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Maltais F, Naya IP, Vogelmeier CF, Boucot IH, Jones PW, Bjermer L, Tombs L, Compton C, Lipson DA, Kerwin EM. Salbutamol use in relation to maintenance bronchodilator efficacy in COPD: a prospective subgroup analysis of the EMAX trial. Respir Res 2020; 21:280. [PMID: 33092591 PMCID: PMC7579818 DOI: 10.1186/s12931-020-01451-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Short-acting β2-agonist (SABA) bronchodilators help alleviate symptoms in chronic obstructive pulmonary disease (COPD) and may be a useful marker of symptom severity. This analysis investigated whether SABA use impacts treatment differences between maintenance dual- and mono-bronchodilators in patients with COPD. Methods The Early MAXimisation of bronchodilation for improving COPD stability (EMAX) trial randomised symptomatic patients with low exacerbation risk not receiving inhaled corticosteroids 1:1:1 to once-daily umeclidinium/vilanterol 62.5/25 μg, once-daily umeclidinium 62.5 μg or twice-daily salmeterol 50 μg for 24 weeks. Pre-specified subgroup analyses stratified patients by median baseline SABA use (low, < 1.5 puffs/day; high, ≥1.5 puffs/day) to examine change from baseline in trough forced expiratory volume in 1 s (FEV1), change in symptoms (Transition Dyspnoea Index [TDI], Evaluating Respiratory Symptoms-COPD [E-RS]), daily SABA use and exacerbation risk. A post hoc analysis used fractional polynomial modelling with continuous transformations of baseline SABA use covariates. Results At baseline, patients in the high SABA use subgroup (mean: 3.91 puffs/day, n = 1212) had more severe airflow limitation, were more symptomatic and had worse health status versus patients in the low SABA use subgroup (0.39 puffs/day, n = 1206). Patients treated with umeclidinium/vilanterol versus umeclidinium demonstrated statistically significant improvements in trough FEV1 at Week 24 in both SABA subgroups (59–74 mL; p < 0.001); however, only low SABA users demonstrated significant improvements in TDI (high: 0.27 [p = 0.241]; low: 0.49 [p = 0.025]) and E-RS (high: 0.48 [p = 0.138]; low: 0.60 [p = 0.034]) scores. By contrast, significant reductions in mean SABA puffs/day with umeclidinium/vilanterol versus umeclidinium were observed only in high SABA users (high: − 0.56 [p < 0.001]; low: − 0.10 [p = 0.132]). Similar findings were observed when comparing umeclidinium/vilanterol and salmeterol. Fractional polynomial modelling showed baseline SABA use ≥4 puffs/day resulted in smaller incremental symptom improvements with umeclidinium/vilanterol versus umeclidinium compared with baseline SABA use < 4 puffs/day. Conclusions In high SABA users, there may be a smaller difference in treatment response between dual- and mono-bronchodilator therapy; the reasons for this require further investigation. SABA use may be a confounding factor in bronchodilator trials and in high SABA users; changes in SABA use may be considered a robust symptom outcome. Funding GlaxoSmithKline (study number 201749 [NCT03034915]).
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Affiliation(s)
- F Maltais
- Centre de Pneumologie, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada.
| | - I P Naya
- GSK, Brentford, Middlesex, UK.,RAMAX Ltd, Bramhall, Cheshire, UK
| | - C F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
| | | | | | - L Bjermer
- Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - L Tombs
- Precise Approach Ltd, contingent worker on assignment at GSK, Stockley Park West, Uxbridge, Middlesex, UK
| | | | - D A Lipson
- Respiratory Clinical Sciences, GSK, Collegeville, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E M Kerwin
- Clinical Research Institute of Southern Oregon, Medford, OR, USA
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Pearson HC, Jones PW, Brandon TP, Stockin KA, Machovsky-Capuska GE. A biologging perspective to the drivers that shape gregariousness in dusky dolphins. Behav Ecol Sociobiol 2019. [DOI: 10.1007/s00265-019-2763-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Miller AP, Mustafa FH, Jones PW, Jeffery HE, Carberry AE, McEwan AL. Near-Infrared Spectroscopy to Monitor Nutritional Status of Neonates: A Review. IEEE Rev Biomed Eng 2019; 13:280-291. [PMID: 31689210 DOI: 10.1109/rbme.2019.2951299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The World Health Organization reported that half or more of all under five deaths were caused by undernutrition in developing countries, with the majority of these deaths occurring in the first week of life. Even if the undernourished neonates manage to survive, they are exposed to long-term health impacts, including obesity, cardiovascular disease, and hypertension. Along with those health-impacts they can be exposed to risks related to detrimental early development, such as physical impairment, stunting, brain dysfunction, and reduced cognitive development. Body fat percentage has been recognized to be closely associated with undernutrition in neonates. In this article, the potential of near infrared spectroscopy (NIRS), along with previous methods to measure body fat in neonates, is reviewed and discussed.
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Jubb RW, Tukmachi ES, Jones PW, Dempsey E, Waterhouse L, Brailsford S. A Blinded Randomised Trial of Acupuncture (Manual and Electroacupuncture) Compared with a Non-Penetrating Sham for the Symptoms of Osteoarthritis of the Knee. Acupunct Med 2018; 26:69-78. [DOI: 10.1136/aim.26.2.69] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives To compare the effect of acupuncture (manual and electroacupuncture) with that of a non-penetrating sham (‘placebo’ needle) in patients with osteoarthritic knee pain and disability who are blind to the treatment allocation. Methods Acupuncture naive patients with symptomatic and radiological evidence of osteoarthritis of the knee were randomly allocated to a course of either acupuncture or non-penetrating sham acupuncture using a sheathed ‘placebo’ needle system. Acupuncture points for pain and stiffness were selected according to acupuncture theory for treating Bi syndrome. Both manual and electrical stimulation were used. Response was assessed using the WOMAC index for osteoarthritis of the knee, self reported pain scale, the EuroQol score and plasma β-endorphin. The effectiveness of blinding was assessed. Results There were 34 patients in each group. The primary end point was the change in WOMAC pain score after the course of treatment. Comparison between the two treatment groups found a significantly greater improvement with acupuncture (mean difference 60, 95% CI 5 to 116, P=0.035) than with sham. Within the acupuncture group there was a significant improvement in pain (baseline 294, mean change 95, 95% CI 60 to 130, P<0.001) which was not seen by those who had sham acupuncture (baseline 261, mean change 35, 95% CI-10 to 80, P=0.12). Similar effects within group, but not between groups, were seen with the secondary end points of WOMAC stiffness, WOMAC function, and self reported pain. One month after treatment the between group pain difference had been lost (mean difference 46; 95% CI −9 to 100, P=0.10) although the acupuncture group was still benefiting compared to baseline (mean difference 59; 95% CI 16 to 102, P=0.009). The EuroQol score, a generic measure of health related quality of life, was not altered by the treatments. A minority of patients correctly guessed their treatment group (41% in the acupuncture group and 44% in the control group). Plasma β-endorphin levels were not affected by either treatment. Conclusions Acupuncture gives symptomatic improvement for patients with osteoarthritis of the knee, and is significantly superior to non-penetrating sham acupuncture. The study did not confirm earlier reports of release of plasma β-endorphin during acupuncture.
