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Gagg H, Williams ST, Conroy S, Myers KN, McGarrity-Cottrell C, Jones C, Helleday T, Rantala J, Rominiyi O, Danson SJ, Collis SJ, Wells G. Ex-vivo drug screening of surgically resected glioma stem cells to replace murine avatars and provide personalise cancer therapy for glioblastoma patients. F1000Res 2024; 12:954. [PMID: 37799492 PMCID: PMC10548111 DOI: 10.12688/f1000research.135809.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 10/07/2023] Open
Abstract
With diminishing returns and high clinical failure rates from traditional preclinical and animal-based drug discovery strategies, more emphasis is being placed on alternative drug discovery platforms. Ex vivo approaches represent a departure from both more traditional preclinical animal-based models and clinical-based strategies and aim to address intra-tumoural and inter-patient variability at an earlier stage of drug discovery. Additionally, these approaches could also offer precise treatment stratification for patients within a week of tumour resection in order to direct tailored therapy. One tumour group that could significantly benefit from such ex vivo approaches are high-grade gliomas, which exhibit extensive heterogeneity, cellular plasticity and therapy-resistant glioma stem cell (GSC) niches. Historic use of murine-based preclinical models for these tumours has largely failed to generate new therapies, resulting in relatively stagnant and unacceptable survival rates of around 12-15 months post-diagnosis over the last 50 years. The near universal use of DNA damaging chemoradiotherapy after surgical resection within standard-of-care (SoC) therapy regimens provides an opportunity to improve current treatments if we can identify efficient drug combinations in preclinical models that better reflect the complex inter-/intra-tumour heterogeneity, GSC plasticity and inherent DNA damage resistance mechanisms. We have therefore developed and optimised a high-throughput ex vivo drug screening platform; GliExP, which maintains GSC populations using immediately dissociated fresh surgical tissue. As a proof-of-concept for GliExP, we have optimised SoC therapy responses and screened 30+ small molecule therapeutics and preclinical compounds against tumours from 18 different patients, including multi-region spatial heterogeneity sampling from several individual tumours. Our data therefore provides a strong basis to build upon GliExP to incorporate combination-based oncology therapeutics in tandem with SoC therapies as an important preclinical alternative to murine models (reduction and replacement) to triage experimental therapeutics for clinical translation and deliver rapid identification of effective treatment strategies for individual gliomas.
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Affiliation(s)
- Hannah Gagg
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Sophie T. Williams
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Neurosurgery, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Samantha Conroy
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Urology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Katie N. Myers
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | | | - Callum Jones
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Thomas Helleday
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Karolinska Institut, Solnavägen, Solna, 171 77, Sweden
| | - Juha Rantala
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Misvik Biology Ltd, Karjakatu, Turku, FI-20520, Finland
| | - Ola Rominiyi
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Neurosurgery, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Sarah J. Danson
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
- Weston Park Hospital, Sheffield, S10 2SJ, UK
| | - Spencer J. Collis
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
| | - Greg Wells
- Oncology & Metabolism, The University of Sheffield, Sheffield, England, S10 2RX, UK
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Conroy S, Catto JWF, Bex A, Brown JE, Cartledge J, Fielding A, Jones RJ, Khoo V, Nicol D, Stewart GD, Sullivan M, Tran MGB, Woodward R, Cumberbatch MG. Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019. BJU Int 2023; 132:541-553. [PMID: 37436368 DOI: 10.1111/bju.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
OBJECTIVES To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019. MATERIALS AND METHODS Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data. RESULTS Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline. CONCLUSION The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.
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Affiliation(s)
- Samantha Conroy
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - James W F Catto
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Axel Bex
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Janet E Brown
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Alison Fielding
- Bladder and Renal Cancer Clinical Studies Group, National Cancer Research Institute, London, UK
| | - Rob J Jones
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - David Nicol
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, London, UK
| | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Mark Sullivan
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- University of Oxford, Oxford, UK
| | - Maxine G B Tran
- Royal Free NHS Foundation Trust, Specialist Centre for Kidney Cancer, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rose Woodward
- Action Kidney Cancer, Manchester, UK
- International Kidney Cancer Coalition, UK
| | - Marcus G Cumberbatch
- Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
- Academic Unit of Urology, Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
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Jones HT, Teranaka W, Hunter P, Gross L, Conroy S. What is the impact of a pre-hospital geriatrician led telephone 'Silver Triage' for older people living with frailty? Eur Geriatr Med 2023; 14:977-981. [PMID: 37219726 PMCID: PMC10587299 DOI: 10.1007/s41999-023-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Most older people are conveyed to hospital via ambulance, therefore presenting a focus to reduce hospitalisation. North Central London has introduced 'Silver Triage', a pre-hospital telephone support scheme where geriatricians support the London Ambulance Service with clinical decision-making. METHODS Data from the first 14 months was analysed descriptively. RESULTS There have been 452 Silver Triage cases (November 2021 to January 2023). 80% resulted in a decision to not convey. The mode clinical frailty scale (CFS) was 6. CFS did not influence conveyance rates. Prior to triage, paramedics thought hospitalisation was not required in 44% of cases (n = 72/165). All paramedics surveyed (n = 176) would use the service again. Most (66%, n = 108/164) felt they learnt something and 16% (n = 27/164) reported it changed their decision-making process. CONCLUSION Silver Triage has the potential to improve the care of older people by preventing unnecessary hospitalisation and has been well received by paramedics.
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Affiliation(s)
- H T Jones
- Central and North West London NHS Foundation Trust, London, UK
- MRC Unit for Lifelong Health and Ageing, University College London, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - W Teranaka
- Central and North West London NHS Foundation Trust, London, UK
| | - P Hunter
- London Ambulance Service, London, UK
| | - L Gross
- London Ambulance Service, London, UK
- North Central London Integrated Care Board, London, UK
| | - S Conroy
- Central and North West London NHS Foundation Trust, London, UK.
- MRC Unit for Lifelong Health and Ageing, University College London, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Conroy S, Griffin J, Cumberbatch M, Pathak S. Acute haemorrhage from a large renal epithelioid angiomyolipoma: diagnostic and management considerations in a teenage patient with a rare cancer. BMJ Case Rep 2023; 16:16/5/e252351. [PMID: 37202109 DOI: 10.1136/bcr-2022-252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Acute renal haemorrhage is a life-threatening condition that is complicated in the context of renal malignancy. Here, we present the case of a teenage male presenting acutely with a large, bleeding renal epithelioid angiomyolipoma (EAML) of the kidney-a rare cancer, which is part of the perivascular epithelioid cell tumour family. The patient was managed acutely with prompt resuscitation, transfer to a centre of expertise and haemorrhagic control using radiologically guided endovascular techniques; this subsequently permitted an oncologically sound procedure (radical nephrectomy, inferior vena cava thrombectomy and lymphadenectomy) to be performed within 24 hours. The description and discussion around this unique case summarises the patient's clinical journey, while exploring the current literature surrounding diagnosis and outcomes of patients with renal EAMLs.
