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Si PEH, Parker S, Abdelhafiz D, Summerbell A, Muzulu S, Abdelhafiz AH. Cardiovascular risk reduction in older people with type 2 diabetes mellitus-a comprehensive narrative review. Diabetes Res Clin Pract 2024; 211:111662. [PMID: 38599285 DOI: 10.1016/j.diabres.2024.111662] [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: 11/15/2023] [Revised: 04/01/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
Metabolic targets are controversial in older people with type 2 diabetes due to functional heterogeneity and morbidity burden. Tight blood pressure and metabolic control appears beneficial in fit individuals who are newly diagnosed with type 2 diabetes and have fewer comorbidities. The benefits of low blood pressure and tight metabolic control is attenuated with the development of comorbidities, especially frailty. Guidelines consider frail older people as one category and recommend relaxed targets. However, sarcopenic obese frail individuals may benefit from tight targets and intensification of therapy due to their unfavourable metabolic profile, accelerated diabetes trajectory and high cardiovascular risk. In addition, the early use of sodium glucose transporter-2 inhibitors and glucagon like peptide-1 receptor agonists may be beneficial in this frailty phenotype due to their cardio-renal protection, which is independent of glycaemic control, provided they are able to engage in resistance exercise training to avoid loss of muscle mass. In the anorexic malnourished frail individual, early use of insulin, due to its weight gain and anabolic properties, is appropriate. In this phenotype, targets should be relaxed with deintensification of therapy due to significant weight loss, decelerated diabetes trajectory and increased risk of medication side effects.
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Affiliation(s)
- Pann Ei Hnynn Si
- Sheffield Kidney Institute, Sheffield Teaching Hospitals, Herries Road, Sheffield S5 7AU, UK
| | - S Parker
- Translational Health Sciences, Bristol Medical School, Bristol, BS8 1QU
| | - D Abdelhafiz
- Lancaster Medical School, Lancaster, LA1 4YG, UK
| | - A Summerbell
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2 UD, UK
| | - S Muzulu
- Department of Diabetes and Endocrinology Rotherham General Hospital, UK
| | - Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2 UD, UK.
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Halima A, Fane L, Parker S, Obi E, Fleming-Hall E, Gentle C, Cherian S, Valente S, Al-Hilli Z, Tendulkar R, Shah C. Intraoperative Radiation Therapy for Early-Stage Breast Cancer: Updated Outcomes from a Single-Institution Experience. Ann Surg Oncol 2024; 31:931-935. [PMID: 37857985 DOI: 10.1245/s10434-023-14448-6] [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: 04/26/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Increasingly, data have supported the use of partial-breast irradiation (PBI) for low-risk patients after breast-conserving surgery, with techniques allowing for completion of treatment in 1-3 weeks. Intraoperative radiation therapy (IORT) is an alternative to PBI. Our institution had used low-energy photon IORT (TARGIT) for more than a decade. The initial results demonstrated a 2% local recurrence rate with a short follow-up period of 2 years. This report presents updated outcomes during with 5-year follow-up. METHODS A review of an institutional review board (IRB)-approved institutional registry was performed. The review identified 215 patients with early-stage breast cancer (stages 0-IIA) who received IORT. At the time of surgery, IORT was delivered with 20 Gy in a single fraction, with 5.1% (n = 11) of patients receiving additional whole-breast irradiation (WBI). RESULTS The mean age at diagnosis was 71 years (range, 49-98 years), and the median follow-up was 5.7 years (interquartile range [IQR], 4.2-7.0 years). Of the 215 patients, 2.8% (n = 6) had ductal carcinoma in situ (DCIS), 90.7% (n = 195) had T1 disease, and 6.5% (n = 14) had T2 disease. Endocrine therapy was prescribed for 79% and chemotherapy for 1.4% of the patients. The 5-year rates were 5.3% for local recurrence, 6.4% for locoregional recurrence, and 2.7% for distant metastases. At 5 years, 93% of the patients were alive. CONCLUSIONS The 5-year outcomes with TARGIT IORT demonstrated high rates of local recurrence, exceeding those seen with alternative modern approaches. The local recurrence outcomes with IORT are more consistent with studies omitting radiation following breast-conserving surgery, using endocrine therapy alone. Consistent with current guidelines and previous data, TARGIT IORT should not be used as monotherapy outside prospective clinical trials.
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Affiliation(s)
- Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lauren Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sean Parker
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Elizabeth Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Erica Fleming-Hall
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Corey Gentle
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sheen Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie Valente
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zahraa Al-Hilli
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rahul Tendulkar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
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Halima A, Parker S, Fane L, Sayed S, Hall EF, Obi E, Figueroa B, Al-Hilli Z, Valente S, Gentle C, Cherian S, Tendulkar R, Shah C. Five Fraction Accelerated Partial Breast Irradiation Versus Intraoperative Radiation Therapy for Early-Stage Breast Cancer. Clin Breast Cancer 2024; 24:79-84. [PMID: 37914593 DOI: 10.1016/j.clbc.2023.10.001] [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: 08/27/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accelerated partial breast irradiation (PBI) delivered in 5 fractions with intensity modulated radiation therapy (IMRT) has been shown to have comparable clinical outcomes to whole breast irradiation with reduced toxicity profiles. In contrast, intraoperative radiation therapy (IORT) offers patients the potential to complete adjuvant radiation therapy in a single treatment. While early data were promising, concerns exist regarding long-term rates of local recurrence after IORT. We present a comparison of 5 fraction PBI versus IORT. MATERIALS/METHODS We performed a retrospective review of 473 patients with early-stage breast cancer treated at a single institution from 2011 to 2021 with 258 receiving PBI and 215 receiving IORT. PBI patients received 30 Gy in 5 fractions delivered with IMRT. IORT patients received 20 Gy in 1 fraction prescribed to the applicator surface at surgery using the low-energy TARGIT technique. RESULTS Mean age was 71 years old (IQR:67-74) for IORT patients and 67 years old (IQR:62-72) for PBI patients. Median follow up was 5.7 years (IQR:4.2-7.0) for IORT patients and 2.4 years (IQR:1.8-3.3) for PBI patients (P < .001). Recurrence at any time (locoregional and distant) was seen in 7.9% (n = 17) of patients receiving IORT as compared to 0.8% (n = 2) of patients receiving PBI. IORT was associated with reduced rates of locoregional relapse free survival at 5 years (93.6% vs. 99.4%, P = .05) with no difference in overall survival(92.8% vs. 95.1%, P = .99). CONCLUSION Low-energy TARGIT IORT was associated with higher rates of locoregional recurrence compared to PBI. These outcomes, consistent with other series and current guidelines, suggest a limited role for low-energy IORT as monotherapy.
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Affiliation(s)
- Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Sean Parker
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Lauren Fane
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Shorouk Sayed
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Erica-Fleming Hall
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Elizabeth Obi
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Brian Figueroa
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Zahraa Al-Hilli
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Stephanie Valente
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Corey Gentle
- Department of Breast Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH
| | - Sheen Cherian
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Rahul Tendulkar
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
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Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
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Parker S, Chang J, Joshi V, Sathanandam SK, Philip R. Cardiopulmonary and echocardiographic metrics for functional assessment of pectus excavatum. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Kilic SS, Mayo ZS, Weleff J, Parker S, Strzalka C, Phelan MP, Suh JH, Campbell SR, Shah CS. Cancer Diagnoses and Use of Radiation Therapy Among Persons Experiencing Homelessness. Int J Radiat Oncol Biol Phys 2023; 116:79-86. [PMID: 36731679 DOI: 10.1016/j.ijrobp.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
PURPOSE Persons experiencing homelessness (PEH) have low rates of cancer screening and worse cancer mortality compared with persons not experiencing homelessness. Data regarding cancer diagnosis and treatment in PEH are limited. We investigated cancer prevalence and use of radiation therapy (RT) in PEH. METHODS AND MATERIALS Patients presenting between January 1, 2014, and September 27, 2021, at a large metropolitan hospital system were assessed for homelessness via intake screening or chart search. PEH data were cross-referenced with the institution's cancer database to identify PEH with cancer diagnoses. Demographic, clinical, and treatment variables were abstracted. RESULTS Of a total of 9654 (9250 evaluable) PEH with a median age of 42 years, 81 patients (0.88%) had at least 1 cancer diagnosis and 5 had multiple diagnoses, for a total of 87 PEH with at least 1 cancer diagnosis. The median age at diagnosis was 60 years. In total, 43% were female and 51% were Black, and 43% presented with advanced or metastatic disease. Lung (17%), prostate (15%), leukemia/lymphoma (13%), and head/neck (9%) were the most common diagnoses. In total, 17% of patients underwent surgery alone, 13% received chemotherapy alone, 14% received RT alone, and 6% received hormone therapy alone. A total of 8% of patients underwent no treatment, and 43% underwent multimodality therapy. In total, 58% of treated patients never achieved disease-free status. Of the 31 patients who received RT, 87% received external beam RT. Most patients (70%) received hypofractionated regimens. For patients who had multifraction treatment, the treatment completion rate was 85%, significantly lower than the departmental completion rate of 98% (P < .00001). CONCLUSIONS In a large cohort of PEH in a metropolitan setting, cancer diagnoses were uncommon and were frequently in advanced stages. Most patients underwent single-modality treatment or no treatment at all. Despite the use of hypofractionation, the RT completion rate was low, likely reflecting complex barriers to care. Further interventions to optimize cancer diagnosis and treatment in PEH are urgently needed.
