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Habicht J, Viswanathan S, Carrington B, Hauser TU, Harper R, Rollwage M. Closing the accessibility gap to mental health treatment with a personalized self-referral chatbot. Nat Med 2024; 30:595-602. [PMID: 38317020 DOI: 10.1038/s41591-023-02766-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 12/14/2023] [Indexed: 02/07/2024]
Abstract
Inequality in treatment access is a pressing issue in most healthcare systems across many medical disciplines. In mental healthcare, reduced treatment access for minorities is ubiquitous but remedies are sparse. Here we demonstrate that digital tools can reduce the accessibility gap by addressing several key barriers. In a multisite observational study of 129,400 patients within England's NHS services, we evaluated the impact of a personalized artificial intelligence-enabled self-referral chatbot on patient referral volume and diversity in ethnicity, gender and sexual orientation. We found that services that used this digital solution identified substantially increased referrals (15% increase versus 6% increase in control services). Critically, this increase was particularly pronounced in minorities, such as nonbinary (179% increase) and ethnic minority individuals (29% increase). Using natural language processing to analyze qualitative feedback from 42,332 individuals, we found that the chatbot's human-free nature and the patients' self-realization of their need for treatment were potential drivers for the observed improvement in the diversity of access. This provides strong evidence that digital tools may help overcome the pervasive inequality in mental healthcare.
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Affiliation(s)
| | | | | | - Tobias U Hauser
- Limbic, London, UK
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
- Department of Psychiatry and Psychotherapy, Medical School and University Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
- German Center for Mental Health (DZPG), Tübingen, Germany
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Gullett N, Zajkowska Z, Walsh A, Harper R, Mondelli V. Heart rate variability (HRV) as a way to understand associations between the autonomic nervous system (ANS) and affective states: A critical review of the literature. Int J Psychophysiol 2023; 192:35-42. [PMID: 37543289 DOI: 10.1016/j.ijpsycho.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/07/2023]
Abstract
Evidence suggests affective disorders such as depression and bipolar disorder are characterised by dysregulated autonomic nervous system (ANS) activity. These findings suggest ANS dysregulation may be involved in the pathogenesis of affective disorders. Different affective states are characterised by different ANS activity patterns (i.e., an increase or decrease in sympathetic or parasympathetic activity). To understand how ANS abnormalities are involved in the development of affective disorders, it is important to understand how affective states correlate with ANS activity before their onset. Using heart rate variability (HRV) as a tool to measure ANS activity, this review aimed to look at associations between affective states and HRV in non-clinical populations (i.e., in those without medical and psychiatric disorders). Searches on PubMed and Google Scholar were completed using the following search terms: heart rate variability, autonomic nervous system, sympathetic nervous system, parasympathetic nervous system, affective state, mood and emotion in all possible combinations. All but one of the studies examined (N = 13), demonstrated significant associations between affect and HRV. Findings suggest negative affect, encompassing both diffused longer-term experiences (i.e., mood) as well as more focused short-term experiences (i.e., emotions), may be associated with a reduction in parasympathetic activity as measured through HRV parameters known to quantify parasympathetic activity (e.g., high frequency (HF)-HRV). HRV measures typically linked to reduction in parasympathetic activity appear to be linked to negative affective states in non-clinical populations. However, given the complex and possibly non-linear relationship between HRV and parasympathetic activity, further studies need to clarify specificity of these findings. Future studies should investigate the potential utility of HRV measures as biomarkers for monitoring changes in affective states and for early detection of onset and relapse of depression in patients with affective disorders.
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Affiliation(s)
- Nancy Gullett
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK.
| | - Zuzanna Zajkowska
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Annabel Walsh
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK
| | - Ross Harper
- Limbic, Kemp House, 160 City Road, London EC1V 2NX, UK
| | - Valeria Mondelli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, UK; National Institute for Health Research Mental Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Pal A, Harper R, Malhotra A, Lavretsky H, Macey P. Does an acute bout of breathing awareness meditation improve breathing stability correlated with regulatory prefrontal cortex neural activity in obstructive sleep apnea? Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Paratz E, Mock N, Cochrane A, Harper R, Larobina M, Wilson W, Appelbe A, Kushwaha V, Almeida IDS, Monteiro A, Bayley N. Adult and Paediatric Cardiac Intervention in Timor-Leste: Disease Burden, Demographics and Clinical Outcomes. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Halton JML, Albisetti M, Biss B, Bomgaars L, Brueckmann M, Gropper S, Harper R, Huang F, Luciani M, Maas H, Tartakovsky I, Mitchell LG. Phase IIa study of dabigatran etexilate in children with venous thrombosis: pharmacokinetics, safety, and tolerability. J Thromb Haemost 2017; 15:2147-2157. [PMID: 28921890 DOI: 10.1111/jth.13847] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 11/30/2022]
Abstract
Essentials Dabigatran etexilate may provide a new treatment option for pediatric venous thromboembolism. Children aged 1 to < 12 years were given dabigatran etexilate in an open-label, single-arm study. The pharmacokinetic-pharmacodynamic relationship was similar to that seen in adult patients. There were no serious adverse events, bleeding events or recurrent venous thromboembolism. SUMMARY Background The current standard-of-care treatments for pediatric venous thromboembolism (VTE) have limitations. Dabigatran etexilate (DE), a direct thrombin inhibitor, may offer an alternative therapeutic option. Objectives To assess the pharmacokinetics, pharmacodynamics, safety, and tolerability of a DE oral liquid formulation (OLF) in pediatric patients with VTE. Patients/Methods Patients who had completed planned treatment with low molecular weight heparin or oral anticoagulants for VTE were enrolled in two age groups (2 to < 12 years and 1 to < 2 years), and received a DE OLF based on an age-adjusted and weight-adjusted nomogram. Originally, patients were to receive a DE OLF twice daily for 3 days, but the protocol was amended to a single dose on day 1. The primary endpoints were pharmacokinetics/pharmacodynamics-related: plasma concentrations of DE and its metabolites; activated partial thromboplastin time (APTT), ecarin clotting time (ECT), and dilute thrombin time (dTT); and pharmacokinetic (PK)-pharmacodynamic (PD) correlation. Safety endpoints included incidence rates of bleeding events and all other adverse events (AEs). Results Eighteen patients entered the study and received the DE OLF (an exposure equivalent to a dose of 150 mg twice daily in adults). The projected steady-state dabigatran trough concentrations were largely comparable between pediatric patients and adults. The PK/PD relationship was linear for ECT and dTT, and non-linear for APTT. No serious or severe AEs, bleeding events, or recurrent VTEs were reported. Mild AEs were reported in three patients in the single-dose group (screening period) and in one patient in the multiple-dose group (on-treatment period). Conclusion The current study supports the further evaluation of DE OLFs in pediatric patients with VTE.
