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Low JKK, Patel K, Jones N, Solomon P, Norman A, Maxwell JWC, Pachl P, Matthews JM, Payne RJ, Passioura T, Suga H, Walport LJ, Mackay JP. mRNA display reveals a class of high-affinity bromodomain-binding motifs that are not found in the human proteome. J Biol Chem 2023; 299:105482. [PMID: 37992806 PMCID: PMC10758951 DOI: 10.1016/j.jbc.2023.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023] Open
Abstract
Bromodomains (BDs) regulate gene expression by recognizing protein motifs containing acetyllysine. Although originally characterized as histone-binding proteins, it has since become clear that these domains interact with other acetylated proteins, perhaps most prominently transcription factors. The likely transient nature and low stoichiometry of such modifications, however, has made it challenging to fully define the interactome of any given BD. To begin to address this knowledge gap in an unbiased manner, we carried out mRNA display screens against a BD-the N-terminal BD of BRD3-using peptide libraries that contained either one or two acetyllysine residues. We discovered peptides with very strong consensus sequences and with affinities that are significantly higher than typical BD-peptide interactions. X-ray crystal structures also revealed modes of binding that have not been seen with natural ligands. Intriguingly, however, our sequences are not found in the human proteome, perhaps suggesting that strong binders to BDs might have been selected against during evolution.
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Affiliation(s)
- Jason K K Low
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Karishma Patel
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Natasha Jones
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Paul Solomon
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Alexander Norman
- School of Chemistry, University of Sydney, New South Wales, Australia
| | | | - Petr Pachl
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Jacqueline M Matthews
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
| | - Richard J Payne
- School of Chemistry, University of Sydney, New South Wales, Australia
| | - Toby Passioura
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia; Department of Chemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Hiroaki Suga
- Department of Chemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Louise J Walport
- Department of Chemistry, Graduate School of Science, The University of Tokyo, Bunkyo, Tokyo, Japan; Protein-Protein Interaction Laboratory, The Francis Crick Institute, London, United Kingdom; Department of Chemistry, Molecular Sciences Research Hub, Imperial College London, London, United Kingdom.
| | - Joel P Mackay
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia.
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2
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Steinacker JM, van Mechelen W, Bloch W, Börjesson M, Casasco M, Wolfarth B, Knoke C, Papadopoulou T, Wendt J, Al Tunaiji H, Andresen D, Andrieieva O, Bachl N, Badtieva V, Beucher FJ, Blauwet CA, Casajus Mallen JA, Chang JH, Clénin G, Constantini N, Constantinou D, Di Luigi L, Declercq L, Doutreleau S, Drozdovska S, Duclos M, Ermolao A, Fischbach T, Fischer AN, Fossati C, Franchella J, Fulcher M, Galle JC, Gerloff C, Georgiades E, Gojanovic B, González Gross M, Grote A, Halle M, Hauner H, Herring MP, Hiura M, Holze K, Huber G, Hughes D, Hutchinson MR, Ionescu A, Janse van Rensburg DC, Jegier A, Jones N, Kappert-Gonther K, Kellerer M, Kimura Y, Kiopa A, Kladny B, Koch G, Kolle E, Kolt G, Koutedakis Y, Kress S, Kriemler S, Kröger J, Kuhn C, Laszlo R, Lehnert R, Lhuissier FJ, Lüdtke K, Makita S, Manonelles Marqueta P, März W, Micallef-Stafrace K, Miller M, Moore M, Müller E, Neunhäuserer D, Onur IR, Ööpik V, Perl M, Philippou A, Predel HG, Racinais S, Raslanas A, Reer R, Reinhardt K, Reinsberger C, Rozenstoka S, Sallis R, Sardinha LB, Scherer M, Schipperijn J, Seil R, Tan B, Schmidt-Trucksäss A, Schumacher N, Schwaab B, Schwirtz A, Suzuki M, Swart J, Tiesler R, Tippelt U, Tillet E, Thornton J, Ulkar B, Unt E, Verhagen E, Weikert T, Vettor R, Zeng S, Budgett R, Engebretsen L, Erdener U, Pigozzi F, Pitsiladis YP. Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration. BMJ Open Sport Exerc Med 2023; 9:e001626. [PMID: 37533594 PMCID: PMC10391804 DOI: 10.1136/bmjsem-2023-001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.
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Affiliation(s)
- Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Institute for Rehabilitation Medicine Research at Ulm University, Institut für rehabilitationsmedizinische Forschung an der Universität Ulm, Bad Buchau, Germany
| | - Willem van Mechelen
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Wilhelm Bloch
- Institute for Cardiology and Sports Medicine, German Sport University, Cologne, Germany
- Exercise is Medicine Germany, Frankfurt, Germany
| | - Mats Börjesson
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, Sahlgrenska University Hospital, Goteborg, Region Västra Götaland, Sweden
| | | | - Bernd Wolfarth
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Deutschland, Germany
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Carolin Knoke
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Hashel Al Tunaiji
- Sports Medicine, United Arab Emirates National Olympic Committee, Dubai, UAE
- Sports Medicine & Sciences Unit, Zayed Military University, Abu Dhabi, UAE
| | | | - Olena Andrieieva
- Department of Health, Fitness and Recreation, National University of Physical Education and Sport of Ukraine, Kiew, Ukraine
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- International Federation of Sports Medicine, Lausanne, Switzerland
| | - Victoriya Badtieva
- Sport Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
- Sport Medicine, Moscow Scientific and Practical Center of Medical Rehabilitation and Sports Medicine, Moscow, Russian
| | - Friedhelm J Beucher
- National Paralympic Committee Germany (Deutscher Behindertensportverband (DBS), Bonn, Germany
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose-Antonio Casajus Mallen
- University of Zaragoza, GENUD “Growth, Exercise, NUtrition and Development” Research Group, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
| | - Ju-Ho Chang
- The Association for International Sport for All (TAFISA), Frankfurt, Germany
| | - German Clénin
- Sportsmedical Centre Bern-Ittigen, Ittigen, Switzerland
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
| | - Naama Constantini
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
- Exercise is Medicine Israel, Hebrew University, Jerusalem, Israel
| | - Demitri Constantinou
- Centre for Exercise Science and Sports Medicine, University of Witwatersrand, Johannesburg, South Africa
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
| | - Luigi Di Luigi
- Unit of Endocrinology - Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | | | - Stephane Doutreleau
- Department of Sports Medicine, University Grenoble Alpes, Grenoble, Auvergne-Rhône-Alpes, France
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
| | - Svitlana Drozdovska
- National University of Physical Education and Sport of Ukraine, Kyiv, Ukraine
| | - Martine Duclos
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
- UMR 1019, INRAE, French National Research Institute for Agriculture, Food and Environment, Clermont-Ferrand, France
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - Thomas Fischbach
- German Association of Paediatric and Adolescent Care Specialists, BVKJ - Berufsverband der Kinder- und Jugendärzte, Cologne, Germany
| | - Anastasia N Fischer
- Sports Medicine and Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- American College of Sports Medicine, Indianapolis, Indiana, USA
| | - Chiara Fossati
- Faculty of Sport and Exercise Sciences, University of Rome 'Foro Italico', Roma, Lazio, Italy
| | - Jeorge Franchella
- Hospital de Clínicas José San Martin, University of Buenos Aires, Buenos Aires, Argentina
| | - Mark Fulcher
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
- AUT Sports Performance Research Institute New Zealand, Auckland, New Zealand
| | - Jan C Galle
- German Society of Nephrology (Deutsche Gesellschaft für Nephrologie (DGfN)), Berlin, Germany
| | - Christian Gerloff
- German Society for Neurology (Deutsche Gesellschaft für Neurologie (DGN)), Berlin, Germany
| | | | - Boris Gojanovic
- Sports Medicine, Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland
- SportAdo Consultation - Multidisciplinary Unit of Adolescent Health, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marcela González Gross
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
- Department of Health and Human Performance - Facultad de CC de la Actividad Física y del Deporte, INEF Universidad Politécnica de Madrid, Madrid, Spain
| | - Andy Grote
- Senat, Freie und Hansestadt Hamburg, Hamburg, Germany
| | - Martin Halle
- European Association of Preventive Cardiology (EAPC), European Society of Cardiology (ECS), Biot, France
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | | | - Mikio Hiura
- Center for Brain and Health Sciences, Aomori University, Aomori, Japan
| | - Kerstin Holze
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Gerhard Huber
- Institute of Sports and Sport Science, University Heidelberg, Heidelberg, Germany
- Deutscher Verband für Gesundheitssport und Sporttherapie e.V. (DVGS), Hamburg, Germany
| | - David Hughes
- Sports Medicine, Australian Institute of Sport, Canberra, Canberra, Australia
- Australian Institute of Sport, Australian Sports Commission, Canberra, Canberra, Australia
| | - Mark R. Hutchinson
- American College of Sports Medicine, Indianapolis, Indiana, USA
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
- American College of Sports Medicine Foundation, Indianapolis, Indiana, USA
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Carol Davila University of Medicine and Pharmacy, Bucharest, Bucharest, Romania
| | - Dina Christina Janse van Rensburg
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
- Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Anna Jegier
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine UK, Edinburgh, UK
| | | | - Monika Kellerer
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | | | - Bernd Kladny
- German Society of Orthopaedics and Trauma (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)) with the German Society for Trauma Surgery (DGU) and German Society of Orthopaedics and Orthopaedic Surgery (DGOOC), Berlin, Germany
| | - Gerhard Koch
- Platform on Nutrition and Physical Activity, Plattform Ernährung und Bewegung e.V. (peb), Berlin, Germany
| | - Elin Kolle
- Exercise is Medicine Norway, Oslo, Norway
| | - Greg Kolt
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Yiannis Koutedakis
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
- School of Exercise Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Stephan Kress
- German Diabetes Association (Deutsche Diabetes Gesellschaft (DDG)), Berlin, Germany
| | - Susi Kriemler
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
- Institute of Epidemiology, Biostatistics and Prevention, Zuerich University, Zuerich, Switzerland
| | - Jens Kröger
- German Diabetes Support (diabetesDE - Deutsche Diabetes-Hilfe), Charlottenburg, Germany
| | - Christian Kuhn
- German Alliance for Baths, Bäderallianz Deutschland, Köln, Germany
- International Assocation for Sport and Leisure Facilities, Köln, Germany
| | - Roman Laszlo
- German Cardiac Society (Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK)), Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ralph Lehnert
- Hamburg Sport Association (Hamburger Sportbund e.V.), Hamburg, Germany
| | - François J Lhuissier
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- UMR INSERM 1272 Hypoxie et poumon, Université Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
- Hôpital Jean-Verdier, Médecine de l’exercice et du sport, Assistance Publique - Hôpitaux de Paris, Bondy, France
| | - Kerstin Lüdtke
- German Society for Physiotherapy Science (Deutsche Gesellschaft für Physiotherapiewissenschaft (DGPTW)), Hamburg, Germany
| | - Shigeru Makita
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine, Lausanne, Switzerland
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Winfried März
- D.A.CH Society Prevention of Cardiovascular Diseases, D.A.CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen, Hamburg, Germany
| | - Kirill Micallef-Stafrace
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- University Sports Complex, Institute for Physical Education and Sport, Msida, Malta
| | - Mike Miller
- World Olympians Association (WOA), Lausanne, Switzerland
| | | | - Erich Müller
- European College of Sport Science, Köln, Germany
| | - Daniel Neunhäuserer
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - I. Renay Onur
- Istanbul Spor Etkinlikleri ve Isletmeciligi A S, City of Istanbul, Istanbul, Turkey
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Anastassios Philippou
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
| | - Hans-Georg Predel
- German Hypertension League (Deutsche Hochdruckliga e.V. (DHL)), Heidelberg, Baden-Württemberg, Germany
- German Society for Hypertension and Prevention (Deutsche Gesellschaft für Hypertonie und Prävention), Heidelberg, Germany
| | - Sebastien Racinais
- Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Algirdas Raslanas
- Department of Educational Assistance, Physical and Health Education, Vytautas Magnus University, Vilnius, Lithuania
| | - Ruediger Reer
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Klaus Reinhardt
- German Medical Association (Bundesaerztekammer), Berlin, Germany
| | - Claus Reinsberger
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Sandra Rozenstoka
- International Federation of Sports Medicine, Lausanne, Switzerland
- Rīga Stradiņš University, Riga, Latvia
- Sports Laboratory, Sports Medicine and Physical Health Centre, Riga, Latvia, Riga, Latvia
- Latvian Sports Medicine Association, Riga, Latvia
| | - Robert Sallis
- Family Medicine, Kaiser Permanente, Fontana, California, USA
| | - Luis B Sardinha
- Exercise is Medicine Portugal, Universidade de Lisboa, Lisboa, Portugal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Martin Scherer
- German Society of General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)), Berlin, Germany
- Department of General Practice and Primary Care, University Medical Center, Hamburg, Germany
| | - Jasper Schipperijn
- International Society for Physical Activity and Health (ISPAH), Vancouver, British Columbia, Canada
| | - Romain Seil
- Society for Orthopaedic and Traumatologic Sports Medicine (GOTS), Jena, Germany
| | - Benedict Tan
- Exercise is Medicine Singapore, Singapore
- Department of Sport & Exercise Medicine, Changi General Hospital, Singapore
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, Basel, Switzerland
| | - Nils Schumacher
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Bernhard Schwaab
- German Society for the Prevention and Rehabilitation of Cardiovascular Diseases (Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR)), Koblenz, Germany
| | - Ansgar Schwirtz
- German Society of Sports Science, Deutsche Vereinigung für Sportwissenschaft (DVS), Frankfurt, Germany
| | - Masato Suzuki
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine, Lausanne, Switzerland
- Health through Physical Activity, Lifestyle and Sport (HPALS) Research Centre, University of Cape Town, Cape Town, South Africa
| | - Ralph Tiesler
- Federal Institute for Sports Science (Bundesinstitut für Sportwissenschaft (BISp)), Bonn, Nordrhein-Westfalen, Germany
| | - Ulf Tippelt
- Institute for Applied Training Science Leipzig, Leipzig, Sachsen, Germany
| | - Eleanor Tillet
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jane Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Bulent Ulkar
- International Federation of Sports Medicine, Lausanne, Switzerland
- Sports Medicine Department, Faculty of Medicine, Ankara University, Ankara, Ankara, Turkey
| | - Eve Unt
- Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Evert Verhagen
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thomas Weikert
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Roberto Vettor
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
- Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Sheng Zeng
- International Federation of Sports Medicine, Lausanne, Switzerland
- Laboratory of Regenerative Medicine, Haikou, Hainan, China
| | | | - Lars Engebretsen
- International Olympic Committee, Lausanne, Switzerland
- Division of Orthopedic Surgery, University of Oslo, Oslo, Norway
| | - Ugur Erdener
- International Olympic Committee, Lausanne, Switzerland
| | - Fabio Pigozzi
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Yannis P Pitsiladis
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
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3
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Werren EA, Guxholli A, Jones N, Wagner M, Hannibal I, Granadillo JL, Tyndall AV, Moccia A, Kuehl R, Levandoski KM, Day-Salvatore DL, Wheeler M, Chong JX, Bamshad MJ, Innes AM, Pierson TM, Mackay JP, Bielas SL, Martin DM. De novo variants in GATAD2A in individuals with a neurodevelopmental disorder: GATAD2A-related neurodevelopmental disorder. HGG Adv 2023; 4:100198. [PMID: 37181331 PMCID: PMC10172836 DOI: 10.1016/j.xhgg.2023.100198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/07/2023] [Indexed: 05/16/2023] Open
Abstract
GATA zinc finger domain containing 2A (GATAD2A) is a subunit of the nucleosome remodeling and deacetylase (NuRD) complex. NuRD is known to regulate gene expression during neural development and other processes. The NuRD complex modulates chromatin status through histone deacetylation and ATP-dependent chromatin remodeling activities. Several neurodevelopmental disorders (NDDs) have been previously linked to variants in other components of NuRD's chromatin remodeling subcomplex (NuRDopathies). We identified five individuals with features of an NDD that possessed de novo autosomal dominant variants in GATAD2A. Core features in affected individuals include global developmental delay, structural brain defects, and craniofacial dysmorphology. These GATAD2A variants are predicted to affect protein dosage and/or interactions with other NuRD chromatin remodeling subunits. We provide evidence that a GATAD2A missense variant disrupts interactions of GATAD2A with CHD3, CHD4, and CHD5. Our findings expand the list of NuRDopathies and provide evidence that GATAD2A variants are the genetic basis of a previously uncharacterized developmental disorder.