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Affiliation(s)
- Samantha Conroy
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jon Griffin
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marcus Cumberbatch
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Cordier Q, Gilbert T, Polazzi S, Conroy S, Duclos A. Combinaison du score de fragilité HFRS (« Hospital Frailty Risk Score ») avec les indices de comorbidités Charlson et Elixhauser pour prédire la mortalité et les séjours prolongés des patients hospitalisés âgés admis par les urgences. Rev Epidemiol Sante Publique 2023. [DOI: 10.1016/j.respe.2023.101452] [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: 02/26/2023] Open
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Conroy S, Pang K, Jubber I, Hussain SA, Rosario DJ, Cumberbatch MG, Catto JWF, Noon AP. Hyperthermic intravesical chemotherapy with mitomycin‐C for the treatment of high‐risk non‐muscle‐invasive bladder cancer patients. BJUI Compass 2022; 4:314-321. [PMID: 37025474 PMCID: PMC10071075 DOI: 10.1002/bco2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/28/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives The objectives of the study are to explore tolerability, acceptability and oncological outcomes for patients with high-risk non-muscle-invasive bladder cancer (NMIBC) treated with hyperthermic intravesical chemotherapy (HIVEC) and mitomycin-C (MMC) at our institution. Patients and Methods Our single-institution, observational study consists of consecutive high-risk NMIBC patients treated with HIVEC and MMC. Our HIVEC protocol included six weekly instillations (induction), followed by two further cycles of three instillations (maintenance) (6 + 3 + 3) if there was cystoscopic response. Patient demographics, instillation dates and adverse events (AEs) were collected prospectively in our dedicated HIVEC clinic. Retrospective case-note review was performed to evaluate oncological outcomes. Primary outcomes were tolerability and acceptability of HIVEC protocol; secondary outcomes were 12-month recurrence-free, progression-free and overall survival. Results In total, 57 patients (median age 80.3 years) received HIVEC and MMC, with a median follow-up of 18 months. Of these, 40 (70.2%) had recurrent tumours, and 29 (50.9%) had received prior Bacillus Calmette-Guérin (BCG). HIVEC induction was completed by 47 (82.5%) patients, but only 19 (33.3%) completed the full protocol. Disease recurrence (28.9%) and AEs (28.9%) were the most common reasons for incompletion of protocol; five (13.2%) patients stopped treatment due to logistical challenges. AEs occurred in 20 (35.1%) patients; the most frequently documented were rash (10.5%), urinary tract infection (8.8%) and bladder spasm (8.8%). Progression during treatment occurred in 11 (19.3%) patients, 4 (7.0%) of whom had muscle invasion and 5 (8.8%) subsequently required radical treatment. Patients who had received prior BCG were significantly more likely to progress (p = 0.04). 12-month recurrence-free, progression-free and overall survival rates were 67.5%, 82.2%, and 94.7%, respectively. Conclusions Our single-institution experience suggests that HIVEC and MMC are tolerable and acceptable. Oncological outcomes in this predominantly elderly, pretreated cohort are promising; however, disease progression was higher in patients pretreated with BCG. Further randomised noninferiority trials comparing HIVEC versus BCG in high-risk NMIBC are required.
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Affiliation(s)
- Samantha Conroy
- Academic Urology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Karl Pang
- Academic Urology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
| | - Ibrahim Jubber
- Academic Urology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Syed A. Hussain
- Academic Oncology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
| | - Derek J. Rosario
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Marcus G. Cumberbatch
- Academic Urology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - James W. F. Catto
- Academic Urology Unit, Department of Oncology and Metabolism University of Sheffield Sheffield UK
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Aidan P. Noon
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
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Marcinkevicius B, Eriksson J, Hjalmarsson A, Conroy S, Ericsson G. Fuel ion ratio determination using the 14 MeV Tandem neutron spectrometer for JET DTE1 campaign discharges. Fusion Engineering and Design 2022. [DOI: 10.1016/j.fusengdes.2022.113259] [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]
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Conroy S, Hubbard R, Noon AP, Hussain SA, Griffin J, Kennish S, Catto JWF. Case of the month from the University of Sheffield, UK: Expediting definitive treatment in patients with invasive bladder cancer: an MRI-guided pathway. BJU Int 2022; 129:691-694. [PMID: 35633131 PMCID: PMC9328312 DOI: 10.1111/bju.15730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Samantha Conroy
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Hubbard
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Aidan P Noon
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Syed A Hussain
- Academic Oncology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Jon Griffin
- Department of Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Steven Kennish
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James W F Catto
- Academic Urology Unit, Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.,Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Conroy S, Nguyen AH. Compound to Clinic? A Preclinical High-throughput Screening Pathway To Expedite Drug Discovery in Bladder Cancer. Eur Urol 2022; 82:271-272. [DOI: 10.1016/j.eururo.2022.04.006] [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] [Received: 03/27/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
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Young H, March D, Highton P, Graham-Brown M, Goodliffe S, Greenwood S, Helen E, Conroy S, Singh S, Smith A, Burton J. Exercise interventions for people living with frailty and receiving haemodialysis: A mixed-methods randomised controlled feasibility study. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lucke JA, Mooijaart SP, Heeren P, Singler K, McNamara R, Gilbert T, Nickel CH, Castejon S, Mitchell A, Mezera V, Van der Linden L, Lim SE, Thaur A, Karamercan MA, Blomaard LC, Dundar ZD, Chueng KY, Islam F, de Groot B, Conroy S. Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine. Eur Geriatr Med 2021; 13:309-317. [PMID: 34738224 PMCID: PMC8568564 DOI: 10.1007/s41999-021-00578-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/20/2021] [Indexed: 01/08/2023]
Abstract
Aim The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Findings Eight posters with expert clinical guidelines on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Message Expert clinical recommendations for Geriatric Emergency Medicine in Europe were created and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1. Purpose Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. Methods A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Results Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/. Conclusion Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00578-1.
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Affiliation(s)
- J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Haarlem, The Netherlands.
| | - S P Mooijaart
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - P Heeren
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - K Singler
- Department of Geriatrics, Klinikum Nürnberg, Paracelsus Private, Medical University, Nuremberg, Germany.,Institute for Biomedicine of Ageing, Friedrich-Alexander-University, Erlangen-Nuremberg, Erlangen, Germany
| | - R McNamara
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | - T Gilbert
- Department of Geriatric Medicine, Lyon-Sud University Hospital, Lyon, France
| | - C H Nickel
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - S Castejon
- Department of Geriatrics and Palliative Care, Consorci Sanitari de Terrassa, Terrassa, Barcelona, Spain
| | - A Mitchell
- Department of Emergency Medicine, Sligo University Hospital, Sligo, Ireland
| | - V Mezera
- Geriatric Center, Pardubice Hospital, Pardubice, Czech Republic
| | - L Van der Linden
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium.,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - S E Lim
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
| | - A Thaur
- Department of Emergency Medicine, Guy's and St.Thomas' NHS Foundation Trust, London, UK
| | - M A Karamercan
- Department of Emergency Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - L C Blomaard
- Department of Internal Medicine, Section on Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Z D Dundar
- Department of Emergency Medicine, Necmettin Erbakan University Meram Faculty of Medicine, Konya, Turkey
| | - K Y Chueng
- Accident and Emergency Department, United Christian Hospital, Kwun Tong, Hong Kong
| | - F Islam
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - B de Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - S Conroy
- Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 5th Floor, 1-19 Torrington Place, London, WC1E 7HB, UK
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Lucke JA, Mooijaart SP, Conroy S, Blomaard LC, De Groot B, Nickel CH. Mortality risk for different presenting complaints amongst older patients assessed with the Manchester triage system. Eur Geriatr Med 2021; 13:323-328. [PMID: 34591279 DOI: 10.1007/s41999-021-00568-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 09/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Older people often present to the Emergency Department with nonspecific complaints. We aimed (1) to examine characteristics of older patients presenting to the ED triaged with the presentational flowchart 'unwell adult' of the Manchester triage system (MTS) and (2) to assess the different mortality and admission rates among triage categories. METHODS Retrospective cohort study including all consecutive patients aged 70 years and older who visited the ED of a tertiary care hospital in the Netherlands during a 1-year period. The primary outcome was 30-day mortality. Secondary outcomes were 7-day mortality, hospital admission and ED length of stay. RESULTS 4255 patients were included in this study. Mean age was 78 years (IQR 73.9-83.4) and 2098 were male (49.3%). The MTS presentational flowchart 'unwell adult' was the most commonly used flowchart (n = 815, 19.3%). After the infrequent flowchart 'major trauma' (n = 9, 13.8%), 'unwell adult' had the highest 30-day mortality (n = 88, 10.8%). When compared to all other flowcharts, patients assigned as 'unwell adult' have significantly higher 30-day mortality rates (OR 1.89 (95%CI 1.46-2.46), p = < 0.001), also when adjusted for age, gender and triage priority (OR 1.75 (95%CI 1.32-2.31), p = < 0.001). Patients from the 'unwell adult' flowchart had the highest hospital admission rate (n = 540, 66.3%), and had among the longest ED length of stay. CONCLUSIONS Older ED patients are most commonly assigned the presentational flowchart 'unwell adult' when using the MTS. Patients in this category have the highest non-trauma mortality and highest hospital admission rates when compared to other presenting complaints.
