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Cheung VHI, Christie LJ, Maister T, Higgins D, Williams D, Woods N, Armstrong M, Hart S. Identifying potential cases of eating disorders in an acute medical hospital. Int J Eat Disord 2024. [PMID: 38647421 DOI: 10.1002/eat.24203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To identify patients presenting to an acute medical hospital with common signs and symptoms that occur in people with eating disorders (EDs), and determine by retrospective file audit if these are diagnosed cases of an ED. METHOD The investigators screened electronic medical records of people 16 years and older for common signs and symptoms of an ED such as hypokalemia, in patients presenting to an acute hospital in Sydney, Australia from 2018 to 2020. Cases where the clinical finding was unexplained had their file audited. Cases with a known ED diagnosis or coded with an ED were also retrieved to audit. RESULTS Investigators identified 192 definite ED cases with a total of 598 episodes of care from 2018 to 2020 presenting to the hospital. Eighty-three cases were identified as possible EDs due to unexplained clinical signs consistent with an ED, but were not confirmed cases due to lack of clinical history in the file. Only 19.1% of presentations were diagnostically coded with an ED in the electronic medical record. DISCUSSION Our study revealed a large number of definite ED cases presenting to an acute medical hospital via the emergency department, who were not recognized as having an ED. Greater awareness of clinical signs and symptoms of an ED, such as unexplained low body mass index and hypokalemia, is necessary among acute care clinicians. Correctly identifying EDs in those seeking somatic care should be a public health priority, to facilitate timely and equitable access to diagnostic assessment and evidence based treatment. PUBLIC SIGNIFICANCE People with eating disorders (EDs) present to acute care settings and have a relatively high utilization of generalist health services with nonspecific problems such as abdominal pain. An enhanced understanding of healthcare utilization by people with EDs, who may not disclose their symptoms, is crucial for improving access to treatment.
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Affiliation(s)
| | - Lauren J Christie
- Allied Health Research Unit, St Vincent's Health Network Sydney, Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, Australia
- Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Australia
| | - Terri Maister
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Devlin Higgins
- The O'Brien Centre Mental Health Services, St Vincent's Health Network Sydney, Australia
| | - David Williams
- Gastroenterology and Hepatology, St Vincent's Health Network Sydney, Australia
| | - Nikki Woods
- Emergency Department, St Vincent's Health Network Sydney, Australia
| | - Melissa Armstrong
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
| | - Susan Hart
- Nutrition and Dietetic Services, St Vincent's Health Network Sydney, Australia
- Eating Disorders and Nutrition Research Group, Western Sydney University, Australia
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Buckey CR, Armstrong M, Chitsazzadeh S, Hobbis D, Clouser EL, Patel SH, Smetanick J, Pettit J, Rong Y. A Free, Open-Source Toolkit to Produce 3D Bolus in the Clinic. Int J Radiat Oncol Biol Phys 2023; 117:e646. [PMID: 37785922 DOI: 10.1016/j.ijrobp.2023.06.2062] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Tissue-equivalent, tissue-approximating and tissue-replacing bolus materials have been in use for decades in radiotherapy. Most frequently these materials are applied to a patient's skin to bring the highest dose region towards the surface of the skin-which is the location of the target. These materials can be applied at the time of simulation and included in a planning CT scan, or can be added during the planning process and first physically applied at the time of treatment. One of the most widely adopted materials for bolus has been sheets of a commercially available proprietary synthetic gel, which is uniform in thickness, and has some ability to match the curvature of the patient's body. Recently investigators have worked to create boluses using 3D printing technology, including several commercially available offerings. We hypothesized that we could create a bespoke, 3D bolus solution, using a series of open-source and free software products. MATERIALS/METHODS For an anthropomorphic phantom, a radiation treatment plan representative of skin cancer treatment was designed, this included a superficial target. The DICOM CT and structure set were imported into 3D Slicer, which is a free, open-source software for visualization, processing, segmentation, and registration. Using 3D Slicer, the bolus structure was saved as an STL file. Meshmixer, a free software for working with triangle meshes, was used to complete a mold design, and the mold parts were then printed using a rigid filament on a 3D printer. The mold parts were glued together, and small spring clamps were used secure the walls to the shells to ensure mold integrity. The mold was then filled with a thinned and degassed silicone. After appropriate curing, demolding was completed by removing the clamps and separating the walls. After QA, the bolus was applied to the anthropomorphic phantom and CTs were taken to compare a commercial sheet bolus with the in-house 3D printed product. RESULTS The bolus made via the in-house 3D printing process fit even complicated patient geometries well, and had both an obvious visual/goodness of fit advantage over the commercial sheet bolus and a nuanced dosimetric improvement as the air gaps present in the commercial sheet bolus were not desirable nor reproducible. The overall in-house workflow was efficient, and clinically reasonable (an estimated time of 72 hours was presented to the physician team, but in testing less than 24 hours was needed from export to delivery of the finished product). CONCLUSION In this work we explored whether motivated groups and departments could produce dosimetrically accurate and clinically reasonable custom boluses for patients undergoing radiotherapy to a superficial area of the body, using a test case on an anthropomorphic phantom. We found that this was absolutely achievable and could be implemented with no funds spent on software or licenses. Provided that a 3D printer, filament and silicone are available, any thoughtful practice can join the bespoke-bolus-club.
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Litvan I, Lang AE, Armstrong M. CBD diagnostic criteria: exclusions as important as inclusions. J Neurol Neurosurg Psychiatry 2023; 94:328. [PMID: 36323508 DOI: 10.1136/jnnp-2022-330564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Irene Litvan
- Neuroscience Department, University of California San Diego, La Jolla, California, USA
| | - Anthony E Lang
- Neurology, Toronto Western Hospital Krembil Neuroscience Centre, Toronto, Ontario, Canada.,Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, University Health Network, Toronto, Ontario, Canada
| | - Melissa Armstrong
- Neurology Department, University of Florida, Gainesville, Florida, USA
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Sim BZ, Aaron L, Coulter C, Parkes-Smith J, Badrick T, May K, Armstrong M, Hendry S, Sundac L, Dang L, Ho J, Hanson J, Smith S, Choong K, Henderson AH, Bursle E. A multi-centre retrospective study of Nocardia speciation and antimicrobial susceptibility in Queensland, Australia. Eur J Clin Microbiol Infect Dis 2023; 42:339-345. [PMID: 36720769 DOI: 10.1007/s10096-022-04542-0] [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: 09/20/2022] [Accepted: 12/15/2022] [Indexed: 02/02/2023]
Abstract
The study aims to characterise the species identification and antimicrobial susceptibility testing (AST) results of Nocardial isolates from adult patients across major public hospitals in Queensland, Australia, over a 15-year period. A multi-centre retrospective observational study of Nocardia sp. isolates was conducted from 7 major public hospitals in Queensland, Australia, over a 15-year period. Clinical samples from patients aged ≥ 18 years that isolated Nocardia sp. were included. Demographic and clinical data were collected, along with species identification and AST results. Overall, 484 Nocardia sp. were isolated. Most patients were male (297, 61%) with a mean (IQR) age of 60 (51-75) and a median (IQR) Charlson Comorbidity Index of 4 (2-6). Of these, 239 (49%) patients were immunosuppressed. Organisms were most frequently isolated from sputum (174, 36%), and superficial swabs (102, 21%). Patients presented with pulmonary infections (165, 35%) and superficial skin and soft tissue infections (87, 18%) most commonly. One hundred (21%) isolates were deemed pulmonary colonisation and were not treated. Of the speciated organisms, N. nova complex was the most common (93, 19%), followed by N. farcinica complex (79, 16%). Organisms were reliably susceptible to linezolid (240/245, 98%), amikacin (455/470, 97%), and trimethoprim/sulfamethoxazole (459/476, 96%), but less so to imipenem (243/472, 51%) and ceftriaxone (261/448, 58%). This is the largest Australian description of Nocardia sp. to date. Given antimicrobials are often commenced prior to AST results and sometimes even speciation, characterisation of local species and antibiogram data is important to guide empiric choices and local guidelines.