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Affiliation(s)
- Sarah S Kilic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Zachary S Mayo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy Weleff
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Sean Parker
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chirag S Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Vu LD, Wallace S, Phan ATQ, Christofferson RC, Turner E, Parker S, Elkind-Hirsch K, Landry D, Stansbury A, Rose R, Nolan DJ, Lamers SL, Hirezi M, Ogden B, Cormier SA. Absence of antibody responses to SARS-CoV-2 N protein in COVID-19 vaccine breakthrough cases. Exp Biol Med (Maywood) 2022; 247:1923-1936. [PMID: 36408542 PMCID: PMC9679329 DOI: 10.1177/15353702221134097] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Understanding the risk factors for breakthrough coronavirus disease 2019 (COVID-19) (BC19) is critical to inform policy. Herein, we assessed Delta (Lineage B.1.617.2) variant-specific effectiveness of the BNT162b2 (Pfizer) vaccine and characterized Delta-driven BC19 cases (fully vaccinated individuals who get infected) with known-time-since-vaccination. In this longitudinal prospective study (January 21-October 30, 2021), 90 naïve and 15 convalescent individuals were enrolled at the initiation of vaccination. Samples from 27 unvaccinated individuals with previous laboratory-confirmed COVID-19 diagnosis were collected at a single time point. Longitudinal serology profile (antibodies against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] S and N proteins) and live-virus-based neutralization capacities were assessed while controlling for age. Sex, age, history of reactions to the COVID-19 vaccine, and viral neutralization capacities were identified as significant risk factors for breakthrough COVID-19. At 8 months postvaccination, male sex, individuals ⩾65 years of age, and individuals who experienced noticeable side effects with the COVID-19 vaccine were at 5.47 (p-value = 0.0102), 4.33 (p-value = 0.0236), and 4.95 (p-value = 0.0159) fold greater risk of BC19 as compared to their peers, respectively. Importantly, every five-fold increase in viral neutralization capacities (by live-virus-based assays) was significantly associated with ~4-fold reduction in the risk occurrence of breakthrough COVID-19 (p-value = 0.045). Vaccine boosting remarkably increased these viral neutralization capacities by 16.22-fold (p- value = 0.0005), supporting the importance of the BNT162b2 booster in efforts to control the incursion of future variants into the population at large. Strikingly, BC19 cases exhibited a delayed/absent antibody response to the N protein, suggesting limited exposure to the virus. Since antibodies against N protein are widely used to evaluate the extent of virus spread in communities, our finding has important implications on the utility of existing serological diagnostic and surveillance for COVID-19.
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Affiliation(s)
- Luan D Vu
- Department of Biological Sciences, Louisiana State University and Pennington Biomedical Research Center, Baton Rouge, LA 70803, USA
| | | | - Anh TQ Phan
- Department of Biological Sciences, Louisiana State University and Pennington Biomedical Research Center, Baton Rouge, LA 70803, USA
| | - Rebecca C Christofferson
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Erik Turner
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
| | - Sean Parker
- Woman’s Hospital, Baton Rouge, LA 70817, USA
| | | | | | | | | | | | | | - Michael Hirezi
- Louisiana Health Sciences Center New Orleans, New Orleans, LA 70112, USA
| | | | - Stephania A Cormier
- Department of Biological Sciences, Louisiana State University and Pennington Biomedical Research Center, Baton Rouge, LA 70803, USA,Stephania A Cormier.
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Evans RA, Leavy OC, Richardson M, Elneima O, McAuley HJC, Shikotra A, Singapuri A, Sereno M, Saunders RM, Harris VC, Houchen-Wolloff L, Aul R, Beirne P, Bolton CE, Brown JS, Choudhury G, Diar-Bakerly N, Easom N, Echevarria C, Fuld J, Hart N, Hurst J, Jones MG, Parekh D, Pfeffer P, Rahman NM, Rowland-Jones SL, Shah AM, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Greening NJ, Heaney LG, Heller S, Howard LS, Jacob J, Jenkins RG, Lord JM, Man WDC, McCann GP, Neubauer S, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Semple MG, Singh SJ, Thomas DC, Toshner M, Lewis KE, Thwaites RS, Briggs A, Docherty AB, Kerr S, Lone NI, Quint J, Sheikh A, Thorpe M, Zheng B, Chalmers JD, Ho LP, Horsley A, Marks M, Poinasamy K, Raman B, Harrison EM, Wain LV, Brightling CE, Abel K, Adamali H, Adeloye D, Adeyemi O, Adrego R, Aguilar Jimenez LA, Ahmad S, Ahmad Haider N, Ahmed R, Ahwireng N, Ainsworth M, Al-Sheklly B, Alamoudi A, Ali M, Aljaroof M, All AM, Allan L, Allen RJ, Allerton L, Allsop L, Almeida P, Altmann D, Alvarez Corral M, Amoils S, Anderson D, Antoniades C, Arbane G, Arias A, Armour C, Armstrong L, Armstrong N, Arnold D, Arnold H, Ashish A, Ashworth A, Ashworth M, Aslani S, Assefa-Kebede H, Atkin C, Atkin P, Aung H, Austin L, Avram C, Ayoub A, Babores M, Baggott R, Bagshaw J, Baguley D, Bailey L, Baillie JK, Bain S, Bakali M, Bakau M, Baldry E, Baldwin D, Ballard C, Banerjee A, Bang B, Barker RE, Barman L, Barratt S, Barrett F, Basire D, Basu N, Bates M, Bates A, Batterham R, Baxendale H, Bayes H, Beadsworth M, Beckett P, Beggs M, Begum M, Bell D, Bell R, Bennett K, Beranova E, Bermperi A, Berridge A, Berry C, Betts S, Bevan E, Bhui K, Bingham M, Birchall K, Bishop L, Bisnauthsing K, Blaikely J, Bloss A, Bolger A, Bonnington J, Botkai A, Bourne C, Bourne M, Bramham K, Brear L, Breen G, Breeze J, Bright E, Brill S, Brindle K, Broad L, Broadley A, Brookes C, Broome M, Brown A, Brown A, Brown J, Brown J, Brown M, Brown M, Brown V, Brugha T, Brunskill N, Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Geller D, Perez-Garcia C, Pei Y, Liu X, Engelhardt J, Hodges C, Mense M, Coote K, Cheng Y, Mahoney J, Parker S, Chivukula P. WS16.03 LUNAR-CF: an mRNA replacement approach for cystic fibrosis lung disease. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00245-4] [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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10
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Woolner B, Moore P, Parker S. 81 An Audit of Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis Implementation. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.042] [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: 11/14/2022]
Abstract
Abstract
Introduction
VTE is considered one of the most common preventable causes of death and significant co-morbidity in inpatients and is responsible for approximately 60,000 deaths occur per annum in the UK. The NHS Standard Contract requires all inpatients to undergo a VTE risk assessment, with a 95% patient assessment threshold. In January 2020 we identified that 72% of patients within our trust had a risk assessment completed, and 15% of these were accurate. We subsequently implemented mandatory VTE prescribing training for all junior doctors joining the trust.
Aim
Review the impact of mandatory training module on VTE risk assessment and prescribing, in compliance with NICE Guidelines.
Method
All inpatient medical notes, VTE risk assessments, and VTE prescriptions were reviewed to assess accurate risk assessment completion and subsequent appropriate prophylaxis prescribing. The standards were as set out in the NICE guidelines [NG89]. Paediatric, Obstetric and ITU patients were excluded.
Results
Our VTE risk assessment completion rates increased from 72.1% to 94.2%, and the accuracy of these assessments from 15.4% to 34.5%. Our prescription rate increased from 84.6% to 90.6%, and prescribing accuracy from 41.2% to 79.5%.