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Affiliation(s)
- J A Lucke
- Department of Emergency Medicine, Spaarne Gasthuis, Postbus 417, 2000 AK, Haarlem, The Netherlands.
| | - S P Mooijaart
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.,Institute for Evidence-Based Medicine in Old Age (IEMO), Leiden, The Netherlands
| | - S Conroy
- Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - L C Blomaard
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - B De Groot
- Department of Emergency Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - C H Nickel
- Emergency Department, University Hospital Basel, Basel, Switzerland
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Galesloot TE, Grotenhuis AJ, Kolev D, Aben KK, Bryan RT, Catto JWF, Cheng KK, Conroy S, Dyrskjøt L, Fleshner NE, James ND, Lamy P, Lindskrog SV, Malats N, Mengual L, Verhaegh G, Zeegers MP, Kiemeney LALM, Vermeulen SH. Genome-wide Meta-analysis Identifies Novel Genes Associated with Recurrence and Progression in Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2021; 5:70-83. [PMID: 34353775 DOI: 10.1016/j.euo.2021.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-muscle-invasive bladder cancer (NMIBC) is characterized by frequent recurrences and a risk of progression in stage and grade. Increased knowledge of underlying biological mechanisms is needed. OBJECTIVE To identify single nucleotide polymorphisms (SNPs) associated with recurrence-free (RFS) and progression-free (PFS) survival in NMIBC. DESIGN, SETTING, AND PARTICIPANTS We analyzed outcome data from 3400 newly diagnosed NMIBC patients from the Netherlands, the UK, Canada, and Spain. We generated genome-wide germline SNP data using Illumina OmniExpress and Infinium Global Screening Array in combination with genotype imputation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cohort-specific genome-wide association studies (GWASs) for RFS and PFS were performed using a Cox proportional hazard model. Results were combined in a fixed-effect inverse-variance weighted meta-analysis. Candidate genes for the identified SNP associations were prioritized using functional annotation, gene-based analysis, expression quantitative trait locus analysis, and transcription factor binding site databases. Tumor expression levels of prioritized genes were tested for association with RFS and PFS in an independent NMIBC cohort. RESULTS AND LIMITATIONS This meta-analysis revealed a genome-wide significant locus for RFS on chromosome 14 (lead SNP rs12885353, hazard ratio [HR] C vs T allele 1.55, 95% confidence interval [CI] 1.33-1.82, p = 4.0 × 10-8), containing genes G2E3 and SCFD1. Higher expression of SCFD1 was associated with increased RFS (HR 0.70, 95% CI 0.59-0.84, pFDR = 0.003). Twelve other loci were suggestively associated with RFS (p < 10-5), pointing toward 18 additional candidate genes. For PFS, ten loci showed suggestive evidence of association, indicating 36 candidate genes. Expression levels of ten of these genes were statistically significantly associated with PFS, of which four (IFT140, UBE2I, FAHD1, and NME3) showed directional consistency with our meta-analysis results and published literature. CONCLUSIONS In this first prognostic GWAS in NMIBC, we identified several novel candidate loci and five genes that showed convincing associations with recurrence or progression. PATIENT SUMMARY In this study, we searched for inherited DNA changes that affect the outcome of non-muscle-invasive bladder cancer (NMIBC). We identified several genes that are associated with disease recurrence and progression. The roles and mechanisms of these genes in NMIBC prognosis should be investigated in future studies.
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Affiliation(s)
- Tessel E Galesloot
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands.
| | - Anne J Grotenhuis
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Dimitar Kolev
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Katja K Aben
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands; Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Richard T Bryan
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; Bladder Cancer Research Centre, University of Birmingham, Birmingham, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Kar K Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samantha Conroy
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Lars Dyrskjøt
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Neil E Fleshner
- Department of Urology, Princess Margaret Cancer Centre, Toronto, Canada
| | - Nicholas D James
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Philippe Lamy
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sia Viborg Lindskrog
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Núria Malats
- Genetic and Molecular Epidemiology Group, Spanish National Cancer Research Center (CNIO), Madrid, Spain; CIBERONC, Madrid, Spain
| | - Lourdes Mengual
- Department and Laboratory of Urology, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Gerald Verhaegh
- Department of Urology, Radboud university medical center, Nijmegen, The Netherlands
| | - Maurice P Zeegers
- Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK; Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands; CAPHRI School for Public Health and Primary Care, University of Maastricht, Maastricht, The Netherlands
| | - Lambertus A L M Kiemeney
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands; Department of Urology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sita H Vermeulen
- Department for Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
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Sahlberg A, Eriksson J, Conroy S, Ericsson G, Hägg L, Giacomelli L, Belli F. Forward modeling of pile-up events in liquid scintillator detectors for neutron emission spectroscopy. Rev Sci Instrum 2021; 92:083502. [PMID: 34470438 DOI: 10.1063/5.0052260] [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] [Received: 03/30/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
When using liquid scintillator detectors to measure the neutron emission spectrum from fusion plasmas, the problem of pile-up distortion can be significant. Because of the large neutron rates encountered in many fusion experiments, some pile-up distortion can remain even after applying traditional pile-up elimination methods, which alters the shape of the measured light-yield spectrum and influences the spectroscopic analysis. Particularly, pile-up events appear as a high-energy tail in the measured light-yield spectrum, which obfuscates the contribution that supra-thermal ions make to the energy spectrum. It is important to understand the behavior of such "fast ions" in fusion plasmas, and it is hence desirable to be able to measure their contribution to the neutron spectrum as accurately as possible. This paper presents a technique for incorporating distortion from undetected pile-up events into the analysis of the light-yield spectrum, hence compensating for pile-up distortion. The spectral contribution from undetected pile-up events is determined using Monte Carlo methods and is included in the spectroscopic study as a pile-up component. The method is applied to data from an NE213 scintillator detector at JET and validated by comparing with results from the time-of-flight spectrometer TOFOR, which is not susceptible to pile-up distortion. Based on the results, we conclude that the suggested analysis method helps counteract the problem of pile-up effects and improves the possibilities for extracting accurate fast-ion information from the light-yield spectrum.
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Affiliation(s)
- A Sahlberg
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - J Eriksson
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - S Conroy
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - G Ericsson
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - L Hägg
- Department of Physics and Astronomy, Uppsala University, SE-75120 Uppsala, Sweden
| | - L Giacomelli
- Istituto per la Scienza e la Tecnologia dei Plasmi, Consiglio Nazionale delle Ricerche, 20125 Milano, Italy
| | - F Belli
- ENEA C. R. Frascati, Dipartimento FSN, via E. Fermi 45, 00044 Frascati (Roma), Italy
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Imam T, Konstant-Hambling R, Fluck R, Hall N, Palmer J, Conroy S. 548 FRAILTY ANALYSIS ACROSS POPULATIONS: THE USE OF THE HOSPITAL FRAILTY RISK SCORE IN SPECIALISED SERVICES USING NHS NATIONAL DATA. Age Ageing 2021. [DOI: 10.1093/ageing/afab117.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Frailty is increasingly used to risk stratify older people, but across specialised services there is no standardised approach. The aim of this study was to answer the question posed by NHS England to assess frailty could be measured and related to outcomes across Specialsed Services. The Hospital Frailty Risk Score (HFRS) was used and the data published in Age and Ageing in 2020.
Method
A retrospective cohort study was performed using the Secondary Uses Service (SUS) electronic database for people aged 75 or older admitted between April 2017 and March 2018. Based on HFRS, the populations were risk stratified into mild, moderate and severe frailty risk. The relationships with length of stay, readmission rate, mortality and some selected condition specific treatment complications were quantified using descriptive statistics.
