1
|
Sackley CM, Rick C, Au P, Brady MC, Beaton G, Burton C, Caulfield M, Dickson S, Dowling F, Hughes M, Ives N, Jowett S, Masterson-Algar P, Nicoll A, Patel S, Smith CH, Woolley R, Clarke CE. A multicentre, randomised controlled trial to compare the clinical and cost-effectiveness of Lee Silverman Voice Treatment versus standard NHS Speech and Language Therapy versus control in Parkinson's disease: a study protocol for a randomised controlled trial. Trials 2020; 21:436. [PMID: 32460885 PMCID: PMC7251680 DOI: 10.1186/s13063-020-04354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Parkinson's disease (PD) affects approximately 145,519 people in the UK. Speech impairments are common with a reported prevalence of 68%, which increase physical and mental demands during conversation, reliance on family and/or carers, and the likelihood of social withdrawal reducing quality of life. In the UK, two approaches to Speech and Language Therapy (SLT) intervention are commonly available: National Health Service (NHS) SLT or Lee Silverman Voice Treatment (LSVT LOUD®). NHS SLT is tailored to the individuals' needs per local practice typically consisting of six to eight weekly sessions; LSVT LOUD® comprises 16 sessions of individual treatment with home-based practice over 4 weeks. The evidence-base for their effectiveness is inconclusive. METHODS/DESIGN PD COMM is a phase III, multicentre, three-arm, unblinded, randomised controlled trial. Five hundred and forty-six people with idiopathic PD, reporting speech or voice problems will be enrolled. We will exclude those with a diagnosis of dementia, laryngeal pathology or those who have received SLT for speech problems in the previous 2 years. Following informed consent and completion of baseline assessments, participants will be randomised in a 1:1:1 ratio to no-intervention control, NHS SLT or LSVT LOUD® via a central computer-generated programme, using a minimisation procedure with a random element, to ensure allocation concealment. Participants randomised to the intervention groups will start treatment within 4 (NHS SLT) or 7 (LSVT LOUD®) weeks of randomisation. PRIMARY OUTCOME Voice Handicap Index (VHI) total score at 3 months. Secondary outcomes include: VHI subscales, Parkinson's Disease Questionnaire-39; Questionnaire on Acquired Speech Disorders; EuroQol-5D-5 L; ICECAP-O; resource utilisation; adverse events and carer quality of life. Mixed-methods process and health economic evaluations will take place alongside the trial. Assessments will be completed before randomisation and at 3, 6 and 12 months after randomisation. The trial started in December 2015 and will run for 77 months. Recruitment will take place in approximately 42 sites around the UK. DISCUSSION The trial will test the hypothesis that SLT is effective for the treatment of speech or voice problems in people with PD compared to no SLT. It will further test whether NHS SLT or LSVT LOUD® provide greater benefit and determine the cost-effectiveness of both interventions. TRIAL REGISTRATION International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ID: 12421382. Registered on 18 April 2016.
Collapse
Affiliation(s)
- C. M. Sackley
- Population Health Sciences, Addison House, King’s College London, Guy’s Campus, London, SE1 1UL UK
- School of Health Science, University of Nottingham, QMC, Nottingham, NG7 2HA UK
| | - C. Rick
- Nottingham Clinical Trials Unit, University of Nottingham, Building 42, University Park, Nottingham, NG7 2RD UK
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - P. Au
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - M. C. Brady
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - G. Beaton
- Queen Elizabeth Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C. Burton
- School of Allied and Public Health Professions, Canterbury Christ church University, Canterbury, CT1 1QU UK
| | - M. Caulfield
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - S. Dickson
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - F. Dowling
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ UK
| | - M. Hughes
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - N. Ives
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - S. Jowett
- Health Economics, University of Birmingham, Birmingham,, B15 2TT UK
| | - P. Masterson-Algar
- Bangor Institute for Health and Medical Research, School of Healthcare Sciences, Bangor University, Bangor, UK
| | - A. Nicoll
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - S. Patel
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. H. Smith
- Division of Psychology and Language Science, Faculty of Brain Sciences, University College London, London, UK
| | - R. Woolley
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT UK
| | - C. E. Clarke
- Institute for Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham,, B18 7QH UK
| |
Collapse
|
2
|
