1
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Paterson RL, La Manna MP, Arena De Souza V, Walker A, Gibbs-Howe D, Kulkarni R, Fergusson JR, Mulakkal NC, Monteiro M, Bunjobpol W, Dembek M, Martin-Urdiroz M, Grant T, Barber C, Garay-Baquero DJ, Tezera LB, Lowne D, Britton-Rivet C, Pengelly R, Chepisiuk N, Singh PK, Woon AP, Powlesland AS, McCully ML, Caccamo N, Salio M, Badami GD, Dorrell L, Knox A, Robinson R, Elkington P, Dieli F, Lepore M, Leonard S, Godinho LF. An HLA-E-targeted TCR bispecific molecule redirects T cell immunity against Mycobacterium tuberculosis. Proc Natl Acad Sci U S A 2024; 121:e2318003121. [PMID: 38691588 DOI: 10.1073/pnas.2318003121] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/08/2024] [Indexed: 05/03/2024] Open
Abstract
Peptides presented by HLA-E, a molecule with very limited polymorphism, represent attractive targets for T cell receptor (TCR)-based immunotherapies to circumvent the limitations imposed by the high polymorphism of classical HLA genes in the human population. Here, we describe a TCR-based bispecific molecule that potently and selectively binds HLA-E in complex with a peptide encoded by the inhA gene of Mycobacterium tuberculosis (Mtb), the causative agent of tuberculosis in humans. We reveal the biophysical and structural bases underpinning the potency and specificity of this molecule and demonstrate its ability to redirect polyclonal T cells to target HLA-E-expressing cells transduced with mycobacterial inhA as well as primary cells infected with virulent Mtb. Additionally, we demonstrate elimination of Mtb-infected cells and reduction of intracellular Mtb growth. Our study suggests an approach to enhance host T cell immunity against Mtb and provides proof of principle for an innovative TCR-based therapeutic strategy overcoming HLA polymorphism and therefore applicable to a broader patient population.
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Affiliation(s)
| | - Marco P La Manna
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo 90127, Italy
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, University of Palermo, Palermo 90127, Italy
| | | | - Andrew Walker
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Dawn Gibbs-Howe
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Rakesh Kulkarni
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | | | - Mauro Monteiro
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | - Marcin Dembek
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | - Tressan Grant
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Claire Barber
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Diana J Garay-Baquero
- National Institute for Health and Care Research, Biomedical Research Centre and Institute for Life Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Liku Bekele Tezera
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo 90127, Italy
| | - David Lowne
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | - Robert Pengelly
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | - Praveen K Singh
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Amanda P Woon
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | | | | | - Nadia Caccamo
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo 90127, Italy
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, University of Palermo, Palermo 90127, Italy
| | - Mariolina Salio
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Giusto Davide Badami
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo 90127, Italy
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, University of Palermo, Palermo 90127, Italy
| | - Lucy Dorrell
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Andrew Knox
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Ross Robinson
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Paul Elkington
- National Institute for Health and Care Research, Biomedical Research Centre and Institute for Life Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, United Kingdom
| | - Francesco Dieli
- Department of Biomedicine, Neurosciences and Advanced Diagnostic, University of Palermo, Palermo 90127, Italy
- Central Laboratory of Advanced Diagnosis and Biomedical Research, Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, University of Palermo, Palermo 90127, Italy
| | - Marco Lepore
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Sarah Leonard
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
| | - Luis F Godinho
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, United Kingdom
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2
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Wallace Z, Heunis T, Paterson RL, Suckling RJ, Grant T, Dembek M, Donoso J, Brener J, Long J, Bunjobpol W, Gibbs-Howe D, Kay DP, Leneghan DB, Godinho LF, Walker A, Singh PK, Knox A, Leonard S, Dorrell L. Instability of the HLA-E peptidome of HIV presents a major barrier to therapeutic targeting. Mol Ther 2024; 32:678-688. [PMID: 38219014 PMCID: PMC10928138 DOI: 10.1016/j.ymthe.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/14/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
Naturally occurring T cells that recognize microbial peptides via HLA-E, a nonpolymorphic HLA class Ib molecule, could provide the foundation for new universal immunotherapeutics. However, confidence in the biological relevance of putative ligands is crucial, given that the mechanisms by which pathogen-derived peptides can access the HLA-E presentation pathway are poorly understood. We systematically interrogated the HIV proteome using immunopeptidomic and bioinformatic approaches, coupled with biochemical and cellular assays. No HIV HLA-E peptides were identified by tandem mass spectrometry analysis of HIV-infected cells. In addition, all bioinformatically predicted HIV peptide ligands (>80) were characterized by poor complex stability. Furthermore, infected cell elimination assays using an affinity-enhanced T cell receptor bispecific targeted to a previously reported HIV Gag HLA-E epitope demonstrated inconsistent presentation of the peptide, despite normal HLA-E expression on HIV-infected cells. This work highlights the instability of the HIV HLA-E peptidome as a major challenge for drug development.
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Affiliation(s)
- Zoë Wallace
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK.
| | - Tiaan Heunis
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
| | | | | | | | | | - Jose Donoso
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
| | | | - Joshua Long
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
| | | | | | - Daniel P Kay
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
| | | | | | | | | | - Andrew Knox
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
| | | | - Lucy Dorrell
- Immunocore Ltd., Abingdon, Oxfordshire OX14 4RY, UK
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3
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Tumin D, Crotty J, Aikman I, Leonard S. Cost and effectiveness in fostering resident physician scholarly activity. Can Med Educ J 2023; 14:140-141. [PMID: 37719394 PMCID: PMC10500395 DOI: 10.36834/cmej.76300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Jennifer Crotty
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Inga Aikman
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
| | - Sarah Leonard
- Department of Pediatrics, Brody School of Medicine, East Carolina University, North Carolina, USA
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4
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Byng R, Kirkpatrick T, Lennox C, Warren FC, Anderson R, Brand SL, Callaghan L, Carroll L, Durcan G, Gill L, Goodier S, Graham J, Greer R, Haddad M, Harris T, Henley W, Hunter R, Leonard S, Maguire M, Michie S, Owens C, Pearson M, Quinn C, Rybczynska-Bunt S, Stevenson C, Stewart A, Stirzaker A, Todd R, Walter F, Weston L, Wright N, Taylor RS, Shaw J. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: the Engager randomised controlled trial. Br J Psychiatry 2023; 222:18-26. [PMID: 35978272 PMCID: PMC10895504 DOI: 10.1192/bjp.2022.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many male prisoners have significant mental health problems, including anxiety and depression. High proportions struggle with homelessness and substance misuse. AIMS This study aims to evaluate whether the Engager intervention improves mental health outcomes following release. METHOD The design is a parallel randomised superiority trial that was conducted in the North West and South West of England (ISRCTN11707331). Men serving a prison sentence of 2 years or less were individually allocated 1:1 to either the intervention (Engager plus usual care) or usual care alone. Engager included psychological and practical support in prison, on release and for 3-5 months in the community. The primary outcome was the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), 6 months after release. Primary analysis compared groups based on intention-to-treat (ITT). RESULTS In total, 280 men were randomised out of the 396 who were potentially eligible and agreed to participate; 105 did not meet the mental health inclusion criteria. There was no mean difference in the ITT complete case analysis between groups (92 in each arm) for change in the CORE-OM score (1.1, 95% CI -1.1 to 3.2, P = 0.325) or secondary analyses. There were no consistent clinically significant between-group differences for secondary outcomes. Full delivery was not achieved, with 77% (108/140) receiving community-based contact. CONCLUSIONS Engager is the first trial of a collaborative care intervention adapted for prison leavers. The intervention was not shown to be effective using standard outcome measures. Further testing of different support strategies for prison with mental health problems is needed.
