1
|
Kuah XYC, Lucas-Herald AK, McCarrison S, Boyle R, Adey C, Amato-Watkins A, Bhattathiri P, Campbell E, Cowie F, Dorris L, Fulton B, Mcintosh D, Murphy D, Ronghe M, O'Kane R, Todd L, Sangra M, Sastry J, Millar E, Hassan S, Shaikh MG. Presentation and outcomes of paediatric craniopharyngioma in the west of Scotland: a 25 year experience. J Neurooncol 2024; 166:51-57. [PMID: 38224403 DOI: 10.1007/s11060-023-04490-5] [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: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Craniopharyngiomas can be aggressive leading to significant complications and morbidity. It is not clear whether there are any predictive factors for incidence or outcomes. Our aim was therefore to record the incidence, presentation, characteristics and progression of paediatric craniopharyngiomas in the West of Scotland. METHOD Retrospective case note review for children diagnosed with paediatric craniopharyngiomas at the Royal Hospital for Children Glasgow, from 1995 to 2021 was conducted. All analyses were conducted using GraphPad Prism 9.4.0. RESULTS Of 21 patients diagnosed with craniopharyngiomas, the most common presenting symptoms were headaches (17/21, 81%); visual impairment (13/21, 62%); vomiting (9/21, 43%) and growth failure (7/21, 33%). Seventeen (81%) patients underwent hydrocephalus and/or resection surgery within 3 months of diagnosis, usually within the first 2 weeks (13/21, 62%). Subtotal resection surgeries were performed in 71% of patients, and median time between subsequent resection surgeries for tumour recurrence was 4 years (0,11). BMI SDS increased at 5 year follow-up (p = 0.021) with 43% being obese (BMI > + 2SD). More patients acquired hypopituitarism post-operatively (14/16, 88%) compared to pre-operatively (4/15, 27%). A greater incidence of craniopharyngiomas were reported in more affluent areas (10/21, 48%) (SIMD score 8-10) compared to more deprived areas (6/10, 29%) (SIMD score 1-3). Five patients (24%) died with a median time between diagnosis and death of 9 years (6,13). CONCLUSION Over 25 years the management of craniopharyngioma has changed substantially. Co-morbidities such as obesity are difficult to manage post-operatively and mortality risk can be up to 25% according to our cohort.
Collapse
Affiliation(s)
- Xuan Ye Chanel Kuah
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Angela K Lucas-Herald
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Sarah McCarrison
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Roisin Boyle
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Claire Adey
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Parameswaran Bhattathiri
- Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Emer Campbell
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Fiona Cowie
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Liam Dorris
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ben Fulton
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Diana Mcintosh
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Dermot Murphy
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Milind Ronghe
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Roddy O'Kane
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Lorraine Todd
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Meharpal Sangra
- Department of Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Jairam Sastry
- Department of Paediatric Oncology, Royal Hospital for Children, Glasgow, UK
| | - Eoghan Millar
- Department of Ophthalmology, Royal Hospital for Children, Glasgow, UK
| | - Samih Hassan
- Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Guftar Shaikh
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK.
- Department of Paediatric Endocrinology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK.
| |
Collapse
|
2
|
Mancini A, Todd L. Inconsistencies in ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment and The ISPD Catheter-Related Infection Recommendations: 2017 Update. Perit Dial Int 2018; 38:309-310. [PMID: 29987068 DOI: 10.3747/pdi.2018.00026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Mancini
- Medical Science Liaison, Baxter Healthcare Corporation
| | - L Todd
- Medical Science Liaison, Baxter Healthcare Corporation
| |
Collapse
|
3
|
Suraev A, Lintzeris N, Stuart J, Kevin RC, Blackburn R, Richards E, Arnold JC, Ireland C, Todd L, Allsop DJ, McGregor IS. Composition and Use of Cannabis Extracts for Childhood Epilepsy in the Australian Community. Sci Rep 2018; 8:10154. [PMID: 29977078 PMCID: PMC6033872 DOI: 10.1038/s41598-018-28127-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 06/04/2018] [Indexed: 12/20/2022] Open
Abstract
Recent surveys suggest that many parents are using illicit cannabis extracts in the hope of managing seizures in their children with epilepsy. In the current Australian study we conducted semi-structured interviews with families of children with diverse forms of epilepsy to explore their attitudes towards and experiences with using cannabis extracts. This included current or previous users of cannabis extracts to treat their child's seizures (n = 41 families), and families who had never used (n = 24 families). For those using cannabis, extracts were analysed for cannabinoid content, with specific comparison of samples rated by families as "effective" versus those rated "ineffective". Results showed that children given cannabis extracts tended to have more severe epilepsy historically and had trialled more anticonvulsants than those who had never received cannabis extracts. There was high variability in the cannabinoid content and profile of cannabis extracts rated as "effective", with no clear differences between extracts perceived as "effective" and "ineffective". Contrary to family's expectations, most samples contained low concentrations of cannabidiol, while Δ9-tetrahydrocannabinol was present in nearly every sample. These findings highlight profound variation in the illicit cannabis extracts being currently used in Australia and warrant further investigations into the therapeutic value of cannabinoids in epilepsy.
