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Vij O, Dey M, Morrison K, Kouranloo K. Incidence, management and prognosis of new-onset sarcoidosis post COVID-19 infection. Sarcoidosis Vasc Diffuse Lung Dis 2024; 41:e2024004. [PMID: 38567560 PMCID: PMC11008326 DOI: 10.36141/svdld.v41i1.15027] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/25/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIM SARS-CoV-2 infection has been linked to hyperinflammation in multiple organs with a potential mechanistic link with resulting autoimmunity. There have been reports of many inflammatory complications following COVID-19, including sarcoidosis. A literature review on new-onset sarcoidosis following COVID-19 is lacking. We evaluated potential associations between COVID-19 and development of new-onset sarcoidosis. METHODS Articles discussing biopsy-proven sarcoidosis after confirmed COVID-19 infection, published 1956 until April 2023, were included. All article types were deemed eligible except opinion and review articles. RESULTS A pooled total of 15 patients with new-onset diagnosis of sarcoidosis after COVID-19 infection were included, 45.5% female, mean age 46.1 years (standard deviation 14.7) at onset of sarcoidosis. Patients were from: Europe (n=11); North America (n=2); South America (n=1); Asia (n=1). The mean time between COVID-19 infection and diagnosis of sarcoidosis was 56.3 days, although this ranged from 10 to 140 days. Organ systems predominantly affected by sarcoidosis were: pulmonary (n=11); cutaneous (n=3); cardiac (n=2); ocular (n=1); systemic (n=1) (with overlapping features in certain patients). Sarcoidosis was treated as follows: glucocorticoids (n=8); azathioprine (n=1); cardiac re-synchronisation therapy (n=1); heart transplant (n=1). All patients were reported to have survived, with one requiring intensive care admission. CONCLUSIONS Our result suggests there is a potential link between COVID-19 and new-onset sarcoidosis. The potential mechanism for this is through cytokine mediated immune modulation in COVID-19 infection. Obtaining a tissue sample remains key in confirming the diagnosis of sarcoidosis and this may be delayed during active COVID-19 infection.
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Affiliation(s)
| | - Mrinalini Dey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | | | - Koushan Kouranloo
- School of Medicine, University of Liverpool, Merseyside, UK
- Department of Rheumatology, East Surrey Hospital, Redhill, UK
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Yasar B, Suh YE, Chapman E, Nicholls L, Henderson D, Jones C, Morrison K, Wells E, Henderson J, Meehan C, Sohaib A, Taylor H, Tree A, van As N. Simultaneous Focal Boost With Stereotactic Radiation Therapy for Localized Intermediate- to High-Risk Prostate Cancer: Primary Outcomes of the SPARC Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00425-5. [PMID: 38499253 DOI: 10.1016/j.ijrobp.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Dose-escalated radiation therapy is associated with better biochemical control at the expense of toxicity. Stereotactic body radiation therapy (SBRT) with dose escalation to the dominant intraprostatic lesion (DIL) provides a logical approach to improve outcomes in high-risk disease while limiting toxicity. This study evaluated the toxicity and quality of life (QoL) with CyberKnife-based SBRT and simultaneous integrated boost in localized prostate cancer. METHODS AND MATERIALS Eligible participants included newly diagnosed, biopsy-proven unfavorable intermediate- to high-risk localized prostate cancer (at least 1 of the following: Gleason ≥4+3, magnetic resonance imaging(MRI)-defined T3a N0, prostate-specific antigen ≥20) with up to 2 MRI-identified DILs. Participants received 36.25 Gy in 5 fractions on alternative days with a simultaneous boost to DIL up to 47.5 Gy as allowed by organ-at-risk constraints delivered by CyberKnife. All participants received androgen deprivation therapy. The primary outcome measure was acute grade 2+ genitourinary toxicity. Acute and late genitourinary and gastrointestinal toxicity using Radiation Therapy Oncology Group scoring, biochemical parameters, International Prostate Symptom Score, International Index of Erectile Function 5, and EQ-5D QoL outcomes were assessed. RESULTS Between 2013 and 2023, 20 participants were enrolled with a median follow-up of 30 months. The median D95 dose to DIL was 47.43 Gy. Cumulative acute grade 2+ genitourinary and gastrointestinal toxicity were 25% and 30%, respectively. One patient developed acute grade 3 genitourinary toxicity (5%). There is no late grade 3 genitourinary or gastrointestinal toxicity to date. International Prostate Symptom Score and urinary QoL scores recovered to baseline by 6 months. Patient-reported outcomes showed no significant change in EQ-5D QoL scores at 12 weeks and 1 year. There are no cases of biochemical relapse reported to date. CONCLUSIONS CyberKnife SBRT-delivered dose of 36.25 Gy to the prostate with a simultaneous integrated boost up to 47.5 Gy is well tolerated. Acute and late genitourinary and gastrointestinal toxicity rates are comparable to other contemporary SBRT trials and series with focal boost.
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Affiliation(s)
- Binnaz Yasar
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom.
| | - Yae-Eun Suh
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ewan Chapman
- St Bartholomew's Hospital, London, United Kingdom
| | | | - Daniel Henderson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Caroline Jones
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kirsty Morrison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Emma Wells
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Carole Meehan
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Aslam Sohaib
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Helen Taylor
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - Nicholas van As
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Kerr S, Bedston S, Cezard G, Sampri A, Murphy S, Bradley DT, Morrison K, Akbari A, Whiteley W, Sullivan C, Patterson L, Khunti K, Denaxas S, Bolton T, Khan S, Keys A, Weatherill D, Mooney K, Davies J, Ritchie L, McMenamin J, Kee F, Wood A, Lyons RA, Sudlow C, Robertson C, Sheikh A. Undervaccination and severe COVID-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales. Lancet 2024; 403:554-566. [PMID: 38237625 DOI: 10.1016/s0140-6736(23)02467-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Undervaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe COVID-19 outcomes-ie, COVID-19 hospitalisation or death-compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with undervaccination, and to investigate the risk of severe COVID-19 outcomes in people who were undervaccinated in each UK nation and across the UK. METHODS We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least 5 years of age to be included in the cohorts. We estimated adjusted odds ratios for undervaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe COVID-19 outcomes during the period June 1 to Sept 30, 2022, with undervaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe COVID-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022. FINDINGS The numbers of people undervaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-White ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe COVID-19 outcomes in the cohorts, with 14 156 of these in undervaccinated participants. We estimated the reduction in severe COVID-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94-326) in the 5-15 years age group, 1544 (1399-1689) in those aged 16-74 years, and 5426 (5340-5512) in those aged 75 years or older. aHRs for severe COVID-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61-2·78) for one dose fewer than recommended, 3·13 (2·93-3·34) for two fewer, 3·61 (3·13-4·17) for three fewer, and 3·08 (2·89-3·29) for four fewer. INTERPRETATION Rates of undervaccination against COVID-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Undervaccination was associated with an elevated risk of severe COVID-19 outcomes. FUNDING UK Research and Innovation National Core Studies: Data and Connectivity.
