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Glaudo M, Urbach M, Panfil C, Herkert S, Brown M, Schrage N. A Novel Ex Vivo Blinking Method for Comparing the Corneal Residence Time of New Shampoo Formulations. Altern Lab Anim 2024:2611929241245723. [PMID: 38606566 DOI: 10.1177/02611929241245723] [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] [Indexed: 04/13/2024]
Abstract
In the cosmetics sector, many products such as shampoos have a probability of accidental ocular exposure during their routine use. One very specific safety parameter is the residence time of the substance on the corneal surface, as prolonged exposure may cause injury. In this study, we developed a system that simulates corneal exposure to blinking and tear flow, for comparing the corneal clearance times of viscous detergent formulations. The Ex Vivo Eye Irritation Test (EVEIT), which uses corneal explants from discarded rabbit eyes from an abattoir, was used as the basis for the new system. To simulate blinking, we developed a silicone wiping membrane to regularly move across the corneal surface, under conditions of constant addition and aspiration of fluid, to mimic tear flow. Six shampoo formulations were tested and were shown to differ widely in their corneal clearance time. Three groups could be identified according to the observed clearance times (fast, intermediate and slow); the reference shampoo had the shortest clearance time of all tested formulations. With this new system, it is now possible to investigate an important physicochemical parameter, i.e. corneal clearance time, for the consideration of ocular safety during the development of novel cosmetic formulations.
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Affiliation(s)
- Markus Glaudo
- Aachen Centre of Technology Transfer in Ophthalmology (ACTO e.V.), Aachen, Germany
| | - Marc Urbach
- Aachen Centre of Technology Transfer in Ophthalmology (ACTO e.V.), Aachen, Germany
- ACTO Service GmbH, Aachen, Germany
| | - Claudia Panfil
- Aachen Centre of Technology Transfer in Ophthalmology (ACTO e.V.), Aachen, Germany
| | | | - Mark Brown
- Procter & Gamble Company, Mason, OH, USA
| | - Norbert Schrage
- Aachen Centre of Technology Transfer in Ophthalmology (ACTO e.V.), Aachen, Germany
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Louch G, Berzins K, Walker L, Wormald G, Blackwell K, Stephens M, Brown M, Baker J. Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool. JMIR Form Res 2024; 8:e53726. [PMID: 38607663 PMCID: PMC11053394 DOI: 10.2196/53726] [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: 10/17/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. OBJECTIVE This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. METHODS The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. RESULTS We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, "getting worse" or "getting better"; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. CONCLUSIONS Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively.
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Affiliation(s)
- Gemma Louch
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, United Kingdom
| | - Kathryn Berzins
- Health Technology Assessment Unit, Applied Health Research Hub, Implementation and Capacity Building Team, NIHR Applied Research Collaboration North West Coast, University of Central Lancashire, Preston, United Kingdom
| | - Lauren Walker
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
| | - Gemma Wormald
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | - Kirstin Blackwell
- Thrive by Design, Leeds and York Partnership NHS Foundation Trust, Leeds, United Kingdom
| | | | - Mark Brown
- Social Spider CIC, London, United Kingdom
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, United Kingdom
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Mah SM, Brown M, Colley RC, Rosella LC, Schellenberg G, Sanmartin C. Exploring the use of experimental small area estimates to examine the relationship between individual-level and area-level community belonging and self-rated health. Health Rep 2024; 35:3-17. [PMID: 38527107 DOI: 10.25318/82-003-x202400300001-eng] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background Small area estimation refers to statistical modelling procedures that leverage information or "borrow strength" from other sources or variables. This is done to enhance the reliability of estimates of characteristics or outcomes for areas that do not contain sufficient sample sizes to provide disaggregated estimates of adequate precision and reliability. There is growing interest in secondary research applications for small area estimates (SAEs). However, it is crucial to assess the analytic value of these estimates when used as proxies for individual-level characteristics or as distinct measures that offer insights at the area level. This study assessed novel area-level community belonging measures derived using small area estimation and examined associations with individual-level measures of community belonging and self-rated health. Data and methods SAEs of community belonging within census tracts produced from the 2016-2019 cycles of the Canadian Community Health Survey (CCHS) were merged with respondent data from the 2020 CCHS. Multinomial logistic regression models were run between area-level SAEs, individual-level sense of community belonging, and self-rated health on the study sample of people aged 18 years and older. Results Area-level community belonging was associated with individual-level community belonging, even after adjusting for individual-level sociodemographic characteristics, despite limited agreement between individual- and area-level measures. Living in a neighbourhood with low community belonging was associated with higher odds of reporting being in fair or poor health, versus being in very good or excellent health (odds ratio: 1.53; 95% confidence interval: 1.22, 1.91), even after adjusting for other factors such as individual-level sense of community belonging, which was also associated with self-rated health. Interpretation Area-level and individual-level sense of community belonging were independently associated with self-rated health. The novel SAEs of community belonging can be used as distinct measures of neighbourhood-level community belonging and should be understood as complementary to, rather than proxies for, individual-level measures of community belonging.
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Affiliation(s)
- Sarah M Mah
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Mark Brown
- Economic Analysis Division, Statistics Canada
| | | | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Grant Schellenberg
- Social Analysis and Modelling Division, Analytical Studies Branch, Statistics Canada
| | - Claudia Sanmartin
- Strategic Analysis, Publications and Training Division, Statistics Canada
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Thia I, Tan A, Botha E, Picardo A, Brown M, Thyer I, Abdul-Hamid A, Tan A, Teichmann D, Hayne D, McCombie SP. Nurse-led renal cell carcinoma clinic: a single center review. ANZ J Surg 2024. [PMID: 38426382 DOI: 10.1111/ans.18920] [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: 10/24/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND In 2015 our centre introduced a nurse-led renal cell cancer follow-up protocol and clinic for patients who have undergone partial or radical nephrectomy for organ-confined kidney tumours. The main aims of this clinic were to improve healthcare efficiency and standardize follow-up processes. OBJECTIVES The primary objective was to assess the effectiveness of a nurse-led renal cell cancer follow up clinic in regard to surveillance protocol compliance and the timely identification and appropriate management of recurrences. A secondary objective was to evaluate this locally developed follow up protocol against the current European Association of Urology (EAU) guidelines surveillance protocol. PATIENT AND METHODS All patients who underwent a partial or radical nephrectomy between 2015 and 2021 at a single Western Australia institution for a primary renal malignancy were included. Data was collected from local clinical information systems and protocol adherence, recurrence characteristics and management were assessed. The current EAU guidelines were applied to the cohort to assess differences in risk-stratification and theoretical outcomes between the protocols. RESULTS After a mean follow up period of 31.2 months (range 0-77 months), 75.5% (185/245) of patients had all follow up imaging and reviews within 1 month of the timeframe scheduled on the protocol. 17.1% (42/245) had a delay in their follow up of more than a month at some stage, 5.7% (14/245) did not attend for follow up but had documented attempts to facilitate their compliance, and 0.4% (1/245) were lost to follow up with no evidence of attempted contact. 15.5% (38/245) of patients had recurrence of malignancy detected during follow up and these were all discussed in a multi-disciplinary team (MDT) meeting. The recurrence rate was 2.5% (3/119) for low risk, 17.7% (14/79) for intermediate risk, and 44.7% (21/47) for high risk patients when they were re-stratified according to EAU risk categories. No recurrences were detected through ultrasound (USS) or chest x-ray (CXR) in this cohort and our protocol tended to place patients in higher risk-stratification groups as compared to current EAU guidelines. CONCLUSION Nurse-led renal cell cancer follow up is a safe, reliable and effective clinical framework that has significant benefits in regard to resource utilization. USS and CXR are ineffective in detecting recurrence and Computerized tomography (CT) should be considered the imaging modality of choice for this purpose. The EAU surveillance protocol appears superior to our protocol, and we have therefore transitioned to the EAU guideline protocol going forward.
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Affiliation(s)
- I Thia
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Tan
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - E Botha
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Picardo
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M Brown
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - I Thyer
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Abdul-Hamid
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Tan
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - D Teichmann
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - D Hayne
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - S P McCombie
- Urology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Linden M, Leonard R, Forbes T, Brown M, Marsh L, Todd S, Hughes N, Truesdale M. Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic. BMC Public Health 2023; 23:2475. [PMID: 38082349 PMCID: PMC10714525 DOI: 10.1186/s12889-023-17432-7] [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: 07/24/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives. METHODS Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis. FINDINGS Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.' CONCLUSIONS The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.
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Affiliation(s)
- Mark Linden
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK.
| | - R Leonard
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - T Forbes
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - M Brown
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - L Marsh
- School of Nursing and Midwifery, The Queen's University of Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL, UK
| | - S Todd
- School of Healthcare Sciences, University of South Wales, Cardiff, UK
| | - N Hughes
- ESRC Centre for Care, Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - M Truesdale
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Silveyra GR, Silveyra P, Brown M, Poole S, Vatnick I, Medesani DA, Rodríguez EM. Oxidative stress and histopathological effects by microplastic beads, in the crayfish Procambarus clarkii, and fiddler crab Leptuca pugilator. Chemosphere 2023; 343:140260. [PMID: 37742760 DOI: 10.1016/j.chemosphere.2023.140260] [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] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/26/2023]
Abstract
The present study was aimed at evaluating the in vivo effects of microplastics (MP), in terms of oxidative stress and histopathological effects, in two crustacean species: Procambarus clarkii and Leptuca pugilator. In addition, MP accumulation in the hepatopancreas (HP) of both species was also determined. Adults of both crayfish and crabs were exposed for one month to fluorescent polystyrene beads (size: 1 μm) at nominal concentrations of 1000 or 5000 particles/mL. During the exposure, animals were maintained under controlled feeding, aeration, temperature, and photoperiod conditions. At the end of the exposure, HP and hemolymph (HL) samples were harvested for analysis of oxidative damage and total antioxidant levels. Additionally, the presence of MPs in both tissues was confirmed. Significant differences with the control groups were observed in lipid peroxidation levels in HP in animals exposed to the lowest concentration in P. clarkii and to the highest concentration in L. pugilator. A marked increase in antioxidant levels was also observed in the HL at both concentrations in P. clarkii, and at the highest MPs concentration in L. pugilator. Moreover, several histopathological changes were detected in both gills and HP, including hypertrophied lamellae, lifting or collapse of gill epithelia, loss of normal shape of hepatopancreatic tubules, and epithelial atrophy in the HP tissue. We conclude that exposure to MP beads at selected concentrations results in oxidative damage, induces histopathological changes in gills and HP, and triggers an antioxidant response in two crustacean species.
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Affiliation(s)
- G R Silveyra
- Dept. of Biodiversity and Experimental Biology, FCEN, University of Buenos Aires, Institute of Biodiversity, Experimental and Applied Biology (IBBEA), CONICET-UBA, Ciudad Universitaria, Pab. II, C1428EGA, Buenos Aires, Argentina
| | - P Silveyra
- Dept of Environmental and Occupational Health, Indiana University Bloomington, School of Public Health, Bloomington, IN, 47401, USA
| | - M Brown
- Dept. of Biology, Widener University, Chester, PA, 19809, USA
| | - S Poole
- Dept. of Biology, Widener University, Chester, PA, 19809, USA
| | - I Vatnick
- Dept. of Biology, Widener University, Chester, PA, 19809, USA
| | - D A Medesani
- Dept. of Biodiversity and Experimental Biology, FCEN, University of Buenos Aires, Institute of Biodiversity, Experimental and Applied Biology (IBBEA), CONICET-UBA, Ciudad Universitaria, Pab. II, C1428EGA, Buenos Aires, Argentina
| | - E M Rodríguez
- Dept. of Biodiversity and Experimental Biology, FCEN, University of Buenos Aires, Institute of Biodiversity, Experimental and Applied Biology (IBBEA), CONICET-UBA, Ciudad Universitaria, Pab. II, C1428EGA, Buenos Aires, Argentina.
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Love DC, Asche F, Fry J, Nguyen L, Gephart J, Garlock TM, Jenkins LD, Anderson JL, Brown M, Viglia S, Nussbaumer EM, Neff R. Aquatic food loss and waste rate in the United States is half of earlier estimates. Nat Food 2023; 4:1058-1069. [PMID: 38093119 PMCID: PMC10727981 DOI: 10.1038/s43016-023-00881-z] [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] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 10/27/2023] [Indexed: 12/20/2023]
Abstract
Food loss and waste (FLW) is a major challenge to food system sustainability, including aquatic foods. We investigated aquatic FLW in the food supply of the United States, the largest importer of aquatic food globally, using primary and secondary data and life cycle methodology. We show that there are significant differences in FLW among species, production technology, origin and stage of supply chain. We estimate total aquatic FLW was 22.7%, which is 43-55% lower than earlier estimates reported in the literature, illustrating the importance of applying a disaggregated approach. Production losses associated with imported food contribute over a quarter of total FLW, and addressing these losses requires multinational efforts to implement interventions along the supply chain. These findings inform prioritization of solutions-including areas of need for innovations, government incentives, policy change, infrastructure and equity.