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Affiliation(s)
- Ronald W Jubb
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Emad S Tukmachi
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Peter W Jones
- School of Computing and Mathematics Keele University, UK
| | - Emma Dempsey
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Lynn Waterhouse
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
| | - Sue Brailsford
- Department of Rheumatology University Hospital Birmingham NHS Trust Birmingham, UK
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Lawson CA, Mamas MA, Jones PW, Teece L, McCann G, Khunti K, Kadam UT. Association of Medication Intensity and Stages of Airflow Limitation With the Risk of Hospitalization or Death in Patients With Heart Failure and Chronic Obstructive Pulmonary Disease. JAMA Netw Open 2018; 1:e185489. [PMID: 30646293 PMCID: PMC6324325 DOI: 10.1001/jamanetworkopen.2018.5489] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE In heart failure (HF), chronic obstructive pulmonary disease (COPD) increases the risk of poor outcomes, but the effect of COPD severity is unknown. This information is important for early intervention tailored to the highest-risk groups. OBJECTIVES To determine the associations between COPD medication intensity or stage of airflow limitation and the risk of hospitalization or death in patients with HF. DESIGN, SETTING, AND PARTICIPANTS This UK population-based, nested case-control study with risk-set sampling used the Clinical Practice Research Datalink linked to Hospital Episode Statistics between January 1, 2002, to January 1, 2014. Participants included patients aged 40 years and older with a new diagnosis of HF in their family practice clinical record. Data analysis was conducted from 2017 to 2018. EXPOSURES In patients with HF, those with COPD were compared with those without it. International COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD]) guidelines were used to stratify patients with COPD by 7 medication intensity levels and 4 airflow limitation severity stages using automatically recorded prescriptions and routinely requested forced expiratory volume in 1 second (FEV1) data. MAIN OUTCOMES AND MEASURES First all-cause admission or all-cause death. RESULTS There were 50 114 patients with new HF (median age, 79 years [interquartile range, 71-85 years]; 46% women) during the study period. In patients with HF, COPD (18 478 [13.8%]) was significantly associated with increased mortality (adjusted odds ratio [AOR], 1.31; 95% CI, 1.26-1.36) and hospitalization (AOR, 1.33; 95% CI, 1.26-1.39). The 3 most severe medication intensity levels showed significantly increasing mortality associations from full inhaler therapy (AOR, 1.17; 95% CI, 1.06-1.29) to oral corticosteroids (AOR, 1.69; 95% CI, 1.57-1.81) to oxygen therapy (AOR, 2.82; 95% CI, 2.42-3.28). The respective estimates for hospitalization were AORs of 1.17 (95% CI, 1.03-1.33), 1.75 (95% CI, 1.59-1.92), and 2.84 (95% CI, 1.22-3.63). Availability of spirometry data was limited but showed that increasing airflow limitation was associated with increased risk of mortality, with the following AORs: FEV1 80% or more, 1.63 (95% CI, 1.42-1.87); FEV1 50% to 79%, 1.69 (95% CI, 1.56-1.83); FEV1 30% to 49%, 2.21 (95% CI, 2.01-2.42); FEV1 less than 30%, 2.93 (95% CI, 2.49-3.43). The strength of associations between FEV1 and hospitalization risk were similar among stages ranging from FEV1 80% or more (AOR, 1.48; 95% CI, 1.31-1.68) to FEV1 less than 30% (AOR, 1.73; 95% CI, 1.40-2.12). CONCLUSIONS AND RELEVANCE In the UK HF community setting, increasing COPD severity was associated with increasing risk of mortality and hospitalization. Prescribed COPD medication intensity and airflow limitation provide the basis for targeting high-risk groups.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keel University, Stoke-on-Trent, United Kingdom
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
| | - Gerry McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
| | - Umesh T Kadam
- Leicester Diabetes Centre, University of Leicester, Leicester, United Kingdom
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
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Lawson CA, Testani JM, Mamas M, Damman K, Jones PW, Teece L, Kadam UT. Chronic kidney disease, worsening renal function and outcomes in a heart failure community setting: A UK national study. Int J Cardiol 2018; 267:120-127. [PMID: 29957251 PMCID: PMC6024224 DOI: 10.1016/j.ijcard.2018.04.090] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/06/2018] [Accepted: 04/20/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Routine heart failure (HF) monitoring and management is in the community but the natural course of worsening renal function (WRF) and its influence on HF prognosis is unknown. We investigated the influence of routinely monitored renal decline and related comorbidities on imminent hospitalisation and death in the HF community population. METHODS A nested case-control study within an incident HF cohort (N = 50,114) with 12-years follow-up. WRF over 6-months before first hospitalisation and 12-months before death was defined by >20% reduction in estimated glomerular filtration rate (eGFR). Additive interactions between chronic kidney disease (CKD) and comorbidities were investigated. RESULTS Prevalence of CKD (eGFR<60 ml/min/1.73m2) in the HF community was 63%, which was associated with an 11% increase in hospitalisation and 17% in mortality. Both risk associations were significantly worse in the presence of diabetes. Compared to HF patients with eGFR,60-89, there was no or minimal increase in risk for mild to moderate CKD (eGFR,30-59) for both outcomes. Adjusted risk estimates for hospitalisation were increased only for severe CKD(eGFR,15-29); Odds Ratio 1.49 (95%CI;1.36,1.62) and renal failure(eGFR,<15); 3.38(2.67,4.29). The relationship between eGFR and mortality was U-shaped; eGFR, ≥90; 1.32(1.17,1.48), eGFR,15-29; 1.68(1.58,1.79) and eGFR,<15; 3.04(2.71,3.41). WRF is common and associated with imminent hospitalisation (1.50;1.37,1.64) and mortality (1.92;1.79,2.06). CONCLUSIONS In HF, the risk associated with CKD differs between the community and the acute HF setting. In the community setting, moderate CKD confers no risk but severe CKD, WRF or CKD with other comorbidities identifies patients at high risk of imminent hospitalisation and death.
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Affiliation(s)
- Claire A Lawson
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK.
| | - J M Testani
- Yale University, New Haven, CT, United States
| | - M Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
| | - K Damman
- University of Groningen, University Medical Center, Groningen, The Netherlands
| | - P W Jones
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - L Teece
- Faculty of Medicine and Health Sciences, Keele University, England, UK
| | - U T Kadam
- Leicester Diabetes Centre, Leicester University, UK; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, UK
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Brouwer TF, Theuns DAMJ, Jones PW, Allavatam V, Donnelley S, Auricchio A, Knops RE, Burke M. P1020An evaluation of the effect of the subcutaneous implantable defibrillator smartpass filter on inappropriate shock reduction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p1020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T F Brouwer
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - D A M J Theuns
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands
| | - P W Jones
- Boston Scientific inc, Minneapolis, United States of America
| | - V Allavatam
- Boston Scientific inc, Minneapolis, United States of America
| | - S Donnelley
- Boston Scientific inc, Minneapolis, United States of America
| | | | - R E Knops
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M Burke
- Corvita Health, Cardiology, Chicago, United States of America
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Mengist MF, Alves S, Griffin D, Creedon J, McLaughlin MJ, Jones PW, Milbourne D. Genetic mapping of quantitative trait loci for tuber-cadmium and zinc concentration in potato reveals associations with maturity and both overlapping and independent components of genetic control. Theor Appl Genet 2018; 131:929-945. [PMID: 29307117 DOI: 10.1007/s00122-017-3048-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/21/2017] [Indexed: 06/07/2023]
Abstract
Cd is a toxic metal, whilst Zn is an essential for plant and human health. Both can accumulate in potato tubers. We examine the genetic control of this process. The aim of this study was to map quantitative trait loci (QTLs) influencing tuber concentrations of cadmium (Cd) and zinc (Zn). We developed a segregating population comprising 188 F1 progeny derived from crossing two tetraploid cultivars exhibiting divergent tuber-Cd-accumulation phenotypes. These progeny were genotyped using the SolCap 8303 SNP array, and evaluated for Cd, Zn, and maturity-related traits. Linkage and QTL mapping were performed using TetraploidSNPMap software, which incorporates all allele dosage information. The final genetic map comprised 3755 SNP markers with average marker density of 2.94 per cM. Tuber-Cd and Zn concentrations were measured in the segregating population over 2 years. QTL mapping identified four loci for tuber-Cd concentration on chromosomes 3, 5, 6, and 7, which explained genetic variance ranging from 5 to 33%, and five loci for tuber-Zn concentration on chromosome 1, 3, 5, and, 6 explaining from 5 to 38% of genetic variance. Among the QTL identified for tuber-Cd concentration, three loci coincided with tuber-Zn concentration. The largest effect QTL for both tuber-Cd and Zn concentration coincided with the maturity locus on chromosome 5 where earliness was associated with increased tuber concentration of both metals. Coincident minor-effect QTL for Cd and Zn sharing the same direction of effect was also found on chromosomes 3 and 6, and these were unrelated to maturity The results indicate partially overlapping genetic control of tuber-Cd and Zn concentration in the cross, involving both maturity-related and non-maturity-related mechanisms.
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Affiliation(s)
- Molla F Mengist
- Teagasc, Crops Research Centre, Oak Park, Carlow, R93 XE12, Ireland
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
| | - Sheila Alves
- Teagasc, Crops Research Centre, Oak Park, Carlow, R93 XE12, Ireland
| | - Denis Griffin
- Teagasc, Crops Research Centre, Oak Park, Carlow, R93 XE12, Ireland
| | - Joanne Creedon
- Teagasc, Environmental Research Centre, Jonhstown Castle, Wexford, Ireland
| | - Mike J McLaughlin
- Soil Science Group, School of Agriculture, Food and Wine, The University of Adelaide, PMB 1 Waite Campus, Glen Osmond, SA, 5064, Australia
| | - Peter W Jones
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
| | - Dan Milbourne
- Teagasc, Crops Research Centre, Oak Park, Carlow, R93 XE12, Ireland.
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Kadam UT, Lawson CA, Moody DK, Teece L, Uttley J, Harvey J, Iqbal Z, Jones PW. Consumer segmentation and time interval between types of hospital admission: a clinical linkage database study. J Public Health (Oxf) 2018; 40:154-162. [PMID: 28334927 DOI: 10.1093/pubmed/fdx028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Healthcare policies target unplanned hospital admissions and 30-day re-admission as key measures of efficiency, but do not focus on factors that influence trajectories of different types of admissions in the same patient over time. Objectives To investigate the influence of consumer segmentation and patient factors on the time intervals between different types of hospital admission. Research design, subjects and measures A cohort design was applied to an anonymised linkage database for adults aged 40 years and over (N = 58 857). Measures included Mosaic segmentation, multimorbidity defined on six chronic condition registers and hospital admissions over a 27-month time period. Results The shortest mean time intervals between two consecutive planned admissions were: 90 years and over (160 days (95% confidence interval (CI): 146-175)), Mosaic groups 'Twilight subsistence' (171 days (164-179)) or 'Welfare borderline' and 'Municipal dependency' (177 days (172-182)) compared to the reference Mosaic groups (186 days (180-193)), and multimorbidity count of four or more (137 days (130-145)). Mosaic group 'Twilight subsistence' (rate ratio (RR) 1.22 (95% CI: 1.08-1.36)) or 'Welfare borderline' and 'Municipal dependency' RR 1.20 (1.10-1.31) were significantly associated with higher rate to an unplanned admission following a planned event. However, associations between patient factors and unplanned admissions were diminished by adjustment for planned admissions. Conclusion Specific consumer segmentation and patient factors were associated with shorter time intervals between different types of admissions. The findings support innovation in public health approaches to prevent by a focus on long-term trajectories of hospital admissions, which include planned activity.