Boswood A, Gordon SG, Häggström J, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Schummer C, Watson P. Longitudinal Analysis of Quality of Life, Clinical, Radiographic, Echocardiographic, and Laboratory Variables in Dogs with Preclinical Myxomatous Mitral Valve Disease Receiving Pimobendan or Placebo: The EPIC Study. J Vet Intern Med 2017; 32:72-85. [PMID: 29214723 PMCID: PMC5787203 DOI: 10.1111/jvim.14885] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 06/30/2017] [Revised: 08/21/2017] [Accepted: 10/23/2017] [Indexed: 11/30/2022] Open
Abstract
Background Changes in clinical variables associated with the administration of pimobendan to dogs with preclinical myxomatous mitral valve disease (MMVD) and cardiomegaly have not been described. Objectives To investigate the effect of pimobendan on clinical variables and the relationship between a change in heart size and the time to congestive heart failure (CHF) or cardiac‐related death (CRD) in dogs with MMVD and cardiomegaly. To determine whether pimobendan‐treated dogs differ from dogs receiving placebo at onset of CHF. Animals Three hundred and fifty‐four dogs with MMVD and cardiomegaly. Materials and Methods Prospective, blinded study with dogs randomized (ratio 1:1) to pimobendan (0.4–0.6 mg/kg/d) or placebo. Clinical, laboratory, and heart‐size variables in both groups were measured and compared at different time points (day 35 and onset of CHF) and over the study duration. Relationships between short‐term changes in echocardiographic variables and time to CHF or CRD were explored. Results At day 35, heart size had reduced in the pimobendan group: median change in (Δ) LVIDDN −0.06 (IQR: −0.15 to +0.02), P < 0.0001, and LA:Ao −0.08 (IQR: −0.23 to +0.03), P < 0.0001. Reduction in heart size was associated with increased time to CHF or CRD. Hazard ratio for a 0.1 increase in ΔLVIDDN was 1.26, P = 0.0003. Hazard ratio for a 0.1 increase in ΔLA:Ao was 1.14, P = 0.0002. At onset of CHF, groups were similar. Conclusions and Clinical Importance Pimobendan treatment reduces heart size. Reduced heart size is associated with improved outcome. At the onset of CHF, dogs treated with pimobendan were indistinguishable from those receiving placebo.
Collapse
Affiliation(s)
- A Boswood
- department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic., Australia
| | - V Szatmári
- Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA
| | - Y Fujii
- Surgery 1, Azabu University, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Gallarate, Varese, Italy
| | - M Uechi
- Japan Animal Specialty Medical Institute Inc., JASMINE Veterinary Cardiovascular Medical Center, Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - C Schummer
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| | - P Watson
- Animal Health, Boehringer Ingelheim, Ingelheim am Rhein, Germany
| |
Collapse
|
3
|
Boswood A, Häggström J, Gordon SG, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M, Smith S, Fox PR, Sanderson K, Woolley R, Szatmári V, Menaut P, Church WM, O'Sullivan ML, Jaudon JP, Kresken JG, Rush J, Barrett KA, Rosenthal SL, Saunders AB, Ljungvall I, Deinert M, Bomassi E, Estrada AH, Fernandez Del Palacio MJ, Moise NS, Abbott JA, Fujii Y, Spier A, Luethy MW, Santilli RA, Uechi M, Tidholm A, Watson P. Effect of Pimobendan in Dogs with Preclinical Myxomatous Mitral Valve Disease and Cardiomegaly: The EPIC Study-A Randomized Clinical Trial. J Vet Intern Med 2016; 30:1765-1779. [PMID: 27678080 PMCID: PMC5115200 DOI: 10.1111/jvim.14586] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [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: 05/08/2016] [Revised: 07/08/2016] [Accepted: 08/23/2016] [Indexed: 11/27/2022] Open
Abstract
Background Pimobendan is effective in treatment of dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD). Its effect on dogs before the onset of CHF is unknown. Hypothesis/Objectives Administration of pimobendan (0.4–0.6 mg/kg/d in divided doses) to dogs with increased heart size secondary to preclinical MMVD, not receiving other cardiovascular medications, will delay the onset of signs of CHF, cardiac‐related death, or euthanasia. Animals 360 client‐owned dogs with MMVD with left atrial‐to‐aortic ratio ≥1.6, normalized left ventricular internal diameter in diastole ≥1.7, and vertebral heart sum >10.5. Methods Prospective, randomized, placebo‐controlled, blinded, multicenter clinical trial. Primary outcome variable was time to a composite of the onset of CHF, cardiac‐related death, or euthanasia. Results Median time to primary endpoint was 1228 days (95% CI: 856–NA) in the pimobendan group and 766 days (95% CI: 667–875) in the placebo group (P = .0038). Hazard ratio for the pimobendan group was 0.64 (95% CI: 0.47–0.87) compared with the placebo group. The benefit persisted after adjustment for other variables. Adverse events were not different between treatment groups. Dogs in the pimobendan group lived longer (median survival time was 1059 days (95% CI: 952–NA) in the pimobendan group and 902 days (95% CI: 747–1061) in the placebo group) (P = .012). Conclusions and Clinical Importance Administration of pimobendan to dogs with MMVD and echocardiographic and radiographic evidence of cardiomegaly results in prolongation of preclinical period and is safe and well tolerated. Prolongation of preclinical period by approximately 15 months represents substantial clinical benefit.