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Affiliation(s)
- David C Love
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA.
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Frank Asche
- School of Forest, Fisheries and Geomatics Sciences, University of Florida, Gainesville, FL, USA
- Department of Safety, Economics and Planning, University of Stavanger, Stavanger, Norway
| | - Jillian Fry
- Department of Health Sciences, College of Health Professions, Towson University, Towson, MD, USA
| | - Ly Nguyen
- Food and Resource Economics Department, University of Florida, Gainesville, FL, USA
| | - Jessica Gephart
- Department of Environmental Science, American University, Washington, DC, USA
| | - Taryn M Garlock
- School of Forest, Fisheries and Geomatics Sciences, University of Florida, Gainesville, FL, USA
- School of Fisheries, Aquaculture, and Aquatic Sciences, Auburn University, Auburn, AL, USA
| | - Lekelia D Jenkins
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ, USA
| | - James L Anderson
- Center for Environmental Policy, University of Florida, Gainesville, FL, USA
| | - Mark Brown
- Center for Environmental Policy, University of Florida, Gainesville, FL, USA
| | - Silvio Viglia
- Center for Environmental Policy, University of Florida, Gainesville, FL, USA
- ENEA, Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Casaccia Research Centre, Rome, Italy
| | - Elizabeth M Nussbaumer
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Roni Neff
- Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, MD, USA
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Baltimore, MD, USA
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Wang X, Salminen LE, Petkus AJ, Driscoll I, Millstein J, Beavers DP, Espeland MA, Erus G, Braskie MN, Thompson PM, Gatz M, Chui HC, Resnick SM, Kaufman JD, Rapp SR, Shumaker S, Brown M, Younan D, Chen JC. Association between late-life air pollution exposure and medial temporal lobe atrophy in older women. medRxiv 2023:2023.11.28.23298708. [PMID: 38077091 PMCID: PMC10705610 DOI: 10.1101/2023.11.28.23298708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background Ambient air pollution exposures increase risk for Alzheimer's disease (AD) and related dementias, possibly due to structural changes in the medial temporal lobe (MTL). However, existing MRI studies examining exposure effects on the MTL were cross-sectional and focused on the hippocampus, yielding mixed results. Method To determine whether air pollution exposures were associated with MTL atrophy over time, we conducted a longitudinal study including 653 cognitively unimpaired community-dwelling older women from the Women's Health Initiative Memory Study with two MRI brain scans (MRI-1: 2005-6; MRI-2: 2009-10; Mage at MRI-1=77.3±3.5years). Using regionalized universal kriging models, exposures at residential locations were estimated as 3-year annual averages of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) prior to MRI-1. Bilateral gray matter volumes of the hippocampus, amygdala, parahippocampal gyrus (PHG), and entorhinal cortex (ERC) were summed to operationalize the MTL. We used linear regressions to estimate exposure effects on 5-year volume changes in the MTL and its subregions, adjusting for intracranial volume, sociodemographic, lifestyle, and clinical characteristics. Results On average, MTL volume decreased by 0.53±1.00cm3 over 5 years. For each interquartile increase of PM2.5 (3.26μg/m3) and NO2 (6.77ppb), adjusted MTL volume had greater shrinkage by 0.32cm3 (95%CI=[-0.43, -0.21]) and 0.12cm3 (95%CI=[-0.22, -0.01]), respectively. The exposure effects did not differ by APOE ε4 genotype, sociodemographic, and cardiovascular risk factors, and remained among women with low-level PM2.5 exposure. Greater PHG atrophy was associated with higher PM2.5 (b=-0.24, 95%CI=[-0.29, -0.19]) and NO2 exposures (b=-0.09, 95%CI=[-0.14, -0.04]). Higher exposure to PM2.5 but not NO2 was also associated with greater ERC atrophy. Exposures were not associated with amygdala or hippocampal atrophy. Conclusion In summary, higher late-life PM2.5 and NO2 exposures were associated with greater MTL atrophy over time in cognitively unimpaired older women. The PHG and ERC - the MTL cortical subregions where AD neuropathologies likely begin, may be preferentially vulnerable to air pollution neurotoxicity.
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Affiliation(s)
- Xinhui Wang
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Lauren E Salminen
- Department of Neurology, University of Southern California, Los Angeles, California
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew J Petkus
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Ira Driscoll
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Joshua Millstein
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Daniel P Beavers
- Departments of Statistical Sciences, Wake Forest University, Winston-Salem, North Carolina
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Guray Erus
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, Pennsylvania
| | - Meredith N Braskie
- Department of Neurology, University of Southern California, Los Angeles, California
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Paul M Thompson
- Department of Neurology, University of Southern California, Los Angeles, California
- Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Margaret Gatz
- Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | - Helena C Chui
- Department of Neurology, University of Southern California, Los Angeles, California
| | - Susan M Resnick
- The Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine (General Internal Medicine), and Epidemiology, University of Washington, Seattle, Washington
| | - Stephen R Rapp
- Departments of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sally Shumaker
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mark Brown
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Diana Younan
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
| | - Jiu-Chiuan Chen
- Department of Neurology, University of Southern California, Los Angeles, California
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Ragwar V, Brown M. Causal factors of childhood pneumonia high mortalities and the impact of community case management on child survival in Sub-Saharan Africa: a systematic review. Public Health 2023; 223:131-138. [PMID: 37639996 DOI: 10.1016/j.puhe.2023.07.033] [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: 10/14/2022] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE This study aimed to (1) evaluate the effectiveness of community case management (CCM) and validity of its implementation in the context of Sub-Saharan Africa (SSA) region; (2) identify potential differences in pneumonia disease aetiology, geographic region and cultural factors that may impact the implementation and delivery of community-based interventions; and (3) identify strategies that public health practitioners, stakeholders and policymakers could use to implement CCM. STUDY DESIGN This was a systematic review. METHODS Comprehensive searches were conducted in Cochrane Library, MEDLINE, CINAHL and Scopus databases from 2012 to 2023. Google Scholar, World Health Organization/United Nations Children's Fund websites, unpublished grey literature, PROSPERO (International Register of Systematic Reviews) and a manual search of references lists for relevant articles. RESULTS A total of 441 articles were screened, and eight articles were included for the review. Studies were from seven countries in SSA located in three regions: East (Kenya, Tanzania, Ethiopia), West (Nigeria, Senegal, Sierra Leone) and South (South Africa). The study designs of articles included two cluster randomised control trials, four cohorts and two case-control studies. A cross-analysis of the papers identified themes under the subheadings CCM and causal factors and risk factors. CONCLUSION Successful impact of implementation and adoption of CCM in the context of SSA culture and environment can be achieved when focused on creating high-demand, dependable and quality healthcare services. Continual monitoring and evaluation of emerging high trends of viral pathogens and co-infections are critical in reducing childhood pneumonia mortalities.
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Affiliation(s)
- V Ragwar
- University of Hertfordshire, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - M Brown
- University of Hertfordshire, Centre of Postgraduate Medicine and Public Health, School of Life and Medical Sciences, Hatfield, Hertfordshire, AL10 9AB, UK
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Hershberger CE, Raj R, Mariam A, Aykun N, Allende DS, Brown M, Aucejo F, Rotroff DM. Characterization of Salivary and Plasma Metabolites as Biomarkers for HCC: A Pilot Study. Cancers (Basel) 2023; 15:4527. [PMID: 37760495 PMCID: PMC10527521 DOI: 10.3390/cancers15184527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: The incidence of hepatocellular carcinoma (HCC) is rising, and current screening methods lack sensitivity. This study aimed to identify distinct and overlapping metabolites in saliva and plasma that are significantly associated with HCC. (2) Methods: Saliva samples were collected from 42 individuals (HCC = 16, cirrhosis = 12, healthy = 14), with plasma samples from 22 (HCC = 14, cirrhosis = 2, healthy = 6). We performed untargeted mass spectrometry on blood and plasma, tested metabolites for associations with HCC or cirrhosis using a logistic regression, and identified enriched pathways with Metaboanalyst. Pearson's correlation was employed to test for correlations between salivary and plasma metabolites. (3) Results: Six salivary metabolites (1-hexadecanol, isooctanol, malonic acid, N-acetyl-valine, octadecanol, and succinic acid) and ten plasma metabolites (glycine, 3-(4-hydroxyphenyl)propionic acid, aconitic acid, isocitric acid, tagatose, cellobiose, fucose, glyceric acid, isocitric acid, isothreonic acid, and phenylacetic acid) were associated with HCC. Malonic acid was correlated between the paired saliva and plasma samples. Pathway analysis highlighted deregulation of the 'The Citric Acid Cycle' in both biospecimens. (4) Conclusions: Our study suggests that salivary and plasma metabolites may serve as independent sources for HCC detection. Despite the lack of correlation between individual metabolites, they converge on 'The Citric Acid Cycle' pathway, implicated in HCC pathogenesis.
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Affiliation(s)
- Courtney E Hershberger
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Roma Raj
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, USA
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Arshiya Mariam
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nihal Aykun
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, USA
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniela S Allende
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Mark Brown
- Department of Cancer Biology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Federico Aucejo
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel M Rotroff
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Quantitative Metabolic Research, Cleveland Clinic, Cleveland, OH 44195, USA
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Haveman NJ, Schuerger AC, Yu PL, Brown M, Doebler R, Paul AL, Ferl RJ. Advancing the automation of plant nucleic acid extraction for rapid diagnosis of plant diseases in space. Front Plant Sci 2023; 14:1194753. [PMID: 37389293 PMCID: PMC10304293 DOI: 10.3389/fpls.2023.1194753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/23/2023] [Indexed: 07/01/2023]
Abstract
Human space exploration missions will continue the development of sustainable plant cultivation in what are obviously novel habitat settings. Effective pathology mitigation strategies are needed to cope with plant disease outbreaks in any space-based plant growth system. However, few technologies currently exist for space-based diagnosis of plant pathogens. Therefore, we developed a method of extracting plant nucleic acid that will facilitate the rapid diagnosis of plant diseases for future spaceflight applications. The microHomogenizer™ from Claremont BioSolutions, originally designed for bacterial and animal tissue samples, was evaluated for plant-microbial nucleic acid extractions. The microHomogenizer™ is an appealing device in that it provides automation and containment capabilities that would be required in spaceflight applications. Three different plant pathosystems were used to assess the versatility of the extraction process. Tomato, lettuce, and pepper plants were respectively inoculated with a fungal plant pathogen, an oomycete pathogen, and a plant viral pathogen. The microHomogenizer™, along with the developed protocols, proved to be an effective mechanism for producing DNA from all three pathosystems, in that PCR and sequencing of the resulting samples demonstrated clear DNA-based diagnoses. Thus, this investigation advances the efforts to automate nucleic acid extraction for future plant disease diagnosis in space.