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Affiliation(s)
- J M L Halton
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - M Albisetti
- Hematology Department, University Children's Hospital, Zürich, Switzerland
| | - B Biss
- Clinical Development, Boehringer Ingelheim RCV, Vienna, Austria
| | - L Bomgaars
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - M Brueckmann
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma, Ingelheim, Germany
- Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - S Gropper
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma, Ingelheim, Germany
| | - R Harper
- Clinical Operations, Boehringer Ingelheim, Bracknell, UK
| | - F Huang
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
| | - M Luciani
- OncoHematology Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - H Maas
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma, Biberach, Germany
| | - I Tartakovsky
- Clinical Development and Medical Affairs, Boehringer Ingelheim Pharma, Ingelheim, Germany
| | - L G Mitchell
- University of Alberta, Edmonton, Alberta, Canada
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Danon Y, Moore MS, Koehler PE, Littleton PE, Miller GG, Ott MA, Rowton LJ, Taylor WA, Wilhelmy JB, Yates MA, Carlson AD, Hill NW, Harper R, Hilko R. Fission Cross-Section Measurements of the Odd-Odd Isotopes 232Pa, 238Np, and 236Np. NUCL SCI ENG 2017. [DOI: 10.13182/nse96-a17926] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Y. Danon
- Rensselaer Polytechnic Institute, Department of Nuclear Engineering and Engineering Physics Troy, New York 12180
| | - M. S. Moore
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - P. E. Koehler
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - P. E. Littleton
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - G. G. Miller
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - M. A. Ott
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - L. J. Rowton
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - W. A. Taylor
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - J. B. Wilhelmy
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - M. A. Yates
- Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico 87545
| | - A. D. Carlson
- National Institute for Standards and Technology, Gaithersburg, Maryland 20899
| | - N. W. Hill
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831
| | - R. Harper
- EG&G Energy Measurements, Los Alamos, New Mexico 87544
| | - R. Hilko
- EG&G Energy Measurements, Los Alamos, New Mexico 87544
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Raja A, Daly A, Harper R, Senghore N, White D, Ravaghi V. Characteristics of children undergoing dental extractions under general anaesthesia in Wolverhampton: 2007-2012. Br Dent J 2017; 220:407-11. [PMID: 27103291 DOI: 10.1038/sj.bdj.2016.297] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Studying characteristics of children requiring extractions under dental general anaesthesia (DGA) can help identify trends, which can be used to facilitate future planning of healthcare services. OBJECTIVE To report on the profile of children who underwent extractions under DGA between 2007 and 2012 at the New Cross Hospital in Wolverhampton, England.Methods Retrospective analyses of hospital records. RESULTS Of the 2692 patients seen between 2007 and 2012, 49.6% were boys and 50.4% were girls. The mean age was 7.1 and 7 to 12 years was the largest age group (43%). The majority of the sample was White British (67%). Of the 8,286 teeth extracted, 85% were primary teeth and 15% permanent. More teeth were extracted in boys than girls (P = 0.002) and 'Other' ethnicities had a higher mean number of extractions compared to White British (P <0.001) and South Asians (P = 0.046). The mean age of the patients has decreased over the years (P = 0.001) and the mean number of primary teeth extracted has increased (P = 0.001). CONCLUSIONS A clear dental public health issue has been reinforced through the relatively high level of DGA activity reported. Though rigorous caries prevention remains the ultimate goal, a better assessment and discharge process may help reduce the need for first time DGAs as well as repeats.
