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Igoe A, Twomey DM, Allen N, Carton S, Brady N, O'Keeffe F. A longitudinal analysis of factors associated with post traumatic growth after acquired brain injury. Neuropsychol Rehabil 2024; 34:430-452. [PMID: 37022203 DOI: 10.1080/09602011.2023.2195190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
ABSTRACTPost-Traumatic Growth (PTG) is a form of positive psychological change that occurs for some individuals following traumatic experiences. High levels of PTG have been reported among survivors of acquired brain injury (ABI). Yet it remains unclear why some survivors of ABI develop PTG and others do not. The present study investigated early and late factors that are associated with long-term PTG in people with moderate to severe ABIs. Participants (n = 32, Mage = 50.59, SD = 12.28) completed self-report outcome measures at two time-points seven years apart (one-year and eight-years post-ABI). Outcome measures assessed emotional distress, coping, quality of life and ongoing symptoms of brain injury, as well as PTG at the later timepoint. Multiple regression analyses indicated that one-year post-ABI, fewer symptoms of depression, more symptoms of anxiety, and use of adaptive coping strategies accounted for a significant amount of variance in later PTG. At eight years post-ABI, fewer symptoms of depression, fewer ongoing symptoms of brain injury, better psychological quality of life and use of adaptive coping strategies explained a substantial amount of variance in PTG. For individuals with ABIs, PTG may be promoted by implementing long-term neuropsychological support which aims to facilitate use of adaptive coping strategies, supports psychological wellbeing and allows individuals to find meaning post-ABI.
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Affiliation(s)
- Anna Igoe
- University College Dublin, Dublin, Ireland
| | | | | | - Simone Carton
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | | | - Fiadhnait O'Keeffe
- University College Dublin, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dun Laoghaire, Ireland
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McGrath J, O'Doherty L, Conlon N, Dunne J, Brady G, Ibrahim A, McCormack W, Walsh C, Domegan L, Walsh S, Kenny C, Allen N, Fleming C, Bergin C. Point of care detection of SARS-CoV-2 antibodies and neutralisation capacity-lateral flow immunoassay evaluation compared to commercial assay to inform potential role in therapeutic and surveillance practices. Front Public Health 2023; 11:1245464. [PMID: 37841735 PMCID: PMC10569692 DOI: 10.3389/fpubh.2023.1245464] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/24/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction As the COVID-19 pandemic moves towards endemic status, testing strategies are being de-escalated. A rapid and effective point of care test (POCT) assessment of SARS-CoV-2 immune responses can inform clinical decision-making and epidemiological monitoring of the disease. This cross-sectional seroprevalence study of anti-SARS-CoV-2 antibodies in Irish healthcare workers assessed how rapid anti-SARS-CoV-2 antibody testing can be compared to a standard laboratory assay, discusses its effectiveness in neutralisation assessment and its uses into the future of the pandemic. Methods A point of care lateral flow immunoassay (LFA) detecting anti-SARS-CoV-2 spike (S)-receptor binding domain (RBD) neutralising antibodies (Healgen SARS-CoV-2 neutralising Antibody Rapid Test Cassette) was compared to the Roche Elecsys/-S anti-SARS-CoV-2 antibody assays and an in vitro surrogate neutralisation assay. A correlation between anti-spike (S), anti-nucleocapsid (N) titres, and in vitro neutralisation was also assessed. Results 1,777 serology samples were tested using Roche Elecsys/-S anti-SARS-CoV-2 assays to detect total anti-N/S antibodies. 1,562 samples were tested using the POC LFA (including 50 negative controls), and 90 samples were tested using an in vitro ACE2-RBD binding inhibition surrogate neutralisation assay. The POCT demonstrated 97.7% sensitivity, 100% specificity, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 61% in comparison to the commercial assay. Anti-S antibody titres determined by the Roche assay stratified by the POC LFA result groups demonstrated statistically significant differences between the "Positive" and "Negative" LFA groups (p < 0.0001) and the "Weak Positive" and "Positive" LFA groups (p < 0.0001). No statistically significant difference in ACE2-RBD binding inhibition was demonstrated when stratified by the LFA POC results. A positive, statistically significant correlation was demonstrated between the in vitro pseudo-neutralisation assay results and anti-S antibody titres (rho 0.423, p < 0.001) and anti-N antibody titres (rho = 0.55, p < 0.0001). Conclusion High sensitivity, specificity, and PPV were demonstrated for the POC LFA for the detection of anti-S-RBD antibodies in comparison to the commercial assay. The LFA was not a reliable determinant of the neutralisation capacity of identified antibodies. POC LFA are useful tools in sero-epidemiology settings, pandemic preparedness and may act as supportive tools in treatment decisions through the rapid identification of anti-Spike antibodies.
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Affiliation(s)
- Jonathan McGrath
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James's Hospital, Dublin, Ireland
| | - Laura O'Doherty
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James's Hospital, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Jean Dunne
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Gareth Brady
- Trinity College, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, St. James's Hospital, Dublin, Ireland
| | - Aya Ibrahim
- Department of Immunology, St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - William McCormack
- Department of Clinical Medicine, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Lisa Domegan
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | | | - Claire Kenny
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Niamh Allen
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James's Hospital, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Colm Bergin
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
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Townsend L, Kelly G, Kenny C, McGrath J, Donohue S, Allen N, Doherty L, Noonan N, Martin G, Fleming C, Bergin C. Healthcare Worker Characteristics Associated with SARS-CoV-2 Vaccine Uptake in Ireland; a Multicentre Cross-Sectional Study. Vaccines (Basel) 2023; 11:1529. [PMID: 37896933 PMCID: PMC10610998 DOI: 10.3390/vaccines11101529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/18/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023] Open
Abstract
The prevention of SARS-CoV-2 acquisition and transmission among healthcare workers is an ongoing challenge. Vaccination has been introduced to mitigate these risks. Vaccine uptake varies among healthcare workers in the absence of vaccine mandates. We investigated engagement with SARS-CoV-2 vaccination among healthcare workers and identified characteristics associated with lower vaccine uptake. This multi-site cross-sectional study recruited n = 1260 healthcare workers in both clinical and non-clinical roles over a three-month period from November 2022. Participants reported their engagement with the primary SARS-CoV-2 vaccination programme and subsequent booster programmes, as well as providing demographic, occupational and personal medical history information. Multivariable linear regression identified characteristics associated with vaccine uptake. Engagement with vaccination programmes was high, with 88% of participants receiving at least one booster dose after primary vaccination course. Younger age and female sex were associated with reduced vaccine uptake. Healthcare workers in non-clinical roles also had reduced vaccine uptake. These findings should inform vaccination strategies across healthcare settings and target populations with reduced vaccine uptake directly, in particular young, female, and non-clinical healthcare workers, both for SARS-CoV-2 and other healthcare-associated vaccine-preventable infections.
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Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Gavin Kelly
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Claire Kenny
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Jonathan McGrath
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Seán Donohue
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | - Niamh Allen
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
| | | | - Noirin Noonan
- Department of Occupational Medicine, St James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Greg Martin
- Health Protection Surveillance Centre, D01 A4A3 Dublin, Ireland
| | | | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, H91 YR71 Galway, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, D08 NHY1 Dublin, Ireland; (L.T.)
- Department of Clinical Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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Stieber F, Allen N, Carpenter K, Hu P, Alagna R, Rao S, Manissero D, Howard J, Nikolayevskyy V. Durability of COVID-19 vaccine induced T-cell mediated immune responses measured using the QuantiFERON SARS-CoV-2 assay. Pulmonology 2023; 29:151-153. [PMID: 36402704 PMCID: PMC9671490 DOI: 10.1016/j.pulmoe.2022.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- F Stieber
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA.
| | - N Allen
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - K Carpenter
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - P Hu
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - R Alagna
- QIAGEN SRL, Via Filippo Sassetti 16, 20124 Milan, Italy
| | - S Rao
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - D Manissero
- QIAGEN Manchester Ltd, Citylabs 2.0 Hathersage Road, Manchester M13 0BH, United Kingdom
| | - J Howard
- QIAGEN Sciences Inc, 19300 Germantown Road, Germantown, MD 20874, USA
| | - V Nikolayevskyy
- QIAGEN Manchester Ltd, Citylabs 2.0 Hathersage Road, Manchester M13 0BH, United Kingdom
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McGrath J, Kenny C, Nielsen CS, Domegan L, Walsh C, Rooney P, Walsh S, Conlon N, Brady G, Ibrahim A, Dunne J, McCormack W, Corcoran N, Allen N, Fleming C, Bergin C. SARS-CoV-2 epidemiology, antibody dynamics, and neutralisation capacity in Irish healthcare workers in the era of booster COVID-19 vaccinations. Front Med (Lausanne) 2023; 10:1078022. [PMID: 36778745 PMCID: PMC9909389 DOI: 10.3389/fmed.2023.1078022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Background The PRECISE Study, a multi-phase cross-sectional seroprevalence study of anti-SARS-CoV-2 antibodies in Irish healthcare workers (HCW) investigated: (1) risk factors for SARS-CoV-2 seropositivity, (2) the durability of antibody responses in a highly vaccinated HCW cohort, and (3) the neutralisation capacity of detected antibodies, prior to booster COVID-19 vaccination. Materials and methods Serology samples were collected across two hospital sites in November 2021 and analysed using the Roche Elecsys Anti-SARS-CoV-2/Elecsys-S Anti-SARS-CoV-2 assays to detect anti-nucleocapsid (N) and anti-spike (S) antibodies respectively. Paired serology results from prior study phases were used to analyse changes in individual HCW serostatus over time. Risk-factors for SARS-CoV-2 infection were assessed for demographic and work-related factors. Antibody neutralisation capacity was assessed in a subset of samples via an in vitro ACE2 binding enzyme-linked immunosorbent assay. Results 2,344 HCW samples were analysed. Median age was 43 years (IQR 33-50) with 80.5% (n = 1,886) female participants. Irish (78.9%, n = 1,850) and Asian (12.3%, n = 288) were the most commonly reported ethnicities. Nursing/midwifery (39.3%, n = 922) was the most common job role. 97.7% of participants were fully vaccinated, with Pfizer (81.1%, n = 1,902) and AstraZeneca (16.1%, n = 377) the most common vaccines received. Seroprevalence for anti-SARS-CoV-2 antibodies indicating prior infection was 23.4%, of these 33.6% represented previously undiagnosed infections. All vaccinated participants demonstrated positive anti-S antibodies and in those with paired serology, no individual demonstrated loss of previously positive anti-S status below assay threshold for positivity. Interval loss of anti-N antibody positivity was demonstrated in 8.8% of previously positive participants with paired results. Risk factors for SARS-CoV-2 seropositivity suggestive of previous infection included age 18-29 years (aRR 1.50, 95% CI 1.19-1.90, p < 0.001), India as country of birth (aRR 1.35, 95% CI 1.01-1.73, p = 0.036), lower education level (aRR 1.35, 95% CI 1.11-1.66, p = 0.004) and HCA job role (aRR 2.12, 95% CI 1.51-2.95, p < 0.001). Antibody neutralisation varied significantly by anti-SARS-CoV-2 antibody status, with highest levels noted in those anti-N positive, in particular those with vaccination plus previous SARS-CoV-2 infection. Conclusion All vaccinated HCWs maintained anti-S positivity prior to COVID-19 booster vaccination, however anti-N positivity was more dynamic over time. Antibody neutralisation capacity was highest in participants with COVID-19 vaccination plus prior SARS-CoV-2 infection.