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Affiliation(s)
- Richard Byng
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Tim Kirkpatrick
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Charlotte Lennox
- Division of Psychology and Mental Health, University of Manchester, UK
| | | | - Rob Anderson
- College of Medicine & Health, University of Exeter, UK
| | | | - Lynne Callaghan
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Lauren Carroll
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Graham Durcan
- Centre for Mental Health, South Bank Technopark, London, UK
| | - Laura Gill
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Sara Goodier
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Jonathan Graham
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Rebecca Greer
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | | | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | - Sarah Leonard
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Mike Maguire
- Centre for Criminology, University of South Wales, UK
| | - Susan Michie
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, UK
| | | | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, Faculty of Health Sciences, University of Hull, UK
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | | | - Amy Stewart
- Community and Primary Care Research Group, University of Plymouth, UK
| | - Alex Stirzaker
- South West Mental Health Clinical Network, NHS England, UK
| | - Roxanne Todd
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Florian Walter
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Lauren Weston
- Community and Primary Care Research Group, University of Plymouth, UK
| | | | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, University of Manchester, UK and Greater Manchester Manchester Health NHS Foundation Trust, UK
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5
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Vasquez‐Rios V, Buckman C, Cortright L, Tumin D, Leonard S, Holder D. Medicaid expansion and adolescents' readiness for transition to adult health insurance. World Med & Health Policy 2022. [DOI: 10.1002/wmh3.482] [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]
Affiliation(s)
| | - Cierra Buckman
- Department of Pediatrics East Carolina University Greenville North Carolina USA
| | - Lindsay Cortright
- Department of Pediatrics East Carolina University Greenville North Carolina USA
| | - Dmitry Tumin
- Department of Pediatrics East Carolina University Greenville North Carolina USA
| | - Sarah Leonard
- Department of Pediatrics East Carolina University Greenville North Carolina USA
| | - David Holder
- Department of Pediatrics East Carolina University Greenville North Carolina USA
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6
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Weston L, Rybczynska-Bunt S, Quinn C, Lennox C, Maguire M, Pearson M, Stirzaker A, Durcan G, Stevenson C, Graham J, Carroll L, Greer R, Haddad M, Hunter R, Anderson R, Todd R, Goodier S, Brand S, Michie S, Kirkpatrick T, Leonard S, Harris T, Henley W, Shaw J, Owens C, Byng R. Interrogating intervention delivery and participants' emotional states to improve engagement and implementation: A realist informed multiple case study evaluation of Engager. PLoS One 2022; 17:e0270691. [PMID: 35834470 PMCID: PMC9282559 DOI: 10.1371/journal.pone.0270691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background ‘Engager’ is an innovative ‘through-the-gate’ complex care intervention for male prison-leavers with common mental health problems. In parallel to the randomised-controlled trial of Engager (Trial registration number: ISRCTN11707331), a set of process evaluation analyses were undertaken. This paper reports on the depth multiple case study analysis part of the process evaluation, exploring how a sub-sample of prison-leavers engaged and responded to the intervention offer of one-to-one support during their re-integration into the community. Methods To understand intervention delivery and what response it elicited in individuals, we used a realist-informed qualitative multiple ‘case’ studies approach. We scrutinised how intervention component delivery lead to outcomes by examining underlying causal pathways or ‘mechanisms’ that promoted or hindered progress towards personal outcomes. ‘Cases’ (n = 24) were prison-leavers from the intervention arm of the trial. We collected practitioner activity logs and conducted semi-structured interviews with prison-leavers and Engager/other service practitioners. We mapped data for each case against the intervention logic model and then used Bhaskar’s (2016) ‘DREIC’ analytic process to categorise cases according to extent of intervention delivery, outcomes evidenced, and contributing factors behind engagement or disengagement and progress achieved. Results There were variations in the dose and session focus of the intervention delivery, and how different participants responded. Participants sustaining long-term engagement and sustained change reached a state of ‘crises but coping’. We found evidence that several components of the intervention were key to achieving this: trusting relationships, therapeutic work delivered well and over time; and an in-depth shared understanding of needs, concerns, and goals between the practitioner and participants. Those who disengaged were in one of the following states: ‘Crises and chaos’, ‘Resigned acceptance’, ‘Honeymoon’ or ‘Wilful withdrawal’. Conclusions We demonstrate that the ‘implementability’ of an intervention can be explained by examining the delivery of core intervention components in relation to the responses elicited in the participants. Core delivery mechanisms often had to be ‘triggered’ numerous times to produce sustained change. The improvements achieved, sustained, and valued by participants were not always reflected in the quantitative measures recorded in the RCT. The compatibility between the practitioner, participant and setting were continually at risk of being undermined by implementation failure as well as changing external circumstances and participants’ own weaknesses. Trial registration number ISRCTN11707331, Wales Research Ethics Committee, Registered 02-04-2016—Retrospectively registered https://doi.org/10.1186/ISRCTN11707331.
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Affiliation(s)
- Lauren Weston
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
- * E-mail:
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Mike Maguire
- Department of Criminology, University of South Wales, Cardiff, United Kingdom
| | - Mark Pearson
- Hull York Medical School, Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Alex Stirzaker
- South West Mental Health Clinical Network, Taunton, United Kingdom
| | | | - Caroline Stevenson
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Jonathan Graham
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lauren Carroll
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Rebecca Greer
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Mark Haddad
- Division of Health Services Research and Management, School of Health Sciences, City, University of London, London, United Kingdom
| | - Rachael Hunter
- Comprehensive Clinical Trials Unit, University College London, London, United Kingdom
| | - Rob Anderson
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Roxanne Todd
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sara Goodier
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Brand
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Susan Michie
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - Tim Kirkpatrick
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Tirril Harris
- Division of Psychology and Language Sciences, Research Department of Clinical, Educational and Health Psychology, Kings College London, London, United Kingdom
| | - William Henley
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Christabel Owens
- Medical School, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, Faculty of Health, University of Plymouth, Plymouth, Devon, United Kingdom
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7
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Barber C, De Souza VA, Paterson RL, Martin‐Urdiroz M, Mulakkal NC, Srikannathasan V, Connolly M, Phillips G, Foong‐Leong T, Pengelly R, Karuppiah V, Grant T, Dembek M, Verma A, Gibbs‐Howe D, Blicher TH, Knox A, Robinson RA, Cole DK, Leonard S. Structure-guided stabilization of pathogen-derived peptide-HLA-E complexes using non-natural amino acids conserves native TCR recognition. Eur J Immunol 2022; 52:618-632. [PMID: 35108401 PMCID: PMC9306587 DOI: 10.1002/eji.202149745] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/26/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022]
Abstract
The nonpolymorphic class Ib molecule, HLA-E, primarily presents peptides from HLA class Ia leader peptides, providing an inhibitory signal to NK cells via CD94/NKG2 interactions. Although peptides of pathogenic origin can also be presented by HLA-E to T cells, the molecular basis underpinning their role in antigen surveillance is largely unknown. Here, we solved a co-complex crystal structure of a TCR with an HLA-E presented peptide (pHLA-E) from bacterial (Mycobacterium tuberculosis) origin, and the first TCR-pHLA-E complex with a noncanonically presented peptide from viral (HIV) origin. The structures provided a molecular foundation to develop a novel method to introduce cysteine traps using non-natural amino acid chemistry that stabilized pHLA-E complexes while maintaining native interface contacts between the TCRs and different pHLA-E complexes. These pHLA-E monomers could be used to isolate pHLA-E-specific T cells, with obvious utility for studying pHLA-E restricted T cells, and for the identification of putative therapeutic TCRs.
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8
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Saeidi H, Opfermann JD, Kam M, Wei S, Leonard S, Hsieh MH, Kang JU, Krieger A. Autonomous robotic laparoscopic surgery for intestinal anastomosis. Sci Robot 2022; 7:eabj2908. [PMID: 35080901 DOI: 10.1126/scirobotics.abj2908] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autonomous robotic surgery has the potential to provide efficacy, safety, and consistency independent of individual surgeon's skill and experience. Autonomous anastomosis is a challenging soft-tissue surgery task because it requires intricate imaging, tissue tracking, and surgical planning techniques, as well as a precise execution via highly adaptable control strategies often in unstructured and deformable environments. In the laparoscopic setting, such surgeries are even more challenging because of the need for high maneuverability and repeatability under motion and vision constraints. Here we describe an enhanced autonomous strategy for laparoscopic soft tissue surgery and demonstrate robotic laparoscopic small bowel anastomosis in phantom and in vivo intestinal tissues. This enhanced autonomous strategy allows the operator to select among autonomously generated surgical plans and the robot executes a wide range of tasks independently. We then use our enhanced autonomous strategy to perform in vivo autonomous robotic laparoscopic surgery for intestinal anastomosis on porcine models over a 1-week survival period. We compared the anastomosis quality criteria-including needle placement corrections, suture spacing, suture bite size, completion time, lumen patency, and leak pressure-of the developed autonomous system, manual laparoscopic surgery, and robot-assisted surgery (RAS). Data from a phantom model indicate that our system outperforms expert surgeons' manual technique and RAS technique in terms of consistency and accuracy. This was also replicated in the in vivo model. These results demonstrate that surgical robots exhibiting high levels of autonomy have the potential to improve consistency, patient outcomes, and access to a standard surgical technique.
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Affiliation(s)
- H Saeidi
- Department of Computer Science, University of North Carolina Wilmington, Wilmington, NC 28403, USA.,Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - J D Opfermann
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - M Kam
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - S Wei
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA.,Department of Electrical and Computer Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - S Leonard
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
| | - M H Hsieh
- Department of Urology, Children's National Hospital, 111 Michigan Ave. N.W., Washington, DC 20010, USA
| | - J U Kang
- Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA.,Department of Electrical and Computer Engineering, Johns Hopkins University; Baltimore, MD 21211, USA
| | - A Krieger
- Department of Mechanical Engineering, Johns Hopkins University; Baltimore, MD 21211, USA.,Laboratory for Computational Sensing and Robotics, Johns Hopkins University; Baltimore, MD 21211, USA
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9
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Edmonds J, Bignell M, Coward P, Leonard S, Wolten E. Managing children's forearm fractures in the emergency department. Emerg Nurse 2022; 30:18-23. [PMID: 34490764 DOI: 10.7748/en.2021.e2099] [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] [Accepted: 06/21/2021] [Indexed: 11/09/2022]
Abstract
Forearm fractures are the most common fractures among children and young people aged up to 19 years and these patients frequently present to the emergency department (ED). Many of these fractures can be treated in the ED without the need for inpatient admission. This article examines the assessment, diagnosis and management of forearm fractures. The authors also use a case study format to demonstrate best practice in the treatment of forearm fractures in this age group. The information in this article will enable ED nurses to enhance the experience of children and their families who present with forearm fractures.