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Affiliation(s)
- A Raja
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - A Daly
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - R Harper
- Wolverhampton Special Care Dental Service, Dental Management Office, Penfields Health Centre, Wolverhampton, WV3 OJH
| | - N Senghore
- Wolverhampton Special Care Dental Service, Dental Management Office, Penfields Health Centre, Wolverhampton, WV3 OJH
| | - D White
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
| | - V Ravaghi
- School of Dentistry, University of Birmingham, 5 Mill Pool, Edgbaston, Birmingham, B5 7EG
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Song X, Roy B, Kang D, Aysola RS, Macey P, Woo M, Harper R, Kumar R. 0142 DECREASED REGIONAL HOMOGENEITY IN THE DEFAULT MODE NETWORK IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Holmes VA, Hamill LL, Alderdice FA, Spence M, Harper R, Patterson CC, Loughridge S, McKenna S, Gough A, McCance DR. Effect of implementation of a preconception counselling resource for women with diabetes: A population based study. Prim Care Diabetes 2017; 11:37-45. [PMID: 27475518 DOI: 10.1016/j.pcd.2016.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 06/20/2016] [Accepted: 07/10/2016] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the effect of regional implementation of a preconception counselling resource into routine diabetes care on pregnancy planning indicators. METHODS A preconception counselling DVD was distributed to women by diabetes care teams and general practices. Subsequently, in a prospective population-based study, pregnancy planning indicators were evaluated. The post-DVD cohort (n=135), including a viewed-DVD subgroup (n=58), were compared with an historical cohort (pre-DVD, n=114). Primary outcome was HbA1c at first diabetes-antenatal visit. Secondary outcomes included preconception folic acid consumption, planned pregnancy and HbA1c recorded in the 6 months preconception. RESULTS Mean first visit HbA1c was lower post-DVD vs. pre-DVD: 7.5% vs. 7.8% [58.4 vs. 61.8mmol/mol]; p=0.12), although not statistically significant. 53% and 20% of women with type 1 and 2 diabetes, respectively, viewed the DVD. The viewed-DVD subgroup were significantly more likely to have lower first visit HbA1c: 6.9% vs. 7.8% [52.1 vs. 61.8mmol/mol], P<0.001; planned pregnancy (88% vs. 59%, P<0.001); taken folic acid preconception (81% vs. 43%, P=0.001); and had HbA1c recorded preconception (88% vs. 53%, P<0.001) than the pre-DVD cohort. CONCLUSIONS Implementation of a preconception counselling resource was associated with improved pregnancy planning indicators. Women with type 2 diabetes are difficult to reach. Greater awareness within primary care of the importance of preconception counselling among this population is needed.
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Affiliation(s)
- V A Holmes
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - L L Hamill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - F A Alderdice
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - M Spence
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - R Harper
- Ulster Hospital, South Eastern Health and Social Care Trust, Dundonald, UK
| | - C C Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - S Loughridge
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - S McKenna
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
| | - A Gough
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - D R McCance
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Belfast, UK
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Biswas S, Dinh D, Brennan A, Tacey M, Andrianopoulos N, Brien R, Duffy S, Harper R, Nadurata V, van Gaal W, Grigg L, Cox N, Clark D, Reid C, Lefkovits J, Stub D. Patient and Hospital Factors Predicting Prolonged Door-to-Balloon Time in STEMI Patients Undergoing Primary PCI. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.409] [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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11
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Nerlekar N, Muthalaly R, Brown A, Harper R, Wong D, Marwick T. Association of Volumetric Epicardial Adipose Tissue Quantification and Cardiac Structure and Function. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.467] [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: 10/19/2022]
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Nerlekar N, Brown A, Muthalaly R, Talman A, Laggoune J, Harper R, Cameron J, Wong D. The Association of Epicardial Adipose Tissue and High Risk Plaque Characteristics: A Systematic Review and Meta-Analysis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.529] [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: 11/30/2022]
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Nerlekar N, Cheshire C, Rashid H, Muthalaly R, Cameron J, Seneviratne S, Wong D, Harper R, Brown A. Computed Tomography Coronary Angiography (CTCA) Derived Plaque Morphology Predicts Major Adverse Cardiovascular Events (MACE): Insights from a 19,943 Patient Meta-Analysis. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.483] [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: 10/19/2022]
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Harper R, Donnelly R, Bi Y, Bashan E, Minhas R, Hodish I. Dynamics in insulin requirements and treatment safety. J Diabetes Complications 2016; 30:1333-8. [PMID: 27288203 DOI: 10.1016/j.jdiacomp.2016.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/22/2022]
Abstract
AIMS The majority of insulin users have elevated HbA1c. There is growing recognition that the low success rates are due to variations in insulin requirements. Thus, frequent dosage adjustments are needed. In practice, adjustments occur sporadically due to limited provider availability. We investigated intra-individual dynamics of insulin requirements using data from a service evaluation of the d-Nav® Insulin Guidance Service. This service facilitates automated insulin dosage adjustments, as often as needed, to achieve and maintain optimal glycemic balance. METHODS Data were collected from subjects who have been using the service for more than a year. Events of considerable and persistent decrease in insulin requirements were identified by drops in total daily insulin ≥25%. RESULTS Overall, 62 patients were studied over an average period of 2.1±0.5 (mean±standard deviation) years. Stability in HbA1c was attained after ~3 quarters at 7.4%±0.2% (57.4mmol/mol±1mmol/mol). Events were identified in 56.5% of the patients. On average, each affected patient had 0.8±0.4 events per year, lasting 9.7±6.6weeks, while total daily insulin dosage decreased by 41.4±13.4%. CONCLUSIONS Our findings may call attention to a major contributing factor to hypoglycemia among insulin users. In reality, insulin dosage is seldom adjusted and thus transient periods of decrease in insulin requirements and overtreatment are usually overlooked.
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Affiliation(s)
- R Harper
- Diabetes Center, Ulster Hospital, South East and Social Care Trust, Belfast, Northern Ireland
| | - R Donnelly
- Diabetes Center, Ulster Hospital, South East and Social Care Trust, Belfast, Northern Ireland
| | - Yixi Bi
- Queen's University, Belfast, Northern Ireland
| | - E Bashan
- Hygieia, Inc., Ann Arbor, Michigan
| | - R Minhas
- Hygieia, Inc., Ann Arbor, Michigan
| | - I Hodish
- Hygieia, Inc., Ann Arbor, Michigan; Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical Center, Ann Arbor, Michigan.
