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Melhado C, Russell KW, Acker SN, Padilla BE, Lofberg K, Spurrier RG, Robinson B, Chao S, Ignacio RC, Ryan M, Jensen AR. Corrigendum to "Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study" [J Pediatr Surg 59 (2024) 326-330]. J Pediatr Surg 2024:S0022-3468(24)00153-2. [PMID: 38599908 DOI: 10.1016/j.jpedsurg.2024.03.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Caroline Melhado
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA
| | | | | | | | | | | | - Bryce Robinson
- University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Mark Ryan
- University of Texas Southwestern, Dallas, TX, USA
| | - Aaron R Jensen
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
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Melhado C, Durand R, Russell KW, Polukoff NE, Rampton J, Iyer RR, Acker SN, Koehler R, Prendergast C, Stence N, O'Neill B, Padilla BE, Jamshidi R, Vaughn JA, Ronecker JS, Selesner L, Lofberg K, Regner M, Thiessen J, Sayama C, Spurrier RG, Ross EE, Liu CSJ, Chu J, McNevin K, Beni C, Robinson BRH, Linnau K, Buckley RT, Chao SD, Sabapaty A, Tong E, Prolo LM, Ignacio R, Floan Sachs G, Kruk P, Gonda D, Ryan M, Pandya S, Koral K, Braga BP, Auguste K, Jensen AR. The Sensitivity of Limited-Sequence MRI in Identifying Pediatric Cervical Spine Injury: A Western Pediatric Surgery Research Consortium Multicenter Retrospective Cohort Study. J Trauma Acute Care Surg 2024:01586154-990000000-00674. [PMID: 38523120 DOI: 10.1097/ta.0000000000004271] [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: 03/26/2024]
Abstract
INTRODUCTION Clinical clearance of a child's cervical spine after trauma is often challenging due to impaired mental status or an unreliable neurologic examination. Magnetic resonance imaging (MRI) is the gold standard for excluding ligamentous injury in children but is constrained by long image acquisition times and frequent need for anesthesia. Limited-sequence MRI (LSMRI) is used in evaluating the evolution of traumatic brain injury and may also be useful for cervical spine clearance while potentially avoiding the need for anesthesia. The purpose of this study was to assess the sensitivity and negative predictive value of LSMRI as compared to gold standard full-sequence MRI as a screening tool to rule out clinically significant ligamentous cervical spine injury. METHODS We conducted a ten-center, five-year retrospective cohort study (2017-2021) of all children (0-18y) with a cervical spine MRI after blunt trauma. MRI images were re-reviewed by a study pediatric radiologist at each site to determine if the presence of an injury could be identified on limited sequences alone. Unstable cervical spine injury was determined by study neurosurgeon review at each site. RESULTS We identified 2,663 children less than 18 years of age who underwent an MRI of the cervical spine with 1,008 injuries detected on full-sequence studies. The sensitivity and negative predictive value of LSMRI were both >99% for detecting any injury and 100% for detecting any unstable injury. Young children (age < 5 years) were more likely to be electively intubated or sedated for cervical spine MRI. CONCLUSION LSMRI is reliably detects clinically significant ligamentous injury in children after blunt trauma. To decrease anesthesia use and minimize MRI time, trauma centers should develop LSMRI screening protocols for children without a reliable neurologic exam. LEVEL OF EVIDENCE 2 (Diagnostic Tests or Criteria).
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Affiliation(s)
- Caroline Melhado
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
| | - Rachelle Durand
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin E Ross
- Children's Hospital Los Angeles, Los Angeles, CA
| | | | - Jason Chu
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Kathryn McNevin
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Catherine Beni
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Bryce R H Robinson
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Ken Linnau
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | - Robert T Buckley
- University of Washington School of Medicine, and Harborview Medical Center, Seattle, WA
| | | | | | | | | | | | | | - Peter Kruk
- University of California San Diego, San Diego, CA
| | - David Gonda
- University of California San Diego, San Diego, CA
| | - Mark Ryan
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Samir Pandya
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Korgun Koral
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | - Bruno P Braga
- University of Texas Southwestern, and Children's Medical Center, Dallas, TX
| | | | - Aaron R Jensen
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA
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3
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Melhado C, Russell KW, Acker SN, Padilla BE, Lofberg K, Spurrier RG, Robinson B, Chao S, Ignacio RC, Ryan M, Jensen AR. Cervical Collar-Associated Pressure Injury in Pediatric Trauma Patients: A Western Pediatric Surgery Research Consortium Study. J Pediatr Surg 2024; 59:326-330. [PMID: 38030530 DOI: 10.1016/j.jpedsurg.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Healthcare-associated pressure injuries (HAPI) are known to be associated with medical devices and are preventable. Cervical spine immobilization is commonly utilized in injured children prior to clinical clearance or for treatment of an unstable cervical spinal injury. The frequency of HAPI has been quantified in adults with cervical spine immobilization but has not been well-described in children. The aim of this study was to describe characteristics of children who developed HAPI associated with cervical immobilization. METHODS We analyzed a retrospective cohort of children (0-18 years) who developed a stage two or greater cervical HAPI. This cohort was drawn from an overall sample of 49,218 registry patients treated over a five-year period (2017-2021) at ten pediatric trauma centers. Patient demographics, injury characteristics, and cervical immobilization were tabulated to describe the population. RESULTS The cohort included 32 children with stage two or greater cervical HAPI. The median age was 5 years (IQR 2-13) and 78% (n = 25) were admitted to the intensive care unit. The median (IQR) time to diagnosis of HAPI was 11 (7-21) days post-injury. The majority of cervical HAPI (78%, 25/32) occurred in children requiring immobilization for cervical injuries, with only four children developing HAPI after wearing a prophylactic cervical collar in the absence of a cervical spine injury. CONCLUSION Advanced-stage HAPI associated with cervical collar use in pediatric trauma patients is rare and usually occurs in patients with cervical spine injuries requiring immobilization for treatment. More expedient cervical spine clearance with MRI is unlikely to substantially reduce cervical HAPI in injured children. LEVEL OF EVIDENCE Level III (Epidemiologic and Prognostic).
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Affiliation(s)
- Caroline Melhado
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
| | | | | | | | | | | | - Bryce Robinson
- University of Washington School of Medicine, Seattle, WA, USA.
| | | | | | - Mark Ryan
- University of Texas Southwestern, Dallas, TX, USA.
| | - Aaron R Jensen
- University of California San Francisco, UCSF Benioff Children's Hospitals, San Francisco, CA, USA.
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Naiditch JA, Notrica DM, Sayrs LW, Linnaus M, Stottlemyre R, Garcia NM, Lawson KA, Cohen AS, Letton RW, Johnson J, Maxson RT, Eubanks JW, Ryan M, Alder A, Ponsky TA, St Peter SD, Bhatia AM, Leys CM. The use and timing of angio-embolization in pediatric blunt liver and spleen injury. J Trauma Acute Care Surg 2024:01586154-990000000-00601. [PMID: 38189680 DOI: 10.1097/ta.0000000000004228] [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: 01/09/2024]
Abstract
BACKGROUND Nonoperative management (NOM) is the standard of care for the management of blunt liver and spleen injuries (BLSI) in the stable pediatric patient. Angiography with embolization (AE) is utilized as an adjunctive therapy in the management of adult BLSI patients, but it is rarely utilized in the pediatric population. In this planned secondary analysis, we describe the current utilization patterns of AE in the management of pediatric BLSI. METHODS After obtaining IRB approval at each center, cohort data was collected prospectively for children admitted with BLSI confirmed on CT at 10 Level 1 pediatric trauma centers (PTCs) throughout the United States from April 2013 to January 2016. All patients who underwent angiography with or without embolization for a BLSI were included in this analysis. Data collected included patient demographics, injury details, organ injured and grade of injury, CT finding specifics such as contrast blush, complications, failure of NOM, time to angiography and techniques for embolization. RESULTS Data were collected for 1004 pediatric patients treated for BLSI over the study period, 30 (3.0%) of which underwent angiography with or without embolization for BLSI. Ten of the patients who underwent angiography for BLSI failed NOM. For patients with embolized splenic injuries, splenic salvage was 100%. Four of 9 patients undergoing embolization of the liver ultimately required an operative intervention, but only one patient required hepatorrhaphy and no patient required hepatectomy after AE. Few angiography studies were obtained early during hospitalization for BLSI, with only 1 patient undergoing angiography within 1 hour of arrival at the PTC, and 7 within 3 hours. CONCLUSIONS Angioembolization is rarely utilized in the management of BLSI in pediatric trauma patients with blunt abdominal trauma and is generally utilized in a delayed fashion. However, when implemented, angioembolization is associated with 100% splenic salvage for splenic injuries. LEVEL OF EVIDENCE Level IV, therapeutic/care management.
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Affiliation(s)
- Jessica A Naiditch
- University of Texas - Austin Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, TX
| | | | - Lois W Sayrs
- Children's Hospital of Orange County Research Institute, Orange County, CA
| | - Maria Linnaus
- Children's Hospital of Orange County Research Institute, Orange County, CA
| | | | - Nilda M Garcia
- University of Texas - Austin Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, TX
| | - Karla A Lawson
- University of Texas - Austin Dell Medical School, Dell Children's Medical Center of Central Texas, Austin, TX
| | | | - Robert W Letton
- Division of Pediatric Surgery, Nemours Children's Healthcare, Jacksonville, FL
| | - Jeremy Johnson
- Trauma Services, Oklahoma Children's Hospital, Oklahoma City, OK
| | - R Todd Maxson
- Department of Surgery, Arkansas Children's Hospital, Little Rock, AR
| | - James W Eubanks
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, Memphis, TN
| | - Mark Ryan
- Trauma Services, Dallas Children's Medical Center, Dallas, TX
| | - Adam Alder
- Trauma Services, Dallas Children's Medical Center, Dallas, TX
| | - Todd A Ponsky
- Division of Pediatric Surgery, Akron Children's Hospital, Akron, OH
| | | | | | - Charles M Leys
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Martin RL, Takla A, Disantis A, Kohlrieser D, Enseki K, Lifshitz L, Grant L, Bizzini M, Voight M, Ryan M, McGovern R, Tyler T, Steinfeld-Mass Y, Campbell A, Zhang Y. Evaluating Functional Performance Tests in those with Non-arthritic Intra-articular Hip Pain: An International Consensus Statement. Int J Sports Phys Ther 2023; 18:1346-1355. [PMID: 38050542 PMCID: PMC10693491 DOI: 10.26603/001c.89269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 12/06/2023] Open
Abstract
Background Non-arthritic intra-articular hip pain, caused by various pathologies, leads to impairments in range of motion, strength, balance, and neuromuscular control. Although functional performance tests offer valuable insights in evaluating these patients, no clear consensus exists regarding the optimal tests for this patient population. Purpose This study aimed to establish expert consensus on the application and selection of functional performance tests in individuals presenting with non-arthritic intra-articular hip pain. Study Design A modified Delphi technique was used with fourteen physical therapy experts, all members of the International Society for Hip Arthroscopy (ISHA). The panelists participated in three rounds of questions and related discussions to reach full consensus on the application and selection of functional performance tests. Results The panel agreed that functional performance tests should be utilized at initial evaluation, re-evaluations, and discharge, as well as criterion for assessing readiness for returning to sports. Tests should be as part of a multimodal assessment of neuromuscular control, strength, range of motion, and balance, applied in a graded fashion depending on the patient's characteristics. Clinicians should select functional performance tests with objective scoring criteria and prioritize the use of tests with supporting psychometric evidence. A list of recommended functional performance tests with varying intensity levels is provided. Low-intensity functional performance tests encompass controlled speed in a single plane with no impact. Medium-intensity functional performance tests involve controlled speed in multiple planes with low impact. High-intensity functional performance tests include higher speeds in multiple planes with higher impact and agility requirements. Sport-specific movement tests should mimic the patient's particular activity or sport. Conclusion This international consensus statement provides recommendations for clinicians regarding selection and utilization of functional performance tests for those with non-arthritic intra-articular hip pain. These recommendations will encourage greater consistency and standardization among clinicians during a physical therapy assessment.
