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Maclean N, Davies P, Lewis S. Is prone positioning a valid intervention for ARDS in the deployed intensive care unit? BMJ Mil Health 2024:e002302. [PMID: 38569719 DOI: 10.1136/military-2022-002302] [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: 12/23/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Abstract
Prone positioning is an intervention used for patients with acute respiratory distress syndrome (ARDS) whose hypoxia is worsening despite conventional treatment. Previously used infrequently, it became an important treatment escalation strategy for hypoxia during the COVID-19 pandemic. Current evidence for prone positioning suggests increased survivability in intubated patients with moderate to severe ARDS who are prone for >12 hours a day. As a relatively low-cost, low-tech intervention with a growing evidence base, the viability of prone positioning in the deployed land environment is considered in this article. The practical technique of prone positioning is easy to teach to healthcare staff experienced in manual handling. However, it requires significant resources, in particular staff numbers, and time to execute and maintain, and necessitates a pressure-minimising mattress. Additionally, staff are placed at increased risk of musculoskeletal injuries and potential exposure to aerosolised microbes if there is a disconnection of the breathing system. We conclude that in the deployed 2/1/2/12 facility (or larger), with access to higher staff numbers and high-specification mattresses, prone positioning is a valid escalation technique for intubated hypoxic patients with ARDS. However, in smaller facilities where resources are constrained, its implementation is unlikely to be achievable.
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Affiliation(s)
| | - P Davies
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
- Joint Hosptial Group (South East), Frimley, UK
| | - S Lewis
- Frimley Park Hospital NHS Foundation Trust, Frimley, UK
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2
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Hawkes LA, Davies P, Hall AE, Horton TW, Stamp T, Witt MJ, Sheehan EV. People behind the "pings"; limiting authorship threatens collaboration in telemetry. J Fish Biol 2024. [PMID: 38519854 DOI: 10.1111/jfb.15700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 03/25/2024]
Affiliation(s)
- L A Hawkes
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - P Davies
- School of Biological and Marine Sciences, University of Plymouth, Plymouth, UK
| | - A E Hall
- School of Biological and Marine Sciences, University of Plymouth, Plymouth, UK
| | - T W Horton
- Faculty of Environment, Society and Economy, University of Exeter, Penryn Campus, Penryn, UK
| | - T Stamp
- School of Biological and Marine Sciences, University of Plymouth, Plymouth, UK
| | - M J Witt
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Faculty of Environment, Society and Economy, University of Exeter, Penryn Campus, Penryn, UK
| | - E V Sheehan
- School of Biological and Marine Sciences, University of Plymouth, Plymouth, UK
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3
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Griksaitis MJ, Zoica B, Raffaj D, Stephens J, Sarfatti A, Rajagopal V, Hargadon-Lowe A, Green J, Shires P, Skevington-Postles L, Davies P. Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study. Arch Dis Child 2024:archdischild-2024-326904. [PMID: 38442949 DOI: 10.1136/archdischild-2024-326904] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics. This article describes the development and launch of the UK's inaugural accredited paediatric-specific POCUS curriculum and training pathway: the 'Children's ACuTe UltraSound' course, addressing this significant gap in paediatric healthcare education and describing the training delivered and available for paediatricians and allied health professionals working with children.
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Affiliation(s)
- Michael J Griksaitis
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
- University of Southampton Faculty of Medicine, Southampton, UK
| | - Bogdana Zoica
- King's College Hospital NHS Foundation Trust, London, UK
| | - Dusan Raffaj
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Jennie Stephens
- Intensive Care & Acute Medicine, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Avishay Sarfatti
- Paediatric Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Veena Rajagopal
- Paediatric Cardiac Intensive Care Unit, Great Ormond Street Hospital for Children, London, UK
| | | | - Jessica Green
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Peter Shires
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | | | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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4
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Starling LT, Tucker R, Quarrie K, Schmidt J, Hassanein O, Smith C, Flahive S, Morris C, Lancaster S, Mellalieu S, Curran O, Gill N, Clarke W, Davies P, Harrington M, Falvey E. The World Rugby and International Rugby Players Contact Load Guidelines: From conception to implementation and the future. S Afr J Sports Med 2023; 35:v35i1a16376. [PMID: 38249755 PMCID: PMC10798596 DOI: 10.17159/2078-516x/2023/v35i1a16376] [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] [Indexed: 01/23/2024] Open
Abstract
Managing training load in rugby union is crucial for optimising performance and injury prevention. Contact training warrants attention because of higher overall injury and head impact risk, yet players must develop physical, technical, and mental skills to withstand the demands of the game. To help coaches manage contact loads in professional rugby, World Rugby and International Rugby Players convened an expert working group. They conducted a global survey with players to develop contact load guidelines. This commentary aims to describe the contact load guidelines and their implementation, and identify areas where future work is needed to support their evolution.
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Affiliation(s)
- LT Starling
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- Department for Health, University of Bath, Bath,
UK
| | - R Tucker
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- Institute of Sport and Exercise Medicine (ISEM), Department of Exercise, University of Stellenbosch,
South Africa
| | - K Quarrie
- New Zealand Rugby, Wellington,
New Zealand
| | - J Schmidt
- New Zealand Rugby, Wellington,
New Zealand
| | - O Hassanein
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - C Smith
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - S Flahive
- International Rugby Players, Clonskeagh, Dublin,
Ireland
| | - C Morris
- C J Morris Consulting Ltd, Cheshire,
UK
| | | | - S Mellalieu
- Centre for Health, Activity and Wellbeing Research (CAWR), Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff,
UK
| | - O Curran
- Irish Rugby Football Union, High Performance Centre, National Sports Campus, Dublin 15,
Ireland
| | - N Gill
- New Zealand Rugby, Wellington,
New Zealand
- University of Waikato, Tauranga,
New Zealand
| | - W Clarke
- New Zealand Rugby, Wellington,
New Zealand
| | - P Davies
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
| | - M Harrington
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
| | - E Falvey
- World Rugby House, Pembroke Street Lower, Dublin,
Ireland
- College of Medicine & Health, University College Cork, Cork,
Ireland
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5
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Miranda M, Ray S, Boot E, Inwald D, Meena D, Kumar R, Davies P, Rivero-Bosch M, Sturgess P, Weeks C, Holliday K, Cuevas-Asturias S, Donnelly P, Elsaoudi A, Lillie J, Nadel S, Tibby S, Mitting R. Variation in Early Pediatric Intensive Care Management Strategies and Duration of Invasive Mechanical Ventilation for Acute Viral Bronchiolitis in the United Kingdom: A Retrospective Multicenter Cohort Study. Pediatr Crit Care Med 2023; 24:1010-1021. [PMID: 37493464 DOI: 10.1097/pcc.0000000000003333] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
OBJECTIVES Management of mechanically ventilated patients with bronchiolitis is not standardized and duration of mechanical ventilation has been shown to vary widely between centers. The aim of this study was to examine practice in a large number of U.K. PICUs with a view to identify if early management choices relating to fluid prescription, sedative agent use, and endotracheal tube (ETT) placement were associated with differences in duration of invasive mechanical ventilation (IMV). DESIGN Retrospective multicenter cohort study. Primary outcome was duration of IMV. A hierarchical gamma generalized linear model was used to test for associations between practice variables (sedative and neuromuscular blocking agents, route of endotracheal intubation at 24 hr and fluid balance at 48 hr) and duration of IMV after adjustment for known confounders. SETTING Thirteen U.K. PICUs. Duration of 2 months between November and December 2019. PATIENTS Three hundred fifty infants receiving IMV for bronchiolitis. Excluded were patients receiving long-term ventilation, extracorporeal life support, or who died before separation from IMV. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS After adjustment for confounders, several variables were associated with an increase in the geometric mean duration of IMV (expressed as a percentage) including: nasal ETT use, 16% (95% CI, 1-32%); neuromuscular blockade use, 39% (95% CI, 21-61%); and fluid balance at 48 hr, 13% per 100 mL/kg positive fluid balance (95% CI, -1% to 28%). The association of sedative use varied with class of agent. The use of an alpha-2 agonist alone was associated with a reduction in duration of IMV by 19% in relation to no sedative agent (95% CI, -31 to -5%), whereas benzodiazepine uses alone or with alpha-2 agonist in combination were similar to using neither agent. CONCLUSIONS Early management strategies for bronchiolitis were associated with the duration of IMV across U.K. centers after adjustment for confounders. Future work should prospectively assess the impact of fluid restriction, route of endotracheal intubation, and alpha-2 agonist use on duration of IMV in infants with bronchiolitis, with the aim of reducing seasonal bed pressure.
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Affiliation(s)
- Mariana Miranda
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Samiran Ray
- Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Elizabeth Boot
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Inwald
- Pediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Daleep Meena
- Pediatric Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ramesh Kumar
- Pediatric Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Patrick Davies
- Pediatric Intensive Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Maria Rivero-Bosch
- Pediatric Intensive Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Philippa Sturgess
- Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Charlotte Weeks
- Pediatric Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, United Kingdom
| | - Kathryn Holliday
- Pediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - Sofia Cuevas-Asturias
- Pediatric Intensive Care Unit, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Peter Donnelly
- Pediatric Intensive Care Unit, The Royal Hospital For Children, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Ahmed Elsaoudi
- Pediatric Intensive Care Unit, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jon Lillie
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Nadel
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
- Centre for Paediatrics and Child Health, Imperial College, London, United Kingdom
| | - Shane Tibby
- Pediatric Intensive Care Unit, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rebecca Mitting
- Pediatric Intensive Care Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
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6
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Evans REC, Barber V, Ramnarayan P, Davies P, Wray J. Emergency Inter-Hospital Transfer of Children to PICUs in the United Kingdom: Qualitative Exploration of Parents' Experiences of Retrieval Teams. Pediatr Crit Care Med 2023; 24:e476-e486. [PMID: 37166250 DOI: 10.1097/pcc.0000000000003267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Each year in the United Kingdom there are around 5,000 inter-hospital transfers of critically ill children into PICUs. There are few published descriptions of what this experience is like for parents. The objective was to describe parents' experiences of the inter-hospital transfer of their critically ill child to a PICU. DESIGN Qualitative in-depth interviews. SETTING Twenty-four PICUs in England and Wales. PARTICIPANTS Parent interview participants ( n = 30) were purposively sampled from a larger pool of parent questionnaire respondents to create a sample diverse in child's age, presenting medical illness, retrieval team and whether a parent traveled in the ambulance. MEASUREMENT AND MAIN RESULTS Open-ended semi-structured interviews using topic guides to encourage parents to describe their experiences of transfer. Interviews were audio recorded, transcribed verbatim and thematically analyzed using Framework Analysis. Parents' perceptions of transport staff as confident and competent through observation of clinical care, and positive communication experiences during the transfer process, were related to feelings of trust and being supported, as well as relief from distress. Parents varied in their needs for conversation and support. Parents who did not travel in the ambulance had fewer opportunities to interact with the transport team and experienced different challenges in the period prior to their child's admission to the PICU. CONCLUSIONS Retrieval teams can influence how parents experience their child's emergency transfer to the PICU, offering parents proximity to knowledgeable staff. Satisfaction may be related to matching parents' needs. Understanding parents' needs and optimizing opportunities for effective communication between parents and staff are beneficial to parents.
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Affiliation(s)
- Ruth E C Evans
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Vicky Barber
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Anaesthetics, Pain Medicine and Intensive Care (APMIC) Section, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Patrick Davies
- Paediatric Intensive Care, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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7
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Pouzo LB, Ceconi I, Davies P, Méndez D, Ortiz Miranda SG, Testa ML, Pavan E. Animal performance and meat quality characteristics from feedlot-finished steers fed increasing levels of wet distillers grain. Meat Sci 2023; 204:109214. [PMID: 37285637 DOI: 10.1016/j.meatsci.2023.109214] [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: 12/02/2022] [Revised: 04/21/2023] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
One hundred forty-four steers were group-housed in 24 pens that were randomly assigned to one of four dietary treatments defined by the proportion of wet distiller grain plus solubles (WDGS; 0, 15, 30, or 45%) and fed for 84 d pre-slaughter. Animal performance was evaluated using the pen as the experimental unit. Whereas for carcass and meat quality characteristics, meat oxidative stability, and the consumer sensory quality of longissimus thoracis muscle one animal from each pen was randomly selected and used as the experimental unit. No differences (P > 0.05) were observed for subcutaneous fat thickness, rib eye area, marbling score or pH, color parameters, proximate composition, sarcomere length, Warner Bratzler shear force, and cooking loss. Feeding WDGS linearly increased total PUFA (P = 0.05), C18:2 n-6 (P = 0.004) proportions, and n-6/n-3 ratio (P < 0.01) but reduced C16:1 to C18:0 ratio (P < 0.01). Lipid oxidation was greater in beef from steers fed 30% and 45% WDGS (P = 0.05). Dietary WDGS linearly improved (P < 0.05) flavor and overall linking score in the consumer sensory panel.