Collapse
Affiliation(s)
- A Boswood
- Department of Veterinary Clinical Sciences, The Royal Veterinary College, Hatfield, Hertfordshire, UK
| | - J Häggström
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - S G Gordon
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - G Wess
- Clinic of Small Animal Medicine, University of Munich, Munich, Germany
| | - R L Stepien
- Medical Sciences, University of Wisconsin Madison School of Veterinary Medicine, Madison, WI
| | - M A Oyama
- Clinical Studies-Philadelphia, MJR-VHUP-Cardiology, University of Pennsylvania, Philadelphia, PA
| | - B W Keene
- Department of Clinical Sciences, North Carolina State University, College of Veterinary Medicine, Raleigh, NC
| | - J Bonagura
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH
| | | | - M Patteson
- HeartVets @ Vale Referrals, The Animal Hospital, Dursley, Gloucestershire, UK
| | - S Smith
- Sarah Smith Cardiology, Derby, UK
| | - P R Fox
- Animal Medical Center, New York, NY
| | - K Sanderson
- Rocky Mountain Veterinary Cardiology, Boulder, CO
| | - R Woolley
- Cardio Respiratory Pet Referrals Victoria, Mordialloc, Vic, Australia
| | - V Szatmári
- Faculty of Veterinary Medicine, Clinical Sciences of Companion Animals, Utrecht University, Utrecht, Utrecht, Netherlands
| | - P Menaut
- Internal Medicine and Cardiology, Clinique Vétérinaire Aquivet, Eysines, France
| | - W M Church
- Desert Veterinary Medical Specialists, Phoenix, AZ
| | - M L O'Sullivan
- Deptartment of Clinical Studies, University of Guelph, Ontario Veterinary College, Guelph, ON, Canada
| | - J-P Jaudon
- Clinique Veterinaire Des Etangs, Villars Les Dombes, France
| | - J-G Kresken
- Clinic for Small Animals Kaiserberg, Duisburg, Germany
| | - J Rush
- Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, MA
| | - K A Barrett
- Cardiology, VCA West Los Angeles, Los Angeles, CA
| | | | - A B Saunders
- Small Animal Clinical Science, Texas A&M University, College Station, TX
| | - I Ljungvall
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, SE
| | - M Deinert
- Tierklinik am Sandpfad, Wiesloch, Germany
| | - E Bomassi
- Cardiology, Centre Hospitalier Vétérinaire des Cordeliers, Meaux, France
| | - A H Estrada
- Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, FL
| | | | - N S Moise
- Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - J A Abbott
- Department of Small Animal Clinical Sciences, Virginia Tech, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA
| | - Y Fujii
- Azabu University, Chuo-ku, Sagamihara, Kanagawa, Japan
| | - A Spier
- Blue Pearl Veterinary Partners, Tampa, FL
| | - M W Luethy
- Chicago Veterinary Emergency and Specialty Center, Chicago, IL
| | - R A Santilli
- Cardiology, Clinica Veterinaria Malpensa, Viale Marconi, Varese, Italy
| | - M Uechi
- JASMINE Veterinary Cardiovascular Medical Center, Japan Animal Specialty Medical Institute Inc., Yokohama, Japan
| | - A Tidholm
- Djursjukhuset Albano, Danderyd, Sweden
| | - P Watson
- Boehringer Ingelheim, Animal Health, Ingelheim am Rhein, Germany
| |
Collapse
|
4
|
Korzeniowska B, Woolley R, DeCourcey J, Wencel D, Loscher CE, McDonagh C. Intracellular pH-sensing using core/shell silica nanoparticles. J Biomed Nanotechnol 2014; 10:1336-45. [PMID: 24804554 DOI: 10.1166/jbn.2014.1815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
An in-depth understanding of biochemical processes occurring within biological systems is key for early diagnosis of disease and identification of appropriate treatments. Nanobiophotonics offers huge potential benefits for intracellular diagnostics and therapeutics. Intracellular sensing using fluorescent nanoparticles is a potentially useful tool for real-time, in vivo monitoring of important cellular analytes. This work is focused on synthesis of optical chemical nanosensors for the quantitative analysis of pH inside living cells. The structure of the nanosensor comprises a biofriendly silica matrix with co-encapsulated Texas Red, acting as a reference dye, and pH-sensitive fluorescein isothiocyanate enabling ratiometric quantitative environmental detection. In order to obtain silica-based nanoparticles -70 nm in size, a modified sol-gel-based Stöber method was employed. The potential of these nanosensors for intracellular pH monitoring is demonstrated inside a live human embryonic kidney cell line whereby a significant change in fluorescence is observed when the cell pH is switched from acidic to basic. High loading efficiencies of nanoparticles into the cells is seen, with little effect on cell morphology even following extended nanoparticle exposure (up to 72 h). Nanoparticle incubation time and the fast response of the nanosensor (-2 s) make it a very powerful tool in monitoring the processes occurring within the cytosol.