Results
Frailty was differentially distributed across the specialties; around one-third had mild frailty; another third had moderate frailty and one-quarter severe frailty. Increasing frailty risk was associated with increased length of stay for the index admission, more days in hospital in the year following intervention and increased risk of dying in hospital. Severe frailty was a powerful discriminator of the risk of death; between 25 and 40% of those with severe frailty risk died at 30 months across all specialties.
Conclusions
This study demonstrates the first application of the HFRS to a national dataset to describe service outcomes and mortality for older people undergoing a range of specialised interventions. This information was used to identify those that might benefit from holistic assessment, aid prognostication, commissioning and service planning. It informed the promotion of quality improvement work in this area via the Specialised Clinical Frailty Network. By implementing the HFRS, changes in outcomes can be plotted across years to assess improvements, performance and benchmarking.
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Affiliation(s)
- T Imam
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - R Konstant-Hambling
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - R Fluck
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - N Hall
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - J Palmer
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
| | - S Conroy
- NHS England and Improvement, London, UK; University of Leicester, Leicester, UK
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16
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Eriksson B, Conroy S, Ericsson G, Eriksson J, Giacomelli L, Hjalmarsson A, Weiszflog M. New method for time alignment and time calibration of the TOFOR time-of-flight neutron spectrometer at JET. Rev Sci Instrum 2021; 92:033538. [PMID: 33820020 DOI: 10.1063/5.0041126] [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] [Received: 12/19/2020] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
The TOFOR time-of-flight (TOF) neutron spectrometer at the Joint European Torus (JET) is composed of 5 start (S1) and 32 stop (S2) scintillation detectors. Recently, the data acquisition system (DAQ) of TOFOR was upgraded to equip each of the 37 detectors with its own waveform digitizer to allow for correlated time and pulse height analysis of the acquired data. Due to varying cable lengths and different pulse processing pathways in the new DAQ system, the 160 (5 · 32) different TOF pairs of start-stop detectors must be time-aligned to enable the proper construction of a summed TOF spectrum. Given the time (energy) resolution required by the entire spectrometer system to measure different plasma neutron emission components, it is of importance to align the detector pairs to each other with sub-nanosecond precision. Previously, the alignment partially depended on using fusion neutron data from Ohmic heating phases of JET experimental pulses. The dependence on fusion neutron data in the time alignment process is, however, unsatisfactory as it involves data one would wish to include in an independent analysis for physics results. In this work, we describe a method of time-aligning the detector pairs by using gamma rays. Given the known geometry and response of TOFOR to gamma rays, the time alignment of the detector pairs is found by examining gamma events interacting in coincidence in both S1-S1 and S1-S2 detector combinations. Furthermore, a technique for separating neutron and gamma events in the different detector sets is presented. Finally, the time-aligned system is used to analyze neutron data from Ohmic phases for different plasma conditions and to estimate the Ohmic fuel ion temperature.
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Affiliation(s)
- B Eriksson
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
| | - S Conroy
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
| | - G Ericsson
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
| | - J Eriksson
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
| | - L Giacomelli
- Instituto de Fisica del Plasma "P. Caldirola," I-20126 Milano, Italy
| | - A Hjalmarsson
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
| | - M Weiszflog
- Department of Physics and Astronomy, Uppsala University, Uppsala SE-751 20, Sweden
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17
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Maynard MT, Conroy S, Lacerenza CN, Barnes LY. Teams in the wild are not extinct, but challenging to research: A guide for conducting impactful team field research with 10 recommendations and 10 best practices. Organizational Psychology Review 2021. [DOI: 10.1177/2041386620986597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
While there is no shortage of calls for research to study management concepts within organizations, there is far too little guidance on how to accomplish this feat. Conducting research in the field is especially important within the domain of organizational team research. Accordingly, we seek to provide an understanding of the current state of the organizational team field research literature and highlight recommendations and best practices. As such, we identified 10 recommendations and 10 best practices through three methods: (1) a literature review, (2) a survey of individuals who have published team field research, as well as some of the most impactful scholars investigating organizational team phenomenon, and (3) a set of interviews with practitioners in positions that can grant field access to researchers. By implementing this multi-pronged approach, we were able to incorporate multiple stakeholder voices so as to fully understand the value and ideal process for scientist-practitioner endeavors.
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18
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Judge M, Conroy S, Hegarty P, Cromie A, Fanning R, Kelly D, Crofton E, Berry D. Eating quality of the longissimus thoracis muscle in beef cattle – Contributing factors to the underlying variability and associations with performance traits. Meat Sci 2021; 172:108371. [DOI: 10.1016/j.meatsci.2020.108371] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
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19
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Catto JWF, Gordon K, Collinson M, Poad H, Twiddy M, Johnson M, Jain S, Chahal R, Simms M, Dooldeniya M, Bell R, Koenig P, Conroy S, Goodwin L, Noon AP, Croft J, Brown JM. Radical Cystectomy Against Intravesical BCG for High-Risk High-Grade Nonmuscle Invasive Bladder Cancer: Results From the Randomized Controlled BRAVO-Feasibility Study. J Clin Oncol 2020; 39:202-214. [PMID: 33332191 PMCID: PMC8078404 DOI: 10.1200/jco.20.01665] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [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] [Indexed: 12/01/2022] Open
Abstract
High-grade nonmuscle invasive bladder cancer (HRNMIBC) is a heterogeneous disease. Treatments include intravesical maintenance Bacillus Calmette-Guerin (mBCG) and radical cystectomy (RC). We wanted to understand whether a randomized trial comparing these options was possible.
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Affiliation(s)
- James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Kathryn Gordon
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Heather Poad
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, United Kingdom
| | | | - Sunjay Jain
- St James's University Hospital, Leeds, United Kingdom
| | - Rohit Chahal
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Matt Simms
- Hull and East Yorkshire NHS Trust, Hull, United Kingdom
| | | | - Richard Bell
- Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | | | - Samantha Conroy
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Louise Goodwin
- Academic Urology Unit, University of Sheffield, Sheffield, United Kingdom
| | - Aidan P Noon
- Department of Urology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Julie Croft
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
| | - Julia M Brown
- Clinical Trials Research Unit, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, United Kingdom
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20
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Berry DP, Conroy S, Hegarty PJ, Evans RD, Pabiou T, Judge MM. Inter-animal genetic variability exist in organoleptic properties of prime beef meat. Meat Sci 2020; 173:108401. [PMID: 33310548 DOI: 10.1016/j.meatsci.2020.108401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 01/27/2023]
Abstract
The objective of the present study was to estimate genetic parameters for four organoleptic traits in beef meat, namely tenderness, juiciness, flavour and chewiness using data from 5380 young crossbred progeny of 748 different sires. As well as using the mean animal sensory score across all panellists for a given trait, other aggregate functions such as the median and modal values were also investigated. The heritability (SE) of mean tenderness, juiciness, flavour and chewiness was 0.16 (0.04), 0.14 (0.04), 0.11 (0.03) and 0.21 (0.06), respectively; heritability estimates for the other aggregate values of these traits were generally lower. All genetic correlations between tenderness, juiciness and flavour were positive (0.52 to 0.68) while the genetic correlations between these three traits with chewiness were all negative varying from -0.95 to -0.48. Weak genetic correlations (≤|0.16|) were evident between the sensory traits and all of carcass weight, conformation and subcutaneous fat cover.
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Affiliation(s)
- D P Berry
- Teagasc, Animal & Grassland Research and Innovation Center, Moorepark, Fermoy, Co. Cork, Ireland.
| | - S Conroy
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - P J Hegarty
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - R D Evans
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - T Pabiou
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - M M Judge
- Teagasc, Animal & Grassland Research and Innovation Center, Moorepark, Fermoy, Co. Cork, Ireland
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21
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Conroy S. Undergraduate Urology Education: A Fundamental Pillar in Building the Next Generation of Urologists. Eur Urol 2020; 78:385-386. [PMID: 32631741 DOI: 10.1016/j.eururo.2020.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Samantha Conroy
- Academic Unit of Urology, University of Sheffield, Sheffield, UK.