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Affiliation(s)
- Elizabeth A. Werren
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Alba Guxholli
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Natasha Jones
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Matias Wagner
- Institute of Human Genetics, Technical University of Munich, 80333 Munich, Germany
| | - Iris Hannibal
- Institute of Human Genetics, Technical University of Munich, 80333 Munich, Germany
| | - Jorge L. Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amanda V. Tyndall
- Department of Medical Genetics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Amanda Moccia
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Ryan Kuehl
- Saint Peter’s University Hospital, New Brunswick, NJ 08901, USA
| | | | | | - Marsha Wheeler
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - University of Washington Center for Mendelian Genomics
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
- Institute of Human Genetics, Technical University of Munich, 80333 Munich, Germany
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Medical Genetics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Saint Peter’s University Hospital, New Brunswick, NJ 08901, USA
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Brotman Baty Institute, Seattle, WA 98195, USA
- Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Division of Pediatric Neurology, Department of Pediatrics, Guerin Children’s, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Center for the Undiagnosed Patient, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Jessica X. Chong
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Brotman Baty Institute, Seattle, WA 98195, USA
| | - Michael J. Bamshad
- Department of Pediatrics, University of Washington, Seattle, WA 98195, USA
- Brotman Baty Institute, Seattle, WA 98195, USA
| | - A. Micheil Innes
- Department of Medical Genetics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tyler Mark Pierson
- Division of Pediatric Neurology, Department of Pediatrics, Guerin Children’s, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Center for the Undiagnosed Patient, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Joel P. Mackay
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW 2006, Australia
| | - Stephanie L. Bielas
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Donna M. Martin
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Marino KR, Jones N, Small C, Shur N, Chatterjee R, Power J, Wright L, Tillett E, Vishnubala D. Sport and exercise medicine in the UK: what lies beyond the crossroads? Br J Sports Med 2023; 57:891-892. [PMID: 37369555 DOI: 10.1136/bjsports-2023-107278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Katherine Rose Marino
- British Association of Sport and Exercise Medicine, Doncaster, UK
- Keele University, Keele, UK
| | - Natasha Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Faculty Of Sport and Exercise Medicine, Edinburgh, UK
| | - Claire Small
- Pure Sports Medicine, London, UK
- Queen Mary University of London, London, UK
| | - Natalie Shur
- University Hospitals of Leicester NHS Trust, Leicester, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Robin Chatterjee
- British Association of Sport and Exercise Medicine, Doncaster, UK
- Institute of Sport, Exercise and Health (ISEH), London, UK
| | | | - Lucy Wright
- British Association of Sport and Exercise Medicine, Doncaster, UK
- University of Exeter, Exeter, UK
| | - Eleanor Tillett
- British Association of Sport and Exercise Medicine, Doncaster, UK
- University College London, London, UK
| | - Dane Vishnubala
- British Association of Sport and Exercise Medicine, Doncaster, UK
- University of Leeds, Leeds, UK
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5
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Schmidt M, Ling S, Ng V, Kamath B, Kortbeek S, Jones N, Miserachs M, Lepore N, Reitzel N, Zachos M, Prowse K, Syed B, Sidhu A, Shurrab S, Kozenko M, Bandsma R. A262 NEONATAL ACUTE LIVER FAILURE DUE TO PRESUMED GESTATIONAL ALLOIMMUNE LIVER DISEASE - A CASE REPORT. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991132 DOI: 10.1093/jcag/gwac036.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Neonatal acute liver failure (NALF) is a rare disease that is distinct from acute liver failure seen in older children and adults. Gestational alloimmune liver disease (GALD) is the most frequent cause, is initiated in utero by sensitization of the maternal immune system to a fetal hepatocyte antigen and subsequent production of maternal immunoglobulin G antibodies that cross the placenta. Maternal IgG binds to a fetal hepatocyte antigen and initiates an innate immune response involving the terminal complement cascade and membrane attach complex. The understanding of the alloimmune origin has led to the use of intravenous immunoglobulin (IVIG) treatment and exchange transfusion, significantly increasing survival. However, approximately 25% of patients may not respond and require salvage liver transplantation. In spite of an increased rate of comorbidities, concern for technical difficulties and limited graft availability, young infants eligible for transplant have been shown to have similar overall patient and graft survival rates compared to older children with other indications for liver transplant. Purpose The primary aim of our study is to report a case of NALF with successful liver transplant. Method We present the case of a preterm girl with NALF due to GALD refractory to medical management, requiring liver transplantation. Result(s) This is a 35-week preterm girl, with scant pre-natal care, birth weight of 1.825 kg and Apgar 9/9. She is the seventh child of non-consanguineous parents, with healthy siblings. On day-of-life (DOL) 1 she presented with acute kidney injury, progressive worsening metabolic acidosis and hyperammonemia and was found to be profoundly coagulopathic (INR 6), with normal liver enzymes and liver failure was diagnosed. Initial investigation ruled out congenital infections, sepsis, neonatal hemophagocytic lymphohistiocytosis and metabolic diseases. Magnetic resonance imaging of the body demonstrated findings in keeping with iron deposition in the thyroid, liver and pancreas, suggestive of GALD. Completed double volume exchange transfusion and IVIG on DOL 9 and repeat IVIG on DOL 13 and 15, with partial improvement in INR. Due to persistent ascites, conjugated hyperbilirubinemia and hyperammonemia she was transferred for urgent liver transplant assessment. Persistent liver dysfunction in the form of hyperammonemia, hypoglycemia and progressive coagulopathy led to transplant listing on DOL 30. ABO incompatible deceased donor liver transplant was completed on DOL 62 (4.075 kg, estimated dry weight 3.5 kg). The procedure was uncomplicated, liver enzymes normalized, coagulopathy and hypoglycemia resolved. She was transferred to the ward on post-operative day (POD) 6. and weaned off sedatives and transitioned to oral feeds within 2 weeks of transplant, with complex abdominal wound closure on POD 29. Conclusion(s) Successful liver transplantation is possible in neonates with acute liver failure due to GALD refractory to medical management and weighing 4kg or less. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared MICROBIOME & MICROBIAL THERAPY
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Affiliation(s)
- M Schmidt
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - S Ling
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - V Ng
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - B Kamath
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - S Kortbeek
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - N Jones
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - M Miserachs
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
| | - N Lepore
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - N Reitzel
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - M Zachos
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - K Prowse
- Pediatric Gastroenterology, Nutrition and Hepatology, McMaster Children's Hospital, Hamilton
| | - B Syed
- General Surgery, The Hospital for Sick children, Toronto
| | | | - S Shurrab
- Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - M Kozenko
- Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - R Bandsma
- Gastroenterology, Hepatology and Nutrition, The Hospital for Sick children, Toronto
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Yusoff A, Davies EA, Burberry DJ, Jones N, Walters C, Beynon Howells C, Davies D, Quinn P. 1103 AN EVALUATION OF A GERIATRICIAN-LED ACUTE MEDICAL ADMISSION UNIT AT MORRISTON HOSPITAL, SWANSEA. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract
Introduction
The medical intake at Morriston Hospital is accepted on two units; Rapid Assessment Unit (RAU) and Acute Medical Assessment Unit. Both were acute physician-led until July 2021
Method
(Phase 1). From July 2021, RAU became geriatrician-led (Phase 2). This evaluation concerns the performance of RAU.
Phase 1 (Acute Physician-Led Unit) Between 01/08/2020-30/06/2021, there were 3102 admissions with a median length of stay (LOS) of 2 days on RAU. 37.2% of patients were discharged directly from the unit. (SBUHB data). A detailed analysis of 496 patients consecutively assessed between November 2020–January 2021 showed a median LOS on RAU of 1, 28.8% were discharged directly from RAU. Overall health board (HB) median LOS for the cohort was 7. In over 70 years, median LOS on RAU was 1, overall HB LOS 9.
Phase 2 (Geriatrician-Led Unit) 1237 patients were assessed July-December 2021, with a median LOS of 2 days. 42.8% of patients were discharged from RAU. (SBUHB data). A detailed analysis of 566 patients consecutively assessed between September-November 2021 showed a median LOS on RAU of 2, 41.7% discharged directly from RAU. Overall HB median LOS for the entire cohort was 5. For the > 70 years, median LOS on RAU was 2, overall HB LOS was 7. Patient flow through assessment areas is dependent on the function of downstream medical wards. Mean LOS within medicine at Morriston increased 1.5 days between Phase 1 and Phase 2.
Results
Acute geriatricians have delivered the 72hr LOS standard that SBUHB has set for assessment areas. The unit has achieved a reduction in overall LOS for the cohort of patients evaluated (p<.01), especially for the > 70 years (p=.007).
Conclusion
This data supported a change in practice; RAU has taken a frailty specific intake since January 2022.
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Affiliation(s)
- A Yusoff
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - E A Davies
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - D J Burberry
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - N Jones
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - C Walters
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - C Beynon Howells
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - D Davies
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
| | - P Quinn
- Morriston Hospital, Swansea Bay University Health Board (SBUHB) Department of Geriatric Medicine,
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7
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Simmen D, Jones N. Eingriffe bei malignen Tumoren von Zunge, Mundboden, Tonsillen und Rachenhinterwand. Laryngorhinootologie 2022; 101:1016-1019. [PMID: 36513093 DOI: 10.1055/a-1928-8673] [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: 12/15/2022]
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8
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Simmen D, Jones N. Eingriffe bei benignen Tumoren und Zysten von Mundhöhle und Oropharynx. Laryngorhinootologie 2022; 101:929-931. [DOI: 10.1055/a-1928-8280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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Ponce SB, Young S, Harris M, Walker D, Sona M, Jones N, Kwartang J, Jankowski C, Griggs J, Berendt M, Cuevas C, Rendon AD, Beyer K. Perceptions of Radiation Therapy amongst Black Female Breast Cancer Survivors in Urban Communities. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.961] [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: 10/31/2022]
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10
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Jones N, Ordonez-Mena JM, Roalfe AK, Goyder C, Hobbs FDR, Taylor CJ. Body mass index and survival in people with heart failure. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
People with obesity are twice as likely to develop heart failure (HF) compared to people with a healthy body mass index (BMI) [1]. However, among people with HF a higher BMI has been linked to a reduced risk of all-cause mortality, a concept known as the “obesity paradox” [2].
Purpose
To examine the association between BMI and survival in patients with chronic HF among a large primary care cohort.
Methods
We extracted data from the Clinical Practice Research Datalink of primary care records from 1st January 2000 to 31st December 2017 and included 47,531 patients with an incident diagnosis of HF, who were aged 45 years and over and who had a recorded BMI. Patients were stratified into categories of baseline BMI as underweight (BMI <18.5 kg/m2), healthy weight (BMI 18.5 to 24.9 kg/m2), overweight (BMI 25.0 to 29.9 kg/m2) or obese, with obesity split into class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2) and class III (40 kg/m2 and over). The primary outcome was all-cause mortality. We used Kaplan-Meier curves and log rank tests to compare survival in people with HF, based on baseline BMI. We also report a Cox regression model for risk of all-cause mortality among people with HF comparing BMI categories.