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Affiliation(s)
- Jonathan McGrath
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James’s Hospital, Dublin, Ireland,*Correspondence: Jonathan McGrath,
| | - Claire Kenny
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Charlotte Salgaard Nielsen
- European Centre for Disease Prevention and Control (ECDC) Fellowship Programme, Field Epidemiology Path (EPIET), Solna, Sweden,Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Lisa Domegan
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Cathal Walsh
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Peadar Rooney
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Shane Walsh
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James’s Hospital, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James’s Hospital, Dublin, Ireland,Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Gareth Brady
- Trinity College, Trinity Health Kidney Centre, Trinity Translational Medicine Institute, St. James’s Hospital, Dublin, Ireland
| | - Aya Ibrahim
- Department of Immunology, St. James’s Hospital, Dublin, Ireland,Department of Clinical Medicine, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Jean Dunne
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - William McCormack
- Department of Clinical Medicine, Trinity Translational Medicine Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Niamh Corcoran
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Niamh Allen
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James’s Hospital, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Colm Bergin
- Department of Genitourinary Medicine and Infectious Diseases (GUIDe), St. James’s Hospital, Dublin, Ireland,Department of Clinical Medicine, Trinity College, Dublin, Ireland
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Allen N, Hevey D, Cogley C, O'Keeffe F. A meta-analysis of the association between event-related rumination and posttraumatic growth: The Event-Related Rumination Inventory and the Posttraumatic Growth Inventory. J Trauma Stress 2022; 35:1575-1585. [PMID: 36065484 DOI: 10.1002/jts.22875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 07/06/2022] [Accepted: 07/14/2022] [Indexed: 12/24/2022]
Abstract
Trauma can disrupt an individual's core beliefs about themselves, others, and the world. Posttraumatic growth (PTG) is thought to be the outcome of a reconstruction process involving ruminative processing. This meta-analysis examined the strength of the associations between event-related intrusive and deliberate rumination and PTG. The moderating effects of variables including age, time since trauma exposure, and trauma type were examined. Eight databases were searched for English-language, peer reviewed studies examining the associations between PTG and types of event-related rumination in adults. Effect sizes (Pearson's r) were extracted and analyzed, and study quality was assessed using the Study Quality Assessment Tool for Observational and Cohort studies. In total, 46 studies were included based on the inclusion and exclusion criteria. A significant main effect was observed for the association between retrospectively reported deliberate rumination that occurred soon after a traumatic event and PTG, r = .45, 95% CI [.41, .49]. There was significant variability in effect sizes, and the strength of this association differed according to age. The association between intrusive rumination and PTG was not significant and varied in direction. Deliberate rumination that occurred relatively soon following trauma exposure was shown to be positively associated with PTG. The findings highlight the importance of supporting trauma survivors to engage in the deliberate cognitive processing of their experiences to encourage PTG. Longitudinal research is needed to further delineate the temporal role of event-related rumination in PTG development.
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Affiliation(s)
- Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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Higham S, Mendham A, Rosenbaum S, Allen N, Duffield R. Effect of Concurrent Exercise Training on Stress, Depression and Anxiety in Inactive Academics: Secondary Analysis of a Randomised Controlled Trial. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Allen N, Garrison T, Curry N, Hunter A. Incorporating a Virtual Interprofessional Case Study into Medical Nutrition Therapy Curriculum to Create Collaborative-Ready Health Professionals. J Acad Nutr Diet 2022. [DOI: 10.1016/j.jand.2022.08.073] [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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Lovegrove CE, Wiberg A, Allen N, Littlejohns T, Mahajan A, McCarthy M, Hannan F, Thakker R, Holmes M, Furniss D, Howles S. O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease. Br J Surg 2022. [DOI: 10.1093/bjs/znac242.108] [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: 11/07/2022]
Abstract
Abstract
Introduction
Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.
Methods
Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.
Results
Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P<0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P<0.001 and OR=1.41, 95%CI=1.17–1.69, P<0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.
Conclusion
Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.
Take-home message
Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.
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Affiliation(s)
- CE Lovegrove
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | - A Wiberg
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | | | | | | | | | | | | | | | - D Furniss
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
| | - S Howles
- University of Oxford
- Oxford University Hospitals NHS Foundation Trust
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Oosthuizen GV, Klopper J, Buitendag J, Variawa S, Čačala SR, Kong VY, Couch D, Allen N, Clarke DL. Correction to: Penetrating colon trauma - outcomes related to single versus multiple colonic injuries. Eur J Trauma Emerg Surg 2022; 48:4313-4314. [PMID: 35802154 DOI: 10.1007/s00068-022-01994-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- G V Oosthuizen
- Department of Surgery, Ngwelezana Hospital, Empangeni, South Africa
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - J Klopper
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town, South Africa
| | - J Buitendag
- Department of Surgery, University of Stellenbosch, Cape Town, South Africa
| | - S Variawa
- Department of Surgery, Khayelitsha District Hospital, Cape Town, South Africa
| | - S R Čačala
- Department of Surgery, Ngwelezana Hospital, Empangeni, South Africa
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - V Y Kong
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand.
| | - D Couch
- Department of Surgery, Queens Medical Centre, Nottingham, United Kingdom
| | - N Allen
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - D L Clarke
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
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Kerr C, Allen N, Hughes G, Kelly M, O'Rourke F, Lynagh Y, Dunne J, Crowley B, Conlon N, Bergin C. SARS-CoV-2 anti-nucleocapsid assay performance in healthcare workers at baseline and 6 months. Ir J Med Sci 2022; 191:1089-1092. [PMID: 34235708 PMCID: PMC8262428 DOI: 10.1007/s11845-021-02700-5] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/25/2021] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Serological SARS-CoV-2 assays have an important role in guiding the pandemic response. This research aimed to compare the performance of 2 antinucleocapsid assays. METHODS Serum from 49 HCWs was analysed at baseline and 6 months using the Abbott diagnostics SARS-CoV-2 IgG assay and the Roche Diagnostics Elecsys Anti-SARS-CoV-2 total antibody assay. RESULTS At baseline, 14/49 participants (29%) demonstrated antibody reactivity using the Abbott assay. At 6 months, 4/14 participants (29%) continued to demonstrate reactivity. A total of 14/49 (29%) participants had detectable antibodies at baseline using the Roche assay. In total, 13/14 (93%) of participants demonstrated antibody reactivity at 6 months. The Abbott assay showed a statistically significant difference in the signal-to-threshold values of baseline reactive samples when repeated at 6 months (p = 0.001). This was not seen with the Roche assay (p = 0.51). CONCLUSION In this small study, the Roche Diagnostics Elecsys Anti-SARS-CoV-2 total antibody assay appears superior in performance to the Abbott diagnostics SARS-CoV-2 IgG assay in accurately detecting participants with a history of confirmed COVID-19 disease at 6 months follow-up. This finding should be born in mind in the planning of future seroprevalence studies, especially when considering the use of anti-nucleocapsid assays.
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Affiliation(s)
- Colm Kerr
- Department of Infectious Diseases, St. James's Hospital, Dublin, Ireland.