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Millington T, Morrison K, Jeffrey K, Sullivan C, Kurdi A, Fagbamigbe AF, Swallow B, Shi T, Shah SA, Kerr S, Simpson CR, Ritchie LD, Robertson C, Sheikh A, Rudan I. Caveats in reporting of national vaccine uptake. J Glob Health 2024; 14:03006. [PMID: 38330197 PMCID: PMC10852533 DOI: 10.7189/jogh.14.03006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Affiliation(s)
| | | | - Karen Jeffrey
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Clinical Pharmacy, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Ben Swallow
- School of Mathematics and Statistics, University of St Andrews, UK
| | - Ting Shi
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Steven Kerr
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Colin R Simpson
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, NZ
| | - Lewis D Ritchie
- School of Medicine, Medical Sciences & Nutrition, Academic Primary Care, University of Aberdeen, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Igor Rudan
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Algebra University College, Zagreb, Croatia
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Kilby W, Lee C, Young P, Dewitt D, Torgov M, Martin TJ, Capo L, Ikeura M, Malinao CC, Morrison KJM, Morrison K. Superiority of BNCT Treatment Planning Metrics Achieved Using Novel vs. Reference (BPA-F) Pharmaceuticals in Head and Neck Locations. Int J Radiat Oncol Biol Phys 2023; 117:e678. [PMID: 37785996 DOI: 10.1016/j.ijrobp.2023.06.2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Several novel boron delivery compounds currently under investigation by our group have demonstrated formulation, biodistribution, and dose response benefits in small animal models [1]. In this study we analyze the potential clinical impact of these compounds for boron neutron capture therapy (BNCT) in human patients. MATERIALS/METHODS Pharmacokinetic models were used to estimate the tumor and normal tissue boron concentrations after continuous infusion of the novel compounds and BPA-F. Patient model segmentation, material assignment, and alignment of one or more treatment beams were exported from a commercial treatment planning system (TPS) to a novel dose calculation tool. This information was used to generate a voxelized model that incorporated the source, beam shaping assembly, collimator, and patient materials so that the full albedo effect was included in each dose calculation. Physical dose from 10B(n,α), 14N(n,p), 1H(n,n') interactions plus gamma rays from 1H(n,γ) and other reactions within the patient and treatment equipment were calculated by Monte Carlo transport of particles originating in a pre-generated phase space at the cover surface. RBE and CBE weighting factors are applied to combine these four physical dose volumes into an equivalent dose volume, and these five dose volumes were passed back to the TPS for evaluation. RESULTS Tumor dose was increased by up to 2.6x for the novel compounds while normal tissue doses were constant or slightly reduced in comparison to BPA-F plans. Alternatively, for identical tumor dose the normal tissue doses and treatment time were reduced by up to 2.6x. In addition, in some cases it was possible to generate a single beam treatment plan using the new compounds that delivered higher tumor dose and lower normal tissues doses than a multiple beam plan using BPA-F. CONCLUSION This study demonstrates both dosimetric and practical benefits of the new compounds in comparison to BPA-F, including the potential to deliver treatment using fewer beam directions and correspondingly easier treatment setups and higher patient throughput. The potential of these compounds to extend the range of clinical indications for BNCT is also discussed. These results motivate upcoming experimental testing of the key assumptions involved in their calculation.
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Affiliation(s)
- W Kilby
- TAE Life Sciences, Foothill Ranch, CA
| | - C Lee
- TAE Life Sciences, Foothill Ranch, CA
| | - P Young
- TAE Life Sciences, Foothill Ranch, CA
| | - D Dewitt
- TAE Life Sciences, Foothill Ranch, CA
| | - M Torgov
- TAE Life Sciences, Foothill Ranch, CA
| | | | - L Capo
- TAE Life Sciences, Foothill Ranch, CA
| | - M Ikeura
- TAE Life Sciences, Foothill Ranch, CA
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Morrison K, Cullen L, James AB, Chua V, Sullivan C, Robertson C, Carruthers J, Wood R, Jeffrey K, MacDonald C, Shah SA, Rudan I, Simpson CR, McCowan C, Vittal Katikireddi S, Grange Z, Ritchie L, Sheikh A. Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: Two retrospective cohort analyses of the primary schedule and third dose. Vaccine 2023; 41:5863-5876. [PMID: 37598025 DOI: 10.1016/j.vaccine.2023.07.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/19/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Vaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death. AIM To identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one. METHODS We conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors. RESULTS Of 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period. The most strongly associated predictors for not receiving the second dose were: being aged 18-29 (reference: 50-59 years; aOR:4.26; 95% confidence interval (CI):4.14-4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29-4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16-3.32). The most strongly associated predictors for not receiving the third dose were: being 18-29 (reference: 50-59 years aOR:4.44; 95%CI: 4.38-4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53-2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30-2.46). Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule. CONCLUSION We observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.
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Affiliation(s)
| | - Lucy Cullen
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Vera Chua
- Public Health Scotland, Glasgow, Scotland, UK
| | | | - Chris Robertson
- Public Health Scotland, Glasgow, Scotland, UK; University of Strathclyde, Glasgow, UK
| | | | - Rachael Wood
- Public Health Scotland, Glasgow, Scotland, UK; Usher Institute, University of Edinburgh, Scotland, UK
| | - Karen Jeffrey
- Usher Institute, University of Edinburgh, Scotland, UK
| | | | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Scotland, UK
| | - Colin R Simpson
- Usher Institute, University of Edinburgh, Scotland, UK; School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow, Scotland, UK; School of Health and Wellbeing, University of Glasgow, Scotland, UK
| | - Zoe Grange
- Public Health Scotland, Glasgow, Scotland, UK
| | - Lewis Ritchie
- School of Medicine, Medical Science & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Scotland, UK
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Guckian J, Lee N, Sutton JE, Mayat NY, Morrison K, Farquhar KEL, Singh M. The dermatologist identity crisis: a phenomenological analysis of dermatology trainee professional identity during generalist redeployment. Clin Exp Dermatol 2023; 48:345-351. [PMID: 36763771 DOI: 10.1093/ced/llac131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Dermatology faces a workforce crisis against a backdrop of wider medical education shifts towards generalism. A pivot towards generalism may have an impact on dermatology trainee professional identity, which, to our knowledge, has not been investigated and is known to have an impact on competence and conceptualization of ethics among physicians. Disruption because of the COVID-19 pandemic led to dermatology trainee redeployment and therefore presents a unique opportunity to examine dermatology trainee professional identity during times of pressure. AIM To identify the impact of COVID-19 redeployment on dermatology trainee professional identity, the factors influencing identity and whether such factors affect trainees' perceptions about their future careers. METHODS Ten trainees were purposively recruited to the study. Data were collected through semistructured interviews and were analysed phenomenologically using the template analysis method. Central and integrative themes were identified. RESULTS Three central themes were identified: trainee identity and values; redeployment transitions; and future clarity. Three integrative themes were found: tribes; sense of purpose; and uncertainty. Trainees see competence and community as central to the dermatologist identity. Most trainees experienced a reaffirmation of their prior values, psychologically retreating to close-knit communities. However, some underwent disorienting dilemmas, later reflecting on their futures as dermatologists. CONCLUSION Healthcare crises may have a significant impact on dermatology trainee professional identity and may lead to reaffirmation of prior tribal values or disorienting reflection upon future career trajectories. Improved support among diverse communities, minimization of uncertainty and fostering a sense of purpose among trainees may aid identity enrichment and safeguard the future dermatology consultant workforce.