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15
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Chuang M, MacIssac A, Lefkovits J, Harper R, Slawomirski L, Horsfall M, Buchan H, Ellis C, Brieger D, Briffa T, Chew D. Variation in Coronary Angiography Across Australia: Exploring the Correlations with Sociodemographic-Health Service and Disease Burden Indices. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.165] [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: 11/30/2022]
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Donnelly N, Harper R, Branagh D, Francey J, Easlea H, Faro-Maza V, Hunniford T, Mooney A, McLaughlin J. Development and integration of a Surveillance Monitoring solution to provide earlier detection of the deteriorating patient. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:1198-202. [PMID: 26736481 DOI: 10.1109/embc.2015.7318581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper presents recent improvement of a Wi-Fi based vital signs monitor used for in-hospital monitoring in medium-risk settings. Valuable insight into design strengths and weaknesses has been gained and device improvements have been confirmed with real-world use. Integration with intuitive central station software is considered with respect to balancing functionality and performance. Practical use of the early warning system in challenging clinical environments has enabled further understanding of the potential impact of the system. A tool to provide a convenient method of tracking patient condition and alerting on deterioration is offered.
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Kuczawski M, Mason S, Teare M, Stevenson M, Goodacre S, Holmes M, Harper R, Ramlakhan S, Morris F. DELAYED BLEEDING IN ANTICOAGULATED PATIENTS AFTER BLUNT HEAD TRAUMA. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.7] [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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Donnelly R, Carr S, Harper R. Diabetes Insulin Guidance System: a real-world evaluation of new technology (d-Nav) to achieve glycaemic control in insulin-treated type 2 diabetes. Pract Diab 2015. [DOI: 10.1002/pdi.1966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R Donnelly
- The Department of Endocrinology & Diabetes; The Ulster Hospital; Dundonald, Belfast Northern Ireland UK
| | - S Carr
- The Department of Endocrinology & Diabetes; The Ulster Hospital; Dundonald, Belfast Northern Ireland UK
| | - R Harper
- The Department of Endocrinology & Diabetes; The Ulster Hospital; Dundonald, Belfast Northern Ireland UK
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Wallace IR, Healy E, Cooke RS, Ellis PK, Harper R, Hunter SJ. TSH-secreting pituitary adenoma: benefits of pre-operative octreotide. Endocrinol Diabetes Metab Case Rep 2015; 2015:150007. [PMID: 26113979 PMCID: PMC4477234 DOI: 10.1530/edm-15-0007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/21/2015] [Indexed: 11/20/2022] Open
Abstract
TSH-secreting pituitary adenomas are rare and the optimal investigation and management is uncertain. We describe a case of a 43 year-old woman with a TSH-secreting pituitary adenoma, highlighting diagnostic testing and our use, pre-operatively of somatostatin analogue therapy, which induced biochemical euthyroidism and a reduction in tumour size.
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Affiliation(s)
- I R Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK
| | - E Healy
- Department of Neuropathology, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK
| | - R S Cooke
- Department of Neurosurgery, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK
| | - P K Ellis
- Department of Radiology, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK
| | - R Harper
- Department of Endocrinology and Diabetes, Ulster Hospital , Dundonald, BT16 1RH , UK
| | - S J Hunter
- Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital , Grosvenor Road, Belfast, BT12 6BA , UK
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Lefkovits J, Brennan A, Dinh D, Harper R, Cox N, Andrianopoulos N, Nadurata V, Duffy S, Clark D, Reid C. Comparative Outcomes Following Percutaneous Coronary Intervention (PCI): The Victorian Cardiac Outcomes Registry (VCOR). Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Buckley K, Benard F, Kovacs M, Hanemaayer V, Hook B, McDiarmid S, Zeisler S, Dodd M, Corsaut J, Vuckovic M, Cockburn N, Economou C, Harper R, Valliant J, Ruth T, Schaffer P. Large-scale cyclotron production of 99mTc. Nucl Med Biol 2014. [DOI: 10.1016/j.nucmedbio.2014.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Donnelly N, Hunniford T, Harper R, Flynn A, Kennedy A, Branagh D, McLaughlin J. Demonstrating the accuracy of an in-hospital ambulatory patient monitoring solution in measuring respiratory rate. Annu Int Conf IEEE Eng Med Biol Soc 2014; 2013:6711-5. [PMID: 24111283 DOI: 10.1109/embc.2013.6611096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper presents clinical testing conducted to evaluate the accuracy of Aingeal, a wireless in-hospital patient monitor, in measuring respiration rate via impedance pneumography. Healthy volunteers were invited to simultaneously wear a CE Marked Aingeal vital signs monitor and a capnograph, the current gold standard in respiration rate measurement. During the test, participants were asked to undergo a series of defined breathing protocols which included normal breathing, paced breathing between 8-23 breaths per minute (bpm) and a recovery period following moderate exercise. Statistical analysis of the data collected shows a mean difference of -0.73, a standard deviation of 1.61, limits of agreement of -3.88 and +2.42 bpm and a P-value of 0.22. This testing demonstrates comparable performance of the Aingeal device in measuring respiration rate with a well-accepted and widely used alternative method.
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Donnelly N, Harper R, McCanderson J, Branagh D, Kennedy A, Caulfield M, McLaughlin J. Development of a ubiquitous clinical monitoring solution to improve patient safety and outcomes. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2012:6068-73. [PMID: 23367313 DOI: 10.1109/embc.2012.6347378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper highlights the main findings of an integrated and ubiquitous remote wireless based vital signs monitoring solution as trialed in a clinical setting. Results demonstrate the feasibility of utilising a Wi-Fi based solution to monitor early-warning signs such as impedance-based respiration rate changes, heart rate/ECG events, temperature, and motion analysis in a clinical setting and act as an early warning system.
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Affiliation(s)
- N Donnelly
- Intelesens Ltd., Heron Road, Belfast, Northern Ireland.