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Affiliation(s)
| | - Amir Takla
- Swinburne University of Technology
- Australian Sports Physiotherapy
- Hip Arthroscopy Australia
| | | | | | | | | | | | | | - Mike Voight
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Mark Ryan
- The Steadman Clinic Steadman Philippon Research Institute
| | | | | | | | - Ashley Campbell
- Nashville Hip Institute at TOA
- School of Physical Therapy Belmont University
| | - Yongni Zhang
- Duquesne University
- Duquesne - China Health Institute
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Cardwell K, Clyne B, Broderick N, Tyner B, Masukume G, Larkin L, McManus L, Carrigan M, Sharp M, Smith SM, Harrington P, Connolly M, Ryan M, O'Neill M. Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study. Public Health 2023; 225:343-352. [PMID: 37979311 DOI: 10.1016/j.puhe.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/11/2023] [Accepted: 10/10/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. METHODS Semi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. RESULTS Lessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. CONCLUSIONS Overall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Clyne
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - G Masukume
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - L McManus
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Carrigan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Sharp
- Department of Public Health & Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - S M Smith
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Connolly
- School of Medicine, College of Medicine Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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Tang SJ, Holle J, Dadario NB, Lesslar O, Teo C, Ryan M, Sughrue M, Yeung JT. Personalized, parcel-guided rTMS for the treatment of major depressive disorder: Safety and proof of concept. Brain Behav 2023; 13:e3268. [PMID: 37798655 PMCID: PMC10636393 DOI: 10.1002/brb3.3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Not all patients with major depressive disorder (MDD) benefit from the US Food and Drug Administration-approved use of repetitive transcranial magnetic stimulation (rTMS) at the dorsolateral prefrontal cortex. We may be undertreating depression with this one-size-fits-all rTMS strategy. METHODS We present a retrospective review of targeted and connectome-guided rTMS in 26 patients from Cingulum Health from 2020 to 2023 with MDD or MDD with associated symptoms. rTMS was conducted by identifying multiple cortical targets based on anomalies in individual functional connectivity networks as determined by machine learning connectomic software. Quality of life assessed by the EuroQol (EQ-5D) score and depression symptoms assessed by the Beck Depression Inventory (BDI) were administered prior to treatment, directly after, and at a follow-up consultation. RESULTS Of the 26 patients treated with rTMS, 16 (62%) attained remission after treatment. Of the 19 patients who completed follow-up assessments after an average interval of 2.6 months, 11 (58%) responded to treatment and 13 (68%) showed significant remission. Between patients classified with or without treatment-resistant depression, there was no difference in BDI improvement. Additionally, there was significant improvement in quality of life after treatment and during follow-up compared to baseline. LIMITATIONS This review is retrospective in nature, so there is no control group to assess the placebo effect on patient outcomes. CONCLUSION The personalized, connectome-guided approach of rTMS is safe and may be effective for depression. This personalized rTMS treatment allows for co-treatment of multiple disorders, such as the comorbidity of depression and anxiety.
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Affiliation(s)
- Si Jie Tang
- School of MedicineUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | | | - Nicholas B. Dadario
- Robert Wood Johnson Medical SchoolRutgers UniversityNew BrunswickNew JerseyUSA
| | | | | | | | | | - Jacky T. Yeung
- Cingulum HealthSydneyAustralia
- Department of NeurosurgeryYale University School of MedicineNew HavenConnecticutUSA
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Benson R, Rigby J, Brunsdon C, Corcoran P, Dodd P, Ryan M, Cassidy E, Colchester D, Hawton K, Lascelles K, de Leo D, Crompton D, Kõlves K, Leske S, Dwyer J, Pirkis J, Shave R, Fortune S, Arensman E. Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice. Arch Suicide Res 2023; 27:1312-1338. [PMID: 36237124 DOI: 10.1080/13811118.2022.2131489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.
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9
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Moran B, Smith CM, Zaborowski A, Ryan M, Karman J, Dunstan RW, Smith KM, Hambly R, Musilova J, Petrasca A, Fabre A, O'Donnell M, Hokamp K, Mills KHG, Housley WJ, Winter DC, Kirby B, Fletcher JM. Targeting the NLRP3 inflammasome reduces inflammation in hidradenitis suppurativa skin. Br J Dermatol 2023; 189:447-458. [PMID: 37243544 DOI: 10.1093/bjd/ljad184] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Treatment for the debilitating disease hidradenitis suppurativa (HS) is inadequate in many patients. Despite an incidence of approximately 1%, HS is often under-recognized and underdiagnosed, and is associated with a high morbidity and poor quality of life. OBJECTIVES To gain a better understanding of the pathogenesis of HS, in order to design new therapeutic strategies. METHODS We employed single-cell RNA sequencing to analyse gene expression in immune cells isolated from involved HS skin vs. healthy skin. Flow cytometry was used to quantify the absolute numbers of the main immune populations. The secretion of inflammatory mediators from skin explant cultures was measured using multiplex and enzyme-linked immunosorbent assays. RESULTS Single-cell RNA sequencing analysis identified a significant enrichment in the frequency of plasma cells, T helper (Th) 17 cells and dendritic cell subsets in HS skin, and the immune transcriptome was distinct and more heterogeneous than healthy skin. Flow cytometry revealed significantly increased numbers of T cells, B cells, neutrophils, dermal macrophages and dendritic cells in HS skin. Genes and pathways associated with Th17 cells, interleukin (IL)-17, IL-1β and the NLRP3 inflammasome were enhanced in HS skin, particularly in samples with a high inflammatory load. Inflammasome constituent genes principally mapped to Langerhans cells and a subpopulation of dendritic cells. The secretome of HS skin explants contained significantly increased concentrations of inflammatory mediators, including IL-1β and IL-17A, and culture with an NLRP3 inflammasome inhibitor significantly reduced the secretion of these, as well as other, key mediators of inflammation. CONCLUSIONS These data provide a rationale for targeting the NLRP3 inflammasome in HS using small-molecule inhibitors that are currently being tested for other indications.
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Affiliation(s)
- Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Conor M Smith
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Ryan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Jozsef Karman
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Robert W Dunstan
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Kathleen M Smith
- AbbVie, Immunology Systems Computational Biology, Cambridge Research Center, Cambridge, MA, USA
| | - Roisin Hambly
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jana Musilova
- Education and Research Centre, University College Dublin, Dublin, Ireland
| | - Andreea Petrasca
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Aurelie Fabre
- Department of Histopathology, St. Vincent's University Hospital and School of Medicine, University College Dublin, Ireland
| | | | - Karsten Hokamp
- Department of Genetics, School of Genetics and Microbiology, Smurfit Institute of Genetics
| | - Kingston H G Mills
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - William J Housley
- AbbVie, Immunology Discovery Research, AbbVie Bioresearch Center, Worcester, MA, USA
| | - Desmond C Winter
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital and Charles Institute of Dermatology, University College Dublin, Dublin, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Nickoles TA, Lewit RA, Notrica DM, Ryan M, Johnson J, Maxson RT, Naiditch JA, Lawson KA, Temkit M, Padilla B, Eubanks JW. Diagnostic accuracy of screening tools for pediatric blunt cerebrovascular injury: An ATOMAC multicenter study. J Trauma Acute Care Surg 2023; 95:327-333. [PMID: 36693233 DOI: 10.1097/ta.0000000000003888] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Blunt cerebrovascular injury (BCVI) is rare but significant among children. There are three sets of BCVI screening criteria validated for adults (Denver, Memphis, and Eastern Association for the Surgery of Trauma criteria) and two that have been validated for use in pediatrics (Utah score and McGovern score), all of which were developed using retrospective, single-center data sets. The purpose of this study was to determine the diagnostic accuracy of each set of screening criteria in children using a prospective, multicenter pediatric data set. METHODS A prospective, multi-institutional observational study of children younger than 15 years who sustained blunt trauma to the head, face, or neck and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. All patients were screened for BCVI using the Memphis criteria, but criteria for all five were collected for analysis. Patients underwent computed tomography angiography of the head or neck if the Memphis criteria were met at presentation or neurological abnormalities were detected at 2-week follow-up. RESULTS A total of 2,284 patients at the 6 trauma centers met the inclusion criteria. After excluding cases with incomplete data, 1,461 cases had computed tomography angiography and/or 2-week clinical follow-up and were analyzed, including 24 cases (1.6%) with BCVI. Sensitivity, specificity, positive predictive value, and negative predictive value for each set of criteria were respectively 75.0, 87.5, 9.1, and 99.5 for Denver; 91.7, 71.1, 5.0, and 99.8 for Memphis; 79.2, 82.7, 7.1, and 99.6 for Eastern Association for the Surgery of Trauma; 45.8, 95.8, 15.5, and 99.1 for Utah; and 75.0, 89.5, 10.7, and 99.5 for McGovern. CONCLUSION In this large multicenter pediatric cohort, the Memphis criteria demonstrated the highest sensitivity at 91.7% and would have missed the fewest BCVI, while the Utah score had the highest specificity at 95.8% but would have missed more than half of the injuries. Development of a tool, which narrows the Memphis criteria while maintaining its sensitivity, is needed for application in pediatric patients. LEVEL OF EVIDENCE Diagnostic Test/Criteria; Level II.