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Affiliation(s)
- Jonathan Guckian
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Natasha Lee
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Jonathan E Sutton
- Department of Dermatology, University Hospital of Southampton NHS Trust, Southampton, UK
| | - Nabilah Y Mayat
- Medical Education Department, Airedale General Hospital, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Minal Singh
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Tree AC, Ostler P, van der Voet H, Chu W, Loblaw A, Ford D, Tolan S, Jain S, Martin A, Staffurth J, Armstrong J, Camilleri P, Kancherla K, Frew J, Chan A, Dayes IS, Duffton A, Brand DH, Henderson D, Morrison K, Brown S, Pugh J, Burnett S, Mahmud M, Hinder V, Naismith O, Hall E, van As N. Intensity-modulated radiotherapy versus stereotactic body radiotherapy for prostate cancer (PACE-B): 2-year toxicity results from an open-label, randomised, phase 3, non-inferiority trial. Lancet Oncol 2022; 23:1308-1320. [PMID: 36113498 DOI: 10.1016/s1470-2045(22)00517-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Localised prostate cancer is commonly treated with external beam radiotherapy and moderate hypofractionation is non-inferior to longer schedules. Stereotactic body radiotherapy (SBRT) allows shorter treatment courses without impacting acute toxicity. We report 2-year toxicity findings from PACE-B, a randomised trial of conventionally fractionated or moderately hypofractionated radiotherapy versus SBRT. METHODS PACE is an open-label, multicohort, randomised, controlled, phase 3 trial conducted at 35 hospitals in the UK, Ireland, and Canada. In PACE-B, men aged 18 years and older with a WHO performance status 0-2 and low-risk or intermediate-risk histologically-confirmed prostate adenocarcinoma (Gleason 4 + 3 excluded) were randomly allocated (1:1) by computerised central randomisation with permuted blocks (size four and six), stratified by centre and risk group to control radiotherapy (CRT; 78 Gy in 39 fractions over 7·8 weeks or, following protocol amendment on March 24, 2016, 62 Gy in 20 fractions over 4 weeks) or SBRT (36·25 Gy in five fractions over 1-2 weeks). Androgen deprivation was not permitted. Co-primary outcomes for this toxicity analysis were Radiation Therapy Oncology Group (RTOG) grade 2 or worse gastrointestinal and genitourinary toxicity at 24 months after radiotherapy. Analysis was by treatment received and included all patients with at least one fraction of study treatment assessed for late toxicity. Recruitment is complete. Follow-up for oncological outcomes continues. The trial is registered with ClinicalTrials.gov, NCT01584258. FINDINGS We enrolled and randomly assigned 874 men between Aug 7, 2012, and Jan 4, 2018 (441 to CRT and 433 to SBRT). In this analysis, 430 patients were analysed in the CRT group and 414 in the SBRT group; a total of 844 (97%) of 874 randomly assigned patients. At 24 months, RTOG grade 2 or worse genitourinary toxicity was seen in eight (2%) of 381 participants assigned to CRT and 13 (3%) of 384 participants assigned to SBRT (absolute difference 1·3% [95% CI -1·3 to 4·0]; p=0·39); RTOG grade 2 or worse gastrointestinal toxicity was seen in 11 (3%) of 382 participants in the CRT group versus six (2%) of 384 participants in the SBRT group (absolute difference -1·3% [95% CI -3·9 to 1·1]; p=0·32). No serious adverse events (defined as RTOG grade 4 or worse) or treatment-related deaths were reported within the analysis timeframe. INTERPRETATION In the PACE-B trial, 2-year RTOG toxicity rates were similar for five fraction SBRT and conventional schedules of radiotherapy. Prostate SBRT was found to be safe and associated with low rates of side-effects. Biochemical outcomes are awaited. FUNDING Accuray.
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Affiliation(s)
- Alison C Tree
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK.
| | | | | | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Daniel Ford
- University Hospitals Birmingham, Birmingham, UK
| | - Shaun Tolan
- The Clatterbridge Cancer Centre, Liverpool, UK
| | | | - Alexander Martin
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - John Armstrong
- Cancer Trials Ireland, Dublin, Ireland; St Luke's Radiation Oncology Network, St Lukes Hospital, Dublin, Ireland
| | | | | | | | - Andrew Chan
- University Hospitals Coventry & Warwickshire, Coventry, UK
| | - Ian S Dayes
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Douglas H Brand
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - Kirsty Morrison
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | | | - Julia Pugh
- The Institute of Cancer Research, London, UK
| | | | | | | | - Olivia Naismith
- The Royal Marsden Hospital, London, UK; Radiotherapy Trials QA Group, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - Nicholas van As
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
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Abstract
Background AI has the potential to improve healthcare. However, there is limited research investigating the factors which influence the adoption of AI within a healthcare system. Research aims I aimed to use innovation theory to understand the barriers and facilitators that influence AI adoption in the NHS; and to explore solutions to overcome these barriers, and examine these factors, particularly within radiology, pathology and general practice. Methodology Twelve semi-structured, one-to-one interviews were conducted with key informants. Interview data were analysed using thematic analysis. Findings A range of barriers and facilitators to the adoption of AI within the NHS were identified, including IT infrastructure and language clarity. Several solutions to overcome the barriers were proposed by participants, including education strategies and innovation champions. Conclusion Future research should explore the importance of IT infrastructure in supporting AI adoption, examine the terminology around AI and explore specialty-specific barriers to AI adoption in greater depth.
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Affiliation(s)
- Kirsty Morrison
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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10
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Bohne AS, Dietrich C, Morrison K, Schwarz T, Wehkamp U, Kaeding M. Two cases of quinine-induced fixed 'drug' eruption induced by long drinks. J Eur Acad Dermatol Venereol 2021; 35:e774-e776. [PMID: 34138490 DOI: 10.1111/jdv.17453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A S Bohne
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - C Dietrich
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - K Morrison
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - T Schwarz
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - U Wehkamp
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - M Kaeding
- Department of Dermatology and Allergology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Morrison K, Ellis R, Cross S. P.74 Enhanced recovery for obstetric surgery in Scotland: Improving mobilisation post-spinal in elective caesarean sections. Int J Obstet Anesth 2021. [DOI: 10.1016/j.ijoa.2021.103072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stephens DN, Wodnicki R, Chen R, Liang LM, Zhou Q, Morrison K, Ferrara KW. The effective coupling coefficient for a completed PIN-PMN-PT array. Ultrasonics 2021; 109:106258. [PMID: 33011614 PMCID: PMC7744335 DOI: 10.1016/j.ultras.2020.106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
The computation of the electromechanical coupling coefficient (EMCC) of a fully assembled medical ultrasound transducer array is directly computed with closed form expressions. The Levenberg-Marquardt non-linear regression algorithm (LMA) is employed to help confirm the EMCC calculated prediction (kEFF) and provide statistical insights. The complex electrical impedance spectra of a 1-3 composite array with two matching layers operating at a 3.75 MHz center frequency using PIN-PMN-PT single crystal material is measured in air both before and after oven heating at 160 °C for 15 min. The oven heating produces changes in the EMCC of -4.9%, clamped dielectric constant of -11%, and effective transducer longitudinal velocity of -2.5%. Utilizing the pre- and post-heating array impedance data, the calculated EMCC values from the new closed form expressions agree well with the complete KLM model based LMA, and also exhibit approximately one tenth the error as compared to the formulas for a flat, unloaded transducer.