Results
There were 25,013 deaths during the study follow-up. The average age of participants was 77.1 years (SD 10.6) and mean BMI was 27.9 (SD 6.1). In an age- and sex-adjusted analysis, people who were underweight were at increased risk of all-cause mortality compared to people with healthy weight (HR 1.52, 95% CI 1.41 to 1.64). People with overweight (HR 0.81, 95% CI 0.79 to 0.84), obesity class I (HR 0.79, 95% CI 0.76 to 0.82) and obesity class II (HR 0.78, 95% CI 0.74 to 0.82) were at decreased risk of all-cause mortality. People with obesity class III had no difference in risk of death compared to people with healthy weight (HR 0.95, 95% CI 0.88 to 1.02). In a Kaplan-Meier analysis, there was an inverse relationship between body weight and risk of death, even within the first year of follow-up.
Conclusion
In our large community cohort of people with HF, we found an inverse relationship between BMI and survival. Underweight people with HF have the poorest prognosis and should be identified as high-risk. Conversely, people with HF who are overweight or obese (class I and II) are at lower risk of death confirming the obesity paradox in a real-world primary care population. These findings suggest a more cautious approach to weight management in overweight and obese patients may be needed for people with HF in primary care.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The SurviveHF study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford at Oxford Health NHS Foundation Trust and the Wellcome Institutional Strategic Fund. The funders did not have any role in the design of the study, analysis and interpretation of the data, or writing of the results for publication.
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Affiliation(s)
- N Jones
- University of Oxford , Oxford , United Kingdom
| | | | - A K Roalfe
- University of Oxford , Oxford , United Kingdom
| | - C Goyder
- University of Oxford , Oxford , United Kingdom
| | - F D R Hobbs
- University of Oxford , Oxford , United Kingdom
| | - C J Taylor
- University of Oxford , Oxford , United Kingdom
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11
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Jones N, Smith M, Lay-Flurrie S, Roalfe AK, Yang Y, Hobbs FDR, Taylor CJ. Survival among people with heart failure and atrial fibrillation; a population cohort study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
People with chronic heart failure (HF) have a poor prognosis, with survival rates at five year follow-up close to 50%.1 More than half of patients with HF will develop atrial fibrillation (AF). The presence of AF in people with HF has been associated with a poor prognosis, irrespective of left ventricular ejection fraction. 2,3 However, the majority of studies to date have analysed prognosis among secondary care cohorts or randomised trial participants, who may not be representative of patients with chronic HF in the community.2
Purpose
To examine the association between survival in patients with HF and AF compared to either condition alone, among a large primary care cohort.
Methods
We extracted data from the Clinical Practice Research Datalink of primary care records from 1st January 2000 to 31st December 2018 and included all patients aged 45 years and over who were registered at an up-to-standard practice for a minimum of 12 months. Records were linked to Hospital Episode Statistics for secondary care data. The primary outcome was all-cause mortality. Exposure groups were defined as HF+AF, HF or AF, with exposure status treated as a time-varying covariate across follow-up. We used Cumulative Hazard plots to compare survival in people with HF and AF, compared to people with either condition alone or neither. We also report a Cox regression model for risk of all-cause mortality among people with HF and AF, adjusting for age, sex, ethnicity, smoking status and comorbid cardiovascular disease.
Results
There were 314,042 deaths during the study follow-up. The average age of participants was 58.0 years (SD 10.6) and 51.4% were women. At some point across follow-up, 94,990 people had HF alone, 147,815 had AF alone and 74,470 had both HF and AF. In an unadjusted Cox regression analysis, people with HF and AF were at the greatest risk of death (HR 17.94, 95% CI 17.75 to 18.13), followed by people with HF alone (HR 12.00, 95% CI 11.87 to 12.13), and AF alone (HR 6.14, 95% CI 6.08 to 6.21) compared to people with neither HF nor AF. In the fully adjusted analysis, the risk of death remained highest among people with HF and AF (HR 3.78, 95% CI 3.73 to 3.83), followed by people with HF alone (HR 3.06, 95% CI 3.02 to 3.10), then people with AF alone (HR 1.85, 95%, CI 1.82 to 1.87). In a cumulative hazard plot, the risk of death across follow-up was similar among people with HF and AF, compared to those with HF alone.
Conclusion
In our large community cohort, we found HF and AF was associated with a worse prognosis than either condition alone. Both HF and AF were also associated with a poor prognosis. These results support the findings of previous secondary care and trial studies regarding the importance of AF as a prognostic indicator among people with HF. Further research could aim to identify preventive strategies that might improve prognosis among this high-risk group of patients.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was undertaken as part of NRJ's Doctoral Research Fellowship, supported by the Wellcome Trust (grant number 203921/Z/16/Z), with additional funding for this project from the National Institute for Health Research (NIHR) Collaboration for Applied Health Research (CLAHRC) Oxford at Oxford Health NHS Foundation Trust (P2-001).
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Affiliation(s)
- N Jones
- University of Oxford , Oxford , United Kingdom
| | - M Smith
- University of Oxford , Oxford , United Kingdom
| | | | - A K Roalfe
- University of Oxford , Oxford , United Kingdom
| | - Y Yang
- University of Oxford , Oxford , United Kingdom
| | - F D R Hobbs
- University of Oxford , Oxford , United Kingdom
| | - C J Taylor
- University of Oxford , Oxford , United Kingdom
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12
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Simmen D, Jones N. Eingriffe bei Abszedierungen in der Mundhöhle. Laryngorhinootologie 2022; 101:836-838. [PMID: 36174570 DOI: 10.1055/a-1871-7171] [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: 10/14/2022]
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13
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Reid H, Smith R, Williamson W, Baldock J, Caterson J, Kluzek S, Jones N, Copeland R. Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare. BMC Public Health 2022; 22:1784. [PMID: 36127688 PMCID: PMC9487060 DOI: 10.1186/s12889-022-14178-6] [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: 02/09/2022] [Accepted: 08/09/2022] [Indexed: 11/12/2022] Open
Abstract
Background An implementation gap exists between the evidence supporting physical activity in the prevention and management of long-term medical conditions and clinical practice. Person-centred conversations, i.e. focussing on the values, preferences and aspirations of each individual, are required from healthcare professionals. However, many currently lack the capability, opportunity, and motivation to have these conversations. This study uses the Behaviour Change Wheel (BCW) to inform the development of practical and educational resources to help bridge this gap. Methods The BCW provides a theoretical approach to enable the systematic development of behaviour change interventions. Authors followed the described eight-step process, considered results from a scoping review, consulted clinical working groups, tested and developed ideas across clinical pathways, and agreed on solutions to each stage by consensus. Results The behavioural diagnosis identified healthcare professionals’ initiation of person-centred conversations on physical activity at all appropriate opportunities in routine medical care as a suitable primary target for interventions. Six intervention functions and five policy categories met the APEASE criteria. We mapped 17 Behavioural Change Techniques onto BCW intervention functions to define intervention strategies. Conclusions This study uses the BCW to outline a coherent approach for intervention development to improve healthcare professionals’ frequency and quality of conversations on physical activity across clinical practice. Time-sensitive and role-specific resources might help healthcare professionals understand the focus of their intervention. Educational resources aimed at healthcare professionals and patients could have mutual benefit, should fit into existing care pathways and support professional development. A trusted information source with single-point access via the internet is likely to improve accessibility. Future evaluation of resources built and coded using this framework is required to establish the effectiveness of this approach and help improve understanding of what works to change conversations around physical activity in clinical practice.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK. .,Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK.
| | - Ralph Smith
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Wilby Williamson
- School of Medicine, Trinity College Dublin, 152-160 Pearse Street, Dublin, Ireland
| | - James Baldock
- Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Jessica Caterson
- Imperial College Healthcare NHS Trust, Praed Street, London, GB, W2 1NY, UK
| | - Stefan Kluzek
- School of Medicine, University of Nottingham, Medical School, Nottingham, NG7 2UH, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine, 6 Hill Square, Edinburgh, UK.,Oxford University Hospital NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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14
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Simmen D, Jones N. Eröffnung von Retropharyngealabszessen. Laryngorhinootologie 2022; 101:765-767. [PMID: 36041452 DOI: 10.1055/a-1871-6791] [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: 10/14/2022]
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15
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Hoffmann S, Jones N, Raynal B, Von Castelmur E, Derbyshire D, Sunnerhagen M. TNA: apply for access to laboratories of excellence in molecular scale biophysics research infrastrure (MOSBRI). Acta Cryst Sect A 2022. [DOI: 10.1107/s2053273322093810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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16
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Simmen D, Jones N. Eingriffe bei entzündlichen tonsillogenen Komplikationen. Laryngorhinootologie 2022; 101:690-691. [PMID: 35915908 DOI: 10.1055/a-1821-4949] [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: 10/16/2022]
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17
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Garrigues GE, Quigley RJ, Johnston PS, Spencer E, Walch G, Neyton L, Kelly J, Schrumpf M, Gillespie R, Sears BW, Hatzidakis AM, Lau B, Lassiter T, Nicholson GP, Friedman L, Hong I, Hagen CJ, Chan W, Naylor A, Blanchard K, Jones N, Poff G, Shea K, Strony J, Mauter L, Finley S, Aitken M. Early clinical and radiographic outcomes of anatomic total shoulder arthroplasty with a biconvex posterior augmented glenoid for patients with posterior glenoid erosion: minimum 2-year follow-up. J Shoulder Elbow Surg 2022; 31:1729-1737. [PMID: 35151882 DOI: 10.1016/j.jse.2021.12.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/19/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Glenoid bone loss in anatomic total shoulder arthroplasty (aTSA) remains a controversial and challenging clinical problem. Previous studies have shown high rates of glenoid loosening for aTSA in shoulders with retroversion, posterior bone loss, and posterior humeral head subluxation. This study is the first to present minimum 2-year follow-up data of an all-polyethylene, biconvex augmented anatomic glenoid component for correction of glenoid retroversion and posterior humeral head subluxation. METHODS This study is a multicenter, retrospective review of prospectively collected data on consecutive patients from 7 global clinical sites. All patients underwent aTSA using the biconvex posterior augmented glenoid (PAG). Inclusion criteria were preoperative computed tomographic (CT) scan, minimum 2 years since surgery, preoperative and minimum 2-year postoperative range of motion examination, and patient-reported outcome measures (PROMs). Glenoid classification, glenoid retroversion, and posterior humeral head subluxation were measured from preoperative CT and radiography and postoperative radiography. Statistical comparisons between pre- and postoperative values were performed with a paired t test. RESULTS Eighty-six of 110 consecutive patients during the study period (78% follow-up) met the inclusion criteria and were included in our analysis. Mean follow-up was 35 ± 10 months, with a mean age of 68 ± 8 years (range 48-85). Range of motion statistically improved in all planes from pre- to postoperation. Mean visual analog scale score improved from 5.2 preoperation to 0.7 postoperation, Single Assessment Numeric Evaluation score from 43.2 to 89.5, Constant score from 41.8 to 76.9, and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score from 49.8 to 86.7 (all P < .0001). Mean glenoid retroversion improved from 19.3° to 7.4° (P < .0001). Posterior subluxation improved from 69.1% to 53.5% and posterior decentering improved from 5.8% to -3.0% (P < .0001). There was 1 patient with both a prosthetic joint infection and radiographic glenoid loosening that required revision. Seventy-nine of 86 patients had a Lazarus score of 0 (no radiolucency seen about peg or keel) at final follow-up. CONCLUSIONS This study shows that at minimum 2-year follow-up, a posterior-augmented all-polyethylene glenoid can correct glenoid retroversion and posterior humeral head subluxation. Clinically, there was significant improvement in both range of motion and PROMs.
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Affiliation(s)
| | | | | | | | | | | | - James Kelly
- California Pacific Orthopaedics, San Francisco, CA, USA
| | - Mark Schrumpf
- California Pacific Orthopaedics, San Francisco, CA, USA
| | | | | | | | - Brian Lau
- Duke University Hospital, Durham, NC, USA
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18
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Simmen D, Jones N. Alternative: Tonsillektomie in Lokalanästhesie. Laryngorhinootologie 2022; 101:620-623. [PMID: 35738276 DOI: 10.1055/a-1821-4599] [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: 10/17/2022]
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19
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Reid H, Caterson J, Smith R, Baldock J, Jones N, Copeland R. What do healthcare professionals want from a resource to support person-centred conversations on physical activity? A mixed-methods, user-centric approach to developing educational resources. BMJ Open Sport Exerc Med 2022; 8:e001280. [PMID: 35813130 PMCID: PMC9226873 DOI: 10.1136/bmjsem-2021-001280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVES Healthcare is a fundamental action area in population efforts to address the global disease burden from physical inactivity. However, healthcare professionals lack the knowledge, skills and confidence to have regular conversations about physical activity. This study aimed to: (1) understand the requirements of healthcare professionals and patients from a resource to support routine physical activity conversations in clinical consultations and (2) develop such a resource. METHODS This study used codesign principles across two phases, actively involving relevant stakeholders in an iterative development process. The preparatory phase included a scoping literature review and workshops with multidisciplinary healthcare professionals and patients. The Delphi phase included the development of a draft resource, a three-stage modified online Delphi study and an external review. RESULTS The scoping review highlighted the importance of addressing time restrictions, a behaviour change skill deficit, the need for resources to fit into existing systems and meeting patient expectations. Consultation included 69 participants across two clinical workshops. They recommended using the internet, valued guidance on all aspects of physical activity conversations and were concerned about how to use a person-centred approach. The Delphi phase, including 15 expert participants, met agreement criteria in two stages to develop the resource. CONCLUSION This mixed-methods study delivered an online resource that was codesigned with and based on the requirements of healthcare professionals and patients. The resource presents condition-specific '1-minute', '5-minute' and 'more minute' person-centred and evidence-based conversation templates on physical activity in an accessible and usable format to meet the needs of real-life clinical practice.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, UK
| | | | - Ralph Smith
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - James Baldock
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK
- Oxsport, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre (AWRC), Sheffield Hallam University, Sheffield, UK
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20
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Lanfranchi V, Jones N, Read J, Fegan C, Field B, Simpson E, Revitt C, Cudd P, Ciravegna F. User attitudes towards virtual home assessment technologies. J Med Eng Technol 2022; 46:536-546. [PMID: 35730495 DOI: 10.1080/03091902.2022.2089250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Telehealth has long been highlighted as a way to solve issues of efficiency and effectiveness in healthcare and to improve patients' care and has become fundamental to address patients' needs during the COVID-19 pandemic; however previous studies have shown mixed results in the user acceptance of such technologies. Whilst many previous studies have focussed on clinical application of telehealth, we focus on the adoption of telehealth for virtual assessments visits aimed to evaluate the suitability of a property where a patient is discharged, and eventual adaptations needed. We present a study of stakeholders' attitudes towards such virtual assessment visits. The study has been carried out with healthcare professionals and patients and allowed us to identify user attitudes, barriers and facilitators for the success of virtual assessment visits from the point of view of healthcare professionals and patients. Finally, we discuss implications for designers of telehealth services and guidelines that can be derived from our study.