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Affiliation(s)
- Umesh T Kadam
- Health Services Research Unit, Guy Hilton Research Centre, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - Claire A Lawson
- Health Services Research Unit, Guy Hilton Research Centre, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - Dawn K Moody
- Health Services Research Unit, Guy Hilton Research Centre, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - Lucy Teece
- Health Services Research Unit, Guy Hilton Research Centre, Keele University, Stoke-on-Trent ST4 7QB, UK
| | - John Uttley
- e-Innovation Unit, Midlands and Lancashire Commissioning Support Unit, Stoke-on-Trent ST4 4LX, UK
| | - John Harvey
- North Staffordshire Clinical Commissioning Group, Morston House, Newcastle-under-Lyme ST5 1QG, UK
| | - Z Iqbal
- Public Health Directorate, City of Stoke-on-Trent, Civic Centre, Stoke-on-Trent ST4 1HH, UK
| | - P W Jones
- Health Services Research Unit, Guy Hilton Research Centre, Keele University, Stoke-on-Trent ST4 7QB, UK
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Mengist MF, Milbourne D, Griffin D, McLaughlin MJ, Creedon J, Jones PW, Alves S. Cadmium uptake and partitioning in potato (Solanum tuberosum L.) cultivars with different tuber-Cd concentration. Environ Sci Pollut Res Int 2017; 24:27384-27391. [PMID: 28975479 DOI: 10.1007/s11356-017-0325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/25/2017] [Indexed: 06/07/2023]
Abstract
Potatoes grown in soil with high Cd concentrations can accumulate high levels of Cd in the tubers. Although there is significant environmental variation involved in the trait of crop uptake of Cd, there are also distinctive cultivar differences. In order to understand this differential Cd accumulation mechanism, two potato cultivars were chosen that accumulate high and low levels of Cd in tubers. The patterns of Cd concentration, Cd content and dry weight accumulation of the two cultivars were examined at different stages of plant growth. The data suggest that differences in total Cd uptake and in Cd partitioning among organs are the mechanisms governing differential Cd-tuber accumulation in the two cultivars. The low tuber-Cd accumulator exhibited lower root-to-shoot and shoot-to-tuber translocation driven by higher root and shoot biomass that retained more Cd in roots and shoots, respectively, reducing its movement to the tubers. Higher remobilization and more efficient tuber loading was observed in the high tuber-Cd accumulator, indicating that remobilization of Cd from leaves to tubers was a major factor, not only in tuber-Cd loading, but also in the establishment of differential tuber-Cd levels. Regardless of cultivar differences, the concentration of Cd in the tuber was very low compared to that in other organs suggesting that, despite its high phloem mobility, Cd tends to be sequestered in the shoots.
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Affiliation(s)
- Molla F Mengist
- Teagasc, Crops Research Centre, Oak Park, Co., Carlow, R93 XE12, Ireland
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
| | - Dan Milbourne
- Teagasc, Crops Research Centre, Oak Park, Co., Carlow, R93 XE12, Ireland
| | - Denis Griffin
- Teagasc, Crops Research Centre, Oak Park, Co., Carlow, R93 XE12, Ireland
| | - Mike J McLaughlin
- Soil Science Group, School of Agriculture, Food and Wine, University of Adelaide, PMB 1 Waite Campus, Glen Osmond, SA, 5064, Australia
| | - Joanne Creedon
- Teagasc, Environment Research Centre, Johnstown Castle, Co., Wexford, Y35 Y521, Ireland
| | - Peter W Jones
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
| | - Sheila Alves
- Teagasc, Crops Research Centre, Oak Park, Co., Carlow, R93 XE12, Ireland.
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Lawson CA, Jones PW, Teece L, Dunbar SB, Seferovic PM, Khunti K, Mamas M, Kadam UT. Association Between Type 2 Diabetes and All-Cause Hospitalization and Mortality in the UK General Heart Failure Population: Stratification by Diabetic Glycemic Control and Medication Intensification. JACC Heart Fail 2017; 6:18-26. [PMID: 29032131 DOI: 10.1016/j.jchf.2017.08.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study sought to investigate in the general heart failure (HF) population, whether the associations between type 2 diabetes (T2D) and risk of hospitalization and death, are modified by changing glycemic or drug treatment intensity. BACKGROUND In the general HF population, T2D confers a higher risk of poor outcomes, but whether this risk is modified by the diabetes status is unknown. METHODS A nested case-control study in an incident HF database cohort (2002 to 2014) compared patients with T2D with those without for risk of all-cause first hospitalization and death. T2D was stratified by categories of glycosylated hemoglobin (HbA1c) or drug treatments measured 6 months before hospitalization and 1 year before death and compared with the HF group without T2D. RESULTS In HF, T2D was associated with risk of first hospitalization (adjusted odds ratio [aOR]: 1.29; 95% confidence interval [CI]: 1.24 to 1.34) and mortality (aOR: 1.24; 95% CI: 1.29 to 1.40). Stratification of T2D by HbA1c levels, compared with the reference HF group without T2D, showed U-shaped associations with both outcomes. Highest risk categories were HbA1c >9.5% (hospitalization, aOR: 1.75; 95% CI: 1.52 to 2.02; mortality, aOR: 1.30; 95% CI: 1.24 to 1.47) and <5.5% (hospitalization, aOR: 1.42; 95% CI: 1.12 to 1.80; mortality, aOR: 1.29; 95% CI: 1.10 to 1.51, respectively). T2D group with change in HbA1c of >1% decrease was associated with hospitalization (aOR: 1.33; 95% CI: 1.18 to 1.49) and mortality (aOR: 1.36; 95% CI: 1.24 to 1.48). T2D drug group associations with hospitalization were no medication (aOR: 1.12; 95% CI: 1.04 to 1.19), oral antihyperglycemic only (aOR: 1.34; 95% CI: 1.27 to 1.41), oral antihyperglycemic+insulin (aOR: 1.36; 95% CI: 1.21 to 1.52), and insulin only (aOR: 1.61; 95% CI: 1.43 to 1.81); and with mortality for the same drug groups were 1.31 (95% CI: 1.23 to 1.39), 1.16 (95% CI: 1.11 to 1.22), 1.19 (95% CI: 1.06 to 1.34), and 1.43 (95% CI: 1.31 to 1.57), respectively. The T2D group with reduced drug treatments were associated with hospitalization (aOR: 2.13; 95% CI: 1.68 to 2.69) and mortality (aOR: 2.09; 95% CI: 1.81 to 2.41). CONCLUSIONS In the general HF population, T2D stratified by glycemic control and drug treatments showed differential risk associations. Routine measures of dynamic diabetes status provide important prognostic indication of poor outcomes in HF.
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Affiliation(s)
- Claire A Lawson
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.
| | - Peter W Jones
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Lucy Teece
- Faculty of Medicine and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | | | | | - Kamlesh Khunti
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
| | - Umesh T Kadam
- University of Leicester, Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, United Kingdom; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom
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Bombara CB, Dürr S, Machovsky-Capuska GE, Jones PW, Ward MP. A preliminary study to estimate contact rates between free-roaming domestic dogs using novel miniature cameras. PLoS One 2017; 12:e0181859. [PMID: 28750073 PMCID: PMC5547700 DOI: 10.1371/journal.pone.0181859] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/07/2017] [Indexed: 11/22/2022] Open
Abstract
Information on contacts between individuals within a population is crucial to inform disease control strategies, via parameterisation of disease spread models. In this study we investigated the use of dog-borne video cameras–in conjunction with global positioning systems (GPS) loggers–to both characterise dog-to-dog contacts and to estimate contact rates. We customized miniaturised video cameras, enclosed within 3D-printed plastic cases, and attached these to nylon dog collars. Using two 3400 mAh NCR lithium Li-ion batteries, cameras could record a maximum of 22 hr of continuous video footage. Together with a GPS logger, collars were attached to six free roaming domestic dogs (FRDDs) in two remote Indigenous communities in northern Australia. We recorded a total of 97 hr of video footage, ranging from 4.5 to 22 hr (mean 19.1) per dog, and observed a wide range of social behaviours. The majority (69%) of all observed interactions between community dogs involved direct physical contact. Direct contact behaviours included sniffing, licking, mouthing and play fighting. No contacts appeared to be aggressive, however multiple teeth baring incidents were observed during play fights. We identified a total of 153 contacts–equating to 8 to 147 contacts per dog per 24 hr–from the videos of the five dogs with camera data that could be analysed. These contacts were attributed to 42 unique dogs (range 1 to 19 per video) which could be identified (based on colour patterns and markings). Most dog activity was observed in urban (houses and roads) environments, but contacts were more common in bushland and beach environments. A variety of foraging behaviours were observed, included scavenging through rubbish and rolling on dead animal carcasses. Identified food consumed included chicken, raw bones, animal carcasses, rubbish, grass and cheese. For characterising contacts between FRDD, several benefits of analysing videos compared to GPS fixes alone were identified in this study, including visualisation of the nature of the contact between two dogs; and inclusion of a greater number of dogs in the study (which do not need to be wearing video or GPS collars). Some limitations identified included visualisation of contacts only during daylight hours; the camera lens being obscured on occasion by the dog’s mandible or the dog resting on the camera; an insufficiently wide viewing angle (36°); battery life and robustness of the deployments; high costs of the deployment; and analysis of large volumes of often unsteady video footage. This study demonstrates that dog-borne video cameras, are a feasible technology for estimating and characterising contacts between FRDDs. Modifying camera specifications and developing new analytical methods will improve applicability of this technology for monitoring FRDD populations, providing insights into dog-to-dog contacts and therefore how disease might spread within these populations.
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Affiliation(s)
- Courtenay B. Bombara
- Sydney School of Veterinary Science, The University of Sydney, Camden, Australia
| | - Salome Dürr
- Veterinary Public Health Institute, University of Bern, Liebefeld, Switzerland
| | - Gabriel E. Machovsky-Capuska
- Sydney School of Veterinary Science, The University of Sydney, Camden, Australia
- The Charles Perkins Centre and School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Peter W. Jones
- School of Electrical and Information Engineering, The University of Sydney, Sydney, Australia
| | - Michael P. Ward
- Sydney School of Veterinary Science, The University of Sydney, Camden, Australia
- * E-mail:
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Hackett G, Jones PW, Strange RC, Ramachandran S. Statin, testosterone and phosphodiesterase 5-inhibitor treatments and age related mortality in diabetes. World J Diabetes 2017; 8:104-111. [PMID: 28344753 PMCID: PMC5348622 DOI: 10.4239/wjd.v8.i3.104] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/14/2016] [Accepted: 01/03/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To determine how statins, testosterone (T) replacement therapy (TRT) and phosphodiesterase 5-inhibitors (PDE5I) influence age related mortality in diabetic men.
METHODS We studied 857 diabetic men screened for the BLAST study, stratifying them (mean follow-up = 3.8 years) into: (1) Normal T levels/untreated (total T > 12 nmol/L and free T > 0.25 nmol/L), Low T/untreated and Low T/treated; (2) PDE5I/untreated and PDE5I/treated; and (3) statin/untreated and statin/treated groups. The relationship between age and mortality, alone and with T/TRT, statin and PDE5I treatment was studied using logistic regression. Mortality probability and 95%CI were calculated from the above models for each individual.