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Nicholls L, Suh YE, Chapman E, Henderson D, Jones C, Morrison K, Sohaib A, Taylor H, Tree A, van As N. Stereotactic radiotherapy with focal boost for intermediate and high-risk prostate cancer: Initial results of the SPARC trial. Clin Transl Radiat Oncol 2020; 25:88-93. [PMID: 33145444 PMCID: PMC7591551 DOI: 10.1016/j.ctro.2020.10.004] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Dose escalation to dominant intraprostatic lesions (DILs) is a novel method to increase the therapeutic ratio in localised prostate cancer. The Stereotactic Prostate Augmented Radiotherapy with Cyberknife (SPARC) trial was designed to determine the feasibility of a focal boost defined with multiparametric magnetic resonance imaging (mpMRI) using stereotactic ablative body radiotherapy (SABR). MATERIALS AND METHODS Patients were included with newly diagnosed intermediate to high risk prostate cancer with at least one of: Gleason score 4 + 3, stage T3a, or PSA > 20 ng/ml. Visible disease on mpMRI was mandatory and up to 2 separate nodules were allowed. All patients received androgen deprivation. Patients received 36.25 Gy in 5 fractions using CyberKnife® and the DIL received a simultaneous boost to a maximum of 47.5 Gy, as allowed by OAR constraints. Genitourinary (GU) and gastrointestinal (GI) toxicity was reported using the RTOG scoring criteria. International Index of Erectile Function (IIEF) and EQ-5D global health scores were regularly captured. RESULTS An interim safety analysis was performed on the first 8 patients, recruited between July 2013 and December 2015. Median follow up was 56 months (range 50-74). Median D95 values for the prostate PTV and boost volume were 36.55 Gy (range 35.87-36.99) and 46.62 Gy (range 44.85-48.25) respectively. Of the dose constraints, 10/80 were not achieved but all were minor dose variations. Grade 2+ acute GU and GI toxicities were 37.5% respectively while grade 2+ late GU and GI toxicities were 12.5% and 0% respectively. IIEF and quality of life scores recovered over time and all patients remain in biochemical remission. CONCLUSION The first patients have been successfully treated with prostate SABR and focal boost on the SPARC trial, with excellent adherence to the planning protocol. Toxicity and efficacy results are promising and further recruitment is underway.
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Affiliation(s)
- Luke Nicholls
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Yae-eun Suh
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Ewan Chapman
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
| | - Daniel Henderson
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, West Midlands B15 2GW, UK
| | - Caroline Jones
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Kirsty Morrison
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Aslam Sohaib
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Helen Taylor
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Alison Tree
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
| | - Nicholas van As
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
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Affiliation(s)
- Ayesha N Ahmed
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nawal Zia
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Halimah Khalil
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Adeolu Banjoko
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Kirsty Morrison
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Alexander Lawson
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Vaibhi Dua
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Pratyusha Saha
- Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Venkat G, Cox CDW, Sola A, Basso V, Morrison K. Measurement of the heat flux normalized spin Seebeck coefficient of thin films as a function of temperature. Rev Sci Instrum 2020; 91:073910. [PMID: 32752805 DOI: 10.1063/5.0007989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
The spin Seebeck effect (SSE) has generated interest in the thermoelectric and magnetic communities for potential high efficiency energy harvesting applications and spintronic communities as a source of pure spin current. Understanding the underlying mechanisms requires characterization of potential materials across a range of temperatures; however, for thin films, the default measurement of an applied temperature gradient (across the sample) has been shown to be compromised by the presence of thermal resistances. Here, we demonstrate a method to perform low temperature SSE measurements where, instead of monitoring the temperature gradient, the heat flux passing through the sample is measured using two calibrated heat flux sensors. This has the advantage of measuring the heat loss through the sample as well as providing a reliable method to normalize the SSE response of thin film samples. We demonstrate this method with an SiO2/Fe3O4/Pt sample where a semiconducting-insulating transition occurs at the Verwey transition, TV, of Fe3O4 and quantify the thermomagnetic response above and below TV.
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Affiliation(s)
- G Venkat
- Department of Physics, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - C D W Cox
- Department of Physics, Loughborough University, Loughborough LE11 3TU, United Kingdom
| | - A Sola
- Instituto Nazionale di Ricerca Metrologica, Strada delle Cacce 91, 10135 Torino, Italy
| | - V Basso
- Instituto Nazionale di Ricerca Metrologica, Strada delle Cacce 91, 10135 Torino, Italy
| | - K Morrison
- Department of Physics, Loughborough University, Loughborough LE11 3TU, United Kingdom
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Maunsell R, Bloomfield S, Erridge C, Foster C, Hardcastle M, Hogden A, Kidd A, Lisiecka D, McDermott C, Morrison K, Recio-Saucedo A, Rickenbach L, White S, Williams P, Wheelwright S. Developing a web-based patient decision aid for gastrostomy in motor neurone disease. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.062] [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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Morrison K, Van As N. PO-0860 Improving consistency of proximal seminal vesicle delineation for prostate SBRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Van As NJ, Brand D, Tree A, Ostler PJ, Chu W, Loblaw A, Ford D, Tolan SP, Jain S, Martin AS, Staffurth J, Brown S, Burnett SM, Duffton A, Griffin C, Hinder V, Morrison K, Naismith OF, Hall E. PACE: Analysis of acute toxicity in PACE-B, an international phase III randomized controlled trial comparing stereotactic body radiotherapy (SBRT) to conventionally fractionated or moderately hypofractionated external beam radiotherapy (CFMHRT) for localized prostate cancer (LPCa). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1 Background: External beam radiotherapy (EBRT) is a curative treatment for LPCa. Large randomised controlled trials (RCTs) have shown moderately hypofractionated regimens (2.5–3 Gy/fraction(f)) as non-inferior to conventionally fractionated regimens (2 Gy/f). PACE-B aims to demonstrate non-inferiority of SBRT compared to CFMHRT for biochemical or clinical failure. Compared to CFMHRT, SBRT reduces patient (pt) attendances but compressed overall treatment time may influence acute toxicity severity. Methods: PACE is a phase III open-label multiple-cohort RCT. Men with LPCa, stage T1-T2, ≤ Gleason 3 + 4, PSA ≤ 20 ng/mL, unsuitable for surgery or preferring EBRT, were eligible for the PACE-B cohort. Between 08/12-01/18, 874 pts (38 centres) were randomised (1:1) to SBRT or CFMHRT. SBRT dose was 36.25 Gy/5f in 1-2 weeks (wks), CFMHRT as 78 Gy/39f over 7.5 wks, or 62 Gy/20f in 4 wks. Androgen deprivation therapy was not permitted. Clinician reported acute toxicity was assessed at baseline, 2-weekly during CFMHRT and at 2, 4, 8 & 12 wks post-treatment. Key toxicity outcomes were worst grade 2+ Radiation Therapy Oncology Group (RTOG) genitourinary (GU) and gastrointestinal (GI) acute toxicities, compared by Chi-square test with alpha 0.05 divided between the two measures. Results: By per protocol analysis n=430 received CFMHRT, n=414 received SBRT. Key characteristics seen in the CFMHRT and SBRT groups respectively were: mean age: 69.5 vs 69.3 years; T-stage ≥T2b: 51.8% vs 56.6%; Gleason Score 3+4: 80.2% vs 85.0%; PSA 10-20 ng/mL: 30.9% vs 31.6%. RTOG G2+ toxicity was not significantly different for GI events (CMFHRT 52/430 (12.1%) vs SBRT 42/414 (10.1%), p=0.368), nor GU events (CFMHRT 117/430 (27.2%) vs SBRT 96/414 (23.2%), p=0.179). Conclusions: Despite an accelerated treatment schedule, RTOG assessments show similar rates of acute GI and GU toxicity for SBRT and CFHFRT. Pt follow-up in PACE-B continues and results of late toxicity and biochemical/clinical failure are awaited. Clinical trial information: NCT01584258.