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22
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Rajkumar C, Wilks M, Islam J, Ali K, Raftery J, Davies K, Timeyin J, Cheek E, Cohen J, Wright J, Natarajan U, Nicholl C, Dewhurst G, Fonseka M, Slovick D, Maskell P, Mukherjee S, Ali K, Nari R, Qureshi A, Gertner D, Khan Z, Shinh N, Bodmer C, Martin-Marero C, Poullis A, Pollok R, Ala A, Chauhan A, Patel M, Roberts H, Conroy S, McGowan D, Pathansali R, Yau C, Vasileiadis E, Guleri A, Orr D, Aldulami D. Do probiotics prevent antibiotic-associated diarrhoea? Results of a multicentre randomized placebo-controlled trial. J Hosp Infect 2020; 105:280-288. [DOI: 10.1016/j.jhin.2020.01.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/27/2020] [Indexed: 02/07/2023]
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23
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Harte H, Conroy S. The importance of leadership in community physiotherapy. Physiotherapy 2020. [DOI: 10.1016/j.physio.2020.03.292] [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: 11/24/2022]
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van Oppen J, Preston L, Ablard S, Buckley Woods H, Mason S, Conroy S. 103 A Review of Reviews of Emergency Department Interventions for Older People: Outcomes, Costs and Implementation Factors. Age Ageing 2020. [DOI: 10.1093/ageing/afz196.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Older people’s emergency care is an international public health priority and remains sub-optimal in the UK. Strategies are needed to manage older patients sensitively and effectively. We reviewed emergency care interventions, evaluating evidence for outcomes, costs, and implementation.
Methods
We developed and registered (with PROSPERO, CRD42018111461) a review of reviews protocol. Screening was according to inclusion criteria for subject and reporting standards. Data were extracted and summarised in tabular and narrative form. Quality was assessed using AMSTAR2 and Joanna Briggs Institute tools. Due to intervention and outcome heterogeneity, findings were synthesised narratively. McCusker’s Elder-Friendly Emergency Department assessment tool was used as a classification framework.
Results
Eighteen review articles and three conference abstracts fulfilled inclusion criteria. The majority were systematic reviews, with four using meta-analysis. Fourteen reviews reported interventions initiated or wholly delivered within the ED, and four focussed on quality indicators or patient preferences.
Confidence was limited to each review’s interpretation of primary studies. Descriptions of interventions were inconsistent, and there was high variability in reporting standards. Interventions mostly focussed on screening and assessment, discharge planning, referrals and follow-up, and multi-disciplinary team composition and professional activities. 26 patient and health service outcomes were reported, including admissions and readmissions, length of stay, mortality, functional decline, and quality of life.
Conclusions
Our review of reviews demonstrated that the current, extensive evidence base of review studies lacks complexity, with limited or no evidence for the effectiveness of interventions; reviews commonly called for more primary research using rigorous methods. There is little review evidence for factors influencing implementation.
There was evidence that among interventions initiated in ED, those continued into the community yielded better outcomes. Service metrics (as valued by care commissioners) were evaluated as intervention outcomes more frequently than person-centred attributes (as valued by older people). Interventions were broadly holistic in nature.
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Cecconello M, Miklaszewski R, Marocco D, Conroy S, Moro F, Esposito B, Podda S, Bienkowska B, Szydlowski A. Strategy and guidelines for the calibration of the ITER Radial Neutron Camera. Fusion Engineering and Design 2019. [DOI: 10.1016/j.fusengdes.2019.03.099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Higgins M, Fitzsimons C, McClure M, McKenna C, Conroy S, Kenny D, McGee M, Waters S, Morris D. 289 Genome-wide association study and expression quantitative trait loci analysis identifies a single nucleotide polymorphism associated with both residual feed intake and GFRA2. J Anim Sci 2018. [DOI: 10.1093/jas/sky404.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - C Fitzsimons
- Department of Agriculture,Ireland, Celbridge, Ireland
| | - M McClure
- Genus PLC,Basingstoke, United Kingdom
| | | | - S Conroy
- Irish Cattle Breeding Federation,Cork, Ireland
| | | | - M McGee
- Teagasc, Animal and Grassland Research and Innovation Centre,Dunsany, Ireland
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27
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Osborne S, Biaggi A, Chua TE, Du Preez A, Hazelgrove K, Nikkheslat N, Previti G, Zunszain PA, Conroy S, Pariante CM. Antenatal depression programs cortisol stress reactivity in offspring through increased maternal inflammation and cortisol in pregnancy: The Psychiatry Research and Motherhood - Depression (PRAM-D) Study. Psychoneuroendocrinology 2018; 98:211-221. [PMID: 30033161 PMCID: PMC6215770 DOI: 10.1016/j.psyneuen.2018.06.017] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Antenatal depression is associated with a broad range of suboptimal outcomes in offspring, although the underlying mechanisms are not yet understood. Animal studies propose inflammation and glucocorticoids as mediators of the developmental programming effect of prenatal stress on offspring stress responses, but studies in humans are not yet at this stage. Indeed, to date no single study has examined the effects of a rigorously defined, clinically significant Major Depressive Disorder (MDD) in pregnancy on maternal antenatal inflammatory biomarkers and hypothalamic-pituitary (HPA) axis, as well as on offspring HPA axis, behavior and developmental outcomes in the first postnatal year. METHODS A prospective longitudinal design was used in 106 women (49 cases vs. 57 healthy controls) to study the effect of MDD in pregnancy and associated antenatal biology (inflammatory and cortisol biomarkers), on offspring stress response (cortisol response to immunization, at 8 weeks and 12 months), early neurobehavior (Neonatal Behavioral Assessment Scale, NBAS, at day 6), and cognitive, language and motor development (Bayley Scales of Infant and Toddler Development at 12 months). RESULTS Compared with healthy controls, women with MDD in pregnancy had raised interleukin (IL) IL-6 (effect size (δ) = 0.53, p = 0.031), IL-10 (δ = 0.53, p = 0.043), tumor necrosis factor alpha (δ = 0.90, p = 0.003) and vascular endothelial growth factor (δ = 0.56, p = 0.008), together with raised diurnal cortisol secretion (δ = 0.89, p = 0.006), raised evening cortisol (δ = 0.64, p = 0.004), and blunted cortisol awakening response (δ = 0.70, p = 0.020), and an 8-day shorter length of gestation (δ = 0.70, p = 0.005). Furthermore, they had neonates with suboptimal neurobehavioral function in four out of five NBAS clusters measured (range of δ = 0.45-1.22 and p = 0.049-<0.001) and increased cortisol response to stress at one year of age (δ = 0.87, p < 0.001). Lastly, maternal inflammatory biomarkers and cortisol levels were correlated with infant stress response, suggesting a mechanistic link. CONCLUSION This study confirms and extends the notion that depression in pregnancy is associated with altered offspring behavior and biological stress response, and demonstrates that changes in maternal antenatal stress-related biology are associated with these infant outcomes.