Conclusions
By implementing mandatory VTE prophylaxis training for all junior doctors joining a new NHS trust, we can see increased compliance with appropriate risk assessment and prophylaxis prescribing. This will reduce the risk of unnecessary death from VTE in hospital inpatients.
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Affiliation(s)
- B. Woolner
- Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - P. Moore
- Imperial College NHS Healthcare Trust, London, United Kingdom
| | - S. Parker
- Isle of Wight NHS Trust, Newport, United Kingdom
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11
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Walia N, Eratne D, Loi SM, Li QX, Varghese S, Malpas CB, Walterfang M, Evans AH, Parker S, Collins SJ, Masters CL, Velakoulis D. Cerebrospinal fluid neurofilament light predicts the rate of executive function decline in younger-onset dementia. J Neurol Sci 2022; 432:120088. [PMID: 34922179 DOI: 10.1016/j.jns.2021.120088] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Determining disease severity and predicting prognosis in younger onset-dementia (YOD) remains challenging. Whether CSF biomarkers neurofilament light (NfL), tau and amyloidβ 42 (Aβ42) can help provide such information has been underexplored. METHODS Patients with YOD and CSF analysis were identified. We compared baseline NfL, tau and Aβ42 concentrations with contemporaneous Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) scores to assess their association with severity of cognitive impairment. Cognitive decline, as measured by longitudinal NUCOG assessment, was correlated against baseline biomarker levels to assess their utility in predicting the rate of cognitive decline. RESULTS 78 patients with YOD (mean age = 56 years, SD = 8) and CSF analysis were identified. Dementia types included Alzheimer's disease, behavioural variant frontotemporal dementia, dementia not-otherwise-specified and other. Tau was associated with contemporaneous memory dysfunction (r = -0.556, 95% CI:[-0.702,-0.393], p < .001). 21 patients had longitudinal cognitive assessment up to 82 months from CSF sampling. NfL was associated with the rate of executive function decline (r = 0.755, 95% CI:[0.259,0.937], p < .001). Aβ42 was associated with the rate of memory decline (r = -0.582, 95% CI:[-0.855,-0.274], p = .007) and rate of total NUCOG decline (r = -0.515, 95% CI: [-0.809, -0.227], p = .017). CONCLUSION CSF tau is related to contemporaneous memory impairment in YOD. NfL and Aβ42 levels are associated with the rate of executive function and memory decline, respectively, and may have a role in prognostication in YOD.
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Affiliation(s)
- N Walia
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| | - D Eratne
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - S M Loi
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
| | - Q-X Li
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - S Varghese
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - C B Malpas
- Clinical Outcomes Research Unit (CORe), Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - M Walterfang
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - A H Evans
- Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - S Parker
- Melbourne Medical School, The University of Melbourne, Parkville, VIC, Australia; Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - S J Collins
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia; Department of Medicine (RMH), The University of Melbourne, Parkville, VIC, Australia
| | - C L Masters
- National Dementia and Diagnostics Laboratory, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - D Velakoulis
- Neuropsychiatry, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
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12
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Wilson J, Carson G, Fitzgerald S, Llewelyn MJ, Jenkins D, Parker S, Boies A, Thomas J, Sutcliffe K, Sowden AJ, O'Mara-Eves A, Stansfield C, Harriss E, Reilly J. Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review. J Hosp Infect 2021; 116:37-46. [PMID: 34245806 PMCID: PMC8264274 DOI: 10.1016/j.jhin.2021.06.011] [Citation(s) in RCA: 9] [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: 05/10/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
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Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, London, UK.
| | - G Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Fitzgerald
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - A Boies
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - J Thomas
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - K Sutcliffe
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - A J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - C Stansfield
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - E Harriss
- Bodleian Health Care Libraries, John Radcliffe Hospital, Oxford, UK
| | - J Reilly
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
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Black J, Campbell J, Sharman J, Nelson M, Parker S, Hamilton G, Marwick T. An absolute risk-guided approach to cardiovascular risk management within a chest pain clinic: the ARCPAC randomized trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2916] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The majority of patients attending chest pain clinics are found not to have a cardiac cause of their symptoms, but have a high burden of cardiovascular risk factors that may be opportunistically addressed. Absolute risk calculators are recommended to guide risk factor management, although it is uncertain to what extent these calculations may assist with patient engagement in risk factor modification.
Purpose
We sought to determine the usefulness of a proactive, absolute risk-based approach, to guide opportunistic cardiovascular risk factor management within a chest pain clinic.
Methods
This was a prospective, open-label, blinded-endpoint study in 192 enhanced risk (estimated 5-year risk ≥8%, based on Australian Absolute Risk Calculator) patients presenting to a tertiary hospital chest pain clinic. Patients were randomized to best practice usual care, or intervention with development of a proactive cardiovascular risk management strategy framed around a discussion of the individual's absolute risk. Patients found to have a cardiac cause of symptoms were excluded as they constitute a secondary prevention population. Primary outcome was 5-year absolute cardiovascular risk score at minimum 12 months follow up. Secondary outcomes were individual modifiable risk factors (lipid profile, blood pressure, smoking status).
Results
192 people entered the study; 100 in the intervention arm and 92 in usual care. There was no statistical difference between the two groups' baseline sociodemographic and clinical variables. The intervention group showed greater reduction in 5-year absolute risk scores (difference −2.77; p<0.001), and more favourable individual risk factors, although only smoking status and LDL cholesterol reached statistical significance (table).
Conclusion
An absolute risk-guided proactive risk factor management strategy employed opportunistically in a chest pain clinic significantly improves 5-year cardiovascular risk scores.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Tasmanian Community Fund
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Affiliation(s)
- J.A Black
- Menzies Research Institute, Hobart, Australia
| | - J Campbell
- Menzies Research Institute, Hobart, Australia
| | - J Sharman
- Menzies Research Institute, Hobart, Australia
| | - M Nelson
- Menzies Research Institute, Hobart, Australia
| | - S Parker
- Royal Hobart Hospital, Hobart, Australia
| | - G Hamilton
- Royal Hobart Hospital, Hobart, Australia
| | - T Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
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Reddy SP, Sewpaul R, Mabaso M, Parker S, Naidoo I, Jooste S, Mokhele T, Sifunda S, Zuma K. South Africans' understanding of and response to the COVID-19 outbreak: An online survey. S Afr Med J 2020. [PMID: 32880275 DOI: 10.2139/ssrn.3576939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The COVID-19 outbreak is in an accelerating phase, and South Africa (SA) has had the highest number of documented cases during the early phase of the pandemic in sub-Saharan Africa. OBJECTIVES To assess South Africans' understanding of and response to COVID-19 during the first week of the country's lockdown period. METHODS An online survey was conducted in SA from 27 March to 2 April 2020. The survey was distributed widely among several websites and social media networks, including on a data-free platform. Descriptive statistics of knowledge, risk perception, access to and trust in information sources, and public and media opinions were calculated. Estimates were benchmarked to the 2019 national adult population estimates. RESULTS Of the 55 823 participants, the majority (83.4%) correctly identified the main symptoms of COVID-19. Over 90% had correct knowledge of the incubation period, with lower rates for 18 - 29-year-olds. Knowledge of symptoms and the incubation period varied significantly by population group (p<0.001), dwelling type (p<0.001) and sex (p<0.001). A quarter (24.9%) perceived themselves as at high risk of contracting COVID-19. Risk perception varied by age, population group, employment status and dwelling type (p<0.001). The most prevalent COVID-19 information sources were government sources (72.9%), news websites/apps (56.3%), satellite television (51.6%) and local television (51.4%). CONCLUSIONS Understanding knowledge, attitudes and behaviours of people facing the COVID-19 pandemic is crucial for guiding strategic policy. These findings provide public understanding of COVID-19 as the phases of the country-level epidemic progress, and also directly inform communication needs and gaps.
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Affiliation(s)
- S P Reddy
- Human and Social Capabilities, Human Sciences Research Council, Cape Town, South Africa; Faculty of Health Sciences, Nelson Mandela University, Port Elizabeth, South Africa.