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Affiliation(s)
- Nicholas John Van As
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Douglas Brand
- Institute of Cancer Research, London, United Kingdom
| | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Loblaw
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Daniel Ford
- City Hospital, Cancer Centre Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Shaun P. Tolan
- Clatterbridge Cancer Centre NHS Foundation, Wirral, United Kingdom
| | | | | | | | - Stephanie Brown
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Stephanie M. Burnett
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Aileen Duffton
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Clare Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Vicki Hinder
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, United Kingdom
| | | | | | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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Morrison K, Naismith O, van As N. Variability Analysis of Clinical Target Volume Outlining for Prostate Stereotactic Body Radiotherapy within the Multicentre PACE Trial. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.012] [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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Morrison K, Tree A, Khoo V, Van As NJ. The PACE trial: International randomised study of laparoscopic prostatectomy vs. stereotactic body radiotherapy (SBRT) and standard radiotherapy vs. SBRT for early stage organ-confined prostate cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.tps153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS153 Background: The development of Stereotactic Body Radiotherapy (SBRT) has provided a further treatment option for early stage prostate cancer. In addition to the benefits of an overall treatment time reduction, profound hypofractionation could result in therapeutic gain given the radiobiology of prostate cancer. Evidence suggests SBRT to be safe and effective; however randomised data is lacking comparing outcomes with standard treatment options. Aim: To assess whether SBRT offers therapeutic benefit in comparison to prostatectomy or standard radiotherapy. Methods: The PACE trial is an international multicentre phase III trial, comprising two parallel randomisation processes. Within PACE A, potential surgical candidates are randomised between radical prostatectomy and SBRT (36.25 Gy in 5 fractions). In PACE B, randomisation is between standard radiotherapy (78Gy in 39 fractions or 62Gy in 20 fractions) and SBRT (36.35Gy in 5 fractions). SBRT can be delivered using Cyberknife or gantry based techniques. Patients with low or intermediate risk prostate cancer are eligible for the trial, and are treated without the use androgen deprivation therapy. Follow up is for a period of 10 years. The aim is to recruit 234 patients to PACE A (117 in each arm) and 858 patients to PACE B (429 patients in each arm). Primary Objectives: PACE A: To determine whether there is improved quality of life after SBRT compared with surgery at 2 years post treatment, using EPIC score to measure urinary incontinence and bowel bother. PACE B: to determine whether SBRT is non-inferior to surgery in terms of freedom from biochemical/clinical failure at 5 years from randomisation. Progress: PACE A has been slower to recruit than anticipated due to the difficulties of a surgery versus radiotherapy randomisation. However, it is expected to reach target accrual, having recruited 57 patients from 3 centres. In contrast, PACE B is recruiting exceptionally well, open in 40 centres, and as of October 2017 recruited 762 patients. Accrual target is expected to be reached by the end of 2017. Clinical trial information: NCT01584258.
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Affiliation(s)
| | - Alison Tree
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom
| | - Vincent Khoo
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Nicholas John Van As
- Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Yeung A, Weir A, Austin H, Morrison K, Inverarity D, Sherval J, Henderson N, Joshi S, Ure R, McAuley A. Assessing the impact of a temporary class drug order on ethylphenidate-related infections among people who inject drugs in Lothian, Scotland: an interrupted time-series analysis. Addiction 2017; 112:1799-1807. [PMID: 28600805 DOI: 10.1111/add.13898] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 02/10/2017] [Revised: 04/02/2017] [Accepted: 06/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS In April 2015, the UK government enacted a temporary class drug order (TCDO) on ethylphenidate in response to reported harms associated with its use, in particular an outbreak of infections among people who inject drugs (PWID) in Lothian, Scotland. This study assesses the effect that the TCDO had on reducing the most common infections identified during the outbreak: Streptococcus pyogenes and Staphylococcus aureus. DESIGN The outbreak was split into a pre-intervention period (35 weeks) and a post-intervention period (26 weeks) based around the date of the TCDO. Segmented negative binomial regression models were used to compare trends in weekly counts of infections between the pre- and post-intervention periods. SETTING AND PARTICIPANTS PWID in the Lothian region of Scotland. MEASUREMENTS Cases of S. pyogenes and S. aureus infections reported within the National Health Service, Lothian. FINDINGS There were 251 S. pyogenes and/or S. aureus infections recorded among 211 PWID between February 2014 and December 2015: 171 infections in the pre-intervention period and 51 in the post-intervention period. Significant trend changes in weekly S. pyogenes and/or S. aureus infections following the TCDO were found [relative risk (RR) = 0.88, 95% confidence interval (CI) = 0.82-0.94]. PWID who self-reported using novel psychoactive substances (NPS) were at higher risk of acquiring these infections (RR = 1.81, 95% CI = 1.12-2.93), particularly when comparing the risk of infection with NPS use for a specific strain, S. pyogenes emm76.0, against the risk of infection with NPS use for S. pyogenes (emm types other than emm76.0) (RR = 3.49, 95% CI = 1.32-9.21). CONCLUSIONS The UK government's 2015 temporary class drug order on ethylphenidate was effective in reducing infections among people who inject drugs during an outbreak situation in Lothian, Scotland.
