at diagnosis. All individuals were assessed at approximately 3-6 monthly intervals in addition to suspected relapse, toxicity or other need for course correction. Relapses were confirmed objectively using a modification of the Kerr criteria. Relapse free survival was recorded at 100 weeks. Patients were given an open invite to contact us in the event of a suspected relapse after coming off prednisolone. A notes review was done to record events at 150 weeks.Results150 consecutive people with objectively diagnosed GCA (mean age 74) since 10/01/2012 have completed 150 weeks since starting prednisolone. Drug-free, relapse-free survival at 100 weeks was met by 133/150 (89%). 7 individuals died and 20 relapsed. A further 5 died and 15 relapsed by week 150; 103/150 (69%) survivors were in prednisolone-free remission. Of the 12 deaths – 6 died of cancer, 1 subdural haemorrhage, 1 ischaemic bowel, 1 septicaemia, 1 general decline (aged 93). The cause of death was not available for 2 individuals who died in the community. The median time to relapse for the 35 individuals was 80 weeks (IQR 64,109).ConclusionWe report the first results of a bespoke prednisolone taper to be used in real life. The Norwich Regimen for the treatment of GCA results in drug-free relapse-free survival of 89% at 100 weeks and 69% at 150 weeks, which is superior to all other reports published so far.References[1]Mukhtyar, C, Cate, H, Graham, C, Merry, P, Mills, K, and Misra, A, 2019, ‘Development of an evidence-based regimen of prednisolone to treat giant cell arteritis – the Norwich regimen’ Rheumatology Advances in Practice, Volume 3, Issue 1, 2019, rkz001, https://doi.org/10.1093/rap/rkz001[2]Hellmich B, Agueda A, Monti S, et al2018 Update of the EULAR recommendations for the management of large vessel vasculitis Annals of the Rheumatic Diseases 2020;79:19-30.Disclosure of InterestsNone declared
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Collins N, Mills K, Vicenzino B. Transitioning from traditional running shoes to barefoot running: probability of success and predictors of failure. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.105] [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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Axford N, Locke V, Mills K, Rae K, Toohey L. The prevalence of tendinopathy in a professional Australian netball team: a Pilot study. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.078] [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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Heales CJ, Mills K, Ladd E. Radiographer advanced and consultant practice and community diagnostic hubs - a vision for the future. Radiography (Lond) 2021; 27 Suppl 1:S28-S33. [PMID: 34119400 DOI: 10.1016/j.radi.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This article combines a brief narrative review of the Richards Report with an overview of current radiographer advanced and consultant clinical practice (ACCP) to provide suggestions for future ACCP within radiography. KEY FINDINGS The 'Diagnostics: Recovery and Renewal' report by Professor Sir Mike Richards, published in 2020, has identified a need for improvements to be made to diagnostic services. His recommendations include the introduction of Community Diagnostic Hubs (CDHs) that would provide quicker and easier access to diagnostic tests for patients(1) A narrative review around the concept of Advanced and Consultant Clinical Practice (ACCP) for radiographers demonstrates the capability of the radiographers to expand their role. The article concludes with a vision of how CDHs could potentially provide multiple career pathways for radiographers working at this level of practice. CONCLUSION AND IMPLICATIONS FOR PRACTICE It is acknowledged that some of these concepts are a combination of visionary and aspirational in outlook rather than being entirely based on current practice. The intention of this article, and the implications for practice, are to support on-going discussions to enable radiography, as a profession, to seek ways and opportunities to do things differently whilst ensuring that the patient remains at the centre of the services delivered.
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Affiliation(s)
- C J Heales
- University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom.
| | - K Mills
- University of the West of England, Glenside Campus, Bristol, BS16 1DD, United Kingdom.
| | - E Ladd
- Somerset NHS Foundation Trust, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, United Kingdom.
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Minniti M, Pedrelli M, Vedin LL, Delbès AS, Denis R, Garagnani P, Mills K, Luquet S, Wilson E, Bial J, Parini P. Metabolic characterization of the high-fat/high sucrose diet challenge in liver-humanized mice. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.307] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hooper J, Paolino KM, Mills K, Kwilas S, Josleyn M, Cohen M, Somerville B, Wisniewski M, Norris S, Hill B, Sanchez-Lockhart M, Hannaman D, Schmaljohn CS. A Phase 2a Randomized, Double-Blind, Dose-Optimizing Study to Evaluate the Immunogenicity and Safety of a Bivalent DNA Vaccine for Hemorrhagic Fever with Renal Syndrome Delivered by Intramuscular Electroporation. Vaccines (Basel) 2020; 8:vaccines8030377. [PMID: 32664486 PMCID: PMC7565952 DOI: 10.3390/vaccines8030377] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 06/15/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/16/2022] Open
Abstract
Hantaan virus (HTNV) and Puumala virus (PUUV) are pathogenic hantaviruses found in Asia and Europe, respectively. DNA vaccines targeting the envelope glycoproteins of these viruses have been constructed and found to elicit neutralizing antibodies when delivered to humans by various technologies including intramuscular electroporation. Here, we report findings from a Phase 2a clinical trial of a combined HTNV/PUUV DNA vaccine delivered at varying doses and administration schedules using the Ichor Medical Systems TriGrid intramuscular electroporation delivery technology. The study was designed to characterize the effects of DNA vaccine dose and number of administrations on the frequency and magnitude of immunological response. Subjects (n = 120) were divided into four cohorts. Cohorts 1 and 2 received a dose of 2 mg of DNA (1 mg per plasmid), and cohorts 3 and 4 received a dose of 1 mg of DNA (0.5 mg per plasmid) each vaccination. Each of the four cohorts received a series of four administrations (days 0, 28, 56 and 168). For cohorts 1 and 3, the DNA vaccine candidate was delivered at each of the four administrations. For cohorts 2 and 4, in order to maintain blinding, subjects received the DNA vaccine on days 0, 56 and 168, but on day 28 received only the phosphate buffered saline vehicle rather the DNA vaccine. Sera were collected on days 0, 28, 56, 84, 140, 168, 196, 252 and 365 and evaluated for the presence of neutralizing antibodies by PUUV and HTNV pseudovirion neutralization assays (PsVNAs). Day 84 was also evaluated by a plaque reduction neutralization test (PRNT). Overall the PsVNA50 geometric mean titers (GMTs) and seropositivity rates among cohorts were similar. Cohort 3 exhibited the highest frequency of subjects that became seropositive to both PUUV and HTNV after vaccination, the highest peak GMT against both viruses, and the highest median titers against both viruses.
