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Gee J, Shimabukuro TT, Su JR, Shay D, Ryan M, Basavaraju SV, Broder KR, Clark M, Buddy Creech C, Cunningham F, Goddard K, Guy H, Edwards KM, Forshee R, Hamburger T, Hause AM, Klein NP, Kracalik I, Lamer C, Loran DA, McNeil MM, Montgomery J, Moro P, Myers TR, Olson C, Oster ME, Sharma AJ, Schupbach R, Weintraub E, Whitehead B, Anderson S. Overview of U.S. COVID-19 vaccine safety surveillance systems. Vaccine 2024:S0264-410X(24)00224-X. [PMID: 38631952 DOI: 10.1016/j.vaccine.2024.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/13/2024] [Accepted: 02/22/2024] [Indexed: 04/19/2024]
Abstract
The U.S. COVID-19 vaccination program, which commenced in December 2020, has been instrumental in preventing morbidity and mortality from COVID-19 disease. Safety monitoring has been an essential component of the program. The federal government undertook a comprehensive and coordinated approach to implement complementary safety monitoring systems and to communicate findings in a timely and transparent way to healthcare providers, policymakers, and the public. Monitoring involved both well-established and newly developed systems that relied on both spontaneous (passive) and active surveillance methods. Clinical consultation for individual cases of adverse events following vaccination was performed, and monitoring of special populations, such as pregnant persons, was conducted. This report describes the U.S. government's COVID-19 vaccine safety monitoring systems and programs used by the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service. Using the adverse event of myocarditis following mRNA COVID-19 vaccination as a model, we demonstrate how the multiple, complementary monitoring systems worked to rapidly detect, assess, and verify a vaccine safety signal. In addition, longer-term follow-up was conducted to evaluate the recovery status of myocarditis cases following vaccination. Finally, the process for timely and transparent communication and dissemination of COVID-19 vaccine safety data is described, highlighting the responsiveness and robustness of the U.S. vaccine safety monitoring infrastructure during the national COVID-19 vaccination program.
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Affiliation(s)
- Julianne Gee
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States.
| | - Tom T Shimabukuro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - John R Su
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - David Shay
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Sridhar V Basavaraju
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Karen R Broder
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - C Buddy Creech
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, United States
| | - Kristin Goddard
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Harrison Guy
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Kathryn M Edwards
- Vanderbilt Vaccine Research Program, Vanderbilt University Medical Center and School of Medicine, Nashville, TN, United States
| | - Richard Forshee
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
| | - Tanya Hamburger
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Anne M Hause
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Ian Kracalik
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Chris Lamer
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - David A Loran
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, United States
| | - Michael M McNeil
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Jay Montgomery
- Defense Health Agency, Immunization Healthcare Division, Bethesda, MD, United States
| | - Pedro Moro
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Tanya R Myers
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Christine Olson
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Matthew E Oster
- National Center for Birth Defects and Developmental Disabilities, CDC, Atlanta GA, United States; Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Andrea J Sharma
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Ryan Schupbach
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Eric Weintraub
- National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, United States
| | - Brett Whitehead
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Durango, CO, United States
| | - Steven Anderson
- Office of Biologics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, United States
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Cooper LT, Hasin T, Ryan M. Third time's a harm? Cardiac risk of SARS-CoV-2 mRNA booster vaccines in younger men. Eur Heart J 2024; 45:1336-1338. [PMID: 38531026 DOI: 10.1093/eurheartj/ehae157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic in Florida, 4500 San Pablo, Jacksonville, FL 32224, USA
| | - Tal Hasin
- Hebrew University and Medical Director of Heart failure Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Margaret Ryan
- DHA Immunization Healthcare, Naval Medical Center San Diego, Building 6, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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Sharifian Gh. M, Norouzi F, Sorci M, Zaid TS, Pier GB, Achimovich A, Ongwae GM, Liang B, Ryan M, Lemke M, Belfort G, Gadjeva M, Gahlmann A, Pires MM, Venter H, Harris TE, Laurie GW. Targeting Iron - Respiratory Reciprocity Promotes Bacterial Death. bioRxiv 2024:2024.03.01.582947. [PMID: 38464199 PMCID: PMC10925246 DOI: 10.1101/2024.03.01.582947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Discovering new bacterial signaling pathways offers unique antibiotic strategies. Here, through an unbiased resistance screen of 3,884 gene knockout strains, we uncovered a previously unknown non-lytic bactericidal mechanism that sequentially couples three transporters and downstream transcription to lethally suppress respiration of the highly virulent P. aeruginosa strain PA14 - one of three species on the WHO's 'Priority 1: Critical' list. By targeting outer membrane YaiW, cationic lacritin peptide 'N-104' translocates into the periplasm where it ligates outer loops 4 and 2 of the inner membrane transporters FeoB and PotH, respectively, to suppress both ferrous iron and polyamine uptake. This broadly shuts down transcription of many biofilm-associated genes, including ferrous iron-dependent TauD and ExbB1. The mechanism is innate to the surface of the eye and is enhanced by synergistic coupling with thrombin peptide GKY20. This is the first example of an inhibitor of multiple bacterial transporters.
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Affiliation(s)
| | - Fatemeh Norouzi
- Department of Cell Biology, University of Virginia, Charlottesville VA, USA
| | - Mirco Sorci
- Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy NY, USA
| | - Tanweer S Zaid
- Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Gerald B. Pier
- Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Alecia Achimovich
- Department of Chemistry, University of Virginia, Charlottesville VA, USA
| | - George M. Ongwae
- Department of Chemistry, University of Virginia, Charlottesville VA, USA
| | - Binyong Liang
- Department of Molecular Physiology and Biological Physics, University of Virginia, Charlottesville VA, USA
| | - Margaret Ryan
- Department of Cell Biology, University of Virginia, Charlottesville VA, USA
| | - Michael Lemke
- Department of Pharmacology, University of Virginia, Charlottesville VA, USA
| | - Georges Belfort
- Howard P. Isermann Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy NY, USA
| | - Mihaela Gadjeva
- Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston MA
| | - Andreas Gahlmann
- Department of Chemistry, University of Virginia, Charlottesville VA, USA
| | - Marcos M. Pires
- Department of Chemistry, University of Virginia, Charlottesville VA, USA
| | - Henrietta Venter
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
| | - Thurl E. Harris
- Department of Pharmacology, University of Virginia, Charlottesville VA, USA
| | - Gordon W. Laurie
- Department of Cell Biology, University of Virginia, Charlottesville VA, USA
- Department of Ophthalmology, University of Virginia, Charlottesville VA, USA
- Department of Biomedical Engineering, University of Virginia, Charlottesville VA, USA
- Contact author: Gordon Laurie
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McClenathan BM, Taylor JN, Housel LA, Ryan M. Incidence of anaphylaxis to YF-VAX® yellow fever vaccination: a retrospective evaluation of vaccine adverse event reports 1999-2018. J Travel Med 2024; 31:taad154. [PMID: 38051650 DOI: 10.1093/jtm/taad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/22/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The incidence of anaphylaxis after receipt of yellow fever (YF) vaccine is highly variable based upon previously published reports. Anaphylaxis after receiving the YF vaccine has been reported to range from 0 up to 22 per 1 000 000 doses. Our clinical experience suggested increased incidence, which prompted our investigation. We sought to evaluate the current incidence rate of anaphylaxis after receipt of the 17D-204 strain YF-VAX® brand reported in the US. METHODS We performed a retrospective review of the Vaccine Adverse Event Reporting System (VAERS) reports of anaphylaxis after receiving the YF-VAX vaccine occurring between 1 October 1999 and 30 September 2018. We utilized the Brighton Collaboration Case Definition and inclusion determination was made by a board-certified allergist. We also obtained the total number of YF-VAX doses distributed across the US during this same time-period and then calculated an updated incidence rate of YF-VAX vaccine-associated anaphylaxis. RESULTS We identified 132 potential cases of possible or probable anaphylaxis. Of these, 111 met inclusion criteria: level 1 (n = 51), level 2 (n = 59) and level 3 (n = 1). The manufacturer reported a total distribution of 7 624 160 doses of YF-VAX from 1 October 1999 to 30 September 2018. The calculated incidence rate of YF-VAX vaccine-associated anaphylaxis is estimated at 14.6 events per 1 000 000 doses. CONCLUSIONS We conclude the estimated rate of anaphylaxis per VAERS reports is 14.6 events per 1 000 000 doses after YF-VAX vaccination. This is consistent with some previous reports and substantially higher than rates of anaphylaxis after other vaccines.