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Smith JA, Kitt MM, Morice AH, Birring SS, McGarvey LP, Sher MR, Li YP, Wu WC, Xu ZJ, Muccino DR, Ford AP, Smith J, McGarvey L, Birring S, Hull J, Carr WW, Goldsobel AB, Gross GN, Holcomb JR, Hussain I, Sher M, Spangenthal S, Storms W, Morice A, Elkayam D, Steven GC, Krainson J, Fakih FA, Matz J, Brooks GD, Casale T, Berman GD, Condemi JJ, Greos LS, Gogate SU, Sher ER, Friesen JH, Schenkel EJ, Bernstein DI, Corren J, Sundar K, Gotfried MH, Montanaro A, Lumry WR, Amar NJ, Kaplan MS, Prenner BM, Murphy TR, Good JS, Parker S, Harrison T, Pavord I, Brightling C, Djukanovic R, McQuaid D, Denenberg M, Ettinger NA, Iyer V. Gefapixant, a P2X3 receptor antagonist, for the treatment of refractory or unexplained chronic cough: a randomised, double-blind, controlled, parallel-group, phase 2b trial. The Lancet Respiratory Medicine 2020; 8:775-785. [DOI: 10.1016/s2213-2600(19)30471-0] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 01/02/2023]
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16
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Parker S, Buckley W, Truesdell A, Riggio M, Collins M, Boardman B. Barriers to the Use of Assistive Technology with Children: A Survey. Journal of Visual Impairment & Blindness 2020. [DOI: 10.1177/0145482x9008401013] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reports on the responses of 120 teachers and habilitative specialists of multiply handicapped blind and deaf-blind children in Massachusetts to a survey on their use of assistive technology. The respondents reported problems in all areas covered by the survey: knowledge of electronic mobility aids and communication devices; the availability, maintenance, and funding of devices; and adequate information about devices. They especially mentioned the need for resources to assess and match students to appropriate devices and to generate more training for themselves.
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Affiliation(s)
- S. Parker
- Division of Development and Behavioral Pediatrics, Department of Pediatrics, Boston City Hospital, Talbot 214, 818 Harrison Avenue, Boston, MA 02118
| | - W. Buckley
- Deaf-Blind Department, Perkins School for the Blind
| | | | - M. Riggio
- National education consultant, Hilton-Perkins Program
| | - M. Collins
- Hilton-Perkins National Program, Perkins School for the Blind, Watertown, MA 02172
| | - B. Boardman
- Division of General Pediatrics, Boston City Hospital, Boston, MA 02118
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Cueva K, Speakman K, Neault N, Richards J, Lovato V, Parker S, Carroll D, Sundbo A, Barlow A. Cultural Connectedness as Obesity Prevention: Indigenous Youth Perspectives on Feast for the Future. J Nutr Educ Behav 2020; 52:632-639. [PMID: 31924560 DOI: 10.1016/j.jneb.2019.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe a community-based obesity-prevention initiative that promoted cultural connectedness and traditional food revitalization and gained insight into youth participants' perspectives on the program through a photovoice methodology. METHODS Photovoice methods were used with fourth- and fifth-grade youths (aged 9-11 years) in the US Southwest who had participated in the Feast for the Future program. A total of 44 youths from 3 communities met for 8-9 sessions; they took photos of current food environments and traditional food systems, and discussed them as well as Feast for the Future and hopes for the future, and then prepared a final presentation. Photovoice sessions were recorded, transcribed verbatim, then open coded using Atlas.ti. RESULTS Five common themes emerged: traditional food is farmed or gardened, traditional foods are healthy, Feast for the Future supported positive connections to culture, hope for more farming or gardening for future generations, and store or less nutrient-dense food is unhealthy. CONCLUSIONS AND IMPLICATIONS Photovoice can be an effective way to engage Indigenous youths in conversations about their culture and food environments. The findings suggest that attention to revitalizing traditional food systems and supporting cultural connectedness may be an effective approach to obesity prevention in tribal communities, although future research would be needed to assess the impact of the intervention on obesity rates.
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Affiliation(s)
- Katie Cueva
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK.
| | - Kristen Speakman
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Nicole Neault
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Jennifer Richards
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Ventura Lovato
- Native American Community Academy Inspired Schools Network
| | - Sean Parker
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | | | - Anna Sundbo
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
| | - Allison Barlow
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Anchorage, AK
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Anderson A, Fawdon M, Booth Z, Hodgson R, Parker S, Goodfellow N, Quibell R, Bourke S. P350 Bereavement: a ‘time to remember’ event for families bereaved by cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30678-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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19
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Tingey L, Larzelere F, Goklish N, Rosenstock S, Jennings Mayo-Wilson L, Pablo E, Goklish W, Grass R, Sprengeler F, Parker S, Ingalls A, Craig M, Barlow A. Entrepreneurial, Economic, and Social Well-Being Outcomes from an RCT of a Youth Entrepreneurship Education Intervention among Native American Adolescents. Int J Environ Res Public Health 2020; 17:E2383. [PMID: 32244495 PMCID: PMC7177681 DOI: 10.3390/ijerph17072383] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/21/2020] [Accepted: 03/28/2020] [Indexed: 12/02/2022]
Abstract
Background: Entrepreneurship education has demonstrated positive impacts in low-resource contexts. However, there is limited evidence of such programs evaluated among Native American (NA) youth in a rural reservation. Methods: A 2:1 randomized controlled trial evaluated the impact of the Arrowhead Business Group (ABG) entrepreneurship education program on entrepreneurship knowledge, economic empowerment, and social well-being among 394 NA youth. An intent to treat analysis using mixed effects regression models examined within and between study group differences from baseline to 24 months. An interaction term measured change in the intervention relative to change in the control. ABG participants were purposively sampled to conduct focus groups and in-depth interviews. Results: Significant intervention vs. control group improvements were sustained at 12 months for entrepreneurship knowledge and economic confidence/security. Significant within-group improvements were sustained for ABG participants at 24 months for connectedness to parents, school, and awareness of connectedness. Qualitative data endorses positive impacts on social well-being among ABG participants. Conclusion: Observed effects on entrepreneurship knowledge, economic empowerment, and connectedness, supplemented by the experiences and changes as described by the youth themselves, demonstrates how a strength-based youth entrepreneurship intervention focused on developing assets and resources may be an innovative approach to dually address health and economic disparities endured in Native American communities.
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Affiliation(s)
- Lauren Tingey
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Francene Larzelere
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Novalene Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Summer Rosenstock
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Larissa Jennings Mayo-Wilson
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
- Department of Applied Health Science, Center for Sexual Health Promotion, Indiana University School of Public Health, 1025 E. 7th St., Bloomington, IN 47405, USA;
| | - Elliott Pablo
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Warren Goklish
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Ryan Grass
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Feather Sprengeler
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Sean Parker
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Allison Ingalls
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
| | - Mariddie Craig
- Department of International Health, Johns Hopkins Center for American Indian Health, 308 Kuper St., Whiteriver, AZ 85941, USA; (F.L.); (N.G.); (E.P.); (W.G.); (R.G.); (F.S.); (S.P.); (M.C.)
| | - Allison Barlow
- Department of International Health, Johns Hopkins Center for American Indian Health, 415 N. Washington St., Baltimore, MD 21231, USA; (S.R.); (A.I.); (A.B.)
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Thøgersen-Ntoumani C, Quested E, Smith BS, Nicholas J, McVeigh J, Fenton SAM, Stamatakis E, Parker S, Pereira G, Gucciardi DF, Ntoumanis N. Feasibility and preliminary effects of a peer-led motivationally-embellished workplace walking intervention: A pilot cluster randomized trial (the START trial). Contemp Clin Trials 2020; 91:105969. [PMID: 32114186 DOI: 10.1016/j.cct.2020.105969] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/18/2022]
Abstract
Walking interventions can be effective in increasing physical activity amongst physically inactive employees. However, despite their promising potential regarding sustainability and scalability, peer-led workplace walking interventions have not been tested. We evaluated a peer-led workplace group walking intervention designed to engage physically inactive employees. A 16-week pilot cluster randomized controlled trial consisted of enhanced (5 worksites; n = 50 participants) and minimal treatment (3 worksites; n = 47) conditions. All participants were provided with a Fitbit Zip and information on health benefits of walking. Enhanced treatment participants had access to a mobile phone app incorporating behavior change techniques, were trained on principles of autonomous motivation, and had a peer leader trained in a motivationally supportive communication style. Feasibility assessments included recruitment and drop-out rates, assessment completion rates, training acceptability (walkers and peer leaders), and intervention acceptability (walkers only). Outcomes assessed included movement-related behaviors (assessed via activPAL devices), cardio-metabolic risk factors, motivation to walk, and well-being, and these measures were taken at baseline and post-intervention. The results supported intervention feasibility. Preliminary efficacy evidence was mixed. Markers of cardio-metabolic risk improved in the enhanced treatment only. Autonomous motivation increased in both conditions. There were no changes in step counts, standing, and sitting time, or well-being. Further fine tuning is needed before a definitive RCT. Australian and New Zealand Clinical Trials Registry: ACTRN12618000807257.