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Affiliation(s)
- L B Pouzo
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Balcarce, Balcarce, Bs. As., Argentina; Universidad Nacional de Mar del Plata, Facultad de Ciencias Agrarias, Balcarce, Bs. As., Argentina
| | - I Ceconi
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Gral, Villegas, Gral. Villegas, Bs. As., Argentina
| | - P Davies
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Gral, Villegas, Gral. Villegas, Bs. As., Argentina
| | - D Méndez
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Gral, Villegas, Gral. Villegas, Bs. As., Argentina
| | - S G Ortiz Miranda
- Universidad Nacional de Mar del Plata, Facultad de Ciencias Agrarias, Balcarce, Bs. As., Argentina
| | - M L Testa
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Balcarce, Balcarce, Bs. As., Argentina
| | - E Pavan
- Instituto Nacional de Tecnología Agropecuaria, Estación Experimental Agropecuaria Balcarce, Balcarce, Bs. As., Argentina; Universidad Nacional de Mar del Plata, Facultad de Ciencias Agrarias, Balcarce, Bs. As., Argentina; Clemson University, Department of Animal and Veterinary Science, Clemson, SC, United States of America.
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8
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Mitchell RL, Dunlop T, Volkenandt T, Russell J, Davies P, Spooner S, Pleydell-Pearce C, Johnston R. Methods to expose subsurface objects of interest identified from 3D imaging: The intermediate sample preparation stage in the correlative microscopy workflow. J Microsc 2023; 289:107-127. [PMID: 36399637 DOI: 10.1111/jmi.13159] [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: 06/10/2022] [Revised: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022]
Abstract
The correlative imaging workflow is a method of combining information and data across modes (e.g. SEM, X-ray CT, FIB-SEM), scales (cm to nm) and dimensions (2D-3D-4D), providing a more holistic interpretation of the research question. Often, subsurface objects of interest (e.g. inclusions, pores, cracks, defects in multilayered samples) are identified from initial exploratory nondestructive 3D tomographic imaging (e.g. X-ray CT, XRM), and those objects need to be studied using additional techniques to obtain, for example, 2D chemical or crystallographic data. Consequently, an intermediate sample preparation step needs to be completed, where a targeted amount of sample surface material is removed, exposing and revealing the object of interest. At present, there is not one singular technique for removing varied thicknesses at high resolution and on a range of scales from cm to nm. Here, we review the manual and automated options currently available for targeted sample material removal, with a focus on those methods which are readily accessible in most laboratories. We summarise the approaches for manual grinding and polishing, automated grinding and polishing, microtome/ultramicrotome, and broad-beam ion milling (BBIM), with further review of other more specialist techniques including serial block face electron microscopy (SBF-SEM), and ion milling and laser approaches such as FIB-SEM, Xe plasma FIB-SEM, and femtosecond laser/LaserFIB. We also address factors which may influence the decision on a particular technique, including the composition, shape and size of the samples, sample mounting limitations, the amount of surface material to be removed, the accuracy and/or resolution of peripheral parts, the accuracy and/or resolution of the technique/instrumentation, and other more general factors such as accessibility to instrumentation, costs, and the time taken for experimentation. It is hoped that this study will provide researchers with a range of options for removal of specific amounts of sample surface material to reach subsurface objects of interest in both correlative and non-correlative workflows.
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Affiliation(s)
- R L Mitchell
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
- Sheffield Tomography Centre (STC), Kroto Research Institute, The University of Sheffield, North Campus, Sheffield, UK
| | - T Dunlop
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
| | | | - J Russell
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
| | - P Davies
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
| | - S Spooner
- Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
| | - C Pleydell-Pearce
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
| | - R Johnston
- Advanced Imaging of Materials (AIM) Core Facility, Faculty of Science and Engineering, Swansea University, Bay Campus, Swansea, UK
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9
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Davies P, Baatz R, Bogena HR, Quansah E, Amekudzi LK. Optimal Temporal Filtering of the Cosmic-Ray Neutron Signal to Reduce Soil Moisture Uncertainty. Sensors (Basel) 2022; 22:9143. [PMID: 36501844 PMCID: PMC9740698 DOI: 10.3390/s22239143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Cosmic ray neutron sensors (CRNS) are increasingly used to determine field-scale soil moisture (SM). Uncertainty of the CRNS-derived soil moisture strongly depends on the CRNS count rate subject to Poisson distribution. State-of-the-art CRNS signal processing averages neutron counts over many hours, thereby accounting for soil moisture temporal dynamics at the daily but not sub-daily time scale. This study demonstrates CRNS signal processing methods to improve the temporal accuracy of the signal in order to observe sub-daily changes in soil moisture and improve the signal-to-noise ratio overall. In particular, this study investigates the effectiveness of the Moving Average (MA), Median filter (MF), Savitzky-Golay (SG) filter, and Kalman filter (KF) to reduce neutron count error while ensuring that the temporal SM dynamics are as good as possible. The study uses synthetic data from four stations for measuring forest ecosystem-atmosphere relations in Africa (Gorigo) and Europe (SMEAR II (Station for Measuring Forest Ecosystem-Atmosphere Relations), Rollesbroich, and Conde) with different soil properties, land cover and climate. The results showed that smaller window sizes (12 h) for MA, MF and SG captured sharp changes closely. Longer window sizes were more beneficial in the case of moderate soil moisture variations during long time periods. For MA, MF and SG, optimal window sizes were identified and varied by count rate and climate, i.e., estimated temporal soil moisture dynamics by providing a compromise between monitoring sharp changes and reducing the effects of outliers. The optimal window for these filters and the Kalman filter always outperformed the standard procedure of simple 24-h averaging. The Kalman filter showed its highest robustness in uncertainty reduction at three different locations, and it maintained relevant sharp changes in the neutron counts without the need to identify the optimal window size. Importantly, standard corrections of CRNS before filtering improved soil moisture accuracy for all filters. We anticipate the improved signal-to-noise ratio to benefit CRNS applications such as detection of rain events at sub-daily resolution, provision of SM at the exact time of a satellite overpass, and irrigation applications.
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Affiliation(s)
- Patrick Davies
- Department of Meteorology and Climate Science, Kwame Nkrumah University of Science Technology, Kumasi AK-385-1973, Ghana
| | - Roland Baatz
- Leibniz Centre for Agricultural Landscape Research (ZALF), Eberswalder Str. 84, 15374 Müncheberg, Germany
| | | | - Emmanuel Quansah
- Department of Meteorology and Climate Science, Kwame Nkrumah University of Science Technology, Kumasi AK-385-1973, Ghana
| | - Leonard Kofitse Amekudzi
- Department of Meteorology and Climate Science, Kwame Nkrumah University of Science Technology, Kumasi AK-385-1973, Ghana
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10
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Evans REC, Barber V, Seaton S, Ramnarayan P, Davies P, Wray J. Is Parental Presence in the Ambulance Associated With Parental Satisfaction During Emergency Pediatric Intensive Care Retrieval? A Cross-Sectional Questionnaire Study. Pediatr Crit Care Med 2022; 23:708-716. [PMID: 35969657 DOI: 10.1097/pcc.0000000000002995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quality standards for pediatric intensive care transport services in the U.K. state that at least one parent should be allowed to travel with their child during emergency transport to a PICU. We aimed to identify the reasons why parents do, or do not, accompany their child and whether there is an association between parental presence in the ambulance and their satisfaction with the transport. DESIGN National cross-sectional parent questionnaire. SETTING Pediatric Critical Care Transport (PCCT) teams and PICUs in England and Wales. PARTICIPANTS Parents of children transferred to one of 24 participating PICUs between January 2018 and January 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A parent feedback questionnaire was completed by parents whose child received an emergency interhospital transfer. As part of the questionnaire, a brief nine-item scale was developed to summarize parental transport experience (ranging from 1 to 5). The association between parental presence in the ambulance and parental experience was analyzed. A total of 4,558 children were transported during the study. Consent was obtained from 2,838 parents, and questionnaires received in 2,084 unique transports (response rate: 45.7%). In 1,563 transports (75%), at least one parent traveled in the ambulance. Parents did not travel in 478 transports (23%) and, in most instances (442 transports; 93%), offered reasons (emotional, practical, and health-related) for declining to travel or explanations why they were not permitted to travel (mainly due to space restrictions). Most parents rated their experience with the retrieval teams very highly, and within this context, we found evidence of greater variability in experience ratings if parents were not present in the ambulance and if this was not their choice. CONCLUSIONS Most parents who completed questionnaires rated their experience with their PCCT team highly. Parental presence and choice to travel in the ambulance were associated with a more positive experience.
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Affiliation(s)
- Ruth E C Evans
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Victoria Barber
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Sarah Seaton
- Department of Health Sciences, University of Leicester, George Davies Centre, Leicester, United Kingdom
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
- Anaesthetics, Pain Medicine and Intensive Care (APMIC) Section, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Patrick Davies
- Nottingham University Hospital NHS Trust, Trust Headquarters, City Hospital Campus, Nottingham, United Kingdom
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Vairavan M, Prayle A, Davies P. The Clinical Research Bias Index (CRBI): A novel journal ranking method applied to child health respiratory studies. Health Sci Rep 2022; 5:e739. [PMID: 35949680 PMCID: PMC9358325 DOI: 10.1002/hsr2.739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background and Aims Journal impact factor has historically been taken as a proxy for quality. However, this is open to significant manipulation and bias. There is currently not widely adopted, robust journal and paper ranking metric which is focused solely on risk of bias. Methods Risk of bias data was extracted from all Cochrane database systematic reviews in Child Health, Lungs, and Airways for the years 2017–2019. A novel paper quality score, the Clinical Research Bias Index (CRBI), was applied. Individual paper data were pooled for each journal. A comparison was made to journal impact factors, individual paper citations, reads, and altmetric scores. Results 927 papers were analyzed for risk of bias. 119 (12·8%) scored a CRBI of 100%, with a mean score of 70%. A journal's overall CRBI risk of bias score was poorly correlated with impact factor (r 0.25). Citations (r 0.02), and reads (r 0.01) of individual papers showed very little association with the paper's risk of bias. Likewise, reads were not correlated with citations (r 0.03). H‐index and Altmetric scores were similarly poorly correlated with CRBI. Conclusion The novel research quality tool CRBI demonstrates the poor correlation between journal impact factor, citations, and risk of bias. Journal and paper ranking metrics should ensure that they are fit for purpose, and enable the dissemination of high‐quality research for the benefit of patients. We propose the CRBI as a potential solution which is resistant to manipulation and will reward the creation and publication of bias‐free research.