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Affiliation(s)
- Bruce M McClenathan
- Immunization Healthcare Division, South Atlantic Region Vaccine Safety Hub, Defense Health Agency, Fort Liberty, NC, USA
- Department of Medicine, Womack Army Medical Center, Fort Liberty, NC, USA
| | - Jillian N Taylor
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Laurie A Housel
- Immunization Healthcare Division, South Atlantic Region Vaccine Safety Hub, Defense Health Agency, Fort Liberty, NC, USA
- Department of Medicine, Womack Army Medical Center, Fort Liberty, NC, USA
| | - Margaret Ryan
- Immunization Healthcare Division Pacific Region Vaccine Safety Hub, Defense Health Agency, San Diego, CA, USA
- Naval Medical Center, San Diego, CA, USA
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Masukume G, Grech V, Ryan M. Sporting tournaments and changed birth rates 9 months later: a systematic review. PeerJ 2024; 12:e16993. [PMID: 38436006 PMCID: PMC10906258 DOI: 10.7717/peerj.16993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Major sporting tournaments may be associated with increased birth rates 9 months afterwards, possibly due to celebratory sex. The influence of major sporting tournaments on birth patterns remains to be fully explored. Methods Studies that examined the relationship between such events and altered birth metrics (number of births and/or birth sex ratio (male/total live births)) 9(±1) months later were sought in PubMed and Scopus and reported via standard guidelines. Database searches were conducted up to 7 November 2022. Results Five events led to increased birth metrics 9(±1) months later and these included the Super Bowl, the 2009 UEFA Champions League, the 2010 FIFA World Cup, the 2016 UEFA Euros and the 2019 Rugby World Cup. Several la Liga soccer matches also had effects. With a few exceptions, major American football, Association football (soccer) and Rugby apex tournaments in Africa, North America, Asia and Europe were associated with increases in the number of babies born and/or in the birth sex ratio 9(±1) months following notable team wins and/or hosting the tournament. Furthermore, unexpected losses by teams from a premier soccer league were associated with a decline in births 9 months on. Conclusions This systematic review establishes that major sporting tournaments have a notable impact on birth patterns, influencing both birth rates and sex ratios. Emotional intensification during these events likely triggers hormonal shifts, driving changes in sexual activity and subsequently shaping birth rates, often positively, about 9 months later. The context is crucial, especially when a region/country hosts a major single-sport tournament or participates for the first time, as population excitement is likely to be at its peak. These findings hold significance for healthcare planning and highlight the role of societal events in shaping demographic trends. PROSPERO registration CRD42022382971.
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Affiliation(s)
- Gwinyai Masukume
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Victor Grech
- Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Msida, Malta
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Markowitz LE, Hopkins RH, Broder KR, Lee GM, Edwards KM, Daley MF, Jackson LA, Nelson JC, Riley LE, McNally VV, Schechter R, Whitley-Williams PN, Cunningham F, Clark M, Ryan M, Farizo KM, Wong HL, Kelman J, Beresnev T, Marshall V, Shay DK, Gee J, Woo J, McNeil MM, Su JR, Shimabukuro TT, Wharton M, Keipp Talbot H. COVID-19 Vaccine Safety Technical (VaST) Work Group: Enhancing vaccine safety monitoring during the pandemic. Vaccine 2024:S0264-410X(23)01505-0. [PMID: 38341293 DOI: 10.1016/j.vaccine.2023.12.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
During the COVID-19 pandemic, candidate COVID-19 vaccines were being developed for potential use in the United States on an unprecedented, accelerated schedule. It was anticipated that once available, under U.S. Food and Drug Administration (FDA) Emergency Use Authorization (EUA) or FDA approval, COVID-19 vaccines would be broadly used and potentially administered to millions of individuals in a short period of time. Intensive monitoring in the post-EUA/licensure period would be necessary for timely detection and assessment of potential safety concerns. To address this, the Centers for Disease Control and Prevention (CDC) convened an Advisory Committee on Immunization Practices (ACIP) work group focused solely on COVID-19 vaccine safety, consisting of independent vaccine safety experts and representatives from federal agencies - the ACIP COVID-19 Vaccine Safety Technical Work Group (VaST). This report provides an overview of the organization and activities of VaST, summarizes data reviewed as part of the comprehensive effort to monitor vaccine safety during the COVID-19 pandemic, and highlights selected actions taken by CDC, ACIP, and FDA in response to accumulating post-authorization safety data. VaST convened regular meetings over the course of 29 months, from November 2020 through April 2023; through March 2023 FDA issued EUAs for six COVID-19 vaccines from four different manufacturers and subsequently licensed two of these COVID-19 vaccines. The independent vaccine safety experts collaborated with federal agencies to ensure timely assessment of vaccine safety data during this time. VaST worked closely with the ACIP COVID-19 Vaccines Work Group; that work group used safety data and VaST's assessments for benefit-risk assessments and guidance for COVID-19 vaccination policy. Safety topics reviewed by VaST included those identified in safety monitoring systems and other topics of scientific or public interest. VaST provided guidance to CDC's COVID-19 vaccine safety monitoring efforts, provided a forum for review of data from several U.S. government vaccine safety systems, and assured that a diverse group of scientists and clinicians, external to the federal government, promptly reviewed vaccine safety data. In the event of a future pandemic or other biological public health emergency, the VaST model could be used to strengthen vaccine safety monitoring, enhance public confidence, and increase transparency through incorporation of independent, non-government safety experts into the monitoring process, and through strong collaboration among federal and other partners.
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Affiliation(s)
- Lauri E Markowitz
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA.
| | - Robert H Hopkins
- National Vaccine Advisory Committee, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karen R Broder
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Grace M Lee
- Stanford University School of Medicine, Stanford, CA, USA
| | | | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Lisa A Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Jennifer C Nelson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | | | - Robert Schechter
- Association of Immunization Managers, California Department of Public Health, Richmond, CA, USA
| | | | - Francesca Cunningham
- Department of Veterans Affairs, Veterans Affairs Center for Medication Safety - Pharmacy Benefit Management Services, Hines, IL, USA
| | - Matthew Clark
- Indian Health Service (IHS), IHS National Pharmacy & Therapeutics Committee, Anchorage, AK, USA
| | - Margaret Ryan
- Defense Health Agency, Immunization Healthcare Division, San Diego, CA, USA
| | - Karen M Farizo
- Office of Vaccines Research and Review, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Hui-Lee Wong
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Jeffery Kelman
- Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Tatiana Beresnev
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Valerie Marshall
- Office of the Assistant Secretary for Health, Department of Health and Human Services, Washington, DC, USA
| | - David K Shay
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Julianne Gee
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Jared Woo
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Michael M McNeil
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - John R Su
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Tom T Shimabukuro
- Immunization Safety Office, National Center for Emerging Zoonotic Infectious Diseases, CDC, Atlanta, GA, USA
| | - Melinda Wharton
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - H Keipp Talbot
- Vanderbilt University School of Medicine, Nashville, TN, USA
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Me HM, Budhiraja P, Nair S, Kodali L, Ryan M, Khamash H, Heilman R, Wagler J, Ruch B, Jadlowiec CC, Moss A, Reddy KS. Utilizing kidneys from a donor with bile-cast nephropathy. Am J Transplant 2024; 24:141-144. [PMID: 37633448 DOI: 10.1016/j.ajt.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
Here we discuss the successful utilization of a pair of deceased donor kidneys with bile-cast nephropathy. The donor had a kidney donor profile index of 48% and an acute kidney injury requiring continuous renal replacement therapy. Peak donor bilirubin was 40.5 mg/dL, and renal wedge biopsies showed bile-cast nephropathy. Both recipients had delayed graft function lasting up to 4 weeks. The 4-month biopsies showed mild interstitial fibrosis, tubular atrophy, and a resolution of bile casts. These kidney allografts showed the reversible course of cholemic nephropathy and the potential for increasing the utilization of previously discarded kidneys.
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Affiliation(s)
- Hay Me Me
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA.
| | | | - Sumi Nair
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Lavanya Kodali
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | - Margaret Ryan
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Arizona, USA
| | - Hasan Khamash
- Division of Nephrology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Josiah Wagler
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Brianna Ruch
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Caroline C Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Adyr Moss
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.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)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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9
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Ryan M. Training and specialisation of psychiatrists in ADHD. Australas Psychiatry 2023; 31:613-615. [PMID: 37376892 DOI: 10.1177/10398562231186140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To identify the level of training of Australian psychiatrists in Attention Deficit Hyperactivity Disorder (ADHD), and to compare the number of psychiatrists specialising in ADHD versus other psychiatric conditions on the basis of the prevalence of conditions, by interrogating the RANZCP 'Find a Psychiatrist' database. CONCLUSION Fewer psychiatrists listed in the RANZCP database specialise in ADHD than in many other psychiatric conditions. Given that 5% of the Australian population suffers from ADHD, the condition can have significant adverse outcomes and is a common comorbidity with other psychiatric conditions, the RANZCP Training Program would be improved by requiring an in-depth knowledge of ADHD. Further training in ADHD would assist many practising psychiatrists.