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Barnett AH, Patel S, Harper R, Toorawa R, Thiemann S, von Eynatten M, Woerle HJ. Linagliptin monotherapy in type 2 diabetes patients for whom metformin is inappropriate: an 18-week randomized, double-blind, placebo-controlled phase III trial with a 34-week active-controlled extension. Diabetes Obes Metab 2012; 14:1145-54. [PMID: 22974280 DOI: 10.1111/dom.12011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 08/06/2012] [Accepted: 09/06/2012] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the efficacy and safety of linagliptin, a dipeptidyl peptidase-4 inhibitor, in type 2 diabetes mellitus (T2DM) patients for whom metformin was inappropriate. METHODS This 1-year double-blind study (ClinicalTrials.gov, NCT00740051) enrolled T2DM patients with inadequate glycaemic control, treatment-naïve [glycated haemoglobin (HbA1c) 7.0-10.0%] or previously treated with one oral antidiabetes drug (HbA1c 6.5-9.0% before washout), ineligible for metformin because of contraindications (e.g. renal impairment) or previous intolerable side effects. Patients were randomized to monotherapy with linagliptin 5 mg once daily (n = 151) or placebo (n = 76) for 18 weeks, after which placebo patients switched to glimepiride 1-4 mg once daily and treatments continued for another 34 weeks. The primary endpoint was change from baseline in HbA1c after 18 weeks (full-analysis set, last observation carried forward). RESULTS At week 18, adjusted mean difference in change from baseline HbA1c (8.1%) was -0.60% (95% confidence interval -0.88, -0.32; p < 0.0001) (-0.39% with linagliptin, +0.21% with placebo). At week 52, mean HbA1c was decreased from baseline in both groups [linagliptin: -0.44%; placebo/glimepiride: -0.72% (observed cases)]. Adverse events occurred in 40.4 and 48.7% of linagliptin and placebo patients, respectively, during the initial 18 weeks. During the 34-week extension, patients receiving linagliptin experienced less hypoglycaemia (2.2% vs. 7.8%) and no weight gain (mean change from baseline of -0.2 and +1.3 kg, respectively) compared with glimepiride patients. CONCLUSIONS In T2DM patients for whom metformin was inappropriate, linagliptin improved glycaemic control and was well tolerated, with less hypoglycaemia and relative weight loss compared with glimepiride.
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Affiliation(s)
- A H Barnett
- Diabetes Centre, Heart of England NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Packer RJ, Rood BR, Onar-Thomas A, Goldman S, Fisher MJ, Smith C, Boyett J, Kun L, Nelson MB, Compton P, Macey P, Patel S, Jacob E, O'Neil S, Finlay J, Harper R, Legault G, Chhabra A, Allen JC, Si SJ, Flores N, Haley K, Malvar J, Fangusaro J, Dhall G, Sposto R, Davidson TB, Finlay JL, Krieger M, Finlay JL, Zhou T, Miller DC, Geyer JR, Pollack IF, Gajjar A, Cohen BH, Nellan A, Murray JC, Honeycutt J, Gomez A, Head H, Braly E, Puccetti DM, Patel N, Kennedy T, Bradley K, Howard S, Salamat S, Iskandar B, Slavc I, Peyrl A, Chocholous M, Kieran M, Azizi A, Czech T, Dieckmann K, Haberler C, Sadighi ZS, Ellezam B, Khatua S, Ater J, Biswas A, Kakkar A, Goyal S, Mallick S, Sarkar C, Sharma MC, Julka PK, Rath GK, Glass T, Cochrane DD, Rassekh SR, Goddard K, Hukin J, Deopujari CE, Khakoo Y, Hanmantgad S, Forester K, McDonald SA, De Braganca K, Yohay K, Wolff JE, Kwiecien R, Rutkowski S, Pietsch T, Faldum A, Kortmann RD, Kramm C, Fouladi M, Olson J, Stewart C, Kocak M, Onar-Thomas A, Wagner L, Packer R, Goldman S, Gururangan S, Blaney S, Pollack I, Smith C, Demuth T, Kun L, Boyett J, Gilbertson R, Powell MK, Klement GL, Roffidal T, Fonkem E, Wolff JE. CLIN-PEDIATRICS CLINICAL RESEARCH. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos234] [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: 11/13/2022] Open
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Abstract
AIMS To determine if an educational DVD increases knowledge and changes attitudes of women with diabetes towards preconception care. METHODS Ninety-seven women with diabetes (Type 1, n = 89; Type 2, n = 8), aged 18-40 years, completed a pre-DVD and post-DVD intervention study by postal questionnaire. Beliefs and attitudes associated with preventing an unplanned pregnancy and seeking preconception care were assessed using a validated questionnaire; scales included benefits, barriers, personal attitudes and self-efficacy. Knowledge of pregnancy planning and pregnancy-related risks were assessed by a 22-item questionnaire. RESULTS After viewing the DVD there was significant positive change in women's perceived benefits of, and their personal attitudes to, receiving preconception care and using contraception: change in score post-DVD viewing 0.7 (95% confidence interval 0.3, 1.2), P = 0.003, and 0.8 (0.3, 1.2), P = 0.001, respectively. The DVD significantly improved self-efficacy, that is, self-confidence to use contraception for prevention of an unplanned pregnancy and to access preconception care [3.3 (1.9, 4.7), P < 0.001], and significantly reduced perceived barriers to preconception care [-0.7 (-1.2, -0.2), P = 0.01]. Knowledge of pregnancy planning and pregnancy-related risks increased significantly after viewing the DVD: mean increase was 37.6 ± 20.0%, P < 0.001, and 16.9 ± 21.2%, P < 0.001, respectively. CONCLUSIONS This study demonstrates the effectiveness of a DVD in increasing knowledge and enhancing attitudes of women with diabetes to preconception care. This DVD could be used as a prepregnancy counselling resource to prepare women with diabetes for pregnancy.
