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Higgs N, Morton L, Alam P, Brennan PA. Reducing aerosol risk in flexible nasendoscopy using a protective facial visor. Br J Oral Maxillofac Surg 2024; 62:205-206. [PMID: 38185580 DOI: 10.1016/j.bjoms.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/18/2023] [Accepted: 10/17/2023] [Indexed: 01/09/2024]
Affiliation(s)
- N Higgs
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK.
| | - L Morton
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - P Alam
- St Richards Hospital, Chichester PO19 6SE, UK
| | - P A Brennan
- Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
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Qin X, McKee G, Yan Z, Geiger B, Ke R, Jaehnig K, Morton L, Wu Y, Wu T, Xu M. Integrated 2D beam emission spectroscopy diagnostic at the Huan-Liuqi-2A (HL-2A) tokamak. Rev Sci Instrum 2022; 93:103535. [PMID: 36319390 DOI: 10.1063/5.0101806] [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: 06/03/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Two newly developed, eight-channel, integrated Beam Emission Spectroscopy (BES) detectors have been installed at Huan-Liuqi-2A tokamak, which extends the existing 16 single-channel modular BES system with additional 16 spatial channels. The BES collects the Doppler-shifted Balmer Dα emission with a spatial resolution of 1 cm (radial) × 1.5 cm (poloidal) and a temporal resolution of 0.5 µs to measure long-wavelength (k⊥ρi < 1) density fluctuations. Compared to the modular BES, the dark noise of the integrated BES is reduced by 50%-60% on average. The signal-to-noise ratio of the integrated BES system is optimized by the high light throughput front-end optics, high quantum efficiency photodiodes, high-gain, low-noise preamplifiers, and sufficient cooling capacity provided by the thermoelectric cooling (TEC) units that maintain the detectors at -20 °C. Crosstalk between channels that share the same optical system is found to be negligible. High-quality density fluctuation data enables 2D (radial-poloidal) imaging of turbulence, which allows for multi-channel spectral analysis, multi-channel cross-correlation analysis and velocimetry analysis. Preliminary results show that BES successfully captures the spatiotemporal features of the local turbulence and obtains statistically consistent turbulence characterization results.
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Affiliation(s)
- X Qin
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - G McKee
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Z Yan
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - B Geiger
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - R Ke
- Southwestern Institute of Physics, Chengdu, Sichuan 610000, China
| | - K Jaehnig
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - L Morton
- Engineering Physics, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Y Wu
- Southwestern Institute of Physics, Chengdu, Sichuan 610000, China
| | - T Wu
- Southwestern Institute of Physics, Chengdu, Sichuan 610000, China
| | - M Xu
- Southwestern Institute of Physics, Chengdu, Sichuan 610000, China
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Brennan M, Morton L. Chronic Palliative Inotropes in Subacute Rehab. J Am Med Dir Assoc 2022. [DOI: 10.1016/j.jamda.2022.01.007] [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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Shaffer K, Morrison C, Araba K, Markovitz M, Quinney N, Morton L, Hill D, O’Neal W, Kesimer M, Gentzsch M, Ehre C. 179: Modulator therapy reverses aberrant mucus properties in vitro via hydration. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Robinson P, Morton L, West C. 557 Becoming Virtual: Lessons Learned from Moving Wessex Core Surgical Training Deanery Teaching On-Line. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Surgical training has been significantly impacted by COVID-19. Social distancing requirements mandated a change in face-to-face teaching with many deaneries adopting ‘virtual' sessions. Surgical training does not immediately lend itself to e-learning owing to its hands-on nature. We describe our experiences in developing a virtual teaching program for Core Surgical Trainees within the Wessex Deanery. We provide tips, tricks, and pitfalls for educators to establish or improve similar programs.
Method
From June 2020 monthly, in-person teaching was replaced with virtual sessions. Quantitative and qualitative feedback directed improvements in the program. In addition to knowledge-based lectures we integrated on-line learning tools (LapPass) and utilised surgical videos to ensure continued development of surgical skills. Mock MRCS and ST3 interviews were conducted remotely using ‘break-out rooms. Where face-to-face teaching was essential (Boot Camp, Field Camp) safety was ensured with reduced numbers (split sessions), social distancing and appropriate PPE.
Results
All trainees strongly agreed (67%) or agreed (33%) that virtual teaching works well. There were no significant differences in feedback scores compared with face-to-face teaching. Attendance increased by 42%. Interactivity was maintained with ‘cameras on, mics off', polling apps and chat box function. Advantages include uploading webinars for future review, ability for educators to present from multiple locations, increased availability and breadth of speakers and reduced burden on clinical commitments.
Conclusions
The COVID-19 pandemic has dictated an evolution of surgical teaching. Virtual teaching has many advantages over face-to-face and should continue to play a part in postgraduate medical education, even after social distancing restrictions are lifted.
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Affiliation(s)
- P Robinson
- Wessex Deanery, Winchester, United Kingdom
- University Hospitals Dorset, Poole, United Kingdom
| | - L Morton
- University Hospital Southampton, Southampton, United Kingdom
| | - C West
- Salisbury District Hospital, Salisbury, United Kingdom
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Elikkottil J, Jaseena Elikkottil J, Morton L. Use of Smart Glass Technology for Resident Education in Long Term Care Facilities During the COVID-19 Pandemic. J Am Med Dir Assoc 2021; 22:B10. [PMID: 34287144 PMCID: PMC7902227 DOI: 10.1016/j.jamda.2021.01.019] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arnold FW, Reyes Vega AM, Salunkhe V, Furmanek S, Furman C, Morton L, Faul A, Yankeelov P, Ramirez JA. Older Adults Hospitalized for Pneumonia in the United States: Incidence, Epidemiology, and Outcomes. J Am Geriatr Soc 2020; 68:1007-1014. [PMID: 31916246 DOI: 10.1111/jgs.16327] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/30/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To define the current incidence, epidemiology, and mortality of older adult patients hospitalized with community-acquired pneumonia (CAP) in Louisville, KY and thus estimate the burden of CAP in the older adult population of the United States. To define risk factors associated with early and late outcomes. DESIGN This was a secondary analysis of older adults (aged ≥65 years) from the University of Louisville Pneumonia Study, a prospective population-based cohort study of all hospitalized adults with CAP between June 1, 2014, and May 31, 2016. SETTING The study took place in all nine acute care hospitals for adults in Louisville, KY. PARTICIPANTS Residents in the city of Louisville, KY, who were diagnosed with CAP between the inclusion dates were included and who were aged 65 years or older. MEASUREMENTS Incidence of CAP and outcomes were measured. A total of nine risk factors were also assessed for any potential association with time to clinical stability, length of stay (LOS), and mortality. RESULTS During the 2-year study, from a Louisville population of 102 264 adults aged 65 years or older, 4760 were hospitalized with CAP. The incidence of older adults hospitalized with CAP was 2093 per 100 000 population. This corresponds to 967 470 older adults in the United States hospitalized per year with CAP. The median time to clinical stability was 2 days, and the median LOS was 6 days. The 30-day all-cause mortality was 17%. The 1-year all-cause mortality was 38% (829 patients), which corresponds to 361 982 deaths in the United States with CAP in older adults. CONCLUSION The estimated burden of CAP in older adults is substantial in the United States. Nearly 1 million older adults are hospitalized for CAP, and over a third of those die within 1 year. J Am Geriatr Soc 68:1007-1014, 2020.