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Affiliation(s)
- Jay Hooper
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
- Correspondence:
| | - K. M. Paolino
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (K.M.P.); (K.M.)
| | - K. Mills
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; (K.M.P.); (K.M.)
| | - S. Kwilas
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - M. Josleyn
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - M. Cohen
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - B. Somerville
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - M. Wisniewski
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - S. Norris
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - B. Hill
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - M. Sanchez-Lockhart
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
| | - D. Hannaman
- Ichor Medical Systems, Inc., San Diego, CA 92121, USA;
| | - C. S. Schmaljohn
- Virology Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702, USA; (S.K.); (M.J.); (M.C.); (B.S.); (M.W.); (S.N.); (B.H.); (M.S.-L.); (C.S.S.)
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Eyles JP, Ferreira M, Mills K, Lucas BR, Robbins SR, Williams M, Lee H, Appleton S, Hunter DJ. Is the Patient Activation Measure a valid measure of osteoarthritis self-management attitudes and capabilities? Results of a Rasch analysis. Health Qual Life Outcomes 2020; 18:121. [PMID: 32370751 PMCID: PMC7201682 DOI: 10.1186/s12955-020-01364-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/06/2018] [Accepted: 04/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Patient Activation Measure (PAM-13) was developed using Rasch analysis to assess knowledge, skills and confidence in the management of one's health. Previous studies report positive relationships between PAM-13 scores, self-management behaviours and longitudinal health outcomes in adults with chronic disease. There is little extant measurement property evidence for the use of PAM-13 in specific osteoarthritis (OA) populations. This study tested measurement properties of the PAM-13 in people living with hip and knee OA. METHODS Item response frequency analysis was conducted. Rasch analysis evaluated the fit of the PAM-13 data to the Rasch model. Model-data fit was evaluated using infit and outfit statistics; person/item reliability and person separation indices were computed. Unidimensionality was evaluated using Principal Components Analysis of Rasch residuals and the data were assessed for item redundancy. Differential Item Functioning (DIF) examined bias in respondent subgroups and correlations tested relationships between PAM-13 and other patient-reported outcomes. RESULTS Two-hundred-and-seventeen PAM-13 surveys were completed; there were no missing responses, floor or ceiling effects. Person and item reliability were acceptable (0.98 and 0.87 respectively) with good separation (person separation index 2.58). Unidimensionality was evaluated, with 49.4% of the variance explained by the first eigenvector. There was evidence of potential local response-dependence. The Rasch fit statistics were acceptable (except for item-2). There were some issues identified with targeting of the PAM-13 items to people with higher ability and the item difficulty order was different to that proposed in original cohorts. Significant DIF was identified for sex and educational level for a small number of items. PAM-13 scores were moderately correlated with depressive symptoms on the Depression Anxiety Stress Scale and Assessment of Quality of Life-6D. There were small correlations between PAM-13 and Knee injury and Osteoarthritis Outcome Score pain and activities of daily living scores. CONCLUSIONS This study provides some evidence of adequate person and item reliability, unidimensionality, and construct validity to support the use of PAM-13 to measure patient activation in people living with hip and knee OA. Possible limitations regarding targeting, different item difficulty order, DIF and local response dependence should be investigated in future research.
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Affiliation(s)
- J P Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia. .,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia. .,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - M Ferreira
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - B R Lucas
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - S R Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
| | - M Williams
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - H Lee
- Rehabilitation Department, Hunters Hill Private Hospital, Sydney, Australia
| | - S Appleton
- Physiotherapy Department, Mount Wilga Private Hospital, Sydney, Australia
| | - D J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital , Sydney, Australia
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Cawood A, Ruiz M, Mills K. Salt‐dependent protein splicing of an intein from the halophile
Haloferax volcanii. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.02647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: A systematic review. Clin Neurophysiol 2020; 131:942-950. [PMID: 32044239 PMCID: PMC7083223 DOI: 10.1016/j.clinph.2019.12.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/23/2019] [Accepted: 12/14/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is an adult-onset neurodegenerative disease that leads to inexorable motor decline and a median survival of three years from symptom onset. Surface EMG represents a major technological advance that has been harnessed in the development of novel neurophysiological biomarkers. We have systematically reviewed the current application of surface EMG techniques in ALS. METHODS We searched PubMed to identify 42 studies focusing on surface EMG and its associated analytical methods in the diagnosis, prognosis and monitoring of ALS patients. RESULTS A wide variety of analytical techniques were identified, involving motor unit decomposition from high-density grids, motor unit number estimation and measurements of neuronal hyperexcitability or neuromuscular architecture. Some studies have proposed specific diagnostic and prognostic criteria however clinical calibration in large ALS cohorts is currently lacking. The most validated method to monitor disease is the motor unit number index (MUNIX), which has been implemented as an outcome measure in two ALS clinical trials. CONCLUSION Surface EMG offers significant practical and analytical flexibility compared to invasive techniques. To capitalise on this fully, emphasis must be placed upon the multi-disciplinary collaboration of clinicians, bioengineers, mathematicians and biostatisticians. SIGNIFICANCE Surface EMG techniques can enrich effective biomarker development in ALS.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. Corrigendum to 'SPiQE: An automated analytical tool for detecting and characterising fasciculations in amyotrophic lateral sclerosis' [Clin. Neurophysiol. 130 (2019) 1083-1090]. Clin Neurophysiol 2019; 131:350. [PMID: 31706721 PMCID: PMC6941466 DOI: 10.1016/j.clinph.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom. https://spiqe.co.uk
| | - A Wickham
- Department of Bioengineering, Imperial College London, United Kingdom
| | - R Iniesta
- Department of Biostatistics and Health Informatics, King's College London, United Kingdom
| | - E Drakakis
- Department of Bioengineering, Imperial College London, United Kingdom
| | - M Boutelle
- Department of Bioengineering, Imperial College London, United Kingdom
| | - K Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - C Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw CE. Preprocessing surface EMG data removes voluntary muscle activity and enhances SPiQE fasciculation analysis. Clin Neurophysiol 2019; 131:265-273. [PMID: 31740273 PMCID: PMC6941467 DOI: 10.1016/j.clinph.2019.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022]
Abstract
A novel preprocessing step removes the need for manual selection of relaxed surface EMG data. SPiQE provides reliable fasciculation analysis from raw thirty-minute recordings in ALS. This paves the way for clinical calibration of a potential novel biomarker of disease progression.