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Affiliation(s)
- C Thøgersen-Ntoumani
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia.
| | - E Quested
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia
| | - B S Smith
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia
| | - J Nicholas
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia
| | - J McVeigh
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - S A M Fenton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, England
| | - E Stamatakis
- Charles Perkins Centre, School of Public Health, University of Sydney, Sydney, Australia
| | - S Parker
- Centre for Transformative Work Design, Future of Work Institute, Curtin University, Perth, Australia
| | - G Pereira
- School of Public Health, Curtin University, Perth, Australia
| | - D F Gucciardi
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - N Ntoumanis
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, Perth, Australia
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Sasser M, Kunitsky C, Jackoway G, Ezzell JW, Teska JD, Harper B, Parker S, Barden D, Blair H, Breezee J, Carpenter J, Cheek WV, DeMartino M, Evans B, Ezzell, JW, Francesconi S, Franko E, Gardner W, Glazier M, Greth K, Harper B, Hart T, Hodel M, Holmes-Talbot, K, Hopkins KL, Iqbal A, Johnson D, Krader P, Madonna A, McDowell M, McKee ML, Park M, Parker S, Pentella, M, Radosevic J, Robison RA, Rotzoll B, Scott K, Smith M, Syed N, Tang J, Teska JD, Trinh H, Hudson LI, Wolcott M. Identification of Bacillus anthracis from Culture Using Gas Chromatographic Analysis of Fatty Acid Methyl Esters. J AOAC Int 2019. [DOI: 10.1093/jaoac/88.1.178] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | | | - John W Ezzell
- U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Ft. Detrick, MD 21702
| | - Jeffrey D Teska
- U.S. Army Medical Research Institute of Infectious Diseases, 1425 Porter St, Ft. Detrick, MD 21702
| | - Bruce Harper
- U.S. Army Dugway Proving Ground, Life Sciences Division, Bldg 2029, Dugway, UT 84022
| | - Stephen Parker
- U.S. Army Dugway Proving Ground, Life Sciences Division, Bldg 2029, Dugway, UT 84022
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Larzelere F, Tingey L, Ingalls A, Sprengeler F, Parker S, Rosenstock S, Jennings L, Craig M, O'Keefe V, Barlow A. Evaluation of an Entrepreneurship Education Intervention for American Indian Adolescents: Trial Design and Baseline Sample Characteristics. Am Indian Alsk Native Ment Health Res 2019; 26:1-20. [PMID: 31743412 DOI: 10.5820/aian.2603.2019.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Entrepreneurship education is a strength-based approach and holds promise for promoting health equity for American Indian youth. Arrowhead Business Group (ABG) was developed by a tribal-academic research partnership and is being rigorously evaluated for impacts on psychosocial, behavioral, educational, and economic outcomes. This article describes: 1) the trial design and conceptual model under-girding the ABG program; 2) the sociodemographic, sociocultural, and family/household characteristics of participants at baseline; and 3) the baseline differences in key outcome indicators between study groups. Results demonstrate participants have baseline characteristics appropriate for study aims and are compared and contrasted with other youth from the participating tribal community and state in which the tribe resides. Findings inform future analyses to explore how baseline characteristics are associated with primary and secondary outcomes of the evaluation.
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Parker S. P443 Introducing advance care planning for adults and young adults with cystic fibrosis: who, when and where? A systematic review. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McArdle PA, De Mel V, DeMonte V, Winckel K, Gore-Jones V, Foley S, Korman N, Parker S, Dark F, Siskind D. An investigation into the relationship between clozapine treatment and cognitive performance in patients with treatment resistant schizophrenia. Schizophr Res 2019; 206:450-451. [PMID: 30527271 DOI: 10.1016/j.schres.2018.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 10/24/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- P A McArdle
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia.
| | - V De Mel
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia
| | - V DeMonte
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia
| | - K Winckel
- Pharmacy Department, Princess Alexandra Hospital, Woolloongabba, Qld, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, Qld, Australia
| | - V Gore-Jones
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia
| | - S Foley
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia
| | - N Korman
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia
| | - S Parker
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia; School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - F Dark
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia; School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - D Siskind
- Rehabilitation Academic Clinical Unit, Metro South Mental Health and Addiction Services, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Richardson S, Davis D, Stephan B, Robinson L, Brayne C, Barnes L, Parker S, Allan L. 69PERCEPTUAL DISTURBANCES IN A POPULATION OF OLDER PEOPLE IN HOSPITAL: INCIDENCE, CONTENT AND ASSOCIATION WITH DELIRIUM. Age Ageing 2018. [DOI: 10.1093/ageing/afy118.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Richardson
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - D Davis
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - B Stephan
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - L Robinson
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - C Brayne
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - L Barnes
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - S Parker
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
| | - L Allan
- Alzheimer’s Society Clinical Research Fellow, Institute of Neuroscience, Newcastle University
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Parker S, Omar S, Mahomed OH. Menstrual abnormalities amongst female South African Hajj pilgrims: a cross-sectional study. S Afr Fam Pract (2004) 2018. [DOI: 10.4102/safp.v60i3.4886] [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: 11/01/2022] Open
Abstract
Introduction: Hajj (pilgrimage), the fifth pillar of Islam, is obligatory for every Muslim, male or female, provided that he/she is physically and financially able to do so, at least once in his/her lifetime. One of the rituals of Hajj requires the absence of menstruation. In the current modern era, many females utilise oral contraception to manipulate their menstrual cycle so that the pilgrim can be menses free during the main rituals of Hajj. However, many such females are at risk of breakthrough bleeding. Very little information has been documented concerning the incidence of menstrual cycle abnormalities amongst female Hajj pilgrims in general and South African pilgrims in particular. This study aims to determine the incidence of menstrual cycle abnormalities amongst South African female Hajj pilgrims and the potential factors that predispose to them.Methods: A cross-sectional descriptive study was conducted amongst South African female pilgrims during the five-day Hajj period. South Africa is usually limited to 5 000 pilgrims annually with a 50:50 gender split. For most of the five days of Hajj, pilgrims, separated by gender, are housed in special tents. Data were collected using an anonymous self-administered questionnaire. The questionnaires were distributed amongst the ladies’ tents in Mina on the last day of Hajj by nursing sisters attached to the South African medical mission. A total of 470 South African female pilgrims participated in the study with 147 excluded as they were either postmenopausal or had had hysterectomies, resulting in a sample size of 323.Results: Of the 318 participants who responded to the question about hormonal menstrual manipulation (HMM), 195 (61%) attempted this and 123 (39%) did not. Of the 308 participants who responded to the question concerning menstrual cycle problems (MCP), 54 (18%) had problems and 254 (82%) did not. Of the 189 participants who attempted HMM and answered the question on MCP, 44/189 (23%) had MCP, whilst 10/108 (9%) of those who did not attempt HMM had MCP. The OR for MCP was 2.97 (CI 1.46–6.04) if HMM was attempted compared with no HMM attempt.Conclusion: Menstrual irregularities occurred more frequently in those who attempt hormonal menstrual manipulation compared with those who do not. Health education on this issue should be integrated into the pre-Hajj classes.
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Patel R, Reid T, Parker S, Windsor A. Intra-luminal mesh migration causing entero-enteric and entero-cutaneous fistula; A case and discussion of the ‘mesh problem’. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.083] [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: 10/28/2022]
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Parker S, Harris A, Thorpe A. A complete audit loop assessing service improvement with use of button type electrode for transurethral resection of prostate and an intention to discharge at less than 24 hours. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Parker S, Omar S, Mahomed OH. Menstrual abnormalities amongst female South African Hajj pilgrims: a cross-sectional study. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2017.1397382] [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: 10/18/2022] Open
Affiliation(s)
- S Parker
- South African Society of Travel Medicine (SASTM) , Johannesburg, South Africa
| | - S Omar
- Intensive Care Unit, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand , Johannesburg, South Africa
| | - OH Mahomed
- Discipline of Public Health Medicine, University of KwaZulu-Natal , Durban, South Africa
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Gales SG, Horsfield CJ, Meadowcroft AL, Leatherland AE, Herrmann HW, Hares JD, Dymoke-Bradshaw AKL, Milnes JS, Kim YH, Kleinrath HG, Meaney K, Zylstra AB, Parker S, Hussey D, Wilson L, James SF, Kilkenny JD, Hilsabeck TJ. Characterisation of a sub-20 ps temporal resolution pulse dilation photomultiplier tube. Rev Sci Instrum 2018; 89:063506. [PMID: 29960515 DOI: 10.1063/1.5031110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A pulse-dilation photomultiplier tube (PD-PMT) with sub-20 ps temporal resolution has been developed for use with γ-ray-sensitive gas Cherenkov detectors at the National Ignition Facility to improve the diagnosis of nuclear fusion burn history and the areal density of the remaining capsule ablator. The pulse-dilation mechanism entails the application of a time-dependent, ramp waveform to a photocathode-mesh structure, introducing a time-dependent photoelectron accelerating potential. The electric field imparts axial velocity dispersion to outgoing photoelectrons. The photoelectron pulse is dilated as it transits a drift region prior to amplification in a microchannel plate and read out with a digital oscilloscope. We report the first measurements with the prototype PD-PMT demonstrating nominal <20 ps FWHM across a 400 ps measurement window and <30 ps FWHM for an extracted charge up to 300 pC. The output peak areas are linear to within 20% over 3 orders of magnitude of input intensity. 3D particle in cell simulations, which included space charge effects, have been carried out to investigate the device temporal magnification, resolution, and linearity.