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Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Andrea M Reyes Vega
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Stephen Furmanek
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
| | - Christian Furman
- Division of General Internal Medicine, Palliative Medicine and Medical Education, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky.,Division of Geriatric Medicine, Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky.,Trager Institute, University of Louisville, Louisville, Kentucky
| | - Laura Morton
- Division of Geriatric Medicine, Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, Kentucky.,Trager Institute, University of Louisville, Louisville, Kentucky
| | - Anna Faul
- Trager Institute, University of Louisville, Louisville, Kentucky.,Kent School of Social Work, University of Louisville, Louisville, Kentucky.,Department of Social Work, University of the Free State, Bloemfontein, South Africa
| | - Pam Yankeelov
- Trager Institute, University of Louisville, Louisville, Kentucky.,Kent School of Social Work, University of Louisville, Louisville, Kentucky
| | - Julio A Ramirez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, Kentucky
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Marin-Felix Y, Hernández-Restrepo M, Iturrieta-González I, García D, Gené J, Groenewald J, Cai L, Chen Q, Quaedvlieg W, Schumacher R, Taylor P, Ambers C, Bonthond G, Edwards J, Krueger-Hadfield S, Luangsa-ard J, Morton L, Moslemi A, Sandoval-Denis M, Tan Y, Thangavel R, Vaghefi N, Cheewangkoon R, Crous P. Genera of phytopathogenic fungi: GOPHY 3. Stud Mycol 2019; 94:1-124. [PMID: 31636728 PMCID: PMC6797016 DOI: 10.1016/j.simyco.2019.05.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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] [Indexed: 12/26/2022] Open
Abstract
This paper represents the third contribution in the Genera of Phytopathogenic Fungi (GOPHY) series. The series provides morphological descriptions, information about the pathology, distribution, hosts and disease symptoms for the treated genera, as well as primary and secondary DNA barcodes for the currently accepted species included in these. This third paper in the GOPHY series treats 21 genera of phytopathogenic fungi and their relatives including: Allophoma, Alternaria, Brunneosphaerella, Elsinoe, Exserohilum, Neosetophoma, Neostagonospora, Nothophoma, Parastagonospora, Phaeosphaeriopsis, Pleiocarpon, Pyrenophora, Ramichloridium, Seifertia, Seiridium, Septoriella, Setophoma, Stagonosporopsis, Stemphylium, Tubakia and Zasmidium. This study includes three new genera, 42 new species, 23 new combinations, four new names, and three typifications of older names.
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Key Words
- Allophoma pterospermicola Q. Chen & L. Cai
- Alternaria aconidiophora Iturrieta-González, Dania García & Gené
- Alternaria altcampina Iturrieta-González, Dania García & Gené
- Alternaria chlamydosporifera Iturrieta-González, Dania García & Gené
- Alternaria curvata Iturrieta-González, Dania García & Gené
- Alternaria fimeti Iturrieta-González, Dania García & Gené
- Alternaria inflata Iturrieta-González, Dania García & Gené
- Alternaria lawrencei Iturrieta-González, Dania García & Gené
- Alternaria montsantina Iturrieta-González, Dania García & Gené
- Alternaria pobletensis Iturrieta-González, Dania García & Gené
- Alternaria pseudoventricosa Iturrieta-González, Dania García & Gené
- Arezzomyces Y. Marín & Crous
- Arezzomyces cytisi (Wanas. et al.) Y. Marín & Crous
- Ascochyta chrysanthemi F. Stevens
- Brunneosphaerella roupeliae Crous
- DNA barcodes
- Elsinoe picconiae Crous
- Elsinoe veronicae Crous, Thangavel & Y. Marín
- Fungal systematics
- Globoramichloridium Y. Marín & Crous
- Globoramichloridium indicum (Subram.) Y. Marín & Crous
- Neosetophoma aseptata Crous, R.K. Schumach. & Y. Marín
- Neosetophoma phragmitis Crous, R.K. Schumach. & Y. Marín
- Neosetophoma sambuci Crous, R.K. Schumach. & Y. Marín
- Neostagonospora sorghi Crous & Y. Marín
- New taxa
- Parastagonospora novozelandica Crous, Thangavel & Y. Marín
- Parastagonospora phragmitis Crous & Y. Marín
- Pestalotia unicornis Cooke & Ellis
- Phaeosphaeria phoenicicola (Crous & Thangavel) Y. Marín & Crous
- Phaeosphaeriopsis aloes Crous & Y. Marín
- Phaeosphaeriopsis aloicola Crous & Y. Marín
- Phaeosphaeriopsis grevilleae Crous & Y. Marín
- Phaeosphaeriopsis pseudoagavacearum Crous & Y. Marín
- Pleiocarpon livistonae Crous & Quaedvl.
