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Smith SL, Walsh DA. Osteoarthritis pain phenotypes: How best to cut the cake? Osteoarthritis Cartilage 2024; 32:124-127. [PMID: 38006965 DOI: 10.1016/j.joca.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/08/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Affiliation(s)
- Stephanie L Smith
- Research Fellow, Pain Centre Versus Arthritis and Advanced Pain Discovery Platform, Academic Rheumatology, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, Nottingham, UK
| | - David A Walsh
- Honorary Consultant, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK; Professor of Rheumatology, co-director Pain Centre Versus Arthritis, and Programme Director Advanced Pain Discovery Platform, NIHR Biomedical Research Centre, Academic Rheumatology, Academic Unit of Injury, Recovery and Inflammation Science, School of Medicine, University of Nottingham, UK, Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK.
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Dickson DM, Smith SL, Hendry GJ. Association between quadriceps tendon elasticity and neuromuscular control in individuals with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2024; 111:106159. [PMID: 38101187 DOI: 10.1016/j.clinbiomech.2023.106159] [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: 06/27/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Knee osteoarthritis is a complex condition with established risk factors such as female sex, increasing age and body mass index, reduced quadriceps muscle strength and knee injury. Despite known associated risks, the role and behaviour of knee tendons in knee osteoarthritis remains unclear. This study explores the association between quadriceps tendon elasticity, muscle strength, neuromuscular control, proprioception and patient reported outcome measures in individuals with knee osteoarthritis. METHODS Adults with doctor-diagnosed knee osteoarthritis were recruited from rheumatology clinics and general practitioner practices. Quadriceps tendon elasticity was estimated using sonoelastography. Neuromuscular control data including electromyography, electromechanical delay and proprioception measures were included. Participants completed the Knee Injury and Osteoarthritis Outcome Score. Associations between elasticity values, physical and neuromuscular data and patient reported outcomes scores were evaluated using Spearman's correlations. FINDINGS Thirty-nine adults with knee osteoarthritis were eligible for inclusion. Increased tendon stiffness was negatively associated with rate of force development, time to half peak force and passive positioning sense in individuals with knee osteoarthritis. Similarly, patient reported symptoms were found to be associated with sonoelastography findings with moderate-strong associations observed between activities of daily living sport and recreation, pain and symptoms and between neuromuscular control measures and muscle strength. INTERPRETATION Stiffer tendon identified within the knee osteoarthritis group was associated with reduced neuromuscular control and knee joint proprioception. Stiffer quadriceps tendon may contribute to the poorer reported symptoms by knee osteoarthritis individuals. These findings may impact disease symptoms and progression which could lead to further joint impairment.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK; Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recovery and Inflammation Sciences, School of Medicine, Clinical Sciences Building, University of Nottingham, Nottingham NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow G4 0BA, UK
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McWilliams DF, Yue B, Smith SL, Stocks J, Doherty M, Valdes AM, Zhang W, Sarmanova A, Fernandes GS, Akin-Akinyosoye K, Hall M, Walsh DA. Associations of Muscle Strength with Central Aspects of Pain: Data from the Knee Pain and Related Health in the Community (KPIC) Cohort. J Pers Med 2023; 13:1450. [PMID: 37888061 PMCID: PMC10608698 DOI: 10.3390/jpm13101450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Knee pain is associated with lower muscle strength, and both contribute to disability. Peripheral and central neurological mechanisms contribute to OA pain. Understanding the relative contributions of pain mechanisms to muscle strength might help future treatments. The Knee Pain and related health In the Community (KPIC) cohort provided baseline and year 1 data from people with early knee pain (n = 219) for longitudinal analyses. A cross-sectional analysis was performed with baseline data from people with established knee pain (n = 103) and comparative data from people without knee pain (n = 98). Quadriceps and handgrip strength indicated local and general muscle weakness, respectively. The indices of peripheral nociceptive drive were knee radiographic and ultrasound scores. The indices associated with central pain mechanisms were Pressure Pain detection Threshold (PPT) distal to the knee, and a validated self-report Central Aspects of Pain Factor (CAPF). The associations were explored using correlation and multivariable regression. Weaker quadriceps strength was associated with both high CAPF and low PPT at baseline. Year 1 quadriceps weakness was predicted by higher baseline CAPF (β = -0.28 (95% CI: -0.55, -0.01), p = 0.040). Weaker baseline and year 1 handgrip strength was also associated with higher baseline CAPF. Weaker baseline quadriceps strength was associated with radiographic scores in bivariate but not adjusted analyses. Quadriceps strength was not significantly associated with total ultrasound scores. Central pain mechanisms might contribute to muscle weakness, both locally and remote from the knee.
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Affiliation(s)
- Daniel F. McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Bin Yue
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - Stephanie L. Smith
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Joanne Stocks
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- Centre for Sports, Exercise, and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham NG7 2UH, UK
| | - Michael Doherty
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Ana M. Valdes
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Weiya Zhang
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Aliya Sarmanova
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | | | - Kehinde Akin-Akinyosoye
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Michelle Hall
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Division of Physiotherapy Education, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - David A. Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield NG17 4JL, UK
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Abstract
This Special Issue of Neuropharmacology on psychedelics provides a timely and comprehensive update on progress following the previous Neuropharmacology Special Issue "Psychedelics: New Doors, Altered Perceptions". Remarkable advances have been made in basic and clinical research on psychedelics in the five years since 2018. It is partly based on the seminar series focused on psilocybin organized by the National Institutes of Health (NIH), USA from April to June 2021, the "NIH Psilocybin Research Speaker Series". Participants were world leading experts, including scientists, medical practitioners, clinical psychologists and oncologists, and attendees from additional disciplines of patient advocacy, law, government science policy and regulatory policy. To provide a global perspective, their contributions are complemented with reviews by some of the world's most eminent scientists in the field. The US Food and Drug Administration (FDA) has granted two breakthrough therapy designations for psilocybin in treatment resistant depression (TRD) in 2018 and major depressive disorder (MDD) in 2019, as well as for MDMA for the treatment of post-traumatic stress disorder (PTSD) in 2017. Clinical trials are in progress to assess the therapeutic value of psilocybin in MDD and TRD, and in other indications such as cancer-related anxiety and depression, anorexia, PTSD, substance use disorders and various types of chronic pain. The contributors' insights should assist basic and applied science for transition of psychedelics from bench to potential mainstream therapies. The implications are global, because FDA approval of these new medicines will increase international interest and efforts.
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Affiliation(s)
- D J Heal
- DevelRx Ltd, BioCity, Nottingham NG1 1GF, UK; Department of Life Sciences, University of Bath, Bath BA2 7AY, UK.
| | - S L Smith
- DevelRx Ltd, BioCity, Nottingham NG1 1GF, UK.
| | - S J Belouin
- United States Public Health Service (USPHS), Germantown, MD, USA; Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, MD, USA; NIH Clinical Research Center, Pain and Palliative Care, Bethesda, MD, USA.
| | - J E Henningfield
- Pinney Associates, 4800 Montgomery Ln Suite 400, Bethesda, MD 20814, USA; Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
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Smith SL. Civil society priorities for global health: concepts and measurement. Health Policy Plan 2023:7175478. [PMID: 37217184 DOI: 10.1093/heapol/czad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/30/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023] Open
Abstract
The global health agenda-a high stakes process in which problems are defined and compete for the kind of serious attention that promises to help alleviate inequities in the burden of disease-is comprised of priorities set within and among a host of interacting stakeholder arenas. This study informs crucial and unanswered conceptual and measurement questions with respect to civil society priorities in global health. The exploratory two-stage inquiry probes insights from experts based in four world regions and pilots a new measurement approach, analysing nearly 20 000 Tweets straddling the COVID-19 pandemic onset from a set of civil society organizations (CSOs) engaged in global health. Expert informants discerned civil society priorities principally on the basis of observed trends in CSO and social movement action, including advocacy, program, and monitoring and accountability activities-all of which are widely documented by CSOs active on Twitter. Systematic analysis of a subset of CSO Tweets shows how their attention to COVID-19 soared amidst mostly small shifts in attention to a wide range of other issues between 2019 and 2020, reflecting impacts of a focusing event and other dynamics. The approach holds promise for advancing measurement of emergent, sustained and evolving civil society priorities in global health.
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Heal DJ, Gosden J, Smith SL, Atterwill CK. Experimental strategies to discover and develop the next generation of psychedelics and entactogens as medicines. Neuropharmacology 2023; 225:109375. [PMID: 36529260 DOI: 10.1016/j.neuropharm.2022.109375] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 08/10/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
Research on classical psychedelics (psilocybin, LSD and DMT) and entactogen, MDMA, has produced a renaissance in the search for more effective drugs to treat psychiatric, neurological and various peripheral disorders. Psychedelics and entactogens act though interaction with 5-HT2A and other serotonergic receptors and/or monoamine reuptake transporters. 5-HT, which serves as a neurotransmitter and hormone, is ubiquitously distributed in the brain and peripheral organs, tissues and cells where it has vasoconstrictor, pro-inflammatory and pro-nociceptive actions. Serotonergic psychedelics and entactogens have known safety and toxicity risks. For these drugs, the risks been extensively researched and empirically assessed through human experience. However, novel drug-candidates require thorough non-clinical testing not only to predict clinical efficacy, but also to address the risks they pose during clinical development and later after approval as prescription medicines. We have defined the challenges researchers will encounter when developing novel serotonergic psychedelics and entactogens. We describe screening techniques to predict clinical efficacy and address the safety/toxicity risks emerging from our knowledge of the existing drugs: 1) An early-stage, non-clinical screening cascade to pharmacologically characterise novel drug-candidates. 2) Models to detect hallucinogenic activity. 3) Models to differentiate hallucinogens from entactogens. 4) Non-clinical preclinical lead optimisation technology (PLOT) screening to select drug-candidates. 5) Modified animal models to evaluate the abuse and dependence risks of novel psychedelics in Safety Pharmacology testing. Our intention has been to design non-clinical screening strategies that will reset the balance between benefits and harms to deliver more effective and safer novel psychedelics for clinical use. This article is part of the Special Issue on 'National Institutes of Health Psilocybin Research Speaker Series'.
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Affiliation(s)
- D J Heal
- DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK; Department of Life Sciences, University of Bath, Bath, BA2 7AY, UK.
| | - J Gosden
- DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
| | - S L Smith
- DevelRx Ltd, BioCity, Nottingham, NG1 1GF, UK.
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Dickson DM, Smith SL, Hendry GJ. Strain sonoelastography in asymptomatic individuals and individuals with knee osteoarthritis: an evaluation of quadriceps and patellar tendon. Rheumatol Int 2022; 42:2241-2251. [PMID: 35974116 PMCID: PMC9548467 DOI: 10.1007/s00296-022-05184-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
An advanced ultrasound imaging technique, sonoelastography (SE) is used to evaluate tissue elasticity. To determine SE potential to detect pathological-related changes, and characteristics related to tendon pathology we aimed to (1) compare quadriceps and patellar tendon findings in individuals with knee osteoarthritis (KOA) and asymptomatic older adults (AC), and (2) explore associations between SE, participant characteristics (age, BMI, and leg circumference) and KOA status. 84 participants (47; KOA and 37; asymptomatic older adults) underwent SE examination of quadriceps (distal) and patellar (distal, proximal) tendon in a supine position with the knee bent at 30°. Colour score (CS) and Elasticity Ratio (ER) analysis were performed by a blinded experienced operator using Esaote Mylab 70 XVG Ultrasound equipment. Significantly reduced elasticity in the distal quadriceps (median (IQR) 2(2), 3(1), p = 0.033 for KOA and AC, respectively) and proximal patellar (3(1), 3(0), p = 0.001) tendons and more elastic distal patellar (1.50 (0.55), 1.87 (0.72), p = 0.034) tendons were observed in the KOA group. Significant associations) were identified between SE and participant BMI (Rs = − 0.249–0.750, p < 0.05) and leg circumference (Rs = − 0.260–0.903, p < 0.05). Age, BMI and KOA status, were independent explanatory variables of SE CS findings at the distal quadriceps tendon patellar tendon, proximal patellar tendon and distal patellar tendon, explaining 66%, 81% and 64% of variance, respectively. Age, BMI and KOA status were independent explanatory variables of SE ER findings at the distal patellar tendon explaining 19% of variance. Potentially clinically relevant altered tendon stiffness were observed between individuals with KOA and asymptomatic controls. Key KOA risk factors and participant characteristics explained variance in tendon stiffness. Findings provide context for future studies to investigate the potential for targeted SE detected early clinical management based on associated participant characteristics.