Collapse
Affiliation(s)
- A Suraev
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - N Lintzeris
- Addiction Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, Sydney, 2006, Australia
- The Langton Centre, Drug and Alcohol Services, South East Sydney Local Health District, NSW Health, Surry Hills, 2010, Australia
| | - J Stuart
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - R C Kevin
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - R Blackburn
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - E Richards
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - J C Arnold
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
- Department of Pharmacology, Faculty of Medicine, University of Sydney, Sydney, NSW, 2006, Australia
| | - C Ireland
- Epilepsy Action Australia, Sydney, Australia
| | - L Todd
- Epilepsy Action Australia, Sydney, Australia
| | - D J Allsop
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia
| | - I S McGregor
- The Lambert Initiative for Cannabinoid Therapeutics, School of Psychology, The University of Sydney, Sydney, 2050, Australia.
| |
Collapse
|
4
|
Abstract
PURPOSE The purpose of this study is to record the 30-day and inpatient morbidity and mortality in paediatric patients in a tertiary neuroscience centre over a 2-year period. The intentions were to establish the frequency of significant adverse events, review the current published rates of morbidity in paediatric neurosurgical patients and propose three clinical indicators for future comparison. METHODS All deaths and adverse events were prospectively recorded from 1 January 2014 to 31 December 2015. Each adverse event was categorised, allocated a clinical impact severity score and linked to a neurosurgical procedure wherever possible. Where a patient suffered several adverse events in the same admission, each event was recorded separately. If a patient had been discharged home, an adverse event was recorded if it occurred within 30 days of admission. RESULTS Five hundred forty-nine procedures were performed in 287 patients (aged <16 years). One hundred thirty significant adverse events were identified. The following are the three clinical indicators: significant adverse event rate: 111 (20.2%) operations were linked to at least one significant adverse event; unscheduled return to theatre rate: 81 (14.8%) operations were associated with an adverse event that resulted in an unscheduled return to theatre; and surgical site infection rate: 29 (5.3%) operations were associated with an infection. CONCLUSION Complications and adverse events are common in paediatric neurosurgery. Prospective, continuous surveillance will promote both quality assurance and quality improvement in the neurosurgical care delivered to patients.
Collapse
Affiliation(s)
- Emer Campbell
- Department of Paediatric Neurosurgery, Royal Hospital for Children, 1345, Govan Road, Glasgow, Scotland, G51 4TF, UK.
| | - Thomas Beez
- 0000 0000 8922 7789grid.14778.3dDepartment of Paediatric Neurosurgery, University Hospital, Dusseldorf, Germany
| | - Lorraine Todd
- Department of Paediatric Neurosurgery, Royal Hospital for Children, 1345, Govan Road, Glasgow, Scotland G51 4TF UK
| |
Collapse
|
5
|
Wenger M, DellaValle D, McKinzie S, Todd L, Haas J. Measuring Perception and Cognition in the Context of Iron Deficiency: Three Approaches. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.900.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- M Wenger
- Psychology Cellular and Behavioral Neurobiology The University of OklahomaNormanOKUnited States
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| | - D DellaValle
- Division of Gastroenterology and Hepatology MedicalUniversity of South CarolinaCharlestonSCUnited States
| | - S McKinzie
- Psychology Cellular and Behavioral Neurobiology The University of OklahomaNormanOKUnited States
| | - L Todd
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
- PsychologyFairleigh Dickinson UniversityTeaneckNJUnited States
| | - J Haas
- Division of Nutritional SciencesCornell UniversityIthacaNYUnited States
| |
Collapse
|
6
|
Aneja VP, Arya SP, Kim DS, Rumsey IC, Arkinson HL, Semunegus H, Bajwa KS, Dickey DA, Stefanski LA, Todd L, Mottus K, Robarge WP, Williams CM. Characterizing ammonia emissions from swine farms in eastern North Carolina: part 1--conventional lagoon and spray technology for waste treatment. J Air Waste Manag Assoc 2008; 58:1130-1144. [PMID: 18817106 DOI: 10.3155/1047-3289.58.9.1130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Ammonia (NH3) fluxes from waste treatment lagoons and barns at two conventional swine farms in eastern North Carolina were measured. The waste treatment lagoon data were analyzed to elucidate the temporal (seasonal and diurnal) variability and to derive regression relationships between NH3 flux and lagoon temperature, pH and ammonium content of the lagoon, and the most relevant meteorological parameters. NH3 fluxes were measured at various sampling locations on the lagoons by a flowthrough dynamic chamber system interfaced to an environmentally controlled mobile laboratory. Two sets of open-path Fourier transform infrared (FTIR) spectrometers were also used to measure NH3 concentrations for estimating NH3 emissions from the animal housing units (barns) at the lagoon and spray technology (LST) sites. Two different types of ventilation systems were used at the two farms. Moore farm used fan ventilation, and Stokes farm used