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Affiliation(s)
- Natasha J. Haveman
- NASA Utilization & Life Sciences Office (UB-A), Kennedy Space Center, Merritt Island, FL, United States
| | - Andrew C. Schuerger
- Department of Plant Pathology, University of Florida, Space Life Science Lab, Merritt Island, FL, United States
| | - Pei-Ling Yu
- Department of Plant Pathology, University of Florida, Gainesville, FL, United States
| | - Mark Brown
- Claremont BioSolutions Limited Liability Company (LLC), Upland, CA, United States
| | - Robert Doebler
- Claremont BioSolutions Limited Liability Company (LLC), Upland, CA, United States
| | - Anna-Lisa Paul
- Department of Horticultural Sciences, University of Florida, Gainesville, FL, United States
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL, United States
| | - Robert J. Ferl
- Department of Horticultural Sciences, University of Florida, Gainesville, FL, United States
- University of Florida Office of Research, University of Florida, Gainesville, FL, United States
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Long-Sutehall T, Madi-Segwagwe BC, Hurlow A, Faull C, Rayment C, Jacob F, Wale J, Short J, Johnston J, Georgiade K, Brown M, Seaton N, Mollart S, Gillon S, Bracher M. The potential for eye donation from hospice and palliative care clinical settings in England: a retrospective case note review of deceased patients' records. Cell Tissue Bank 2023; 24:341-349. [PMID: 36322205 PMCID: PMC10209221 DOI: 10.1007/s10561-022-10036-2] [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: 04/06/2022] [Accepted: 08/13/2022] [Indexed: 05/25/2023]
Abstract
There is a need to identify additional routes of supply for ophthalmic tissue in the UK. This paper reports the findings from a national study exploring the potential for eye donation (ED) from three Hospice Care (HC) and three Hospital Palliative Care Services (HPC) in England. The objectives addressed in this paper are i.) to establish the size and describe the clinical characteristics of the potential eye donor population across six clinical sites; ii.) to identify challenges for clinicians in applying the standard ED criteria for assessing patient eligibility. Retrospective assessment of 1199 deceased patient case notes, 601 Hospice Care and 598 Hospital Palliative Care services, against current eye donation criteria. Clinicians' assessments were then evaluated against the same criteria. by specialists based at the National Health Service Blood and Transplant Tissue Services division (NHSBT-TS). Results of the assessment and evaluation are reported as descriptive statistics (numerical data). Free-text comment boxes facilitated clarification and/or justification of review and evaluation decisions. 46% (n = 553) of 1199 deceased patients' notes were agreed as eligible for eye donation (Hospice care settings = 56% (n = 337); Palliative care settings = 36% (n = 216). For all eligible cases (n = 553) the option of ED was recorded as being raised with family members in only 14 cases (3%). Significant potential exists for eye donation from the clinical sites in this study. This potential is not currently being realised.
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Affiliation(s)
- Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK.
| | | | - Adam Hurlow
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | | | | | - Faith Jacob
- LOROS Hospice, Leicester, Leicestershire, UK
| | - Jane Wale
- Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, Buckinghamshire, UK
| | - Jill Short
- Rowans Hospice, Waterlooville, Havant, UK
| | - Julie Johnston
- National Health Service Blood and Transplant - Tissue and Eye Services, Speke, Liverpool, UK
| | | | - Mark Brown
- National Health Service Blood and Transplant - Tissue and Eye Services, Speke, Liverpool, UK
| | | | - Sarah Mollart
- West Suffolk Hospital NHS Foundation Trust, Bury, Greater Manchester, UK
| | - Suzie Gillon
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
| | - Mike Bracher
- School of Health Sciences, University of Southampton, Southampton, Hampshire, UK
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Brown M, Kashem A, Zhao H, Cheng K, Kehara H, Mokashi S, Yanagida R, Shigemura N, Toyoda Y. Does Donor Age Impact Survival Outcome of Increased-Risk Lung Transplantation? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1559] [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: 04/05/2023] Open
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15
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Firoz A, Kashem A, Brown M, Yanagida R, Shigemura N, Toyoda Y. Concomitant Heart and Lung Surgery During Lung Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.421] [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: 04/05/2023] Open
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16
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Brown M, Lekan A, Hofmeyer M, Rodrigo M, Kadakkal A, Lam P, Krishnan M, Afari-Armah N, Rao S, Gupta R, Alassar A, Molina E, Sheikh F. Hemodynamic Effects of Intra-Aortic Balloon Pump as a Bridge to Durable Left Ventricular Assist Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1054] [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: 04/05/2023] Open
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17
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Wang L, Chilvers N, Huang M, Bates L, Pang C, Chelsea G, Brown M, Murphy M, MacGowan G, Ali S, Dark J. Non-Ischaemic Heart Preservation to Improve Donor Heart Quality. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.205] [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: 04/05/2023] Open
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18
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Chou A, Li C, Farshid S, Hoffman A, Brown M. Survival, symptoms and hospitalization of older patients with advanced chronic kidney disease managed without dialysis. Nephrol Dial Transplant 2023; 38:405-413. [PMID: 35438786 DOI: 10.1093/ndt/gfac154] [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: 09/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Shared decision-making (SDM) is important when considering whether an older patient with advanced chronic kidney disease (CKD) should be managed with dialysis or conservative kidney management (CKM). Physicians may find these conversations difficult because of the relative paucity of data on patients managed without dialysis. METHODS This prospective observational study was conducted in a unit supported by a multidisciplinary Kidney Supportive Care (KSC) programme, in a cohort of 510 patients (280 CKM and 230 dialysis) ≥65 years of age with CKD stages 4 and 5. Survival was evaluated using logistic regression and Cox proportional hazards models. Linear mixed models were utilized to assess symptoms over time. RESULTS CKM patients were older (mean 84 versus 74 years; P < .001) and almost 2-fold more likely to have three or more comorbidities (P < .001). The median survival of CKM patients was lower compared with dialysis from all time points: 14 months [interquartile range (IQR) 6-32] versus 53 (IQR 28-103) from decision of treatment modality or dialysis start date (P < .001); 15 months (IQR 7-34) versus 64 (IQR 30-103) from the time the estimated glomerular filtration rate (eGFR) was ≤15 mL/min/1.73 m2 (P < .001); and 8 months (IQR 3-18) versus 49 (19-101) from eGFR ≤10 mL/min/1.73 m2. A total of 59% of CKM patients reported an improvement in symptoms by their third KSC clinic visit (P < .001). The rate of unplanned hospitalization was 2-fold higher in the dialysis cohort. CONCLUSIONS CKM patients survive a median of 14 months from the time of modality choice and have a lower rate of hospitalization than dialysis patients. Although the symptom burden in advanced CKD is high, most elderly CKM patients managed through an integrated KSC programme and can achieve improvement in their symptoms over time. These data might help with SDM.
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Affiliation(s)
- Angela Chou
- St George Hospital, Department of Renal Medicine, and University of New South Wales, Sydney, NSW, Australia
| | - Chenlei Li
- St George Hospital, Department of Renal Medicine, and University of New South Wales, Sydney, NSW, Australia
| | - Sanjay Farshid
- St George Hospital, Department of Renal Medicine, and University of New South Wales, Sydney, NSW, Australia
| | - Anna Hoffman
- St George Hospital, Department of Renal Medicine, and University of New South Wales, Sydney, NSW, Australia
| | - Mark Brown
- St George Hospital, Department of Renal Medicine, and University of New South Wales, Sydney, NSW, Australia
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19
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Jones C, Gray S, Brown M, Brown J, Mc Closkey E, Rai B, Clarke N, Sachdeva A. Fracture and fall risk in men with advanced or metastatic prostate cancer treated with novel androgen receptor signalling inhibitors: A systematic review and meta-analysis of randomised controlled trials. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01036-9] [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: 02/12/2023]
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20
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Doane MP, Ostrowski M, Brown M, Bramucci A, Bodrossy L, van de Kamp J, Bissett A, Steinberg P, Doblin MA, Seymour J. Defining marine bacterioplankton community assembly rules by contrasting the importance of environmental determinants and biotic interactions. Environ Microbiol 2023. [PMID: 36700447 DOI: 10.1111/1462-2920.16341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023]
Abstract
Bacterioplankton communities govern marine productivity and biogeochemical cycling, yet drivers of bacterioplankton assembly remain unclear. Here, we contrast the relative contribution of deterministic processes (environmental factors and biotic interactions) in driving temporal dynamics of bacterioplankton diversity at three different oceanographic time series locations, spanning 15° of latitude, which are each characterized by different environmental conditions and varying degrees of seasonality. Monthly surface samples (5.5 years) were analysed using 16S rRNA amplicon sequencing. The high- and mid-latitude sites of Maria Island and Port Hacking were characterized by high and intermediate levels of environmental heterogeneity, respectively, with both alpha diversity (72%; 24% of total variation) and beta diversity (32%; 30%) patterns within bacterioplankton assemblages explained by day length, ammonium, and mixed layer depth. In contrast, North Stradbroke Island, a sub-tropical location where environmental conditions are less variable, interspecific interactions were of increased importance in structuring bacterioplankton diversity (alpha: 33%; beta: 26%) with environment only contributing 11% and 13% to predicting diversity, respectively. Our results demonstrate that bacterioplankton diversity is the result of both deterministic environmental and biotic processes and that the importance of these different deterministic processes varies, potential in response to environmental heterogeneity.
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Affiliation(s)
- Michael P Doane
- College of Science and Engineering, Flinders University, Bedford Park, South Australia, Australia
| | - Martin Ostrowski
- Sydney Institute of Marine Science, Mosman, New South Wales, Australia.,Climate Change Cluster, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Mark Brown
- School of Environmental and Life Sciences, University of Newcastle Australia, Callaghan, New South Wales, Australia
| | - Anna Bramucci
- Climate Change Cluster, University of Technology Sydney, Ultimo, New South Wales, Australia
| | | | | | | | - Peter Steinberg
- Sydney Institute of Marine Science, Mosman, New South Wales, Australia.,Centre for Marine Science and Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Martina A Doblin
- Sydney Institute of Marine Science, Mosman, New South Wales, Australia.,Climate Change Cluster, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Justin Seymour
- Climate Change Cluster, University of Technology Sydney, Ultimo, New South Wales, Australia
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21
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Marshall AR, Waite CE, Pfeifer M, Banin LF, Rakotonarivo S, Chomba S, Herbohn J, Gilmour DA, Brown M, Chazdon RL. Fifteen essential science advances needed for effective restoration of the world's forest landscapes. Philos Trans R Soc Lond B Biol Sci 2023; 378:20210065. [PMID: 36373922 PMCID: PMC9661955 DOI: 10.1098/rstb.2021.0065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
There has never been a more pressing and opportune time for science and practice to collaborate towards restoration of the world's forests. Multiple uncertainties remain for achieving successful, long-term forest landscape restoration (FLR). In this article, we use expert knowledge and literature review to identify knowledge gaps that need closing to advance restoration practice, as an introduction to a landmark theme issue on FLR and the UN Decade on Ecosystem Restoration. Aligned with an Adaptive Management Cycle for FLR, we identify 15 essential science advances required to facilitate FLR success for nature and people. They highlight that the greatest science challenges lie in the conceptualization, planning and assessment stages of restoration, which require an evidence base for why, where and how to restore, at realistic scales. FLR and underlying sciences are complex, requiring spatially explicit approaches across disciplines and sectors, considering multiple objectives, drivers and trade-offs critical for decision-making and financing. The developing tropics are a priority region, where scientists must work with stakeholders across the Adaptive Management Cycle. Clearly communicated scientific evidence for action at the outset of restoration planning will enable donors, decision makers and implementers to develop informed objectives, realistic targets and processes for accountability. This article paves the way for 19 further articles in this theme issue, with author contributions from across the world. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.
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Affiliation(s)
- Andrew R. Marshall
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
- Department of Environment and Geography, University of York, York YO10 5DD, UK
- Reforest Africa, Mang'ula, Tanzania
- Flamingo Land Ltd, Kirby Misperton, North Yorkshire YO17 6UX, UK
| | - Catherine E. Waite
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
| | - Marion Pfeifer
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK
| | - Lindsay F. Banin
- UK Centre for Ecology & Hydrology, Library Avenue, Bailrigg, Lancaster LA1 4AP, UK
| | - Sarobidy Rakotonarivo
- École Supérieure des Sciences Agronomiques, Université d'Antananarivo, BP 566 Antananarivo, Madagascar
| | | | - John Herbohn
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
| | - Donald A. Gilmour
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
| | - Mark Brown
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
| | - Robin L. Chazdon
- Forest Research Institute, University of the Sunshine Coast, QLD 4556, Australia
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22
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Linden MA, Forbes T, Brown M, Marsh L, Truesdale M, McCann E, Todd S, Hughes N. Correction: Impact of the COVID-19 pandemic on family carers of those with profound and multiple intellectual disabilities: perspectives from UK and Irish Non-Governmental Organisations. BMC Public Health 2022; 22:2302. [PMID: 36503401 PMCID: PMC9741943 DOI: 10.1186/s12889-022-14740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- M. A. Linden
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - T. Forbes
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Brown
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - L. Marsh
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Truesdale
- grid.8756.c0000 0001 2193 314XSchool of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - E. McCann
- grid.4464.20000 0001 2161 2573Division of Nursing at City, University of London, London, UK
| | - S. Todd
- grid.410658.e0000 0004 1936 9035School of Care Sciences, University of South Wales, Caerleon, Wales
| | - N. Hughes
- Department of Sociological Studies, University of Shefeld, Shefeld, England
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23
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Linden MA, Forbes T, Brown M, Marsh L, Truesdale M, McCann E, Todd S, Hughes N. Impact of the COVID-19 pandemic on family carers of those with profound and multiple intellectual disabilities: perspectives from UK and Irish Non-Governmental Organisations. BMC Public Health 2022; 22:2095. [PMID: 36384516 PMCID: PMC9668390 DOI: 10.1186/s12889-022-14560-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family carers of people with profound and multiple intellectual disabilities (PMID) experienced a reduction in healthcare services due to the COVID-19 pandemic. Many subsequently turned to Non-Governmental Organisations who worked to support families. However, little research has sought to capture the experiences of family carers or identify effective interventions which might support them. To address these concerns we explored the views of Non-Governmental sector workers across the UK and Ireland who supported families people with PMID during the COVID-19 pandemic. We also sought to explore their views on the characteristics of online support programmes for family carers. METHODS: This study employed a qualitative design using focus groups with participants (n = 24) from five Non-Governmental Organisations across the UK and Ireland. A focus group guide included questions on challenges, supports, coping and resources which helped during lockdown restrictions. Focus groups were held online, were audio recorded and transcribed verbatim. The resulting transcripts were pseudonymised and subjected to thematic analysis. FINDINGS Four themes were identified (i) 'mental and emotional health', (ii) 'they who shout the loudest' (fighting for services), (iii) 'lack of trust in statutory services' and (iv) 'creating an online support programme'. Mental and emotional health emerged as the most prominent theme and included three subthemes named as 'isolation', 'fear of COVID-19' and 'the exhaustion of caring'. CONCLUSIONS The COVID-19 pandemic has increased the vulnerability of family carers who were already experiencing difficulties in accessing services and supports for their families. While Non-Governmental Organisations have been a crucial lifeline there is urgent need to design services, including online support programmes, in partnership with family carers which adequately address their needs.