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Affiliation(s)
- Todd A Nickoles
- From the Phoenix Children's Center for Trauma Care, Phoenix Children's (T.A.N., D.M.N., M.T., B.P.), Phoenix, Arizona; Department of Pediatric Surgery, Le Bonheur Children's Hospital (R.A.L., J.W.E.) Memphis, Tennessee; Division of Pediatric Surgery, Department of Surgery (R.A.L., J.W.E.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Surgery (D.M.N., B.P.), College of Medicine, University of Arizona Phoenix, Arizona; Trauma Services, Children's Medical Center (M.R.), Dallas, Texas; Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center Dallas, Texas; Trauma Services, Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center Oklahoma City, Oklahoma; Trauma Services, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences Little Rock, Arkansas; Department of Surgery, Dell Medical School (J.A.N., K.A.L.), University of Texas at Austin Austin, Texas; and Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas
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Nickoles TA, Lewit RA, Notrica DM, Ryan M, Johnson J, Maxson RT, Naiditch JA, Lawson KA, Temkit M, Padilla B, Eubanks JW. Lower incidence of blunt cerebrovascular injury among young, properly restrained children: An ATOMAC multicenter study. J Trauma Acute Care Surg 2023; 95:334-340. [PMID: 36899460 DOI: 10.1097/ta.0000000000003900] [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: 03/12/2023]
Abstract
BACKGROUND Motor vehicle collision (MVC) remains a leading cause of injury and death among children, but the proper use of child safety seats and restraints has lowered the risks associated with motor vehicle travel. Blunt cerebrovascular injury (BCVI) is rare but significant among children involved in MVC. This study reviewed the incidence of BCVI after MVC causing blunt injury to the head, face, or neck, comparing those that were properly restrained with those that were not. METHODS A prospective, multi-institutional observational study of children younger than 15 years who sustained blunt trauma to the head, face, or neck (Abbreviated Injury Scale score >0) and presented at one of six level I pediatric trauma centers from 2017 to 2020 was conducted. Diagnosis of BCVI was made either by imaging or neurological symptoms at 2-week follow-up. Restraint status among those involved in MVC was compared for each age group. RESULTS A total of 2,284 patients were enrolled at the 6 trauma centers. Of these, 521 (22.8%) were involved in an MVC. In this cohort, after excluding patients with missing data, 10 of 371 (2.7%) were diagnosed with a BCVI. For children younger than 12 years, none who were properly restrained suffered a BCVI (0 of 75 children), while 7 of 221 (3.2%) improperly restrained children suffered a BCVI. For children between 12 and 15 years of age, the incidence of BCVI was 2 of 36 (5.5%) for children in seat belts compared with 1 of 36 (2.8%) for unrestrained children. CONCLUSION In this large multicenter prospectively screened pediatric cohort, the incidence of BCVI among properly restrained children under 12 years after MVC was infrequent, while the incidence was 3.2% among those without proper restraint. This effect was not seen among children older than 12 years. Restraint status in young children may be an important factor in BCVI screening. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Todd A Nickoles
- From the Center for Trauma Care, Phoenix Children's (T.A.N., D.M.N, M.T., B.P.), Phoenix, Arizona; Department of Pediatric Surgery, Le Bonheur Children's Hospital (R.A.L., J.W.E.) Memphis, Tennessee; Division of Pediatric Surgery, Department of Surgery (R.A.L., J.W.E.), College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee ; Department of Surgery (D.M.N., B.P.), College of Medicine, University of Arizona, Phoenix, Arizona; Trauma Services, Children's Medical Center (M.R.), Dallas, Texas; Division of Pediatric Surgery (M.R.), University of Texas Southwestern Medical Center Dallas, Texas; Trauma Services, Oklahoma Children's Hospital (J.J.), OU Health, Oklahoma City, Oklahoma; Department of Surgery (J.J.), University of Oklahoma Health Science Center Oklahoma City, Oklahoma; Trauma Services, Arkansas Children's Hospital (R.T.M.), Little Rock, Arkansas; Department of Surgery (R.T.M.), University of Arkansas for Medical Sciences Little Rock, Arkansas; Department of Surgery, Dell Medical School (J.A.N., K.A.L.), University of Texas at Austin, Austin, Texas; and Trauma and Injury Research Center, Dell Children's Medical Center of Central Texas (J.A.N.), Austin, Texas
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MacArthur TA, Vogel AM, Glasgow AE, Moody S, Kotagal M, Williams RF, Kayton ML, Alberto EC, Burd RS, Schroeppel TJ, Baerg JE, Munoz A, Rothstein WB, Boomer LA, Campion EM, Robinson C, Nygaard RM, Richardson CJ, Garcia DI, Streck CJ, Gaffley M, Petty JK, Ryan M, Pandya S, Russell RT, Yorkgitis BK, Mull J, Pence J, Santore MT, Klinkner DB, Safford SD, Trevilian T, Jensen AR, Mooney DP, Ketha B, Dassinger MS, Goldenberg-Sandau A, Falcone RA, Polites SF. Crystalloid volume is associated with short-term morbidity in children with severe traumatic brain injury: An Eastern Association for the Surgery of Trauma multicenter trial post hoc analysis. J Trauma Acute Care Surg 2023; 95:78-86. [PMID: 37072882 DOI: 10.1097/ta.0000000000004013] [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: 04/20/2023]
Abstract
OBJECTIVE This study examined differences in clinical and resuscitation characteristics between injured children with and without severe traumatic brain injury (sTBI) and aimed to identify resuscitation characteristics associated with improved outcomes following sTBI. METHODS This is a post hoc analysis of a prospective observational study of injured children younger than 18 years (2018-2019) transported from the scene, with elevated shock index pediatric-adjusted on arrival and head Abbreviated Injury Scale score of ≥3. Timing and volume of resuscitation products were assessed using χ 2t test, Fisher's exact t test, Kruskal-Wallis, and multivariable logistic regression analyses. RESULTS There were 142 patients with sTBI and 547 with non-sTBI injuries. Severe traumatic brain injury patients had lower initial hemoglobin (11.3 vs. 12.4, p < 0.001), greater initial international normalized ratio (1.4 vs. 1.1, p < 0.001), greater Injury Severity Score (25 vs. 5, p < 0.001), greater rates of ventilator (59% vs. 11%, p < 0.001) and intensive care unit (ICU) requirement (79% vs. 27%, p < 0.001), and more inpatient complications (18% vs. 3.3%, p < 0.001). Severe traumatic brain injury patients received more prehospital crystalloid (25% vs. 15%, p = 0.008), ≥1 crystalloid boluses (52% vs. 24%, p < 0.001), and blood transfusion (44% vs. 12%, p < 0.001) than non-sTBI patients. Among sTBI patients, receipt of ≥1 crystalloid bolus (n = 75) was associated with greater ICU need (92% vs. 64%, p < 0.001), longer median ICU (6 vs. 4 days, p = 0.027) and hospital stay (9 vs. 4 days, p < 0.001), and more in-hospital complications (31% vs. 7.5%, p = 0.003) than those who received <1 bolus (n = 67). These findings persisted after adjustment for Injury Severity Score (odds ratio, 3.4-4.4; all p < 0.010). CONCLUSION Pediatric trauma patients with sTBI received more crystalloid than those without sTBI despite having a greater international normalized ratio at presentation and more frequently requiring blood products. Excessive crystalloid may be associated with worsened outcomes, including in-hospital mortality, seen among pediatric sTBI patients who received ≥1 crystalloid bolus. Further attention to a crystalloid sparing, early transfusion approach to resuscitation of children with sTBI is needed. LEVEL OF EVIDENCE Therapeutic/Care Management; Level IV.
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Affiliation(s)
- Taleen A MacArthur
- Department of Surgery, Division of Pediatric Surgery (T.A.M., A.E.G., D.B.K., S.F.P.), Mayo Clinic, Rochester, Minnesota; Department of Pediatric Surgery (A.M.V.), Texas Children's Hospital, Houston, Texas; Division of Pediatric General and Thoracic Surgery (S.M., M.K., R.A.F.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Surgery (R.F.W.), Le Bonheur Children's Hospital, Memphis, Tennessee; Jersey Shore University Medical Center (M.L.K.), Hackensack-Meridian Health Network, Neptune, New Jersey; Department of Pediatric Surgery (E.C.A., R.S.B.), Children's National Hospital, Washington, DC; UCHealth Memorial Hospital (T.J.S.), Pediatric Surgery, Colorado Springs, Colorado; Division of Pediatric Surgery (J.E.B., A.M.), Loma Linda University, Loma Linda, California; Department of Surgery, Virginia Commonwealth University (W.B.R., L.A.B.), Children's Hospital of Richmond, Richmond, Virginia; Department of Surgery (E.M.C., C.R.), Denver Health Medical Center, Denver, Colorado; Department of Surgery (R.M.N., C.J.R.), Hennepin Healthcare, Minneapolis, Minnesota; Department of Surgery (D.I.G., C.J.S.), The Medical University of South Carolina, Charleston, South Carolina; Department of Surgery (M.G., J.K.P.), Wake Forest Baptist Medical Center, Brenner Children's Hospital, Winston-Salem, North Carolina; Department of Surgery (M.R., S.P.), Children's Health Dallas, Dallas, Texas; Department of Pediatric Surgery, (R.T.R.), Children's of Alabama, Birmingham, Alabama; Department of Surgery (B.K.Y., J.M.), College of Medicine, University of Florida Jacksonville, Jacksonville, Florida; Department of Surgery (J.P.), Dayton Children's Hospital, Dayton, Ohio; Department of Surgery (M.T.S.), Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Surgery (S.D.S., T.T.), Carilion Children's Hospital, Carilion Roanoke Memorial Hospital, Roanoke, Virginia; Department of Surgery (A.R.J.), Benioff Children's Hospital, University of California San Francisco, San Francisco, California; Department of Pediatric Surgery (D.P.M.), Boston Children's Hospital, Boston, Massachusetts; Department of Surgery (B.K., M.S.D.), Arkansas Children's Hospital, Little Rock, Arkansas; and Department of Surgery (A.G.-S.), Cooper University Hospital, Camden, New Jersey
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Ankeny RA, Whittaker AL, Ryan M, Boer J, Plebanski M, Tuke J, Spencer SJ. The power of effective study design in animal Experimentation: Exploring the statistical and ethical implications of asking multiple questions of a data set. Brain Behav Immun 2023:S0889-1591(23)00156-3. [PMID: 37315700 DOI: 10.1016/j.bbi.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/31/2023] [Accepted: 06/10/2023] [Indexed: 06/16/2023] Open
Abstract
One of the chief advantages of using highly standardised biological models including model organisms is that multiple variables can be precisely controlled so that the variable of interest is more easily studied. However, such an approach often obscures effects in sub-populations resulting from natural population heterogeneity. Efforts to expand our fundamental understanding of multiple sub-populations are in progress. However, such stratified or personalised approaches require fundamental modifications of our usual study designs that should be implemented in Brain, Behavior and Immunity (BBI) research going forward. Here we explore the statistical feasibility of asking multiple questions (including incorporating sex) within the same experimental cohort using statistical simulations of real data. We illustrate and discuss the large explosion in sample numbers necessary to detect effects with appropriate power for every additional question posed using the same data set. This exploration highlights the strong likelihood of type II errors (false negatives) for standard data and type I errors when dealing with complex genomic data, where studies are too under-powered to appropriately test these interactions. We show this power may differ for males and females in high throughput data sets such as RNA sequencing. We offer a rationale for the use of alternative experimental and statistical strategies based on interdisciplinary insights and discuss the real-world implications of increasing the complexities of our experimental designs, and the implications of not attempting to alter our experimental designs going forward.
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Affiliation(s)
- R A Ankeny
- School of Humanities, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - A L Whittaker
- School of Animal and Veterinary Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia
| | - M Ryan
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Boer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - M Plebanski
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia
| | - J Tuke
- School of Computer and Mathematical Sciences, University of Adelaide, Adelaide, South Australia 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - S J Spencer
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria 3083, Australia.
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Kyser AJ, Masigol M, Mahmoud MY, Ryan M, Lewis WG, Lewis AL, Frieboes HB, Steinbach-Rankins JM. Fabrication and characterization of bioprints with Lactobacillus crispatus for vaginal application. J Control Release 2023; 357:545-560. [PMID: 37076014 PMCID: PMC10696519 DOI: 10.1016/j.jconrel.2023.04.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 10/28/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
Bacterial vaginosis (BV) is characterized by low levels of lactobacilli and overgrowth of potential pathogens in the female genital tract. Current antibiotic treatments often fail to treat BV in a sustained manner, and > 50% of women experience recurrence within 6 months post-treatment. Recently, lactobacilli have shown promise for acting as probiotics by offering health benefits in BV. However, as with other active agents, probiotics often require intensive administration schedules incurring difficult user adherence. Three-dimensional (3D)-bioprinting enables fabrication of well-defined architectures with tunable release of active agents, including live mammalian cells, offering the potential for long-acting probiotic delivery. One promising bioink, gelatin alginate has been previously shown to provide structural stability, host compatibility, viable probiotic incorporation, and cellular nutrient diffusion. This study formulates and characterizes 3D-bioprinted Lactobacillus crispatus-containing gelatin alginate scaffolds for gynecologic applications. Different weight to volume (w/v) ratios of gelatin alginate were bioprinted to determine formulations with highest printing resolution, and different crosslinking reagents were evaluated for effect on scaffold integrity via mass loss and swelling measurements. Post-print viability, sustained-release, and vaginal keratinocyte cytotoxicity assays were conducted. A 10:2 (w/v) gelatin alginate formulation was selected based on line continuity and resolution, while degradation and swelling experiments demonstrated greatest structural stability with dual genipin and calcium crosslinking, showing minimal mass loss and swelling over 28 days. 3D-bioprinted L. crispatus-containing scaffolds demonstrated sustained release and proliferation of live bacteria over 28 days, without impacting viability of vaginal epithelial cells. This study provides in vitro evidence for 3D-bioprinted scaffolds as a novel strategy to sustain probiotic delivery with the ultimate goal of restoring vaginal lactobacilli following microbiological disturbances.