- Department of Clinical Medicine, St. James's Hospital, Trinity College Dublin, Dublin, Ireland.
| | - Niamh Allen
- Department of Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Gerry Hughes
- Department of Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Martina Kelly
- Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland
| | - Fiona O'Rourke
- Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland
| | - Yvonne Lynagh
- Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland
| | - Jean Dunne
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Brendan Crowley
- Department of Clinical Microbiology, St. James's Hospital, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, St. James's Hospital, Trinity College Dublin, Dublin, Ireland
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12
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Allen N, Brady M, Ni Riain U, Conlon N, Domegan L, Carrion Martin AI, Walsh C, Doherty L, Higgins E, Kerr C, Bergin C, Fleming C. Prevalence of Antibodies to SARS-CoV-2 Following Natural Infection and Vaccination in Irish Hospital Healthcare Workers: Changing Epidemiology as the Pandemic Progresses. Front Med (Lausanne) 2022; 8:758118. [PMID: 35186963 PMCID: PMC8854655 DOI: 10.3389/fmed.2021.758118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 08/13/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
Abstract
Background In October 2020 SARS-CoV-2 seroprevalence among hospital healthcare workers (HCW) of two Irish hospitals was 15 and 4. 1%, respectively. We compare seroprevalence in the same HCW population 6 months later, assess changes in risk factors for seropositivity with progression of the pandemic and serological response to vaccination. Methods All staff of both hospitals (N = 9,038) were invited to participate in an online questionnaire and SARS-CoV-2 antibody testing in April 2021. We measured anti-nucleocapsid and anti-spike antibodies. Frequencies and percentages for positive SARS-CoV-2 antibodies were calculated and adjusted relative risks for participant characteristics were calculated using multivariable regression analysis. Results Five thousand and eighty-five HCW participated. Seroprevalence increased to 21 and 13%, respectively; 26% of infections were previously undiagnosed. Black ethnicity (aRR 1.7, 95% CI 1.3–2.2, p < 0.001), lower level of education (aRR 1.4 for secondary level education, 95% CI 1.1–1.8, p = 0.002), living with other HCW (aRR 1.2, 95% CI 1.0–1.4, p = 0.007) were significantly associated with seropositivity. Having direct patient contact also carried a significant risk being a healthcare assistant (aRR 1.8, 95% CI 1.3–2.3, p < 0.001), being a nurse (aRR 1.4, 95% CI 1.0–1.8, p = 0.022), daily contact with COVID-19 patients (aRR 1.4, 95% CI 1.1–1.7, p = 0.002), daily contact with patients without suspected or confirmed COVID-19 (aRR 1.3, 95% CI 1.1–1.5, p = 0.013). Breakthrough infection occurred in 23/4,111(0.6%) of fully vaccinated participants; all had anti-S antibodies. Conclusion The increase in seroprevalence reflects the magnitude of the third wave of the pandemic in Ireland. Genomic sequencing is needed to apportion risk to the workplace vs. the household/community. Concerted efforts are needed to mitigate risk factors due to ethnicity and lower level of education, even at this stage of the pandemic. The undiagnosed and breakthrough infections call for ongoing infection prevention and control measures and testing of HCW in the setting of close contact. Vaccinated HCW with confirmed infection should be actively assessed, including SARS-CoV-2 whole genome sequencing (WGS), serology testing and assessment of host determinants, to advance understanding of the reasons for breakthrough infection.
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Affiliation(s)
- Niamh Allen
- Department of GU Medicine and Infectious Diseases (GUIDE), St. James's Hospital, Dublin, Ireland
- *Correspondence: Niamh Allen
| | - Melissa Brady
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Una Ni Riain
- Department of Microbiology, University Hospital Galway, Galway, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Lisa Domegan
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Antonio Isidro Carrion Martin
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Murcia, Spain
| | - Cathal Walsh
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
- Health Research Institute and MACSI, University of Limerick, Limerick, Ireland
- MISA and NCPE, St James's Hospital, Dublin, Ireland
| | | | - Eibhlin Higgins
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Colm Kerr
- Department of GU Medicine and Infectious Diseases (GUIDE), St. James's Hospital, Dublin, Ireland
| | - Colm Bergin
- Department of GU Medicine and Infectious Diseases (GUIDE), St. James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
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13
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Twomey DM, Allen N, Agan MLF, Hayes AM, Higgins A, Carton S, Roche R, Hevey D, Bramham J, Brady N, O'Keeffe F. Self-reported outcomes and patterns of service engagement after an acquired brain injury: a long-term follow-up study. Brain Inj 2021; 35:1649-1657. [PMID: 34898342 DOI: 10.1080/02699052.2021.2004617] [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: 10/19/2022]
Abstract
PRIMARY OBJECTIVE To describe the clinical characteristics, self-reported outcomes in domains relating to activities of daily living and patterns of service engagement in the survivors of a moderate-to-severe acquired brain injury over seven years. RESEARCH DESIGN A longitudinal research design was used. METHODS AND PROCEDURES Thirty-two individuals who sustained a moderate-to-severe acquired brain injury completed a Sociodemographic and Support Questionnaire at one (t1) and seven years (t2) after completing a publicly funded inpatient neurorehabilitation program. MAIN OUTCOMES AND RESULTS There were minimal changes in independent living, mobility, ability to maintain key relationships and in return to work in the interval between t1 and t2. Sixty-nine percent of participants engaged with two or more allied health professional services and 75% engaged with support services in the community over the seven years. CONCLUSIONS There were minimal additional gains in outcomes relating to activities of daily-living and there was a high level of service need in the first decade postinjury. Young and middle-aged individuals who sustain an ABI may continue to live in the community for decades with some level of disability and may require ongoing access to services.
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Affiliation(s)
- Deirdre M Twomey
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | | | - Aoife M Hayes
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Andrea Higgins
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Simone Carton
- Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Richard Roche
- Department of Psychology, Maynooth University, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Jessica Bramham
- School of Psychology, University College Dublin, Dublin, Ireland.,Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland
| | - Nuala Brady
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Fiadhnait O'Keeffe
- School of Psychology, University College Dublin, Dublin, Ireland.,School of Psychology, Trinity College Dublin, Dublin, Ireland.,Psychology and Clinical Neuropsychology Services, National Rehabilitation Hospital, Dun Laoghaire, Ireland.,Psychology Department St. Vincent's University Hospital, Dublin, Ireland
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14
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Allen N, Brady M, Carrion Martin AI, Domegan L, Walsh C, Houlihan E, Kerr C, Doherty L, King J, Doheny M, Griffin D, Molloy M, Dunne J, Crowley V, Holmes P, Keogh E, Naughton S, Kelly M, O’Rourke F, Lynagh Y, Crowley B, de Gascun C, Holder P, Bergin C, Fleming C, Ni Riain U, Conlon N. SARS-CoV-2 Antibody Testing in Health Care Workers: A Comparison of the Clinical Performance of Three Commercially Available Antibody Assays. Microbiol Spectr 2021; 9:e0039121. [PMID: 34585976 PMCID: PMC8557912 DOI: 10.1128/spectrum.00391-21] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/18/2021] [Indexed: 12/31/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies are an excellent indicator of past COVID-19 infection. As the COVID-19 pandemic progresses, retained sensitivity over time is an important quality in an antibody assay that is to be used for the purpose of population seroprevalence studies. We compared 5,788 health care worker (HCW) serum samples by using two serological assays (Abbott SARS-CoV-2 anti-nucleocapsid immunoglobulin G (IgG) and Roche anti-SARS-CoV-2 anti-nucleocapsid total antibody) and a subset of samples (all Abbott assay positive or grayzone, n = 485) on Wantai SARS-CoV-2 anti-spike antibody enzyme-linked immunosorbent assay (ELISA). For 367 samples from HCW with a previous PCR-confirmed SARS-CoV-2 infection, we correlated the timing of infection with assay results. Overall, seroprevalence was 4.2% on Abbott and 9.5% on Roche. Of those with previously confirmed infection, 41% (150/367) and 95% (348/367) tested positive on Abbott and Roche, respectively. At 21 weeks (150 days) after confirmed infection, positivity on Abbott started to decline. Roche positivity was retained for the entire study period (33 weeks). Factors associated (P ≤ 0.050) with Abbott seronegativity in those with previous PCR-confirmed infection included sex (odds ratio [OR], 0.30 male ; 95% confidence interval [CI], 0.15 to 0.60), symptom severity (OR 0.19 severe symptoms; 95% CI, 0.05 to 0.61), ethnicity (OR, 0.28 Asian ethnicity; 95% CI, 0.12 to 0.60), and time since PCR diagnosis (OR, 2.06 for infection 6 months previously; 95% CI, 1.01 to 4.30). Wantai detected all previously confirmed infections. In our population, Roche detected antibodies up to at least 7 months after natural infection with SARS-CoV-2. This finding indicates that the Roche total antibody assay is better suited than Abbott IgG assay to population-based studies. Wantai demonstrated high sensitivity, but sample selection was biased. The relationship between serological response and functional immunity to SARS-CoV-2 infection needs to be delineated. IMPORTANCE As the COVID-19 pandemic progresses, retained sensitivity over time is an important quality in an antibody assay that is to be used for the purpose of population seroprevalence studies. There is a relative paucity of published literature in this field to help guide public health specialists when planning seroprevalence studies. In this study, we compared results of 5,788 health care worker blood samples tested by using two assays (Roche and Elecsys, anti-nucleocapsid antibody) and by testing a subset on a third assay (Wantai enzyme-linked immunosorbent assay [ELISA] anti-spike antibody). We found significant differences in the performance of these assays, especially with distance in time from PCR-confirmed COVID-19 infection, and we feel these results may significantly impact the choice of assay for others conducting similar studies.