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Affiliation(s)
- S G Gales
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | - C J Horsfield
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | | | | | - H W Herrmann
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J D Hares
- Kentech Instruments Ltd., Wallingford OX10 8BD, United Kingdom
| | | | - J S Milnes
- Photek Ltd., St Leonards-on-Sea TN38 9NS, United Kingdom
| | - Y H Kim
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - H G Kleinrath
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - K Meaney
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - A B Zylstra
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - S Parker
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | - D Hussey
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | - L Wilson
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | - S F James
- AWE plc, Aldermaston, Reading RG7 4PR, United Kingdom
| | - J D Kilkenny
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
| | - T J Hilsabeck
- General Atomics, P.O. Box 85608, San Diego, California 92186-5608, USA
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Belcheva A, El Feghali R, Nihtianova T, Parker S. Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study. Lasers Med Sci 2018; 33:1009-1017. [PMID: 29354864 DOI: 10.1007/s10103-018-2446-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 09/15/2017] [Accepted: 01/12/2018] [Indexed: 11/29/2022]
Abstract
The aim of this in-vitro study was to evaluate positive effects of the carbon dioxide laser (CO2, 10,600 nm) with acidulated phosphate fluoride (APF) gel on enamel acid resistance. Twenty extracted human third molars (40 surfaces) were randomly assigned into four groups: group C, untreated control; group L, CO2 laser alone group; group F, APF 1.23% fluoride gel; and group FL, APF 1.23% gel and laser. Samples from group L were irradiated with a CO2 laser for 30s. The parameter settings used were average power, 0.73 W; time on, 100 μs; time off, 40 ms; tip-to-tissue distance, 20 mm; tip diameter 700 μm; and energy density with movements, 5 J/cm2. Samples from group F were treated with the APF gel for 4 min, and the gel was washed off with distilled water. The enamel samples from group FL were treated with APF gel for 4 min and then irradiated with the CO2 laser for 30s without removing the gel. Each enamel sample was placed in 50 ml soft drink (pH = 2.75) for 10 min then rinsed with deionized water and stored in artificial saliva at 37 °C for 1 h. Samples were assessed for Vickers hardness number (VHN) before and after treatments and subjected to SEM analysis. Data were analyzed using a one-way analysis of variance (ANOVA) and Tukey's test (α < 0.05). After the acid challenge, the untreated C group was demineralized to a great extent and the enamel surface was with the lowest mean score of microhardness. The observed VHN in the control (C group) had a mean value of 176.13, the scores in the CO2 laser group (L group) were with mean value of 238.40, the F group with a mean value of 218.45, and the fluoride-treated and laser-irradiated FL group-with a mean of 268.28 VHN. Paired t test performed to compare groups C, L, F, and FL has shown that group FL has greater resistance to decrease in microhardness of dental enamel (P ≤ 0.05) on exposure to acidic protocol. After the acid challenge, the fluoride-treated and laser-irradiated samples (group FL) showed the least diminution in enamel surface microhardness. The sub-ablative carbon dioxide laser irradiation in combination with fluoride treatment is more effective in protecting enamel surface and resisting demineralization than CO2 laser irradiation or fluoride alone.
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Affiliation(s)
- A Belcheva
- Department of Pediatric Dentistry, Faculty of Dental medicine, Medical University of Plovdiv, Plovdiv, Bulgaria.
| | - R El Feghali
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - T Nihtianova
- Department of Pediatric Dentistry, Faculty of Dental medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - S Parker
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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O’Brien J, Martin L, Judkins S, Yeoh M, Chan T, Taylor D, Horrigan M, Parker S. Gender-Specific Findings in Patients Admitted to the Emergency Department with Atrial Fibrillation. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hendra L, Hendra T, Parker S. Decision Making in the Emergency Laparotomy. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.222] [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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Smith LJ, Johnson-Lawrence V, Andrews M, Parker S. Opportunity for interprofessional collaborative care-findings from a sample of federally qualified health center patients in the Midwest. Public Health 2017; 151:131-136. [PMID: 28797923 DOI: 10.1016/j.puhe.2017.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/30/2017] [Accepted: 07/07/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Federally qualified health centers (FQHCs) frequently serve more socio-economically disadvantaged populations; existing literature suggests that underserved groups are more likely to experience various chronic physical and mental health conditions. FQHC patients may have significant needs for various specialty services that are beyond common FQHC providers. This study examines chronic condition prevalence, healthcare satisfaction, and use of multiprovider services in a Midwest FQHC patient population. We also evaluated the potential of interprofessional collaborative practices in FQHC settings. STUDY DESIGN Cross-sectional study. METHODS A total of 232 participants were recruited prior to or immediately after their scheduled clinic visit within an FQHC located on the fringes of an urban area. Respondents were invited to complete a brief questionnaire and grant access to their electronic medical records. RESULTS Nearly half of participants were covered by Medicaid, private insurance carriers (19.4%), or Medicare (17.7%). The most prevalent chronic conditions included diabetes, depression, anxiety, and chronic pain. Almost half (46.6%) of participants were seen by two or three providers; 20% had 7+ office visits in the last year. While 35.3% reported health dissatisfaction, 30.6% reported health satisfaction. When asked if they were satisfied with their health care, nearly 70% reported satisfaction with health care, while only 4.7% reported healthcare dissatisfaction. CONCLUSIONS The authors of this study recommend an interprofessional collaborate healthcare model be explored to address the complex and multifaceted healthcare needs of this population. Future research in this area should prospectively examine the utility of monitoring patient satisfaction in a collaborative practice setting.
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Affiliation(s)
- L J Smith
- Department of Physical Therapy, University of Michigan-Flint, 2157 William S. White Building, 303 E. Kearsley Street, Flint, MI 48502, USA.
| | - V Johnson-Lawrence
- Department of Public Health and Health Sciences, University of Michigan-Flint, 3124 William S. White Building, 303 E. Kearsley Street, Flint, MI 48502, USA
| | - M Andrews
- School of Nursing, University of Michigan-Flint, 2180 William S. White Building, 303 E. Kearsley Street, Flint, MI 48502, USA
| | - S Parker
- Department of Public Health and Health Sciences, University of Michigan-Flint, 3124 William S. White Building, 303 E. Kearsley Street, Flint, MI 48502, USA
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Moggy MA, Pajor EA, Thurston WE, Parker S, Greter AM, Schwartzkopf-Genswein KS, Campbell JR, Windeyer MC. Management practices associated with pain in cattle on western Canadian cow-calf operations: A mixed methods study. J Anim Sci 2017; 95:958-969. [PMID: 28380614 DOI: 10.2527/jas.2016.0949] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The implementation of on-farm pain mitigation strategies is dependent on feasibility and importance to producers. Currently, there is a lack of information regarding adoption of management practices associated with pain in cattle within the Canadian beef industry. The objective of this mixed methods study was to describe pain-associated practices implemented on farm and producer perceptions toward pain mitigation strategies. A questionnaire about calving management and calf processing was delivered to 109 cow-calf producers in western Canada. In addition, 15 respondents were purposively selected based on questionnaire responses to participate in individual semistructured, on-farm interviews. The prevalence of pain mitigation strategies used for dystocia and cesarean section by respondents were 46 and 100%, respectively. The majority of operations reported castrating and dehorning calves before 3 mo of age (95 and 89%, respectively). The majority of operations did not use pain mitigation strategies for castration and dehorning (90 and 85%, respectively). Branding was practiced by 57% of respondents, 4% of which used pain mitigation. Thematic content analysis revealed that producers' perception of pain were influenced by what they referred to as "common sense," relatability to cattle, visual evidence of pain, and age of the animal. Factors that influenced participant rationale for the implementation of pain mitigation practices included access to information and resources, age of the animal, benefit to the operation, cost and logistics, market demands, and personal conscience. Overall, management practices were generally in compliance with published Canadian guidelines. Results of this study may provide direction for future policy making, research, and extension efforts to encourage the adoption of pain mitigation strategies.
