1
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Zhang J, Le Leu RK, Xu Q, Bennett P. The futility of post-haemodialysis blood glucose levels: A retrospective cohort study. J Ren Care 2024. [PMID: 38477224 DOI: 10.1111/jorc.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Frequent blood glucose tests are performed for people with diabetes receiving haemodialysis. OBJECTIVES To determine the rate of out-of-range post-haemodialysis blood glucose levels that are clinically acted upon, the intervention and outcome of each intervention, and the associations between post-haemodialysis blood glucose levels and relevant clinical predictors. DESIGN 12-month retrospective cohort medical record review in one Australian haemodialysis centre. Post-haemodialysis blood glucose levels, prehaemodialysis blood glucose levels, time of treatment, diabetes medications, intradialytic fluid removal, dialysate dextrose concentration, clinical actions, interventions, and outcomes on out-of-range blood glucose levels were retrieved. PARTICIPANTS 22 participants with a median time receiving dialysis 3.1 years (interquartile range 2.3-4.7). MEASUREMENTS AND RESULTS The proportion of out-of-range post-haemodialysis blood glucose levels was 87.3% (95% confidence interval, 86.1%-88.5%). No out-of-range post-haemodialysis blood glucose levels were clinically acted upon. Out-of-range post-haemodialysis blood glucose levels were 4.6 times more likely if a higher dextrose bath was used (95% confidence interval: 3.3; 6.3. p < 0.001). The odds of the post-haemodialysis blood glucose levels increased by each 1 mmol/L. Intradialytic fluid removal, dialysate dextrose concentration, sex, dialysis time, anti-hyperglycaemic agents were also associated with out-of-range post-haemodialysis blood glucose levels. CONCLUSION Routine post-haemodialysis blood glucose levels testing has limited clinical utility in care for people with diabetes receiving maintenance haemodialysis. Higher dextrose dialysate may require individual titration depending on prehaemodialysis blood glucose levels.
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Affiliation(s)
- Jing Zhang
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Richard K Le Leu
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Qunyan Xu
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia
| | - Paul Bennett
- School of Nursing and Midwifery, Griffith Health, Griffith University, Brisbane, Queensland, Australia
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2
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Jaramillo D, Busby BP, Bestbier M, Bennett P, Waddington Z. New Zealand rickettsia-like organism and Tenacibaculum maritimum vaccine efficacy study. J Fish Dis 2024; 47:e13883. [PMID: 37975241 DOI: 10.1111/jfd.13883] [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] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
A cohort of Chinook salmon juveniles was vaccinated, with an autogenous bivalent vaccine against New Zealand RLOs (NZ-RLO1) and Tenacibaculum maritimum. A proportion of the cohort was not vaccinated to act as controls. At smoltification, the fish were challenged with NZ-RLO1, NZ-RLO2, or T. maritimum. We found that challenge with T. maritimum by immersion in (7.5 × 105 cfu/mL of water) did not yield any pathology. Challenge with RLOs produced clinical signs that were more or less severe depending on the challenge route, dose or vaccination status. Survival was significantly higher for vaccinated fish within the groups challenged with NZ-RLO1 by intraperitoneal injection with a relative percent survival (RPS) of 48.84%. Survival was not significantly different between vaccinated and non-vaccinated fish for groups challenged with NZ-RLO2 by intraperitoneal injection or by NZ-RLO1 by immersion. Yet, anecdotally the clinical disease presentation (manifesting as haemorrhagic, ulcerative skin lesions) was more severe for the non-vaccinated fish. This study demonstrates that autogenous vaccine against NZ-RLO is protective against severe disease and death by NZ-RLO1 challenge which warrants implementation and further evaluation under field conditions. Yet, this study also highlights the importance of the route of administration and dose when evaluating pathogenicity and vaccine efficacy.
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Affiliation(s)
- D Jaramillo
- Biosecurity New Zealand, Ministry for Primary Industries, Wellington, New Zealand
| | - B P Busby
- Animal Health Laboratory, Ministry for Primary Industries, Upper Hutt, New Zealand
| | - M Bestbier
- Animal Health Laboratory, Ministry for Primary Industries, Upper Hutt, New Zealand
| | - P Bennett
- Animal Health Laboratory, Ministry for Primary Industries, Upper Hutt, New Zealand
| | - Z Waddington
- New Zealand King Salmon Ltd, Picton, New Zealand
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3
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Matricciani L, Dumuid D, Stanford T, Maher C, Bennett P, Bobrovskaya L, Murphy A, Olds T. Time use and dimensions of healthy sleep: A cross-sectional study of Australian children and adults. Sleep Health 2024:S2352-7218(23)00250-4. [PMID: 38199899 DOI: 10.1016/j.sleh.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/12/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Sleep is increasingly recognized as a multidimensional construct that occurs within the 24-hour day. Despite advances in our understanding, studies continue to consider the relationship between sleep, sedentary time and physical activity separately, and not as part of the 24-hour day. AIMS To determine the association between the 24-hour activity composition and dimensions of healthy sleep. METHODS This study examined data on 1168 children (mean age 12years; 49% female) and 1360 adults (mean age 44years; 87% female) collected as part of the Child Health CheckPoint study. Participants were asked to wear a GENEActiv monitor (Activinsights, Cambs, UK) on their nondominant wrist for eight consecutive days to measure 24-hour time-use. Compositional data analysis was used to examine the association between time use (actigraphy-derived sleep duration, sedentary time, light physical activity and moderate-vigorous physical activity) and dimensions of healthy sleep. Healthy sleep was conceptualized in terms of continuity/efficiency, timing, alertness/sleepiness, satisfaction/quality, and regularity. Time allocations were also examined. RESULTS The 24-hour activity composition was significantly associated with all objectively measured and self-report dimensions of healthy sleep in both children and adults. Allocating more time to sleep was associated with earlier sleep onsets, later sleep offsets, less efficient and more consistent sleep patterns for both children and adults. CONCLUSION This study highlights the integral relationship between daily activities and dimensions of sleep. Considering sleep within the 24-hour day activity composition framework may help inform lifestyle decisions to improve sleep health.
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Affiliation(s)
- Lisa Matricciani
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia.
| | - Dorothea Dumuid
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ty Stanford
- Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia; Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia
| | - Paul Bennett
- School of Nursing and Midwifery, Griffith Health, Griffith University, Brisbane, Queensland, Australia
| | - Larisa Bobrovskaya
- Health and Biomedical Innovation, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Andrew Murphy
- Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia
| | - Tim Olds
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia; Allied Health and Human Performance (AHHP), University of South Australia, Adelaide, South Australia, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Purtell L, Bennett P, Bonner A. Multimodal approaches for inequality in kidney care: turning social determinants of health into opportunities. Curr Opin Nephrol Hypertens 2024; 33:34-42. [PMID: 37847046 DOI: 10.1097/mnh.0000000000000936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Kidney disease is associated with major health and economic burdens worldwide, disproportionately carried by people in low and middle socio-demographic index quintile countries and in underprivileged communities. Social determinants such as education, income and living and working conditions strongly influence kidney health outcomes. This review synthesised recent research into multimodal interventions to promote kidney health equity that focus on the social determinants of health. RECENT FINDINGS Inequity in kidney healthcare commonly arises from nationality, race, sex, food insecurity, healthcare access and environmental conditions, and affects kidney health outcomes such as chronic kidney disease progression, dialysis and transplant access, morbidity and mortality. Multimodal approaches to addressing this inequity were identified, targeted to: patients, families and caregivers (nutrition, peer support, financial status, patient education and employment); healthcare teams (workforce, healthcare clinician education); health systems (data coding, technology); communities (community engagement); and health policy (clinical guidelines, policy, environment and research). SUMMARY The engagement of diverse patients, families, caregivers and communities in healthcare research and implementation, as well as clinical care delivery, is vital to counteracting the deleterious effects of social determinants of kidney health.
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Affiliation(s)
- Louise Purtell
- School of Nursing and Midwifery
- Menzies Health Institute Queensland, Griffith University
- Research Development Unit, Caboolture Hospital, Metro North Health
- Kidney Health Service, Metro North Health, Queensland, Australia
| | - Paul Bennett
- School of Nursing and Midwifery
- Menzies Health Institute Queensland, Griffith University
| | - Ann Bonner
- School of Nursing and Midwifery
- Menzies Health Institute Queensland, Griffith University
- Kidney Health Service, Metro North Health, Queensland, Australia
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Bennett P, Celik F, Winstanley J, Hunt BJ, Pavord S. Qualitative study of the consequences of vaccine-induced immune thrombocytopenia and thrombosis: the experiences of family members. BMJ Open 2023; 13:e080363. [PMID: 38070933 PMCID: PMC10729125 DOI: 10.1136/bmjopen-2023-080363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To explore the experiences of family members of patients who died or survived following a diagnosis of vaccine-induced immune thrombocytopenia and thrombosis (VITT). DESIGN A semistructured qualitative study, conducted via Zoom. SETTING Participants discussed their experiences during hospitalisation and following discharge. PARTICIPANTS Sixteen family members of patients with VITT (survivors=11; bereaved=5), recruited via a Facebook support group and advertising on Twitter. RESULTS Analysis identified two themes common to both groups of participants: the stress of hospitalisation and the experience of multiple losses. A third theme, living with VITT, was unique to the survivor group and a fourth, battling against the system, was predominantly reported by bereaved participants. CONCLUSIONS This is a significantly challenged group of people, with multiple emotional, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.
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Affiliation(s)
| | | | | | - Beverley J Hunt
- Thrombosis and Haemophilia Centre, Kings Healthcare Partners, London, UK
| | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Bohm C, Bennett P, Lambert K, Wilund K, Verdin N, Fowler K, Sumida K, Wang AYM, Tangri N, MacRae JM, Thompson S. Advancing Exercise Science for Better Health Outcomes Across the Spectrum of Chronic Kidney Disease. J Ren Nutr 2023; 33:S103-S109. [PMID: 37632512 DOI: 10.1053/j.jrn.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/27/2022] [Accepted: 12/10/2022] [Indexed: 08/28/2023] Open
Abstract
Despite over 30 years of evidence for improvements in physical function, physical fitness, and health-related quality of life with exercise training in individuals with chronic kidney disease, access to dedicated exercise training programs remains outside the realm of standard of care for most kidney care programs. In this review, we explore possible reasons for this by comparing approaches in other chronic diseases where exercise rehabilitation has become the standard of care, identifying enablers and factors that need to be addressed for continued growth in this area, and discussing knowledge gaps for future research. For exercise rehabilitation to be relevant to all stakeholders and become a sustainable component of kidney care, a focus on the effect of exercise on clinically relevant outcomes that are prioritized by individuals living with kidney disease, use of evidence-based implementation strategies for diverse settings and populations, and approaching exercise as a medical therapy are required.
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Affiliation(s)
- Clara Bohm
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Chronic Disease Innovation Centre, Winnipeg, Canada.
| | - Paul Bennett
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Ken Wilund
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | | | - Kevin Fowler
- The Voice of the Patient, Inc, Saint Louis, Missouri
| | - Keiichi Sumida
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Angela Yee-Moon Wang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, SAR
| | - Navdeep Tangri
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Chronic Disease Innovation Centre, Winnipeg, Canada
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Urbanowicz AM, Shankland R, Rance J, Bennett P, Leys C, Gauchet A. Cognitive behavioral stress management for parents: Prevention and reduction of parental burnout. Int J Clin Health Psychol 2023; 23:100365. [PMID: 36908695 PMCID: PMC9999161 DOI: 10.1016/j.ijchp.2023.100365] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/02/2023] [Indexed: 03/07/2023] Open
Abstract
Context Parental burnout increases the risk of deleterious consequences on parents', couples', and children's physical and mental health. Methods The current study (N = 134) aimed to assess the effectiveness of a Cognitive Behavioural Stress Management (CBSM) group programme in terms of parental burnout reduction. In total 67 parents attended the 8-week CBSM intervention groups, and another 67 parents were assigned to the waiting-list control group. We compared the effectiveness of the CBSM intervention with a waiting-list control group directly after the end of the programme and at three-months follow-up. Results The results showed that compared to the control group the CBSM programme contributed to the reduction of parental burnout symptoms with statistically significant and small effect size. Moreover, the contrast analyses showed that the reduction in parental burnout severity was maintained at 3 month-follow-up. The reduction in parental burnout scores was mediated by the decrease in stress and the increase in unconditional self-kindness. Conclusions These results highlight the potential benefits of the CBSM programme for parental burnout prevention and reduction.