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Affiliation(s)
- Diane M Dickson
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Stephanie L Smith
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK.,Pain Centre Versus Arthritis, Academic Rheumatology, Injury Recover and Inflammation Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham, NG5 1PB, UK
| | - Gordon J Hendry
- Research Centre for Health, Department of Podiatry and Radiography, School of Health and Life Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
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Rose AL, Fenelon DL, Fils-Aimé JR, Dubuisson W, Singer SFC, Smith SL, Jerome G, Eustache E, Raviola G. Development of an Innovative Digital Data Collection System for Routine Mental Health Care Delivery in Rural Haiti. Glob Health Sci Pract 2021; 9:990-999. [PMID: 34933992 PMCID: PMC8691881 DOI: 10.9745/ghsp-d-20-00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/22/2021] [Indexed: 11/17/2022]
Abstract
Mental health information systems in low-resource settings are scarce worldwide. Data collection was accurate, yet sustainable staffing was a challenge when using task-shared clinical providers for data collection in health centers in rural Haiti. Integrating mental health data collection within existing data collection systems would help close this key gap. Introduction: Effective digital health management information systems (HMIS) support health data validity, which enables health care teams to make programmatic decisions and country-level decision making in support of international development targets. In 2015, mental health was included within the Sustainable Development Goals, yet there are few applications of HMIS of any type in the practice of mental health care in resource-limited settings. Zanmi Lasante (ZL), one of the largest providers of mental health care in Haiti, developed a digital data collection system for mental health across 11 public rural health facilities. Program Intervention: We describe the development, implementation, and evaluation of the digital system for mental health data collection at ZL. To evaluate system reliability, we assessed the number of missing monthly reports. To evaluate data validity, we calculated concordance between the digital system and paper charts at 2 facilities. To evaluate the system's ability to inform decision making, we specified and then calculated 4 priority indicators. Results: The digital system was missing 5 of 143 monthly reports across all facilities and had 74.3% (55/74) and 98% (49/50) concordance with paper charts. It was possible to calculate all 4 indicators, which led to programmatic changes in 2 cases. In response to implementation challenges, it was necessary to use strategies to increase provider buy-in and ultimately to introduce dedicated data clerks to keep pace with data collection and protect time for clinical work. Lessons Learned: While demonstrating the potential of collecting mental health data digitally in a low-resource rural setting, we found that it was necessary to consider the ongoing roles of paper records alongside digital data collection. We also identified the challenge of balancing clinical and data collection responsibilities among a limited staff. Ongoing work is needed to develop truly sustainable and scalable models for mental health data collection in resource-limited settings.
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Affiliation(s)
- Alexandra L Rose
- Department of Psychology, University of Maryland, College Park, MD, USA.
- Partners In Health, Boston, MA, USA
| | | | | | | | | | - Stephanie L Smith
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - Giuseppe Raviola
- Partners In Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Smith SL, Nyirandagijimana B, Hakizimana J, Levy RP, Bienvenu R, Uwamwezi A, Hakizimfura O, Uwimana E, Kundu P, Mpanumusingo E, Nshimyiryo A, Rusangwa C, Kateera F, Mukasakindi H, Raviola G. Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design. BMJ Open 2021; 11:e054630. [PMID: 34862298 PMCID: PMC8647529 DOI: 10.1136/bmjopen-2021-054630] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Evidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda. METHODS AND ANALYSIS We will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews. ETHICS AND DISSEMINATION This evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.
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Affiliation(s)
- Stephanie L Smith
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Roger P Levy
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | | | | | | | | | | | | | | | | | | | - Giuseppe Raviola
- Partners In Health, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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Collier S, Meyen R, Smith SL, Valentin C, Eustache FE. Enhancing Quality Supervision for the Delivery of Mental Health Care Through Nonspecialist Clinicians in Resource-Limited Settings. Harv Rev Psychiatry 2021; 29:390-400. [PMID: 34431791 DOI: 10.1097/hrp.0000000000000313] [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: 11/25/2022]
Abstract
Supervision of nonspecialist clinicians by trained mental health professionals is integral to developing capacity for providing mental health care in low-resource settings. Current supervision efforts in low-resource settings, however, are often variable in quality. Scant published literature addresses how supervision practices affect treatment outcomes; only a few studies have been published on evidence-based supervision methods. Additionally, in low-resource settings many systems-level obstacles exist in providing adequate mental health supervision to nonspecialist clinicians. This article seeks to address psychiatrists' role in providing supervision and promoting quality of care in low-resource settings. We review the literature on evidence-based supervision practices, address obstacles and current practices of providing high-quality mental health supervision in low-resource settings, and weave this knowledge with our experiences learning from the clinicians at Partners in Health in Haiti. We also discuss feasible strategies and provide recommendations for strengthening the supervision process in resource-limited settings.
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Affiliation(s)
- Stephanie Collier
- From Harvard Medical School (Drs. Collier and Smith); McLean Hospital, Belmont, MA (Dr. Collier); Edith Norse Rogers Memorial VA, Bedford, MA (Dr. Meyen); Brigham and Women's Hospital, Boston, MA (Dr. Smith); Partners in Health (Dr. Smith); Zanmi Lasante/Partners in Health, Mirebalais, Haiti (Dr. Valentin and Fr. Eustache)
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11
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Rose AL, McBain R, Wilson J, Coleman SF, Mathieu E, Fils-Aimé JR, Affricot E, Thérosmé T, Dubuisson W, Eustache E, Smith SL, Raviola G. Evaluating clinical outcomes of routinely delivered task-shared care for depression in rural Haiti. Glob Ment Health (Camb) 2021; 8:e19. [PMID: 34168884 PMCID: PMC8192595 DOI: 10.1017/gmh.2021.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/02/2021] [Accepted: 04/22/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake. METHODS For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose. RESULTS 306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0-39), controlling for sex, age, and days in treatment (95% CI -1.478 to -0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms. CONCLUSIONS Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.
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Affiliation(s)
- Alexandra L. Rose
- Department of Psychology, University of Maryland, College Park, USA
- Partners in Health, Boston, USA
| | - Ryan McBain
- Partners in Health, Boston, USA
- RAND Corporation, Boston, USA
| | | | | | | | | | | | | | | | | | - Stephanie L. Smith
- Partners in Health, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | - Giuseppe Raviola
- Partners in Health, Boston, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
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12
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Smith SL, Shiffman J, Shawar YR, Shroff ZC. The rise and fall of global health issues: an arenas model applied to the COVID-19 pandemic shock. Global Health 2021; 17:33. [PMID: 33781272 PMCID: PMC8006127 DOI: 10.1186/s12992-021-00691-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background The global health agenda is ill-defined as an analytical construct, complicating attempts by scholars and proponents to make claims about the agenda status of issues. We draw on Kingdon’s definition of the agenda and Hilgartner and Bosk’s public arenas model to conceptualize the global health agenda as those subjects or problems to which collectivities of actors operating nationally and globally are paying serious attention at any given time. We propose an arenas model for global health agenda setting and illustrate its potential utility by assessing priority indicators in five arenas, including international aid, pharmaceutical industry, scientific research, news media and civil society. We then apply the model to illustrate how the status of established (HIV/AIDS), emergent (diabetes) and rising (Alzheimer’s disease) issues might be measured, compared and change in light of a pandemic shock (COVID-19). Results Coronavirus priority indicators rose precipitously in all five arenas in 2020, reflecting the kind of punctuation often caused by focusing events. The magnitude of change varied somewhat by arena, with the most pronounced shift in the global news media arena. Priority indicators for the other issues showed decreases of up to 21% and increases of up to 41% between 2019 and 2020, with increases suggesting that the agenda for global health issues expanded in some arenas in 2020— COVID-19 did not consistently displace priority for HIV/AIDS, diabetes or Alzheimer’s disease, though it might have for other issues. Conclusions We advance an arenas model as a novel means of addressing conceptual and measurement challenges that often undermine the validity of claims concerning the global health agenda status of problems and contributing causal factors. Our presentation of the model and illustrative analysis lays the groundwork for more systematic investigation of trends in global health agenda setting. Further specification of the model is needed to ensure accurate representation of vital national and transnational arenas and their interactions, applicability to a range of disease-specific, health systems, governance and policy issues, and sensitivity to subtler influences on global health agenda setting than pandemic shocks.
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Affiliation(s)
| | - Jeremy Shiffman
- Johns Hopkins Bloomberg School of Public Health and Paul H. Nitze School of Advanced International Studies, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Yusra Ribhi Shawar
- Johns Hopkins Bloomberg School of Public Health and Paul H. Nitze School of Advanced International Studies, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Zubin Cyrus Shroff
- Alliance for Health Policy and Systems Research, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
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13
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McFarlane SE, Senn HV, Smith SL, Pemberton JM. Locus-specific introgression in young hybrid swarms: Drift may dominate selection. Mol Ecol 2021; 30:2104-2115. [PMID: 33638185 DOI: 10.1111/mec.15862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/01/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
Closely related species that have previously inhabited geographically separated ranges are hybridizing at an increasing rate due to human disruptions. These human-mediated hybrid zones can be used to study reproductive isolation between species at secondary contact, including examining locus-specific rates of introgression. Introgression is expected to be heterogenous across the genome, reflecting variation in selection. Those loci that introgress especially slowly are good candidates for being involved in reproductive isolation, while those loci that introgress quickly may be involved in adaptive introgression. In the context of conservation, policy makers are especially concerned about introduced alleles moving quickly into the background of a native or endemic species, as these alleles could replace the native alleles in the population, leading to extinction via hybridization. We applied genomic cline analyses to 44,997 SNPs to identify loci introgressing more or less when compared to the genome wide expectation in a human-mediated hybridizing population of red deer and sika in Kintyre Scotland. We found 11.4% of SNPs had cline centres that were significantly different from the genome wide expectation, and 17.6% of all SNPs had excess rates of introgression. Based on simulations, we believe that many of these markers have diverged from the genome-wide average due to drift, rather than because of selection, and we suggest that these simulations can be useful as a null distribution for future studies of genomic clines. Future work on red deer and sika could determine the policy implications of allelic-replacement due to drift rather than selection, and could use replicate, geographically distinct hybrid zones to narrow down those loci that are responding to selection.
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Affiliation(s)
- S Eryn McFarlane
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK.,Department of Biology, Lund University, Lund, Sweden
| | - Helen V Senn
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK.,WildGenes Laboratory, Royal Zoological Society of Scotland, Edinburgh, UK
| | - Stephanie L Smith
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK.,The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Edinburgh, UK
| | - Josephine M Pemberton
- School of Biological Sciences, Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, UK
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14
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Brand W, Wells AT, Smith SL, Denholm SJ, Wall E, Coffey MP. Predicting pregnancy status from mid-infrared spectroscopy in dairy cow milk using deep learning. J Dairy Sci 2021; 104:4980-4990. [PMID: 33485687 DOI: 10.3168/jds.2020-18367] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Accurately identifying pregnancy status is imperative for a profitable dairy enterprise. Mid-infrared (MIR) spectroscopy is routinely used to determine fat and protein concentrations in milk samples. Mid-infrared spectra have successfully been used to predict other economically important traits, including fatty acid content, mineral content, body energy status, lactoferrin, feed intake, and methane emissions. Machine learning has been used in a variety of fields to find patterns in vast quantities of data. This study aims to use deep learning, a sub-branch of machine learning, to establish pregnancy status from routinely collected milk MIR spectral data. Milk spectral data were obtained from National Milk Records (Chippenham, UK), who collect large volumes of data continuously on a monthly basis. Two approaches were followed: using genetic algorithms for feature selection and network design (model 1), and transfer learning with a pretrained DenseNet model (model 2). Feature selection in model 1 showed that the number of wave points in MIR data could be reduced from 1,060 to 196 wave points. The trained model converged after 162 epochs with validation accuracy and loss of 0.89 and 0.18, respectively. Although the accuracy was sufficiently high, the loss (in terms of predicting only 2 labels) was considered too high and suggested that the model would not be robust enough to apply to industry. Model 2 was trained in 2 stages of 100 epochs each with spectral data converted to gray-scale images and resulted in accuracy and loss of 0.97 and 0.08, respectively. Inspection on inference data showed prediction sensitivity of 0.89, specificity of 0.86, and prediction accuracy of 0.88. Results indicate that milk MIR data contains features relating to pregnancy status and the underlying metabolic changes in dairy cows, and such features can be identified by means of deep learning. Prediction equations from trained models can be used to alert farmers of nonviable pregnancies as well as to verify conception dates.