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Affiliation(s)
- S Osborne
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK.
| | - A Biaggi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - T E Chua
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Psychological Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
| | - A Du Preez
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Basic and Clinical Neuroscience, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - K Hazelgrove
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Psychosis Studies, London, SE5 9AF, UK
| | - N Nikkheslat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - G Previti
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK; Department of Mental Health and Addiction, Via Risorgimento 57 42123, Reggio Emilia, Italy
| | - P A Zunszain
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - S Conroy
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
| | - C M Pariante
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, Section of Perinatal Psychiatry & Stress, Psychiatry and Immunology, The Maurice Wohl Clinical Neuroscience Institute, Cutcombe Road, London, SE5 9RX, UK
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Giacomelli L, Rigamonti D, Nocente M, Rebai M, Tardocchi M, Cecconello M, Conroy S, Hjalmarsson A, Franke T, Biel W. Conceptual studies of gamma ray diagnostics for DEMO control. Fusion Engineering and Design 2018. [DOI: 10.1016/j.fusengdes.2018.05.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Cecconello M, Sperduti A, Fitzgerald I, Conroy S, Holm SJ, Weiszflog M. The neutron camera upgrade for MAST Upgrade. Rev Sci Instrum 2018; 89:10I110. [PMID: 30399869 DOI: 10.1063/1.5038948] [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] [Received: 05/07/2018] [Accepted: 06/13/2018] [Indexed: 06/08/2023]
Abstract
The Neutron Camera Upgrade (NCU) is a neutron flux monitor consisting of six lines of sight (LoSs) under installation on Mega Ampere Spherical Tokamak (MAST) Upgrade. The NCU is expected to contribute to the study of the confinement of fast ions and on the efficiency of non-inductive current drive in the presence of on-axis and off-axis neutral beam injection by measuring the neutron emissivity profile along the equatorial plane. This paper discusses the NCU main design criteria, the engineering and interfacing issues, and the solutions adopted. In addition, the results from the characterization and performance studies of the neutron detectors using standard γ-rays sources and a 252Cf source are discussed. The proposed design has a time resolution of 1 ms with a statistical uncertainty of less than 10% for all MAST Upgrade scenarios with a spatial resolution of 10 cm: higher spatial resolution is possible by moving the LoSs in-between plasma discharges. The energy resolution of the neutron detector is better than 10% for a light output of 0.8 MeVee, and the measured pulse shape discrimination is satisfactory.
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Affiliation(s)
- M Cecconello
- Department of Physics and Astronomy, Uppsala University, EURATOM-VR Association, Uppsala, Sweden
| | - A Sperduti
- Department of Physics and Astronomy, Uppsala University, EURATOM-VR Association, Uppsala, Sweden
| | - I Fitzgerald
- EURATOM/CCFE Fusion Association, Culham Science Centre, Abingdon, United Kingdom
| | - S Conroy
- Department of Physics and Astronomy, Uppsala University, EURATOM-VR Association, Uppsala, Sweden
| | - S J Holm
- Department of Physics and Astronomy, Uppsala University, EURATOM-VR Association, Uppsala, Sweden
| | - M Weiszflog
- Department of Physics and Astronomy, Uppsala University, EURATOM-VR Association, Uppsala, Sweden
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Bouvier C, Caplin M, Conroy S, Davies P, Dureja S, Falconi M, Ferolla P, Fisher G, Goldstein G, Hicks R, Hollander R, Kolarova T, Lawrence B, Leyden S, Majima Y, Metz D, O’Toole D, Ruszniewski P, Wiedenmann B. Unmet needs in the management of neuroendocrine tumours (NETs): A global survey of patients, patient advocates and healthcare professionals. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy293.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- F Aijaz
- University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - S Conroy
- University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
| | - J Banerjee
- University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, UK
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Judge MM, Conroy S, Pabiou T, Cromie AR, Berry DP. Heritability estimates of meat sensory characteristics are a function of the number of panellists and their inter-correlations. Meat Sci 2018; 141:91-93. [PMID: 29625415 DOI: 10.1016/j.meatsci.2018.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to quantify, using simulated data, the impact on estimated heritability of varying the number of panellists and their inter-correlations using meat sensory tenderness in cattle as an example. Estimated parameters from actual sensory-based tenderness scores from 9 individual panellists on 1252 beef cattle were used to parameterise the simulation. A single "tenderness score" for each of 10 panellists was simulated for 15,000 cattle. Heritability estimates were calculated for each of the 10 panellists individually as well as the mean score per animal for all n combinations of panellists. Heritability estimates improved with increasing number of panellists in line with expectations from a deterministic equation. The increase in heritability was due to a reduction in the residual variance, albeit the rate of reduction in residual variance declined with each additional panellist included in the calculated mean tenderness score. Results highlight the importance of reporting the number of panellist scores per animal as well as their inter-correlations in sensory-based studies.
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Affiliation(s)
- M M Judge
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, Ireland.
| | - S Conroy
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - T Pabiou
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - A R Cromie
- Irish Cattle Breeding Federation, Highfield House, Bandon, Co. Cork, Ireland
| | - D P Berry
- Teagasc, Animal & Grassland Research and Innovation Centre, Moorepark, Fermoy, Co. Cork, Ireland
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Chisholm D, Conroy S, Glangeaud-Freudenthal N, Oates MR, Asten P, Barry S, Figueiredo B, Kammerer MH, Klier CM, Seneviratne G, Sutter-Dallay AL. Health services research into postnatal depression: results from a preliminary cross-cultural study. Br J Psychiatry 2018; 46:s45-52. [PMID: 14754818 DOI: 10.1192/bjp.184.46.s45] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundLittle is known about the availability and uptake of health and welfare services by women with postnatal depression in different countries.AimsWithin the context of a cross cultural research study, to develop and test methods for undertaking quantitative health services research in postnatal depression.MethodInterviews with service planners and the collation of key health indicators were used to obtain a profile of service avail ability and provision. A service use questionnaire was developed and administered to a pilot sample in a number of European study centres.ResultsMarked differences in service access and use were observed between the centres, including postnatal nursing care and contacts with primary care services. Rates of use of specialist services were generally low. Common barriers to access to care included perceived service quality and responsiveness. On the basis of the pilot work, a postnatal depression version of the Service Receipt Inventory was revised and finalised.ConclusionsThis preliminary study demonstrated the methodological feasibility of describing and quantifying service use, highlighted the varied and often limited use of care in this population, and indicated the need for an improved understanding of the resource needs and implications of postnatal depression.
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Affiliation(s)
- D Chisholm
- Health Services Research Department, Institute of Psychiatry, London, UK.
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34
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Gunning M, Conroy S, Valoriani V, Figueiredo B, Kammerer MH, Muzik M, Glatigny-Dallay E, Murray L. Measurement of mother-infant interactions and the home environment in a European setting: preliminary results from a cross-cultural study. Br J Psychiatry 2018; 46:s38-44. [PMID: 14754817 DOI: 10.1192/bjp.184.46.s38] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BackgroundInfant development is adversely affected in the context of postnatal depression. This relationship may be mediated by both the nature of early mother-infant interactions and the quality of the home environment.AimsTo establish the usefulness of the Global Ratings Scales of Mother–Infant Interaction and the Infant–Toddler version of the Home Observation for the Measurement of the Environment (IT–HOME), and to test expected associations of the measures with characteristics of the social context and with major or minor depression.MethodBoth assessments were administered postnatally in four European centres; 144 mothers were assessed with the Global Ratings Scales and 114 with the IT–HOME. Affective disorder was assessed by means of the Structured Clinical Interview for DSM–IV Disorders.ResultsAnalyses of mother–infant interaction indicated no main effect for depression but maternal sensitivity to infant behaviour was associated with better infant communication, especially for women who were not depressed. Poor overall emotional support also reduced sensitivity scores. Poor support was also related to poorer IT–HOME scores, but there was no effect of depression.ConclusionsThe Global Ratings Scales were effectively applied but there was less evidence of the usefulness of the IT–HOME.
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Affiliation(s)
- M Gunning
- Department of Psychology, University of Reading, UK
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35
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Parker SG, McCue P, Phelps K, McCleod A, Arora S, Nockels K, Kennedy S, Roberts H, Conroy S. What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing 2018; 47:149-155. [PMID: 29206906 DOI: 10.1093/ageing/afx166] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [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: 07/17/2017] [Indexed: 12/24/2022] Open
Abstract
Background Comprehensive Geriatric Assessment (CGA) is now the accepted gold standard for caring for frail older people in hospital. However, there is uncertainty about identifying and targeting suitable recipients and which patients benefit the most. Objectives our objectives were to describe the key elements, principal measures of outcome and the characteristics of the main beneficiaries of inpatient CGA. Methods we used the Joanna Briggs Institute umbrella review method. We searched for systematic reviews and meta-analyses describing CGA services for hospital inpatients in the Cochrane Database of Systematic Reviews, Database of Reviews of Effectiveness (DARE), MEDLINE and EMBASE and a range of other sources. Results we screened 1,010 titles and evaluated 419 abstracts for eligibility, 143 full articles for relevance and included 24 in a final quality and relevance check. Thirteen reviews, reported in 15 papers, were selected for review. The most widely used definition of CGA was: 'a multidimensional, multidisciplinary process which identifies medical, social and functional needs, and the development of an integrated/co-ordinated care plan to meet those needs'. Key clinical outcomes included mortality, activities of daily living and dependency. The main beneficiaries were people ≥55 years in receipt of acute care. Frailty in CGA recipients and patient related outcomes were not usually reported. Conclusions we confirm a widely used definition of CGA. Key outcomes are death, disability and institutionalisation. The main beneficiaries in hospital are older people with acute illness. The presence of frailty has not been widely examined as a determinant of CGA outcome.