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Affiliation(s)
- Niamh Allen
- Department of GU Medicine and Infectious Diseases, St. James’s Hospital, Dublin, Ireland
| | - Melissa Brady
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Cathal Walsh
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
- Health Research Institute and MACSI, University of Limerick, Limerick, Ireland
- MISA and NCPE, St James’s Hospital, Dublin, Ireland
| | - Elaine Houlihan
- Department of Microbiology, University Hospital Galway, Galway, Ireland
| | - Colm Kerr
- Department of GU Medicine and Infectious Diseases, St. James’s Hospital, Dublin, Ireland
| | - Lorraine Doherty
- Health Service Executive-Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Joanne King
- Department of Virology, University Hospital Galway, Galway, Ireland
| | - Martina Doheny
- Department of Clinical Biochemistry, University Hospital Galway, Galway, Ireland
| | - Damian Griffin
- Department of Clinical Biochemistry, University Hospital Galway, Galway, Ireland
| | - Maria Molloy
- Galway University Hospital Group, Galway, Ireland
| | - Jean Dunne
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
| | - Vivion Crowley
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - Philip Holmes
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - Evan Keogh
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - Sean Naughton
- Department of Biochemistry, St. James’s Hospital, Dublin, Ireland
| | - Martina Kelly
- Department of Virology, St. James’s Hospital, Dublin, Ireland
| | - Fiona O’Rourke
- Department of Virology, St. James’s Hospital, Dublin, Ireland
| | - Yvonne Lynagh
- Department of Virology, St. James’s Hospital, Dublin, Ireland
| | - Brendan Crowley
- Department of Virology, St. James’s Hospital, Dublin, Ireland
| | | | - Paul Holder
- National Virus Reference Laboratory, Dublin, Ireland
| | - Colm Bergin
- Department of GU Medicine and Infectious Diseases, St. James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Galway, Ireland
| | - Una Ni Riain
- Department of Microbiology, University Hospital Galway, Galway, Ireland
| | - Niall Conlon
- Department of Immunology, St. James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College, Dublin, Ireland
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15
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Lovegrove C, Littlejohns T, Allen N, Howles S, Turney B. 323 Association of Increased Body Mass Index and Waist to Hip Ratio with Kidney Stone Disease: a Prospective Analysis of 493,410 UK Biobank participants. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1076] [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
Aim
To investigate the relationship between measures of adiposity and risk of incident kidney stone disease.
Method
The UK Biobank is a prospective cohort study of ∼500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage, and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes identified individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones.
Results
From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist, and hip circumferences, WHR, and body and truncal fat were all associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men >0.9, women >0.85) conferred >40% increased risk of stone formation.
Conclusions
This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which have been linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.
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Affiliation(s)
- C Lovegrove
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, United Kingdom
| | - T Littlejohns
- University of Oxford Nuffield Department of Public Health, Oxford, United Kingdom
| | - N Allen
- University of Oxford Nuffield Department of Public Health, Oxford, United Kingdom
| | - S Howles
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - B Turney
- Oxford University Hospitals NHS Trust, Oxford, United Kingdom
- University of Oxford Nuffield Department of Surgical Sciences, Oxford, United Kingdom
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16
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Allen N, Brady M, Carrion Martin AI, Domegan L, Walsh C, Doherty L, Riain UN, Bergin C, Fleming C, Conlon N. Serological markers of SARS-CoV-2 infection; anti-nucleocapsid antibody positivity may not be the ideal marker of natural infection in vaccinated individuals. J Infect 2021; 83:e9-e10. [PMID: 34384812 PMCID: PMC8351117 DOI: 10.1016/j.jinf.2021.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/04/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Niamh Allen
- Department of GU Medicine and Infectious Diseases (GUIDE), St. James's Hospital, Dublin, Ireland.
| | - Melissa Brady
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden; Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Antonio Isidro Carrion Martin
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, University of Murcia School of Medicine, Murcia, Spain
| | - Lisa Domegan
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland
| | - Cathal Walsh
- Health Protection Surveillance Centre (HPSC), Dublin, Ireland; Health Research Institute and MACSI, University of Limerick, Ireland; MISA and NCPE, St James's Hospital, Dublin, Ireland
| | | | - Una Ni Riain
- Department of Microbiology, University Hospital Galway, Ireland
| | - Colm Bergin
- Department of GU Medicine and Infectious Diseases (GUIDE), St. James's Hospital, Dublin, Ireland
| | - Catherine Fleming
- Department of Infectious Diseases, University Hospital Galway, Ireland
| | - Niall Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
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17
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Nurdin N, Quirke S, Kerr C, Allen N, O'Halloran J, Moynan D, O'Doherty L, Grant C, Townsend L, Bergin C. A changing demographic - Ten years of HIV care. Int J STD AIDS 2021; 33:48-54. [PMID: 34565258 DOI: 10.1177/09564624211043614] [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: 11/16/2022]
Abstract
We aimed to benchmark the quality of care and describe characteristics of patients newly attending the HIV clinic at differing time points over the past 10 years, against the Infectious Disease Society of America HIV/AIDS performance measures. We performed a retrospective analysis of records for patients newly attending the HIV clinic in 2011, 2016 and 2018. There was an increase in male attendees in 2018 and 2016 compared to 2011 (88%, 88% vs. 59% p < .001), viral suppression rates were 97%, 83% and 99% (p < .001), respectively. We observed an increase in patients of South American origin over time. Acquisition risk changed, with increased proportion of MSM (24% in 2011 vs 78% in 2018, p < .001), lower rates of heterosexual (20% in 2018 vs 48% in 2011, p < .001) and IDU transmission (1.5% in 2018 vs 24% in 2011, p < .001). There were lower rates of Chlamydia trachomatis and Neisseria gonorrhoeae testing in 2018 (72%, p < .001), compared to 2016 (84%) and 2011 (83%). Hepatitis B virus vaccination and pneumococcal vaccine rates are declining (p < .001). We demonstrate the changes in both ethnicity and risk of acquisition over time, high rates of antiretroviral therapy prescription and viral suppression, and highlight the importance of health prevention with sexual health screening and vaccination in this population.
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Affiliation(s)
- Nadra Nurdin
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Siobhan Quirke
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Colm Kerr
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Niamh Allen
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Jane O'Halloran
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - David Moynan
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Laura O'Doherty
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Conor Grant
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Liam Townsend
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
| | - Colm Bergin
- Department of Genitourinary Medicine & Infectious Diseases (GUIDe), St James Hospital, Dublin 8, Ireland
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18
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Allen N, Adam M, O'Regan G, Seery A, McNally C, McConkey S, Brown A, de Barra E. Outpatient parenteral antimicrobial therapy (OPAT) for aortic vascular graft infection; a five-year retrospective evaluation. BMC Infect Dis 2021; 21:670. [PMID: 34243725 PMCID: PMC8268523 DOI: 10.1186/s12879-021-06373-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES An estimated 1% of endovascular aneurysm repair (EVAR) devices become infected, carrying a high mortality rate. Surgical explantation is recommended and prognosis is guarded. This retrospective cohort analysis focuses on the role of outpatient parenteral antimicrobial therapy (OPAT) in the management of aortic vascular graft infections following EVAR. METHODS Patients who received OPAT for aortic graft infections (AGI) following EVAR from 2014 to 2018 inclusive were identified using the OPAT database. Clinical, microbiological and radiological data were collected. Survivors were followed up for a median of 36 months (range 25-60) after first presentation with infection. Outcomes were assessed. RESULTS Eleven cases with 20 OPAT episodes were identified: 10/11 male, median age 76 (IQR 71-81). Median time to presentation was 7 months (range 0-81 months) after EVAR. OPAT lead to a 55% reduction in length of hospital stay. One patient had graft explantation; four others had temporising measures. Eight of 11 were alive a median of 36 months after presentation with infection, having had a median of 2 re-treatments on OPAT (range 1-3). Seven of the eight survivors were on continuous suppressive oral antimicrobials; three were also intermittently on intravenous antibiotics for flares of infection. Patient/ infection outcomes were cure (1/11), improved (7/11), failure (3/11). CONCLUSION AGI following EVAR usually presents in the first year after graft deployment. OPAT has an important peri-operative role in patients suitable for curative surgery. OPAT followed by oral suppressive antimicrobial therapy can be a feasible long-term treatment for non-curative management of AGI. Survival in our cohort was longer than expected, and OPAT was feasible despite the complexity of these infections. OPAT can avoid multiple and lengthy hospital admissions and maximise time at home and quality of life in this cohort with life-limiting infection.
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Affiliation(s)
- Niamh Allen
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.
| | - Mohamed Adam
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Grace O'Regan
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Aoife Seery
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland
| | - Cora McNally
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.,Department of International Health and Tropical Medicine, Royal College of Surgeons of Ireland (RSCI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Samuel McConkey
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.,Department of International Health and Tropical Medicine, Royal College of Surgeons of Ireland (RSCI), University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Brown
- Department of Infectious Diseases, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Eoghan de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin, Ireland.,Department of International Health and Tropical Medicine, Royal College of Surgeons of Ireland (RSCI), University of Medicine and Health Sciences, Dublin, Ireland
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19
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Lovegrove C, Wiberg A, Littlejohns T, Allen N, Furniss D, Turney B, Howles S. Evidence for the genetic influence of waist-hip ratio on risk of kidney stone disease. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Allen N, Gregg A, McGuigan J. 356 Reducing Long Term Opioid Prescribing Post Thoracic Surgery. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.411] [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
Patients are routinely started on strong opioid analgesia after surgery with most receiving a prescription for these to continue discharge. We examine the analgesia prescribed in our unit, comparing to ERAS principles from EACTS. We aimed to reduce the total equivalent dose of morphine prescribed on discharge by implementing ERAS principles.
Method
We undertook a retrospective analysis of the analgesia prescribing for patients post open and VATS procedure noting the total dose opioids (using the equivalent dose of morphine). We examined how many patients were still being prescribed opioids analgesia long term, defined as 6 weeks post procedure. We implemented ERAS principles, changing to morphine rather than oxycodone, using short-acting preparations and increasing use of opioid sparing analgesia including NSAIDs.
Results
20% of patients started on strong opioids post procedure were still being prescribed these 6 weeks later. We used ERAS principles to reduce the equivalent dose of morphine dispensed on discharge by a third.