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10
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Noonan D, Ryan M, Whelan D, O'Neill D. Medical fitness to drive, emergency service vehicles and crash risk. Ir J Med Sci 2023; 192:2487-2493. [PMID: 36752949 PMCID: PMC10522721 DOI: 10.1007/s11845-023-03301-0] [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: 09/22/2022] [Accepted: 01/29/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Emergency service vehicle (ESV) drivers are an important part of the health, fire and police services. ESV driving is associated with increased crash risk, but little guidance exists in the literature on relevant medical conditions among drivers and their potential for adding to higher crash risks. AIMS We undertook a narrative review to examine the role of medical and other conditions in crash risk of ESV drivers. METHOD A literature search was conducted using the ScienceDirect and Transport Research International Documentation (TRID) databases. There was no time frame for the search, and results were restricted to review and research articles. RESULTS Of 570 papers identified, 13 remained after screening and full-text review. A range of factors have been shown to have an impact on increased crash risk, including the nature of the task, physical features of the equipment, training, experience, environmental conditions and secondary tasks. There was scant information on medical conditions other than alcohol use disorders. CONCLUSIONS Given issues of speed, vehicle and environment, it would seem prudent to mandate levels of medical fitness to drive similar to and sometimes exceeding (i.e. colour blindness for traffic signals and alerts, hearing impairment as first responders) those for group 2 drivers with extra stipulations relating to specific service needs such as enhanced visual (such as colour blindness and contrast sensitivity) and auditory function. Further research is needed on the prevalence and emergence of relevant medical conditions among ESV drivers, with due consideration of their application to the driving tasks in each service.
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Affiliation(s)
- Donna Noonan
- National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Margaret Ryan
- National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Declan Whelan
- National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Desmond O'Neill
- National Office for Traffic Medicine, Royal College of Physicians of Ireland, Dublin, Ireland.
- Centre for Ageing, Neuroscience and the Humanities, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland.
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11
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Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Colchester D, Hawton K, Lascelles K, de Leo D, Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Arch Suicide Res 2023; 27:1312-1338. [PMID: 36237124 DOI: 10.1080/13811118.2022.2131489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.
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12
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Punukollu R, Ryan M, Misra S, Budhiraja P, Ohara S, Kumm K, Guerra G, Reddy KS, Heilman R, Jadlowiec CC. Past, Current, and Future Perspectives on Transplanting Acute Kidney Injury Kidneys. Clin Pract 2023; 13:944-958. [PMID: 37623267 PMCID: PMC10453697 DOI: 10.3390/clinpract13040086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background: Acute kidney injury (AKI) kidneys have high non-utilization rates due to concerns regarding unfavorable outcomes. In this paper, we aimed to review the past, present, and future opinions on AKI kidneys. (2) Methods: A PubMed search was conducted for topics relevant to AKI kidney transplantation. (3) Results: Current short- and long-term data on AKI kidneys have demonstrated good outcomes including favorable graft function and survival. The role of procurement biopsies is controversial, but they have been shown to be beneficial in AKI kidneys by allowing clinicians to differentiate between reversible tubular injury and irreversible cortical necrosis. Machine perfusion has also been applied to AKI kidneys and has been shown to reduce delayed graft function (DGF). The incidence of DGF increases with AKI severity and its management can be challenging. Strategies employed to counteract this have included early initiation of dialysis after kidney transplantation, early targeting of adequate immunosuppression levels to minimize rejection risk, and establishment of outpatient dialysis. (4) Conclusions: Despite good outcomes, there continue to be barriers that impact AKI kidney utilization. Successful strategies have included use of procurement biopsies or machine perfusion and expectant management of DGF. With increasing experience, better use of AKI kidneys can result in additional opportunities to expand the donor pool.
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Affiliation(s)
- Rachana Punukollu
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Margaret Ryan
- Division of Anatomic Pathology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Suman Misra
- Division of Nephrology, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Stephanie Ohara
- Division of Surgery, Valleywise Health Medical Center, Creighton University, Phoenix, AZ 85008, USA
| | - Kayla Kumm
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Giselle Guerra
- Division of Nephrology, Miami Transplant Institute, Miami, FL 33136, USA
| | - Kunam S. Reddy
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
| | | | - Caroline C. Jadlowiec
- Division of Transplant Surgery, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, USA
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13
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Ankeny RA, Whittaker AL, Ryan M, Boer J, Plebanski M, Tuke J, Spencer SJ. The power of effective study design in animal Experimentation: Exploring the statistical and ethical implications of asking multiple questions of a data set. Brain Behav Immun 2023:S0889-1591(23)00156-3. [PMID: 37315700 DOI: 10.1016/j.bbi.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/16/2023] Open
Abstract
One of the chief advantages of using highly standardised biological models including model organisms is that multiple variables can be precisely controlled so that the variable of interest is more easily studied. However, such an approach often obscures effects in sub-populations resulting from natural population heterogeneity. Efforts to expand our fundamental understanding of multiple sub-populations are in progress. However, such stratified or personalised approaches require fundamental modifications of our usual study designs that should be implemented in Brain, Behavior and Immunity (BBI) research going forward. Here we explore the statistical feasibility of asking multiple questions (including incorporating sex) within the same experimental cohort using statistical simulations of real data. We illustrate and discuss the large explosion in sample numbers necessary to detect effects with appropriate power for every additional question posed using the same data set. This exploration highlights the strong likelihood of type II errors (false negatives) for standard data and type I errors when dealing with complex genomic data, where studies are too under-powered to appropriately test these interactions. We show this power may differ for males and females in high throughput data sets such as RNA sequencing. We offer a rationale for the use of alternative experimental and statistical strategies based on interdisciplinary insights and discuss the real-world implications of increasing the complexities of our experimental designs, and the implications of not attempting to alter our experimental designs going forward.
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Affiliation(s)
- R A Ankeny
- School of Humanities, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - A L Whittaker
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - M Ryan
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Boer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - J Tuke
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - S J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia.
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14
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Harmer V, Harbeck N, Boyle F, Werutsky G, Ammendolea C, El Mouzain D, Marshall D, Thomas C, Heidenreich S, Lu H, Dionne PA, Gao M, Aubel D, Pathak P, Ryan M. P263 Patients’ perspectives on treatments for HR+/HER2– early breast cancer: developing a quantitative patient preference survey. Breast 2023. [DOI: 10.1016/s0960-9776(23)00381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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15
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Ryan M, Tuke J, Hutchinson MR, Spencer SJ. Gender-specific effects of COVID-19 lockdowns on scientific publishing productivity: Impact and resilience. Soc Sci Med 2023; 320:115761. [PMID: 36780736 PMCID: PMC9896855 DOI: 10.1016/j.socscimed.2023.115761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
RATIONALE The SARS-CoV2 pandemic led to drastic social restrictions globally. Early data suggest that women in science have been more adversely affected by these lockdowns than men, with relatively fewer scientific articles authored by women. However, these observations test broad populations with many potential causes of disparity. Australia presents a natural experimental condition where several states of similar demographics and disease impact had differing approaches in their social isolation strategies. The state of Victoria experienced 280 days of lockdowns from 2020 to 2021, whereas the comparable state of New South Wales experienced 107 days, most of these in 2021, and other states even fewer restrictions. OBJECTIVE AND METHODS To assess how the gender balance changed in Australian biomedical publishing with the lockdowns, we created a custom workflow to analyse PubMed data from more than 120,000 published articles submitted in 2019-2021 from Australian authors. RESULTS Broadly, Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men, including from Victoria. On the other hand, articles specifically addressing COVID-19 were significantly less likely to be authored by women than those on other topics, a finding not likely due to particular gender imbalance in virology or viral epidemiology, since publications on HIV followed similar patterns to previous years. By 2021, this imbalance had reversed, with more COVID-19-related papers authored by women than men. CONCLUSIONS These data suggest women from Victoria were less able to rapidly transition to new research early in the pandemic but had accommodated to the new conditions by 2021. This work indicates we need strategies to support women in science as the pandemic continues and to continue to monitor the situation for its impact on vulnerable groups.
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Affiliation(s)
- M Ryan
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - M R Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; Davies Livestock Research Centre, University of Adelaide, South Australia, 5005, Australia; Institute for Photonics & Advanced Sensing, University of Adelaide, South Australia, 5005, Australia; Robinson Research Institute, University of Adelaide, South Australia, 5005, Australia
| | - S J Spencer
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic, 3083, Australia.