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Affiliation(s)
- W Brand
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - A T Wells
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - S L Smith
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - S J Denholm
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - E Wall
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | - M P Coffey
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh, EH9 3JG, UK.
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15
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Coleman SF, Mukasakindi H, Rose AL, Galea JT, Nyirandagijimana B, Hakizimana J, Bienvenue R, Kundu P, Uwimana E, Uwamwezi A, Contreras C, Rodriguez-Cuevas FG, Maza J, Ruderman T, Connolly E, Chalamanda M, Kayira W, Kazoole K, Kelly KK, Wilson JH, Houde AA, Magill EB, Raviola GJ, Smith SL. Adapting Problem Management Plus for Implementation: Lessons Learned from Public Sector Settings Across Rwanda, Peru, Mexico and Malawi. Intervention (Amstelveen) 2021; 19:58-66. [PMID: 34642580 PMCID: PMC8503941] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Problem Management Plus (PM+) is a low-intensity psychological intervention developed by the World Health Organization that can be delivered by nonspecialists to address common mental health conditions in people affected by adversity. Emerging evidence demonstrates the efficacy of PM+ across a range of settings. However, the published literature rarely documents the adaptation processes for psychological interventions to context or culture, including curriculum or implementation adaptations. Practical guidance for adapting PM+ to context while maintaining fidelity to core psychological elements is essential for mental health implementers to enable replication and scale. This paper describes the process of contextually adapting PM+ for implementation in Rwanda, Peru, Mexico and Malawi undertaken by the international nongovernmental organization Partners In Health. To our knowledge, this initiative is among the first to adapt PM+ for routine delivery across multiple public sector primary care and community settings in partnership with Ministries of Health. Lessons learned contribute to a broader understanding of effective processes for adapting low-intensity psychological interventions to real-world contexts.
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Affiliation(s)
| | | | | | - Jerome T. Galea
- School of Social Work and College of Public Health, University of South Florida, Tampa, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
| | | | | | | | - Priya Kundu
- Partners In Health/Inshuti Mu Buzima, Rwanda
| | | | | | - Carmen Contreras
- Partners In Health/Socios En Salud, Peru, Harvard Global Health Institute, Boston, USA
| | | | - Jimena Maza
- Partners In Health/Compañeros En Salud, Mexico
| | | | - Emilia Connolly
- Partners In Health/Abwenzi Pa Za Umoyo, Malawi; Division of Pediatrics and Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | - Giuseppe J. Raviola
- Partners In Health, Boston, USA,Partners In Health, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Stephanie L. Smith
- Partners In Health, Boston, MA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Department of Psychiatry, Brigham and Women’s Hospital, Boston, USA
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16
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Dickson DM, Smith SL, Hendry GJ. Can patient characteristics explain variance in ultrasound strain elastography measures of the quadratus femoris and patellar tendons? Knee 2021; 28:282-293. [PMID: 33460994 DOI: 10.1016/j.knee.2020.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/18/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To explore the associations between participant characteristics and magnitudes of difference in paired elastography measures of knee tendon from different ultrasound systems, and to compare strain elastography pattern description. MATERIALS AND METHODS Quadriceps and patellar tendons of 20 healthy volunteers (40 tendons) were examined by an experienced operator employing two ultrasound systems (GE S8 and Esaote MyLab 70XVG). Pearson/Spearman correlations explored the influence of participant characteristics (BMI, body fat %, leg circumference, activity level) on the magnitude of differences between measures. Paired-sample t test or Wilcoxon signed rank test were performed to compare repeated measures of individual ultrasound systems. RESULTS The quadriceps tendon was characteristically stiffer than the patellar tendon. Participant characteristics were associated with within machine differences of the distal quadriceps tendon (BMI; r = 0.49, p = 0.028-0.03 and body fat %; r = 0.43, p = 0.05-0.056) ER measures. CONCLUSIONS Anthropometric and body composition parameters were associated with within machine differences for elasticity measures, where high BMI and body fat % contribute to paired measurement variance at the distal quadriceps tendon. Strain elastography protocols should be standardised, repeated ER measures performed using the same US system and patient characteristics considered for future clinical applications.
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Affiliation(s)
- Diane M Dickson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK.
| | - Stephanie L Smith
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK; University of Nottingham, University Park, Nottingham, UK
| | - Gordon J Hendry
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, UK
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17
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Nyirandagijimana B, Nshimyiryo A, Mukasakindi H, Odhiambo J, Uwimana E, Mukamurenzi V, Bienvenu R, Ndikubwimana JS, Uwamaliya C, Kundu P, Park PH, Mpunga T, Raviola GJ, Kateera F, Rusangwa C, Smith SL. Decentralized, primary-care delivered epilepsy services in Burera District, Rwanda: Service use, feasibility, and treatment. eNeurologicalSci 2020; 22:100296. [PMID: 33319078 PMCID: PMC7724371 DOI: 10.1016/j.ensci.2020.100296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 03/06/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Integrating epilepsy care into primary care settings could reduce the global burden of illness attributable to epilepsy. Since 2012, the Rwandan Ministry of Health and the international nonprofit Partners In Health have collaboratively used a multi-faceted implementation program- MESH MH—to integrate and scale-up care for epilepsy and mental disorders within rural primary care settings in Burera district, Rwanda. We here describe demographics, service use and treatment patterns for patients with epilepsy seeking care at MESH-MH supported primary care health centers. Methods and findings This was a retrospective cohort study using routinely collected data from fifteen health centers in Burera district, from January 2015 to December 2016. 286 patients with epilepsy completed 3307 visits at MESH-MH participating health centers over a two year period (Jan 1st 2015 to Dec 31st 2016). Men were over twice as likely to be diagnosed with epilepsy than women (OR 2.38, CI [1.77–3.19]), and children under 10 were thirteen times as likely to be diagnosed with epilepsy as those 10 and older (OR 13.27, CI [7.18–24.51]). Carbamazepine monotherapy was prescribed most frequently (34% of patients). Conclusion Task-sharing of epilepsy care to primary care via implementation programs such as MESH-MH has the potential to reduce the global burden of illness attributable to epilepsy. Primary-care delivered epilepsy services in rural Rwanda are described. High epilepsy service use, treatment uptake and follow-up was observed. Primary-care integration could increase epilepsy treatment availability globally.
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Affiliation(s)
| | | | | | - Jackline Odhiambo
- Ministry of Health, Kigali, Rwanda.,Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | | | - Priya Kundu
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Paul H Park
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA
| | | | - Giuseppe J Raviola
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | | | | | - Stephanie L Smith
- Partners In Health, Boston, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.,Department of Psychiatry, Brigham and Women's Hospital, Boston, USA
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18
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Patterson EI, Elia G, Grassi A, Giordano A, Desario C, Medardo M, Smith SL, Anderson ER, Prince T, Patterson GT, Lorusso E, Lucente MS, Lanave G, Lauzi S, Bonfanti U, Stranieri A, Martella V, Solari Basano F, Barrs VR, Radford AD, Agrimi U, Hughes GL, Paltrinieri S, Decaro N. Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy. Nat Commun 2020; 11:6231. [PMID: 33277505 PMCID: PMC7718263 DOI: 10.1038/s41467-020-20097-0] [Citation(s) in RCA: 237] [Impact Index Per Article: 59.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
SARS-CoV-2 emerged from animals and is now easily transmitted between people. Sporadic detection of natural cases in animals alongside successful experimental infections of pets, such as cats, ferrets and dogs, raises questions about the susceptibility of animals under natural conditions of pet ownership. Here, we report a large-scale study to assess SARS-CoV-2 infection in 919 companion animals living in northern Italy, sampled at a time of frequent human infection. No animals tested PCR positive. However, 3.3% of dogs and 5.8% of cats had measurable SARS-CoV-2 neutralizing antibody titers, with dogs from COVID-19 positive households being significantly more likely to test positive than those from COVID-19 negative households. Understanding risk factors associated with this and their potential to infect other species requires urgent investigation.
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Affiliation(s)
- E I Patterson
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - G Elia
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - A Grassi
- I-VET srl, Laboratorio di Analisi Veterinarie, Via Ettore Majorana, 10 - 25020, Flero, BS, Italy
| | - A Giordano
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - C Desario
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - M Medardo
- La Vallonèa Veterinary Diagnostic Laboratory, via G. Sirtori 9, 20017, Passirana di Rho, MI, Italy
| | - S L Smith
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - E R Anderson
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - T Prince
- NIHR Health Protection Unit in Emerging and Zoonotic Infections, Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - G T Patterson
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - E Lorusso
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - M S Lucente
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - G Lanave
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - S Lauzi
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - U Bonfanti
- La Vallonèa Veterinary Diagnostic Laboratory, via G. Sirtori 9, 20017, Passirana di Rho, MI, Italy
| | - A Stranieri
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - V Martella
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy
| | - F Solari Basano
- Arcoblu s.r.l., via Alessandro Milesi 5, 20133, Milan, Italy
| | - V R Barrs
- City University's Jockey Club College of Veterinary Medicine and Life Sciences, 5/F, Block 1A, To Yuen Building, 31 To Yuen Street, Kowloon, Hong Kong
| | - A D Radford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Chester High Road, Neston, CH64 7TE, UK
| | - U Agrimi
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy
| | - G L Hughes
- Centre for Neglected Tropical Disease, Departments of Vector Biology and Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - S Paltrinieri
- Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Milan, Via dell'Università 6, 26900, Lodi, Italy
| | - N Decaro
- Department of Veterinary Medicine, University of Bari Aldo Moro, Strada Prov. per Casamassima Km 3, 70010, Valenzano, BA, Italy.
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19
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Abstract
Many claims are made concerning which issues are on the global health agenda and which are neglected. Scholarship is inconsistent and generally vague about how an issue's status is (or should be) measured, however, leaving such claims open to questions about their validity. This inquiry explores a novel way of addressing the largely overlooked matter of how to comparatively assess the agenda status of health issues systematically, over time and in consideration of a global health context that lacks centralised authority. We draw upon a model from sociology which proposes that collective definitions of social problems and public attention evolve in multiple, interacting institutional arenas, each of which has the capacity to give robust attention to a limited number of issues. We systematically track status indicators for two significant global health issues, diabetes and oral diseases, in three arenas since 2000. Oral health's status declined while diabetes rose in international representation, international organisation and scientific research arenas during the past decade. This article sets out some preliminary contours of an analytical approach that holds promise for enhancing understanding of causal mechanisms and outcomes across a wider set of global health issues and agenda setting arenas.
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Affiliation(s)
- Stephanie L Smith
- School of Public and International Affairs, Virginia Tech, Arlington, VA, USA
| | - Ramya Gorantla
- School of Public Administration, University of New Mexico, Albuquerque, NM, USA
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20
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Denholm SJ, Brand W, Mitchell AP, Wells AT, Krzyzelewski T, Smith SL, Wall E, Coffey MP. Predicting bovine tuberculosis status of dairy cows from mid-infrared spectral data of milk using deep learning. J Dairy Sci 2020; 103:9355-9367. [PMID: 32828515 DOI: 10.3168/jds.2020-18328] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022]
Abstract
Bovine tuberculosis (bTB) is a zoonotic disease in cattle that is transmissible to humans, distributed worldwide, and considered endemic throughout much of England and Wales. Mid-infrared (MIR) analysis of milk is used routinely to predict fat and protein concentration, and is also a robust predictor of several other economically important traits including individual fatty acids and body energy. This study predicted bTB status of UK dairy cows using their MIR spectral profiles collected as part of routine milk recording. Bovine tuberculosis data were collected as part of the national bTB testing program for Scotland, England, and Wales; these data provided information from over 40,500 bTB herd breakdowns. Corresponding individual cow life-history data were also available and provided information on births, movements, and deaths of all cows in the study. Data relating to single intradermal comparative cervical tuberculin (SICCT) skin-test results, culture, slaughter status, and presence of lesions were combined to create a binary bTB phenotype labeled 0 to represent nonresponders (i.e., healthy cows) and 1 to represent responders (i.e., bTB-affected cows). Contemporaneous individual milk MIR spectral data were collected as part of monthly routine milk recording and matched to bTB status of individual animals on the single intradermal comparative cervical tuberculin test date (±15 d). Deep learning, a sub-branch of machine learning, was used to train artificial neural networks and develop a prediction pipeline for subsequent use in national herds as part of routine milk recording. Spectra were first converted to 53 × 20-pixel PNG images, then used to train a deep convolutional neural network. Deep convolutional neural networks resulted in a bTB prediction accuracy (i.e., the number of correct predictions divided by the total number of predictions) of 71% after training for 278 epochs. This was accompanied by both a low validation loss (0.71) and moderate sensitivity and specificity (0.79 and 0.65, respectively). To balance data in each class, additional training data were synthesized using the synthetic minority over sampling technique. Accuracy was further increased to 95% (after 295 epochs), with corresponding validation loss minimized (0.26), when synthesized data were included during training of the network. Sensitivity and specificity also saw a 1.22- and 1.45-fold increase to 0.96 and 0.94, respectively, when synthesized data were included during training. We believe this study to be the first of its kind to predict bTB status from milk MIR spectral data. We also believe it to be the first study to use milk MIR spectral data to predict a disease phenotype, and posit that the automated prediction of bTB status at routine milk recording could provide farmers with a robust tool that enables them to make early management decisions on potential reactor cows, and thus help slow the spread of bTB.