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Affiliation(s)
- M. A. Linden
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - T. Forbes
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Brown
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - L. Marsh
- grid.4777.30000 0004 0374 7521School of Nursing and Midwifery, Queen’s University Belfast, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland
| | - M. Truesdale
- grid.8756.c0000 0001 2193 314XSchool of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - E. McCann
- grid.4464.20000 0001 2161 2573Division of Nursing at City, University of London, London, UK
| | - S. Todd
- grid.410658.e0000 0004 1936 9035School of Care Sciences, University of South Wales, Caerleon, Wales
| | - N. Hughes
- grid.11835.3e0000 0004 1936 9262Department of Sociological Studies, University of Sheffield, Sheffield, England
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24
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Long-Sutehall T, Bracher M, Madi-Segwagwe BC, Faull C, Hurlow A, Mollart S, Rayment C, Short J, Wale J, Brown M, Winstanley E, Jacob F, Goerge K, Seaton N, Gillon S, Johnson J. 12 The potential for eye donationfrom hospice and palliative care clinical settings in England - a retrospective case notes review of deceased patient records. BMJ Open Ophthalmol 2022; 7:A5-A6. [PMID: 37282675 DOI: 10.1136/bmjophth-2022-eeba.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND There is a need to identify additional routes of supply for ophthalmic tissue in the UK due to deficits between supply and demand. In response to this need the NIHR funded study, Eye Donation from Palliative and Hospice Care: Investigating Potential, Practice, Preference, and Perceptions) (EDiPPPP) project was developed in partnership with NHSBT Tissue Services ( now Organ Tissue Donation and Transplantation). AIM This presentation will report findings from work package one of EDiPPPP which aimed to: scope the size and clinical characteristics of the potential eye donation (ED) population via a large-scale, multi-site retrospective case notes review across England establishing: the size of the potential ED population; describe the clinical characteristics of the potential ED population and identify challenges for clinicians in applying the standard ED criteria for assessing patient eligibility. RESULTS Retrospective review of 1200 deceased patient case notes (600 HPC; 600 HPCS) by reviewers (healthcare professionals) at research sites against current ED criteria were then evaluated by specialists based at the National Health Service Blood and Transplant Tissue services (NHSBT-TS). Note review established that 46% (n=553) of 1200 deceased patients notes were agreed as eligible for eye donation (total cases Hospice care settings = 56% (n=337); Palliative care settings = 36% (n=216) with only 1.2% of potential donors referred to NHSBT-TS for eye donation (Hospice care settings = 1.2% (n=4); Palliative care settings = 1.3% (n=3).Application of the eye donation criteria resulted in an 81% agreement rate outcome for all sites (HPC = 79.2%; HPCS = 82.8%). If cases where there was a difference of assessment but where NHSBT evaluation indicated eligibility are included (n=113) the potential donor pool rises from 553 (46.1% total cases) to 666 (56%) eligible cases. CONCLUSIONS Significant potential exists for eye donation from the clinical sites in this study. This potential is not currently being realised. In view of the predicted increase in need for ophthalmic tissue it is essential that the potential route to increase the supply of ophthalmic tissue demonstrated in this retrospective note review is accessed. The presentation will conclude with recommendations for service development.
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Affiliation(s)
| | | | | | | | | | | | | | - Jill Short
- University Of Southampton, Southampton, UK
| | - Jane Wale
- University Of Southampton, Southampton, UK
| | - Mark Brown
- University Of Southampton, Southampton, UK
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25
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Katz I, Lane C, Pirabhahar S, Williamson P, Kelly J, Preece R, Raghunath V, Brown M. Integrated virtual medical consultations versus traditional clinic care in a public and a private outpatient service. Integ Health J 2022. [DOI: 10.1136/ihj-2020-000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ObjectivesThe iConnect Care programme provided integrated ‘virtual care’ (VC) for patients with chronic kidney disease (CKD) in the South Eastern Sydney Local Health District. VC is an alternative to outpatient care which expedites time to specialists’ opinions and is safe. Comparing different outpatient care models is important to understand the role of telehealth and integrated care, especially following the COVID-19 pandemic. This study aimed to compare a VC model with existing CKD outpatient care.Design, participants and settingA multisite, comparative, retrospective cohort study with parallel groups. 374 patients with mild CKD were recruited (July 2013 and August 2015) from public and private outpatients and followed for 12 months (n=304) or via VC (n=70). Estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR) were compared at baseline, 6 and 12 months.ResultsAt 12 months, no significant differences existed among groups in eGFR or ACR or haemoglobin, but serum creatinine was lower in the VC cohort. A significant difference existed in time to see a patient from time of referral; 7 days for VC clinic and 35–42 days for outpatient clinic. Patients interviewed felt VC was efficient and they were well managed.ConclusionVC can be a faster mechanism to access a nephrologist and other specialists. It provided similar outcomes to outpatient care. VC represents an additional assessment and follow-up pathway supported in the community. Time to deliver is similar, but specific resources are needed. It has the potential to evolve into a standard component of chronic disease care.
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26
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Das A, Wang X, Wei J, Hoji A, Coon TA, Popescu I, Brown M, Frizzell S, Iasella CJ, Noda K, Sembrat J, Devonshire K, Hannan SJ, Snyder ME, Pilewski J, Sanchez PG, Chandra D, Mallampalli RK, Alder JK, Chen BB, McDyer JF. Cross-Regulation of F-Box Protein FBXL2 with T-bet and TNF-α during Acute and Chronic Lung Allograft Rejection. J Immunol 2022; 209:1788-1795. [PMID: 36113884 PMCID: PMC9588753 DOI: 10.4049/jimmunol.2200245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023]
Abstract
Chronic lung allograft dysfunction is the major barrier to long-term survival in lung transplant recipients. Evidence supports type 1 alloimmunity as the predominant response in acute/chronic lung rejection, but the immunoregulatory mechanisms remain incompletely understood. We studied the combinatorial F-box E3 ligase system: F-box protein 3 (FBXO3; proinflammatory) and F-box and leucine-rich repeat protein 2 (FBXL2; anti-inflammatory and regulates TNFR-associated factor [TRAF] protein). Using the mouse orthotopic lung transplant model, we evaluated allografts from BALB/c → C57BL/6 (acute rejection; day 10) and found significant induction of FBXO3 and diminished FBXL2 protein along with elevated T-bet, IFN-γ, and TRAF proteins 1-5 compared with isografts. In the acute model, treatment with costimulation blockade (MR1/CTLA4-Ig) resulted in attenuated FBXO3, preserved FBXL2, and substantially reduced T-bet, IFN-γ, and TRAFs 1-5, consistent with a key role for type 1 alloimmunity. Immunohistochemistry revealed significant changes in the FBXO3/FBXL2 balance in airway epithelia and infiltrating mononuclear cells during rejection compared with isografts or costimulation blockade-treated allografts. In the chronic lung rejection model, DBA/2J/C57BL/6F1 > DBA/2J (day 28), we observed persistently elevated FBXO3/FBXL2 balance and T-bet/IFN-γ protein and similar findings from lung transplant recipient lungs with chronic lung allograft dysfunction versus controls. We hypothesized that FBXL2 regulated T-bet and found FBXL2 was sufficient to polyubiquitinate T-bet and coimmunoprecipitated with T-bet on pulldown experiments and vice versa in Jurkat cells. Transfection with FBXL2 diminished T-bet protein in a dose-dependent manner in mouse lung epithelial cells. In testing type 1 cytokines, TNF-α was found to negatively regulate FBXL2 protein and mRNA levels. Together, our findings show the combinatorial E3 ligase FBXO3/FBXL2 system plays a role in the regulation of T-bet through FBXL2, with negative cross-regulation of TNF-α on FBXL2 during lung allograft rejection.
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Affiliation(s)
- Antu Das
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Xingan Wang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Jianxin Wei
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Aki Hoji
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Tiffany A. Coon
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Iulia Popescu
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Mark Brown
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Sheila Frizzell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Carlo J. Iasella
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy; Pittsburgh, Pennsylvania, 15213, USA
| | - Kentaro Noda
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - John Sembrat
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Kaitlyn Devonshire
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Stefanie J. Hannan
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Mark E. Snyder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Joseph Pilewski
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Pablo G. Sanchez
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Divay Chandra
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Rama K. Mallampalli
- Department of Medicine, Ohio State University School of Medicine; Columbus, Ohio, 43210, USA
| | - Jonathan K. Alder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - Bill B. Chen
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA,Aging Institute, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
| | - John F. McDyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine; Pittsburgh, Pennsylvania, 15213, USA
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Banaszak‐Holl J, Morello R, Soh S, Cameron P, Brown M, Mitsch V, Moubarak R, Winkler D. Do young people with neurological conditions in residential aged care use hospitals differently than those in the community? Evidence from Victorian hospital data, 2014-2017. Health Soc Care Community 2022; 30:e5907-e5915. [PMID: 36111880 PMCID: PMC10087403 DOI: 10.1111/hsc.14022] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 07/08/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
This study describes the duration and reasons for hospitalisation for three cohorts of younger adults with neurological conditions who either used residential aged care (RAC) or lived in the community. Hospitalisations as a clinical event indicate conditions for which younger people in RAC may need support as they move into community-based housing. Data describing 3 years of hospitalisations in Victorian public hospitals and emergency departments were used. The neurological conditions occurring among the three cohorts include (1) Cerebral Vascular Accident (CVA), (2) Traumatic Brain Injury (TBI) and (3) Multiple Sclerosis (MS). Frequency of hospitalisation, length of stay and leading causes of potentially preventable hospitalisations were examined. Two hundred and fifty-two (2.7%) of 9333 patients hospitalised for these neurological conditions subsequently used RAC. Hospitalisations were more frequent for those using RAC compared to those living in the community for cohorts with CVA and TBI (6.26 vs. 2.65 events per person-year for CVA and 4.34 vs. 1.88 for TBI) while hospitalisations were more frequent among those in the community compared to those using RAC for the cohort living with MS (3.62 vs. 5.35 per person-year). However, for all the cohorts, the average length of acute hospital stays was longer among RAC users than among those in the community (19.6 vs. 6.2 days for CVA, 15.5 vs. 4.5 for TBI and 12.2 vs. 7.0 for MS). Leading causes for hospitalisation were complex comorbidities and changes in health status (such as seizures, ulcers, dehydration and cellulitis). Efforts should be made to design supports and proactively manage health needs leading to these hospitalisations.