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Affiliation(s)
- S G Parker
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - P McCue
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, Tyne and Wear, UK
| | - K Phelps
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK
| | - A McCleod
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - S Arora
- Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK
| | - K Nockels
- University of Leicester Library, Leicester, UK
| | - S Kennedy
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield S1 4DA, UK
| | - H Roberts
- University of Southampton, Academic Geriatric Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - S Conroy
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester LE1 7RH, UK
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36
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Cecconello M, Conroy S, Marocco D, Moro F, Esposito B. Neural network implementation for ITER neutron emissivity profile recognition. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.02.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Moro F, Marocco D, Esposito B, Flammini D, Podda S, Villari R, Conroy S. Nuclear analysis of the ITER radial neutron camera architectural options. Fusion Engineering and Design 2017. [DOI: 10.1016/j.fusengdes.2017.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Batistoni P, Popovichev S, Conroy S, Lengar I, Čufar A, Abhangi M, Snoj L, Horton L. Calibration of neutron detectors on the Joint European Torus. Rev Sci Instrum 2017; 88:103505. [PMID: 29092477 DOI: 10.1063/1.4991780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present paper describes the findings of the calibration of the neutron yield monitors on the Joint European Torus (JET) performed in 2013 using a 252Cf source deployed inside the torus by the remote handling system, with particular regard to the calibration of fission chambers which provide the time resolved neutron yield from JET plasmas. The experimental data obtained in toroidal, radial, and vertical scans are presented. These data are first analysed following an analytical approach adopted in the previous neutron calibrations at JET. In this way, a calibration function for the volumetric plasma source is derived which allows us to understand the importance of the different plasma regions and of different spatial profiles of neutron emissivity on fission chamber response. Neutronics analyses have also been performed to calculate the correction factors needed to derive the plasma calibration factors taking into account the different energy spectrum and angular emission distribution of the calibrating (point) 252Cf source, the discrete positions compared to the plasma volumetric source, and the calibration circumstances. All correction factors are presented and discussed. We discuss also the lessons learnt which are the basis for the on-going 14 MeV neutron calibration at JET and for ITER.
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Affiliation(s)
- Paola Batistoni
- ENEA, Department of Fusion and Technology for Nuclear Safety and Security, I-00044 Frascati, Rome, Italy
| | - S Popovichev
- CCFE, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
| | - S Conroy
- Department of Physics and Astronomy, Uppsala University, Uppsala, Sweden
| | - I Lengar
- Reactor Physics Division, Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
| | - A Čufar
- Reactor Physics Division, Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
| | - M Abhangi
- Institute for Plasma Research, Bhat, Gandhinagar 382428, Gujarat, India
| | - L Snoj
- Reactor Physics Division, Jožef Stefan Institute, Jamova cesta 39, SI-1000 Ljubljana, Slovenia
| | - L Horton
- JET Exploitation Unit, Culham Science Centre, Abingdon, Oxon OX14 3DB, United Kingdom
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Conroy S, Hale MF, Cross SS, Swallow K, Sidhu RH, Sargur R, Lobo AJ. Unrestricted faecal calprotectin testing performs poorly in the diagnosis of inflammatory bowel disease in patients in primary care. J Clin Pathol 2017; 71:316-322. [DOI: 10.1136/jclinpath-2017-204506] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/06/2017] [Accepted: 07/22/2017] [Indexed: 11/04/2022]
Abstract
BackgroundFaecal calprotectin (FC) measurement distinguishes patients with inflammatory bowel disease (IBD) from those with irritable bowel syndrome but evidence of its performance in primary care is limited.AimsTo assess the yield of IBD from FC testing in primary care.MethodsRetrospective review of hospital records to assess the outcome following FC testing in primary care. Investigations for all patients undergoing FC testing in a single laboratory for 6 months from 1 October 2013 to 28 February 2014 were reviewed.Results410 patients (162 male; median age 42; range 16–91) were included. FC>50 µg/g was considered positive (FC+). 148/410 (36.1%; median age 44 (17–91)) were FC+ (median FC 116.5 µg/g (51–1770)). 122/148 FC-positive patients (82.4%) underwent further investigation. 97 (65.5%) underwent lower gastrointestinal endoscopy (LGIE), of which 7 (7.2%) had IBD. 49/262 (18.7%) FC-negative (FC−) patients (FC ≤50 µg/g) (median age 47 (19–76)) also underwent LGIE, of whom 3 (6.1%) had IBD.IBD was diagnosed in 11/410 (2.7%; 4 ulcerative colitis, 3 Crohn’s disease, 4 microscopic colitis). 8/11 were FC+ (range 67–1170) and 3 FC−. At a 50 µg/g threshold, sensitivity for detecting IBD was 72.7%, specificity 64.9%, positive predictive value (PPV) 5.41% and negative predictive value 98.9%. Increasing the threshold to 100 µg/g reduced the sensitivity of the test for detecting IBD to 54.6%.ConclusionsFC testing in primary care has low sensitivity and specificity with poor PPV for diagnosing IBD. Its use needs to be directed to those with a higher pretest probability of disease. Local services and laboratories should advise general practitioners accordingly.
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Bunn JG, O'Keeffe C, Jacques R, Croft S, Conroy S, Mason S. 45URGENT CARE AXIS FOR THE OLDER ADULT: WHERE IS BEST TO TARGET AN INTERVENTION? Age Ageing 2017. [DOI: 10.1093/ageing/afx111.45] [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: 11/12/2022] Open
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McCue P, McLeod A, Phelps K, Nockels K, Conroy S, Roberts H, Kennedy S, Parker S. HOSPITAL-WIDE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) FOR OLDER PEOPLE: EMERGING MODELS OF CARE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P. McCue
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - A. McLeod
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom,
| | - K. Phelps
- Leicester University, Leicester, UK, United Kingdom,
| | - K. Nockels
- Leicester University, Leicester, UK, United Kingdom,
| | - S. Conroy
- Leicester University, Leicester, UK, United Kingdom,
| | - H. Roberts
- Southampton University, Southampton, United Kingdom,
| | - S. Kennedy
- Sheffield University, Sheffield, United Kingdom
| | - S.G. Parker
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom,
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Samra R, Cox T, Gordon A, Conroy S, Lucassen M, Griffiths A. WHAT FACTORS ARE RELATED TO MEDICAL STUDENTS’ AND DOCTORS’ ATTITUDES TOWARD OLDER PATIENTS? Innov Aging 2017. [DOI: 10.1093/geroni/igx004.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R. Samra
- The Open University, Milton Keynes, United Kingdom,
| | - T. Cox
- University of Leicester, Leicester, United Kingdom,
| | - A. Gordon
- University of Nottingham, Nottingham, United Kingdom
| | - S. Conroy
- University of Leicester, Leicester, United Kingdom,
| | - M. Lucassen
- The Open University, Milton Keynes, United Kingdom,
| | - A. Griffiths
- University of Nottingham, Nottingham, United Kingdom
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McCue P, Parker S, Roberts H, Kennedy S, Conroy S. HOSPITAL-WIDE COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) FOR OLDER PEOPLE: A SURVEY OF UK HOSPITALS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P. McCue
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - S.G. Parker
- Newcastle University, Newcastle upon Tyne, United Kingdom,
| | - H. Roberts
- Southampton University, Southampton, United Kingdom,
| | - S. Kennedy
- Sheffield University, Sheffield, United Kingdom,
| | - S. Conroy
- Leicester University, Leicester, United Kingdom
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Abstract
This article contributes to research on emotion expression, attributions, and discrete work emotions by developing an observer-focused model to explain the outcomes of crying at work. Our model is focused on crying as a form of emotion expression because crying may be driven by different felt emotions or be used as a means of manipulation. In addition, the model focuses on observers, who must form perceptions of the emotion expression in order to determine an appropriate response. This model is particularly valuable because it addresses the reality that an observer will develop an impression of another person’s emotion and intention, and that this impression may not always align with the reality of the emotion being experienced by the expresser.