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16
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Masukume G, Ryan M, Masukume R, Zammit D, Grech V, Mapanga W, Inoue Y. COVID-19 induced birth sex ratio changes in England and Wales. PeerJ 2023; 11:e14618. [PMID: 36814957 PMCID: PMC9940645 DOI: 10.7717/peerj.14618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/01/2022] [Indexed: 02/19/2023] Open
Abstract
Background The sex ratio at birth (male live births divided by total live births) may be a sentinel health indicator. Stressful events reduce this ratio 3-5 months later by increasing male fetal loss. This ratio can also change 9 months after major population events that are linked to an increase or decrease in the frequency of sexual intercourse at the population level, with the ratio either rising or falling respectively after the event. We postulated that the COVID-19 pandemic may have affected the ratio in England and Wales. Methods Publicly available, monthly live birth data for England and Wales was obtained from the Office for National Statistics up to December 2020. Using time series analysis, the sex ratio at birth for 2020 (global COVID-19 onset) was predicted using data from 2012-2019. Observed and predicted values were compared. Results From 2012-2020 there were 3,133,915 male and 2,974,115 female live births (ratio 0.5131). Three months after COVID-19 was declared pandemic (March 2020), there was a significant fall in the sex ratio at birth to 0.5100 in June 2020 which was below the 95% prediction interval of 0.5102-0.5179. Nine months after the pandemic declaration, (December 2020), there was a significant rise to 0.5171 (95% prediction interval 0.5085-0.5162). However, December 2020 had the lowest number of live births of any month from 2012-2020. Conclusions Given that June 2020 falls within the crucial window when population stressors are known to affect the sex ratio at birth, these findings imply that the start of the COVID-19 pandemic caused population stress with notable effects on those who were already pregnant by causing a disproportionate loss of male fetuses. The finding of a higher sex ratio at birth in December 2020, i.e., 9 months after COVID-19 was declared a pandemic, could have resulted from the lockdown restrictions that initially spurred more sexual activity in a subset of the population in March 2020.
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Affiliation(s)
| | | | - Rumbidzai Masukume
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Victor Grech
- Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Msida, Malta
| | - Witness Mapanga
- Division of Medical Oncology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Johannesburg, South Africa
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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17
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Ryan M, Morella K, Boan A, Key J, Head K. Evaluating equity in participation within a comprehensive school based wellness initiative amongst schools from different resource settings. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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18
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Ryan M, Boan A, Morella K, Key J, Head K. The impact of the COVID-19 pandemic on implementation and maintenance of an evidence-$$$based school wellness initiative. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00738-3] [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: 01/28/2023]
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19
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Nair S, Budhiraja P, Smith M, Ryan M, Heilman R, Reddy K. Recipient outcomes of donor-derived glomerular fibrin thrombi in deceased donor kidney transplants. Korean Journal of Transplantation 2022. [DOI: 10.4285/atw2022.f-4980] [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: 11/16/2022] Open
Affiliation(s)
- Sumi Nair
- Department of Nephrology, Mayo Clinic, Rochester, MN, USA
| | | | - Maxwell Smith
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Margaret Ryan
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Kunnam Reddy
- Department of Hepatobiliary and Pancreatic Surgery, Mayo Clinic, Rochester, MN, USA
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20
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Ryan M, Hoffmann T, Hofmann R, van Sluijs E. Incomplete reporting of activity behaviour interventions in school-based research: a systematic review of randomised controlled trials published 2015-2020. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Boyle O, Kelly L, Whelan C, Murtagh E, O'Dwyer A, Ryan M, Hill F, McCabe A, Hayden D. 251 PREVALENCE AND CHARACTERISTICS OF SWALLOWING/COMMUNICATION IMPAIRMENTS IN FRAIL OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.220] [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: 11/15/2022] Open
Abstract
Abstract
Background
The presentation of frail older adults to the Emergency Department (ED) may be complicated by swallowing and/or communication impairment. Adults with communication impairment may experience difficulty accessing healthcare. Dysphagia is associated with frailty irrespective of age and/or number of chronic diseases [1]. This study aims to determine the prevalence and characteristics of swallowing and/or communication impairments among frail older adults attending the ED.
Methods
A retrospective cohort study of consecutive ED attendees aged ≥ 75 years assessed by an interdisciplinary Gerontological ED team between October 2021 – February 2022 was conducted. A swallow/communication screening tool determined requirement for Speech and Language Therapy (SLT) referral. Data related to demographics and SLT interventions was extracted. Data analysis was completed using STATA Version 12. Ethical approval was obtained.
Results
Among 518 patients, 118 (23%) (mean age 82.4 (+/-6.4) years, 54% male) required SLT assessment. These patients had high rates of frailty (Median CFS= 6 (IQR 5-7), suspected delirium (4AT ≥ 4 in 45%), suspected malnutrition (MNA score 0-11 in 75%), and probable sarcopenia (SARC-F= ≥ 4 in 75%). Therapy Outcome Measurement Scales and the Functional Oral Intake Scale were used in this first episode of SLT care. Oropharyngeal dysphagia was identified for 43% (27% mild, 10% moderate, 3% moderate-severe, 3% severe), with 6% presenting with signs/symptoms of oesophageal dysphagia. Changes in baseline communication was identified for 57%; cognitive communication difficulties (38%), dysarthria (11%), dysphonia (8%). SLT intervention and management approaches were initiated in the ED.
Conclusion
Findings indicate a high prevalence of swallowing/communication impairment in frail older adults attending the ED. Future research should explore SLT outcomes at point of discharge to refine these swallowing/communication presentations.
Reference
1. Bahat G et al. Association between dysphagia and frailty in community-dwelling older adults. The Journal of Nutrition, Health & Ageing. 2019:23, 571–577.
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Affiliation(s)
- O Boyle
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - L Kelly
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - C Whelan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - E Murtagh
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - A O'Dwyer
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - M Ryan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - F Hill
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
| | - A McCabe
- Tallaght University Hospital Department of Emergency Medicine, , Tallaght, Dublin 24, Ireland
| | - D Hayden
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
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22
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Mahon CM, Ryan M, Kennelly SM, Martin R. 204 DEDICATED NURSING HOME SERVICE IN A TERTIARY HOSPITAL: EFFECT ON ADMISSION NUMBERS AND LENGTH OF STAY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.176] [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: 11/14/2022] Open
Abstract
Abstract
Background
In 2019 a dedicated Nursing Home (NH) in-patient service was established in a tertiary hospital, comprising a Consultant Geriatrician, clinical nurse specialist, NCHD and administrative support. All NH residents over 65 with medical diagnoses were admitted by the NH team who also provide a consult service for NH residents under other specialties.
Methods
Data were sourced from the Hospital Inpatient Enquiry system on length of stay of patients identified as admitted from a nursing home compared to those admitted under the NH team and their average lengths of stay over 2019-2021.
Results
In 2019, 749 NH residents were admitted to hospital with an average length of stay (ALOS) of 7.93 days, the NH inpatient service was established in July 2019 and showed a reduction of ALOS from 9.25 to 6.6 days in the 6 months following its establishment (29% difference.) In 2020, 707 NH residents were admitted with 352 admitted under the NH team. The ALOS of NH residents admitted under the NH team was 5.66 days in 2020 compared to 8.65 overall (35% difference.) In 2021, 765 NH residents were admitted with 402 under the NH team. ALOS of NH residents admitted under the NH team was 5.33 days in 2021 compared to 8.28 overall (36% difference.)
Conclusion
Within six months of its commencement the dedicated NH service had decreased length of stay by 29%. The average length of stay across all services has decreased year on year from 6.6 to 5.3 days from 2019 to 2021. The ALOS in the total cohort (including residents admitted surgically and those under 65) was 29-36% higher. Though difficult to accurately compare these cohorts due to different presenting diagnoses and medical backgrounds in those admitted surgically or those under 65, the overall reduction in length of stay over the three years does highlight the benefit from this dedicated service.
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Affiliation(s)
- CM Mahon
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - M Ryan
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - SM Kennelly
- Royal College of Surgeons Ireland , Dublin, Ireland
| | - R Martin
- Connolly Hospital, Blanchardstown , Dublin, Ireland
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23
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Cardwell K, Broderick N, Tyner B, Masukume G, Harrington P, Connolly M, Larkin L, Clyne B, Ryan M, O'Neill M. High level review of configuration and reform of Public Health systems in selected countries. Eur J Public Health 2022. [PMCID: PMC9594392 DOI: 10.1093/eurpub/ckac129.206] [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] [Indexed: 11/19/2022] Open
Abstract
Background The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2). Methods Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and. Results Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience. Conclusions When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - N Broderick
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Tyner
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - G Masukume
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Connolly
- School of Medicine, National University of Ireland Galway , Galway, Ireland
| | - L Larkin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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24
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Norris M, Carty P, McDowell C, O’Loughlin M, Comaskey F, Jingjing J, Harrington P, Ryan M, O'Neill M. Organisational perspectives on Public Health delivery in Ireland: Lessons learned from COVID-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.208] [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] Open
Abstract
Abstract
Background
The COVID-19 pandemic has placed healthcare systems worldwide under unprecedented pressure, with the Irish Public Health system no different. To strengthen delivery of Essential Public Health Functions (EPHFs) and increase future pandemic preparedness, Public Health leaders are now focused on identifying learnings from the pandemic. Within Ireland, given their experience, organisations situated within the Public Health system may be in a unique position to provide valuable information around the delivery of EPHFs, both prior to and in light of the COVID-19 pandemic, and how this can be improved in the future.