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Affiliation(s)
- V Lanfranchi
- Department of Computer Science, The University of Sheffield, Sheffield, UK.,Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity, MedTech Co-operative Affiliate, Sheffield, UK
| | - N Jones
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - J Read
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - C Fegan
- Department Allied Health Professions, Sheffield Hallam University, Sheffield, UK
| | - B Field
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Simpson
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - C Revitt
- Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - P Cudd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - F Ciravegna
- Department of Computer Science, The University of Sheffield, Sheffield, UK
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21
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Kennedy JS, Reinke EK, Friedman LGM, Cook C, Forsythe B, Gillespie R, Hatzidakis A, Jawa A, Johnston P, Nagda S, Nicholson G, Sears B, Wiesel B, Garrigues GE, Hagen C, Hong I, Roach M, Jones N, Mahendraraj K, Michaelson E, Bader J, Mauter L, Mengers S, Renko N, Strony J, Hart P, Steele E, Naylor A, Gaudette J, Sprengel K. Protocol for a multicenter, randomised controlled trial of surgeon-directed home therapy vs. outpatient rehabilitation by physical therapists for reverse total shoulder arthroplasty: the SHORT trial. Arch Physiother 2021; 11:28. [PMID: 34886910 PMCID: PMC8662891 DOI: 10.1186/s40945-021-00121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Reverse total shoulder arthroplasty (RTSA) has emerged as a successful surgery with expanding indications. Outcomes may be influenced by post-operative rehabilitation; however, there is a dearth of research regarding optimal rehabilitation strategy following RTSA. The primary purpose of this study is to compare patient reported and clinical outcomes after RTSA in two groups: in one group rehabilitation is directed by formal, outpatient clinic-based physical therapists (PT group) as compared to a home therapy group, in which patients are instructed in their rehabilitative exercises by surgeons at post-operative appointments (HT group). Secondary aims include comparisons of complications, cost of care and quality of life between the two groups. Methods This randomised controlled trial has commenced at seven sites across the United States. Data is being collected on 200 subjects by clinical research assistants pre-operatively and post-operatively at 2, 6, and 12 weeks, 6 months, 1 and 2 year visits. The following variables are being assessed: American Shoulder and Elbow Surgeons (ASES), pain level using the numeric pain scale, the Single Assessment Numeric Evaluation (SANE) score, and shoulder active and passive range of motion for analysis of the primary aim. Chi square and t-tests will be used to measure differences in baseline characteristics of both groups. Repeated measures linear mixed effects modeling for measurement of differences will be used for outcomes associated with ASES and SANE and scores, and range of motion measures. Secondary aims will be analyzed for comparison of complications, cost, and quality of life assessment scores using data obtained from the PROMIS 29 v. 2, questionnaires administered at standard of care post-operative visits, and the electronic health record. Subjects will be allowed to crossover between the PT and HT groups, and analysis will include both intention-to-treat including patients who crossed over, and a second with cross-over patients removed, truncated to the time they crossed over. Discussion RTSA is being performed with increasing frequency, and the optimal rehabilitation strategy is unclear. This study will help clarify the role of formal physical therapy with particular consideration to outcomes, cost, and complications. In addition, this study will evaluate a proposed rehabilitation strategy. Trial registration This study is registered as NCT03719859 at ClincialTrials.gov. Supplementary Information The online version contains supplementary material available at 10.1186/s40945-021-00121-2.
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Affiliation(s)
- June S Kennedy
- Department of Physical and Occupational Therapy, Duke University Health System, 3475 Erwin Rd, Durham, NC, 27705, USA.
| | - Emily K Reinke
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA
| | - Lisa G M Friedman
- Department of Orthopedics, Geisinger Medical Center, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, 3475 Erwin Rd, Durham, NC, 27705, USA.,Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC, 27701, USA.,Duke Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Robert Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland, 11000 Euclid Ave, Cleveland, OH, 44106, United States
| | | | - Andrew Jawa
- Boston Sports and Shoulder Center, 40 Allied Dr., Suite 102, Dedham, MA, 02026, USA
| | - Peter Johnston
- Centers for Advanced Orthopaedics, 25500 Point Lookout Road, Leonardtown, MD, 20650, USA
| | - Sameer Nagda
- Anderson Orthopaedic Clinic, 2445 Army Navy Drive, Arlington, VA, 22206, USA
| | - Gregory Nicholson
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
| | - Benjamin Sears
- Western Orthopaedics, 1830 Franklin St, 450, Denver, CO, 80218, USA
| | - Brent Wiesel
- MedStar Orthopaedic Institute, 3800 Reservoir Road Northwest, Washington, DC, 20007, USA
| | - Grant E Garrigues
- Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St., Suite 400, Chicago, IL, 60612, USA
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22
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Azizoddin DR, Kvaternik N, Beck M, Zhou G, Hasdianda MA, Jones N, Johnsky L, Im D, Chai PR, Boyer EW. Heal the Healers: A pilot study evaluating the feasibility, acceptability, and exploratory efficacy of a Transcendental Meditation intervention for emergency clinicians during the coronavirus disease 2019 pandemic. J Am Coll Emerg Physicians Open 2021; 2:e12619. [PMID: 35005707 PMCID: PMC8716568 DOI: 10.1002/emp2.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Emergency clinicians face elevated rates of burnout that result in poor outcomes for clinicians, patients, and health systems. The objective of this single-arm pilot study was to evaluate the feasibility of a Transcendental Meditation (TM) intervention for emergency clinicians during the coronavirus disease 2019 (COVID-19) pandemic and to explore the potential effectiveness in improving burnout, sleep, and psychological health. METHODS Emergency clinicians (physicians, nurses, and physician-assistants) from 2 urban hospitals were recruited to participate in TM instruction (8 individual or group in-person and remote sessions) for 3 months. Session attendance was the primary feasibility outcome (prespecified as attending 6/8 sessions), and burnout was the primary clinical outcome. Participant-reported measures of feasibility and validated measures of burnout, depression, anxiety, sleep disturbance, and stress were collected at baseline and the 1-month and 3-month follow-ups. Descriptive statistics and linear mixed-effects models were used. RESULTS Of the 14 physicians (46%), 7 nurses (22%), and 10 physician-assistants (32%) who participated, 61% were female (n = 19/32). TM training and at-home meditation practice was feasible for clinicians as 90.6% (n = 29/32) attended 6/8 training sessions and 80.6% self-reported meditating at least once a day on average. Participants demonstrated significant reductions in burnout (P < .05; effect sizes, Cohen's d = 0.43-0.45) and in symptoms of depression, anxiety, stress, and sleep disturbance (P values < .001; Cohen's d = 0.70-0.87). CONCLUSION TM training was feasible for emergency clinicians during the COVID-19 pandemic and led to significant reductions in burnout and psychological symptoms. TM is a safe and effective meditation tool to improve clinicians' well-being.
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Affiliation(s)
- Desiree R. Azizoddin
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Department of Internal MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Noelia Kvaternik
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Meghan Beck
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Guohai Zhou
- Center for Clinical InvestigationBrigham and Women's HospitalBostonMassachusettsUSA
| | | | - Natasha Jones
- Harvard Graduate School of EducationHarvard UniversityCambridgeUSA
| | - Lily Johnsky
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Dana Im
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Internal MedicineHarvard Medical SchoolBostonMassachusettsUSA
| | - Peter R. Chai
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- Department of Psychosocial Oncology and Palliative CareDana‐Farber Cancer InstituteBostonMassachusettsUSA
- Department of Internal MedicineHarvard Medical SchoolBostonMassachusettsUSA
- The Koch Institute for Integrated Cancer ResearchMassachusetts Institute of TechnologyCambridgeMassachusettsUSA
- The Fenway InstituteBostonMassachusettsUSA
| | - Edward W. Boyer
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
- The Fenway InstituteBostonMassachusettsUSA
- Department of Emergency MedicineThe Ohio State UniversityColumbusOhioUSA
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23
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Smith R, Baldock J, FitzPatrick M, Jones N, Newton JL. Incidence of Undiagnosed Celiac Disease Presenting as Bone Stress Injuries to a Sport and Exercise Medicine Clinic. Clin J Sport Med 2021; 31:e306-e312. [PMID: 32032163 DOI: 10.1097/jsm.0000000000000820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the incidence of undiagnosed celiac disease (CD) in patients presenting with bone stress injuries (BSI) to a NHS Sport and Exercise Medicine (SEM) clinic. DESIGN Retrospective cohort study. SETTING Single tertiary-level SEM clinic. PATIENT/PARTICIPANTS One hundred consecutive patients with radiologically proven BSIs. INTERVENTIONS Laboratory blood tests (LBT) can unmask underlying metabolic bone disorders. Anti-tissue transglutaminase antibody (TTG) testing has a high sensitivity and specificity for CD. In this SEM clinic, clinicians were encouraged to perform LBT including TTG, at time of diagnosis of BSI. A retrospective analysis of age, sex, fracture site, co-morbidities, TTG result, and subsequent investigations was performed. MAIN OUTCOME MEASURES The primary outcome was the number and percentage of patients with BSIs and either positive TTG (CD seropositivity) or a diagnosis of CD. RESULTS Of the 100 patients with radiologically proven BSIs, 70% were female, and the mean age was 37 years (range 16-69). Eighty-five percent had the appropriate LBTs, of which 70% (60/85) were female, and the mean age was 37(16-69). Metatarsal (35%) and tibial (21%) were the most common BSIs. Anti-tissue transglutaminase antibody was performed in 85 patients. Two patients (2/85) had pre-existing CD and were excluded from incidence calculations. Five patients [5/83 (6%), mean age 38 years (28-57), 80% female] had a positive TTG, of whom 3 have subsequently had CD confirmed by endoscopic biopsy. Four patients with a positive TTG underwent dual-energy X-ray absorptiometry with osteopenia found in 3 (75%) cases. CONCLUSIONS In this cohort, the incidence of CD seropositivity was 6%, and the prevalence of biopsy-confirmed CD was 5%, approximately 5-fold higher than UK population estimates. Anti-tissue transglutaminase antibody screening for CD should be considered in all patients presenting with BSIs.
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Affiliation(s)
- Ralph Smith
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; and
| | - James Baldock
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; and
| | - Michael FitzPatrick
- Translational Gastroenterology Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Natasha Jones
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; and
| | - Julia L Newton
- Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom; and
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24
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Reid H, Ridout AJ, Tomaz SA, Kelly P, Jones N. Benefits outweigh the risks: a consensus statement on the risks of physical activity for people living with long-term conditions. Br J Sports Med 2021; 56:427-438. [PMID: 34649919 PMCID: PMC8995821 DOI: 10.1136/bjsports-2021-104281] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/29/2022]
Abstract
Introduction The benefits of physical activity for people living with long-term conditions (LTCs) are well established. However, the risks of physical activity are less well documented. The fear of exacerbating symptoms and causing adverse events is a persuasive barrier to physical activity in this population. This work aimed to agree clear statements for use by healthcare professionals about medical risks of physical activity for people living with LTCs through expert consensus. These statements addressed the following questions: (1) Is increasing physical activity safe for people living with one or more LTC? (2) Are the symptoms and clinical syndromes associated with common LTCs aggravated in the short or long term by increasing physical activity levels? (3) What specific risks should healthcare professionals consider when advising symptomatic people with one or more LTCs to increase their physical activity levels? Methods Statements were developed in a multistage process, guided by the Appraisal of Guidelines for Research and Evaluation tool. A patient and clinician involvement process, a rapid literature review and a steering group workshop informed the development of draft symptom and syndrome-based statements. We then tested and refined the draft statements and supporting evidence using a three-stage modified online Delphi study, incorporating a multidisciplinary expert panel with a broad range of clinical specialties. Results Twenty-eight experts completed the Delphi process. All statements achieved consensus with a final agreement between 88.5%–96.5%. Five ‘impact statements’ conclude that (1) for people living with LTCs, the benefits of physical activity far outweigh the risks, (2) despite the risks being very low, perceived risk is high, (3) person-centred conversations are essential for addressing perceived risk, (4) everybody has their own starting point and (5) people should stop and seek medical attention if they experience a dramatic increase in symptoms. In addition, eight symptom/syndrome-based statements discuss specific risks for musculoskeletal pain, fatigue, shortness of breath, cardiac chest pain, palpitations, dysglycaemia, cognitive impairment and falls and frailty. Conclusion Clear, consistent messaging on risk across healthcare will improve people living with LTCs confidence to be physically active. Addressing the fear of adverse events on an individual level will help healthcare professionals affect meaningful behavioural change in day-to-day practice. Evidence does not support routine preparticipation medical clearance for people with stable LTCs if they build up gradually from their current level. The need for medical guidance, as opposed to clearance, should be determined by individuals with specific concerns about active symptoms. As part of a system-wide approach, consistent messaging from healthcare professionals around risk will also help reduce cross-sector barriers to engagement for this population.