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Affiliation(s)
- Alan Yeung
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK
| | - Amanda Weir
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK
| | - Hannah Austin
- Department of Public Health, NHS Lothian, Edinburgh, UK
| | | | - Donald Inverarity
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Jim Sherval
- Department of Public Health, NHS Lothian, Edinburgh, UK
| | - Naomi Henderson
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Shruti Joshi
- Department of Microbiology, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Roisin Ure
- Scottish Haemophilus Legionella Meningococcus Pneumococcus Reference Laboratory, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, UK
| | - Andrew McAuley
- Blood-borne Viruses and Sexually Transmitted Infections Section, Health Protection Scotland, Glasgow, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Doñate F, Yang P, Morrison K, Karki S, Aviña H, Lackey J, Sawas A, Savage K, Perez R, Advani R, Zain J, O'Connor O, Reyno L. Analysis of preclinical and clinical samples after treatment with a CD37 targeting antibody drug conjugate (AGS67E) support a high level of CD37 expression in NHL. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- F. Doñate
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - P. Yang
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - K. Morrison
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - S. Karki
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - H. Aviña
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - J.M. Lackey
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
| | - A. Sawas
- Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - K.J. Savage
- Department of Medicine; British Columbia Cancer Center; Vancouver BC Canada
| | - R.P. Perez
- Division of Hematology / Oncology; University of Kansas Clinical Research Center; Westwood KS USA
| | - R.H. Advani
- Division of Oncology; Stanford University Medical Center; Stanford CA USA
| | - J.M. Zain
- Hematology and Hematopoietic Transplantation; City of Hope; Duarte CA USA
| | - O.A. O'Connor
- Center for Lymphoid Malignancies; Columbia University Medical Center; New York NY USA
| | - L.M. Reyno
- Translational Research/Clinical Oncology; Agensys; Santa Monica CA USA
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Ost P, Van As N, Pasquier D, Ingresso G, Zilli T, De Meerleer G, Surgo A, Morrison K, Orecchia R, Lancia A, Fonteyne V, Tree A, Ponti E, Miralbell R, Jereczek-Fossa B. Stereotactic body radiotherapy for nodal oligorecurrent prostate cancer: A multi-institutional analysis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/s1569-9056(16)30437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Petrylak D, Heath E, Sonpavde G, George S, Morgans A, Eigl B, Picus J, Cheng S, Hotte S, Gartner E, Vincent M, Chu R, Anand B, Morrison K, Jackson L, Melhem-Bertrandt A, Yu E. Interim analysis of a phase I dose escalation trial of the antibody drug conjugate (ADC) AGS15E (ASG-15ME) in patients (Pts) with metastatic urothelial cancer (mUC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sohani Z, Anand S, Robiou-du-Pont S, Morrison K, McDonald S, Atkinson S, Teo K, Meyre D. 137: Genes Increasing Glucose Levels in Early Childhood Provide Support for the Fetal Insulin Hypothesis: Results from the Family Study. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morrison K, Zerizer I, Trouncer R, Murray I, Amin K, Taylor A. EP-1267: Defining a standard method for functional bone marrow sparing with IMRT for cervical cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wolpin BM, O'Reilly EM, Ko YJ, Blaszkowsky LS, Rarick M, Rocha-Lima CM, Ritch P, Chan E, Spratlin J, Macarulla T, McWhirter E, Pezet D, Lichinitser M, Roman L, Hartford A, Morrison K, Jackson L, Vincent M, Reyno L, Hidalgo M. Global, multicenter, randomized, phase II trial of gemcitabine and gemcitabine plus AGS-1C4D4 in patients with previously untreated, metastatic pancreatic cancer. Ann Oncol 2013; 24:1792-1801. [PMID: 23448807 PMCID: PMC3716216 DOI: 10.1093/annonc/mdt066] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/08/2012] [Accepted: 01/28/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We evaluated AGS-1C4D4, a fully human monoclonal antibody to prostate stem cell antigen (PSCA), with gemcitabine in a randomized, phase II study of metastatic pancreatic cancer. PATIENTS AND METHODS Patients with Eastern Cooperative Oncology Group (ECOG) performance status 0/1 and previously untreated, metastatic pancreatic adenocarcinoma were randomly assigned 1:2 to gemcitabine (1000 mg/m(2) weekly seven times, 1 week rest, weekly three times q4weeks) or gemcitabine plus AGS-1C4D4 (48 mg/kg loading dose, then 24 mg/kg q3weeks IV). The primary end point was 6-month survival rate (SR). Archived tumor samples were collected for pre-planned analyses by PSCA expression. RESULTS Between April 2009 and May 2010, 196 patients were randomly assigned to gemcitabine (n = 63) or gemcitabine plus AGS-1C4D4 (n = 133). The 6-month SR was 44.4% (95% CI, 31.9-57.5) in the gemcitabine arm and 60.9% (95% CI, 52.1-69.2) in the gemcitabine plus AGS-1C4D4 arm (P = 0.03), while the median survival was 5.5 versus 7.6 months and the response rate was 13.1% versus 21.6% in the two arms, respectively. The 6-month SR was 57.1% in the gemcitabine arm versus 79.5% in the gemcitabine plus AGS-1C4D4 arm among the PSCA-positive subgroup and 31.6% versus 46.2% among the PSCA-negative subgroup. CONCLUSIONS This randomized, phase II study achieved its primary end point, demonstrating an improved 6-month SR with addition of AGS-1C4D4 to gemcitabine among patients with previously untreated, metastatic pancreatic adenocarcinoma. ClinicalTrials.gov identifier: NCT00902291.
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Affiliation(s)
| | - E M O'Reilly
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Y J Ko
- Sunnybrook Health Science Center, Toronto, Canada
| | | | - M Rarick
- Kaiser Permanente Northwest Region Oncology Hematology, Portland
| | - C M Rocha-Lima
- Sylvester Comprehensive Cancer Center, University of Miami, Miami
| | - P Ritch
- Medical College of Wisconsin, Milwaukee
| | - E Chan
- Vanderbilt University Medical Center, Nashville, USA
| | - J Spratlin
- Cross Cancer Institute, Edmonton, Alberta, Canada
| | - T Macarulla
- Hospital Vall d'Hebrón, Servicio de Oncología, Barcelona, Spain
| | - E McWhirter
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - D Pezet
- Inserm U1071, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - M Lichinitser
- State Institution 'Blokhin Cancer Research Centre RAMS', Moscow
| | - L Roman
- State Healthcare Institution 'Leningrad Regional Oncologic Dispensary', Saint Petersburg, Russia
| | | | | | | | | | - L Reyno
- Agensys, Inc., Santa Monica, USA
| | - M Hidalgo
- Centro Integral Oncológico 'Clara Campal', Madrid; Centro Nacional de Investigaciones Oncologicas, Madrid, Spain
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Al-Chalabi A, Shaw P, Kelly J, Morrison K, Murphy C, Thornhill M, Steen N, Leigh PN. LITHIUM CARBONATE IS NOT BENEFICIAL FOR PATIENTS WITH AMYOTROPHIC LATERAL SCLEROSIS: RESULTS OF THE LICALS TRIAL [EUDRACT NUMBER: 2008-006891-31]. J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Doñate F, Hartford A, Morrison K, da Cruz L, Nater J, Brooks T, Ou J, Chalita-Eid P, Stover D, Reyno L. 480 Detection by Immunohistochemistry of Prostate Stem Cell Antigen (PSCA) in Tumors is Not a Predictive Biomarker for the Anti-PSCa Monoclonal Antibody AGS-1C4D4: Identification of Alternative Predictive Biomarkers. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Helden L, Morrison K, Levinson A, Ng S, Colizza L. NP026 Randomized Trial of E-Learning Vs Face-to-Face Education on Patient Knowledge and Treatment Choices for Cholesterol Lowering Interventions. Can J Cardiol 2012. [DOI: 10.1016/j.cjca.2012.07.841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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31
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Korczak D, Szatmari P, Duku E, Morrison K, Georgiadis K, Lipman E. Childhood Onset Depression is Associated with Adult Overweight: Results from a Prospective Longitudinal Community Study. Paediatr Child Health 2012. [DOI: 10.1093/pch/17.suppl_a.11a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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32
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Morrison K, Bratko M, Turcaud J, Berenov A, Caplin AD, Cohen LF. A calorimetric method to detect a weak or distributed latent heat contribution at first order magnetic transitions. Rev Sci Instrum 2012; 83:033901. [PMID: 22462932 DOI: 10.1063/1.3690381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Microcalorimetry has proven to be a versatile tool to investigate first order magnetic phase transitions as it can be used in different experimental modes to separate the latent heat from heat capacity. However, the methodology fails if the latent heat contribution is below instrumental resolution of 10 nJ. If the nucleation size of the new phase is much less than 100 μm, the typical size of the fragment measured, the latent heat could appear to be too distributed in temperature or magnetic field to be detected. Here, we show that for certain classes of magnetic transition, our microcalorimetry technique can be extended to enable an estimate of the latent heat to be obtained from a combination of heat capacity and magnetic measurements. This technique is best suited for material systems with weakly first order phase transitions, or highly distributed due to inhomogeneity.