natural ventilation. The early fall and winter season intensive measurement campaigns were conducted during September 9 to October 11, 2002 (lagoon temperature ranged from 21.2 to 33.6 degrees C) and January 6 to February 2, 2003 (lagoon temperature ranged from 1.7 to 12 degrees C), respectively. Significant differences in seasonal NH3 fluxes from the waste treatment lagoons were found at both farms. Typical diurnal variation of NH3 flux with its maximum value in the afternoon was observed during both experimental periods. Exponentially increasing flux with increasing surface lagoon temperature was observed, and a linear regression relationship between logarithm of NH3 flux and lagoon surface temperature (T1) was obtained. Correlations between lagoon NH3 flux and chemical parameters, such as pH, total Kjeldahl nitrogen (TKN), and total ammoniacal nitrogen (TAN) were found to be statistically insignificant or weak. In addition to lagoon surface temperature, the difference (D) between air temperature and the lagoon surface temperature was also found to influence the NH3 flux, especially when D > 0 (i.e., air hotter than lagoon). This hot-air effect is included in the statistical-observational model obtained in this study, which was used further in the companion study (Part II), to compare the emissions from potential environmental superior technologies to evaluate the effectiveness of each technology.
Collapse
Affiliation(s)
- Viney P Aneja
- Department of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695-8208, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Aneja VP, Arya SP, Rumsey IC, Kim DS, Bajwa K, Arkinson HL, Semunegus H, Dickey DA, Stefanski LA, Todd L, Mottus K, Robarge WP, Williams CM. Characterizing ammonia emissions from swine farms in eastern North Carolina: part 2--potential environmentally superior technologies for waste treatment. J Air Waste Manag Assoc 2008; 58:1145-1157. [PMID: 18817107 DOI: 10.3155/1047-3289.58.9.1145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The need for developing environmentally superior and sustainable solutions for managing the animal waste at commercial swine farms in eastern North Carolina has been recognized in recent years. Program OPEN (Odor, Pathogens, and Emissions of Nitrogen), funded by the North Carolina State University Animal and Poultry Waste Management Center (APWMC), was initiated and charged with the evaluation of potential environmentally superior technologies (ESTs) that have been developed and implemented at selected swine farms or facilities. The OPEN program has demonstrated the effectiveness of a new paradigm for policy-relevant environmental research related to North Carolina's animal waste management programs. This new paradigm is based on a commitment to improve scientific understanding associated with a wide array of environmental issues (i.e., issues related to the movement of N from animal waste into air, water, and soil media; the transmission of odor and odorants; disease-transmitting vectors; and airborne pathogens). The primary focus of this paper is on emissions of ammonia (NH3) from some potential ESTs that were being evaluated at full-scale swine facilities. During 2-week-long periods in two different seasons (warm and cold), NH3 fluxes from water-holding structures and NH3 emissions from animal houses or barns were measured at six potential EST sites: (1) Barham farm--in-ground ambient temperature anaerobic digester/energy recovery/greenhouse vegetable production system; (2) BOC #93 farm--upflow biofiltration system--EKOKAN; (3) Carrolls farm--aerobic blanket system--ISSUES-ABS; (4) Corbett #1 farm--solids separation/ gasification for energy and ash recovery centralized system--BEST; (5) Corbett #2 farm--solid separation/ reciprocating water technology--ReCip; and (6) Vestal farm--Recycling of Nutrient, Energy and Water System--ISSUES-RENEW. The ESTs were compared with similar measurements made at two conventional lagoon and spray technology (LST) farms (Moore farm and Stokes farm). A flow-through dynamic chamber system and two sets of open-path Fourier transform infrared (OP-FTIR) spectrometers measured NH3 fluxes continuously from water-holding structures and emissions from housing units at the EST and conventional LST sites. A statistical-observational model for lagoon NH3 flux was developed using a multiple linear regression analysis of 15-min averaged NH3 flux data against the relevant environmental parameters measured at the two conventional farms during two different seasons of the year. This was used to compare the water-holding structures at ESTs with those from lagoons at conventional sites under similar environmental conditions. Percentage reductions in NH3 emissions from different components of each potential EST, as well as the whole farm on which the EST was located were evaluated from the estimated emissions from water-holding structures, barns, etc., all normalized by the appropriate nitrogen excretion rate at the potential EST farm, as well as from the appropriate conventional farm. This study showed that ammonia emissions were reduced by all but one potential EST for both experimental periods. However, on the basis of our evaluation results and analysis and available information in the scientific literature, the evaluated alternative technologies may require additional technical modifications to be qualified as unconditional ESTs relative to NH3 emissions reductions.