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Affiliation(s)
- S J Denholm
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK.
| | - W Brand
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - A P Mitchell
- Animal and Plant Health Agency (APHA), Woodham Lane, Addlestone, Surrey KT15 3NB, UK
| | - A T Wells
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - T Krzyzelewski
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - S L Smith
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - E Wall
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
| | - M P Coffey
- Scotland's Rural College (SRUC), Peter Wilson Building, Kings Buildings, West Mains Road, Edinburgh EH9 3JG, UK
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Smith SL, Raviola GJ. 'Jack be nimble, Jack be quick…': mental health and psychosocial response in the time of coronavirus. Glob Ment Health (Camb) 2020; 7:e21. [PMID: 32908676 PMCID: PMC7417996 DOI: 10.1017/gmh.2020.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Stephanie L. Smith
- Partners In Health, 800 Boylston Street, Suite 300, Boston, MA02199, USA
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA02115, USA
| | - Giuseppe J. Raviola
- Partners In Health, 800 Boylston Street, Suite 300, Boston, MA02199, USA
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA02114, USA
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22
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Patterson EI, Elia G, Grassi A, Giordano A, Desario C, Medardo M, Smith SL, Anderson ER, Prince T, Patterson GT, Lorusso E, Lucente MS, Lanave G, Lauzi S, Bonfanti U, Stranieri A, Martella V, Basano FS, Barrs VR, Radford AD, Agrimi U, Hughes GL, Paltrinieri S, Decaro N. Evidence of exposure to SARS-CoV-2 in cats and dogs from households in Italy. bioRxiv 2020. [PMID: 32743588 DOI: 10.1101/2020.07.21.214346] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
SARS-CoV-2 originated in animals and is now easily transmitted between people. Sporadic detection of natural cases in animals alongside successful experimental infections of pets, such as cats, ferrets and dogs, raises questions about the susceptibility of animals under natural conditions of pet ownership. Here we report a large-scale study to assess SARS-CoV-2 infection in 817 companion animals living in northern Italy, sampled at a time of frequent human infection. No animals tested PCR positive. However, 3.4% of dogs and 3.9% of cats had measurable SARS-CoV-2 neutralizing antibody titers, with dogs from COVID-19 positive households being significantly more likely to test positive than those from COVID-19 negative households. Understanding risk factors associated with this and their potential to infect other species requires urgent investigation. One Sentence Summary SARS-CoV-2 antibodies in pets from Italy.
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Dickson DM, Fawole HO, Hendry GJ, Smith SL. Intermachine Variation of Ultrasound Strain Elastographic Measures of the Quadriceps and Patellar Tendons in Healthy Participants: Implications for Clinical Practice. J Ultrasound Med 2020; 39:1343-1353. [PMID: 31981428 DOI: 10.1002/jum.15228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To evaluate intermachine variation and compare intraoperator and interoperator agreement and repeatability characteristics of 2 ultrasound (US) systems for measurements of quadriceps and patellar tendons by strain elastography (SE). METHODS Forty tendons from 20 healthy participants were investigated by operators with different experience (operator 1, 12 years of US experience and >50 SE examinations; operator 2, no US experience and 1 day of SE training). Repeated measures were performed on GE Healthcare (Waukesha, WI) and Esaote (Genoa, Italy) US systems. The percentage of agreement, Cohen κ, intraclass correlation coefficient, and correlation tests assessed agreement, repeatability, and associations of SE measures. A paired t test and Wilcoxon signed rank test assessed differences in SE measures. RESULTS The study participants included 5 male and 15 female volunteers (mean [range] age, 29.3 [21-39] years). Better agreement and repeatability characteristics were observed for the patellar compared to the quadriceps tendon and the color score (CS) method over the elasticity ratio (ER). Intraoperator agreement was better for the experienced operator. Intraoperator repeatability was achieved in 55% of ER (intraclass correlation coefficient, 0.40-0.91; P < .05) and 77% to 85% (κ = -0.25-1) of CS measures. Interoperator repeatability was achieved in 35% (t/z, -2.93-7.94; P < .001-.048) of all ER measures. No significant differences in proximal (z, -0.13- -0.78) and distal patellar (z, -1.52-2.26; P > .5) patellar ER measures were observed. Seventy-four percent to 75% mean agreement (κ = 0-0.5) for CS measures comparable across both US systems was observed. Intermachine ER associations were poor (r = -0.39-0.13; P > .05), whereas greater than 70% agreement (κ = -0.87-0.53) for the CS was achieved. CONCLUSIONS The reproducibility of knee tendon SE measurements is influenced by the operator experience, US system, and tendon site.
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Affiliation(s)
- Diane M Dickson
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Henrietta O Fawole
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
- Physiotherapy Department, University of Benin, School of Basic Medical Sciences, Benin City, Nigeria
| | - Gordon J Hendry
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
| | - Stephanie L Smith
- Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, Scotland
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24
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Turton JF, Davies F, Taori SK, Turton JA, Smith SL, Sajedi N, Wootton M. IncN3 and IncHI2 plasmids with an In1763 integron carrying bla IMP-1 in carbapenem-resistant Enterobacterales clinical isolates from the UK. J Med Microbiol 2020; 69:739-747. [PMID: 32368998 DOI: 10.1099/jmm.0.001193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Imipenemase (IMP) carbapenemase genes are relatively rare among Enterobacterales in the UK. Emergence in multiple hospitals, in different strains and species, prompted an investigation into their genetic context.Aim. Our goal was to identify and describe the elements carrying bla IMP genes in a variety of Enterobacterales from five hospitals in the UK.Methodology. Long-read nanopore sequencing was carried out on 18 IMP-positive isolates belonging to 6 species. The locations of the bla IMP genes and other associated genetic elements were identified.Results. Ten out of 18 isolates carried bla IMP-1 on an IncN3 plasmid (52-57 kb) in an In1763 class 1 integron. These plasmids also contained genes encoding type IV secretion and conjugal transfer proteins. Five out of 18 isolates carried bla IMP-1 in the same In1763 integron in much larger IncHI2 plasmids. A further isolate carried the In1763 integron in a chromosomally located plasmid fragment. Two isolates carried bla IMP-4 in IncHI2 plasmids. The isolates included three representatives of sequence type 20 of Klebsiella pneumoniae, with one carrying a distinct plasmid from the other two.Conclusion. Highly similar IncN3 plasmids were found in a range of Enterobacterales, mostly K. pneumoniae and the Enterobacter cloacae complex, from three of four London hospitals, with the same In1763 integron carrying bla IMP-1 also being found in IncHI2 plasmids and chromosomally. These plasmids carried multiple elements facilitating self-transmission. Strain typing alone was not sufficient to investigate cross-infection among this set of isolates, many of which appeared to be unrelated until plasmid analysis was undertaken, and vice versa.
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Affiliation(s)
- Jane F Turton
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Frances Davies
- Imperial College Healthcare NHS Trust, North West London Pathology, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - Surabhi K Taori
- Department of Microbiology, Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | | | - Stephanie L Smith
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Noshin Sajedi
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - Mandy Wootton
- Specialist Antimicrobial and Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK
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25
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Smith SL, Franke MF, Rusangwa C, Mukasakindi H, Nyirandagijimana B, Bienvenu R, Uwimana E, Uwamaliya C, Ndikubwimana JS, Dorcas S, Mpunga T, Misago CN, Iyamuremye JD, Dusabeyezu JD, Mohand AA, Atwood S, Osrow RA, Aldis R, Daimyo S, Rose A, Coleman S, Manzi A, Kayiteshonga Y, Raviola GJ. Outcomes of a primary care mental health implementation program in rural Rwanda: A quasi-experimental implementation-effectiveness study. PLoS One 2020; 15:e0228854. [PMID: 32084663 PMCID: PMC7035003 DOI: 10.1371/journal.pone.0228854] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/25/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION To address the know-do gap in the integration of mental health care into primary care in resource-limited settings, a multi-faceted implementation program initially designed to integrate HIV/AIDS care into primary care was adapted for severe mental disorders and epilepsy in Burera District, Rwanda. The Mentoring and Enhanced Supervision at Health Centers (MESH MH) program supported primary care-delivered mental health service delivery scale-up from 6 to 19 government-run health centers over two years. This quasi-experimental study assessed implementation reach, fidelity, and clinical outcomes at health centers supported by MESH MH during the scale up period. METHODS MESH MH consisted of four strategies to ensure the delivery of the priority care packages at health centers: training; supervision and mentorship; audit and feedback; and systems-based quality improvement (QI). Implementation reach (service use) across the 19 health centers supported by MESH MH during the two year scale-up period was described using routine service data. Implementation fidelity was measured at four select health centers by comparing total clinical supervisory visits and checklists to target goals, and by tracking clinical observation checklist item completion rates over a nine month period. A prospective before and after evaluation measured clinical outcomes in consecutive adults presenting to four select health centers over a nine month period. Primary outcome assessments at baseline, 2 and 6 months included symptoms and functioning, measured by the General Health Questionnaire (GHQ-12) and the World Health Organization Disability Assessment Scale (WHO-DAS Brief), respectively. Secondary outcome assessments included engagement in income generating work and caregiver burden using a quantitative scale adapted to context. RESULTS A total of 2239 mental health service users completed 15,744 visits during the scale up period. MESH MH facilitated 70% and 76% of supervisory visit and clinical checklist utilization target goals, respectively. Checklist item completion rates significantly improved overall, and for three of five checklist item subgroups examined. 121 of 146 consecutive service users completed outcome measurements six months after entry into care. Scores improved significantly over six months on both the GHQ-12, with median score improving from 26 to 10 (mean within-person change 12.5 [95% CI: 10.9-14.0] p< 0.0001), and the WHO-DAS Brief, with median score improving from 26.5 to 7 (mean within-person change 16.9 [95% CI: 14.9-18.8] p< 0.0001). Over the same period, the percentage of surveyed service users reporting an inability to work decreased significantly (51% to 6% (p < 0.001)), and the proportion of households reporting that a caregiver had left income-generating work decreased significantly (41% to 4% (p < 0.001)). CONCLUSION MESH MH was associated with high service use, improvements in mental health care delivery by primary care nurses, and significant improvements in clinical symptoms and functional disability of service users receiving care at health centers supported by the program. Multifaceted implementation programs such as MESH MH can reduce the evidence to practice gap for mental health care delivery by nonspecialists in resource-limited settings. The primary limitation of this study is the lack of a control condition, consistent with the implementation science approach of the study. STUDY REGISTRATION ISRCTN #37231.