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Affiliation(s)
- B Z Sim
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. .,Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia. .,University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - L Aaron
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - C Coulter
- Queensland Mycobacterium Reference Laboratory, Herston Road, Herston, QLD, 4029, Australia
| | - J Parkes-Smith
- The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - T Badrick
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - K May
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - M Armstrong
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - S Hendry
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - L Sundac
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - L Dang
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - J Ho
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - J Hanson
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia.,Kirby Institute, High Street, Kensington, NSW, 2052, Australia
| | - S Smith
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - K Choong
- Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - A H Henderson
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - E Bursle
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,University of Queensland, St. Lucia, QLD, 4072, Australia
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Tholanikunnel T, Chapin B, Armstrong M. Prodromal Dementia with Lewy Bodies: A Case Series of the 3 Prodromal Types from Clinical Practice. Case Rep Neurol 2023; 15:199-206. [PMID: 37933327 PMCID: PMC10625810 DOI: 10.1159/000533378] [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: 01/08/2023] [Accepted: 07/19/2023] [Indexed: 11/08/2023] Open
Abstract
Prodromal dementia with Lewy bodies (DLB) refers to a state prior to the onset of dementia with clinical signs or symptoms that may indicate the future development of DLB. Prodromal symptoms can include not only cognitive deficits but also a mix of clinical features including sleep disorders, autonomic dysfunction, and neuro-psychiatric disturbances. While diagnostic criteria for the subtypes of prodromal DLB were recently published, they are largely used in research settings. However, these criteria have important implications for clinical practice. Recognition of prodromal DLB stages can lead to identifying deficits sooner, improved patient and family counseling, and advance care planning. This case series presents examples of the 3 subtypes of prodromal DLB - mild cognitive impairment onset, delirium onset, and psychiatric onset - to help clinicians identify individuals who may be on a trajectory to develop DLB.
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Affiliation(s)
- Tracy Tholanikunnel
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Benjamin Chapin
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
- Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Melissa Armstrong
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, USA
- UF Health Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
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Cain C, Hunt DC, Armstrong M, Collie-Akers VL, Ablah E. Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic. Int J Environ Res Public Health 2022; 19:14321. [PMID: 36361202 PMCID: PMC9655751 DOI: 10.3390/ijerph192114321] [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] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.
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Affiliation(s)
- Cristi Cain
- Kansas Department of Health and Environment, 1000 SW Jackson St, Topeka, KS 66612, USA
| | - D. Charles Hunt
- Johnson County Department of Health and Environment, 11875 S Sunset Dr., Olathe, KS 66061, USA
| | - Melissa Armstrong
- Department of Population Health, University of Kansas School of Medicine-Wichita, 1010 N Kansas, Wichita, KS 67214, USA
| | - Vicki L. Collie-Akers
- Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1008, Kansas City, KS 66160, USA
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, 1010 N Kansas, Wichita, KS 67214, USA
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Yoon J, Armstrong M, Cotton C, Mense M, Allaire N. 592 Ribosome profiling reveals distinct translation termination kinetics and efficiency between Fischer rat thyroid and human bronchial epidermal cells. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01282-6] [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: 11/07/2022]
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8
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Bukis K, Cheng Y, Armstrong M, Conte J, Coote K, Allaire N, Sivachenko A, Mense M, Cotton C, Valley H. 634 Generation of a cystic fibrosis transmembrane conductance regulator R1162X “TAG” model and comparison of readthrough to the naturally occurring R1162X “TGA”. J Cyst Fibros 2022. [PMCID: PMC9527874 DOI: 10.1016/s1569-1993(22)01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Allaire N, Yoon J, Armstrong M, Valley H, Macadino C, Sivachenko A, Conte J, Tabak B, Bihler H, Cheng Y, Coote K, Cotton C, Mense M. 663 Modulation of cystic fibrosis transmembrane conductance regulator intron 22 alternative polyadenylation use may have therapeutic potential for the treatment of certain 3′ cystic fibrosis transmembrane conductance regulator premature termination codon variants. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01353-4] [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: 11/06/2022]
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Armstrong M, Czechanski A, Chen Q, Swanzey E, O’Connor C, Reinholdt L. LP-65 Interstrain variation of cellular dose response traits in mouse pluripotent stem cells establishes feasibility for population-based studies of genetic susceptibility to triphenyl phosphate exposure. Toxicol Lett 2022. [DOI: 10.1016/j.toxlet.2022.07.798] [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: 11/30/2022]
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Yaeger MJ, Reece SW, Kilburg-Basnyat B, Hodge MX, Pal A, Dunigan-Russell K, Luo B, You DJ, Bonner JC, Spangenburg EE, Tokarz D, Hannan J, Armstrong M, Manke J, Reisdorph N, Tighe RM, Shaikh SR, Gowdy KM. Sex Differences in Pulmonary Eicosanoids and Specialized Pro-Resolving Mediators in Response to Ozone Exposure. Toxicol Sci 2021; 183:170-183. [PMID: 34175951 DOI: 10.1093/toxsci/kfab081] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ozone (O3) is a criteria air pollutant known to increase the morbidity and mortality of cardiopulmonary diseases. This occurs through a pulmonary inflammatory response characterized by increased recruitment of immune cells into the airspace, pro-inflammatory cytokines, and pro-inflammatory lipid mediators. Recent evidence has demonstrated sex-dependent differences in the O3-induced pulmonary inflammatory response. However, it is unknown if this dimorphic response is evident in pulmonary lipid mediator metabolism. We hypothesized that there are sex-dependent differences in lipid mediator production following acute O3 exposure. Male and female C57BL/6J mice were exposed to 1 part per million O3 for 3 hours and were necropsied at 6 or 24 hours following exposure. Lung lavage was collected for cell differential and total protein analysis, and lung tissue was collected for mRNA analysis, metabololipidomics, and immunohistochemistry. Compared to males, O3-exposed female mice had increases in airspace neutrophilia, neutrophil chemokine mRNA, pro-inflammatory eicosanoids such as prostaglandin E2, and specialized pro-resolving mediators (SPMs) such as resolvin D5 in lung tissue. Likewise, precursor fatty acids (arachidonic and docosahexaenoic acid; DHA) were increased in female lung tissue following O3 exposure compared to males. Experiments with ovariectomized females revealed that loss of ovarian hormones exacerbates pulmonary inflammation and injury. However, eicosanoid and SPM production were not altered by ovariectomy despite depleted pulmonary DHA concentrations. Taken together, these data indicate that O3 drives an increased pulmonary inflammatory and bioactive lipid mediator response in females. Furthermore, ovariectomy increases susceptibility to O3-induced pulmonary inflammation and injury, as well as decreases pulmonary DHA concentrations.
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Affiliation(s)
- M J Yaeger
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
| | - S W Reece
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - B Kilburg-Basnyat
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - M X Hodge
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - A Pal
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - K Dunigan-Russell
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
| | - B Luo
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - D J You
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27107
| | - J C Bonner
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27107
| | - E E Spangenburg
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - D Tokarz
- Experimental Pathology Laboratories, Inc, Research Triangle Park, NC, 27709
| | - J Hannan
- Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC, 27858
| | - M Armstrong
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - J Manke
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - N Reisdorph
- Department of Pharmaceutical Sciences, University of Colorado-AMC, Aurora, CO, 80045
| | - R M Tighe
- Department of Medicine, Duke University Medical Center, Durham, NC, 27710
| | - S R Shaikh
- Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599
| | - K M Gowdy
- Pulmonary, Critical Care and Sleep Medicine, Ohio State University Wexner Medical Center, Davis Heart and Lung Research Institute, Columbus, OH, 43210
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Rogans-Watson R, Shulman C, Lewer D, Armstrong M, Hudson B. 23 Frailty, Older Age-Associated Conditions, and Multimorbidity Amongst People Experiencing Homelessness in A Hostel in London. Age Ageing 2021. [DOI: 10.1093/ageing/afab029.02] [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
Introduction
People experiencing homelessness (PEH) face poor health outcomes and extreme health inequity, and evidence suggests earlier onset of older age-associated conditions and signs of premature ageing. This is the first UK study to assess frailty in this population. The objective was to assess frailty, age-associated conditions, and multimorbidity in PEH residing in hostel accommodation, drawing comparisons with population data.
Methods
Participants were drawn from a hostel in London for PEH aged over 30. Age-associated conditions were identified using validated tools and a questionnaire modelled on comprehensive geriatric assessments. Participants’ keyworkers completed questionnaires to provide collateral information. Frailty was defined according to five criteria in Fried’s phenotype model: participants with three or more criteria are classified as frail, one or two criteria as vulnerable, and no criteria as not frail. Multimorbidity was defined as the presence of two or more long-term conditions in one person. Comparisons were made with population data from The English Longitudinal Study of Ageing and Health Survey for England.
Results
Thirty-three people participated (83% of eligible residents), with a mean age of 55.7 years (range 38–74). Frailty was identified in 18/33 participants (55%), with 13/33 (39%) classified as vulnerable, and 2/33 (6%) as not frail. Participants met an average of 2.6/5 frailty phenotype criteria, comparable to 90-year-olds in the general population. The most common age-associated conditions identified were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%), and cognitive impairment (45%). Multimorbidity was present in all thirty-three participants.