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Affiliation(s)
- Jenny Edmonds
- Children's Emergency Department, Paediatrics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Matilda Bignell
- Children's Emergency Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Phoebe Coward
- Children's Emergency Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Sarah Leonard
- Children's Emergency Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Emma Wolten
- Children's Emergency Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
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10
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Lennox C, Leonard S, Senior J, Hendricks C, Rybczynska-Bunt S, Quinn C, Byng R, Shaw J. Conducting Randomized Controlled Trials of Complex Interventions in Prisons: A Sisyphean Task? Front Psychiatry 2022; 13:839958. [PMID: 35592376 PMCID: PMC9110768 DOI: 10.3389/fpsyt.2022.839958] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 03/29/2022] [Indexed: 11/26/2022] Open
Abstract
Randomized Controlled Trials (RCT) are the "gold standard" for measuring the effectiveness of an intervention. However, they have their limitations and are especially complex in prison settings. Several systematic reviews have highlighted some of the issues, including, institutional constraints e.g., "lock-downs," follow-ups, contamination of allocation conditions and a reliance on self-report measures. In this article, we reflect on our experiences and will describe two RCTs. People in prison are a significantly disadvantaged and vulnerable group, ensuring equitable and effective interventions is key to reducing inequality and promoting positive outcomes. We ask are RCTs of complex interventions in prisons a sisyphean task? We certainly don't think so, but we propose that current accepted practice and research designs may be limiting our understanding and ability to test complex interventions in the real-world context of prisons. RCTs will always have their place, but designs need to be flexible and adaptive, with the development of other rigorous methods for evaluating impact of interventions e.g., non-randomized studies, including pre-post implementation studies. With robust research we can deliver quality evidence-based healthcare in prisons - after all the degree of civilization in a society is revealed by entering its prisons.
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Affiliation(s)
- Charlotte Lennox
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Leonard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Jane Senior
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Caroline Hendricks
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah Rybczynska-Bunt
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Cath Quinn
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Richard Byng
- Community and Primary Care Research Group, University of Plymouth, Plymouth, United Kingdom
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Leonard S, Webb RT, Doyle M, Shaw J. Characteristics of People Returned to Prison From Medium Secure Psychiatric Services in England and Wales: National Cohort Study. Front Psychiatry 2022; 13:881279. [PMID: 35845447 PMCID: PMC9277066 DOI: 10.3389/fpsyt.2022.881279] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Little is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS "prison-transfer" patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too "high risk" to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community. AIM (a) To describe the characteristics of prison-transfers who receive an RMO directed discharge from MSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge. METHODS Prospective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk--20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community. RESULTS Persons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of <6 months. Individuals returned to prison displayed significantly more issues with psychological adjustment at time of discharge, and had a higher risk of future violence and a lower prevalence of protective factors that mitigate subsequent risks of relapse and reoffending. DISCUSSION MSs in England and Wales are returning vulnerable individuals to prison in lieu of adequate aftercare services. The role of and responsibilities of MSSs as regards admissions from prison needs to be reconsidered.
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Affiliation(s)
- Sarah Leonard
- Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom
| | - Roger T Webb
- Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom
| | - Michael Doyle
- Department of Nursing and Midwifery, University of Huddersfield, Huddersfield, United Kingdom
| | - Jennifer Shaw
- Centre for Mental Health and Safety, University of Manchester, Manchester, United Kingdom
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Tumin D, Crotty J, Aikman I, Leonard S. Out of time? Resident scholarly publication and time pressures. Acta Paediatr 2021; 110:1965. [PMID: 33713034 DOI: 10.1111/apa.15831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Dmitry Tumin
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville NC USA
| | - Jennifer Crotty
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville NC USA
- Vidant Medical Center Greenville NC USA
| | - Inga Aikman
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville NC USA
- Vidant Medical Center Greenville NC USA
| | - Sarah Leonard
- Department of Pediatrics Brody School of Medicine at East Carolina University Greenville NC USA
- Vidant Medical Center Greenville NC USA
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13
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Fergusson JR, Wallace Z, Connolly MM, Woon AP, Suckling RJ, Hine DW, Barber C, Bunjobpol W, Choi B, Crespillo S, Dembek M, Dieckmann N, Donoso J, Godinho LF, Grant T, Howe D, McCully ML, Perot C, Sarkar A, Seifert FU, Singh PK, Stegmann KA, Turner B, Verma A, Walker A, Leonard S, Maini MK, Wiederhold K, Dorrell L, Simmons R, Knox A. Immune-Mobilizing Monoclonal T Cell Receptors Mediate Specific and Rapid Elimination of Hepatitis B-Infected Cells. Hepatology 2020; 72:1528-1540. [PMID: 32770836 PMCID: PMC7702151 DOI: 10.1002/hep.31503] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Therapies for chronic hepatitis B virus (HBV) infection are urgently needed because of viral integration, persistence of viral antigen expression, inadequate HBV-specific immune responses, and treatment regimens that require lifelong adherence to suppress the virus. Immune mobilizing monoclonal T Cell receptors against virus (ImmTAV) molecules represent a therapeutic strategy combining an affinity-enhanced T Cell receptor with an anti-CD3 T Cell-activating moiety. This bispecific fusion protein redirects T cells to specifically lyse infected cells expressing the target virus-derived peptides presented by human leukocyte antigen (HLA). APPROACH AND RESULTS ImmTAV molecules specific for HLA-A*02:01-restricted epitopes from HBV envelope, polymerase, and core antigens were engineered. The ability of ImmTAV-Env to activate and redirect polyclonal T cells toward cells containing integrated HBV and cells infected with HBV was assessed using cytokine secretion assays and imaging-based killing assays. Elimination of infected cells was further quantified using a modified fluorescent hybridization of viral RNA assay. Here, we demonstrate that picomolar concentrations of ImmTAV-Env can redirect T cells from healthy and HBV-infected donors toward hepatocellular carcinoma (HCC) cells containing integrated HBV DNA resulting in cytokine release, which could be suppressed by the addition of a corticosteroid in vitro. Importantly, ImmTAV-Env redirection of T cells induced cytolysis of antigen-positive HCC cells and cells infected with HBV in vitro, causing a reduction of hepatitis B e antigen and specific loss of cells expressing viral RNA. CONCLUSIONS The ImmTAV platform has the potential to enable the elimination of infected cells by redirecting endogenous non-HBV-specific T cells, bypassing exhausted HBV-specific T cells. This represents a promising therapeutic option in the treatment of chronic hepatitis B, with our lead candidate now entering trials.
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MESH Headings
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/pharmacology
- Antibodies, Monoclonal/therapeutic use
- CD3 Complex/antagonists & inhibitors
- Cell Line, Tumor
- Epitopes/immunology
- HLA-A2 Antigen/immunology
- Hepatitis B Surface Antigens/immunology
- Hepatitis B virus/immunology
- Hepatitis B virus/isolation & purification
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/immunology
- Hepatitis B, Chronic/virology
- Hepatocytes
- Humans
- Immunoconjugates/genetics
- Immunoconjugates/immunology
- Immunoconjugates/pharmacology
- Immunoconjugates/therapeutic use
- Lymphocyte Activation/drug effects
- Primary Cell Culture
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/immunology
- Receptors, Antigen, T-Cell/therapeutic use
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/immunology
- Recombinant Fusion Proteins/pharmacology
- Recombinant Fusion Proteins/therapeutic use
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Dawn Howe
- Immunocore LtdAbingdonUnited Kingdom
| | | | | | | | | | | | - Kerstin A. Stegmann
- Division of Infection and ImmunityInstitute of Immunity and TransplantationUniversity College LondonLondonUnited Kingdom
| | | | | | | | | | - Mala K. Maini
- Division of Infection and ImmunityInstitute of Immunity and TransplantationUniversity College LondonLondonUnited Kingdom
| | | | - Lucy Dorrell
- Immunocore LtdAbingdonUnited Kingdom
- Nuffield Department of MedicineUniversity of OxfordOxfordUnited Kingdom
- Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUnited Kingdom
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14
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Devine R, Kelada M, Leonard S, Martin D, Walsh J, Breen C, Driver R, Kinsella G, Findlay J, Stephens J. Design, synthesis, and biological evaluation of aryl piperazines with potential as antidiabetic agents via the stimulation of glucose uptake and inhibition of NADH:ubiquinone oxidoreductase. Eur J Med Chem 2020; 202:112416. [DOI: 10.1016/j.ejmech.2020.112416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/18/2022]
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15
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Phibbs C, Lorch S, Schmitt S, Main E, Kozhimannil K, Leonard S, Phibbs C. Racial/Ethnic Disparities in Costs, Length of Stay, and Severity of Severe Maternal Morbidity. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13537] [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: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
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16
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Phibbs C, Leonard S, Kozhimannil K, Main E, Phibbs C, Schmitt S, Lorch S. Expanding the Estimate of the Costs of Severe Maternal Morbidity to Include Readmissions, Physician Fees, and Infant Costs. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13536] [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: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
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17
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Forsyth K, Heathcote L, Senior J, Malik B, Meacock R, Perryman K, Tucker S, Domone R, Carr M, Hayes H, Webb R, Archer-Power L, Dawson A, Leonard S, Challis D, Ware S, Emsley R, Sanders C, Karim S, Fazel S, Hayes A, Burns A, Piper M, Shaw J. Dementia and mild cognitive impairment in prisoners aged over 50 years in England and Wales: a mixed-methods study. Health Serv Deliv Res 2020. [DOI: 10.3310/hsdr08270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
People aged ≥ 50 years constitute the fastest-growing group in the prison population of England and Wales. This population has complex health and social care needs. There is currently no national strategy to guide the development of the many-faceted services required for this vulnerable population; therefore, prisons are responding to the issue with a range of local initiatives that are untested and often susceptible to failure if they are not fully embedded in and securely funded as part of commissioned services.