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Affiliation(s)
- Anthony J Kyser
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY 40202, USA.
| | - Mohammadali Masigol
- Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, USA.
| | - Mohamed Y Mahmoud
- Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, USA; Department of Toxicology and Forensic Medicine, Faculty of Veterinary Medicine, Cairo University, Egypt.
| | - Mark Ryan
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY 40202, USA.
| | - Warren G Lewis
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA; Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA, USA.
| | - Amanda L Lewis
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA; Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA, USA.
| | - Hermann B Frieboes
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY 40202, USA; Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; UofL Health - Brown Cancer Center, University of Louisville, KY 40202, USA.
| | - Jill M Steinbach-Rankins
- Department of Bioengineering, University of Louisville Speed School of Engineering, Louisville, KY 40202, USA; Center for Predictive Medicine, University of Louisville, Louisville, KY 40202, USA; Department of Pharmacology and Toxicology, University of Louisville School of Medicine, Louisville, KY 40202, USA; Department of Microbiology and Immunology, University of Louisville School of Medicine, Louisville, KY, USA.
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Harmer V, Harbeck N, Boyle F, Werutsky G, Ammendolea C, El Mouzain D, Marshall D, Thomas C, Heidenreich S, Lu H, Dionne PA, Gao M, Aubel D, Pathak P, Ryan M. P263 Patients’ perspectives on treatments for HR+/HER2– early breast cancer: developing a quantitative patient preference survey. Breast 2023. [DOI: 10.1016/s0960-9776(23)00381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Ryan M, Tuke J, Hutchinson MR, Spencer SJ. Gender-specific effects of COVID-19 lockdowns on scientific publishing productivity: Impact and resilience. Soc Sci Med 2023; 320:115761. [PMID: 36780736 PMCID: PMC9896855 DOI: 10.1016/j.socscimed.2023.115761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
RATIONALE The SARS-CoV2 pandemic led to drastic social restrictions globally. Early data suggest that women in science have been more adversely affected by these lockdowns than men, with relatively fewer scientific articles authored by women. However, these observations test broad populations with many potential causes of disparity. Australia presents a natural experimental condition where several states of similar demographics and disease impact had differing approaches in their social isolation strategies. The state of Victoria experienced 280 days of lockdowns from 2020 to 2021, whereas the comparable state of New South Wales experienced 107 days, most of these in 2021, and other states even fewer restrictions. OBJECTIVE AND METHODS To assess how the gender balance changed in Australian biomedical publishing with the lockdowns, we created a custom workflow to analyse PubMed data from more than 120,000 published articles submitted in 2019-2021 from Australian authors. RESULTS Broadly, Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men, including from Victoria. On the other hand, articles specifically addressing COVID-19 were significantly less likely to be authored by women than those on other topics, a finding not likely due to particular gender imbalance in virology or viral epidemiology, since publications on HIV followed similar patterns to previous years. By 2021, this imbalance had reversed, with more COVID-19-related papers authored by women than men. CONCLUSIONS These data suggest women from Victoria were less able to rapidly transition to new research early in the pandemic but had accommodated to the new conditions by 2021. This work indicates we need strategies to support women in science as the pandemic continues and to continue to monitor the situation for its impact on vulnerable groups.
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Affiliation(s)
- M Ryan
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - J Tuke
- School of Mathematical Sciences, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Australia
| | - M R Hutchinson
- Adelaide Medical School, University of Adelaide, Adelaide, South Australia, 5005, Australia; Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; Davies Livestock Research Centre, University of Adelaide, South Australia, 5005, Australia; Institute for Photonics & Advanced Sensing, University of Adelaide, South Australia, 5005, Australia; Robinson Research Institute, University of Adelaide, South Australia, 5005, Australia
| | - S J Spencer
- Australian Research Council Centre of Excellence for Nanoscale BioPhotonics, Australia; School of Health and Biomedical Sciences, RMIT University, Melbourne, Vic, 3083, Australia.
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Ryan M, Morella K, Boan A, Key J, Head K. Evaluating equity in participation within a comprehensive school based wellness initiative amongst schools from different resource settings. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00744-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ryan M, Boan A, Morella K, Key J, Head K. The impact of the COVID-19 pandemic on implementation and maintenance of an evidence-$$$based school wellness initiative. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Young IM, Osipowicz K, Mackenzie A, Clarke O, Taylor H, Nicholas P, Ryan M, Holle J, Tanglay O, Doyen S, Sughrue ME. Comparison of consistency between image guided and craniometric transcranial magnetic stimulation coil placement. Brain Stimul 2022; 15:1465-1466. [PMID: 36309343 DOI: 10.1016/j.brs.2022.10.008] [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] [Received: 07/28/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
| | | | | | | | - Hugh Taylor
- Omniscient Neurotechnology, Sydney, 2000, Australia
| | | | - Mark Ryan
- Cingulum Health, Rosebery, 2018, Australia
| | | | - Onur Tanglay
- Omniscient Neurotechnology, Sydney, 2000, Australia
| | | | - Michael E Sughrue
- Omniscient Neurotechnology, Sydney, 2000, Australia; Cingulum Health, Rosebery, 2018, Australia.
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Ryan M, Hoffmann T, Hofmann R, van Sluijs E. Incomplete reporting of activity behaviour interventions in school-based research: a systematic review of randomised controlled trials published 2015-2020. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Boyle O, Kelly L, Whelan C, Murtagh E, O'Dwyer A, Ryan M, Hill F, McCabe A, Hayden D. 251 PREVALENCE AND CHARACTERISTICS OF SWALLOWING/COMMUNICATION IMPAIRMENTS IN FRAIL OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: A RETROSPECTIVE COHORT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The presentation of frail older adults to the Emergency Department (ED) may be complicated by swallowing and/or communication impairment. Adults with communication impairment may experience difficulty accessing healthcare. Dysphagia is associated with frailty irrespective of age and/or number of chronic diseases [1]. This study aims to determine the prevalence and characteristics of swallowing and/or communication impairments among frail older adults attending the ED.
Methods
A retrospective cohort study of consecutive ED attendees aged ≥ 75 years assessed by an interdisciplinary Gerontological ED team between October 2021 – February 2022 was conducted. A swallow/communication screening tool determined requirement for Speech and Language Therapy (SLT) referral. Data related to demographics and SLT interventions was extracted. Data analysis was completed using STATA Version 12. Ethical approval was obtained.
Results
Among 518 patients, 118 (23%) (mean age 82.4 (+/-6.4) years, 54% male) required SLT assessment. These patients had high rates of frailty (Median CFS= 6 (IQR 5-7), suspected delirium (4AT ≥ 4 in 45%), suspected malnutrition (MNA score 0-11 in 75%), and probable sarcopenia (SARC-F= ≥ 4 in 75%). Therapy Outcome Measurement Scales and the Functional Oral Intake Scale were used in this first episode of SLT care. Oropharyngeal dysphagia was identified for 43% (27% mild, 10% moderate, 3% moderate-severe, 3% severe), with 6% presenting with signs/symptoms of oesophageal dysphagia. Changes in baseline communication was identified for 57%; cognitive communication difficulties (38%), dysarthria (11%), dysphonia (8%). SLT intervention and management approaches were initiated in the ED.
Conclusion
Findings indicate a high prevalence of swallowing/communication impairment in frail older adults attending the ED. Future research should explore SLT outcomes at point of discharge to refine these swallowing/communication presentations.
Reference
1. Bahat G et al. Association between dysphagia and frailty in community-dwelling older adults. The Journal of Nutrition, Health & Ageing. 2019:23, 571–577.
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Affiliation(s)
- O Boyle
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - L Kelly
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - C Whelan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - E Murtagh
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - A O'Dwyer
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - M Ryan
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
| | - F Hill
- Tallaght University Hospital Department of Speech and Language Therapy, , Tallaght, Dublin 24, Ireland
| | - A McCabe
- Tallaght University Hospital Department of Emergency Medicine, , Tallaght, Dublin 24, Ireland
| | - D Hayden
- Tallaght University Hospital Department of Age-Related Healthcare, , Tallaght, Dublin 24, Ireland
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22
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Mahon CM, Ryan M, Kennelly SM, Martin R. 204 DEDICATED NURSING HOME SERVICE IN A TERTIARY HOSPITAL: EFFECT ON ADMISSION NUMBERS AND LENGTH OF STAY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In 2019 a dedicated Nursing Home (NH) in-patient service was established in a tertiary hospital, comprising a Consultant Geriatrician, clinical nurse specialist, NCHD and administrative support. All NH residents over 65 with medical diagnoses were admitted by the NH team who also provide a consult service for NH residents under other specialties.
Methods
Data were sourced from the Hospital Inpatient Enquiry system on length of stay of patients identified as admitted from a nursing home compared to those admitted under the NH team and their average lengths of stay over 2019-2021.
Results
In 2019, 749 NH residents were admitted to hospital with an average length of stay (ALOS) of 7.93 days, the NH inpatient service was established in July 2019 and showed a reduction of ALOS from 9.25 to 6.6 days in the 6 months following its establishment (29% difference.) In 2020, 707 NH residents were admitted with 352 admitted under the NH team. The ALOS of NH residents admitted under the NH team was 5.66 days in 2020 compared to 8.65 overall (35% difference.) In 2021, 765 NH residents were admitted with 402 under the NH team. ALOS of NH residents admitted under the NH team was 5.33 days in 2021 compared to 8.28 overall (36% difference.)
Conclusion
Within six months of its commencement the dedicated NH service had decreased length of stay by 29%. The average length of stay across all services has decreased year on year from 6.6 to 5.3 days from 2019 to 2021. The ALOS in the total cohort (including residents admitted surgically and those under 65) was 29-36% higher. Though difficult to accurately compare these cohorts due to different presenting diagnoses and medical backgrounds in those admitted surgically or those under 65, the overall reduction in length of stay over the three years does highlight the benefit from this dedicated service.
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Affiliation(s)
- CM Mahon
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - M Ryan
- Connolly Hospital, Blanchardstown , Dublin, Ireland
| | - SM Kennelly
- Royal College of Surgeons Ireland , Dublin, Ireland
| | - R Martin
- Connolly Hospital, Blanchardstown , Dublin, Ireland
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23
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Cardwell K, Broderick N, Tyner B, Masukume G, Harrington P, Connolly M, Larkin L, Clyne B, Ryan M, O'Neill M. High level review of configuration and reform of Public Health systems in selected countries. Eur J Public Health 2022. [PMCID: PMC9594392 DOI: 10.1093/eurpub/ckac129.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The impact of the COVID-19 pandemic has prompted governments internationally to consider reform and strengthening of their Public Health systems. To support this work in Ireland, we undertook a review Public Health systems internationally (research question [RQ] 1), and identified lessons learned from the COVID-19 pandemic (RQ2). Methods Data relating to Public Health systems (RQ1), and lessons learned (RQ2) for a select group of 12 countries were identified from organisations’ websites, an electronic database and grey literature search and representatives from key national-level organisations. Data for RQ1 were extracted, mapped to the 12 Essential Public Health functions (EPHFs) at national, regional and local levels, and verified by participating representatives. For RQ2, thematic analysis of semi-structured interviews with participating representatives was undertaken and. Results Typically, across all included countries, there is national strategic oversight of all EPHFs and, for certain functions, there is regional and local level implementation. Lessons learned from the COVID-19 pandemic broadly related to the themes of legislation and decision making; data collection, surveillance, evidence synthesis and collaboration; public health interventions; public participation, public messaging and communication; continuation of healthcare services; and workforce capacity and resilience. Conclusions When structuring Public Health systems, there is a need to identify which functions, and or which elements of a function, should be delivered at a national, regional or local level to ensure a sustainable and comprehensive Public Health system. Appropriate IT infrastructure, strong communication and an established evidence synthesis function are key to timely and informed decision making. Ideally, these functions should be established during periods of relative stability to permit a faster response during a pandemic or emergency situation.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - N Broderick
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Tyner
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - G Masukume
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Connolly
- School of Medicine, National University of Ireland Galway , Galway, Ireland
| | - L Larkin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - B Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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24
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Norris M, Carty P, McDowell C, O’Loughlin M, Comaskey F, Jingjing J, Harrington P, Ryan M, O'Neill M. Organisational perspectives on Public Health delivery in Ireland: Lessons learned from COVID-19. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic has placed healthcare systems worldwide under unprecedented pressure, with the Irish Public Health system no different. To strengthen delivery of Essential Public Health Functions (EPHFs) and increase future pandemic preparedness, Public Health leaders are now focused on identifying learnings from the pandemic. Within Ireland, given their experience, organisations situated within the Public Health system may be in a unique position to provide valuable information around the delivery of EPHFs, both prior to and in light of the COVID-19 pandemic, and how this can be improved in the future.