- Pyrenophora avenicola Y. Marín & Crous
- Pyrenophora cynosuri Y. Marín & Crous
- Pyrenophora nisikadoi Y. Marín & Crous
- Pyrenophora novozelandica Y. Marín & Crous
- Pyrenophora poae (Baudyš) Y. Marín & Crous
- Pyrenophora pseudoerythrospila Y. Marín & Crous
- Pyrenophora sieglingiae Y. Marín & Crous
- Pyrenophora variabilis Hern.-Restr. & Y. Marín
- Pyrenophora wirreganensis (Wallwork et al.) Y. Marín & Crous
- Rhynchosphaeria cupressi Nattrass et al
- Seiridium cupressi (Nattrass et al.) Bonthond, Sandoval-Denis & Crous
- Seiridium pezizoides (de Not.) Crous
- Septoriella agrostina (Mapook et al.) Y. Marín & Crous
- Septoriella artemisiae (Wanas. et al.) Y. Marín & Crous
- Septoriella arundinicola (Wanas. et al.) Y. Marín & Crous
- Septoriella arundinis (W.J. Li et al.) Y. Marín & Crous
- Septoriella bromi (Wijayaw. et al.) Y. Marín & Crous
- Septoriella dactylidicola Y. Marín & Crous
- Septoriella dactylidis (Wanas. et al.) Y. Marín & Crous
- Septoriella elongata (Wehm.) Y. Marín & Crous
- Septoriella forlicesenica (Thambug. et al.) Y. Marín & Crous
- Septoriella garethjonesii (Thambug. et al.) Y. Marín & Crous
- Septoriella germanica Crous, R.K. Schumach. & Y. Marín
- Septoriella hibernica Crous, Quaedvl. & Y. Marín
- Septoriella hollandica Crous, Quaedvl. & Y. Marín
- Septoriella italica (Thambug. et al.) Y. Marín & Crous
- Septoriella muriformis (Ariyaw. et al.) Y. Marín & Crous
- Septoriella neoarundinis Y. Marín & Crous
- Septoriella neodactylidis Y. Marín & Crous
- Septoriella pseudophragmitis Crous, Quaedvl. & Y. Marín
- Septoriella rosae (Mapook et al.) Y. Marín & Crous
- Septoriella subcylindrospora (W.J. Li et al.) Y. Marín & Crous
- Septoriella vagans (Niessl) Y. Marín & Crous
- Setophoma brachypodii Crous, R.K. Schumach. & Y. Marín
- Setophoma pseudosacchari Crous & Y. Marín
- Stemphylium rombundicum Moslemi, Y.P. Tan & P.W.J. Taylor
- Stemphylium truncatulae Moslemi, Y.P. Tan & P.W.J. Taylor
- Stemphylium waikerieanum Moslemi, Jacq. Edwards & P.W.J Taylor
- Vagicola arundinis Phukhams., Camporesi & K.D. Hyde
- Wingfieldomyces Y. Marín & Crous
- Wingfieldomyces cyperi (Crous & M.J. Wingf.) Y. Marín & Crous
- Zasmidium ducassei (R.G. Shivas et al.) Y. Marín & Crous
- Zasmidium thailandicum Crous
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Affiliation(s)
- Y. Marin-Felix
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Spain
| | - M. Hernández-Restrepo
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
| | - I. Iturrieta-González
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Spain
| | - D. García
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Spain
| | - J. Gené
- Mycology Unit, Medical School and IISPV, Universitat Rovira i Virgili, Sant Llorenç 21, 43201, Reus, Spain
| | - J.Z. Groenewald
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
| | - L. Cai
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
| | - Q. Chen
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, 100101, China
| | - W. Quaedvlieg
- Royal Van Zanten, P.O. Box 265, 1430 AG, Aalsmeer, The Netherlands
| | | | - P.W.J. Taylor
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - C. Ambers
- P.O. Box 631, Middleburg, VA, 20118, USA
| | - G. Bonthond
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
- Benthic Ecology, GEOMAR Helmholtz Centre for Ocean Research Kiel, Hohenbergstraße 2, 24105, Kiel, Germany
| | - J. Edwards
- Agriculture Victoria Research, Department of Jobs, Precincts and Regions, AgriBio Centre, Bundoora, Victoria, 3083, Australia
- School of Applied Systems Biology, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - S.A. Krueger-Hadfield
- Department of Biology, University of Alabama at Birmingham, 1300 University Blvd, CH464, Birmingham, AL, 35294, USA
| | - J.J. Luangsa-ard
- Plant Microbe Interaction Research Team, Integrative Crop Biotechnology and Management Research Group, Bioscience and Biotechnology for Agriculture, NSTDA 113, Thailand Science Park Phahonyothin Rd., Khlong Nueng, Khlong Luang, Pathum Thani, 12120, Thailand
| | - L. Morton
- P.O. Box 5607, Charlottesville, VA, 22905, USA
| | - A. Moslemi
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - M. Sandoval-Denis
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
- Faculty of Natural and Agricultural Sciences, Department of Plant Sciences, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
| | - Y.P. Tan
- Department of Agriculture and Fisheries, Biosecurity Queensland, Ecosciences Precinct, Dutton Park, 4012, QLD, Australia
- Microbiology, Department of Biology, Utrecht University, Utrecht, Netherlands
| | - R. Thangavel
- Plant Health and Environment Laboratory, Ministry for Primary Industries, P.O. Box 2095, Auckland, 1140, New Zealand
| | - N. Vaghefi
- Centre for Crop Health, University of Southern Queensland, Queensland, 4350, Australia
| | - R. Cheewangkoon
- Department of Entomology and Plant Pathology, Faculty of Agriculture, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - P.W. Crous
- Westerdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD, Utrecht, The Netherlands
- Department of Biochemistry, Genetics & Microbiology, Forestry & Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
- Wageningen University and Research Centre (WUR), Laboratory of Phytopathology, Droevendaalsesteeg 1, 6708 PB, Wageningen, The Netherlands
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Furman CD, Wagner L, Gomes J, Gopalraj R, Parker BF, Morton L, Antimisiaris D, Neamtu D, Masroor S, Martin-Galijatovic R, Cotton S, Shaw MA. Implementing Chief Resident Immersion Training (CRIT) in the Care of Older Adults: Overcoming Barriers and Promoting Facilitators. Geriatrics (Basel) 2018; 3:geriatrics3040062. [PMID: 31011098 PMCID: PMC6371170 DOI: 10.3390/geriatrics3040062] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/16/2022] Open
Abstract
The Chief Resident Immersion Training (CRIT) in the Care of Older Adults curriculum was developed at Boston University School of Medicine to improve the care of older adults through an educational intervention. The curriculum targeted chief residents (CRs) because their role as mediators between learners and faculty provides the greatest potential impact for transmitting knowledge. The goals of CRIT are to: (1) provide education on geriatric principles and on teaching/leadership skills, (2) foster interdisciplinary collaboration, and (3) complete an action project. This study demonstrates successful implementation of CRIT at a different academic institution in a rural state. The CRs indicated that their confidence in their ability to apply and teach geriatrics improved after CRIT. In addition, the CRs indicated that CRIT improved their confidence in their overall skills as CRs. The barriers and facilitators to implementation are addressed in order to promote successful adoption of CRIT at other institutions, including those in rural states.
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Affiliation(s)
- Christian Davis Furman
- Institute for Sustainable Health & Optimal Aging, University of Louisville, 300 E. Market Street, Suite 200, Louisville, KY 40202, USA.