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Affiliation(s)
| | - Andrew Prayle
- University of Nottingham School of Medicine Nottingham UK
- Paediatric Respiratory, Nottingham University Hospitals NHS Trust Nottingham UK
- Paediatric Critical Care Unit, Nottingham University Hospitals NHS Trust Nottingham UK
| | - Patrick Davies
- University of Nottingham School of Medicine Nottingham UK
- Paediatric Critical Care Unit, Nottingham University Hospitals NHS Trust Nottingham UK
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Barton O, Broad G, Darling H, Dhuga Y, Emms L, Habib S, Jain R, Jeater J, Kan CYP, Kathiravelupillai A, Khatkar H, Kirmani S, Kulasabanathan K, Lacey H, Lal K, Manafa C, Mansoor M, McDonald S, Mittal A, Mustoe S, Nottrodt L, Oliver P, Papapetrou I, Pattinson F, Raja M, Reyhani H, Shahmiri A, Small O, Soni U, Aguirrezabala Armbruster B, Bunni J, Hakim MA, Hawkins-Hooker L, Howell KA, Hullait R, Jaskowska A, Ottewell L, Thomas-Jones I, Vasudev A, Clements B, Fenton J, Gill M, Haider S, Lim AJM, Maguire H, McMullan J, Nicoletti J, Samuel S, Unais MA, White N, Yao PC, Yow L, Boyle C, Brady R, Cheekoty P, Cheong J, Chew SJHL, Chow R, Ganewatta Kankanamge D, Mamer L, Mohammed B, Ng Chieng Hin J, Renji Chungath R, Royston A, Sharrad E, Sinclair R, Tingle S, Treherne K, Wyatt F, Maniarasu VS, Moug S, Appanna T, Bucknall T, Hussain F, Owen A, Parry M, Parry R, Sagua N, Spofforth K, Yuen ECT, Bosley N, Hardie W, Moore T, Regas C, Abdel-Khaleq S, Ali N, Bashiti H, Buxton-Hopley R, Constantinides M, D'Afflitto M, Deshpande A, Duque Golding J, Frisira E, Germani Batacchi M, Gomaa A, Hay D, Hutchison R, Iakovou A, Iakovou D, Ismail E, Jefferson S, Jones L, Khouli Y, Knowles C, Mason J, McCaughan R, Moffatt J, Morawala A, Nadir H, Neyroud F, Nikookam Y, Parmar A, Pinto L, Ramamoorthy R, Richards E, Thomson S, Trainer C, Valetopoulou A, Vassiliou A, Wantman A, Wilde S, Dickinson M, Rockall T, Senn D, Wcislo K, Zalmay P, Adelekan K, Allen K, Bajaj M, Gatumbu P, Hang S, Hashmi Y, Kaur T, Kawesha A, Kisiel A, Woodmass M, Adelowo T, Ahari D, Alhwaishel K, Atherton R, Clayton B, Cockroft A, Curtis Lopez C, Hilton M, Ismail N, Kouadria M, Lee L, MacConnachie A, Monks F, Mungroo S, Nikoletopoulou C, Pearce L, Sara X, Shahid A, Suresh G, Wilcha R, Atiyah A, Davies E, Dermanis A, Gibbons H, Hyde A, Lawson A, Lee C, Leung-Tack M, Li Saw Hee J, Mostafa O, Nair D, Pattani N, Plumbley-Jones J, Pufal K, Ramesh P, Sanghera J, Saram S, Scadding S, See S, Stringer H, Torrance A, Vardon H, Wyn-Griffiths F, Brew A, Kaur G, Soni D, Tickle A, Akbar Z, Appleyard T, Figg K, Jayawardena P, Johnson A, Kamran Siddiqui Z, Lacy-Colson J, Oatham R, Rowlands B, Sludden E, Turnbull C, Allin D, Ansar Z, Azeez Z, Dale VH, Garg J, Horner A, Jones S, Knight S, McGregor C, McKenna J, McLelland T, Packham-Smith A, Rowsell K, Spector-Hill I, Adeniken E, Baker J, Bartlett M, Chikomba L, Connell B, Deekonda P, Dhar M, Elmansouri A, Gamage K, Goodhew R, Hanna P, Knight J, Luca A, Maasoumi N, Mahamoud F, Manji S, Marwaha PK, Mason F, Oluboyede A, Pigott L, Razaq AM, Richardson M, Saddaoui I, Wijeyendram P, Yau S, Atkins W, Liang K, Miles N, Praveen B, Ashai S, Braganza J, Common J, Cundy A, Davies R, Guthrie J, Handa I, Iqbal M, Ismail R, Jones C, Jones I, Lee KS, Levene A, Okocha M, Olivier J, Smith A, Subramaniam E, Tandle S, Wang A, Watson A, Wilson C, Chan XHF, Khoo E, Montgomery C, Norris M, Pugalenthi PP, Common T, Cook E, Mistry H, Shinmar HS, Agarwal G, Bandyopadhyay S, Brazier B, Carroll L, Goede A, Harbourne A, Lakhani A, Lami M, Larwood J, Martin J, Merchant J, Pattenden S, Pradhan A, Raafat N, Rothwell E, Shammoon Y, Sudarshan R, Vickers E, Wingfield L, Ashworth I, Azizi S, Bhate R, Chowdhury T, Christou A, Davies L, Dwaraknath M, Farah Y, Garner J, Gureviciute E, Hart E, Jain A, Javid S, Kankam HK, Kaur Toor P, Kaz R, Kermali M, Khan I, Mattson A, McManus A, Murphy M, Nair K, Ngemoh D, Norton E, Olabiran A, Parry L, Payne T, Pillai K, Price S, Punjabi K, Raghunathan A, Ramwell A, Raza M, Ritehnia J, Simpson G, Smith W, Sodeinde S, Studd L, Subramaniam M, Thomas J, Towey S, Tsang E, Tuteja D, Vasani J, Vio M, Badran A, Adams J, Anthony Wilkinson J, Asvandi S, Austin T, Bald A, Bix E, Carrick M, Chander B, Chowdhury S, Cooper Drake B, Crosbie S, D Portela S, Francis D, Gallagher C, Gillespie R, Gravett H, Gupta P, Ilyas C, James G, Johny J, Jones A, Kinder F, MacLeod C, Macrow C, Maqsood-Shah A, Mather J, McCann L, McMahon R, Mitham E, Mohamed M, Munton E, Nightingale K, O'Neill K, Onyemuchara I, Senior R, Shanahan A, Sherlock J, Spyridoulias A, Stavrou C, Stokes D, Tamang R, Taylor E, Trafford C, Uden C, Waddington C, Yassin D, Zaman M, Bangi S, Cheng T, Chew D, Hussain N, Imani-Masouleh S, Mahasivam G, McKnight G, Ng HL, Ota HC, Pasha T, Ravindran W, Shah K, Vishnu K S, Zaman S, Carr W, Cope S, Eagles EJ, Howarth-Maddison M, Li CY, Reed J, Ridge A, Stubbs T, Teasdaled D, Umar R, Worthington J, Dhebri A, Kalenderov R, Alattas A, Arain Z, Bhudia R, Chia D, Daniel S, Dar T, Garland H, Girish M, Hampson A, Kyriacou H, Lehovsky K, Mullins W, Omorphos N, Vasdev N, Venkatesh A, Waldock W, Bhandari A, Brown G, Choa G, Eichenauer CE, Ezennia K, Kidwai Z, Lloyd-Thomas A, Macaskill Stewart A, Massardi C, Sinclair E, Skajaa N, Smith M, Tan I, Afsheen N, Anuar A, Azam Z, Bhatia P, Davies-kelly N, Dickinson S, Elkawafi M, Ganapathy M, Gupta S, Khoury EG, Licudi D, Mehta V, Neequaye S, Nita G, Tay VL, Zhao S, Botsa E, Cuthbert H, Elliott J, Furlepa M, Lehmann J, Mangtani A, Narayan A, Nazarian S, Parmar C, Shah D, Shaw C, Zhao Z, Beck C, Caldwell S, Clements JM, French B, Kenny R, Kirk S, Lindsay J, McClung A, McLaughlin N, Watson S, Whiteside E, Alyacoubi S, Arumugam V, Beg R, Dawas K, Garg S, Lloyd ER, Mahfouz Y, Manobharath N, Moonesinghe R, Morka N, Patel K, Prashar J, Yip S, Adeeko ES, Ajekigbe F, Bhat A, Evans C, Farrugia A, Gurung C, Long T, Malik B, Manirajan S, Newport D, Rayer J, Ridha A, Ross E, Saran T, Sinker A, Waruingi D, Allen R, Al Sadek Y, Alves do Canto Brum H, Asharaf H, Ashman M, Balakumar V, Barrington J, Baskaran R, Berry A, Bhachoo H, Bilal A, Boaden L, Chia WL, Covell G, Crook D, Dadnam F, Davis L, De Berker H, Doyle C, Fox C, Gruffydd-Davies M, Hafouda Y, Hill A, Hubbard E, Hunter A, Inpadhas V, Jamshaid M, Jandu G, Jeyanthi M, Jones T, Kantor C, Kwak SY, Malik N, Matt R, McNulty P, Miles C, Mohomed A, Myat P, Niharika J, Nixon A, O'Reilly D, Parmar K, Pengelly S, Price L, Ramsden M, Turnor R, Wales E, Waring H, Wu M, Yang T, Ye TTS, Zander A, Zeicu C, Bellam S, Francombe J, Kawamoto N, Rahman MR, Sathyanarayana A, Tang HT, Cheung J, Hollingshead J, Page V, Sugarman J, Wong E, Chiong J, Fung E, Kan SY, Kiang J, Kok J, Krahelski O, Liew MY, Lyell B, Sharif Z, Speake D, Alim L, Amakye NY, Chandrasekaran J, Chandratreya N, Drake J, Owoso T, Thu YM, Abou El Ela Bourquin B, Alberts J, Chapman D, Rehnnuma N, Ainsworth K, Carpenter H, Emmanuel T, Fisher T, Gabrel M, Guan Z, Hollows S, Hotouras A, Ip Fung Chun N, Jaffer S, Kallikas G, Kennedy N, Lewinsohn B, Liu FY, Mohammed S, Rutherfurd A, Situ T, Stammer A, Taylor F, Thin N, Urgesi E, Zhang N, Ahmad MA, Bishop A, Bowes A, Dixit A, Glasson R, Hatta S, Hatt K, Larcombe S, Preece J, Riordan E, Fegredo D, Haq MZ, Li C, McCann G, Stewart D, Baraza W, Bhullar D, Burt G, Coyle J, Deans J, Devine A, Hird R, Ikotun O, Manchip G, Ross C, Storey L, Tan WWL, Tse C, Warner C, Whitehead M, Wu F, Court EL, Crisp E, Huttman M, Mayes F, Robertson H, Rosen H, Sandberg C, Smith H, Al Bakry M, Ashwell W, Bajaj S, Bandyopadhyay D, Browlee O, Burway S, Chand CP, Elsayeh K, Elsharkawi A, Evans E, Ferrin S, Fort-Schaale A, Iacob M, I K, Impelliziere Licastro G, Mankoo AS, Olaniyan T, Otun J, Pereira R, Reddy R, Saeed D, Simmonds O, Singhal G, Tron K, Wickstone C, Williams R, Bradshaw E, De Kock Jewell V, Houlden C, Knight C, Metezai H, Mirza-Davies A, Seymour Z, Spink D, Wischhusen S. Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study. Lancet Digit Health 2022; 4:e520-e531. [PMID: 35750401 DOI: 10.1016/s2589-7500(22)00069-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 01/07/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. METHODS We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). FINDINGS In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]). INTERPRETATION In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. FUNDING British Journal of Surgery Society.
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Read C, Wignell A, Stewart C, Davies P. Clinical effects of hypertonic saline boluses in children with severe traumatic brain injury. J Paediatr Child Health 2022; 58:256-260. [PMID: 34427010 DOI: 10.1111/jpc.15695] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/28/2021] [Indexed: 11/28/2022]
Abstract
AIM To quantify the effects of 3% hypertonic saline (HTS) boluses on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children. METHODS A retrospective study of patients admitted to a regional neurosurgical children's intensive care unit. RESULTS A total of 156 HTS boluses were given to children with traumatic brain injury. ICP decreased 6 mmHg (P < 0.01) and CPP increased 4 mmHg (P = 0.003) 1-h post-bolus. Effects persisted for 3 h post-dose ICP was 5 mmHg lower) and 4 h post-bolus CPP was 3 mmHg higher. ICP change was not associated with pre-bolus serum sodium concentration. CONCLUSIONS Hypertonic saline 3% at 5 mL/kg is an effective osmolar therapy for reducing ICP and increasing CPP in children for up to 3 h. '53-53' is a suitable guide - 5 mL/kg of 3% HTS will on average decrease ICP by at least 5 mmHg for 3 h. Pre-bolus serum sodium concentration is not correlated with effect size.
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Affiliation(s)
- Claire Read
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom.,School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Wignell
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom.,Pharmacy Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Craig Stewart
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom.,School of Medicine, University of Nottingham, Nottingham, United Kingdom
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14
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Davies P, Davies AK, Kirkham JJ, Young AE. Secondary analysis of data from a core outcome set for burns demonstrated the need for involvement of lower income countries. J Clin Epidemiol 2021; 144:56-71. [PMID: 34906674 PMCID: PMC9094759 DOI: 10.1016/j.jclinepi.2021.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/17/2021] [Accepted: 12/07/2021] [Indexed: 11/08/2022]
Abstract
Objective To compare the views of participants from different income-status countries on outcome selection for a burn care Core Outcome Set (COS). Methods A retrospective analysis of data collected during a two round Delphi survey to prioritise the most important outcomes in burn care research. Results There was considerable agreement between participants from low- and middle-income countries (LMICs) and high-income countries (HICs) across outcomes. The groups agreed on 91% of 88 outcomes in round 1 and 92% of 100 in round 2. In cases of discordance, the consensus of participants from LMICs was to include the outcome and for participants from HICs to exclude. There was also considerable agreement between the groups for the top-ten ranking outcomes. Discordance in outcome prioritisation gives an insight into the different values clinicians from LMICs place on outcomes compared to those from HICs. Limitations of the study were that outcome rankings from international patients were not available. Healthcare professionals from LMICs were not involved in the final consensus meeting. Conclusion COS developers should consider the need for a COS to be global at protocol stage. Global COS should include equal representation from both LMICs and HICs at all stages of development.
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Affiliation(s)
- P Davies
- Bristol Centre for Surgical Research, Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, United Kingdom
| | - A K Davies
- Centre for Academic Child Health, University of Bristol, United Kingdom
| | - J J Kirkham
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - A E Young
- Bristol Centre for Surgical Research, Bristol Biomedical Research Centre, Population Health Sciences, University of Bristol, United Kingdom.
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15
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Vairavan M, Prayle A, Davies P. You are what you read: bias, journal prestige and manipulation. Arch Dis Child Educ Pract Ed 2021; 106:378-380. [PMID: 33106329 DOI: 10.1136/archdischild-2020-320246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Manishaa Vairavan
- Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Child Health, University of Nottingham, Nottingham, UK
| | - Andrew Prayle
- Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Child Health, University of Nottingham, Nottingham, UK
| | - Patrick Davies
- Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Child Health, University of Nottingham, Nottingham, UK
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16
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Abstract
This study examines 1-year outcomes of critical care patients in the UK after COVID-19 multisystem inflammatory syndrome in children.
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Affiliation(s)
- Patrick Davies
- Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Pascale du Pré
- Paediatric Intensive Care, Great Ormond Street Hospital, London, United Kingdom
| | - Jon Lillie
- Paediatric Intensive Care, Evelina Children’s Hospital, London, United Kingdom
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17
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Abstract
BACKGROUND AMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. Our objective was to compare, contrast and establish both inter-rater reliability and usability of both tools as part of two overviews of systematic reviews. Strictly speaking, one tool assesses methodological quality (AMSTAR-2) and the other assesses risk of bias (ROBIS), but there is considerable overlap between the tools in terms of the signalling questions. METHODS Three reviewers independently assessed 31 systematic reviews using both tools. The inter-rater reliability of all sub-sections using each instrument (AMSTAR-2 and ROBIS) was calculated using Gwet's agreement coefficient (AC1 for unweighted analysis and AC2 for weighted analysis). RESULTS Thirty-one systematic reviews were included. For AMSTAR-2, the median agreement for all questions was 0.61. Eight of the 16 AMSTAR-2 questions had substantial agreement or higher (> 0.61). For ROBIS, the median agreement for all questions was also 0.61. Eleven of the 24 ROBIS questions had substantial agreement or higher. CONCLUSION ROBIS is an effective tool for assessing risk of bias in systematic reviews and AMSTAR-2 is an effective tool at assessing quality. The median agreement between raters for both tools was identical (0.61). Reviews that included a meta-analysis were easier to rate with ROBIS; however, further developmental work could improve its use in reviews without a formal synthesis. AMSTAR-2 was more straightforward to use; however, more response options would be beneficial.