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Affiliation(s)
- Agata Maria Urbanowicz
- Grenoble-Alpes University, 621 Avenue Centrale, 38400 Saint-Martin-d'Hères, France
- Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
| | | | - Jaynie Rance
- Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
| | - Paul Bennett
- Swansea University, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
| | - Christophe Leys
- Université Libre de Bruxelles, Campus du Solbosch, Avenue F.D. Roosevelt, 501050 Bruxelles, Belgium
| | - Aurélie Gauchet
- Savoie Mont Blanc University, 27 rue Marcoz, 73011 Chambéry, France
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8
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Abstract
OBJECTIVES To explore the experiences of people up to 18 months after being diagnosed with vaccine-induced immune thrombocytopenia and thrombosis (VITT). DESIGN A semistructured qualitative study, conducted via Zoom, of a cohort of people with VITT. SETTING Participants discussed their experiences of hospitalisation and following discharge. PARTICIPANTS 14 individuals diagnosed with VITT, recruited via a Facebook support group and advertising on Twitter. RESULTS Thematic analysis identified challenges of obtaining medical care and diagnosis; fear of the severity of symptoms and unclear prognosis; and lack of family support due to isolation imposed by the COVID-19 pandemic. Once home, participants experienced continued significant symptoms; fear of recurrence; inadequate medical knowledge of their condition; and difficulties coping with residual physical disabilities and psychosocial losses. Also reported were feelings of isolation and abandonment due to lack of government support. CONCLUSIONS This is a significantly challenged group of people, with multiple health, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.
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Affiliation(s)
- Paul Bennett
- School of Psychology, Swansea University, Swansea, UK
| | - Filiz Celik
- School of Psychology, Swansea University, Swansea, UK
| | | | | | - Sue Pavord
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Grohol B, Fortin GT, Ingold T, Bennett P. Mirizzi Syndrome: A Case Report. Cureus 2023; 15:e34783. [PMID: 36915851 PMCID: PMC10005894 DOI: 10.7759/cureus.34783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 02/10/2023] Open
Abstract
Mirizzi syndrome (MS) describes a rare complication of cholelithiasis resulting from extrinsic compression of the common hepatic duct by impacted gallstones in the cystic duct or Hartmann's pouch. MS is most commonly seen in adults and is more prevalent in the female population. Due to the pathophysiology of MS being similar to other causes of cholecystitis and biliary obstruction, the symptomatology is rather nonspecific. While ultrasound and magnetic resonance cholangiopancreatography are commonly used for diagnosis, treatment of this condition typically involves cholecystectomy. Identifying MS versus other more common causes of obstructive jaundice is paramount in limiting complications. In this report, we describe a case of MS diagnosed in a 32-year-old male who presented with nonspecific abdominal pain and other signs of obstructive jaundice. The goal of this study is to show how identifying a rare underlying cause of a common presentation can lead to improved patient outcomes.
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Affiliation(s)
- Bryce Grohol
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Grayson T Fortin
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Tyler Ingold
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Paul Bennett
- Internal Medicine, Centra Lynchburg General Hospital, Lynchburg, USA
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10
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Roldán-Jiménez C, Cuadros-Romero M, Bennett P, Cuesta-Vargas AI. Differences in Tridimensional Shoulder Kinematics between Asymptomatic Subjects and Subjects Suffering from Rotator Cuff Tears by Means of Inertial Sensors: A Cross-Sectional Study. Sensors (Basel) 2023; 23:1012. [PMID: 36679809 PMCID: PMC9864778 DOI: 10.3390/s23021012] [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: 12/06/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to analyze differences in three-dimensional shoulder kinematics between asymptomatic subjects and patients who were diagnosed with rotator cuff tears. Methods: This cross-sectional study recruited 13 symptomatic subjects and 14 asymptomatic subjects. Data were obtained from three inertial sensors placed on the humerus, scapula and sternum. Kinematic data from the glenohumeral, scapulothoracic and thoracohumeral joints were also calculated. The participants performed shoulder abductions and flexions. The principal angles of movements and resultant vectors in each axis were studied. Results: The glenohumeral joint showed differences in abduction (p = 0.001) and flexion (p = 0.000), while differences in the scapulothoracic joint were only significant during flexion (p = 0.001). The asymptomatic group showed higher velocity values in all sensors for both movements, with the differences being significant (p < 0.007). Acceleration differences were found in the scapula during abduction (p = 0.001) and flexion (p = 0.014), as well as in the sternum only during shoulder abduction (p = 0.022). Conclusion: The results showed kinematic differences between the patients and asymptomatic subjects in terms of the mobility, velocity and acceleration variables, with lower values for the patients.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, 29016 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
| | - Miguel Cuadros-Romero
- Unit of Upper Limb Orthopedic Surgery of Hospital, University of Malaga, 29010 Málaga, Spain
| | - Paul Bennett
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane City, QLD 4059, Australia
| | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Sciences, Universidad de Malaga, 29016 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29590 Málaga, Spain
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Brisbane City, QLD 4059, Australia
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Aziz I, Farndon D, Bennett P. Femoral Distal Bypass Using Giacomini Vein As an Autologous Vein Conduit: Case Report and Review of the Literature. EJVES Vasc Forum 2023. [DOI: 10.1016/j.ejvsvf.2023.02.030] [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: 04/08/2023] Open
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12
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Yazbeck P, Cullere X, Bennett P, Yajnik V, Wang H, Kawada K, Davis VM, Parikh A, Kuo A, Mysore V, Hla T, Milstone DS, Mayadas TN. DOCK4 Regulation of Rho GTPases Mediates Pulmonary Vascular Barrier Function. Arterioscler Thromb Vasc Biol 2022; 42:886-902. [PMID: 35477279 DOI: 10.1161/atvbaha.122.317565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The vascular endothelium maintains tissue-fluid homeostasis by controlling the passage of large molecules and fluid between the blood and interstitial space. The interaction of catenins and the actin cytoskeleton with VE-cadherin (vascular endothelial cadherin) is the primary mechanism for stabilizing AJs (adherens junctions), thereby preventing lung vascular barrier disruption. Members of the Rho (Ras homology) family of GTPases and conventional GEFs (guanine exchange factors) of these GTPases have been demonstrated to play important roles in regulating endothelial permeability. Here, we evaluated the role of DOCK4 (dedicator of cytokinesis 4)-an unconventional Rho family GTPase GEF in vascular function. METHODS We generated mice deficient in DOCK4' used DOCK4 silencing and reconstitution approaches in human pulmonary artery endothelial cells' used assays to evaluate protein localization, endothelial cell permeability, and small GTPase activation. RESULTS Our data show that DOCK4-deficient mice are viable. However, these mice have hemorrhage selectively in the lung, incomplete smooth muscle cell coverage in pulmonary vessels, increased basal microvascular permeability, and impaired response to S1P (sphingosine-1-phosphate)-induced reversal of thrombin-induced permeability. Consistent with this, DOCK4 rapidly translocates to the cell periphery and associates with the detergent-insoluble fraction following S1P treatment, and its absence prevents S1P-induced Rac-1 activation and enhancement of barrier function. Moreover, DOCK4-silenced pulmonary artery endothelial cells exhibit enhanced basal permeability in vitro that is associated with enhanced Rho GTPase activation. CONCLUSIONS Our findings indicate that DOCK4 maintains AJs necessary for lung vascular barrier function by establishing the normal balance between RhoA (Ras homolog family member A) and Rac-1-mediated actin cytoskeleton remodeling, a previously unappreciated function for the atypical GEF family of molecules. Our studies also identify S1P as a potential upstream regulator of DOCK4 activity.
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Affiliation(s)
- Pascal Yazbeck
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Xavier Cullere
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Paul Bennett
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Vijay Yajnik
- Department of Medicine, Massachusetts General Hospital, Boston (V.Y., K.K., A.P.).,Now with GI Therapeutic Area Unit, Takeda Pharmaceuticals, Cambridge, MA (V.Y., A.P.)
| | - Huan Wang
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Kenji Kawada
- Department of Medicine, Massachusetts General Hospital, Boston (V.Y., K.K., A.P.).,Now with Department of Surgery, Kyoto University, Japan (K.K.)
| | - Vanessa M Davis
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Asit Parikh
- Department of Medicine, Massachusetts General Hospital, Boston (V.Y., K.K., A.P.).,Now with GI Therapeutic Area Unit, Takeda Pharmaceuticals, Cambridge, MA (V.Y., A.P.)
| | - Andrew Kuo
- Vascular Biology Program, Department of Surgery' Boston Children's Hospital and Harvard Medical School, MA (A.K., T.H.)
| | - Vijayashree Mysore
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Timothy Hla
- Vascular Biology Program, Department of Surgery' Boston Children's Hospital and Harvard Medical School, MA (A.K., T.H.)
| | - David S Milstone
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
| | - Tanya N Mayadas
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (P.Y., F.C., P.B., H.W., V.M.D., V.M., D.S.M., T.N.M.)
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Farahani L, Mowla S, Tharakan T, Lee Y, Kundu S, Khanjani S, Sindi E, Rai R, Regan L, Ramsay J, Bennett P, Dhillo W, Minhas S, Jayasena C, MacIntyre D. O-252 Next generation sequencing analysis of the seminal microbiome in male partners of women with idiopathic recurrent pregnancy loss: results of a prospective cohort study. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Is there an association between the semen microbiome, seminal reactive oxygen species (ROS) and DNA fragmentation in men with recurrent pregnancy loss (RPL)?
Summary answer
This pilot study outlines the subtle role that microbiota play in influencing ROS and sperm DNA damage for male partners of women with RPL
What is known already
RPL is defined as the loss of two or more consecutive pregnancies. This devastating condition impacts approximately 1% of couples. Paternal causes are not routinely screened for and an underlying cause is not found in up to 50% of cases. Recent studies have reported an association between elevated seminal ROS and sperm DNA fragmentation in the male partner, and RPL. We hypothesised that seminal microbiota contribute to increased ROS and sperm DNA damage. To test this, we investigated the relationship between seminal bacterial composition and ROS levels in men with proven fertility versus men with a history of RPL.
Study design, size, duration
We conducted a prospective, case-control study and recruited participants between November 2018 and March 2020 at Imperial College Healthcare NHS Trust. A total of 109 men participated in the study; 46 men with RPL and 63 men with proven fertility and no history of RPL. Each participant attended for a single study visit which consisted of a full medical history, assessment of testicular volume, height, weight, blood samples and production of a semen sample.
Participants/materials, setting, methods
Routine semen analysis (WHO) and endocrine and lipid profiles were performed for all patients. Semen ROS and DNA fragmentation were performed (luminol and TUNEL methodologies, respectively). ROS were classified as high (>3.77 RLU/s) or low (<3.77 RLU/s). Metataxonomic profiling of samples was performed using Illumina Miseq-based sequencing of the V1-V2 hypervariable regions of bacterial 16S rRNA gene amplicons. Multivariate and univariate modelling was performed to explore associations between metataxonomic profiles, ROS levels and clinical metadata.
Main results and the role of chance
Men with RPL had higher mean semen volume (p = 0.02) and increased prevalence of high ROS (p = 0.02, Fisher's exact) compared with controls; but other clinical characteristics were similar between groups. A total of 3,700,136 high quality sequence reads were generated for the dataset with an average of 33,946 reads/sample. Hierarchical clustering of bacterial genera relative abundances identified 4 distinct microbial signatures characterised by high relative abundance of 1. Streptococcus, 2. Lactobacillus and Gardnerella, 3. polymicrobial (including Prevotella), and 4. Corynebacterium and Finegoldia. Prevalences of these groups were similar in control and RPL groups (p = 0.11). Additionally, no association between the bacterial genera groups and elevated ROS, DNA fragmentation, or clinical factors such as age, ethnicity, or semen volume were observed (chi-square tests). At species taxonomy level relative abundance of L. crispatus was higher in controls compared to RPL, but did not withstand false discovery rate correction for multiple testing (p = 0.006, q = 0.67). Higher relative abundance of Microbacterium was detected in semen samples with high DNA fragmentation (p = 8.7E-4, q = 0.08). This relationship was even stronger within the RPL cohort (p = 2.8E-5, q = 0.002). No significant enrichment of specific taxa was observed between high or low ROS samples however, low ROS was associated with Corynebacterium relative abundance >20%.
Limitations, reasons for caution
More patients are required to enhance statistical power. Duplicate sample collection may establish the robustness of seminal compositions observed. Time since last sexual intercourse samples may affect the analysis. Concomitant analysis of the vaginal microbiome of female partners may improve our understanding of how partners may affect each other’s fertility.