Objectives
The objectives were to establish the prevalence of dementia and mild cognitive impairment in prisoners in England and Wales and their health and social care needs; validate the six-item cognitive impairment test for routine use in prisons to aid early and consistent identification of older prisoners with possible dementia or mild cognitive impairment; identify gaps in current service provision; understand the first-hand experiences of prisoners living with dementia and mild cognitive impairment; develop a care pathway for prisoners with dementia and mild cognitive impairment; develop dementia and mild cognitive impairment training packages for staff and prisoners; and produce health economic costings for the care pathway and training packages.
Design
This was a mixed-methods study.
Setting
The study setting was prisons in England and Wales.
Participants
Prisoners aged ≥ 50 years and multiagency staff working in prison discipline and health and social care services took part.
Results
Quantitative research estimated that the prevalence rate of suspected dementia and mild cognitive impairment in the prison population of England and Wales is 8%. This equates to 1090 individuals. Only two people (3%) in our sample had a relevant diagnosis in their health-care notes, suggesting current under-recognition of these conditions. The prevalence rate in prisons was approximately two times higher among individuals aged 60–69 years and four times higher among those aged ≥ 70 years than among those in the same age groups living in the community. The Montreal Cognitive Assessment screening test was found to be more effective than the six-item cognitive impairment test assessment in the older prisoner population. Qualitative research determined that staff and prisoners lacked training in knowledge and awareness of dementia and mild cognitive impairment, and this leads to problematic behaviour being viewed as a disciplinary issue rather than a health issue. Local initiatives to improve the lives of prisoners with dementia and mild cognitive impairment are often disadvantaged by not being part of commissioned services, making them difficult to sustain. Multidisciplinary working is hampered by agencies continuing to work in silos, with inadequate communication across professional boundaries. A step-by-step care pathway for prisoners with dementia and mild cognitive impairment was developed, and two tiers of training materials were produced for staff and prisoners.
Limitations
Our prevalence rate was based on the results of a standardised assessment tool, rather than on clinical diagnosis by a mental health professional, and therefore it may represent an overestimation. Furthermore, we were unable to distinguish subcategories of dementia. We were also unable to distinguish between a likely diagnosis of dementia and other conditions presenting with mild cognitive impairment, including learning disability, severe depression and hearing impairment. Questionnaires regarding current service provision were collected over an extended period of time, so they do not reflect a ‘snapshot’ of service provision at a particular point.
Conclusions
We hypothesise that implementing the step-by-step care pathway and the training resources developed in this study will improve the care of older prisoners with dementia and mild cognitive impairment.
Future work
The care pathway and training materials should be evaluated in situ. Alternatives to prison for those with dementia or mild cognitive impairment should be developed and evaluated.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 27. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katrina Forsyth
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Leanne Heathcote
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Jane Senior
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Baber Malik
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Katherine Perryman
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Sue Tucker
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Rachel Domone
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Matthew Carr
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Helen Hayes
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Roger Webb
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Laura Archer-Power
- Cheshire and Greater Manchester Community Rehabilitation Company, Manchester, UK
| | - Alice Dawson
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Sarah Leonard
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - David Challis
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stuart Ware
- Restore Support Network, Exeter Council for Voluntary Service, Exeter, UK
| | - Richard Emsley
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Caroline Sanders
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Salman Karim
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Adrian Hayes
- Avon and Wiltshire Mental Health Partnership NHS Trust, Bath, UK
| | - Alistair Burns
- Offender Health Research Network, University of Manchester, Manchester, UK
| | - Mary Piper
- Restore Support Network, Exeter Council for Voluntary Service, Exeter, UK
| | - Jenny Shaw
- Offender Health Research Network, University of Manchester, Manchester, UK
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18
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McDonnell S, Nelson PA, Leonard S, McGale B, Chew-Graham CA, Kapur N, Shaw J, Smith S, Cordingley L. Evaluation of the Impact of the PABBS Suicide Bereavement Training on Clinicians' Knowledge and Skills. Crisis 2020; 41:351-358. [PMID: 31918582 PMCID: PMC8208499 DOI: 10.1027/0227-5910/a000646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Health-care professionals do not routinely receive training on how best to support parents bereaved by suicide. Evidence-based training - Postvention Assisting Those Bereaved by Suicide (PABBS) - was designed to address this gap. Aims: The study aimed (a) to pilot PABBS training and evaluate its perceived effectiveness (impact on self-reported knowledge, skills and confidence) in managing suicide bereavement; and (b) to explore training acceptability. Method: A pre- and postevaluation design was used. Professionals attended intensive, structured 1-day PABBS training comprising: didactic/interactive teaching; practice-orientated activities supported with real-life materials and a manual/workbook. Evaluation forms completed immediately before and after training analyzed: (a) self-reported changes in knowledge, skills, and confidence (perceived effectiveness of training); and (b) the acceptability of training. Results: In total, 62 professionals completed training. Perceived knowledge, skills, and confidence improved after training as did self-reported understanding, motivation to learn more, and intention to change practice. Training was highly rated, particularly the evidence-based, real-life materials, with some suggestions for improvement. Limitations: Self-selected sample and reliance on self-report measures are the study's limitations. Conclusion: PABBS training may help address gaps in professionals' capacity to support parents bereaved by suicide. The evidence-based content was highly acceptable and appeared to be a key ingredient in effecting self-reported changes in attitudes/intentions.
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Affiliation(s)
- Sharon McDonnell
- The Centre for Mental Health and Safety, The University of Manchester, UK.,Suicide Bereavement UK, Manchester, UK
| | - Pauline A Nelson
- Alliance Manchester Business School, The University of Manchester, UK
| | - Sarah Leonard
- The Centre for Mental Health and Safety, The University of Manchester, UK
| | | | - Carolyn A Chew-Graham
- Primary Care and Health Sciences, Keele University, UK.,West Midlands CLAHRC, Coventry, UK
| | - Nav Kapur
- The Centre for Mental Health and Safety, The University of Manchester, UK.,Greater Manchester Mental Health Trust, Manchester, UK.,NIHR Patient Safety Translational Research Centre, The University of Manchester, UK
| | - Jenny Shaw
- The Centre for Mental Health and Safety, The University of Manchester, UK
| | | | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Research and Manchester Biomedical Research Centre, University of Manchester, UK
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19
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Larkin S, Leonard S, Zuchora A. Commissioning process for high dose rate prostate brachytherapy. Phys Med 2019. [DOI: 10.1016/j.ejmp.2019.09.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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20
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Saeidi H, Ge J, Kam M, Opfermann JD, Leonard S, Joshi AS, Krieger A. Supervised Autonomous Electrosurgery via Biocompatible Near-Infrared Tissue Tracking Techniques. IEEE Trans Med Robot Bionics 2019; 1:228-236. [PMID: 33458603 PMCID: PMC7810241 DOI: 10.1109/tmrb.2019.2949870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Autonomous robotic surgery systems aim to improve patient outcomes by leveraging the repeatability and consistency of automation and also reducing human induced errors. However, intraoperative autonomous soft tissue tracking and robot control still remains a challenge due to the lack of structure, and high deformability of such tissues. In this paper, we take advantage of biocompatible Near-Infrared (NIR) marking methods and develop a supervised autonomous 3D path planning, filtering, and control strategy for our Smart Tissue Autonomous Robot (STAR) to enable precise and consistent incisions on complex 3D soft tissues. Our experimental results on cadaver porcine tongue samples indicate that the proposed strategy reduces surface incision error and depth incision error by 40.03% and 51.5%, respectively, compared to a teleoperation strategy via da Vinci. Furthermore, compared to an autonomous path planning method with linear interpolation between the NIR markers, the proposed strategy reduces the incision depth error by 48.58% by taking advantage of 3D tissue surface information.
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Affiliation(s)
- H. Saeidi
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - J. Ge
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - M. Kam
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
| | - J. D. Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - S. Leonard
- Electrical and Computer Science Eng. Dept., Johns Hopkins University, Baltimore, MD 21211
| | - A. S. Joshi
- Division of Otolaryngology - Head & Neck Surgery at The George Washington University Medical Faculty Associates, 2300 M St. NW 4th Floor, Washington DC 20037
| | - A. Krieger
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA., Fischell Institute for Biomedical Devices and the Marlene and Stewart Greenebaum Cancer Center
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21
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Kam M, Saeidi H, Wei S, Opfermann JD, Leonard S, Hsieh MH, Kang JU, Krieger A. Semi-autonomous Robotic Anastomoses of Vaginal Cuffs Using Marker Enhanced 3D Imaging and Path Planning. Med Image Comput Comput Assist Interv 2019; 11768:65-73. [PMID: 33521798 PMCID: PMC7841647 DOI: 10.1007/978-3-030-32254-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Autonomous robotic anastomosis has the potential to improve surgical outcomes by performing more consistent suture spacing and bite size compared to manual anastomosis. However, due to soft tissue's irregular shape and unpredictable deformation, performing autonomous robotic anastomosis without continuous tissue detection and three-dimensional path planning strategies remains a challenging task. In this paper, we present a novel three-dimensional path planning algorithm for Smart Tissue Autonomous Robot (STAR) to enable semi-autonomous robotic anastomosis on deformable tissue. The algorithm incorporates (i) continuous detection of 3D near infrared (NIR) markers manually placed on deformable tissue before the procedure, (ii) generating a uniform and consistent suture placement plan using 3D path planning methods based on the locations of the NIR markers, and (iii) updating the remaining suture plan after each completed stitch using a non-rigid registration technique to account for tissue deformation during anastomosis. We evaluate the path planning algorithm for accuracy and consistency by comparing the anastomosis of synthetic vaginal cuff tissue completed by STAR and a surgeon. Our test results indicate that STAR using the proposed method achieves 2.6 times better consistency in suture spacing and 2.4 times better consistency in suture bite sizes than the manual anastomosis.