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Affiliation(s)
- Jane Banaszak‐Holl
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of Health Services Administration, School of Health ProfessionsUniversity of Alabama – BirminghamBirminghamAlabamaUSA
| | - Renata Morello
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Sze‐Ee Soh
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- School of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Peter Cameron
- School of Population Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Mark Brown
- Summer FoundationMelbourneVictoriaAustralia
- Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Virginia Mitsch
- Resolution Consulting and TherapyAlburyNew South WalesAustralia
| | - Rosemary Moubarak
- South Western Sydney Local Health DistrictLiverpoolNew South WalesAustralia
| | - Dianne Winkler
- Summer FoundationMelbourneVictoriaAustralia
- Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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28
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Winstanley E, Chandrasekar A, Carroll V, Ambrose A, Brown M, Lyon M, Paulus U, Wells A. 33 NHSBT tissue and eye services clinical support nurse team: advanced nursing practice. BMJ Open Ophthalmol 2022; 7:A14. [PMID: 37282680 DOI: 10.1136/bmjophth-2022-eeba.33] [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: 06/08/2023] Open
Abstract
NHS Blood and Transplant (NHSBT) Tissue and Eye Services (TES) save and improve the lives of thousands of patients every year.The Clinical Support Nurse Team (CSNT) within TES is an example of registered nurses working at an advanced level, making professionally autonomous decisions for which they are accountable.The concept of nurses working at this level began with a pilot study in 2012 under a robust governance system and change process within NHSBT. The development and progress of the team has also been reviewed by NHSBT Clinical Audit.The CSNT currently comprises two band 7 nurses and a band 8a manager who work together to safely assess and authorise donated tissue for transplant. There are plans to expand the team in 2022 and to ensure that the work is underpinned by a suitable academic framework that reflects the level of clinical responsibility. The CSNT work in conjunction with TES medical consultants who provide education, guidance and governance.The team is required to use complex reasoning, critical thinking, reflection and analysis to inform their assessment and clinical judgement.CSNT practice is guided by the Donor Selection Guidelines set by the Joint United Kingdom (UK) Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (2013). These guidelines stipulate contraindications to tissue donation on which the CSNT bases clinical decisions to ensure the safety of the recipients of any donated tissue by ruling out the chances of contracting any transmissible illness or transplanting tissue of compromised quality.Although a large component of the TES CSNT workload is to authorise donor files from deceased donors there are also living donation programmes. CSNT also review the Autologous/Allogeneic Serum Eye Drop Programme (ASE/AlloSE). This involves reviewing clinical requests made by ophthalmologists for serum eye drop options.This is a brief summary of how CSNT nurses apply their expert knowledge and skills to a broad range of Clinically challenging and complex situations.
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Affiliation(s)
| | | | | | | | | | - Marc Lyon
- NHS Blood and Transplant, Liverpool, UK
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29
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Mah S, Brown M, Colley R, Rosella R, Sanmartin C, Schellenberg G. Associations between area- and individual-level community belonging and self-rated health. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.308] [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
Previous studies point to the importance of individuals’ sense of community belonging to multiple measures of health and well-being. However, the extent to which collective sense of belonging within neighbourhoods might influence individual health has not been characterized. The objectives of this study are to describe variations in self-rated health by a novel area-level measure of community belonging and determine the impact of including these measures in models of individual-level community belonging and self-rated health.
Methods
We conducted a cross-sectional study of respondents of the 2020 Canadian Community Health Survey (CCHS) living in census tracts. These data were merged with novel small area estimates of community belonging derived by Statistics Canada from the CCHS 2016-2019. Multinomial logistic regression models were used to analyse associations of individual- and area-level community belonging, and self-rated health. We adjusted for sex, age, recent immigrant status, visible minority status, province, marital status, presence of children in the household, smoking status, presence of chronic conditions, income, and employment status. All results were generated using survey weights and bootstraps representing a subpopulation of 21 million people.
Results
A greater proportion of CCHS respondents living in neighbourhoods with the strongest collective sense of community belonging reported being in good, very good, or excellent health. Models indicate that living in a neighbourhood with low collective sense of community belonging is associated with higher odds of reporting being in poor or fair health (OR = 1.44, 95% CI 1.15-1.81) even after adjusting for other factors, including individual-level sense of community belonging, which also remained independently associated with self-rated health.
Conclusions
Both area- and individual-level sense of community belonging are independently associated with self-rated health.
Key messages
• The collective sense of belonging within neighbourhoods may influence health outcomes.
• Measures of area-level and individual-level community belonging may capture different aspects of social connections with respect to health.
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Affiliation(s)
- S Mah
- Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
| | - M Brown
- Statistics Canada , Ottawa, Canada
| | - R Colley
- Statistics Canada , Ottawa, Canada
| | - R Rosella
- Dalla Lana School of Public Health, University of Toronto , Toronto, Canada
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30
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Evans S, Schulze MJ, Dunlop S, Dunlop B, McClelland J, Hodgkiss R, Brown M. Investigating the effectiveness of a well‐managed hatchery as a tool for hawksbill sea turtle (
Eretmochelys imbricata
) conservation. Conservat Sci and Prac 2022. [DOI: 10.1111/csp2.12819] [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: 11/05/2022] Open
Affiliation(s)
- Sean Evans
- C/O Cousine Island Company Limited Cousine Island Providence Mahe Seychelles
| | | | - Stuart Dunlop
- C/O Cousine Island Company Limited Cousine Island Providence Mahe Seychelles
| | - Bronwyn Dunlop
- C/O Cousine Island Company Limited Cousine Island Providence Mahe Seychelles
| | - James McClelland
- C/O Cousine Island Company Limited Cousine Island Providence Mahe Seychelles
| | - Rebecca Hodgkiss
- C/O Cousine Island Company Limited Cousine Island Providence Mahe Seychelles
| | - Mark Brown
- School of Life Sciences University of KwaZulu‐Natal University Road Pietermaritzburg KwaZulu‐Natal South Africa
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31
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Brown M, Krishnananthan N, Paul V. Right heart catherisation – a virtual reality. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2787] [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
Introduction
Right heart catheterisation (RHC) is the gold standard for assessing patients with pulmonary hypertension. Doctors require training in this procedure in a safe and friendly environment with minimal risk to patients. Due to the Covid pandemic, formal RHC teaching workshops were cancelled in our country, so we sought to develop a Virtual Reality Right Heart Catheterisation (VRRHC) training program to fulfil this area of need without the need for face to face contact. The aim was to improve training, competency and confidence in this technique with improved diagnostic skills and reduction of procedural errors.
Method
We approached a health technology company to design a VRRHC training module based on our current RHC simulation workshops. Phase 1 required virtual insertion of RHC via the right internal jugular vein using micro-puncture, double Seldinger technique under ultrasound guidance, followed by insertion of the RHC to the right atrium, right ventricle and pulmonary artery with pulmonary artery occlusion using real time pressure tracings and fluoroscopy. Thermodilution cardiac outputs and chamber saturations were also performed.
The proprietary platform technology was delivered via a laptop and VR headset. Clinicians perform the VRRHC with imaging, monitoring and haptic feedback with the collection of real time performance tracking allowing user data (e.g. failed steps and proficiency scores) to be captured and subsequently visualised in the learning management system.
We collected analytics and data on user engagement, experience and retention, targeted learning outcomes and learning curve, reduction in operating costs, reduction in procedure times due to higher proficiency, early diagnosis of pulmonary hypertension, reduced complications, improved interpretation and diagnosis.
Results
The program was launched in October 2021. Preliminary data shows a learning curve is associated with both using VR (10–15 minutes) and the RHC procedure itself. Initial time to completion of the RHC was 30–40 mins, reducing to 20–30 minutes with experience and 15 minutes in experts. Completion rates increase with experience from 40–50% to 100% and error rates reduce with frequency of completion.
Conclusion
A Virtual Reality Right Heart Catheter training program is safe, feasible and non-invasive. Increased experience results in increased completion rates, reduced procedure time and reduced errors. Using this program will potentially have beneficial effects on doctor training, outcomes, patient safety and health economics with no risk to a real patient.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Janssen Pharmaceuticals
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Affiliation(s)
- M Brown
- Macquarie University Hospital , Sydney , Australia
| | | | - V Paul
- Campbelltown Hospital, Emergency , Sydney , Australia
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32
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Brown M, Diaz L, Aslan A, Sanati M, Portillo S, Schamiloglu E, Joshi RP. Carbon-oxygen surface formation enhances secondary electron yield in Cu, Ag and Au. Sci Rep 2022; 12:15808. [PMID: 36138077 PMCID: PMC9499956 DOI: 10.1038/s41598-022-19924-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
First-principles calculations coupled with Monte Carlo simulations are used to probe the role of a surface CO monolayer formation on secondary electron emission (SEE) from Cu, Ag, and Au (110) materials. It is shown that formation of such a layer increases the secondary electron emission in all systems. Analysis of calculated total density of states (TDOS) in Cu, Ag, and Au, and partial density of states (PDOS) of C and O confirm the formation of a covalent type bonding between C and O atoms. It is shown that such a bond modifies the TDOS and extended it to lower energies, which is then responsible for an increase in the probability density of secondary electron generation. Furthermore, a reduction in inelastic mean free path is predicted for all systems. Our predicted results for the secondary electron yield (SEY) compare very favorably with experimental data in all three materials, and exhibit increases in SEY. This is seen to occur despite increases in the work function for Cu, Ag, and Au. The present analysis can be extended to other absorbates and gas atoms at the surface, and such analyses will be present elsewhere.
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Affiliation(s)
- M Brown
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX, 79409, USA
| | - L Diaz
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX, 79409, USA
| | - A Aslan
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX, 79409, USA
| | - M Sanati
- Department of Physics and Astronomy, Texas Tech University, Lubbock, TX, 79409, USA
| | - S Portillo
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, 87131, USA
| | - E Schamiloglu
- Department of Electrical and Computer Engineering, University of New Mexico, Albuquerque, NM, 87131, USA
| | - R P Joshi
- Department of Electrical and Computer Engineering, Texas Tech University, Lubbock, TX, 79409, USA.
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Beard DJ, Davies L, Cook JA, Stokes J, Leal J, Fletcher H, Abram S, Chegwin K, Greshon A, Jackson W, Bottomley N, Dodd M, Bourke H, Shirkey BA, Paez A, Lamb SE, Barker K, Phillips M, Brown M, Lythe V, Mirza B, Carr A, Monk P, Morgado Areia C, O'Leary S, Haddad F, Wilson C, Price A. Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial. Lancet 2022; 400:605-615. [PMID: 35988569 DOI: 10.1016/s0140-6736(22)01424-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability. METHODS We did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score-4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367. FINDINGS Between Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5-13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications. INTERPRETATION Surgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management. FUNDING The UK National Institute for Health Research Health Technology Assessment Programme.
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Affiliation(s)
- David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Loretta Davies
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Jonathan A Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Jamie Stokes
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Heidi Fletcher
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Simon Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Katie Chegwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Akiko Greshon
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - William Jackson
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Nicholas Bottomley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matt Dodd
- Swansea Bay University Health Board, Swansea, UK
| | - Henry Bourke
- Heatherwood & Wexham Park Hospitals, Frimley Health NHS Foundation Trust, Slough, UK
| | - Beverly A Shirkey
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Arsenio Paez
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Swansea, UK
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - Vanessa Lythe
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Burhan Mirza
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Paul Monk
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Carlos Morgado Areia
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Sean O'Leary
- Royal Berkshire Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Fares Haddad
- University College Hospitals, University College London Hospitals NHS Foundation Trust, London, UK
| | - Chris Wilson
- University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Kiepiel I, Brown M, Johnson SD. A generalized bird pollination system in Schotia brachypetala (Fabaceae). Plant Biol (Stuttg) 2022; 24:806-814. [PMID: 35500151 DOI: 10.1111/plb.13433] [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] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
Bird pollination systems are diverse, ranging from narrow-tubed flowers pollinated by specialist nectarivores such as hummingbirds and sunbirds, to relatively open flowers pollinated by opportunistic (i.e. generalist) nectarivores. The role of opportunistic avian nectarivores as pollinators has historically been under-appreciated. A key aspect to understanding the importance of opportunistic birds as pollinators is to investigate how efficiently they transfer pollen among flowers. Here, we document the pollination and breeding systems of Schotia brachypetala, a southern African tree known as the 'weeping boer-bean' on account of its prolific production of dilute hexose-dominated nectar. The cup-shaped flowers of this tree attract a large number of bird species, including both opportunistic and specialist nectarivores. We identified floral visitors using observations and camera traps and quantified the floral traits responsible for animal attraction. We documented the breeding system, used selective pollinator exclusion to test the contribution of birds to fecundity, and performed supplemental pollination to test for pollen limitation. Single-visit pollen deposition trials were undertaken to determine the efficacy of bird pollinators. Controlled hand-pollination experiments showed that S. brachypetala is genetically self-incompatible and therefore dependent on pollinators for seed production. Supplemental hand-pollination experiments showed that natural fecundity is limited by either the amount and/or the quality of pollen on stigmas. Flowers from which birds but not insects were experimentally excluded set fewer seeds than open control flowers. Opportunistic birds deposited more pollen per visit than did specialist sunbirds. We conclude that S. brachypetala has a generalized bird pollination system that mainly involves opportunistic nectarivores.