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Affiliation(s)
- V A Holmes
- School of Nursing and Midwifery, Queen's University Belfast, UK.
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Ko B, Malaiapan Y, Gooley R, Hilling Smith R, Garner K, Harper R, Meredith I. Routine Use of Appropriateness Criteria and Departmental Discussion in Referrals for Non-Urgent Percutaneous Coronary Intervention. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hutchison A, Rajendram R, Harper R, Cameron J, Meredith I. High Rates of Two-Year Rehospitalisation for a Cardiac Cause in Patients with Non-ACS Troponin Elevations. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.617] [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: 10/28/2022]
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Harper R, Donnelly N, McCullough I, Francey J, Anderson J, McLaughlin JA, Catherwood PA. Evaluation of a CE approved ambulatory patient monitoring device in a general medical ward. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:94-7. [PMID: 21095644 DOI: 10.1109/iembs.2010.5626132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An evaluation of a newly CE approved bedside monitoring device used in a general hospital ward is presented. This evaluation has shown that it is feasible to use the system within this environment to provide medical staff with supplementary information on patient health, at more frequent intervals than traditional monitoring methods. The physiological data recorded by the body worn device is wirelessly transmitted to a patient management system for storage and display. Good correlation between heart rate values recorded by hospital staff and those recorded by the automated Vitalsens VS100 system was observed. The system has highlighted clinical information that routine observations alone did not readily identify. This can provide clinicians with a better view of the overall health status of the patient. Such medical issues include those witnessed in this study, namely paroxysmal AF, ectopic beats, increasing heart rates recorded prior to a hypoglycaemic event, general high and low heart rate trends and various instances where clinically relevant ECG data has been captured.
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Dundon B, Hutchison A, Malaiapan Y, Gooley R, Lipshutz J, Harper R, Meredith I. Femoral Artery Anatomy: A Simple Strategy to Minimise Access-site Complications. Heart Lung Circ 2011. [DOI: 10.1016/j.hlc.2011.05.313] [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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Abstract
AIMS Pre-pregnancy care optimizes pregnancy outcome in women with pre-gestational diabetes, yet most women enter pregnancy unprepared. We sought to determine knowledge and attitudes of women with Type 1 and Type 2 diabetes of childbearing age towards pre-pregnancy care. METHODS Twenty-four women (18 with Type 1 diabetes and six with Type 2 diabetes) aged 17-40 years took part in one of four focus group sessions: young nulliparous women with Type 1 diabetes (Group A), older nulliparous women with Type 1 diabetes (Group B), parous women with Type 1 diabetes (Group C) and women with Type 2 diabetes of mixed parity (Group D). RESULTS Content analysis of transcribed focus groups revealed that, while women were well informed about the need to plan pregnancy, awareness of the rationale for planning was only evident in parous women or those who had actively sought pre-pregnancy advice. Within each group, there was uncertainty about what pre-pregnancy advice entailed. Despite many women reporting positive healthcare experiences, frequently cited barriers to discussing issues around family planning included unsupportive staff, busy clinics and perceived social stereotypes held by health professionals. CONCLUSIONS Knowledge and attitudes reported in this study highlight the need for women with diabetes, regardless of age, marital status or type of diabetes, to receive guidance about planning pregnancy in a motivating, positive and supportive manner. The important patient viewpoints expressed in this study may help health professionals determine how best to encourage women to avail of pre-pregnancy care.
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Affiliation(s)
- M Spence
- Nursing and Midwifery Research Unit, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Abstract
Many surgical procedures have been described for the treatment of mucous cysts. We report a case series of a surgical technique that excises the cyst along with overlying skin and reconstructs the defect using a Wolfe graft harvested from the wrist crease. This technique can be applied to cysts in all locations, even those adjacent to the nail. The procedure has been performed on 51 mucous cysts with satisfactory results, a very low recurrence rate (4%) and negligible complications.
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Affiliation(s)
- B Jamnadas-Khoda
- Department of Plastic Surgery, Northern General Hospital, Sheffield, UK.
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Lopera J, Harper R, Cura M, Kroma G, El-Merhi F, Suri R. Abstract No. 49: In-Vitro Model of Translumbar Embolization of Endoleaks with n-BCA: Risk of “Gluing” of Different Access Devices. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.054] [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: 10/21/2022] Open
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Sukumar S, Spencer F, Fenerty C, Harper R, Henson D. The influence of socioeconomic and clinical factors upon the presenting visual field status of patients with glaucoma. Eye (Lond) 2008; 23:1038-44. [DOI: 10.1038/eye.2008.245] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Harper R, Bennett W, Cuadra E, Vaughn C, Whitworth N. Effects of GnRH in combination with PGF2α on the dynamics of follicular and luteal cells in post-pubertal Holstein heifers. Livest Sci 2008. [DOI: 10.1016/j.livsci.2007.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wayne V, Harper R, Lauekr E, Federman J, Anderson S, Pitt A. ADVERSE INTERACTION BETWEEN ORAL BETA ADRENERGIC BLOCKING DRUGS and VERAPAMIL. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1445-5994.1982.tb02501.x] [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: 11/27/2022]
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Harper R, Shardey G, Rosenfeldt F, Wayne V, Stirling G, Pitt A. FRAGMENTED and DELAYED ELECTRICAL ACTIVITY DURING SINUS RYTHYM DETECTED DURING SURGERY FOR VENTRICULAR ARRHYTHMIAS. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1445-5994.1982.tb02533.x] [Citation(s) in RCA: 2] [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: 11/27/2022]
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Black LA, McTear M, Black N, Harper R, Lemon M. DI@L-log by design: an integrated tele-care communication infrastructure. Conf Proc IEEE Eng Med Biol Soc 2007; 2004:3290-3. [PMID: 17270984 DOI: 10.1109/iembs.2004.1403925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A spoken dialogue system for the acquisition of type 2 diabetes mellitus (T2DM) home monitored patient data known as DI@L-log is presented. The purpose of the system is to collect weight, blood sugar and blood pressure readings from a cohort of hypertensive T2DM patients on a weekly basis using their home telephone. The recent voice-data convergence affords an arguably improved means for doctors to track patient health states at a distance in order to provide health institutions with more frequent and accurate patient profiles. Our system architecture integrates VoiceXML and the standard PSTN, with a Pan-European open source for hosting Internet telephony applications. This paper reports on recent developments in the design of DI@L-log, which aims to serve as a communication intervention that disparages the traditional paper logbook used to document readings by the patient.