RESULTS Age was associated with mortality (logistic regression, OR = 1.10, 95%CI: 1.08-1.13, P < 0.001). With all factors included, age (OR = 1.08, 95%CI: 1.06-1.11, P < 0.001), Low T/treated (OR = 0.38, 95%CI: 0.15-0.92, P = 0.033), PDE5I/treated (OR = 0.17, 95%CI: 0.053-0.56, P = 0.004) and statin/treated (OR = 0.59, 95%CI: 0.36-0.97, P = 0.038) were associated with lower mortality. Age related mortality was as described by Gompertz, r2 = 0.881 when Ln (mortality) was plotted against age. The probability of mortality and 95%CI (from logistic regression) of individuals, treated/untreated with the drugs, alone and in combination was plotted against age. Overlap of 95%CI lines was evident with statins and TRT. No overlap was evident with PDE5I alone and with statins and TRT, this suggesting a change in the relationship between age and mortality.
CONCLUSION We show that statins, PDE5I and TRT reduce mortality in diabetes. PDE5I, alone and with the other treatments significantly alter age related mortality in diabetic men.
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Mustafa FH, Jones PW, McEwan AL. Near infrared spectroscopy for body fat sensing in neonates: quantitative analysis by GAMOS simulations. Biomed Eng Online 2017; 16:14. [PMID: 28086963 PMCID: PMC5234151 DOI: 10.1186/s12938-016-0310-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/27/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Under-nutrition in neonates is closely linked to low body fat percentage. Undernourished neonates are exposed to immediate mortality as well as unwanted health impacts in their later life including obesity and hypertension. One potential low cost approach for obtaining direct measurements of body fat is near-infrared (NIR) interactance. The aims of this study were to model the effect of varying volume fractions of melanin and water in skin over NIR spectra, and to define sensitivity of NIR reflection on changes of thickness of subcutaneous fat. GAMOS simulations were used to develop two single fat layer models and four complete skin models over a range of skin colour (only for four skin models) and hydration within a spectrum of 800-1100 nm. The thickness of the subcutaneous fat was set from 1 to 15 mm in 1 mm intervals in each model. RESULTS Varying volume fractions of water in skin resulted minimal changes of NIR intensity at ranges of wavelengths from 890 to 940 nm and from 1010 to 1100 nm. Variation of the melanin volume in skin meanwhile was found to strongly influence the NIR intensity and sensitivity. The NIR sensitivities and NIR intensity over thickness of fat decreased from the Caucasian skin to African skin throughout the range of wavelengths. For the relationship between the NIR reflection and the thickness of subcutaneous fat, logarithmic relationship was obtained. CONCLUSIONS The minimal changes of NIR intensity values at wavelengths within the ranges from 890 to 940 nm and from 1010 to 1100 nm to variation of volume fractions of water suggests that wavelengths within those two ranges are considered for use in measurement of body fat to solve the variation of hydration in neonates. The stronger influence of skin colour on NIR shows that the melanin effect needs to be corrected by an independent measurement or by a modeling approach. The logarithmic response obtained with higher sensitivity at the lower range of thickness of fat suggests that implementation of NIRS may be suited for detecting under-nutrition and monitoring nutritional interventions for malnutrition in neonates in resource-constrained communities.
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Affiliation(s)
- Fatin Hamimi Mustafa
- School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, New South Wales, Australia
| | - Peter W. Jones
- School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, New South Wales, Australia
| | - Alistair L. McEwan
- School of Electrical and Information Engineering, Faculty of Engineering, University of Sydney, New South Wales, Australia
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Abstract
The effects of interspecific competition between the potato cyst nematodes (PCN), Globodera pallida and G. rostochiensis, under variable population conditions were examined. PCN-susceptible potato cultivars were inoculated with single- and mixed-species populations of PCN. There was a significant difference in species multiplication between single- and mixed-species populations. Globodera rostochiensis multiplication in mixed-species populations was significantly lower than single-species populations. Density-dependent trials showed a significantly greater increase in multiplication of G. pallida at low inoculation densities relative to G. rostochiensis. These results indicate that G. pallida has a negative effect on G. rostochiensis populations and is the more successful species when competing. A staggered inoculation trial showed that the greater competitiveness of G. pallida was not wholly attributed to its later hatch. Globodera pallida outcompeted G. rostochiensis regardless of the timing of inoculation; however, G. pallida multiplication was lowest when plants were simultaneously inoculated with both species.
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Affiliation(s)
- Rachel Hearne
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - Eoin P. Lettice
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - Peter W. Jones
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
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16
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Bajaj MK, Spilling CA, Dodd JW, Jones PW, Howe FA, Baker EH, Barrick TR. P44 Comparison of structural brain abnormalities and cognitive function in COPD patients after hospitalisation, stable COPD patients and healthy age-matched controls. Thorax 2016. [DOI: 10.1136/thoraxjnl-2016-209333.187] [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: 11/04/2022]
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Abstract
A linear mixed model is used to detect a change, if any, in the prescribing habits in the UK at the general practice (family medicine) level due to an educational intervention given repeated measures data before and after the intervention and a control group. Inferences are corrected for general practice size and fundholding status. The estimates of the model parameters are obtained using Bayesian inference by applying Gibbs sampling. We develop three different priors for the parameters of the model. These three priors correspond to ‘sceptical,’ ‘reference’ and ‘enthusiastic’ priors in terms of the opinion about the treatment effects that they represent. We compare the results obtained by using these three priors for the parameters in the random effects model.
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Affiliation(s)
- Jabu S Sithole
- MRC Institute of Hearing Research, University Park, Nottingham, NG7 2RD, UK.
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18
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Clayton RN, Jones PW, Reulen RC, Stewart PM, Hassan-Smith ZK, Ntali G, Karavitaki N, Dekkers OM, Pereira AM, Bolland M, Holdaway I, Lindholm J. Mortality in patients with Cushing's disease more than 10 years after remission: a multicentre, multinational, retrospective cohort study. Lancet Diabetes Endocrinol 2016; 4:569-76. [PMID: 27265184 DOI: 10.1016/s2213-8587(16)30005-5] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND No agreement has been reached on the long-term survival prospects for patients with Cushing's disease. We studied life expectancy in patients who had received curative treatment and whose hypercortisolism remained in remission for more than 10 years, and identified factors determining their survival. METHODS We did a multicentre, multinational, retrospective cohort study using individual case records from specialist referral centres in the UK, Denmark, the Netherlands, and New Zealand. Inclusion criteria for participants, who had all been in studies reported previously in peer-reviewed publications, were diagnosis and treatment of Cushing's disease, being cured of hypercortisolism for a minimum of 10 years at study entry, and continuing to be cured with no relapses until the database was frozen or death. We identified the number and type of treatments used to achieve cure, and used mortality as our primary endpoint. We compared mortality rates between patients with Cushing's disease and the general population, and expressed them as standardised mortality ratios (SMRs). We analysed survival data with multivariate analysis (Cox regression) with no corrections for multiple testing. FINDINGS The census dates on which the data were frozen ranged from Dec 31, 2009, to Dec 1, 2014. We obtained data for 320 patients with 3790 person-years of follow-up from 10 years after cure (female:male ratio of 3:1). The median patient follow-up was 11·8 years (IQR 17-26) from study entry and did not differ between countries. There were no significant differences in demographic characteristics, duration of follow-up, comorbidities, treatment number, or type of treatment between women and men, so we pooled data from both sexes for survival analysis. 51 (16%) of the cohort died during follow-up from study entry (10 years after cure). Median survival from study entry was similar for women (31 years; IQR 19-38) and men (28 years; 24-42), and about 40 years (IQR 30-48) from remission. The overall SMR for all-cause mortality was 1·61 (95% CI 1·23-2·12; p=0·0001). The SMR for circulatory disease was increased at 2·72 (1·88-3·95; p<0·0001), but deaths from cancer were not higher than expected (0·79, 0·41-1·51). Presence of diabetes, but not hypertension, was an independent risk factor for mortality (hazard ratio 2·82, 95% CI 1·29-6·17; p=0·0095). We noted a step-wise reduction in survival with increasing number of treatments. Patients cured by pituitary surgery alone had long-term survival similar to that of the general population (SMR 0·95, 95% CI 0·58-1·55) compared with those who were not (2·53, 1·82-3·53; p<0·0001). INTERPRETATION Patients with Cushing's disease who have been in remission for more than 10 years are at increased risk of overall mortality compared with the general population, particularly from circulatory disease. However, median survival from cure is excellent at about 40 years of remission. Treatment complexity and an increased number of treatments, reflecting disease that is more difficult to control, appears to negatively affect survival. Pituitary surgery alone is the preferred treatment to secure an optimum outcome, and should be done in a centre of surgical excellence. FUNDING None.
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Affiliation(s)
| | - Peter W Jones
- Health Services Research Unit, Keele University, Stoke on Trent, UK
| | - Raoul C Reulen
- Centre for Childhood Survivor Studies, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Zaki K Hassan-Smith
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
| | - Georgia Ntali
- Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, UK
| | - Niki Karavitaki
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK; Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, UK
| | - Olaf M Dekkers
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Nederlands; Institute of Clinical Epidemiology, Aarhus, Denmark
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Centre, Leiden, Nederlands
| | - Mark Bolland
- Department of Endocrinology, University of Auckland, Auckland, New Zealand
| | - Ian Holdaway
- Department of Endocrinology, University of Auckland, Auckland, New Zealand
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Ganesan R, Hirschowitz L, Dawson P, Askew S, Pearmain P, Jones PW, Singh K, Chan KK, Moss EL. Neuroendocrine Carcinoma of the Cervix: Review of a Series of Cases and Correlation With Outcome. Int J Surg Pathol 2016; 24:490-6. [PMID: 27098591 DOI: 10.1177/1066896916643385] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Neuroendocrine carcinoma (NEC) of the cervix is associated with a poor prognosis despite multimodal treatment. The correct diagnosis of this tumor type is imperative to provide clinicians and patients with prognostic information and ensure that appropriate treatment is provided. Methods A clinicopathological study was undertaken on all cervical tumors registered as NEC with the West Midlands Cancer Intelligence Unit between January 1, 1998 and December 31, 2009. Of the 45 cases diagnosed during the study period, the tumor samples of 41 cases were traced, anonymized, and then independently reviewed by 2 gynecological pathologists. Results The review confirmed 31/41 (78%) cases to be NEC, which overall, represented 1.3% of all the cervical cancers registered in the West Midlands over the period of the study. In the correct histological context, synaptophysin was the most sensitive and specific positive immunohistochemical marker of NEC differentiation. The cases that on review were confirmed as NEC had a significantly worse outcome than the non-NEC cases: median survival for NEC cases was 33.3 months versus 315.0 months for the non-NEC cases, P = .013. Conclusions Histological review of a series of NECs has shown significantly reduced survival in those patients with confirmed NEC in comparison with those patients where a diagnosis of NEC was not confirmed. We propose morphological and immunohistochemical criteria for the diagnosis of cervical NEC; and discourage unqualified use of the term "small cell carcinoma" as this does not accurately convey the diagnosis of SCNEC. We urge pathologists to use the 2014 World Health Organization classification when reporting these tumors.