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Affiliation(s)
- Hamish Reid
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK.,Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, South Yorkshire, UK
| | - Ashley Jane Ridout
- Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
| | - Simone Annabella Tomaz
- Stirling Physical Activity Research Knowledge and Learning Exchange (SPARKLE), University of Stirling, Stirling, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre, University of Edinburgh Institute for Sport Physical Education and Health Sciences, Edinburgh, UK
| | - Natasha Jones
- Moving Medicine, Faculty of Sport And Exercise Medicine, Edinburgh, UK .,Sport and Exercise Medicine, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK
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25
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Taylor C, Ordonez-Mena J, Lay-Flurrie S, Goyder C, Jones N, Roalfe A, Hobbs F. Natriuretic peptide referral thresholds and heart failure diagnosis: population-based cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Natriuretic peptide (NP) testing is recommended by both the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) for people presenting with symptoms of heart failure (HF) in primary care. However, ESC and NICE guidelines suggest different NP referral thresholds: ESC recommend referral at a lower NP level (BNP≥35pg/ml / NT-proBNP≥125pg/ml) compared to NICE (BNP≥100pg/ml/NT-proBNP≥400pg/ml).
Purpose
We aimed to evaluate NP test performance for HF diagnosis for ESC and NICE guideline-defined thresholds.
Methods
Population-based cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England between 1st January 2000 and 31st December 2018. Participants were adults aged 45 years and above with a NP result: 74,233 had a BNP and 155,347 had a NT-proBNP measurement. The main outcome measures were diagnostic performance of NP test (sensitivity, specificity, positive predictive value, negative predictive value) by threshold.
Results
A total of 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF. The ESC NT-proBNP threshold of 125pg/ml had a sensitivity of 94.6% (94.2 to 95.0) and specificity of 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP 400pg/ml threshold. For both guidelines, nearly all patients with a NP level below the threshold did not have HF (negative predictive value ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Similar performance was found for BNP.
Conclusions
The performance of NP testing is dependent on the guideline-specified threshold for referral. In 100 people with HF, using the NICE threshold would falsely reassure 18 patients, whereas the lower ESC threshold would miss just 5 people but twice as many patients would be referred for diagnostic assessment. The optimal NP threshold for referral for HF diagnosis will depend on the healthcare setting. The trade-off between missing HF cases and overwhelming diagnostic services needs to be determined at a national level.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research
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Affiliation(s)
- C Taylor
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - J.M Ordonez-Mena
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - S Lay-Flurrie
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - C Goyder
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - N Jones
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - A Roalfe
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - F.D.R Hobbs
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
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26
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Contos G, Baca Y, Xiu J, Brown J, Holloway R, Korn WM, Herzog TJ, Jones N, Winer I. Assessment of immune biomarkers and establishing a triple negative phenotype in gynecologic cancers. Gynecol Oncol 2021; 163:312-319. [PMID: 34563366 DOI: 10.1016/j.ygyno.2021.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Immuno-oncology (IO) has rapidly evolved, with many IO therapies either approved or under investigation for multiple malignancies. Biomarkers exist that can predict response to IO therapies including PD-L1 expression, microsatellite instability (MSI), and total mutation burden (TMB). This paper serves to analyze the presence of these biomarkers across gynecologic cancers. METHODS A total of 16,300 gynecologic cancer specimens submitted for molecular profiling to Caris Life Sciences were reviewed. Immunohistochemistry was performed using the SP142 anti-PD-L1 clone and assessed for intensity. Next-generation sequencing, immunohistochemistry, and fragment analysis were used to determine MSI status. TMB was measured by counting all non-synonymous missense mutations found per tumor not previously described as germline alterations. Chi-Square, Fisher Exact, and the Kruskal-Wallis test were used to compare cohorts. RESULTS Of 16,300 specimens, 54.1% were ovarian, 37.2% uterine, 7.2% cervical, 0.3% vulvar, 1.2% vaginal, with 0.1% unspecified. MSI-H was most frequent in uterine cancer (17.7%) and only 1% of ovarian cancers. PD-L1 expression was present in 38.3% of cervical and 62.5% of vulvar cancers, but less than 8% of ovarian and uterine cancers. TMB-H was present in 21.1% cervical, 19.7% uterine, and 5% ovarian cancers. Few specimens exhibited a "triple positive" phenotype - 0.3% ovarian, 1.5% uterine, and 1.5% cervical. Associations were seen between MSI, TMB, and PD-L1 across all cancer types. CONCLUSIONS The frequency of individual biomarkers pertinent to IO therapy varies by cancer type. HPV-driven genital tract cancers have higher frequencies of PD-L1 expression, MSI-H, and TMBH. Endometrial cancers are characterized by MSI-H and TMB, whereas ovarian cancers have a low frequency of MSI-H and modest PD-L1 or TMBH. The incidence of 'triple positive" cases was less than 2%.
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Affiliation(s)
- G Contos
- Wayne State University and Karmanos Cancer Institute, 4100 John R. St., Detroit, MI 48201, United States of America.
| | - Y Baca
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - J Xiu
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - J Brown
- Levine Cancer Institute, 1021 Morehead Medical Dr. #2100, Charlotte, NC 28204, United States of America.
| | - R Holloway
- Advent Health Medical Group, 2501 N. Orange Ave. Suite 786, Orlando, FL 32804, United States of America
| | - W M Korn
- Caris Life Sciences, 4750 S. 44(th) Pl., Phoenix, AZ 85040, United States of America
| | - T J Herzog
- University of Cincinnati Cancer Institute, 3255 Eden Ave. Suite 250B, Cincinnati, OH 45019, United States of America.
| | - N Jones
- University of South Alabama Mitchell Cancer Institute, 1660 Springhill Avenue, Mobile, AL 36604, United States of America.
| | - I Winer
- Wayne State University and Karmanos Cancer Institute, 4100 John R. St., Detroit, MI 48201, United States of America
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27
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Grushko M, Goldstein J, ElSeht Z, Alarcon A, Jones N, Samizadeh M, Zhu Y, Kaplan J, Arline K. 1146P Closing the target gap: A computational approach to optimizing therapeutic selection for cancer patients. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.787] [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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Staley JT, Redhead JW, O'Connor RS, Jarvis SG, Siriwardena GM, Henderson IG, Botham MS, Carvell C, Smart SM, Phillips S, Jones N, McCracken ME, Christelow J, Howell K, Pywell RF. Designing a survey to monitor multi-scale impacts of agri-environment schemes on mobile taxa. J Environ Manage 2021; 290:112589. [PMID: 33906116 DOI: 10.1016/j.jenvman.2021.112589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/09/2021] [Accepted: 04/09/2021] [Indexed: 06/12/2023]
Abstract
Agri-environment schemes (AES) are key mechanisms to deliver conservation policy, and include management to provide resources for target taxa. Mobile species may move to areas where resources are increased, without this necessarily having an effect across the wider countryside or on populations over time. Most assessments of AES efficacy have been at small spatial scales, over short timescales, and shown varying results. We developed a survey design based on orthogonal gradients of AES management at local and landscape scales, which will enable the response of several taxa to be monitored. An evidence review of management effects on butterflies, birds and pollinating insects provided data to score AES options. Predicted gradients were calculated using AES uptake, weighted by the evidence scores. Predicted AES gradients for each taxon correlated strongly, and with the average gradient across taxa, supporting the co-location of surveys across different taxa. Nine 1 × 1 km survey squares were selected in each of four regional blocks with broadly homogenous background habitat characteristics. Squares in each block covered orthogonal contrasts across the range of AES gradients at local and landscape scales. This allows the effects of AES on species at each scale, and the interaction between scales, to be tested. AES options and broad habitats were mapped in field surveys, to verify predicted gradients which were based on AES option uptake data. The verified AES gradient had a strong positive relationship with the predicted gradient. AES gradients were broadly independent of background habitat within each block, likely allowing AES effects to be distinguished from potential effects of other habitat variables. Surveys of several mobile taxa are ongoing. This design will allow mobile taxa responses to AES to be tested in the surrounding countryside, as well as on land under AES management, and potentially in terms of population change over time. The design developed here provides a novel, pseudo-experimental approach for assessing the response of mobile species to gradients of management at two spatial scales. A similar design process could be applied in other regions that require a standardized approach to monitoring the impacts of management interventions on target taxa at landscape scales, if equivalent spatial data are available.
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Affiliation(s)
- J T Staley
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK.
| | - J W Redhead
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R S O'Connor
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S G Jarvis
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - G M Siriwardena
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - I G Henderson
- British Trust for Ornithology (BTO), The Nunnery, Thetford, Norfolk, IP24 2PU, UK
| | - M S Botham
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - C Carvell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - S M Smart
- UKCEH, Lancaster Environment Centre, Library Avenue, Bailrigg, Lancaster, LA1 4AP, UK
| | - S Phillips
- Natural England, Foss House, Kings Pool, 1-2 Peasholme Green, York, YO1 7PX, UK
| | - N Jones
- FERA Science Ltd, National Agri-food Innovation Campus, Sand Hutton, York, YO41 1LZ, UK
| | - M E McCracken
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - J Christelow
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - K Howell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
| | - R F Pywell
- UK Centre for Ecology and Hydrology (UKCEH), Maclean Building, Benson Lane, Crowmarsh Gifford, Oxfordshire, OX10 8BB, UK
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Lindsay L, Mao HA, Cheng JE, Chuo CY, Jones N, Cascino MD, Tuckwell K. POS0792 BASELINE FACTORS ASSOCIATED WITH LUPUS FLARES: A POST-HOC ANALYSIS OF PATIENTS WITH MODERATE TO SEVERE ACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS ENROLLED IN A 48 WEEK PHASE II RANDOMIZED CLINICAL TRIAL. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4042] [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
Background:Systemic lupus erythematosus (SLE) is a chronic disease characterized by periodic flares associated with poor outcomes and subsequent organ damage (1-2). Flare prevention is important for optimal patient management and development of effective therapies.Objectives:To identify patient-level factors associated with flares among patients with moderate/severe SLE.Methods:We conducted a post-hoc analysis of 260 patients with active, autoantibody+ SLE enrolled in a phase II randomized clinical trial (Fenebrutinib) (3). The relationship between baseline demographic (age, gender, ethnicity, BMI), region (US/EU, outside US/EU), disease severity (PGA, SLEDAI-2K, BILAG domain involvement), disease duration, serologic markers (C3, C4, ANA, anti-dsDNA Ab, anti-Smith Ab), treatment arm, standard of care (SOC) and flares (BILAG and SFI) over 48 wks was assessed by survival analysis and multiple Cox Proportional Hazard models. We examined concordance between BILAG and SFI flares using Cohen’s Kappa Index.Results:The overall rate of flare was low (n=37 SFI flare, n=25 BILAG flare). Median time to first flare was 8 wks for SFI flares compared to 12 wks for BILAG flares. There was no difference in flare rate by treatment arm. Cumulative flare hazard increased over time. Concordance between SFI and BILAG flares was 0.14. Multivariable analyses identified a higher flare rate for both SFI and BILAG-defined flares in patients with severe disease at baseline (PGA >1.7, SLEDAI-2K ≥10) and <7 y disease duration.Flares were more common in patients ANA, anti-dsDNA and anti-Smith+ at baseline compared to patients with <3 + markers (p<.001). Furthermore, anti-dsDNA (p = .03) and/or anti-Smith (p = .001) positivity at baseline were better indicators of higher flare rate compared to ANA (p = 0.5). Low baseline complement level (C3 and C4) was associated with a higher flare rate (p = .03 and p = .03 respectively).Patients from non-US/EU regions had a higher flare rate compared to patients from the US/EU, despite receiving more frequent SOC therapy and higher baseline corticosteroid doses (≥10 mg/d). Overall, flare-free probability was comparable at 48 wks regardless of baseline corticosteroid dose but patients receiving <10 mg/d had a median time to flare of 4 vs 24 wks for those receiving ≥10 mg/d (p = .004).Conclusion:In this study, flares were more common among patients with more severe disease, shorter disease duration, multiple serologic markers, were from outside the US/EU, and received lower steroid doses at baseline.References:[1]Fernandez D and Kirou KA. Curr Rheumatol Rep 2016 18:14.[2]Stoll T, et al. Rheum (Oxford) 2004 43(8):1039–44.[3]Isenberg D, et al. Arth Rheum 2019 71 suppl 10.Baseline Factors (%)No Flare n=206FlareBILAG n=25SFI n=37BILAG and SFI n=8Age (mean (SD))41.8 (12)35.2 (9)40.4 (10)34.9 (8)Female199 (97)24 (96)35 (95)7 (88)PGA (mean (SD))1.7 (0.5)1.7 (0.4)1.9 (0.5)1.7 (0.6)BILAG A/B any domain197 (96)23 (92)35 (95)7 (88)SLEDAI 2K >=1087 (42)18 (72)17 (46)4 (50)Disease duration (y) (mean (SD))9.4 (7)5.3 (4)6.6 (6)2.9 (3)ANA +203 (99)24 (96)35 (95)8 (100)anti-dsDNA +102 (50)18 (72)21 (57)5 (63)anti-Smith +45 (22)13 (52)12 (32)4 (50)Low C357 (28)12 (48)13 (35)3 (38)Low C426 (13)7 (28)4 (11)1 (13)Non US/EU157 (76)21 (84)32 (87)8 (100)Corticosteroid130 (63)14 (56)21 (57)5 (63) ≥10 mg/d80 (39)9 (36)14 (38)4 (50)Immunosuppressant74 (36)12 (48)15 (41)3 (38)Antimalarial135 (66)14 (56)21 (57)5 (63)Notes: included patients 18-75 y; 1+ serologic marker of SLE; SLEDAI-2K >=8, PGA>=1; 1+ oral SOC treatmentSFI = SELENA- SLEDAI Flare IndexDisclosure of Interests:Lisa Lindsay Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Huiyan (Ashley) Mao Shareholder of: Employee of Hoffmann-La Roche Limited, Employee of: Employee of Hoffmann-La Roche Limited, Ji (Emmy) Cheng Shareholder of: Employee of Hoffmann-La Roche Limited, Employee of: Employee of Hoffmann-La Roche Limited, Ching-Yi Chuo Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Nicholas Jones Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Matthew D. Cascino Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc., Katie Tuckwell Shareholder of: Employee of Genentech, Inc., Employee of: Employee of Genentech, Inc.