Wider implications of the findings
Our data suggests interactions between microbiota composition, ROS and sperm DNA damage which may be implicated in the pathogenesis of recurrent miscarriage. Further studies are needed to determine if seminal microbiota play causal roles in RPL, and whether interventions modifying the seminal microbiome may modify pregnancy outcomes in affected couples
Trial registration number
not applicable
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Affiliation(s)
- L Farahani
- Imperial College Healthcare NHS Trust, Obstetrics & Gynaecology , London, United Kingdom
| | - S Mowla
- Imperial College, Institute of Reproductive Developmental Biology , London, United Kingdom
| | - T Tharakan
- Charing Cross Hospital , Urology, London, United Kingdom
| | - Y Lee
- Imperial College, Institute of Reproductive Developmental Biology , London, United Kingdom
| | - S Kundu
- Imperial College, Institute of Reproductive Developmental Biology , London, United Kingdom
| | - S Khanjani
- University College London Hospital , Gynaecology, London, United Kingdom
| | - E Sindi
- Imperial College, Section of Investigative Medicine , London, United Kingdom
| | - R Rai
- Imperial College Healthcare NHS Trust, Obstetrics & Gynaecology , London, United Kingdom
| | - L Regan
- Imperial College Healthcare NHS Trust, Obstetrics & Gynaecology , London, United Kingdom
| | - J Ramsay
- Hammersmith Hospital , Andrology, London, United Kingdom
| | - P Bennett
- Imperial College, Institute of Reproductive Developmental Biology , London, United Kingdom
| | - W Dhillo
- Imperial College, Section of Investigative Medicine , London, United Kingdom
| | - S Minhas
- Charing Cross Hospital , Urology, London, United Kingdom
| | - C Jayasena
- Imperial College, Section of Investigative Medicine , London, United Kingdom
| | - D MacIntyre
- Imperial College, Institute of Reproductive Developmental Biology , London, United Kingdom
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14
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Kistler BM, Khubchandani J, Bennett P, Wilund KR, Sosnoff J. Depressive Disorders Are Associated With Risk of Falls in People With Chronic Kidney Disease. J Am Psychiatr Nurses Assoc 2022; 28:235-240. [PMID: 33150807 DOI: 10.1177/1078390320970648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES People with chronic kidney disease (CKD) are at increased risk for falls and fall-related injuries. Depressive disorders (DEP) are common in individuals with CKD and may increase the risk of falls and fall-related injuries. However, not much is known about the relationship between DEP and falls in people with CKD. The purpose of this study was to determine the influence of DEP on the relationship between CKD, falls, and fall-related injuries. METHOD Using the Behavioral Risk Factor Surveillance System, we identified 16,574 adults with CKD. Patients with CKD were stratified by history of self-reported DEP (SRDEP), and multivariate logistic regression was conducted to determine the odds for falls and fall-related injuries among those with and without SRDEP. RESULTS In unadjusted regression analysis, falls (OR = 2.40, 95% CI = 2.08-2.76) and fall-related injuries (OR = 2.12, 95% CI = 1.72-2.59) were higher in individuals with CKD and history of SRDEP compared to those with CKD and no history of SRDEP. Adjustment for confounders had little effect on the relationship between a history of SRDEP and either falls (AOR = 1.87, 95% CI = 1.60-2.19) or fall-related injuries (AOR = 1.58, 95% CI = 1.26-1.97). CONCLUSIONS People with CKD and DEP are at increased odds for falls and fall-related injuries even after adjustment for sociodemographic, lifestyle factors, and comorbidities. Prospective studies are warranted to further understand this relationship, but it may be prudent for clinicians, in particular nurses, to consider fall risk when treating DEP in patients with CKD.
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Affiliation(s)
- Brandon M Kistler
- Brandon M. Kistler, PhD, RD, Department of Nutrition and Health Science, Ball State University, Muncie, IN, USA
| | - Jagdish Khubchandani
- Jagdish Khubchandani, MBBS, PhD, Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Paul Bennett
- Paul Bennett, PhD, BN, Director, Research, Satellite Healthcare, San Jose, California, USA; Honorary Professor of Nursing, Deakin University, Melbourne, Victoria, Australia
| | - Kenneth R Wilund
- Kenneth R. Wilund, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jacob Sosnoff
- Jacob Sosnoff, PhD, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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15
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Bennett P, Burns R, Champion S, Gordon S. Effectiveness of an aged simulation training suit to support development of compassion and person‐centred care in the aged‐care workforce. Australas J Ageing 2022; 41:314-324. [DOI: 10.1111/ajag.13057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Paul Bennett
- Broken Hill Rural Clinical School University of Sydney Sydney New South Wales Australia
| | | | - Stephanie Champion
- Caring Futures Institute College of Nursing and Health Sciences Flinders University Bedford Park South Australia Australia
| | - Susan Gordon
- ACH Group Inc Mile End South Australia Australia
- Caring Futures Institute College of Nursing and Health Sciences Flinders University Bedford Park South Australia Australia
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16
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Gordon S, Burns R, Champion S, Niutta L, Bennett P. Compassion and person-centred care: Survey development for aged care workers. Australas J Ageing 2021; 41:e140-e150. [PMID: 34821443 DOI: 10.1111/ajag.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/18/2021] [Accepted: 10/24/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES With a growing emphasis on personalised care, there is a need for effective workforce training to enable person-centred care (PCC) in aged care practice. The Australian aged care workforce is very diverse; thus, tools to evaluate compassion and PCC training need to reflect an understanding of these concepts relevant to the Australian context. There are currently no tools validated for use in aged care settings in Australia. METHODS Two existing compassion and PCC questionnaires were modified for an Australian audience using cognitive interviews with aged care workers. The reliability of the modified questionnaires was assessed. RESULTS The modified questionnaires were found to have acceptable inter-reliability and test-retest intra-class correlation for the subscales and overall. However, the investigation also found low Cohen's kappa values between the test and retest responses for the individual items, subscales and overall, and had low inter-class correlation for individual items, indicating poor inter-rater agreement. High inter-item correlation scores also suggest the questions encapsulate overly similar constructs. CONCLUSIONS While further investigation of the psychometric properties of the new items is needed, these modified questionnaires may offer a method of assessing and re-assessing compassion and PCC using language that is understandable to the Australian aged care workforce. Tools to accurately measure Australian aged care staff perceptions of compassion and their ability to deliver PCC are important to improve the quality of care provided in aged care and facilitate the delivery of PCC in aged care settings.
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Affiliation(s)
- Susan Gordon
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,ACH Group Inc., Mile End, South Australia, Australia
| | - Rebecca Burns
- ACH Group Inc., Mile End, South Australia, Australia
| | - Stephanie Champion
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Liana Niutta
- ACH Group Inc., Mile End, South Australia, Australia
| | - Paul Bennett
- Broken Hill Rural Clinical School, University of Sydney, Sydney, New South Wales, Australia
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17
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Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Christensen R, Ørnbjerg LM, Glinatsi D, Møller JM, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Larsen L, Jurik AG, Thomsen HS, Østergaard M. Effect of initiating biologics compared to intensifying conventional DMARDs on clinical and MRI outcomes in established rheumatoid arthritis patients in clinical remission: Secondary analyses of the IMAGINE-RA trial. Scand J Rheumatol 2021; 51:268-278. [PMID: 34474649 DOI: 10.1080/03009742.2021.1935312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: To compare the effect of treat-to-target-based escalations in conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) and biologics on clinical disease activity and magnetic resonance imaging (MRI) inflammation in a rheumatoid arthritis (RA) cohort in clinical remission.Method: One-hundred patients with established RA, Disease Activity Score based on 28-joint count-C-reactive protein (DAS28-CRP) < 3.2, and no swollen joints (hereafter referred to as 'in clinical remission') who received csDMARDs underwent clinical evaluation and MRI of the wrist and second to fifth metacarpophalangeal joints every 4 months. They followed a 2 year MRI treatment strategy targeting DAS28-CRP ≤ 3.2, no swollen joints, and absence of MRI osteitis, with predefined algorithmic treatment escalation: first: increase in csDMARDs; second: adding a biologic; third: switch biologic. MRI osteitis and Health Assessment Questionnaire (HAQ) (co-primary outcomes) and MRI combined inflammation and Simplified Disease Activity Index (SDAI) (key secondary outcomes) were assessed 4 months after treatment change and expressed as estimates of group differences. Statistical analyses were based on the intention-to-treat population analysed using repeated-measures mixed models.Escalation to first biologic compared to csDMARD escalation more effectively reduced MRI osteitis (difference between least squares means 1.8, 95% confidence interval 1.0-2.6), HAQ score (0.08, 0.03-0.1), MRI combined inflammation (2.5, 0.9-4.1), and SDAI scores (2.7, 1.9-3.5).Treat-to-target-based treatment escalations to biologics compared to escalation in csDMARDs more effectively improved MRI inflammation, physical function, and clinical disease activity in patients with established RA in clinical remission. Treatment escalation in RA patients in clinical remission reduces clinical and MRI-assessed disease activity.Trial registration: Clinicaltrials.gov identifier: NCT01656278.
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Affiliation(s)
- S Møller-Bisgaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - K Hørslev-Petersen
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - B Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - M L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Frederiksberg Hospital, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L M Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark
| | - D Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - J M Møller
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Boesen
- Department of Radiology, Frederiksberg Hospital, Frederiksberg, Denmark
| | - K Stengaard-Pedersen
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - O R Madsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - B Jensen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - J A Villadsen
- Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - E M Hauge
- Department of Rheumatology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - P Bennett
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - O Hendricks
- Department of Rheumatology, Sønderborg Sygehus, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - K Asmussen
- Center for Rheumatology and Spine Diseases, Frederiksberg Hospital, Frederiksberg, Denmark
| | - M Kowalski
- Department of Rheumatology, Sygehus Vendsyssel i Hjørring, Hjørring, Denmark
| | - H Lindegaard
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, Frederiksberg, Denmark
| | | | - T Ellingsen
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - A H Nielsen
- Department of Radiology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - L Larsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - A G Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - H S Thomsen
- Department of Radiology, Herlev Hospital, Herlev, Denmark
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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18
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Fourie H, Al-Memar M, Smith A, Ng S, Lee Y, Timmerman D, Bourne T, MacIntyre D, Bennett P. P–385 The relationship between systemic oestradiol and vaginal microbiota composition in miscarriage and normal pregnancy. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Is there an association between serum oestradiol, vaginal microbial composition and pregnancy outcome in the early first trimester?
Summary answer
In women with a vaginal microbiome deplete of Lactobacillus species at the time of Pregnancy of Uncertain Viability (IPUV), higher serum oestradiol associates with livebirth.
What is known already
During pregnancy, oestradiol mediates vaginal mucosal properties and increases glycogen deposition in epithelial cells which is thought to support colonisation of Lactobacillus species. Low levels of Lactobacillus associates with adverse outcomes such as miscarriage and preterm birth. The direct relationship between systemic oestradiol and the vaginal microbiome has never been studied in pregnancy. However studies have shown a positive correlation between serum oestrone, vaginal glycogen and Lactobacillus abundance in menopausal women.
Study design, size, duration
This was a prospective cohort study where one-hundred women were recruited in early pregnancy at the time of IPUV and donated paired blood and vaginal samples. 40 women had an eventual miscarriage, 58 had a livebirth and two pregnancies were terminated. All 100 women donated one paired serum and vaginal sample at this time point, and 22 women with Lactobacillus depletion at the time of IPUV donated further longitudinal vaginal samples.
Participants/materials, setting, methods
Participants were recruited from an Early Pregnancy Unit and underwent transvaginal ultrasound assessment of their pregnancy. Serum samples were analysed with an immunoassay on a ROCHE COBAS E411 analyser for Oestradiol (pg/ml) and Progesterone (ng/ml). Bacterial DNA was extracted from paired vaginal swabs and sequenced using Illumina MiSeq sequencing of 16S rRNA gene amplicons.
Main results and the role of chance
Lactobacillus dominance of the vagina was associated with higher serum levels of E2 and progesterone compared to depletion (E2=398pg/ml vs 302pg/ml(p = 0.02), P4=23.1ng/ml vs 17ng/ml(p = 0.02)). E2 and P4 were positively correlated (r = 0.6, p < 0.05). At species level, L. crispatus dominance associated with significantly higher levels of E2 compared to high-diversity communities (468pg/ml vs 302pg/ml(p = 0.03) but no such relationship was observed for P4. Both E2 and P4 levels were lower in women who eventually miscarried. However there was no significant difference in the vaginal bacterial composition at genera or species level at this early gestational age (P = 0.08) regardless of per vaginal bleeding. However in women with Lactobacillus depleted microbiota, livebirth was associated with significantly higher E2 levels compared to women suffering miscarriage (212pg/ml in miscarriage vs 395pg/ml in livebirth, p = 0.003) (OR = 22.4 P = 0.004). In 22 women who had Lactobacillus depletion at the time of IPUV (7 with an eventual outcome of miscarriage, and 15 with an eventual outcome of livebirth), longitudinal vaginal bacterial DNA sequencing was performed. In 7/15 women with livebirth, and higher E2 levels, the microbial composition changed to become more Lactobacillus dominant during pregnancy, whereas in those with miscarriage, only 1/7 changed to become Lactobacillus dominant.