Collapse
Affiliation(s)
- Viney P Aneja
- Department of Marine, Earth, and Atmospheric Sciences, North Carolina State University, Raleigh, NC 27695-8208, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Todd L. Franz Bergel: 13 February 1900-1 January 1987. Biogr Mem Fellows R Soc 2001; 34:1-19. [PMID: 11616111] [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: 02/21/2023]
|
9
|
Todd L. Rwanda: gods and ghosts. Semin Perioper Nurs 2001; 10:131-4. [PMID: 15129533] [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: 04/29/2023]
Abstract
This paper provides a personal story. I was born in Africa and have a great empathy for its people. The perceptions I provide are through the eyes of an African born individual who has lived in Australia for many years. It is said that you can take the child out of Africa; however, you cannot take Africa out of the child. During my return to Rwanda in 1994 to 1995, I learned many lessons. Perhaps the most significant being that the Rwandan people displayed absolute stoicism and acceptance of adversity, and from the suffering they had endured, they displayed a great dignity.
Collapse
Affiliation(s)
- L Todd
- Canungra Medical Centre, Queensland, Australia
| |
Collapse
|
10
|
Abstract
The aim of this study was to further investigate optokinetic reflex function in multiple sclerosis. Gaze-holding in darkness, optokinetic nystagmus, optokinetic afternystagmus and latency to circularvection were measured using electro-oculography and a rotating optokinetic drum. Gaze-holding was not significantly different between the multiple sclerosis and control groups; however, four of 23 multiple sclerosis patients exhibited eccentric gaze-evoked nystagmus. There were no significant differences in either optokinetic nystagmus frequency or latency to circularvection. However, optokinetic nystagmus slow phase velocity during rise time and amplitude during beat time were significantly reduced in the multiple sclerosis group (p < 0.05 and p < 0.0001, respectively). The time constant of optokinetic afternystagmus was also significantly reduced in the multiple sclerosis group (p < 0.005). These results indicate that optokinetic nystagmus and optokinetic afternystagmus are significantly impaired multiple sclerosis.
Collapse
Affiliation(s)
- L Todd
- Department of Psychology and the Neuroscience Research Centre, University of Otago, Dunedin, New Zealand
| | | | | | | |
Collapse
|
11
|
Shelton RC, Keller MB, Gelenberg A, Dunner DL, Hirschfeld R, Thase ME, Russell J, Lydiard RB, Crits-Cristoph P, Gallop R, Todd L, Hellerstein D, Goodnick P, Keitner G, Stahl SM, Halbreich U. Effectiveness of St John's wort in major depression: a randomized controlled trial. JAMA 2001; 285:1978-86. [PMID: 11308434 DOI: 10.1001/jama.285.15.1978] [Citation(s) in RCA: 266] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Extracts of St John's wort are widely used to treat depression. Although more than 2 dozen clinical trials have been conducted with St John's wort, most have significant flaws in design and do not enable meaningful interpretation. OBJECTIVE To compare the efficacy and safety of a standardized extract of St John's wort with placebo in outpatients with major depression. DESIGN AND SETTING Randomized, double-blind, placebo-controlled clinical trial conducted between November 1998 and January 2000 in 11 academic medical centers in the United States. PARTICIPANTS Two hundred adult outpatients (mean age, 42.4 years; 67.0% female; 85.9% white) diagnosed as having major depression and having a baseline Hamilton Rating Scale for Depression (HAM-D) score of at least 20. INTERVENTION Participants completed a 1-week, single-blind run-in of placebo, then were randomly assigned to receive either St John's wort extract (n = 98; 900 mg/d for 4 weeks, increased to 1200 mg/d in the absence of an adequate response thereafter) or placebo (n = 102) for 8 weeks. MAIN OUTCOME MEASURES The primary outcome measure was rate of change on the HAM-D over the treatment period. Secondary measures included the Beck Depression Inventory (BDI), Hamilton Rating Scale for Anxiety (HAM-A), the Global Assessment of Function (GAF) scale, and the Clinical Global Impression-Severity and -Improvement scales (CGI-S and CGI-I). RESULTS The random coefficient analyses for the HAM-D, HAM-A, CGI-S, and CGI-I all showed significant effects for time but not for treatment or time-by-treatment interaction (for HAM-D scores, P<.001, P =.16, and P =.58, respectively). Analysis of covariance showed nonsignificant effects for BDI and GAF scores. The proportion of participants achieving an a priori definition of response did not differ between groups. The number reaching remission of illness was significantly higher with St John's wort than with placebo (P =.02), but the rates were very low in the full intention-to-treat analysis (14/98 [14.3%] vs 5/102 [4.9%], respectively). St John's wort was safe and well tolerated. Headache was the only adverse event that occurred with greater frequency with St John's wort than placebo (39/95 [41%] vs 25/100 [25%], respectively). CONCLUSION In this study, St John's wort was not effective for treatment of major depression.