Methods
An online survey was distributed by the Department of Health, from 2 March 2022 to 25 March 2022, amongst organisations situated within the Public Health domain in Ireland. The survey consisted of six open-ended questions around the delivery of EPHFs prior to and in light of the pandemic, success stories that could provide scalable solutions to EPHF delivery and current health system barriers, key areas in the public health system that require strengthening, and barriers to achieving these actions. Thematic analysis to identify key themes was conducted on survey responses.
Results
Twenty-eight organisational responses were received. Themes around the workforce were apparent throughout, with staff training, staff diversity and staff morale, identified as areas for strengthening EPHF delivery. Themes around ICT, data collection and research were frequently identified with a lack of adequate ICT identified as a key lesson from the pandemic, while the Public Health ICT strategy was identified as key to strengthening future EPHF delivery.
Conclusions
In general, themes around the workforce; leadership, management and governance and ICT, data collection and research were reoccurring across organisational responses and therefore may be key areas for consideration when strengthening delivery of the EPHFs in Ireland.
Speakers/Panelist
Louise Hendricks
Department of Health, Ireland
Sohel Saikat
WHO, Geneva, Switzerland
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Affiliation(s)
- M Norris
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Carty
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - C McDowell
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M O’Loughlin
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Public Health, Health Service Executive Midwest , Limerick, Ireland
| | - F Comaskey
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - J Jingjing
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - P Harrington
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
| | - M Ryan
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
- Department of Pharmacology and Therapeutics, Trinity College Dublin , Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment, Health Information and Quality Authority , Dublin, Ireland
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25
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Ryan M, Morgan H, O'Gallagher K, Demir O, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah A, De Silva K, Chiribiri A, Perera D. Coronary wave energy to predict functional recovery in patients with ischemic left ventricular dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Invasive coronary angiography and non-invasive viability testing are the cornerstones of diagnosing and managing ischemic left ventricular dysfunction. At present there is no single test which serves both needs but, if developed, could revolutionise investigation of this condition. Coronary wave intensity analysis (cWIA) interrogates both contractility and microvascular physiology of the subtended myocardium [1,2] and therefore has the potential to fulfil this goal.
Objectives
We hypothesized that cWIA measured during coronary angiography would predict functional recovery with a similar accuracy to late gadolinium enhanced cardiac magnetic resonance imaging (LGE-CMR).
Methods
Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. cWIA, fractional flow reserve and microvascular resistance were assessed with a simultaneous coronary Doppler and pressure-sensing guidewire during cardiac catheterization at rest, during hyperaemia and during low-dose dobutamine stress. Viability was assessed using LGE-CMR. Regional left ventricular function was assessed at baseline and 6-month follow up after optimization of medical therapy +/− revascularization, using transthoracic echocardiography. The primary outcome was regional functional recovery.
Results
Forty participants underwent baseline physiology, LGE-CMR and thirty had echocardiography at baseline and 6 months; 21/42 territories demonstrated functional recovery. Resting backward compression wave energy was significantly greater in recovering than non-recovering territories (−5240±3772 vs. −1873±1605 W m–2 s–1, p=0.099, Figure 1), and had comparable diagnostic accuracy to CMR (area under the curve 0.812 vs. 0.757, p=0.649, Figure 2); a threshold of −2500 W mm–2 s–1 had 86% sensitivity and 76% specificity at predicting recovery. Backward expansion wave energy did not predict recovery. FFR was numerically higher in recovering territories (0.81±0.17 vs. 0.71±0.16, p=0.058), whilst hyperaemic microvascular resistance did not differentiate recovering from non-recovering territories (1.97±0.73 vs. 2.29±1.00, p=0.287). The likelihood of functional recovery was similar in revascularised and non-revascularised territories (15/29 vs. 6/13 respectively, p=0.739). Low-dose dobutamine stress increased the energy of all waves, but did not improve the accuracy of cWIA in predicting recovery. In a regression model, resting backward compression wave energy and optimization of medical therapy predicted functional recovery; fractional flow reserve and hyperemic microvascular resistance did not.
Conclusions
Backward compression wave energy has similar accuracy to LGE-CMR in the prediction of functional recovery. cWIA has the potential to revolutionise the management of ischaemic left ventricular dysfunction, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation Clinical Research Training Fellowship
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Affiliation(s)
- M Ryan
- King's College London , London , United Kingdom
| | - H Morgan
- King's College London , London , United Kingdom
| | | | - O Demir
- King's College London , London , United Kingdom
| | - H Rahman
- King's College London , London , United Kingdom
| | - H Ellis
- King's College London , London , United Kingdom
| | - L Dancy
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - D Sado
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - J Strange
- Bristol Heart Institute , Bristol , United Kingdom
| | - N Melikian
- King's College Hospital NHS Foundation Trust , London , United Kingdom
| | - M Marber
- King's College London , London , United Kingdom
| | - A Shah
- King's College London , London , United Kingdom
| | - K De Silva
- King's College London , London , United Kingdom
| | - A Chiribiri
- King's College London , London , United Kingdom
| | - D Perera
- King's College London , London , United Kingdom
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26
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Kirschner J, Crawford T, Ryan M, Finkel R, Swoboda K, De Vivo D, Bertini E, Hwu H, Sansone V, Pechmann A, Montes J, Krasinski D, Chin R, Berger Z, Zhu C, Raynaud S, Paradis A, Johnson N. VP.51 Impact of nusinersen on caregiver experience and health-related quality of life (HRQoL) when initiated in the presymptomatic stage of SMA in NURTURE. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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27
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Day J, Finkel R, Pascual S, Ryan M, Mercuri E, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Makepeace C, Foster R, Irzhevsky V, Berger Z. FP.22 Results from the end of Part A of the ongoing 3-part DEVOTE study to explore higher doses of nusinersen in SMA. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Benson R, Brunsdon C, Rigby J, Corcoran P, Ryan M, Cassidy E, Dodd P, Hennebry D, Arensman E. The development and validation of a dashboard prototype for real-time suicide mortality data. Front Digit Health 2022; 4:909294. [PMID: 36065333 PMCID: PMC9440192 DOI: 10.3389/fdgth.2022.909294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/28/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction/Aim Data visualisation is key to informing data-driven decision-making, yet this is an underexplored area of suicide surveillance. By way of enhancing a real-time suicide surveillance system model, an interactive dashboard prototype has been developed to facilitate emerging cluster detection, risk profiling and trend observation, as well as to establish a formal data sharing connection with key stakeholders via an intuitive interface. Materials and Methods Individual-level demographic and circumstantial data on cases of confirmed suicide and open verdicts meeting the criteria for suicide in County Cork 2008–2017 were analysed to validate the model. The retrospective and prospective space-time scan statistics based on a discrete Poisson model were employed via the R software environment using the “rsatscan” and “shiny” packages to conduct the space-time cluster analysis and deliver the mapping and graphic components encompassing the dashboard interface. Results Using the best-fit parameters, the retrospective scan statistic returned several emerging non-significant clusters detected during the 10-year period, while the prospective approach demonstrated the predictive ability of the model. The outputs of the investigations are visually displayed using a geographical map of the identified clusters and a timeline of cluster occurrence. Discussion The challenges of designing and implementing visualizations for suspected suicide data are presented through a discussion of the development of the dashboard prototype and the potential it holds for supporting real-time decision-making. Conclusions The results demonstrate that integration of a cluster detection approach involving geo-visualisation techniques, space-time scan statistics and predictive modelling would facilitate prospective early detection of emerging clusters, at-risk populations, and locations of concern. The prototype demonstrates real-world applicability as a proactive monitoring tool for timely action in suicide prevention by facilitating informed planning and preparedness to respond to emerging suicide clusters and other concerning trends.
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Affiliation(s)
- R. Benson
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
- Correspondence: Ruth Benson
| | - C. Brunsdon
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - J. Rigby
- National Centre for Geocomputation, National University of Ireland Maynooth, Maynooth, Ireland
| | - P. Corcoran
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
| | - M. Ryan
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Cork, Ireland
| | - P. Dodd
- National Office for Suicide Prevention, Health Service Executive, Dublin, Ireland
| | - D. Hennebry
- Cork Kerry Community Health Services, Health Service Executive, Cork, Ireland
| | - E. Arensman
- School of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, WHO Collaborating Centre for Surveillance and Research in Suicide Prevention, Cork, Ireland
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29
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O'Donovan T, McNulty J, Ryan M. PO-1856 Artificial intelligence: the opinions of radiation therapists in Ireland. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Berman M, Ali A, Macklam D, Garcia Saez D, Jothidasan A, Husain M, Stock U, Mehta V, Venkateswaran R, Curry P, Messer S, Mukadam M, Mascaro J, Clarke S, Baxter J, Tsui S, Large S, Osman M, Kaul P, Boda G, Jenkins D, Simmonds J, Quigley R, Whitney J, Gardiner D, Watson C, Rubino A, Currie I, Foley J, Macleod A, Slater C, Marley F, Downward L, Rushton S, Armstrong L, Ayton L, Ryan M, Parker M, Gibson S, Spence S, Quinn K, Watson S, Forsythe J. UK National DCD Heart Transplant Program - First Year Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Moser F, Todoran T, Ryan M, Baker E, Gunnarsson C, Kellum J. Hemorrhagic Transformation Rates following Contrast Media Administration in Patients Hospitalized with Ischemic Stroke. AJNR Am J Neuroradiol 2022; 43:381-387. [PMID: 35144934 PMCID: PMC8910803 DOI: 10.3174/ajnr.a7412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation is a critical complication associated with ischemic stroke and has been associated with contrast media administration. The objective of our study was to use real-world in-hospital data to evaluate the correlation between contrast media type and transformation from ischemic to hemorrhagic stroke. MATERIALS AND METHODS We obtained data on inpatient admissions with a diagnosis of ischemic stroke and a record of either iso-osmolar or low-osmolar iodinated contrast media for a stroke-related diagnostic test and a treatment procedure (thrombectomy, thrombolysis, or angioplasty). We performed multivariable regression analysis to assess the relationship between contrast media type and the development of hemorrhagic transformation during hospitalization, adjusting for patient characteristics, comorbid conditions, procedure type, a threshold for contrast media volume, and differences across hospitals. RESULTS Inpatient visits with exclusive use of either low-osmolar (n = 38,130) or iso-osmolar contrast media (n = 4042) were included. We observed an overall risk reduction in hemorrhagic transformation among patients who received iso-osmolar compared with low-osmolar contrast media, with an absolute risk reduction of 1.4% (P = .032), relative risk reduction of 12.5%, and number needed to prevent harm of 70. This outcome was driven primarily by patients undergoing endovascular thrombectomy (n = 9211), in which iso-osmolar contrast media was associated with an absolute risk reduction of 4.6% (P = .028), a relative risk reduction of 20.8%, and number needed to prevent harm of 22, compared with low-osmolar contrast media. CONCLUSIONS Iso-osmolar contrast media was associated with a lower rate of hemorrhagic transformation compared with low-osmolar contrast media in patients with ischemic stroke.