Objectives Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). The Surface Potential Quantification Engine (SPiQE) is a novel analytical tool to identify fasciculation potentials from high-density surface electromyography (HDSEMG). This method was accurate on relaxed recordings amidst fluctuating noise levels. To avoid time-consuming manual exclusion of voluntary muscle activity, we developed a method capable of rapidly excluding voluntary potentials and integrating with the established SPiQE pipeline. Methods Six ALS patients, one patient with benign fasciculation syndrome and one patient with multifocal motor neuropathy underwent monthly thirty-minute HDSEMG from biceps and gastrocnemius. In MATLAB, we developed and compared the performance of four Active Voluntary IDentification (AVID) strategies, producing a decision aid for optimal selection. Results Assessment of 601 one-minute recordings permitted the development of sensitive, specific and screening strategies to exclude voluntary potentials. Exclusion times (0.2–13.1 minutes), processing times (10.7–49.5 seconds) and fasciculation frequencies (27.4–71.1 per minute) for 165 thirty-minute recordings were compared. The overall median fasciculation frequency was 40.5 per minute (10.6–79.4 IQR). Conclusion We hereby introduce AVID as a flexible, targeted approach to exclude voluntary muscle activity from HDSEMG recordings. Significance Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
- Corresponding author. https://spiqe.co.uk
| | - A. Wickham
- Department of Bioengineering, Imperial College London, UK
| | - R. Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, UK
| | - E. Drakakis
- Department of Bioengineering, Imperial College London, UK
| | - M. Boutelle
- Department of Bioengineering, Imperial College London, UK
| | - K. Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | - CE. Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
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Fuller J, Peralta P, White-Alikakos D, Jeffery S, Breckenridge J, Mungovan S, Mills K. Is there a link between common adult movement screening tests and ankle or foot injury in junior netballers? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.190] [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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Abstract
Joint pain attributable to osteoarthritis (OA) is complex and influenced by a myriad of factors beyond local joint pathology. Current practice continues to predominantly adopt a biomedical approach to OA despite emerging evidence of the importance of a more holistic approach. This paper will summarise evidence for the presence of multidimensional pain profiles in knee joint pain and the presence of subgroups characterized by systemic features such as psychological distress, high comorbidity load or sensitisation of the nervous system. These factors have the potential to influence patient outcomes making them relevant for clinicians and highlighting the necessity of a broader multifactorial approach to assessment and treatment. This review describes the current state of the evidence for treatments of people with knee OA-related pain, including those receiving strong recommendations from current clinical guidelines, namely exercise, weight loss, self-management advice and pharmacological approaches. Other pain-modulating treatment options are emerging such as sleep and psychological interventions, pain education and multisensory retraining. The evidence and rationale for these newer therapeutic approaches is discussed. Finally, this review will highlight some of the limitations of current international guidelines for the management of OA and make recommendations for future research.
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Affiliation(s)
- K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - M Hübscher
- Neuroscience Research Australia, Barker Street, Randwick, NSW 2031, Sydney, Australia.
| | - H O'Leary
- Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - N Moloney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.,Thrive Physiotherapy, Guernsey, Channel Islands, UK
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Schroer WC, LeMarr AR, Mills K, Childress AL, Morton DJ, Reedy ME. 2019 Chitranjan S. Ranawat Award: Elective joint arthroplasty outcomes improve in malnourished patients with nutritional intervention: a prospective population analysis demonstrates a modifiable risk factor. Bone Joint J 2019; 101-B:17-21. [PMID: 31256648 DOI: 10.1302/0301-620x.101b7.bjj-2018-1510.r1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS To date, no study has demonstrated an improvement in postoperative outcomes following elective joint arthroplasty with a focus on nutritional intervention for patients with preoperative hypoalbuminaemia. In this prospective study, we evaluated differences in the hospital length of stay (LOS), rate of re-admission, and total patient charges for a malnourished patient study population who received a specific nutrition protocol before surgery. PATIENTS AND METHODS An analytical report was extracted from the electronic medical record (EMR; Epic, Verona, Wisconsin) of a five-hospital network joint arthroplasty patient data set between 2014 and 2017. A total of 4733 patients underwent joint arthroplasty and had preoperative measurement of albumin levels: 2220 at four hospitals and 2513 at the study hospital. Albumin ≤ 3.4 g/l, designated as malnutrition, was found in 543 patients (11.5%). A nutritional intervention programme focusing on a high-protein, anti-inflammatory diet was initiated in January 2017 at one study hospital. Hospital LOS, re-admission rate, and 90-day charges were compared for differential change between patients in study and control hospitals for all elective hip and knee arthroplasty patients, and for malnourished patients over time as the nutrition intervention was implemented. RESULTS Malnourished patients with nutritional intervention at the study hospital had shorter hospital LOS beginning in 2017 than malnourished patients at control hospitals during the same period (p = 0.04). Similarly, this cohort had significantly lower primary hospitalization charges, charges associated with hospital re-admissions, and 90-day total charges (p < 0.001). Inclusion of covariant potential confounders (age, anaemia, diabetes, and obesity) did not alter the conclusions of the primary statistical analysis. CONCLUSION Joint arthroplasty outcomes were positively affected in study patients with low albumin when a high-protein, anti-inflammatory diet was encouraged. Elective surgery was neither cancelled nor delayed with a malnutrition designation. While the entire network population experienced improved postoperative outcomes, malnourished control patients did not experience this improvement. This study demonstrated that education on malnutrition can benefit patients. Cite this article: Bone Joint J 2019;101-B(7 Supple C):17-21.
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Affiliation(s)
- W C Schroer
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
| | - A R LeMarr
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
| | - K Mills
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
| | - A L Childress
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
| | - D J Morton
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
| | - M E Reedy
- St. Louis Joint Replacement Institute, SSM Health DePaul Hospital, Bridgeton, Missouri, USA
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Bashford J, Wickham A, Iniesta R, Drakakis E, Boutelle M, Mills K, Shaw C. SPiQE: An automated analytical tool for detecting and characterising fasciculations in amyotrophic lateral sclerosis. Clin Neurophysiol 2019; 130:1083-1090. [PMID: 31078984 PMCID: PMC6553680 DOI: 10.1016/j.clinph.2019.03.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/14/2019] [Accepted: 03/17/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Fasciculations are a clinical hallmark of amyotrophic lateral sclerosis (ALS). Compared to concentric needle EMG, high-density surface EMG (HDSEMG) is non-invasive and records fasciculation potentials (FPs) from greater muscle volumes over longer durations. To detect and characterise FPs from vast data sets generated by serial HDSEMG, we developed an automated analytical tool. METHODS Six ALS patients and two control patients (one with benign fasciculation syndrome and one with multifocal motor neuropathy) underwent 30-minute HDSEMG from biceps and gastrocnemius monthly. In MATLAB we developed a novel, innovative method to identify FPs amidst fluctuating noise levels. One hundred repeats of 5-fold cross validation estimated the model's predictive ability. RESULTS By applying this method, we identified 5,318 FPs from 80 minutes of recordings with a sensitivity of 83.6% (+/- 0.2 SEM), specificity of 91.6% (+/- 0.1 SEM) and classification accuracy of 87.9% (+/- 0.1 SEM). An amplitude exclusion threshold (100 μV) removed excessively noisy data without compromising sensitivity. The resulting automated FP counts were not significantly different to the manual counts (p = 0.394). CONCLUSION We have devised and internally validated an automated method to accurately identify FPs from HDSEMG, a technique we have named Surface Potential Quantification Engine (SPiQE). SIGNIFICANCE Longitudinal quantification of fasciculations in ALS could provide unique insight into motor neuron health.