Collapse
Affiliation(s)
- R C Shelton
- Department of Psychiatry, Vanderbilt University, Nashville Tennessee, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Schulz MR, Hertz-Picciotto I, Todd L, Ball LM. Reconciling animal and human data in a cancer risk assessment of acrylonitrile. Scand J Work Environ Health 2001; 27:14-20. [PMID: 11266142 DOI: 10.5271/sjweh.582] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [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: 11/11/2022] Open
Abstract
OBJECTIVES Bioassays of rats exposed to acrylonitrile have consistently detected an elevated incidence of central nervous system (CNS) cancer. In contrast, epidemiologic studies have not found a statistically stable increase in CNS cancer mortality. The purpose of this paper is to examine whether or not CNS cancers predicted from the most appropriate inhalation bioassay in rats are consistent with CNS cancers observed in 3 recent, large epidemiologic studies. METHODS A linearized multistage model was fit to dose-response data from a rat inhalation bioassay to estimate carcinogenic potency. This potency was applied to epidemiologic studies of acrylonitrile-exposed workers. After adjustment for less than complete lifetime follow-up in the epidemiologic studies, consistency was examined between CNS cancers predicted by the model fit to the animal data for the exposure levels and sample sizes of the epidemiologicy studies and the CNS cancers observed in the epidemiologic studies. RESULTS The model predicted totals of 17.7, 3.6, and 7.6 CNS cancer deaths for the studies. These predictions were not far from the observed CNS cancer deaths (12, 6, and 6) and were well within their 95% confidence intervals of 6.9-22.3, 2.2-13.1, and 2.2-13.1, respectively. CONCLUSIONS The CNS cancer potency estimated from the best available inhalation bioassay was consistent with the observed deaths in the epidemiologic studies as long as continuous lifetime exposure was chosen as the exposure metric. The lack of observed excess in CNS cancer among the studied workers may have been due to low exposures, insufficient follow-up times, or both.
Collapse
Affiliation(s)
- M R Schulz
- Department of Epidemiology University of North Carolina at Chapel Hill, 27599-7400, USA
| | | | | | | |
Collapse
|
13
|
Cole D, Todd L, Wing S. Concentrated swine feeding operations and public health: a review of occupational and community health effects. Environ Health Perspect 2000; 108:685-99. [PMID: 10964788 PMCID: PMC1638284 DOI: 10.1289/ehp.00108685] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Recent industry changes in swine-management practices have resulted in a growing controversy surrounding the environmental and public health effects of modern swine production. The numerous wastes produced by intensive swine production not only pose a significant challenge to effective environmental management but also are associated with decreased air quality in confinement houses, potentially transferable antimicrobial resistance patterns, and several infectious agents that can be pathogenic to humans. Published studies have documented a variety of contaminants, microbial agents, and health effects in those occupationally exposed to swine, and these have provided the groundwork for an increasing body of research to evaluate possible community health effects. Nonetheless, several factors limit our ability to define and quantify the potential role of intensive swine-rearing facilities in occupational and community health. Our incomplete understanding and ability to detect specific exposures; the complicated nature of disease etiology; pathogenesis; and surveillance; and the inherent difficulties associated with study design all contribute to the inadequate level of knowledge that currently prevails. However; an evaluation of the published literature; and a recognition of the elements that may be compromising these studies; provides the foundation from which future studies may develop.
Collapse
Affiliation(s)
- D Cole
- Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7400, USA.
| | | | | |
Collapse
|
14
|
Early BP, Smith ED, Todd L, Beem T. The needs and supportive networks of the dying: an assessment instrument and mapping procedure for hospice patients. Am J Hosp Palliat Care 2000; 17:87-96. [PMID: 11406963 DOI: 10.1177/104990910001700208] [Citation(s) in RCA: 10] [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: 11/17/2022] Open
Abstract
If institutional systems that provide end-of-life care are to survive the demands of managed care, they will need to tie together methods of assessing the needs of the dying, leading to a new understanding of the functioning of a patient's existing helping networks. This paper presents the preliminary findings of a research project conducted at a Midwest hospice. The study utilized a cross sectional correlational survey of patients' needs via the Early Risk and Resiliency Inventory (ERRI), while mapping their helping networks with a Circles of Care Ecomap. It addressed the question, "What is the relationship between the needs of the dying and the formal and informal support provided?" Study findings supported the contention that higher need patients utilized the more expensive institutional services rather than relying on available natural networks; and statistical analysis of the study instrument suggested the creation of a new conceptual domain of psychospiritual need.