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Jones N, Francis J, Parikh R, Shaath M. 102 Peer Teaching in Hip Fracture: Responding to the Medical Needs of Surgical Patients and Educational Needs of Junior Doctors. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.114] [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]
Abstract
Abstract
Introduction
Fractured Neck of Femur (FNOF) patients are complex. A mortality project identified topics for a peer-led teaching programme.
Method
Eight bite-sized case-based sessions were devised, to provide a framework to approach the following topics: Anaemia, delirium/dementia, ECG abnormalities, metastatic cancer, osteoporosis, renal disease, respiratory disease, and vascular complications. Attendees were asked to complete pre- and post- teaching programme questionnaires using a Likert Scale to indicate agreement with statements relating to the topic areas chosen (1=strongly disagree and 5=strongly agree).
Result
Pre-programme questionnaire: respondents were neutral (average 3.04) when asked whether topic areas were currently “well managed”. Attendees lacked confidence, indicating preparedness as neutral (average 3.35). Trainees agreed that they would benefit from teaching (average 4.56).
Post-programme questionnaire: increased confidence was reported when considering preparedness (average 4.3). Attendees felt the teaching programme was “accessible” and the “topics well-chosen”. 100% of attendees regarded the teaching as ‘excellent’ or ‘very-good’.
Conclusions
Matching patient needs to an educational programme is important.
The “bite-sized” nature of the programme paired with case-based learning increased confidence. A peer-led teaching programme is a positive response to themes emerging from morbidity and mortality reviews.
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Affiliation(s)
- N Jones
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - J Francis
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - R Parikh
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
| | - M Shaath
- Royal Oldham Hospital, Northern Care Alliance, Manchester, United Kingdom
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Lawrence EG, Jones N, Greenberg N, Fear NT, Wessely S, Michael G, Taylor-Beirne S, Simms A. Mental well-being interventions in the military: The ten key principles. BMJ Mil Health 2021; 168:179-180. [PMID: 33911012 DOI: 10.1136/bmjmilitary-2020-001740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/04/2022]
Abstract
Organisations including the United Kingdom Armed Forces should seek to implement mental health interventions to increase the psychological well-being of their workforce. This editorial briefly presents ten key principles that military forces should consider before implementing such interventions. These include job-focused training; evaluating interventions; the use of internal versus external training providers; the role of leaders; unit cohesion, single versus multiple session psychological interventions; not overgeneralising the applicability of interventions; the need for repeated skills practice; raising awareness and the fallibility of screening.
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Affiliation(s)
- Erin G Lawrence
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Wessely
- Academic Department of Military Mental Health, King's College London, London, UK.,King's Centre for Military Health Research, King's College London, London, UK
| | - G Michael
- Academic Department of Military Mental Health, King's College London, London, UK
| | - S Taylor-Beirne
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
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Jones M, Jones N, Burdett H, Bergman BP, Fear NT, Wessely S, Rona RJ. Do Junior Entrants to the UK Armed Forces have worse outcomes than Standard Entrants? BMJ Mil Health 2021; 169:218-224. [PMID: 33879526 DOI: 10.1136/bmjmilitary-2021-001787] [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: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The UK is the only permanent member of the UN Security Council that has a policy of recruiting 16 and 17 year old individuals into its regular Armed Forces. Little is known about the consequences of enlisting as a Junior Entrant (JE), although concerns have been expressed. We compare the mental health, deployment history, and pre-enlistment and post-enlistment experiences of personnel who had enlisted as JEs with personnel who joined as Standard Entrants (SEs). METHOD Participants from a large UK military cohort study completed a self-report questionnaire between 2014 and 2016 that included symptoms of probable post-traumatic stress disorder (PTSD), common mental disorders, alcohol consumption, physical symptoms and lifetime self-harm. Data from regular non-officer participants (n=4447) from all service branches were used in the analysis. JEs were defined as having enlisted before the age of 17.5 years. A subgroup analysis of participants who had joined or commenced adult service after April 2003 was carried out. RESULTS JEs were not more likely to deploy to Iraq or Afghanistan but were more likely to hold a combat role when they did (OR 1.25, 95% CI 1.00 to 1.56). There was no evidence of an increase in symptoms of common mental disorders, PTSD, multiple somatic symptoms (MSS), alcohol misuse or self-harm in JEs in the full sample, but there was an increase in alcohol misuse (OR 1.84, 95% CI 1.18 to 2.87), MSS (OR 1.51, 95% CI 1.04 to 2.20) and self-harm (OR 2.13, 95% CI 1.15 to 3.95) in JEs who had commenced adult service after April 2003. JEs remain in adult service for longer and do not have more difficulties when they leave service. CONCLUSIONS JEs do not have worse mental health than SEs, but there is uncertainty in relation to alcohol misuse, MSS and self-harm in more recent joiners. Monitoring these concerns is advisable.
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Affiliation(s)
- Margaret Jones
- Psychological Medicine, King's College London, London, UK
| | - N Jones
- Academic Department for Military Mental Health, King's College London, London, UK
| | - H Burdett
- Psychological Medicine, King's College London, London, UK
| | - B P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - N T Fear
- Psychological Medicine, King's College London, London, UK
| | - S Wessely
- Psychological Medicine, King's College London, London, UK
| | - R J Rona
- Psychological Medicine, King's College London, London, UK
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Flanagan M, Little R, Siddiqui I, Jones N, Ng V. A215 MDR3 DEFICIENCY MIMICKING WILSON DISEASE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The chronic phenotype of ALF includes a broad differential diagnosis. Class III multi-drug resistance P-glycoprotein 3 (MDR3) deficiency, also referred to as progressive familial intrahepatic cholestasis type 3, is an autosomal recessive genetic disorder. It is caused by a defect on the ABCB4 gene located on chromosome 7, which encodes MDR3. MDR3 is responsible for transporting phosphatidylcholine across the canalicular membrane, thereby allowing it to be incorporated into bile micelles. MDR3 deficiency results in increased levels of free bile acids and detergent bile. Progressive cholangiopathy ensues from this detergent bile and indirectly leads to cholestasis and liver failure in severe cases. Significantly increased urinary and hepatic copper (Cu), which are hallmarks of Wilson disease, have also been reported in patients with acute hepatitis and cholestasis including patients with MDR3 deficiency
Aims
We report a case of a girl who presented with a chronic phenotype of PALF, who had multiple features of Wilson disease and so was treated as such until genetic analysis confirmed MDR3 deficiency
Methods
Results
A 6 year old girl presented to the ED with a 1mth history of epistaxis and a 1wk history of abdominal pain and distension, facial edema, pallor and fever. Her family history was significant for parental consanguinity and maternal itch during pregnancy. On examination she had clubbing, scleral icterus and a distended abdomen with hepatosplenomegaly. Her bloodwork showed bicytopenia (HGB 53 & Plts 63) along with liver dysfunction (INR 2.9, albumin 25, conjugated bilirubin 9) and raised liver enzymes (transaminases & GGT >10xULN). Her total serum bile acids were raised at 134. An US showed hepatosplenomegaly with multiple hyperechoic nodules and perisplenic varices. She was extensively worked up for malignancy, autoimmune and metabolic disease. Serum ceruloplasmin was reduced, ophthalmology examination showed no KF rings and her 24hr urinary Cu was 10xULN. Liver Cu quantification was markedly raised at 40xULN. Liver biopsy showed cirrhosis with fibrosis related minimal non-specific portal and septal inflammation. Additionally, complete loss of canalicular staining on immunohistochemistry for MDR3 protein was noted, suggestive of MDR3 deficiency. Based on the Cu levels, a provisional diagnosis of Wilson disease was made and Cu chelation therapy was commenced pending genetic testing. A cholestatic gene panel subsequently showed homozygous pathogenic variant for the ABCB4 gene. Trientine was stopped and she was commenced on ursodeoxycholic acid. Though biochemically she remains largely unchanged, she is clinically stable whilst awaiting a liver transplant
Conclusions
This case highlights the diagnostic difficulties associated with Cu test result interpretation in patients with chronic cholestatic liver disease and urges a thorough consideration of alternative diagnoses of PALF
Funding Agencies
None
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Affiliation(s)
- M Flanagan
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - R Little
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - I Siddiqui
- GI, The Hospital for Sick Children, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children, Toronto, ON, Canada
| | - V Ng
- Division of Pediatric GI/Hepatology/Nutrition, The Hospital for Sick Children, Toronto, ON, Canada
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Adhikhari D, Henderson T, Dolce M, Banks AR, Zaim H, Onwuka A, Jones N. An evaluation of PlayStreets in the South Side neighborhood of Columbus, Ohio. Perspect Public Health 2021; 141:97-101. [PMID: 33602030 DOI: 10.1177/1757913921990411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Outdoor play, physical activity, and social cohesion are crucial indicators of community health. PlayStreets, a street play initiative to engage local children and families in outdoor play, physical activity, and social interactions, were implemented in a low-income neighborhood in Columbus, Ohio throughout the summer of 2019. This article aims to describe the implementation of a hospital-sponsored PlayStreets model executed through support from a community health initiative and to assess neighborhood impact through parent and child surveys. METHODS Approximately 350 children attended the events and 69 surveys were collected. Descriptive statistics were used to analyze survey data. RESULTS The mean age of children was 7 years, and the majority of children who attended were male. If not for PlayStreets, 55% of caregivers reported that their children would be inside. Event satisfaction levels were high, and 54% of caregivers said that they had more contact with their neighbors because of the events. CONCLUSIONS Hospital buy-in and community support were crucial to the success of the event. We found that this model can successfully engage the local community while increasing opportunity for childhood outdoor play, physical activity, and neighborhood social interaction.
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Affiliation(s)
- D Adhikhari
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - T Henderson
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - M Dolce
- Nationwide Children's Hospital, Columbus, OH, USA
| | - A R Banks
- Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - H Zaim
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - A Onwuka
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - N Jones
- Nationwide Children's Hospital, Columbus, OH, USA
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Irizar P, Leightley D, Stevelink S, Rona R, Jones N, Gouni K, Puddephatt JA, Fear N, Wessely S, Goodwin L. Drinking motivations in UK serving and ex-serving military personnel. Occup Med (Lond) 2020; 70:259-267. [PMID: 31961932 PMCID: PMC7305700 DOI: 10.1093/occmed/kqaa003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Drinking motivations within the UK military have not been studied despite the high prevalence of alcohol misuse in this group. AIMS We aimed to characterize drinking motivations and their demographic, military and mental health associations in UK serving and ex-serving personnel. METHODS Serving and ex-serving personnel reporting mental health, stress or emotional problems occurring in the last 3 years were selected from an existing cohort study. A semi-structured telephone interview survey examined participants' mental health, help-seeking, alcohol use and drinking motivations. RESULTS Exploratory factor analysis of drinking motivations in military personnel (n = 1279; response rate = 84.6%) yielded 2 factors, labelled 'drinking to cope' and 'social pressure'. Higher drinking to cope motivations were associated with probable anxiety (rate ratio [RR] = 1.4; 95% confidence interval [CI] = 1.3-1.5), depression (RR = 1.3; 95% CI = 1.2-1.4) and post-traumatic stress disorder (RR = 1.4; 95% CI = 1.3-1.6). Higher social pressure motivations were associated with probable anxiety (odds ratio = 1.1; 95% CI = 1.0-1.1). Alcohol misuse and binge drinking were associated with reporting higher drinking to cope motivations, drinking at home and drinking alone. CONCLUSIONS Amongst military personnel with a stress, emotional or mental health problem, those who drink to cope with mental disorder symptoms or because of social pressure, in addition to those who drink at home or drink alone, are more likely to also drink excessively.
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Affiliation(s)
- P Irizar
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - D Leightley
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Stevelink
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Rona
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - K Gouni
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - J-A Puddephatt
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - N Fear
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - L Goodwin
- Department of Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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Dimitri P, Joshi K, Jones N. Moving more: physical activity and its positive effects on long term conditions in children and young people. Arch Dis Child 2020; 105:1035-1040. [PMID: 32198161 DOI: 10.1136/archdischild-2019-318017] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 11/04/2022]
Abstract
While the benefits of regular participation in physical activity in children and young people are clear, misconceptions have developed about the possible negative effects and potential complications of exercise on long-term conditions such as epilepsy, asthma and diabetes. Over the last decade evidence has emerged supporting the positive impact that physical activity has on long-term conditions. Previous concerns were raised about the risks of hypoglycaemia in children with type 1 diabetes mellitus (T1DM) thus limiting participation in sports. Importantly, physical activity improves the metabolic profile, bone mineral density, cardiorespiratory fitness and insulin sensitivity while lowering mortality risk in children with T1DM. Children with asthma were prevented from doing exercise due to concerns about precipitating an acute asthmatic episode. To the contrary, physical activity interventions have consistently shown an increase in cardiovascular fitness, physical capacity, asthma-free days and quality of life in childhood asthmatics. Children with epilepsy are often excluded from sports due to concerns relating to increased seizure frequency, yet evidence suggests that this is not the case. The evidence supporting physical activity in childhood survivors of cancer is growing but still primarily confined to patients with acute lymphoblastic leukaemia. Participation in sports and physical activity also reduces mental health problems developing in adolescence. While further research is required to investigate benefits of physical activity on specific aspects of long-term conditions in children, in general this group should be advised to increase participation in sports and exercise as a means of improving long-term physical and mental health.