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Affiliation(s)
- J. Bashford
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - A. Wickham
- Department of Bioengineering, Imperial College London, United Kingdom
| | - R. Iniesta
- Department of Biostatistics and Health Informatics, King’s College London, United Kingdom
| | - E. Drakakis
- Department of Bioengineering, Imperial College London, United Kingdom
| | - M. Boutelle
- Department of Bioengineering, Imperial College London, United Kingdom
| | - K. Mills
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
| | - C. Shaw
- UK Dementia Research Institute, Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
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Lynch A, Amunya S, Gomez A, Reitter JN, Mills K. Differential protein splicing of salt‐dependent inteins from
Haloquadratum walsbyi. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.633.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Mills K, Pocovi N, Descallar J, Naylor J. Prevalence and factors associated with physical activity after total hip or knee arthroplasty. J Sci Med Sport 2018. [DOI: 10.1016/j.jsams.2018.09.124] [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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21
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Lamb JS, Fiorello CV, Satgé YG, Mills K, Ziccardi M, Jodice PGR. Movement patterns of California brown pelicans (Pelecanus occidentalis californicus) following oiling and rehabilitation. Mar Pollut Bull 2018; 131:22-31. [PMID: 29886941 DOI: 10.1016/j.marpolbul.2018.03.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/23/2018] [Accepted: 03/25/2018] [Indexed: 06/08/2023]
Abstract
Direct mortality of wildlife is generally used to quantify the damage caused by pollution events. However, free-ranging wildlife that survive initial exposure to pollutants may also experience long-term consequences. Individuals that are rehabilitated following oil exposure have a known history of oiling and provide a useful study population for understanding behavior following pollution events. We GPS-tracked 12 rehabilitated brown pelicans and compared their movements to those of eight non-oiled, non-rehabilitated controls over 87-707 (mean = 271) days. Rehabilitated pelicans traveled farther, spent more time in long-distance movements, and occupied more productive waters than controls. These differences were more apparent among females than males. Rehabilitated pelicans also visited breeding colonies and nest sites at lower rates than controls. Our results indicate that, although rehabilitated pelicans undertake long-distance movements, they may display increased dispersion and reduced breeding investment, particularly among females. Such behavioral changes could have long-term effects on populations.
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Affiliation(s)
- J S Lamb
- Department of Forestry and Environmental Conservation, South Carolina Cooperative Fish and Wildlife Research Unit, Lehotsky Hall, Clemson University, Clemson, SC 29634, USA.
| | - C V Fiorello
- Oiled Wildlife Care Network, Karen C. Drayer Wildlife Health Center, 1089 Veterinary Drive VM3B, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Y G Satgé
- Department of Forestry and Environmental Conservation, South Carolina Cooperative Fish and Wildlife Research Unit, Lehotsky Hall, Clemson University, Clemson, SC 29634, USA
| | - K Mills
- Oiled Wildlife Care Network, Karen C. Drayer Wildlife Health Center, 1089 Veterinary Drive VM3B, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - M Ziccardi
- Oiled Wildlife Care Network, Karen C. Drayer Wildlife Health Center, 1089 Veterinary Drive VM3B, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - P G R Jodice
- U.S. Geological Survey South Carolina Cooperative Fish and Wildlife Research Unit, Department of Forestry and Environmental Conservation, Lehotsky Hall, Clemson, SC 29634, USA
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Boullosa LF, Cooksey L, Savaliya P, Bonney S, Orchard L, Smits E, Mills K, Orchard K, Guinn B. PO-408 New targets for the immunotherapy of adult B-cell acute lymphocytic leukaemia. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Lynch AK, Amunya S, Gomez A, Reitter J, Mills K. Differential protein splicing of salt‐dependent inteins from
Haloquadratum walsbyi. FASEB J 2018. [DOI: 10.1096/fasebj.2018.32.1_supplement.655.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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24
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Eyles JP, Hunter DJ, Meneses SRF, Collins NJ, Dobson F, Lucas BR, Mills K. Instruments assessing attitudes toward or capability regarding self-management of osteoarthritis: a systematic review of measurement properties. Osteoarthritis Cartilage 2017; 25:1210-1222. [PMID: 28263899 DOI: 10.1016/j.joca.2017.02.802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/23/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To make a recommendation on the "best" instrument to assess attitudes toward and/or capabilities regarding self-management of osteoarthritis (OA) based on available measurement property evidence. METHODS Electronic searches were performed in MEDLINE, EMBASE, CINAHL and PsychINFO (inception to 27 December 2016). Two reviewers independently rated measurement properties using the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) 4-point scale. Best evidence synthesis was determined by considering COSMIN ratings for measurement property results and the level of evidence available for each measurement property of each instrument. RESULTS Eight studies out of 5653 publications met the inclusion criteria, with eight instruments identified for evaluation: Multidimensional Health Locus of Control (MHLC), Perceived Behavioural Control (PBC), Patient Activation Measure (PAM), Educational Needs Assessment (ENAT), Stages of Change Questionnaire in Osteoarthritis (SCQOA), Effective Consumer Scale (EC-17) and Perceived Efficacy in Patient-Physician Interactions five item (PEPPI-5) and ten item scales. Measurement properties assessed for these instruments included internal consistency (k = 8), structural validity (k = 8), test-retest reliability (k = 2), measurement error (k = 1), hypothesis testing (k = 3) and cross-cultural validity (k = 3). No information was available for content validity, responsiveness or minimal important change (MIC)/minimal important difference (MID). The Dutch PEPPI-5 demonstrated the best measurement property evidence; strong evidence for internal consistency and structural validity but limited evidence for reliability and construct validity. CONCLUSION Although PEPPI-5 was identified as having the best measurement properties, overall there is a poor level of evidence currently available concerning measurement properties of instruments to assess attitudes toward and/or capabilities regarding osteoarthritis self-management. Further well-designed studies investigating measurement properties of existing instruments are required.