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Affiliation(s)
- R. Perry
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - A. Whitmarsh
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - V. Leach
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - P. Davies
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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18
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Mitchell RL, Davies P, Kenrick P, Volkenandt T, Pleydell-Pearce C, Johnston R. Correlative Microscopy: a tool for understanding soil weathering in modern analogues of early terrestrial biospheres. Sci Rep 2021; 11:12736. [PMID: 34140576 PMCID: PMC8211647 DOI: 10.1038/s41598-021-92184-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023] Open
Abstract
Correlative imaging provides a method of investigating complex systems by combining analytical (chemistry) and imaging (tomography) information across dimensions (2D-3D) and scales (centimetres-nanometres). We studied weathering processes in a modern cryptogamic ground cover from Iceland, containing early colonizing, and evolutionary ancient, communities of mosses, lichens, fungi, and bacteria. Targeted multi-scale X-ray Microscopy of a grain in-situ within a soil core revealed networks of surficial and internal features (tunnels) originating from organic-rich surface holes. Further targeted 2D grain characterisation by optical microscopy (OM), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (SEM-EDS), following an intermediate manual correlative preparation step, revealed Fe-rich nodules within the tunnels. Finally, nanotomographic imaging by focussed ion beam microscopy (FIB-SEM) revealed coccoid and filamentous-like structures within subsurface tunnels, as well as accumulations of Fe and S in grain surface crusts, which may represent a biological rock varnish/glaze. We attribute these features to biological processes. This work highlights the advantages and novelty of the correlative imaging approach, across scales, dimensions, and modes, to investigate biological weathering processes. Further, we demonstrate correlative microscopy as a means of identifying fingerprints of biological communities, which could be used in the geologic rock record and on extra-terrestrial bodies.
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Affiliation(s)
- R. L. Mitchell
- grid.4827.90000 0001 0658 8800Advanced Imaging of Materials (AIM) Facility, College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN UK ,grid.35937.3b0000 0001 2270 9879Earth Sciences Department, The Natural History Museum, Cromwell Road, London, SW7 5BD UK ,grid.11835.3e0000 0004 1936 9262Sheffield Tomography Centre (STC), The University of Sheffield, North Campus, Broad Lane, Sheffield, S3 7HQ UK
| | - P. Davies
- grid.4827.90000 0001 0658 8800Advanced Imaging of Materials (AIM) Facility, College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN UK
| | - P. Kenrick
- grid.35937.3b0000 0001 2270 9879Earth Sciences Department, The Natural History Museum, Cromwell Road, London, SW7 5BD UK
| | - T. Volkenandt
- grid.424549.a0000 0004 0379 7801Carl Zeiss Microscopy GmbH, Carl-Zeiss-Straße 22, 73447 Oberkochen, Germany
| | - C. Pleydell-Pearce
- grid.4827.90000 0001 0658 8800Advanced Imaging of Materials (AIM) Facility, College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN UK
| | - R. Johnston
- grid.4827.90000 0001 0658 8800Advanced Imaging of Materials (AIM) Facility, College of Engineering, Bay Campus, Swansea University, Swansea, SA1 8EN UK
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19
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Pritchard CE, Williams AP, Davies P, Jones D, Smith AR. Spatial behaviour of sheep during the neonatal period: Preliminary study on the influence of shelter. Animal 2021; 15:100252. [PMID: 34090091 DOI: 10.1016/j.animal.2021.100252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/16/2022] Open
Abstract
Effective shelter has been demonstrated to reduce neonatal lamb mortality rates during periods of inclement weather. Periods of high wind speed and rainfall have been shown to influence shelter usage; however, it is not yet known how ewe factors such as breed, age and body condition score influence shelter-seeking behaviour. This study, conducted on a working upland farm in the UK, examined impact of artificial shelter on the biological and climatic factors that influence peri-parturient ewe behaviour. Pregnant ewes (n = 147) were randomly allocated between two adjacent fields which were selected for their similarity in size, topography, pasture management, orientation to the prevailing wind and available natural shelter. In one field, three additional artificial shelters were installed to increase the available shelter for ewes, this field was designated the Test field; no additional artificial shelter was provided in the second field which was used as the Control field. Individual ewes were observed every 2 h between 0800 and 1600 for 14 continuous days to monitor their location relative to shelter. Ewe breed (Aberfield and Highlander), age (2-8 years) and body condition score were considered as explanatory variables to explain flock and individual variance in shelter-seeking behaviour and the prevalence of issues which required the intervention of the shepherd, termed 'shepherding problems'. Any ewe observed with dystocia, a dead or poor vigour lamb or who exhibited mismothering behaviour was recorded as a shepherding problem. The prevalence of these shepherding problems which necessitate human intervention represents arguably the most critical limiting factor for the successful management of commercial sheep flocks in outdoor lambing systems. Overall, ewes in the Test field with access to additional artificial shelter experienced fewer shepherding problems than those in the Control field (P < 0.05). A significant breed effect was also observed, with Highlander ewes more likely to seek shelter than Aberfield ewes (P < 0.001), and experiencing significantly fewer shepherding interventions (P < 0.05). These findings demonstrate the substantial and significant benefits to animal welfare and productivity that can be achieved through the provision of shelter in commercial, upland, outdoor lambing systems in the UK.
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Affiliation(s)
- C E Pritchard
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2DG, UK
| | - A P Williams
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2DG, UK.
| | - P Davies
- Department of Livestock & One Health, Institute of Infection, University of Liverpool, Neston, CH64 7TE, UK
| | - D Jones
- Innovis Ltd., Capel Dewi, Aberystwyth SY23 3HU, UK
| | - A R Smith
- School of Natural Sciences, Bangor University, Bangor, Gwynedd LL57 2DG, UK
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20
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Davies P, Lillie J, Prayle A, Evans C, Griffiths B, du Pré P, Johnson M, Krishnan Kanthimathinathan H, Playfor S, Deep A, Brierley J, Waters G, Mohammad Z, Singh D, Jardine M, Ross O, Shetty N, Worrall M, Sinha R, Koul A, Whittaker E, Vyas H, Ramnarayan P, Scholefield BR. Association Between Treatments and Short-Term Biochemical Improvements and Clinical Outcomes in Post-Severe Acute Respiratory Syndrome Coronavirus-2 Inflammatory Syndrome. Pediatr Crit Care Med 2021; 22:e285-e293. [PMID: 33767074 PMCID: PMC8096187 DOI: 10.1097/pcc.0000000000002728] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To 1) analyze the short-term biochemical improvements and clinical outcomes following treatment of children with post-severe acute respiratory syndrome coronavirus-2 inflammatory syndrome (multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2) admitted to U.K. PICUs and 2) collate current treatment guidance from U.K. PICUs. DESIGN Multicenter observational study. SETTING Twenty-one U.K. PICUs. PATIENTS Children (< 18 yr) admitted to U.K. PICUs between April 1, 2020, and May 10, 2020, fulfilling the U.K. case definition of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Routinely collected, deidentified data were analyzed. Propensity score and linear mixed effects models were used to analyze the effect of steroids, IV immunoglobulin, and biologic agents on changes in C-reactive protein, platelet counts, and lymphocyte counts over the course of PICU stay. Treatment recommendations from U.K. clinical guidelines were analyzed. Over the 6-week study period, 59 of 78 children (76%) received IV immunoglobulin, 57 of 78 (73%) steroids, and 18 of 78 (24%) a biologic agent. We found no evidence of a difference in response in clinical markers of inflammation between patients with multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 who were treated with IV immunoglobulin, steroids, or biologics, compared with those who were not. By the end of the study period, most patients had received immunomodulation. The 12 patients who did not receive any immunomodulators had similar decrease in inflammatory markers as those treated. Of the 14 guidelines analyzed, the use of IV immunoglobulin, steroids, and biologics was universally recommended. CONCLUSIONS We were unable to identify any short-term benefit from any of the treatments, or treatment combinations, administered. Despite a lack of evidence, treatment guidelines for multisystem inflammatory syndrome in children/pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus-2 have become very similar in advising step-wise treatments. Retaining clinical equipoise regarding treatment will allow clinicians to enroll children in robust clinical trials to determine the optimal treatment for this novel important condition.
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Affiliation(s)
- Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
- Child Health, University of Nottingham, Nottingham, United Kingdom
| | - Jon Lillie
- Paediatric Intensive Care Unit, Evelina Children's Hospital, London, United Kingdom
| | - Andrew Prayle
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - Claire Evans
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Benedict Griffiths
- Paediatric Intensive Care Unit, Evelina Children's Hospital, London, United Kingdom
| | - Pascale du Pré
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Mae Johnson
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | | | - Stephen Playfor
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital, London, United Kingdom
| | - Joe Brierley
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | - Gareth Waters
- Paediatric Intensive Care Unit, Evelina Children's Hospital, London, United Kingdom
| | - Zoha Mohammad
- Paediatric Intensive Care Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Davinder Singh
- Paediatric Intensive Care Unit, Leeds Royal Infirmary, Leeds, United Kingdom
| | - Michelle Jardine
- Paediatric Critical Care Unit, Children's Hospital for Wales, Cardiff, United Kingdom
| | - Oliver Ross
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, United Kingdom
| | - Nayan Shetty
- Paediatric Intensive Care Unit. Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Mark Worrall
- Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, United Kingdom
| | - Ruchi Sinha
- Paediatric Intensive Care Unit, St Mary's Hospital, London, United Kingdom
| | - Ashwani Koul
- Paediatric Critical Care Unit, John Radcliffe Hospital, Oxford, United Kingdom
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases Department, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Harish Vyas
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
- Child Health, University of Nottingham, Nottingham, United Kingdom
| | - Padmanabhan Ramnarayan
- Paediatric Intensive Care Unit, St Mary's Hospital, London, United Kingdom
- Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust and NIHR Biomedical Research Centre, London, United Kingdom
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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21
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De Rozario MR, Van Velzen LS, Davies P, Rice SM, Davey CG, Robinson J, Alvarez-Jimenez M, Allott K, McKechnie B, Felmingham KL, Schmaal L. Mental images of suicide: Theoretical framework and preliminary findings in depressed youth attending outpatient care. J Affect Disord Rep 2021; 4:100114. [PMID: 36567757 PMCID: PMC9785063 DOI: 10.1016/j.jadr.2021.100114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- MR De Rozario
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, VIC 3052, Australia. (M. De Rozario)
| | - LS Van Velzen
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - P Davies
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - SM Rice
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - CG Davey
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - J Robinson
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - K Allott
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | - KL Felmingham
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - L Schmaal
- Orygen, Parkville, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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22
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Affiliation(s)
- Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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23
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Wimmer K, Korten W, Doornenbal P, Arici T, Aguilera P, Algora A, Ando T, Baba H, Blank B, Boso A, Chen S, Corsi A, Davies P, de Angelis G, de France G, Delaroche JP, Doherty DT, Gerl J, Gernhäuser R, Girod M, Jenkins D, Koyama S, Motobayashi T, Nagamine S, Niikura M, Obertelli A, Libert J, Lubos D, Rodríguez TR, Rubio B, Sahin E, Saito TY, Sakurai H, Sinclair L, Steppenbeck D, Taniuchi R, Wadsworth R, Zielinska M. Shape Changes in the Mirror Nuclei ^{70}Kr and ^{70}Se. Phys Rev Lett 2021; 126:072501. [PMID: 33666458 DOI: 10.1103/physrevlett.126.072501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
We studied the proton-rich T_{z}=-1 nucleus ^{70}Kr through inelastic scattering at intermediate energies in order to extract the reduced transition probability, B(E2;0^{+}→2^{+}). Comparison with the other members of the A=70 isospin triplet, ^{70}Br and ^{70}Se, studied in the same experiment, shows a 3σ deviation from the expected linearity of the electromagnetic matrix elements as a function of T_{z}. At present, no established nuclear structure theory can describe this observed deviation quantitatively. This is the first violation of isospin symmetry at this level observed in the transition matrix elements. A heuristic approach may explain the anomaly by a shape change between the mirror nuclei ^{70}Kr and ^{70}Se contrary to the model predictions.