Limitations, reasons for caution
In this study, serum oestradiol levels were compared to the local vaginal bacterial environment. The ideal would be to study local vaginal oestradiol, glycogen and the bacterial composition.
Wider implications of the findings: In contrast to previous studies in menopause where low oestrogen levels associate with the vaginal microbial composition, this study uses the high oestradiol environment of early pregnancy to study the mechanistic relationship between oestradiol and vaginal Lactobacillus abundance.
Trial registration number
NA
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Affiliation(s)
- H Fourie
- Imperial College London, Metabolism- Digestion and Reproduction, London, United Kingdom
| | - M Al-Memar
- Imperial College London, Early Pregnancy and Acute Gynaecology Unit, London, United Kingdom
| | - A Smith
- Cardiff University, School of Biosciences, Cardiff, United Kingdom
| | - S Ng
- Imperial College London, Faculty of Medicine- Department of Metabolism- Digestion and Reproduction, London, United Kingdom
| | - Y Lee
- Imperial College London, Faculty of Medicine- Department of Metabolism- Digestion and Reproduction, London, United Kingdom
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - T Bourne
- Imperial College London, Early Pregnancy and Acute Gynaecology Unit, London, United Kingdom
| | - D MacIntyre
- Imperial College London, Faculty of Medicine- Department of Metabolism- Digestion and Reproduction, London, United Kingdom
| | - P Bennett
- Imperial College London, Faculty of Medicine- Department of Metabolism- Digestion and Reproduction, London, United Kingdom
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19
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Grewal K, Lee Y, Smith A, Brosens J, Al-Memar M, Bourne T, Kundu S, MacInytre D, Bennett P. O-129 Lactobacillus deplete vaginal microbial composition is associated with chromosomally normal miscarriage and local inflammation. Hum Reprod 2021. [DOI: 10.1093/humrep/deab126.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
To investigate the vaginal microbial composition and the local immune response in chromosomally normal and abnormal miscarriages and compare this to uncomplicated pregnancies delivering at term.
Summary answer
We show that euploid miscarriage is associated with a significantly higher prevalence of Lactobacillus spp. deplete vaginal microbial communities compared to aneuploid miscarriage.
What is known already
Emerging evidence supports the role of the vaginal microbiota in adverse pregnancy outcome, but the underlying mechanisms are poorly understood. A dominance of Lactobacillus spp. in pregnancy provides protection against pathogenic bacteria by producing lactic acid and antimicrobial compounds. A depletion in Lactobacillus spp. is often linked to adverse pregnancy outcomes.Current work also implicates the reproductive tract microbiota as a key modulator of local inflammatory and immune pathways. We have previously shown that miscarriage is associated with vaginal dysbiosis but without knowledge of the cytogenetic status of those miscarriages or the local immune profile.
Study design, size, duration
This study was a prospective observational cohort study based at Queen Charlotte’s & Chelsea Hospital, Early Pregnancy Unit, London between March 2014-February 2019. Vaginal swabs were collected from the posterior vaginal fornix of 167 patients.
Participants/materials, setting, methods
We used 16S rRNA gene based metataxonomics to interrogate the vaginal microbiota in a cohort of 167 women, 93 miscarriage patients (54 euploid and 39 aneuploid using molecular cytogenetics) and 74 women who delivered at term and correlate this with the aneuploidy status of the miscarriages. We also measured the concentrations of IL-2, IL-4, IL-6, IL-8, TNF-α, IFN-γ, IL-1β, IL-18 and IL-10 in cervical vaginal fluid using Human Magnetic Luminex Screening Assay (8-plex).
Main results and the role of chance
We show that euploid miscarriage is associated with a significantly higher prevalence of Lactobacillus spp. deplete vaginal microbial communities compared to aneuploid miscarriage (P=0.008). In women having Lactobacillus spp. deplete vaginal microbial communities, euploid miscarriage associates with higher concentrations of pro-inflammatory cytokines IL-1β, IL-8, IL-6 (P<0.001, P=0.01 and P<0.001 respectively) and lower concentrations of anti-inflammatory cytokines IL10 (P<0.001) when compared to viable term pregnancy. We identified Prevotella bivia and Streptococcus as particularly common in euploid miscarriage and as drivers of pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α). Co-occurrence network analyses revealed low levels of co-occurrence between Lactobacillus crispatus and other organisms and strong co-occurrence between Streptococcal species. Our data show a combination of both an adverse vaginal microbiota and a cytokine response to it influences early pregnancy outcome. Although this may be a reflection of intrinsic maternal immune response, it appears that the cytokine response is largely driven by the bacterial taxa present in the vagina, which presents an opportunity for specific, directed intervention. The negative co-occurrence between L.crispatus and all other organisms suggests a possible therapeutic role for probiotics containing this organism. The influence of Streptococci also suggests a potential benefit of targeted antibiotics with probiotics for some patients.
Limitations, reasons for caution
There were no longitudinal samples in this cohort and our results are based on the assumption that the vaginal microbial composition is stable throughout the first trimester.Future longitudinal studies with larger sample sizes are needed to corroborate these findings and provide insights to the mechanisms that trigger the inflammatory response.
Wider implications of the findings
These findings support the hypothesis that the vaginal microbiota plays an important aetiological role in euploid miscarriage and may represent a target to modify the risk of pregnancy loss.
Trial registration number
n/a
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Affiliation(s)
- K Grewal
- Imperial College London, Metabolism- Digestion and Reproduction, London, United Kingdom
| | - Y Lee
- Imperial College London, Metabolism- Digestion and Reproduction, London, United Kingdom
| | - A Smith
- University West of England, Faculty of Health and Applied Sciences, Bristol, United Kingdom
| | - J Brosens
- University of Warwick, Division of Biomedical Sciences, Warwick, United Kingdom
| | - M Al-Memar
- Imperial College London, Metabolism- Digestion and Reproduction, London, United Kingdom
| | - T Bourne
- Imperial College London, Metabolism- Digestation and Reproduction, London, United Kingdom
| | - S Kundu
- Imperial College London, Metabolism- Digestion and Reproduction, London, United Kingdom
| | - D MacInytre
- Imperial College London, Metabolism- Digestation and Reproduction, London, United Kingdom
| | - P Bennett
- Imperial College London, Metabolism- Digestation and Reproduction, London, United Kingdom
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20
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Thomas AG, Stone B, Bennett P, Stewart-Williams S, Kennair LEO. Sex Differences in Voyeuristic and Exhibitionistic Interests: Exploring the Mediating Roles of Sociosexuality and Sexual Compulsivity from an Evolutionary Perspective. Arch Sex Behav 2021; 50:2151-2162. [PMID: 34231108 PMCID: PMC8275528 DOI: 10.1007/s10508-021-01991-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 05/28/2023]
Abstract
Sociosexuality and sexual compulsivity predict sex differences in voyeuristic interest in the population. In this study, we used a sample of 1113 participants from the UK (46% men) to consider whether sociosexuality and sexual compulsivity interacted to explain these sex differences and whether this relationship extended to the related domain of exhibitionism. In doing so, we tested novel predictions derived from an evolutionary perspective which views voyeuristic and exhibitionistic interest as manifestations of a short-term mating strategy. Participants reported their levels of repulsion toward voyeurism and exhibitionism and their interest in performing such acts under different levels of risk. There were clear sex differences in voyeuristic and exhibitionistic repulsion that were partially mediated by the serial combination of sociosexuality and sexual compulsivity. Examining the sexes separately revealed qualitatively different relationships between sociosexuality and sexual compulsivity when predicting exhibitionistic, but not voyeuristic, repulsion. Combined, sociosexuality and sexual compulsivity also mediated the sex difference in willingness to commit acts of voyeurism, but not exhibitionism, which was equally low for both sexes. The results highlight the role sociosexuality plays in voyeuristic and exhibitionistic interest, which coupled with an evolutionary perspective, may have implications for how we view courtship disorders.
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Affiliation(s)
| | - Bridie Stone
- Department of Psychology, Swansea University, Swansea, SA2 8PP, UK
| | - Paul Bennett
- Department of Psychology, Swansea University, Swansea, SA2 8PP, UK
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Kyrgiou M, Bowden SJ, Athanasiou A, Paraskevaidi M, Kechagias K, Zikopoulos A, Terzidou V, Martin-Hirsch P, Arbyn M, Bennett P, Paraskevaidis E. Morbidity after local excision of the transformation zone for cervical intra-epithelial neoplasia and early cervical cancer. Best Pract Res Clin Obstet Gynaecol 2021; 75:10-22. [PMID: 34148778 DOI: 10.1016/j.bpobgyn.2021.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/29/2021] [Accepted: 05/12/2021] [Indexed: 12/31/2022]
Abstract
The awareness that cervical intra-epithelial neoplasia (CIN) treatment increases the risk of preterm birth has led to major changes in clinical practice. Women with CIN have a higher baseline risk of prematurity but local treatment further increases this risk. The risk further increases with increasing cone length and multiplies for repeat excisions; it is unclear whether small cones confer any additional risk to CIN alone. There is no evidence to suggest that fertility is affected by local treatment, although this increases the risk of mid-trimester loss. Caution should prevail when deciding to treat women with CIN of reproductive age. If treatment is offered, this should be conducted effectively to optimise the clearance of disease and minimise the risk of recurrence. Colposcopists should alert women undergoing treatment that this may increase the risk of preterm birth and that they may be offered interventions when pregnant. The cone length should be clearly documented and used as a risk stratifier.
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Affiliation(s)
- M Kyrgiou
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK.
| | - S J Bowden
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK
| | - A Athanasiou
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Royal Cornwall Hospital, Truro, UK
| | - M Paraskevaidi
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK
| | - K Kechagias
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK
| | - A Zikopoulos
- Department of Obstetrics & Gynaecology, Royal Cornwall Hospital, Truro, UK
| | - V Terzidou
- Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK; Department of Obstetrics & Gynaecology, Chelsea and Westminster NHS Trust, London, UK
| | - P Martin-Hirsch
- Department of Obstetrics & Gynaecology, Central Lancashire Teaching Hospitals, Preston, UK
| | - M Arbyn
- Coordinator Unit Cancer Epidemiology, Belgian Cancer Centre, Sciensano, Brussels, Belgium
| | - P Bennett
- Department of Metabolism, Digestion and Reproduction, Department of Surgery and Cancer, IRDB, Imperial College London, London, UK; Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK
| | - E Paraskevaidis
- Department of Obstetrics & Gynaecology, Imperial Healthcare NHS Trust, London, UK; Department of Obstetrics & Gynaecology, University Hospital of Ioannina, Ioannina, Greece
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Hill K, Bennett P, Hunter R. 'It's social interaction. . . but it's not': A qualitative study investigating the psycho-social experience of social media by individuals with a visual impairment. J Health Psychol 2021; 27:1070-1083. [PMID: 33586499 DOI: 10.1177/1359105321995949] [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] [Indexed: 11/16/2022] Open
Abstract
People with visual impairment (VI) may encounter psychosocial challenges including difficulties with socialisation/interpreting visual social cues. Social media (SM) may provide alternative means of socialisation but little is known about the experience of SM from their perspective. Semi-structured interviews with 10 individuals with VI who regularly use SM were analysed according to interpretative phenomenological analysis. Analysis yielded two overarching themes: social media and identity, and social connectedness. Participants described benefits of shared experience, feelings of enhanced control and challenges of SM which emphasise exclusion/inequality. Findings highlight a need for further research to understand/improve the online experience for people with VI.
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Klinner C, Bennett P, Hooker C. Engaging Medical Students with Art: What’s the Value? MedEdPublish 2021. [DOI: 10.15694/mep.2021.000105.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
OBJECTIVES To gain insight into the experiences and concerns of front-line National Health Service (NHS) workers while caring for patients with COVID-19. DESIGN Qualitative analysis of data collected through an anonymous website (www.covidconfidential) provided a repository of uncensored COVID-19 experiences of front-line NHS workers, accessed via a link advertised on the Twitter feed of two high profile medical tweeters and their retweets. SETTING Community of NHS workers who accessed this social media. PARTICIPANTS 54 healthcare workers, including doctors, nurses and physiotherapists, accessed the website and left a 'story'. RESULTS Stories ranged from 1 word to 10 min in length. Thematic analysis identified common themes, with a central aspect being the experience and psychological consequence of trauma. Specific themes were: (1) the shock of the virus, (2) staff sacrifice and dedication, (3) collateral damage ranging from personal health concerns to the long-term impact on, and care of, discharged patients and (4) a hierarchy of power and inequality within the healthcare system. CONCLUSIONS COVID-19 confidential gave an outlet for unprompted and uncensored stories of healthcare workers in the context of COVID-19. In addition to personal experiences of trauma, there were perceptions that many operational difficulties stemmed from inequalities of power between management and front-line workers. Learning from these experiences will reduce staff distress and improve patient care in the face of further waves of the pandemic.