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Parker S, Nagra NS, Kulkarni K, Pegrum J, Barry S, Hughes R, Ghani Y. Inadequate pelvic radiographs: implications of not getting it right the first time. Ann R Coll Surg Engl 2017; 99:534-539. [PMID: 28682132 DOI: 10.1308/rcsann.2017.0095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Pelvic radiography is a frequent investigation. European guidelines aim to ensure appropriate use and adequate quality. When initial images are inadequate, repeat radiographs are often required, which may have significant patient safety and economic implications. Objectives The study aimed to assess the adequacy of pelvic imaging across three orthopaedic centres, to identify causes for inadequate imaging and to establish the cost of inadequate imaging from financial and patient safety perspectives. Methods Pelvic radiographs were identified on Picture Archiving and Communication System software at three UK hospitals. Radiographs were assessed against European guidelines and indications for repeat imaging were analysed. Results A total of 1,531 sequential pelvic radiographs were reviewed. The mean age of patients was 60 years (range 5 months to 101 years). Of this total, 51.9% of images were suboptimal, with no significant difference across the three hospitals (P > 0.05). Hospital 3 repeated radiographs in 6.3% of cases, compare with 18.1% and 19.7% at hospitals 1 and 2, respectively (P > 0.05). Hospital 3 identified pathology missed on the initial radiograph in 1% of cases, compared with 5.4% and 5.5% at hospitals 1 and 2, respectively (P > 0.05). Out-of-hours imaging is associated with a higher rate of suboptimal quality (69.1%) compared with normal working hours (51.3%; P = 0.006). Adequacy rates vary with age (χ 2 = 43.62, P < 0.001). Risk of having a suboptimal radiograph increases above the age of 60-years (χ 2 = 4.45, P < 0.05). The annual cost of repeat radiographs was £56,200 per hospital. Discussion and conclusion High rates of pelvic radiograph inadequacy can lead to missed pathology and the requirement for repeat imaging, which has significant patient safety and financial implications. Risk factors for inadequate radiographs include older patients and those having out-of-hours imaging.
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Affiliation(s)
- S Parker
- Department of Trauma and Orthopaedics, Royal Berkshire Hospital , Reading , UK
| | - N S Nagra
- Oxford University Clinical Academic Graduate School, John Radcliffe Hospital , Oxford , UK
| | - K Kulkarni
- Department of Trauma and Orthopaedics, East and North Herts NHS Trust, Lister Hospital , Stevenage , UK
| | - J Pegrum
- Department of Orthopaedics, Nuffield Orthopaedic Centre, Headington , Oxford , UK
| | - S Barry
- Department of Radiology, John Radcliffe Hospital , Oxford , UK
| | - R Hughes
- Department of Radiology, Stoke Mandeville Hospital , Aylesbury , UK
| | - Y Ghani
- Department of Trauma and Orthopaedic Surgery, Stoke Mandeville Hospital , Aylesbury , UK
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Fawdon M, Perry A, Anderson A, Parker S, Doe S, Gascoigne A, Robb A, Bourke S. 351 Environmental screening for Mycobacterium abscessus complex and other significant cystic fibrosis respiratory pathogens including transmissible Pseudomonas aeruginosa and Burkholderia cepacia complex. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30688-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Anderson A, Levey J, Parker S, Fawdon M, Blanch L, Gurney A, Doe S, Bourke S. EPS6.7 Patients' views on the use of video consultations as part of a cystic fibrosis service. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Moggy MA, Pajor EA, Thurston WE, Parker S, Greter AM, Schwartzkopf-Genswein KS, Campbell JR, Windeyer MC. Management practices associated with stress in cattle on western Canadian cow-calf operations: A mixed methods study. J Anim Sci 2017; 95:1836-1844. [PMID: 28464114 DOI: 10.2527/jas.2016.1310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Handling, weaning, and euthanasia are some of the most stressful practices performed on cow-calf operations. Although strategies to minimize stress exist, their use on western Canadian cow-calf operations is unknown. The objectives were to describe current stress-associated practices on western Canadian cow-calf operations, describe producer and operation demographics associated with the use of nonabrupt weaning methods, and explore producer perceptions toward these practices. A questionnaire focusing on stressful management practices was delivered to 109 cow-calf producers in western Canada. Fifteen respondents were purposively selected for individual interviews. The majority of producers reported calves less than 1 wk of age were handled by manual restraint (87%) and those older than 1 wk of age were handled using a cattle squeeze or table. Most producers performed abrupt weaning (70%). Interviewees often mentioned that cost and logistics were major factors in deciding on a weaning strategy. Pasture availability and facilities were viewed as constraints toward the adoption of a nonabrupt weaning method. Animal stress was considered, as producers expressed concern that nonabrupt weaning methods may cause increased stress because of the additional handling required. Producers conveyed that animal age was a major factor that impacted weaning stress and that improved animal performance might motivate them to adopt a nonabrupt weaning strategy. Producers also expressed reluctance to change previously successful traditional approaches. Of respondents, 13% did not euthanize cattle on farm and 8% did not confirm death. Producers interviewed reported that the decision to euthanize cattle on farm was difficult and that veterinary advice was often considered. Factors that influenced their decision to euthanize included the animal's likelihood of recovery and degree of pain and distress. Finally, producers explained that they considered whether the animal was salvageable and able to be transported. Identification of common methods of handling provides focus for future research to determine optimal handling strategies. Identified barriers to nonabrupt weaning may be addressed through research, extension, or policy to encourage the adoption of weaning methods that could improve animal welfare. Confirmation of death after euthanasia was identified as an area that needs to be addressed by producer education to minimize animal stress during on-farm euthanasia.
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Abstract
This paper reviews the organisation and outcomes of a pleural service, specifically geared towards the management of malignant pleural effusions, in a district general hospital in the north east of England. We summarise the evidence behind local anaesthetic thoracoscopy and indwelling pleural catheters. We then summarise the review of our service, including a discussion around complications.
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Affiliation(s)
- A Aujayeb
- A Aujayeb, Respiratory Department, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear NE29 8NH, UK. Email
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Banerjee S, El-Sheikh S, Hamoudi R, Acedo-Nunez P, Parker S, Neal M, MacRobert A, Keshtgar M. Effects of low power PDT and PDT combined with 5′aza deoxycitide in a murine primary breast cancer model. Photodiagnosis Photodyn Ther 2017. [DOI: 10.1016/j.pdpdt.2017.01.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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MacKay RS, Kenna R, Low RJ, Parker S. Calibration with confidence: a principled method for panel assessment. R Soc Open Sci 2017; 4:160760. [PMID: 28386432 PMCID: PMC5367308 DOI: 10.1098/rsos.160760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/09/2017] [Indexed: 06/07/2023]
Abstract
Frequently, a set of objects has to be evaluated by a panel of assessors, but not every object is assessed by every assessor. A problem facing such panels is how to take into account different standards among panel members and varying levels of confidence in their scores. Here, a mathematically based algorithm is developed to calibrate the scores of such assessors, addressing both of these issues. The algorithm is based on the connectivity of the graph of assessors and objects evaluated, incorporating declared confidences as weights on its edges. If the graph is sufficiently well connected, relative standards can be inferred by comparing how assessors rate objects they assess in common, weighted by the levels of confidence of each assessment. By removing these biases, 'true' values are inferred for all the objects. Reliability estimates for the resulting values are obtained. The algorithm is tested in two case studies: one by computer simulation and another based on realistic evaluation data. The process is compared to the simple averaging procedure in widespread use, and to Fisher's additive incomplete block analysis. It is anticipated that the algorithm will prove useful in a wide variety of situations such as evaluation of the quality of research submitted to national assessment exercises; appraisal of grant proposals submitted to funding panels; ranking of job applicants; and judgement of performances on degree courses wherein candidates can choose from lists of options.