Collapse
|
5
|
Woolley R, Roy S, Prendergast Ú, Panzera A, Basabe-Desmonts L, Kenny D, McDonagh C. From particle to platelet: Optimization of a stable, high brightness fluorescent nanoparticle based cell detection platform. Nanomedicine: Nanotechnology, Biology and Medicine 2013; 9:540-9. [DOI: 10.1016/j.nano.2012.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 09/12/2012] [Accepted: 10/08/2012] [Indexed: 01/11/2023]
|
6
|
|
7
|
Cohen AB, Gentile C, Tully CG, Austin R, Calaprice F, McDonald K, Ascione G, Baker G, Davidson R, Dudek L, Grisham L, Kugel H, Pagdon K, Stevenson T, Woolley R, Zwicker A. Development of an Extreme Environment Materials Research Facility at Princeton. Fusion Science and Technology 2011. [DOI: 10.13182/fst60-454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. B. Cohen
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - C.A. Gentile
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - C. G. Tully
- Princeton University, Physics Department, New Jersey 08540
| | - R. Austin
- Princeton University, Physics Department, New Jersey 08540
| | - F. Calaprice
- Princeton University, Physics Department, New Jersey 08540
| | - K. McDonald
- Princeton University, Physics Department, New Jersey 08540
| | - G. Ascione
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - G. Baker
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - R. Davidson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - L. Dudek
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - L. Grisham
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - H. Kugel
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - K. Pagdon
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - T. Stevenson
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - R. Woolley
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| | - A. Zwicker
- Princeton Plasma Physics Laboratory, P.O. Box 451, Princeton, New Jersey 08543
| |
Collapse
|
8
|
Pereira YM, Woolley R, Culshaw G, French A, Martin M. The vasovagal tonus index as a prognostic indicator in dogs with dilated cardiomyopathy. J Small Anim Pract 2008; 49:587-92. [DOI: 10.1111/j.1748-5827.2008.00654.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Abstract
INTRODUCTION There is a large population of elderly medical inpatients with co-existent medical and mental health disorders who pose a significant management challenge for medical, nursing and allied staff. Our hospital has a joint elderly medicine-psychiatry unit to cater for this patient group; this article reviews how this unit was set up and presents a representative sample of inpatients. RESULTS The mean age was 81 years with a female preponderance. The mean length of stay was 44 days. The commonest medical conditions were cerebrovascular disease, urinary tract infections, chest infections and falls. The commonest mental health diagnoses were cognitive impairment, delirium and depression. The mortality rate was 21%; of the remainder, 55% were discharged to long-term care, 40% returned home and 5% were transferred to the local psychiatric hospital. DISCUSSION This cohort of elderly patients has complex medical, nursing and therapy needs in addition to complex discharge planning needs. Our unit has a shared care approach, with joint responsibility shared by a consultant in Medicine for the Elderly and a Consultant in Old Age Psychiatry. This, in combination with a multidisciplinary team approach, provides an effective means of delivering care to this patient group. CONCLUSION A joint elderly medicine-old age psychiatry ward provides a high standard of care for elderly patients with co-existent physical and mental health needs. We hope that the information presented in this article will be of use to those hoping to set up a similar unit in their own hospitals.