Methods
An online survey was distributed by the Department of Health, from 2 March 2022 to 25 March 2022, amongst organisations situated within the Public Health domain in Ireland. The survey consisted of six open-ended questions around the delivery of EPHFs prior to and in light of the pandemic, success stories that could provide scalable solutions to EPHF delivery and current health system barriers, key areas in the public health system that require strengthening, and barriers to achieving these actions. Thematic analysis to identify key themes was conducted on survey responses.
Results
Twenty-eight organisational responses were received. Themes around the workforce were apparent throughout, with staff training, staff diversity and staff morale, identified as areas for strengthening EPHF delivery. Themes around ICT, data collection and research were frequently identified with a lack of adequate ICT identified as a key lesson from the pandemic, while the Public Health ICT strategy was identified as key to strengthening future EPHF delivery.
Conclusions
In general, themes around the workforce; leadership, management and governance and ICT, data collection and research were reoccurring across organisational responses and therefore may be key areas for consideration when strengthening delivery of the EPHFs in Ireland.
Speakers/Panelist
Louise Hendricks
Department of Health, Ireland
Sohel Saikat
WHO, Geneva, Switzerland
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Affiliation(s)
- M Norris
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Carty
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - C McDowell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M O’Loughlin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Public Health, Health Service Executive Midwest , Limerick, Ireland
| | - F Comaskey
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - J Jingjing
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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Kirschner J, Crawford T, Ryan M, Finkel R, Swoboda K, De Vivo D, Bertini E, Hwu H, Sansone V, Pechmann A, Montes J, Krasinski D, Chin R, Berger Z, Zhu C, Raynaud S, Paradis A, Johnson N. VP.51 Impact of nusinersen on caregiver experience and health-related quality of life (HRQoL) when initiated in the presymptomatic stage of SMA in NURTURE. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Day J, Finkel R, Pascual S, Ryan M, Mercuri E, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Makepeace C, Foster R, Irzhevsky V, Berger Z. FP.22 Results from the end of Part A of the ongoing 3-part DEVOTE study to explore higher doses of nusinersen in SMA. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.181] [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: 11/05/2022]
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Masukume G, Ryan M, Masukume R, Zammit D, Grech V, Mapanga W. COVID-19 onset reduced the sex ratio at birth in South Africa. PeerJ 2022; 10:e13985. [PMID: 36061753 PMCID: PMC9435519 DOI: 10.7717/peerj.13985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/10/2022] [Indexed: 01/19/2023] Open
Abstract
Background The sex ratio at birth (defined as male/(male+female) live births) is anticipated to approximate 0.510 with a slight male excess. This ratio has been observed to decrease transiently around 3-5 months following sudden unexpected stressful events. We hypothesised that stress engendered by the onset of the COVID-19 pandemic may have caused such a decrease in South Africa 3-5 months after March 2020 since in this month, South Africa reported its first COVID-19 case, death and nationwide lockdown restrictions were instituted. Methods We used publicly available, recorded monthly live birth data from Statistics South Africa. The most recent month for which data was available publicly was December 2020. We analysed live births for a 100-month period from September 2012 to December 2020, taking seasonality into account. Chi-squared tests were applied. Results Over this 100-month period, there were 8,151,364 live births. The lowest recorded monthly sex ratio at birth of 0.499 was in June 2020, 3 months after March 2020. This June was the only month during this period where the sex ratio inverted i.e., fewer male live births occurred. The predicted June 2020 ratio was 0.504. The observed June 2020 decrease was statistically significant p = 0.045. Conclusions The sex ratio at birth decreased and inverted in South Africa in June 2020, for the first time, during the most recent 100-month period. This decline occurred 3 months after the March 2020 onset of COVID-19 in South Africa. As June 2020 is within the critical window when population stressors are known to impact the sex ratio at birth, these findings suggest that the onset of the COVID-19 pandemic engendered population stress with notable effects on pregnancy and public health in South Africa. These findings have implications for future pandemic preparedness and social policy.
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Affiliation(s)
| | - Margaret Ryan
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Rumbidzai Masukume
- Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Victor Grech
- Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Msida, Malta
| | - Witness Mapanga
- Division of Medical Oncology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,Noncommunicable Diseases Research Division, Wits Health Consortium (PTY) Ltd., Johannesburg, South Africa
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Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E. The development and validation of a dashboard prototype for real-time suicide mortality data. Front Digit Health 2022; 4:909294. [PMID: 36065333 PMCID: PMC9440192 DOI: 10.3389/fdgth.2022.909294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction/Aim Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface. Materials and Methods Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface. Results Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence. Discussion The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making. Conclusions The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.
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Affiliation(s)
- R. Benson
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
- Correspondence: Ruth Benson
| | - C. Brunsdon
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - J. Rigby
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - P. Corcoran
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
| | - M. Ryan
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - P. Dodd
- National Office for Suicide Prevention, Health Service Executive, Dublin, Ireland
| | - D. Hennebry
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
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Ryan M, Montgomery J. Myopericarditis after COVID-19 vaccination: unexpected but not unprecedented. The Lancet Respiratory Medicine 2022; 10:624-625. [PMID: 35421377 PMCID: PMC9000911 DOI: 10.1016/s2213-2600(22)00091-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
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O'Donovan T, McNulty J, Ryan M. PO-1856 Artificial intelligence: the opinions of radiation therapists in Ireland. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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MacBride-Stewart S, Marwick C, Ryan M, Guthrie B. Feedback of actionable individual patient prescription data to improve asthma prescribing: pragmatic cluster randomised trial in 233 UK general practices. Br J Gen Pract 2022; 72:BJGP.2021.0695. [PMID: 35817581 PMCID: PMC9282800 DOI: 10.3399/bjgp.2021.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Potentially inappropriate prescribing (PIP) of asthma bronchodilator inhalers is associated with increased morbidity and mortality. AIM To evaluate the effectiveness of feedback on the PIP of bronchodilator inhalers. DESIGN AND SETTING Pragmatic cluster randomised trial involving 235 of 244 (96.3%) GP practices in one Scottish health board. METHOD Practices were randomly allocated (1:1 ratio) to individualised feedback (including visualised medication histories for each patient and action-oriented messages) on PIP of bronchodilator inhalers from prescription data; feedback reports were sent in July 2015, February 2016, and August 2016. Controls were sent feedback on an unrelated subject. The primary outcome was the change in the mean number of patients per practice with PIP of bronchodilator inhalers from the baseline period (August 2014-July 2015) until the post-feedback period (February 2016-January 2017), identified through a composite of five individual measures using prescription data. RESULTS In the analysis of the primary outcome, the mean number of patients with PIP of bronchodilator inhalers fell in the 118 practices that were sent feedback from 21.8 per practice to 17.7 per practice. Numbers fell marginally in the 115 control practices, from 20.5 per practice to 20.2 per practice, with a statistically significant difference between the two groups. There were 3.7 fewer patients per practice with PIP of bronchodilator inhalers in the intervention practices versus the control practices (95% confidence interval = -5.3 to -2.0). CONCLUSION Individualised feedback of PIP of asthma bronchodilators that included background information, visualised medication histories for each patient, and action-oriented messages was effective at reducing the number of patients exposed to excess or unsafe prescribing of bronchodilator inhalers.
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Affiliation(s)
| | - Charis Marwick
- Department of Population Health and Genomics, University of Dundee, Dundee
| | - Margaret Ryan
- Glasgow School of Business and Society, Glasgow Caledonian University, Glasgow
| | - Bruce Guthrie
- Advanced Care Research Centre, University of Edinburgh, Edinburgh
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Moser F, Todoran T, Ryan M, Baker E, Gunnarsson C, Kellum J. Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke. AJNR Am J Neuroradiol 2022; 43:381-387. [PMID: 35144934 PMCID: PMC8910803 DOI: 10.3174/ajnr.a7412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation is a critical complication associated with ischemic stroke and has been associated with contrast media administration. The objective of our study was to use real-world in-hospital data to evaluate the correlation between contrast media type and transformation from ischemic to hemorrhagic stroke. MATERIALS AND METHODS We obtained data on inpatient admissions with a diagnosis of ischemic stroke and a record of either iso-osmolar or low-osmolar iodinated contrast media for a stroke-related diagnostic test and a treatment procedure (thrombectomy, thrombolysis, or angioplasty). We performed multivariable regression analysis to assess the relationship between contrast media type and the development of hemorrhagic transformation during hospitalization, adjusting for patient characteristics, comorbid conditions, procedure type, a threshold for contrast media volume, and differences across hospitals. RESULTS Inpatient visits with exclusive use of either low-osmolar (n = 38,130) or iso-osmolar contrast media (n = 4042) were included. We observed an overall risk reduction in hemorrhagic transformation among patients who received iso-osmolar compared with low-osmolar contrast media, with an absolute risk reduction of 1.4% (P = .032), relative risk reduction of 12.5%, and number needed to prevent harm of 70. This outcome was driven primarily by patients undergoing endovascular thrombectomy (n = 9211), in which iso-osmolar contrast media was associated with an absolute risk reduction of 4.6% (P = .028), a relative risk reduction of 20.8%, and number needed to prevent harm of 22, compared with low-osmolar contrast media. CONCLUSIONS Iso-osmolar contrast media was associated with a lower rate of hemorrhagic transformation compared with low-osmolar contrast media in patients with ischemic stroke.