Conclusions
A wide range of unmet health needs was identified. The high prevalence of frailty and age-associated conditions support evidence of premature ageing, indicating a need to include holistic older-age assessments in PEH at a younger age. Involvement of health professionals with experience of working with older people could contribute to improving health outcomes for homeless patients.
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Affiliation(s)
- R Rogans-Watson
- Dept of Elderly Care, Croydon University Hospital, London
- Pathway: UK's leading homeless healthcare charity, London
| | - C Shulman
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
| | - D Lewer
- Department of Epidemiology & Public Health, UCL, London
| | - M Armstrong
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
| | - B Hudson
- Pathway: UK's leading homeless healthcare charity, London
- Marie Curie Research Department, Division of Psychiatry, UCL
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Armstrong M, Seitz MJ, Beetle-Moorcroft F, Lipson DS. No-Purge Groundwater Sampling for PFAS. Ground Water 2020; 58:872-876. [PMID: 32901918 DOI: 10.1111/gwat.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
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Reed S, Getahun D, Gatz J, Armstrong M, Raine-Bennett T, Zhou X, Fassett M, Peipert J, Saltus C, Im T, Alabaster A, Hunter S, Takhar H, Chillemi G, Xie F, Wang J, Chiu V, Frenz A, Shi J, Lynen R, Asiimwe A, Anthony M. 78 Postpartum timing of IUD insertion is associated with risk of uterine perforation: Results from APEX IUD. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.099] [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: 10/23/2022]
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Fink J, Burns J, Perez Moreno AC, Kram JJF, Armstrong M, Chopp S, Maul SJ, Conway N. A Quality Brief of an Oncological Multisite Massage and Acupuncture Therapy Program to Improve Cancer-Related Outcomes. J Altern Complement Med 2020; 26:820-824. [PMID: 32924553 DOI: 10.1089/acm.2019.0371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objectives: Cancer treatment can present its own physical and mental challenges resulting in symptoms such as fatigue, stress, pain, nausea, and vomiting. Aurora Health Care is a large health system with 19 cancer centers. Integrative therapies such as acupuncture and massage have demonstrated success in reducing cancer-related symptoms and side effects to conventional cancer treatment and improving patient outcomes. In 2018, 15 of the 19 Aurora Cancer Clinics embedded a replicable Integrative Cancer Care closed model to provide adjuvant therapies for the best patient outcomes. This quality improvement study aimed to explore if the replicable integrative care model could demonstrate consistent outcomes for massage and acupuncture therapies aimed at symptom reduction across multiple oncology clinics. Design: Aurora Cancer Care and Aurora Integrative Medicine designed a reproducible integrative therapy service model to be embedded into the Aurora Cancer Centers. Integrative therapies within the cancer centers allow patients easy access to care before, during, or after their cancer treatment. In 2018, 15 of the 19 cancer clinics had integrative therapies available to patients with cancer. This model required unified operations, onboarding, training, competency, and clinical oversight to achieve consistent processes for consistent outcomes. Furthermore, these innovative models prioritized the following: patient access (easy and affordable); service delivery (consistent and operationalized); clinical outcomes (effective and meaningful); and caliber of clinician (competent and confident). Aurora Health Care employs massage therapists (Mts) and acupuncturists (Ats). This employment model allows for standards and program model adherence. To achieve competent and confident clinician's, MT or AT must complete a cancer treatment-focused competency training program relative to their respective profession and adherence to practice standards outlined. The training program is built on evidence-based practice, observation, direct demonstration, return demonstration, mentorship, and ongoing quality review by clinical leaders. Aurora's Integrative Cancer Care closed model of care is accessible to patients through philanthropic funds secured to underwrite the free service of MT provided during infusion treatments. Funds also provided three free AT sessions. Ongoing acupuncture therapies were provided at a low-cost group acupuncture fee at $25.00 per treatment. Acupuncture is available in group format and provided either before or after chemotherapy treatment. The free services were intended to introduce the concept of integrative therapies as a viable adjuvant option with conventional cancer care. As this model incorporates a mix of philanthropic funding and low-cost fees to offset the cost of the therapy provider, it is referred to as a "closed model" or accessible only to those patients under the care of an Aurora Cancer specialist. In 2018, 15 Aurora Cancer Clinics offered massage and 11 Aurora Cancer Clinics offered acupuncture. Patients who self-selected integrative therapies via system-employed Mts and Ats were surveyed pre/post acupuncture and MT treatments using a visual analog scale about their perceived levels of pain, stress, nausea, and neuropathy. The staff integrative clinicians collected data from patients, and post-treatment data were compiled by the Department of Integrative Medicine. Settings/Location: Aurora Cancer Centers are embedded within Aurora hospitals or free-standing clinics located throughout Wisconsin. In 2018, 15 cancer clinic locations embedded Mts, and 11 cancer clinic locations embedded Ats. Subjects: Oncology patients. Interventions: Clinical competencies were developed and applied to address indications, contraindications, and oncology-specific procedures to ensure that consistent quality of therapies was provided across sites. In 2018, Ats delivered 4367 Ats across 11 locations and Mts delivered 4197 Mts across 15 locations. During this study, the number of treatments provided was tracked versus episodic care. Outcome Measures: Pre/post AT and MT pain, stress, nausea, and neuropathy scores were recorded (0 [least] to 10 [worst]) and compared using paired t-tests. Results: Pre/post AT scores for pain, neuropathy, stress, and nausea were all significantly different (p < 0.001). For AT, there was a reported decrease in pain, stress, and neuropathy of 61.7%, 68.8%, and 47.9%, respectively. Pre/post MT scores for pain, neuropathy, nausea, and stress were also significantly different (p < 0.001). MT was greater at reducing stress and pain, 42.5% and 34.4%, respectively. Conclusions: Across 15 cancer clinics, both AT and MT treatments consistently and significantly reduced cancer-related side effects. These findings highlight the value of conducting a larger randomized-controlled trial to further assess the impact of Oncological Multisite Massage and Acupuncture Therapy on cancer-related symptoms across multiple oncologic clinics.
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Affiliation(s)
- Jennifer Fink
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - John Burns
- Department of Integrative Medicine, Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, USA
| | | | - Jessica J F Kram
- Aurora UW Medical Group and Center for Urban Population Health, Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, USA
| | - Melissa Armstrong
- Department of Integrative Medicine, Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, USA
| | - Sara Chopp
- Department of Health Informatics and Administration, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Scott J Maul
- Department of Oncology, Aurora Health Care, Milwaukee, WI, USA
| | - Nancy Conway
- Department of Integrative Medicine, Aurora Health Care, Aurora Sinai Medical Center, Milwaukee, WI, USA
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Karatuna O, Dance DAB, Matuschek E, Åhman J, Turner P, Hopkins J, Amornchai P, Wuthiekanun V, Cusack TP, Baird R, Hennessy J, Norton R, Armstrong M, Zange S, Zoeller L, Wahab T, Jacob D, Grunow R, Kahlmeter G. Burkholderia pseudomallei multi-centre study to establish EUCAST MIC and zone diameter distributions and epidemiological cut-off values. Clin Microbiol Infect 2020; 27:S1198-743X(20)30384-0. [PMID: 32653660 DOI: 10.1016/j.cmi.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Melioidosis, caused by Burkholderia pseudomallei, requires intensive antimicrobial treatment. However, standardized antimicrobial susceptibility testing (AST) methodology based on modern principles for determining breakpoints and ascertaining performance of methods are lacking for B. pseudomallei. This study aimed to establish MIC and zone diameter distributions on which to set epidemiological cut-off (ECOFF) values for B. pseudomallei using standard EUCAST methodology for non-fastidious organisms. METHODS Non-consecutive, non-duplicate clinical B. pseudomallei isolates (9-70 per centre) were tested at eight study centres against eight antimicrobials by broth microdilution (BMD) and the EUCAST disc diffusion method. Isolates without and with suspected resistance mechanisms were deliberately selected. The EUCAST Development Laboratory ensured the quality of study materials, and provided guidance on performance of the tests and interpretation of results. Aggregated results were analysed according to EUCAST recommendations to determine ECOFFs. RESULTS MIC and zone diameter distributions were generated using BMD and disc diffusion results obtained for 361 B. pseudomallei isolates. MIC and zone diameter ECOFFs (mg/L; mm) were determined for amoxicillin-clavulanic acid (8; 22), ceftazidime (8; 22), imipenem (2; 29), meropenem (2; 26), doxycycline (2; none), tetracycline (8; 23), chloramphenicol (8; 22) and trimethoprim-sulfamethoxazole (4; 28). CONCLUSIONS We have validated the use of standard BMD and disc diffusion methodology for AST of B. pseudomallei. The MIC and zone diameter distributions generated in this study allowed us to establish MIC and zone diameter ECOFFs for the antimicrobials studied. These ECOFFs served as background data for EUCAST to set clinical MIC and zone diameter breakpoints for B. pseudomallei.