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Affiliation(s)
- Paul Bennett
- Department of Psychology, Swansea University, Swansea, UK
| | - S Noble
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, UK
| | | | - David Jones
- Dept Anaesthetics and Critical Care, Prince Charles Hospital, Merthyr Tydfil, UK
| | - Rachael Hunter
- Department of Psychology, Swansea University, Swansea, UK
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25
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Moshofsky K, Chang E, Bednar M, Bennett P, Hedlund S, Cook K. Implementation of a Private Screening Survey to Assess for Needs in Sensitive Areas for Patients in a Radiation Oncology Clinic. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Peacock OJ, Western MJ, Batterham AM, Chowdhury EA, Stathi A, Standage M, Tapp A, Bennett P, Thompson D. Effect of novel technology-enabled multidimensional physical activity feedback in primary care patients at risk of chronic disease - the MIPACT study: a randomised controlled trial. Int J Behav Nutr Phys Act 2020; 17:99. [PMID: 32771018 PMCID: PMC7414690 DOI: 10.1186/s12966-020-00998-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Technological progress has enabled the provision of personalised feedback across multiple dimensions of physical activity that are important for health. Whether this multidimensional approach supports physical activity behaviour change has not yet been examined. Our objective was to examine the effectiveness of a novel digital system and app that provided multidimensional physical activity feedback combined with health trainer support in primary care patients identified as at risk of chronic disease. METHODS MIPACT was a parallel-group, randomised controlled trial that recruited patients at medium (≥10 and < 20%) or high (≥20%) risk of cardiovascular disease and/or type II diabetes from six primary care practices in the United Kingdom. Intervention group participants (n = 120) received personal multidimensional physical activity feedback using a customised digital system and web-app for 3 months plus five health trainer-led sessions. All participants received standardised information regarding physical activity. Control group participants (n = 84) received no further intervention. The primary outcome was device-based assessment of physical activity at 12 months. RESULTS Mean intervention effects were: moderate-vigorous physical activity: -1.1 (95% CI, - 17.9 to 15.7) min/day; moderate-vigorous physical activity in ≥10-min bouts: 0.2 (- 14.2 to 14.6) min/day; Physical Activity Level (PAL): 0.00 (- 0.036 to 0.054); vigorous physical activity: 1.8 (- 0.8 to 4.2) min/day; and sedentary time: 10 (- 19.3 to 39.3) min/day. For all of these outcomes, the results showed that the groups were practically equivalent and statistically ruled out meaningful positive or negative effects (>minimum clinically important difference, MCID). However, there was profound physical activity multidimensionality, and only a small proportion (5%) of patients had consistently low physical activity across all dimensions. CONCLUSION In patients at risk of cardiovascular disease and/or type II diabetes, MIPACT did not increase mean physical activity. Using a sophisticated multidimensional digital approach revealed enormous heterogeneity in baseline physical activity in primary care patients, and practitioners may need to screen for low physical activity across dimensions rather than rely on disease-risk algorithms that are heavily influenced by age. TRIAL REGISTRATION This trial is registered with the ISRCTN registry ( ISRCTN18008011 ; registration date 31 July 2013).
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Affiliation(s)
| | - Max J Western
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Alan M Batterham
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | | | - Afroditi Stathi
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Martyn Standage
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Alan Tapp
- Bristol Business School, University of West of England, Bristol, UK
| | - Paul Bennett
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK.
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27
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Pomeroy E, Hunt CO, Reynolds T, Abdulmutalb D, Asouti E, Bennett P, Bosch M, Burke A, Farr L, Foley R, French C, Frumkin A, Goldberg P, Hill E, Kabukcu C, Lahr MM, Lane R, Marean C, Maureille B, Mutri G, Miller CE, Mustafa KA, Nymark A, Pettitt P, Sala N, Sandgathe D, Stringer C, Tilby E, Barker G. Issues of theory and method in the analysis of Paleolithic mortuary behavior: A view from Shanidar Cave. Evol Anthropol 2020; 29:263-279. [PMID: 32652819 DOI: 10.1002/evan.21854] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/17/2019] [Accepted: 06/06/2020] [Indexed: 02/02/2023]
Abstract
Mortuary behavior (activities concerning dead conspecifics) is one of many traits that were previously widely considered to have been uniquely human, but on which perspectives have changed markedly in recent years. Theoretical approaches to hominin mortuary activity and its evolution have undergone major revision, and advances in diverse archeological and paleoanthropological methods have brought new ways of identifying behaviors such as intentional burial. Despite these advances, debates concerning the nature of hominin mortuary activity, particularly among the Neanderthals, rely heavily on the rereading of old excavations as new finds are relatively rare, limiting the extent to which such debates can benefit from advances in the field. The recent discovery of in situ articulated Neanderthal remains at Shanidar Cave offers a rare opportunity to take full advantage of these methodological and theoretical developments to understand Neanderthal mortuary activity, making a review of these advances relevant and timely.
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Affiliation(s)
- Emma Pomeroy
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Chris O Hunt
- School of Biological and Environmental Sciences, Liverpool John Moores University, Liverpool, UK
| | - Tim Reynolds
- Department of History, Classics and Archaeology Birkbeck, University of London, London, UK
| | | | - Eleni Asouti
- Department of Archaeology, Classics and Egyptology, University of Liverpool, Liverpool, UK
| | | | - Marjolein Bosch
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Ariane Burke
- Département d'Anthropologie, Université de Montréal, Montreal, Quebec, Canada
| | - Lucy Farr
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK
| | - Robert Foley
- Leverhulme Centre for Human Evolutionary Studies, Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Charles French
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Amos Frumkin
- Institute of Earth Sciences, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Paul Goldberg
- Centre for Archaeological Science, University of Wollongong, Wollongong, New South Wales, Australia.,Institute for Archaeological Sciences, Senckenberg Centre for Human Evolution and Paleoenvironment, University of Tübingen, Tübingen, Germany
| | - Evan Hill
- School of Natural and Built Environment, Queen's University Belfast, Belfast, UK
| | - Ceren Kabukcu
- Department of Archaeology, Classics and Egyptology, University of Liverpool, Liverpool, UK
| | - Marta Mirazón Lahr
- Leverhulme Centre for Human Evolutionary Studies, Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Ross Lane
- Canterbury Archaeological Trust, Canterbury, UK
| | - Curtis Marean
- Institute of Human Origins, School of Human Evolution and Social Change, Tempe, Arizona, USA
| | - Bruno Maureille
- CNRS, UMR5199 PACEA, Université de Bordeaux, Ministry of Culture, Pessac Cedex, France
| | - Giuseppina Mutri
- The Cyprus Institute, Nicosia, Cyprus.,International Association for Mediterranean and Oriental Studies (ISMEO), Rome, Italy
| | - Christopher E Miller
- SFF Centre for Early Sapiens Behaviour (SapienCE), University of Bergen, Bergen, Norway
| | - Kaify Ali Mustafa
- General Directorate of Antiquities in Kurdistan, Kurdish Regional Government, Erbil, Iraq
| | - Andreas Nymark
- Department of History, Classics and Archaeology Birkbeck, University of London, London, UK
| | - Paul Pettitt
- Department of Archaeology, Durham University, Durham, UK
| | - Nohemi Sala
- Centro Nacional de Investigación sobre Evolución Humana (CENIEH), Paseo Sierra de Atapuerca, Burgos, Spain
| | - Dennis Sandgathe
- Department of Archaeology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Chris Stringer
- CHER, Department of Earth Sciences, Natural History Museum, London, UK
| | - Emily Tilby
- Department of Archaeology, University of Cambridge, Cambridge, UK
| | - Graeme Barker
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, UK
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Affiliation(s)
- Paul Bennett
- Department of Psychology, Swansea University, Swansea SA2 8PP, UK
| | - Rachael Hunter
- Department of Psychology, Swansea University, Swansea SA2 8PP, UK
| | - Steve Johnston
- Department of Psychology, Swansea University, Swansea SA2 8PP, UK
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Møller-Bisgaard S, Georgiadis S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Ørnbjerg L, Glinatsi D, Møllenbach Møller J, Boesen M, Stengaard-Pedersen K, Rintek Madsen O, Jensen B, Villadsen J, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard HM, Bliddal H, Steen Krogh N, Ellingsen T, Nielsen A, Balding L, Jurik AG, Thomsen H, Ǿstergaard M. AB0209 PREDICTORS OF ACHIEVING STRINGENT REMISSION IN PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS IN CLINICAL REMISSION FOLLOWING A TREAT-TO-TARGET STRATEGY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Achieving remission according to stringent criteria such as Simplified Disease Activity Index (SDAI) and ACR/EULAR Boolean remission is associated with a better long-term outcome in patients with RA1. Possible predictors of achieving stringent remission in patients in clinical remission, following targeted treatment strategies, have not been investigated.Objectives:To investigate the predictive value of clinical, radiographic and MRI variables on achieving more stringent remission in RA patients in clinical remission, following MRI and conventional treat-to-target (T2T) strategies.Methods:In this post-hoc study, data were used from 171 RA patients in clinical remission (DAS28-CRP< 3.2 and no swollen joints) on conventional synthetic DMARDs, included in the IMAGINE-RA randomized clinical trial2, where they followed an MRI T2T strategy (targeting absence of osteitis) combined with clinical remission (DAS28-CRP≤3.2 and no swollen joints) or a conventional T2T strategy (targeting clinical remission only). Baseline contrast-enhanced MRIs of the dominant wrist and 2nd-5thMCP joints and radiographs of hands and feet were evaluated according to the OMERACT RAMRIS scoring system and Sharp/van der Heijde method, respectively, by two experienced readers. Potential clinical, radiographic and MRI baseline predictors of remission were first tested in univariate logistic regression analyses with achievement of Clinical Disease Activity Index (CDAI), SDAI, and ACR/EULAR Boolean remission at 24 months as dependent variables. Variables with p<0.25 were subsequently tested in multivariate logistic regression analyses with backward selection, adjusted for age, gender and strategy group. Missing values of covariates were imputed using chained equations.Results:Based on the univariate analyses, tender joint count, patient VAS global, VAS pain, VAS fatigue, physician VAS global, HAQ, MRI osteitis, radiographic and MRI erosion and joint space narrowing scores were included in multivariate analyses (Table).Following the MRI T2T strategy was a positive predictor and high patient VAS global a negative predictor of achieving all definitions of remission. Furthermore, high patient VAS pain was negatively associated with achieving SDAI and ACR/EULAR Boolean remission and high tender joint count negatively associated with achieving CDAI and SDAI remission.Multivariate logistic regression analyses with backward selection, final modelsDependent variables, remission at 24 monthsCDAISDAIACR/EULAR BooleanOR95% CIp-valueOR95% CIp-valueOR95% CIp-valueCovariatesMRI T2T strategy group2.941.25-7.520.0132.461.03-6.350.0435.472.33-14.11<0.001Female0.900.36-2.250.820.800.31-2.050.640.800.32-1.970.63Age1.020.98-1.070.321.020.98-1.070.331.030.99-1.070.15Tender joint count (0-28)0.330.12-0.860.0230.290.10-0.780.013Patient VAS global0.910.88-0.94<0.0010.930.88-0.97<0.0010.930.88-0.980.003Patient VAS pain0.950.91-1.000.0490.920.87-0.980.004Conclusion:In RA patients in clinical remission, poor patient reported outcomes and tender joint count were associated with decreased chance of achieving stringent remission, while following an MRI T2T strategy predicted stringent remission across all definitions thereof.References:[1]Smolen et al. Ann Rheum Dis 2017[2]Møller-Bisgaard et al. JAMA 2019Disclosure of Interests:Signe Møller-Bisgaard Grant/research support from: AbbVie, Consultant of: BMS, Speakers bureau: BMS, Celgene, Pfizer, Stylianos Georgiadis Grant/research support from: Novartis, Kim Hørslev-Petersen: None declared, Bo Ejbjerg: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Lykke Ørnbjerg: None declared, Daniel Glinatsi: None declared, Jakob Møllenbach Møller: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Kristian Stengaard-Pedersen: None declared, Ole Rintek Madsen: None declared, Bente Jensen: None declared, Jan Villadsen: None declared, Ellen Margrethe Hauge: None declared, Philip Bennett: None declared, Oliver Hendricks: None declared, Karsten Asmussen: None declared, Marcin Kowalski: None declared, Hanne Merete Lindegaard: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Niels Steen Krogh: None declared, Torkell Ellingsen: None declared, Agnete Nielsen: None declared, Lone Balding: None declared, Anne Grethe Jurik: None declared, Henrik Thomsen: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB
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Viecelli A, Dansie K, McDonald S, Jesudason S, Duncanson E, Bennett P, Morton R. MO037SYMPTOM MONITORING WITH FEEDBACK TRIAL (SWIFT) PILOT TO EXPLORE THE FEASIBILITY AND ACCEPTABILITY OF ELECTRONIC PATIENT REPORTED OUTCOME MEASURES (E-PROMS) DATA CAPTURE AND FEEDBACK. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa140.mo037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
People on haemodialysis (HD) often experience overwhelming and debilitating symptoms of fatigue, pain, nausea, itching, sleeping problems and depression that contribute to poor quality of life. Trials in oncology have shown that active symptom monitoring can improve quality of life and survival, but it remains unknown if this intervention is effective in people on HD. The use of PROMs is increasing in nephrology care; but they are not routinely collected in kidney registries. The SWIFT pilot aims to assess the feasibility and acceptability of tablet-based symptom monitoring with feedback to clinicians in preparation of a large-scale, registry-based cluster-randomised trial to assess the clinical- and cost-effectiveness of this intervention in HD (SWIFT; ACTRN12618001976279).