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Affiliation(s)
- L A Black
- Faculty of Engineering,University of Ulster, Jordanstown, Belfast, Northern Ireland
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Harper R, Anson L. The clinical and psychosocial challenges associated with bilateral hand traumas. J Wound Care 2006; 15:19-26. [PMID: 16669301 DOI: 10.12968/jowc.2006.15.1.26866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This case study highlights the importance of providing holistic and multidisciplinary care when managing patients with complex bilateral traumatic hand wounds. Such collaboration can achieve optimum results.
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Affiliation(s)
- R Harper
- Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Johnson R, Harper R, Leece S. Effect of healthcare personnel handwash products on skin moisturization. Am J Infect Control 2005. [DOI: 10.1016/j.ajic.2005.04.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Davis∗ D, Harper R. Skin Health Improvements Associated with Use of Nitrile Exam Gloves with Dermal Therapy Coating. Am J Infect Control 2004. [DOI: 10.1016/j.ajic.2004.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
AIM To describe a Manchester-based glaucoma referral refinement scheme designed to reduce the number of false-positive referrals to the hospital eye service. To report on the first years results of this scheme and its financial costs to the NHS. METHODS Patients with suspected glaucoma, instead of being referred to their GP and then on to the hospital eye service, were referred to a group of specially trained community optometrists working to an agreed set of referral criteria. Those patients who did not meet the referral criteria were returned to the referring optometrist, while those who met the referral criteria were referred directly to Manchester Royal Eye Hospital. The patient's GP was informed in all cases. RESULTS The number of suspect glaucoma cases referred to the Manchester Royal Eye Hospital was reduced by 40%. This figure is close to the percentage of false-positive referrals measured at Manchester Royal Eye Hospital prior to the onset of this study. The information accompanying referral has been improved and the scheme produces a small financial cost saving to the NHS of approximately 17 pounds sterling per patient. CONCLUSION Community refinement of suspect glaucoma offers some important benefits over the current referral pathway.
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Affiliation(s)
- D B Henson
- Academic Department of Ophthamology, Manchester University and Manchester Royal Eye Hospital, UK.
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Skibinski DAG, Golby P, Chang YS, Sargent F, Hoffman R, Harper R, Guest JR, Attwood MM, Berks BC, Andrews SC. Regulation of the hydrogenase-4 operon of Escherichia coli by the sigma(54)-dependent transcriptional activators FhlA and HyfR. J Bacteriol 2002; 184:6642-53. [PMID: 12426353 PMCID: PMC135417 DOI: 10.1128/jb.184.23.6642-6653.2002] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2002] [Accepted: 08/30/2002] [Indexed: 11/20/2022] Open
Abstract
The hyf locus (hyfABCDEFGHIJ-hyfR-focB) of Escherichia coli encodes a putative 10-subunit hydrogenase complex (hydrogenase-4 [Hyf]); a potential sigma(54)-dependent transcriptional activator, HyfR (related to FhlA); and a putative formate transporter, FocB (related to FocA). In order to gain insight into the physiological role of the Hyf system, we investigated hyf expression by using a hyfA-lacZ transcriptional fusion. This work revealed that hyf is induced under fermentative conditions by formate at a low pH and in an FhlA-dependent fashion. Expression was sigma(54) dependent and was inhibited by HycA, the negative transcriptional regulator of the formate regulon. Thus, hyf expression resembles that of the hyc operon. Primer extension analysis identified a transcriptional start site 30 bp upstream of the hyfA structural gene, with appropriately located -24 and -12 boxes indicative of a sigma(54)-dependent promoter. No reverse transcriptase PCR product could be detected for hyfJ-hyfR, suggesting that hyfR-focB may be independently transcribed from the rest of the hyf operon. Expression of hyf was strongly induced ( approximately 1,000-fold) in the presence of a multicopy plasmid expressing hyfR from a heterologous promoter. This induction was dependent on low pH, anaerobiosis, and postexponential growth and was weakly enhanced by formate. The hyfR-expressing plasmid increased fdhF-lacZ transcription just twofold but did not influence the expression of hycB-lacZ. Interestingly, inactivation of the chromosomal hyfR gene had no effect on hyfA-lacZ expression. Purified HyfR was found to specifically interact with the hyf promoter/operator region. Inactivation of the hyf operon had no discernible effect on growth under the range of conditions tested. No Hyf-derived hydrogenase or formate dehydrogenase activity could be detected, and no Ni-containing protein corresponding to HyfG was observed.