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Affiliation(s)
- J P Eyles
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - D J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Australia.
| | - S R F Meneses
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Australia; Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Australia.
| | - N J Collins
- School of Health & Rehabilitation Sciences, University of Queensland, Australia.
| | - F Dobson
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
| | - B R Lucas
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - K Mills
- Centre for Physical Health, Department of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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Abstract
Sensory neurons in the gastrointestinal tract have multifaceted roles in maintaining homeostasis, detecting danger and initiating protective responses. The gastrointestinal tract is innervated by three types of sensory neurons: dorsal root ganglia, nodose/jugular ganglia and intrinsic primary afferent neurons. Here, we examine how these distinct sensory neurons and their signal transducers participate in regulating gastrointestinal inflammation and host defence. Sensory neurons are equipped with molecular sensors that enable neuronal detection of diverse environmental signals including thermal and mechanical stimuli, inflammatory mediators and tissue damage. Emerging evidence shows that sensory neurons participate in host-microbe interactions. Sensory neurons are able to detect pathogenic and commensal bacteria through specific metabolites, cell-wall components, and toxins. Here, we review recent work on the mechanisms of bacterial detection by distinct subtypes of gut-innervating sensory neurons. Upon activation, sensory neurons communicate to the immune system to modulate tissue inflammation through antidromic signalling and efferent neural circuits. We discuss how this neuro-immune regulation is orchestrated through transient receptor potential ion channels and sensory neuropeptides including substance P, calcitonin gene-related peptide, vasoactive intestinal peptide and pituitary adenylate cyclase-activating polypeptide. Recent studies also highlight a role for sensory neurons in regulating host defence against enteric bacterial pathogens including Salmonella typhimurium, Citrobacter rodentium and enterotoxigenic Escherichia coli. Understanding how sensory neurons respond to gastrointestinal flora and communicate with immune cells to regulate host defence enhances our knowledge of host physiology and may form the basis for new approaches to treat gastrointestinal diseases.
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Affiliation(s)
- N Y Lai
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA
| | - K Mills
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA
| | - I M Chiu
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA
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Mehta V, Jackson A, Mills K, Shaw M, Field M, Agarwal S. Reversal of coagulopathy with factor concentrates and autologous platelet rich plasma for aortic surgery with deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth 2017. [DOI: 10.1053/j.jvca.2017.02.073] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Miles LM, Allen E, Clarke R, Mills K, Uauy R, Dangour AD. Impact of baseline vitamin B12 status on the effect of vitamin B12 supplementation on neurologic function in older people: secondary analysis of data from the OPEN randomised controlled trial. Eur J Clin Nutr 2017; 71:1166-1172. [PMID: 28225050 DOI: 10.1038/ejcn.2017.7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The available evidence from randomised controlled trials suggests that vitamin B12 supplementation does not improve neurologic function in older people with marginal but not deficient Vitamin B12 status. This secondary analysis used data from the Older People and Enhanced Neurological function (OPEN) randomised controlled trial to assess whether baseline vitamin B12 status or change in vitamin B12 status over 12 months altered the effectiveness of dietary vitamin B12 supplementation on neurologic function in asymptomatic older people with depleted vitamin B12 status at study entry. SUBJECTS/METHODS Vitamin B12 status was measured as serum concentrations of vitamin B12, holotranscobalamin, homocysteine and via a composite indicator (cB12). Neurological function outcomes included eleven electrophysiological measures of sensory and motor components of peripheral and central nerve function. Linear regression analyses were restricted to participants randomised into the intervention arm of the OPEN trial (n=91). RESULTS Analyses revealed an inconsistent pattern of moderate associations between some measures of baseline vitamin B12 status and some neurological responses to supplementation. The directions of effect varied and heterogeneity in effect across outcomes could not be explained according to type of neurological outcome. There was no evidence of differences in the neurological response to vitamin B12 supplementation according to change from baseline over 12 months in any indicator of B12 status. CONCLUSIONS This secondary analysis of high-quality data from the OPEN trial provides no evidence that baseline (or change from baseline) vitamin B12 status modifies the effect of vitamin B12 supplementation on peripheral or central nerve conduction among older people with marginal vitamin B12 status. There is currently insufficient evidence of efficacy for neurological function to support population-wide recommendations for vitamin B12 supplementation in healthy asymptomatic older people with marginal vitamin B12 status.
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Affiliation(s)
- L M Miles
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - E Allen
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - R Clarke
- Clinical Trial Services Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - K Mills
- Department of Clinical Neurosciences, King's College, London, UK
| | - R Uauy
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - A D Dangour
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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da Silva T, Macaskill P, Mills K, Maher C, Williams C, Lin C, Hancock MJ. Predicting recovery in patients with acute low back pain: A Clinical Prediction Model. Eur J Pain 2017; 21:716-726. [PMID: 28107604 DOI: 10.1002/ejp.976] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND There is substantial variability in the prognosis of acute low back pain (LBP). The ability to identify the probability of individual patients recovering by key time points would be valuable in making informed decisions about the amount and type of treatment to provide. Predicting recovery based on presentation 1-week after initially seeking care is clinically important and may be more accurate than predictions made at initial presentation. The aim of this study was to predict the probability of recovery at 1-week, 1-month and 3-months after 1-week review in patients who still have LBP 1-week after initially seeking care. METHODS The study sample comprised 1070 patients with acute LBP, with a pain score of ≥2 1-week after initially seeking care. The primary outcome measure was days to recovery from pain. Ten potential prognostic factors were considered for inclusion in a multivariable Cox regression model. RESULTS The final model included duration of current episode, number of previous episodes, depressive symptoms, intensity of pain at 1-week, and change in pain over the first week after seeking care. Depending on values of the predictor variables, the probability of recovery at 1-week, 1-month and 3-months after 1-week review ranged from 4% to 59%, 19% to 91% and 30% to 97%, respectively. The model had good discrimination (C = 0.758) and calibration. CONCLUSIONS This study found that a model based on five easily collected variables could predict the probability of recovery at key time points in people who still have LBP 1-week after seeking care. SIGNIFICANCE A clinical prediction model based on five easily collected variables was able to predict the likelihood of recovery from an episode of acute LBP at three key time points. The model had good discrimination (C = 0.758) and calibration.