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Affiliation(s)
- Stephanie L. Smith
- Partners In Health, Boston, MA, United States of America
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Molly F. Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | | | | | | | | | | | | | | | - Sifa Dorcas
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - C. Nancy Misago
- Mental Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Achour A. Mohand
- Mental Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Sidney Atwood
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | | | - Rajen Aldis
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Alexandra Rose
- Partners In Health, Boston, MA, United States of America
| | - Sarah Coleman
- Partners In Health, Boston, MA, United States of America
| | - Anatole Manzi
- Partners In Health, Boston, MA, United States of America
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - Giuseppe J. Raviola
- Partners In Health, Boston, MA, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
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McFarlane SE, Hunter DC, Senn HV, Smith SL, Holland R, Huisman J, Pemberton JM. Increased genetic marker density reveals high levels of admixture between red deer and introduced Japanese sika in Kintyre, Scotland. Evol Appl 2020; 13:432-441. [PMID: 31993087 PMCID: PMC6976951 DOI: 10.1111/eva.12880] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/01/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Hybridization is a natural process at species range boundaries, but increasing numbers of species are hybridizing due to direct or indirect human activities. In such cases of anthropogenic hybridization, subsequent introgression can threaten the survival of native species. To date, many such systems have been studied with too few genetic markers to assess the level of threat resulting from advanced backcrossing. Here, we use 44,999 single nucleotide polymorphisms (SNPs) and the ADMIXTURE program to study two areas of Scotland where a panel of 22 diagnostic microsatellites previously identified introgression between native red deer (Cervus elaphus) and introduced Japanese sika (Cervus nippon). In Kintyre, we reclassify 26% of deer from the pure species categories to the hybrid category whereas in the NW Highlands we only reclassify 2%. As expected, the reclassified individuals are mostly advanced backcrosses. We also investigate the ability of marker panels selected on different posterior allele frequency criteria to find hybrids assigned by the full marker set and show that in our data, ancestry informative markers (i.e. those that are highly differentiated between the species, but not fixed) are better than diagnostic markers (those markers that are fixed between the species) because they are more evenly distributed in the genome. Diagnostic loci are concentrated on the X chromosome to the detriment of autosomal coverage.
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Affiliation(s)
- S. Eryn McFarlane
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
- Department of BiologyLund UniversityLundSweden
| | - Darren C. Hunter
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
- Department of Animal and Plant SciencesUniversity of SheffieldSheffieldUK
| | - Helen V. Senn
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
- WildGenes LaboratoryRoyal Zoological Society of ScotlandEdinburghUK
| | - Stephanie L. Smith
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
- The Royal (Dick) School of Veterinary StudiesUniversity of EdinburghEaster Bush CampusMidlothian, EdinburghUK
| | - Rebecca Holland
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
| | - Jisca Huisman
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
| | - Josephine M. Pemberton
- Institute of Evolutionary BiologySchool of Biological ScienceUniversity of EdinburghEdinburghUK
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27
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Smith SL, Allan R, Marreiros SP, Woodburn J, Steultjens MPM. Muscle Co-Activation Across Activities of Daily Living in Individuals With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 71:651-660. [PMID: 29953745 DOI: 10.1002/acr.23688] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Muscle co-activation has been shown to be elevated in individuals with knee osteoarthritis (OA) during gait. Comparisons of muscle co-activation across different activities of daily living such as stair negotiation have yet to be explored. The aim of this study was to explore muscle co-activation across different activities of daily living in patients with knee OA. METHODS Muscle co-activation was assessed in 77 symptomatic knee OA patients (mean ± SD age 62.5 ± 8.1 years, body mass index 29.4 ± 6.0 kg/m2 , and sex 48:29 female:male) using electromyography (EMG), during a series of walking, stair negotiation (ascent, descent), and sit-to-walk activities. EMG was recorded from 7 sites, mediolateral gastrocnemius, biceps femoris, semitendinosus, vastus lateralis/medialis, and rectus femoris, and normalized to maximal voluntary isometric contraction. Correlation was used to assess the consistency of co-activation across activities. Repeated-measures analysis of variance assessed the muscle combination by activity differences. RESULTS Muscle co-activation was highest during stair ascent. When comparing muscle combinations within the same activity, we found that correlations ranged from r = 0.003 to r = 0.897, of which 80% of the combinations were significant. Between activities, muscle co-activation was significantly different (P < 0.05). Mediolateral muscle co-activation was higher than hamstrings/quadriceps across activities. CONCLUSION Two muscle co-activation strategies were observed during activities of daily living in patients with knee OA to maintain stability. Muscle co-activation was higher during more challenging activities, particularly when the joint was accepting load. Mediolateral muscle co-activation was higher than hamstrings/quadriceps, so that mediolateral co-activation was thought to be a stabilization mechanism, while hamstrings/quadriceps co-activation responds to knee flexion moments, suggesting that different muscle combinations may have different roles in responding to joint demand.
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Affiliation(s)
- Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Richard Allan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Sara P Marreiros
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - James Woodburn
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Martijn P M Steultjens
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
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28
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Naslund JA, Gonsalves PP, Gruebner O, Pendse SR, Smith SL, Sharma A, Raviola G. Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention. Curr Treat Options Psychiatry 2019; 6:337-351. [PMID: 32457823 PMCID: PMC7250369 DOI: 10.1007/s40501-019-00186-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Globally, individuals living with mental disorders are more likely to have access to a mobile phone than mental health care. In this commentary, we highlight opportunities for expanding access to and use of digital technologies to advance research and intervention in mental health, with emphasis on the potential impact in lower resource settings. RECENT FINDINGS Drawing from empirical evidence, largely from higher income settings, we considered three emerging areas where digital technology will potentially play a prominent role: supporting methods in data science to further our understanding of mental health and inform interventions, task sharing for building workforce capacity by training and supervising non-specialist health workers, and facilitating new opportunities for early intervention for young people in lower resource settings. Challenges were identified related to inequities in access, threats of bias in big data analyses, risks to users, and need for user involvement to support engagement and sustained use of digital interventions. SUMMARY For digital technology to achieve its potential to transform the ways we detect, treat, and prevent mental disorders, there is a clear need for continued research involving multiple stakeholders, and rigorous studies showing that these technologies can successfully drive measurable improvements in mental health outcomes.
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Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Oliver Gruebner
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Sachin R. Pendse
- Microsoft Research India, Bangalore, India
- Georgia Institute of Technology, School of Interactive Computing, Atlanta, GA, USA
| | | | | | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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29
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Smith SL. Factoring civil society actors into health policy processes in low- and middle-income countries: a review of research articles, 2007-16. Health Policy Plan 2019; 34:67-77. [PMID: 30668676 DOI: 10.1093/heapol/czy109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 01/12/2023] Open
Abstract
Civil society actors have substantially increased their participation in global and national health policymaking processes since the 1970s. Civil society roles in shaping such significant global health milestones as the Doha Declaration on Intellectual Property Rights, the Framework Convention on Tobacco Control and the recently adopted United Nations Sustainable Development Goals are well documented, but knowledge of civil society actor influence on health policy processes in low- and middle-income countries remains fragmented. This study analyses 24 peer-reviewed research articles published between 2007 and 2016 to identify factors affecting civil society influence in the pre-implementation stages of the policy process. The articles reviewed span 13 health issues and more than 50 countries in four regions of the world. This body of work focuses on civil society as represented by formal groups, primarily domestic and to some extent international non-governmental organizations, but also social movements, professional associations and faith-based organizations, among others. The studies document several actor-centred and contextual factors that affect civil society actor power, commonly across stages of the policy process. Crucially, civil society actors were challenged to impact the process in countries that lacked participative norms and governing structures. When repressive conditions existed, regime changes and donors sometimes helped to open doors to participation. The power of civil society actors was enhanced when they joined strong epistemic networks and broader coalitions of stakeholders, were resourced, and framed issues in ways that resonated with national policies and political priorities. The synthesis offers guidance to practitioners on factors to consider in strategy development and points to several issues for further investigation by health policy analysis scholars, including the implications of issue (non)adoption by civil society actors and contestation dynamics among those with differing perspectives.
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Affiliation(s)
- Stephanie L Smith
- School of Public Administration, The University of New Mexico, Social Sciences Building, Room 3008, MSC05-3100, 1 University of New Mexico, Albuquerque, NM, USA
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30
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Smith SL, Denholm SJ, Coffey MP, Wall E. Energy profiling of dairy cows from routine milk mid-infrared analysis. J Dairy Sci 2019; 102:11169-11179. [PMID: 31587910 DOI: 10.3168/jds.2018-16112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 12/06/2018] [Accepted: 07/24/2019] [Indexed: 01/04/2023]
Abstract
The balance of body energy within and across lactations can have health and fertility consequences for the dairy cow. This study aimed to create a large calibration data set of dairy cow body energy traits across the cow's productive life, with concurrent milk mid-infrared (MIR) spectral data, to generate a prediction tool for use in commercial dairy herds. Detailed phenotypic data from 1,101 Holstein Friesian cows from the Langhill research herd (SRUC, Scotland) were used to generate energy balance (EB) and effective energy intake (EI), both in megajoules per day. Pretreatment of spectral data involved standardization to account for drift over time and machine. Body energy estimates were aligned with their spectral data to generate a prediction of these traits based on milk MIR spectroscopy. After data edits, partial least squares analysis generated prediction equations with a coefficient of determination from split sample 10-fold cross validation of 0.77 and 0.75 for EB and EI, respectively. These prediction equations were applied to national milk MIR spectra on over 11 million animal test dates (January 2013 to December 2016) from 4,453 farms. The predictions generated from these were subject to phenotypic analyses with a fixed regression model highlighting differences between the main dairy breeds in terms of energy traits. Genetic analyses generated heritability estimates for EB and EI ranging from 0.12 to 0.17 and 0.13 to 0.15, respectively. This study shows that MIR-based predictions from routinely collected national data can be used to generate predictions of dairy cow energy turnover profiles for both animal management and genetic improvement of such difficult and expensive-to-record traits.
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Affiliation(s)
- S L Smith
- Scotland's Rural College (SRUC), Edinburgh EH9 3JG, UK
| | - S J Denholm
- Scotland's Rural College (SRUC), Edinburgh EH9 3JG, UK.
| | - M P Coffey
- Scotland's Rural College (SRUC), Edinburgh EH9 3JG, UK
| | - E Wall
- Scotland's Rural College (SRUC), Edinburgh EH9 3JG, UK
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Robinson AL, Williamson H, Güere ME, Tharaldsen H, Baker K, Smith SL, Pérez-Espona S, Krojerová-Prokešová J, Pemberton JM, Goldmann W, Houston F. Variation in the prion protein gene (PRNP) sequence of wild deer in Great Britain and mainland Europe. Vet Res 2019; 50:59. [PMID: 31366372 PMCID: PMC6668158 DOI: 10.1186/s13567-019-0675-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/05/2019] [Indexed: 01/01/2023] Open
Abstract
Susceptibility to prion diseases is largely determined by the sequence of the prion protein gene (PRNP), which encodes the prion protein (PrP). The recent emergence of chronic wasting disease (CWD) in Europe has highlighted the need to investigate PRNP gene diversity in European deer species, to better predict their susceptibility to CWD. Here we report a large genetic survey of six British deer species, including red (Cervus elaphus), sika (Cervus nippon), roe (Capreolus capreolus), fallow (Dama dama), muntjac (Muntiacus reevesii), and Chinese water deer (Hydropotes inermis), which establishes PRNP haplotype and genotype frequencies. Two smaller data sets from red deer in Norway and the Czech Republic are also included for comparison. Overall red deer show the most PRNP variation, with non-synonymous/coding polymorphisms at codons 98, 168, 226 and 247, which vary markedly in frequency between different regions. Polymorphisms P168S and I247L were only found in Scottish and Czech populations, respectively. T98A was found in all populations except Norway and the south of England. Significant regional differences in genotype frequencies were observed within both British and European red deer populations. Other deer species showed less variation, particularly roe and fallow deer, in which identical PRNP gene sequences were found in all individuals analysed. Based on comparison with PRNP sequences of North American cervids affected by CWD and limited experimental challenge data, these results suggest that a high proportion of wild deer in Great Britain may be susceptible to CWD.