Method
This pragmatic, multicenter cluster-randomised controlled pilot study tests the hypothesis that 3-monthly tablet-based PROMs monitoring using the Integrated Palliative Outcome Scale-Renal Symptom Tool with electronic feedback to clinicians using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) compared with usual care will improve health-related quality of life measured by EQ-5D-5L and is technically feasible and clinically acceptable to patients, nurses and nephrologists in different HD settings. Acceptability and feasibility outcomes are assessed through a process evaluation using the Medical Research Council framework: (1) patient acceptability of ePROMS (5-point Likert scale; focus groups with 20 purposively sampled participants), (2) feasibility of embedding ePROMS in routine care (response rates, time from data capture to feedback, ease of generating PROMs reports by the ANZDATA registry), (3) acceptability and usefulness of ePROMs data for nephrologists and nurses (qualitative semi-structured interviews with thematic analysis).
Results
163 adult patients from 4 HD units across Australia were enrolled (83 in the intervention units and 80 to the control units) and completed baseline PROMs, representing 77% of eligible patients (range 44-90%). At 3-months, 61% of enrolled patients in the intervention units completed the PROMs (range 48-73%). Reasons for non-completion included transfer to another unit and lack of ability to read English. Severe or overwhelming symptoms were reported by 30 of 83 enrolled patients (36%) at baseline and by 32 of 62 (52%) at 3 months. Technical feasibility was demonstrated by successful development of a Qualtrics survey platform presented on tablet computers, use of QR reader codes for linkage with the ANZDATA registry which captures clinical outcomes, and linkage to the relevant survey for the patient’s allocation and trial timepoint. Emails containing a short report of any symptoms identified as severe or overwhelming along with a summary of evidence-based guidelines for management of those symptoms were sent to and opened by treating clinicians. Assessment of patient and clinician acceptability of the feedback mechanism is ongoing.
Conclusion
Electronic symptom monitoring in adults on HD with feedback to clinicians is feasible and provides a template for ongoing registry-based monitoring of PROMs to facilitate patient-centred care and the infrastructure for future evaluations of interventions to improve patients’ quality of life and survival.
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Affiliation(s)
| | - Kathryn Dansie
- SAHMRI (South Australian Health and Medical Research Institute), Adelaide, Australia
| | - Stephen McDonald
- SAHMRI (South Australian Health and Medical Research Institute), Adelaide, Australia
| | | | - Emily Duncanson
- SAHMRI (South Australian Health and Medical Research Institute), Adelaide, Australia
| | - Paul Bennett
- Satellite Healthcare San Jose, San Jose, United States of America
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31
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Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Christensen R, Ørnbjerg L, Glinatsi D, Møllenbach Møller J, Boesen M, Stengaard-Pedersen K, Rintek Madsen O, Jensen B, Villadsen J, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard HM, Bliddal H, Steen Krogh N, Ellingsen T, Nielsen A, Jurik AG, Balding L, Thomsen H, Ǿstergaard M. FRI0019 MRI INFLAMMATION, DISEASE ACTIVITY AND FUNCTIONAL IMPAIRMENT ARE MORE EFFECTIVELY REDUCED BY ESCALATION TO BIOLOGICS COMPARED TO CSDMARD-ESCALATION IN RHEUMATOID ARTHRITIS PATIENTS IN CLINICAL REMISSION FOLLOWING A TREAT-TO-TARGET STRATEGY: SECONDARY ANALYSES OF THE IMAGINE-RA TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The effect of different treatment escalations on MRI inflammation in rheumatoid arthritis (RA) patients following an MRI treat-to-target (T2T) strategy has not previously been investigated.Objectives:To compare the effect of different treatment escalations on MRI inflammation, physical function and disease activity in RA patients in clinical remission, following an MRI T2T strategy.Methods:One hundred RA patients in clinical remission (DAS28-CRP<3.2 and no swollen joints), on conventional synthetic (cs) DMARDs following an MRI T2T strategy targeting DAS28-CRP≤3.2, no swollen joints plus absence of MRI osteitis, were followed for 2 years with clinical and MRI (wrist and 2nd-5thMCP joints) evaluation every 4 months1. If target was not met, a predefined treatment escalation algorithm dictated: First: increase in csDMARDs (A), second: adding a TNF inhibitor (TNFi) (B), third and onwards: switch between biologics (C). If target was met, no change in baseline csDMARDs was done (D). Outcomes were assessed 4 months after treatment change. MRIs were evaluated with known chronology by one experienced reader. Repeated measures mixed linear models were used to express estimates of group differences on predefined co-primary outcomes (MRI osteitis, HAQ) and key secondary outcomes (MRI combined inflammation, Simplified Disease Activity Index (SDAI)).Results:Escalation to first TNFi (B) or to 2ndor later biologic (C) compared to csDMARDs (A) was consistently more effective on all outcomes (e.g. in group B osteitis was reduced with 1.8 units more than A) (Table). Unchanged (D) compared to escalation in csDMARD (A) treatment did not differ, except for HAQ-score. Escalation to a 2ndor later biologics (C) compared to the first TNFi (B) was more effective suppressing MRI inflammation. Escalation to TNFi treatment (B) or to 2ndor later biologic (C) compared to unchanged treatment (D) was more effective on all outcomes except from HAQ-score (no difference between groups).Comparisons of treatment escalations1A: Increment in csDMARD mono/combination therapy (n=73)); B: Switch from csDMARD combination therapy to TNFi (n=39); C: Switch from TNFi to 2ndbiologic/switch between biologics (n=21); D: No change in csDMARDs from baseline (n=58)A vs BA vs CA vs DB vs CB vs DC vs DOutcomesPrimaryMRIOsteitis1.8 (1.0; 2.6) p<.00013.6 (2.3; 4.8) p<.00010.3 (−0.3; 1.0)p=.321.8 (0.8; 2.9) p=.0006−1.4 (−2.4; −0.5) p=.0045−3.3 (−4.6; −1.9) p<.0001HAQ0.081(0.033; 0.13) p=.00110.091(0.031; 0.15) p=.00320.054(0.014; 0.095) p=.00910.0092(−0.051; 0.070) p=.77−0.027(−0.082; 0.028) p=.33−0.037(−0.10; 0.031) p=.29Key secondaryMRI combined inflammationa2.5 (0.9; 4.1) p=.00185.4 (3.1; 7.7) p<.00010.4 (−0.9; 1.8)p=.522.9 (0.8; 4.9) p=.0064−2.1 (−4.0; −0.2) p=.032−5.0 (−7.5; −2.4) p=.0002SDAI2.7 (1.9; 3.5) p<.00012.4 (1.4; 3.4) p<.00010.5 (−0.2; 1.2)p=.14−0.3 (−1.3; 0.7)p=.60−2.2 (−3.1; −1.3) p<.0001−1.9 (−3.0; 0.8) p=.00061Estimates of group differences (least squares means (95% CI)).aSum score of synovitis, osteitis and tenosynovitisConclusion:T2T-based treatment escalations to biologics compared to csDMARD-escalations more effectively improved MRI inflammation, physical function and disease activity. Further optimization of the treatment in RA patients in clinical remission may improve long-term outcomes.References:[1]Møller-Bisgaard et al. JAMA 2019Disclosure of Interests:Signe Møller-Bisgaard Grant/research support from: AbbVie, Consultant of: BMS, Speakers bureau: BMS, Celgene, Pfizer, Kim Hørslev-Petersen: None declared, Bo Ejbjerg: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Robin Christensen: None declared, Lykke Ørnbjerg: None declared, Daniel Glinatsi: None declared, Jakob Møllenbach Møller: None declared, Mikael Boesen Consultant of: AbbVie, AstraZeneca, Eli Lilly, Esaote, Glenmark, Novartis, Pfizer, UCB, Paid instructor for: IAG, Image Analysis Group, AbbVie, Eli Lilly, AstraZeneca, esaote, Glenmark, Novartis, Pfizer, UCB (scientific advisor)., Speakers bureau: Eli Lilly, Esaote, Novartis, Pfizer, UCB, Kristian Stengaard-Pedersen: None declared, Ole Rintek Madsen: None declared, Bente Jensen: None declared, Jan Villadsen: None declared, Ellen Margrethe Hauge: None declared, Philip Bennett: None declared, Oliver Hendricks: None declared, Karsten Asmussen: None declared, Marcin Kowalski: None declared, Hanne Merete Lindegaard: None declared, Henning Bliddal Grant/research support from: received research grant fra NOVO Nordic, Consultant of: consultant fee fra NOVO Nordic, Niels Steen Krogh: None declared, Torkell Ellingsen: None declared, Agnete Nielsen: None declared, Anne Grethe Jurik: None declared, Lone Balding: None declared, Henrik Thomsen: None declared, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB
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Al-Memar M, Vaulet T, Fourie H, Bobdiwala S, Farren J, Saso S, Bracewell-Milnes T, Moor BD, Sur S, Stalder C, Bennett P, Timmerman D, Bourne T. First-trimester intrauterine hematoma and pregnancy complications. Ultrasound Obstet Gynecol 2020; 55:536-545. [PMID: 31483898 DOI: 10.1002/uog.20861] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess whether sonographic diagnosis of intrauterine hematoma (IUH) in the first trimester of pregnancy is associated with first-trimester miscarriage and antenatal, delivery and neonatal complications. METHODS This was a prospective observational cohort study of women with an intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's and Chelsea Hospital, London, UK, between March 2014 and March 2016. Participants underwent serial ultrasound examinations in the first trimester, and the presence, location, size and persistence of any IUH was evaluated. First-trimester miscarriage was defined as pregnancy loss before 14 weeks' gestation. Clinical symptoms, including pelvic pain and vaginal bleeding, were recorded at each visit using validated symptom scores. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis and the chi-square test were used to assess the association between the presence and features of IUH and the incidence of adverse pregnancy outcome. Odds ratios (OR) were first adjusted for maternal age (aOR) and then further adjusted for the presence of vaginal bleeding or pelvic pain in the first trimester. RESULTS Of 1003 women recruited to the study, 946 were included in the final analysis and of these, 268 (28.3%) were diagnosed with an IUH in the first trimester. The presence of IUH was associated with the incidence of preterm birth (aOR, 1.94 (95% CI, 1.07-3.52)), but no other individual or overall antenatal, delivery or neonatal complications. No association was found between the presence of IUH in the first trimester and first-trimester miscarriage (aOR, 0.81 (95% CI, 0.44-1.50)). These findings were independent of the absolute size of the hematoma and the presence of vaginal bleeding or pelvic pain in the first trimester. When IUH was present in the first trimester, there was no association between its size, content or position in relation to the gestational sac and overall antenatal, delivery and neonatal complications. Diagnosis of a retroplacental IUH was associated with an increased risk of overall antenatal complications (P = 0.04). CONCLUSIONS Our findings demonstrate that there is no association between the presence of IUH in the first trimester and first-trimester miscarriage. However, an association with preterm birth, independently of the presence of symptoms of pelvic pain and/or vaginal bleeding, is evident. Women diagnosed with IUH in the first trimester should be counseled about their increased risk of preterm birth and possibly be offered increased surveillance during the course of their pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Al-Memar
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - T Vaulet
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- imec, Leuven, Belgium
| | - H Fourie
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - S Bobdiwala
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - J Farren
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - S Saso
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - T Bracewell-Milnes
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - B De Moor
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- imec, Leuven, Belgium
| | - S Sur
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - C Stalder
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - P Bennett
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
| | - D Timmerman
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- Tommy's National Centre for Miscarriage Research, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Division of Surgery and Cancer, Institute of Developmental Reproductive and Developmental Biology, Imperial College London, London, UK
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Nelson K, Bennett P, Rance J. The experiences of giving and receiving social support for men with localised prostate cancer and their partners. Ecancermedicalscience 2020; 13:989. [PMID: 32010213 PMCID: PMC6974370 DOI: 10.3332/ecancer.2019.989] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 12/05/2022] Open
Abstract
Objective To explore how men and their partners utilise social support in the first 12 months following a localised prostate cancer diagnosis. Design A longitudinal qualitative design. Methods Eighteen couples were recruited from two outpatient clinics following a localised prostate cancer diagnosis. Participants took part in semi-structured interviews at three time-points following diagnosis. Data were analysed using thematic analysis. Results Support networks for couples became smaller as time progressed. Stigma was seen to have a role in men’s disclosure decisions. Partners generally provided higher levels of support than they received back. By Time 3, men who had previously attended social support groups rejoined to seek informational and emotional support. For partners, there appeared to be a fine line between disclosing their true feelings and protecting their partner, and they appeared to struggle to access meaningful emotional support and accept instrumental support from trusted others. Conclusions The findings expand our understanding of the support between couples in the months following diagnosis. Social support groups were highlighted as an important source of support. Further research is now needed to help identify which couples may benefit from professional encouragement to attend these groups and which couples may benefit from alternative support provision.