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Affiliation(s)
- F.G. Moser
- From the Department of Imaging (F.G.M.), Cedars-Sinai Medical Center, Los Angeles, California
| | - T.M. Todoran
- Divisions of Cardiology and Vascular Surgery, Medical University of South Carolina (T.M.T.), Charleston, South Carolina
| | - M. Ryan
- MPR Consulting (M.R.), Cincinnati, Ohio
| | - E. Baker
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - C. Gunnarsson
- CTI Clinical Trial & Consulting Services (E.B., C.G.), Covington, Kentucky
| | - J.A. Kellum
- Center for Critical Care Nephrology (J.A.K.), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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32
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33
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Ikpeme M, Omotoyinbo F, Toluwade T, Ryan M. Work-Life Balance Inequalities among Veterinary and Allied Professionals: A Qualitative Review. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This study aimed to review qualitative psychological and non-psychologically based literature for work-life balance (WLB) inequalities within the veterinary and other allied professions.
Methods
The PECO framework includes qualitative studies published in any language but with an English translation involving adult workers in the veterinary or allied profession and outcomes around work-life balance. Seven relevant electronic databases EMBASE, PsycARTICLES, PsycINFO, MEDLINE, Social Policy and Practice, HMIC Health Management Information Consortium, and Global Health, were used. The retrieved hits were exported to Endnote Desktop (Version 7.7.1) for sorting and management.
Results
Of the 3610 hits, 31 studies were eligible for narrative synthesis. The studies were published from 1980-2017 and came from 15 countries. 9(29%) of the 31 studies were from the USA. 22 of the 31 studies (71%) focused on a mix of professions. Data were collected in six different ways, with the most common being interviews (17 (54.8%) of 31 studies). Twenty-three questions were used to assess WLB. The most common ones focused on women becoming mothers, maternity leave, and return to work (five (16.1%) of 31 articles). Secondly were attitudes of ethnic minorities concerning education, employment, role-family conflict, etc., and family commitments (three (9.7%) of the 31 papers). Findings came under 74 different topics. Nineteen (25.7%) of the 74 topics occurred more than four times and were allocated under the appropriate sub-theme. The nine sub-themes include pregnancy, breastfeeding, motherhood, job/life satisfaction, age/gender/ethnic inequalities, return to work (RTW), health and lifestyle, dual-earning couples/family, workplace support, and work-family/family-work conflicts.
Conclusions
The review suggests that women, ethnic minorities, older staff, and those with health concerns are negatively impacted by inequalities around WLB in veterinary and allied professions.
Key messages
The findings from the review were used to support the development of psychological measures of work-life balance and gender differences. The results were used in online questionnaires/surveys for future participants within the veterinary profession in addressing inequalities.
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Affiliation(s)
- M Ikpeme
- Faculty of Medicine, Imperial College, London, UK
- FACE, University of Hull, Hull, UK
| | | | - T Toluwade
- SES, Ogun State Institute of Technology, Igbesa, Nigeria
| | - M Ryan
- CLES, University of Exeter, Exeter, UK
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34
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Sharp M, Forde Z, McGeown C, O'Murchu E, Smith SM, O'Neill M, Ryan M, Clyne B. Media coverage of evidence outputs during the COVID-19 pandemic: findings from one national agency. Eur J Public Health 2021. [PMCID: PMC8574242 DOI: 10.1093/eurpub/ckab164.740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The COVID-19 Evidence Synthesis Team within the Health Information and Quality Authority (HIQA) in Ireland produced a range of evidence-based reports on a broad range of public health topics related to COVID-19. These evidence outputs (EO) arose directly from questions posed by policy makers and clinicians supporting Ireland's National Public Health Emergency Team (NPHET). Findings from these EOs informed the national response to the COVID-19 pandemic in Ireland and influenced international public health guidance. How research findings are presented through domestic news can influence behaviour and risk perceptions.
Methods
We investigated traditional media coverage of nine COVID-19 EOs and associated press releases, published (April to July 2020) by HIQA. NVivo was used for conceptual content analysis of manifest content. ‘Core messages' from each evidence output were proposed and 488 sources from national and regional broadcast, print, and online media were coded at the phrase level. The presence of political and public health actors in coverage were also coded.
Results
Coverage largely did not distort or misrepresent the results of the EOs, however, there was variability in terms of what content was reported on and to what extent different stakeholders were involved in the contextualization of the findings of the EOs. Coverage appeared to focus more on ‘human-interest' stories as opposed to more technical reports (e.g. focusing on viral load, antibodies, testing, etc.). Selective reporting and the variability in the use of quotes from governmental and public health stakeholders changed and contextualized results in different manners than perhaps originally intended in the press release.
Conclusions
Our findings provide a case-study of European media coverage of evidence reports produced by a national agency. Results highlighted several strengths and weaknesses of current communication efforts.
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Affiliation(s)
- M Sharp
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Z Forde
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - C McGeown
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
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35
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Clyne B, Byrne P, Smith SM, O'Neill M, Ryan M. Evaluating rapid review provision to inform policy during the COVID-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574241 DOI: 10.1093/eurpub/ckab164.741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence based decision making is central to population health, particularly during a pandemic. Few studies examine the production and use of evidence in decision-making during crisis management. This study describes and evaluates the provision of rapid evidence products by a single agency to support national decision making.
Methods
Semi-structured interviews were conducted with a convenience sample of evidence providers (who gathered and disseminated the required evidence) and service users (policy makers). Interviews were transcribed verbatim and analysed using thematic analysis. Quantitative data of work activity were summarised descriptively.
Results
Three themes were generated from the data: the work, the use and the future, with a fourth theme cross-cutting across these: the team. The work followed clear protocols and was centrally managed. The scope and changing nature of the evidence were highlighted as issues. The service providers reported a strong sense of team work and ‘being in this together', however, the majority of the participants felt that the workload was huge and exhausting and not sustainable long-term. Overall the service users thought the rapid evidence synthesis was indispensable to the decision-making process and had trust and confidence in the work, largely based on existing working relationships with the team. While they recognised that the evidence synthesis support would be an essential component of the continued pandemic response, they did query the sustainability of the process and reflected on the amount of work the team performed.
Conclusions
This evaluation, drawing on qualitative data, has highlighted that, across the services users and evidence providers, the support provided by HIQA was generally perceived as positive. From the service users' perspective, having access to the team was indispensable to the decision making process. However, the sustainability of the work load was identified as a major challenge.
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Affiliation(s)
- B Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Ryan M. Evidence Synthesis to support the public health response during the COVID-19 pandemic. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In January 2020, the Irish National Public Health Emergency Team (NPHET) for COVID-19 was established. NPHET oversees and provides national direction, guidance, support and expert advice on the development and implementation of strategies to contain COVID-19 in Ireland. Since March 2020, HIQA's COVID-19 Evidence Synthesis Team has provided research evidence to support the work of NPHET and associated groups and inform the development of national public health guidance. From September 2020, as part of the move towards a sustainable response to the public health emergency, HIQA also provides evidence based advice in response to requests from NPHET. The advice provided to NPHET is informed by research evidence developed by HIQA's COVID-19 Evidence Synthesis Team and with expert input from HIQA's COVID-19 Expert Advisory Group.
Methods
This presentation describes the establishment and organisation of the COVID-19 Evidence Synthesis Team, with an overview of the processes and methodological approaches involved. The role of HIQA's COVID-19 Evidence Synthesis Team in informing the public health response during the COVID-19 pandemic is discussed, along with the challenges and opportunities this presents. The relevance now and for future pandemic preparedness is outlined.
Results
As of 19 April 2021, HIQA has produced, and in some instances has regularly updated, 25 evidence summaries, 11 advice documents, 9 reviews of international guidance, 3 scoping reports, 5 reviews of care pathways, 2 analyses/models and 2 databases.
Conclusions
In the context of the COVID-19 pandemic, HIQA has developed and implemented a process to ensure rapid access to the best available evidence relevant to the COVID-19 outbreak to inform decision-making at each stage of the pandemic.
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Affiliation(s)
- M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Broderick N, Fawsitt CG, Tyner B, Larkin J, McCarthy M, Walsh KA, O'Neill M, Ryan M. COVID-19 Public Health Guidance Database. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Since March 2020, members of the Health Technology Assessment (HTA) team in HIQA have been identifying, reviewing and presenting COVID-19 public health guidance produced by international organisations. The aim of this work has been to inform the development of public health guidance and policy by the Health Protection Surveillance Centre (HPSC), Department of Health and Health Service Executive (HSE), using international evidence and best practice.
Methods
International resources are searched on a weekly basis to identify new or updated public health guidance on COVID-19. The three distinct steps in the process include, searching relevant international resources, reviewing identified relevant public health guidance for COVID-19, and presenting new or updated guidance in a COVID-19 Public Health Guidance Database, which was created by the team using Microsoft Excel. The international organisations reviewed include the World Health Organisation, European Centre for Disease Prevention and Control and Centers for Disease Control and Prevention, as well as a range of ministries of health and public health agencies from 10 countries. These were chosen, based on guidance being available in English, widespread use of the organisation's advice, and/or the working constraints of the HTA team.
Results
The COVID-19 Public Health Guidance Database is updated weekly and provided to the relevant individuals within HPSC, Department of Health, and HSE, who are responsible for developing public health and infection, prevention and control guidance related to COVID-19 in Ireland. Following this the database is published online and may be utilised by the public or other international organisations.
Conclusions
The COVID-19 Public Health Guidance Database is used to inform the ongoing response to the COVID-19 pandemic, specifically, to inform the development of public health and infection, prevention and control guidance to prevent the spread of COVID-19.
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Affiliation(s)
- N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - CG Fawsitt
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - B Tyner
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - J Larkin
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M McCarthy
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - KA Walsh
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Cardwell K, O'Murchu E, Byrne P, Broderick N, O'Neill S, Smith SM, Harrington P, O'Neill M, Ryan M. COVID-19 - Interventions and lifestyle factors that prevent infection or minimise progression to severe disease. Eur J Public Health 2021. [PMCID: PMC8574924 DOI: 10.1093/eurpub/ckab164.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
This evidence summary synthesised the evidence relating to pharmacological and non-pharmacological interventions in the community to prevent COVID-19/progression to severe disease. An additional aim was to identify potentially modifiable lifestyle factors associated with reduced risk of infection/progression to severe disease.
Methods
A systematic search of published peer-reviewed articles and non-peer-reviewed pre-prints was undertaken from 1 January 2020 to 19 April 2021; no language restrictions were applied. All potentially eligible papers were exported to Covidence. Titles/abstracts and full texts were single screened for relevance. Data extraction and quality appraisal of included studies was completed by a single reviewer and checked by a second.
Results
In total, 50 studies, three randomised controlled trials (RCTs), one non-RCT and 46 cohort studies were included. The four included controlled trials tested variations of the pharmacological intervention, ivermectin. While these controlled trials reported a protective effect for ivermectin use, these trials were of poor quality and had serious risk of bias. Across 46 cohort studies, the modifiable lifestyle risk factors identified were obesity, smoking, vitamin D status, physical activity, alcohol consumption and processed meat consumption. These studies reported mixed results in terms of the association between modifiable lifestyle risk factors and poor COVID-19 outcomes.
Conclusions
At the time of writing there is no high quality evidence of benefit to support pharmacological interventions to prevent COVID-19. Although there were mixed results for the risk factors identified, maintenance of healthy weight, smoking cessation, engaging in physical activity and moderation of alcohol and processed meat consumption are likely to be beneficial to health and should continue to be encouraged.