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Affiliation(s)
- R. S. MacKay
- Mathematics Institute and Centre for Complexity Science, University of Warwick, Coventry CV4 7AL, UK
| | - R. Kenna
- Applied Mathematics Research Centre, Coventry University, Coventry CV1 5FB, UK
| | - R. J. Low
- Applied Mathematics Research Centre, Coventry University, Coventry CV1 5FB, UK
| | - S. Parker
- Mathematics Institute and Centre for Complexity Science, University of Warwick, Coventry CV4 7AL, UK
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Moggy MA, Pajor EA, Thurston WE, Parker S, Greter AM, Schwartzkopf-Genswein KS, Campbell JR, Windeyer MC. Management practices associated with stress in cattle on western Canadian cow–calf operations: A mixed methods study. J Anim Sci 2017. [DOI: 10.2527/jas2016.1310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Moggy MA, Pajor EA, Thurston WE, Parker S, Greter AM, Schwartzkopf-Genswein KS, Campbell JR, Windeyer MC. Management practices associated with pain in cattle on western Canadian cow–calf operations: A mixed methods study. J Anim Sci 2017. [DOI: 10.2527/jas2016.0949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Glasbey J, Galloway L, Whitham R, Parker S, Blocker O, Ghandour A. Inappropriate measurement of postoperative c-reactive protein in trauma and orthopaedic surgery: A quality improvement project. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Patel J, Granger C, Parker S, Patel M. The effect of instrument lubricant on the diametral tensile strength and water uptake of posterior composite restorative material. J Dent 2016; 56:33-38. [PMID: 27746333 DOI: 10.1016/j.jdent.2016.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/30/2016] [Revised: 09/19/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES This in-vitro study investigated the effect of 'instrument lubricants' used during placement of composite restorative material, on the diametral tensile strength (DTS) and water uptake of composite specimens. METHODS 300 posterior composite cylindrical specimens were manufactured: 60 with each instrument lubricant (ethanol, 3-step, 2-step and 1-step 'bonding agent') and 60 with no lubricant (controls). Each set of 60 specimens was evenly allocated to one of the following test groups (n=100/group): Group 1 - tested for DTS immediately after manufacture; Groups 2 and 3 - tested for DTS after immersion in phosphate-buffered saline (PBS) for 1 and 12-weeks respectively, using a Universal Instron machine. Water uptake was assessed gravimetrically. Data were statistically analysed with two-way ANOVA and Tukey's post hoc test (α=0.05). RESULTS The mean DTS and percentage weight change of composite specimens ranged between 32.49-53.14MPa and 0.51-1.36% and varied with lubricant used and time incubated in PBS. All control groups exhibited significantly higher DTS (MPa) (groups 1-3: 53.17±1.78; 50.64±1.85; 45.17±1.77) and lower percentage weight change (groups 2-3: 0.51±0.03; 0.61±0.01) than specimens placed with an instrument lubricant, with significant differences between certain lubricant groups. CONCLUSION Data from the present study suggest that the use of instrument lubricant may adversely effect the DTS and water uptake of composite restorative material. CLINICAL SIGNIFICANCE The use of instrument lubricants to aid composite placement is widespread however based on the data obtained it is suggested that discontinuing or limiting the use of instrument lubricants, and if necessary using the 'bonding agent' from a 3-step adhesive system is recommended as results suggest this has the least deleterious effect upon material properties..
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Affiliation(s)
- J Patel
- Barts & the London School of Medicine and Dentistry, Dental Physical Sciences, Institute of Dentistry, Francis Bancroft Building, Queen Mary, University of London, Mile End Road, London E1 4NS, United Kingdom.
| | - C Granger
- Barts & the London School of Medicine and Dentistry, Dental Physical Sciences, Institute of Dentistry, Francis Bancroft Building, Queen Mary, University of London, Mile End Road, London E1 4NS, United Kingdom
| | - S Parker
- Barts & the London School of Medicine and Dentistry, Dental Physical Sciences, Institute of Dentistry, Francis Bancroft Building, Queen Mary, University of London, Mile End Road, London E1 4NS, United Kingdom
| | - M Patel
- Barts & the London School of Medicine and Dentistry, Dental Physical Sciences, Institute of Dentistry, Francis Bancroft Building, Queen Mary, University of London, Mile End Road, London E1 4NS, United Kingdom
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Howell A, Parker S, Tsitskaris K, Oddy MJ. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital. Ann R Coll Surg Engl 2016; 98:34-9. [PMID: 26688397 DOI: 10.1308/rcsann.2015.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.
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Affiliation(s)
- A Howell
- University College London Hospitals NHS Foundation Trust , UK
| | - S Parker
- University College London Hospitals NHS Foundation Trust , UK
| | - K Tsitskaris
- University College London Hospitals NHS Foundation Trust , UK
| | - M J Oddy
- University College London Hospitals NHS Foundation Trust , UK
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Kenney A, Chambers RA, Rosenstock S, Neault N, Richards J, Reid R, Nelson L, Begay M, Grass R, Parker S, Barlow A. The Impact of a Home-Based Diabetes Prevention and Management Program on High-Risk American Indian Youth. Diabetes Educ 2016; 42:585-95. [PMID: 27422151 DOI: 10.1177/0145721716658357] [Citation(s) in RCA: 13] [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: 01/21/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of a home-based diabetes prevention and management program on high-risk American Indian youth. METHODS Together on Diabetes (TOD) was designed via a participatory approach with 4 tribal communities in the southwestern United States. A multisite pre- and postevaluation design was used to evaluate the efficacy of the TOD intervention on improving youth's psychosocial, knowledge, behavioral, and physiological outcomes at 4 time points from baseline to 12 months postenrollment. RESULTS A total of 256 youth and 225 support persons were enrolled in the TOD program. At 12 months postenrollment, improvements were observed in youth's quality of life (P < .001), depressive symptoms (P < .001), knowledge related to TOD content (P < .001), standardized body mass index scores (P = .004), and hypertension (P = .026). Improvements in mean A1C were observed among diabetic youth with baseline A1C >6.5% (P = .036). CONCLUSIONS The TOD program was feasible, acceptable, and effective in lowering diabetes risk among reservation-based American Indian youth. It is the first efficacious youth-focused diabetes prevention and management program developed and implemented in partnership with tribal communities.
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Affiliation(s)
- Anne Kenney
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (Ms Kenney, Ms Chambers, Dr Rosenstock, Dr Barlow)
| | - Rachel A Chambers
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (Ms Kenney, Ms Chambers, Dr Rosenstock, Dr Barlow)
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (Ms Kenney, Ms Chambers, Dr Rosenstock, Dr Barlow)
| | - Nicole Neault
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (Ms Kenney, Ms Chambers, Dr Rosenstock, Dr Barlow),Johns Hopkins Center for American Indian Health: Albuquerque Office, Johns Hopkins Bloomberg School of Public Health, Albuquerque, New Mexico, USA (Ms Neault)
| | - Jennifer Richards
- Johns Hopkins Center for American Indian Health: Tuba City Office, Johns Hopkins Bloomberg School of Public Health, Tuba City, Arizona, USA (Ms Richards, Mr Grass)
| | - Raymond Reid
- Johns Hopkins Center for American Indian Health: Shiprock Office, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico, USA (Dr Reid, Ms Nelson)
| | - Leonela Nelson
- Johns Hopkins Center for American Indian Health: Shiprock Office, Johns Hopkins Bloomberg School of Public Health, Shiprock, New Mexico, USA (Dr Reid, Ms Nelson)
| | - Marissa Begay
- Johns Hopkins Center for American Indian Health: Chinle Office, Johns Hopkins Bloomberg School of Public Health, Chinle, Arizona, USA (Ms Begay)
| | - Ryan Grass
- Johns Hopkins Center for American Indian Health: Tuba City Office, Johns Hopkins Bloomberg School of Public Health, Tuba City, Arizona, USA (Ms Richards, Mr Grass)
| | - Sean Parker
- Johns Hopkins Center for American Indian Health: Whiteriver Office, Johns Hopkins Bloomberg School of Public Health, Whiteriver, Arizona, USA (Mr Parker)
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA (Ms Kenney, Ms Chambers, Dr Rosenstock, Dr Barlow)
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Fong de los Santos L, Dong L, Greener A, Johnson J, Johnson P, Kim G, Mechalakos J, Napolitano B, Parker S, Schofield D, Wells M, Yorke E, Ford E. TU-D-201-02: Medical Physics Practices for Plan and Chart Review: Results of AAPM Task Group 275 Survey. Med Phys 2016. [DOI: 10.1118/1.4957468] [Citation(s) in RCA: 4] [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] [Indexed: 11/07/2022] Open
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Parker S. WE-G-BRC-03: Risk Assessment for Physics Plan Review. Med Phys 2016. [DOI: 10.1118/1.4957964] [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: 11/07/2022] Open
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