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Affiliation(s)
- I Kiepiel
- Centre for Functional Biodiversity, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - M Brown
- Centre for Functional Biodiversity, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - S D Johnson
- Centre for Functional Biodiversity, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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McCann N, Nabarro L, Morris-Jones S, Patel T, Godbole G, Heyderman R, Brown M. Outpatient management of uncomplicated enteric fever: A case series of 93 patients from the Hospital of Tropical Diseases, London. J Infect 2022; 85:397-404. [PMID: 35781016 DOI: 10.1016/j.jinf.2022.06.025] [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: 03/04/2022] [Revised: 05/04/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Enteric fever is predominantly managed as an outpatient condition in endemic settings but there is little evidence to support this approach in non-endemic settings. This study aims to review the outcomes of outpatients treated for enteric fever at the Hospital of Tropical Diseases in London, UK. METHODS We conducted a retrospective analysis of all patients with confirmed enteric fever between August 2009 and September 2020. Demographic, clinical, laboratory and microbiological data were collected and compared between the inpatient and outpatient populations. Outcomes investigated were complicated enteric fever, treatment failure and relapse. RESULTS Overall, 93 patients (59% male, median age 31) were identified with blood and/or stool culture confirmed enteric fever and 49 (53%) of these were managed as outpatients. The commonest empirical treatment for outpatients was azithromycin (70%) and for inpatients was ceftriaxone (84%). Outpatients were more likely than inpatients to receive only one antibiotic (57% vs 19%, p < 0.01) and receive a shorter duration of antibiotics (median 7 vs 11 days, p <0.01). There were no cases of complicated disease or relapse in either the inpatient or outpatient groups. There was one treatment failure in the outpatient group. Azithromycin was well-tolerated with no reported side effects. CONCLUSIONS Our findings suggest that outpatient management of uncomplicated imported enteric fever is safe and effective with the use of oral azithromycin. Careful monitoring of patients is recommended as treatment failure can occur.
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Affiliation(s)
- N McCann
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK.
| | - L Nabarro
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; St George's University Hospitals NHS Foundation Trust, London, UK
| | - S Morris-Jones
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - T Patel
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | - G Godbole
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Gastrointestinal Pathogens and Food Safety (One Health), United Kingdom Health Security Agency, UK
| | - R Heyderman
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - M Brown
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
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Strydom Z, Waller LJ, Brown M, Fritz H, Shaw K, Venter JA. Factors that influence Cape fur seal predation on Cape gannets at Lambert's Bay, South Africa. PeerJ 2022; 10:e13416. [PMID: 35722261 PMCID: PMC9202551 DOI: 10.7717/peerj.13416] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/19/2022] [Indexed: 01/14/2023] Open
Abstract
Seabird populations experience predation that can impact their breeding density and breeding success. The Cape gannet Morus capensis is endemic to the Benguela upwelling ecosystem and is classified as Endangered by the IUCN. They are affected by several threats, including predation by the Cape fur seal Arctocephalus pusillus pusillus. Many fledglings succumb to predation during their maiden flight across waters around the island. To curb predation, the selective culling of individual predatory seals was implemented in 2014, 2015, and 2018. Our first study objective was to determine if selective culling of Cape fur seals significantly reduced predation probability on Cape gannets. We tested whether predation probability in 2014, 2015, and 2018 was affected by fish biomass, gannet fledgling numbers, and/or the presence/absence of selective culling. Our second objective was to determine what led to fluctuations in Cape fur seal predation on Cape gannet fledglings between 2007 and 2018. We tested whether fish biomass and the amount of Cape gannet fledglings in the water affected predation probability on the fledglings. Results indicated that selective culling reduced predation within years. We found that with both increased fledgling numbers and increased fish biomass, seal predation probability was reduced. This suggests that a sustainable way to promote the conservation of Cape gannets would be to increase food availability for both the Cape fur seals and Cape gannets. Our findings, collectively with the global trend of the declining Cape gannet population and their endemism, provide reasons advocating for the conservation of the food resources of both the Cape fur seal and the Cape gannet in the Benguela system.
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Affiliation(s)
- Zanri Strydom
- Department of Conservation Management, Faculty of Science, Nelson Mandela University, George, South Africa,REHABS International Research Laboratory, CNRS-UCBL-NMU, Nelson Mandela University, George, South Africa
| | - Lauren J. Waller
- Department of Biodiversity and Conservation Biology, University of the Western Cape, Bellville, South Africa,Southern African Foundation for the Conservation of Coastal Birds (SANCCOB), Cape Town, South Africa
| | - Mark Brown
- School of Life Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Hervé Fritz
- Department of Conservation Management, Faculty of Science, Nelson Mandela University, George, South Africa,REHABS International Research Laboratory, CNRS-UCBL-NMU, Nelson Mandela University, George, South Africa
| | - Kevin Shaw
- Scientific Services, CapeNature, Cape Town, South Africa
| | - Jan A. Venter
- Department of Conservation Management, Faculty of Science, Nelson Mandela University, George, South Africa,REHABS International Research Laboratory, CNRS-UCBL-NMU, Nelson Mandela University, George, South Africa
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Cohen L, Danhauer S, Rosenthal DI, Chambers MS, Garcia MK, Cusimano A, Brown M, Dressler EVM, Ochoa J, Yang P, Chiang JS, Gordon O, Crutcher R, Kim JK, Russin MP, Lukenbill J, Porosnicu M, Yost KJ, Weaver KE, Lesser GJ. A phase III, randomized, sham-controlled trial of acupuncture for treatment of radiation-induced xerostomia (RIX) in patients with head and neck cancer: Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB) trial WF-97115. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12004] [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] [Indexed: 11/20/2022] Open
Abstract
12004 Background: The majority of head/neck (HN) patients who undergo radiotherapy develop RIX. Unfortunately, existing treatments are of limited benefit and have side effects. Initial small studies suggest acupuncture may treat chronic RIX. A multicenter, phase III, randomized, sham-controlled trial (NCT02589938) was conducted to compare true acupuncture (TA) with sham acupuncture (SA) and wait list control (WLC) group in treating chronic RIX. Methods: HN patients with chronic RIX at least 12 months post-RT were recruited through the WF NCORP RB network (2UG1CA189824). Patients must have received bilateral radiation therapy with subsequent grade 2 or 3 xerostomia per modified RTOG scale, with no history of xerostomia or other illness known to affect salivation prior to HN XRT. All patients received standard oral hygiene and were randomized to TA, SA, or WLC. Patients in TA and SA were treated 2 times per week for 4 weeks. Those experiencing a marginal response (10-19 point decrease on the Xerostomia questionnaire (XQ)) received another 4 weeks of the respective treatment. Patients who had no response (increase in XQ score or decrease of < 10 points from baseline), partial response (20 or more point decrease in XQ score from baseline), or complete response (XQ score = 0) did not receive further treatment. Patient outcomes including XQ and FACT-HN were collected at baseline, 4, 8, and 12 weeks; the primary endpoint was XQ at 4 weeks. A sample size of 80 per group (240 total), had 80% power to detect a difference of 10 points between groups, assuming two-sided alpha = 0.013 and 20% attrition. Analysis of covariance adjusted for baseline XQ and Bonferroni corrections for pairwise comparisons. Results: 258 from 33 different practices participated. Average age was 65 years, 78% male, and 67% had AJCC stage IV a,b disease. At week 4, there was a group main effect on the XQ (P = 0.02) revealing significant between group differences between TA and WLC (51.1 vs 56.8, P = 0.008), with marginal between group difference between TA and SA (51.1 vs 54.5, P = 0.066) and no difference between SA and WLC (P = 0.36). A similar pattern was seen at week 8 (TA = 48.3, SA = 50.8, WLC = 54.8; only TA vs WLC significant, P = 0.012) and 12 (TA = 48.6, SA = 49.3.8, WLC = 54.6; TA vs WLC, P = 0.02; SA vs WLC, P = 0.04; TA vs SA, P = 0.79). Incidence of clinically significant RIX (XQ scores > 30) followed a similar pattern. The FACT-HN at week 12 revealed statistically and clinically significant group differences for the total score and several subscales between TA vs SA and WLC with no differences between SA and WLC. Completer and mediation analyses will be presented. Conclusions: True acupuncture was more effective in treating chronic RIX and improving QOL one or more years after the end of XRT than sham acupuncture or standard oral hygiene. Clinical trial information: NCT02589938.
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Affiliation(s)
- Lorenzo Cohen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - David Ira Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - M. Kay Garcia
- University of Texas MD Anderson Cancer Center, retired, Houston, TX
| | - Andrew Cusimano
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark Brown
- Wake Forest School of Medicine, Winston Salem, NC
| | | | - Jewel Ochoa
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Peiying Yang
- Department of General Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Joseph S Chiang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ora Gordon
- Providence St Joseph Health, Burbank, CA
| | - Rhonda Crutcher
- Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, CA
| | - Jung K Kim
- The Living Acupuncture, the Center of Wellness, Burbank, CA
| | | | | | | | - Kathleen J Yost
- Cancer Research Consortium of West Michigan, Grand Rapids, MI
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Irby M, Lesser GJ, Penzien D, Dressler EVM, Rini C, Keefe F, Snavely A, Ang D, Danhauer S, Brown M, Blackwell-Young C, Boothe S, Craver K, Lawson H, Pardy M, Stanfield B, Turner J, Vitolins M, Weaver KE. Internet-delivered management of pain among cancer treatment survivors (IMPACTS WF-1901). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12151] [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: 11/20/2022] Open
Abstract
TPS12151 Background: Pain is a common symptom among cancer patients and often is inadequately treated. Treatment guidelines recommend patients have access to behavioral interventions that educate about pain and pain management. Pain coping skills training (PCST) accomplishes these goals through teaching cognitive and behavioral coping skills shown to reduce pain. When delivered in in-person, PCST can substantially improve chronic pain conditions. Yet, these interventions are underused due to myriad barriers (high costs, shortage of therapists, travel needs). There is a critical need for improved options to help reduce cancer-related pain and related impairment that should include evidence-based PCST interventions capable of overcoming access barriers. To address this need, we developed a web-based PCST program using a novel expert systems approach that retains critical features of in-person PCST in an automated program that requires no therapist. PainTRAINER, is an 8-week, interactive PCST program using tailoring algorithms, a knowledge database, and a virtual coach to guide development of essential skills for coping with chronic pain. Methods: With funding from the NIH HEAL Initiative, we have undertaken a randomized, prospective, comparative effectiveness trial through the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base to determine the impact of painTRAINER on pain outcomes when compared to Enhanced Usual Care (EUC). Participants have a documented diagnosis of invasive cancer who are undergoing anticancer therapy or within 5 years of completing all cancer therapy. Participants must report cancer-related pain most days of the week of 4 or greater on the PROMIS Pain Intensity Scale; with pain of new onset or significantly exacerbated since cancer diagnosis. All participants receive usual care provided by their physician along with pain education materials. PainTRAINER arm participants have access to the painTRAINER program and a tutorial on how to use the program, and complete the painTRAINER modules on their own (1 session/week for 8 weeks). To enhance study access, patients without internet availability are provided a WiFi/cellular-enabled tablet during the intervention period. This trial examines short- and long-term outcomes measured immediately post-intervention and 3- and 6- months post-intervention. Primary outcomes are: pre- to post-intervention change in pain interference/severity. Secondary outcomes are: pain severity/interference at 3- and 6-month follow-up, opioid/analgesic use, health-related quality of life, and pain management self-efficacy. Qualitative interviews are conducted with a random sample of diverse participants who have completed the painTRAINER, and all who exit the study early, to subjectively assess experiences with pain and the clinical trial. Enrollment for this trial has begun (n = 36 of 456 patients enrolled) and is ongoing at 12 sites. Clinical trial information: NCT04462302.