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Affiliation(s)
- M Kam
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - H Saeidi
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - S Wei
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211, USA
| | - J D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue N.W., Washington, DC 20010, USA
| | - S Leonard
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211, USA
| | - M H Hsieh
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, 111 Michigan Avenue N.W., Washington, DC 20010, USA
| | - J U Kang
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211, USA
| | - A Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
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Bradbury K, Wagner A, Leonard S, Williams C, Piantino J, Luther M, Hall T. B-54 Insights into a Novel Integrated Screening Clinic: Parent Perceptions of Emotional Functioning in Acute Recovery Phase Following Pediatric Neurocritical Care. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Children with traumatic brain injury (TBI) requiring neurocritical care are at high risk for neurocognitive, emotional, physical, and psychosocial difficulties, collectively known as Post-Intensive Care Syndrome. Our study sought to characterize parent ratings of emotional functioning in the acute recovery phase based upon mechanism of injury.
Method
Twenty children (Mdn = 12.6 years, IQR = 9-15; 65% male) were screened as part of a multidisciplinary follow-up clinic 1-month following hospital discharge. Emotional functioning was assessed using PROMIS Parent Proxy Report for Anxiety and Depression. A brief neurocognitive battery estimated presence of cognitive impairment. MANCOVA was used to compare emotional functioning across injury mechanism (high velocity injury [HVI], 65%; fall, 35%).
Results
Groups did not differ on age, gender, and presence of cognitive impairment. After controlling for severity, mechanism of injury had a significant effect on both anxiety (p = .026) and depression (p = .004). The HVI group had mildly elevated anxiety (M = 50.5, SD = 12.2) and depression (M = 54.2, SD = 10.6) scores, while the fall group had anxiety (M = 38.0, SD = 6.2) and depression (M = 39.0, SD = 7.3) scores within normal limits.
Conclusions
In the acute recovery phase following TBI, anxiety and depression symptoms are more common after HVI than falls, even when controlling for severity of injury. The HVI group includes injuries resulting from motor vehicle accidents which may have a broader impact on the family and may explain higher rates of emotional distress in this patient group compared to other mechanisms of TBI. Additional research is needed to further explore variables related to emotional functioning following TBI and how they change over the course of recovery.
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Saeidi H, Le HND, Opfermann JD, Leonard S, Kim A, Hsieh MH, Kang JU, Krieger A. Autonomous Laparoscopic Robotic Suturing with a Novel Actuated Suturing Tool and 3D Endoscope. IEEE Int Conf Robot Autom 2019; 2019:1541-1547. [PMID: 33628614 PMCID: PMC7901147 DOI: 10.1109/icra.2019.8794306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Compared to open surgical techniques, laparoscopic surgical methods aim to reduce the collateral tissue damage and hence decrease the patient recovery time. However, constraints imposed by the laparoscopic surgery, i.e. the operation of surgical tools in limited spaces, turn simple surgical tasks such as suturing into time-consuming and inconsistent tasks for surgeons. In this paper, we develop an autonomous laparoscopic robotic suturing system. More specific, we expand our smart tissue anastomosis robot (STAR) by developing i) a new 3D imaging endoscope, ii) a novel actuated laparoscopic suturing tool, and iii) a suture planning strategy for the autonomous suturing. We experimentally test the accuracy and consistency of our developed system and compare it to sutures performed manually by surgeons. Our test results on suture pads indicate that STAR can reach 2.9 times better consistency in suture spacing compared to manual method and also eliminate suture repositioning and adjustments. Moreover, the consistency of suture bite sizes obtained by STAR matches with those obtained by manual suturing.
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Affiliation(s)
- H Saeidi
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
| | - H N D Le
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - J D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - S Leonard
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - A Kim
- University of Maryland School of Medicine, 655 W Baltimore S, Baltimore, MD 21201
| | - M H Hsieh
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010
| | - J U Kang
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211
| | - A Krieger
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA
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Saeidi H, Opfermann JD, Kam M, Raghunathan S, Leonard S, Krieger A. A Confidence-Based Shared Control Strategy for the Smart Tissue Autonomous Robot (STAR). Rep U S 2019; 2018:1268-1275. [PMID: 31475075 DOI: 10.1109/iros.2018.8594290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Autonomous robotic assisted surgery (RAS) systems aim to reduce human errors and improve patient outcomes leveraging robotic accuracy and repeatability during surgical procedures. However, full automation of RAS in complex surgical environments is still not feasible and collaboration with the surgeon is required for safe and effective use. In this work, we utilize our Smart Tissue Autonomous Robot (STAR) to develop and evaluate a shared control strategy for the collaboration of the robot with a human operator in surgical scenarios. We consider 2D pattern cutting tasks with partial blood occlusion of the cutting pattern using a robotic electrocautery tool. For this surgical task and RAS system, we i) develop a confidence-based shared control strategy, ii) assess the pattern tracking performances of manual and autonomous controls and identify the confidence models for human and robot as well as a confidence-based control allocation function, and iii) experimentally evaluate the accuracy of our proposed shared control strategy. In our experiments on porcine fat samples, by combining the best elements of autonomous robot controller with complementary skills of a human operator, our proposed control strategy improved the cutting accuracy by 6.4%, while reducing the operator work time to 44 % compared to a pure manual control.
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Affiliation(s)
- H Saeidi
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA. , , ,
| | - Justin D Opfermann
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Childrens National Health System, 111 Michigan Ave. N.W., Washington, DC 20010.
| | - Michael Kam
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA. , , ,
| | - Sudarshan Raghunathan
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA. , , ,
| | - S Leonard
- Electrical and Computer Science Engineering Department, Johns Hopkins University, Baltimore, MD 21211.
| | - A Krieger
- Mechanical Engineering Department, University of Maryland, College Park, MD 20742, USA. , , ,
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Anderson LM, Leonard S, Jonassaint J, Lunyera J, Bonner M, Shah N. Mobile health intervention for youth with sickle cell disease: Impact on adherence, disease knowledge, and quality of life. Pediatr Blood Cancer 2018; 65:e27081. [PMID: 29693797 DOI: 10.1002/pbc.27081] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/25/2018] [Accepted: 03/06/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Adherence to illness self-management among youth with sickle cell disease (SCD) positively impacts health outcomes and decreases overall healthcare costs. Despite this, children with SCD face several barriers to adherence, with adherence rates that remain moderate to low. The current feasibility study examined the Intensive Training Program (ITP), a mobile health (mHealth) intervention for youth with SCD designed to promote disease knowledge, adherence, and patient-provider communication. PROCEDURE Youth with SCD prescribed hydroxyurea between ages 7-18 completed baseline disease knowledge and psychosocial assessments and then were provided with the ITP app. Youth participated in the 90-day ITP, during which they completed three education modules, tracked adherence through daily self-recorded videos on the app, and received video messages from providers. Participants completed poststudy knowledge, psychosocial, and feasibility questionnaires. Medication possession ratio (MPR) was obtained via pharmacy-refill rates. RESULTS Thirty-two youths (mean age = 13.0 years) participated, with an average adherence tracking rate of 0.6 (standard deviation = 0.34). All participants demonstrated increased MPR (0.57-0.74, P < 0.001, d = 0.75) and disease knowledge (59.6-88.6%, P < 0.001). There was variable engagement in the ITP; completers demonstrated significantly better SCD-related functioning (P < 0.05), higher parent-reported treatment functioning (P < 0.05), and lower pain impact than noncompleters of the ITP (P < 0.05). CONCLUSIONS Results support the ITP can feasibly be implemented to promote adherence among youth with SCD. All participants demonstrated increased adherence and disease knowledge. However, there was variable engagement and only intervention completers showed improvements in psychosocial outcomes. Further research is needed to evaluate long-term outcomes and ways to promote engagement in mHealth interventions among the youth.
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Affiliation(s)
- Lindsay M Anderson
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Sarah Leonard
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina.,Department of Pediatrics, Eastern Carolina University, Greenville, North Carolina
| | - Jude Jonassaint
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Joseph Lunyera
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Melanie Bonner
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Nirmish Shah
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
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Pritchard W, Woods D, Leonard S, Esparza-Trujillo J, Bakhutashvili I, Mikhail A, Levy E, Krishnasamy V, Karanian J, Wood B. 4:03 PM Abstract No. 319 Development and use of the common woodchuck as a model for treatment of hepatocellular carcinoma. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
Telepsychiatry is the delivery of healthcare and the exchange of healthcare information for purposes of providing psychiatric services across distances (Yellowlees et al, 2003). In practice, this most often means an interaction between a patient and clinician who are in different sites, through the use of transmitted live sound and video images. The term telepsychiatry was first used by Dwyer in 1973 who described the use of closed-circuit television at Massachusetts General Hospital for consultations between psychiatrists and patients. However, telemedicine was pioneered at the Nebraska Psychiatric Institute nearly 20 years earlier (Wittson & Dutton, 1956).