Conclusions
We identified a significant issue with long term opioid prescribing and initiated measures which have resulted in positive change. Our next cycle will measure the outcome of our changes on long-term prescribing implement a multi-disciplinary approach to try reducing the burden of long-term opioid prescribing further.
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Affiliation(s)
- N Allen
- Royal Victoria Hospital, Belfast, United Kingdom
| | - A Gregg
- Royal Victoria Hospital, Belfast, United Kingdom
| | - J McGuigan
- Royal Victoria Hospital, Belfast, United Kingdom
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21
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Allen N, McBride R, Lindsay R, Wallace W. 30 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Introduction
Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation.
We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61-year-old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.
Method
Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.
Conclusions
This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control, and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time.
This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.
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Affiliation(s)
- N Allen
- Belfast City Hospital, Belfast, United Kingdom
| | - R McBride
- Belfast City Hospital, Belfast, United Kingdom
| | - R Lindsay
- Belfast City Hospital, Belfast, United Kingdom
| | - W Wallace
- Belfast City Hospital, Belfast, United Kingdom
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Allen N, Hevey D, Carton S, O'Keeffe F. Life is about "constant evolution": the experience of living with an acquired brain injury in individuals who report higher or lower posttraumatic growth. Disabil Rehabil 2021; 44:3479-3492. [PMID: 33459069 DOI: 10.1080/09638288.2020.1867654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To explore the experience of living with an Acquired Brain Injury (ABI) in individuals who report higher or lower posttraumatic growth (PTG). METHOD A multi-method design was employed. Participant scores on the Posttraumatic Growth Inventory (PTGI) were used to identify groups for qualitative comparative analysis. Individual semi-structured interviews were conducted with fourteen individuals with ABI. Data were analysed thematically. RESULTS Four themes emerged. The first two themes: "In my mind I was fine" surviving in aftermath of acquiring a brain injury and The everyday as "derailing" capture the transition process from an initial rehabilitation state characterised by neuropsychological and avoidance coping, towards active rebuilding for PTG. Internal building blocks for PTG and Growing in the social world: "you need to have that social connection" elaborate on the internal (e.g., acceptance, integration of the pre and post-injury self) and external (e.g., social relationships) factors seen to facilitate or obstruct PTG. CONCLUSIONS Under certain conditions, individuals living with ABI may construe positive growth from their experiences. Practitioners can support PTG development by providing individual and family-based supports aimed at increasing acceptance, the integration of self, and social connection throughout all stages of ABI rehabilitation.IMPLICATIONS FOR REHABILITATIONInternal factors such as having a flexible and positive mindset and external factors such as one's social environment can affect how individuals living with an ABI construe positive growth.Individuals with ABI and their families require access to individualised longitudinal support for neuropsychological and social challenges that can result in increased distress and obstruct the development of PTG.Efforts to facilitate acceptance and support the integration of the pre and post-injury self through recognition of continuity of self and processing of new schematic beliefs can benefit PTG development.Rehabilitation providers should support individuals with ABI to develop or maintain a positive social identity within new or existing social groups.
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Affiliation(s)
- Niamh Allen
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - David Hevey
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Simone Carton
- National Rehabilitation Hospital, Dún Laoghaire, Dublin, Ireland
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Geiger S, Suarez-Lopez J, Colangelo L, Jacobs D, Steffes M, Allen N, Krefman A, Lee DH. Persistent Organochlorine Pollutants and Cardiovascular Disease, By Diabetes and Triglycerides. Ann Epidemiol 2020. [DOI: 10.1016/j.annepidem.2020.08.035] [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: 11/26/2022]
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Allen N, O'Sullivan K, Jones JM. The most influential papers in mitral valve surgery; a bibliometric analysis. J Cardiothorac Surg 2020; 15:175. [PMID: 32690042 PMCID: PMC7370429 DOI: 10.1186/s13019-020-01214-y] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.
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Affiliation(s)
- N Allen
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK.
| | - K O'Sullivan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - J M Jones
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
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Allen N, Desai N, Song C, Yu J, Prasad U, Francis G. Clinical features may help to identify children and adolescents with greatest risk for thyroid nodules. J Endocrinol Invest 2020; 43:925-934. [PMID: 31927747 DOI: 10.1007/s40618-019-01176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Thyroid nodules (TN) are detected in a small number of asymptomatic children and adolescents but are more frequently malignant (22-26%) than in adults leading some clinicians to perform thyroid ultrasound (US) for all children with goiter or autoimmune thyroiditis (AIT). Our study was designed to determine if suspicious clinical features predict the presence of TN in children with goiter or AIT so that US could be performed on those at highest risk. METHODS This was a retrospective review of 223 children and adolescents with goiter or AIT evaluated at a single institution. US was not performed on all patients. It is our practice to define glands that are large, firm, or nodular to palpation as "suspicious". Suspicious glands were interrogated by US and if TN was confirmed, this was further evaluated by fine-needle aspiration followed by surgery if indicated. RESULTS The median age was 12.9 years with 74.4% female. TN were confirmed by US in 16.6% of all patients but only 4.8% of those with AIT. By univariate analysis, TN were more common in those with family history of TN or differentiated thyroid carcinoma (DTC), thyroid asymmetry, and lower thyrotropin (TSH) levels. Differentiated thyroid carcinoma (DTC) was identified in 10.8% of TN and 1.8% of all patients. Firmness was significantly more common in patients with DTC (p = 0.0013). CONCLUSION TN were less common in those with AIT than reported in previous studies, suggesting that clinical features might fail to identify the majority of TN in patients with AIT. However, patients with asymmetric thyroid and a family history of TN or DTC have greatest risk for TN.
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Affiliation(s)
- N Allen
- Department of Pediatrics, Virginia Commonwealth University, Richmond, VA, USA
| | - N Desai
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - C Song
- Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA
| | - J Yu
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA
| | - U Prasad
- Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA
| | - G Francis
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Texas Health Science Center at San Antonio, 7301 Floyd Curl Drive, San Antonio, TX, 78229, USA.
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Sexton F, McConkey S, de Barra E, McNally C, Allen N. A New Tool for the Assessment and Improvement of Clinical Record Keeping. Ir Med J 2020; 113:44. [PMID: 32815704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- F Sexton
- Department of Infectious Diseases, Beaumont Hospital, Dublin
| | - S McConkey
- Department of Infectious Diseases, Beaumont Hospital, Dublin
| | - E de Barra
- Department of Infectious Diseases, Beaumont Hospital, Dublin
| | - C McNally
- Department of Infectious Diseases, Beaumont Hospital, Dublin
| | - N Allen
- Department of Infectious Diseases, Beaumont Hospital, Dublin
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Oates R, Lettal K, Allen N, Deivasikamani G. 81 Can Simulation-Based Training be Used to Teach Geriatric Medicine? Age Ageing 2020. [DOI: 10.1093/ageing/afz191.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Health Education England (HEE) and the Joint Royal Colleges of Physicians Training Boards recognise the importance of simulation-based training especially for Core Medical Trainees in improving patient outcomes and enhancing learning (Enhancing UK Core Medical Training through Simulation based training, Health Education England 2016). Research also suggests simulation training can be used to address a wide variety of medical curricula agenda from emergency presentations to breaking bad news (Beaubien 2004, Quality & Safety in healthcare). HEE suggests simulation training can be used to develop understanding but also communication skills and awareness of human factors and are focusing on developing a national strategy.
Geriatric Medicine is complex and trainees are expected to be competent in managing elderly patients in a variety of presentations. Our aim was to ascertain the confidence levels of CMT doctors managing elderly patients and whether simulation-based teaching is effective for geriatric teaching.
Methods
Three scenarios addressing common geriatric conditions were developed by a Geriatric Medicine Registrar and overseen by Geriatric Consultant. Scenarios including delirium secondary to sepsis, Opiate toxicity secondary to acute kidney injury (complicated by addressing dementia and risk of self-harm) and identifying and demonstrating appropriate palliative approaches to a catastrophic subdural haemorrhage. Trainees were given a brief summary of a case and asked to review and manage the ‘patient’.
A geriatric registrar alongside two CMT doctors designed a pre and post confidence questionnaire using Likert scales and free text boxes to explore respondents’ views.
Results
100% of trainees found the simulation training useful and would recommend the sessions. 100% of trainees stated preference for simulation-based teaching opposed to lecture and work based assessments. Confidence increased across all three scenarios post simulation. 70% of trainees stated they felt confident to manage delirium with sepsis pre-simulation, this increased to 91% post simulation. Trainees commented ‘feel confident to manage sepsis but not complicated by delirium or AKI’ and ‘prefer simulation to lectures’
Conclusions
CMT doctors enjoy and find simulation training in geriatric medicine useful and show preponderance to this. Simulation training can be used to expose trainees to real life complex geriatric medicine scenarios in a safe environment. This programme will be developed to encompass additional medical scenarios and also to be delivered to foundation year doctors.