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- Division of General Internal Medicine, Palliative Medicine and Medical Education, Department of Internal Medicine, University of Louisville, 550 South Jackson St, 3rd Fl, Ste A3K00, Louisville, KY 40202, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Lori Wagner
- Division of General Internal Medicine, Palliative Medicine and Medical Education, Department of Internal Medicine, University of Louisville, 550 South Jackson St, 3rd Fl, Ste A3K00, Louisville, KY 40202, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
- Robley Rex Veterans Affairs Medical Center, 800 Zorn Ave., Louisville, KY 40206, USA.
| | - Josephine Gomes
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Rangaraj Gopalraj
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - B Frank Parker
- Division of General Internal Medicine, Palliative Medicine and Medical Education, Department of Internal Medicine, University of Louisville, 550 South Jackson St, 3rd Fl, Ste A3K00, Louisville, KY 40202, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Laura Morton
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Demetra Antimisiaris
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Daniela Neamtu
- Geriatrics, University of Louisville, 1941 Bishop Ln, Suite 900, Louisville, KY 40218, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
| | - Sadaf Masroor
- Institute for Sustainable Health & Optimal Aging, University of Louisville, 300 E. Market Street, Suite 200, Louisville, KY 40202, USA.
| | - Ramie Martin-Galijatovic
- Kent School of Social Work, University of Louisville, Oppenheimer Hall, 2217 S. Third St., Louisville, KY 40292, USA.
| | - Samantha Cotton
- Institute for Sustainable Health & Optimal Aging, University of Louisville, 300 E. Market Street, Suite 200, Louisville, KY 40202, USA.
- Kent School of Social Work, University of Louisville, Oppenheimer Hall, 2217 S. Third St., Louisville, KY 40292, USA.
| | - M Ann Shaw
- Division of General Internal Medicine, Palliative Medicine and Medical Education, Department of Internal Medicine, University of Louisville, 550 South Jackson St, 3rd Fl, Ste A3K00, Louisville, KY 40202, USA.
- School of Medicine, University of Louisville, Abell Administration Bldg, 323 East Chestnut St., Louisville, KY 40202, USA.
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Morton L, de Bruin M, Krajewska M, Whibley D, Macfarlane GJ. Beliefs about back pain and pain management behaviours, and their associations in the general population: A systematic review. Eur J Pain 2018; 23:15-30. [PMID: 29984553 PMCID: PMC6492285 DOI: 10.1002/ejp.1285] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2018] [Indexed: 12/19/2022]
Abstract
Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain‐related outcomes. Five databases were searched up until April 2017. Quantitative studies which reported a measure of agreement with a belief about back pain, cross‐sectional associations, or associations between beliefs and future outcomes were eligible. Eligibility was assessed and data extracted independently by two authors. Results were tabulated and narratively synthesized. Nineteen studies from 10 countries were eligible (median study n [IQR] = 990.5 [524.75–2387.5]). Beliefs were measured using eight questionnaires and 57 stand‐alone items. Beliefs about back pain's negative consequences were common across countries and populations, whereas most samples did not hold fear‐avoidance beliefs. Beliefs about back pain's consequences were associated with pain and disability, but only one study investigated this specific relationship prospectively. No studies investigated whether beliefs are associated with future pain management behaviours. Agreement with certain beliefs (e.g. about negative consequences) was associated with sociodemographic characteristics (e.g. older age) and poorer self‐rated health. Interventions may benefit from targeting beliefs about the perceived negative consequences of back pain in these populations. However, future research should explore how beliefs prospectively influence the management of back pain. Significance This review brings together studies which have assessed the prevalence of beliefs about back pain, and factors associated with holding them. It highlights that whether or not these beliefs represent important determinants of how people manage pain remains unknown.
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Affiliation(s)
- L Morton
- Epidemiology Group, University of Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK.,Health Psychology Group, University of Aberdeen, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - M de Bruin
- Health Psychology Group, University of Aberdeen, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - M Krajewska
- Department of Medical Informatics, Biometry and Epidemiology, Ludwig Maximilian University of Munich, Germany
| | - D Whibley
- Epidemiology Group, University of Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
| | - G J Macfarlane
- Epidemiology Group, University of Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, UK.,Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, Southampton, UK
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Morton L, Downie I. Surgical and social implications of extraction of mandibular third molars as a separate procedure before bilateral sagittal split osteotomy. Br J Oral Maxillofac Surg 2017; 55:937-939. [PMID: 29055570 DOI: 10.1016/j.bjoms.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/06/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
In some units, lower wisdom teeth are extracted in a separate procedure before bilateral sagittal split osteotomy (BSSO), whereas in others they are removed at the time of the osteotomy. We identified 57 patients who had BSSO at Salisbury Hospital between October 2013 and September 2015, 40 of whom had their wisdom teeth extracted at the same time. The remaining 17 did not have wisdom teeth. Patients who have these teeth extracted as a separate procedure require at least one day off work, which can result in a loss of earnings. Our findings showed that the removal of third molars at the time of orthognathic surgery has considerable social and financial benefits, and does not increase the risk of morbidity.
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Affiliation(s)
- L Morton
- Salisbury Hospital, Odstock Road, Salisbury, SP2 8BJ.
| | - I Downie
- Salisbury Hospital, Odstock Road, Salisbury, SP2 8BJ.
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Abstract
OBJECTIVE To survey the status of current tamoxifen pharmacovigilance documentation reflecting tamoxifen use in an academic outpatient multispecialty practice in older adults. This data will help provide information to develop improved pharmacovigilance for a growing cohort of older adult users. The data will be utilized by an interdisciplinary team developing new methods of identifying factors for individualized pharmacovigilance in older adults. DESIGN Retrospective chart review to gather descriptive and quantitative data on tamoxifen pharmacovigilance. SETTING Multi-specialty clinic. PATIENTS Ninety-three patients 60 years of age and older. MAIN OUTCOME MEASURES Quantitative report of tamoxifen monitoring as well as descriptive analysis of individual cases. RESULTS We found 19 cases of serious adverse events possibly related to tamoxifen (thrombi, uterine malignancies). There were 15 cases with no documentation of pharmacovigilance. All cases had incomplete pharmacovigilance documented. There were two cases of hypercalcemia. There was one case of tamoxifen discontinuation resulting from muscle pain and with chronic muscle pain complaints while receiving tamoxifen. We observed a correlation in older age or high comorbidity burden patients and adverse events patients. CONCLUSION Some studies direct the important pharmacovigilance toward prevention of thrombi, uterine malignancies, and hypercalcemia; however, it is not easy to identify recommendations for frequency or focus of monitoring to prevent adverse events for individual older adults based on existing recommendations. The data collected and presented in this study serve to heighten awareness of tamoxifen pharmacovigilance and as a starting point for the application of machine learning techniques and modeling to identify high-risk patients and individualized pharmacovigilance recommendations.