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28
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Palmio J, Leonard S, Sacconi S, Savarese M, Semmler A, Bach J, Kress W, Mozaffar T, Lai T, Stojkovic T, Schoser B, Walter M, Reisin R, Berardo A, Attarian S, Urtizberea A, Fatehi F, Hackman P, Udd B. Expanding importance of HMERF titinopathy: new mutations and clinical aspects. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pounds R, Leonard S, Dawson C, Kehoe S. Repurposing itraconazole for the treatment of cancer. Oncol Lett 2017; 14:2587-2597. [PMID: 28927025 DOI: 10.3892/ol.2017.6569] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 01/14/2017] [Accepted: 04/06/2017] [Indexed: 12/21/2022] Open
Abstract
The repurposing of drugs is becoming increasingly attractive as it avoids the lengthy process and cost implications associated with bringing a novel drug to market. Itraconazole is a broad-spectrum anti-fungal agent. An emerging body of in vivo, in vitro and clinical evidence have confirmed that it also possesses antineoplastic activities and has a synergistic action when combined with other chemotherapeutic agents. It acts via several mechanisms to prevent tumour growth, including inhibition of the Hedgehog pathway, prevention of angiogenesis, decreased endothelial cell proliferation, cell cycle arrest and induction of auto-phagocytosis. These allow itraconazole, either alone or in combination with other cytotoxic agents, to increase drug efficacy and overcome drug resistance. This study reviews the reported literature on the use of itraconazole in a variety of malignancies and highlights the recent insights into the critical pathways acted upon to prevent tumour growth.
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Affiliation(s)
- Rachel Pounds
- Obstetrics and Gynaecology Department, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, United Kingdom
| | - Sarah Leonard
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Christopher Dawson
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Sean Kehoe
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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Espelin C, Geretti E, Coma S, Koncki Z, Leonard S, Dumont N, Reynolds J, Molnar I, Wickham T. Abstract P3-06-05: Receptor-mediated binding of HER2-targeted antibody-liposomal doxorubicin conjugate MM-302 increases liposome binding, nuclear doxorubicin, DNA damage and efficacy relative to untargeted PEGylated liposomal doxorubicin (PLD/Doxil). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-06-05] [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: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- C Espelin
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - E Geretti
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - S Coma
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - Z Koncki
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - S Leonard
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - N Dumont
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - J Reynolds
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - I Molnar
- Merrimack Pharmaceuticals Inc., Cambridge, MA
| | - T Wickham
- Merrimack Pharmaceuticals Inc., Cambridge, MA
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Abstract
Prisoners are not typical of the general population with regard to their health needs, as they have a disproportionately high incidence of mental health problems and drug misuse. Health-care delivery in prison faces a significant number of challenges not experienced by other health-care organizations. Telepsychiatry is one strategy to improve the accessibility and quality of mental health-care in the prison setting. Despite some initial challenges, a telepsychiatry service was successfully established between a medium-secure unit in Fareham, Hampshire, and a category B training prison on the Isle of Wight. A low-cost, PC-based videoconferencing system was used, connected by ISDN lines at 128 kbit/s. A valuable lesson that was learnt was the importance of having the support of key individuals in a prison setting.
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Affiliation(s)
- Sarah Leonard
- School of Nursing and Midwifery, University of Southampton, and Ravenswood House, Medium Secure Service, Fareham, UK.
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Leonard S, Pereira M, Fox R, Gordon N, Yap J, Kehoe S, Luesley D, Woodman C, Ganesan R. Over-expression of DNMT3A predicts the risk of recurrent vulvar squamous cell carcinomas. Gynecol Oncol 2016; 143:414-420. [PMID: 27623253 DOI: 10.1016/j.ygyno.2016.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cancer initiation and progression has been linked to aberrant expression of the DNA methyltransferases (DNMT), the enzymes which establish and maintain DNA methylation patterns throughout the genome. In this study, we investigated if DNMT expression in vulvar squamous cell carcinomas (VSCC) was related to clinical outcome. METHODS DNMT1, DNMT3A and DNMT3B expression was measured in a subset of cases drawn from a cohort of consecutive women treated for primary VSCC at the Pan Birmingham Gynaecological Cancer Centre between 2001 and 2008. Univariable and multivariable competing risk modelling was performed to identify whether DNMT expression was associated with local disease recurrence or disease morbidity. RESULTS Over-expression of DNMT3A in the invasive component of the tumour was seen in 44% of tumours and was associated with an increased risk of local vulvar recurrence (LVR) (HR=4.51, p=0.012). This risk was found to increase further after adjustment for disease stage (HR=6.00, p=0.003) and groin node metastasis (HR=4.81, p=0.008). Over-expression of DNMT3B was associated with an increased risk of LVR (HR=5.69 p=0.03), however this ceased to be significant after adjustment for groin node metastasis. In a subset analysis, over-expression of DNMT3A was found to be significantly more common in VSCCs that stained negative for CDKN2A. CONCLUSIONS These observations are consistent with the possibility that epigenetic changes contribute to vulvar neoplasia and DNMT3A over-expression may be useful in predicting local disease recurrence.
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Affiliation(s)
- Sarah Leonard
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Merlin Pereira
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Richard Fox
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Naheema Gordon
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Jason Yap
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Sean Kehoe
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - David Luesley
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Ciaran Woodman
- Institute of Cancer and Genomic Sciences, College of Dental and Medical School, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Raji Ganesan
- Birmingham Women's NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2TG, United Kingdom.
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Ma YT, Leonard S, Gordon N, Anderton J, Huen D, Woodman C, Palmer DH. A haploid genetic screen identifies the key determinant of response to novel combination therapy with gemcitabine and entinostat in pancreatic cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15685] [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: 11/20/2022] Open
Affiliation(s)
- Yuk Ting Ma
- University of Birmingham, Birmingham, United Kingdom
| | - Sarah Leonard
- University of Birmingham, Birmingham, United Kingdom
| | | | | | - David Huen
- University of Wolverhampton, Wolverhampton, United Kingdom
| | | | - Daniel H. Palmer
- University of Liverpool Cancer Research UK Centre, Liverpool, United Kingdom
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Castro M, Leonard S, Celik H, Wakim P, Karanian J, Pritchard W, Borys N, Lencioni R, O’Neal M, Tak W, Wood B. Do geometric features of hepatocellular carcinomas correlate with survival following radiofrequency ablation (RFA) with and without lyso-thermosensitive liposomal doxorubicin (LTLD/Thermodox)? J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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Higginson IJ, Rumble C, Shipman C, Koffman J, Sleeman KE, Morgan M, Hopkins P, Noble J, Bernal W, Leonard S, Dampier O, Prentice W, Burman R, Costantini M. The value of uncertainty in critical illness? An ethnographic study of patterns and conflicts in care and decision-making trajectories. BMC Anesthesiol 2016; 16:11. [PMID: 26860461 PMCID: PMC4746769 DOI: 10.1186/s12871-016-0177-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 02/01/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND With increasingly intensive treatments and population ageing, more people face complex treatment and care decisions. We explored patterns of the decision-making processes during critical care, and sources of conflict and resolution. METHODS Ethnographic study in two Intensive Care Units (ICUs) in an inner city hospital comprising: non-participant observation of general care and decisions, followed by case studies where treatment limitation decisions, comfort care and/or end of life discussions were occurring. These involved: semi-structured interviews with consenting families, where possible, patients; direct observations of care; and review of medical records. RESULTS Initial non-participant observation included daytime, evenings, nights and weekends. The cases were 16 patients with varied diagnoses, aged 19-87 years; 19 family members were interviewed, aged 30-73 years. Cases were observed for <1 to 156 days (median 22), depending on length of ICU admission. Decisions were made serially over the whole trajectory, usually several days or weeks. We identified four trajectories with distinct patterns: curative care from admission; oscillating curative and comfort care; shift to comfort care; comfort care from admission. Some families considered decision-making a negative concept and preferred uncertainty. Conflict occurred most commonly in the trajectories with oscillating curative and comfort care. Conflict also occurred inside clinical teams. Families were most often involved in decision-making regarding care outcomes and seemed to find it easier when patients switched definitively from curative to comfort care. We found eight categories of decision-making; three related to the care outcomes (aim, place, response to needs) and five to the care processes (resuscitation, decision support, medications/fluids, monitoring/interventions, other specialty involvement). CONCLUSIONS Decision-making in critical illness involves a web of discussions regarding the potential outcomes and processes of care, across the whole disease trajectory. When measures oscillate between curative and comfort there is greatest conflict. This suggests a need to support early communication, especially around values and preferred care outcomes, from which other decisions follow, including DNAR. Offering further support, possibly with expert palliative care, communication, and discussion of 'trial of treatment' may be beneficial at this time, rather than waiting until the 'end of life'.