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Affiliation(s)
- F.G. Moser
- From the Department of Imaging (F.G.M.), Cedars-Sinai Medical Center, Los Angeles, California
| | - T.M. Todoran
- Divisions of Cardiology and Vascular Surgery, Medical University of South Carolina (T.M.T.), Charleston, South Carolina
| | - M. Ryan
- MPR Consulting (M.R.), Cincinnati, Ohio
| | - E. Baker
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - C. Gunnarsson
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - J.A. Kellum
- Center for Critical Care Nephrology (J.A.K.), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Ikpeme M, Omotoyinbo F, Toluwade T, Ryan M. Work-Life Balance Inequalities among Veterinary and Allied Professionals: A Qualitative Review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.328] [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: 11/14/2022] Open
Abstract
Abstract
Background
This study aimed to review qualitative psychological and non-psychologically based literature for work-life balance (WLB) inequalities within the veterinary and other allied professions.
Methods
The PECO framework includes qualitative studies published in any language but with an English translation involving adult workers in the veterinary or allied profession and outcomes around work-life balance. Seven relevant electronic databases EMBASE, PsycARTICLES, PsycINFO, MEDLINE, Social Policy and Practice, HMIC Health Management Information Consortium, and Global Health, were used. The retrieved hits were exported to Endnote Desktop (Version 7.7.1) for sorting and management.
Results
Of the 3610 hits, 31 studies were eligible for narrative synthesis. The studies were published from 1980-2017 and came from 15 countries. 9(29%) of the 31 studies were from the USA. 22 of the 31 studies (71%) focused on a mix of professions. Data were collected in six different ways, with the most common being interviews (17 (54.8%) of 31 studies). Twenty-three questions were used to assess WLB. The most common ones focused on women becoming mothers, maternity leave, and return to work (five (16.1%) of 31 articles). Secondly were attitudes of ethnic minorities concerning education, employment, role-family conflict, etc., and family commitments (three (9.7%) of the 31 papers). Findings came under 74 different topics. Nineteen (25.7%) of the 74 topics occurred more than four times and were allocated under the appropriate sub-theme. The nine sub-themes include pregnancy, breastfeeding, motherhood, job/life satisfaction, age/gender/ethnic inequalities, return to work (RTW), health and lifestyle, dual-earning couples/family, workplace support, and work-family/family-work conflicts.
Conclusions
The review suggests that women, ethnic minorities, older staff, and those with health concerns are negatively impacted by inequalities around WLB in veterinary and allied professions.
Key messages
The findings from the review were used to support the development of psychological measures of work-life balance and gender differences. The results were used in online questionnaires/surveys for future participants within the veterinary profession in addressing inequalities.
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Affiliation(s)
- M Ikpeme
- Faculty of Medicine, Imperial College, London, UK
- FACE, University of Hull, Hull, UK
| | | | - T Toluwade
- SES, Ogun State Institute of Technology, Igbesa, Nigeria
| | - M Ryan
- CLES, University of Exeter, Exeter, UK
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37
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Sharp M, Forde Z, McGeown C, O'Murchu E, Smith SM, O'Neill M, Ryan M, Clyne B. Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency. Eur J Public Health 2021. [PMCID: PMC8574242 DOI: 10.1093/eurpub/ckab164.740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.
Methods
We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.
Results
Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.
Conclusions
Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.
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Affiliation(s)
- M Sharp
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z Forde
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - C McGeown
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Clyne B, Byrne P, Smith SM, O'Neill M, Ryan M. Evaluating rapid review provision to inform policy during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574241 DOI: 10.1093/eurpub/ckab164.741] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence based decision making is central to population health, particularly during a pandemic. Few studies examine the production and use of evidence in decision-making during crisis management. This study describes and evaluates the provision of rapid evidence products by a single agency to support national decision making.
Methods
Semi-structured interviews were conducted with a convenience sample of evidence providers (who gathered and disseminated the required evidence) and service users (policy makers). Interviews were transcribed verbatim and analysed using thematic analysis. Quantitative data of work activity were summarised descriptively.
Results
Three themes were generated from the data: the work, the use and the future, with a fourth theme cross-cutting across these: the team. The work followed clear protocols and was centrally managed. The scope and changing nature of the evidence were highlighted as issues. The service providers reported a strong sense of team work and ‘being in this together', however, the majority of the participants felt that the workload was huge and exhausting and not sustainable long-term. Overall the service users thought the rapid evidence synthesis was indispensable to the decision-making process and had trust and confidence in the work, largely based on existing working relationships with the team. While they recognised that the evidence synthesis support would be an essential component of the continued pandemic response, they did query the sustainability of the process and reflected on the amount of work the team performed.
Conclusions
This evaluation, drawing on qualitative data, has highlighted that, across the services users and evidence providers, the support provided by HIQA was generally perceived as positive. From the service users' perspective, having access to the team was indispensable to the decision making process. However, the sustainability of the work load was identified as a major challenge.
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Affiliation(s)
- B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Ryan M. Evidence Synthesis to support the public health response during the COVID-19 pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.737] [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: 11/13/2022] Open
Abstract
Abstract
Background
In January 2020, the Irish National Public Health Emergency Team (NPHET) for COVID-19 was established. NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of strategies to contain COVID-19 in Ireland. Since March 2020, HIQA's COVID-19 Evidence Synthesis Team has provided research evidence to support the work of NPHET and associated groups and inform the development of national public health guidance. From September 2020, as part of the move towards a sustainable response to the public health emergency, HIQA also provides evidence based advice in response to requests from NPHET. The advice provided to NPHET is informed by research evidence developed by HIQA's COVID-19 Evidence Synthesis Team and with expert input from HIQA's COVID-19 Expert Advisory Group.
Methods
This presentation describes the establishment and organisation of the COVID-19 Evidence Synthesis Team, with an overview of the processes and methodological approaches involved. The role of HIQA's COVID-19 Evidence Synthesis Team in informing the public health response during the COVID-19 pandemic is discussed, along with the challenges and opportunities this presents. The relevance now and for future pandemic preparedness is outlined.
Results
As of 19 April 2021, HIQA has produced, and in some instances has regularly updated, 25 evidence summaries, 11 advice documents, 9 reviews of international guidance, 3 scoping reports, 5 reviews of care pathways, 2 analyses/models and 2 databases.
Conclusions
In the context of the COVID-19 pandemic, HIQA has developed and implemented a process to ensure rapid access to the best available evidence relevant to the COVID-19 outbreak to inform decision-making at each stage of the pandemic.
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Affiliation(s)
- M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Broderick N, Fawsitt CG, Tyner B, Larkin J, McCarthy M, Walsh KA, O'Neill M, Ryan M. COVID-19 Public Health Guidance Database. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.738] [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: 11/14/2022] Open
Abstract
Abstract
Background
Since March 2020, members of the Health Technology Assessment (HTA) team in HIQA have been identifying, reviewing and presenting COVID-19 public health guidance produced by international organisations. The aim of this work has been to inform the development of public health guidance and policy by the Health Protection Surveillance Centre (HPSC), Department of Health and Health Service Executive (HSE), using international evidence and best practice.
Methods
International resources are searched on a weekly basis to identify new or updated public health guidance on COVID-19. The three distinct steps in the process include, searching relevant international resources, reviewing identified relevant public health guidance for COVID-19, and presenting new or updated guidance in a COVID-19 Public Health Guidance Database, which was created by the team using Microsoft Excel. The international organisations reviewed include the World Health Organisation, European Centre for Disease Prevention and Control and Centers for Disease Control and Prevention, as well as a range of ministries of health and public health agencies from 10 countries. These were chosen, based on guidance being available in English, widespread use of the organisation's advice, and/or the working constraints of the HTA team.
Results
The COVID-19 Public Health Guidance Database is updated weekly and provided to the relevant individuals within HPSC, Department of Health, and HSE, who are responsible for developing public health and infection, prevention and control guidance related to COVID-19 in Ireland. Following this the database is published online and may be utilised by the public or other international organisations.
Conclusions
The COVID-19 Public Health Guidance Database is used to inform the ongoing response to the COVID-19 pandemic, specifically, to inform the development of public health and infection, prevention and control guidance to prevent the spread of COVID-19.