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Affiliation(s)
- Paul Dimitri
- Paediatric Endocrinology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Kush Joshi
- Faculty of Sports and Exercise Medicine, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
| | - Natasha Jones
- Faculty of Sports and Exercise Medicine, Oxford University Hospitals NHS Trust, Oxford, Oxfordshire, UK
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Harden L, Jones N, Whelan C, Phillips A, Simms A, Greenberg N. A systematic review of psychological training or interventions given to UK military personnel prior to deployment. BMJ Mil Health 2020; 167:63-69. [PMID: 33109732 DOI: 10.1136/bmjmilitary-2019-001296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Predeployment stress management/mental health training is routinely delivered in an effort to mitigate potential adverse psychological effects. Little is known about the effectiveness of such interventions. METHODS A systematic literature review explored research outcomes related to this subject, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. An electronic database search using key terms identified studies published between January 2007 and March 2019. Comprehensive inclusion/exclusion criteria were applied and study quality was appraised by two reviewers using 12 criteria adapted from the Critical Appraisal Skills Programme (CASP) checklist. Papers were excluded if they were allocated CASP scores ≤10 out of 24. RESULTS 2003 references were identified; 15 papers fulfilled inclusion criteria and quality threshold requirements. Included studies were randomised controlled trial design (n=8), quasi-experimental (n=5), case report (n=1) and cross-sectional (n=1). Duration of follow-up assessment varied from immediately postintervention to 24 months. The included studies were heterogeneous so clear recommendations relating to predeployment training for military personnel could not be made. Although somewhat disparate, predeployment interventions shared the aim of promoting prior to, during and after deployment health and well-being. Social benefits such as improved cohesion and improved stress management skills were identified in some studies, although substantial mental health and well-being benefits were not found. CONCLUSIONS Evidence for the effectiveness of predeployment psychological interventions is scant. Every attempt should be made to use methods and measures to facilitate comparisons across studies, to attempt a longer follow-up timescale and to clarify key trainer characteristics.
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Affiliation(s)
- Larissa Harden
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Jones
- Academic Department of Military Mental Health, King's College London, London, UK
| | - C Whelan
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, London, UK
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Santillo M, Sivyer K, Krusche A, Mowbray F, Jones N, Peto TEA, Walker AS, Llewelyn MJ, Yardley L. Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine. J Antimicrob Chemother 2020; 74:3362-3370. [PMID: 31430366 PMCID: PMC6798845 DOI: 10.1093/jac/dkz333] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/07/2019] [Accepted: 07/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors. Objectives To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics. Methods A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development. Results A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions. Conclusions The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS.
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Affiliation(s)
- M Santillo
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - K Sivyer
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - A Krusche
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - F Mowbray
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - N Jones
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - T E A Peto
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Centre, Oxford, UK
| | - A S Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.,NIHR Biomedical Centre, Oxford, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - L Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
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Tennyson M, Redlaff J, Biosse-Duplan G, Lewin M, Jones N, Layard Horsfall H. Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit. J Perioper Pract 2020; 31:334-340. [PMID: 32895000 PMCID: PMC8733415 DOI: 10.1177/1750458920943361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim To investigate if the massive blood loss protocol ‘Code Red’ at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit. Methods Electronic and paper patient care systems were searched in 2015 and 2018 to access records for the ‘Code Red’ activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit’s Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated. Results ‘Code Red’ protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of ‘Code Red’ cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to ‘Code Red’ activation. Conclusion There has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring ‘Code Red’ activation, permitting delivery of safe patient care.
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Affiliation(s)
| | - J Redlaff
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - G Biosse-Duplan
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - M Lewin
- Department of Transfusion, Addenbrooke's Hospital, Cambridge, UK
| | - N Jones
- Department of Cardiothoracic Anaesthesia and Critical Care Medicine, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - H Layard Horsfall
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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40
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Kilowski K, Dietrich M, Xiu J, Jones N, Powell M, Galvan Turner V, Erickson B, Mutch D, Thaker P, ElNaggar A, Dizon D, Ahmad S, Herzog T, Korn W, Holloway R. 844P KRAS mutant epithelial ovarian carcinomas (EOC) represent distinct genomic genotypes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.983] [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: 12/01/2022] Open
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41
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Shieh C, Jones N, Vanle B, Au M, Huang AY, Silva APG, Lee H, Douine ED, Otero MG, Choi A, Grand K, Taff IP, Delgado MR, Hajianpour MJ, Seeley A, Rohena L, Vernon H, Gripp KW, Vergano SA, Mahida S, Naidu S, Sousa AB, Wain KE, Challman TD, Beek G, Basel D, Ranells J, Smith R, Yusupov R, Freckmann ML, Ohden L, Davis-Keppen L, Chitayat D, Dowling JJ, Finkel R, Dauber A, Spillmann R, Pena LDM, Metcalfe K, Splitt M, Lachlan K, McKee SA, Hurst J, Fitzpatrick DR, Morton JEV, Cox H, Venkateswaran S, Young JI, Marsh ED, Nelson SF, Martinez JA, Graham JM, Kini U, Mackay JP, Pierson TM. GATAD2B-associated neurodevelopmental disorder (GAND): clinical and molecular insights into a NuRD-related disorder. Genet Med 2020; 22:878-888. [PMID: 31949314 PMCID: PMC7920571 DOI: 10.1038/s41436-019-0747-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/24/2019] [Accepted: 12/27/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Determination of genotypic/phenotypic features of GATAD2B-associated neurodevelopmental disorder (GAND). METHODS Fifty GAND subjects were evaluated to determine consistent genotypic/phenotypic features. Immunoprecipitation assays utilizing in vitro transcription-translation products were used to evaluate GATAD2B missense variants' ability to interact with binding partners within the nucleosome remodeling and deacetylase (NuRD) complex. RESULTS Subjects had clinical findings that included macrocephaly, hypotonia, intellectual disability, neonatal feeding issues, polyhydramnios, apraxia of speech, epilepsy, and bicuspid aortic valves. Forty-one novelGATAD2B variants were identified with multiple variant types (nonsense, truncating frameshift, splice-site variants, deletions, and missense). Seven subjects were identified with missense variants that localized within two conserved region domains (CR1 or CR2) of the GATAD2B protein. Immunoprecipitation assays revealed several of these missense variants disrupted GATAD2B interactions with its NuRD complex binding partners. CONCLUSIONS A consistent GAND phenotype was caused by a range of genetic variants in GATAD2B that include loss-of-function and missense subtypes. Missense variants were present in conserved region domains that disrupted assembly of NuRD complex proteins. GAND's clinical phenotype had substantial clinical overlap with other disorders associated with the NuRD complex that involve CHD3 and CHD4, with clinical features of hypotonia, intellectual disability, cardiac defects, childhood apraxia of speech, and macrocephaly.
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Affiliation(s)
- Christine Shieh
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Natasha Jones
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Brigitte Vanle
- Department of Psychiatry & Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Medical College of Wisconsin-Central Wisconsin, Wausau, WI, USA
| | - Margaret Au
- Department of Pediatrics Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alden Y Huang
- Institute for Precision Health, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Ana P G Silva
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Hane Lee
- Department of Human Genetics and Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Emilie D Douine
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Maria G Otero
- Board of Governor's Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Choi
- Board of Governor's Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katheryn Grand
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ingrid P Taff
- Department of Neurology, Hofstra School of Medicine, Great Neck, NY, USA
| | - Mauricio R Delgado
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - M J Hajianpour
- Department of Pediatrics, Division of Medical Genetics, East Tennessee State University, Quillen College of Medicine, Mountain Home, TN, USA
| | | | - Luis Rohena
- Division of Genetics, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Pediatrics, UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA
| | - Hilary Vernon
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Balitmore, MD, USA
| | - Karen W Gripp
- Division of Medical Genetics, Al DuPont Hospital for Children, Wilmington, DE, USA
| | - Samantha A Vergano
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - Sonal Mahida
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sakkubai Naidu
- Department of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ana Berta Sousa
- Serviço de Genética Médica, Hospital Santa Maria, CHULN, Lisboa, Portugal and Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Karen E Wain
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Thomas D Challman
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Geoffrey Beek
- Children's Hospitals and Clinics of Minnesota Department of Genetics, Minneapolis, MN, USA
| | - Donald Basel
- Department of Pediatrics, Division of Genetics; Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Judith Ranells
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Rosemarie Smith
- Department of Pediatrics, Division of Genetics, Maine Medical Center, Portland, ME, USA
| | - Roman Yusupov
- Division of Clinical Genetics, Joe DiMaggio Children's Hospital, Hollywood, FlL, USA
| | | | - Lisa Ohden
- Department of Genetic Counseling, Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
| | - Laura Davis-Keppen
- Department of Pediatrics, Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD, USA
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James J Dowling
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard Finkel
- Division of Pediatric Neurology, Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
| | - Andrew Dauber
- Division of Endocrinology, Children's National Health System, Washington, DC, USA
| | - Rebecca Spillmann
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Loren D M Pena
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kay Metcalfe
- Manchester Centre for Genomic Medicine, Manchester University NHS FT, Manchester, UK
| | - Miranda Splitt
- Institute of Genetic Medicine, Northern Genetics Service, Newcastle upon Tyne Hospitals Trust, Newcastle, UK
| | - Katherine Lachlan
- Faculty of Medicine, University of Southampton, Southampton, UK
- Human Development and Health Division, Wessex Clinical Genetics Service, University Hospitals of Southampton NHS Trust, Southampton, UK
| | - Shane A McKee
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, UK
| | - Jane Hurst
- Department of Clinical Genetics, NE Thames Genetics Service, Great Ormond Street Hospital, London, UK
| | - David R Fitzpatrick
- Medical Research Council Human Genetics Unit, University of Edinburgh, Edinburgh, UK
| | - Jenny E V Morton
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham, UK
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
- Birmingham Women's Hospital, Edgbaston, Birmingham, UK
| | - Helen Cox
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham, UK
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
- Birmingham Women's Hospital, Edgbaston, Birmingham, UK
| | - Sunita Venkateswaran
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Juan I Young
- John P Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric D Marsh
- Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Stanley F Nelson
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Julian A Martinez
- Department of Human Genetics; Division of Medical Genetics, Department of Pediatrics; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - John M Graham
- Department of Pediatrics, Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Usha Kini
- Oxford Centre for Genomic Medicine, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Joel P Mackay
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Tyler Mark Pierson
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Sinno A, Pinkerton J, Febbraro T, Jones N, Khanna N, Temkin S, Iglesias D, Pothuri B. Hormone therapy (HT) in women with gynecologic cancers and in women at high risk for developing a gynecologic cancer: A Society of Gynecologic Oncology (SGO) clinical practice statement. Gynecol Oncol 2020; 157:303-306. [DOI: 10.1016/j.ygyno.2020.01.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
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Kintz E, Williams NJ, Jones N, van der Es M, Lake IR, O'Brien SJ, Hunter PR. Regional differences in presence of Shiga toxin-producing Escherichia coli virulence-associated genes in the environment in the North West and East Anglian regions of England. Lett Appl Microbiol 2020; 71:179-186. [PMID: 32333799 DOI: 10.1111/lam.13303] [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: 01/30/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022]
Abstract
Shiga toxin-producing Escherichia coli is carried in the intestine of ruminant animals, and outbreaks have occurred after contact with ruminant animals or their environment. The presence of STEC virulence genes in the environment was investigated along recreational walking paths in the North West and East Anglia regions of England. In all, 720 boot sock samples from walkers' shoes were collected between April 2013 and July 2014. Multiplex PCR was used to detect E. coli based on the amplification of the uidA gene and investigate STEC-associated virulence genes eaeA, stx1 and stx2. The eaeA virulence gene was detected in 45·5% of the samples, where stx1 and/or stx2 was detected in 12·4% of samples. There was a difference between the two regions sampled, with the North West exhibiting a higher proportion of positive boot socks for stx compared to East Anglia. In univariate analysis, ground conditions, river flow and temperature were associated with positive boot socks. The detection of stx genes in the soil samples suggests that STEC is present in the English countryside and individuals may be at risk for infection after outdoor activities even if there is no direct contact with animals. SIGNIFICANCE AND IMPACT OF THE STUDY: Several outbreaks within the UK have highlighted the danger of contracting Shiga toxin-producing Escherichia coli from contact with areas recently vacated by livestock. This is more likely to occur for STEC infections compared to other zoonotic bacteria given the low infectious dose required. While studies have determined the prevalence of STEC within farms and petting zoos, determining the risk to individuals enjoying recreational outdoor activities that occur near where livestock may be present is less researched. This study describes the prevalence with which stx genes, indicative of STEC bacteria, were found in the environment in the English countryside.