Collapse
Affiliation(s)
- B P Early
- Catholic University of America, National Catholic School of Social Service, Washington DC, USA
| | | | | | | |
Collapse
|
15
|
Kellen JC, Ettinger A, Todd L, Brezsnyak ML, Campion J, McBride R, Thomas S, Corum J, Schron E. The Cardiac Arrhythmia Suppression Trial: Implications for nursing practice. Am J Crit Care 1996; 5:19-25. [PMID: 8680488] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Care of patients with ventricular arrhythmia after myocardial infarction requires careful nursing management, including assisting with arrhythmia monitoring and testing. Because ventricular premature depolarization is a known risk factor for sudden cardiac death, it was hypothesized that the suppression of asymptomatic or mildly symptomatic ventricular premature depolarization would improve survival in these patients. OBJECTIVE To review the Cardiac Arrhythmia Suppression Trial findings and provide implications for nursing practice for patients after myocardial infarction. METHODS The Cardiac Arrhythmia Suppression Trial was a multicenter, randomized, placebo-controlled trial designed to determine whether the suppression of ventricular premature depolarizations in postmyocardial infarction patients would improve survival. Three class I antiarrhythmic drugs were used: encainide, flecainide, or moricizine. Patients for whom the drug suppressed their arrhythmia 80% or more were randomly assigned to that drug and dose or its matching placebo and were followed every 4 months (main study). Patients with 1% to 79% suppression were randomly assigned to the drug or its placebo that best treated their arrhythmia and followed every 4 months. RESULTS Suppression of asymptomatic or mildly symptomatic ventricular premature depolarization in patients using encainide, flecainide, or moricizine failed to improve patient survival and was even harmful in some cases. CONCLUSIONS Our results showed that in the absence of effective antiarrhythmic drug therapy, supportive nursing care and arrhythmia monitoring is important until appropriate therapy for the management of these arrhythmias in patients who have had a myocardial infarction can be found. Clinical trials are essential to provide an evaluation of therapies and direction for further studies, as well as a basis for practicing clinicians.
Collapse
|
16
|
Kellen JC, Ettinger A, Todd L, Brezsnyak ML, Campion J, McBride R, Thomas S, Corum J, Schron E. The Cardiac Arrhythmia Suppression Trial: Implications for nursing practice. Am J Crit Care 1996. [DOI: 10.4037/ajcc1996.5.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND: Care of patients with ventricular arrhythmia after myocardial infarction requires careful nursing management, including assisting with arrhythmia monitoring and testing. Because ventricular premature depolarization is a known risk factor for sudden cardiac death, it was hypothesized that the suppression of asymptomatic or mildly symptomatic ventricular premature depolarization would improve survival in these patients. OBJECTIVE: To review the Cardiac Arrhythmia Suppression Trial findings and provide implications for nursing practice for patients after myocardial infarction. METHODS: The Cardiac Arrhythmia Suppression Trial was a multicenter, randomized, placebo-controlled trial designed to determine whether the suppression of ventricular premature depolarizations in postmyocardial infarction patients would improve survival. Three class I antiarrhythmic drugs were used: encainide, flecainide, or moricizine. Patients for whom the drug suppressed their arrhythmia 80% or more were randomly assigned to that drug and dose or its matching placebo and were followed every 4 months (main study). Patients with 1% to 79% suppression were randomly assigned to the drug or its placebo that best treated their arrhythmia and followed every 4 months. RESULTS: Suppression of asymptomatic or mildly symptomatic ventricular premature depolarization in patients using encainide, flecainide, or moricizine failed to improve patient survival and was even harmful in some cases. CONCLUSIONS: Our results showed that in the absence of effective antiarrhythmic drug therapy, supportive nursing care and arrhythmia monitoring is important until appropriate therapy for the management of these arrhythmias in patients who have had a myocardial infarction can be found. Clinical trials are essential to provide an evaluation of therapies and direction for further studies, as well as a basis for practicing clinicians.