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Affiliation(s)
- K Wimmer
- Instituto de Estructura de la Materia, CSIC, E-28006 Madrid, Spain
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - W Korten
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - P Doornenbal
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - T Arici
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
- Justus-Liebig-Universität Giessen, D-35392 Giessen, Germany
| | - P Aguilera
- Comisión Chilena de Energía Nuclear, Casilla 188-D, Santiago, Chile
| | - A Algora
- Instituto de Fisica Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
- Institute of Nuclear Research of the Hungarian Academy of Sciences, Debrecen H-4026, Hungary
| | - T Ando
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H Baba
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - B Blank
- CENBG, CNRS/IN2P3, Université de Bordeaux, F-33175 Gradignan, France
| | - A Boso
- Istituto Nazionale di Fisica Nucleare, Sezione di Padova, I-35131 Padova, Italy
| | - S Chen
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - A Corsi
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - P Davies
- Department of Physics, University of York, YO10 5DD York, United Kingdom
| | - G de Angelis
- Istituto Nazionale di Fisica Nucleare, Laboratori Nazionali di Legnaro, I-35020 Legnaro, Italy
| | - G de France
- GANIL, CEA/DSM-CNRS/IN2P3, F-14076 Caen Cedex 05, France
| | | | - D T Doherty
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Gerl
- GSI Helmholtzzentrum für Schwerionenforschung, D-64291 Darmstadt, Germany
| | - R Gernhäuser
- Physik Department, Technische Universität München, D-85748 Garching, Germany
| | - M Girod
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - D Jenkins
- Department of Physics, University of York, YO10 5DD York, United Kingdom
| | - S Koyama
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - T Motobayashi
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - S Nagamine
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - M Niikura
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - A Obertelli
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
| | - J Libert
- CEA, DAM, DIF, F-91297 Arpajon, France
| | - D Lubos
- Physik Department, Technische Universität München, D-85748 Garching, Germany
| | - T R Rodríguez
- Departamento de Física Teórica and Centro de Investigación Avanzada en Física Fundamental, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
| | - B Rubio
- Instituto de Fisica Corpuscular, CSIC-Universidad de Valencia, E-46071 Valencia, Spain
| | - E Sahin
- Department of Physics, University of Oslo, PO Box 1048 Blindern, N-0316 Oslo, Norway
| | - T Y Saito
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H Sakurai
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - L Sinclair
- Department of Physics, University of York, YO10 5DD York, United Kingdom
| | - D Steppenbeck
- RIKEN Nishina Center, 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - R Taniuchi
- Department of Physics, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - R Wadsworth
- Department of Physics, University of York, YO10 5DD York, United Kingdom
| | - M Zielinska
- IRFU, CEA, Université Paris-Saclay, F-91191 Gif-sur-Yvette, France
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24
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Wilson JN, Thisse D, Lebois M, Jovančević N, Gjestvang D, Canavan R, Rudigier M, Étasse D, Gerst RB, Gaudefroy L, Adamska E, Adsley P, Algora A, Babo M, Belvedere K, Benito J, Benzoni G, Blazhev A, Boso A, Bottoni S, Bunce M, Chakma R, Cieplicka-Oryńczak N, Courtin S, Cortés ML, Davies P, Delafosse C, Fallot M, Fornal B, Fraile L, Gottardo A, Guadilla V, Häfner G, Hauschild K, Heine M, Henrich C, Homm I, Ibrahim F, Iskra ŁW, Ivanov P, Jazrawi S, Korgul A, Koseoglou P, Kröll T, Kurtukian-Nieto T, Le Meur L, Leoni S, Ljungvall J, Lopez-Martens A, Lozeva R, Matea I, Miernik K, Nemer J, Oberstedt S, Paulsen W, Piersa M, Popovitch Y, Porzio C, Qi L, Ralet D, Regan PH, Rezynkina K, Sánchez-Tembleque V, Siem S, Schmitt C, Söderström PA, Sürder C, Tocabens G, Vedia V, Verney D, Warr N, Wasilewska B, Wiederhold J, Yavahchova M, Zeiser F, Ziliani S. Angular momentum generation in nuclear fission. Nature 2021; 590:566-570. [PMID: 33627809 DOI: 10.1038/s41586-021-03304-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/09/2020] [Indexed: 01/31/2023]
Abstract
When a heavy atomic nucleus splits (fission), the resulting fragments are observed to emerge spinning1; this phenomenon has been a mystery in nuclear physics for over 40 years2,3. The internal generation of typically six or seven units of angular momentum in each fragment is particularly puzzling for systems that start with zero, or almost zero, spin. There are currently no experimental observations that enable decisive discrimination between the many competing theories for the mechanism that generates the angular momentum4-12. Nevertheless, the consensus is that excitation of collective vibrational modes generates the intrinsic spin before the nucleus splits (pre-scission). Here we show that there is no significant correlation between the spins of the fragment partners, which leads us to conclude that angular momentum in fission is actually generated after the nucleus splits (post-scission). We present comprehensive data showing that the average spin is strongly mass-dependent, varying in saw-tooth distributions. We observe no notable dependence of fragment spin on the mass or charge of the partner nucleus, confirming the uncorrelated post-scission nature of the spin mechanism. To explain these observations, we propose that the collective motion of nucleons in the ruptured neck of the fissioning system generates two independent torques, analogous to the snapping of an elastic band. A parameterization based on occupation of angular momentum states according to statistical theory describes the full range of experimental data well. This insight into the role of spin in nuclear fission is not only important for the fundamental understanding and theoretical description of fission, but also has consequences for the γ-ray heating problem in nuclear reactors13,14, for the study of the structure of neutron-rich isotopes15,16, and for the synthesis and stability of super-heavy elements17,18.
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Affiliation(s)
- J N Wilson
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France.
| | - D Thisse
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - M Lebois
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - N Jovančević
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - D Gjestvang
- Department of Physics, University of Oslo, Blindern, Oslo, Norway
| | - R Canavan
- Department of Physics, University of Surrey, Guildford, UK.,National Physical Laboratory, Teddington, UK
| | - M Rudigier
- Department of Physics, University of Surrey, Guildford, UK.,Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | | | - R-B Gerst
- Institut für Kernphysik, Universität zu Köln, Cologne, Germany
| | | | - E Adamska
- Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - P Adsley
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - A Algora
- IFIC, CSIC-University of Valencia, Valencia, Spain.,Institute for Nuclear Research (Atomki), Debrecen, Hungary
| | - M Babo
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - K Belvedere
- Department of Physics, University of Surrey, Guildford, UK
| | - J Benito
- Grupo de Fisica Nuclear & IPARCOS, Universidad Complutense de Madrid, CEI Moncloa, Madrid, Spain
| | | | - A Blazhev
- Institut für Kernphysik, Universität zu Köln, Cologne, Germany
| | - A Boso
- National Physical Laboratory, Teddington, UK
| | - S Bottoni
- INFN, Milan, Italy.,Dipartimento di Fisica, Universitá degli Studi di Milano, Milan, Italy
| | - M Bunce
- National Physical Laboratory, Teddington, UK
| | - R Chakma
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | | | - S Courtin
- Université de Strasbourg, CNRS, IPHC UMR 7178, Strasbourg, France
| | | | - P Davies
- School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - C Delafosse
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - M Fallot
- Subatech, IMT-Atlantique, Université de Nantes, Nantes, France
| | - B Fornal
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - L Fraile
- Grupo de Fisica Nuclear & IPARCOS, Universidad Complutense de Madrid, CEI Moncloa, Madrid, Spain
| | - A Gottardo
- INFN Laboratori Nazionali di Legnaro, Legnaro, Italy
| | - V Guadilla
- Subatech, IMT-Atlantique, Université de Nantes, Nantes, France
| | - G Häfner
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France.,Institut für Kernphysik, Universität zu Köln, Cologne, Germany
| | - K Hauschild
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - M Heine
- Université de Strasbourg, CNRS, IPHC UMR 7178, Strasbourg, France
| | - C Henrich
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | - I Homm
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | - F Ibrahim
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - Ł W Iskra
- INFN, Milan, Italy.,Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - P Ivanov
- National Physical Laboratory, Teddington, UK
| | - S Jazrawi
- Department of Physics, University of Surrey, Guildford, UK.,National Physical Laboratory, Teddington, UK
| | - A Korgul
- Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - P Koseoglou
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany.,GSI Helmoltzzentrum für Schwerionenforschung GmbH, Darmstadt, Germany
| | - T Kröll
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | | | - L Le Meur
- Subatech, IMT-Atlantique, Université de Nantes, Nantes, France
| | - S Leoni
- INFN, Milan, Italy.,Dipartimento di Fisica, Universitá degli Studi di Milano, Milan, Italy
| | - J Ljungvall
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - A Lopez-Martens
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - R Lozeva
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - I Matea
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - K Miernik
- Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - J Nemer
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - S Oberstedt
- European Commission, Joint Research Centre, Geel, Belgium
| | - W Paulsen
- Department of Physics, University of Oslo, Blindern, Oslo, Norway
| | - M Piersa
- Faculty of Physics, University of Warsaw, Warsaw, Poland
| | - Y Popovitch
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - C Porzio
- INFN, Milan, Italy.,Dipartimento di Fisica, Universitá degli Studi di Milano, Milan, Italy.,TRIUMF, Vancouver, British Columbia, Canada
| | - L Qi
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - D Ralet
- Grand Accélérateur National d'Ions Lourds, Caen, France
| | - P H Regan
- Department of Physics, University of Surrey, Guildford, UK.,National Physical Laboratory, Teddington, UK
| | - K Rezynkina
- Institute for Nuclear and Radiation Physics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - V Sánchez-Tembleque
- Grupo de Fisica Nuclear & IPARCOS, Universidad Complutense de Madrid, CEI Moncloa, Madrid, Spain
| | - S Siem
- Department of Physics, University of Oslo, Blindern, Oslo, Norway
| | - C Schmitt
- Université de Strasbourg, CNRS, IPHC UMR 7178, Strasbourg, France
| | - P-A Söderström
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany.,Extreme Light Infrastructure-Nuclear Physics, Horia Hulubei National Institute for Physics and Nuclear Engineering, Bucharest-Măgurele, Romania
| | - C Sürder
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | - G Tocabens
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - V Vedia
- Grupo de Fisica Nuclear & IPARCOS, Universidad Complutense de Madrid, CEI Moncloa, Madrid, Spain
| | - D Verney
- Université Paris-Saclay, CNRS/IN2P3, IJC Laboratory, Orsay, France
| | - N Warr
- Institut für Kernphysik, Universität zu Köln, Cologne, Germany
| | - B Wasilewska
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - J Wiederhold
- Technische Universität Darmstadt, Fachbereich Physik, Institut für Kernphysik, Darmstadt, Germany
| | - M Yavahchova
- Institute for Nuclear Research and Nuclear Energy, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | - F Zeiser
- Department of Physics, University of Oslo, Blindern, Oslo, Norway
| | - S Ziliani
- INFN, Milan, Italy.,Dipartimento di Fisica, Universitá degli Studi di Milano, Milan, Italy
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25
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Zahid A, Raffaj D, Wignell A, Davies P. Continuous Drug Delivery is Significantly Affected by Relative Height Changes Between Patient and Syringe Driver. J Patient Saf 2021; 17:e15-e19. [PMID: 32175967 DOI: 10.1097/pts.0000000000000645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Syringe drivers are the principle method of giving small-volume continuous infusions of important drugs to patients. Many of these drugs are critical for the maintenance of normal physiology. Anecdotal evidence abounds of severe patient instability on movement of syringe drivers during infusion. We aimed to define the variation in drug delivery seen in three syringe drivers, with changes in relative height between the syringe driver and the end of the giving set. DESIGN Three syringe drivers (Alaris CC [Becton Dickinson], Perfusor Space [B Braun], and Synamed μSP6000 [Arcomed]) were analyzed for reliability of flow at 0.5, 1, 2, and 5 mL/h. SETTING AND SUBJECTS This is an in vitro investigation. INTERVENTIONS A small air bubble was introduced into the giving set, and the progression of this was documented before and after a vertical movement of the syringe driver by 25 or 50 cm upward or downward relative to the delivery port. MEASUREMENTS AND MAIN RESULTS For all pumps, delivery was interrupted on movement of the pumps downward, and a bolus was given with movement of the pump upward. Delivery halted at lower pump speeds for longer than higher pump speeds. The maximum delivery interruption was 11.8 minutes. Boluses given on moving the pump up were calculated as the equivalent number of minutes needed to deliver the bolus volume at steady state. The maximum bolus given was equivalent to 15.8 minutes of delivery. We were unable to eliminate the effects seen by very slow, steady movement of the pumps up or down. Static height differences made no difference to delivery. CONCLUSIONS Syringe drivers should not be moved vertically in relation to the patient. Critical drug delivery is interrupted for up to 12 minutes with relative downward movements, and significant boluses of drugs are given with relative upward movements. As far as possible, elimination of relative height movements is advised, and extreme caution is necessary if any movements are unavoidable.
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Abstract
The novel post SARS-COV2 Paediatric Inflammatory Syndrome, first recognized in April 2020, took worldwide clinicians by surprise. There rapidly followed a plethora of case definitions, nomenclatures, descriptive papers, and guidelines on treatment. There has been controversy around this condition. Is it really new? Is it an atypical form of a known disease? How should we communicate and report such cases? What is the pathogenesis? Which treatments are given, and which are effective? What are the short and long-term outcomes? We are all learning fast. The clinical and immunological patterns seen are unique. There are significant differences in both presentation and pathogenesis to any known condition, including Kawasaki's disease. This implies that treatments are not necessarily transferrable: and indeed it is unknown which treatments are effective at all. Outcomes, as far as are known, are good, but long term data is lacking. The international cooperation has been an example of how today's connected medicine can be a force for good, however calm assessment of evidence remains necessary to ensure the best outcomes for our patients. This short article identifies what we have learnt from the first surge of COVID-19 cases about paediatric inflammatory syndrome and how it affects children.
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Affiliation(s)
- Claire Evans
- , Senior Registrar in Paediatric Intensive Care, Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK. Conflicts of interest: none declared.,, Consultant in Paediatric Intensive Care, Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK. Conflicts of interest: none declared
| | - Patrick Davies
- , Senior Registrar in Paediatric Intensive Care, Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK. Conflicts of interest: none declared.,, Consultant in Paediatric Intensive Care, Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK. Conflicts of interest: none declared
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27
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Abstract
OBJECTIVE To analyse the therapeutic effects and toxicity of the eponymous concoction described in Roald Dahl's book George's Marvellous Medicine. DESIGN Literature review. SETTING Two literature loving households in England. PARTICIPANTS George Kranky and grandma Kranky. MAIN OUTCOME MEASURES Clinical and toxic effects of the individual ingredients checked against those listed in ToxBase, the National Poisons Information Service's poisons database. RESULTS The medicine contained 34 ingredients. The most common toxic effect identified on ToxBase was nausea and vomiting (16 ingredients, 47%). Potentially life threatening effects were associated with 13 (38%) ingredients, including depression of the central nervous system, kidney injury, convulsions, cardiac toxicity, and mucosal erosion. The effects described in the book were accurate initially but then diverted from the most likely clinical outcome (death). CONCLUSIONS Although Dahl ought to be applauded for his initial accuracy about the toxicology of the ingredients in George's marvellous medicine, the overall effect would be fatal catastrophic physiological collapse. Scientific exploration and experimentation should be encouraged in children, although any medicinal ingredients need to be checked for potential toxicity before being administered-to grandmas or anyone else.