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Affiliation(s)
- E Kintz
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - N J Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, Leahurst Campus, University of Liverpool, Liverpool, UK
| | - N Jones
- School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - M van der Es
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK
| | - I R Lake
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,School of Environmental Sciences, University of East Anglia, Norwich, UK
| | - S J O'Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - P R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Health Protection Research Unit in Gastrointestinal Infections, Liverpool, UK.,Department of Environmental Health, Tshwane University of Technology, Pretoria, South Africa
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Tsai K, Hirschi-Budge KM, Davis T, Llavina S, Tullis B, Jones N, Fowers R, Graff T, Reynolds PR, Arroyo J. RAGE and phospho‐ATM correlation during DNA Double Strand Breaks in trophoblast cells. FASEB J 2020. [DOI: 10.1096/fasebj.2020.34.s1.04273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shieh C, Jones N, Vanle B, Au M, Huang AY, Silva APG, Lee H, Douine ED, Otero MG, Choi A, Grand K, Taff IP, Delgado MR, Hajianpour MJ, Seeley A, Rohena L, Vernon H, Gripp KW, Vergano SA, Mahida S, Naidu S, Sousa AB, Wain KE, Challman TD, Beek G, Basel D, Ranells J, Smith R, Yusupov R, Freckmann ML, Ohden L, Davis-Keppen L, Chitayat D, Dowling JJ, Finkel R, Dauber A, Spillmann R, Pena LDM, Metcalfe K, Splitt M, Lachlan K, McKee SA, Hurst J, Fitzpatrick DR, Morton JEV, Cox H, Venkateswaran S, Young JI, Marsh ED, Nelson SF, Martinez JA, Graham JM, Kini U, Mackay JP, Pierson TM. Correction: GATAD2B-associated neurodevelopmental disorder (GAND): clinical and molecular insights into a NuRD-related disorder. Genet Med 2020; 22:822. [PMID: 32047287 PMCID: PMC11000750 DOI: 10.1038/s41436-020-0760-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Christine Shieh
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Natasha Jones
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Brigitte Vanle
- Department of Psychiatry & Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Medical College of Wisconsin-Central Wisconsin, Wausau, WI, USA
| | - Margaret Au
- Department of Pediatrics Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alden Y Huang
- Institute for Precision Health, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Ana P G Silva
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Hane Lee
- Department of Human Genetics and Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Emilie D Douine
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Maria G Otero
- Board of Governor's Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew Choi
- Board of Governor's Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Katheryn Grand
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ingrid P Taff
- Department of Neurology, Hofstra School of Medicine, Great Neck, NY, USA
| | - Mauricio R Delgado
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - M J Hajianpour
- Department of Pediatrics, Division of Medical Genetics, East Tennessee State University, Quillen College of Medicine, Mountain Home, TN, USA
| | | | - Luis Rohena
- Division of Genetics, Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Pediatrics, UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA
| | - Hilary Vernon
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Balitmore, MD, USA
| | - Karen W Gripp
- Division of Medical Genetics, Al DuPont Hospital for Children, Wilmington, DE, USA
| | - Samantha A Vergano
- Division of Medical Genetics and Metabolism, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - Sonal Mahida
- Department of Neurogenetics, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sakkubai Naidu
- Department of Neurology and Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Hugo Moser Research Institute, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ana Berta Sousa
- Serviço de Genética Médica, Hospital Santa Maria, CHULN, Lisboa, Portugal and Faculdade de Medicina de Lisboa, Universidade de Lisboa, Lisboa, Portugal
| | - Karen E Wain
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Thomas D Challman
- Autism & Developmental Medicine Institute, Geisinger, Lewisburg, PA, USA
| | - Geoffrey Beek
- Children's Hospitals and Clinics of Minnesota Department of Genetics, Minneapolis, MN, USA
| | - Donald Basel
- Department of Pediatrics, Division of Genetics, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Judith Ranells
- Division of Genetics and Metabolism, Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Rosemarie Smith
- Department of Pediatrics, Division of Genetics, Maine Medical Center, Portland, ME, USA
| | - Roman Yusupov
- Division of Clinical Genetics, Joe DiMaggio Children's Hospital, Hollywood, FlL, USA
| | | | - Lisa Ohden
- Department of Genetic Counseling, Sanford Children's Specialty Clinic, Sioux Falls, SD, USA
| | - Laura Davis-Keppen
- Department of Pediatrics, Sanford School of Medicine of the University of South Dakota, Sioux Falls, SD, USA
| | - David Chitayat
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - James J Dowling
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Richard Finkel
- Division of Pediatric Neurology, Department of Pediatrics, Nemours Children's Hospital, Orlando, FL, USA
| | - Andrew Dauber
- Division of Endocrinology, Children's National Health System, Washington, DC, USA
| | - Rebecca Spillmann
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Loren D M Pena
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kay Metcalfe
- Manchester Centre for Genomic Medicine, Manchester University NHS FT, Manchester, UK
| | - Miranda Splitt
- Institute of Genetic Medicine, Northern Genetics Service, Newcastle upon Tyne Hospitals Trust, Newcastle, UK
| | - Katherine Lachlan
- Faculty of Medicine, University of Southampton, Southampton, UK
- Human Development and Health Division, Wessex Clinical Genetics Service, University Hospitals of Southampton NHS Trust, Southampton, UK
| | - Shane A McKee
- Northern Ireland Regional Genetics Service, Belfast City Hospital, Belfast, UK
| | - Jane Hurst
- Department of Clinical Genetics, NE Thames Genetics Service, Great Ormond Street Hospital, London, UK
| | - David R Fitzpatrick
- Medical Research Council Human Genetics Unit, University of Edinburgh, Edinburgh, UK
| | - Jenny E V Morton
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham, UK
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
- Birmingham Women's Hospital, Edgbaston, Birmingham, UK
| | - Helen Cox
- West Midlands Regional Clinical Genetics Service and Birmingham Health Partners, Birmingham, UK
- Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
- Birmingham Women's Hospital, Edgbaston, Birmingham, UK
| | - Sunita Venkateswaran
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Juan I Young
- John P Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric D Marsh
- Division of Neurology, Children's Hospital of Philadelphia and Department of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Stanley F Nelson
- Department of Human Genetics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA, USA
| | - Julian A Martinez
- Department of Human Genetics; Division of Medical Genetics, Department of Pediatrics; David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - John M Graham
- Department of Pediatrics, Medical Genetics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Usha Kini
- Oxford Centre for Genomic Medicine, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - Joel P Mackay
- School of Life and Environmental Sciences, University of Sydney, Sydney, NSW, Australia
| | - Tyler Mark Pierson
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Abstract
Background While it is known that some UK Armed Forces (UK AF) personnel and veterans experience physical and mental health problems, the possible future healthcare needs of military veterans are unknown. Aims To estimate the number of military personnel who may experience physical and/or psychological health problems associated with their military service. Methods Data were obtained via Freedom of Information requests to several sources, including Defence Statistics. Raw data from research studies were also used where available. Data were analysed using meta-analytic methods to determine the rate of physical, mental or comorbid health problems in AF personnel. Results Musculoskeletal problems were the predominant reason for medical discharge from service. In terms of mental health, meta-analyses estimated that veteran reservists (part-time military members) previously deployed to operational areas had the highest proportion of general health problems (35%), previously deployed veteran regulars (those in full time military employment) and veteran reservists had the highest proportion of post-traumatic stress disorder (9%), and regular personnel with a deployment history had the highest proportion of alcohol problems (14%). Overall, our findings suggest that at least 67515 veterans are likely to suffer from mental and/or physical health problems at some point as a result of their service between 2001 and 2014. Conclusions The results of this study highlight that the difficulties personnel may face are largely musculoskeletal or mental health-related. These findings may help with planning the provision of future physical and mental health care and support for those who serve in the UK AF.
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Affiliation(s)
- V Williamson
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - J Diehle
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - R Dunn
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
| | - N Jones
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - N Greenberg
- King's Centre for Military Health Research, King's College London, Weston Education Centre, London, UK
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Xia S, Laselva O, Bear CE, Jones N. A115 MODELING CYSTIC FIBROSIS (CF) INTESTINAL DISEASE USING PATIENT DERIVED TISSUES. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cystic Fibrosis is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene, which encodes for a chloride/bicarbonate anion channel expressed on the apical membrane of most epithelial tissues, such as the lungs, liver, pancreas, small and large intestines, and reproductive tissues. CFTR is responsible for the transport of chloride and bicarbonate ions to maintain tissue surface hydration and pH balance of epithelial tissues. Historically, recurrent lung infections have been the most common cause of mortality in CF patients. With advances in clinical care and therapeutics, the current mean survival age of Canadian patients has increased to 52.3 years. However, this increase in survival has also been associated with an elevated risk of developing gastrointestinal cancers in CF adults. Compared to the general public, CF patients are 10 times more likely to develop cancer. This risk is increased to 25-20 times in patients that have undergone organ transplantations. Although the exact molecular mechanism regarding increased cancer risk in CF remains unclear, chronic intestinal inflammation has been known to contribute to elevated cancer development.
Aims
CF patients display an increased baseline inflammatory status that is exacerbated with microbiome exposure leading to possible increased risk for inflammation-mediated cancer development.
Methods
To reduce inter-patient heterogeneity, we have differentiated human intestinal organoids using induced pluripotent stem cells from homozygous F508del CF patients and gene edited isogenic non-CF (Wt-CFTR) controls. We conducted gene expression studies using RT-qPCR to determine baseline differences in gene expression prior to environmental exposures and following exposure to LPS and flagellin.
Results
We determined the expression levels of stem cell, intestinal epithelial cell, innate immunity genes and differentiation markers and found expression of such genes were not significantly different between 3D CF and gene-edited non-CF organoids. We are currently conducting RNA sequencing to survey expression pattern of all genes to definitively determine possible fundamental changes in the CF intestinal epithelium and determining the effect of LPS and flagellin treatment to determine if there is an altered response to inflammatory stimuli.
Conclusions
iPSC derived HIOs is a novel, patient based, and renewable model that can be used to dissect the primary intestinal pathologies in CF. Transcriptomic data of CF HIOs at steady state will provide insights to possible developmental defects. Complex interactions between the host intestinal epithelia and the commensal microbiome can also be investigated using this model.
Funding Agencies
CAG
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Affiliation(s)
- S Xia
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - O Laselva
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - C E Bear
- Cell Biology, Hospital For Sick Children, Toronto, ON, Canada
| | - N Jones
- The Hospital for Sick Children, Toronto, ON, Canada
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Jones N, Jones M, Greenberg N, Phillips A, Simms A, Wessely S. UK military women: mental health, military service and occupational adjustment. Occup Med (Lond) 2020; 70:235-242. [DOI: 10.1093/occmed/kqaa019] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Recently, the UK Armed Forces have revised the ground close combat role to include women.
Aims
To assess the potential mental health impact of this initiative we examined gender differences in deployment patterns, work strain, occupational factors, mental health, alcohol use and help-seeking following operational deployment.
Methods
The study was a secondary analysis of self-report survey data; 8799 men (88%) and 1185 women (12%) provided data. A sub-sample (47%, n = 4659) provided data concerning post-deployment help-seeking. The latter consisted of 408 women (8.8%) and 4251 men (91%).
Results
With the exception of alcohol misuse, which was significantly lower for women, women reported significantly more common mental disorder symptoms, subjective depression and self-harm. Women were significantly more likely to seek help from healthcare providers. Men were significantly more likely to have deployed operationally and for longer cumulative periods. Subjective work strain, but not job control, was significantly lower for women whose military careers were significantly shorter. Post-traumatic stress disorder (PTSD) symptom intensity was similar to men.
Conclusions
With the exception of PTSD and alcohol misuse, UK military women experience more mental health-related problems than military men. This finding was not related to the more arduous aspects of military service as women served for shorter times, deployed less and for shorter cumulative periods and were less likely to report work-related stress.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - M Jones
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King’s College London, London, UK
| | - S Wessely
- King’s Centre for Military Health Research, Weston Education Centre, King’s College London, London, UK
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49
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Jones N, Greenberg N, Phillips A, Simms A, Wessely S. British military women: combat exposure, deployment and mental health. Occup Med (Lond) 2019; 69:549-558. [PMID: 31404463 DOI: 10.1093/occmed/kqz103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Internationally, women are about to undertake combat duties alongside their male colleagues. The psychological effect of this policy change is largely unknown. AIMS To explore the mental health impact of combat exposure among military women. METHODS Self-report, between-subjects survey data were collected in Iraq and Afghanistan on four occasions between 2009 and 2014 (n = 4139). Differences in mental health, stigmatization, deployment experiences, intimate relationship impact, perception of family support levels, unit cohesion, leadership and help-seeking were compared between deployed men and women. Comparisons were repeated with the study sample stratified by level of combat exposure. Outcomes were examined using logistic regression adjusted for socio-demographic, mental health and military factors. RESULTS Overall, 4.1% of women and 4.3% of men reported post-traumatic stress disorder (PTSD) (odds ratio (OR) 1.31, 95% confidence interval (95% CI) 0.70-2.46); 22% of women and 16% of men reported symptoms of common mental disorder (CMD) (OR 1.52, 95% CI 1.11-2.08). Women were less likely to report mental health-related stigmatization (OR 0.68, 95% CI 0.53-0.87), negative relationship impact from deployment (OR 0.69, 95% CI 0.49-0.98) and subjective unit cohesion (OR 0.69, 95% CI 0.53-0.90). Help-seeking for emotional problems was similar by gender (OR 1.22, 95% CI 0.84-1.77). Overall, outcomes were minimally impacted by level of combat exposure. CONCLUSIONS Although women experienced more CMD symptoms, PTSD symptoms were similar by gender. Subject to confirmation of the study findings, women may not require enhanced mental healthcare during deployment for exposure-based conditions such as PTSD when undertaking the ground close combat role.
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Affiliation(s)
- N Jones
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - N Greenberg
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - A Phillips
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK.,King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
| | - A Simms
- Academic Department of Military Mental Health, Weston Education Centre, King's College London, London, UK
| | - S Wessely
- King's Centre for Military Health Research, Weston Education Centre, King's College London, London, UK
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50
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Freshwater W, Montaner L, Peterson B, White C, Lefae M, Roebuck C, Jones N, Robinson D, Johnson S, Burton E. Awareness of HIV cure-directed research among HIV clinic patients in Philadelphia. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30182-5] [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: 11/30/2022] Open
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