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Affiliation(s)
- Kayleigh Nelson
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Paul Bennett
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK
| | - Jaynie Rance
- College of Human and Health Sciences, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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Kalliala I, Athanasiou A, Veroniki AA, Salanti G, Efthimiou O, Raftis N, Bowden S, Paraskevaidi M, Aro K, Arbyn M, Bennett P, Nieminen P, Paraskevaidis E, Kyrgiou M. Incidence and mortality from cervical cancer and other malignancies after treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis of the literature. Ann Oncol 2020; 31:213-227. [PMID: 31959338 PMCID: PMC7479506 DOI: 10.1016/j.annonc.2019.11.004] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Although local treatments for cervical intraepithelial neoplasia (CIN) are highly effective, it has been reported that treated women remain at increased risk of cervical and other cancers. Our aim is to explore the risk of developing or dying from cervical cancer and other human papillomavirus (HPV)- and non-HPV-related malignancies after CIN treatment and infer its magnitude compared with the general population. MATERIALS AND METHODS Design: Systematic review and meta-analysis. Eligibility criteria: Studies with registry-based follow-up reporting cancer incidence or mortality after CIN treatment. DATA SYNTHESIS Summary effects were estimated using random-effects models. OUTCOMES Incidence rate of cervical cancer among women treated for CIN (per 100 000 woman-years). Relative risk (RR) of cervical cancer, other HPV-related anogenital tract cancer (vagina, vulva, anus), any cancer, and mortality, for women treated for CIN versus the general population. RESULTS Twenty-seven studies were eligible. The incidence rate for cervical cancer after CIN treatment was 39 per 100 000 woman-years (95% confidence interval 22-69). The RR of cervical cancer was elevated compared with the general population (3.30, 2.57-4.24; P < 0.001). The RR was higher for women more than 50 years old and remained elevated for at least 20 years after treatment. The RR of vaginal (10.84, 5.58-21.10; P < 0.001), vulvar (3.34, 2.39-4.67; P < 0.001), and anal cancer (5.11, 2.73-9.55; P < 0.001) was also higher. Mortality from cervical/vaginal cancer was elevated, but our estimate was more uncertain (RR 5.04, 0.69-36.94; P = 0.073). CONCLUSIONS Women treated for CIN have a considerably higher risk to be later diagnosed with cervical and other HPV-related cancers compared with the general population. The higher risk of cervical cancer lasts for at least 20 years after treatment and is higher for women more than 50 years of age. Prolonged follow-up beyond the last screening round may be warranted for previously treated women.
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Affiliation(s)
- I Kalliala
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A Athanasiou
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - A A Veroniki
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - G Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - O Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - N Raftis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - S Bowden
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - M Paraskevaidi
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - K Aro
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium
| | - P Bennett
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - P Nieminen
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - E Paraskevaidis
- Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Ioannina, Greece
| | - M Kyrgiou
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, UK; Queen Charlotte's and Chelsea - Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
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Bennett P, Cook ABS, Soomro N. Reinvigorating the Role of Spirituality in Patient-Centered Care: Islam as a doorway to increased understanding of patient spirituality. MedEdPublish 2020. [DOI: 10.15694/mep.2020.000273.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Roldán-Jiménez C, Cuadros-Romero M, Bennett P, McPhail S, Kerr GK, Cuesta-Vargas AI, Martin-Martin J. Assessment of abduction motion in patients with rotator cuff tears: an analysis based on inertial sensors. BMC Musculoskelet Disord 2019; 20:597. [PMID: 31830985 PMCID: PMC6909443 DOI: 10.1186/s12891-019-2987-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/21/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background Reduced range of motion in the shoulder can be a source of functional limitation. The use of inertial sensors to quantify movement in addition to more common clinical assessments of the shoulder may allow clinicians to understand that they are potentially unnoticed by visual identification. The aim of this study was to generate an explanatory model for shoulder abduction based on data from inertial sensors. Method A cross-sectional study was carried out to generate an explanatory model of shoulder abduction based on data from inertial sensors. Shoulder abduction of thirteen older adults suffering from shoulder dysfunction was recorded with two inertial sensors placed on the humerus and scapula. Movement variables (maximum angular mobility, angular peak of velocity, peak of acceleration) were used to explain the functionality of the upper limb assessed using the Upper Limb Functional Index (ULFI). The abduction movement of the shoulder was explained by six variables related to the mobility of the shoulder joint complex. A multivariate analysis of variance (MANOVA) was used to explain the results obtained on the functionality of the upper limb. Results The MANOVA model based on angular mobility explained 69% of the variance of the ULFI value (r-squared = 0.69). The most relevant variables were the abduction-adduction of the humerus and the medial/lateral rotation of the scapula. Conclusions The method used in the present study reveals the potential importance of the analysis of the scapular and humeral movements for comprehensive evaluation of the upper limb. Further research should include a wider sample and may seek to use this assessment technique in a range of potential clinical applications.
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Affiliation(s)
- Cristina Roldán-Jiménez
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Arquitecto Francisco Peñalosa 3, Campus de Teatinos, 29071, Málaga, Spain.,Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain
| | - Miguel Cuadros-Romero
- Unit of Upper Limb Orthopedic Surgery of Hospital at University of Malaga, Málaga, Spain
| | - Paul Bennett
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia
| | - Steven McPhail
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
| | - Graham K Kerr
- Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia
| | - Antonio I Cuesta-Vargas
- Department of Psychiatry and Physiotherapy, University of Malaga, Faculty of Health Sciences, Arquitecto Francisco Peñalosa 3, Campus de Teatinos, 29071, Málaga, Spain. .,Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain. .,Institute of Health & Biomedical Innovation, Faculty of Health, Queensland University Technology, Brisbane, Australia.
| | - Jaime Martin-Martin
- Clinimetric Group F-14 Biomedical Research Institute of Malaga, (IBIMA), Málaga, Spain.,Department of Human Anatomy, Legal Medicine and History of Science. Legal Medicine Area, University of Malaga, Faculty of Medicine, Malaga, Spain
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Al-Memar M, Vaulet T, Fourie H, Nikolic G, Bobdiwala S, Saso S, Farren J, Pipi M, Van Calster B, de Moor B, Stalder C, Bennett P, Timmerman D, Bourne T. Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study. Ultrasound Obstet Gynecol 2019; 54:530-537. [PMID: 30887596 DOI: 10.1002/uog.20262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess prospectively the association between pelvic pain, vaginal bleeding, and nausea and vomiting occurring in the first trimester of pregnancy and the incidence of later adverse pregnancy outcomes. METHODS This was a prospective observational cohort study of consecutive women with confirmed intrauterine singleton pregnancy between 5 and 14 weeks' gestation recruited at Queen Charlotte's & Chelsea Hospital, London, UK, from March 2014 to March 2016. Serial ultrasound scans were performed in the first trimester. Participants completed validated symptom scores for vaginal bleeding, pelvic pain, and nausea and vomiting. The key symptom of interest was any pelvic pain and/or vaginal bleeding during the first trimester. Pregnancies were followed up until the final outcome was known. Antenatal, delivery and neonatal outcomes were obtained from hospital records. Logistic regression analysis was used to assess the association between first-trimester symptoms and pregnancy complications by calculating adjusted odds ratios (aOR) with correction for maternal age. RESULTS Of 1003 women recruited, 847 pregnancies were included in the final analysis following exclusion of cases due to first-trimester miscarriage (n = 99), termination of pregnancy (n = 20), loss to follow-up (n = 32) or withdrawal from the study (n = 5). Adverse antenatal complications were observed in 166/645 (26%) women with pelvic pain and/or vaginal bleeding in the first trimester (aOR = 1.79; 95% CI, 1.17-2.76) and in 30/181 (17%) women with no symptoms. Neonatal complications were observed in 66/634 (10%) women with and 11/176 (6%) without pelvic pain and/or vaginal bleeding (aOR = 1.73; 95% CI, 0.89-3.36). Delivery complications were observed in 402/615 (65%) women with and 110/174 (63%) without pelvic pain and/or vaginal bleeding during the first trimester (aOR = 1.16; 95% CI, 0.81-1.65). For 18 of 20 individual antenatal complications evaluated, incidence was higher among women with pelvic pain and/or vaginal bleeding, despite the overall incidences being low. Nausea and vomiting in pregnancy showed little association with adverse pregnancy outcomes. CONCLUSIONS Our study suggests that there is an increased incidence of antenatal complications in women experiencing pelvic pain and/or vaginal bleeding in the first trimester. This should be considered when advising women attending early-pregnancy units. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Al-Memar
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - T Vaulet
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- Imec, Leuven, Belgium
| | - H Fourie
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - G Nikolic
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- Imec, Leuven, Belgium
| | - S Bobdiwala
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - S Saso
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - J Farren
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - M Pipi
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - B Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Centre (LUMC), Leiden, The Netherlands
| | - B de Moor
- ESAT-STADIUS, Stadius Centre for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- Imec, Leuven, Belgium
| | - C Stalder
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - P Bennett
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - T Bourne
- Tommy's National Early Miscarriage Research Centre, Queen Charlotte's & Chelsea Hospital, Imperial College London, London, UK
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Roldán Jiménez C, Bennett P, Ortiz García A, Cuesta Vargas AI. Fatigue Detection during Sit-To-Stand Test Based on Surface Electromyography and Acceleration: A Case Study. Sensors (Basel) 2019; 19:s19194202. [PMID: 31569776 PMCID: PMC6806592 DOI: 10.3390/s19194202] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/18/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022]
Abstract
The latest studies of the 30-second sit-to-stand (30-STS) test aim to describe it by employing kinematic variables, muscular activity, or fatigue through electromyography (EMG) instead of a number of repetitions. The aim of the present study was to develop a detection system based on acceleration measured using a smartphone to analyze fatigue during the 30-STS test with surface electromyography as the criterion. This case study was carried out on one woman, who performed eight trials. EMG data from the lower limbs and trunk muscles, as well as trunk acceleration were recorded. Both signals from eight trials were preprocessed, being averaged and temporarily aligned. The EMG signal was processed, calculating the spectral centroid (SC) by Discrete Fourier Transform, while the acceleration signal was processed by Discrete Wavelet Transform to calculate its energy percentage. Regarding EMG, fatigue in the vastus medialis of the quadriceps appeared as a decrease in SC, with a descending slope of 12% at second 12, indicating fatigue. However, acceleration analysis showed an increase in the percentage of relative energy, acting like fatigue firing at second 19. This assessed fatigue according to two variables of a different nature. The results will help clinicians to obtain information about fatigue using an accessible and inexpensive device, i.e., as a smartphone.
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Affiliation(s)
- Cristina Roldán Jiménez
- Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetría (F-14), 29010 Málaga ,Spain.
| | - Paul Bennett
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Queensland, Kelvin Grove QLD 4059, Australia.
| | - Andrés Ortiz García
- Department of Engineering Communication, Faculty of Health Sciences, Universidad de Malaga, 29010 Málaga, Spain.
| | - Antonio I Cuesta Vargas
- Instituto de Biomedicina de Málaga (IBIMA), Grupo de Clinimetría (F-14), 29010 Málaga ,Spain.
- School of Clinical Science, Faculty of Health Science, Queensland University Technology, Queensland, Kelvin Grove QLD 4059, Australia.
- Department of Physiotherapy. University of Malaga, Faculty of Health Sciences, 29071 Malaga, Spain.