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Affiliation(s)
- Graham Johnson
- Emergency Department, University Hospitals of Derby and Burton NHS Foundation Trust, Royal Derby Hospital, Derby DE22 3NE, UK
- University of Nottingham School of Medicine, Nottingham, UK
| | - Patrick Davies
- University of Nottingham School of Medicine, Nottingham, UK
- Paediatric Critical Care Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
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28
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Abstract
We report a case of hypersensitivity pneumonitis (HP) in a young person secondary to vaping. He presented with a putative diagnosis of asthma and required extracorporeal membrane oxygenationbecause of intractable respiratory failure. He developed a critical illness and steroid myopathy and required prolonged rehabilitation. Our patient fulfils diagnostic criteria for HP secondary to e-cigarettes with a positive exposure history, deterioration after skin prick testing, specific serum IgM antibodies against the implicated liquid raising the possibility that the relevant antigen was present in that liquid and radiological and histopathological features compatible with acute HP. There are two learning points. The first is always to consider a reaction to e-cigarettes in someone presenting with an atypical respiratory illness. The second is that we consider e-cigarettes as 'much safer than tobacco' at our peril.
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Affiliation(s)
- Nisha Nair
- Paediatric Therapy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Matthew Hurley
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Simon Gates
- Paediatric Therapy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Patrick Davies
- Department of Paediatric Critical Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - I-Ling Chen
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Ian Todd
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lucy Fairclough
- Academic Immunology, School of Life Sciences, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Andrew Bush
- Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jayesh Mahendra Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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29
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Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, Johnson M, Griffiths B, du Pré P, Mohammad Z, Deep A, Playfor S, Singh D, Inwald D, Jardine M, Ross O, Shetty N, Worrall M, Sinha R, Koul A, Whittaker E, Vyas H, Scholefield BR, Ramnarayan P. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health 2020; 4:669-677. [PMID: 32653054 PMCID: PMC7347350 DOI: 10.1016/s2352-4642(20)30215-7] [Citation(s) in RCA: 291] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND In April, 2020, clinicians in the UK observed a cluster of children with unexplained inflammation requiring admission to paediatric intensive care units (PICUs). We aimed to describe the clinical characteristics, course, management, and outcomes of patients admitted to PICUs with this condition, which is now known as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). METHODS We did a multicentre observational study of children (aged <18 years), admitted to PICUs in the UK between April 1 and May 10, 2020, fulfilling the case definition of PIMS-TS published by the Royal College of Paediatrics and Child Health. We analysed routinely collected, de-identified data, including demographic details, presenting clinical features, underlying comorbidities, laboratory markers, echocardiographic findings, interventions, treatments, and outcomes; serology information was collected if available. PICU admission rates of PIMS-TS were compared with historical trends of PICU admissions for four similar inflammatory conditions (Kawasaki disease, toxic shock syndrome, haemophagocytic lymphohistiocytosis, and macrophage activation syndrome). FINDINGS 78 cases of PIMS-TS were reported by 21 of 23 PICUs in the UK. Historical data for similar inflammatory conditions showed a mean of one (95% CI 0·85-1·22) admission per week, compared to an average of 14 admissions per week for PIMS-TS and a peak of 32 admissions per week during the study period. The median age of patients was 11 years (IQR 8-14). Male patients (52 [67%] of 78) and those from ethnic minority backgrounds (61 [78%] of 78) were over-represented. Fever (78 [100%] patients), shock (68 [87%]), abdominal pain (48 [62%]), vomiting (49 [63%]), and diarrhoea (50 [64%]) were common presenting features. Longitudinal data over the first 4 days of admission showed a serial reduction in C-reactive protein (from a median of 264 mg/L on day 1 to 96 mg/L on day 4), D-dimer (4030 μg/L to 1659 μg/L), and ferritin (1042 μg/L to 757 μg/L), whereas the lymphocyte count increased to more than 1·0 × 109 cells per L by day 3 and troponin increased over the 4 days (from a median of 157 ng/mL to 358 ng/mL). 36 (46%) of 78 patients were invasively ventilated and 65 (83%) needed vasoactive infusions; 57 (73%) received steroids, 59 (76%) received intravenous immunoglobulin, and 17 (22%) received biologic therapies. 28 (36%) had evidence of coronary artery abnormalities (18 aneurysms and ten echogenicity). Three children needed extracorporeal membrane oxygenation, and two children died. INTERPRETATION During the study period, the rate of PICU admissions for PIMS-TS was at least 11-fold higher than historical trends for similar inflammatory conditions. Clinical presentations and treatments varied. Coronary artery aneurysms appear to be an important complication. Although immediate survival is high, the long-term outcomes of children with PIMS-TS are unknown. FUNDING None.
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Affiliation(s)
- Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK.
| | - Claire Evans
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | | | - Jon Lillie
- Paediatric Intensive Care Unit, Evelina Children's Hospital, London, UK
| | - Joseph Brierley
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - Gareth Waters
- Paediatric Intensive Care Unit, Evelina Children's Hospital, London, UK
| | - Mae Johnson
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | | | - Pascale du Pré
- Paediatric Intensive Care Unit, Great Ormond Street Hospital, London, UK
| | - Zoha Mohammad
- Paediatric Intensive Care Unit, Leicester Royal Infirmary, Leicester, UK
| | - Akash Deep
- Paediatric Intensive Care Unit, King's College Hospital, London, UK
| | - Stephen Playfor
- Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK
| | - Davinder Singh
- Paediatric Intensive Care Unit, Leeds Royal Infirmary, Leeds, UK
| | - David Inwald
- Paediatric Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Michelle Jardine
- Paediatric Critical Care Unit, Children's Hospital for Wales, Cardiff, UK
| | - Oliver Ross
- Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK
| | - Nayan Shetty
- Paediatric Intensive Care Unit, Alder Hey Children's Hospital, Liverpool, UK
| | - Mark Worrall
- Paediatric Intensive Care Unit, Royal Hospital for Children, Glasgow, UK
| | - Ruchi Sinha
- Paediatric Intensive Care Unit, St Mary's Hospital, London, UK
| | - Ashwani Koul
- Paediatric Critical Care Unit, John Radcliffe Hospital, Oxford, UK
| | - Elizabeth Whittaker
- Paediatric Infectious Diseases Department, Imperial College Healthcare NHS Trust, London, UK
| | - Harish Vyas
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Barnaby R Scholefield
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Padmanabhan Ramnarayan
- Paediatric Intensive Care Unit, St Mary's Hospital, London, UK; Children's Acute Transport Service, Great Ormond Street Hospital NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
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30
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Eckstein OS, Nuchtern JG, Mallory GB, Guillerman RP, Musick MA, Barclay M, Bhatt JM, Davies P, Grundy RG, Martin A, Hilliard T, Lowis SP, Picton S, Nanduri V, Visser J, Allen CE, McClain KL. Management of severe pulmonary Langerhans cell histiocytosis in children. Pediatr Pulmonol 2020; 55:2074-2081. [PMID: 32511892 PMCID: PMC7771630 DOI: 10.1002/ppul.24822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/21/2020] [Accepted: 05/06/2020] [Indexed: 01/17/2023]
Abstract
Patients with pulmonary Langerhans cell histiocytosis (LCH) typically have a benign course but may have extensive cystic lung disease with rare life-threatening complications including multiple and recurrent pneumothoraces and respiratory failure. We report seven severely affected pediatric patients treated with chemotherapy, aggressive chest tube management, and pleurodesis of whom five survived. Patients with extraordinary amounts of pulmonary cystic disease and multiple pneumothoraces due to LCH can have remarkable, curative outcomes with early recognition, optimal LCH-directed therapy, and supportive care.
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Affiliation(s)
- Olive S Eckstein
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas.,Michael E. DeBakey Department of Pediatric Surgery, Baylor College of Medicine, Houston, Texas
| | - George B Mallory
- Division of Pulmonology, Texas Children's Hospital, Houston, Texas
| | - R Paul Guillerman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas
| | - Matthew A Musick
- Section of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Mhairi Barclay
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Jayesh M Bhatt
- Department of Paediatric Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Patrick Davies
- Department of Paediatric Intensive Care, Nottingham University Hospitals, Nottingham, UK
| | - Richard G Grundy
- Department of Paediatric Oncology, Nottingham University Hospitals, Nottingham, UK
| | - Alice Martin
- Department of Paediatric Intensive Care, Bristol Children's Hospital, Bristol, UK
| | - Tom Hilliard
- Department of Paediatric Respiratory Medicine, Bristol Children's Hospital, Bristol, UK
| | - Stephen P Lowis
- Department of Paediatric Oncology, Bristol Royal Hospital for Children, Bristol, UK
| | - Susan Picton
- Department of Paediatric Oncology, Leeds Children's Hospital, Leeds, UK
| | - Vasanta Nanduri
- Department of Paediatrics, Watford General Hospital, Watford, UK
| | - Johannes Visser
- Department of Paediatric Oncology, Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Carl E Allen
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Kenneth L McClain
- Department of Pediatrics, Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas.,Division of Pediatric Hematology-Oncology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas
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31
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Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F, Brierley J, McDougall M, Carter M, Tremoulet A, Shimizu C, Herberg J, Burns JC, Lyall H, Levin M. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020. [PMID: 32511692 DOI: 10.1001/jama,2020,10369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
IMPORTANCE In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation. OBJECTIVES To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders. DESIGN, SETTING, AND PARTICIPANTS Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019. EXPOSURES Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization. MAIN OUTCOMES AND MEASURES Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders. RESULTS Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively). CONCLUSIONS AND RELEVANCE In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Infection, Immunity, and Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Julia Kenny
- Department of Paediatric Infectious Diseases, Evelina London Children's Hospital, London, United Kingdom
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, United Kingdom
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Priyen Shah
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Children's Acute Transport Service, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, United Kingdom
- Institute in Child Health, King's College Hospital, London, United Kingdom
| | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, United Kingdom
| | - Filip Kucera
- Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Joe Brierley
- Paediatric Intensive Care, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Marilyn McDougall
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, United Kingdom
- Paediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - Michael Carter
- Department of Women and Children's Health, School of Life Course Sciences, Kings College London, London, United Kingdom
- Paediatric Intensive Care, Evelina London Children's Hospital, London, United Kingdom
| | - Adriana Tremoulet
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Chisato Shimizu
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Jethro Herberg
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Jane C Burns
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Levin
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
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32
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Whittaker E, Bamford A, Kenny J, Kaforou M, Jones CE, Shah P, Ramnarayan P, Fraisse A, Miller O, Davies P, Kucera F, Brierley J, McDougall M, Carter M, Tremoulet A, Shimizu C, Herberg J, Burns JC, Lyall H, Levin M. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020; 324:259-269. [PMID: 32511692 PMCID: PMC7281356 DOI: 10.1001/jama.2020.10369] [Citation(s) in RCA: 1108] [Impact Index Per Article: 277.0] [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: 05/15/2020] [Accepted: 05/29/2020] [Indexed: 12/12/2022]
Abstract
Importance In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation. Objectives To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders. Design, Setting, and Participants Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n = 1132), KD shock syndrome (n = 45), and toxic shock syndrome (n = 37) who had been admitted to hospitals in Europe and the US from 2002 to 2019. Exposures Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization. Main Outcomes and Measures Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders. Results Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 20 girls [34%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively). Conclusions and Relevance In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.