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Affiliation(s)
- O Karatuna
- EUCAST Development Laboratory, Växjö, Sweden.
| | - D A B Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - E Matuschek
- EUCAST Development Laboratory, Växjö, Sweden
| | - J Åhman
- EUCAST Development Laboratory, Växjö, Sweden
| | - P Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - J Hopkins
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - P Amornchai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - V Wuthiekanun
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - T-P Cusack
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic; National Infection Service, Public Health England, London, UK
| | - R Baird
- Royal Darwin Hospital, Darwin, NT, Australia
| | - J Hennessy
- Royal Darwin Hospital, Darwin, NT, Australia
| | - R Norton
- Townsville Hospital, Townsville, QLD, Australia
| | - M Armstrong
- Townsville Hospital, Townsville, QLD, Australia
| | - S Zange
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - L Zoeller
- Bundeswehr Institute of Microbiology, Munich, Germany
| | - T Wahab
- Public Health Agency of Sweden, Stockholm, Sweden
| | - D Jacob
- Robert Koch Institute, Berlin, Germany
| | - R Grunow
- Robert Koch Institute, Berlin, Germany
| | - G Kahlmeter
- EUCAST Development Laboratory, Växjö, Sweden
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17
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Gao A, Armstrong M, Liu C, Liu L, Yang J, Lou W, Li P, Evans C. Inhibition steroid sulfatase suppresses androgen signaling and improves response to enzalutamide. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33829-5] [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: 10/23/2022] Open
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Abstract
The causative agent of melioidosis, Burkholderia pseudomallei, a tier 1 select agent, is endemic in Southeast Asia and northern Australia, with increased incidence associated with high levels of rainfall. Increasing reports of this condition have occurred worldwide, with estimates of up to 165,000 cases and 89,000 deaths per year. The ecological niche of the organism has yet to be clearly defined, although the organism is associated with soil and water. The culture of appropriate clinical material remains the mainstay of laboratory diagnosis. Identification is best done by phenotypic methods, although mass spectrometric methods have been described. Serology has a limited diagnostic role. Direct molecular and antigen detection methods have limited availability and sensitivity. Clinical presentations of melioidosis range from acute bacteremic pneumonia to disseminated visceral abscesses and localized infections. Transmission is by direct inoculation, inhalation, or ingestion. Risk factors for melioidosis include male sex, diabetes mellitus, alcohol abuse, and immunosuppression. The organism is well adapted to intracellular survival, with numerous virulence mechanisms. Immunity likely requires innate and adaptive responses. The principles of management of this condition are drainage and debridement of infected material and appropriate antimicrobial therapy. Global mortality rates vary between 9% and 70%. Research into vaccine development is ongoing.
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Affiliation(s)
- I Gassiep
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - M Armstrong
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
| | - R Norton
- Pathology Queensland, Townsville Hospital, Townsville, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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19
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Dreesens D, Stiggelbout A, Agoritsas T, Elwyn G, Flottorp S, Grimshaw J, Kremer L, Santesso N, Stacey D, Treweek S, Armstrong M, Gagliardi A, Hill S, Légaré F, Ryan R, Vandvik P, van der Weijden T. A conceptual framework for patient-directed knowledge tools to support patient-centred care: Results from an evidence-informed consensus meeting. Patient Educ Couns 2019; 102:1898-1904. [PMID: 31118137 DOI: 10.1016/j.pec.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient-directed knowledge tools are designed to engage patients in dialogue or deliberation, to support patient decision-making or self-care of chronic conditions. However, an abundance of these exists. The tools themselves and their purposes are not always clearly defined; creating challenges for developers and users (professionals, patients). The study's aim was to develop a conceptual framework of patient-directed knowledge tool types. METHODS A face-to-face evidence-informed consensus meeting with 15 international experts. After the meeting, the framework went through two rounds of feedback before informal consensus was reached. RESULTS A conceptual framework containing five patient-directed knowledge tool types was developed. The first part of the framework describes the tools' purposes and the second focuses on the tools' core elements. CONCLUSION The framework provides clarity on which types of patient-directed tools exist, the purposes they serve, and which core elements they prototypically include. It is a working framework and will require further refinement as the area develops, alongside validation with a broader group of stakeholders. PRACTICE IMPLICATIONS The framework assists developers and users to know which type a tool belongs, its purpose and core elements, helping them to develop and use the right tool for the right job.
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Affiliation(s)
- Dunja Dreesens
- Knowledge Institute of Medical Specialists, Utrecht, the Netherlands; Department of Family Medicine, Maastricht University/School CAPHRI, Maastricht, the Netherlands.
| | - Anne Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, USA.
| | - Signe Flottorp
- Division of health services, Norwegian Institute of Public Health, Oslo, Norway; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Leontien Kremer
- Department Pediatrics, University of Amsterdam, Amsterdam, the Netherlands; Princess Maxima Centrum for Pediatric Oncology, Utrecht, the Netherlands.
| | - Nancy Santesso
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Nursing, University of Ottawa, Ottawa, Canada.
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Melissa Armstrong
- Department of Neurology, College of Medicine / University of Florida, Gainesville, USA.
| | - Anna Gagliardi
- University Health Network/Toronto General Hospital Research Institute, Toronto, Canada.
| | - Sophie Hill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia; Cochrane Consumers and Communication Group, La Trobe University, Melbourne, Australia.
| | | | - Rebecca Ryan
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia; Cochrane Consumers and Communication Group, La Trobe University, Melbourne, Australia.
| | - Per Vandvik
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University/School CAPHRI, Maastricht, the Netherlands.
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20
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Peterson B, Armstrong M, Galasko D, Galvin JE, Goldman J, Irwin D, Paulson H, Kaufer D, Leverenz J, Lunde A, McKeith IG, Siderowf A, Taylor A, Amodeo K, Barrett M, Domoto-Reilly K, Duda J, Gomperts S, Graff-Radford N, Holden S, Honig L, Huddleston D, Lippa C, Litvan I, Manning C, Marder K, Moussa C, Onyike C, Pagan F, Pantelyat A, Pelak V, Poston K, Quinn J, Richard I, Rosenthal LS, Sabbagh M, Scharre D, Sha S, Shill H, Torres-Yaghi Y, Christie T, Graham T, Richards I, Koehler M, Boeve B. Lewy Body Dementia Association's Research Centers of Excellence Program: Inaugural Meeting Proceedings. Alzheimers Res Ther 2019; 11:23. [PMID: 30867052 PMCID: PMC6417280 DOI: 10.1186/s13195-019-0476-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator’s meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson’s disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or other) professionals, and (4) create infrastructure for a clinical trials-ready network as well as resources to advance the study of new therapeutics.
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Affiliation(s)
| | | | | | | | | | - David Irwin
- University of Pennsylvania, Philadelphia, USA
| | | | | | | | - Angela Lunde
- Mayo Clinic campus, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | | | | | | | | | - John Duda
- University of Pennsylvania, Philadelphia, USA
| | | | | | | | | | | | - Carol Lippa
- Thomas Jefferson University, Philadelphia, USA
| | | | | | | | - Charbel Moussa
- Georgetown University Medical Center, Washington, D.C., USA
| | | | - Fernando Pagan
- Georgetown University Medical Center, Washington, D.C., USA
| | | | | | | | - Joseph Quinn
- Oregon Health & Science University, Portland, USA
| | | | | | | | | | | | | | | | | | - Todd Graham
- Lewy Body Dementia Association, Lilburn, USA
| | | | | | - Brad Boeve
- Mayo Clinic campus, 200 1st Street SW, Rochester, MN, 55905, USA.