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Affiliation(s)
- N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - CG Fawsitt
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - J Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M McCarthy
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - KA Walsh
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Cardwell K, O'Murchu E, Byrne P, Broderick N, O'Neill S, Smith SM, Harrington P, O'Neill M, Ryan M. COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease. Eur J Public Health 2021. [PMCID: PMC8574924 DOI: 10.1093/eurpub/ckab164.739] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.
Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.
Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.
Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - S O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Bruen R, Stirling A, Ryan M, Sheehan M, MacMahon P. Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emerg Radiol 2021; 29:67-73. [PMID: 34609674 DOI: 10.1007/s10140-021-01989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In excess of 100 million procedures using iodinated radio-contrast media are conducted each year. There is a common misunderstanding regarding the links between allergy to iodinated substances and the risk of allergic reaction to intravenous iodinated contrast agents. These perceived risks are managed via administration of corticosteroids or avoidance of iodinated contrast altogether. METHODS An extensive review of published literature on scientific databases and international guidelines was conducted in order to inform the research question. A questionnaire was formulated and distributed to hospital doctors in four tertiary centres. Within this questionnaire, hospital doctors were presented with six different scenarios of bona fide allergy to iodinated substances (e.g. shellfish) and asked to select the treatment response option which they deemed to be the most suitable from a choice of three (standard contrast scan/delay scan with pre-medication/change to non-contrast scan). RESULTS Eighty-seven questionnaire responses were received. Contrast (standard protocol) was the most appropriate regimen in the setting of all the listed allergies. This was identified correctly by 76%, 69%, 44%, 32%, 18% and 14% for kiwi, fish, poly-food, shellfish, betadine and tincture of iodine allergies, respectively. CONCLUSIONS There is a lack of understanding amongst local junior medical staff regarding administration of iodinated contrast media to patients with a history of allergy to iodinated substances. These misconceptions may potentiate the unnecessary usage of pre-medication and ordering of non-contrast scans in the setting of a gold-standard enhanced scan. Findings from this study suggest that there is a need for future education efforts targeted during the basic specialty training stage.
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Affiliation(s)
| | - Aaron Stirling
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - M Ryan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - M Sheehan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Peter MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Mercuri E, Finkel R, Day J, Pascual SP, Ryan M, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Nuzzo R, Makepeace C, Garafalo S, Berger Z. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hoffman E, Dang U, Clemens P, Gordish-Dressman H, Schwartz B, Mengle-Gaw L, Leinonen M, Smith E, Castro D, Kuntz N, Finkel R, Tulinius M, Nevo Y, Ryan M, Webster R, van den Anker J, Ward L, Damsker J, McDonald C, Guglieri M, Mah J. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.020] [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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McMichael AJ, Zafeiridi E, Ryan M, Cunningham EL, Passmore AP, McGuinness B. Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland. Aging Ment Health 2021; 25:1475-1482. [PMID: 33073601 DOI: 10.1080/13607863.2020.1830028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Anticholinergic burden refers to the cumulative effect of medications which contain anticholinergic properties. We assessed how anticholinergic burden and different types of anticholinergic medications influence mortality rates among people with dementia in Northern Ireland. Our secondary aim was to determine what demographic characteristics predict the anticholinergic burden of people with dementia. METHODS Data were extracted from the Enhanced Prescribing database for 25,418 people who were prescribed at least one dementia management medication between 2010 and 2016. Information was also extracted on the number of times each available anticholinergic drug was prescribed between 2010 and 2016, allowing the calculation of an overall anticholinergic burden. Cox proportional hazard models were used to determine how anticholinergic burden influenced mortality whilst multilevel model regression determined what demographic characteristics influence overall anticholinergic burden. RESULTS Of the 25,418 people with dementia, only 15% (n = 3880) had no anticholinergic burden. Diazepam (42%) and risperidone (18%) were the two most commonly prescribed drugs. Unadjusted Cox proportional hazard models indicated that higher anticholinergic burden was associated with significantly higher mortality rates in comparison to people with dementia who had no anticholinergic burden (HR = 1.59: 95% CI = 1.07-2.36). In particular, urological (HR = 1.20: 95% CI = 1.05-1.38) and respiratory (HR = 1.17: 95% CI = 1.08-1.27) drugs significantly increased mortality rates. People with dementia living in areas with low levels of deprivation had significantly lower anticholinergic burden (HR=-.39: 95% CI=-.47:-30). CONCLUSIONS Reducing anticholinergic burden is essential for people with dementia. Further research should address the unfavourable prognosis of people living with dementia in highly deprived areas.
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Affiliation(s)
- A J McMichael
- Centre for Public Health, Institute for Clinical Sciences Block B, Queens University Belfast, Belfast, Northern Ireland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez‐Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 PMCID: PMC8359367 DOI: 10.1111/cobi.13671] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 06/11/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C. Wyborn
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
- Institute for Water Futures, Fenner School of Environment and SocietyAustralian National UniversityCanberraACT0200Australia
| | - J. Montana
- School of Geography and the EnvironmentUniversity of OxfordSouth Parks RoadOxfordOX1 3QYU.K.
| | - N. Kalas
- Department of Environmental Systems ScienceETH ZürichUniversitätstrasse 8‐22Zürich8092Switzerland
| | - S. Clement
- Geography and PlanningUniversity of LiverpoolLiverpoolL69 3BXU.K.
| | - F. Davila
- Institute for Sustainable FuturesUniversity of Technology Sydney253 Jones StreetUltimoNSW2007Australia
| | - N. Knowles
- Department of Geography and Environmental ManagementUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - E. Louder
- School of Geography and DevelopmentUniversity of ArizonaENR2 Building, South 4th floor 1064 E. Lowell StreetTucsonAZ85721U.S.A.
| | - M. Balan
- The Forest WayNo 8, 2nd St, D P Nagar, KotturpuramChennaiTamil Nadu600085India
| | - J. Chambers
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - L. Christel
- School of Politics and Government (EPyG)National University of San MartinAvenida 25 de Mayo 1021San MartínProvincia de Buenos Aires1650Argentina
| | - T. Forsyth
- Department of International DevelopmentLondon School of Economics and Political ScienceHoughton StreetLondonWC2A 2AEU.K
| | - G. Henderson
- Harry Ransom CenterThe University of Texas at AustinP.O. Drawer 7219, 300 W 21st StreetAustinTX78712U.S.A.
| | - S. Izquierdo Tort
- Institut des Sciences de la Forêt TempéréeUniversité du Québec en Outaouais58 rue PrincipaleRiponQCJ0V 1V0Canada
- Natura y Ecosistemas Mexicanos A.C.Plaza San Jacinto 23D, San Ángel, Álvaro ObregónMexico City01000Mexico
| | - M. Lim
- Centre for Environmental Law, Macquarie Law SchoolMacquarie University6 First WalkSydneyNSW2109Australia
| | - M. J. Martinez‐Harms
- Center for Applied Ecology and Sustainability (CAPES)Pontificia Universidad Católica de ChileSantiago, Avd. Libertador Bernardo O'Higgins 340SantiagoChile
| | - J. Merçon
- Instituto de Investigaciones en EducasiónUniversidad VeracruzanaPaseo 112, Nuevo JalapaXalapa‐Enríquez91193Mexico
| | - E. Nuesiri
- Social Science FacultyAfrican Leadership University (ALU)Powder Mill RoadPamplemousses21001Mauritius
| | - L. Pereira
- Stockholm Resilience CentreStockholm UniversityKräftriket 2BStockholmSE‐10691Sweden
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityPrincetonlaan 8aUtrecht3584 CBThe Netherlands
- Centre for Complex Systems in TransitionStellenbosch University19 Jonkershoek Rd, MostertsdriftStellenbosch7600South Africa
| | - V. Pilbeam
- Clear Horizon Consulting132B Gwynne StCremorneVIC3121Australia
| | - E. Turnhout
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - S. Wood
- Future Earth1250 Guy St, MontrealQuebecONH3H 2L3Canada
| | - M. Ryan
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez-Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 DOI: 10.13140/rg.2.2.12086.52804/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 05/18/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C Wyborn
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
- Institute for Water Futures, Fenner School of Environment and Society, Australian National University, Canberra, ACT, 0200, Australia
| | - J Montana
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, U.K
| | - N Kalas
- Department of Environmental Systems Science, ETH Zürich, Universitätstrasse 8-22, Zürich, 8092, Switzerland
| | - S Clement
- Geography and Planning, University of Liverpool, Liverpool, L69 3BX, U.K
| | - F Davila
- Institute for Sustainable Futures, University of Technology Sydney, 253 Jones Street, Ultimo, NSW, 2007, Australia
| | - N Knowles
- Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - E Louder
- School of Geography and Development, University of Arizona, ENR2 Building, South 4th floor 1064 E. Lowell Street, Tucson, AZ, 85721, U.S.A
| | - M Balan
- The Forest Way, No 8, 2nd St, D P Nagar, Kotturpuram, Chennai, Tamil Nadu, 600085, India
| | - J Chambers
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - L Christel
- School of Politics and Government (EPyG), National University of San Martin, Avenida 25 de Mayo 1021, San Martín, Provincia de Buenos Aires, 1650, Argentina
| | - T Forsyth
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, U.K
| | - G Henderson
- Harry Ransom Center, The University of Texas at Austin, P.O. Drawer 7219, 300 W 21st Street, Austin, TX, 78712, U.S.A
| | - S Izquierdo Tort
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, 58 rue Principale, Ripon, QC, J0V 1V0, Canada
- Natura y Ecosistemas Mexicanos A.C., Plaza San Jacinto 23D, San Ángel, Álvaro Obregón, Mexico City, 01000, Mexico
| | - M Lim
- Centre for Environmental Law, Macquarie Law School, Macquarie University, 6 First Walk, Sydney, NSW, 2109, Australia
| | - M J Martinez-Harms
- Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Avd. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - J Merçon
- Instituto de Investigaciones en Educasión, Universidad Veracruzana, Paseo 112, Nuevo Jalapa, Xalapa-Enríquez, 91193, Mexico
| | - E Nuesiri
- Social Science Faculty, African Leadership University (ALU), Powder Mill Road, Pamplemousses, 21001, Mauritius
| | - L Pereira
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, Stockholm, SE-10691, Sweden
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, The Netherlands
- Centre for Complex Systems in Transition, Stellenbosch University, 19 Jonkershoek Rd, Mostertsdrift, Stellenbosch, 7600, South Africa
| | - V Pilbeam
- Clear Horizon Consulting, 132B Gwynne St, Cremorne, VIC, 3121, Australia
| | - E Turnhout
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - S Wood
- Future Earth, 1250 Guy St, Montreal, Quebec, ON, H3H 2L3, Canada
| | - M Ryan
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
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Franks R, Milidonis X, Morgan H, Ryan M, Perera D, Plein S, Chiribiri A. Myocardial perfusion quantification by CMR for detection of obstructive coronary artery disease in patients with previous coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): British Heart Foundation
Background
Coronary artery bypass grafting (CABG) is an established treatment for patients with advanced coronary artery disease (CAD). A subsequent recurrence of symptoms can cause the need for re-assessment of the coronary circulation. The accuracy of visually assessed stress perfusion cardiovascular magnetic resonance (CMR) for the detection of obstructive CAD is reduced in patients with prior CABG. In patients with complex multi-vessel CAD, myocardial perfusion quantification by CMR is superior to visual assessment (VA) for detection of obstructive disease however patients with CABG have been absent from previous studies.