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Affiliation(s)
- R Oates
- Department of Complex Care Medicine, Royal Bolton Hospital
| | - K Lettal
- Department of Complex Care Medicine, Royal Bolton Hospital
| | - N Allen
- Department of Complex Care Medicine, Royal Bolton Hospital
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Grandou C, Wallace L, Allen N, Impellizzeri F, Coutts A. Overtraining in Resistance Exercise: A Systematic Review and Methodological Appraisal of the Literature. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.096] [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: 11/26/2022]
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O'Rahelly M, Fernandez-Garcia M, Hahn A, Nguyen C, Kim D, Byun S, Koelbel H, Schara U, Henrich M, Leslie J, Eymard B, Chouchane M, Roefke K, Thieme A, van den Bergh P, Paquay S, Schneider-Gold C, Vincent A, Allen N, Jungbluth H. P.379Fetal Acetylcholine Receptor Inactivation Syndrome (FARIS): A potentially treatable autoimmune disorder mimicking a wide range of genetic neuromuscular conditions. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.541] [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: 10/25/2022]
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Allen N, Faherty C, Davies A, Lyons A, Scarry M, Bohan Keane M, Boyle N, O’Connell S, McCarthy E, Keady D, Bergin C, Lee J, Fleming C, Gallagher D, Tuite H. Opt-out bloodborne virus screening: a cross-sectional observational study in an acute medical unit. BMJ Open 2019; 9:e022777. [PMID: 31315851 PMCID: PMC6661585 DOI: 10.1136/bmjopen-2018-022777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Recent treatment developments for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV) have greatly improved prognoses. Current screening practices are mainly risk based and are suboptimal. Improved efforts are critically needed to identify persons with these viruses. The aims of this study were to assess the feasibility of an opt-out bloodborne virus (BBV) screening programme in an acute medical unit (AMU) and to describe the prevalence of HIV, HBV and HCV in this population. DESIGN AND SETTING This was a cross-sectional observational study in the AMU of a tertiary referral hospital in Galway, a city in the west of Ireland. PARTICIPANTS 1936 patients entered the study; 54% were male, mean age was 53.1 years (SD 19.6). During the study period, all patients attending the AMU aged ≧16 years who were having bloods drawn and who had the ability to verbally consent for an additional blood sample met the inclusion criteria for the study. RESULTS Over 44 weeks, 1936/4793 (40.4%) patients consented to BBV panel testing. Diagnosed prevalence rates for HIV, HBV and HCV were 0.5/1000, 2/1000 and 1.5/1000, respectively. There was one HIV-positive result; the patient was already engaged in care. Four patients tested positive for HBV surface antigen; one new diagnosis, one previously lost to follow-up and two already engaged in care. Three patients had active HCV infection; two had been lost to follow-up and are now linked back into services. CONCLUSION BBV testing uptake of 40.4% is higher than previous studies in AMU settings that used opt-in strategies, but lower than expected, possibly due to not incorporating testing into routine practice. The diagnosed prevalence of HBV is notable as little data currently exist about its prevalence in Ireland. These data are valuable in order to inform further prevention strategies for these infections in low-prevalence settings.
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Affiliation(s)
- Niamh Allen
- Infectious Diseases, St James' Hospital, Dublin, Ireland
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
| | - Collette Faherty
- Microbiolgy/ Virology, Galway University Hospitals, Galway, Ireland
| | - Andre Davies
- Acute Medicine Unit, Galway University Hospitals, Galway, Ireland
| | - Anne Lyons
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
| | - Margarent Scarry
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
| | | | - Nicola Boyle
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
| | - Sarah O’Connell
- Infectious Disease, University Hospital Limerick, Dooradoyle, Ireland
| | | | | | - Colm Bergin
- Department of Genitourinary and Infectious Diseases, St. James’s Hospital, Dublin, Ireland
| | - John Lee
- Hepatology, Galway University Hospitals, Galway, Ireland
| | | | - David Gallagher
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
- Acute Medicine Unit, Galway University Hospitals, Galway, Ireland
| | - Helen Tuite
- Infectious Diseases, Galway University Hospitals, Galway, Ireland
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Allen N, Allen M, Ahmed K, Gomm J, Nelan R, Nagano A, Chelala C, Gadaleta E, Thorat M, Cuzick J, Jones LJ. Abstract P5-18-08: Defining molecular signatures to personalise management of patients with early breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-18-08] [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: 11/16/2022]
Abstract
Abstract
Background
A review of breast screening highlighted the need to reduce overdiagnosis. Ductal Carcinoma In-Situ (DCIS) contributes significantly to this overdiagnosis. Epithelial cells in DCIS are as genetically advanced as those in invasive disease, focusing attention on the tumour microenvironment (ME). A key components of the ME in DCIS is the myoepithelial cell(MEC). These cells lie at the interface of the epithelial and stromal compartments, regulating cell function. We previously have identified changes in the MEC that contribute to tumour progression. Here we investigate the functional and clinical significance of a novel change in MEC phenotype: loss of Galectin-7 (Gal-7) expression. Gal-7 is proposed to play a role in apoptosis. We hypothesise that changes in MEC phenotype in DCIS alter the ME towards a pro-invasive phenotype, and hypothesise that loss of Gal-7 modifies the ME, destabilizes the MEC interface and ultimately may lead to loss of the MEC population through apoptosis.
Methods
Gal-7 expression and function was investigated in clinical samples and in-vitro model systems, respectively.
Gal-7 expression was assessed in a series of pure DCIS samples (low risk model) and DCIS with co-existant invasion (high risk model). Tissue sections were stained for Gal-7 and MEC expression scored on a duct-by-duct basis as positive, heterogeneous or negative.
An in-vitro model of normal primary myoepithelial cells isolated from reduction mammoplasty was used to investigate the functional impact of loss of Gal-7. These cells have high endogenous levels of Gal-7. Gal-7 was knocked down using siRNA and apoptosis assessed using cleaved caspase-3. The effect of Gal-7 on MEC layer integrity was assessed using immunofluorescence and adhesion assays.
The global impact of loss of Gal-7 was investigated using RNA sequencing.
Results
In the tissue analysis 1926 DCIS ducts were scored for MEC expression of Gal-7. Significantly more ducts showed loss of Gal-7 in DCIS with co-existant invasion, with pure DCIS showing 388 ducts positive and DCIS with invasion 144 DCIS ducts positive (p=0.0014). Pure DCIS and DCIS with invasion had 99 and 646 negative DCIS ducts respectively (p=0.0002).
In model systems of primary MEC, knockdown of Gal-7 resulted in increased expression of cleaved caspase-3, suggesting lower levels of Gal-7 increases apoptosis. In functional assays silencing Gal-7 reduces adhesion to both fibronectin and laminin extracellular matrices (p-value 0.005 and 0.001 respectively)
RNA sequencing indicates silencing Gal-7 increases LOX expression - a key regulator of the collagen matrix of the microenvironment.
Conclusion
Normal MEC strongly express Gal-7. Expression is lost in DCIS, with significantly more frequent loss in DCIS with co-existant invasion, suggesting that loss is associated with a more advanced phenotype. Functional assays indicate that loss of MEC Gal-7 enhances MEC apoptosis, which may be one mechanism by which this interface is lost during progression. Gal-7 negative MEC also show impaired adhesion to matrix proteins and lead to up-regulation of LOX, an enzyme key in promoting tumourigenesis. The incorporation of Gal-7 expression into a risk stratification algorithm has functional evidence and is currently being investigated.
Citation Format: Allen N, Allen M, Ahmed K, Gomm J, Nelan R, Nagano A, Chelala C, Gadaleta E, Thorat M, Cuzick J, Jones LJ. Defining molecular signatures to personalise management of patients with early breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-18-08.
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Affiliation(s)
- N Allen
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - M Allen
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - K Ahmed
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - J Gomm
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - R Nelan
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - A Nagano
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - C Chelala
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - E Gadaleta
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - M Thorat
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - J Cuzick
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
| | - LJ Jones
- Barts Cancer Institute, London, United Kingdom; Wolfson Institute of Preventative Medicine, London, United Kingdom
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Kerr C, Allen N, Moynan D, Moriarty M, Murphy S, Farrell G, Bergin C. 1903. Cost Minimization Analysis of a Preferred ARV Prescribing Pathway for Treatment-Naïve HIV-Positive Patients. Open Forum Infect Dis 2018. [PMCID: PMC6253799 DOI: 10.1093/ofid/ofy210.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background There were 266 new attendees to the HIV clinic of St. James’ Hospital in 2016. HIV care is expensive. The modelled lifetime cost of treating one HIV-positive patient in the UK is estimated at £360,800, with ARVs accounting for 68% of the cost. This audit aims to assess potential savings in ARV spend if a cost-based prescribing approach was adopted for suitable treatment-naïve patients of the clinic. Methods A retrospective analysis of newly attending HIV-positive patients attending the HIV Clinic in 2016 was undertaken. Treatment-naïve patients were identified. 2016 ARV drug acquisition costs were obtained from the St. James’ Hospital Finance department. The cost of first-line ARV regimens were calculated. Patients were evaluated for their suitability for the lowest-cost, first-line ARV regimen by analysing baseline viral loads, CD4 counts, resistance patterns, renal function, bone health and HLA B5701 status. The price difference between their prescribed regimens and the most cost-effective first-line regimen was calculated. Results From January to December 2016, there were 266 new attendances. One hundered fifty-four of these patients (58%) were treatment naïve. The treatment regimens were ascertained for 145/154 (94%). A cost difference of approx. €390 per month existed between the most expensive and least expensive first-line ARV regimens. The monthly cost of ARV regimens prescribed came to €152,949.09, equating to an annual spend of €1,835,389.08. The predicted monthly ARV cost of the cost-based prescribing approach has been calculated at €139,186.27 with an annual cost of €1,670,235.24. This would lead to an annual saving of €165.153.84, equating to 9% of the 2016 ARV spend for this population. Conclusion This audit outlines the potential cost-effectiveness of a cost-based prescribing approach for suitable treatment-naïve patients that also adheres to best clinical practice guidelines. It demonstrates that significant cost savings (9%) can be made by simple analysis of ARV costs. These data can be used to support future options in ARV procurement and tender-processing for the department and nationally. It can also serve as a template in the construction of a pathway for the safe and cost-effective switching of ARV regimens of patients already on established regimens when generic ARV medications become available in Ireland. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Colm Kerr
- St. James’ Hospital, Dublin, Ireland
| | | | - David Moynan
- Guide Department, St James’s Hospital, Dublin, Ireland
| | | | | | - Gillian Farrell
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
| | - Colm Bergin
- Infectious Diseases, St. James’s Hospital, Dublin, Ireland
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Barchfeld R, Domier CW, Ren Y, Ellis R, Riemenschneider P, Allen N, Kaita R, Stratton B, Dannenberg J, Zhu Y, Luhmann NC. The high- k poloidal scattering system for NSTX-U. Rev Sci Instrum 2018; 89:10C114. [PMID: 30399655 DOI: 10.1063/1.5035410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/25/2018] [Indexed: 06/08/2023]
Abstract
An 8-channel, high-k poloidal far-infrared (FIR) scattering system is under development for the National Spherical Torus eXperiment Upgrade (NSTX-U). The 693 GHz poloidal scattering system replaces a 5-channel, 280 GHz high-k toroidal scattering system to study high-k electron density fluctuations on NSTX-U. The FIR probe beam launched from Bay G is aimed toward Bay L, where large aperture optics collect radiation at 8 simultaneous scattering angles ranging from 2° to 15°. The reduced wavelength in the poloidal system results in less refraction, and coupled with a new poloidal scattering geometry, extends measurement of poloidal wavenumbers from the previous limit of 7 cm-1 up to >40 cm-1. Steerable launch optics coupled with receiver optics that can be remotely translated in 5 axes allow the scattering volume to be placed from r/a = 0.1 out to the pedestal region (r/a ∼ 0.99) and allow for both upward and downward scattering to cover different regions of the 2D fluctuation spectrum.