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Morton L, Ferguson M, Baty F. Improving wellbeing and self-efficacy by social prescription. Public Health 2015; 129:286-9. [PMID: 25744110 DOI: 10.1016/j.puhe.2014.12.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 12/05/2014] [Accepted: 12/12/2014] [Indexed: 11/20/2022]
Affiliation(s)
- L Morton
- Department of Psychology, NHS Fife, UK.
| | | | - F Baty
- Department of Psychology, NHS Fife, UK
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Millar DG, Morton L, Gaspar MC, Mistry P, Peña HDL, Joseph R, Penny S, Goodyear OC, Goodall M, Pratt GE, Cobbold M. Abstract 2893: Engineered release and presentation of antibody-bound viral antigens: A highly specific and novel immunotherapeutic approach to target cancer in vivo. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-2893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Harnessing the power of adaptive immunity to combat cancer has been a long-term goal of translational immunotherapy. Tumor-specific immunity, where present, is typically at low frequency and affinity with compromised effector function. By contrast, immunity against persistent herpesviruses in man is characterised by high affinity cytotoxic T-lymphocytes (CTL) at high frequency with potent effector function. Furthermore, the immunosubversive mechanisms employed by herpesviruses show striking parallels to tumors, yet the associated anti-viral immunity limits these to life-long asymptomatic infections.
We reasoned that the delivery of immunodominant viral peptide epitopes to the tumor surface might facilitate passive-loading of peptides into empty MHC class-I molecules, effectively mimicking viral infection, rendering tumors susceptible to lysis by anti-viral immunity.
To address this we developed a new class of targeting antibodies: APEC (Antibody Peptide Epitope Complexes) that are able to deliver an antigenic payload at the cell surface through proteolytic release of covalently-coupled peptide antigens. As a proof-of-concept we used clinically-validated antibodies cetuximab (anti-EGFR) and rituximab (anti-CD20) to develop APECs that are able to target human tumors.
We screened 15 HLA-A*0201+ EGFR-expressing NCI-60 cell lines, CD20+ lymphoma cell lines, 20 primary CD20+ CLL tumor samples and four healthy B-cells against a library of 190 cetuximab-APECs (cAPEC) or rituximab (rAPEC) incorporating the immunodominant cytomegalovirus (CMV) pp65495-503 epitope and candidate protease cleavage sites following co-incubation with CMV-specific CTL (CMV-CTL). The most effective cAPEC and rAPEC were those incorporating MMP2, MMP9, Cathepsin B and Cathepsin D protease recognition domains. Very few (2/190) rAPEC were able to redirect CMV-CTL against healthy cells. Heterogeneity was observed for primary CLL tumors but a limited number of rAPEC were effective in all cases (5/190).
Mechanistic studies demonstrated that: (i) peptide loading occurred at the cell surface, (ii) required the expression of target antigens at the cell surface and (iii) T-cell recognition could be inhibited by unconjugated antibody (92%) or by incubation with protease inhibitors (83%).
T-cell specificity was examined using rAPEC treated tumor targets co-incubated with various HLA-matched effector T-cell populations. No activation of CD4+ was observed including CD4+CD25hi regulatory T-cell populations. Incubation with CD8+ T-cells revealed that only pp65495-503-specific CD8+ T-cells engaged with APEC-treated tumor cells. Lastly, xenograft studies using EGFR+ and CD20+ tumor cell lines demonstrated efficacy of both cAPEC and rAPEC to eliminate tumors in vivo by redirecting anti-viral CTL.
These data indicate that APECs represent a powerful new approach to combat cancer.
Citation Format: David G. Millar, Laura Morton, Manuela Carvalho Gaspar, Punam Mistry, Hugo De La Peña, Ricky Joseph, Sarah Penny, Oliver C. Goodyear, Margaret Goodall, Guy E. Pratt, Mark Cobbold. Engineered release and presentation of antibody-bound viral antigens: A highly specific and novel immunotherapeutic approach to target cancer in vivo. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2893. doi:10.1158/1538-7445.AM2014-2893
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Affiliation(s)
| | - Laura Morton
- University of Birmingham, Birmingham, United Kingdom
| | | | - Punam Mistry
- University of Birmingham, Birmingham, United Kingdom
| | | | - Ricky Joseph
- University of Birmingham, Birmingham, United Kingdom
| | - Sarah Penny
- University of Birmingham, Birmingham, United Kingdom
| | | | | | - Guy E. Pratt
- University of Birmingham, Birmingham, United Kingdom
| | - Mark Cobbold
- University of Birmingham, Birmingham, United Kingdom
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Saifee TA, Kassavetis P, Pareés I, Kojovic M, Fisher L, Morton L, Foong J, Price G, Joyce EM, Edwards MJ. Inpatient treatment of functional motor symptoms: a long-term follow-up study. J Neurol 2012; 259:1958-63. [DOI: 10.1007/s00415-012-6530-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/16/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
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Harris C, Remedios D, Aptowitzer T, Keat A, Hamilton L, Guile G, Belkhiri A, Newman D, Toms A, Macgregor A, Gaffney K, Morton L, Jones GT, MacDonald AG, Downham C, Macfarlane GJ, Tillett W, Jadon D, Wallis D, Costa L, Waldron N, Griffith N, Cavill C, Korendowych E, de Vries C, McHugh N, Iaremenko O, Fedkov D, Emery P, Baeten D, Sieper J, Braun J, van der Heijde D, McInnes I, Van Laar J, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Paramarta I, Bertolino A, Wright AM, Hueber W, Sofat N, Smee C, Hermansson M, Wajed J, Sanyal K, Kiely P, Howard M, Howe FA, Barrick TR, Abraham AM, Pearce MS, Mann KD, Francis RM, Birrell F, Carr A, Macleod I, Ng WF, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger G, Xu W, Goldstein N, Beutler A, Van Laar J, Baraliakos X, Braun J, Laurent DD, Baeten D, van der Heijde D, Sieper J, Emery P, McInnes I, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Wright AM, Gsteiger S, Hueber W, Conaghan PG, Peterfy CG, DiCarlo J, Olech E, Alberts AR, Alper JA, Devenport J, Anisfeld AM, Troum OM, Cooper P, Gimpel M, Deakin G, Jameson K, Godtschailk M, Gadola S, Stokes M, Cooper C, Gordon C, Kalunian K, Petri M, Strand V, Kilgallen B, Barry A, Wallace D, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S. Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes118] [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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Wong J, Gowda S, Vota S, Morton L, Towne A. Utilization and Effectiveness of Different Antiepileptic Drugs [AEDs] in Status Epilepticus [SE] (P06.102). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Borad S, Gowda S, Morton L, Vota S, Delorenzo R, Towne A. Troponin Elevation and Increased Mortality in Patients with Status Epileptics (SE) (PD3.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pd3.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jones LBKR, McGrogan P, Flood TJ, Gennery AR, Morton L, Thrasher A, Goldblatt D, Parker L, Cant AJ. Special article: chronic granulomatous disease in the United Kingdom and Ireland: a comprehensive national patient-based registry. Clin Exp Immunol 2008; 152:211-8. [PMID: 18410635 DOI: 10.1111/j.1365-2249.2008.03644.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
There are no epidemiological studies from the British Isles of chronic granulomatous disease, characterized by recurrent, life-threatening bacterial and fungal infections and inflammatory sequelae. Patients were enrolled in a national registry and medical records were analysed. Of 94 subjects, 69 had X-linked disease, 16 had autosomal recessive disease and nine were unknown. Prevalence was 7.5/million for 1990-99 and 8.5/million for 1980-89. Suppurative adenitis, abscesses and pneumonia presented commonly. Twenty-three of 30 patients who underwent high resolution computerized tomography had chronic respiratory disease. Inflammatory sequelae included bowel stricture and urogenital tract granulomata. Growth failure was common; 75% of those measured were below the population mean. All patients received prophylactic antibiotics and 93% anti-fungal prophylaxis. Interferon gamma was used to treat infection, but rarely as prophylaxis. Despite prophylaxis, estimated survival was 88% at 10 years but 55% at age 30 years. Morbidity remains significant, severe infectious complications common. Curative treatments including stem cell transplantation should be considered for patients with frequent or serious complications.