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21
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Kang A, Armstrong M, Parry J. 48. CD30 expression in a small bowel follicular lymphoma transforming to diffuse large B cell lymphoma; should CD30 be part of the standard workup of all follicular lymphomas? Pathology 2019. [DOI: 10.1016/j.pathol.2018.09.047] [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: 10/27/2022]
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22
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Christoforou A, Robbins A, Giacino J, Armstrong M, Bergin M, McCrea M, Erwin P, Merillat S, Getchius T. An Evidence-Based Clinical Outcome Assessment Platform (EB-COP) for the Validation of TBI Assessment Measures. Arch Phys Med Rehabil 2018. [DOI: 10.1016/j.apmr.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Candy B, Armstrong M, Amey R, Booth J, Flemming K, Kupeli N, Maclean V, Preston J, Stone P, Wilkinson S. 9 Using what people value to develop new interventions in palliative care: a multilevel level review approach. BMJ Support Palliat Care 2018. [DOI: 10.1136/bmjspcare-2018-mariecurie.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
IntroductionComplex interventions are common in palliative care (PC) but are difficult to evaluate. Complementary therapies (CT) are one type of widely-used complex intervention for which there is inconclusive evidence. No systematic review has been conducted in PC of trials or of qualitative studies of patients’ views of CTs. There are novel approaches with established exemplars of using both types of reviews to help develop more clinically appropriate interventions. These approaches are in their infancy in PC research and have much to offer the specialism.AimsUsing our on-going review on CT we present as an exemplar in PC an approach to draw together the findings of trials and qualitative studies in a data table (matrix) to contrast what patients value and want with how the intervention is tested.MethodsWe sought trials on the effectiveness of CT and qualitative studies on patients’ perspectives about these therapies. Our primary outcomes for trials included anxiety. Eight databases were searched in 2017. Citations and full-text papers were reviewed to identify relevant studies. Meta-analyses pooled trial data where appropriate and a thematic synthesis is being undertaken to understand patient experience. These findings will be combined in a matrix to explore similarities and differences.Results19 trials and five qualitative studies were included. Data analysis and development of the matrix which includes intervention content and patients’ needs is currently underway. We will present the final matrix framework.ConclusionsOur approach demonstrates a potential way in PC to enhance development of practice appropriate complex interventions.
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24
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Boeve BF, Armstrong M, Galvin JE, Goldman J, Irwin DJ, Kaufer D, Leverenz JB, Lunde AM, McKeith IG, Paulson HL, Siderowf AD, Barrett MJ, Kimiko DR, Duda J, Galasko DR, Gomperts S, Graff-Radford NR, Holden SK, Honig LS, Huddleston D, Lippa C, Litvan I, Manning CA, Marder K, E-H Moussa C, Onyike CU, Pagan F, Pantelyat A, Pelak VS, Poston K, Quinn JF, Richard I, Rosenthal L, Sabbagh MN, Scharre DW, Sha S, Shill H, Torres-Yaghi Y, Amodeo K, Christie T, Graham T, Koehler M, Peterson B, Richard I, Taylor A. O5‐03‐04: THE LEWY BODY DEMENTIA ASSOCIATION RESEARCH CENTERS OF EXCELLENCE PROGRAM: TOWARD OPTIMIZING CLINICAL CARE AND CLINICAL TRIAL INFRASTRUCTURE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | | | | | - David J. Irwin
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | - Ian G. McKeith
- Institute of NeuroscienceNewcastle University, Wolfson Research Centre, Campus for Ageing and VitalityNewcastle upon TyneUnited Kingdom
| | | | | | | | | | - John Duda
- University of PennsylvaniaPhiladelphiaPAUSA
| | | | | | | | | | | | | | | | - Irene Litvan
- University of California San DiegoSan DiegoCAUSA
| | | | | | | | | | | | - Alex Pantelyat
- Johns Hopkins University School of MedicineBaltimoreMDUSA
| | | | | | | | | | | | | | | | | | | | - Yasar Torres-Yaghi
- George Washington School of Medicine and Health SciencesWashingtonD.C.USA
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25
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Wadman R, Armstrong M, Clarke D, Harroe C, Majumder P, Sayal K, Vostanis P, Townsend E. Experience of Self-Harm and Its Treatment in Looked-After Young People: An Interpretative Phenomenological Analysis. Arch Suicide Res 2018; 22:365-379. [PMID: 28786765 DOI: 10.1080/13811118.2017.1355286] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 12/21/2022]
Abstract
We report the first Interpretative Phenomenological Analysis examination of self-harm and experience of clinical services in young people in the public care system. Qualitative interviews with 24 looked-after young people were completed. Prevalent themes were 1) Changes in care placement, 2) Feelings of anger, 3) Not wanting/feeling able to talk, 4) Developing coping techniques, 5) Clinical services: A relational mixed bag (subthemes: feeling (i) patronized, not listened to, (ii) nothing being done, (iii) comfortable/able to talk). Placement change and anger were highly salient to self-harm in this group and experiences of clinical services depended on individual relationships with clinicians. Implications include increasing compassion in therapeutic relationships, recognizing and managing emotional dysregulation, and increasing support during placement changes.
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Quinn KD, Schedel M, Nkrumah-Elie Y, Joetham A, Armstrong M, Cruickshank-Quinn C, Reisdorph R, Gelfand EW, Reisdorph N. Dysregulation of metabolic pathways in a mouse model of allergic asthma. Allergy 2017; 72:1327-1337. [PMID: 28213886 DOI: 10.1111/all.13144] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Asthma is a complex lung disease resulting from the interplay of genetic and environmental factors. To understand the molecular changes that occur during the development of allergic asthma without genetic and environmental confounders, an experimental model of allergic asthma in mice was used. Our goals were to (1) identify changes at the small molecule level due to allergen exposure, (2) determine perturbed pathways due to disease, and (3) determine whether small molecule changes correlate with lung function. METHODS In this experimental model of allergic asthma, matched bronchoalveolar lavage (BAL) fluid and plasma were collected from three groups of C57BL6 mice (control vs sensitized and/or challenged with ovalbumin, n=3-5/group) 6 hour, 24 hour, and 48 hour after the last challenge. Samples were analyzed using liquid chromatography-mass spectrometry-based metabolomics. Airway hyper-responsiveness (AHR) measurements and differential cell counts were performed. RESULTS In total, 398 and 368 dysregulated metabolites in the BAL fluid and plasma of sensitized and challenged mice were identified, respectively. These belonged to four, interconnected pathways relevant to asthma pathogenesis: sphingolipid metabolism (P=6.6×10-5 ), arginine and proline metabolism (P=1.12×10-7 ), glycerophospholipid metabolism (P=1.3×10-10 ), and the neurotrophin signaling pathway (P=7.0×10-6 ). Furthermore, within the arginine and proline metabolism pathway, a positive correlation between urea-1-carboxylate and AHR was observed in plasma metabolites, while ornithine revealed a reciprocal effect. In addition, agmatine positively correlated with lung eosinophilia. CONCLUSION These findings point to potential targets and pathways that may be central to asthma pathogenesis and can serve as novel therapeutic targets.
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Affiliation(s)
- K. D. Quinn
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
- Immunology & Microbiology Department School of Medicine; University of Colorado Denver; Aurora CO USA
| | - M. Schedel
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - Y. Nkrumah-Elie
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - A. Joetham
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - M. Armstrong
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - C. Cruickshank-Quinn
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - R. Reisdorph
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
| | - E. W. Gelfand
- Division of Cell Biology; Department of Pediatrics; National Jewish Health; Denver CO USA
| | - N. Reisdorph
- School of Pharmacy and Pharmaceutical Sciences; University of Colorado Denver; Aurora CO USA
- Immunology & Microbiology Department School of Medicine; University of Colorado Denver; Aurora CO USA
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27
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Armstrong M, Ladwa R, Lockyer A. Dental radiography: Cherry picking evidence. Br Dent J 2017; 223:4. [DOI: 10.1038/sj.bdj.2017.562] [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: 11/09/2022]
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28
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Joshi N, Rolheiser TM, Fisk JD, McKelvey JR, Schoffer K, Phillips G, Armstrong M, Khan MN, Leslie RA, Rusak B, Robertson HA, Good KP. Lateralized microstructural changes in early-stage Parkinson's disease in anterior olfactory structures, but not in substantia nigra. J Neurol 2017; 264:1497-1505. [PMID: 28653210 DOI: 10.1007/s00415-017-8555-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/17/2022]
Abstract
Parkinson's disease (PD) is a progressive neurological disorder characterized by motor symptoms as well as severe deficits in olfactory function and microstructural changes in olfactory brain regions. Because of the evidence of asymmetric neuropathological features in early-stage PD, we examined whether lateralized microstructural changes occur in olfactory brain regions and the substantia nigra in a group of early-stage PD patients. Using diffusion tensor imaging (DTI) and the University of Pennsylvania Smell Identification Test (UPSIT), we assessed 24 early-stage PD patients (Hoehn and Yahr stage 1 or 2) and 26 healthy controls (HC). We used DTI and a region of interest (ROI) approach to study the microstructure of the left and right anterior olfactory structures (AOS; comprising the olfactory bulbs and anterior end of the olfactory tracts) and the substantia nigra (SN). PD patients had reduced UPSIT scores relative to HC and showed increased mean diffusivity (MD) in the SN, with no lateralized differences. Significant group differences in fractional anisotropy (FA) and MD were seen in the AOS, but these differences were restricted to the right side and were not associated with the primary side of motor symptoms amongst PD patients. No associations were observed between lateralized motor impairment and lateralized microstructural changes in AOS. Impaired olfaction and microstructural changes in AOS are useful for early identification of PD but asymmetries in AOS microstructure seem unrelated to the laterality of PD motor symptoms.