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Affiliation(s)
- William Becker
- Department of Management, Virginia Polytechnic Institute and State University, USA
| | | | | | - Michael Gross
- Department of Management, Colorado State University, USA
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Turpin S, Conroy S. 111DEVELOPING A EUROPEAN GERIATRIC EMERGENCY MEDICINE CURRICULUM. Age Ageing 2017. [DOI: 10.1093/ageing/afx071.111] [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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Sjöstrand H, Sundén EA, Bertalot L, Conroy S, Ericsson G, Johnson MG, Giacomelli L, Gorini G, Hellesen C, Hjalmarsson A, Källne J, Popovichev S, Ronchi E, Weiszflog M, Tardocchi M. Fusion Power Measurement Using a Combined Neutron Spectrometer-Camera System at JET. Fusion Science and Technology 2017. [DOI: 10.13182/fst10-a9370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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)
- Henrik Sjöstrand
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - E. Andersson Sundén
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - L. Bertalot
- ITER Diagnostic Division, ITER, Cadarache Centre, 13108 St. Paul lez Durance, France
| | - S. Conroy
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - G. Ericsson
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - M. Gatu Johnson
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - L. Giacomelli
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - G. Gorini
- Physics Department, Milano-Bicocca University, and Istituto di Fisica del Plasma del CNR, Milan, Italy (EURATOM-ENEA-CNR Association)
| | - C. Hellesen
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - A. Hjalmarsson
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - J. Källne
- JET-EFDA, Culham Science Centre, OX14 3DB, Abingdon, United Kingdom
| | - S. Popovichev
- EURATOM0UKAEA Fusion Association, Culham Science Centre, Abingdon, United Kingdom
| | - E. Ronchi
- JET-EFDA, Culham Science Centre, OX14 3DB, Abingdon, United Kingdom
| | - M. Weiszflog
- Uppsala University, Department of Physics and Astronomy, Division of Applied Nuclear Physics, 75120 Uppsala, Sweden (EURATOM-VR Association)
| | - M. Tardocchi
- Physics Department, Milano-Bicocca University, and Istituto di Fisica del Plasma del CNR, Milan, Italy (EURATOM-ENEA-CNR Association)
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Coelho R, Äkäslompolo S, Dinklage A, Kus A, Reimer R, Sundén E, Conroy S, Blanco E, Conway G, Hacquin S, Heuraux S, Lechte C, Silva FD, Sirinelli A, ITM-TF C. Synthetic Diagnostics in the European Union Integrated Tokamak Modelling Simulation Platform. Fusion Science and Technology 2017. [DOI: 10.13182/fst12-473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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)
- R. Coelho
- Associação EURATOM0IST, Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico Universidade Técnica de Lisboa, P-1049-001 Lisboa, Portugal
| | - S. Äkäslompolo
- Aalto University, Euratom-Tekes Association, P.O. Box 14100, FI-00076 AALTO, Finland
| | - A. Dinklage
- Max-Planck-Institut für Plasma physik, EURATOM-Association, Wendelsteinstr. 1, Greifswald, Germany
| | - A. Kus
- Max-Planck-Institut für Plasma physik, EURATOM-Association, Wendelsteinstr. 1, Greifswald, Germany
| | - R. Reimer
- Max-Planck-Institut für Plasma physik, EURATOM-Association, Wendelsteinstr. 1, Greifswald, Germany
| | - E. Sundén
- Uppsala University, VR-Euratom Association, Box 516, 751 20 Uppsala, Sweden
| | - S. Conroy
- Uppsala University, VR-Euratom Association, Box 516, 751 20 Uppsala, Sweden
| | - E. Blanco
- Asociación EURATOM-CIEMAT para Fusión, CIEMAT, Madrid, Spain Association
| | - G. Conway
- Max-Planck-Institut für Plasma physik, EURATOM-IPP Association, Garching, Germany
| | - S. Hacquin
- CEA, IRFM, F-13108 Saint-Paul-lez-Durance, France
| | - S. Heuraux
- Université de Lorraine, IJL, UMR 7198, BP 70239, Vandoeuvre, F-54506 Cedex, France
| | - C. Lechte
- Institute for Plasma Research, University of Stuttgart, 70569 Stuttgart, Germany
| | - F. Da Silva
- Associação EURATOM0IST, Instituto de Plasmas e Fusão Nuclear, Instituto Superior Técnico Universidade Técnica de Lisboa, P-1049-001 Lisboa, Portugal
| | - A. Sirinelli
- CEA, IRFM, F-13108 Saint-Paul-lez-Durance, France
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Logan PA, Murphy A, Drummond AER, Bailey S, Radford KA, Gladman JRF, Walker MF, Robertson K, Edmans JA, Conroy S. An Investigation of the Number and Cost of Assistive Devices Used by Older People Who Had Fallen and Called a 999 Ambulance. Br J Occup Ther 2016. [DOI: 10.1177/030802260707001104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - A Murphy
- Nottingham City Primary Care Trust
| | | | - S Bailey
- Nottingham Integrated Community Equipment Service
| | | | | | | | - K Robertson
- Nottinghamshire County Teaching Primary Care Trust
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Abstract
BACKGROUND Research has shown that maternal mental illness can affect mother-infant interactions with implications for infant outcomes. Severe and chronic mental illness (SMI), particularly schizophrenia, is associated with the greatest risk. Schizophrenia is also associated with impairments in attribution of mental states, 'theory of mind' (ToM). Recent attachment research has suggested that maternal mentalizing skills are strongly associated with attachment outcome in infants. To date, no research has explored the relationship between ToM and maternal sensitivity in mothers with SMI using standard tests of ToM. The present study was designed as an exploratory study in order to investigate this. METHOD A total of 40 women with SMI in the postpartum period were administered a battery of ToM tasks and general neuropsychological tasks. The women were also filmed in an unstructured play session with their infants, which was coded for maternal sensitivity using the Crittenden CARE-Index. RESULTS One ToM task, the Frith-Happé Animations, predicted maternal sensitivity across all diagnoses. There was also an effect of diagnosis, with lower sensitivity observed in women with schizophrenia. ToM impairments did not fully explain the effect of diagnosis on sensitivity. Mothers of girls were rated as being more sensitive than mothers of boys. CONCLUSIONS The results suggest that ToM is a significant predictor of maternal sensitivity across all mental health diagnoses, extending the results of studies focusing on healthy populations. Clinical interventions emphasizing the importance of understanding the perspective of the infant may enhance maternal sensitivity.
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Affiliation(s)
- J Rigby
- South London and Maudsley NHS Foundation Trust,London,UK
| | - S Conroy
- King's College London, Institute of Psychiatry,Psychology and Neuroscience,London,UK
| | | | - S Pawlby
- King's College London, Institute of Psychiatry,Psychology and Neuroscience,London,UK
| | - F Happé
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,MRC Social, Genetic and Developmental Psychiatry Centre,London,UK
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Vasilopoulou T, Stamatelatos I, Batistoni P, Conroy S, Obryk B, Popovichev S, Syme D. Neutron streaming along ducts and labyrinths at the JET biological shielding: Effect of concrete composition. Radiat Phys Chem Oxf Engl 1993 2015. [DOI: 10.1016/j.radphyschem.2015.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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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