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Affiliation(s)
- L B K R Jones
- School of Clinical Medical Sciences, Child Health, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
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Cale CM, Morton L, Goldblatt D. Cutaneous and other lupus-like symptoms in carriers of X-linked chronic granulomatous disease: incidence and autoimmune serology. Clin Exp Immunol 2007; 148:79-84. [PMID: 17286762 PMCID: PMC1868856 DOI: 10.1111/j.1365-2249.2007.03321.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 6.8] [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: 02/06/2023] Open
Abstract
The objective of this study was to determine the utility of anti-nuclear antibody (ANA) testing in the investigation of cutaneous and other lupus symptoms in female carriers of X-linked chronic granulomatous disease (CGD). We undertook a prospective study of 19 carrier mothers attending our institution, with direct questioning of carriers concerning symptoms and testing for anti-nuclear and anti-phospholipid antibodies. A total of 58% reported significant photosensitive skin rashes, 42% reported mouth ulcers and 37% complained of joint pains that could not be attributed to other known causes. Anti-nuclear antibody (ANA) testing was negative in 73% of all carriers. The five positive ANAs were of low titre (maximum 1 : 320 on Hep 2 cells in two women) and only one weak positive double-stranded DNA antibody and no extractable nuclear antibodies were found. Several of the mothers, despite negative serology, benefited from referral to a specialist, and in some cases to specific treatment. A history of skin rashes, joint pain, fatigue and mouth ulcers should be sought actively in the female relatives of X-CGD patients but negative lupus serology should not preclude referral to appropriate dermatology or rheumatology services. as symptoms may respond well to appropriate treatment.
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Affiliation(s)
- C M Cale
- Immunology Department, Great Ormond Street Hospital for Children, London, UK.
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Abstract
Many IV antiepileptic drugs administered in emergency situations to patients with prolonged seizures have serious adverse effects. For this reason, the authors conducted a multicenter, open-label, prospective, dose-escalation study of IV valproate sodium administered to patients with epilepsy at rates of infusion of up to 6 mg/kg/minute and doses of up to 30 mg/kg. Valproate sodium had no clinically significant negative effects on blood pressure and pulse rate and caused only mild-to-moderate, reversible adverse events.
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Affiliation(s)
- J W Wheless
- Department of Neurology, University of Texas Health Science Center, Houston, USA
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Abstract
BACKGROUND Millions of people worldwide may have a hidden medical condition that could endanger their life in an emergency. These conditions may include cardiac conditions, severe allergies, or diabetes. Emergency identification schemes such as Medic Alert produce emblems that alert health care professionals to potential problems and can ensure appropriate and prompt treatment. This paper uses mechanical failure of the Björk-Shiley convexo-concave (BSCC) heart valve as an example of a hidden medical condition. These patients have been encouraged to carry information to alert staff in an emergency that they have a BSCC patient in their care and to be alert to the signs and symptoms of acute valve malfunction. OBJECTIVE To establish awareness and credibility of emergency identification schemes among emergency personnel and to assess if information on specific medical conditions would influence ambulance personnel regarding destination hospitals. METHODS Questionnaires were sent to senior staff (n=380) of accident and emergency (A&E) departments and operational directors of ambulance headquarters (n=39) throughout the United Kingdom. Hospitals were divided into regional divisions to assess differences in responses across regions. RESULTS The majority of respondents (99%) had heard of emergency identification schemes and felt that it was important for patients with special conditions to carry some form of identification. Nearly all ambulance respondents (97%) indicated it was routine to search for body worn emblems in contrast with only 71% of A & E staff. However, more than half of ambulance respondents (53.9%) stated information on emblems/cards would not influence their choice of destination hospital. CONCLUSIONS The importance of how information on pre-existing medical conditions can influence care, is highlighted by the BSCC valve issue, where immediate diagnosis is essential for patient survival. It is vital that all staff routinely search patients for this information and if necessary act upon the information provided.
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Affiliation(s)
- L Morton
- Imperial College School of Science, Technology and Medicine, National Heart and Lung Institute, Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK.
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Poolman R, Goslings C, Morton L, Statius MM, Steller F. Conservative treatment for closed fifth (small finger) metacarpal neck fractures in adults. Hippokratia 2001. [DOI: 10.1002/14651858.cd003210] [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: 11/11/2022]
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Abstract
The effects of oxygen exposure on pulmonary and blood non-enzymic antioxidant concentrations was evaluated in budgerigars (Melopsittacus undulatus). Budgerigars were exposed to acute (3 h), repeated acute (3 exposures each of 3 h) or chronic (72 h) normobaric hyperoxic environments and the pulmonary and plasma concentrations of selected non-enzymic antioxidants, namely glutathione, uric acid, alpha- and gamma-tocopherol and carotenoids were assayed. With increasing duration of oxygen exposure, the ratio of oxidised to reduced glutathione was significantly increased, while the concentrations of uric acid, alpha- and gamma-tocopherol and carotenoids were significantly reduced, especially following chronic oxygen exposure. Following acute and repeated acute exposure, alteration in glutathione concentrations and reduction in alpha-tocopherol concentrations indicated oxygen stress. Following chronic exposure, depletion of non-enzymic antioxidants indicated exhaustion of these protective mechanisms and progression from oxygen stress to oxygen toxicity.