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Affiliation(s)
- N Joshi
- Department of Psychiatry, IWK Hospital, Halifax, NS, Canada
| | - T M Rolheiser
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada
| | - J D Fisk
- Department of Psychology, Nova Scotia Health Authority, Central Zone, Halifax, NS, Canada
| | - J R McKelvey
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - K Schoffer
- Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - G Phillips
- Division of Respirology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - M Armstrong
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - M N Khan
- Department of Radiology, IWK Hospital, Halifax, NS, Canada
| | - R A Leslie
- Department of Medical Neurosciences, Dalhousie University, Halifax, NS, Canada
| | - B Rusak
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - H A Robertson
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada.,Division of Neurology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - K P Good
- Department of Psychiatry, Dalhousie University, 4064 AJLB, 5909 Veterans Memorial Lane, Halifax, NS, Canada. .,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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Willson ML, Vernooij RW, Gagliardi AR, Armstrong M, Bernhardsson S, Brouwers M, Bussières A, Fleuren M, Gali K, Huckson S, Jones S, Lewis SZ, James R, Marshall C, Mazza D. Questionnaires used to assess barriers of clinical guideline use among physicians are not comprehensive, reliable, or valid: a scoping review. J Clin Epidemiol 2017; 86:25-38. [DOI: 10.1016/j.jclinepi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/27/2016] [Accepted: 12/23/2016] [Indexed: 01/26/2023]
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Townsend E, Wadman R, Sayal K, Armstrong M, Harroe C, Majumder P, Vostanis P, Clarke D. Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS). J Affect Disord 2016; 206:161-168. [PMID: 27475886 PMCID: PMC5082440 DOI: 10.1016/j.jad.2016.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. METHODS Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). RESULTS A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. LIMITATIONS Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. CONCLUSIONS The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions.
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Affiliation(s)
- E. Townsend
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK,Corresponding author.
| | - R. Wadman
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
| | - K. Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - M. Armstrong
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - C. Harroe
- Harmless, 7 Mansfield Road, Nottingham NG1 3FB, UK
| | - P. Majumder
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Thorneywood CAMHS, Porchester Rd, Nottingham NG3 6LF, UK
| | - P. Vostanis
- School of Neurosciences, Psychology and Behaviour, University of Leicester, Westcotes Drive, Leicester LE3 0QU, UK
| | - D. Clarke
- Self-Harm Research Group, School of Psychology, University Park, The University of Nottingham, Nottingham NG7 2RD, UK
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Shulman LM, Armstrong M, Ellis T, Gruber-Baldini A, Horak F, Nieuwboer A, Parashos S, Post B, Rogers M, Siderowf A, Goetz CG, Schrag A, Stebbins GT, Martinez-Martin P. Disability Rating Scales in Parkinson's Disease: Critique and Recommendations. Mov Disord 2016; 31:1455-1465. [DOI: 10.1002/mds.26649] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 02/26/2016] [Accepted: 03/13/2016] [Indexed: 11/08/2022] Open
Affiliation(s)
- Lisa M. Shulman
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Melissa Armstrong
- Department of Neurology; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Terry Ellis
- Department of Physical Therapy & Athletic Training; Boston University; Boston Massachusetts USA
| | - Ann Gruber-Baldini
- Department of Epidemiology and Public Health; University of Maryland School of Medicine; Baltimore Maryland USA
| | - Fay Horak
- Department of Neurology; Oregon Health and Science University and Portland VA Medical System; Portland Oregon USA
| | - Alice Nieuwboer
- Department of Rehabilitation Science; KU Leuven-University of Leuven; Heverlee Belgium
| | | | - Bart Post
- Department of Neurology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Mark Rogers
- Department of Physical Therapy & Rehabilitation; University of Maryland School of Medicine; Baltimore Maryland USA
| | | | | | - Anette Schrag
- UCL Institute of Neurology; University College London; UK
| | - Glenn T. Stebbins
- Department of Neurology; Rush University Medical Center; Chicago USA
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED; Carlos III Institute of Health; Madrid Spain
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Pakhale S, Baron J, Armstrong M, Tasca G, Gaudet E, Aaron SD, Cameron W, Balfour L. Lost in translation? How adults living with Cystic Fibrosis understand treatment recommendations from their healthcare providers, and the impact on adherence to therapy. Patient Educ Couns 2016; 99:1319-1324. [PMID: 27036082 DOI: 10.1016/j.pec.2016.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/16/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE This study builds on the limited research documenting Cystic Fibrosis (CF) patients' understanding of treatment recommendations and how this may impact adherence to therapy. METHODS We surveyed adults with CF and their healthcare professional (HCP) to capture treatment recommendations provided by the HCP, and patients' knowledge, and frequency of performance, of these recommendations. We classified CF participants' understanding of treatment recommendations (correct/incorrect) as compared to the actual recommendations made by the HCP. We computed CF participants' adherence in relation to HCP treatment recommendations and to their own understanding of treatment recommendations (adherent/non-adherent). RESULTS Complete HCP and patient data were available for 42 participants. The recommended treatment frequency was correctly understood by 0%-87.8% of CF participants. Adherence to HCP treatment recommendations ranged from 0 to 68.3% (mean 45.4%±21.5), and rates were low (<33%) for acapella, percussion/postural drainage, tobramycin nebulization and insulin. Participants' adherence was greater when calculated in relation to participants' understanding of treatment recommendations (62.4%±25.1) than when calculated in relation to actual HCP treatment recommendations (45.4%±21.5%) (p=0.009). CONCLUSION AND PRACTICE IMPLICATIONS Adults with CF misunderstand treatment recommendations; this likely affects treatment adherence. Interventions to ensure HCPs use effective communication strategies are needed.
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Affiliation(s)
- S Pakhale
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada.
| | - J Baron
- Ottawa Hospital Research Institute, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - M Armstrong
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - G Tasca
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - E Gaudet
- The Ottawa Hospital, Ottawa, Canada
| | - S D Aaron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada; Division of Respiratory Medicine, The Ottawa Hospital, Ottawa, Canada
| | - W Cameron
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
| | - L Balfour
- Ottawa Hospital Research Institute, Ottawa, Canada; The Ottawa Hospital, Ottawa, Canada; The University of Ottawa, Ottawa, Canada
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33
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Armstrong M, Rabi D, Southern D, Nanji A, Ghali W, Sigal R. CLINICAL UTILITY OF PRE-EXERCISE SCREENING USING EXERCISE STRESS TESTING IN PEOPLE WITH DIABETES. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.438] [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: 11/30/2022] Open
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34
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Nabarro LEB, Lever RA, Armstrong M, Chiodini PL. Increased incidence of nitroimidazole-refractory giardiasis at the Hospital for Tropical Diseases, London: 2008-2013. Clin Microbiol Infect 2015; 21:791-6. [PMID: 25975511 DOI: 10.1016/j.cmi.2015.04.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/12/2015] [Accepted: 04/27/2015] [Indexed: 11/25/2022]
Abstract
Giardia intestinalis is the commonest gastrointestinal protozoal pathogen worldwide, and causes acute and chronic diarrhoea with malabsorption. First-line treatment is with a nitroimidazole, with a reported efficacy rate of 89%. Failure of treatment can occur in patients with hypogammaglobulinaemia or human immunodeficiency virus (HIV), or be due to nitroimidazole-resistant organisms. There is little evidence to guide the clinical management of nitroimidazole-refractory disease. We performed a retrospective audit of nitroimidazole-refractory giardiasis in returned travellers at the Hospital for Tropical Diseases, London between 2011 and 2013. Seventy-three patients with microscopy-proven or PCR-proven giardiasis in whom nitroimidazole treatment had failed were identified, and their management was investigated. In 2008, nitroimidazole treatment failed in 15.1% of patients. This increased to 20.6% in 2011 and to 40.2% in 2013. Patient demographics remained stable during this period, as did routes of referral. Of patients with giardiasis, 39.0% had travelled to India; this rose to 69.9% in patients with nitroimidazole-refractory disease. Of the patients with refractory disease, 44.6% had HIV serological investigations performed and 36.5% had immunoglobulin levels determined. Patients with refractory disease were treated with various agents, including albendazole, nitazoxanide, and mepacrine, alone or in combination. All 20 patients who received a mepacrine-containing regimen were cured. This data shows a worrying increase in refractory disease, predominantly in travellers from India, which is likely to represent increasing nitroimidazole resistance. Improved tools for the diagnosis of resistant G. intestinalis are urgently needed to establish the true prevalence of nitroimidazole-resistant giardiasis, together with clinical trials to establish the most effective second-line agent for empirical treatment regimens.