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Affiliation(s)
- I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
| | - C Rumble
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - C Shipman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - J Koffman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - K E Sleeman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - M Morgan
- King's College London, Department of Primary Care and Public Health Sciences, Capital House, London Bridge, London, UK
| | - P Hopkins
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - J Noble
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - W Bernal
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - S Leonard
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - O Dampier
- King's College Hospital, King's Critical Care, Denmark Hill, London, UK
| | - W Prentice
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - R Burman
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - M Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
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Reiter A, Leonard S, Sinha A, Ishii M, Taylor RH, Hager GD. Endoscopic-CT: Learning-Based Photometric Reconstruction for Endoscopic Sinus Surgery. Proc SPIE Int Soc Opt Eng 2016; 9784:978418. [PMID: 29225399 PMCID: PMC5720356 DOI: 10.1117/12.2216296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
In this work we present a method for dense reconstruction of anatomical structures using white light endoscopic imagery based on a learning process that estimates a mapping between light reflectance and surface geometry. Our method is unique in that few unrealistic assumptions are considered (i.e., we do not assume a Lambertian reflectance model nor do we assume a point light source) and we learn a model on a per-patient basis, thus increasing the accuracy and extensibility to different endoscopic sequences. The proposed method assumes accurate video-CT registration through a combination of Structure-from-Motion (SfM) and Trimmed-ICP, and then uses the registered 3D structure and motion to generate training data with which to learn a multivariate regression of observed pixel values to known 3D surface geometry. We demonstrate with a non-linear regression technique using a neural network towards estimating depth images and surface normal maps, resulting in high-resolution spatial 3D reconstructions to an average error of 0.53mm (on the low side, when anatomy matches the CT precisely) to 1.12mm (on the high side, when the presence of liquids causes scene geometry that is not present in the CT for evaluation). Our results are exhibited on patient data and validated with associated CT scans. In total, we processed 206 total endoscopic images from patient data, where each image yields approximately 1 million reconstructed 3D points per image.
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Affiliation(s)
- A Reiter
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - S Leonard
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - A Sinha
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - M Ishii
- Johns Hopkins Medical Institutions, Dept. of Otolaryngology - Head and Neck Surgery, Baltimore, MD, USA
| | - R H Taylor
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
| | - G D Hager
- Johns Hopkins University, Dept. of Computer Science, Baltimore, MD, USA
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37
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Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, Brindle M, Wright N, Heeney MM, Smithers CJ, Brown RL, Kalfa T, Langer JC, Cada M, Oldham KT, Scott JP, St Peter SD, Sharma M, Davidoff AM, Nottage K, Bernabe K, Wilson DB, Dutta S, Glader B, Crary SE, Dassinger MS, Dunbar L, Islam S, Kumar M, Rescorla F, Bruch S, Campbell A, Austin M, Sidonio R, Blakely ML, Rice HE. Hematologic outcomes after total splenectomy and partial splenectomy for congenital hemolytic anemia. J Pediatr Surg 2016; 51:122-7. [PMID: 26613837 PMCID: PMC5083068 DOI: 10.1016/j.jpedsurg.2015.10.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). METHODS The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. Using random effects mixed modeling, we evaluated the association of operative type with change in hemoglobin, reticulocyte counts, and bilirubin. We also compared laparoscopic to open splenectomy. RESULTS The analysis included 130 children, with 62.3% (n=81) undergoing TS. For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. Hematologic parameters also improved after PS, although the response was less robust (hemoglobin increase 2.4 g/dl, p<0.001). For children with SCD, there was no change in hemoglobin. Laparoscopy was not associated with differences in hematologic outcomes compared to open. TS and laparoscopy were associated with shorter length of stay. CONCLUSION Children with HS have an excellent hematologic response after TS or PS, although the hematologic response is more robust following TS. Children with SCD have smaller changes in their hematologic parameters. These data offer guidance to families and clinicians considering TS or PS.
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Affiliation(s)
- Brian R. Englum
- Duke University Medical Center, Durham, NC, United States,Corresponding author at: Duke University Medical Center, DUMC, Box #3443, Durham, NC 27710-0001, United States. Tel.: +1 317 213 2360
| | | | - Sarah Leonard
- Duke University Medical Center, Durham, NC, United States
| | - Audra Reiter
- Duke University Medical Center, Durham, NC, United States
| | | | - Mary Brindle
- Calgary Children’s Hospital, Calgary, AB, Canada
| | | | | | | | | | - Theodosia Kalfa
- Cincinnati Children’s Medical Center, Cincinnati, OH, United States
| | | | | | | | - J. Paul Scott
- Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Mukta Sharma
- Children’s Mercy Hospital, Kansas City, MO, United States
| | | | - Kerri Nottage
- St. Jude Children’s Research Hospital, Memphis, TN, United States
| | | | | | | | | | | | | | - Levette Dunbar
- University of Arkansas, Little Rock, AR, United States,University of Florida, Gainesville, FL, United States
| | - Saleem Islam
- University of Florida, Gainesville, FL, United States
| | | | - Fred Rescorla
- University of Indiana, Indianapolis, IN, United States
| | - Steve Bruch
- University of Michigan, Ann Arbor, MI, United States
| | | | - Mary Austin
- University of Texas/MD Anderson Cancer Center, Houston, TX, United States
| | | | | | - Henry E. Rice
- Duke University Medical Center, Durham, NC, United States
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Otake Y, Leonard S, Reiter A, Rajan P, Siewerdsen JH, Gallia GL, Ishii M, Taylor RH, Hager GD. Rendering-Based Video-CT Registration with Physical Constraints for Image-Guided Endoscopic Sinus Surgery. Proc SPIE Int Soc Opt Eng 2015; 9415. [PMID: 25991876 DOI: 10.1117/12.2081732] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
We present a system for registering the coordinate frame of an endoscope to pre- or intra- operatively acquired CT data based on optimizing the similarity metric between an endoscopic image and an image predicted via rendering of CT. Our method is robust and semi-automatic because it takes account of physical constraints, specifically, collisions between the endoscope and the anatomy, to initialize and constrain the search. The proposed optimization method is based on a stochastic optimization algorithm that evaluates a large number of similarity metric functions in parallel on a graphics processing unit. Images from a cadaver and a patient were used for evaluation. The registration error was 0.83 mm and 1.97 mm for cadaver and patient images respectively. The average registration time for 60 trials was 4.4 seconds. The patient study demonstrated robustness of the proposed algorithm against a moderate anatomical deformation.
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Affiliation(s)
- Y Otake
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA ; Graduate School of Information Science, Nara Institute of Science and Technology, Nara, Japan
| | - S Leonard
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - A Reiter
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - P Rajan
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - J H Siewerdsen
- Department of Boimedical Engineering, Johns Hopkins University, Baltimore MD, USA
| | - G L Gallia
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore MD, USA
| | - M Ishii
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore MD, USA
| | - R H Taylor
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
| | - G D Hager
- Department of Computer Science, Johns Hopkins University, Baltimore MD, USA
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Rice HE, Englum BR, Rothman J, Leonard S, Reiter A, Thornburg C, Brindle M, Wright N, Heeney MM, Smithers C, Brown RL, Kalfa T, Langer JC, Cada M, Oldham KT, Scott JP, St. Peter S, Sharma M, Davidoff AM, Nottage K, Bernabe K, Wilson DB, Dutta S, Glader B, Crary SE, Dassinger MS, Dunbar L, Islam S, Kumar M, Rescorla F, Bruch S, Campbell A, Austin M, Sidonio R, Blakely ML. Clinical outcomes of splenectomy in children: report of the splenectomy in congenital hemolytic anemia registry. Am J Hematol 2015; 90:187-92. [PMID: 25382665 DOI: 10.1002/ajh.23888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 10/29/2014] [Indexed: 11/10/2022]
Abstract
The outcomes of children with congenital hemolytic anemia (CHA) undergoing total splenectomy (TS) or partial splenectomy (PS) remain unclear. In this study, we collected data from 100 children with CHA who underwent TS or PS from 2005 to 2013 at 16 sites in the Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium using a patient registry. We analyzed demographics and baseline clinical status, operative details, and outcomes at 4, 24, and 52 weeks after surgery. Results were summarized as hematologic outcomes, short-term adverse events (AEs) (≤30 days after surgery), and long-term AEs (31-365 days after surgery). For children with hereditary spherocytosis, after surgery there was an increase in hemoglobin (baseline 10.1 ± 1.8 g/dl, 52 week 12.8 ± 1.6 g/dl; mean ± SD), decrease in reticulocyte and bilirubin as well as control of symptoms. Children with sickle cell disease had control of clinical symptoms after surgery, but had no change in hematologic parameters. There was an 11% rate of short-term AEs and 11% rate of long-term AEs. As we accumulate more subjects and longer follow-up, use of a patient registry should enhance our capacity for clinical trials and engage all stakeholders in the decision-making process.