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Affiliation(s)
- David A G Skibinski
- School of Animal and Microbial Sciences, The University of Reading, Reading RG6 6AJ, United Kingdom
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Harper R, Wu K, Chang MM, Yoneda K, Pan R, Reddy SP, Wu R. Activation of nuclear factor-kappa b transcriptional activity in airway epithelial cells by thioredoxin but not by N-acetyl-cysteine and glutathione. Am J Respir Cell Mol Biol 2001; 25:178-85. [PMID: 11509327 DOI: 10.1165/ajrcmb.25.2.4471] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Increasing evidence indicates that intracellular redox status modulates the activity of various transcriptional factors, including nuclear factor (NF)-kappa B and activator protein-1. Our laboratory has been interested in characterizing the role thioredoxin (TRX) plays in regulating cellular redox status in airway epithelium. TRX is a small, ubiquitous protein with two redox-active half-cysteine residues, -Cys-Gly-Pro-Cys, in its active center. Using primary passage-1 human tracheobronchial epithelial cell cultures and an immortalized human bronchial epithelial cell line, HBE1, we observed that tumor necrosis factor (TNF)-alpha enhanced NF-kappa B transcriptional activity. This observation was based on gel mobility shift assays and interleukin (IL)-8 promoter-reporter gene transfection studies. TNF-alpha activation coincided with translocation of NF-kappa B p65 from the cytoplasm to the nucleus. Pretreatment with N-acetyl-cysteine (NAC) (1 to 10 mM) or glutathione (1 to 10 mM) inhibited TNF-alpha-induced activation of NF-kappa B transcriptional activity and IL-8 promoter-mediated reporter gene expression. In contrast, elevated TRX protein levels in cells enhanced TNF-alpha-dependent NF-kappa B transcriptional activity and IL-8 promoter activity. This observation was independent of the manner in which TRX was elevated in cells (e.g., by cotransfection with a FLAG-TRX expression clone, or by direct exposure to commercially available human TRX protein). Localization of TRX protein by anti-TRX antibody indicated an accumulation of TRX protein in the nucleus after TNF-alpha treatment. The nuclear localization phenomenon was different from the major cytosolic accumulation of glutathione and NAC. This is the first known report demonstrating movement of TRX into the nucleus of airway epithelial cells after an inflammatory stress. These results suggest a compartment effect of thiol chemicals in the regulation of redox-dependent transcriptional activity.
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Affiliation(s)
- R Harper
- Center for Comparative Respiratory Biology and Medicine, University of California at Davis, Davis, California 95616, USA.
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Harper R, Radi N, Reeves BC, Fenerty C, Spencer AF, Batterbury M. Agreement between ophthalmologists and optometrists in optic disc assessment: training implications for glaucoma co-management. Graefes Arch Clin Exp Ophthalmol 2001; 239:342-50. [PMID: 11482337 DOI: 10.1007/s004170100272] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Many studies have estimated observer variability for optic disc assessment among experts, but there are few data on agreement between optometrists and ophthalmologists. The aim of this study is to report inter- and intraobserver agreement among optometrists and ophthalmologists in optic disc assessment and discuss the implications for glaucoma co-management. METHODS Twelve observers (six optometrists and six ophthalmologists) graded 48 stereo-pairs of optic disc photographs from 48 patients on two separate occasions. Observers graded the vertical C/D ratio, the narrowest rim width and the presence/absence of disc haemorrhage. Agreement was assessed by calculating the standard deviation (SD) of differences and the kappa statistic, within and between observers. Systematic differences in grading between and within individuals were described by calculating mean differences. RESULTS Intra-observer agreement is "substantial" and significantly better than inter-observer agreement for all disc features (P<0.0001). Intra-observer agreement is comparable for optometrists and ophthalmologists with regard to C/D ratio estimates. Although some optometrists show close agreement with ophthalmologists, overall agreement between optometrists and ophthalmologists is significantly worse than agreement among ophthalmologists alone for vertical C/D ratio (P=0.002) and disc haemorrhage (P=0.02). There are fewer inter-observer mean differences that differ significantly from zero among ophthalmologists (7%) than among optometrists (67%; chi2=11.63, P<0.001) or between optometrists and ophthalmologists (69%; chi2=16.7, P<0.001). There is evidence of systematic under-reading of C/D ratios by less experienced optometrists. CONCLUSION Although individual optometrists can show good agreement with ophthalmologists on disc grading, the variation in individual performance indicates that training and accreditation in disc assessment is an essential prerequisite for participation by optometrists in glaucoma co-management.
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Affiliation(s)
- R Harper
- Academic Department of Ophthalmology, Manchester Royal Eye Hospital, UK.
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Abstract
OBJECTIVE To identify a simple, cost-effective, reliable fixation method for fine needle aspiration biopsy (FNAB) yielding a specimen suitable for mail transport. STUDY DESIGN Smears prepared from 59 FNABs of surgical specimens were fixed by continuous fixation in 95% ethanol, spray fixation, air drying, ethanol fixation for either 5 minutes or 4 hours followed by spray fixation, or fixation in 95% ethanol for either 30 minutes or 4 hours followed by air drying. Fixation was graded as unsatisfactory, suboptimal, average, good or excellent. RESULTS Of smears continuously fixed in ethanol, 96.6% were graded as excellent. Of smears fixed in ethanol followed by spray fixation, 93.2% were excellent irrespective of fixation time; 64.4% of spray-fixed smears were excellent and 27.1% good. Of air dried smears, 93.2% were unsatisfactory or suboptimal; 83.0% of smears fixed in ethanol for 30 minutes and 74.6% of smears fixed for 4 hours prior to air drying were unsatisfactory or suboptimal. CONCLUSION Fixation of smears in 95% ethanol followed by spray fixation produces excellent results, comparable to those with continuous fixation in ethanol. Spray fixation is generally good but not consistently excellent. Air drying or fixation in ethanol followed by air drying yields unsatisfactory or suboptimal results in most cases.
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Affiliation(s)
- J R Safneck
- Section of Cytology, Department of Pathology, Health Sciences Centre and University of Manitoba, Winnipeg, Manitoba, Canada.
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Harper R. Private sector care a notch above the NHS. Nurs Times 2001; 97:21. [PMID: 11957908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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