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Affiliation(s)
- T da Silva
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - P Macaskill
- Sydney Medical School, The University of Sydney, Australia
| | - K Mills
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - C Maher
- Sydney Medical School, The University of Sydney, Australia
| | - C Williams
- Sydney Medical School, The University of Sydney, Australia
| | - C Lin
- Sydney Medical School, The University of Sydney, Australia
| | - M J Hancock
- Department of Health Professions, Macquarie University, Sydney, Australia
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Mills K, Eyles J, Martin M, Hancock M, Hunter D. Predictors of different response trajectories to non-surgical management in individuals with patellofemoral OA. J Sci Med Sport 2017. [DOI: 10.1016/j.jsams.2017.01.086] [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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Paterson RW, Heywood WE, Heslegrave AJ, Magdalinou NK, Andreasson U, Sirka E, Bliss E, Slattery CF, Toombs J, Svensson J, Johansson P, Fox NC, Zetterberg H, Mills K, Schott JM. A targeted proteomic multiplex CSF assay identifies increased malate dehydrogenase and other neurodegenerative biomarkers in individuals with Alzheimer's disease pathology. Transl Psychiatry 2016; 6:e952. [PMID: 27845782 PMCID: PMC5314115 DOI: 10.1038/tp.2016.194] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/31/2016] [Indexed: 12/12/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia. Biomarkers are required to identify individuals in the preclinical phase, explain phenotypic diversity, measure progression and estimate prognosis. The development of assays to validate candidate biomarkers is costly and time-consuming. Targeted proteomics is an attractive means of quantifying novel proteins in cerebrospinal and other fluids, and has potential to help overcome this bottleneck in biomarker development. We used a previously validated multiplexed 10-min, targeted proteomic assay to assess 54 candidate cerebrospinal fluid (CSF) biomarkers in two independent cohorts comprising individuals with neurodegenerative dementias and healthy controls. Individuals were classified as 'AD' or 'non-AD' on the basis of their CSF T-tau and amyloid Aβ1-42 profile measured using enzyme-linked immunosorbent assay; biomarkers of interest were compared using univariate and multivariate analyses. In all, 35/31 individuals in Cohort 1 and 46/36 in Cohort 2 fulfilled criteria for AD/non-AD profile CSF, respectively. After adjustment for multiple comparisons, five proteins were elevated significantly in AD CSF compared with non-AD CSF in both cohorts: malate dehydrogenase; total APOE; chitinase-3-like protein 1 (YKL-40); osteopontin and cystatin C. In an independent multivariate orthogonal projection to latent structures discriminant analysis (OPLS-DA), these proteins were also identified as major contributors to the separation between AD and non-AD in both cohorts. Independent of CSF Aβ1-42 and tau, a combination of these biomarkers differentiated AD and non-AD with an area under curve (AUC)=0.88. This targeted proteomic multiple reaction monitoring (MRM)-based assay can simultaneously and rapidly measure multiple candidate CSF biomarkers. Applying this technique to AD we demonstrate differences in proteins involved in glucose metabolism and neuroinflammation that collectively have potential clinical diagnostic utility.
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Affiliation(s)
- R W Paterson
- Dementia Research Centre, Institute of Neurology, University College London, London, UK,Department of Neurodegeneration, University College London, Dementia Research Centre, Queen Square, London WC1N3BG, UK. E-mail:
| | - W E Heywood
- Centre for Translational Omics, Genetics and Genomic Medicine Programme, Institute of Child Health, University College London, London, UK
| | - A J Heslegrave
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - N K Magdalinou
- Lila Weston Institute, University College London Institute of Neurology, London, UK
| | - U Andreasson
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - E Sirka
- Centre for Translational Omics, Genetics and Genomic Medicine Programme, Institute of Child Health, University College London, London, UK
| | - E Bliss
- Centre for Translational Omics, Genetics and Genomic Medicine Programme, Institute of Child Health, University College London, London, UK
| | - C F Slattery
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - J Toombs
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK
| | - J Svensson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Endocrinology, Skaraborg Central Hospital, Skövde, Sweden
| | - P Johansson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Neuropsychiatry, Skaraborg Central Hospital, Falköping, Sweden
| | - N C Fox
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
| | - H Zetterberg
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, UK,Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
| | - K Mills
- Dementia Research Centre, Institute of Neurology, University College London, London, UK,Centre for Translational Omics, Genetics and Genomic Medicine Programme, Institute of Child Health, University College London, London, UK
| | - J M Schott
- Dementia Research Centre, Institute of Neurology, University College London, London, UK
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Bulman C, Forde-Johnson C, Griffiths A, Hallworth S, Kerry A, Khan S, Mills K, Sharp P. The development of peer reflective supervision amongst nurse educator colleagues: An action research project. Nurse Educ Today 2016; 45:148-155. [PMID: 27504899 DOI: 10.1016/j.nedt.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/30/2016] [Accepted: 07/20/2016] [Indexed: 06/06/2023]
Abstract
This action research study developed the use of peer reflective supervision (PRS) amongst eight nurse educators contributing to an undergraduate Adult Nursing programme at a UK University. During the academic year (2013-14), nurse educator co-researchers met for an introductory workshop and then met regularly in pairs to facilitate each other's reflection. This provided an opportunity for nurse educators to reflect on identified issues linked to their role with a facilitative peer. Educators met three additional times in a Reflexive Learning Group (RLG), to gather data on their use of PRS. Audio-recordings from the RLGs were transcribed and analysed using Norton's (2009) thematic analysis framework. Co-researchers iteratively validated the data and an external validation group critically viewed the evidence. Overall, seven themes were generated from the three research cycles. These were: PRS as a Valuable Affirming Experience; Time Issues; Facilitation- Support, Trust and Challenge; Developing a Flexible 'Toolbox'; To Write or Not to Write; Drawing on Literature; and Requirement for Action. Findings add new evidence regarding use of a flexible toolbox of resources to develop reflection and offer practical guidance on the development of PRS. Nurse educators often experienced similar concerns, and a facilitative supervision structure allowed co-researchers to positively explore these. Recognition of work pressures and requirement for time and space for reflection was highlighted, particularly regarding writing, and exploring the literature, to develop critical analysis of experiences. The importance of action as part of the reflective process was emphasised. Co-researchers reported positive personal change as well as the opportunity to highlight issues through their reflection for further action within the organisation. The study adds constructive evidence for the use of reflection to explore professional work, make sense of experiences and develop positive action. It has transferability to a wider international audience interested in the development of reflection amongst colleagues and the use of insider research techniques to challenge and develop practice.