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Affiliation(s)
- L E B Nabarro
- The Hospital for Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - R A Lever
- The Hospital for Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - M Armstrong
- The Hospital for Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - P L Chiodini
- The Hospital for Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Coltart CEM, Chew A, Storrar N, Armstrong M, Suff N, Morris L, Chiodini PL, Whitty CJM. Schistosomiasis presenting in travellers: a 15 year observational study at the Hospital for Tropical Diseases, London. Trans R Soc Trop Med Hyg 2015; 109:214-20. [DOI: 10.1093/trstmh/tru195] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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36
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Affiliation(s)
- S. V. Mallett
- Department of Anaesthesia; Royal Free London NHS Trust; London UK
| | - M. Armstrong
- Department of Anaesthesia; Royal Free London NHS Trust; London UK
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37
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Bonilla NO, Scholl J, Armstrong M, Pieri D, Otero B, Labrado A, McPherson D, Nelson M. Ecological Science and Public Policy: an Intersection of Action Ecology. ACTA ACUST UNITED AC 2012. [DOI: 10.1890/0012-9623-93.4.340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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38
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Herbert R, Ashraf AN, Yates TA, Spriggs K, Malinnag M, Durward-Brown E, Phillips D, Mewse E, Daniel A, Armstrong M, Kidd IM, Waite J, Wilks P, Burns F, Bailey R, Brown M. Nurse-delivered universal point-of-care testing for HIV in an open-access returning traveller clinic. HIV Med 2012; 13:499-504. [PMID: 22413841 DOI: 10.1111/j.1468-1293.2012.01001.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open-access returning traveller clinic. METHODS Data were prospectively recorded for all patients attending the open-access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point-of-care test (POCT) (phase 2). RESULTS A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 (P < 0.0001). Two new diagnoses of HIV-1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT. CONCLUSIONS A nurse-delivered universal point-of-care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low-prevalence country. Caution is required in communicating reactive results in low-prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.
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Affiliation(s)
- R Herbert
- Hospital for Tropical Diseases, UCLH NHS Foundation Trust, London, UK.
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Woinarski JCZ, Fisher A, Armstrong M, Brennan K, Griffiths AD, Hill B, Choy JL, Milne D, Stewart A, Young S, Ward S, Winderlich S, Ziembicki M. Monitoring indicates greater resilience for birds than for mammals in Kakadu National Park, northern Australia. Wildl Res 2012. [DOI: 10.1071/wr11213] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context
A previous study reported major declines for native mammal species from Kakadu National Park, over the period 2001–09. The extent to which this result may be symptomatic of more pervasive biodiversity decline was unknown.
Aims
Our primary aim was to describe trends in the abundance of birds in Kakadu over the period 2001–09. We assessed whether any change in bird abundance was related to the arrival of invading cane toads (Rhinella marina), and to fire regimes.
Methods
Birds were monitored at 136 1-ha plots in Kakadu, during the period 2001–04 and again in 2007–09. This program complemented sampling of the same plots over the same period for native mammals.
Key results
In contrast to the decline reported for native mammals, the richness and total abundance of birds increased over this period, and far more individual bird species increased than decreased. Fire history in the between-sampling period had little influence on trends for individual species. Interpretation of the overall positive trends for bird species in Kakadu over this period should be tempered by recognition that most of the threatened bird species present in Kakadu were unrecorded in this monitoring program, and the two threatened species for which there were sufficient records to assess trends – partridge pigeon (Geophaps smithii) and white-throated grass-wren (Amytornis woodwardi) – both declined significantly.
Conclusions
The current decline of the mammal fauna in this region is not reflected in trends for the region’s bird fauna. Some of the observed changes (mostly increases) in the abundance of bird species may be due to the arrival of cane toads, and some may be due to local or regional-scale climatic variation or variation in the amount of flowering. The present study provides no assurance about threatened bird species, given that most were inadequately recorded in the study (perhaps because their decline pre-dated the present study).
Implications
These contrasting trends between mammals and birds demonstrate the need for biodiversity monitoring programs to be broadly based. The declines of two threatened bird species over this period indicate the need for more management focus for these species.
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Rhouma O, McMahon A, Conway D, Armstrong M, Welbury R, Goodall C. Paediatric facial injuries in Scotland 2001–2009: epidemiological and sociodemographic aspects. Int J Oral Maxillofac Surg 2011. [DOI: 10.1016/j.ijom.2011.07.411] [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: 11/25/2022]
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41
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Armstrong M, Spencer E, Cairns B, Beral V. P1-80 Different effects of body mass index and physical activity on the risk of ankle, wrist and hip fractures in postmenopausal women. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976c.73] [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: 11/03/2022]
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Marshall K, Hamlin J, Armstrong M, Mendoza J, Lee C, Pieri D, Rivera R, Lastra-Diaz L, Stonefish A, Bailey J. Science for a Social Revolution: Ecologists Entering the Realm of Action. ACTA ACUST UNITED AC 2011. [DOI: 10.1890/0012-9623-92.3.241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Stevenson R, Fatehullah A, Jagan I, Deevi RK, Bingham V, Irvine AE, Armstrong M, Morrison PJ, Dimmick I, Stewart R, Campbell FC. Enhanced lymphocyte interferon (IFN)-γ responses in a PTEN mutation-negative Cowden disease kindred. Clin Exp Immunol 2011; 164:202-10. [PMID: 21361912 DOI: 10.1111/j.1365-2249.2011.04336.x] [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: 11/27/2022] Open
Abstract
Identification of immune modifiers of inherited cancer syndromes may provide a rationale for preventive therapy. Cowden disease (CD) is a genetically heterogeneous inherited cancer syndrome that arises predominantly from germline phosphatase and tensin homologue deleted on chromosome 10 (PTEN) mutation and increased phosphoinositide 3-kinase/mammalian target of rapamycin (PI3K/mTOR) signalling. However, many patients with classic CD diagnostic features are mutation-negative for PTEN (PTEN M-Neg). Interferon (IFN)-γ can modulate the PI3K/mTOR pathway, but its association with PTEN M-Neg CD remains unclear. This study assessed IFN-γ secretion by multi-colour flow cytometry in a CD kindred that was mutation-negative for PTEN and other known susceptibility genes. Because IFN-γ responses may be regulated by killer cell immunoglobulin-like receptors (KIR) and respective human leucocyte antigen (HLA) ligands, KIR/HLA genotypes were also assessed. Activating treatments induced greater IFN-γ secretion in PTEN M-Neg CD peripheral blood lymphocytes versus healthy controls. Increased frequency of activating KIR genes, potentially activating KIR/HLA compound genotypes and reduced frequency of inhibitory genotypes, were found in the PTEN M-Neg CD kindred. Differences of IFN-γ secretion were observed among PTEN M-Neg CD patients with distinct KIR/HLA compound genotypes. Taken together, these findings show enhanced lymphocyte secretion of IFN-γ that may influence the PI3K/mTOR CD causal molecular pathway in a PTEN mutation-negative CD kindred.
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Affiliation(s)
- R Stevenson
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, UK
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Stadtmauer L, Armstrong M. Short Term Follow-Up of a Series of Robot-Assisted Myomectomies in Women with Symptomatic Fibroids and/or Infertility. J Minim Invasive Gynecol 2010. [DOI: 10.1016/j.jmig.2010.08.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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45
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Rivera N, Calderon-Ayala J, Calle L, Du S, Gerald B, Lanas M, Lualhati M, Moreno L, Pérez AE, Sylvain I, Vieira D, Armstrong M. Multidisciplinary and Multimedia Approaches to Action-Oriented Ecology. ACTA ACUST UNITED AC 2010. [DOI: 10.1890/0012-9623-91.3.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Thomas DR, Becker WC, Armstrong M. Production and elimination of disruptive classroom behavior by systematically varying teacher's behavior. J Appl Behav Anal 2010; 1:35-45. [PMID: 16795158 PMCID: PMC1310973 DOI: 10.1901/jaba.1968.1-35] [Citation(s) in RCA: 239] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effects of teacher behaviors on the classroom behaviors of children were investigated by systematically varying approving (praise, smiles, contacts, etc.) and disapproving (verbal reprimands, physical restraint, etc.) classes of teacher behavior. Measures were taken on both teacher and child behaviors. Each day a sample of 10 children was observed. The subject pool was a class of 28 well-behaved children in a middle-primary public school class. The results demonstrated that approving teacher responses served a positive reinforcing function in maintaining appropriate classroom behaviors. Disruptive behaviors increased each time approving teacher behavior was withdrawn. When the teacher's disapproving behaviors were tripled, increases appeared most markedly in the gross motor and noise-making categories of disruptive behavior. The findings emphasize again the important role of the teacher in producing, maintaining, and eliminating disruptive as well as pro-social classroom behavior.