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Affiliation(s)
- K Morrison
- Blackett Laboratory, Imperial College London, London, SW7 2AZ United Kingdom.
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33
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Marsh E, Young T, Morrison K, Winer JB, Llewelyn JG. 163 Inflammatory demyelinating neuropathy complicating anti-TNF-α therapy. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.205] [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: 11/03/2022]
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34
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Siller L, Wong K, Farah C, Morrison K, Bryan P, Wolstenholme J, Warren A. 040 Can Child Life Interventions Replace Sedation for Obtaining Complete Echocardiograms on Toddlers With Heart Disease? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.037] [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] Open
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35
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Kerins M, Fitzgerald G, O Neill M, Morrison K, Bannon J, Spain M, McKee G. P96 A descriptive study of some outcome measures in cardiac rehabilitation: obesity, physical fitness, anxiety and depression. Eur J Cardiovasc Nurs 2011. [DOI: 10.1016/s1474-5151(11)60130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Morrison K, Goodall EF, Stockton J, Hill S, Dong YY, Moorby C. PATU6 Protein interactors of EAAT2 and their role in motor neurone disease/amyotrophic lateral sclerosis. Journal of Neurology, Neurosurgery & Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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38
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Branford WR, Yates KA, Barkhoudarov E, Moore JD, Morrison K, Magnus F, Miyoshi Y, Sousa PM, Conde O, Silvestre AJ, Cohen LF. Coexistence of universal and topological anomalous hall effects in metal CrO2 thin films in the dirty limit. Phys Rev Lett 2009; 102:227201. [PMID: 19658897 DOI: 10.1103/physrevlett.102.227201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Indexed: 05/28/2023]
Abstract
The scaling exponent of 1.6 between anomalous Hall and longitudinal conductivity, characteristic of the universal Hall mechanism in dirty-metal ferromagnets, emerges from a series of CrO2 films as we systematically increase structural disorder. Magnetic disorder in CrO2 increases with temperature and this drives a separate topological Hall mechanism. We find that these terms are controlled discretely by structural and magnetic defect populations, and their coexistence leads to apparent divergence from exponent 1.6, suggesting that the universal term is more prevalent than previously realized.
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Affiliation(s)
- W R Branford
- Physics Department, Blackett Laboratory, Imperial College London, Prince Consort Road, SW7 2BZ, United Kingdom
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39
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Miyoshi Y, Morrison K, Moore JD, Caplin AD, Cohen LF. Heat capacity and latent heat measurements of CoMnSi using a microcalorimeter. Rev Sci Instrum 2008; 79:074901. [PMID: 18681727 DOI: 10.1063/1.2960556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A new method of utilizing a commercial silicon nitride membrane calorimeter to measure the latent heat at a first order phase transition is presented. The method is a direct measurement of the thermoelectric voltage jump induced by the latent heat, in a thermally isolated system ideally suited for single crystal and small microgram samples. We show that when combined with the ac calorimetry technique previously developed, the resultant thermal measurement capabilities are extremely powerful. We demonstrate the applicability of the combined method with measurements on a 100 microm size fragment of CoMnSi exhibiting a sizable magnetocaloric effect near room temperature, and obtain good agreement with previously reported values on bulk samples.
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Affiliation(s)
- Y Miyoshi
- Blackett Laboratory, Imperial College London, London, United Kingdom
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40
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Magnus F, Wood B, Moore J, Morrison K, Perkins G, Fyson J, Wiltshire MCK, Caplin D, Cohen LF, Pendry JB. A d.c. magnetic metamaterial. Nat Mater 2008; 7:295-297. [PMID: 18297077 DOI: 10.1038/nmat2126] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 01/21/2008] [Indexed: 05/25/2023]
Abstract
Electromagnetic metamaterials are a class of materials that have been artificially structured on a subwavelength scale. They are currently the focus of a great deal of interest because they allow access to previously unrealizable properties such as a negative refractive index. Most metamaterial designs have so far been based on resonant elements, such as split rings, and research has concentrated on microwave frequencies and above. Here, we present the first experimental realization of a non-resonant metamaterial designed to operate at zero frequency. Our samples are based on a recently proposed template for an anisotropic magnetic metamaterial consisting of an array of superconducting plates. Magnetometry experiments show a strong, adjustable diamagnetic response when a field is applied perpendicular to the plates. We have calculated the corresponding effective permeability, which agrees well with theoretical predictions. Applications for this metamaterial may include non-intrusive screening of weak d.c. magnetic fields.
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Affiliation(s)
- F Magnus
- Physics Department, Imperial College London, Exhibition Road, London SW7 2AZ, UK
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41
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Shetty V, Teubner A, Morrison K, Scott NA. Proximal loop jejunostomy is a useful adjunct in the management of multiple intestinal suture lines in the septic abdomen. Br J Surg 2006; 93:1247-50. [PMID: 16862610 DOI: 10.1002/bjs.5473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Bowel repair in the septic abdomen can be problematic. This study investigated the use of a proximal loop jejunostomy to protect injured or fistulated bowel that had been returned to the abdomen after repair and/or anastomosis.
Methods
Ten patients who underwent laparotomy for intra-abdominal sepsis and/or fistulation, followed by distal enteric repair and/or anastomosis and construction of a proximal defunctioning loop jejunostomy, were studied retrospectively. Seven patients had 21 intestinal suture lines returned to the peritoneal cavity in the presence of intra-abdominal sepsis (14 anastomoses, two enterotomy closures and five serotomy repairs). Two patients had a difficult relaparotomy for pelvic abscess (two distal anastomoses, one enterotomy closure and three serotomy repairs). The final patient had pelvic sepsis and radiation enteritis; the distal anastomosis was defunctioned by a loop jejunostomy.
Results
The median distance from the duodenojejunal flexure to the loop stoma was 80 (range 30–170) cm. All jejunostomies were closed via a local approach, a median of 11 (range 9–18) months after formation. There was no significant postoperative morbidity and no postoperative death. At a median follow-up of 7 (range 0·5–56) months eight patients had no requirement for nutritional support.
Conclusion
Use of a loop jejunostomy to protect suture lines in the septic abdomen justifies consideration of this procedure in selected patients.