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Affiliation(s)
- S Jaensch
- Division of Veterinary and Biomedical Science, Murdoch University, South Street, Murdoch, WA, 6150, Australia.
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Khair J, Morton L. Nutritional assessment and screening in children. Nurs Times 2000; 96:2-4. [PMID: 11968597] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- J Khair
- Royal Hospitals NHS Trust, London
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Morton L, Omar R, Carroll S, Beirne M, Halliday D, Taylor KM. Incomplete and inaccurate death certification--the impact on research. J Public Health Med 2000; 22:133-7. [PMID: 10912549 DOI: 10.1093/pubmed/22.2.133] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The objectives of this study were (1) to investigate the extent of erroneous and/or omitted information on death certificates of patients-implanted with Bjork-Shiley Convexo-Concave (BSCC) heart valves; (2) to determine whether this information could be associated with a possible under-reporting of acute mechanical failure of this valve. METHODS A review was carried out of death certificates and clinical notes for patients implanted in the United Kingdom with BSCC valves. This was a multicentre study (38 hospitals) based at the Cardiothoracic Department, NHLI, Imperial College School of Medicine at Hammersmith Hospital, London. The subjects were 478 patients implanted with a BSCC valve between 1979 and 1986 who died in the following years: 1984, 1987, 1990, 1993 and 1996. The main outcome measures were: (1) percentage of death certificates that record the presence of a valve prosthesis; (2) percentage of death certificates that record the presence of a valve prosthesis for patients who had a post mortem; (3) percentage of death certificates that record inaccurate or incomplete information related to the surgery; (4) percentage of death certificates that do not record a post mortem where one is known to have been performed. RESULTS Twenty-one per cent (101/478) of the total number of death certificates record the presence of the valve prosthesis. Thirty-five per cent (43/123) of the death certificates for patients who had a post mortem record the presence of a valve prosthesis. Six per cent (30/478) of death certificates report inaccurate information related to the valve surgery. Twenty-five per cent (118/478) of the total number of death certificates recorded a single cause of death. Twenty-three per cent (110/478) of all death certificates reviewed recorded only the mode of dying. Eight per cent (10/123) of the total number of death certificates for patients who had a post mortem did not record a post mortem. CONCLUSIONS The relatively high number of death certificates that do not record the presence of a valve prosthesis and the observed under-reporting of post mortems may lead to inaccurate reporting of the number of BSCC valves that fail. Previous recommendations to improve accuracy in death certification appear to have gone unheeded, and changes in the way certificates are completed for patients with implanted cardiac devices should be considered.
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Affiliation(s)
- L Morton
- Imperial College School of Medicine, National Heart and Lung Institute at Hammersmith Hospital Campus, London
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Affiliation(s)
- J R Myers
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV 26505, USA.
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30
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Affiliation(s)
- D Hard
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV 26505, USA.
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Gollub B, Morton L. Understanding patients with multiple chemical sensitivity. Am Fam Physician 1999; 59:2110-1; author reply 2112, 2115. [PMID: 10221299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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DeLorenzo RJ, Garnett LK, Towne AR, Waterhouse EJ, Boggs JG, Morton L, Choudhry MA, Barnes T, Ko D. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia 1999; 40:164-9. [PMID: 9952262 DOI: 10.1111/j.1528-1157.1999.tb02070.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [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] [Indexed: 11/27/2022]
Abstract
PURPOSE Status epilepticus (SE) is a major medical and a neurologic emergency associated with significant morbidity and mortality. The current definition of SE is continuous seizure activity or intermittent seizure activity without regaining consciousness, lasting > or =30 min. Epilepsy monitoring unit data indicate that many seizures self-terminate within minutes. Thus consideration was recently given to include seizure episodes lasting > or =10 min in the definition of SE. Because no large studies have been conducted on seizures lasting 10-29 min, this study was initiated to compare cases of SE and 10 to 29-min seizure episodes seen within the same period. METHODS Patients seen at the Medical College of Virginia Hospitals of Virginia Commonwealth University over the same 2-year period were studied. Two hundred twenty-six prospective SE cases (91 children and 135 adults) and 81 retrospective 10- to 29-min seizure episodes (31 children and 50 adults) were compared. A standardized data-entry-form system was compiled on each patient and was used to evaluate the data collected. RESULTS The 10- to 29-min seizure patients and the SE cases had similar demographic characteristics, such as sex, race, and age, and also had similar etiologies. The majority (93%) of SE cases required anticonvulsant (AED) treatment to control and stop seizure activity. In the 10- to 29-min group, 43% stopped seizing spontaneously, and the remainder (57%) required AED treatment to stop seizure activity. The mortality for the SE patients was 19% compared with 2.6% for 10- to 29-min group (p<0.001). In the 10- to 29-min group that stopped seizing spontaneously, the mortality was 0. In the 10- to 29-min patients that required AED treatment, the mortality was 4.4%. CONCLUSIONS The results demonstrate that a significant number of patients experience seizure activity lasting from 10- to 29-min. Approximately half of these seizure events stopped spontaneously and did not require AED treatment. The other half of the patients responded quickly to medications and stopped seizing before the 30-min definition for SE. The overall mortality of this group was significantly lower than that of the patients with SE. The results demonstrate that further studies on the 10- to 29-min seizure group are needed to differentiate seizures that will stop spontaneously and those that will only stop with AED treatment. Because almost half of the prolonged seizures stopped spontaneously, further studies are needed before including prolonged seizure activity in the definition of SE.
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Affiliation(s)
- R J DeLorenzo
- Department of Neurology, Virginia Commonwealth University, Richmond 23298-0599, USA
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Abstract
OBJECTIVE To evaluate the clinical features and outcome of antiphospholipid syndrome (APS) in children. STUDY DESIGN Retrospective chart review of patients seen at the Children's Hospital of Philadelphia and Children's Seashore House Pediatric Rheumatology Center between 1988 and 1993. RESULTS Nine patients with ages ranging from 8 months to 17 years are presented. Clinical features of five patients with primary APS, described in detail, were digital ischemia, stroke, chorea, Addison disease, and pulmonary vaso-occlusive disease. The four children with secondary APS had systemic lupus erythematosus. Clinical features of these patients include livedo reticularis, deep venous thrombosis, and pulmonary hypertension. Antiphospholipid titers, results of coagulation studies, and serologic findings did not predict outcome. CONCLUSION APS in children has diverse clinical features similar to those in adults and should be considered in cases of unexplained vaso-occlusive disease.