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Affiliation(s)
- Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Infection, Immunity, and Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Julia Kenny
- Department of Paediatric Infectious Diseases, Evelina London Children’s Hospital, London, United Kingdom
- Department of Women and Children’s Health, School of Life Course Sciences, Kings College London, London, United Kingdom
| | - Myrsini Kaforou
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Christine E. Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Priyen Shah
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Children’s Acute Transport Service, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Alain Fraisse
- Paediatric Cardiology Services, Royal Brompton Hospital, London, United Kingdom
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children’s Hospital, London, United Kingdom
- Institute in Child Health, King’s College Hospital, London, United Kingdom
| | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children’s Hospital, Nottingham, United Kingdom
| | - Filip Kucera
- Cardiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Joe Brierley
- Paediatric Intensive Care, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Marilyn McDougall
- Department of Women and Children’s Health, School of Life Course Sciences, Kings College London, London, United Kingdom
- Paediatric Intensive Care, Evelina London Children’s Hospital, London, United Kingdom
| | - Michael Carter
- Department of Women and Children’s Health, School of Life Course Sciences, Kings College London, London, United Kingdom
- Paediatric Intensive Care, Evelina London Children’s Hospital, London, United Kingdom
| | - Adriana Tremoulet
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Chisato Shimizu
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Jethro Herberg
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Jane C. Burns
- Kawasaki Disease Research Center, Department of Pediatrics, University of California San Diego
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael Levin
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
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33
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McLean KA, Ahmed WUR, Akhbari M, Claireaux HA, English C, Frost J, Henshall DE, Khan M, Kwek I, Nicola M, Rehman S, Varghese S, Drake TM, Bell S, Nepogodiev D, McLean KA, Drake TM, Glasbey JC, Borakati A, Drake TM, Kamarajah S, McLean KA, Bath MF, Claireaux HA, Gundogan B, Mohan M, Deekonda P, Kong C, Joyce H, Mcnamee L, Woin E, Burke J, Khatri C, Fitzgerald JE, Harrison EM, Bhangu A, Nepogodiev D, Arulkumaran N, Bell S, Duthie F, Hughes J, Pinkney TD, Prowle J, Richards T, Thomas M, Dynes K, Patel M, Patel P, Wigley C, Suresh R, Shaw A, Klimach S, Jull P, Evans D, Preece R, Ibrahim I, Manikavasagar V, Smith R, Brown FS, Deekonda P, Teo R, Sim DPY, Borakati A, Logan AE, Barai I, Amin H, Suresh S, Sethi R, Bolton W, Corbridge O, Horne L, Attalla M, Morley R, Robinson C, Hoskins T, McAllister R, Lee S, Dennis Y, Nixon G, Heywood E, Wilson H, Ng L, Samaraweera S, Mills A, Doherty C, Woin E, Belchos J, Phan V, Chouari T, Gardner T, Goergen N, Hayes JDB, MacLeod CS, McCormack R, McKinley A, 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Livesey C, McLachlan G, Mohammad M, Pranesh N, Richards C, Ross F, Sajid M, Brooke M, Francombe J, Gresly J, Hutchinson S, Kerrigan K, Matthews E, Nur S, Parsons L, Sandhu A, Vyas M, White F, Zulkifli A, Zuzarte L, Al-Mousawi A, Arya J, Azam S, Yahaya AA, Gill K, Hallan R, Hathaway C, Leptidis I, McDonagh L, Mitrasinovic S, Mushtaq N, Pang N, Peiris GB, Rinkoff S, Chan L, Christopher E, Farhan-Alanie MMH, Gonzalez-Ciscar A, Graham CJ, Lim H, McLean KA, Paterson HM, Rogers A, Roy C, Rutherford D, Smith F, Zubikarai G, Al-Khudairi R, Bamford M, Chang M, Cheng J, Hedley C, Joseph R, Mitchell B, Perera S, Rothwell L, Siddiqui A, Smith J, Taylor K, Wright OW, Baryan HK, Boyd G, Conchie H, Cox L, Davies J, Gardner S, Hill N, Krishna K, Lakin F, Scotcher S, Alberts J, Asad M, Barraclough J, Campbell A, Marshall D, Wakeford W, Cronbach P, D'Souza F, Gammeri E, Houlton J, Hall M, Kethees A, Patel R, Perera M, Prowle J, Shaid M, Webb E, Beattie S, Chadwick M, El-Taji O, Haddad S, Mann M, Patel M, Popat K, Rimmer L, Riyat H, Smith H, Anandarajah C, Cipparrone M, Desai K, Gao C, Goh ET, Howlader M, Jeffreys N, Karmarkar A, Mathew G, Mukhtar H, Ozcan E, Renukanthan A, Sarens N, Sinha C, Woolley A, Bogle R, Komolafe O, Loo F, Waugh D, Zeng R, Crewe A, Mathias J, Mills A, Owen A, Prior A, Saunders I, Baker A, Crilly L, McKeon J, Ubhi HK, Adeogun A, Carr R, Davison C, Devalia S, Hayat A, Karsan RB, Osborne C, Scott K, Weegenaar C, Wijeyaratne M, Babatunde F, Barnor-Ahiaku E, Beattie G, Chitsabesan P, Dixon O, Hall N, Ilenkovan N, Mackrell T, Nithianandasivam N, Orr J, Palazzo F, Saad M, Sandland-Taylor L, Sherlock J, Ashdown T, Chandler S, Garsaa T, Lloyd J, Loh SY, Ng S, Perkins C, Powell-Chandler A, Smith F, Underhill R. Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Br J Surg 2020; 107:1023-1032. [PMID: 32026470 DOI: 10.1002/bjs.11453] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/21/2019] [Accepted: 11/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. METHODS This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. RESULTS A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). CONCLUSION There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.
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Hammond S, Wignell A, Cooling P, Barrett DA, Davies P. Plasma-Lyte 148 and Plasma-Lyte 148 + 5% glucose compatibility with commonly used critical care drugs. Intensive Care Med Exp 2020; 8:25. [PMID: 32577941 PMCID: PMC7311557 DOI: 10.1186/s40635-020-00311-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/26/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Plasma-Lyte is a balanced, crystalloid intravenous fluid which has been shown to avoid the hyperchloremic metabolic acidosis associated with 0.9% sodium chloride. Data on physical, pH and chemical compatibility with other medicines are essential. METHODS The compatibility of adrenaline, dobutamine, dopamine, furosemide, midazolam, morphine and milrinone with Plasma-Lyte 148 (PLA) and Plasma-Lyte 148 with 5% glucose (PLA-G) was investigated. Control solutions were 0.9% sodium chloride and 5% glucose. Chemical stability was defined as < 5% concentration change with high-performance liquid chromatography (HPLC). Physical compatibility was assessed by checking for colour changes and precipitate formation. The pH of the admixtures was considered acceptable if between 5 and 9 at all time points. Six repeats were carried out for HPLC, 2 for physical compatibility checks and pH measurements, with all admixtures being tested at 0, 2 and 24 h after mixing. RESULTS All combinations were found to be chemically stable at 0, 2 and 24 h apart from furosemide with PLA-G at 24 h and midazolam with PLA or PLA-G at both 2 and 24 h. Only midazolam was physically incompatible when mixed with both Plasma-Lyte solutions. The pH remained stable in all admixtures, although not all pH values recorded were within the range of 5-9. CONCLUSION All drugs excluding furosemide and midazolam were shown to be chemically, physically and pH stable at the tested concentrations when diluted with PLA and PLA-G.
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Affiliation(s)
- Sophie Hammond
- School of Medicine, University of Nottingham, Nottingham, UK
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Derby Road, Nottingham, UK
| | - Andrew Wignell
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Derby Road, Nottingham, UK
- Pharmacy Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Paul Cooling
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - David A Barrett
- Division of Advanced Materials and Healthcare Technologies, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Patrick Davies
- School of Medicine, University of Nottingham, Nottingham, UK.
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Derby Road, Nottingham, UK.
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Seaton SE, Ramnarayan P, Pagel C, Davies P, Draper ES. Impact on 30-day survival of time taken by a critical care transport team to reach the bedside of critically ill children. Intensive Care Med 2020; 46:1953-1955. [PMID: 32572530 DOI: 10.1007/s00134-020-06149-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Patrick Davies
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Elizabeth S Draper
- Department of Health Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
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Seaton SE, Ramnarayan P, Davies P, Hudson E, Morris S, Pagel C, Rajah F, Wray J, Draper ES. Does time taken by paediatric critical care transport teams to reach the bedside of critically ill children affect survival? A retrospective cohort study from England and Wales. BMC Pediatr 2020; 20:301. [PMID: 32560633 PMCID: PMC7304220 DOI: 10.1186/s12887-020-02195-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Background Reaching the bedside of a critically ill child within three hours of agreeing the child requires intensive care is a key target for Paediatric Critical Care Transport teams (PCCTs) to achieve in the United Kingdom. Whilst timely access to specialist care is necessary for these children, it is unknown to what extent time taken for the PCCT to arrive at the bedside affects clinical outcome. Methods Data from transports of critically ill children who were admitted to Paediatric Intensive Care Units (PICUs) in England and Wales from 1 January 2014 to 31 December 2016 were extracted from the Paediatric Intensive Care Audit Network (PICANet) and linked with adult critical care data and Office for National Statistics mortality data. Logistic regression models, adjusted for pre-specified confounders, were fitted to investigate the impact of time-to-bedside on mortality within 30 days of admission and other key time points. Negative binomial models were used to investigate the impact of time-to-bedside on PICU length of stay and duration of invasive ventilation. Results There were 9116 children transported during the study period, and 645 (7.1%) died within 30 days of PICU admission. There was no evidence that 30-day mortality changed as time-to-bedside increased. A similar relationship was seen for mortality at other pre-selected time points. In children who waited longer for a team to arrive, there was limited evidence of a small increase in PICU length of stay (expected number of days increased from: 7.17 to 7.58). Conclusion There is no evidence that reducing the time-to-bedside target for PCCTs will improve the survival of critically ill children. A shorter time to bedside may be associated with a small reduction in PICU length of stay.
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Affiliation(s)
- Sarah E Seaton
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital NHS Foundation Trust, London, UK.,Respiratory, Critical Care and Anaesthesia Section, Infection, Immunity and Inflammation Research & Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Patrick Davies
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Emma Hudson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christina Pagel
- Clinical Operational Research Unit, University College London, London, UK
| | - Fatemah Rajah
- Yorkshire and Humber Infant and Children's Transport Service (Embrace), Barnsley, UK
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, University Road, Leicester, UK.
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Nelson D, Edwards S, Ennis O, Morgan A, Samir H, Davies P, Hopkins S. Musculoskeletal MRI requesting is an overused resource: can a multi-disciplinary group reduced inappropriate referrals from primary care to secondary care? Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Davies P, Silvestre C. Electrical impedance tomography in clinical use: Unnecessary technology or a unique angle in respiratory monitoring? Pediatr Pulmonol 2020; 55:845-846. [PMID: 31995665 DOI: 10.1002/ppul.24668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Catarina Silvestre
- Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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Sheppeard R, Samuels A, Davies P. i-DERMIFY: does using practical illustration and verbal description in a game format improve recognition and confidence in describing common skin diseases? Clin Exp Dermatol 2020; 45:610-611. [PMID: 32017161 DOI: 10.1111/ced.14189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 01/06/2020] [Accepted: 02/01/2020] [Indexed: 11/28/2022]
Affiliation(s)
- R Sheppeard
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
| | - A Samuels
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
| | - P Davies
- Gloucestershire Academy (University of Bristol), Gloucestershire Hospital NHS Foundation Trust, Gloucester, UK
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Lima E, Lovatt F, Davies P, Kaler J. Using lamb sales data to investigate associations between implementation of disease preventive practices and sheep flock performance. Animal 2019; 13:2630-2638. [PMID: 31094306 DOI: 10.1017/s1751731119001058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the UK is the largest lamb meat producer in Europe, there are limited data available on sheep flock performance and on how sheep farmers manage their flocks. The aims of this study were to gather evidence on the types of disease control practices implemented in sheep flocks, and to explore husbandry factors associated with flock productivity. A questionnaire focusing on farm characteristics, general husbandry and flock health management was carried out in 648 farms located in the UK over summer 2016. Abattoir sales data (lamb sales over 12 months) was compared with the number of breeding ewes on farm to estimate flock productivity (number of lambs sold for meat per 100 ewes per farm per year). Results of a multivariable linear regression model, conducted on 615 farms with complete data, indicated that farms vaccinating ewes against abortion and clostridial agents and administering a group 4/5 anthelmintic to ewes (as recommended by the Sustainable Control of Parasites in Sheep Initiative) during quarantining had a greater flock productivity than farms not implementing these actions (P<0.01 and 0.02, respectively). Flocks with maternal breed types had higher productivity indexes compared with flocks with either pure hill or terminal breeds (P<0.01). Farms weighing lambs during lactation had greater productivity than those not weighing (P<0.01). Importantly, these actions were associated with other disease control practices, for example, treating individual lame ewes with an antibiotic injection, weaning lambs between 13 and 15 weeks of age and carrying out faecal egg counts, suggesting that an increase in productivity may be associated with the combined effect of these factors. This study provides new evidence on the positive relationship between sheep flock performance and disease control measures and demonstrates that lamb sales data can be used as a baseline source of information on flock performance and for farm benchmarking. Further research is needed to explore additional drivers of flock performance.
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Affiliation(s)
- E Lima
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - F Lovatt
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - P Davies
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
| | - J Kaler
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Leicestershire, United Kingdom
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Davies P. A personal tribute to Peter Ormerod. Int J Tuberc Lung Dis 2019. [DOI: 10.5588/ijtld.19.0392] [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: 11/10/2022] Open
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42
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Le Guen-Geffroy A, Le Gac PY, Habert B, Davies P. Physical ageing of epoxy in a wet environment: Coupling between plasticization and physical ageing. Polym Degrad Stab 2019. [DOI: 10.1016/j.polymdegradstab.2019.108947] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Mitchell RL, Coleman M, Davies P, North L, Pope EC, Pleydell-Pearce C, Harris W, Johnston R. Macro-to-nanoscale investigation of wall-plate joints in the acorn barnacle Semibalanus balanoides: correlative imaging, biological form and function, and bioinspiration. J R Soc Interface 2019; 16:20190218. [PMID: 31387487 PMCID: PMC6731510 DOI: 10.1098/rsif.2019.0218] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/26/2019] [Accepted: 06/25/2019] [Indexed: 11/12/2022] Open
Abstract
Correlative imaging combines information from multiple modalities (physical-chemical-mechanical properties) at various length scales (centimetre to nanometre) to understand the complex biological materials across dimensions (2D-3D). Here, we have used numerous coupled systems: X-ray microscopy (XRM), scanning electron microscopy (SEM), electron backscatter diffraction (EBSD), optical light microscopy (LM) and focused ion beam (FIB-SEM) microscopy to ascertain the microstructural and crystallographic properties of the wall-plate joints in the barnacle Semibalanus balanoides. The exoskeleton is composed of six interlocking wall plates, and the interlocks between neighbouring plates (alae) allow barnacles to expand and grow while remaining sealed and structurally strong. Our results indicate that the ala contain functionally graded orientations and microstructures in their crystallography, which has implications for naturally functioning microstructures, potential natural strengthening and preferred oriented biomineralization. Elongated grains at the outer edge of the ala are oriented perpendicularly to the contact surface, and the c-axis rotates with the radius of the ala. Additionally, we identify for the first time three-dimensional nanoscale ala pore networks revealing that the pores are only visible at the tip of the ala and that pore thickening occurs on the inside (soft bodied) edge of the plates. The pore networks appear to have the same orientation as the oriented crystallography, and we deduce that the pore networks are probably organic channels and pockets, which are involved with the biomineralization process. Understanding these multiscale features contributes towards an understanding of the structural architecture in barnacles, but also their consideration for bioinspiration of human-made materials. The work demonstrates that correlative methods spanning different length scales, dimensions and modes enable the extension of the structure-property relationships in materials to form and function of organisms.