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Affiliation(s)
- C Bulman
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom.
| | - C Forde-Johnson
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - A Griffiths
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - S Hallworth
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - A Kerry
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - S Khan
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - K Mills
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
| | - P Sharp
- Oxford Brookes University, Faculty of Health and Life Sciences, Marston Road Campus, Oxford, United Kingdom
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Naylor JM, Mills K, Buhagiar M, Fortunato R, Wright R. Minimal important improvement thresholds for the six-minute walk test in a knee arthroplasty cohort: triangulation of anchor- and distribution-based methods. BMC Musculoskelet Disord 2016; 17:390. [PMID: 27624720 PMCID: PMC5022203 DOI: 10.1186/s12891-016-1249-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/09/2016] [Indexed: 01/28/2023] Open
Abstract
Background The 6-minute walk test (6MWT) is a commonly used metric for measuring change in mobility after knee arthroplasty, however, what is considered an improvement after surgery has not been defined. The determination of important change in an outcome assessment tool is controversial and may require more than one approach. This study, nested within a combined randomised and observational trial, aimed to define a minimal important improvement threshold for the 6MWT in a knee arthroplasty cohort through a triangulation of methods including patient-perceived anchor-based thresholds and distribution-based thresholds. Methods Individuals with osteoarthritis performed a 6MWT pre-arthroplasty then at 10 and 26 weeks post-surgery. Each rated their perceived improvement in mobility post-surgery on a 7-point transition scale anchored from “much better” to “much worse”. Based on these responses the cohort was dichotomised into ‘improved’ and ‘not improved’. The thresholds for patient-perceived improvements were then identified using two receiver operating curve methods producing sensitivity and specificity indices. Distribution-based change thresholds were determined using two methods utilising effect size (ES). Agreement between the anchor- and distribution-based methods was assessed using kappa. Results One hundred fifty-eight from 166 participants in the randomised cohort and 222 from 243 in the combined randomised and observational cohort were included at 10 and 26 weeks, respectively. The slightly or more patient-perceived improvement threshold at 26 weeks (an absolute improvement of 26 m) was the only one to demonstrate sensitivity and specificity results both better than chance. At 10- and 26-weeks, the ES based on the mean change score divided by the baseline standard deviation (SD), was an absolute change of 24.5 and 37.9 m, respectively. The threshold based on a moderate ES (a 0.5 SD of the baseline score) was a change of 55.0 and 55.4 m at 10- and 26-weeks, respectively. The level of agreement between the 26-week anchor-based and distribution-based minimal absolute changes was very good (k = 0.88 (95 % CI 0.81 0.95)). Conclusion A valid threshold of improvement for the 6MWT can only be proposed for changes identified from baseline to 26 weeks post-surgery. The level of agreement between anchor- and distribution-based methods indicates that a true minimal or more threshold of meaningful improvement following surgery is likely within the ranges proposed by the triangulation of all four methods, that is, 26 to 55 m.
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Affiliation(s)
- J M Naylor
- Whitlam Orthopaedic Research Centre, Orthopaedic Department, Liverpool Hospital, Locked Bag 7103, Liverpool BC, 1871, Sydney, NSW, Australia. .,South West Sydney Clinical School, UNSW, Sydney, Australia. .,Ingham Institute of Applied Medical Health Research, Sydney, Australia.
| | - K Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - M Buhagiar
- South West Sydney Clinical School, UNSW, Sydney, Australia.,Ingham Institute of Applied Medical Health Research, Sydney, Australia.,Braeside Hospital, Hammondcare Group, Sydney, Australia
| | - R Fortunato
- Physiotherapy Department, Campbelltown Hospital, Sydney, Australia
| | - R Wright
- Occupational Therapy Department, Fairfield Hospital, Sydney, Australia
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Smith L, Moran B, Rea H, Raverdeau M, McDonald I, Mills K, Steinhoff M. 268 Expression of Interleukin-33 by resident and immune cells in the skin of patients with atopic dermatitis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.06.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stella C, Robinson M, Mills K. LB797 Gene expression profiling of dry skin shows pronounced seasonal influence and evidence for genetic susceptibility factors. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Koulopoulos M, Giaccone Z, Reitter J, Mills K. A Biophysical Analysis of Aspartic Acid Cyclization Coupled to Peptide Bond Cleavage. FASEB J 2016. [DOI: 10.1096/fasebj.30.1_supplement.1083.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Naylor J, Mills K, Buhagiar M, Fortunato R, Wright F. Exploring the minimal, moderate and maximal important differences for the 6 MWT post total knee arthroplasty: Which is the appropriate change metric? J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.202] [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: 11/29/2022]
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37
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Eyles J, Mills K, Handcock M, Martin M, Hunter D. Can patients with patellofemoral osteoarthritis be sub-grouped at baseline? J Sci Med Sport 2015. [DOI: 10.1016/j.jsams.2015.12.206] [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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Hall N, Birt L, Banks J, Emery J, Mills K, Johnson M, Rubin GP, Hamilton W, Walter FM. Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study. BMJ Open 2015; 5:e008448. [PMID: 26453591 PMCID: PMC4606388 DOI: 10.1136/bmjopen-2015-008448] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Timely diagnosis of colorectal cancer is important to improve survival. This study explored symptom appraisal and help-seeking among patients referred to specialist services with symptoms of colorectal cancer. DESIGN Qualitative in-depth interview study. SETTING AND PARTICIPANTS Participants were recruited on referral to gastroenterology clinics (North East and East of England); interviews were conducted soon after referral. We purposively sampled participants to ensure a range of accounts in terms of age, sex, diagnosis and geographical location. METHODS Data collection and analysis were underpinned by the Model of Pathways to Treatment. Framework analysis was used to explore the data within and across cases, focusing on patient beliefs and experiences, disease factors and healthcare influences. RESULTS 40 participants were interviewed (aged 43-87 years, 17 women, 18 diagnosed with colorectal cancer). Patients diagnosed with and without colorectal cancer had similar symptom pathways. We found a range of interacting and often competing biopsychosocial, contextual and cultural influences on the way in which people recognised, interpreted and acted on their symptoms. People attempted to 'maintain normality' through finding benign explanations for their symptoms. Bodily changes were appraised within the context of usual bowel patterns, comorbidities and life events, and decisions to seek help were made in relation to expectations about the course of symptoms. The 'private nature' of colorectal cancer symptoms could affect both their identification and discussions with others including healthcare professionals. Within the context of the National Health Service, people needed to legitimise appropriate use of healthcare services and avoid being thought of as wasting doctors' time. CONCLUSIONS Findings provide guidance for awareness campaigns on reducing stigma around appraising and discussing bowel movements, and the importance of intermittent and non-specific symptoms. Altering perceptions about the appropriate use of health services could have a beneficial effect on time to presentation.