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Affiliation(s)
- D R Thomas
- University of Illinois, Urbana, Illinois
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Abstract
Increased U.S. involvement in rehabilitation activities in other countries is opening more opportunities for rehabilitationists to work in cross-cultural situations. On the home front, there is need for practitioners who are prepared to work with members of cultural minorities and recent immigrant groups. Equally compelling is the need for practitioners whose education has prepared them to work effectively with people who are different from themselves in gender, age, socioeconomic circumstance, religion, or other ways. In these interactions, too, there will be differences in cultural knowledge and behavior and, accordingly, differences in responses to disablement. In short, a cultural perspective on human behavior from which to develop an understanding of variation and a culturally informed mode of practice has potential relevance for all rehabilitation practice situations.
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Affiliation(s)
- M. Armstrong
- The Division of Rehabilitation Education, University of Illinois, Urbana-Champaign
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Woinarski JCZ, Armstrong M, Brennan K, Fisher A, Griffiths AD, Hill B, Milne DJ, Palmer C, Ward S, Watson M, Winderlich S, Young S. Monitoring indicates rapid and severe decline of native small mammals in Kakadu National Park, northern Australia. Wildl Res 2010. [DOI: 10.1071/wr09125] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Context. Australia has a lamentable history of mammal extinctions. Until recently, the mammal fauna of northern Australia was presumed to have been spared such loss, and to be relatively intact and stable. However, several recent studies have suggested that this mammal fauna may be undergoing some decline, so a targeted monitoring program was established in northern Australia’s largest and best-resourced conservation reserve.
Aims. The present study aims to detect change in the native small-mammal fauna of Kakadu National Park, in the monsoonal tropics of northern Australia, over the period of 1996–2009, through an extensive monitoring program, and to consider factors that may have contributed to any observed change.
Methods. The small-mammal fauna was sampled in a consistent manner across a set of plots established to represent the environmental variation and fire regimes of Kakadu. Fifteen plots were sampled three times, 121 plots sampled twice and 39 plots once. Resampling was typically at 5-yearly intervals. Analysis used regression (of abundance against date), and Wilcoxon matched-pairs tests to assess change. For resampled plots, change in abundance of mammals was related to fire frequency in the between-sampling period.
Key results. A total of 25 small mammal species was recorded. Plot-level species richness and total abundance decreased significantly, by 54% and 71%, respectively, over the course of the study. The abundance of 10 species declined significantly, whereas no species increased in abundance significantly. The number of ‘empty’ plots increased from 13% in 1996 to 55% in 2009. For 136 plots sampled in 2001–04 and again in 2007–09, species richness declined by 65% and the total number of individuals declined by 75%. Across plots, the extent of decline increased with increasing frequency of fire. The most marked declines were for northern quoll, Dasyurus hallucatus, fawn antechinus, Antechinus bellus, northern brown bandicoot, Isoodon macrourus, common brushtail possum, Trichosurus vulpecula, and pale field-rat, Rattus tunneyi.
Conclusions. The native mammal fauna of Kakadu National Park is in rapid and severe decline. The cause(s) of this decline are not entirely clear, and may vary among species. The most plausible causes are too frequent fire, predation by feral cats and invasion by cane toads (affecting particularly one native mammal species).
Implications. The present study has demonstrated a major decline in a key conservation reserve, suggesting that the mammal fauna of northern Australia may now be undergoing a decline comparable to the losses previously occurring elsewhere in Australia. These results suggest that there is a major and urgent conservation imperative to more precisely identify, and more effectively manage, the threats to this mammal fauna.
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Takeda K, Okamoto M, de Langhe S, Dill E, Armstrong M, Reisdorf N, Irwin D, Koster M, Wilder J, Stenmark KR, West J, Klemm D, Gelfand EW, Nozik-Grayck E, Majka SM. Peroxisome proliferator-activated receptor-g agonist treatment increases septation and angiogenesis and decreases airway hyperresponsiveness in a model of experimental neonatal chronic lung disease. Anat Rec (Hoboken) 2009; 292:1045-61. [PMID: 19484746 DOI: 10.1002/ar.20921] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic lung disease (CLD) affects premature newborns requiring supplemental oxygen and results in impaired lung development and subsequent airway hyperreactivity. We hypothesized that the maintenance of peroxisome proliferator-activated receptor gamma (PPARgamma) signaling is important for normal lung morphogenesis and treatment with PPARgamma agonists could protect against CLD and airway hyperreactivity (AHR) following chronic hyperoxic exposure. This was tested in an established hyperoxic murine model of experimental CLD. Newborn mice and mothers were exposed to room air (RA) or moderate hyperoxia (70% oxygen) for 10 days and fed a standard diet or chow impregnated with the PPARgamma agonist rosiglitazone (ROSI) for the duration of study. Following hyperoxic exposure (HE) animals were returned to RA until postnatal day (P) 13 or P41. The accumulation of ROSI in neonatal and adult tissue was confirmed by mass spectrometry. Analyses of body weight and lung histology were performed on P13 and P41 to localize and quantitate PPARgamma expression, determine alveolar and microvessel density, proliferation and alpha-smooth muscle actin (alpha-SMA) levels as a measure of myofibroblast differentiation. Microarray analyses were conducted on P13 to examine transcriptional changes in whole lung. Pulmonary function and airway responsiveness were analyzed at P55. ROSI treatment during HE preserved septation and vascular density. Key array results revealed ontogeny groups differentially affected by hyperoxia including cell cycle, angiogenesis, matrix, and muscle differentiation/contraction. These results were further confirmed by histological evaluation of myofibroblast and collagen accumulation. Late AHR to methacholine was present in mice following HE and attenuated with ROSI treatment. These findings suggest that rosiglitazone maintains downstream PPARgamma effects and may be beneficial in the prevention of severe CLD with AHR.
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Affiliation(s)
- K Takeda
- Division of Cell Biology, Department of Pediatrics, National Jewish Health, Denver, Colorado 80045, USA
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Männikkö R, Overend G, Perrey C, Gavaghan CL, Valentin JP, Morten J, Armstrong M, Pollard CE. Pharmacological and electrophysiological characterization of nine, single nucleotide polymorphisms of the hERG-encoded potassium channel. Br J Pharmacol 2009; 159:102-14. [PMID: 19673885 DOI: 10.1111/j.1476-5381.2009.00334.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND PURPOSE Potencies of compounds blocking K(V)11.1 [human ether-ago-go-related gene (hERG)] are commonly assessed using cell lines expressing the Caucasian wild-type (WT) variant. Here we tested whether such potencies would be different for hERG single nucleotide polymorphisms (SNPs). EXPERIMENTAL APPROACH SNPs (R176W, R181Q, Del187-189, P347S, K897T, A915V, P917L, R1047L, A1116V) and a binding-site mutant (Y652A) were expressed in Tet-On CHO-K1 cells. Potencies [mean IC(50); lower/upper 95% confidence limit (CL)] of 48 hERG blockers was estimated by automated electrophysiology [IonWorks HT (IW)]. In phase one, rapid potency comparison of each WT-SNP combination was made for each compound. In phase two, any compound-SNP combinations from phase one where the WT upper/lower CL did not overlap with those of the SNPs were re-examined. Electrophysiological WT and SNP parameters were determined using conventional electrophysiology. KEY RESULTS IW detected the expected sixfold potency decrease for propafenone in Y652A. In phase one, the WT lower/upper CL did not overlap with those of the SNPs for 77 compound-SNP combinations. In phase two, 62/77 cases no longer yielded IC(50) values with non-overlapping CLs. For seven of the remaining 15 cases, there were non-overlapping CLs but in the opposite direction. For the eight compound-SNP combinations with non-overlapping CLs in the same direction as for phase 1, potencies were never more than twofold apart. The only statistically significant electrophysiological difference was the voltage dependence of activation of R1047L. CONCLUSION AND IMPLICATIONS Potencies of hERG channel blockers defined using the Caucasian WT sequence, in this in vitro assay, were representative of potencies for common SNPs.
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