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Affiliation(s)
- K Cardwell
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E O'Murchu
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - P Byrne
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - N Broderick
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - S O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - SM Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M O'Neill
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - M Ryan
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
- Department of Pharmacology & Therapeutics, Trinity College Dublin, Dublin, Ireland
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Bruen R, Stirling A, Ryan M, Sheehan M, MacMahon P. Shelling the myth: allergies to Iodine containing substances and risk of reaction to Iodinated contrast media. Emerg Radiol 2021; 29:67-73. [PMID: 34609674 DOI: 10.1007/s10140-021-01989-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In excess of 100 million procedures using iodinated radio-contrast media are conducted each year. There is a common misunderstanding regarding the links between allergy to iodinated substances and the risk of allergic reaction to intravenous iodinated contrast agents. These perceived risks are managed via administration of corticosteroids or avoidance of iodinated contrast altogether. METHODS An extensive review of published literature on scientific databases and international guidelines was conducted in order to inform the research question. A questionnaire was formulated and distributed to hospital doctors in four tertiary centres. Within this questionnaire, hospital doctors were presented with six different scenarios of bona fide allergy to iodinated substances (e.g. shellfish) and asked to select the treatment response option which they deemed to be the most suitable from a choice of three (standard contrast scan/delay scan with pre-medication/change to non-contrast scan). RESULTS Eighty-seven questionnaire responses were received. Contrast (standard protocol) was the most appropriate regimen in the setting of all the listed allergies. This was identified correctly by 76%, 69%, 44%, 32%, 18% and 14% for kiwi, fish, poly-food, shellfish, betadine and tincture of iodine allergies, respectively. CONCLUSIONS There is a lack of understanding amongst local junior medical staff regarding administration of iodinated contrast media to patients with a history of allergy to iodinated substances. These misconceptions may potentiate the unnecessary usage of pre-medication and ordering of non-contrast scans in the setting of a gold-standard enhanced scan. Findings from this study suggest that there is a need for future education efforts targeted during the basic specialty training stage.
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Affiliation(s)
| | - Aaron Stirling
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - M Ryan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - M Sheehan
- Department of Radiology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - Peter MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
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Mercuri E, Finkel R, Day J, Pascual SP, Ryan M, De Vivo D, Montes J, Gurgel-Giannetti J, Gambino G, Nuzzo R, Makepeace C, Garafalo S, Berger Z. SMA - TREATMENT. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hoffman E, Dang U, Clemens P, Gordish-Dressman H, Schwartz B, Mengle-Gaw L, Leinonen M, Smith E, Castro D, Kuntz N, Finkel R, Tulinius M, Nevo Y, Ryan M, Webster R, van den Anker J, Ward L, Damsker J, McDonald C, Guglieri M, Mah J. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lambe G, Courtney M, Judge C, Donlon NE, Ravi N, Ryan M. A case report of endovascular management of delayed upper gastrointestinal bleeding after open esophagectomy for a benign esophageal stricture. Int J Surg Case Rep 2021; 85:106277. [PMID: 34388907 PMCID: PMC8355951 DOI: 10.1016/j.ijscr.2021.106277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/10/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Delayed upper gastrointestinal (GI) bleeding is a rare complication of esophagectomy and can be difficult to manage. PRESENTATION A 76-year-old female represented 17 days post open esophagectomy with an unstable upper GI bleed. When control could not be achieved endoscopically, she was transferred to the Radiology Department where a triphasic CT angiogram confirmed active contrast extravasation into the gastric tube. She proceeded to the Interventional Radiology suite where a thoracic angiogram revealed an active arterial bleed from a branch of the thyrocervical trunk. The bleeding vessel was successfully embolised with coils and haemostasis was achieved. DISCUSSION Management options for upper GI bleeding post esophagectomy include medical, endoscopic and endovascular approaches. CONCLUSION Our case represents a rare example of delayed bleeding into a gastric conduit post open esophagectomy for a benign stricture. The case reinforces.
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Affiliation(s)
- Gerard Lambe
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland,Corresponding author.
| | - Michael Courtney
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Ciaran Judge
- Gastroenterology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Noel E. Donlon
- Department of Upper GI Surgery, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Narayanasamy Ravi
- Department of Upper GI Surgery, St. James's Hospital, James's Street, Dublin 8, Ireland
| | - Mark Ryan
- Radiology Department, St. James's Hospital, James's Street, Dublin 8, Ireland
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McMichael AJ, Zafeiridi E, Ryan M, Cunningham EL, Passmore AP, McGuinness B. Anticholinergic drug use and risk of mortality for people with dementia in Northern Ireland. Aging Ment Health 2021; 25:1475-1482. [PMID: 33073601 DOI: 10.1080/13607863.2020.1830028] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Anticholinergic burden refers to the cumulative effect of medications which contain anticholinergic properties. We assessed how anticholinergic burden and different types of anticholinergic medications influence mortality rates among people with dementia in Northern Ireland. Our secondary aim was to determine what demographic characteristics predict the anticholinergic burden of people with dementia. METHODS Data were extracted from the Enhanced Prescribing database for 25,418 people who were prescribed at least one dementia management medication between 2010 and 2016. Information was also extracted on the number of times each available anticholinergic drug was prescribed between 2010 and 2016, allowing the calculation of an overall anticholinergic burden. Cox proportional hazard models were used to determine how anticholinergic burden influenced mortality whilst multilevel model regression determined what demographic characteristics influence overall anticholinergic burden. RESULTS Of the 25,418 people with dementia, only 15% (n = 3880) had no anticholinergic burden. Diazepam (42%) and risperidone (18%) were the two most commonly prescribed drugs. Unadjusted Cox proportional hazard models indicated that higher anticholinergic burden was associated with significantly higher mortality rates in comparison to people with dementia who had no anticholinergic burden (HR = 1.59: 95% CI = 1.07-2.36). In particular, urological (HR = 1.20: 95% CI = 1.05-1.38) and respiratory (HR = 1.17: 95% CI = 1.08-1.27) drugs significantly increased mortality rates. People with dementia living in areas with low levels of deprivation had significantly lower anticholinergic burden (HR=-.39: 95% CI=-.47:-30). CONCLUSIONS Reducing anticholinergic burden is essential for people with dementia. Further research should address the unfavourable prognosis of people living with dementia in highly deprived areas.
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Affiliation(s)
- A J McMichael
- Centre for Public Health, Institute for Clinical Sciences Block B, Queens University Belfast, Belfast, Northern Ireland
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez‐Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 PMCID: PMC8359367 DOI: 10.1111/cobi.13671] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 06/11/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C. Wyborn
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
- Institute for Water Futures, Fenner School of Environment and SocietyAustralian National UniversityCanberraACT0200Australia
| | - J. Montana
- School of Geography and the EnvironmentUniversity of OxfordSouth Parks RoadOxfordOX1 3QYU.K.
| | - N. Kalas
- Department of Environmental Systems ScienceETH ZürichUniversitätstrasse 8‐22Zürich8092Switzerland
| | - S. Clement
- Geography and PlanningUniversity of LiverpoolLiverpoolL69 3BXU.K.
| | - F. Davila
- Institute for Sustainable FuturesUniversity of Technology Sydney253 Jones StreetUltimoNSW2007Australia
| | - N. Knowles
- Department of Geography and Environmental ManagementUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - E. Louder
- School of Geography and DevelopmentUniversity of ArizonaENR2 Building, South 4th floor 1064 E. Lowell StreetTucsonAZ85721U.S.A.
| | - M. Balan
- The Forest WayNo 8, 2nd St, D P Nagar, KotturpuramChennaiTamil Nadu600085India
| | - J. Chambers
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - L. Christel
- School of Politics and Government (EPyG)National University of San MartinAvenida 25 de Mayo 1021San MartínProvincia de Buenos Aires1650Argentina
| | - T. Forsyth
- Department of International DevelopmentLondon School of Economics and Political ScienceHoughton StreetLondonWC2A 2AEU.K
| | - G. Henderson
- Harry Ransom CenterThe University of Texas at AustinP.O. Drawer 7219, 300 W 21st StreetAustinTX78712U.S.A.
| | - S. Izquierdo Tort
- Institut des Sciences de la Forêt TempéréeUniversité du Québec en Outaouais58 rue PrincipaleRiponQCJ0V 1V0Canada
- Natura y Ecosistemas Mexicanos A.C.Plaza San Jacinto 23D, San Ángel, Álvaro ObregónMexico City01000Mexico
| | - M. Lim
- Centre for Environmental Law, Macquarie Law SchoolMacquarie University6 First WalkSydneyNSW2109Australia
| | - M. J. Martinez‐Harms
- Center for Applied Ecology and Sustainability (CAPES)Pontificia Universidad Católica de ChileSantiago, Avd. Libertador Bernardo O'Higgins 340SantiagoChile
| | - J. Merçon
- Instituto de Investigaciones en EducasiónUniversidad VeracruzanaPaseo 112, Nuevo JalapaXalapa‐Enríquez91193Mexico
| | - E. Nuesiri
- Social Science FacultyAfrican Leadership University (ALU)Powder Mill RoadPamplemousses21001Mauritius
| | - L. Pereira
- Stockholm Resilience CentreStockholm UniversityKräftriket 2BStockholmSE‐10691Sweden
- Copernicus Institute of Sustainable DevelopmentUtrecht UniversityPrincetonlaan 8aUtrecht3584 CBThe Netherlands
- Centre for Complex Systems in TransitionStellenbosch University19 Jonkershoek Rd, MostertsdriftStellenbosch7600South Africa
| | - V. Pilbeam
- Clear Horizon Consulting132B Gwynne StCremorneVIC3121Australia
| | - E. Turnhout
- Forest and Nature Conservation Policy GroupWageningen UniversityP.O. Box 47Wageningen6700 AAThe Netherlands
| | - S. Wood
- Future Earth1250 Guy St, MontrealQuebecONH3H 2L3Canada
| | - M. Ryan
- Luc Hoffmann InstituteIUCN Conservation CentreRue Mauverney 28Gland1196Switzerland
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45
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Wyborn C, Montana J, Kalas N, Clement S, Davila F, Knowles N, Louder E, Balan M, Chambers J, Christel L, Forsyth T, Henderson G, Izquierdo Tort S, Lim M, Martinez-Harms MJ, Merçon J, Nuesiri E, Pereira L, Pilbeam V, Turnhout E, Wood S, Ryan M. An agenda for research and action toward diverse and just futures for life on Earth. Conserv Biol 2021; 35:1086-1097. [PMID: 33244774 DOI: 10.13140/rg.2.2.12086.52804/2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/14/2020] [Accepted: 11/20/2020] [Indexed: 05/18/2023]
Abstract
Decades of research and policy interventions on biodiversity have insufficiently addressed the dual issues of biodiversity degradation and social justice. New approaches are therefore needed. We devised a research and action agenda that calls for a collective task of revisiting biodiversity toward the goal of sustaining diverse and just futures for life on Earth. Revisiting biodiversity involves critically reflecting on past and present research, policy, and practice concerning biodiversity to inspire creative thinking about the future. The agenda was developed through a 2-year dialogue process that involved close to 300 experts from diverse disciplines and locations. This process was informed by social science insights that show biodiversity research and action is underpinned by choices about how problems are conceptualized. Recognizing knowledge, action, and ethics as inseparable, we synthesized a set of principles that help navigate the task of revisiting biodiversity. The agenda articulates 4 thematic areas for future research. First, researchers need to revisit biodiversity narratives by challenging conceptualizations that exclude diversity and entrench the separation of humans, cultures, economies, and societies from nature. Second, researchers should focus on the relationships between the Anthropocene, biodiversity, and culture by considering humanity and biodiversity as tied together in specific contexts. Third, researchers should focus on nature and economies by better accounting for the interacting structures of economic and financial systems as core drivers of biodiversity loss. Finally, researchers should enable transformative biodiversity research and action by reconfiguring relationships between human and nonhuman communities in and through science, policy, and practice. Revisiting biodiversity necessitates a renewed focus on dialogue among biodiversity communities and beyond that critically reflects on the past to channel research and action toward fostering just and diverse futures for human and nonhuman life on Earth.