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Affiliation(s)
- Megan Irby
- Wake Forest School of Medicine, Clemmons, NC
| | | | | | | | | | | | - Anna Snavely
- Wake Forest School of Medicine, Winston Salem, NC
| | - Dennis Ang
- Wake Forest School of Medicine, Winston Salem, NC
| | | | - Mark Brown
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | - Karen Craver
- Wake Forest School of Medicine, Winston Salem, NC
| | | | | | | | - Julie Turner
- Wake Forest School of Medicine, Winston Salem, NC
| | - Mara Vitolins
- Wake Forest University School of Medicine, Winston Salem, NC
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Karmacharya P, Crowson CS, Poudel D, Davis JM, Ogdie A, Liew J, Ward M, Ishimori M, Weisman M, Brown M, Rahbar M, Hwang M, Reveille JD, Gensler LS. OP0154 COMORBIDITY CLUSTERS IN ANKYLOSING SPONDYLITIS AND THEIR ASSOCIATION WITH DISEASE ACTIVITY AND FUNCTIONAL IMPAIRMENT: DATA FROM THE PSOAS COHORT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundComorbidities in ankylosing spondylitis (AS) occur more frequently than in the general population and are associated with higher morbidity and mortality. Some comorbidities may occur together, making one more likely in the presence of another, and different combinations of comorbidities may have differential considerations for AS management and outcomes.ObjectivesTo examine the association of baseline comorbidities with disease activity and functional status in AS.MethodsWe used baseline data from the Prospective Study Of Ankylosing Spondylitis (PSOAS) cohort, a multicenter, prospective cohort from five centers (4 in the US, 1 in Australia). AS patients ≥ 18 years fulfilling mNY criteria for AS (2002-20) were included. Patient-reported AS comorbidities (N=28) and extra-musculoskeletal manifestations (EMMs, N=2) within 3 years of enrollment (prespecified on the baseline case-report form) and only those occurring in ≥1% were included. Undocumented comorbidities were assumed to be absent if missing in <15% of patients, and those missing in >50% of patients were excluded. Comorbidity clusters were identified using K-median clustering. The optimal number of clusters was determined using scree plot of the sum of squared errors and “elbow” on the graph line. Baseline characteristics of the clusters were compared, and associations of with disease activity and functional status measures (primary outcomes: ASDAS-CRP and BASFI) were examined using linear regression adjusted for age and sex.ResultsThere were 1,270 AS patients included with a mean age of 44.6 ±14.3 years, 74.4% males, and 81.2% whites. Mean AS symptom duration was 20.6±5.6 years, 81.6% HLA-B27 positive, and CRP elevated in 27.5% of patients at baseline. Depression was the most prevalent comorbidity (31.4%) followed by hypertension (26.1%); uveitis was the most common EMM (30.4%). The five clusters identified included depression (27%), no comorbidities (22%), hypertension (21%), uveitis (20%), and asthma/low bone mass (10%) (Figure 1). The cluster with no comorbidities was significantly younger, with lower symptom duration (p<0.001). Females had higher odds of being in the depression (OR=2.00, 95% CI 1.38- 2.90) and uveitis (OR=2.09, 95% CI 1.41-3.11) clusters compared to the cluster with no comorbidities. The number of comorbidities and clusters with depression and hypertension were significantly associated with worse disease activity and functional status (Table 1).Table 1.Age and sex adjusted associations between comorbidity clusters, compared to cluster 3, and baseline disease activity/ functional status measures in ankylosing spondylitis based on Linear regression models.Cluster 1 (depression)Cluster 3 (hypertension)Cluster 4 (uveitis)Cluster 5 (asthma, low bone mass)OutcomesCoef (95% CI)Coef (95% CI)Coef (95% CI)Coef (95% CI)ASDAS-CRP0.98 (0.78-1.18)0.43 (0.18-0.68)0.04 (-0.19-0.27)0.16 (-0.12-0.44)BASFI (0-10)1.92 (1.51-2.34)1.00 (0.53-1.48)-0.03 (-0.49-0.42)0.64 (0.076-1.20)Enthesitis count1.17 (0.73-1.61)0.73 (0.19-1.26)0.18 (-0.32-0.68)0.48 (-0.13-1.08)Swollen joint count (0-44)0.27 (-0.08-0.62)0.43 (-0.01-0.86)0.31 (-0.09-0.71)-0.95 (-0.58-0.39)Tender joint count (0-46)1.24 (0.59-1.88)0.44 (-0.34-1.23)0.56 (-0.18-1.29)0.34 (-0.55-1.23)BASDAI (0-10)2.30 (1.88-2.71)0.88 (0.36-1.40)0.30 (-0.17-0.78)0.61 (0.03-1.19)Patient Global (0-10)2.25 (1.82-2.68)0.76 (0.21-1.30)-0.22 (-0.71-0.27)0.29 (-0.31-0.89)Patient Pain (0-10)2.45 (1.95-2.94)1.00 (0.37-1.62)0.19 (-0.38-0.75)0.16 (-0.54-0.85)Spinal pain (0-10)2.40 (1.89-2.91)1.05 (0.41-1.70)0.43 (-0.16-1.01)0.76 (0.04-1.47)Figure 1.Comorbidity clusters in PSOAS cohort at baselineConclusionDistinct comorbidity clusters were identified in AS patients in the PSOAS cohort. In addition to the number of comorbidities, the type of comorbidity seems to be important. Depression and hypertension clusters seem to be associated with worse disease activity and function.Disclosure of InterestsParas Karmacharya: None declared, Cynthia S. Crowson: None declared, Dilli Poudel: None declared, John M Davis III Consultant of: Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each), Grant/research support from: Dr. Davis has received research support from Pfizer., Alexis Ogdie Consultant of: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Gilead, Janssen, Lilly, Novartis, Pfizer, and UCB (less than 10,000 each), Grant/research support from: Dr. Ogdie has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000)., Jean Liew Grant/research support from: Dr. Liew received grant/research support from Pfizer (> $10,000), Michael Ward: None declared, Mariko Ishimori: None declared, Michael Weisman Consultant of: Dr. Weisman received consulting fees for Novartis, UCB, Gilead, and GSK (< $10,000)., Matthew Brown: None declared, Mohammad Rahbar: None declared, Mark Hwang: None declared, John D Reveille Consultant of: JDR received consulting fees for UCB (< $10,000), Grant/research support from: Dr. Reveille received research support from Lilly and Janssen unrelated to this work., Lianne S. Gensler Consultant of: Dr. Gensler has received consulting fees for AbbVie, Eli Lilly, GSK, Gilead, Pfizer (< $10,000)., Grant/research support from: Dr. Gensler received grant/research support from UCB and Novartis (> $10,000).
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Van der Heijde D, Baraliakos X, Dougados M, Brown M, Poddubnyy D, Van den Bosch F, Haroon N, Xu H, Tomita T, Gensler LS, Oortgiesen M, Fleurinck C, Vaux T, Marten A, Deodhar A. OP0019 BIMEKIZUMAB IN PATIENTS WITH ACTIVE ANKYLOSING SPONDYLITIS: 24-WEEK EFFICACY & SAFETY FROM BE MOBILE 2, A PHASE 3, MULTICENTRE, RANDOMISED, PLACEBO-CONTROLLED STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundBimekizumab (BKZ) is a monoclonal IgG1 antibody that selectively inhibits IL-17F in addition to IL-17A. In a phase 2b study, BKZ showed rapid and sustained efficacy and was well tolerated up to 156 weeks (wks) in patients (pts) with active ankylosing spondylitis (AS).1,2ObjectivesTo assess efficacy and safety of BKZ vs placebo (PBO) in pts with active AS up to Wk 24 in the ongoing pivotal phase 3 study, BE MOBILE 2.MethodsBE MOBILE 2 (NCT03928743) comprises a 16-wk double-blind, PBO-controlled period and 36-wk maintenance period. Pts were aged ≥18 yrs, met modified New York criteria and had active AS (BASDAI ≥4, spinal pain ≥4) at BL. Pts were randomised 2:1, BKZ 160 mg Q4W:PBO. From Wk 16, all pts received BKZ 160 mg Q4W. Primary and secondary efficacy endpoints were assessed at Wk 16.ResultsOf 332 randomised pts (BKZ: 221; PBO: 111), 322 (97.0%) completed Wk 16 and 313 (94.3%) Wk 24. BL characteristics were comparable between groups: mean age 40.4 yrs, symptom duration 13.5 yrs; 72.3% pts male, 85.5% HLA-B27+, 16.3% TNFi-experienced. At Wk 16, the primary (ASAS40: 44.8% BKZ vs 22.5% PBO; p<0.001) and all ranked secondary endpoints were met (Table 1). Responses with BKZ were rapid, including in PBO pts who switched to BKZ at Wk 16, and increased to Wk 24 (Figure 1; Table 1). Substantial reductions of hs-CRP by Wk 2 and MRI SIJ and spine inflammation by Wk 16 were achieved with BKZ vs PBO (Table 1). At Wk 24, ≥50% pts had achieved ASDAS <2.1 (Figure 1).Table 1.Efficacy at Wks 16 and 24BLWk 16Wk 24PBO N=111BKZ 160 mg Q4W N=221PBO N=111BKZ 160 mg Q4W N=221p valuePBO→BKZ 160 mg Q4W N=111BKZ 160 mg Q4W N=221Ranked endpoints in hierarchical orderASAS40* [NRI] n (%)--25 (22.5)99 (44.8)<0.00163 (56.8)119 (53.8)ASAS40 in TNFi-naïve† [NRI] n (%)--22 (23.4)a84 (45.7)b<0.00156 (59.6)a100 (54.3)bASAS20† [NRI]n (%)--48 (43.2)146 (66.1)<0.00185 (76.6)159 (71.9)BASDAI CfB† [MI] mean (SE)6.5 (0.1)6.5 (0.1)–1.9 (0.2)–2.9 (0.1)<0.001–3.3 (0.2)–3.3 (0.1)ASAS PR† [NRI]n (%)--8 (7.2)53 (24.0)<0.00128 (25.2)56 (25.3)ASDAS-MI† [NRI] n (%)--6 (5.4)57 (25.8)<0.00143 (38.7)67 (30.3)ASAS 5/6† [NRI]n (%)--16 (14.4)94 (42.5)<0.00157 (51.4)107 (48.4)BASFI CfB† [MI] mean (SE)5.2 (0.2)5.3 (0.2)–1.1 (0.2)–2.2 (0.1)<0.001–2.2 (0.2)–2.4 (0.2)Nocturnal spinal pain CfB† [MI]mean (SE)6.8 (0.2)6.6 (0.1)–1.9 (0.2)–3.3 (0.2)<0.001–3.7 (0.3)–3.8 (0.2)ASQoL CfB† [MI] mean (SE)8.5 (0.4)9.0 (0.3)–3.2 (0.3)–4.9 (0.3)<0.001–4.9 (0.4)–5.4 (0.3)SF-36 PCS CfB† [MI] mean (SE)34.6 (0.8)34.4 (0.6)5.9 (0.8)9.3 (0.6)<0.00110.6 (0.8)10.8 (0.6)BASMI CfB† [MI] mean (SE)3.8 (0.2)3.9 (0.1)–0.2 (0.1)–0.5 (0.1)0.005–0.5 (0.1)–0.6 (0.1)Other endpointsnEnthesitis-free state†c [NRI]n (%)--22 (32.8)d68 (51.5)e-33 (49.3)d70 (53.0)eASAS40 in TNFi-experienced [NRI]n (%)--3 (17.6)f15 (40.5)g---ASDAS-CRP CfB [MI]mean (SE)3.7 (0.1)3.7 (0.1)–0.7 (0.1)–1.4 (0.1)-–1.7 (0.1)–1.6 (0.1)hs-CRP (mg/L) [MI] geometric mean (median)6.7 (6.3)6.5 (8.2)6.0 (6.3)2.4 (2.4)-1.9 (2.2)2.1 (2.3)MRI spine Berlin CfBh [OC] mean (SD)3.3 (4.9)i3.8 (5.3)j0.0 (1.4)k–2.3 (3.9)l---SPARCC MRI SIJ score CfBh [OC] mean (SD)5.8 (7.7)i7.4 (10.7)m1.1 (6.9)k–5.6 (9.9)l---Randomised set. *Primary endpoint; †Secondary endpoint; an=94; bn=184; cMASES=0 in pts with BL MASES >0; dn=67; en=132; fn=17; gn=37; hIn pts in MRI sub-study; in=45; jn=82; kn=43; ln=79; mn=83; nNominal p values not shown.Over 16 wks, 120/221 (54.3%) BKZ pts had ≥1 TEAE vs 48/111 (43.2%) PBO; three most frequent on BKZ were nasopharyngitis (BKZ: 7.7%; PBO: 3.6%), headache (4.1%; 4.5%) and oral candidiasis (4.1%; 0%). No systemic candidiasis was observed. Up to 16 wks, incidence of SAEs was low (1.8%; 0.9%); no MACE or deaths were reported; 2 (0.9%) IBD cases occurred in pts on BKZ.ConclusionDual inhibition of IL-17A and IL-17F with BKZ in pts with active AS resulted in rapid, clinically relevant improvements in efficacy outcomes vs PBO. No new safety signals were observed.1,2References[1]van der Heijde D. Ann Rheum Dis 2020;79:595–604; 2. Gensler L. Arthritis Rheumatol 2021;73(suppl 10):0491.AcknowledgementsThis study was funded by UCB Pharma. Editorial services were provided by Costello Medical.Disclosure of InterestsDésirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma, Employee of: Imaging Rheumatology BV (Director), Xenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer, and UCB Pharma, Maxime Dougados Consultant of: AbbVie, Eli Lilly, Novartis, Merck, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, Novartis, Pfizer, and UCB Pharma, Matt Brown Speakers bureau: Novartis, Consultant of: Pfizer, Clementia, Ipsen, Regeneron, Grey Wolf Therapeutics, Grant/research support from: UCB Pharma, Denis Poddubnyy Speakers bureau: AbbVie, BMS, Eli Lilly, MSD, Novartis, Pfizer, and UCB Pharma, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GSK, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB Pharma, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Filip van den Bosch Speakers bureau: AbbVie, Bristol Myers-Squibb, Celgene, Janssen, Merck, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Amgen, Eli Lilly, Galapagos, Janssen, Merck, Novartis, Pfizer and UCB Pharma, Nigil Haroon Consultant of: AbbVie, Amgen, Janssen, Merck, Novartis and UCB Pharma, Huji Xu: None declared, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, Bristol-Myers Squibb, Eisai, Eli Lilly, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis, and Pfizer, Consultant of: AbbVie, Eli Lilly, Gilead, Novartis, and Pfizer, Lianne S. Gensler Consultant of: AbbVie, Eli Lilly, Gilead, GSK, Novartis, Pfizer, and UCB Pharma, Grant/research support from: Novartis, Pfizer, and UCB Pharma; paid to institution, Marga Oortgiesen Employee of: UCB Pharma, Carmen Fleurinck Employee of: UCB Pharma, Thomas Vaux Employee of: UCB Pharma, Alexander Marten Employee of: UCB Pharma, Atul Deodhar Speakers bureau: Janssen, Novartis, and Pfizer; consultant of AbbVie, Amgen, Aurinia, BMS, Celgene, Eli Lilly, GSK, Janssen, MoonLake, Novartis, Pfizer, and UCB Pharma, Grant/research support from: AbbVie, Eli Lilly, GSK, Novartis, Pfizer, and UCB Pharma.