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Affiliation(s)
- Amy L Robinson
- Division of Infection and Immunity, The Roslin Institute and The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK.
| | - Helen Williamson
- Division of Infection and Immunity, The Roslin Institute and The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK
| | - Mariella E Güere
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Oslo, Norway
| | - Helene Tharaldsen
- Norwegian University of Life Sciences, Faculty of Veterinary Medicine, Oslo, Norway
| | - Karis Baker
- Department of Biosciences, Durham University, South Road, Durham, DH1 3LE, UK
| | - Stephanie L Smith
- The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK
| | - Sílvia Pérez-Espona
- Division of Infection and Immunity, The Roslin Institute and The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK.,The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK
| | - Jarmila Krojerová-Prokešová
- Institute of Vertebrate Biology of the Czech Academy of Sciences, Květná 8, 603 65, Brno, Czech Republic.,Department of Zoology, Fisheries, Hydrobiology and Apiculture, Faculty of AgriSciences, Mendel University in Brno, Zemědělská 1, 613 00, Brno, Czech Republic
| | - Josephine M Pemberton
- Institute of Evolutionary Biology, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
| | - Wilfred Goldmann
- Division of Infection and Immunity, The Roslin Institute and The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK
| | - Fiona Houston
- Division of Infection and Immunity, The Roslin Institute and The Royal Dick School of Veterinary Studies, University of Edinburgh, Midlothian, EH259RG, UK
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Dickson DM, Fawole HO, Newcombe L, Smith SL, Hendry GJ. Reliability of ultrasound strain elastography in the assessment of the quadriceps and patellar tendon in healthy adults. Ultrasound 2019; 27:252-261. [PMID: 31762782 DOI: 10.1177/1742271x19859380] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022]
Abstract
Objective To report the intra- and inter-operator reliability of ultrasound strain elastography measures in the assessment of quadriceps and patellar tendons. Materials and methods Forty tendons were investigated of 20 healthy volunteers. Five anatomical sites were examined and analysed by three operators of differing levels of experience. Ultrasound was performed over two measures, employing three sonoelastography measurement techniques using a GE S8 with linear probe (L6-15 MHz). The percentage of exact agreement, Cohen's kappa and ICC2,1 were performed to assess intra- and inter-operator reliability. Results The patellar tendon is more reliably measured across all techniques compared to the quadriceps tendon, particularly the distal region. Colour scoring was the most reliable method of sonoelastography. Colour scoring intra- and inter-operator reliability was better for patella tendon sites across all operators (60-95% agreement range), and greatest for experienced operators. Elasticity index intra-operator reliability was greatest for the most experienced operator compared with the least (ICC range 0.35-0.72 and ICC 0.17-0.60). Elasticity ratio intra-operator reliability of the patella tendon was fair-excellent for the experienced operator (ICC range 0.43-0.91), excluding the mid patellar region (ICC 0.13). Poor-fair inter-operator reliability was observed for elasticity ratio (ICC range 0.0-0.54) and elasticity index (ICC range 0.0-0.57). Conclusions Strain elastography of the patellar tendon is more reliable than the quadriceps tendon. Intra- and inter-operator reliability was better when undertaken by more experienced operators. Colour scoring was more reliable than elasticity ratio and index methods. Poor-fair intra- and inter-operator reliability of the elasticity ratio and elasticity index was observed.
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Affiliation(s)
- Diane M Dickson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Henrietta O Fawole
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Physiotherapy Department, School of Basic Medical Sciences, University of Benin, Benin-City, Nigeria
| | - Lisa Newcombe
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Stephanie L Smith
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gordon J Hendry
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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Raviola G, Naslund JA, Smith SL, Patel V. Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap. Curr Psychiatry Rep 2019; 21:44. [PMID: 31041554 DOI: 10.1007/s11920-019-1028-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Most people do not have access to adequate mental health care, and lack of skilled human resources is a major factor. We provide a narrative review of approaches to implementing task sharing-engaging non-specialist providers-to deliver mental health care. RECENT FINDINGS There is strong evidence both for the effectiveness of task sharing as a means of delivering care for a range of conditions across settings and for the effectiveness of non-specialist providers and health workers in delivering elements of culturally adapted psychosocial and psychological interventions for common and severe mental disorders. Key approaches to facilitate task sharing of care include balanced care, collaborative care, sustained training and supervision, use of trans-diagnostic interventions based on a dimensional approach to wellness and illness, and the use of emerging digital technologies. Non-specialist providers and health workers are well positioned to deliver evidence-based interventions for mental disorders, and a variety of delivery approaches can support, facilitate, and sustain this innovation. These approaches should be used, and evaluated, to increase access to mental health services.
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Affiliation(s)
- Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA. .,Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Stephanie L Smith
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
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Smith SL, Woodburn J, Steultjens MPM. 155 Sex-related differences in muscle co-activation in individuals with knee osteoarthritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez108.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stephanie L Smith
- School of Health and Life Science, Institute for Applied Health Research, Centre for Living, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - James Woodburn
- School of Health and Life Science, Institute for Applied Health Research, Centre for Living, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
| | - Martijn P M Steultjens
- School of Health and Life Science, Institute for Applied Health Research, Centre for Living, Glasgow Caledonian University, Glasgow, UNITED KINGDOM
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Smith SL, Senn HV, Pérez‐Espona S, Wyman MT, Heap E, Pemberton JM. Introgression of exotic Cervus ( nippon and canadensis) into red deer ( Cervus elaphus) populations in Scotland and the English Lake District. Ecol Evol 2018; 8:2122-2134. [PMID: 29468030 PMCID: PMC5817139 DOI: 10.1002/ece3.3767] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 11/04/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022] Open
Abstract
Since the mid-19th century, multiple introductions of Japanese sika deer (Cervus nippon nippon) and North American wapiti (C. canadensis) have taken place in the British Isles. While wapiti have generally been unsuccessful, sika have been very successful, especially in Scotland where they now overlap at least 40% of the range of native red deer (C. elaphus). Hybridization between these two species and red deer has been demonstrated in captivity and in the wild. Using a panel of 22 microsatellite loci that are highly diagnostic between red deer and sika, and moderately diagnostic between red deer and wapiti, we investigated the extent of introgression between these species in 2,943 deer sampled from around Scotland and from the English Lake District using the Bayesian clustering software STRUCTURE. We also used a diagnostic mitochondrial marker for red deer and sika. Our survey extends previous studies indicating little introgression of wapiti nuclear alleles into red deer, in particular in Northern Scotland, Kintyre, and the Lake District. We found a new area of extensive sika introgression in South Kintyre. In the North Highlands, we show for the first time geographically scattered evidence of past hybridization followed by extensive backcrossing, including one red-like individual with sika introgression, two sika-like individuals with red deer introgression, and six individuals that were apparently pure sika at the nuclear markers assessed but which carried red deer mitochondria. However, there has not been a collapse of assortative mating in this region. Similarly, in the English Lake District red deer, we found only traces of past sika introgression. No sika alleles were detected in the Central Highlands or the Hebridean red deer refugia. We make suggestions for management to prevent further spread of sika alleles into red deer and vice versa.
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Affiliation(s)
- Stephanie L. Smith
- Institute of Evolutionary BiologySchool of Biological SciencesUniversity of EdinburghEdinburghUK
| | - Helen V. Senn
- WildGenes LaboratoryRoyal Zoological Society of ScotlandEdinburghUK
| | | | - Megan T. Wyman
- Mammal Vocal Communication and Cognition ResearchSchool of PsychologyUniversity of SussexFalmerUK
| | - Elizabeth Heap
- Institute of Evolutionary BiologySchool of Biological SciencesUniversity of EdinburghEdinburghUK
| | - Josephine M. Pemberton
- Institute of Evolutionary BiologySchool of Biological SciencesUniversity of EdinburghEdinburghUK
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Abstract
Docosahexaenoic acid (DHA) is a long chain poly-unsaturated fatty acid (LCPUFA) that has a role in the cognitive and visual development, as well as in the immune function of newborns. Premature infants are typically deficient in DHA for several reasons, to include fetal accretion of DHA that typically occurs during the third trimester. These premature infants are reliant on enteral sources of DHA, most commonly through breast milk. The DHA content in breast milk varies in direct correlation with maternal DHA intake and mothers consuming a Western diet typically have lower levels of DHA in their breast milk. Maternal DHA supplementation and direct supplementation of DHA to the infant has been tried successfully but there are still conflicting results on the optimal dosage and method of delivery of DHA to the infant. This has led to inconsistent results in trials evaluating the effects of DHA supplementation to the preterm infant in terms of cognitive and immunological outcomes. While short-term benefits have been seen in several studies, long-term benefits are not consistent. Future studies continue to be needed to optimize DHA intake in our premature infants.
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Affiliation(s)
- Stephanie L Smith
- Uniformed Services University of Health Sciences, 4301 Jones Bridge, Bethesda, MD 20814 USA
| | - Christopher A Rouse
- Uniformed Services University of Health Sciences, 4301 Jones Bridge, Bethesda, MD 20814 USA.,Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20814 USA
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Dell'Isola A, Smith SL, Andersen MS, Steultjens M. Knee internal contact force in a varus malaligned phenotype in knee osteoarthritis (KOA). Osteoarthritis Cartilage 2017; 25:2007-2013. [PMID: 28882753 DOI: 10.1016/j.joca.2017.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Multiple phenotypes characterized by different disease mechanisms have been hypothesized to explain the large variability in the knee osteoarthritis (KOA) population. The purpose of this study was: to estimate and compare the medial and lateral knee compression forces (CF) during gait of three subgroups of KOA subjects characterized by different alignment and cartilage disruption patterns. METHODS A secondary data analysis was conducted on a sample of 39 KOA subjects and 18 controls (C). The patients were classified in the different groups according to the following criteria: Varus medial disease (VMD) (12): varus alignment and predominant medial cartilage degeneration Varus generalized disease (VGD) (17): varus alignment and cartilage degeneration that extends to the lateral compartment. Neutral alignment (NA) (10): neutral alignment. The total, medial and lateral CF corrected for body weight were estimated using an inverse dynamics model (AnyBody Modeling System, AnyBody Technology) during stance. RESULTS The impulse of the medial compressive force (MCF) (overall effect of the CF over the stance) was significantly higher (P < 0.01) in the VMD compared to all the other groups. Peak MCF was higher in the VMD compared to all the other groups, but the difference reached significance only when compared to the VGD group (P < 0.05). The results of the regression analysis showed a significant relationship in the VMD group between alignment and impulse of the MCF (R2 = 0.62; P < 0.01). This relationship disappears in the other groups. CONCLUSIONS These findings suggest the existence of a phenotype characterized by increased MCF.
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Affiliation(s)
- A Dell'Isola
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - S L Smith
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
| | - M S Andersen
- Department of Mechanical, Manufacturing and Management Engineering, Aalborg University, Denmark.
| | - M Steultjens
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.
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Nyirandagijimana B, Edwards JK, Venables E, Ali E, Rusangwa C, Mukasakindi H, Borg R, Fabien M, Tharcisse M, Nshimyiryo A, Park PH, Raviola GJ, Smith SL. Closing the gap: decentralising mental health care to primary care centres in one rural district of Rwanda. Public Health Action 2017; 7:231-236. [PMID: 29201658 DOI: 10.5588/pha.16.0130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Programmes that integrate mental health care into primary care settings could reduce the global burden of mental disorders by increasing treatment availability in resource-limited settings, including Rwanda. Objective: We describe patient demographics, service use and retention of patients in care at health centres (HC) participating in an innovative primary care integration programme, compared to patients using existing district hospital-based specialised out-patient care. Design: This was a retrospective cohort study using routinely collected data from six health centres and one district hospital from October 2014 to March 2015. Results: Of 709 patients, 607 were cared for at HCs; HCs accounted for 88% of the total visits for mental disorders. Patients with psychosis used HC services more frequently, while patients with affective disorders were seen more frequently at the district hospital. Of the 68% of patients who returned to care within 90 days of their first visit, 76% had a third visit within a further 90 days. There were no significant differences in follow-up rates between clinical settings. Conclusion: This study suggests that a programme of mentorship for primary care nurses can facilitate the decentralisation of out-patient mental health care from specialised district hospital mental health services to HCs in rural Rwanda.