Purpose
This study sought to assess the performance of myocardial perfusion quantification by CMR against invasive coronary angiography (ICA) for detecting obstructive CAD in patients with previous CABG.
Methods
Twenty-nine patients with a history of previous CABG and subsequent clinically indicated perfusion CMR study and invasive coronary angiography were recruited. Patients underwent a dual bolus stress perfusion CMR with late gadolinium enhancement (LGE) imaging at 3 Tesla. Stress myocardial blood flow (MBF) was estimated at the coronary territory level according to the AHA 16 segment model using Fermi function-constrained deconvolution. Segments with transmural LGE were excluded from MBF analysis. Stress perfusion images were analysed visually alongside LGE images and matched perfusion-LGE defects were considered negative. On ICA, coronary territories with lumen stenosis >70% without an unobstructed bypass graft (<70% stenosis) were considered positive.
Results
86/87 coronary territories were suitable for analysis. Sixty-five territories had at least one bypass graft including 32 territories with arterial grafts. 28/86 territories (33%) had obstructive disease on angiography. Territories with obstructive CAD had significantly lower stress MBF than unobstructed territories (1.21 [IQR: 0.96–1.45] vs 1.58 [1.40–1.84] ml/g/min, p < 0.001, Figure 1). Stress MBF had good accuracy to detect coronary territories with obstructive CAD (sensitivity 71%, specificity 84%, area under the curve (AUC) 0.83, p < 0.001, Figure 2A). For visual assessment, sensitivity was 79%, specificity 78% and diagnostic accuracy 78%. When analysis was confined to only territories with bypass grafts, stress MBF had 78% sensitivity, 81% specificity and AUC of 0.85, p < 0.001 (Figure 2B).. In this subgroup, VA had a sensitivity of 78%, specificity of 76% and a 77% diagnostic accuracy.
Conclusions
In patients with previous surgical revascularisation, quantification of stress myocardial blood flow by CMR offers good diagnostic accuracy for the detection and localisation of anatomically significant stenoses. Accuracy is reduced compared with published data in patients without coronary grafts but remains comparable to expert visual assessment.
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Affiliation(s)
- R Franks
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - X Milidonis
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Morgan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ryan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Perera
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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May T, Marra J, Leu A, Torbert D, VanWagner T, Alexander Z, Rainie-Lobacz R, Ryan M. Accuracy of the Tuning Fork Test for Determination of Presence and Location of Tibial Stress Fractures in a Military Training Population. Mil Med 2021; 186:733-736. [PMID: 33576428 DOI: 10.1093/milmed/usab052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/29/2020] [Accepted: 02/02/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Stress fractures or bone stress injuries arise from trauma or overuse, often as a result of rapid increase in training. This rapid increase in training occurs frequently as military recruits begin their entry-level training, as many individuals are not accustomed to the level of activity required during boot camp. Tibial stress fractures are the most common bone stress injuries in the military setting. MRI is the gold standard test for identification of stress fractures, but MRI may not be available in field settings. Although limited evidence has suggested that a vibrating tuning fork may be beneficial in determining the presence of a stress fracture, the tuning fork has become a frequent tool used to detect or diagnose stress fractures. MATERIALS AND METHODS Military personnel with suspected unilateral tibial stress fractures were asked to participate in evaluation of tuning forks as a diagnostic tool, in addition to receiving standard diagnostics and treatment. Points of maximal shin tenderness to palpation and vibration, followed by the application of a tuning fork, were evaluated. Each service member also underwent an abbreviated MRI evaluation with a 1.5T magnet consisting of coronal and sagittal STIR (Short Tau Inversion Recovery) and T1 (weighted longitudinal relaxation time) sequences. The results of tuning fork testing were compared to the MRI findings, considering grade 1 changes on MRI to represent a true stress fracture. A two-by-two table was used to determine the performance of tuning fork testing, relative to MRI findings, applying conventional definitions of sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Among 63 male active duty members with suspected tibial stress fractures, 39 had MRI-confirmed stress fractures. Tuning fork testing, relative to MRI, demonstrated overall sensitivity of 61.5%, specificity of 25.0%, positive predictive value of 57.1%, and negative predictive value of 28.6%. A sub-analysis restricting to grade 3 and grade 4 MRI findings did not improve the diagnostic performance of tuning forks. CONCLUSIONS The tuning fork is an ineffective tool for diagnosing tibial stress fractures.
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Affiliation(s)
- Todd May
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Janelle Marra
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Amy Leu
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Denise Torbert
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Tricia VanWagner
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Zachary Alexander
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Robin Rainie-Lobacz
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
| | - Margaret Ryan
- SMART (Sports Medicine and Reconditioning Team), Naval Hospital Camp Pendleton, Oceanside, CA 92055, USA
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50
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Montgomery J, Ryan M, Engler R, Hoffman D, McClenathan B, Collins L, Loran D, Hrncir D, Herring K, Platzer M, Adams N, Sanou A, Cooper LT. Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military. JAMA Cardiol 2021; 6:1202-1206. [PMID: 34185045 DOI: 10.1001/jamacardio.2021.2833] [Citation(s) in RCA: 359] [Impact Index Per Article: 119.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination. Objective To describe myocarditis presenting after COVID-19 vaccination within the Military Health System. Design, Setting, and Participants This retrospective case series studied patients within the US Military Health System who experienced myocarditis after COVID-19 vaccination between January and April 2021. Patients who sought care for chest pain following COVID-19 vaccination and were subsequently diagnosed with clinical myocarditis were included. Exposure Receipt of a messenger RNA (mRNA) COVID-19 vaccine between January 1 and April 30, 2021. Main Outcomes and Measures Clinical diagnosis of myocarditis after COVID-19 vaccination in the absence of other identified causes. Results A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report. The military administered more than 2.8 million doses of mRNA COVID-19 vaccine in this period. While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose. Conclusions and Relevance In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine. Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.
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Affiliation(s)
- Jay Montgomery
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Margaret Ryan
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Naval Medical Center, San Diego, California
| | - Renata Engler
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Donna Hoffman
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Bruce McClenathan
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Womack Army Medical Center, Fort Bragg, North Carolina
| | - Limone Collins
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia
| | - David Loran
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Naval Medical Center, San Diego, California
| | - David Hrncir
- Immunization Healthcare Division, Defense Health Agency, Falls Church, Virginia.,Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, San Antonio, Texas
| | | | | | - Nehkonti Adams
- Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Marine Expeditionary Forces, Okinawa, Japan
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