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Affiliation(s)
- Raji Ganesan
- Birmingham Women's NHS Foundation Trust, Birmingham, UK
| | | | - Philip Dawson
- West Midlands Cervical Screening QA Reference Centre, Public Health England, Birmingham, UK
| | - Sarah Askew
- West Midlands Cervical Screening QA Reference Centre, Public Health England, Birmingham, UK
| | - Philippa Pearmain
- West Midlands Cervical Screening QA Reference Centre, Public Health England, Birmingham, UK
| | | | - Kavita Singh
- Pan-Birmingham Gynaecological Cancer Centre, Birmingham, UK
| | - Kiong K Chan
- Pan-Birmingham Gynaecological Cancer Centre, Birmingham, UK
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Hackett G, Heald AH, Sinclair A, Jones PW, Strange RC, Ramachandran S. Serum testosterone, testosterone replacement therapy and all-cause mortality in men with type 2 diabetes: retrospective consideration of the impact of PDE5 inhibitors and statins. Int J Clin Pract 2016; 70:244-53. [PMID: 26916621 DOI: 10.1111/ijcp.12779] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Low testosterone levels occur in over 40% of men with type 2 diabetes mellitus (T2DM) and have been associated with increased mortality. Testosterone replacement together with statins and phosphodiesterase 5 inhibitors (PDE5I) are widely used in men with T2DM. PURPOSE To determine the impact of testosterone and testosterone replacement therapy (TRT) on mortality and assess the independence of this effect by adjusting statistical models for statin and PDE5I use. METHODS We studied 857 men with T2DM screened from five primary care practices during April 2007-April 2009. Of the 857 men, 175/637 men with serum total testosterone ≤ 12 nmol/l or free testosterone (FT) ≤ 0.25 nmol/l received TU for a mean of 3.8 ± 1.2 (SD) years. PDE5I and statins were prescribed to 175/857 and 662/857 men respectively. All-cause mortality was the primary end-point. Cox regression models were used to compare survival in the three testosterone level/treatment groups, the analysis adjusted for age, statin and PDE5I use, BMI, blood pressure and lipids. RESULTS Compared with the Low T/untreated group, mortality in the Normal T/untreated (HR: 0.62, CI: 0.41-0.94) or Low T/treated (HR: 0.38, CI: 0.16-0.90) groups was significantly reduced. PDE5I use was significantly associated with reduced mortality (HR: 0.21, CI: 0.066-0.68). After repeating the Cox regression in the 682 men not given a PDE5I, mortality in the Normal T/untreated and Low T/treated groups was significantly lower than that in the reference Low T/untreated group. Mortality in the PDE5I/treated was significantly reduced compared with the PDE5I/untreated group (OR: 0.06, CI: 0.009-0.47). CONCLUSIONS Testosterone replacement therapy is independently associated with reduced mortality in men with T2DM. PDE5I use, included as a confounding factor, was associated with decreased mortality in all patients and, those not on TRT, suggesting independence of effect. The impact of PDE5I treatment on mortality (both HR and OR < 0.25) needs confirmation by independent studies.
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Affiliation(s)
- G Hackett
- University of Bedfordshire, Bedfordshire, UK
- Heart of England Foundation Trust, West Midlands, UK
| | - A H Heald
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - A Sinclair
- University of Bedfordshire, Bedfordshire, UK
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, UK
| | - P W Jones
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, UK
| | - R C Strange
- Institute of Science and Technology in Medicine, Keele University, Staffordshire, UK
| | - S Ramachandran
- Heart of England Foundation Trust, West Midlands, UK
- University Hospitals of North Midlands, Staffordshire, UK
- Faculty of Health Sciences, Staffordshire University, Staffordshire, UK
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Schürmann W, Barnes NC, Pavord ID, Jones PW, Wedzicha JA, Lettis S, Locantore N, Pascoe SJ. Eosinophilenzahl im Blut zur Vorhersage des Ansprechens auf inhalative Kortikosteroide (ICS) bei COPD. Pneumologie 2016. [DOI: 10.1055/s-0036-1572273] [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: 10/22/2022]
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Abstract
Soil samples taken from the ridge of field-grown potato (cv. British Queen) as well as from bulk soil of the same field were incubated with sterile potato root leachate or water. Samples were filtered and filtrates used in anin vitrobioassay to determine their effect on hatch of potato cyst nematodes (PCN)Globodera rostochiensisandG. pallida. Concurrently, an experiment was established where the sterile potato root leachate or water was incubated with a sterile soil wash. Ridge soil was shown to induce significantly more hatching than bulk soil, indicating the presence of PCN hatching factors. When a soil wash of ridge soil was used it did not increase hatch, suggesting a role for soil microorganisms in the hatching process. Greater hatch ofG. rostochiensisin bulk soil compared toG. pallidasuggests a role for soil microorganisms in spontaneous hatch of PCNin vivo.
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Affiliation(s)
- Eoin P. Lettice
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
| | - Peter W. Jones
- School of Biological, Earth and Environmental Sciences, University College Cork, Cork, Ireland
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Ruickbie S, Prasad A, Jones PW, Baker EH. P224 The association between degree of airflow limitation and degree of coronary artery atheroma is not attributable to smoking history: Abstract P224 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Savage CC, Pennington C, Jones PW, Dodd JW. P15 Regional cerebral atrophy and cognitive function in Chronic Obstructive Pulmonary Disease. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.152] [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: 11/04/2022]
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Ruickbie SV, Prasad A, Jones PW, Baker EH. S123 Coronary atherosclerosis detected at elective angiography is more severe in people with COPD than in those without: Abstract S123 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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O'Keeffe R, Kenny O, Brunton NP, Hossain MB, Rai DK, Jones PW, O'Brien N, Maguire AR, Collins SG. Synthesis of novel 24-amino-25,26,27-trinorlanost-8-enes: cytotoxic and apoptotic potential in U937 cells. Bioorg Med Chem 2015; 23:2270-80. [PMID: 25800433 DOI: 10.1016/j.bmc.2015.02.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/17/2015] [Accepted: 02/04/2015] [Indexed: 11/29/2022]
Abstract
In the present study, the synthesis of a range of novel 24-amino-25,26,27-trinorlanost-8-ene derivatives including 24-piperadino-trinorlanost-8-enes, 24-piperazino-trinorlanost-8-enes, 24-morpholino-trinorlanost-8-enes, and 24-diethylamino-trinorlanost-8-enes is reported and their cytotoxic and apoptotic potential evaluated in U937 cell lines. Excellent IC₅₀ results for piperidine and 1-(2-hydroxyethyl)piperazine derivatives have been observed (IC₅₀ values of 1.9 μM and 2.7 μM in U937 cells, respectively).
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Affiliation(s)
- Roisin O'Keeffe
- Department of Chemistry, Analytical and Biological Chemistry Research Facility, Synthesis and Solid State Pharmaceutical Centre, University College Cork, Ireland
| | - Olivia Kenny
- School of Food and Nutritional Sciences, University College Cork, Ireland
| | - Nigel P Brunton
- School of Agriculture and Food Science, University College Dublin, Dublin 4, Ireland
| | - Mohammad B Hossain
- Food Biosciences Department, Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland
| | - Dilip K Rai
- Food Biosciences Department, Teagasc Food Research Centre, Ashtown, Dublin 15, Ireland
| | - Peter W Jones
- Department of Zoology, Ecology and Plant Science, University College Cork, Ireland
| | - Nora O'Brien
- School of Food and Nutritional Sciences, University College Cork, Ireland.
| | - Anita R Maguire
- Department of Chemistry and School of Pharmacy, Analytical and Biological Chemistry Research Facility, Synthesis and Solid State Pharmaceutical Centre, University College Cork, Ireland.
| | - Stuart G Collins
- Department of Chemistry, Analytical and Biological Chemistry Research Facility, Synthesis and Solid State Pharmaceutical Centre, University College Cork, Ireland.
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Johanson RB, Heycock E, Carter J, Sultan AH, Walklate K, Jones PW. Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse. BJOG 2015; 121 Suppl 7:23-8. [PMID: 25488084 DOI: 10.1111/1471-0528.13210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/1998] [Revised: 10/14/1998] [Accepted: 01/28/1999] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study. DESIGN Follow up of a randomised controlled trial. SETTING District general hospital in the West Midlands. POPULATION Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (n = 115) and vacuum extractor (n = 113). MAIN OUTCOME MEASURES Bowel and urinary dysfunction, child vision assessment, and child development. RESULTS Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97, 95% CI 0.38-2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups. CONCLUSIONS There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.