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Affiliation(s)
- R. L. Mitchell
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
| | - M. Coleman
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
| | - P. Davies
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
| | - L. North
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
| | - E. C. Pope
- Department of Biosciences, Swansea University, Swansea SA2 8PP, UK
| | - C. Pleydell-Pearce
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
| | - W. Harris
- Carl Zeiss Microscopy, Pleasanton, CA 94588, USA
| | - R. Johnston
- Advanced Imaging of Materials (AIM) Facility, College of Engineering, Swansea University, Swansea SA1 8EN, UK
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44
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Dawson R, Wignell A, Cooling P, Barrett D, Vyas H, Davies P. Physico-chemical stability of Plasma-Lyte 148® and Plasma-Lyte 148® + 5% Glucose with eight common intravenous medications. Paediatr Anaesth 2019; 29:186-192. [PMID: 30472805 DOI: 10.1111/pan.13554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Plasma-Lyte 148® is a balanced, crystalloid intravenous (IV) fluid which is both calcium-free and isotonic. It prevents the hyperchloremic metabolic acidosis and iatrogenic hyponatremia seen with use of 0.9% sodium chloride and hypotonic solutions, respectively. However, data on compatibility with commonly used drugs are lacking. AIMS To investigate the stability of Plasma-Lyte 148® and Plasma-Lyte 148® + 5% Glucose with eight commonly used therapeutic agents when compared with 5% glucose and 0.9% sodium chloride as diluents. We aimed to provide vital data which may facilitate the introduction of what appears to be a safer and more economic fluid. METHODS Plasma-Lyte 148® and Plasma-Lyte 148® + 5% Glucose were mixed with morphine, midazolam, fentanyl, ketamine, clonidine, aminophylline, salbutamol, and furosemide at set concentrations. Comparisons were made to 0.9% sodium chloride and 5% glucose fluid controls. Six repeats of each IV fluid and drug admixture were analyzed through high-performance liquid chromatography at three time points: 0, 2, and 24 hours. A concentration change of <5% was defined as chemically stable. Physical stability was assessed by observation of precipitate formation or color change. pH changes were measured using a Fisherbrand Hydrus 300 pH meter. RESULTS Relative to starting concentration, all drugs except midazolam were stable to ±3%. All examined therapeutic agents were chemically stable at 2 and 24 hours relative to control solutions. No precipitate formed in any of the samples. All Plasma-Lyte 148® and Plasma-Lyte 148® + 5% Glucose drug admixtures remained in a safe, peripheral administration pH range of 5-9 and were closer to the pH of blood than standard fluid-drug admixtures. CONCLUSION Morphine, fentanyl, ketamine, salbutamol, aminophylline, and clonidine are stable for 24 hours when mixed with Plasma-Lyte 148® and Plasma-Lyte 148®+5% Glucose for administration at concentrations equivalent to those found at a typical Y-site with maintenance fluid. Furosemide is stable at lower concentrations than those seen at a Y-site, but midazolam displayed instability.
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Affiliation(s)
- Rachael Dawson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew Wignell
- School of Pharmacy, University of Nottingham, Nottingham, UK.,Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Paul Cooling
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - David Barrett
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Harish Vyas
- School of Medicine, University of Nottingham, Nottingham, UK.,Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
| | - Patrick Davies
- School of Medicine, University of Nottingham, Nottingham, UK.,Paediatric Critical Care Unit, Nottingham Children's Hospital, Nottingham, UK
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45
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Carone L, Ardley R, Davies P. Cycling related traumatic brain injury requiring intensive care: association with non-helmet wearing in young people. Injury 2019; 50:61-64. [PMID: 30197205 DOI: 10.1016/j.injury.2018.08.015] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/05/2018] [Accepted: 08/17/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traumatic injury is the leading cause of death in children after infancy. Almost 25% of all cyclists killed in the UK are children, and two thirds of these will die because of their head injuries. We compared the population of young people wearing helmets whilst cycling, to those admitted with serious post cycling head injuries to our paediatric critical care unit. METHOD All children aged 0-18 years admitted to our intensive care following a bicycle accident between the years January 2011-June 2018 were identified and information on the mechanism of injury, and both immediate and long term clinical data were collected. For comparison data, helmet wearing on a random morning was observed from six schools. All pupils arriving at school by bicycle were observed. Data collected included the school year and sex of the child, and whether each child was wearing a helmet or not. RESULTS Of 28 cases, 22 were admitted due to head injuries. None wore a helmet. 23/133 school pupils wore a helmet. The intensive care population were significantly less likely to be wearing helmets than the general population (p = 0.044, Fisher's exact test). A Chi-Square test for helmet wearing by school year showed a reduction in helmet wearing with increasing school year with a p value of 0.0026. There was no association between helmet wearing and abdominal injury. CONCLUSION Young people admitted to a Critical Care Unit with cycling related head trauma are statistically significantly less likely to wear a helmet than the general, age matched cycling population. Helmet wearing decreases as children get older. Outcomes were mixed, but in the head trauma group only 3/18 recovered with no neurological deficit.
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Affiliation(s)
| | - Rohan Ardley
- Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom.
| | - Patrick Davies
- Paediatric Critical Care Unit, Nottingham Children's Hospital, United Kingdom; University of Nottingham, United Kingdom.
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46
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Jackson J, Davies P, Leggett N, Nugawela MD, Scott LJ, Leach V, Richards A, Blacker A, Abrams P, Sharma J, Donovan J, Whiting P. Systematic review of interventions for the prevention and treatment of postoperative urinary retention. BJS Open 2018; 3:11-23. [PMID: 30734011 PMCID: PMC6354194 DOI: 10.1002/bjs5.50114] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 06/29/2018] [Accepted: 09/14/2018] [Indexed: 12/14/2022] Open
Abstract
Background Postoperative urinary retention (PO‐UR) is an acute and painful inability to void after surgery that can lead to complications and delayed hospital discharge. Standard treatment with a urinary catheter is associated with a risk of infection and can be distressing, undignified and uncomfortable. This systematic review aimed to identify effective interventions for the prevention and treatment of PO‐UR that might be alternatives to urinary catheterization. Methods Electronic databases were searched from inception to September 2017. Randomized trials of interventions for the prevention or treatment of PO‐UR were eligible for inclusion. Studies were assessed for risk of bias using the Cochrane (2.0) tool. Two reviewers were involved at all review stages. Where possible, data were pooled using random‐effects meta‐analysis. The overall quality of the body of evidence was rated using the GRADE approach. Results Some 48 studies involving 5644 participants were included. Most interventions were pharmacological strategies to prevent PO‐UR. Based on GRADE, there was high‐certainty evidence to support replacing morphine in a regional anaesthetic regimen, using alpha‐blockers (number needed to treat to prevent one case of PO‐UR (NNT) 5, 95 per cent c.i. 5 to 7), the antispasmodic drug drotaverine (NNT 9, 7 to 30) and early postoperative mobilization (NNT 5, 4 to 8) for prevention, and employing hot packs or gauze soaked in warm water for treatment (NNT 2, 2 to 4). Very few studies reported on secondary outcomes of pain, incidence of urinary tract infection or duration of hospital stay. Conclusion Promising interventions exist for PO‐UR, but they need to be evaluated in randomized trials investigating comparative clinical and cost effectiveness, and acceptability to patients.
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Affiliation(s)
- J Jackson
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - P Davies
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - N Leggett
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - M D Nugawela
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - L J Scott
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - V Leach
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - A Richards
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - A Blacker
- University Hospitals Coventry and Warwickshire Coventry UK
| | - P Abrams
- Bristol Urological Institute, North Bristol NHS Trust Bristol UK
| | - J Sharma
- University Hospitals Coventry and Warwickshire Coventry UK
| | - J Donovan
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
| | - P Whiting
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) University Hospitals Bristol NHS Foundation Trust Bristol UK.,Population Health Sciences, Bristol Medical School University of Bristol Bristol UK
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47
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Bouvier C, Caplin M, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher G, Goldstein G, Hicks R, Hollander R, Kolarova T, Lawrence B, Leyden S, Majima Y, Metz D, O’Toole D, Ruszniewski P, Wiedenmann B. Unmet needs in the management of neuroendocrine tumours (NETs): A global survey of patients, patient advocates and healthcare professionals. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.021] [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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Ardley R, Carone L, Smith S, Spreadborough S, Davies P, Brooks A. Blunt splenic injury in children: haemodynamic status key to guiding management, a 5-year review of practice in a UK major trauma centre. Eur J Trauma Emerg Surg 2018; 45:791-799. [PMID: 30251151 DOI: 10.1007/s00068-018-1014-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the management of children and adolescents (0-18 years), with blunt splenic injury treated at a single UK major trauma centre over a 5-year period, focusing upon efficacy of non-operative management and the use of haemodynamic stability as a guide to planning treatment strategy, rather than radiological injury grading. To produce a treatment pathway for management of blunt splenic injury in children. METHODS Retrospective, cross-sectional study of all paediatric patients admitted with radiologically proven blunt splenic injury between January 2011 and March 2016. Penetrating injuries were excluded. Follow up was for at least 30 days. RESULTS 30 Patients were included, mean age was 14.5 (SD 3.6), median injury severity score was 16 (IQR 10-31). 6 Patients (20%) had a splenectomy, whilst 22 patients (73%) were successfully treated non-operatively with 100% efficacy at index admission. 5/8 (63%) patients with radiological grade V injuries were managed non-operatively, injury grade was not associated with surgical intervention (p = 1.57). Haemodynamic instability was initially treated with fluid resuscitation leading to successful non-operative management in 5/11 (45%) patients. However, haemodynamic instability is a significant predictor of requirement for surgical intervention (p = 0.03), admission to critical care (p = 0.017), presence of additional injuries (p = 0.015) and increased length of stay (p = 0.038). No such relationships were found to be associated with increased radiological injury grade. CONCLUSIONS Non-operative management should be first-line treatment in the haemodynamically stable child with a blunt splenic injury and may be carried out with a high degree of efficacy. It may also be successfully implemented in those initially showing signs of haemodynamic instability that respond to fluid resuscitation. Radiological injury grade does not predict definitive management, level of care, or length of stay; however, haemodynamic stability may be utilised to produce a treatment algorithm and is key to guiding management.
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Affiliation(s)
- Rohan Ardley
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK.
| | - Laura Carone
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
- LNR deanery, Nottingham, UK
| | - Stella Smith
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | | | - Patrick Davies
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
| | - Adam Brooks
- East Midlands Major Trauma Centre, Queens Medical Centre, Nottingham, UK
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49
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Davies P, Gates S, Grundy R. Electrical impedance tomography effectively used in a case of paediatric pulmonary Langerhans cell histiocytosis. BMJ Case Rep 2018; 2018:bcr-2017-224040. [PMID: 30185449 DOI: 10.1136/bcr-2017-224040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 2-year-old boy with severe pulmonary Langerhans cell histiocytosis presented in extreme respiratory failure. He was intubated and ventilated. Despite maximal support, he deteriorated and needed extremely high ventilator pressures. An electrical impedance tomography monitor was used to inform management. This is a monitoring technique which is not used in children due to the lack of suitable interface devices and a lack of randomised clinical evidence. Despite technical difficulties, a good signal was achieved. This informed management and enabled the selection of a suitable ventilator strategy, facilitating weaning. Electrical impedance tomography is a viable technology for use in paediatric critical respiratory failure. This is a non-invasive and safe technology which adds individual patient information which is not available through any other modalities. We urge equipment manufacturers to develop belts which will allow routine application of this life-saving technology in children.
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Affiliation(s)
- Patrick Davies
- Paediatric Critical Care Unit, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Gates
- Paediatric Critical Care Unit, Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK
| | - Richard Grundy
- Department of Haematology and Oncology, Nottingham Children's Hospital, Nottingham, UK.,Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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Brindle RJ, Ijaz A, Davies P. Procalcitonin and cellulitis: correlation of procalcitonin blood levels with measurements of severity and outcome in patients with limb cellulitis. Biomarkers 2018; 24:127-130. [DOI: 10.1080/1354750x.2018.1501764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- R. J. Brindle
- Department of Clinical Sciences, University of Bristol, Bristol, UK
| | - A. Ijaz
- Emergency Department, Royal Lancaster Infirmary, University Hospitals of Morecambe Bay, Lancaster, UK
| | - P. Davies
- General Practice Support Unit, University Hospitals Bristol, Bristol, UK
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