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Abstract
Little is known about the impact of proning on oxygenation and ventilatory efficiency on patients with severe Covid-19. In this retrospective observational study we calculated Pa/FiO2 ratio (P/F) as a marker of oxygenation and dead space fraction (Vd/Vt) to assess ventilation. 12 patients who were proned twice or more were included. There was a significant improvement in P/F ratio when prone (110.18 ± 28.11) compared to supine (88.95 ± 19.34) (p < 0.01). There was no improvement in Vd/Vt on proning (p > 0.05). Vd/Vt as a function of time displayed a positive linear correlation in those who did not survive (n = 9) (Rs = 0.48, p < 0.01) but no observed correlation in those who survived (n = 3) (Rs = 0.002, p = 0.97). Our findings indicate that prone position in patients with Covid-19 has little effect on dead space fraction but does improve oxygenation. Rise in dead space with time appears to be a prognostic factor for death in patients with severe Covid- 19.
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Affiliation(s)
- T Sharp
- Barts Health NHS Trust, London, UK
| | | | - M Brown
- Barts Health NHS Trust, London, UK
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Hall N, Constantinou M, Brown M, Beck B, Steele M, Rousseau J, Kuys S. Profiles of Recruits Entering Army Basic Training in New Zealand. Mil Med 2022; 188:usac090. [PMID: 35411371 PMCID: PMC10363008 DOI: 10.1093/milmed/usac090] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/15/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A high incidence of musculoskeletal injuries is sustained by army recruits during basic training. Describing recruits' personal, lifestyle, and physical performance characteristics at the entry to training can help identify existing intrinsic risk factors that may predispose some recruits to injury. Identifying modifiable and preventable intrinsic risk factors may contribute to lower recruit injury and associated burdens during the course of basic training. The aim of this study was to therefore describe the profile of New Zealand Army recruits upon entry to basic training using personal, lifestyle, and physical performance characteristics. METHODS New Zealand Army male and female recruits from two intakes in the same year were invited to participate. Recruits' data on personal (sex, age, height, and weight), lifestyle (self-reported responses to the Military Pre-training Questionnaire comprising physical and injury history, diet, alcohol, and smoking status) and physical performance characteristics (2.4-km timed run, weight-bearing dorsiflexion lunge test, and the Y Balance TestTM for lower limb dynamic stability) were collected and analyzed. RESULTS Participants included 248 New Zealand Army recruits: 228 males (91.9%), 20 females (8.1%), average age of 20.3 ± 2.8 years. Findings indicated 30.9% of recruits reported injury in the 12 months prior to training commencing, with 44.8% of those injuries in the lower limbs. Pre-entry alcohol consumption was higher than recommended and 20.1% of recruits identified as current smokers. Recruits who passed the 2.4-km timed run included 53.8% of males and 28.6% of females. Weight-bearing dorsiflexion lunge test performance was within a normal range (right = 10.3 ± 3.3 cm), however limb asymmetry (>1.5 cm) was present with 30.9% of recruits. For the Y Balance TestTM for dynamic lower limb stability, 70% of female recruits had high posterolateral reach asymmetry (8.1 ± 6.0 cm), while normalized composite reach scores were low (right) for male (92.2 ± 8.1%) and female recruits (89.0 ± 7.5%). CONCLUSIONS New Zealand Army recruits entering basic training were predominantly active young males, reported few injuries in the previous year, had higher than recommended alcohol consumption and a minority were smokers. The majority of recruits had low aerobic fitness, average ankle dorsiflexion range, and low dynamic lower limb stability. While a number of adverse characteristics identified are potentially modifiable, more research is required to identify an association to musculoskeletal injury risk in New Zealand Army recruits. Describing the profile of recruits entering training, particularly recruits at risk of injury is one of the first steps in injury prevention.
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Affiliation(s)
- Narelle Hall
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
| | - Maria Constantinou
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
| | - Mark Brown
- Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
| | - Belinda Beck
- School of Allied Health Sciences, Exercise and Sport, Gold Coast Campus, Griffith University, Southport, QLD 4215, Australia
| | - Michael Steele
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
| | - Jacques Rousseau
- Human Performance Cell, Joint Support Group, New Zealand Army, Upper Hutt 5018, New Zealand
| | - Suzanne Kuys
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, Banyo, QLD 4014, Australia
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Barat M, Duran J, Sung K, Brown M, Lin A, King K, Adler E, Aslam S. Breakthrough Infections and Low Mortality Observed in Heart Transplant Recipients Infected with COVID-19 at UC San Diego. J Heart Lung Transplant 2022. [PMCID: PMC8988601 DOI: 10.1016/j.healun.2022.01.805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusion
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Brown M, Cruz Rodgriguez J, Duran J, Tran H, Urey M, Silva J, Winnike K, Topik A, Anguiano H, Kearns M, Pretorius V, Adler E. Outcomes in Cardiac Transplantation in Patients with a History of Methamphetamine Use: A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1668] [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: 10/18/2022] Open
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Van der Walt IS, Brown M, Lodh S. Adrenal gland-sparing transcatheter embolisation of an aldosteronoma for the treatment of refractory hypertension. Radiol Case Rep 2022; 17:1088-1094. [PMID: 35169406 PMCID: PMC8829521 DOI: 10.1016/j.radcr.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/26/2022] Open
Abstract
In patients with hypertension secondary to aldosterone secreting adrenal adenomas, medical and surgical treatments are both well described, with trans-catheter arterial embolization an uncommon form of therapy, currently. In patients where medical therapy has not provided sufficient response, and where surgical therapy is not deemed appropriate, trans-catheter arterial embolization of aldosteronomas has shown promise in a number of case series. We present the case of a 69-year-old man with hypertension refractory to medical therapy, and deemed not to be a surgical candidate for laparoscopic adrenalectomy. The patient underwent successful selective embolization of a functional adrenal adenoma, with sustained improvement in his prior hypertension, and without major complication. We conclude that trans-catheter embolization, when performed in the carefully selected suitable candidate, is a promising therapeutic option, and warrants a cohort study to assess long term outcomes.
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Bui C, Schneider L, Brown M, McIlvennan C, Char D, Hollander S. Bereaved Caregiver Perspectives on Implantation and End of Life in Pediatric Ventricular Assist Device Patients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1269] [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: 11/27/2022] Open
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Johnson S, Gordijn S, Damhuis S, Ganzevoort W, Brown M, von Dadelszen P, Magee LA, Khalil A. Diagnosis and Monitoring of White Coat Hypertension in Pregnancy: an ISSHP Consensus Delphi Procedure. Hypertension 2022; 79:993-1005. [PMID: 35263999 DOI: 10.1161/hypertensionaha.121.18356] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is no accepted definition or standardized monitoring for white coat hypertension in pregnancy. This Delphi procedure aimed to reach consensus on out-of-office blood pressure (BP) monitoring, and white coat hypertension diagnostic criteria and monitoring. METHOD Relevant international experts completed three rounds of a modified Delphi questionnaire. For each item, the predefined cutoff for group consensus was ≥70% agreement, with 60% to 70% considered to warrant reconsideration at the subsequent round, and <60% considered insufficient to warrant consideration. RESULTS Of 230 experts, 137 completed the first round and 114 (114/137, 83.2%) completed all three. For out-of-office BP monitoring, there was consensus that home BP monitoring (HBPM) should be chosen; instructions given, pairs of BP values taken, opportunity given for women to qualify values they do not regard as valid, and BP considered evaluated when ≥25% of values are above a cutoff. For HBPM, BP should be taken at least 2 to 3 d/wk, at minimum in the morning; however, many factors may affect frequency and timing. Experts endorsed a clinic BP <140/90 mm Hg as normal. While not reaching consensus, most agreed that HBPM values should be lower than clinic BP. Among those, HBPM <135/85 mm Hg was considered normal. There was consensus that white coat hypertension warrants: HBPM at least 1 d/wk before 20 weeks, 2 to 3 d/wk after 20 weeks or if persistent hypertension develops, and symptom monitoring (ie, headache, visual symptoms, and right upper quadrant/epigastric pain). CONCLUSIONS Consensus-based diagnostic criteria and monitoring strategies should inform clinical care and research, to facilitate evaluation of out-of-office BP monitoring on pregnancy outcomes.
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Affiliation(s)
- Sonia Johnson
- Barts and the London Medical School, Queen Mary University of London, United Kingdom (S.J.)
| | - Sanne Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands (S.G., S.D.)
| | - Stefanie Damhuis
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, the Netherlands (S.G., S.D.)
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, University of Amsterdam, the Netherlands (W.G.)
| | - Mark Brown
- Department of Renal Medicine, St. George Hospital and University of New South Wales, Sydney, Australia (M.B.)
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom (P.v.D., L.A.M.)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, United Kingdom. (A.K.).,Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, United Kingdom. (A.K.)
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Slatnick BL, Yu LJ, Yang A, Wu KC, Crum R, Betit P, Brown M, Pires C, Priest J, Staffa SJ, Weldon C, Fishman SJ, Kim HB, Demehri F. Early Experiences Designing a Scalable COVID-19 Reusable Elastomeric Respirator. J Med Device 2022. [DOI: 10.1115/1.4054055] [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: 11/08/2022] Open
Abstract
Abstract
The COVID-19 pandemic created an unprecedented shortage of personal protective equipment (PPE) for healthcare workers - especially respirators. In response to a lack of commercial respirator equipment, a multidisciplinary prototyping hackathon was held and the key components required to develop an inexpensive, scalable "COVID-19 Reusable Elastomeric Respirator" (RER-19) were identified. Available hospital supplies were assessed based on their published technical specifications to meet each of the key component requirements. The fully assembled prototype was then validated through user testing, and volunteers underwent standard fit testing with cardiopulmonary monitoring while wearing the RER-19 in a small pilot study. Multiple social media platforms were then used to disseminate educational information on respirator assembly, use, and maintenance. Here we present our institution's initial experience with prototyping to meet a specific healthcare challenge, in combination with prompt dissemination of information to educate and empower healthcare workers in the face of a critical PPE shortage during an unprecedented and evolving pandemic.
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Affiliation(s)
| | | | | | - Kyle C. Wu
- Boston Children's Hospital, Boston MA; Brigham and Women's Hospital, Boston MA
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