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Affiliation(s)
- C Wyborn
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
- Institute for Water Futures, Fenner School of Environment and Society, Australian National University, Canberra, ACT, 0200, Australia
| | - J Montana
- School of Geography and the Environment, University of Oxford, South Parks Road, Oxford, OX1 3QY, U.K
| | - N Kalas
- Department of Environmental Systems Science, ETH Zürich, Universitätstrasse 8-22, Zürich, 8092, Switzerland
| | - S Clement
- Geography and Planning, University of Liverpool, Liverpool, L69 3BX, U.K
| | - F Davila
- Institute for Sustainable Futures, University of Technology Sydney, 253 Jones Street, Ultimo, NSW, 2007, Australia
| | - N Knowles
- Department of Geography and Environmental Management, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - E Louder
- School of Geography and Development, University of Arizona, ENR2 Building, South 4th floor 1064 E. Lowell Street, Tucson, AZ, 85721, U.S.A
| | - M Balan
- The Forest Way, No 8, 2nd St, D P Nagar, Kotturpuram, Chennai, Tamil Nadu, 600085, India
| | - J Chambers
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - L Christel
- School of Politics and Government (EPyG), National University of San Martin, Avenida 25 de Mayo 1021, San Martín, Provincia de Buenos Aires, 1650, Argentina
| | - T Forsyth
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, U.K
| | - G Henderson
- Harry Ransom Center, The University of Texas at Austin, P.O. Drawer 7219, 300 W 21st Street, Austin, TX, 78712, U.S.A
| | - S Izquierdo Tort
- Institut des Sciences de la Forêt Tempérée, Université du Québec en Outaouais, 58 rue Principale, Ripon, QC, J0V 1V0, Canada
- Natura y Ecosistemas Mexicanos A.C., Plaza San Jacinto 23D, San Ángel, Álvaro Obregón, Mexico City, 01000, Mexico
| | - M Lim
- Centre for Environmental Law, Macquarie Law School, Macquarie University, 6 First Walk, Sydney, NSW, 2109, Australia
| | - M J Martinez-Harms
- Center for Applied Ecology and Sustainability (CAPES), Pontificia Universidad Católica de Chile, Santiago, Avd. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - J Merçon
- Instituto de Investigaciones en Educasión, Universidad Veracruzana, Paseo 112, Nuevo Jalapa, Xalapa-Enríquez, 91193, Mexico
| | - E Nuesiri
- Social Science Faculty, African Leadership University (ALU), Powder Mill Road, Pamplemousses, 21001, Mauritius
| | - L Pereira
- Stockholm Resilience Centre, Stockholm University, Kräftriket 2B, Stockholm, SE-10691, Sweden
- Copernicus Institute of Sustainable Development, Utrecht University, Princetonlaan 8a, Utrecht, 3584 CB, The Netherlands
- Centre for Complex Systems in Transition, Stellenbosch University, 19 Jonkershoek Rd, Mostertsdrift, Stellenbosch, 7600, South Africa
| | - V Pilbeam
- Clear Horizon Consulting, 132B Gwynne St, Cremorne, VIC, 3121, Australia
| | - E Turnhout
- Forest and Nature Conservation Policy Group, Wageningen University, P.O. Box 47, Wageningen, 6700 AA, The Netherlands
| | - S Wood
- Future Earth, 1250 Guy St, Montreal, Quebec, ON, H3H 2L3, Canada
| | - M Ryan
- Luc Hoffmann Institute, IUCN Conservation Centre, Rue Mauverney 28, Gland, 1196, Switzerland
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Franks R, Milidonis X, Morgan H, Ryan M, Perera D, Plein S, Chiribiri A. Myocardial perfusion quantification by CMR for detection of obstructive coronary artery disease in patients with previous coronary artery bypass surgery. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): British Heart Foundation
Background
Coronary artery bypass grafting (CABG) is an established treatment for patients with advanced coronary artery disease (CAD). A subsequent recurrence of symptoms can cause the need for re-assessment of the coronary circulation. The accuracy of visually assessed stress perfusion cardiovascular magnetic resonance (CMR) for the detection of obstructive CAD is reduced in patients with prior CABG. In patients with complex multi-vessel CAD, myocardial perfusion quantification by CMR is superior to visual assessment (VA) for detection of obstructive disease however patients with CABG have been absent from previous studies.
Purpose
This study sought to assess the performance of myocardial perfusion quantification by CMR against invasive coronary angiography (ICA) for detecting obstructive CAD in patients with previous CABG.
Methods
Twenty-nine patients with a history of previous CABG and subsequent clinically indicated perfusion CMR study and invasive coronary angiography were recruited. Patients underwent a dual bolus stress perfusion CMR with late gadolinium enhancement (LGE) imaging at 3 Tesla. Stress myocardial blood flow (MBF) was estimated at the coronary territory level according to the AHA 16 segment model using Fermi function-constrained deconvolution. Segments with transmural LGE were excluded from MBF analysis. Stress perfusion images were analysed visually alongside LGE images and matched perfusion-LGE defects were considered negative. On ICA, coronary territories with lumen stenosis >70% without an unobstructed bypass graft (<70% stenosis) were considered positive.
Results
86/87 coronary territories were suitable for analysis. Sixty-five territories had at least one bypass graft including 32 territories with arterial grafts. 28/86 territories (33%) had obstructive disease on angiography. Territories with obstructive CAD had significantly lower stress MBF than unobstructed territories (1.21 [IQR: 0.96–1.45] vs 1.58 [1.40–1.84] ml/g/min, p < 0.001, Figure 1). Stress MBF had good accuracy to detect coronary territories with obstructive CAD (sensitivity 71%, specificity 84%, area under the curve (AUC) 0.83, p < 0.001, Figure 2A). For visual assessment, sensitivity was 79%, specificity 78% and diagnostic accuracy 78%. When analysis was confined to only territories with bypass grafts, stress MBF had 78% sensitivity, 81% specificity and AUC of 0.85, p < 0.001 (Figure 2B).. In this subgroup, VA had a sensitivity of 78%, specificity of 76% and a 77% diagnostic accuracy.
Conclusions
In patients with previous surgical revascularisation, quantification of stress myocardial blood flow by CMR offers good diagnostic accuracy for the detection and localisation of anatomically significant stenoses. Accuracy is reduced compared with published data in patients without coronary grafts but remains comparable to expert visual assessment.
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Affiliation(s)
- R Franks
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - X Milidonis
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - H Morgan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Ryan
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - D Perera
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Plein
- University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - A Chiribiri
- King"s College London, London, United Kingdom of Great Britain & Northern Ireland
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Takla A, O'Donnell J, Voight M, Byrd T, Dienst M, Martin RR, Philippon MJ, Enseki K, Andrade T, Safran M, Christoforetti JJ, Martin H, Grant L, Campbell A, Ryan M, Tyler T, McGovern RP, Bizzini M, Kohlrieser D. Erratum to: The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statement. J Hip Preserv Surg 2021; 7:643. [PMID: 34379059 PMCID: PMC8349590 DOI: 10.1093/jhps/hnab027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sanford EL, Zagory J, Blackwell JM, Szmuk P, Ryan M, Ambardekar A. Changes in pediatric trauma during COVID-19 stay-at-home epoch at a tertiary pediatric hospital. J Pediatr Surg 2021; 56:918-922. [PMID: 33516579 PMCID: PMC7817462 DOI: 10.1016/j.jpedsurg.2021.01.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/04/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Trauma is the leading cause of morbidity and mortality in the pediatric population. However, during the societal disruptions secondary to the coronavirus (COVID-19) stay-at-home regulations, there have been reported changes to the pattern and severity of pediatric trauma. We review our two-institution experience. METHODS Pediatric trauma emergency department (ED) encounters from the National Trauma Registry for a large, tertiary, metropolitan level 1 pediatric trauma center and pediatric burn admission at the regional burn center were extracted for children less than 19 years from March 15th thru May 15th during the years 2015-2020. The primary outcome was the difference in encounters during the COVID-19 (2020) epoch versus the pre-COVID-19 epoch (2015-2019). RESULTS There were 392 pediatric trauma encounters during the COVID-19 epoch as compared to 451, 475, 520, 460, 432 (mean 467.6) during the pre-COVID-19 epoch. Overall trauma admissions and ED trauma encounters were significantly lower (p < 0.001) during COVID-19. Burn injury admissions (p < 0.001) and penetrating trauma encounters (p = 0.002) increased during the COVID-19 epoch while blunt trauma encounters decreased (p < 0.001). Trauma occurred among more white (p = 0.01) and privately insured (p < 0.001) children, but no difference in suspected abuse, injury severity, mortality, age, or gender were detected. Sub-analysis showed significant decreases in motor vehicle crashes (p < 0.001), pedestrians struck by automobile (p < 0.001), all-terrain vehicle (ATV)/motorcross/bicycle/skateboard involved injuries (p = 0.02), falls (p < 0.001), and sports related injuries (p < 0.001). Fewer injuries occurring in the playground or home play equipment such as trampolines neared significance (p = 0.05). Interpersonal violence (assault, NAT, self-harm) was lower during the COVID-19 era (p = 0.04). For burn admissions, there was a significant increase in flame burns (p < 0.001). CONCLUSIONS Stay-at-home regulations alter societal patterns, leading to decreased overall and blunt traumas. However, the proportion of penetrating and burn injuries increased. Owing to increased stressors and time spent at home, healthcare professionals should keep a high suspicion for abuse and neglect.
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Affiliation(s)
- Ethan L Sanford
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Children's Health, Division of Pediatric Critical Care, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Jessica Zagory
- Department of Surgery, Division of Pediatric Surgery, Louisiana State University Health Sciences Center, New Orleans LA, United States; Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States.
| | - James-Michael Blackwell
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Peter Szmuk
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States; Outcome Research Consortium, Cleveland, OH, United States
| | - Mark Ryan
- Department of Surgery, Division of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas TX, United States
| | - Aditee Ambardekar
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas TX, United States; Children's Health, Division of Pediatric Anesthesiology, Dallas TX, United States
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Redwood E, Hyun K, French JK, Kritharides L, Ryan M, Chew DP, D'Souza M, Brieger DB. The influence of travelling to hospital by ambulance on reperfusion time and outcomes for patients with STEMI. Med J Aust 2021; 214:377-378. [PMID: 33811331 DOI: 10.5694/mja2.51005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Eleanor Redwood
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Karice Hyun
- Concord Repatriation General Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Leonard Kritharides
- Concord Repatriation General Hospital, Sydney, NSW.,ANZAC Research Institute, Sydney, NSW
| | - Mark Ryan
- Shoalhaven District Memorial Hospital, Nowra, NSW
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50
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Tambakis G, Lee T, Shah R, Wright E, Connell W, Miller A, Demediuk B, Ryan M, Howell J, Tsoi E, Lust M, Basnayake C, Ding N, Croagh C, Hong T, Kamm M, Farrell A, Papaluca T, MacIsaac M, Iser D, Mahady S, Holt B, Thompson A, Holmes J. Low failure to attend rates and increased clinic capacity with Telehealth: A highly effective outpatient model that should continue beyond the COVID-19 pandemic. J Gastroenterol Hepatol 2021; 36:1136-1137. [PMID: 33338284 DOI: 10.1111/jgh.15379] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 12/09/2022]
Affiliation(s)
- G Tambakis
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Lee
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - R Shah
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - W Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Miller
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Demediuk
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Ryan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Howell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - E Tsoi
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Lust
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Basnayake
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - N Ding
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - C Croagh
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Hong
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Farrell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Papaluca
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - M MacIsaac
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - D Iser
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - S Mahady
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - B Holt
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - A Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - J Holmes
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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