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Affiliation(s)
| | - J K Edwards
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg.,School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - E Venables
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - E Ali
- Médecins Sans Frontières, Luxembourg Operational Research Unit (LuxOR), Brussels Operational Centre, Luxembourg City, Luxembourg
| | - C Rusangwa
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - H Mukasakindi
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - R Borg
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - M Fabien
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | - A Nshimyiryo
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - P H Park
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - G J Raviola
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Boston Children's Hospital, Boston, Massachusetts, USA
| | - S L Smith
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Harvard Medical School, Boston, Massachusetts, USA.,Brigham and Women's Hospital, Boston, Massachusetts, USA
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39
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Smith SL, Misago CN, Osrow RA, Franke MF, Iyamuremye JD, Dusabeyezu JD, Mohand AA, Anatole M, Kayiteshonga Y, Raviola GJ. Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol. BMJ Open 2017; 7:e014067. [PMID: 28246140 PMCID: PMC5337739 DOI: 10.1136/bmjopen-2016-014067] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Integrating mental healthcare into primary care can reduce the global burden of mental disorders. Yet data on the effective implementation of real-world task-shared mental health programmes are limited. In 2012, the Rwandan Ministry of Health and the international healthcare organisation Partners in Health collaboratively adapted the Mentoring and Enhanced Supervision at Health Centers (MESH) programme, a successful programme of supported supervision based on task-sharing for HIV/AIDS care, to include care of neuropsychiatric disorders within primary care settings (MESH Mental Health). We propose 1 of the first studies in a rural low-income country to assess the implementation and clinical outcomes of a programme integrating neuropsychiatric care into a public primary care system. METHODS AND ANALYSIS A mixed-methods evaluation will be conducted. First, we will conduct a quantitative outcomes evaluation using a pretest and post-test design at 4 purposively selected MESH MH participating health centres. At least 112 consecutive adults with schizophrenia, bipolar disorder, depression or epilepsy will be enrolled. Primary outcomes are symptoms and functioning measured at baseline, 8 weeks and 6 months using clinician-administered scales: the General Health Questionnaire and the brief WHO Disability Assessment Scale. We hypothesise that service users will experience at least a 25% improvement in symptoms and functioning from baseline after MESH MH programme participation. To understand any outcome improvements under the intervention, we will evaluate programme processes using (1) quantitative analyses of routine service utilisation data and supervision checklist data and (2) qualitative semistructured interviews with primary care nurses, service users and family members. ETHICS AND DISSEMINATION This evaluation was approved by the Rwanda National Ethics Committee (Protocol #736/RNEC/2016) and deemed exempt by the Harvard University Institutional Review Board. Results will be submitted for peer-reviewed journal publication, presented at conferences and disseminated to communities served by the programme.
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Affiliation(s)
- Stephanie L Smith
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
- Division of Medical Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Achour A Mohand
- Mental Health Division, Rwanda Biomedical Center, Kigali, Rwanda
| | | | | | - Giuseppe J Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
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40
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Hinks A, Bowes J, Cobb J, Ainsworth HC, Marion MC, Comeau ME, Sudman M, Han B, Becker ML, Bohnsack JF, de Bakker PIW, Haas JP, Hazen M, Lovell DJ, Nigrovic PA, Nordal E, Punnaro M, Rosenberg AM, Rygg M, Smith SL, Wise CA, Videm V, Wedderburn LR, Yarwood A, Yeung RSM, Prahalad S, Langefeld CD, Raychaudhuri S, Thompson SD, Thomson W. Fine-mapping the MHC locus in juvenile idiopathic arthritis (JIA) reveals genetic heterogeneity corresponding to distinct adult inflammatory arthritic diseases. Ann Rheum Dis 2016; 76:765-772. [PMID: 27998952 PMCID: PMC5530326 DOI: 10.1136/annrheumdis-2016-210025] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/12/2016] [Accepted: 11/05/2016] [Indexed: 11/06/2022]
Abstract
Objectives Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases, comprising seven categories. Genetic data could potentially be used to help redefine JIA categories and improve the current classification system. The human leucocyte antigen (HLA) region is strongly associated with JIA. Fine-mapping of the region was performed to look for similarities and differences in HLA associations between the JIA categories and define correspondences with adult inflammatory arthritides. Methods Dense genotype data from the HLA region, from the Immunochip array for 5043 JIA cases and 14 390 controls, were used to impute single-nucleotide polymorphisms, HLA classical alleles and amino acids. Bivariate analysis was performed to investigate genetic correlation between the JIA categories. Conditional analysis was used to identify additional effects within the region. Comparison of the findings with those in adult inflammatory arthritic diseases was performed. Results We identified category-specific associations and have demonstrated for the first time that rheumatoid factor (RF)-negative polyarticular JIA and oligoarticular JIA are genetically similar in their HLA associations. We also observe that each JIA category potentially has an adult counterpart. The RF-positive polyarthritis association at HLA-DRB1 amino acid at position 13 mirrors the association in adult seropositive rheumatoid arthritis (RA). Interestingly, the combined oligoarthritis and RF-negative polyarthritis dataset shares the same association with adult seronegative RA. Conclusions The findings suggest the value of using genetic data in helping to classify the categories of this heterogeneous disease. Mapping JIA categories to adult counterparts could enable shared knowledge of disease pathogenesis and aetiology and facilitate transition from paediatric to adult services.
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Affiliation(s)
- A Hinks
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK
| | - J Bowes
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK
| | - J Cobb
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - H C Ainsworth
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - M C Marion
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - M E Comeau
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - M Sudman
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - B Han
- Divisions of Genetics and Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.,Department of Convergence Medicine, University of Ulsan College of Medicine & Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | | | - M L Becker
- Division of Rheumatology and Division of Clinical Pharmacology, Toxicology, and Therapeutic Innovation, Children's Mercy-Kansas City, Kansas City, Missouri, USA
| | - J F Bohnsack
- Division of Allergy, Immunology and Paediatric Rheumatology, University of Utah, Salt Lake City, Utah, USA
| | - P I W de Bakker
- Department of Medical Genetics, Center for Molecular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - M Hazen
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - D J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - P A Nigrovic
- Division of Immunology, Department of Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - E Nordal
- Department of Paediatrics, University Hospital of North Norway, and UIT The Arctic University of Norway, Tromsø, Norway
| | - M Punnaro
- Arthritis Clinic Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.,Department of Paediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - A M Rosenberg
- Division of Rheumatology, Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada
| | - M Rygg
- Department of Laboratory Medicine, Children's and Women's Health, NTNU - Norwegian University of Science and Technology, and St. Olavs University Hospital, Trondheim, Norway
| | - S L Smith
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK
| | - C A Wise
- Sarah M. and Charles E. Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.,Department of Orthopaedic Surgery, Paediatrics, and McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas, USA
| | - V Videm
- Department of Laboratory Medicine, Children's and Women's Health, NTNU - Norwegian University of Science and Technology, and St. Olavs University Hospital, Trondheim, Norway
| | - L R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, UCL GOS Institute of Child Health, University College London, London, UK.,NIHR-Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - A Yarwood
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK
| | - R S M Yeung
- The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - S Prahalad
- Department of Paediatrics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, USA
| | - C D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - S Raychaudhuri
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK.,Divisions of Genetics and Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.,Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, USA.,Department of Medicine, Karolinska Institutet and Karolinska University Hospital Solna, Stockholm, Sweden
| | - S D Thompson
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - W Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre, University Of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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41
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Abstract
Maxillary sinus volumetric and surface area data and growth models from longitudinal samples of children and adolescents are presented. Cone-beam radiographic CT scans from two small retrospective longitudinal samples, one from the Baylor College of Dentistry, Dallas, TX (N=17, 12 females, 5 males, 10.9-17.4 years) and one from a group private orthodontic practice in Nevada (N=15, 9 females, 6 males, 6.4-13.4 years) were used to collect maxillary sinus volumes and surface areas from each individual imaged at two times separated by variable intervals. Volume and surface area values were collected in Analyze® (Mayo Clinic) and growth models were produced in MLwiN®, a multi-level modeling program. There is a large degree of inter-individual variation. Surface area and surface-area-to-volume ratio (SA:V) changes are particularly variable. Growth models suggest linear growth in both volume and surface area, without growth spurts.
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Affiliation(s)
- S L Smith
- Department of Sociology and Anthropology, University of Texas at Arlington, Arlington, TX 76019, USA.
| | - P H Buschang
- Department of Orthodontics, Texas A&M University, Baylor College of Dentistry, Dallas, TX 75246, USA
| | - P C Dechow
- Department of Biomedical Sciences, Texas A&M University, Baylor College of Dentistry, Dallas, TX 75246, USA
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Dell'Isola A, Allan R, Smith SL, Marreiros SSP, Steultjens M. Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord 2016; 17:425. [PMID: 27733199 PMCID: PMC5062907 DOI: 10.1186/s12891-016-1286-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/07/2016] [Indexed: 01/08/2023] Open
Abstract
Background Knee Osteoarthritis (KOA) is a heterogeneous pathology characterized by a complex and multifactorial nature. It has been hypothesised that these differences are due to the existence of underlying phenotypes representing different mechanisms of the disease. Methods The aim of this study is to identify the current evidence for the existence of groups of variables which point towards the existence of distinct clinical phenotypes in the KOA population. A systematic literature search in PubMed was conducted. Only original articles were selected if they aimed to identify phenotypes of patients aged 18 years or older with KOA. The methodological quality of the studies was independently assessed by two reviewers and qualitative synthesis of the evidence was performed. Strong evidence for existence of specific phenotypes was considered present if the phenotype was supported by at least two high-quality studies. Results A total of 24 studies were included. Through qualitative synthesis of evidence, six main sets of variables proposing the existence of six phenotypes were identified: 1) chronic pain in which central mechanisms (e.g. central sensitisation) are prominent; 2) inflammatory (high levels of inflammatory biomarkers); 3) metabolic syndrome (high prevalence of obesity, diabetes and other metabolic disturbances); 4) Bone and cartilage metabolism (alteration in local tissue metabolism); 5) mechanical overload characterised primarily by varus malalignment and medial compartment disease; and 6) minimal joint disease characterised as minor clinical symptoms with slow progression over time. Conclusions This study identified six distinct groups of variables which should be explored in attempts to better define clinical phenotypes in the KOA population. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1286-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Dell'Isola
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK.
| | - R Allan
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - S L Smith
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - S S P Marreiros
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
| | - M Steultjens
- Institute of Applied Health Research/School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA, Scotland, UK
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43
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Smith SL, Shiffman J. Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival. Soc Sci Med 2016; 166:86-93. [PMID: 27543685 PMCID: PMC5034850 DOI: 10.1016/j.socscimed.2016.08.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [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: 05/16/2016] [Revised: 07/22/2016] [Accepted: 08/07/2016] [Indexed: 11/23/2022]
Abstract
This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years.
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Affiliation(s)
- Stephanie L Smith
- School of Public Administration, The University of New Mexico, Social Sciences Bldg. 3008, MSC05 3100, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Jeremy Shiffman
- Department of Public Administration and Policy, School of Public Affairs, American University, 4400 Massachusetts Ave., NW, Washington, DC, 20016-8070, USA.
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44
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Smith SL, Bowers D, Jennings P, Soomal R. Pulmonary radiofrequency ablation in a district general hospital: is it a safe and effective treatment? Clin Radiol 2016; 71:939.e1-8. [PMID: 27157314 DOI: 10.1016/j.crad.2016.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/07/2016] [Accepted: 03/31/2016] [Indexed: 11/29/2022]
Abstract
AIM To analyse the technical success of ablation therapy and the incidence of complications in patients treated with pulmonary ablation and to assess factors affecting local disease control and patient survival in a subgroup with metastatic colorectal cancer. MATERIALS AND METHODS Technical success and complications in all patients undergoing lung ablation between June 2009 and July 2015 were recorded. Overall survival and local disease control in a subgroup with metastases from a colorectal primary were calculated. Factors influencing outcome were explored. RESULTS Two hundred and seven pulmonary ablations were performed in 86 patients at 156 attendances. Technical success was achieved in 207/207 (100%). Thirty and 90-day mortality was 0%. The major complication rate was 13/86 (15%). One hundred and one metastases were treated in 46 patients with a colorectal primary. This group had a mean ± standard error survival time of 53.58±3.47 months with a 1, 2, 3, 4, and 5-year survival rate of 97.4%, 91.3%, 81.5%, 59.8%, and 48%. There was no statistically significant difference in survival regarding time to development of metastatic disease, the total number of lesions ablated, the initial number of lesions ablated, the maximum size of lesion treated, or unilateral versus bilateral disease. Patients with extrapulmonary disease were found to have a shorter survival from the primary diagnosis. Seventy-eight (77.2%) of the 101 lesions were stable after first RFA. Local relapse was more likely when a metastasis was close to a large (>3 mm) vessel. CONCLUSION RFA is a safe and effective procedure that can be performed without on-site cardiothoracic support. Good outcomes depend upon careful patient selection. This study supports its use in oligometastatic disease.