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Affiliation(s)
- N Hall
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - L Birt
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - J Banks
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - J Emery
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - K Mills
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | | | - G P Rubin
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - W Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - F M Walter
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
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Kim J, Mills K, Fehniger J, Diaz E, Febbraro T, Yamada S, Lee N, Tenney M. Venous thromboembolism in patients receiving extended pharmacologic prophylaxis following robotic surgery for endometrial cancer. Gynecol Oncol 2015. [DOI: 10.1016/j.ygyno.2015.07.041] [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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Yakely A, Bonano A, Jaramillo M, Williams J, Reitter J, Mills K. Relating Intein Flexibility to the Temperature Dependence of Activity. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.722.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anthony Yakely
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Alexander Bonano
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Mario Jaramillo
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Jennie Williams
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Julie Reitter
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Kenneth Mills
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
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Koulopoulos M, Giaccone Z, Reitter J, Mills K. A Biophysical Analysis of Asp Cyclization Coupled to Peptide Bond Cleavage. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.722.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Zachary Giaccone
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Julie Reitter
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Kenneth Mills
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
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Mills K. Integrating Biochemistry into a First‐year Undergraduate Rhetoric‐intensive Seminar Program. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.559.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kenneth Mills
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
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Giaccone Z, Reitter J, Steeves A, Kulik H, Mills K. Peptide Bond Cleavage through Asparagine Cyclization. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.722.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zachary Giaccone
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Julie Reitter
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Adam Steeves
- Massachusetts Institute of Technology Chemical EngineeringBostonMassachusettsUnited States
| | - Heather Kulik
- Massachusetts Institute of Technology Chemical EngineeringBostonMassachusettsUnited States
| | - Kenneth Mills
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
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Siegart N, Colelli K, Reitter J, Mills K. Protein Splicing of a Temperature‐Dependent Intein from an Extreme Thermophile. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.573.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicolle Siegart
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Kathryn Colelli
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Julie Reitter
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
| | - Kenneth Mills
- ChemistryCollege of the Holy CrossWorcesterMassachusettsUnited States
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Jaramillo M, Williams J, Reitter J, Mills K. Structure and Activity of Inteins from
Pyrococcus abyssi
and
Pyrococcus horikoshii. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.722.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mario Jaramillo
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Jennie Williams
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Julie Reitter
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
| | - Kenneth Mills
- Department of ChemistryCollege of the Holy CrossWorcesterMAUnited States
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Walter FM, Rubin G, Bankhead C, Morris HC, Hall N, Mills K, Dobson C, Rintoul RC, Hamilton W, Emery J. Symptoms and other factors associated with time to diagnosis and stage of lung cancer: a prospective cohort study. Br J Cancer 2015; 112 Suppl 1:S6-13. [PMID: 25734397 PMCID: PMC4385970 DOI: 10.1038/bjc.2015.30] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND This prospective cohort study aimed to identify symptom and patient factors that influence time to lung cancer diagnosis and stage at diagnosis. METHODS Data relating to symptoms were collected from patients upon referral with symptoms suspicious of lung cancer in two English regions; we also examined primary care and hospital records for diagnostic routes and diagnoses. Descriptive and regression analyses were used to investigate associations between symptoms and patient factors with diagnostic intervals and stage. RESULTS Among 963 participants, 15.9% were diagnosed with primary lung cancer, 5.9% with other thoracic malignancies and 78.2% with non-malignant conditions. Only half the cohort had an isolated first symptom (475, 49.3%); synchronous first symptoms were common. Haemoptysis, reported by 21.6% of cases, was the only initial symptom associated with cancer. Diagnostic intervals were shorter for cancer than non-cancer diagnoses (91 vs 124 days, P=0.037) and for late-stage than early-stage cancer (106 vs 168 days, P=0.02). Chest/shoulder pain was the only first symptom with a shorter diagnostic interval for cancer compared with non-cancer diagnoses (P=0.003). CONCLUSIONS Haemoptysis is the strongest symptom predictor of lung cancer but occurs in only a fifth of patients. Programmes for expediting earlier diagnosis need to focus on multiple symptoms and their evolution.
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Affiliation(s)
- F M Walter
- 1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - G Rubin
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - C Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - H C Morris
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - N Hall
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - K Mills
- Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - C Dobson
- School of Medicine, Pharmacy & Health, Durham University, Wolfson Building, Stockton on Tees TS17 6BH, UK
| | - R C Rintoul
- Department of Thoracic Oncology, Papworth Hospital NHS Foundation Trust, Cambridge CB23 3RE, UK
| | - W Hamilton
- University of Exeter, College House, St Luke's Campus, Exeter EX2 4TE, UK
| | - J Emery
- 1] Department of Public Health & Primary Care, University of Cambridge, Cambridge CB1 8RN, UK [2] General Practice & Primary Care Academic Centre, University of Melbourne, Melbourne, Victoria, Australia [3] Department of General Practice, University of Western Australia, Perth, Western Australia, Australia
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Mills K, Reitter J, Nicastri M, Colleli K, Williams J. Protein Splicing: Regulation by Temperature and Oxidation State of Non-Canonical Inteins. Biophys J 2015. [DOI: 10.1016/j.bpj.2014.11.188] [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: 10/24/2022] Open
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Mills K, Osis S, Martin M, Hettinga B, Ferber R. A preliminary study of potential indicators of standardised exercise program success in individuals with knee osteoarthritis: Is self-report enough? J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.350] [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: 10/24/2022]
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Myrdal Miller A, Mills K, Wong T, Drescher G, Lee S, Sirimuangmoon C, Schaefer S, Langstaff S, Minor B, Guinard JX. Flavor-Enhancing Properties of Mushrooms in Meat-Based Dishes in Which Sodium Has Been Reduced and Meat Has Been Partially Substituted with Mushrooms. J Food Sci 2014; 79:S1795-804. [DOI: 10.1111/1750-3841.12549] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - K. Mills
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - T. Wong
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - G. Drescher
- The Culinary Inst. of America at Greystone; St. Helena CA USA
| | - S.M. Lee
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | - C. Sirimuangmoon
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | - S. Schaefer
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
| | | | - B. Minor
- The Culinary Inst. of America at Greystone; St. Helena CA USA
- Mushroom Council; San José CA USA
| | - J.-X Guinard
- Dept. of Food Science and Technology; Univ. of California; Davis CA USA
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Mills K, Reitter J, Nicastri M, Williams J, Colelli K. The stops and starts of protein splicing: regulation and mechanism of non‐canonical inteins (584.1). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.584.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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