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Affiliation(s)
- R Barchfeld
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - C W Domier
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - Y Ren
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - R Ellis
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - P Riemenschneider
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - N Allen
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - R Kaita
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - B Stratton
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - J Dannenberg
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - Y Zhu
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
| | - N C Luhmann
- Department of Electrical and Computer Engineering, University of California, Davis, California 95616, USA
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Gray TK, Allen N, Reinke ML, Smalley G, Youchison DL, Ellis R, Jaworski MA, Looby T, Mardenfeld M, Wolfe DE. Integrated plasma facing component calorimetry for measurement of shot integrated deposited energy in the NSTX-U. Rev Sci Instrum 2018; 89:10J128. [PMID: 30399927 DOI: 10.1063/1.5039337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 08/03/2018] [Indexed: 06/08/2023]
Abstract
The upgrade to the National Spherical Torus eXperiment (NSTX-U) [J. Menard et al., Nucl. Fusion 52, 083015 (2012)] increases the injected neutral beam power up to 12 MW and the plasma current up to Ip = 2 MA for plasma durations up to 5 s. The graphite plasma facing components have been re-designed to handle greater heat and energy fluxes than were seen in NSTX using a castellated design. We present the experimental testing and validation of a castellated graphite target, similar to the prototype tile design, instrumented with thermocouples at various depths in the castellation. During testing, incident heat flux is provided by a programmed electron beam system and surface temperatures are measured via infrared thermography directly viewing the target surface. It was found that the thermocouple response scaled linearly with the measured surface temperature rise regardless of thermocouple depth in the castellation. A sensitivity of 14.3 °C/kJ of deposited energy was found when treating individual castellations as a semi-infinite solid.
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Affiliation(s)
- T K Gray
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - N Allen
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - M L Reinke
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - G Smalley
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - D L Youchison
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - R Ellis
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - M A Jaworski
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - T Looby
- University of Tennessee, Knoxville, Tennessee 37996, USA
| | - M Mardenfeld
- Princeton Plasma Physics Laboratory, Princeton, New Jersey 08543, USA
| | - D E Wolfe
- The Pennsylvania State University, State College, Pennsylvania 16802, USA
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O'Shaughnessy M, Allen N, O'Regan J, Payne-Danson E, Mentre L, Davin D, Lavin P, Grimes T. Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease. QJM 2017; 110:623-628. [PMID: 28431157 PMCID: PMC6256938 DOI: 10.1093/qjmed/hcx086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown. AIM We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP. DESIGN Single-centre observational study. METHODS A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission. RESULTS Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P < 0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14). CONCLUSIONS PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.
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Affiliation(s)
- M O'Shaughnessy
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - N Allen
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - J O'Regan
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - E Payne-Danson
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - L Mentre
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
| | - D Davin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - P Lavin
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
| | - T Grimes
- Department of Pharmacy, Adelaide and Meath Hospital, Trinity Health Kidney Centre, Tallaght, Dublin D24 NROA, Ireland
- School of Pharmacy and Pharmaceutical Sciences, University of Dublin Trinity College, Dublin D02 W272, Ireland
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Holmes J, Allen N, Roberts G, Geen J, Williams JD, Phillips AO. Acute kidney injury electronic alerts in primary care - findings from a large population cohort. QJM 2017; 110:577-582. [PMID: 28402560 DOI: 10.1093/qjmed/hcx080] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Electronic reporting of AKI has been used to aid early AKI recognition although its relevance to CA-AKI and primary care has not been described. AIMS We described the characteristics and clinical outcomes of patients with CA-AKI, and AKI identified in primary care (PC-AKI) through AKI e-Alerts. DESIGN A prospective national cohort study was undertaken to collect data on all e-alerts representing adult CA-AKI. METHOD The study utilized the biochemistry based AKI electronic (e)-alert system that is established across the Welsh National Health Service. RESULTS 28.8% of the 22 723 CA-AKI e-alerts were classified as PC-AKI. Ninety-day mortality was 24.0% and lower for PC-AKI vs. non-primary care (non-PC) CA-AKI. Hospitalization was 22.3% for PC-AKI and associated with greater disease severity, higher mortality, but better renal outcomes (non-recovery: 18.1% vs. 21.6%; progression of pre-existing CKD: 40.5% vs. 58.3%). 49.1% of PC-AKI had a repeat test within 7 days, 42.5% between 7 and 90 days, and 8.4% was not repeated within 90 days. There was significantly more non-recovery (24.0% vs. 17.9%) and progression of pre-existing CKD (63.3% vs. 47.0%) in patients with late repeated measurement of renal function compared to those with early repeated measurement of renal function. CONCLUSION The data demonstrate the clinical utility of AKI e-alerts in primary care. We recommend that a clinical review, or referral together with a repeat measurement of renal function within 7 days should be considered an appropriate response to AKI e-alerts in primary care.
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Affiliation(s)
- J Holmes
- Welsh Renal Clinical Network, Cwm Taf University Health Board
| | - N Allen
- Redlands Surgery, Penarth, Cardiff and Vale University Health Board
| | - G Roberts
- Department of Clinical Biochemistry, Hywel Dda University Health Board
| | - J Geen
- Department of Clinical Biochemistry, Cwm Taf University Health Board, Merthyr, UK
- Faculty of Life Sciences and Education, University of South Wales, UK
| | - J D Williams
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
| | - A O Phillips
- Institute of Nephrology, Cardiff University School of Medicine, Cardiff, UK
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Lubman DI, Cheetham A, Jorm AF, Berridge BJ, Wilson C, Blee F, Mckay-Brown L, Allen N, Proimos J. Australian adolescents' beliefs and help-seeking intentions towards peers experiencing symptoms of depression and alcohol misuse. BMC Public Health 2017; 17:658. [PMID: 28814325 PMCID: PMC5559792 DOI: 10.1186/s12889-017-4655-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 07/30/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many young people are reluctant to seek professional help for mental health problems, preferring to rely on their friends for support. It is therefore important to ensure that adolescents can identify signs of psychological distress in their peers, talk to them about these, and help them access appropriate services when necessary. The current study examined adolescents' ability to recognise symptoms of depression and alcohol misuse, perceived barriers to help-seeking, and their intentions to encourage a peer to seek help from a range of informal and formal help sources. METHOD The current study used baseline data from a randomised controlled trial of a school-based intervention that teaches adolescents how to overcome barriers to accessing professional help for mental health and substance use problems (MAKINGtheLINK). Participants (n = 2456) were presented with two vignettes portraying depression and alcohol misuse, respectively, and were asked to identify the problems described. Participants provided data on their past help-seeking behaviour, confidence to help a peer, perceived barriers to help-seeking, and intentions to encourage a peer to seek help. RESULTS Health professionals were the main source of help that participants had relied on for depressive symptoms, followed by friends and parents. In contrast, friends were the main source of help that participants had relied on for alcohol and other drug problems, followed by health professionals and parents. Just over half of the sample correctly identified the problems described in the two vignettes, although the majority of participants were confident that they could talk to a peer and help them seek professional help if needed. Most agreed that the vignettes described problems that warranted professional help, however approximately half the sample was unsure or considered it unlikely that they would seek help if they experienced similar problems. For both disorders, participants were most likely to encourage a peer to seek help from their family, followed by formal help sources and friends. CONCLUSIONS While the results point towards a greater willingness to approach formal help sources, particularly for depression, peers remain an important source of support for young people experiencing mental health and substance use problems.