Collapse
|
17
|
Peters RW, Brooks MM, Todd L, Liebson PR, Wilhelmsen L. Smoking cessation and arrhythmic death: the CAST experience. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. J Am Coll Cardiol 1995; 26:1287-92. [PMID: 7594045 DOI: 10.1016/0735-1097(95)00328-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES This study was performed to assess the effect of cigarette smoking cessation on overall mortality and the incidence of arrhythmic death in the population of the Cardiac Arrhythmia Suppression Trial (CAST). BACKGROUND Cigarette smoking is a known risk factor for sudden cardiac death. Some of the adverse effects of smoking have been shown to dissipate with smoking cessation, but the time frame over which these changes occur and the population that stands to benefit have not been well delineated. CAST was a multicenter double-blind placebo-controlled study to determine whether suppression of ventricular ectopic activity by means of antiarrhythmic drugs in patients with left ventricular dysfunction after acute myocardial infarction would reduce the incidence of arrhythmic death. METHODS Of 2,752 patients randomized to blinded therapy, 1,026 were smoking at the time of their baseline examination and completed a 4-month follow-up visit. Of these, 517 stopped smoking by the time of this visit ("quitters") and 509 continued to smoke ("smokers"). RESULTS Over a mean follow-up period of slightly < 16 months, there were 17 arrhythmic deaths and 32 total deaths among the quitters versus 30 and 45, respectively, among the smokers; these differences were of marginal statistical significance. Most of the fatal events occurred in a group at high risk of ongoing ischemia: the 558 patients who did not have thrombolysis or undergo revascularization after their qualifying myocardial infarction. In this high risk cohort, smoking cessation greatly reduced the incidence of arrhythmic death and was associated with a statistically significant benefit in survival. CONCLUSIONS Smoking cessation was accompanied by a marked reduction in arrhythmic death and overall mortality that achieved statistical significance in a high risk cohort. These data imply that smoking cessation is important in risk factor reduction in patients with advanced ischemic heart disease.
Collapse
Affiliation(s)
- R W Peters
- Department of Medicine, Baltimore Department of Veterans Affairs Medical Center, Maryland 21201, USA
| | | | | | | | | |
Collapse
|
18
|
Abstract
This study evaluated the use of a controlled exposure chamber and calibration cell to investigate the performance of open-path remote sensing instruments for workplace monitoring of pollutants. An open-path infrared spectrometer was deployed in a chamber, and a range of homogeneous air concentrations were generated using the tracer gas sulfur hexafluoride (SF6). Open-path measurements were compared with point-sample measurements taken along the beam and analyzed using an infrared (IR) and electron capture detector (ECD). A five-compartment calibration cell placed in the optical path was used to simulate heterogeneous concentrations of pollutants. Fifteen concentration patterns were created by injecting different volumes of SF6 into each compartment. Open-path spectrometer measurements were compared with compartment concentrations measured using an ECD. Results indicated that stable homogeneous and heterogeneous concentrations of SF6 were generated in the controlled exposure chamber and five-compartment calibration cell, respectively. Overall, individual open-path measurements were within 20% of point samples measured with the IR and ECDs. The open-path spectrometer measurements had a consistent positive bias of about 12%. Exposure chamber experiments uncovered remote sensing instrument design aspects that could adversely impact its use for indoor monitoring. The weight and size of the instrument make it useable only in a fixed position, thus limiting spatial coverage of the beam in a room. The instrument components were not air-tight, resulting in overestimation of some open-path concentrations. A controlled test chamber and a long calibration cell placed in the optical path are useful tools for evaluating a variety of open-path spectrometer instrument performance issues relevant to industrial hygiene monitoring.
Collapse
Affiliation(s)
- L Todd
- University of North Carolina, Department of Environmental Sciences and Engineering, Chapel Hill 27599
| | | |
Collapse
|
19
|
Todd L, Ramachandran G. Evaluation of optical source-detector configurations for tomographic reconstruction of chemical concentrations in indoor air. Am Ind Hyg Assoc J 1994; 55:1133-43. [PMID: 7825513 DOI: 10.1080/15428119491018204] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This article reports on numerical studies to evaluate and compare optical remote sensing configurations for tomographically reconstructing pollutant concentrations in indoor air. With a remote sensing/computed tomography system, two-dimensional maps of pollutant concentrations with good spatial resolution can be created for an entire room. The successful use of such a system for exposure assessment, ventilation assessment, or source monitoring depends on the remote sensing configuration. A systematic method was developed to evaluate the performance of 10 configurations. One hundred and twenty test maps were reconstructed with an algebraic reconstruction method using all 10 configurations; reconstruction quality was evaluated using 4 criteria. Reconstruction quality was related to the number and location of detectors in the room and the complexity of the test maps. Configurations using the same number of detectors placed in different locations resulted in reconstructions that differed in quality. The effect of reducing the number density of rays on reconstruction quality was studied. Based on these simulations, two configurations that used four detectors to scan the room were selected, and their performance was evaluated in the presence of various levels of measurement noise. Two configurations that used four detectors were most suited for exposure assessment. It was found that when designing a configuration, the number and independence of rays should be maximized. Results underscored the need to thoroughly test configurations through numerical studies prior to field implementation; a wide variety of concentration maps, relevant to the application, should be tested under both ideal and nonideal sampling conditions.