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Affiliation(s)
- R B Johanson
- Keele University Centre for Maternal and Child Health, North Staffordshire Hospital Trust, Newcastle-under-Lyme
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Jones PW, D'Urzo A, Rennard S, Molins E, Mergel V, Leselbaum A. Effect of aclidinium/formoterol fixed-dose combinations on respiratory symptoms in patients with COPD. Pneumologie 2015. [DOI: 10.1055/s-0035-1544641] [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: 10/24/2022]
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Singh D, D'Urzo A, Jones PW, Serra C, Mergel V, Leselbaum A. Lung function improvements with twice-daily aclidinium/formoterol fixed-dose combination in two 24-week studies in patients with COPD. Pneumologie 2015. [DOI: 10.1055/s-0035-1544789] [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: 10/24/2022]
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Bateman ED, Rennard S, Jones PW, Molins E, Mergel V, Leselbaum A. Effect of aclidinium bromide/formoterol fumarate fixed-dose combination on exacerbations in moderate-to-severe COPD: Pooled analysis of two studies. Pneumologie 2015. [DOI: 10.1055/s-0035-1544792] [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: 10/24/2022]
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Jones PW, Korn S, Scanlon PD, Singh D, Mergel V, Molins E, Leselbaum A. Effects of aclidinium bromide/formoterol fumarate fixed-dose combination on health status in COPD. Pneumologie 2015. [DOI: 10.1055/s-0035-1544636] [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: 10/24/2022]
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Pitt WG, Zhao Y, Jack DR, Perez KX, Jones PW, Marelli R, Nelson JL, Pruitt JD. Extended elution of phospholipid from silicone hydrogel contact lenses. J Biomater Sci Polym Ed 2015; 26:224-34. [PMID: 25555029 DOI: 10.1080/09205063.2014.994947] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Characterization of phospholipid release from an experimental reusable wear silicone hydrogel contact lens was performed to assess the possible use of these lenses for phospholipid delivery to increase eye comfort to patients who prefer reusable wear lenses. Contact lenses were loaded with 200 μg of radio-labeled 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) from a solution of n-propanol. To simulate 30 days of diurnal use with overnight cleaning, these lenses were eluted for 16 h at 35 °C into artificial tear fluid (ATF), and then eluted at room temperature (~22 °C) for 8 h in one of three commercial contact lens cleaning systems. This was repeated for 30 days. The elution of DMPC into ATF was greater on the first day, followed by a fairly constant amount of elution each day thereafter. The type of cleaning system had a statistically significant effect on the elution rate during daily exposure to ATF. The rate of elution into cleaning solutions did not show any enhanced elution on the first day; there was a fairly constant elution rate. Again, the type of cleaning system significantly influenced the elution rate into the nightly cleaner.
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Affiliation(s)
- William G Pitt
- a Chemical Engineering Department , Brigham Young University , 350 Clyde Bldg, Provo , UT 84602 , USA
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Abstract
Three bacterial isolates, SB13 (Acinetobacter sp.), SB14 (Arthrobacter sp.) and SB15 (Bacillus sp.), were previously isolated from the rhizosphere of sugar beet (Beta vulgaris ssp. vulgaris) plants and shown to increase hatch of potato cyst nematodes in vitro. In this study, the three isolates were assayed for rhizosphere competence. Each isolate was applied to seeds at each of four concentrations (105-108 CFU ml−1) and the inoculated seeds were planted in plastic microcosms containing coarse sand. All three isolates were shown to colonise the rhizosphere, although to differing degrees, with the higher inoculation densities providing significantly better colonisation. The isolates increased sugar beet root and shoot dry weight. Isolates SB14 and SB15 were analysed for their ability to induce in vivo hatch of Globodera pallida in non-sterile soil planted with sugar beet. After 4 and 6 weeks, both isolates had induced significantly greater percentage hatch compared to controls.
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Affiliation(s)
- Eoin P. Lettice
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
| | - Peter W. Jones
- School of Biological, Earth and Environmental Sciences, University College Cork, Western Road, Cork, Ireland
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Driskell OJ, Holland D, Waldron JL, Ford C, Scargill JJ, Heald A, Tran M, Hanna FW, Jones PW, Pemberton RJ, Fryer AA. Reduced testing frequency for glycated hemoglobin, HbA1c, is associated with deteriorating diabetes control. Diabetes Care 2014; 37:2731-7. [PMID: 25249670 DOI: 10.2337/dc14-0297] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We previously showed that in patients with diabetes mellitus, glycated hemoglobin (HbA1c) monitoring outside international guidance on testing frequency is widespread. Here we examined the relationship between testing frequency and diabetes control to test the hypothesis that retest interval is linked to change in HbA1c level. RESEARCH DESIGN AND METHODS We examined repeat HbA1c tests (400,497 tests in 79,409 patients, 2008-2011) processed by three U.K. clinical laboratories. We examined the relationship between retest interval and 1) percentage change in HbA1c and 2) proportion of cases showing a significant HbA1c rise. The effect of demographics factors on these findings was also explored. RESULTS Our data showed that the optimal testing frequency required to maximize the downward trajectory in HbA1c was four times per year, particularly in those with an initial HbA1c of ≥7% (≥53 mmol/mol), supporting international guidance. Testing 3-monthly was associated with a 3.8% reduction in HbA1c compared with a 1.5% increase observed with annual testing; testing more frequently provided no additional benefit. Compared with annual monitoring, 3-monthly testing was associated with a halving of the proportion showing a significant rise in HbA1c (7-10 vs. 15-20%). CONCLUSIONS These findings provide, in a large, multicenter data set, objective evidence that testing outside guidance on HbA1c monitoring frequency is associated with a significant detrimental effect on diabetes control. To achieve the optimum downward trajectory in HbA1c, monitoring frequency should be quarterly, particularly in cases with suboptimal HbA1c. While this impact appears small, optimizing monitoring frequency across the diabetes population may have major implications for diabetes control and comorbidity risk.
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Affiliation(s)
- Owen J Driskell
- Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K
| | - David Holland
- National Pathology Benchmarking Service, Department of Medicines Management, Keele University, Staffordshire, U.K
| | - Jenna L Waldron
- Department of Clinical Biochemistry, Royal Wolverhampton National Health Service Trust, Wolverhampton, U.K
| | - Clare Ford
- Department of Clinical Biochemistry, Royal Wolverhampton National Health Service Trust, Wolverhampton, U.K
| | - Jonathan J Scargill
- Department of Clinical Biochemistry, Salford Royal Hospital National Health Service Foundation Trust, U.K
| | - Adrian Heald
- Department of Clinical Biochemistry, Salford Royal Hospital National Health Service Foundation Trust, U.K. School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, U.K
| | - Martin Tran
- Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K
| | - Fahmy W Hanna
- Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Department of Diabetes and Endocrinology, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K
| | - Peter W Jones
- Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K. School of Computing and Mathematics, Keele University, Keele, Staffordshire, U.K
| | - R John Pemberton
- Diabetes UK, North Staffordshire Branch, Newcastle-under-Lyme, Staffordshire, U.K
| | - Anthony A Fryer
- Department of Clinical Biochemistry, University Hospital of North Staffordshire National Health Service Trust, Stoke-on-Trent, Staffordshire, U.K. Institute of Science and Technology in Medicine, University of Keele, Stoke-on-Trent, Staffordshire, U.K.
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Ramachandran S, Strange RC, Jones PW, Kalra S, Nayak D, Hawkins CP. Associations between onset age and disability in multiple sclerosis patients studied using MSSS and a progression model. Mult Scler Relat Disord 2014; 3:593-9. [DOI: 10.1016/j.msard.2014.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 05/14/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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Strauss VY, Jones PW, Kadam UT, Jordan KP. Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis. J Clin Epidemiol 2014; 67:1163-71. [PMID: 25063556 PMCID: PMC4165436 DOI: 10.1016/j.jclinepi.2014.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 06/04/2014] [Accepted: 06/10/2014] [Indexed: 12/21/2022]
Abstract
Objectives To investigate the use of latent class growth analysis (LCGA) in understanding onset and changes in multimorbidity over time in older adults. Study Design and Setting This study used primary care consultations for 42 consensus-defined chronic morbidities over 3 years (2003–2005) by 24,615 people aged >50 years at 10 UK general practices, which contribute to the Consultations in Primary Care Archive database. Distinct groups of people who had similar progression of multimorbidity over time were identified using LCGA. These derived trajectories were tested in another primary care consultation data set with linked self-reported health status. Results Five clusters of people representing different trajectories were identified: those who had no recorded chronic problems (40%), those who developed a first chronic morbidity over 3 years (10%), a developing multimorbidity group (37%), a group with increasing number of chronic morbidities (12%), and a multi-chronic group with many chronic morbidities (1%). These trajectories were also identified using another consultation database and associated with self-reported physical and mental health. Conclusion There are distinct trajectories in the development of multimorbidity in primary care populations, which are associated with poor health. Future research needs to incorporate such trajectories when assessing progression of disease and deterioration of health.
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Affiliation(s)
- Vicky Y Strauss
- Arthritis Research UK Primary Care Centre, Keele University, the Institute of Primary Care and Health Sciences, Keele, Staffordshire ST5 5BG, United Kingdom; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom.
| | - Peter W Jones
- The Health Service Research Unit, the Institute for Science & Technology in Medicine, Innovation Centre 1, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Umesh T Kadam
- Arthritis Research UK Primary Care Centre, Keele University, the Institute of Primary Care and Health Sciences, Keele, Staffordshire ST5 5BG, United Kingdom; The Health Service Research Unit, the Institute for Science & Technology in Medicine, Innovation Centre 1, Keele University, Staffordshire ST5 5BG, United Kingdom
| | - Kelvin P Jordan
- Arthritis Research UK Primary Care Centre, Keele University, the Institute of Primary Care and Health Sciences, Keele, Staffordshire ST5 5BG, United Kingdom
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Abstract
Abstract Surgical excision is the management of choice in vulval cancer however, the patient population are typically elderly and comorbid, for whom general anaesthesia (GA) carries considerable risk. The outcome of 107 procedures were reviewed in order investigate the postoperative complication rates associated with general and regional anaesthesia for the surgical management of vulval cancer. GA was used in 78 (72.9%) cases; 27 (22.9%) had a regional anaesthetic (spinal/epidural/ileoinguinal) and two women had a GA following a failed spinal anaesthetic. Women having a regional anaesthetic were significantly older (p = 0.0198), had a higher ACE (p = 0.0001) and ASA score (p < 0.0001) than those having a GA. There was an association between GA and grade II+ complications, compared with regional techniques (odds ratio, OR 2.72) but this was not significant due to the small number of events. Regional anaesthetic techniques are safe, well-tolerated alternatives to GA for the surgical management of vulval cancer, especially in an elderly and comorbid population.