Collapse
Affiliation(s)
- S J Hanna
- Department of Medicine for the Elderly, York District Hospital, York, UK.
| | | | | | | |
Collapse
|
10
|
Abstract
A 10-year-old male cairn terrier cross was presented with a history of myxomatous mitral valve disease diagnosed six months previously and with a four-week history of intermittent collapse. On 24 hour electrocardiograph (Holter) analysis, periods of no discernable electrical cardiac activity, which coincided with three collapsing episodes, were identified. Unfortunately, on re-presentation for removal of the Holter monitor, the dog collapsed and died. A post-mortem examination was conducted, and histology of the right and left atrium showed evidence of myocarditis. This is the first reported case, to our knowledge, of collapse because of electrical asystole in a dog with atrial myocarditis.
Collapse
Affiliation(s)
- R Woolley
- Department of Veterinary Clinical Studies, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Hospital for Small Animals, Easter Bush, Roslin, Midlothian EH25 9RG, UK
| | | | | | | | | | | |
Collapse
|
11
|
Ying A, Abdou M, Morley N, Sketchley T, Woolley R, Burris J, Kaita R, Fogarty P, Huang H, Lao X, Narula M, Smolentsev S, Ulrickson M. Exploratory studies of flowing liquid metal divertor options for fusion-relevant magnetic fields in the MTOR facility. Fusion Engineering and Design 2004. [DOI: 10.1016/j.fusengdes.2004.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
12
|
Neumeyer C, Heitzenroeder P, Kessel C, Ono M, Peng M, Schmidt J, Woolley R, Zatz I. Next step spherical torus design studies. Fusion Engineering and Design 2003. [DOI: 10.1016/s0920-3796(03)00161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
13
|
Mitchell G, Gray S, Shipton B, Woolley R, Erbacher J, Egerton G, McKnoulty J. Evaluating integrated urban water systems alternatives for Brisbane, Australia. Water Sci Technol 2003; 47:1-9. [PMID: 12793655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The Brazil Development Study investigates the feasibility of alternative approaches to providing sustainable water services to a 226 ha mixed residential and industrial greenfield development within the city of Brisbane, Australia. The alternatives include techniques such a the use of rainwater tanks, water use efficiency, a local wastewater treatment plant for recycling of reclaimed water and composting toilets amongst others. This paper evaluates a series of urban development scenarios against the objectives of the study. The insights gained into the drivers for cost and environmental impact for this particular site are discussed as well as a number of issues of concern and challenges to Council and the community.
Collapse
Affiliation(s)
- G Mitchell
- CSIRO Building Construction and Engineering, PO Box 56, Highett, Vic 3190, Australia.
| | | | | | | | | | | | | |
Collapse
|
14
|
Kaita R, Majeski R, Boaz M, Efthimion P, Jones B, Hoffman D, Kugel H, Menard J, Munsat T, Post-Zwicker A, Soukhanovskii V, Spaleta J, Taylor G, Timberlake J, Woolley R, Zakharov L, Finkenthal M, Stutman D, Antar G, Doerner R, Luckhardt S, Maingi R, Maiorano M, Smith S. Spherical torus plasma interactions with large-area liquid lithium surfaces in CDX-U. Fusion Engineering and Design 2002. [DOI: 10.1016/s0920-3796(02)00117-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Abdou M, TEAM TAPEX, Ying A, Morley N, Gulec K, Smolentsev S, Kotschenreuther M, Malang S, Zinkle S, Rognlien T, Fogarty P, Nelson B, Nygren R, McCarthy K, Youssef M, Ghoniem N, Sze D, Wong C, Sawan M, Khater H, Woolley R, Mattas R, Moir R, Sharafat S, Brooks J, Hassanein A, Petti D, Tillack M, Ulrickson M, Uchimoto T. On the exploration of innovative concepts for fusion chamber technology. Fusion Engineering and Design 2001. [DOI: 10.1016/s0920-3796(00)00433-6] [Citation(s) in RCA: 254] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
|
17
|
Davies G, Oates AS, Newman RC, Woolley R, Lightowlers EC, Binns MJ, Wilkes JG. Carbon-related radiation damage centres in Czochralski silicon. ACTA ACUST UNITED AC 2000. [DOI: 10.1088/0022-3719/19/6/006] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
18
|
|
19
|
Schacher S, Kandel ER, Woolley R. Development of neurons in the abdominal ganglion of Aplysia californica. I. Axosomatic synaptic contacts. Dev Biol 1979; 71:163-75. [PMID: 467787 DOI: 10.1016/0012-1606(79)90090-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|