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Edwards DJ, Rainey E, Boukouvala V, Wells Y, Bennett P, Tree J, Kemp AH. Novel ACT-based eHealth psychoeducational intervention for students with mental distress: a study protocol for a mixed-methodology pilot trial. BMJ Open 2019; 9:e029411. [PMID: 31315873 PMCID: PMC6661604 DOI: 10.1136/bmjopen-2019-029411] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Recent studies have revealed a high prevalence of depression, anxiety and stress symptoms among university students, highlighting an urgent need for preventative measures at low cost to better support often overwhelmed support services. OBJECTIVE Here we propose a protocol for assessing the feasibility of a randomised controlled trial (RCT) for an online transdiagnostic psychoeducational intervention called 'A Bite of ACT' compared with a waitlist control. METHODS AND ANALYSIS This is an RCT with crossover design involving baseline assessments and two follow-up periods. The primary outcome measure will be the Acceptance Checklist for Clinical Effectiveness Pilot Trials (ACCEPT) for measuring the feasibility of the trial design and methods. Secondary outcomes include measures of well-being, social connectedness, quality of life (EuroQol Five Dimensions), depression, anxiety and stress (Depression Anxiety Stress Scales-21), as well as the process measures: psychological flexibility (Acceptance and Action Questionnaire-Second Version and the Mindful Attention Awareness Scale) and heart rate variability. Analysis will involve calculating descriptive statistics, examining trial feasibility outcomes through ACCEPT, and determining effect size measures to determine the sample size needed in a future trial (if indicated). Qualitative interviews and preliminary health economics analysis will provide additional insights into the feasibility of the intervention and trial methods. ETHICS AND DISSEMINATION This study has been approved by the Department of Psychology Research Ethics Committee in the College of Human and Health Sciences at Swansea University. Dissemination will involve publication in international peer-reviewed journals, presentation of findings at relevant local, national and international conferences, and promotion of study outcomes using social media and other channels for disseminating findings to the wider community. TRIAL REGISTRATION NUMBER NCT03810131; Pre-results.
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Affiliation(s)
- Darren J Edwards
- Department of Public Health, Policy and Social Sciences, Swansea University, Swansea, UK
| | - Elinor Rainey
- Department of Psychology, Swansea University, Swansea, UK
| | | | - Yasmin Wells
- Department of Psychology, Swansea University, Swansea, UK
| | - Paul Bennett
- Department of Psychology, Swansea University, Swansea, UK
| | - Jeremy Tree
- Department of Psychology, Swansea University, Swansea, UK
| | - Andrew H Kemp
- Department of Psychology, Swansea University, Swansea, UK
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TARCA B, Ferrar K, Wycherley T, Bennett P, Meade A. MON-066 MODIFIABLE PHYSICAL FACTORS ASSOCIATED WITH PHYSICAL FUNCTIONING FOR PATIENTS RECEIVING DIALYSIS: A SYSTEMATIC REVIEW. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Morton R, Jose M, Brown C, Bennett P, Palmer S, Caskey F, Da Silva Liliana L, Couchoud C, Jesudason S, Mcdonald S. FO031THE SYMPTOM MONITORING WITH FEEDBACK TRIAL (SWIFT): A NOVEL REGISTRY-BASED CLUSTER RANDOMISED CONTROLLED TRIAL AMONG AUSTRALIAN AND NEW ZEALAND ADULTS WITH END-STAGE KIDNEY DISEASE MANAGED ON HAEMODIALYSIS. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz096.fo031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rachael Morton
- NHMRC Clinical Trials Centre, Univeristy of Sydney, Sydney, Australia
| | - Matthew Jose
- University of Tasmania, Hobart TAS, Australia, Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, Univeristy of Sydney, Sydney, Australia
| | - Paul Bennett
- Royal Adelaide hospital, Adelaide SA, Australia, Australia
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Roldán-Jiménez C, Cuesta-Vargas AI, Bennett P. Assessing trunk flexo-extension during sit-to-stand test variant in male and female healthy subjects through inertial sensors. PHYSICIAN SPORTSMED 2019; 47:152-157. [PMID: 30334642 DOI: 10.1080/00913847.2018.1538542] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The objective of the present study was to measure trunk flexo-extension during different Sit-To-Stand (STS) tasks and to analyze differences in those variables when STS repetitions are increased, by using an inertial sensor. METHODS In this cross-sectional study trunk flexo-extension was obtained through inertial measurements using an inertial sensor placed on the flat part of the sternum with the Y transversally oriented and attached using double-sided adhesive tape. Trunk flexo-extension was expressed along the Y axis (pitch angle) in a sagittal plane, representing antero-posterior motion (degrees, °). Descriptive anthropometric independent variables were also recorded. Subject had to sit and rise from a 43 cm high chair at a speed of 40 bpm in 5, 10 and 15 repetitions of STS variants. RESULTS Men showed higher mean mobility (between 41.51° and 43.23°) than women (between 32.16° and 33.31°) in all STS test, although significant was only found for 10-STS and 15-STS (<0.05). Male gender showed stronger Pearson correlation between each test than female gender. In men, correlations were highly significant in all tests (r between 0.891 and 0.939). However, in the case of women, significance varied between each test comparison (r between 0.474 and 0.745). There were no significant differences observed between trunk flexo-extension and STS variants (p = 0.908; F = 0.097). CONCLUSION Men showed a wider range of trunk motion and a more consistent pattern than women through STS variants. However, no significant differences were found in mobility between each test. The results provided in this study should be taken into account when performing STS in this population and should be applied only to a healthy population.
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Affiliation(s)
- Cristina Roldán-Jiménez
- a Department of Physiotherapy, Faculty of Health Sciences , Universidad de Malaga and Instituto de Investigación de Biomedicina de Malaga (IBIMA) , Málaga , Spain
| | - Antonio I Cuesta-Vargas
- a Department of Physiotherapy, Faculty of Health Sciences , Universidad de Malaga and Instituto de Investigación de Biomedicina de Malaga (IBIMA) , Málaga , Spain.,b School of Clinical Science, Faculty of Health Science , Queensland University Technology , Brisbane , Australia
| | - Paul Bennett
- b School of Clinical Science, Faculty of Health Science , Queensland University Technology , Brisbane , Australia
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Abstract
OBJECTIVES Venous thromboembolism (VTE) is a serious, potentially traumatic, life-threatening condition and a major cause of mortality and morbidity. The aim of this study was to obtain detailed understandings of the impact of VTE and examine individual's experiences over the first year since a first-time VTE. DESIGN A longitudinal qualitative interview study using inductive thematic analysis. This study presents follow-up data for 11 participants, first interviewed 6 months following a first-time VTE. SETTING Outpatients recruited from a community haematology clinic in a UK District General Hospital. PARTICIPANTS Eleven participants (seven females and four males) recruited from a community haematology clinic. Participants had experienced a first-time VTE and participated in qualitative interviews 3 months previously. INTERVENTION Audio-recorded semistructured interviews with a sample of 11 participants who experienced a first-time deep vein thrombosis or pulmonary embolism within the previous year. Interviews were transcribed and analysed using inductive thematic analysis. RESULTS Four overarching themes were identified: life changing and forever changed, the trauma of care, 'thrombo-neuroses' and through adversity comes growth. Theme content varied according to age and developmental stage, presence of VTE symptoms and the experience of diagnosis. CONCLUSIONS The data demonstrate the psychosocial impact of VTE and its diagnosis as physically and psychologically challenging, and individuals reported being forever changed by the experience. Participants' reported continued high levels of trauma and anxiety symptoms, triggered by physical (eg, symptoms) and psychological (eg, health anxiety, negative emotions) reminders of VTE. Wider primary care service issues including misdiagnosis maintained negative emotions and health anxiety with implications for relationships with professionals. Targeted clinical interventions to better identify and support individuals at risk of distress and enhance psychological well-being and reduce distress are discussed.
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Affiliation(s)
- Rachael Hunter
- Department of Psychology, Swansea University, Swansea, UK
| | - Simon Noble
- Department of Palliative Medicine, Cardiff University, Newport, South Wales, UK
| | - Sarah Lewis
- Department of Haematology, Aneurin Bevan University Health Board, Abergavenny, UK
| | - Paul Bennett
- Department of Clinical Psychology, Swansea University, Swansea, UK
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Kushnir M, Winter H, Murias C, Bains P, Abbosh C, Papadatos-Pastos D, Newsome-Davis T, Ahmed T, Swanton C, Forster M, Moore D, Bennett P, Faull I, Lanman R, Arkenau HT. Cell-free circulating tumour DNA (ctDNA) in the management of patients with non-biopsiable advanced non-small cell lung cancer (NSCLC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.052] [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: 11/15/2022] Open
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Bennett P, Harnett M. Bioindustry Down Under. Ind Biotechnol (New Rochelle N Y) 2018. [DOI: 10.1089/ind.2018.29139.pbe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Nickinson A, Bennett P. A Baker’s cyst causing popliteal artery occlusion: Not just your usual case of intermittent claudication…. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nickinson A, Bennett P. Prospective radiological assessment of arteriovenous fistulae in established dialysis patient: A case of radiology trumping clinical assessment? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.662] [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: 11/29/2022]
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Lyudin A, Bennett P, Pointing NR. Ankyloglossia: Cohort and Results of Frenulotomies within Primary Health Setting. J Paediatr Child Health 2018; 54:706-707. [PMID: 29870096 DOI: 10.1111/jpc.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/07/2018] [Accepted: 04/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Alexander Lyudin
- General Practice, Hutt City Health Centre Lower Hutt, New Zealand
| | - Paul Bennett
- General Practice, Broadway Medical Centre Dunedin, New Zealand
| | - Nicola R Pointing
- General Practice, Peninsular Medical Centre, Wellington, New Zealand
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Bu DX, Singh R, Choi EE, Ruella M, Nunez-Cruz S, Mansfield KG, Bennett P, Barton N, Wu Q, Zhang J, Wang Y, Wei L, Cogan S, Ezell T, Joshi S, Latimer KJ, Granda B, Tschantz WR, Young RM, Huet HA, Richardson CJ, Milone MC. Pre-clinical validation of B cell maturation antigen (BCMA) as a target for T cell immunotherapy of multiple myeloma. Oncotarget 2018; 9:25764-25780. [PMID: 29899820 PMCID: PMC5995247 DOI: 10.18632/oncotarget.25359] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 11/30/2017] [Accepted: 04/24/2018] [Indexed: 01/22/2023] Open
Abstract
Multiple myeloma has a continued need for more effective and durable therapies. B cell maturation antigen (BCMA), a plasma cell surface antigen and member of the tumor necrosis factor (TNF) receptor superfamily, is an attractive target for immunotherapy of multiple myeloma due to its high prevalence on malignant plasma cells. The current work details the pre-clinical evaluation of BCMA expression and development of a chimeric antigen receptor (CAR) targeting this antigen using a fully human single chain variable fragment (scFv). We demonstrate that BCMA is prevalently, but variably expressed by all MM with expression on 25–100% of malignant plasma cells. Extensive Immunohistochemical analysis of normal tissue expression using commercially available polyclonal antibodies demonstrated expression within B-lineage cells across a number of tissues as expected. Based upon the highly restricted expression of BCMA within normal tissues, we generated a set of novel, fully human scFv binding domains to BCMA by screening a naïve B-cell derived phage display library. Using a series of in vitro and pre-clinical in vivo studies, we identified a scFv with high specificity for BCMA and robust anti-myeloma activity when used as the binding domain of a second-generation CAR bearing a CD137 costimulatory domain. This BCMA-specific CAR is currently being evaluated in a Phase 1b clinical study in relapsed and refractory MM patients (NCT02546167).
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Affiliation(s)
- De-Xiu Bu
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Reshma Singh
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Eugene E Choi
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Marco Ruella
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Selene Nunez-Cruz
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Keith G Mansfield
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Paul Bennett
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Nathanial Barton
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Qilong Wu
- China Novartis Institutes for Biomedical Research, Shanghai 201203, China
| | - Jiquan Zhang
- China Novartis Institutes for Biomedical Research, Shanghai 201203, China
| | - Yongqiang Wang
- China Novartis Institutes for Biomedical Research, Shanghai 201203, China
| | - Lai Wei
- China Novartis Institutes for Biomedical Research, Shanghai 201203, China
| | - Shawn Cogan
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Tucker Ezell
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Shree Joshi
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Kellie J Latimer
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | - Brian Granda
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | | | - Regina M Young
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Heather A Huet
- Novartis Institutes for Biomedical Research, Cambridge, MA 02139, USA
| | | | - Michael C Milone
- Center for Cellular Immunotherapies, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
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Bennett P, Cook L, Betal D, Ostrowski M. Audit of management decision for elderly patients with early breast cancer. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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