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Affiliation(s)
- E L Moss
- Pan Birmingham Gynaecological Cancer Centre , Birmingham , UK
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Leidy NK, Sexton CC, Jones PW, Notte SM, Monz BU, Nelsen L, Goldman M, Murray LT, Sethi S. Measuring respiratory symptoms in clinical trials of COPD: reliability and validity of a daily diary. Thorax 2014; 69:443-9. [PMID: 24595666 PMCID: PMC3995276 DOI: 10.1136/thoraxjnl-2013-204428] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [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] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Although respiratory symptoms are characteristic features of COPD, there is no standardised method for quantifying their severity in stable disease. OBJECTIVE To evaluate the EXACT-Respiratory Symptom (E-RS) measure, a daily diary comprising 11 of the 14 items in the Exacerbations of Chronic Pulmonary Disease Tool (EXACT). METHODS Qualitative: patient focus group and interviews to address content validity. Quantitative: secondary data analyses to test reliability and validity. RESULTS Qualitative: n=84; mean (SD) age 65 (10) years, FEV1 1.2(0.4) L; 44% male. Subject descriptions of their respiratory symptoms were consistent with E-RS content and structure. Quantitative: n=188; mean (SD) age 66 (10) years, FEV1 1.2(0.5) L; 50% male. Factor analysis (FA) showed 3 subscales: RS-Breathlessness, RS-Cough & Sputum, and RS-Chest Symptoms; second-order FA supported a general factor and total score. Reliability (total and subscales): 0.88, 0.86, 0.73, 0.81; 2-day test-retest ICC: 0.90, 0.86, 0.87, 0.82, respectively. VALIDITY Total scores correlated significantly (p < 0.0001) with SGRQ Total (r=0.75), Symptoms (r=0.66), Activity (r=0.57), Impact (r=0.70) scores; subscale correlations were also significant (r=0.26, p < 0.05 (RS-Chest Symptoms with Activity) to r=0.69, p < 0.0001 (RS-Cough & Sputum with Symptoms). RS-Breathlessness correlated with rescue medication use (r=0.32, p < 0.0001), clinician-reported mMRC (r=0.33, p < 0.0001), and FEV1% predicted (r=-0.17, p < 0.05). E-RS scores differentiated groups based on chronic bronchitis diagnosis (p < 0.01-0.001), smoking status (p < 0.05-0.001), and rescue medication use (p < 0.05-0.0001). CONCLUSIONS Results suggest the RS-Total is a reliable and valid instrument for evaluating respiratory symptom severity in stable COPD. Further study of sensitivity to change is warranted.
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Kenny OM, Brunton NP, Rai DK, Collins SG, Jones PW, Maguire AR, O’Brien NM. Cytotoxic and apoptotic potential of potato glycoalkaloids in a number of cancer cell lines. ACTA ACUST UNITED AC 2013. [DOI: 10.14511/jasa.2013.020401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jones PW, Saralaya D, Morjaria JB, Quadrino T, Qurbain A. P231 The impact of indacaterol (Onbrez®) on the daily lives and health status of patients with COPD: interim results. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Doos L, Uttley J, Onyia I, Iqbal Z, Jones PW, Kadam UT. Mosaic segmentation, COPD and CHF multimorbidity and hospital admission costs: a clinical linkage study. J Public Health (Oxf) 2013; 36:317-24. [PMID: 23903003 DOI: 10.1093/pubmed/fdt070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND How multimorbidity and socio-economic factors influence healthcare costs is unknown. Geo-demographic profiling system, Mosaic, which adds to socio-economic factors, provides the potential for an investigation of the relationship with multimorbidity, and their influence on healthcare costs. METHODS Using chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) registers from 53 general practices for a population aged 40 years and over in Stoke-on-Trent, England (N = 10,113), were linked to hospital admissions data and Healthcare Resource Groups as a measure of hospital cost (2007-09). Eleven Mosaic groups were linked on the basis of individual patients' post codes. RESULTS The COPD and CHF multimorbid group (n = 763) had the highest proportion with at least one hospital admission in the 3-year time period (n = 550, 72%), compared with the index COPD (56%) and CHF (66%) groups. Multimorbid patients had significantly higher mean costs for hospital admission (£4896) compared with the index COPD (£2769) or CHF (£3876). The associations between multimorbid groups and hospital admission costs compared with index groups varied by different Mosaic groups. CONCLUSIONS CHF and COPD multimorbidity is associated with high costs, and average hospital admission costs vary by Mosaic segmentation. Multimorbidity and Mosaic provide an innovative basis for developing and targeting healthcare interventions in high-hospital-cost patients.
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Affiliation(s)
- Lucy Doos
- Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK
| | - John Uttley
- NHS Staffordshire Commissioning Support Service, St George's Chambers, 31 Merrial Street, Newcastle under Lyme, Staffordshire ST5 2AE, UK
| | - Ifeoma Onyia
- Directorate of Public Health, Civic Centre, Glebe Street, Stoke-on-Trent ST4 1HH, UK
| | - Zafar Iqbal
- Directorate of Public Health, Civic Centre, Glebe Street, Stoke-on-Trent ST4 1HH, UK
| | - Peter W Jones
- Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK
| | - Umesh T Kadam
- Health Service Research Unit, Innovation Centre 1, Keele University, Staffordshire ST5 5NB, UK
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Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are widely regarded as one risk factor, which influences chronic kidney disease (CKD) progression. However, previous literature reviews have not quantified the risk in moderate to severe CKD patients. OBJECTIVE To estimate the strength of association between chronic NSAID use and CKD progression. METHODS We conducted a systematic review and meta-analysis of observational general practice or population studies featuring patients aged 45 years and over. The electronic databases searched were MEDLINE, EMBASE, Cochrane, AMED, BNI and CINAHL until September 2011 without date or language restrictions. Searches included the reference lists of relevant identified studies, WEB of KNOWLEDGE, openSIGLE, specific journals, the British Library and expert networks. For relevant studies, random effects meta-analysis was used to estimate the association between NSAID use and accelerated CKD progression (estimated glomerular filtration rate decline ≥ 15 ml/min/1.73 m2). RESULTS From a possible 768 articles, after screening and selection, seven studies were identified (5 cohort, 1 case-control and 1 cross-sectional) and three were included in the meta-analysis. Regular-dose NSAID use did not significantly affect the risk of accelerated CKD progression; pooled odds ratio (OR) = 0.96 (95%CI: 0.86-1.07), but high-dose NSAID use significantly increased the risk of accelerated CKD progression; pooled OR = 1.26 (95%CI: 1.06-1.50). CONCLUSIONS The avoidance of NSAIDs in the medium term is unnecessary in patients with moderate to severe CKD, if not otherwise contraindicated. As the definition of high-dose of NSAID use remains unclear, the lowest effective dose of NSAIDs should be prescribed where indicated.
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Affiliation(s)
- Paul Nderitu
- Health Services Research Unit, Institute of Science and Technology in Medicine, Keele University, Keele, UK.
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Kenny OM, McCarthy CM, Brunton NP, Hossain MB, Rai DK, Collins SG, Jones PW, Maguire AR, O'Brien NM. Anti-inflammatory properties of potato glycoalkaloids in stimulated Jurkat and Raw 264.7 mouse macrophages. Life Sci 2013; 92:775-82. [PMID: 23454444 DOI: 10.1016/j.lfs.2013.02.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 01/31/2013] [Accepted: 02/11/2013] [Indexed: 12/21/2022]
Abstract
AIMS The potato glycoalkaloids, α-chaconine, α-solanine and solanidine, along with potato peel extracts were investigated for potential anti-inflammatory effects in vitro. Their potential to reduce two biomarkers of inflammation, cytokine and nitric oxide (NO) productions, were assessed in the stimulated Jurkat and macrophage models, respectively. MAIN METHODS Cytokine and nitric oxide productions were stimulated in Jurkat and Raw 264.7 macrophages with Concanavalin A (Con A; 25 μg/ml) and lipopolysaccaride (LPS; 1 μg/ml), respectively. Selective concentrations of glycoalkaloids and potato peel extracts were added simultaneously with Con A or LPS for 24h to investigate their potential to reduce inflammatory activity. KEY FINDINGS α-Chaconine and solanidine significantly reduced interleukin-2 (IL-2) and interleukin-8 (IL-8) productions in Con A-induced Jurkat cells. The potato peel extracts did not influence cytokine production. In LPS-stimulated Raw macrophages, α-solanine, solanidine and two potato peel extracts significantly reduced induced NO production. SIGNIFICANCE Our findings suggest that sub-cytotoxic concentrations of potato glycoalkaloids and potato peel extracts possess anti-inflammatory effects in vitro and with further investigation may be useful in the prevention of anti-inflammatory diseases.