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Affiliation(s)
- D. I. Lubman
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - A. Cheetham
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - A. F. Jorm
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC Australia
| | - B. J. Berridge
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - C. Wilson
- Illawarra Health and Medical Research Institute, Wollongong, NSW Australia
- School of Medicine, University of Wollongong, Wollongong, NSW Australia
| | - F. Blee
- Turning Point, Eastern Health, Fitzroy, VIC Australia
- Eastern Health Clinical School, Monash University, Box Hill, VIC Australia
| | - L. Mckay-Brown
- Travancore School, Victorian Department of Education and Training, Travancore, VIC Australia
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, VIC Australia
| | - N. Allen
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC Australia
- Department of Psychology, University of Oregon, Eugene, OR USA
| | - J. Proimos
- Victorian Department of Education and Training, Melbourne, VIC Australia
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Landau E, Blake M, Waloszek J, Schwartz O, Raniti M, Simmons J, Blake L, Dudgeon P, Bootzin R, Dahl R, Murray G, Trinder J, Allen N. 0956 ADOLESCENT SLEEP DISTURBANCE AMONG A COMMUNITY-BASED SCREEN: PREVALENCE AND CO-MORBIDITY RATES FROM THE SENSE STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.955] [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: 11/12/2022] Open
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Landau E, Raniti M, Blake M, Schwartz O, Simmons J, Waloszek J, Murray G, Bootzin R, Dahl R, O’Brien-Simpson N, Trinder J, Allen N. 1090 THE LONGITUDINAL NEUROENDOCRINE, IMMUNE, AND CARDIOVASCULAR IMPACT OF A MINDFULNESS-BASED SLEEP INTERVENTION FOR AT-RISK ADOLESCENTS. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1089] [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: 11/14/2022] Open
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Allen N, Fleming C, O'Donovan D, O'Regan A, Higgins C. Low Uptake of Treatment for Latent Tuberculosis (TB) in an Outbreak Affecting an Island. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Niamh Allen
- Infectious Disease, Galway University Hospital, Galway, Ireland
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Abstract
BACKGROUND Increased co-morbidities and physiological changes mean older patients may be at higher risk of adverse outcomes from certain imported illnesses. One of the most commonly diagnosed imported infections in returning travelers is malaria. Increasing age is strongly and independently associated with increasing morbidity and mortality from malaria. Delayed diagnosis leads to higher risks of poor clinical outcomes in older patients presenting with malaria. The objective of this study was to quantify malaria presentations in older patients as a percentage of total malaria presentations, compare length of hospital stay (LOS) between the older and younger cohort, and to describe medical co-morbidities, length of time to diagnosis and factors contributing to delayed diagnosis and increased LOS in the older cohort. METHODS A retrospective cohort study was undertaken in two university hospitals of all patients aged 65 years or older presenting with malaria from 2002-2012. A national hospital inpatient database was used to identify patients of all ages with a discharge diagnosis of malaria over this ten year period, and quantify LOS in those aged <65 and those aged 65 years or older. The case-notes for all of the older cohort were reviewed. RESULTS There were a total of 203 cases, 12 of whom were aged ≥65 years (5.9 %- total). Median time to diagnosis in this older group was two days (range 0-35), median LOS was eight days (range 1-77), compared to a median LOS of three days in those aged <65 years. All patients aged ≥65 years presented with fever. Travel history was documented in only 6/12 charts, and 11/12 had two or more co-morbid illnesses. Six of the 12 patients were not diagnosed or treated within 48 h of presentation. CONCLUSIONS This case series highlights the need for appropriate history-taking and timely diagnosis of the older traveler returning with fever, as delayed diagnosis and treatment can contribute to prolonged hospital stay and increased morbidity. With increasing numbers of older travelers, physicians must remain vigilant to the presence of imported illnesses, particularly malaria, in older patients with unexplained fever.
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Affiliation(s)
- N Allen
- Department of Genitourinary medicine and Infectious Diseases, St. James’s Hospital, Dublin 8, Ireland
| | - C Bergin
- Department of Genitourinary medicine and Infectious Diseases, St. James’s Hospital, Dublin 8, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - SP Kennelly
- Department of Age Related Healthcare, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland
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Robertson C, King D, Bagge S, Allen N, Parker S, Piper L, Wade T, Beezhold J. Service Evaluation of Headucate’s Educational Intervention to Reduce Stigma and Increase Mental Health Literacy Among School Children. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)30953-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Gordon DM, Shehibo A, Tazebew A, Huddart MR, Kadir A, Allen N, Draper H, Kokeb M. Implementation of an in-patient pediatric mortality reduction intervention, Gondar University Hospital, Ethiopia. Public Health Action 2014; 4:265-70. [PMID: 26400707 DOI: 10.5588/pha.14.0077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/03/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Gondar University Hospital (GUH) is a resource-limited tertiary care hospital in northern Ethiopia. OBJECTIVE To evaluate the aggregate effect of care standardization, institutional guidelines, and simulation-based training on pediatric mortality at a resource-limited hospital. DESIGN Uncontrolled pre-post study. GUH in-patients aged from 30 days to 14 years were included in the program evaluation (baseline 11 September-18 November 2010; intervention 19 September-9 December 2011). Interns attached to the GUH pediatrics department from 6 September to 9 December 2011 were included in the training evaluation. Institution-specific management guidelines were prepared for choking, respiratory distress, dehydration, sepsis, congestive heart failure, coma, and seizure. Approval for the protocols was obtained from each pediatric faculty member. Interns received a 3.5 h simulation-based training in triage, procedural skills, and protocol usage. Primary outcome was overall deaths (%); secondary outcomes were deaths within 24 h of admission (%) and median pre/post-training emergency management test scores (%). RESULTS No difference in mortality (OR 0.72, 95%CI 0.40-1.29, P = 0.265) or first 24 h mortality (crude OR 0.97, 95%CI 0.37-2.55) was observed. Trainee examination scores improved from 33% to 74% (P < 0.001). CONCLUSION Combining care standardization, management protocols, and simulation-based training did not reduce mortality among pediatric in-patients. Focused, simulation-based training improved short-term test scores among interns.
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Affiliation(s)
- D M Gordon
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - A Shehibo
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
| | - A Tazebew
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
| | - M R Huddart
- Embrace, Yorkshire and Humber Infant and Childrens Transport Service, Sheffield, UK
| | - A Kadir
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - N Allen
- Yale University Global Health Leadership Institute, Eugene, Oregon, USA
| | - H Draper
- Texas Children's Hospital Global Health Corps, Baylor International Pediatric AIDS Initiative, Houston, Texas, USA
| | - M Kokeb
- Department of Pediatrics and Child Health, Gondar University Hospital, Gondar, Ethiopia
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Affiliation(s)
- N Allen
- Cardiff University, Cardiff, UK
| | - I Lipska
- Utrecht University, Utrecht, The Netherlands
| | - L Liberti
- Centre for Innovation in Regulatory Science, London, UK
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Skaltsa K, Allen N, Van EA, Blogg K. An Archetype For Classification and Comparison of Hta Activities in Latin America. Value Health 2014; 17:A443. [PMID: 27201197 DOI: 10.1016/j.jval.2014.08.1170] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- K Skaltsa
- Quintiles Consulting, Barcelona, Spain
| | - N Allen
- Centre for Innovation in Regulatory Science, London, UK
| | - Engen A Van
- Quintiles Consulting, Hoofddorp, The Netherlands
| | - K Blogg
- Quintiles Consulting, Reading, UK
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Allen N, Robinson AC, Snowden J, Davidson YS, Mann DMA. Patterns of cerebral amyloid angiopathy define histopathological phenotypes in Alzheimer's disease. Neuropathol Appl Neurobiol 2014; 40:136-48. [PMID: 23808763 DOI: 10.1111/nan.12070] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
Abstract
AIMS Pathological heterogeneity of Aβ deposition in senile plaques (SP) and cerebral amyloid angiopathy (CAA) in Alzheimer's disease (AD) has been long noted. The aim of this study was to classify cases of AD according to their pattern of Aβ deposition, and to seek factors which might predict, or predispose towards, this heterogeneity. METHODS The form, distribution and severity of Aβ deposition (as SP and/or CAA) was assessed semiquantitatively in immunostained sections of frontal, temporal and occipital cortex from 134 pathologically confirmed cases of AD. RESULTS Four patterns of Aβ deposition were defined. Type 1 describes cases predominantly with SP, with or without CAA within leptomeningeal vessels alone. Type 2 describes cases where, along with many SP, CAA is present in both leptomeningeal and deeper penetrating arteries. Type 3 describes cases where capillary CAA is present along with SP and arterial CAA. Type 4 describes a predominantly vascular phenotype, where Aβ deposition is much more prevalent in and around blood vessels, than as SP. As would be anticipated from the group definitions, there were significant differences in the distribution and degree of CAA across the phenotype groups, although Aβ deposition as SP did not vary. There were no significant differences between phenotype groups with regard to age of onset, age at death, disease duration and brain weight, or disease presentation. Women were over-represented in the type 1 phenotype and men in type 2. Genetically, type 3 (capillary subtype) cases were strongly associated with possession of the APOE ε4 allele. CONCLUSIONS This study offers an alternative method of pathologically classifying cases of AD. Further studies may derive additional genetic, environmental or clinical factors which associate with, or may be responsible for, these varying pathological presentations of AD.
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Affiliation(s)
- N Allen
- Clinical and Cognitive Sciences Research Group, Institute of Brain, Behaviour and Mental Health, Faculty of Medical and Human Sciences, University of Manchester, Salford Royal Hospital, Salford, UK
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Sanders P, Straccia M, Joy S, Comella Bolla A, Bombau G, Svendsen C, Kemp P, Allen N, Canals J. B39 The Effect Of Huntingtin Gene Cag Repeat Expansion On Human Induced Pluripotent Stem Cell Neuronal Differentiation. Journal of Neurology, Neurosurgery & Psychiatry 2014. [DOI: 10.1136/jnnp-2014-309032.67] [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: 11/04/2022]
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Allen N, Robertson C, Parker S, Bhutto A, Lavarack R, Piper L, Smith R, Wade T, Beezhold J. EPA-0554 – Recruitment and training of Headucate members to enable the delivery of a school-based educational intervention. Eur Psychiatry 2014. [DOI: 10.1016/s0924-9338(14)77946-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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