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Affiliation(s)
- V Shetty
- Intestinal Failure Unit, Hope Hospital, Manchester, UK
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42
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Santaguida PL, Balion C, Hunt D, Morrison K, Gerstein H, Raina P, Booker L, Yazdi H. Diagnosis, prognosis, and treatment of impaired glucose tolerance and impaired fasting glucose. Evid Rep Technol Assess (Summ) 2005:1-11. [PMID: 16194123 PMCID: PMC4780988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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43
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Jakobovits A, Gudas JM, Jia X, Morrison K, An Z, Shao H, Raitano AB, Morrison KJ, Challita P, Kanner SB. Therapeutic potential of AGS-PSCA: A fully human monoclonal antibody to prostate stem cell antigen (PSCA) for the treatment of prostate and pancreatic cancers. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.4722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - X. Jia
- Agensys, Santa Monica, CA
| | | | - Z. An
- Agensys, Santa Monica, CA
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Vazquez BG, Morrison K, Fitzpatrick AL. 11 E-MAIL EVALUATION OF A COURSE IN HIV PREVENTION FOR HEALTH PROFESSIONALS IN MEXICO AND LATIN AMERICA. J Investig Med 2005. [DOI: 10.2310/6650.2005.00005.10] [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: 11/18/2022]
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45
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Sood R, Bader PI, Speer MC, Edwards YH, Eddings EM, Blair RT, Hu P, Faruque MU, Robbins CM, Zhang H, Leuders J, Morrison K, Thompson D, Schwartzberg PL, Meltzer PS, Trent JM. Cloning and characterization of an inversion breakpoint at 6q23.3 suggests a role for Map7 in sacral dysgenesis. Cytogenet Genome Res 2004; 106:61-7. [PMID: 15218243 DOI: 10.1159/000078563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 02/11/2004] [Indexed: 11/19/2022] Open
Abstract
Here we report on a male patient with sacral dysgenesis (SD) and constitutional pericentric inversion of chromosome 6 (p11.2;q23.3). SD is a heterogeneous group of congenital anomalies with complex genetic etiology. Previously, a patient with sacral abnormalities and an interstitial deletion of 6q23-->q25 region has been described. We speculated that a susceptibility gene for SD lies in 6q23.3 region (disrupted in both patients), and therefore, cloning of the breakpoint in our patient would lead to the identification of the disrupted gene. We performed FISH analysis followed by Southern blot analysis and inverse PCR to clone the breakpoint. The 6p11.2 breakpoint mapped very close to the centromere, and the 6q23.3 breakpoint localized in the ninth intron of the MAP7 gene. We then evaluated the involvement of MAP7 in SD by further screening of the gene in several patients with a similar phenotype. Two nucleotide changes causing Ile257Asn and Glu571Ala substitutions in the protein, both affecting amino acid residues conserved in the mouse homolog, were identified in two patients. Both changes are either very rare polymorphisms or true mutations, since they were not detected in 167 normal individuals nor found in the SNP database. Therefore, our study suggests MAP7 as a candidate gene for SD. However, we were unable to detect any sacral defects in the MAP7 knockout mice.
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Affiliation(s)
- R Sood
- Cancer Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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Abstract
A total of 267 families with two or more siblings with multiple sclerosis (MS) were genotyped with 14 restriction fragment length polymorphisms at the TCR beta locus. A nonparametric linkage analysis of the data showed no evidence for linkage to this locus (mlod=0.11). No significant allelic or haplotype transmissions were observed in the total sample of 565 patients. After stratification for the presence of HLA DRB1*15, an association was observed between the BV25S1*1-BV26S1*1-BV2S1*1 haplotype and MS (P=0.00089). This was not significant upon correction for multiple comparisons. It was also not significant when the haplotype frequency in affected individuals was compared to a normal control sample (P=0.77). Furthermore, the associated haplotype was followed-up in an independent sample of 97 nuclear families with a single DRB1*15-positive child with MS. The BV25S1*1-BV26S1*1-BV2S1*1 haplotype did not show significant evidence for transmission distortion but the same trend was seen (P=0.21). There were no significant associations observed in the DRB1*15-negative patients and no detectable difference was seen in the DRB1*15-positive BV25S1*1-BV26S1*1-BV2S1*1 association when comparing different subgroups based on clinical course of MS. These results show no evidence for linkage and fail to establish an association between MS susceptibility and the TCR beta locus.
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Affiliation(s)
- D A Dyment
- Wellcome Trust Center for Human Genetics, Oxford, UK
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47
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Teubner A, Morrison K, Ravishankar HR, Anderson ID, Scott NA, Carlson GL. Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula. Br J Surg 2004; 91:625-31. [PMID: 15122616 DOI: 10.1002/bjs.4520] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Use of total parenteral nutrition (TPN) in patients with acute intestinal failure due to enteric fistulation might be avoided if a simpler means of nutritional support was available. The aim of this study was to determine whether feeding via an intestinal fistula (fistuloclysis) would obviate the need for TPN.
Methods
Fistuloclysis was attempted in 12 patients with jejunocutaneous or ileocutaneous fistulas with mucocutaneous continuity. Feeding was achieved by inserting a gastrostomy feeding tube into the intestine distal to the fistula. Infusion of enteral feed was increased in a stepwise manner, without reinfusion of chyme, until predicted nutritional requirements could be met by a combination of fistuloclysis and regular diet, following which TPN was withdrawn. Energy requirements and nutritional status were assessed before starting fistuloclysis and at the time of reconstructive surgery.
Results
Fistuloclysis replaced TPN entirely in 11 of 12 patients. Nutritional status was maintained for a median of 155 (range 19–422) days until reconstructive surgery could be safely undertaken in nine patients. Two patients who did not undergo surgery remained nutritionally stable over at least 9 months. TPN had to be recommenced in one patient. There were no complications associated with fistuloclysis.
Conclusion
Fistuloclysis appears to provide effective nutritional support in selected patients with enterocutaneous fistula.
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Affiliation(s)
- A Teubner
- Intestinal Failure Unit, Department of Surgery, Hope Hospital, Salford, UK
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48
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Morrison K. Stakeholder involvement in water management: necessity or luxury? Water Sci Technol 2003; 47:43-51. [PMID: 12731770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Stakeholder involvement in water management is widely recognized as an important component of the design and implementation of sustainable water management initiatives. Despite this, there remains a deep-rooted resistance to the widespread implementation of programs to prioritize such involvement (as witnessed by, for example, the low priority given to the public involvement element of the European Union Water Framework Directive). This paper addresses the issue of stakeholder involvement by first confronting the fact that it is not a water issue, per se. Such diverse fields as economics, agriculture, public health, pollution prevention, business and education have also identified stakeholder involvement as a difficult but necessary component of successful action in their fields. For the water sector, the issue of stakeholder involvement as either a necessity for sustainable water management, or a luxury to be used to complement traditional approaches, is discussed.
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Affiliation(s)
- K Morrison
- University of Guelph, 287 Byng Avenue, North York M2N 4L4, Canada.
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49
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Affiliation(s)
- J E Kopfman
- Department of Communication, Cleveland State University, Cleveland, Ohio, USA.
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50
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Affiliation(s)
- K. Morrison
- Department of Applied Computing, University of Dundee, Dundee DD1 4HN, Scotland, UK. Tel.: ; Fax: ; E-mail: ,
| | - S.J. McKenna
- Department of Applied Computing, University of Dundee, Dundee DD1 4HN, Scotland, UK. Tel.: ; Fax: ; E-mail: ,
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