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Affiliation(s)
- Olivia M Kenny
- School of Food and Nutritional Sciences, University College Cork, Cork, Ireland
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Haworth KE, Farrell WE, Emes RD, Ismail KMK, Carroll WD, Borthwick HAD, Yates AM, Hubball E, Rooney A, Khanam M, Aggarwal N, Jones PW, Fryer AA. Combined influence of gene-specific cord blood methylation and maternal smoking habit on birth weight. Epigenomics 2013; 5:37-49. [DOI: 10.2217/epi.12.72] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: Evidence suggests that folic acid intake affects birth weight and that these effects may be mediated via the fetal epigenome. Our previous array data indicate that methylation in human cord blood at gene-specific CpGs is associated with birth weight percentile (BWP). Our aims were to investigate associations with BWP in specific CpGs identified by the array analysis in a significantly larger cohort and investigate the effects of other relevant factors on this association. Materials & methods: Methylation status was examined in candidate CpGs in 129 cord blood samples using Pyrosequencing™. The effects of other potentially important factors; maternal smoking, folate-related metabolite levels and genetic variation in the MTHFR gene, were examined. Linear and logistic regression analyses were used to identify relationships between BWP and methylation levels in the context of other key factors. Results: Increased cord methylation at CpGs in GSTM5 and MAP2K3 was associated with a reduced risk of having a birth weight below the 50th percentile (p = 0.010; odds ratio [OR]: 0.33 and p = 0.024; OR: 0.24, respectively) while higher methylation levels in APOB were associated with an increased risk (p = 0.023; OR: 2.56). Smoking during pregnancy modified the effect of methylation on BWP. Thus, compared with nonsmokers with a GSTM5 methylation level of >25% (median BWP: 54.7%), those who had smoked during pregnancy and whose GSTM5 methylation was <25% had the lowest median BWP (12.0%; p = 0.001). Furthermore, this latter group had the highest proportion of cases with BWPs below 50% (92.9 compared with 47.8% in nonsmokers with a GSTM5 methylation level of >25%; p = 0.013; OR: 14.2). Similar results were identified for MAP2K3, while the link with APOB reflected the inverse relationship between methylation at this locus and BWP. Conclusion: Our data suggest that gene-specific methylation of cord DNA is associated with BWP and this methylation provides an additional effect on BWP to that of smoking during pregnancy.
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Affiliation(s)
- Kim E Haworth
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - William E Farrell
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Richard D Emes
- School of Veterinary Medicine & Science, University of Nottingham, Sutton Bonington Campus, Sutton Bonington, Leicestershire, UK
| | - Khaled MK Ismail
- School of Clinical & Experimental Medicine, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK and Birmingham Women’s NHS Foundation Trust, Edgbaston, Birmingham UK
| | - William D Carroll
- Department of Paediatrics, Derbyshire Children’s Hospital, Derby, UK
| | - Hazel-Ann D Borthwick
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Alexandra M Yates
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Emma Hubball
- Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK
| | - Angela Rooney
- Maternity Centre, University Hospital of North Staffordshire, Stoke-on-Trent, Staffordshire, UK
| | - Mazeda Khanam
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Neyha Aggarwal
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
| | - Peter W Jones
- Department of Primary Care Sciences, Keele University, Stoke-on-Trent, Staffordshire, UK
| | - Anthony A Fryer
- Institute of Science & Technology in Medicine, Keele University School of Medicine, Stoke-on-Trent, Staffordshire, UK
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Kadam UT, Uttley J, Jones PW, Iqbal Z. Chronic disease multimorbidity transitions across healthcare interfaces and associated costs: a clinical-linkage database study. BMJ Open 2013; 3:bmjopen-2013-003109. [PMID: 23872294 PMCID: PMC3717459 DOI: 10.1136/bmjopen-2013-003109] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate multimorbidity transitions from general practice populations across healthcare interfaces and the associated healthcare costs. DESIGN Clinical-linkage database study. SETTING Population (N=60 660) aged 40 years and over registered with 53 general practices in Stoke-on-Trent. PARTICIPANTS Population with six specified multimorbidity pairs were identified based on hypertension, diabetes mellitus (DM), coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and chronic kidney disease (CKD). MAIN OUTCOMES MEASURES Chronic disease registers were linked to accident and emergency (A&E) and hospital admissions for a 3-year time period (2007-2009), and associated costs measured by Healthcare Resource Groups. Associations between multimorbid groups and direct healthcare costs were compared with their respective single disease groups using linear regression methods, adjusting for age, gender and deprivation. RESULTS In the study population, there were 9735 patients with hypertension and diabetes (16%), 3574 with diabetes and CHD (6%), 2894 with diabetes and CKD (5%), 1855 with COPD and CHD (3%), 754 with CHF and COPD (1%) and 1425 with CHF and CKD (2%). Transition, defined as at least one episode in each of the 3-year time periods, was as follows: patients with hypertension and DM had the fewest transitions in the 3-year time period (37% A&E episode and 51% hospital admission), but those with CHF and CKD had the most transitions (67% A&E episode and 79% hospital admission). The average 3-year total costs per multimorbid patient for A&E episodes ranged from £69 to £166 and for hospital admissions ranged from between £2289 and £5344. The adjusted costs were significantly higher for all six multimorbid groups compared with their respective single disease groups. CONCLUSIONS Specific common multimorbid pairs are associated with higher healthcare transitions and differential costs. Identification of multimorbidity type and linkage of information across interfaces provides opportunities for targeted intervention and delivery of integrated care.
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Affiliation(s)
- Umesh T Kadam
- Health Service Research Unit, Keele University, Staffordshire, UK
| | - John Uttley
- NHS Staffordshire Commissioning Support Service, Stoke-on-Trent, UK
| | - Peter W Jones
- Health Service Research Unit, Keele University, Staffordshire, UK
| | - Zafar Iqbal
- Department of Public Health, Stoke-on-Trent City Council, Stoke on Trent, UK
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Pitt WG, Zhao Y, Jones PW, Nelson JL, Pruitt JD. Autoclaving SiHy lenses loaded with phospholipid. Cont Lens Anterior Eye 2012. [DOI: 10.1016/j.clae.2012.08.029] [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: 11/16/2022]
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Driskell OJ, Holland D, Hanna FW, Jones PW, Pemberton RJ, Tran M, Fryer AA. Inappropriate Requesting of Glycated Hemoglobin (Hb A1c) Is Widespread: Assessment of Prevalence, Impact of National Guidance, and Practice-to-Practice Variability. Clin Chem 2012; 58:906-15. [DOI: 10.1373/clinchem.2011.176487] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Estimates suggest that approximately 25% of requests for pathology tests are unnecessary. Even in diabetes, for which international guidance provides recommended testing frequency, considerable variability in requesting practice exists. Using the diabetes marker, Hb A1c, we examined (a) the prevalence of under- and overrequesting, (b) the impact of international guidance on prevalence, and (c) practice-to-practice variability.
METHODS
We examined Hb A1c requests (519 664 requests from 115 730 patients, January 2001 to March 2011) processed by the Clinical Biochemistry Department, University Hospital of North Staffordshire, and prevalence of requesting outside guidance from intervals between requests was calculated. Requests were classified as “appropriate,” “too soon,” or “too late.” We also assessed the effect of demographic factors and publication of guidance, along with between-practice variability, on prevalence.
RESULTS
Only 49% of requests conformed to guidance; 21% were too soon and 30% were too late. Underrequesting was more common in primary care, in female patients, in younger patients, and in patients with generally poorer control (all P < 0.001); the reverse generally was true for overrequesting. Publication of guidance (e.g., American Diabetes Association, UK National Institute for Health and Clinical Excellence) had no significant impact on under- or overrequesting rates. Prevalence of inappropriate requests varied approximately 6-fold between general practices.
CONCLUSIONS
Although overrequesting was common, underrequesting was more prevalent, potentially affecting longer-term health outcomes. National guidance appears to be an ineffective approach to changing request behavior, supporting the need for a multisystem approach to reducing variability.
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Affiliation(s)
- Owen J Driskell
- Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - David Holland
- National Pathology Benchmarking Service, Department of Medicines Management, and
| | - Fahmy W Hanna
- Department of Diabetes and Endocrinology, Norton Unit, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Peter W Jones
- School of Computing and Mathematics, Keele University, Staffordshire, UK
| | - R John Pemberton
- Diabetes UK North Staffordshire Branch, Newcastle-under-Lyme, Staffordshire, UK
| | - Martin Tran
- Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
| | - Anthony A Fryer
- Department of Clinical Biochemistry, Keele University School of Medicine, University Hospital of North Staffordshire, Stoke-on-Trent, UK
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White SH, Roberts S, Jones PW. The Twin Peg Oxford partial knee replacement: the first 100 cases. Knee 2012; 19:36-40. [PMID: 21251839 DOI: 10.1016/j.knee.2010.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 02/02/2023]
Abstract
We present the clinical results of the first 100 patients who received the Twin Peg Oxford partial knee replacement which has a 15° extra femoral surface for contact in deep flexion, and has two pegs for more secure fixation. We measured the clinical outcome 2 years after the medial unicompartmental arthroplasty using patient and surgeon derived outcome measures. The results showed a mean Oxford Knee Score of 41, a mean American Knee Society Objective Score of 93 and a Functional Score of 84, a mean range of motion of 130° and a high satisfaction rate. Results were significantly better in male patients. There were no deaths, infections, dislocations, fractures or revisions. There were no pathological radiolucencies suggestive of early loosening. We conclude that the Twin Peg Oxford partial knee replacement shows excellent clinical and radiological results at 2 years. For surgeons who have concern over the risk of femoral loosening with the single peg Oxford knee, or seek an improved surface area of contact in full flexion, this implant offers an excellent alternative.
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Affiliation(s)
- Stephen H White
- Department of Orthopaedic Surgery, The Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, Shropshire. SY10 7AG, United Kingdom.
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Abstract
Noise is a major concern in circuits processing electrical signals, including neural circuits. There are many factors that influence how noise propagates through neural circuits, and there are few systems in which noise levels have been studied throughout a processing pathway. We recorded intracellularly from multiple stages of a sensory-motor pathway in the locust that detects approaching objects. We found that responses are more variable and that signal-to-noise ratios (SNRs) are lower further from the sensory periphery. SNRs remain low even with the use of stimuli for which the pathway is most selective and for which the neuron representing its final sensory level must integrate many synaptic inputs. Modeling of this neuron shows that variability in the strength of individual synaptic inputs within a large population has little effect on the variability of the spiking output. In contrast, jitter in the timing of individual inputs and spontaneous variability is important for shaping the responses to preferred stimuli. These results suggest that neural noise is inherent to the processing of visual stimuli signaling impending collision and contributes to shaping neural responses along this sensory-motor pathway.
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Affiliation(s)
- Peter W Jones
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
Two articles in this issue of Neuron (Eichner et al. and Clark et al.) attack the problem of explaining how neuronal hardware in Drosophila implements the Reichardt motion detector, one of the most famous computational models in neuroscience, which has proven intractable up to now.
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Affiliation(s)
- Fabrizio Gabbiani
- Department of Neuroscience, Baylor College of Medicine, Houston, TX 77030, USA.
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