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Affiliation(s)
- S L Smith
- Department of Radiology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK.
| | - D Bowers
- Department of Science and Technology, University Campus Suffolk, Neptune Quay, Ipswich, Suffolk IP4 1QJ, UK
| | - P Jennings
- Department of Radiology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
| | - R Soomal
- Department of Oncology, Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK
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45
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Shiffman J, Quissell K, Schmitz HP, Pelletier DL, Smith SL, Berlan D, Gneiting U, Van Slyke D, Mergel I, Rodriguez M, Walt G. A framework on the emergence and effectiveness of global health networks. Health Policy Plan 2016; 31 Suppl 1:i3-16. [PMID: 26318679 PMCID: PMC4954553 DOI: 10.1093/heapol/czu046] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [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] [Accepted: 04/27/2014] [Indexed: 12/18/2022] Open
Abstract
Since 1990 mortality and morbidity decline has been more extensive for some conditions prevalent in low- and middle-income countries than for others. One reason may be differences in the effectiveness of global health networks, which have proliferated in recent years. Some may be more capable than others in attracting attention to a condition, in generating funding, in developing interventions and in convincing national governments to adopt policies. This article introduces a supplement on the emergence and effectiveness of global health networks. The supplement examines networks concerned with six global health problems: tuberculosis (TB), pneumonia, tobacco use, alcohol harm, maternal mortality and newborn deaths. This article presents a conceptual framework delineating factors that may shape why networks crystallize more easily surrounding some issues than others, and once formed, why some are better able than others to shape policy and public health outcomes. All supplement papers draw on this framework. The framework consists of 10 factors in three categories: (1) features of the networks and actors that comprise them, including leadership, governance arrangements, network composition and framing strategies; (2) conditions in the global policy environment, including potential allies and opponents, funding availability and global expectations concerning which issues should be prioritized; (3) and characteristics of the issue, including severity, tractability and affected groups. The article also explains the design of the project, which is grounded in comparison of networks surrounding three matched issues: TB and pneumonia, tobacco use and alcohol harm, and maternal and newborn survival. Despite similar burden and issue characteristics, there has been considerably greater policy traction for the first in each pair. The supplement articles aim to explain the role of networks in shaping these differences, and collectively represent the first comparative effort to understand the emergence and effectiveness of global health networks.
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Affiliation(s)
| | | | | | | | | | - David Berlan
- Florida State University, Tallahassee, FL 32306, USA
| | | | | | - Ines Mergel
- Syracuse University, Syracuse, NY 13244, USA
| | | | - Gill Walt
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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46
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Shiffman J, Schmitz HP, Berlan D, Smith SL, Quissell K, Gneiting U, Pelletier D. The emergence and effectiveness of global health networks: findings and future research. Health Policy Plan 2016; 31 Suppl 1:i110-23. [PMID: 27067141 PMCID: PMC4954561 DOI: 10.1093/heapol/czw012] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [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] [Accepted: 01/31/2016] [Indexed: 11/13/2022] Open
Abstract
Global health issues vary in the amount of attention and resources they receive. One reason is that the networks of individuals and organizations that address these issues differ in their effectiveness. This article presents key findings from a research project on the emergence and effectiveness of global health networks addressing tobacco use, alcohol harm, maternal mortality, neonatal mortality, tuberculosis and pneumonia. Although networks are only one of many factors influencing priority, they do matter, particularly for shaping the way the problem and solutions are understood, and convincing governments, international organizations and other global actors to address the issue. Their national-level effects vary by issue and are more difficult to ascertain. Networks are most likely to produce effects when (1) their members construct a compelling framing of the issue, one that includes a shared understanding of the problem, a consensus on solutions and convincing reasons to act and (2) they build a political coalition that includes individuals and organizations beyond their traditional base in the health sector, a task that demands engagement in the politics of the issue, not just its technical aspects. Maintaining a focused frame and sustaining a broad coalition are often in tension: effective networks find ways to balance the two challenges. The emergence and effectiveness of a network are shaped both by its members' decisions and by contextual factors, including historical influences (e.g. prior failed attempts to address the problem), features of the policy environment (e.g. global development goals) and characteristics of the issue the network addresses (e.g. its mortality burden). Their proliferation raises the issue of their legitimacy. Reasons to consider them legitimate include their members' expertise and the attention they bring to neglected issues. Reasons to question their legitimacy include their largely elite composition and the fragmentation they bring to global health governance.
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Affiliation(s)
- Jeremy Shiffman
- Department of Public Administration and Policy, American University, 4400 Massachusetts Ave., NW, Washington, DC 20016-8070, USA,
| | - Hans Peter Schmitz
- Department of Leadership Studies, University of San Diego, San Diego, CA 92110-2492, USA
| | - David Berlan
- Reubin O'D. Askew School of Public Administration and Policy, Florida State University, 627 Bellamy Building, Tallahassee, FL 32306-2250, USA
| | - Stephanie L Smith
- School of Public Administration, The University of New Mexico MSC05 3100, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
| | - Kathryn Quissell
- Department of Public Administration and Policy, American University, 4400 Massachusetts Ave., NW, Washington, DC 20016-8070, USA, Department of Health Sciences, Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA 02215, USA
| | - Uwe Gneiting
- Oxfam America, Private Sector Department, 1101 17th St NW #1300, Washington, DC 20036, USA and
| | - David Pelletier
- Division of Nutritional Sciences, 212 Savage Hall, Cornell University, Ithaca, NY 14853, USA
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47
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Abstract
Nearly 300,000 women--almost all poor women in low-income countries--died from pregnancy-related complications in 2010. This represents a decline since the 1980s, when an estimated half million women died each year, but is still far higher than the aims set in the United Nations Millennium Development Goals (MDGs) at the turn of the century. The 1970s, 1980s and 1990 s witnessed a shift from near complete neglect of the issue to emergence of a network of individuals and organizations with a shared concern for reducing maternal deaths and growth in the number of organizations and governments with maternal health strategies and programmes. Maternal health experienced a marked change in agenda status in the 2000s, attracting significantly higher level attention (e.g. from world leaders) and greater resource commitments (e.g. as one issue addressed by US$40 billion in pledges to the 2010 Global Strategy for Women's and Children's Health) than ever before. Several differences between network and actor features, issue characteristics and the policy environment pre- and post-2000 help to explain the change in agenda status for global maternal mortality reduction. Significantly, a strong poverty reduction norm emerged at the turn of the century; represented by the United Nations MDGs framework, the norm set unusually strong expectations for international development actors to advance included issues. As the norm grew, it drew policy attention to the maternal health goal (MDG 5). Seeking to advance the goals agenda, world leaders launched initiatives addressing maternal and child health. New network governance and framing strategies that closely linked maternal, newborn and child health shaped the initiatives. Diverse network composition--expanding beyond a relatively narrowly focused and technically oriented group to encompass allies and leaders that brought additional resources to bear on the problem--was crucial to maternal health's rise on the agenda in the 2000s.
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Affiliation(s)
- Stephanie L Smith
- School of Public Administration, University of New Mexico, Social Science Bldg Rm 3008, MSC053100, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA and
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48
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Smith KJ, Wildfong KW, Hoiland RL, Harper M, Lewis NC, Pool A, Smith SL, Kuca T, Foster GE, Ainslie PN. Role of CO2 in the cerebral hyperemic response to incremental normoxic and hyperoxic exercise. J Appl Physiol (1985) 2016; 120:843-54. [PMID: 26769951 DOI: 10.1152/japplphysiol.00490.2015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 01/11/2016] [Indexed: 11/22/2022] Open
Abstract
Cerebral blood flow (CBF) is temporally related to exercise-induced changes in partial pressure of end-tidal carbon dioxide (PetCO2 ); hyperoxia is known to enhance this relationship. We examined the hypothesis that preventing PetCO2 from rising (isocapnia) during submaximal exercise with and without hyperoxia [end-tidal Po2(PetO2 ) = 300 mmHg] would attenuate the increases in CBF. Additionally, we aimed to identify the magnitude that breathing, per se, influences the CBF response to normoxic and hyperoxic exercise. In 14 participants, CBF (intra- and extracranial) measurements were measured during exercise [20, 40, 60, and 80% of maximum workload (Wmax)] and during rest while ventilation (V̇e) was volitionally increased to mimic volumes achieved during exercise (isocapnic hyperpnea). While V̇ewas uncontrolled during poikilocapnic exercise, during isocapnic exercise and isocapnic hyperpnea, V̇ewas increased to prevent PetCO2 from rising above resting values (∼40 mmHg). Although PetCO2 differed by 2 ± 3 mmHg during normoxic poikilocapnic and isocapnic exercise, except for a greater poikilocapnic compared with isocapnic increase in blood velocity in the posterior cerebral artery at 60% Wmax, the between condition increases in intracranial (∼12-15%) and extracranial (15-20%) blood flow were similar at each workload. The poikilocapnic hyperoxic increases in both intra- and extracranial blood-flow (∼17-29%) were greater compared with poikilocapnic normoxia (∼8-20%) at intensities >40% Wmax(P< 0.01). During both normoxic and hyperoxic conditions, isocapnia normalized both the intracranial and extracranial blood-flow differences. Isocapnic hyperpnea did not alter CBF. Our findings demonstrate a differential effect of PetCO2 on CBF during exercise influenced by the prevailing PetO2.
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Affiliation(s)
- K J Smith
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - K W Wildfong
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - R L Hoiland
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - M Harper
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - N C Lewis
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - A Pool
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - S L Smith
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - T Kuca
- Department of Anesthesia, Pain and Perioperative Medicine, Department of Critical Care Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - G E Foster
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
| | - P N Ainslie
- Centre for Heart Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada; and
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49
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Smith SL, Singh P, Harding D, Lun D, Chambers JP. Thalidomide pharmacokinetics in sheep. N Z Vet J 2016; 64:238-42. [PMID: 26727254 DOI: 10.1080/00480169.2015.1130663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To determine the half life (T1/2), time taken to reach maximum plasma concentration (Tmax) and maximum plasma concentration (Cmax) of thalidomide in sheep following I/V, oral and topical treatment with a single dose of thalidomide. METHOD Three groups of 4-6-month-old ram lambs were treated with thalidomide dissolved in dimethylsulphoxide (DMSO). The first group (n=10) was treated I/V with 100 mg thalidomide in 2 mL DMSO; the second group (n=8) received 400 mg thalidomide in 2 mL DMSO orally, and the third group (n=8) had 400 mg thalidomide in 4 mL DMSO applied topically. Plasma samples were collected up to 36 hours after treatment, snap-frozen at -80°C and analysed for concentrations of thalidomide using high performance liquid chromatography. RESULTS Following I/V administration, T1/2 was 5.0 (SEM 0.4) hours, volume of distribution was 3,372.0 (SEM 244.3) mL/kg and clearance was 487.1 (SEM 46.1) mL/hour.kg. Topical application of 400 mg thalidomide did not increase plasma concentrations. Following oral administration, thalidomide bioavailability was 89%, with T1/2, Tmax, and Cmax being 7.2 (SEM 0.8) hours, 3.0 (SEM 0.4) hours and 1,767.3 (SEM 178.1) ng/mL, respectively. CONCLUSION Topical administration using DMSO as a solvent did not increase concentrations of thalidomide in plasma. The mean pharmacokinetic parameters determined following oral treatment with 400 mg of thalidomide were similar to those reported in humans receiving a single 400 mg oral dose (T1/2 7.3 hours; Tmax 4.3 hours and Cmax 2,820 ng/mL). There is potential for thalidomide to be used as a model for the treatment of chronic inflammatory conditions in sheep, such as Johne's disease, where tumour necrosis factor alpha plays a pathogenic role.
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Affiliation(s)
- S L Smith
- a Institute of Veterinary, Animal and Biological Sciences , Massey University , Tennent Drive, Palmerston North 4443 , New Zealand
| | - P Singh
- a Institute of Veterinary, Animal and Biological Sciences , Massey University , Tennent Drive, Palmerston North 4443 , New Zealand
| | - D Harding
- b Institute of Fundamental Sciences , Massey University , Tennent Drive, Palmerston North 4474 , New Zealand
| | - D Lun
- b Institute of Fundamental Sciences , Massey University , Tennent Drive, Palmerston North 4474 , New Zealand
| | - J P Chambers
- a Institute of Veterinary, Animal and Biological Sciences , Massey University , Tennent Drive, Palmerston North 4443 , New Zealand
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50
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Webster AP, Smith SL, Worthington J, Barton A, Plant D. Cryopreservation of cells does not substantially alter the DNA methylome of CD3+CD4+ T cells. Scand J Rheumatol 2015; 45:329-30. [PMID: 26690697 DOI: 10.3109/03009742.2015.1115896] [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]
Affiliation(s)
- A P Webster
- a Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester , Manchester , UK
| | - S L Smith
- a Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester , Manchester , UK
| | - J Worthington
- a Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester , Manchester , UK.,b NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academy of Health Sciences , Manchester , UK
| | - A Barton
- a Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester , Manchester , UK.,b NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academy of Health Sciences , Manchester , UK
| | - D Plant
- b NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academy of Health Sciences , Manchester , UK
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