Collapse
Affiliation(s)
- L Todd
- University of North Carolina, Department of Environmental Sciences and Engineering, Chapel Hill 27599
| | | |
Collapse
|
20
|
Abstract
Numerical studies were performed to evaluate and compare four different algorithms for tomographically reconstructing pollutant concentrations in indoor air measured with an optical remote sensing system. With a remote sensing/computed tomography system, two-dimensional maps of air concentrations can be created for an entire room with good spatial and temporal resolution. The success of such a system for characterizing the flow of contaminants in air, exposure assessment, and leak detection depends on the choice of tomographic reconstruction algorithm. A systematic method was developed to evaluate the performance of four algorithms: ART, ART3, SIRT, and SART. One hundred and twenty test maps were reconstructed by each algorithm under ideal and nonideal sampling conditions, and image quality was evaluated using four criteria. The nonideal sampling conditions included simulation of measurement noise and reduction in the number density of rays. Performance of the algorithms was found to be intimately related to the number of peaks in the test maps. The importance of using multiple measures of image quality was underscored by the fact that for some sampling conditions simulated, performance of the algorithms was judged differently depending on the evaluation criteria. Results indicated that using numerical studies is successful for evaluating such algorithms.
Collapse
Affiliation(s)
- L Todd
- University of North Carolina, Department of Environmental Sciences and Engineering, Chapel Hill 27599
| | | |
Collapse
|
21
|
|
22
|
Abstract
We injected 3-day-old (neonatal), 8-day-old (infant), and 8-wk-old (adult) Sprague-Dawley rats with monocrotaline to examine the effect of a toxic agent at various stages of lung development. Two and four weeks after injection the rats were killed and the heart and lungs removed: the right and left ventricles were separated and weighed, the pulmonary artery was injected with barium-gelatin, and the lung was fixed in the inflated state. Morphometric techniques were applied to assess lung volume, alveolar size and number, and arterial size, muscularity, and concentration relative to alveolar. Rats injected with monocrotaline in the neonatal period did not survive to 3 wk. After 2 wk, there was no significant right ventricular hypertrophy and pulmonary vascular changes were no worse than in the other rat groups injected with monocrotaline, but alveolar development was severely impaired; less than one-third the normal number was present. Rats injected with monocrotaline in infancy had normal alveolar development. After 2-wk, the arterial changes, i.e. extension of muscle into peripheral arteries, medial hypertrophy of muscular arteries, and decreased arterial concentration relative to alveolar were similar to those observed in adult rats. After 4 wk, there was a decrease in medial hypertrophy associated with growth in artery size and only a lack of regression of right ventricular weight. In adult rats, after 4 wk medial hypertrophy became progressively more severe, the arterial concentration relative to alveolar decreased further, and right ventricular hypertrophy developed.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
23
|
Todd L. Address of the President Lord Todd, O.M. at the Anniversary Meeting, 30 November 1978: Award of Medals 1978. Proc R Soc Lond B Biol Sci 1979; 204:1-14. [PMID: 37509 DOI: 10.1098/rspb.1979.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Copley Medal is awarded to Professor R. B. Woodward, ForMem. R. S. Professor Woodward is universally acknowledged to be the leading organic chemist of his generation. He has constantly been attracted by the chemistry of naturally occurring substances and his work has transformed the field. He recognized at a very early stage that spectroscopy allowed a control of synthetic and degradative research that could not previously have been contemplated. He made major contributions to the structure determination of complex molecules from widely different classes of compounds, including penicillin, strychnine, patulin, gelsemine, cevine, aureomycin, calycanthine and tetrodotoxin.
Collapse
|
24
|
Todd L. Chemistry and medicine. Community Health (Bristol) 1970; 1:297-303. [PMID: 5420639] [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: 01/15/2023]
|
25
|
Todd L, Tkach S. Synovectomy of the knee in rheumatoid arthritis. South Med J 1969; 62:1093-6. [PMID: 5809980 DOI: 10.1097/00007611-196909000-00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
26
|
Delpierre GR, Eastwood FW, Gream GE, Kingston DG, Sarin PS, Todd L, Williams DH. Antibiotics of the ostreogrycin complex. II. Structure of ostreogrycin A. J Chem Soc Perkin 1 1966; 19:1653-69. [PMID: 5950461 DOI: 10.1039/j39660001653] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
27
|
Kingston DG, Sarin PS, Todd L, Williams DH. Antibiotics of the ostreogrycin complex. IV. The structure of ostreogrycin G. J Chem Soc Perkin 1 1966; 20:1856-60. [PMID: 5950473 DOI: 10.1039/j39660001856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
28
|
|
29
|
Kingston DG, Todd L, Williams DH. Antibiotics of the ostreogrycin complex. 3. The structure of ostreogrycin A. Evidence based on nuclear magnetic double resonance experiments and high-resolution mass spectrometry. J Chem Soc Perkin 1 1966; 19:1669-76. [PMID: 5950462 DOI: 10.1039/j39660001669] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|