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Affiliation(s)
- E von Scheven
- Pediatric Rheumatology Center, Children's Seashore House, Philadelphia, Pennsylvania, USA
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Abstract
This study reports the expression, purification, and renaturation of biologically active Transforming Growth Factor-beta 1 (TGF-beta 1) fusion proteins from Escherichia coli (E. coli). A prokaryotic expression vector was engineered to produce tripartite fusion proteins consisting of (i) a purification tag, (ii) a protease-sensitive linker/collagen binding domain, and (iii) a cDNA sequence encoding the active fragment of human TGF-beta 1. The expressed fusion proteins TGF-B1-F1 and TGF-B1-F2, located in inclusion bodies, were solubilized with 8 M urea and renatured using a glutathione redox-coupled system and protracted dialysis under several experimental conditions. The purification of the recombinant proteins was achieved by binding the His-tag of the fusion proteins on a Ni-NTA metal chelate column. The biological activity of the recombinant growth factor was demonstrated by its ability to inhibit mink lung (Mv1Lu) cell proliferation and/or to stimulate proliferation of NIH-3T3 mouse fibroblasts, where purified human platelet TGF-beta 1 served as a positive control. Purified TGF-B1-F1 and TGF-B1-F2 (collagen-binding) constructs exhibited anti-proliferative activities comparable to purified platelet TGF-beta 1, but at lower specific activities. Binding of the renatured TGF-B1-F2 fusion protein to collagen was demonstrated by stable binding on a collagen-conjugated Sephadex-G15 column. The high affinity binding was also demonstrated by the binding of 3H-collagen to the TGF-B1-F2 protein immobilized on a Ni-NTA column. The TGF-B1-F2 fusion protein bound to collagen coated surfaces with high affinity but exhibited comparatively lower biological activity than the fusion protein in solution, suggesting a potentially latent configuration. Taken together, these results demonstrate that biologically active TGF-beta 1 fusion proteins can be recovered from transformed bacteria by oxidative refolding; thus, providing a means for its high-yield production, purification, and renaturation from microorganisms. Furthermore, these results support the concept that auxiliary domains may be used to modulate and/or target TGF-beta 1 for specific applications.
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Affiliation(s)
- T L Tuan
- Research Institute Childrens Hospital Los Angeles, University of Southern California School of Medicine 90027, USA
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Abstract
Peak bone mass is an important determinant of the risk of osteoporotic fracture, and preventive strategies against osteoporosis require a clear understanding of the factors influencing bone gain in early life. We report a longitudinal study aiming to identify the relationships between childhood growth, lifestyle, and peak bone mass in women. One hundred and fifty-three women born in a British city during 1968-1969 were traced and studied in 1990. Data on their growth in childhood was obtained from linked birth and school health records; current bone mineral measurements were made by dual X-ray absorptiometry. There were statistically significant associations between weight at 1 year and BMC (but not BMD) at the lumbar spine (r = 0.32, p < 0.01) and femoral neck (r = 0.26, p < 0.01). These remained significant after adjusting for current weight. There were also strong relationships between childhood height measurements and adult BMC at the two skeletal sites. Physical activity was the major lifestyle determinant of BMD after allowing for body build. We conclude that infant growth and physical activity in childhood are important determinants of peak bone mass in women. Growth primarily determines the size of the skeletal envelope, and its trajectory is established by age 1 year. Activity, in contrast, modulates the mineral density within the skeletal envelope and may contribute to the consolidation of bone following the end of linear growth.
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Affiliation(s)
- C Cooper
- MRC Environmental Epidemiology Unit, Southampton General Hospital, United Kingdom
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Wells GR, Taylor EW, Lindsay G, Morton L. Relationship between bile colonization, high-risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving a prophylactic antibiotic. West of Scotland Surgical Infection Study Group. Br J Surg 1989; 76:374-7. [PMID: 2497926 DOI: 10.1002/bjs.1800760419] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [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: 01/01/2023]
Abstract
A prospective audit of 644 patients undergoing biliary tract operations has been conducted to assess the incidence of bile colonization and its association with the incidence of postoperative sepsis when all patients received the same prophylactic antibiotic. The accuracy of the determination of high-risk factors has been assessed as has the correlation between bile colonization and patients assessed as 'high risk'. Organisms were cultured from the bile of 121 (19 per cent) patients and among these the incidence of wound or intra-abdominal sepsis was 22 per cent whereas among patients with sterile bile the incidence was only 2 per cent (P less than 0.0001). Although the incidence of bile colonization within the high-risk group (32 per cent) was more than twice that in the low-risk group (14 per cent), more than half (54 per cent) of the patients with positive bile cultures were in the low-risk group. It is concluded that, despite prophylactic antibiotics, bile colonization remains the major factor associated with postoperative sepsis, but that this cannot be predicted accurately by preoperative assessment of high-risk factors. Furthermore, we believe that a policy of selective administration of prophylactic antibiotics solely to high-risk patients cannot be justified.
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Affiliation(s)
- G R Wells
- Southern General Hospital, Glasgow, UK
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Kuehl KS, Elliot DL, Goldberg L, Morton L. 81. Med Sci Sports Exerc 1987. [DOI: 10.1249/00005768-198704001-00081] [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: 11/21/2022]
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Solyom C, Solyom L, LaPierre Y, Pecknold J, Morton L. Phenelzine and exposure in the treatment of phobias. Biol Psychiatry 1981; 16:239-47. [PMID: 6112024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A double-blind study was carried out on 40 agoraphobic and socially phobic patients, matched, then randomly assigned to one of four treatment groups; phenelzine-exposure, phenelzine-no exposure, placebo-exposure, and placebo-no exposure. Exposure consisted of encouraging the patient to face the phobic situation a predetermined number of times. Assessments, made at the beginning and end of 8 weeks of therapy and 8 weeks thereafter, showed that the phobia ratings of groups decreased significantly. The combined exposure group improved significantly more than the combined no exposure group during treatment. At 8 weeks follow-up there was some deterioration in the phenelzine-exposure and placebo-no exposure groups. Exposure, with or without phenelzine, was the superior treatment modality. The antiphobic effect of phenelzine was not supported, although it seemed to reduce subjective anxiety during exposure experiences. The possibility that effect of phenelzine is dose-related is discussed.
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Morton L. Letter to the editor. Bull Med Libr Assoc 1979; 67:68. [PMID: 16017761 PMCID: PMC226890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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