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Affiliation(s)
- Henry E. Rice
- Duke University Medical Center; Durham North Carolina
| | | | | | - Sarah Leonard
- Duke University Medical Center; Durham North Carolina
| | - Audra Reiter
- Duke University Medical Center; Durham North Carolina
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kerri Nottage
- St. Jude Children's Research Hospital; Memphis Tennessee
| | | | | | | | | | | | | | | | | | | | | | | | | | - Mary Austin
- University of Texas/MD Anderson Cancer Center; Houston Texas
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Lecouteux-Glomot K, Chubilleau C, Leonard S, Le Grusse P, Mandart E, Defossez G, Ingrand P, Ben-Brik E. Maladie de Parkinson et produits phytosanitaires : apport de la consultation de pathologies professionnelles et environnementales de Poitiers dans la caractérisation des matières actives d’intérêt. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2014.03.083] [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: 11/25/2022]
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Ekambaram P, Jayachandran T, Venkatraman U, Leonard S. Preeclamptic cord blood hemolysis and the effect of Monascus purpureus and Saccharomyces cerevisiae in modulating preeclamptic stress. ACTA ACUST UNITED AC 2014; 114:508-13. [PMID: 24020706 DOI: 10.4149/bll_2013_106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preeclampsia is associated with impaired antioxidant defense that results in materno- fetal complications. In addition to antioxidant deficiency, hemolytic disorder has also been observed in preeclamptic mother. METHODS This study aims in analyzing the fetal complications using cord blood RBC (red blood cell); further the antihemolytic and antioxidant efficiency of two common probiotic yeasts Monascus purpureus and Saccharomyces cerevisiae in preeclamptic and normotensive RBCs were assessed. RESULTS There was a significant decrease in the antioxidant status (p<0.05) with increased oxidative stress, nitrative stress (p<0.05) and hemolysis (p<0.001) in preeclamptic RBC comparatively. M. purpureus demonstrated a highly significant reactive oxygen radical scavenging activity (p<0.001) whereas S. cerevisiae exhibited a highly significant nitric oxide radical scavenging activity (p<0.001). It was noted that oxidative stress hemolysis was decreased with increased antioxidant level in cord blood RBC from both samples after incubation with both yeasts in a similar manner. The antihemolytic property of M. purpureus and S. cerevisiae suggests that S. cerevisiae functions efficiently with increasing stress. CONCLUSION This study demonstrates for the first time that despite their differential scavenging activities, a diet rich in M. purpureus and S. cerevisiae could equally serve as a good natural supplement to alleviate the stress status in the preeclamptic fetus (Tab. 4, Fig. 1, Ref. 39).
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Jouhra F, Sapontis J, Leonard S, Melikian N, Byrne J, Dworakowski R, Shah A, Hill J, Whitbread M, MacCarthy P. 057 MANAGEMENT AND OUTCOME OF OUT-OF-HOSPITAL CARDIAC ARREST AT A MAJOR UK TERTIARY CENTRE. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.57] [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: 11/04/2022]
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Higginson I, Rumble C, Koffman J, Hopkins P, Heenen S, Prentice W, Burman R, Leonard S, Dampier O, Noble J, Morgan M, Shipman C. Alternative to improve palliative care for all patients and families in critical care units: development and preliminary evaluation following MRC guidance of the King's Psychosocial, Assessment and Care tool. Crit Care 2013. [PMCID: PMC3643050 DOI: 10.1186/cc12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Laramee P, Kusel J, Leonard S, Aubin HJ, Francois C, Daeppen JB. The Economic Burden of Alcohol Dependence in Europe. Alcohol Alcohol 2013; 48:259-69. [DOI: 10.1093/alcalc/agt004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [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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Kaunert C, Leonard S. The European Union Asylum Policy after the Treaty of Lisbon and the Stockholm Programme: Towards Supranational Governance in a Common Area of Protection? Refugee Survey Quarterly 2012. [DOI: 10.1093/rsq/hds018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Wang Q, Yang X, Leonard S, Archbold T, Sullivan JA, Duncan AM, D.L. Ma W, Bizimungu B, Murphy A, Htoo JK, Fan MZ. Responses of dietary ileal amino acid digestibility to consumption of different cultivars of potatoes and conventional fibers in grower pigs fed a high-fat basal diet1. J Anim Sci 2012; 90 Suppl 4:356-8. [DOI: 10.2527/jas.53807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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)
- Q. Wang
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - X. Yang
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - S. Leonard
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - T. Archbold
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - J. A. Sullivan
- Department of Plant Agriculture, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - A. M. Duncan
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - W. D.L. Ma
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada N1G 2W
| | - B. Bizimungu
- Agriculture and Agri-Food Canada Potato Research Center, Fredericton, New Brunswick, Canada E3B 4Z7
| | - A. Murphy
- Agriculture and Agri-Food Canada Potato Research Center, Fredericton, New Brunswick, Canada E3B 4Z7
| | - J. K. Htoo
- Evonik Industries AG, Hanau-Wolfgang, Germany 463457
| | - M. Z. Fan
- Department of Animal and Poultry Science, University of Guelph, Guelph, Ontario, Canada N1G 2W
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Tapp A, Leonard S, Collins K, Jones S, Spotswood F. Socio-cultural forces that impact on cycling behaviour in car-dominant societies: A survey of the UK population. J Sci Med Sport 2012. [DOI: 10.1016/j.jsams.2012.11.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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48
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Vrzalikova K, Leonard S, Fan Y, Bell A, Vockerodt M, Flodr P, Wright KL, Rowe M, Tao Q, Murray PG. Hypomethylation and Over-Expression of the Beta Isoform of BLIMP1 is Induced by Epstein-Barr Virus Infection of B Cells; Potential Implications for the Pathogenesis of EBV-Associated Lymphomas. Pathogens 2012; 1:83-101. [PMID: 25436766 PMCID: PMC4235687 DOI: 10.3390/pathogens1020083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/19/2012] [Accepted: 09/24/2012] [Indexed: 12/03/2022] Open
Abstract
B-lymphocyte-induced maturation protein 1 (BLIMP1) exists as two major isoforms, α and β, which arise from alternate promoters. Inactivation of the full length BLIMP1α isoform is thought to contribute to B cell lymphomagenesis by blocking post-germinal centre (GC) B cell differentiation. In contrast, the shorter β isoform is functionally impaired and over-expressed in several haematological malignancies, including diffuse large B cell lymphomas (DLBCL). We have studied the influence on BLIMP1β expression of the Epstein-Barr virus (EBV), a human herpesvirus that is implicated in the pathogenesis of several GC-derived lymphomas, including a subset of DLBCL and Hodgkin’s lymphoma (HL). We show that BLIMP1β expression is increased following the EBV infection of normal human tonsillar GC B cells. We also show that this change in expression is accompanied by hypomethylation of the BLIMP1β-specific promoter. Furthermore, we confirmed previous reports that the BLIMP1β promoter is hypomethylated in DLBCL cell lines and show for the first time that BLIMP1β is hypomethylated in the Hodgkin/Reed-Sternberg (HRS) cells of HL. Our results provide evidence in support of a role for BLIMP1β in the pathogenesis of EBV-associated B cell lymphomas.
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Affiliation(s)
| | - Sarah Leonard
- School of Cancer Sciences, University of Birmingham, B15 2TT, UK.
| | - Yichao Fan
- The Cancer Epigenetics Laboratory, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, 999077, Hong Kong.
| | - Andrew Bell
- School of Cancer Sciences, University of Birmingham, B15 2TT, UK.
| | | | - Patrik Flodr
- Laboratory of Molecular Pathology, Department of Pathology, and Institute of Molecular and Translation Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, 779 00, Czech Republic.
| | - Kenneth L Wright
- H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, MRC-4 East, Tampa, FL 33612, USA.
| | - Martin Rowe
- School of Cancer Sciences, University of Birmingham, B15 2TT, UK.
| | - Qian Tao
- The Cancer Epigenetics Laboratory, Sir YK Pao Center for Cancer, Department of Clinical Oncology, Hong Kong Cancer Institute and Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, 999077, Hong Kong.
| | - Paul G Murray
- School of Cancer Sciences, University of Birmingham, B15 2TT, UK.
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Leonard S, Gordon N, Smith N, Rowe M, Murray PG, Woodman CB. Arginine Methyltransferases Are Regulated by Epstein-Barr Virus in B Cells and Are Differentially Expressed in Hodgkin's Lymphoma. Pathogens 2012; 1:52-64. [PMID: 25436604 PMCID: PMC4235682 DOI: 10.3390/pathogens1010052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 08/28/2012] [Accepted: 09/04/2012] [Indexed: 11/28/2022] Open
Abstract
Although there is increasing evidence that aberrant expression of those enzymes which control protein arginine methylation contribute to carcinogenesis, their de-regulation by oncogenic viruses in primary cells has yet to be reported. We first show that the protein arginine methyltransferases, CARM1, PRMT1 and PRMT5 are strongly expressed in Hodgkin Reed-Sternberg (HRS) cells, and up-regulated in Hodgkin's lymphoma (HL) cell lines. Given that Epstein-Barr virus (EBV) can be detected in approximately 50% of primary HL, we next examined how EBV infection of germinal centre (GC) B cells, the presumptive precursors of HRS cells, modulated the expression of these proteins. EBV infection of GC B cells was followed by the up-regulation of CARM1, PRMT1 and PRMT5, and by the down-regulation of the arginine deiminase, PADI4. Latent membrane protein 1 (LMP1), the major EBV transforming gene was shown to induce PRMT1 in GC B cells and in a stably transfected B cell line. The recent development of compounds which inhibit PRMT-mediated reactions provides a compelling case for continuing to dissect the contribution of virus induced changes in these proteins to lymphomagenesis.
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Affiliation(s)
- Sarah Leonard
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Naheema Gordon
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Nikki Smith
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Martin Rowe
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Paul G Murray
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Ciarán B Woodman
- School of Cancer Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Chubilleau C, Comte J, Ben-Brik E, Pubert M, Hulin A, Leonard S, Giraud J, Ingrand P. Étude écologique du lien entre pesticides et mortalité en Poitou-Charentes entre 2003 et 2007. ARCH MAL PROF ENVIRO 2012. [DOI: 10.1016/j.admp.2012.03.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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